About tens years ago Warren Buffett injected a staggering US$30 billion into the Bill Gates Foundation to support efforts of fighting disease and reducing inequity. around the world.
Like the Biblical sower little did Buffett know that his charity would save millions of lives.
December 12, 2016, Warren, as his friend Bill Gates calls him, writes a letter asking Gates and Melinda “to reflect on what impact his gift had had on the world.”
Note that, by all standards, there would be utterly a few things to impress the world’s richest man of the caliber of Bill Gates. Now, a letter of gratitude which the Gates wrote back to his long time comrade Warren was very long. It must have baffled Warren, too.
The Gates go on to pick on Rwanda. It is Melinda writing. She says, “It’s super-exciting to find countries that have figured things out.” In this case she is talking about Rwanda.
The Gates have found out that in all the countries where they funded efforts to cut down child deaths, Rwanda scored beyond expectations, factoring in a pool of interventions by the government and the involvement of the population.
Melinda picks a timeline. From 2008 through 2015. For her, Rwanda, being one of the poorest countries in Africa, to have cut its newborn mortality by 30%, down to 19 deaths per 1,000 births, is “super-exciting”.
Nevertheless, Bill Gates explains that back in 1990, over 12 million children under five years died. “Today, we have cut that in half, we are below six million.”
Most of the six million deaths, happen in the first month after birth and these deaths are taking place in poor countries, according the Gapminder statistics, a Swedish non-profit. This indicates that there is a strong relationship between the income level and child deaths. “
And this, raises a question. “Are there best practices that may show us what we should be doing in all these poor countries even before they develop economically?” Bill Gates asks in a video where he analysed the trends.
And the answer is yes. “There are positive outliers,” says Bill Gates. He adds that some countries with low levels of economic growth are doing quite well. “Rwanda is a fantastic example about this,” he says.
With just US$1,550 as GDP per capita, the country has managed to contain child deaths to 18.7 deaths per 1000 newborns. Yet, by comparison, Mali — with a comparable GDP per capita of US$1,680—has a newborn mortality rate of 38 deaths per 1000, twice as high as Rwanda.
Tracing it back in 2000, Rwanda had 107 deaths.The figures went on falling dramatically, to 85 by 2005, 62 in 2008, and 50 in 2010.
To achieve the Mellinium Development Goals target of 28, the rate of decrease would need to accelerate significantly. And Rwanda went on to drop the figure to 18.7 by 2015, expecting to drop even further.
Melinda attributes Rwanda’s startling drop in the newborn mortality to health practices in which the government has consciously been investing and strict observance of clinical and medical basics and care administered during the prenatal and postnatal periods.
The practices that have become part of the Rwandan lifestyle have helped to prevent potential health problems.
“A few things so cheap that any government can support them: breastfeeding in the first hour and exclusively for the first six months. Cutting the umbilical cord in a hygienic way. And kangaroo care: skin-to-skin contact between mother and baby to raise the baby’s body temperature. These practices led to big drops in newborn deaths,” Melinda explains in the letter to Warren.
Alphonsine Mukeshimana is a mother of three now with a 17-months daughter. She spends nearly all her time close to her baby even when she is ploughing the land in a remote village of Kaborogota in Nyagatare District of Eastern Rwanda or cooking in the kitchen with her baby on her back.
“Yes, we need government support, especially medical supplies and services but will I also expect the government to carry my baby on the back?” Mukeshimana asks.
In Mukeshimana’s village, back in the days, child deaths were so rampant almost every week there was a child to burry. “Well, some mothers had to be forced to ensure a close attention to their babies, but with constant government sensitisation and public awareness, we have seen some mothers in our village improve on child care…its now rare to hear of a dead child,” she says.
Bill Gates’ observations are comparative and in retrospection of the fact that he has offered charity to other poor nations, but he has seen less returns.
Rwanda is divided up into 14 837 villages. Each village has two community health workers who volunteer to be trained through a government program.
These health workers spend much of their free time moving from home to another within their village. In addition to diagnosing several diseases such as malaria and prescribing treatment, the health workers are trained to give first aid, provide nutritional advice and help women give birth.
“…but the real gains came when trained health care workers with the right tools attended the births. Rwanda doubled the percentage of childbirths attended by a skilled worker…,” Bill notes.
With this practice, and spending about 10% of the national budget on health, Bill Gates says, “Rwanda is doing something right.”
Bill Gates letter is here