Tuck Global Consultancy in Rwanda
May 6, 2013 -- Guest post by Heidi Eldred, TGC Program Coordinator --
Last December, six Tuck second-year students: Joyce Cadesca, Andrew Friedman, Graham Lincoln, Mimi Macauley, Emily Servinsky, Kelsey Stratton, and advisor Bill Martin went to Rwanda on a Tuck Global Consultancy (TGC) project funded by Dean Paul Danos’s office to identify sustainable methods of health care delivery. My role was to support the team with logistics, translation, and advising.
Rwanda, the size of Maryland, has a pyramid-like system of health care delivery. At the top are specialty hospitals in the capitol, followed by middle layers of general care hospitals located in the outlaying district centers and Health Centers found in more rural areas. Supporting the base is a corps of Community Health Care Workers, three to a village, who provide basic care.
Much has been accomplished in Rwanda since the 1994 genocide when over 1 million Rwandans were killed. With a declining child mortality rate, lower birth rate, and solid progress towards reaching other health Millennium Development Goals (MDGs), Rwanda has established itself as one of the best health performers in Africa.
However, much of the population is more than 3 hours walking distance from the nearest Health Center. As a result, many people do not seek more advanced care beyond what is available in their villages. In response, the Ministry of Health wants to expand the Health Post concept-a nurse-run facility within a one hour walk of every village- to fill the gap between Community Worker and Health Center.
In mid-November, the TGC team began their work to provide business insights to the Rwandan Minister of Health, the Honorable Minister Dr. Agnes Binagwaho. The students consulted with health professionals at DHMC and The Dartmouth Institute for Health Policy and Clinical Practice to learn more about health care in developing nations and Rwanda. At the same, they sorted through thousands of pages of secondary research including Ministry of Health documents and NGO reports.
Upon arrival, the team met immediately with the Honorable Minister to better understand her perspective and goals for the project. Subsequently, they conducted over 50 interviews with other MoH officials, doctors, nurses, community health workers, patients, and representatives from NGOs. Over 90 percent of these interviews were conducted in person. The team also traveled to every part of Rwanda, visiting both urban and rural care facilities, to see firsthand how health care was delivered.
The TGC team initially developed eight business models, and after further analysis and discussion, presented two to the Honorable Minster. With her feedback, the Tuck team refined their business and financial model, and created an initial implementation plan to increase the number of Health Posts from 200 to 1,200. They also submitted their plans for maintaining and supporting the Health Posts over time.
In retrospect, working in Rwanda on such a worthwhile project was more than just a team exercise in research, analysis and presentation. The TGC experience was eye-opening and fulfilling in ways that are hard to match in Hanover. As Tuck continues to develop its Global Education program, TGC will certainly remain a cornerstone of the initiative.
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