A Paradigm Shift in Global Surgery Training: Rwanda's Human Resources for Health (HRH) Program
In November 2014, Dr. Georges Ntakiyiruta, Academic Head of the Department of Surgery for the University of Rwanda, was readying himself for the upcoming Physician Subcommittee meeting. The group met regularly to discuss and advance the innovative Human Resources for Health (HRH) Program launched in Rwanda in August 2012. It was an exciting time for Dr. Ntakiyiruta and his colleagues. They were part of leading a high-profile global consortium aimed at, in the words of Rwandan Minister of Health Agnes Binagwaho, creating "a critical mass of health professionals" and transforming Rwanda's health care system. HRH paired United States faculty from more than 20 institutions-including Dartmouth, University of Virginia, Duke, and Yeshiva-with Rwandan college faculty counterparts. A discipline-specific "twinning model" sought to provide a two-way learning experience that would help support and develop a sustainable health care system in Rwanda. The HRH Program held not only great promise for the country of Rwanda, but it also held personal promise for Dr. Ntakiyiruta's day-to-day life and work. Since joining the University of Rwanda in 2008, where Dr. Ntakiyiruta taught undergraduate as well as post-graduate courses in addition to maintaining a full clinical schedule at the University Teaching Hospital of Kigali (CHUK), there had never been more than four permanent university-employed faculty in the Department of Surgery. If the HRH program achieved its ambitious human resource growth targets, it was reasonable to conclude that the professional lives of devoted physicians like Dr. Ntakiyiruta would witness desired improvements with the opportunity to serve more patients and to educate the next generation of surgeons in Rwanda. It would also provide more time for published research and academic inquiry. When the HRH program was launched a little more than two years earlier, news of the Rwandan effort was accompanied by great fanfare. "This is the boldest effort I've seen to make good on a central promise of global health," said Dr. Paul Farmer, the Kolokotrones University Professor at Harvard University and Chair of the Harvard Medical School Department of Global Health and Social Medicine. "The fruits of science serve everyone, especially those that bear the highest burden of disease," he also noted. Medical professionals across the many Rwandan hospitals participating in the HRH program also expressed a feeling of great anticipation and optimism at the program's launch. One of the aspects that made HRH unique was that external funding acquired to support the program would not be funneled through nongovernment organizations (NGOs), as was the custom. Instead, Rwanda's Ministry of Health would have full ownership and oversight of the program, which was scheduled to run from 2012-2019. The project was largely funded by the US government at a level of US $170 million.