Health economist Gemma Williams has recently joined LSE as a Research Assistant on the Health Inc project coordinated by LSE Health. Here, she looks back at the last couple of years spent working in Rwanda’s Ministry of Health.
Every year for the last forty years the Overseas Development Institute (ODI) in London has sent a group of young economists to work in the public sectors of developing countries throughout the world. In 2008 I became one of these ‘ODI Fellows’ and was dispatched to Rwanda in East Africa to work as an economist in the Ministry of Health.
I arrived armed with the goals of building capacity and improving the execution of economic policy, but with little idea of what to expect from Rwanda or an African government or whether I, as an ‘outsider’, would be able to work on sensitive budgets and policies.
I was therefore grateful, and surprised, to be attending a Ministerial meeting on my second day and being set the daunting task of writing the Health Sector Strategic Plan at the end of my first month.
Before my fellowship I had expected all African governments to have large levels of corruption, so I was delighted to find this was not the case in Rwanda. There was good stewardship of the health sector, helping to create an environment where donors were willing to commit to long-term funding of government priorities rather than dictate strategies themselves.
Although this helped planning, the fragility of aid was also clearly demonstrated when a number of donors withdrew without notice in protest at an escalation of fighting in the Democratic Republic of Congo; this episode underlined why one of Rwanda’s key aims was to quickly reduce reliance on external funding.
Inevitably there were major frustrations in working in an African ministry. The endless bureaucracy that had to be negotiated to complete even the simplest task, colleagues watching Grey’s Anatomy during work hours, the lack of running water in the ministry, making our national hygiene campaigns slightly hypocritical, and being giving important ministerial briefs to complete an hour before a high-level conference made every day both interesting and frustrating in equal measure.
In my second year I left on a Friday evening and returned on Monday to find all but 10 of my colleagues had been fired over the weekend, a rather interesting managerial tactic used to increase ministry productivity. This predictably failed after it took eight months to find replacements, most of whom were the same people let go in the first place.
Overall, Rwanda was a great place to undertake a health economics fellowship. It is a dynamic country in the early stages of implementing many ambitious health financing reforms, including a mass re-structuring of their health insurance system.
Despite being an ‘outsider’ I was trusted to work on many high profile projects such as formulating health financing policies and creating sector budgets. I am sure Rwanda gave me more than I gave back, but I like to think that even small attempts at capacity building, such as teaching colleagues how to use Excel and PowerPoint or emphasising the importance of planning, improved the functionality of the ministry.
Although it was often difficult and challenging to live in Rwanda, the opportunity to witness from the ‘inside’ the considerable constraints under which developing country government workers operate and the immense obstacles they face in reforming the sectors in which they work, was an invaluable and unique experience.