Punching above their weight: Rwanda’ Government and private sector boost global anti-HIV campaign

I don’t know how many governments in Africa pride in acting unconventionally. I know, however, that the Government of Rwanda is one of them.

Officials in Kigali are keen to explain what they see as the failure by foreign commentators and analysts to understand them and their country, in terms of their unconventional behaviour and ways of doing things.

They argue that their ways are not easily understood or appreciated by those who analyse and evaluate them on the basis of conventional thinking and one-size-fits-all templates. There is a great deal of truth in this.

How else, if not by the word “maverick”, could one describe a country that, while elsewhere user fees in the health sector have been abolished, introduces a mandatory health insurance scheme that does not exempt the poor from payment and goes on to stick to its guns in the face of opposition by donors?

Or how else could one describe a country where, the ruling party participates directly in stimulating private sector development and growth by setting up businesses that specialise in investing in areas of the economy where private businesses are reluctant to invest?

These are only two of a string of decisions made by the government in defiance of convention, and which have earned it ample criticism and condemnation by, as one official put it to me recently, “people who don’t know us”.   

On a recent visit to Rwanda, I followed closely a meeting at which the Rwanda Government’s penchant for unorthodox behaviour was on full display. The meeting, which took place on November 6, had been convened jointly by the government and Friends of the Global Fund Africa (Friends Africa). With the theme; “Increasing returns on investment against Aids, Tuberculosis and Malaria” and dubbed “Gift from Africa”, the event sought to boost efforts by The Global Fund and its friends in Africa to draw the private sector into taking responsibility for some of the continent’s problems.

Well-heeled delegates

It was attended by both President Paul Kagame and First Lady Jeannette. Mrs Kagame also happens to be a board member of Friends Africa. Other well-heeled delegates included Nigerian tycoon Aigboje Aig-Imoukhuede, CEO of Access Bank Plc, and also Chair of the Friends Africa board.

The rationale for private sector involvement is quite simple: HIV/Aids, tuberculosis and malaria continue to kill millions of Africans per year. The impact on African economies is huge: reduction in productivity through devastation of the work force and eventual reduction in the actual number of days spent at work. The impact on businesses and their growth is, by extension, immense.

Already, we know that the average impact of the HIV/Aids pandemic alone on economic growth has been a reduction by 2-4 per cent annually.

Malaria afflicts over 200 million sub-Saharan Africans per year, costing the continent over $12 billion directly and indirectly. Businesses cannot hope or expect to prosper in the long-term within such a context. And so getting involved in efforts to combat the three pandemics is clearly in their own interest.

It is in this spirit that the meeting was organised, and that attention has in recent years been fixed on roles the private sector can play in efforts to keep Africans healthy and less vulnerable to these otherwise preventable afflictions. The truth of the matter as Mrs Kagame and Mr Aig-Imoukhuede wrote in a recent article in The East African, “there is no doubt that high rates of disease weaken economies, while weakened economies breed high rates of disease”.

Break this cycle

It is in recognition of the imperative to break this cycle, of the potential possessed by the African private sector to play a meaningful role through financial and other contributions, that the Kigali meeting stands out as a very important step in the right direction.

Attendance by representatives of over 200 businesses is testimony that even the private sector has come to the realisation that it can only be a beneficiary of a healthier and more productive work force.

It also testifies to how far relations between the private sector and the state in Africa have evolved. Unlike in the past when the private sector generally operated separately from the state, these days private-public partnerships (PPP) are seen by both sides as the best way to overcome some types of constraints.

The step taken last week in Rwanda, though, is a continuation of a campaign by Africa Friends of the Global Fund, through which strong relationships between the Fund and African businesses have been created. Already, the $10 billion the Global Fund has allocated to projects in Africa since 2002 is set to be supplemented by contributions coming from Africa’s private sector.

The willingness of African businesses to put their money where their collective mouths are was shown at the meeting by the raising of over $2 million, of which $1.2 came from Rwanda’s private sector.

Members of the business community had risen to the occasion following challenge by Mrs Kagame, who made the point that Africa’s wealth could and should contribute to Africa’s health. Not to be outdone, the Government of Rwanda, in a spirit of collective responsibility, not only with Rwandan companies, but also the Global Fund, threw $1 million into the kitty.

The contributions are part of the Third Voluntary Replenishment of the Global Fund, which has so far received $11.7 billion in financial commitments for the years 2011-2013. A significant outcome of all this, in political terms, is the graduation of tiny and not-so-rich Rwanda from mere recipient of Global Fund largesse to being a donor to the global fight against HIV/Aids, malaria and tuberculosis.

International scene

The donation also carries more political symbolism in that as it demonstrates Rwanda’s on-going ambition to play roles on the international scene that would otherwise be considered too big for a country many know only because of its connection with the most recent genocide in world history.

It is a move only smart governments, of which we have very few on the continent, make. Rwanda is only the fifth African country to give financial support to The Global Fund. Others are South Africa, Nigeria, Namibia and Tunisia.  

And here the government’s smartness seems to have rubbed off the country’s rather small, still infant, but increasingly dynamic, private sector whose members have now joined global and continental giants such as Access Bank Plc, Anglo American South Africa, Multichoice Africa, the MTN Group, and Old Mutual, as early contributors to efforts to build and strengthen the emergent tripartite partnership bringing together traditional donors, aid-recipient governments and Africa’s private sector.

The importance of this tripartite partnership was emphasised by President  Kagame in his speech when he made reference to the need to look beyond traditional donors and governments in thinking about how to finance the continent’s health sector. He lauded the Global Fund’s role both in mobilising resources and facilitating countries to use them in line with local priorities as a salutary example of successful public private partnership.

Meanwhile, Rwanda itself is the beneficiary of grants from the Global Fund totalling about $700 million, to combat the three pandemics. So far, about $363 million has been disbursed and is already being used in pursuit of government’s objectives in the health sector.

The Global Fund officials are full of praise for the country for its “outstanding ability” to put resources to good use in pursuit of the overall goal of improving the general health of Rwandans.

In many ways, this ability is evident in Rwanda counting among countries in Africa that are on course to achieve the Millennium Development Goals targets, especially in the domains of maternal and children's health. Already, the East African Community’s second poorest country ahead of Burundi has, within 8 years (2000-2008) achieved the incredible feat of reduction in under-five mortality by 50 per cent and maternal mortality by 64 per cent.

Going by what we know about how Global Fund money has been used elsewhere, it seems as if Rwanda is not about to become conventional.