The government of Rwandan President Paul Kagame — accused by some of imposing authoritarian rule on the country — received almost unanimous praise for its strides in health care. Kagame had a chance to tout his health care policy as an example to other African nations at the opening of the World Health Assembly in Geneva Monday.

According to Rwandan officials, the country’s universal health care system has brought coverage to more than 90 percent of its population.

Kagame, an advocate for the adoption of universal health coverage in Africa,  leads a country that has a successful, widely-admired system. As chairman of the African Union, he has promoted universal coverage as the continent’s top strategic objective.

The effort is receiving full support from the World Health Organization, which aims to achieve coverage for one billion more people by 2023 as part of a five-year strategic plan.

Touting his own efforts as an example, Kagame says achieving universal health coverage is feasible for countries at every income.These systems, he says, avoid catastrophic out-of-pocket health expenditures, which are an increasing source of impoverishment in Africa.

He says community-based, primary health systems all around Africa have shown good results.

“In Rwanda,” he said, “a combination of community-based health insurance, community health workers, and good external partnerships led to the steepest reductions in child and maternal mortality ever recorded.”

Kagame says more than 90 percent of Rwandans are enrolled in health insurance today. He says two-thirds of the costs are borne by the beneficiaries, with the government subsidizing the remaining one-third.

He says it acts as a boon for entrepreneurship, helps families invest in their children’s education, and allows for the economic empowerment of women.

Kagame’s account of his success is largely uncontested by the WHO, western aid agencies, and the media. Virtually all of the publicity surrounding Rwanda’s health care achievements in the West has been overwhelmingly positive.

But to international human rights organizations and his political opponents at home, Kagame is using the success of his health care policy to shadow a more sinister aspect of his rule. Amnesty International says this is characterized by widespread human rights abuses including unlawful killings and unresolved disappearances.

Rwanda’s clampdown on freedom of expression is so severe, the group Reporters Without Borders calls Kagame a “predator of press freedom.”
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