Non peer-Reviewed articles

Opinion: We need structural change to enable self-empowerment — not empowerment by others

Published by Devex on 31 July 2020

By Dr. Timothy Carey and Dr. Agnes Binagwaho

Image credit: UN Photo / Albert Gonzalez Farran 

“There can be no question that vulnerable people often require assistance to live the lives they would wish for themselves and their families. What form this assistance should take and how it should be provided, however, are matters where there is much less agreement. A solution that has been increasingly discussed in recent times has been the so-called empowerment of vulnerable populations.

When decision-makers and people in positions of power report that they are empowering different individuals or groups, we should be very wary about their intentions.

For some decision-makers, the rhetoric of empowering the vulnerable is the fashionable tactic they have adopted for the purpose of self-promotion and perhaps also to secure another term in office. For others, while they might genuinely want vulnerable people to be empowered to live as they would wish, these decision-makers encounter a dilemma because they do not really want to share their power with the vulnerable.”

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Africa: Greatest Global Challenge is Cooperation – Not COVID-19

Published by on 14 July 2020

By Dr. Timothy Carey and Dr. Agnes Binagwaho

Image credit: Vincent Tremeau/World Bank

“Kigali — Pandemics come and go. The tragic effect of plague in the Middle Ages reminds us that Covid-19 wasn’t the first, and it is clear that it won’t be the last…

…While large amounts of resources and tireless efforts are being dedicated to finding a vaccine, there is still no solution on the horizon. There are, however, some discernible patterns of what it means to address this problem effectively.

Where solidarity and compassion are cultivated, the penetration of SARS-CoV-2 is harder. A refusal to invest in cooperative and collaborative solutions is far more dangerous in the long-term than the fragility of our health systems or our own individual physical health. Comprehensive solutions to problems such as Covid-19 require genuine cooperation, both nationally and internationally, between governments and the private sector, and at all levels of the health system.”

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Beyond Florence Nightingale: how African nurses have decolonised the profession

Published by The Conversation on 9 July 2020

By Timothy Carey, Agnes Binagwaho, and Judy Khanyola

Image credit: Ihsaan Haffejee/Anadolu Agency/Getty Images

“This year – 2020 – marks the 200th anniversary of Florence Nightingale’s birth. It’s therefore understandable that it’s being marked as the year of the nurse and midwife.

Nightingale is best known for her pioneering spirit and fearless approach to changing atrocious conditions and improving healthcare service delivery. These qualities still characterise the attitudes and habits of nurses around the world. They are often the only frontline healthcare workers caring for people – whether they are vulnerable and living in poor and isolated settings or well-off in rich parts of the world.

But Nightingale left two legacies. The other is less known.”

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Opinion: ‘Silent discriminator’ — the women global data is leaving behind

Published by Devex on 19 June 2020

By Agnes Binagwaho and Tsion Yohannes Waka

Image Credit: UN Women / Pathumporn Thongking

“We, as women, might be surprised at this time to see figures that suggest we are less vulnerable to COVID-19 than our male counterparts, with more male deaths reported globally than female. This data fills our screens, via live updates and situation reports. But look closely and you’ll find it is incomplete — and terrifyingly so.

This “silent discriminator” weaves a parallel web of destruction in its economic, political, and social burden on women. The reality is that COVID-19 has aggravated the preexisting inequities that women face in the division of labor, widespread gender-based violence, and hardship roles in front-line health care. While there is some sex-disaggregated data on coronavirus deaths among most-affected countries, there is still lack of sex-disaggregated data to support future interventions that tackle the long-term impacts of the pandemic.”

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COVID-19 shows the world needs physicians who can look beyond medical charts

Published by The Conversation on 3 June 2020

By Abebe Bekele and Agnes Binagwaho

“As modern medicine has advanced, so too has our understanding of what affects health. Over recent decades this has generated a number of new fields in medicine. One of the most important that has been born out of the latest generation is social medicine. It studies how social and economic factors help determine our health, specifically inequalities within societies that negatively influence health outcomes.

Similar to primary health care, social medicine prioritises health equity and promotes a broad view of health, multi-sectoral action and the participation of communities. Both significantly contribute to progress in improving health equity.

COVID-19 has placed a spotlight on the field of social medicine. It has done so by showing up inherent injustices in society. An example is the fact that African-American and Native American communities in the US are experiencing disproportionate COVID-19 deaths. The result is that more people are beginning to argue that social medicine should take centre state in the medical community. But the argument towards a more progressive approach to healthcare is also being met with criticism by those who still cling to the traditional model of medicine.”

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The difference between gender equity and equality—and why it matters

Published by Fortune on 25 March 2020

By Agnes Binagwaho

Image credit: STEPHANIE AGLIETTI/AFP via Getty Images)

“The theme of this year’s International Women’s Day was centered around the notion that “[a]n equal world is an enabled world.” Indeed, there has been global progress toward a world that has gender equality; nearly 68% of the countries (101 of 149) included in the World Economic Forum’s latest Global Gender Gap Report showed improvements in their scores for gender parity for 2019. 

But despite this progress, education is one of many areas in which men and women are still not equally enabled. So while the world is close to reaching gender parity in terms of access to primary education, girls still face more obstacles to their education than boys in low- and middle-income countries. Laws may enable girls to attend school, but in many countries there are still other barriers limiting girls’ education, such as families prioritizing boys’ education and cultural beliefs that girls should be limited to a future of raising children…

… Today, our global society still has 10 years left to reach the goal of gender equality set by the UN’s Sustainable Development Goals. To achieve this, it is time for all of us to shift from an equality to equity agenda and ensure that all are actively promoting and supporting women, in education and in all aspects of life. Only then can an equal and truly enabled world be achieved.”

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Lessons from Rwanda on how trust can help repair a broken health system.

Published by The Conversation on 30 September 2019

By Agnes Binagwaho and Miriam Frisch

“Seven countries around the world – three of them in Africa – have made faster than expected progress over the past 15 years in reducing deaths among children younger than five. These seven countries, Bangladesh, Cambodia, Ethiopia, Nepal, Peru, Rwanda and Senegal, were selected because they have all performed unexpectedly well in improving childhood health relative to their economic growth.

There are many factors at the root of their achievements, most notably, a strong integrated and coordinated health system built on primary health care. However, one cross-cutting factor stands out that we believe allowed them all to achieve significant health gains but which, so far, tends to be always overlooked: trust.”

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A Medical School for The Future that Africa Needs.

Published by Devex on 12 September 2019

By Agnes Binagwaho and Miriam Frisch

“The vision of achieving “health for all” by 2030 is gaining political support across the developing world. More and more leaders recognize the imperative of investing in health at a time when every $1 invested in health in developing countries can produce up to $4 in benefits annually.

But one of the challenges in realizing the goal of universal health coverage in Africa — which would ensure that everyone has access to quality, affordable health care — is the need to rapidly scale up the health care workforce.

Although Africa accounts for 24% of the global burden of disease, it has only 3% of the global health workforce. Shortages of health workers at the national level are exacerbated by severe imbalances in their distribution within countries, especially between rural and urban areas.”

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Binagwaho, A. (2016). We need to bring mental health illnesses out of the shadows. World Bank Blog.

Binagwaho A, Hedge A. (2015). Rwanda’s sustainable strategy for saving lives. Vaccines Work.

Binagwaho A. (2015). Rwanda’s Quest for Universal Health Coverage. The Commonwealth Health Partnerships 2015.  Nexus Strategic Partnerships.

Binagwaho A, Karema C. (2015). Preserving hope amid false protection. The New Times.

Binagwaho, A. (2015). Lessons on Aid Effectiveness from Rwanda. Paper presented at the 143rd APHA Annual Meeting and Expo (Oct. 31-Nov. 4, 2015).

Binagwaho A. (2015). Beyond MDGs: Why we need to strengthen our institutions. The New Times.

Binagwaho A. (2014). World Health Organization and UNICEF accountability: we are not there yet. The New Times.

Yamey G, Binagwaho A. (2014). Global Health’s Grand Convergence. Guardian Global Development Professionals Network.

Mohand, A. A., Binagwaho, A., Kayiteshonga, Y., Misago, N. C., & Munyandamutsa, N. (2014). Violences de masse, reconstruction psychique et des liens sociaux: Initiative de développement de la santé mentale dans la région des Grands Lacs: Editions L’Harmattan.

Fromont, A., Kayiteshonga, Y., Misago, N. C., Ait Mohand, A., Munyandamutsa, N., & Binagwaho, A. (2014). Le renforcement de l’estime de soi des acteurs comme stratégie de réussite des interventions en santé: de la socio-psychologie aux politiques de santé. iolences de masse & reconstruction psychique et des liens sociaux: pour une initiative de développement de la santé mentale dans la région des Grands Lacs: Capitalisation de la 3e conférence internationale de Santé mentale, Kigali, 215-225.

Binagwaho A. (2014). Preparation is Paramount. Finance & Development Magazine, International Monetary Fund, 51(4).

Binagwaho A. (2014). We must work hard to own our liberation. The New Times.

Binagwaho A. (2013). Rwanda’s approach proves perfect antidote to counterfeit drugs.

Binagwaho A. (2013). Rwandan health minister hits back at critics of drug company deal.

Binagwaho A. (2013). Clarification on study of TB drugs. The New Times.

Vincent, M., Kaplan, S., Bitega, J., Ngeruka, M., Karema, C., & Binagwaho, A. (2012). One arm, open label, prospective, cohort field study to assess the safety and efficacy of the PrePex device for scale-up of non-surgical circumcision when performed by nurses in resource-limited settings for HIV prevention. Paper presented at the Journal of the International AIDS Society.

Karasi, J., Musonera, F., Iranyumviye, K., Servais, J., Devaux, C., Binagwaho, A., Schmit, J. (2012). Assessing the WHO recommended first-line ART regimens for resource-limited settings: comparing the relative virologic efficacy and resistance patterns of TDF/3TC/NVP to AZT/3TC/NVP in a Rwandan cohort. Paper presented at the Journal of the International AIDS Society.

Binagwaho, A., Hartwig, R., Ingeri, D., & Makaka, A. (2012). Mutual Health Insurance and the Contribution to Improvements in Child Health in Rwanda. Erasmus University. Rotterdam, Netherlands: International Institute of Social Studies.

Binagwaho A. (2012). Uniting to uproot malnutrition in Rwanda. The New Times.

Binagwaho A. (2012). Global Health Solidarity at a Crossroads. Project Syndicate.

Binagwaho A. (2012). Rwanda’s pursuit of shared wealth through health for all. Commonwealth Health Partnerships.

Binagwaho A. (2012). Rebuilding Confidence in Rwanda’s Future. The New Times.

Binagwaho A. (2012). Time to take hygiene issues seriously. The New Times.

Binagwaho A.  (2012). Reflections on the Genocide commemoration week. The New Times.

Binagwaho A. (2012). Conceptualizing global health delivery in Rwanda. The New Times.

Binagwaho A. (2012). The Government Accountability Day: my experience. The New Times.

Binagwaho A. (2012). To improve quality of health services, we must build trust. The New Times.

Binagwaho A. (2012). Direct Democracy and the Health Sector: Umushyikirano 2011. The New Times.

Binagwaho A. (2011). Outdated evidence at the WHO: case of Rwanda. The New Times.

Binagwaho A. (2011). Health, Human Rights, and Democracy. The New Times.

Binagwaho A. (2011). Rwanda, the Entrepreneurial Nation. The New Times.

Binagwaho A. (2011). Mobilized Against AIDS. Letters to the Editor, The New York Times.

Binagwaho A. (2011). Letters to the Editor: Responses to Auditing the Auditor. Global Fund Observer, Issue 150.

Binagwaho A. (2011). Co-financing, an investment in our children. GAVI Alliance.

Knaul FM, Frenk J, and Shulman J, for the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries. (2011). Closing the Cancer Divide: A Blueprint to Expand Access in Low and Middle Income Countries. Harvard Global Equity Initiative, Boston, MA. [Contributions by Binagwaho A]

Binagwaho A. (2010). Innovative Approaches to Political Leadership. In Background Paper for the Global Strategy for Women’s and Children’s Health: Investing in Our Common Future. Geneva, Switzerland: World Health Organization.

Basinga, P., Gertler, P., Binagwaho, A., Soucat, A., Sturdy, J., & Vermeersch, C. (2010). Policy Research Working paper, 5190. Washington, DC: World Bank.

Binagwaho, A. (2009). Nutritional Status Among Status Among HIV Non-infected Children Born to HIV Infected Mothers in Rwanda. Paper presented at the Annals of Nutrition and Metabolism.

O’Brien, M. E., Chung, J., Binagwaho, A., Shumbusho, F., Price, J., & O’Brien, M. E. (2009). Nurse delivery of HIV care: modeling the impact of task-shifting on physician demand. Press (personal communication).

Basinga, P., Gertler, P. J., Binagwaho, A., Soucat, A. L., Sturdy, J. R., & Vermeersch, C. M. (2009). GDN Working Paper Series.

Basinga P, Gertler P, Binagwaho A, Soucat A, Sturdy J, Vermeersch C. (2009). Paying primary health care centers for performance in Rwanda (policy research working paper 5190). Washington DC, USA: The World Bank.

Binagwaho A, Noguchi J, Senyana-Mottier MN, Smith Fawzi MC. (2009). Community-Centered Integrated Services for Orphans and Vulnerable Children in Rwanda, Joint Learning Initiative of Children and HIV/AIDS.

Basinga, P., Gertler, P., Binagwaho, A., Soucat, A., Sturdy, J., & Vermeersch, C. (2009). Impact of paying primary health care centers for performance in Rwanda. Washington, DC: World Bank.

Binagwaho, A., Kramer, M., Asiimwe, A., Munyakazi, L., & Rwakunda, A. (2008). HIV-AIDS in Rwanda. 2008 epidemic update.

Lin, Z., Engelson, E., Rusine, J., Binagwaho, A., Cohen, M., Fabri, M., Kotler, D. (2007). Factors affecting the short term nutritional response to HAART in Rwandan Women. Paper presented at the Antiviral Therapy.

Robison, E., Rwemarika, F., Binagwaho, A., Cohen, M., Asiimwe, A., Lu, J., Anastos, K. (2006). Establishing a cohort study to assess effectiveness and toxicity of antiretroviral therapy in Rwandan survivors of genocidal. Paper presented at the American Journal of Epidemiology.

Ruxin, J., Binagwaho, A., & Wilson, P. A. (2005). Combating AIDS in the developing world: Earthscan.

Binagwaho, A., & Sachs, J. D. (2005). Investing in Development: A Practical Plan to Achieve the Millennium Development Goals: Overview: Millennium Project.

UN Millennium Project. Task Force on HIV/AIDS, M., Ruxin, J., Binagwaho, A., & Wilson, P. A. (2005). Combating AIDS in the developing world. London: Earthscan.

Wilson, P. A., Stabinski, L., Binagwaho, A., & Ruxin, J. (2004). Combating HIV/AIDS in the Developing World. Interim Report of the Millennium Project Task Force, 5, 42.

Binagwaho, A., Ruxin, J., Wilson, P., & Stabinski, L. (2004). Interim report of task force 5 working group on HIV/AIDS Interim report of task force 5 working group on HIV/AIDS: UNDP.

Paul, D. B., Goosby, E. P., Deborah von Zinkernagel, R., Binagwaho, A., Kagame, A., & Ngabo, F. (2003). Client health and quality of life baseline for HIV/AIDS testing and treatment at the Kacyiru Health Center, Kigali, Rwanda. The 131st Annual Meeting.