Aid effectiveness: The experience of Rwanda

Abstract

In 2002, when I began working with Rwanda’s National AIDS Control Commission, there were fewer than 1,000 people in our country on antiretroviral therapy. Tens of thousands died uncounted each year. Today we have universal access to HIV treatment, thanks to global solidarity. In this chapter, I explain how the good intentions of our partners are not enough to assure good outcomes and that aid effectiveness cannot be reduced to a simple equation; it is the result of a complex series of interacting factors over time. I also share key lessons that we have learned throughout our pursuit of aid effectiveness in the health sector. In Rwanda, progress has been possible due to a sustained and rigorous focus on strategically developing and implementing solid systems that exhibit the principle of health as a human right. We have learned that all aid is not good and that the key determinant of whether aid is used effectively is whether it is directed towards priorities based on the needs of the population rather than the wishes of donors. Also, we have witnessed the importance of following the money and how strong national coordination of all stakeholders is critical to this process. We also have seen the value of building systems and not projects, and how this requires national ownership of setting the priorities to implementing our policy. We have recognized that accountability must go both ways and that our international partners must also be held to the highest of standards. Lastly, we have learned that strengthening the public sector is critical to ensure any promise of sustainability and future improvements in health outcomes.