Source: Deseret News
The ongoing Ebola virus epidemic in West Africa has fueled pessimism and led many commentators to declare that these nations are beyond help and hope.

Indeed, health indicators in sub-Saharan Africa, such as maternal death rates and life expectancy, are among the worst in the world. But it need not be this way. We need only to look toward Rwanda for an example of how a nation's health and health system can be transformed in less than 20 years.

When most people think of this landlocked African country, they conjure up images from 1994, when a horrific genocide resulted in the murder of approximately one in five Rwandans, and the displacement of millions more. It is no surprise that prior to the genocide, the health of the average Rwandan was as dismal as that of the citizens of Ebola-ravaged Sierra Leone today.

In 1990, maternal death rates in Rwanda were significantly higher than those of Sierra Leone, but something remarkable happened during the two decades since the genocide. Between 1990 and 2013, maternal deaths in Rwanda decreased by nearly two-thirds. In Sierra Leone, where rates have increased, women now face a one in 21 chance of dying due to complications of pregnancy or childbirth over their lifetime. From 1994 to 2013, the rates of deaths among children under 5 in Rwanda, once the highest in the world, decreased by over 80 percent, twice as much as in Sierra Leone. Soon, the rates of child survival among Rwandan children will exceed the global average.

A man walks past a billboard warning people of the deadly Ebola virus in Monrovia, Liberia. Friday, Oct. 10, 2014. The ongoing Ebola virus epidemic in West Africa has fueled pessimism and led many commentators to declare that these nations are beyond help and hope.

Abbas Dulleh, Associated Press

In 1995, the odds were certainly stacked against Rwanda. The genocide had left the government and economy in tatters, health facilities were in ruins and many of the country's health professionals had been murdered or had fled. Foreign aid to Rwanda was among the lowest in all of Africa, and life expectancy was 31 years.

But in 2000, Rwandans put forth a roadmap for rebuilding their broken nation. Rwanda's Vision 2020 strategy emphasized economic development with a focus on poverty alleviation and health equity. Through strong participatory policymaking with Rwandan leadership, the Ministry of Health established robust public-private partnerships and incorporated a countrywide network of community health workers linked to a decentralized but integrated health system.

Nationwide health insurance with a progressive premium structure was implemented, and successful HIV/AIDS programs and facilities were expanded to provide primary health care services. Finally, the Ministry of Health implemented performance incentives for health care workers, clinics and hospitals, and harnessed 21st century information technology to enhance health care delivery.

American academic institutions increasingly play a role in Rwanda's transformation. In partnership with 25 U.S. universities, the Rwandan Ministry of Health is addressing the critical shortage of skilled health workers by training the next generation of health professionals.

Some are concerned that improvements in health will lead Rwanda into a Malthusian trap whereby increased child survival and life expectancy will result in explosive population growth. This scenario is unlikely considering the brisk uptake of family planning services by Rwandans. A decade ago, rates of contraceptive use were nil, but today nearly one in two Rwandan women use a modern form of contraception and fertility rates decreased by 25 percent between 2005 and 2010.

Prior to the Ebola outbreak, economic gains in Liberia, Sierra Leone and Guinea suggested that these nations have the necessary resources for a transformation, Rwanda-style, of their economies and health systems. Liberia and Sierra Leone were experiencing annual economic growth that Western countries would envy, 8.1 percent and 16 percent, respectively, and Guinea's gross domestic product was predicted to double between 2013 and 2014. Furthermore, foreign direct investment in Liberia and Sierra Leone has more than doubled over the last few years.

In short, this region has a model and growth potential; it now only has to focus on equitable health care systems, and the Ebola-ravaged region in West Africa can be optimistic for the future.