Dr. Agnes Binagwaho
Roux Prize Winner 2015
As a child, Dr. Agnes Binagwaho was inspired by her father and her love for children to pursue the medical field, specifically pediatrics with a focus in neonatology.
Dr. Binagwaho was working as a pediatrician in France when the Rwandan genocide occurred in 1994. When she returned to her country in 1996 to help her family, most of the health system infrastructure had been destroyed and many health workers had been killed or fled the country.
“There was no trust in the health system, no medications, and no tools to provide health care,” said Dr. Binagwaho. “I remember coming back with kilos of meds in my bag, just to be able to provide care.”
At the time, only a few people were able to provide care to millions of those who needed it. After one week with no easy solution and in a desperate situation, Dr. Binagwaho contemplated giving up, but she realized that if people like her ran away from the problem, who would stay?
Life expectancy at this time was just 45 years.
Rebuilding trust in the health system
Dr. Binagwaho’s work was part of a wider effort led by the government of Rwanda to rebuild the country from the ground up and ensure that even the poorest citizens could receive health care.
After working directly with patients within this system, Dr. Binagwaho took on increasingly higher leadership roles. She served as Executive Secretary of the National AIDS Control Commission starting in 2002 and was appointed Permanent Secretary of the Ministry of Health in 2008. In 2011, she was appointed Minister of Health.
By 2013, life expectancy at birth in Rwanda had increased to 66 years, 20 years greater than it was when Dr. Binagwaho first returned to the country.
As people live longer, though, their risk of developing non-communicable diseases (NCDs) increases.
Under Dr. Binagwaho’s guidance, the Rwandan Ministry of Health is responding to the growing burden of non-communicable diseases through a variety of interventions that include expanding screenings, follow-up services, and palliative care.
After studying the data and charting out the health landscape, Dr. Binagwaho and her team identified that cancer, especially for women, was a major disease that they could tackle. She determined that they could mitigate the impact of cancer in two ways: consultation and vaccination. After finding out about a vaccine to prevent cervical cancer and with the support of Rwanda’s First Lady, Dr. Binagwaho led Rwanda’s effort to roll out a national vaccination campaign. Over 90% of girls in school were immunized against human papillomavirus (HPV) as a result, making Rwanda the first African nation to introduce this vaccine.
Using data to improve health
To ensure the health system meets the needs of all Rwandans, even the most vulnerable, Dr. Binagwaho is using data from the Global Burden of Disease (GBD) study to drive many national health policies.
When she learned that the leading risk factor for premature death and disability in her country was household air pollution caused by cooking with solid fuel such as wood and dung, she started a program to help 1 million Rwandan households access clean cookstoves. Household air pollution poses the greatest risk for young children as it can increase their chances of developing lower respiratory infections. In 1990, household air pollution accounted for nearly 8,000 deaths overall; 3,300 of these were in children under 5.
The clean cookstoves were designed to reduce amounts of both fuel used and smoke produced. Since the program began, 250,000 cookstoves have been distributed to homes throughout Rwanda.
“The global burden of disease, by creating and generating such data, helped to know where we need to invest the next dollar, the next effort, the next education,” said Dr. Binagwaho.
Global burden of disease data also revealed a large percentage of Rwandans were dying during the first months of their lives. Based on this information, Dr. Binagwaho and her staff decided to embark on a campaign to decrease neonatal deaths. By investing money in education, equipment, and training in neonatology at hospitals throughout the country, they have started to see improvements in the data.
Importance of data
At the same time Dr. Binagwaho is using GBD data to improve health outcomes in her country, she is also advocating for its improvement.
“Whatever we do in the ministry, we use information, it means we use data. Everything that you present, everything that you come to either discuss with her, she always asks, ‘show me the science behind it,’” said Andrew Muhire, Head of Rwanda’s Health Management Information System in the Ministry of Health.
To this end, Dr. Binagwaho has become a collaborator on the GBD study and has sent staff from the Ministry of Health to Global Burden of Disease technical trainings. Along with Dr. Bingawaho, more than 20 Rwandans now collaborate on the GBD study.
Dr. Binagwaho is also working to address data gaps that would improve the accuracy of the Global Burden of Disease study’s findings for Rwanda. For example, few sources of data on non-communicable diseases exist in Rwanda, and Dr. Binagwaho is working to find ways to fill these gaps.
The Ministry of Health has created a platform that captures health data throughout all districts of Rwanda. Community health workers and hospital staff are expected to regularly submit data they collect from their patients to this system, which allows analysts at the MOH to then review, analyze, and present, leading to informed decisions.
“I am interested in knowing what I am doing, and I am interested in knowing how the world is working, and to know that, you need data, you need science,” she said.
In October 2015, Dr. Binagwaho was awarded the Roux Prize to recognize her use of health data to improve population health in Rwanda and adapt the country’s health system to respond to the population’s evolving health needs.
The Roux Prize rewards bold action to improve population health through disease burden evidence. The winner, chosen after a worldwide nomination and selection process, receives US$100,000.
David and Barbara Roux established the Roux Prize in 2013 to award innovation in the application of Global Burden of Disease (GBD) research. The prize recognizes the person who has used burden of disease data in bold ways to make people healthier.
Mr. Roux is a founding board member of IHME and, over the past decade, he championed IHME’s most ambitious project, the updating of the Global Burden of Disease. And he encouraged IHME, as the coordinating center for researchers around the world, to find ways to make the information more useful, so that it would actually have an impact on the ground.
Since the first GBD publication in 1993, GBD data have been used in a wide variety of ways to inform better policymaking at the local and international levels. Mr. Roux wanted to reward that kind of evidence-based innovation and to encourage even bolder attempts to improve population health through better measurement of disease burden.
The winner of the 2014 Roux Prize was Dr. Rodrigo Guerrero, Mayor of Cali, Colombia.
The Global Burden of Disease (GBD) is a systematic, scientific effort to quantify the comparative magnitude of health loss due to diseases, injuries, and risk factors. In 1993, the original GBD study was funded by the World Bank and featured in its landmark World Development Report 1993: Investing in Health. Co-authored by Dr. Christopher Murray, now Director of IHME, this study included estimates for 107 diseases and 483 nonfatal health consequences in eight regions and five age groups.
Now an ongoing enterprise with annual updates, GBD is an international, collaborative effort with more than 1,400 researchers in over 100 countries, led by IHME. Results are regularly published in peer-reviewed journals for more than 300 diseases, injuries, and risk factors, by age, gender, and country. For more information about GBD, visit IHME’s website.