How Rwanda is beating the U.S. in the fight against the coronavirus

For many in the West, the name Rwanda may still carry memories of that country’s horrific upheavals of a quarter-century ago and tap broader Western biases against Africa. But today the country is a leading innovator on health. That includes the ongoing fight against the coronavirus: Rwanda’s efforts to control the pandemic have trounced those of ostensibly more advanced countries, including the United States.

In its first month of fighting the virus, Rwanda saw coronavirus cases grow from two to 134, according to the nonprofit Partners in Health. During the same period, Belgium—Rwanda’s former colonizer, which has a similar population—went from two cases to 7,400. By the end of June, a handful of outbreak clusters pushed Rwanda’s total reported infections to 582. New York City, with about three-quarters of Rwanda’s population and arguably one of America’s coronavirus success stories, is still seeing nearly 300 new cases each day.

According to Agnes Binagwaho, Rwanda’s former health minister and now a senior lecturer at Harvard Medical School, the success comes down to a health care system focused on communities.

“Rwanda has prioritized a decentralized health care system,” she told vaccination advocate Seth Berkley at Fortune’s Brainstorm Health virtual conference on Wednesday. That has meant distributing community health workers across the country. The system, Binagwaho said, also works to get buy-in from everyone, from educators to law enforcement, to help in advancing health goals.

The U.S. stands in contrast to that approach. “[U.S.] investment in community health and public health has really been decimated in the last few decades,” said Sheila Davis, CEO of Partners in Health, which focuses on expanding medical services for the world’s poorest people. “So we don’t have the benefits of a community health system like they have in Rwanda.”

One outcome that may be particularly frustrating to some Americans is Rwandans’ deep trust in their health care system and health authorities. According to a 2019 report, Rwandans have the world’s highest level of trust in clinics and hospitals, and place high importance on vaccinations. The U.S., meanwhile, has been a hotbed of distrust and denialism toward precautions as basic as cloth masks.

Most of all, Davis faulted U.S. reliance on hospitals as a focal point of health care, in contrast to Rwanda’s approach of putting health workers closer to the communities they serve. That has included providing what Davis called “aggressive testing” during the pandemic, and setting up facilities to let possible coronavirus carriers isolate away from their families, including providing food for quarantiners.

Though Rwanda has gotten some attention for its use of drones and other technology in the pandemic, Davis thinks that’s secondary. “The innovation is not a technology. It’s more the innovation of human caring and providing social support.”

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