Malawi and Rwanda prove that poverty does not prevent life expectancy from skyrocketing

At the turn of this century, life expectancy in Malawi and Rwanda was around 45 years.

In 2020, he was around 65 years old.

The dramatic improvement—unparalleled on the African continent—was 19.6 years in Malawi and 19.3 years in Rwanda, according to UN data.

In those two decades, the two countries gained, each year, one year of average life time for their inhabitants.

Since then, the indicator has fallen slightly in Malawi (largely due to the effect of covid-19 on general healthcare) and has risen by a few tenths of a point in Rwanda.

The success of these two East African countries shares -each having its own recipe- some ingredients.

Priority focuses and measures of proven effectiveness, such as, for example, the emphasis on maternal and child health, orchestrated by a common denominator: the firm will of the State to stop a trail of preventable deaths despite the fact that the two countries are located in the low part of the regional list of GDP

and do not have great natural resources in their favor.

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The experts consulted for this report agree that Malawi and Rwanda have sent a powerful message to the rest of Africa: with an accurate cocktail of planning, political determination and the use of international aid, incredible results can be achieved.

“They are doing an excellent job from a human development perspective, not just focused on economic growth,” says Yohannes Dibaba, a researcher at the African Population and Health Research Center (APHRC), based in Naironi, Kenya.

Oil-rich Nigeria has a life expectancy of just under 54, up just seven years so far this century.

It is also, according to Oxfam, one of the countries in the world least committed to the fight against inequality

By way of comparison, Kenya, with more than 2,000 euros of GDP

(neither Rwanda nor Malawi exceeds 1,000 euros), has a lower life expectancy (63.3 years), which has increased less than 10 years since the year 2000. Even more flagrant is the example of Nigeria.

Rich in oil, with a GDP

similar to Kenya, its life expectancy stands at just under 54 years, an increase of just seven years so far this century.

Not surprisingly, Nigeria is, according to Oxfam, one of the countries in the world least committed to the fight against inequality.

Another case also draws special attention: Equatorial Guinea, with a

GDP of more than 7,000 euros , has an average life expectancy of 62 years.

Reduce infant mortality

It is no coincidence that Rwanda and Malawi are also the two African states that have most succeeded in reducing their infant mortality rate: at the beginning of the century, for every 1,000 born in Rwanda and Malawi, some 180 did not reach the age of five.

Currently, that rate has been reduced to less than 40. As Thomas Spoorenberg, an analyst at the United Nations Population Division, explains, the 0-5 age group is the one that has the most weight when calculating life expectancy.

"If you survive to those ages, the probability of dying is considerably reduced," he says.

The notable decrease in the number of children brought into the world has also contributed to this aspect.

In Rwanda it has dropped from seven to three children per mother, Dibaba stresses.

“If you have children too close together, they compete for lactation, which increases the risk of malnutrition,” adds Joel Mubiligi, Rwanda executive director of Partners in Health, a US-based NGO with divisions in 10 countries around the world. the world.

At the same time, public investment has been building a more accessible assistance network.

In Malawi, more than 90% of mothers give birth in a health facility staffed by skilled personnel, says Adamson Muula, a professor of public health at the Kamuzu University of Health Sciences in Blantyre, the country's second-largest city.

And in Rwanda, says Mubiligi,

While Rwanda finally glimpses the goal of universal health, in Kenya coverage does not exceed 20%

Furthermore, in these countries children are rapidly immunized.

Although it has not yet reached all corners of the country, the pentavalent vaccine (protects against five diseases) has become widespread in Malawi.

Professor Muula comments that, thanks to it, the feared infections caused by the haemophilus influenzae bacterium currently have a low prevalence.

“Before, it was one of the main causes of infant mortality, frequently leading to pneumonia or meningitis,” he says.

Muula also mentions another front that has saved thousands of Malawian lives: the battle against AIDS.

This professor evokes the times when "the incidence was 15% among the adult population, with a third of pregnant women" infected.

And he keeps a shocking memory that symbolizes the extent to which the epidemic was widespread in the country: "In one year, three ministers who had developed the disease died."

Since that fateful time, between the end of the nineties and the first years of this century, the number of infected has dropped significantly, which today stands at less than 8% of the population.

And even more important, deaths have plummeted.

Muula places the turning point in 2004, "when treatment with antiretrovirals began to be distributed."

Universality and decentralization

Foreign aid has also played an essential role in increasing life expectancy in the two countries.

Muula estimates 60% of the foreign contribution (almost all from the US and the European Union) in the health budget in Malawi, where the money that comes from abroad fully finances the programs against HIV and malaria.

In Rwanda, external funds constitute, according to UNICEF, almost 50% of the total allocated to the public health sector.

Mubiligi maintains that foreign money does not land in Rwanda with already assigned purposes and without decision margin for the Rwandans themselves.

“We explain to the donors that perhaps in other places it is done differently, but here the aid must be integrated into our national strategy”, he clarifies.

Two pillars support the healthcare structure that Rwanda has been building after the unfortunate era of genocide: universality and decentralization.

Real coverage already reaches 90% of its population, while in a country like Kenya, coverage does not exceed 20%.

The Kigali authorities have set national and local targets under a strict accountability model.

“If politicians don't comply, they don't last long in office,” Mubiligi points out.

In both Rwanda and Malawi, the role of community health workers must also be emphasized.

This is a very present figure in sub-Saharan Africa, so common that the acronym CHW (Community Health Workers, in English) is already in common use.

Without higher education, they exercise with closeness and versatility by flag.

They live in the same rural environment as the beneficiaries of their services, report and collect information, act as a link in preventive campaigns and emergencies, provide vaccinations and detect severe cases of malnutrition.

Its essential value lies in the cost-benefit.

“It's about making the most of the available resources,” says Mubiligi.

And the health services of Rwanda and Malawi have been betting big on CHWs for some time.

In Rwanda, says researcher Dibaba, each town or village has its own community health center with three or four workers.

Malawi, for its part, has created a network of 11,000 community workers available to its rural population, the overwhelming majority in the country.

In the war against premature deaths that these two countries have been waging, they are the vanguard of their armies.

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