Rwanda improves health sector.

Over the past 10 years, Rwanda has transformed itself. About 45,000 community health workers have been trained, there is a 91% success rate for tuberculosis treatment, and 90% of the population is enrolled in universal health care. The results of these interventions are equally impressive.

Mortality from HIV, tuberculosis, and malaria has dropped by about 80% while the probability of a child dying by the age of five has declined 70%.

Rwanda is the only country in sub-Saharan Africa on track to meet almost all of the health-related millennium development goals.

But there is one area where progress is slow. Chronic childhood malnutrition and stunting remain high. Even worse, cases of severe anaemia increased from 2008-2010. Partly these problems may be due to population; with over 400 people per sqkm, Rwanda is the most densely populated country in Africa.

In order to address these issues, development agencies are directing new attention at hunger and food insecurity.

For instance, the World Bank and the Rwandan ministry of agriculture have a programme of agricultural intensification that encourages farmers to specialise on only those crops they produce well. This is boosting production and weaning the country off imports.

But where such strategies have been tried elsewhere in the world, the results have been mixed. Large monocultures are indeed productive, but they can displace the poor and may hurt the environment.

While in Rwanda recently I asked a group of farmers in one hillside community about the nearby rice intensification project. They replied it mostly benefits those lucky enough to own or rent land in the project.

And while everyone benefits indirectly when production goes up, for the poorest people, life continues as hard as always.

In contrast, NGOs such as Catholic Relief Service and Partners in Healthwork with vulnerable groups such as HIV-positive women. These NGOs empower women to plant gardens, raise livestock, and build water storage facilities.

But while these programmes have a huge impact on many of the recipients, such interventions seem modest when compared with the overall picture of grinding poverty.

This confronts us with a tension between two familiar models: a market-led paradigm, which is based on the premise that to reduce food insecurity we increase production and ‘modernise’ agriculture; and a social welfare paradigm that empowers those people who have the fewest assets.

Understanding the tension between these approaches is important not only for Rwanda, but also for development experts everywhere who are working to address the challenges of our growing population.

This is because despite apparent disagreements between those who promote agricultural modernisation versus those who focus on building up the poor’s assets, we need both approaches.

For instance, in regions where farmers fail to reach their full food producing potential (and much of Africa has grain harvests that are only about 10% of what they could be) those who promote agricultural modernisation are right: farmers need access to better seeds, soil nutrients, and pest management techniques.

Using such tools will help boost productivity, stabilise prices, and increase incomes for those with access to decent land. But often, such policies also mean land becomes consolidated on fewer, larger, and more capital-intensive farms.

So social welfare based programmes, such as working with HIV-positive women to establish kitchen gardens or micro-enterprises, are also needed to help ensure the poor gain the capability to lift themselves out of poverty.

The appropriate metaphor is to think about different food security strategies as components of a well balanced investment portfolio that is strong through its diversity.

But such a blending of programmes is beyond the scope of any single government department, NGO, or multilateral.

It requires co-ordination and co-operation. And this must run across the length and breadth of government ministries and aid agencies who need to figure out ways of working effectively with civil society. But maybe this is why Rwanda is doing so well.

Rwanda requires NGOs to align their work with national priorities. And the country’s national land policy provides a legal framework to ensure the poor are not left behind in the push for economic growth.

And so, Rwanda, once one of the worst performing countries in Africa after the genocide, is steadily addressing one of the major challenges facing the world today. That should make development experts sit up and take notice.

The guardian