University of Global Health Equity’s Contribution to the Reduction of Education and Health Services Rationing

Document Type : Editorial


1 Harvard Medical School, Boston, MA, USA

2 Geisel School of Medicine, Dartmouth University, Hanover, NH, USA

3 University of Global Health Equity, Kigali, Rwanda


The inadequate supply of health workers and demand-side barriers due to clinical practice that heeds too little attention to cultural context are serious obstacles to achieving universal health coverage and the fulfillment of the human rights to health, especially for the poor and vulnerable living in remote rural areas. A number of strategies have been deployed to increase both the supply of healthcare workers and the demand for healthcare services. However, more can be done to improve service delivery as well as mitigate the geographic inequalities that exist in this field.
To contribute to overcoming these barriers and increasing access to health services, especially for the most vulnerable, Partners In Health (PIH), a US non-governmental organization specializing in equitable health service delivery, has created the University of Global Health Equity (UGHE) in a remote rural district of Rwanda. The act of building this university in such a rural setting signals a commitment to create opportunities where there have traditionally been few. Furthermore, through its state-of-the-art educational approach in a rural setting and its focus on cultural competency, UGHE is contributing to progress in the quest for equitable access to quality health services.


Main Subjects

"Watch the Video Summary"

  1. World Health Organization (WHO). Working Together for Health - The World Health Report 2006. Vol 19. Geneva: WHO; 2006. doi:10.1186/1471-2458-5-67
  2. World Health Organization (WHO). Transforming and Scaling up Health Professionals’ Education and Training: WHO Education Guidelines 2013. Geneva: WHO; 2013.
  3. World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. Published 2016.
  4. Kim JY, Farmer P, Porter ME. Redefining global health-care delivery. Lancet. 2013;382(9897):1060-1069. doi:10.1016/S0140-6736(13)61047-8
  5. The World Bank. Poverty and Health. World Bank Briefs.  Accessed March 25, 2017. Published 2014.
  6. Braveman P, Gruskin S. Poverty, equity, human rights and health. Bull World Health Organ. 2003;81(7):539-545.
  7. Binagwaho A, Sarriera G, Eagan A. The evolution of the physician role in the setting of increased non-physician clinicians in sub-Saharan Africa: an insistence on timing and culturally-sensitive, purposefully selected skill development: Comment on “Non-physician clinicians in sub-Saharan. Int J Health Policy Manag. 2017;6(1):53-55. doi:10.15171/ijhpm.2016.90.
  8. Shumbusho F, Van Griensven J, Lowrance D, et al. Task shifting for scale-up of HIV care: Evaluation of nurse-centered antiretroviral treatment at Rural Health Centers in Rwanda. PLoS Med. 2009;6(10):1-12. doi:10.1371/journal.pmed.1000163
  9. Cancedda C, Riviello R, Wilson K, et al. Building workforce capacity abroad while strengthening global health programs at home: participation of seven Harvard-affiliated institutions in a Health Professional Training Initiative in Rwanda. Acad Med. 2017; forthcoming.
  10. PIH Countries. Partners In Health website  Accessed May 1, 2017. Published 2017.
  11. Abiiro GA, Mbera GB, De Allegri M. Gaps in universal health coverage in Malawi: a qualitative study in rural communities. BMC Health Serv Res. 2014;14:234. doi:10.1186/1472-6963-14-234
  12. WHO. Social determinants of health.   Accessed May 1, 2017. Published 2017.
  13. Woloschuk W, Tarrant M. Does a rural educational experience influence students’ likelihood of rural practice? Impact of student background and gender. Med Educ. 2002;36(3):241-247. doi:10.1046/j.1365-2923.2002.01143.x
  14. Dossajee H, Obonyo N, Ahmed SM. Career preferences of final year medical students at a medical school in Kenya--A cross sectional study. BMC Med Educ. 2016;16(1):5. doi:10.1186/s12909-016-0528-1
  15. Hurst SA. Eroding students’ rural motivation: First do no harm? Swiss Med Wkly. 2014;144:1-6. doi:10.4414/smw.2014.14020
  16. Teichholtz S, Kreniske JS, Morrison Z, Shack AR, Dwolatzky T. Teaching corner: an undergraduate medical education program comprehensively integrating global health and global health ethics as core curricula: student experiences of the medical school for international health in Israel. J Bioeth Inq. 2015;12(1):51-55. doi:10.1007/s11673-014-9602-8
  17. Schmidt VH. Models of Health Care Rationing. Curr Sociol. 2004;52(6):969-988. doi:10.1177/0011392104046618
  18. Price J, Binagwaho A. From medical rationing to the use of human resources for AIDS care and treatment in Africa: a case for task shifting. Dev World Bioeth. 2010;10(2):99-103. doi:10.1111/j.1471-8847.2010.00281.x