This April, Rwanda will commemorate the 20th anniversary of one of the last century's greatest human tragedies, the 1994 genocide that took the lives of one million Tutsis and moderate Hutus in just one hundred days. As the global community turns its attention to Rwanda on this occasion, they will find a country radically different from the Rwanda of the past. The new Rwanda is a stable and increasingly prosperous country, one where life expectancy has doubled since the difficult aftermath of the genocide. The government's commitment to equity has catalyzed rapid and widespread development, largely by creating opportunity for its poorest citizens. Meanwhile, the health sector's pioneering efforts in health care delivery have drawn global attention. With strong leadership, smart partnerships and innovative programs, Rwanda is forging a new pathway for development.

Partners In Health (PIH), a Harvard-affiliated global health and social justice organization, has worked side by side with Rwanda's public sector for nearly a decade, embedding ourselves within the rural communities that we serve. As such, we have had a unique vantage on the country's evolution. Rwanda has demonstrated that what PIH co-founder, Paul. Farmer, has called "vicious cycles of disease and poverty" can be transformed into generative cycles of health and prosperity. Rwanda has been called a "health care miracle." But the word "miracle" implies mystery, and there is no mystery here: the key is to link effective health care delivery systems to an equity agenda.

Rwanda in the Aftermath of Genocide

While division and conflict had been cultivated in Rwanda since the colonial period, the hundred-day span of premeditated mass violence in 1994 was shocking in its scale and swiftness. When the genocide ended on July 4, 1994, Rwanda was virtually left in ruins, its infrastructure destroyed and its society in disarray. In addition to the million lives lost, hundreds of thousands of women were raped--often as a means of weaponizing HIV--and over two million people displaced, both throughout the country and in disease- and conflict-ridden refugee camps in neighboring countries.

In a single year, the country's GDP was halved, and according to the Rwanda Ministry of Finance and Economic Planning, eighty percent of the population was thrown into poverty. The economic system collapsed, almost no taxes were collected, and government infrastructure--both physical and human--was destroyed.

Malaria, cholera, HIV/AIDS, and waterborne infections--ever thriving along social fault lines--ravaged the remaining population in Rwanda, as well as those in the refugee camps across the border. While the health system was weak and under-resourced before the genocide, it utterly collapsed in 1994. Many clinicians either fled or were killed, and health systems laid in ruins. According to the World Health Organization (WHO), less than 5% of the population had access to clean water, and food insecurity spiked as land and livestock were destroyed throughout the country.

The genocide and its aftermath left Rwanda one of the poorest and most fragile countries in the world. Perversely, the resulting human emergency in Rwanda led many in the international community to...