‘The @CoryBooker of Rwanda’ – The Health Minister Who Solves Problems Tweet-by-Tweet

Minister of Health Dr. Agnes Binagwaho is proud of the country’s health for good reason. Rwanda’s health statistics are a scorecard of positively trending indicators. In addition to achieving targets for child survival and healthcare access, Rwanda is among the only countries on the African continent that has already achieved the elusive MDG 5, after halving its maternal mortality rate in the past 20 years. This year, Rwanda became a world leader in vaccination coverage, achieving 93% coverage with cervical cancer vaccinations.

The Ministry of Health credits transparent communication networks from the village-level to the Ministry. In November 2011, Dr. Binagwaho created Minister Mondays, an online event held every other Monday, in which the Minister herself hosts an open discussion and question session through Twitter and SMS. With two staff fellows assisting her, she promises to answer every tweet and SMS message.

To ensure access, health workers in each village are tasked with making mobile phones available to anyone who wants to contact the Minister. Radio talkshow hosts also help by promoting the events and repeating the information shared. Many messages are complaints regarding service quality or lack of equipment. Dr. Binagwaho often calls the responsible office on the spot to investigate where the failure occurred and how it can be repaired. Tweets from outside Rwanda have included offers for sharing research resources from other Ministries and institutions.

Although any topic is welcome, the online conversations are given a theme. After the country launched its HPV national vaccination campaign, the Minister hosted a Minister Monday on the topic of public perception of vaccines. Today, Dr. Binagwaho will be online at 12:30 EST. Following last week’s announcement of international university collaborations, the theme will be collaborations between Rwanda and US and European hospitals.

At meetings with her international counterparts, Dr. Binagwaho is often approached with curiosity for her non-stop tweeting. “Colleagues say things like they do not have so much time,” the Minister says—we are talking by phone between her meetings, near midnight Kigali time. When asked when she finds the time, she says she always has her iPhone with her. She gets carsick if she texts in the car, but otherwise, she is always texting and tweeting in any free moment between meetings and events. When asked why she doesn’t follow anyone on Twitter, she answered, “I don’t want to leave anyone out. This way, everyone can contact me equally.”

Offline communication networks are also employed in the MoH strategy for engagement. Following each maternal death, for example, a sort of community-level morbidity & mortality meeting is held in which the deceased woman’s friends and family are asked at what point they first thought something was wrong and medical staff explore what they could have done differently. Given that many countries still lack the ability to track maternal deaths, the community focus is especially laudable. Dr. Binagwaho explained that the meetings themselves contribute to institutional behavior change because “no one wants to ask themselves later if they could have done something more.”

The success of Rwanda’s communication-enabled health gains is clearly possible, in part, because of the country’s small size. Like @CoryBooker, the mayor of Newark, NJ famous for solving problems from potholes to snow piles that his constituents tell him about over Twitter, Rwanda’s health minister uses her online engagement as a monitoring and evaluation system, a transparency mechanism, and an educational tool. In time, tweeting global leaders will likely become commonplace, but that begins with leaders like Dr. Binagwago providing a best practices case study for government accountability through embracing emerging media and technology.