State of the World's Minorities and Indigenous Peoples 2013 - Case study: Community health care succeeds for Batwa

As Rwandans enjoy rising life expectancy and falling disease burdens, marginalized Batwa remain excluded from mainstream health care. But now a community project is beginning to change attitudes.

In recent years, Rwanda has made impressive progress in combating poverty and inequality through inclusive economic growth. It has established universal health insurance and recorded a 40 per cent reduction in the infant mortality rate.

At the same time, Rwanda has taken steps at a policy level to address the inter-ethnic issues that led to the 1994 genocide. The Constitution rejects ethnic classifications; it commits itself to 'fighting the ideology of genocide' and to 'the eradication of ethnic, regional and other divisions and promotion of national unity'.

New laws have prohibited 'divisiveness' along ethnic lines. Experts have expressed concern that the non-recognition of ethnicity contravenes the individual's right to identify with a specific ethnic group, and ignores such groups' specific needs and situations.

The Rwandan state has recognized the particular challenges facing what it terms 'historically marginalized peoples', namely, roughly 33,000 indigenous Batwa. Traditionally forest-dwelling hunters and gatherers, over past decades they have been expelled from their ancestral lands without compensation to make way for agriculture or conservation.

Through discrimination and difficulties in accessing services, Batwa communities have largely missed out on Rwanda's progress, with the result that they have higher infant mortality rates, shorter average lifespans and higher rates of disease and malnutrition than their neighbours.

In 2011, the Young Women's Christian Association of Rwanda (YWCA), a non-governmental, non-profit grassroots organization, developed a street theatre project as a way of challenging stereotypes and discriminatory attitudes against the Batwa. Over two years, it reached about 52,500 people through community, market and street performances.

While preparing the theatre production, actors and staff spent time living in a Batwa community. This, explained YWCA Programme Officer Archimede Sekamana, was an eye-opening experience for the development workers, who saw straight away that the community 'needed more support than just changing the mindset ... you see young 16-year-old girls with babies, you see the needs, and you think "How can I help them?"'

YWCA staff began to search for ways to respond. In January 2013, a pilot Young Women's Action Club was set up in a Batwa community in Gitarama. Eighteen young Batwa women have received training in reproductive health and family planning, with the aim of carrying out outreach work among other young women in the community.

Batwa women have also been included in the YWCA's programme for HIV-positive women. Sekamana, describing the initial outreach effort, said, 'in the Batwa community, we asked them how many knew about their (HIV) status. We realized that none had been to clinic or hospital to get tested ... we were looking for 50 women and found 200.' YWCA is now working on HIV prevention education.

Fifty Batwa women have been incorporated into a project helping them develop skills in handicrafts or small businesses. The programme was initially set up to support children who had been orphaned in the genocide or whose parents were in prison on genocide charges. Batwa children, without an authority figure to advocate for them, were often left out. Now the project is trying to recruit young heads of households among Batwa families, such as those orphaned by HIV/AIDS.

International donors have cut some of the aid that makes up 40 per cent of Rwanda's budget in response to reports that the government is supporting the notorious M23 rebels in neighbouring DRC, reports that Rwanda vehemently denies.

Meanwhile, quietly, groups like the YWCA, which have shown an impressive willingness to challenge their own mindsets as well as those of their beneficiaries, continue to make a genuine difference in the lives of extremely vulnerable people.