How PIH Is Supporting Farmers In Rural Rwanda

At around 8:00 a.m., PIH staff are in a car bound for Bungwe, a village in Northern Rwanda where farming is the heart and soul of the community. The village is about 20 miles from the hospital and university campus in Butaro, where Inshuti Mu Buzima, as Partners In Health is known locally, works. But, unlike other such journeys, this visit isn’t about delivering medical care—it’s about meeting patients turned entrepreneurs.

Jean Nepomuscene Nkiliyehe, who always starts the day with a joke to keep his colleagues entertained, starts the car to begin the journey—or home visit, as it is called at Inshuti Mu Buzima.

For Nkiliyehe, a driver with Inshuti Mu Buzima for almost a decade, and Eddy Mukwiza, livelihood program coordinator with Inshuti Mu Buzima, this is a route they are accustomed to. They are part of a team that travels beyond the walls of Butaro Hospital to follow up with patients across rural Burera district who live in poverty and face financial barriers to health care.

That outreach is part of a Partners In Health program called POSER. The Program on Social and Economic Rights (POSER) stems from the belief that care must extend beyond medical and addresses the whole patient. PIH offers the program in Rwanda and Malawi and provides social support—such as food, housing, and transportation—in all countries where it works.

Inshuti Mu Buzima has worked in Rwanda since 2005 and focuses its work in three rural districts—Burera, Kayonza, and Kirehe—home to more than 1 million people. In partnership with the government, Inshuti Mu Buzima strengthens the public health system to provide not only quality medical care, but also financial resources to ensure that patients have the means to stay healthy.

After a 50-minute drive, Nkiliyehe and Mukwiza reach Bungwe and are welcomed by Sylvien Gakwenza, secretary of a local farmers’ cooperative called INZIRA Y’UBUKIRE (“Path to Wealth” in Kinyarwanda), near a 6.7-hectare (16.5 acres) field that still has remains of trunks of cassava from the last harvesting season.

For at least nine months of the year, this field is where Gakwenza and some 140 members of INZIRA Y’UBUKIRE spend their days planting or harvesting crops such as Irish potatoes, beans, corn, and wheat.

“I am a farmer, my parents were farmers, and their parents were farmers too,” says Gakwenza. “Farming is important to our everyday life.”

A Community Effort

Farming is the foundation of people's wellbeing and livelihoods in Burera, a rural district with volcanic fertile soils located near the Virunga Mountains in northern Rwanda.

But over the years, climate change, coupled with obsolete traditional farming methods, has threatened to push many farmers to the brink of starvation and destitution, leaving them exposed to a cycle of poverty and illness.

Before joining the cooperative, Gakwenza and his family of eight, like many members of the cooperative, used to cultivate small, segmented plots of land, which not only severely limited the amount of crops they produced but also was very hard to manage, especially when some members of the family were too sick to do any physical activity.

In 2012, following a dry season that led to fewer crops in Bungwe and left many farmers struggling financially, Gakwenza had no option but to sell land. Without any other source of income, he was destined to lose all of his land, despite it being essential to his livelihood.

“After failing to get enough harvest for a long time and selling a big portion of my wealth,” he says, “my family started to rely on in-kind food assistance from neighbors and local government.”

Then, in 2013, Gakwenza was one of dozens of people who started to receive economic support from Inshuti Mu Buzima through the POSER program. The program brought together local farmers—most of them patients with chronic illnesses—into saving groups, which allow members, who usually don’t have the means to deal with a bank, to save money and borrow money on flexible terms. Eventually, that group became the INZIRA Y’UBUKIRE farmers cooperative. Through this cooperative, the farmers received resources and financial support from Inshuti Mu Buzima, including livestock, fertilizers, seeds, land for cultivation, and training in modern and commercial farming methods.

“We believe that the most important way to support farmers is to be closer to them to understand the challenges they are facing,” says Mukwiza, who coordinates the program. “We also provide training on saving and modern farming to equip them with the skills needed to generate their own sources of income and then give them starting capital like land, agricultural inputs such as seeds and fertilizer, and livestock.”

For farmers like Gakwenza, that support has been life-changing.

“I managed to move from an old house to this beautiful house, thanks to the skills and money I gained from the cooperative,” he says, standing in front of his house. “I also bought a cow and a big plot of land.”

Now, Gakwenza is the village’s agricultural advisor and well-respected for the advice and mentorship he provides. He uses the skills he learned from the cooperative to train farmers in Bungwe, helping them embrace modern farming methods to earn income, reduce poverty, and have the means to access health care, including associated costs such as transportation, lodging, and medications.

‘We Have Seen Tremendous Change’

In the same village, less than a mile from Gakwenza’s house, Evaliste Nsengiyaremnye, Joseline Urayeneza, and their five children have also reaped the benefits of the POSER program.

The family was referred to the program by their neighbors, who saw how they spent months cultivating other people’s land for low wages and still struggled to put food on the table. 

“Watching helplessly my children crying because of hunger broke my heart,” says Urayeneza.

The hunger took a toll on the family in more ways than just health. As Nsengiyaremnye and Urayeneza worked on other people’s farms, they barely had time to spend together. After a long day of work, they would return home to crying, hungry children and despair about where the next meal would come from.

The POSER program came as a lifeline.

After they started receiving support from Inshuti Mu Buzima, they were able to save money and use pooled funds from INZIRA Y’UBUKIRE to buy land of their own, which they cultivated using modern farming techniques and fertilizers and seeds from the cooperative. Within months, they had harvested enough food to feed their family and sold the remaining yields at the local market and to wholesalers from as far as Kigali and neighboring Uganda.

Now, the family is healthy and their farm is thriving—so much so that they are able to provide job opportunities to their neighbors.

When asked about how his life turned around, Nsengiyaremnye points at a big plot of land he recently bought.

“Today, you can’t afford to pay me to work for you,” he says. “We have just bought this land for 2.5 million Rwf [Rwandan franc] and we own multiple plots of land in different places.”

Programs like POSER are crucial to breaking the cycle of poverty that prevents many farmers in Burera from accessing health care and living a healthy lifestyle. To continue and strengthen this life-changing source of support, Inshuti Mu Buzima works with Rwandan government officials and all health centers across Burera district to provide health insurance to farmers, make sure they have enough land for cultivation, and help them to find markets for their yields. Inshuti Mu Buzima also conducts home visits to identify people in need of social and economic support and enroll them in POSER.

Over the years, Mukwiza has seen the program change lives—and communities.

“We have seen tremendous change in the lives of families who went from not being able to pay for health insurance to owning multiple income-generating projects,” he says. “We plan to scale up our support to even more people in need.”