The Rwandan government worries that PIH fosters dependency. "Everything for free -- we don't believe it is sustainable," said Dr. Agnes Binagwaho, a top health official who is nonetheless one of PIH's strongest allies.
So PIH has helped patients form HIV associations, provided training in intensive farming methods and offered small loans to more than 6,000 farmers. The associations must repay the loans within 12 months.
Since the program began 18 months ago, six associations have repaid their loans and turned a profit.
In 2007, PIH projects in Rwanda got only $300,000 to $400,000 from the Global Fund, a major grantee of the Bill & Melinda Gates Foundation. PIH receives about $3.5 million for its Rwanda operations from the William J. Clinton Foundation, operated by the former president, and about $3 million from the Rwandan government.
It costs PIH about $23 per person annually to provide comprehensive care to 450,000 people in eastern Rwanda -- less than half of healthcare spending in Lesotho, less than 10% of spending in Botswana and less than 1% of what is spent per capita in the United States.
Rwanda has pushed other aid agencies, such as the Global Fund, to support full health systems -- not just programs to fight AIDS -- with some success. "People are starting to understand," said Dr. Innocent Nyaruhirira, minister of state for HIV/AIDS.
The Gates Foundation has paid to build a training center under construction in Rwinkwavu.
Nyaruhirira said he hoped the foundation would give more to the government's partnership with PIH. But the Gates Foundation doesn't give directly to ongoing treatment, said Dr. Tadataka Yamada, who directs its global health efforts. Instead, it supports large health financing agencies, such as the Global Fund, and health research.
In 2000, the Gates Foundation funded an experimental PIH project in Peru that cured poor patients with multi-drug-resistant TB. That project has been replicated in Lesotho and elsewhere.
Rwanda and the Clinton Foundation say they will finance a major expansion of the PIH model in 2008. "We need more ambitious plans," said Rich, the head of PIH operations in Rwanda -- plans "as ambitious as fighting the Iraq war."
Not that PIH hasn't been successful, especially at the clinic that treated Teboho Mahate in Ha Nohana.
"We already [have] put the local coffin maker out of business," Furin said.
A TIMES INVESTIGATION
Treating the sick without bias
Partners in Health rejects taking a narrow approach to the AIDS crisis, even helping with food and other needs.
We've upgraded our reader commenting system. Learn more about the new features.
Los Angeles Times welcomes civil dialogue about our stories; you must register with the site to participate. We filter comments for language and adherence to our Terms of Service, but not for factual accuracy. By commenting, you agree to these legal terms. Please flag inappropriate comments.
Having technical problems? Check here for guidance.