The University of Global Health Equity Model of Impact

Philip Cotton shares the story of the University of Global Health Equity (UGHE) in Rwanda, an institution intentionally designed to drive social transformation and health equity. Built in one of the most remote parts of the country, UGHE offers tuition-free education to students — 70% of whom are women — and deeply integrates community engagement into its pedagogy. Cotton describes how UGHE measures success through impact: increased local incomes, gender parity, and graduate service to underserved areas. The model is not just about teaching medicine — it’s about building a shared life of purpose, compassion, and community.

UGHE is the University of Global Health Equity. It's now about 10 years old. So next January, we will have our 10th anniversary graduation. But the university was established by the vision of of a physician advocate called Paul Farmer, Dr. Paul Farmer, who had a a permanent position at Harvard University, but worked across the world, continued to be a position, continued to be an advocate and active campaigner for justice in healthcare, continued to look at the way in which health systems sometimes inhibited and prevented people from getting the care that they could get. Who taught students, who taught medical students, nursing students, health care professional students, public policy students, [he] never stopped in in the kind of work that he was doing. And his vision was to create a university that would train people to work in the health sector. But the university had to be essentially very different from other institutions because the students graduating, the young people graduating had to be very different. They had to be people who were committing themselves to lives of transformation. People, who would not only make those connections with the people who presented themselves as patients, sometimes at the the the most painful times in their lives and sometimes at the most joyous moments in their lives. But always making those connections, because through connection comes compassion, and compassion is a result of understanding people, loving people, believing them, trying to to get to grips with the kinds of lives that they lead. And so we had to begin to teach students very differently, but we had to be clear about the kinds of students who would enter the institution. We're completely tuition free. So students come and learn in the university and get all of their learning paid for. They get their accommodation, their food, their transport paid for. Because some of the young people who come to our institution have no financial reserves or or support from the families and communities that they come from, but have a deep passion to serve and a deep desire to practice medicine. We also have a profile across the university, that means that I can proudly tell you that 70% of all of our students are young women. And that's because we believe that we have to address the historical barriers for young women accessing education, and particularly health professions and medicine. We also want to make sure that our students come from the right communities, and sometimes those communities are communities that don't traditionally send young people to university. So, we spend a lot of time with our admissions team going out to to access schools that we know haven't had a pipeline of students coming into higher education. But we teach students, I think, very differently. The learning starts with embedding yourself into the communities and the lives that that we ultimately serve. I sometimes call our curriculum dirty fingernails and dusty shoes because by the time you've walked to communities and into the houses of the people who live there and sat on the the dirt floor, either outside the the the the living quarters or sometimes inside the living quarters, your fingernails are dirty and your shoes are dusty. But it's a glorious way to learn. You know, and and we have adages in in western medical schools, in global north medical schools , you know that if you really listen to the patient they'll tell you the diagnosis. Well that's untrue in the part of the world that we choose to operate in. Our compass is situated in what was the most remote and rural part of Rwanda. And that was intentionally the case. A lot of new universities and campuses of established universities want to be in the major cities, where there's the networking and connectivity, the schools and the support systems. We moved to this particular part of the country. But we made a pledge. We made a pledge that of all the people we would employ on the campus, to help us operationalize the university, that between 70 and 75% would come from the local community. That 70 to 75% of everything that we consumed on the campus, the food that we eat in our restaurants, and the paper, and the water, and the other things that we purchase would come from companies operating and established through entrepreneurship, trading schemes or the local community. And then we look at measures of impact. You know, there's two ways to grow a university. One is just scaling up the numbers, bringing more and more students in. The other way is through scope. How far do we reach out? How far are we felt in the community and in what ways are we felt at the community? So we spent a fair bit of time trying to understand what our impact might be and how we might measure that. We know that the average salary in the town in which we operate in the 10 years that we've been there, the average salary has tripled. We know that the salary differential between men and women was sevenfold. It's now equal. We know that families are now saving every month into saving schemes where they didn't have the resources to do that before. So those are just some of the measures that we're using at the moment to test whether we are actually doing what we were set up to do which was to have impact to send ripples of impact through the local community. But we're going to be tested quite soon because although we've graduated students from our master's programs in the last 10 years, we're going to be graduating our first class of undergraduate medical students. So, this was Dr. Paul Farmer's inaugural class. And so, they've done their undergraduate medical degree. They've worked in hospitals for a year and they've come back to complete their integrated masters in global health delivery. And so we will celebrate them next January as they move forward. And one of the things in moving forward is that they've pledged to go wherever the Ministry of Health needs them to go for the next six years after graduate. So they've signed a public service agreement and they will go wherever they're needed to serve. And we have to keep supporting them in that, as they learn the the realities of social medicine, as they understand the realities of community health, as they learn in their early careers from the nurses working in hospitals, the nurses working in health centers, from the community health workers, working in the villages, because their learning will continue. But their learning doesn't suddenly escalate and get promoted to learning, only from the the cleverest of the doctors in the country. But the real essence of what they need to learn will come from the people that they work with.