A glimpse into Rwanda’s Covid-19 response

This post is written by Agnes Binagwaho and Kedest Mathewos at the University of Global Health Equity.

• The problem: Countries across the globe failed to effectively and equitably implement the known-evidence based interventions to respond to the Covid-19 pandemic.

• Why it matters: This failure in Covid-19 response has caused preventable suffering and deaths, disrupted health and education systems, slowed down our economies and stymied progress in human development.

• The solution: Rwanda’s exemplary response to Covid-19 was marked by the rapid, effective implementation of evidence-based interventions and strategies to respond to Covid-19 and maintain the delivery of essential health services.

Over the past two years of the Covid-19 pandemic, we have seen significantly varied national responses across the globe. Some leaders made evidence-based decisions backed by the latest science. However, too many didn’t. In some countries the response to the pandemic was rapid, even preparing their health systems weeks before the first case of the virus was reported. Others chose to delay their response, instead prioritising economic and political incentives over the health security of their populations.

Rwanda’s experience provides a case study of a country that rapidly implemented the known evidence-based interventions, adapted to its local context, through a people-centred approach at all steps of the national COVID-19 national response.

As soon as China sounded the alarm in late December 2019, Rwanda was on alert. The adoption of a preparedness approach was prioritised to prevent overburdening a health system that will unlikely be able to provide sufficient ICU care in case of an uncontrolled spread of the virus. The National Epidemic Preparedness and Response Coordination Committee established the COVID-19 National Joint Task Force Committee composed of professionals from various sectors to implement its preparedness and response plan. At all levels of governance, from national to village level, command posts were established with clear instructions to track the virus and coordinate the Covid-19 response. As early as January 2020, temperature screening and contact tracing strategies were implemented at the airport and mass communication to the public regarding the prevention of the novel virus was carried out.

"The government readily and consistently communicated its measures to respond to Covid-19 to the population, relying on the local government as well as Twitter, radio and television channels to educate the community."

Act fast, act now

With the first case of Covid-19 reported on 14 March 2020, Rwanda implemented various social distancing measures, contact tracing, strict lockdowns, school closures, prohibition of gatherings such as weddings and sporting and conferences events. Commercial flights were initially cancelled and a 14-day quarantine was required for all recent travellers.

On 21 March 2021, Rwanda became the first African country to impose a full lockdown, with movement only permitted for essential services such as healthcare and grocery shopping. When the lockdown was lifted on 30 April 2020, districts with high transmission rates such as Rusizi which is on the border of Burundi and the Democratic Republic of Congo (DRC), were put under additional full lockdown. Throughout the pandemic, curfews, lockdown restrictions and quarantine requirements upon entry into the country were adapted based on evidence in the decision-making process and according to the evolution of scientific knowledge on risks and transmission rate as well as the emergence of variants such as Omicron.

The government readily and consistently communicated its measures to respond to Covid-19 to the population, relying on the local government as well as Twitter, radio and television channels to educate the community about the virus and explain any enforced measures. This open communication further builds on the high trust that the public has in the Rwanda health system.

Building trust in the public sector

Despite the breakdown of Rwanda’s social fabric during the 1994 genocide against the Tutsis, a 2018 Wellcome Trust study showed that the Rwandan population has the highest trust in the public health sector and this could be explained by the human development policies and strategies implemented. As a result, the community followed the government’s COVID-19 regulations. For months, those found violating the lockdown or the curfew were asked to spend the night at the stadium where they are educated on Covid-19 and asked to pay a fine – a small individual price to pay for the health security of the country.

We know that the pandemic has disproportionately affected the most vulnerable and has exacerbated existing inequities. Knowing this, the Rwandan government provided quarantine and Covid-19 treatment services for free and has now negotiated with health insurance to contribute. Moreover, given that the economic slowdown caused by the pandemic affected household income and their ability to afford the basic necessities, the government provided food support to the most vulnerable. This allowed the community to adhere to national Covid-19 guidelines such as lockdowns.

"To prevent overburdening health facilities, home-based care with follow up from community health workers was adopted."

A critical aspect of responding to health threats is maintaining the delivery of ordinary health services. This requires the health system to address both demand and supply-side crisis-related hindrances to health service uptake and delivery. On the demand side, community health workers and local leaders played a key role in encouraging community members to continue seeking care. Dispelling myths about Covid-19 and addressing their fear of infection at facilities was a crucial component. To reduce fear of cross-infection, the Rwandan Ministry of Health created Covid-19 treatment centres completely separated from ordinary health facilities across the country. Today, because the country has increased its capacity to provide oxygen therapy and ICU care and also because the number of new cases has decreased significantly, these centres no longer exist.

Supply and demand

On the supply side, despite shortages in the first few months of the pandemic, personal protective equipment (PPE) was distributed to healthcare workers, Home-based care was done using distance diagnostics and treatment when possible, with tools such as phones and the internet. This also helped address community fear of Covid-19. To prevent overburdening health facilities, home-based care with follow up from community health workers was adopted. During lockdowns, transport was provided to those seeking care and to healthcare workers. Rwanda’s resilient health system allowed it to maintain its core function while responding to the new health threat.

As a result of this rapid and effective response to the COVID-19 pandemic, Rwanda has been able to keep the pandemic under control within its borders. The effective and equitable distribution of Covid-19 vaccines has also been instrumental in curbing the spread of the virus and reducing the number of deaths. As of 2 February 2022, Rwanda has recorded 128,971

confirmed Covid-19 cases and 1,444 deaths. So far, nearly 3.7 million have been fully vaccinated and over six million have received at least one dose. Rwanda’s ability to create a flexible and learning health sector, to follow the science, adopt a preparedness approach, and focus on equity has helped maintain the delivery of essential health services and mitigate the impact of the pandemic on the health system and population health outcomes.

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