Impact of COVID-19 on Rwanda’s Health Sector
Date
2021-10-14
Authors
Bigirimana, Noella
Rwagasore, Edson
Condo, Jeanine
Journal Title
Journal ISSN
Volume Title
Publisher
African Economic Research Consortium
Abstract
On 30 January 2020, the World Health Organization (WHO) declared the new
coronavirus COVID-19 outbreak as a Public Health Emergency of International Concern
(PHEIC) with a strong recommendation for countries to take appropriate measures to
interrupt virus spread. By 11 March 2020, the WHO had declared COVID-19 as a global
pandemic with the number of cases estimated at 118,319, and the virus had expanded
to 114 countries with ripple effects on every aspect of human life.
The COVID-19 burden has been asymmetrically distributed. Although the infection
and death rates in Africa did not reach the inflection points that had been predicted,
there was unprecedented pressure on the public health systems in many African
countries and far-reaching socioeconomic implications which may trigger major
setbacks for years to come. Many African countries deployed the national budget to
support in mitigating the health and economic crisis.
Rwanda is the focus in the current report and evaluated as an illustrative example
of a country which stemmed the spread of COVID-19 with early measures, while
leveraging previous investments in the healthcare system and outbreak preparedness.
This report seeks to: document the interventions put in place to mitigate COVID-19
transmission, including ongoing vaccination; examine the impact of COVID-19 on
health outcomes; and describe interventions to mitigate socioeconomic impact.
The report uses historical data, primary data, review of government and
international reports, as well as published papers. The historical data covered two
years before the onset of COVID-19 pandemic until December 2020 to reflect on
any potential change in the use of key health services. Global reports are used to
provide context for the outbreak preparedness. Key informant interviews were used
to triangulate information collected with perspectives from policy makers, health
implementers, academics, members of the National COVID-19 Task Force, and the
general population as the consumers of services.
The national information health systems were used to collate data prior to
the COVID-19 pandemic. This involved the extraction of key routine services data
(vaccination, ANC, and outpatients’ records), from June 2018 to December 2020 to
understand any disruption of the use of health services. Secondary data analysis was
conducted to determine positivity rate, demographic characteristics and case fatality
rate. Disease-specific HMIS countrywide data was analysed to determine trend of
hospital consultation of major chronic diseases and mortality between June 2018 to December 2020 and compare two critical periods (before and after COVID-19 onset)
to assess any existence of disruption of services and increase in number of mortalities
as a result of COVID-19 pandemic.
In Rwanda, the first case was confirmed on 14 March 2020, and was detected
through preparedness and response measures that had been deployed in late January.
The National Steering Committee, chaired by the Prime Minister, is in charge of overall
management, leadership, mobilizing, and coordinating resources to fight COVID-19
and its socioeconomic consequences. A National COVID-19 Task Force was activated to
run daily activities and report to the National Steering Committee. The establishment
of the command post was coordinated by the Government of Rwanda (GoR), in
collaboration with bilateral and multilateral partners in the country, which guided
the timely implementation and monitoring of public health and policy measures.
A total of 11,032 cases were reported between 14 March 2020 and 17 January 2021.
During this period, the epidemic in Rwanda progressed through four phases which
comprise of: first phase which was characterized by a stable period with case either
imported or linked to imported cases; it was followed by phase two characterized by
the occurrence of the first clusters of community transmission identified on 31 May
2020 in the district bordering the Republic Democratic of Congo (DRC) with peaks of
200 cases daily, with positivity rate reaching 1.1%. The third phase was characterized
by drop of cases with decreased number of daily confirmed cases and low case fatality
rate; while in the last and fourth phase, started in December 2020, the number of cases
and case fatality rate increased compared to the previous phases, the percentage
positivity of tests tripled (3.4% vs ~1.0%), and the average number of daily cases
reported has more than quintupled (124 vs 24). The majority of positive cases were
male (64%) compared to 36% female. Among the 142 deaths recorded as of 17 January
2021, there were 102 (72%) male compared to 40 (28%) female.
As implementation strategies, Rwanda sought to limit the spread of the virus
through non-pharmaceutical public health to prevent community spread including
a six-week lockdown across the country in March 2020, in addition to maintaining
physical distancing and hygiene measures. The restrictions also included closure of
non-essential businesses, school and church closures, limitations on intra- and inter regional transport, which aimed to contain the pandemic and protect the healthcare
systems from being overwhelmed with demand from COVID-19 and other essential
services. The national response focused on community surveillance, increased
testing and developed targeted containment measures with intermittent lockdowns
during sharp increases of cases and deaths. The country rolled out the first COVID-19
vaccination campaign on 5 March 2021 with Pfizer-BioNTech and AstraZeneca vaccines
received through the international vaccine cooperative, COVAX Facility. This report
provides recommendations for policy makers in the context of COVID-19 response in
Rwanda. These recommendations aim at strengthening epidemic preparedness and
response, based on lessons from the COVID-19 crisis in the country and region. Such
discussions are particularly important given the risk of a second wave of infections,
and the constant threat of other outbreaks.