COVID 19 - Training Working Papers

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Browsing COVID 19 - Training Working Papers by Author "Rwagasore, Edson"

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    Impact of COVID-19 on Rwanda’s Health Sector
    (African Economic Research Consortium, 2021-10-14) Bigirimana, Noella; Rwagasore, Edson; Condo, Jeanine
    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.
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    State of the EAC Health Sector Amidst the COVID-19 Crisis
    (African Economic Research Consortium, 2021-10-25) Bigirimana, Noella; Rwagasore, Edson; Condo, Jeanine
    On 11 March 2020, the World Health Organization (WHO) declared the ongoing COVID-19 outbreak as a global pandemic with recommendations for countries to take appropriate measures to eliminate virus spread. As the pandemic continues to evolve, an estimated 156,496,592 confirmed cases and 3,264,143 deaths have been reported in more than 220 countries and territories (WHO, 2021). The COVID-19 disease caused by SARS-CoV-2 virus is highly transmissible from person to person, with a reproduction number, Ro, (number of additional cases resulting from initial case) estimated between 1.6 and 2.4 (Aylward & Liang, 2020). The COVID-19 burden has been asymmetrically distributed, with the Americas accounting for the greatest proportion of reported new cases, followed by Europe, South-East Asia, and Eastern Mediterranean. Africa and Western Pacific are the least affected regions (Aylward & Liang, 2020). The East African region has crossed the first year since the first cases were reported in March 2020. The region has recorded an estimated 7.3% of the cases and 4.4% of deaths reported in Africa. As of 8 May 2021, there were 246,427 confirmed COVID-19 cases across EAC countries, and among them 54,278 (22%) were active cases. There were 3,709 reported deaths in the region (EAC, 2021). Based on available records, Kenya has recorded the highest number of confirmed COVID-19 cases in the EAC region at 163,238 (66.2%), followed by Uganda at 42,308 (17.1%), Rwanda at 25,586 (10.4%), South Sudan at 10,637 (4.3%), and Burundi at 4,149 (1.7%). Tanzania’s last report on 29 April 2020 indicated 509 confirmed COVID-19 cases and 21 deaths (EAC, 2021). These moderately low numbers, compared to other regions, could be partially attributed to Africa’s young population age structure, potentially underreporting of events and low testing rates. Another factor, however, is the containment measures adopted by several EAC member states in order to mitigate the spread. The first case in the East African region was reported on 13 March 2020 in Kenya, followed by initial case reports in other EAC states the same week. The approach by most countries was to put in place enhanced measures to flatten the curve of COVID-19 transmission, including lockdown restrictions, immediate isolation of confirmed cases, quarantining close contacts of confirmed cases, contact tracing, quarantining travellers, mandatory use of face masks, and expanding testing and treatment capacities. As the virus continued to spread, EAC countries took different approaches to reducing the incidence of the pandemic.