Rwanda, like many countries in the African region has made changes, especially in fighting communicable and non-communicable diseases (NCDs).
Rwanda is among the low- income countries, whose NCDs now make up 25 percent of the disease burden, which are usually caused by infections, malnutrition, and conditions associated with poverty.
Hence, in conjunction with the Ministry of Health, 13 intervention areas have been identified.
All these are aligned with the country priorities as defined in the framework documents, (Health Sector Strategic Plan, 2009-2012).
Four priority strategic areas were supported by World Health Organization during the next four years. They are: Reduction of maternal and child mortality; Control of communicable and non-communicable diseases; Health promotion, food safety and nutrition, health and environment and Improvement of health system performance.
There are nonprofit global health models that have catalyzed lasting change. Partners in Health works closely with the Rwanda Ministry of Health and has trained more than 200 medical professionals and more than 700 community health workers there for fighting communicable and non- communicable diseases. The fight against HIV/AIDS, malaria and tuberculosis is one of the major priorities of the Government and are taken into account in the strategic objectives of the HSSP II (2009-2012).
World Health Organization (WHO) pursued its support for development/updating of national policies and strategic plans for the control of HIV/AIDS, tuberculosis and malaria, as well as national guidelines, training tools, norms and procedures in the area of prevention, care and treatment; Intensification of the core prevention activities aimed at reducing the incidence of HIV within the general population.
World Health Organization provided a support for Strengthening of capacities of staff and community workers to ensure efficient contribution to HIV and AIDS, malaria and tuberculosis prevention, testing, care and treatment services and the government of Rwanda reviewed the national mental health policy and strategies for prevention and management of mental health, drug and tobacco abuse problems
In line with government efforts to ensure a healthy population as well as global efforts to fight non-communicable diseases, (NCDs), the Ministry of Health has finalized plans to conduct a nationwide study on the diseases that include heart disease, stroke, cancer, asthma, diabetes, chronic kidney disease, osteoporosis, Alzheimer’s disease and cataracts.
According to the Director of Hospitals in the Ministry of Health, Dr Bonavanture Nizeyimana, the study is in line with the World Health Organisation requirements of assessing the causes of these diseases.
“By using the same standardised questions and protocols, we can use this approach for monitoring the trends of these factors. The approach encourages the collection of small amounts of useful data information on a regular and continuing basis,” he said.
NCD is a medical condition or disease which is non-infectious. NCDs are diseases of long duration and generally slow progression. Cervical cancer is considered to be the most common cancer among women in Rwanda.
In 2010, there were 986 new cases of cervical cancer reported by Rwanda’s three referral hospitals; while 678 women died from the disease. The data was collected by the Institute for Health Metrics and Evaluation based in the United States.
Figures in the institute’s report indicate that 54.4 percent of the diagnosed cancers in Rwanda arise in female subjects. Tumors represent 38.5 percent of examined tissues in the anatomy pathology laboratory, of which 20.85 percent are malignant.
A cancer report from the Ministry of Health indicates that by 2004, only 30.1 percent of cancer suspicions in the hospitals were verified. The average age of people with cancer is 44.8 years.
The main cancers of men are stomach, amounting to16.4 percent of all cancer cases in men. In women, cervical cancer leads the table with 27.3 percent followed by breast 10.5 percent and stomach 8.8 percent.
It’s in this context that the ministry of health, together with Partners In Health, the Jeff Gordon Children’s Foundation and the Dana-Farber/Brigham and Women’s Cancer Center inaugurated the Butaro Cancer Center of Excellence on July 18, which will serve as the first national cancer referral facility in rural Rwanda.
“The new Butaro Cancer Centre of Excellence not only comes at an appropriate time, but also fits well into our vision,” remarks Health Minister Agnes Binagwaho. “As Rwanda makes significant strides in combating major infectious diseases like HIV/AIDS, TB and Malaria, efforts are now put into the diagnosis and treatment of the most frequently occurring non-communicable diseases.”
The minister points out that this adds value to the interventions designed in combating non-communicable diseases.
The Cancer Center of Excellence aims to address both existing resource limitations and the growing global cancer burden. The Butaro Cancer Center of Excellence will provide a full spectrum of cancer care including screening, diagnosis, chemotherapy, surgery, patient follow-up, and palliative care. It will also serve as the first facility to implement standardized cancer training and protocols that align with Rwanda’s new national guidelines.
Paul Farmer, co-founder of Partners In Health and chair of Harvard’s Department of Global Health and Social Medicine, expressed optimism that access to cancer treatment by all is possible. “Just a few years ago we had no system or financing mechanism to diagnose and treat AIDS in Africa. People said it was too expensive or too complicated,” he points out. “But today nearly 7 million people in developing countries are receiving treatment for HIV. We can do the same with cancer.”
The Center, located within Butaro Hospital in Burera district, Northern Province, is a critical element of the country’s ambitious five-year plan to introduce cancer prevention, screening and treatment on a national level. The facility’s opening will mark a major milestone as the first center of its kind to bring comprehensive cancer care to rural East Africa.
Rwanda is aware of the need to both treat its population and to protect its population from emerging risk factors that accompany urbanization and we have started to work on it. Over the next five years, the country anticipates expanding access to integrated chronic care by building on the existing healthcare platforms established by programs fighting infectious diseases.
Currently, there are many disease-specific advocacy groups in Rwanda and in the world fighting for advanced care for conditions such as cardiovascular illness, diabetes, epilepsy, and hemophilia. The challenge for a country like Rwanda is to coordinate those efforts, and identify and execute the right set of integrated strategic plans to prevent and treat NCDs in a holistic manner.
Currently, many Rwandans are able to afford the prevention and treatment of uncomplicated cases of common diseases such as malaria or pneumonia, but most cannot afford the costs of chronic care of HIV/AIDS, heart disease, diabetes, epilepsy or cancer.
Therefore, chronic lifelong treatment and managed care for NCDs must be derive from a publicly-sponsored, tactical and efficient plan to achieve accessibility and affordability. Already Rwanda has taken steps to tackle some of the prevention issues unique to NCDs, including the improvement of household cooking stoves and access to treatment for streptococcal pharyngitis, among numerous other steps.