As part of the implementation of the national strategy for transformation (National Strategy for Transformation 2017-2024 – NST1) the Rwandan government has requested a loan from the French Development Agency (AFD). The project aims to finance the first phase of the reconstruction of the hospital in Ruhengeri. This project is one of the major symbols of the revitalization of cooperation between France and Rwanda. This project has been the subject of a commitment by the Rwandan executive to the population and is therefore evolving in a context of very constrained calendar.

In support of the AFD loan, financing is being mobilized to improve access to quality care throughout the country. In this context, Expertise France is managing a 4 million euros grant for the implementation of a project to strengthen human resources in health in Rwanda and capacity building of the Rwanda Biomedical Center (RBC) and the Rwanda Housing Authority (RHA), in particular with regard to its missions related to the Project Management of the Ruhengeri Referral Hospital.

The Ruhengeri hospital, capital of the district of Musanze (population 398,986), is a referral hospital for a population of about 2.15 million to date, located in the Northern and Western provinces of the country. Due to its strong population growth (+3% per year), this basin will have 3 million inhabitants by 2040. It has also been identified as a second-level teaching hospital (level just below a university hospital). Sixteen health centres in the Musanze district refer patients to the Ruhengeri hospital, but the hospital also receives patients from eleven health centers in other districts. Musanze is located in the tourist region of the Volcanoes National Park. The catchment area of the Ruhengeri hospital is therefore large and the needs for health, especially specialized health services, are growing.

The current pavilion type hospital, built between 1930 and 1980, consists of 320 beds, and carries out annually about 7000 deliveries of which 50% by cesarean section, and over 2,500 surgical procedures per year. The hospital’s emergency unit receives many cases of trauma (road or farming accidents).

The hospital is therefore very active in internal medicine, surgery and maternity. The hospital also has a one stop center in charge of Sexual and Gender based violence cases management. Its medical team (the current hospital has about 350 permanent staff to date) performs about 16,000 admissions per year, 46% in obstetrics and gynecology, 15% in internal medicine, 13% in pediatrics, 12% in surgery, 9% in neonatology and 4% in intensive care and 60,000 outpatient visits.

The international subsidiary of Assistance Publique – Hôpitaux de Paris (AP-HPi) has been hired by AFD to carry out a feasibility study in 2023. This study highlighted that the hospital faces many obstacles:

• Extremely constrained spaces, which are often obsolete;
• 8 to 16 bed common rooms with almost contiguous beds posing major problems of hygiene and quality of hospital life;
• Difficult working conditions for caregivers, unsuitable for respecting patient privacy and hygiene rules;
• Lack of human, medical and paramedical resources and care, particularly in the areas of intensive care, neonatology, emergency, surgery and medicine;
• Very insufficient equipment, particularly in radiology;
• The buildings are not interconnected and therefore the patient flow is to be reviewed.”

The strengthening of the healthcare offer and the reconstruction of the hospital are therefore essential for the region.

Based on a prospective and territorial diagnosis of health needs, the study by AP-HPi has clarified the capacity requirements for the future hospital, developed a detailed technical program, and proposed a budget plan for this project. The total cost of the project is €96M, for a first tranche of financing, including €75M financed by the sovereign loan availed by AFD. This cost covers all the expenses – studies, works, equipment – and construction costs estimated at 52 million euros. Refer to the Detailed Technical Program (PTD) by the AH-HPi, volume I functional program – volume II technical program – volume III detailed sheets by type of premises.

The capacity sizing of the establishment was set at 550 beds and places for a theoretical surface area of 44 272 m² SDO. This new facility will notably have an enhanced capacity in gynecology and obstetrics with 180 beds, 40 incubators in neonatology and a dedicated 4 operating rooms. In addition, the facility will have 36 intensive care beds, 120 medical beds, 100 surgical beds with 8 operating rooms.

In addition to this support provided by AFD through APHPi, Expertise France has hired SFEH (Société Française d’Equipements Hospitaliers) a French company specialized in hospital infrastructure project engineering since April 2024 to support the project owner in the recruitment of the design and supervision company for the project. DAR Al Handasah have been contratced by the client as the design and supervision company. Expertise France has also hired since March 2025 AMPC International Health Consultants to provide technical assistance to the client up to the end of the project.

The project is managed by the Rwanda Biomedical Center (RBC) under the Ministry of Health. This agency is supported on the construction part (procurement, control of works, etc.) by the Rwanda Housing Authority (RHA) under the Ministry of Infrastructure. Due to the support provided by AFD through the loan, its Procurement Guidelines apply to contracts financed by AFD (design and construction of the new hospital, equipment).