Context

Rwanda's National Strategic Plan for the Health Sector (2018 - 2024), which was defined by the Ministry of Health, aims to improve four key identified sectors of health development by 2024: (a) increase social protection throughout life, (b) expand access to essential health services for communicable and non-communicable diseases, (c) strengthening health systems and (d) strengthen health security and resilience of the health system.  

In addition to this strategic plan, the Ministry of Health (MoH) has put in place since July 2023 a reform called 4X4 with the objective to multiply the production of health care workers by 4 in 4 years. But also, to increase the capacity of the existing medical and paramedical personnel:  

In this reform, among others there are fellowships planned in Neonatology

In June 2021, the Ministry of Finance and Economic Planning sent a request to AFD to finance the first tranche of a project to rebuild the Ruhengeri Hospital. The current capacity of the hospital is 350 beds and the objective of the project is to build a modern structure of 550 beds in order to offer a wide range of activities: medical imaging, outpatient consultations (dentistry, surgery, maternity and neonatology, physiotherapy, paediatrics and ENT), emergency departments, gynaecology and obstetrics, intensive care, infection prevention and control services.

Following AFD's identification mission held in February 2022, the authorities validated the opportunity to support the Rwandan authorities in this project. This support will take the form of a loan dedicated to the rehabilitation of the hospital for a maximum amount of €75 million.

In addition to the loan to rehabilitate the Ruhengeri hospital (Northern Rwanda province), AFD financing is being mobilized to improve access to quality care throughout the country.

Context of Ruhengeri Referral Hospital

Musanze, a district in the northern province of Rwanda, has 398’986 inhabitants, with the city of Musanze being the 4th largest in Rwanda and quickly growing.

As the district's referral hospital, the district has 16 health centres that refer patients to the hospital, but it also receives patients from 11 health centres in other districts, particularly in the west. The hospital therefore takes care of patients from the northern region but also from the western region due to its proximity. Other districts in the northern region covered by Ruhengeri Referral Hospital include Burera, Gakenke, Gicumbi, Musanze, Rulindo.

The Ruhengeri referral hospital has also been designated as a 2nd degree Teaching Hospital (below a University Hospital) by the Ministry of Health. As such the hospital receives internships assigned by the MOH and universities (residents doctors, trainee doctors etc.)

In terms of medical activity, the hospital has strong activities in paediatric, internal medicine, surgery and the maternity and a gender component. However, services are affected by the general lack of staff and limited medical equipment. As example Neonatology is lacking physicians and nurses, there is no paediatrician surgeon for paediatrics, there is no senior dedicated Emergency physician etc.

Description of Neonatology unit

A wide range of services are offered to babies requiring admission. Various levels of care and services will be offered to babies at or above 28 weeks’ gestation including CPAP, phototherapy as well as routine care of the premature baby and kangaroo mother care (KMC). There are 35 beds in total with 10 kangaroo beds, and 6 incubators. 7 phototherapy machines, 7 infant radians warmer, 2 mobile Neonatal Monitoring Machines

 Fexte Project – Strengthening human resources for health in Rwanda

The general objective of the project is to improve access to healthcare for the population of Rwanda and specifically in the North Province.

The specific objective of the project is to:

SO1: Improving the availability and quality of human resources for health in Rwanda and more particularly in the north province.

This objective will be achieved through mobilization of medical and paramedical international expert to provide technical support, mentorship, good practices and experience sharing with their Rwandan colleagues. French expertise will also be mobilized in Ruhengeri Referral Hospital.

Mobilization of short-term medical and paramedical expertise from French Teaching Hospital

Medical and paramedical trainers from French university hospitals will be mobilized in Rwanda to train and share the best practices of their discipline with their Rwandan colleagues. Based on findings and recommendations from the assessment that will be conducted a training program/ plan will be designed and organized on the following medical specialties: adult and pediatric cardiology; pediatric surgery; neonatal resuscitation; interventional imaging etc.

The interventions will target the Ruhengeri Hospital and at the central level in different tertiary health facilities (CHU K, King Faisal Hospital, Military Hospital etc.).

Mobilization of medium-term medical expertise within the Ruhengeri Hospital

In addition to the mobilization of short-term expertise and in order to meet the urgent needs at the Ruhengeri hospital, specialists will be mobilized in the medium term on the following three disciplines: emergencies, neonatology and Intensive Care Unit.

It is in this context that  a senior paediatrician will be mobilized at RRH.

Provision of technical assistance in midwifery expertise to strengthen the capacity of midwives and improve the organisation of the maternity ward at Ruhengeri Hospital

In collaboration with Ministry of health to implement the 4X4 reform, Expertise France-AFD conducted a double field mission; a first one in 2024 to assess the neonatal unit’s organizational and operational capacity, and its performance margins and a second one in 2025 to improve the organization of the maternity ward and the obstetric skills of midwives in delivery. 

The results of the two situational assessments converged and revealed several key points.

-       Insufficient collaboration between the maternity ward and neonatal unit regarding more specifically the delivery room and operating theatre.

-       High‑risk births (extreme prematurity, fetal hypoxia…) occur without a neonatologist present in the delivery room.

-       Delays in transferring newborns and inadequate planning for safe medical transport

-       Essential data are missing about indications for caesarean sections, neonatal resuscitation, practical transport of newborns, staff organization, availability of medicines, and incubator as well as hygiene issue.

-       Some of the main shortcomings of the current operation of the neonatal unit impact the transfer of newborns from the delivery room and operating theatre. They connect with the insufficient organization of patient flows, the prevention of nosocomial infections, the monitoring and safety of care, the management of development and pain, the technical environment, human resources management, and medical equipment.

These combined findings highlight the need to strengthen collaboration between maternity, neonatal and intensive care teams to ensure appropriate care for at‑risk newborns and safe transfers to neonatal/intensive care units.

In line with this approach, a senior midwife will be assigned to work alongside the senior pediatrician mobilized at RRH. The collaboration between the two departments will facilitate the organisation of continuity of care for new-borns, paving the way for the establishment of an obstetric-paediatric care centre.