Introduction to Rwanda
Rwanda has made remarkable socioeconomic progress in the past decade with real GDP growth averaging 8.2% annually. This has translated into improvements in the health situation. Major health reforms took place, including the health insurance improvement, which aims to guarantee access for all to health care; and experience from Rwanda has shown that it is possible to achieve universal health coverage in a country with 90% of its population in the informal sector.
Life expectancy has doubled during the 20 years following the devastating 1994 genocide against the Tutsi, as a result of increase in the number of health facilities, improvement in immunization coverage, good access to safe drinking water, and improved housing. All targets related to the three health-MDGs were met, with a notable success in reduction of child mortality and considerable improvements in maternal health.
"Rwanda’s eHealth Strategic Plan for 2016–2020 is the key driver to economic growth and to improving the lives of people. Digital health improves service delivery and clinical outcomes, and we know that cannot happen if we don’t look at the data."
Dr. Patrick Ndimubanzi, Honorable Minister of State, Public Health and Primary Health Care, Rwanda
Digital Health Innovation in Rwanda
Let's explore 5 examples of Digital Health innovation in Rwanda ranging from artificial intelligence and machine learning to blood delivery by drones and telemedicine.
1) Jembi - Rwanda Health Information Exchange (RHIE)
The RHIE project comprises of an international project team and is funded by the IDRC, Rockefeller Foundation, PEPFAR and the HIPPP initiative. The international project team has designed an enterprise architecture based solution at country level, and seeks to further strengthen eHealth and health information systems within Rwanda.
The first phase is focused on the maternal healthcare domain, and the main objectives are to:
Complete an Implementation Science/Research Project to present the impact of a Health Information Exchange (HIE) on the maternal healthcare delivery system in Rwanda.
Develop a pilot implementation of the Health Information Exchange (HIE) in Rwanda that is focused on the maternal health care system in Rwanda.
Expand the understanding of HIE in Rwanda within the health delivery system and the technical community. The project includes identifying and defining high level architecture for the health domain in Rwanda, identification of appropriate standards, functional requirements and interoperability profiles across multiple business, and foundational domains.
2) ZipLine - Blood Delivery by Drones
More than two billion people lack adequate access to essential medical products, such as blood and vaccines, due to challenging terrain and gaps in infrastructure. Zipline improves access to these supplies by flying over impassable mountains and washed-out roads, delivering directly to remote clinics.
We centralize supply and provide on-demand deliveries, completely reducing waste and stock-outs. Zipline provides a seamless delivery system at an affordable price, obsessing over every detail, so you can focus on patient health.
2.9 million children under age five die every year. And up to 150,000 pregnancy-related deaths could be avoided each year if mothers had reliable access to safe blood.
Through a partnership with the Government of Rwanda, Zipline will deliver all blood products for twenty hospitals and health centers starting this summer, improving access to healthcare for millions of Rwandans.
Learn more at flyzipline.com
Follow us on Twitter @zipline
3) Babyl Rwanda - Artificial Intelligence and Machine Learning
Babyl Rwanda is a digital healthcare provider, registered in Rwanda but with its headquarters in London. Its objective is to put an accessible and affordable health service into the hands of everyone on earth by combining the ever growing computing power of machines with the best medical expertise of humans to create a comprehensive, immediate and personalized health service and make it universally available.
Babyl uses a combination of artificial intelligence and machine learning with live doctors and nurses to provide medical consultations to anyone with a mobile device. In the developed world where the penetration of smart phones is much higher, this is done through an app. A patient will download the app and privately go through a triage, or seek medical advise on the app and get a diagnosis. They can then go to a pharmacy or lab for more tests or request to speak to a doctor.
In Rwanda where the mobile telephone penetration is over 75%, with the majority of the population using feature phones, we have developed a USSD version. Anyone may dial *811#, and register for the platform using their National ID - which is attached to their sim card. Your ID is verified with NIDA in a second and feedback provided.
This is an important step because patient information is very sensitive, so we need to be sure we are treating the right person. The patient may then book an appointment, after which they will receive an SMS confirmation of the appointment and get a call from the consulting doctor at the time of the appointment. The doctor will either diagnose the patient and send them a prescription or if further tests need to be done, send them to one of our partner labs for lab work and ultimately give a patient a diagnosis.
4) IntraHealth International - Integrated Health Service Delivery
For over 20 years, we’ve collaborated with the government of Rwanda and local partners to meet the country’s need for high-quality health care services by training health workers and strengthening the systems that support them.
We’ve helped the country establish decentralized health services that involve communities in defining and ensuring quality, bringing high-quality services closer to communities who need them, including services for family planning, HIV/AIDS, pediatric care, nutrition education, gender-based violence, and more.
We’ve also helped Rwanda centralize data on its health workforce so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients.
IntraHealth provided technical assistance for significant scale-up of family planning services, training hundreds of health workers and bringing long- acting reversible contraception to the health center level. We served as one of USAID’s key HIV prevention, care, and treatment clinical partners from 2005-2012, creating an innovative strategy to invite male partners of women in antenatal care to be tested for HIV, achieving high rates of participation (>90%).
IntraHealth is supporting Rwanda’s efforts to centralize health workforce data so it can analyze health worker information alongside service delivery and medical record data to improve services and referrals for clients.
5) TeleMedicine - Rwanda Military Hospital
In an enclosed room at Rwanda Military Hospital in Kanombe, students listen attentively to instructions from a video interaction. This is part of their medical training, a session that allows them to interface with senior health professionals from top countries around the world. However, this practice is not entirely limited to teaching future doctors. On the opposite side of this hospital building, medics gather in a conference room to discuss sophisticated cases with other doctors from different hospitals who have more knowledge on the issues.
This is telemedicine; a trend of offering medical services that started as early as 2011 at Rwanda Military Hospital. The aim of this new approach was to improve student training and consequently medical service delivery through regular consultation of experts on advanced medical cases.
"Everyone is involved nowadays; it is part of the medical practice. Medical students follow the training in real time but the technology applies even in medical procedures. You could be having a patient here in Rwanda but get guidance from other countries," says Dr Pacifique Mugenzi, the head of research and education at Rwanda Military Hospital.
Dr Mugenzi, who is also a trained oncologist, adds that at least once a week, doctors at the hospital meet to discuss complicated cases with other doctors, eventually deriving useful solutions.
"We have discussed surgical cases, gynaecological cases and I recall a liver case where we deliberated about its management. Many issues are involved in these discussions but most of them revolve around surgery," adds Dr Mugenzi.
Telemedicine provides a base to collaborate with hospitals all over the world and Rwanda Military Hospital has been working with institutions such as the Mercy Hospital in Oklahoma, USA.
The recently signed memorandum of understanding between Rwanda and South Korea will improve the quality of telemedicine offered at Rwanda Military Hospital and other referral hospitals within the country.
Also, this arrangement is expected to improve hospital information system (HIS) and provision of ICT-based medical services.
"Much as the pact is still in early stages, Korea is far more advanced in the field of telemedicine. For example, they may have health centres without all the facilities but use the technology to treat people from another centre with the necessary facilities. During the visit of their delegation, they made assessments on the infrastructure at the hospital. We performed exchanges using telemedicine between RMH and Bushenge to exhibit whether the systems would support the project," Dr Mugenzi explains.
The Future - What's Next?
Rwanda is poised to play a central role in the African Alliance of Digital Health Networks ahead of its formal 2018 launch. In order to achieve strong and sustainable digital health systems, the African Alliance advocates for in-country leadership, technical capacity and digital innovation to be fostered across the continent.
By investing in the development of human resources, the African Alliance will help governments develop the cadres of technology experts and tech-savvy leaders needed to support digital health policies. The African Alliance will also seek to develop a health workforce that is able to use digital health systems effectively in day to day practice, as well as for training, mentoring and performance management.
Digital innovations have already transformed the way humans interact and communicate.
In Africa, the use of digital technology continues to grow rapidly, with roughly 170 million internet users and more and more people joining the internet via computers and mobile devices. Digital health encompasses technologies that enable better collection and sharing of information, improved quality and reach of health service delivery, and better decision-making by governments, health workers, and individuals. It has a critical role to play in achieving Universal Health Coverage and the health-related Sustainable Development Goals.
African government leaders play a vital role in developing national digital health systems. Strong governance and leadership is foundational to developing, costing, and implementing a national digital health strategy.
Government leadership is also indispensable in responding to the ongoing challenges of fragmentation in digital health investments, limited data exchange capacity within and between countries, and the absence of legislation and policies that promote digital health systems.
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