Journal of Public Health International

Journal of Public Health International

Current Issue Volume No: 3 Issue No: 4

Commentaries Article Open Access
  • Available online freely Peer Reviewed

  • The Multi Sectorial Approach To COVID-19 Pandemic In Limited-Resource Settings: Discussing Rwandan Experience

    1 Mount Kenya University, School of Health Sciences, Department of Public Health, P.O. Box 5826, Kigali Campus, Rwanda 

    2 Global Public Health Department; Karolinska Institutet, Solna, Sweden 

    3 Department of internal medicine, University Teaching Hospital of Kigali, Kigali, Rwanda. 

    4 Global Health Focus Africa, Kigali, Rwanda 

    5 International Pharmaceutical Federation, Hague, Netherlands 

    6 Medical Research Office, Sudanese Medical Research Association, Khartoum, Sudan 

    7 College of medicine and health sciences, University of Rwanda, Kigali, Rwanda 

    8 Faculty of Pharmacy, University of Ibadan, Ibadan, Nigeria 

    9 Department of Global Health and Development, London School of Hygiene and Tropical Medicine, United Kingdom 

    Abstract

    COVID-19 has unprecedentedly shaken the health systems across the globe. Rwanda, a low-income country in East Africa, has succeeded to contain the first wave but is struggling to curb the second wave in the wait for a massive vaccination program. The national committee composed of different ministries and a COVID-19 Joint Task Force was established as a Multi-sectoral approach in the early days of the pandemic. The approach together with transparent communication to the population has been effective. However, much more tailored and cost-effective measures against the drivers of cluster outbreaks are needed to save both the economy and more lives. It is challenging to produce evidence about behaviors attributable to the surge of infections, and their hardship, and how to allow the population to live their lives with less risk. With important research, policymakers will be able to think locally and provide easy and inexpensive recommended behaviors while awaiting the vaccine.
    Author Contributions
    Received Mar 14, 2021     Accepted Apr 10, 2021     Published Apr 12, 2021

    Copyright© 2021 Uwizeyimana Theogene, et al.
    License
    Creative Commons License   This work is licensed under a Creative Commons Attribution 4.0 International License. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    Competing interests

    The authors have declared that no competing interests exist.

    Funding Interests:

    Citation:

    Uwizeyimana Theogene, Ntacyabukura Blaise, Damascene Kabakambira Jean, Shonza Felicitee, Dushime Jackson et al. (2021) The Multi Sectorial Approach To COVID-19 Pandemic In Limited-Resource Settings: Discussing Rwandan Experience Journal of Public Health International. - 3(4):19-24
    DOI 10.14302/issn.2641-4538.jphi-21-3776

    Introduction

    Introduction

    Since December 2019 when the coronavirus disease (COVID-19) was first identified, it has been spreading all over the world affecting more than 100 million people and taking the lives of more than 2 million so far1. In March 2020 when World Health Organization (WHO) declared COVID-19 as a global pandemic 2, Rwanda on its high-level alert decided to handle the pandemic employing a multi-sectoral approach. The national committee was established on 9March 2020, chaired by the Prime Minister, right before the country recorded its first COVID-19 case3. The committee is composed of different ministries (Ministry of Health, Ministry of Finance and Economic Planning, Ministry of Defence, Ministry of Local Government, and Ministry of Internal security), and a COVID-19 Joint Task Force (JTF) which was established to implement the preparedness and response plan. This is known in other countries as the One-Government approach. On 14 March 2020, Rwanda confirmed its first COVID-19 case which ranked Rwanda the 19th African country to report the existence of the disease on its land4.

    More tough decisions were yet to come as after the first few cases, schools and churches were closed, and other mass gatherings were prohibited. On 22 March 2020 total country lockdown was imposed; which later was eased on 4 May 20205. During that time, a series of preventive measures were mandated including frequent hand hygiene, avoiding handshaking, avoiding unnecessary travels, stay at home, and avoiding mass gathering among others. The population was educated on the mode of transmission of COVID-19 and precautionary measures to be undertaken.

    Rwanda is a low-income state with limited resources; a situation that would have made it vulnerable to the impact of COVID-19; however, the country has been pivotal in combating the current global pandemic. Even though different African states have been proactively trying to contain the virus, by adopting the preventive and precautionary measures similar to those implemented in the developed world6, different factors like political instability, limited resources, and security-related issues have failed the approaches taken. Thus, in this commentary, we will discuss approaches adopted by the government of Rwanda when responding to COVID-19 and highlight challenges that impede the containment of the virus during this wait for vaccination.

    Risk Communication and Community Awareness

    Since the possible duration of the current pandemic is not known, the continued upsurge in the number of new COVID-19 cases can threaten the population. The emotional contagion developed can erode the population’s trust on their governments, leading to serious social and economic disturbance7. Timely information sharing in transparent as well as effective communication channels can lead to prompt compliance to preventive measures. Thus, the government of Rwanda adopted a bimonthly cabinet meeting chaired by the President of the Republic of Rwanda to assess the country’s COVID-19 situation and to evaluate the population compliance to existing COVID-19 preventive measures. The Cabinet meeting resolutions are publicly shared as a centralized source of policies and regulations and officials transparently explain the measures in different media such as the state radio and television channels, social media (Twitter, Instagram, and Facebook), where they also address the public concerns and doubts that may hinder the compliance to COVID-19 preventive measures.

    The Ministry of Health shares daily updates on COVID-19 to the public with an emphasis on: sample tests done, new cases identified and their respective location, number of people treated, and new COVID-19 related deaths. Several community awareness and rumor management campaigns are organized, including a call to “stay at home” (GumaMuRugo) to limit the spread or catching the virus, and the “Let it not be me” (NtabeAriNjye) who spread or catch the COVID-19 virus. Both aim to encourage the limitation of disease transmission at the individual level 3. Rwanda National Police (RNP), as the leading law enforcement organ, has adopted the use of drones with speakers that fly all over different towns and remote areas, reminding people to stay at home, wash their hands, and wear properly the facemasks. Furthermore, billboards widely spread across the cities are used to communicate basic information on transmission and prevention of COVID-19.

    Prevention and Protection

    As COVID-19 is very contagious, it is of paramount to maintain reasonable preventive and protection measures all the time. It is in this regard that wearing facemasks in public became mandatory when total lockdown measures were eased on 4 May 2020. Public and private services were greenlighted to resume activities, but using only essential employees while others worked from home 58. The Rwanda Ministry of Health provided health guidelines and other government boards such as the Rwanda Development Board (RDB) or Rwanda Utilities Regulatory Authority (RURA) approve a good implementation and grant authorization to resume businesses. These guidelines include but not limited to establishing hand hygiene stations at the entrance, temperature-monitoring services, maintaining a one-meter distance between individuals, avoid overcrowding, and record key information for tracing clients in designated registries. In order to reduce the interaction time, a curfew from 8:00 PM to 4:00 AM was imposed, and these measures are continuously revised every 15 days. The country’s borders were closed except for essential goods, and Rwandan citizens returning home are subjected to present a negative PCR test for COVID-19 and undergo a new test while quarantined in designated hotels in Kigali. Those with a negative test before traveling and on arrival are allowed to continue their businesses5. Rwanda introduced the use of high-tech robots at different treatment centers to limit the interaction between health workers and COVID-19 patients. They check the vital signs of COVID-19 patients, monitor their status, as well as keep their medical records3. Those robots also serve for increasing awareness and remind good prevention practices in some key places such as Kigali International Airport. Electronic questionnaires were introduced at different borders to screen all people entering the country. Cashless payments were encouraged among the public, and a team of youth volunteers was created to monitor the population’s compliance to preventive measures. RNP has established fining methods for people who challenge the preventive measures, and local leaders are involved to evaluate the compliance9. Rwanda has expressed a strong desire to acquire and properly administer the vaccine as soon as it is available 10. There is no doubt that vaccine coverage will be successful in Rwanda given the previous experience in vaccination coverage for other vaccine-preventable diseases at the national level.

    Control and Surveillance System

    In public health, a strong surveillance system has a reputable record in being essential for assessing the disease progression, as well as guiding and proving prompt strategic responses. It is in this regard that the Rwandan government established command posts chaired by district mayors in all districts across the country311. This was to strengthen communication and community awareness, ensure effective coordination of resources, active case finding, enforce the surveillance systems, as well as ensuring preparedness at both district and provincial levels if there is a local outbreak. The Rapid Response Teams (RRT) were created at all districts and they monitor and report all the activities to the central level on a daily basis. Screening activities were introduced at key entry points. Several digital solutions were introduced including the use of GPS tracking systems to monitor the movement of drivers crossing the borders and to minimize the time spent by Rwanda National Police when escorting them from borders to isolation sites11. Monitoring devices and applications were introduced to help asymptomatic or people with mild symptoms to be tested using breathing tests or screened using different questions12. All resumed public and private services are obliged to record the names and contact addresses of their clients, for easing contact tracing.

    Case Treatment

    Until recently, all positive patients were taken to the centralized treatment centers available in different regions of the country. Treating COVID-19 in designated centers has played a key role in protecting health care providers from massively contracting the infection. Keeping patients with COVID-19 away from regular health facilities has provided an opportunity for the health system to continue providing care to already existing and naturally occurring diseases. On 8 January 2021, Rwanda opened a brand new hospital to solely serve as the national referral center for COVID-19 treatment. However, not all COVID-19 positive patients need to be followed up in treatment centers. The country has developed a national protocol for taking care of COVID-19 patients according to the severity and has trained enough healthcare providers for additional support in case the toll of infections would surpass the capacity of the current treating team. A 24/7 toll-free line (114) was introduced and anyone with the suspected signs of COVID-19 is encouraged to contact the response teams using the line. The Ministry of Health through Rwanda Biomedical Centre developed a guideline for Home-Based Care in which the Community Health Workers (CHW) will adopt after being trained. However, there other digital-based solutions being tested for home-based treatment of mild cases.

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