Rwanda’s health system follows a decentralized model that emphasizes prevention and care at the community level, thus ensuring geographic equity and access. Each village has a team of elected Community Health Workers who understand the specific needs of their constituencies.
Since the pandemic emerged, the country’s 60 000 CHWs have assisted the Rwanda Biomedical Centre, the institution leading the nationwide response, in educating citizens on prevention measures, identifying vulnerable populations in need of support, conducting contact tracing, and following up on discharged patients who have received two negative test results.
This decentralized yet integrated approach has helped Rwanda achieve the highest level of public trust of any health system in the world. Nearly all Rwandans are confident that vaccines guaranteed by UNICEF and the World Health Organization are safe and effective.
As a result, since 2011, the country has nearly eliminated the risk of cervical cancer among Rwandans aged 12 to 23 by administering the HPV vaccine to girls.
Meanwhile, some Western countries have struggled to get their citizens to abide by public-health guidelines as basic as wearing a face mask in public, owing to a widespread loss of trust in institutions and expertise.
If the COVID-19 pandemic has shown anything, it is that public trust is a strong determinant of public health. A country can have the most advanced medical technologies in the world, but if its people do not have faith in their government or public-health institutions, the value of these assets will be squandered.
As climate change and human encroachments continue to disrupt natural systems, the risk of another zoonotic disease outbreak will only increase in the years and decades ahead. It is therefore critical that we learn from the mistakes and the successes of the COVID-19 crisis, in order to be better prepared for future prevention and treatment needs.
In Rwanda, we used what we learned from the 2014 and 2018 Ebola outbreaks in neighboring countries, and the steps we took to prevent the epidemic from entering our country, to guide our response to COVID-19.
Hence, there was a rapid push to train CHWs and educate the public on basic sanitation and hygiene. But since every epidemic is different, this is an ongoing process. With each new challenge comes new innovations, knowledge, and strategies to strengthen the existing system and prepare for the next outbreak.
Moreover, training and public education must be refreshed and updated with each new generation of disease detectives and global health experts. That is why we at the UGHE are training students from around the world in epidemic and pandemic preparedness and response, and in managing outbreaks equitably through a “One Health,” community-based approach.
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