MSH Experts Discuss Digital Transformation of Rwanda’s Health System in USAID Webinar

June 17, 2024

MSH Experts Discuss Digital Transformation of Rwanda’s Health System in USAID Webinar

How can digitalization transform the health system of a low- or middle-income country and improve the lives of millions of patients? Rwanda provides an example that other countries can learn from. That was the topic of a recent USAID webinar. 

Experts from Management Sciences for Health (MSH) recently took part in the online event to share insights from the exciting progress Rwanda has made in digitizing its health system. The webinar was part of USAID’s Health Systems Strengthening (HSS) Learning Series, which convenes HSS practitioners to share, learn, and use HSS evidence, strengthening the global evidence base and supporting collective efforts toward sustainable health systems. More than 300 people attended. 

The event’s packed agenda included multiple speakers from USAID, each of whom shared their perspectives on the “inspiring and remarkable transformation” that Rwanda’s health system has achieved, improving access to care for millions of its citizens. Through concerted efforts at multiple levels of the health system, Rwanda has enacted strong reforms to processes including health information management, financing, human resources, and logistics for its health supply chain. The USAID Ireme Activity and the USAID MTaPs Program in Rwanda, both led by MSH, have been deeply involved in supporting these efforts of our Rwandan partners.  

Sylvere Mugumya, Acting Chief Digital Officer for Rwanda’s Ministry of Health, talked about the strategic approach that has guided the country’s digitalization efforts. He outlined the “key pillars” of Rwanda’s Digital Health Strategy: enhancing interoperability, strengthening infrastructure, synthesizing and visualizing data, digitizing primary health care, and establishing a framework for institutional digital health governance, leadership, and funding. “The digital health governance structure helps us to collaborate,” Mugumya explained. “We understand digital health is an enabler to all the health services. That’s why we have a ‘smart health’ steering committee. At the national level the Minister of Information Communication Technology and Innovation and the Minister of Health are bringing together their institutions, and their leaders sit together biweekly to see what we have to implement. And under this steering committee, we have a permanent secretary at the Ministry of Health, where the budget is planned. This means that the digital initiatives are preauthorized in terms of budgeting.” 

Mugumya went on to talk about work at all levels of the health system, including at the facility and community level where the country’s ‘digital toolkit’ means that community health workers are now able to screen for malnutrition and noncommunicable diseases in addition to things like malaria and pneumonia. “The system they are using is connected to the national grid so that the Ministry can view how many cases of malaria have been treated in the community per day, per week, per month, and we are able to make the necessary decisions quickly.” He also described the “One Patient, One Record” Flagship Project to synchronize patient data across the system, which he hopes can serve as a use case for other countries looking to digitalize patient information systems.

Dr. Anita Asiimwe, a former Minister of State in the Rwandan Ministry of Health who now serves as Chief of Party for the USAID Ireme Activity, highlighted the partnership between the project and the Rwandan government across three key areas: health financing; leadership, management, and governance; and health workforce development. She gave a broad overview of how the project is taking a holistic approach to strengthening Rwanda’s health system and how digital tools are playing a central role in that effort, from improving financial management to enhancing health care workforce allocation. “We are working with the government of Rwanda and building on what was done way before Ireme started to continually improve health systems resilience, ensuring optimizing resources and looking at how we can continue to offer quality services to Rwandans.” 

Following Dr. Asiimwe’s presentation, Abimana Rwandenzi Eugene, Senior Technical Advisor for the USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program in Rwanda, also led by MSH, discussed the implementation of the open regulatory information management system, commonly known as Open RIMS. He outlined the digitalization of the Rwanda Food and Drugs Authority and its impact on regulatory processes, including pharmacovigilance (monitoring the safety of and tracking adverse reactions to new medical products). “The institution can now conduct active surveillance on monitoring the new medicines that are introduced in the country, including the recently introduced treatment of Dolutegravir for HIV patients.” Eugene also highlighted the importance of digital pharmacovigilance processes during the COVID and Ebola crises.  

Webinar attendees then heard a different perspective from someone who regularly interacts with the digital health systems Rwanda has put in place. Fileille Naberwe is a Product Manager at the Rwanda Social Security Board (RSSB), which administers the country’s community-based health insurance program. They use a health benefits system called “Kwivuza” to ensure that patients who are covered by the insurance can receive services properly and efficiently. She talked about the challenges faced before the digital system was implemented, including slow and inefficient paper-based processes that led to lack of oversight and the inability to properly monitor for fraud. Delays in payment affected the liquidity of the health facilities and their day-to-day operations. Limited data for decision-making hindered RSSB’s ability to manage risk and make policies. But now, with the digitized system, they have been able to reduce invoice processing time at health centers from 93 days to 23 days, among other improvements. “We had lots of paper coming from the different facilities to our branches to our HQ. With this digitization process, we have been able to reduce the amount of paper that circulates amongst the users.” Digitalization has also enhanced pharmacy operations, Naberwe said.  

Dr. Charles Ntare, Technical Advisor with the Health Information Systems Program (HISP) Rwanda, discussed the different modules implemented in the Rwanda Health Management Information System, how they have contributed informed planning and decision-making, and the general digitalization challenges remaining in Rwanda’s health care system. He described how difficult it was when more than 500 health facilities were working with different tools, many not web-based, and supported by different technologies. “They would load the data on flash disks and any other devices and transport them physically,” he explained. It could take up to two months for a monthly report to get from the reporting site to the central level. The government’s decision to adopt the DHIS2, an open-source software platform that collects, reports, analyzes, and disseminates health data, changed everything. Data collection was simplified, reporting time improved, and important data is visible nationwide—which leads to more informed decision-making. “This all wouldn’t have been possible without some enabling factors. One of them was a committed and accountable leadership that was intentional to improve health outcomes based on data-driven planning and resource allocation. Another was the government’s investment in infrastructure improvement to facilitate its implementation.”

MSH’s Randy Wilson, Principal Digital Health Advisor for Data, Health Information, and Measurement, summed up the presentations of the panelists. “Rwandan’s digitalization journey is a perfect example of how a Ministry of Health and its partners were able to use systems thinking approaches to drive change and to transform service delivery across the country.” 

Watch the recording here: