CoE on Biomedical Engineering and e-Health: Catalyst to Transform Healthcare in Rwanda

A center of excellence in biomedical engineering, e-health, and allied fields can be of particular interest to Rwanda as it can act as a catalyst for transforming the country’s healthcare from one that is deficient in the provision and reach to the one that has excess capacity and can offer services in the region and beyond, making Rwanda a major medical tourism hub.

Healthcare is integral to dignified living, declared President Kagame in an interview with pbs.org, an American public broadcaster. Over the years, Rwanda has made great strides in the provision of healthcare. More than 96 percent of Rwandans have access to medical insurance. Compared to this, the US has 91 percent coverage while India has coverage for only 27 percentage of the population. The government’s commitment to healthcare can be further gauged by public and government healthcare spending. Rwanda spent 6.6 percent of its GDP on healthcare in 2017, which puts it in the league of OECD nations which is a group of mainly rich social welfare states. In order to fulfill its vision of making healthcare more accessible and affordable, Rwanda has put great emphasis on increasing the number of medical professionals including nurses, midwives, biomedical engineers, and other allied specialists including pharmacists. As of 2019, Rwanda had 1,492 physicians of which 642 are specialists and 850 are general physicians. The number translates to 1 physician for 8,291 persons. At the same time, the availability of nurses stands at one per 1,420 persons. Rwanda has had great success in increasing assisted deliveries. In 2010, there was only one midwife for 66,749 women of reproductive age, in 2019, the number has improved to a midwife per 28,849 women in the same age group.

The government has been stressing on the need to provide state-of-the-art specialized medical care within its boundaries. The effort has increased the provision of services for diseases such as cancer, cardiovascular, diabetes, and chronic respiratory ailments. In 2017, Rwanda had only one oncologist but in 2019, there are 6 with more graduating soon. On the same line, the government has also increased focus on eradicating communicable diseases and has improved access to testing kits to enable early detection, treatment, and prevention.

The efforts from public groups and government have led to an increase in the number of biomedical experts. There are 139 biomedical engineers with A1 certification and 286 are under training. This will greatly enhance the biomedical capacity in the country. The government has also emphasized the expansion of quality and quantity of medical training in the country. In 2018 alone 69 new specialists and 72 general physicians were employed.

96 percent of public health facilities in Rwanda have a working internet connection and the country also has an integrated health management system that collects routine and specialized data on the health of the citizens. The next step is to improve the quality of data collection and expand its reach and scope.

The challenges

Despite the achievements that have been made over many years, the challenges facing Rwanda in the provision of versatile healthcare remain stern. Quality of emergency medical care remains a challenge even in the Kigali district. Rwanda has a poor network of paved roads. The lack of network hinders accessibility to the location of urgent need and increases the chance of fatality. The electricity supply remains erratic in the country. Even the capital city Kigali faces power cuts for hours leaving many medical equipment useless. Facilities such as ICUs do get generator supplies in referral hospitals such as King Faisal Hospital or Masaka Hospital. The laboratory facilities in the country remain poor at best. King Faisal Hospital is the only hospital in the country with the ability to carry out advanced laboratory testing such as MRI and CT scans.  

Lack of biomedical engineers and e-health experts further compounds the problem. The lack of biomedical engineers leads to longer maintenance time for malfunctioned equipment which further strains already stretched laboratory infrastructure. It also poses hurdles in assistive care and rehabilitation. The situation puts an additional financial burden on the government and individuals. In the absence of local capacity, the expertise or the equipment must be imported leading to cascading of cost due to factors involving time and distance. Lack or, to put it more neatly, the near absence of e-health experts limits the reach of the healthcare system. The integration of e-health in the healthcare system can greatly expand the reach of quality medical consultations in far flung areas at significantly reduced cost and effort. Even in urban areas, expansion of e-health infrastructure will enhance the efficiency and quality as the number of beds in good hospitals remain very limited in comparison to the requirement and are provisioned for only very serious cases.

Private participation in the healthcare system of Rwanda is minimal. This is despite the universal health coverage accompanied by a very high demand for quality medical care, especially in urban and suburban localities. This suboptimal participation can be mainly attributed to labor market failure. The number of individuals entering the labor market in the medical sector of Rwanda is piecemeal in comparison to accumulated requirements and, as a result, they are immediately absorbed by government facilities. The poaching of the medical staff can be very costly eroding the comparative advantage vis-à-vis government facility. Uncertainty on sustained financial flows in healthcare along with the not-so-good quality of insurance schemes may have also exacerbated the lesser private participation in the sector.

Looking for solutions

Rwanda is among the small group of countries that are uniquely disadvantaged in pursuit of their effort to build capacities towards universal provisioning of healthcare at an affordable cost. It is a small country with a small population when compared in absolute terms making economies of scale nearly irrelevant in providing quality public services. This makes it costlier for the government to offer some services as the cost is distributed over a smaller population. Such disadvantages have impacted the quality of education, roads, etc. which further affects and attenuates the quality of other services. The Nominal GDP of Rwanda stands at just USD 10 billion with a nominal per capita income of only USD 644. A healthcare strategy that can succeed in Rwanda must be based on premises such as affordability, relatively quick results, and should correct labor market failures by building local capacity thus also aiding the government economic goal of increasing the country’s GDP sevenfold in the next fifteen years.

Centre of Excellence on biomedical engineering, e-health, and allied fields

The establishment of a center of excellence has emerged as a viable strategy for building capacities in targeted areas in a cost-effective and efficient way. The strategy has been successful in achieving said goals in developing countries like India. IIT Delhi, a premier institute in India like the University of Rwanda, alone hosts 14 centers of excellence in different fields. The advantages of a CoE lie in creating a sharp focus on one niche area without the need to set up a completely new institute or even a new department. The focus makes it easier to secure funding and monitor results.  

Rwanda can build sustainable, cost-efficient, and high-quality capacity in areas of biomedical engineering, e-health, and other areas of immediate and persistent needs by building centers of excellence that are run in collaboration by multiple departments in universities. For example, the center of excellence in e-health can be established jointly by the department of computer science and the department of medicine. Such a process will reduce the fixed costs for setting up new institutes.

A center of excellence in biomedical engineering, e-health, and allied fields can be of particular interest to Rwanda as it can act as a catalyst for transforming the country’s healthcare from one that is deficient in the provision and reach to the one that has excess capacity and can offer services in the region and beyond, making Rwanda a major medical tourism hub. The CoE will help in building a team of experts dedicated to the task of building the aforementioned capacities through in-house research, by collaborating with experts from universities and industry. The capacities built in CoE can be tailored for the needs of Rwanda and will provide expanded scope for developing the domestic industry. Budding entrepreneurs can also be nurtured through incubation centers in universities and funds can be provided through multilateral funding, exchequer, etc.

The presence of quality labor will correct externalities in the medical sector that will also pave the way for private sector investment further enhancing the quality of services with an expanded list. Private investment will also allow the market forces to work more efficiently resulting in increased provision with a relatively higher quality of services that are in greater demand. And thus, reducing the need to seek advanced medical care in foreign lands. This spur of quality and provision of medical care in Rwanda will enhance the country’s prestige and standing in the region along with furthering economic and political integration efforts.

VisionRI's Centre of Excellence on Emerging Development Perspectives (COE-EDP) aims to keep track of the transition trajectory of global development and works towards conceptualization, development, and mainstreaming of innovative developmental approaches, frameworks, and practices.