State of Cancer Control in Rwanda: Past, Present, and Future Opportunities

Abstract

Rwanda is a densely populated low-income country in East Africa. Previously considered a failed state after the genocide against the Tutsi in 1994, Rwanda has seen remarkable growth over the past 2 decades. Health care in Rwanda is predominantly delivered through public hospitals and is emerging in the private sector. More than 80% of patients are covered by community-based health insurance (Mutuelle de Santé). The cancer unit at the Rwanda Biomedical Center (a branch of the Ministry of Health) is responsible for setting and implementing cancer care policy. Rwanda has made progress with human papillomavirus (HPV) and hepatitis B vaccination. Recently, the cancer unit at the Rwanda Biomedical Center launched the country’s 5-year National Cancer Control Plan. Over the past decade, patients with cancer have been able to receive chemotherapy at Butaro Cancer Center, and recently, the Rwanda Cancer Center was launched with 2 linear accelerator radiotherapy machines, which greatly reduced the number of referrals for treatment abroad. Palliative care services are increasing in Rwanda. A cancer registry has now been strengthened, and more clinicians are becoming active in cancer research. Despite these advances, there is still substantial work to be done and there are many outstanding challenges, including the need to build capacity in cancer awareness among the general population (and shift toward earlier diagnosis), cancer care workforce (more in-country training programs are needed), and research.

Public Hospitals Preparedness in the Provision of Breast and Cervical Cancer Services in Busia and Trans-Nzoia Counties in Kenya

“…This is because most of these facilities are available in national teaching hospitals as well as a few tier -four hospitals in some counties in Kenya. This finding is consistent to that reported in Rwanda (21) where MRI machines were available in one national public and one private hospital. The diagnosis of breast cancer involves thorough bimanual palpation of the breasts and locoregional nodes, blood testing that includes complete blood count and blood chemistries (liver and renal function tests, alkaline phosphatase and .…”

“…Among the 73 facilities assessed, none of them had an MRI machine to support breast cancer screening, however each county referral hospital had a digital mammogram. This finding is consistent to that reported in Rwanda [21] where MRI machines were available in one national public and one private hospital. The diagnosis of breast cancer involves triple assessment through a clinical breast examination by a trained health provider, breast biopsy and breast imaging using mammography, ultrasound or MRI as appropriate [23] .…”

“…The copyright holder for this preprint this version posted May 26, 2021. ; https://doi.org/10.1101/2021.05.24.21257702 doi: medRxiv preprint Low levels on knowledge in cancer are not limited to healthcare workers practicing in public hospitals in Kenya. In Rwanda (21), it was reported that cancer care is mainly offered by physicians who work in collaboration with colleagues in USA and Canada through virtual tumor boards. The authors (21) further noted that in Rwanda, there are gaps in prevention and early detection of breast and cervical cancer despite introduction of mitigation measures such as breast surgery fellowship at the national military hospital.…”

“…Low levels on knowledge in cancer are not limited to healthcare workers practicing in public hospitals in Kenya. In Rwanda [21], it was reported that cancer care is mainly offered by physicians who work in collaboration with colleagues in USA and Canada through virtual tumor boards. The authors [21] further noted that in Rwanda, there are gaps in prevention and early detection of breast and cervical cancer despite introduction of mitigation measures such as breast surgery fellowship at the national military hospital.…”

Continuing medical education during COVID-19: virtual training for gynecologic oncology management in Rwanda

“…Rwanda, a landlocked country in sub-Saharan Africa with a population of 12.3 million, is investing in cancer control and prioritizing the response to its highest-incidence cancers. 1 2 Over 1500 Rwandan women develop gynecologic cancers each year, with 71% of those women dying from their disease. 3 4…”