Andrew Muhire - "Cholera and Other Diseases Don't Last Long in Rwanda"

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Apr 23, 2015
by Stuart Milne
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Andrew Muhire - "Cholera and Other Diseases Don't Last Long in Rwanda"

Health Ministry official tells how Rwanda became the first country to contain a cholera outbreak at fewer than 15 cases Andrew Muhire at Session 548 | The Promise of Data: Will this Bring a Revolution in Health Care?

Since 2011 Agnes Binagwaho, Minister of Health of Rwanda, has regularly joined Salzburg Global Seminar’s Health and Health Care in the 21st Century sessions by Skype to share how health care is being improved in her country.

During Session 548 | The Promise of Data: Will this Bring a Revolution in Health Care?, the Rwandan Health Ministry was also represented in person by Andrew Muhire, sector monitoring and evaluation and report lead specialist. He spoke to Salzburg Global about the innovative ways Rwanda is improving its health outcomes with limited resources.

Muhire says the Rwandan government’s investment in switching to electronic health information systems is paying dividends.

“Everything is being tracked using electronic information, from health center level to central level,” he said. “Everything is centralized, and it helps us to take decisions based on fact and be more focused, which really makes health care delivery more efficient and also reduces costs.

“It is a big change, because now we are really aggregated electronically. If there was an outbreak before, you had to know by someone telling you about it. Now because of this threshold that is set in the system, it is automatic.

“If there is any case of cholera reported, for example, the system automatically sends messages to people concerned, including the health facility in that catchment area. Not only that, it even helps us to track information that has been recorded by community health workers about the services that they offer. They either send it by SMS or they aggregate it back to internet reporting.

“Mobile phone technology is really interesting and attractive to monitor, because if there is any complication, the community health worker just sends the message through the server, then the server automatically informs the ambulance site, or even people at the central level to make sure they follow up if the ambulance was really sent.

“So the change is really significant, because now everything is electronic, data sharing is really good at all levels.”

The Health Ministry has embraced Rwanda’s good mobile phone and internet coverage, common to much of sub-Saharan Africa. Using the central database of phone numbers and a server that sends messages to all contacts automatically, an outbreak alert can reach the country’s 45,000 community health workers in under 30 minutes.

This SMS technology allowed Rwanda to become the first country to contain a cholera outbreak at fewer than 15 cases.

Muhire said: “The good thing about these electronic systems is they really inform us at the early stages, so it helps us to send people to go and investigate and make sure that those people cannot contaminate the whole geographic area.

“Then we make sure that case is treated as soon as possible to make sure even the patient with cholera is not affected. It makes some real improvements when it comes to patient level, and also population level at risk.

“When you have a very strong surveillance system, it’s always easy to make sure that nothing is moving far away. In Rwanda our integrated surveillance system tracks if there is an outbreak - not only cholera, but any outbreak that can occur.

“The good thing about this system is it alerts you in seconds, if there’s anything it reported. From that perspective, cholera and other diseases don’t last long in Rwanda.”

Muhire says he has found exchanging knowledge with other participants to be very valuable, with a number of colleagues expressing interest in Rwanda’s efficient and effective use of technology to improve health outcomes.

“All of us are learning from each other,” he said. “Participants are saying, ‘How do you manage to do that in that limited resources area?’ They don’t understand how Rwanda managed to do it, but it’s all about commitment, leadership, prioritizing what you want, having a vision, and also having an accountability approach. Rwanda is really good in all those components.

“I have gained exposure to very experienced people. This is a very big community that will keep working together. We have already created a forum where we will keep discussing and bring in some more new ideas to make sure not only Rwanda, but even the world, will really improve health delivery to our people.”


Andrew Muhire was a participant at the session The Promise of Data: Will This Bring a Revolution in Health Care? The session is part of the Salzburg Global series “Health and Health Care Innovation in the 21st Century” and was held in collaboration with the Mayo Clinic, Arizona State University, The Dartmouth Center for Health Care Delivery Science, and in association with the Karolinska Insititutet. More information on the session can be found here: www.salzburgglobalseminar.org/go/548