Building Surgical Capacity in Rwanda

Building Surgical Capacity in Rwanda
Center for Surgery and Public Health

An imposing obstacle to improving access to health care is the global shortage of 41.3 million health professionals, disproportionately impacting vulnerable and impoverished communities around the world. One of the world’s poorest countries, Rwanda was devastated by genocide in 1994, with the average life expectancy falling below 40 years, and experienced a vast exodus of its health workforce. By 2012, Rwanda had taken great steps in rebuilding its health system, turning around child and maternal mortality, but faced a steep challenge in sustaining those gains and taking on the untouched burden of injury and non-communicable diseases, including cancer.

In 2012, the Human Resources for Health (HRH) Program was formed to rebuild the country’s health care education infrastructure and workforce. When the HRH Program began, 85% of surgeries performed at the University of Rwanda Teaching Hospital in Kigali (CHUK) were emergency procedures, overwhelming an already strained health system. The HRH program supported the recruitment of U.S. faculty across the healthcare spectrum via a consortium of U.S. universities to establish a sustainable higher education system in Rwanda that would produce sufficient numbers of competent, specialized health professionals to meet national need. Acting as consortium coordinator for all 22 U.S. academic institutions, Brigham and Women’s Hospital also provided more than 50 full-time employees across the entire program, including surgeons, anesthesiologists, internists, radiologists, psychiatrists, and pediatricians.

In 2019, the Program is set to double Rwanda’s 2012 physician workforce and greatly scale up the number of physicians with advanced training. In addition to increasing training output, the HRH Program sought to improve the quality of the training programs, integrating competency-based training and pedagogic innovation, building a stronger educational administration, and expanding accessibility to better equipment and supplies at teaching hospitals. As co-principal investigator and U.S. Surgery Faculty Liaison, over the past six years Dr. Robert Riviello has spent up to 75% of his time in Rwanda supporting the advancement of the University of Rwanda Surgery Residency Program and continues to work to support the professional development of the new cohorts of Rwandan surgeons. Today, thanks to improvements in referral systems and the decentralization of surgical services, emergency surgeries now constitute only 35% of CHUK’s surgical volume and waiting times for surgery have dropped from one year to one month.