A Future for Emergency Medicine in Rwanda

Dr. Stephen Rulisa, MD, MMed, PhD.Dean of the Medical School, University of RwandaUniversity of Rwanda College of Medicine and Health Sciences (UR CMHS)Rwanda Emergency Care Association Conference26 August 2016

College of Medicine and Health Sciences

The University of Rwanda: History

– Formerly the National University of Rwanda (NUR)

– Opened in Butare in 1963

• The Faculty of Medicine opened shortly thereafter

– 1966-1987: Average annual enrollment of 25 medical students, average of 20 graduates per year

– 1995 to date: increasing numbers

• Average annual enrollment in College of Medicine and Health Sciences now at 100, average of 80 graduate/year

– 1998: Creation of postgraduate program at the Faculty of Medicine

– 2005: Official re-launching of in-house post-graduate programs

Health Workforce Figures

Why Emergency Medicine?

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Rwanda’s Health System

Tertiary hospitals

~ 250

~ 255, 000

National

(~12 m)

Health care

delivery system

Av. Catchment

area pop

Health centers

Health posts

No. of public

facilities / CHWs

478

368

45,011

District hospitals

~ 23 000

Type of service offered

▪ Specialized hospitals serving the entire country

▪ Medical training

▪ Provide government defined “minimum package of activities at the peripheral level (MPA)

▪ This includes complete and integrated services such as curative, preventive, promotional, and rehabilitation services

▪ Supervise health posts and CHWs operating in their catchment area

Community-based :

• Prevention, screening and treatment of malnutrition

• Integrated Management of Child Illness (CB-IMCI)

• Provision of family planning

• Maternal Newborn Health (C-MNH)

• DOT HIV, TB and other chronic illnesses

• Behavior change and communication

Provinces (5)

Sector (416)

District (30)

▪ Provide government defined “Complementary package ofactivities (CPA) (C-section, treatment of complicatedcases,..

▪ Provide care to patients referred by the primary healthcenters

▪ Carry out planning activities for the health district andsupervise district health personnel

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5

▪ Services provided are similar, albeit reduced from, that byHealth Centers.

▪ Established in areas which are far from health centers,

▪ Services include curative out-patient care, certaindiagnostic tests, child immunization, growth monitoring forchildren under five years, antenatal consultation, familyplanning, and health education

Village (14,837)

Cell (2148)

Administrative

structure

Community Health

Workers

80% of burden of disease addressed at this level

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Need for Highly Skilled and Diverse Health Workforce to Achieve Health Sector Goals

5 Referral Hospitals

42 District Hospitals

469 Health Centers

Nationally, Rwanda has:

School of Medicine

Approx. 800 Physicians

6,970 Nurses

~45,000 Community

Health Workers

Healthcare Facilities

Health Education Teaching Institutions

Healthcare Workers

School of Allied Health

Sciences (i.e. dentistry)

School of Nursing

(excluding 2 private)

Mostly general

physicians

90% with only high school

diploma

Only sites for specialty care

Where did formal emergency medical training start?

• In 2011 : national stakeholders meeting

• To decide what type of emergency care training should be introduced

• Born out of need for emergency care in Rwanda

Where did formal emergency medical training start?

• Started as Post graduate deploma

• Then as need increased, upgraded to Mmed

Program

• Now enrolling every year

Post Graduate Diploma (PGD) in Emergency andCritical Care Medicine – Launch, September 2013

Genesis and current status

• Anew speciality in the Region

• EM was not one of the initial HRH specialties

• MMed approved and launch September 2013

• Now Pert of HRH

The future of emergency medicine in Rwanda

• A growing workforce of locally-trained emergency medicine specialists

• The EM Mmed is a uniquely interesting program to support health system.

• interested – plan to keep enrolment because of the need

• New class Sept 2016 - seven new students

Future of emergency & Challenges

• Network ..

• Advocacy/publicity..

• Collaboration with other teams in patient care

• Outreach Programs

• Sustainability plan for the future

Thank You