In the context of the ongoing complex Ebola outbreak declared on 1 August 2018 in the Congolese provinces of North Kivu and Ituri, Uganda, South Sudan and Rwanda were declared as priority one countries and are currently undergoing Ebola Virus Disease readiness and preparedness. The Rwandan Ministry of Health, supported by partners, organized a transdisciplinary workshop in January 2019 in Nyamata (Bugesera District of the Eastern Province) gathering its Health Partners, Donors and United Nations Agencies to review and update the national Contingency Plan. Nyamata is a promising growing city and has an airport, the Bugesera International Airport (BIA) under construction since August 2017 and expected to be completed in 2019.
Rwanda is considered to be the African country on the verge of reaching Universal Health Coverage (UHC). West Africa’s recent Ebola outbreak revealed how vulnerabilities in health systems can drastically compound global health crises and how up-front investments in health programming and critical partnerships can be much more cost-effective than treating issues as they arise. The long term partnership between the Rwanda Ministry of Health and WHO Country Office in Rwanda has proven to be the best combination for EVD preparedness and response and has put to the test both organizations as Rwanda has never faced a deadly and highly contagious disease outbreak. Rwanda intends to become a model country in Africa in Ebola preparedness and response. Though the country has never faced any outbreak, the operational readiness of the country lies on four pillars, namely the capacity to:
1. Invest on time
2. Find complementary partners
3. Seek new and flexible cost effective solutions
4. Mobilize the communities due to the integrated structure of their Health Care system
Based on this measurable asset and following the Full Simulation Exercise (FSIMEX) conducted at Rusisi and Rubavu Districts and the Joint Assessment Monitoring Mission (JAMM) gathering experts from WHO AFRO and WHO Head Quarters in Geneva, the Rwandan Ministry of Health, in collaboration with WHO Country Office immediately followed through on the improvements and gaps assessed by the FSIMEX and the JAMM by organizing a workshop to update their EVD National Contingency Plan, edition 2019.
According to WHO African Regional Office’s sources (AFRO) 14 High Risk Districts (HRDs) have been identified in the country and 6 new alerts were reported this week, against a cumulative of 193 reported and investigated since 01 August 2018. The Rwandan Ministry of Health reiterated that various preventive measures were already in place to contain the disease from the country, including strengthening surveillance at all Points of Entries (POEs) including border posts and airports. The objective of revising the Contingency Plan is not only to strengthen preparedness capacities for the prevention, earlier detection, response and containment of any potential case of EVD in Rwanda, but also to have a multi-level readiness and master it at all stages from POEs, to Leadership and Coordination structures, Surveillance, Case Management , Intervention Prevention and Control (IPC) and SDB, Risk Communication and Community Engagement (RC&CE), Community Health Workers, school teachers, community leaders. This includes EVD survivors as inspiring model to be used in RC&CE to facilitate the understanding of the importance of basic hygiene and systematic EVD case reporting to the nearest health authority. Laboratory support in health emergency is key to disease surveillance.
EVD Laboratory diagnostic capacity, the Rwanda Biomedical Centre (RBC) is equipped with state of the art laboratory for diagnosis and confirmation of Ebola viral disease should any case be imported into the country. During the simulation exercise, the laboratory staff capacity in specimen collection, packaging and transportation was also tested. Accurate laboratory-based information is a critical component of disease surveillance and is among the highest goals of disease control programmes. Pathogen-specific surveillance information, based on factors such as geographic range, vectors and biotype/serotype of the etiologic agent, is critical for predicting outbreaks and for differentiating background events from true outbreaks. Early detection of disease outbreaks with confirmation of etiology allows the institution of proper treatment, control and prevention practices. Likewise, during a disease outbreak, a sample of cases should be laboratory confirmed in order to monitor the characteristics of the epidemic strain of the organism. Significant changes in key phenotypic or genotypic characteristics (serotype, biotype, antigenic shifts, etc.) may warrant changes in treatment or control practices.
The ultimate scope of the whole Simulation exercise was to develop a realistic plan of activities, update the National Contingency Plan and ensure that the country has the operational and financial capacity to implement it timely. Incidentally, this will impact on resource mobilization activities for both organizations, lead to a fair media coverage adapted to Rwanda’s differentiated response as the outbreak continues in DRC due to problems independent of Rwanda authorities such as: the lack of stability and accessibility to high risk zones and persisting insecurity.