Kigali – When COVID-19 cases and deaths in Rwanda began to spike in early 2022, the health authorities were determined to avoid reliving the experience of prior pandemic waves. Despite the country’s well-coordinated response, hospitals had been overwhelmed with demand and struggling to keep up.

The solution? Operation Save the Neighbour, an initiative to save lives at the community level and reduce the burden on hospitals by integrating doctors into home-based care teams.

“When you are a medical professional and there is a health emergency in your community, it is your responsibility to be part of the solution,” says Dr Emile Rwamasirabo, a urological surgeon participating in the programme.

COVID-19 home-based care had been introduced in September 2020 to relieve pressure on health facilities, adapting guidance issued by World Health Organization (WHO) to the country’s context.

With Operation Save the Neighbour, patients’ and doctors’ geolocations are mapped, then doctors paired with community health workers to attend to cases within walking distance.

Operation Save the Neighbour was launched in the Gasabo District, site of Rwanda’s highest COVID-19 infection rates earlier this year, with over 2500 cases in 501 villages. It was supported by district officials and the Joint Action Development Forum, a multi-stakeholder platform ensuring sustainable socio-economic development and improved service delivery for Rwandan communities.

Within two weeks of the initiative’s launch, home-based visits had increased from 30% to 92% coverage. With 82% of home-based patients having their oxygen saturation monitored regularly, early referrals have contributed to a decrease in the number of deaths.

The approach has strengthened the support system around community health workers, who can be assigned to care for as many as 100 COVID-19 patients. The initiative has trained and equipped community health workers and guaranteed them the support of doctors.

“As community health workers, our knowledge and skills are limited, and the population is aware of that,” says Rutagarama Wendislas, lead community health worker in Gisozi Sector in the capital Kigali.  “Knowing we can just pick up the phone and ring a doctor for support has boosted our confidence and created trust among the population.”

Rutagarama recalls an acute case he managed with the help of Operation Save the Neighbour.

“It really felt like we were a team,” he says. “The doctors were helpful in the analysis of the information we shared and made quick decisions when they noticed the patient could plunge into critical condition.”

The home-based care approach made a positive impact on Rwanda’s response to peak pandemic waves. For example, by the end of March 2022, 98% of cumulative COVID-19 confirmed cases in the country were being treated from their homes.

Dr Brian Chirombo, WHO Representative in Rwanda, says the country’s belief in home-grown solutions has served it well in the pandemic response.

“The greatest asset of Rwanda’s health system is its people and an innovative spirit,” he says. “We hope that Operation Save the Neighbour will be replicated elsewhere, even beyond crisis times.”