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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
37
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
7
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