Other countries aiming to prevent or respond to a drop in delivery of EBIs for the reduction of U5M can learn from Rwanda’s experience. Because Rwanda had already built a resilient health system, consistently investing in key inputs and quality improvement, it could quickly adapt and respond to the challenges posed by the COVID-19 pandemic. Consequently, many of these lessons originated in Rwanda’s earlier work to reduce U5M between 2000 and 2015.
Before the next health system shock, countries can:
Proactively invest in health systems, inputs, and quality at all levels of care.
The presence of a strong primary health care system in Rwanda, and ongoing investments in health system inputs and quality at all levels of care, were critical to the country’s ability to respond to and mitigate the EBI disruptions caused by the COVID-19 pandemic and response. Before a crisis strikes, countries can build strong, resilient primary and community health systems and invest in infrastructure, human resources, and robust supply chains. These systems will boost and support EBI delivery under ordinary circumstances; they will also allow countries to respond quickly and effectively to emergency situations.
Build and empower leadership at all levels.
Leaders at all levels, from local to national governments, can muster the political will to unite behind a shared goal: a strong, well-run, accountable health system that meets the population’s needs under ordinary circumstances and is well-prepared for epidemics and other health system shocks.
Coordinate activities and priorities across partners and sectors.
In Rwanda’s experience, a strong system of coordination between the Ministry of Health, donors and implementing partners, and local leaders (including religious leaders) supported pandemic response and prioritized the maintenance of EBIs during the pandemic. Their work was supported by the central government using existing mechanisms of coordination and communication, from technical working groups to local command posts.
Build an information system that ensures the availability of quality data, and use data for decision-making at all levels of the health system.
Rwanda’s centralized electronic data-reporting system, including a strong HMIS and a rapid SMS, was in place before the pandemic began. As a result, Rwanda could quickly pivot to pandemic response while maintaining its previous functions, by using data to identify challenges and drive decisions relating to COVID-19 response as well as delivery of EBIs.
Create systems that ensure timely and relevant public health communication and build public trust.
Providing timely information to patients, health care workers, and communities is particularly important during health emergencies. Robust, reliable, and well-used communications systems help disseminate accurate information related to disease transmission, prevention, and care, as well as available and accessible EBIs. This helps increase public trust in the health system and alleviate crisis-driven fears.
Countries can do this even if they have not yet accomplished all the other things on this list. In fact, it is an action they can take while they are building (and to help them build) better health systems, political will, and public trust.
Ensure health system ownership and accountability at all levels.
Facilitating a comprehensive culture of teamwork, ownership, and accountability concerning health systems and interventions, as Rwanda has done with its Imihigo contracts at all levels, is critical to maintaining EBIs and preventing and mitigating disruptions during crisis periods.
Support the most vulnerable—in times of crisis and under ordinary circumstances—by focusing on equity.
Using tools such as disaggregated data analysis, Rwanda identified and supported its most vulnerable people during the COVID-19 pandemic. Because it had a pre-existing equity agenda, it had a road map for action in a crisis and a set of tools for steering resources (such as nutritional support) to especially high-need populations.
Overall, while Rwanda did experience a slight drop in some evidence-based interventions during the early phase of the pandemic, the country was able to rebound quickly and largely maintain provision of EBIs over the course of 2020. By building on a resilient health system and implementation strategies used to successfully reduce under-five mortality, Rwanda was able to mitigate the impact of COVID-19 on the provision of EBIs. Indeed, the lessons from Rwanda can help countries prepare for and respond to ongoing and future health system shocks.