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Coronavirus and Africa - in Rwanda, Technology to the Rescue

BLOG - 29 April 2020

Rwanda seems to be relatively spared by the Covid-19 epidemic, compared to other countries on the continent, with only 191 confirmed cases, of which 92 recovered and no deaths, as of April 27. The first case of coronavirus was registered on March 14 and a week later, the first total lockdown in sub-Saharan Africa was implemented in the country. What measures did the authorities adopt to fight the epidemic? Is the health system resilient enough to cope with the Covid-19? What role are new technologies playing in this African tech hub? What will be the economic impact of the pandemic? Shivon Byamukama, Managing Director of Babyl-Rwanda, a digital healthcare provider, answers our questions. 

What is the current health situation in Rwanda? How could it evolve in the coming weeks?

Rwanda confirmed its first case of Covid-19 on March 14. To date, we have 191 Covid-19 cases, 92 have recovered, 99 are active cases and there are no Covid-19 related deaths. The number of daily infections rose from single digits to double digits, but have in the past two weeks gone down to between 0-3 cases. All suspected and confirmed cases of the virus, including those coming from abroad, are undergoing mandatory quarantine. 

The Covid-19 pandemic is taking place at the time of the 26th Commemoration of the genocide against the Tutsi. Commemorating the genocide during social distancing is particularly hard for survivors of the genocide, as this is the time we as a country remember what happened together in close community, as a people. 

In the coming weeks, I see a downward trend given the very stringent measures that the government is putting in place to control the pandemic. All borders have been closed, except for the movement of goods. In the past couple of days, there have been reports of a number of truck drivers across East Africa testing positive, which may increase the rate of infection. Given that Rwanda is a land-locked country, hence heavily dependent on importation of goods by these truck drivers, governments across East Africa will have to work together to reduce the risk of spreading the virus to these countries. 

What are the measures adopted by the country to fight the epidemic? What lessons did the authorities draw from their response to the Ebola scare in 2019?

As early as January, when it was clear that Covid-19 was of global concern, Rwanda took a number of measures. RwandAir flights to China were interrupted, everyone coming through the airport was checked for temperatures and a record of people's travel history was taken to isolate those that had recently travelled to China. The Ministry of Health started a mass campaign through SMS, social media, radio and television, warning people about Covid-19, using WHO recommendations such as social distancing, but also assuring the population that there were no confirmed cases of the virus at the time. 

There were no Ebola cases reported in Rwanda but one of the lessons learnt from the Ebola scare was the importance of early intervention and sensitization of the population on how to avoid contamination.

When the first case of Covid-19 was confirmed in Rwanda on March 14th, it was immediately communicated to the public and three days later, by which time the number of confirmed cases had increased to 5, the government implemented a total lockdown of the country, the first one in sub-Saharan Africa. Borders and airspace were closed, the ability to travel across the country from one district to another, as well as public transport were stopped, shops were closed (except grocery stores), work from home was advisable but quickly became mandatory except for essential workers. There is constant communication from the Ministry of Health to the public on the number of people tested, new infections, people recovered, and continuously encouraging social distancing, hand washing, etc.

The government has set up a national helpline for people concerned they may be infected by the virus and also put in place a self-triage tool that citizens can call should they be concerned or suspect they may have Covid-19. 

The government has also acquired about 110,000 testing kits and are rigorously testing people. In addition to the WHO guidelines, 20 companies were approved to produce face masks that people are encouraged to wear when they leave their home. The military and the police have been co-opted to support in rigorous contact tracing. 

There were no Ebola cases reported in Rwanda but one of the lessons learnt from the Ebola scare was the importance of early intervention and sensitization of the population on how to avoid contamination.

Is the health system resilient enough to cope with the epidemic?

We know that even the most sophisticated healthcare systems in the world are struggling. The Rwandan health system, like many countries in the developing world, would struggle handling large numbers of critically ill Covid-19 cases. Even with a good decentralised system, universal health coverage, over 500 health centers throughout the country and an army of community health workers, what is really needed for this pandemic is ventilators, intensive care units and the necessary staff to handle critically ill patients. There are few ventilators in Rwanda and the government has ordered for more in preparation for the worst. 

The government’s strategy is to ensure that the number of Covid-19 cases remains low so as to safeguard the health system. Measures such as the rigorous contact tracing by the police and the military and the quarantine of every suspected case in different hotels and apartments across the country at the government’s cost, which is by no means a cheap venture for a developing country like Rwanda, is necessary to safeguard the health system. What the country lacks in a robust health system, it is making up in being very organised to ensure that the health system is protected. 

What the country lacks in a robust health system, it is making up in being very organised to ensure that the health system is protected. 

One issue that arises today is that fewer people are seeking healthcare for fear of contracting the virus. This will have long term effects on people’s lives, as seeking medical care later could mean that the conditions they may be suffering from will be much worse and therefore more expensive to treat.

What role can new technologies play in the healthcare sector to cope more efficiently with the pandemic in Rwanda?

Rwanda, already known as a technology-savvy country, has leveraged technology in a number of ways. 

  • First, authorities are sending continuous SMS about WHO guidelines to prevent Covid-19 and its symptoms. It has been a very effective way of communication as about 81% of Rwandans have a mobile phone. 
  • Then, the government has put a national helpline for anyone concerned they may have contracted the virus, and a USSD platform that allows people to self-triage and seek the right medical care. 
  • The government is also using drones to blast information about Covid-19 and to remind people to socially distance and stay at home where necessary. Rwandans are now required to apply through a USSD platform for permission to leave their homes should it be necessary to attain essential services. 
  • Data analytics are also used to be able to forecast properly.
  • Given that the virus can be transmitted through the use of paper money and coins, all transaction fees to mobile money have been waived in this period to encourage people to use these contactless means of payment
  • Lastly, the government is looking to partner with economic actors (such as my company Babyl-Rwanda), for a digital first solution to encourage patients to seek care from home, in order to avoid overcrowding the health system so that the government health system can focus on the critically ill patients, should the need arise.

What will be the economic impact of the coronavirus in Rwanda? 

Tourism and travel, which is by far the worst hit sector by the pandemic, contributes about 15% of Rwanda’s GDP. The lockdown means that almost everything is at a standstill. The growth forecast reduced as a result from +8% to +5.1%, and may go down to +3%, if not lower. The economy will be hit hard and the consequences will be felt for a very long time. 

In addition, like many developing countries, a large number of the population, in Rwanda’s case about 64%, is in the informal sector. The government is now burdened with feeding the millions of people that are at risk of starvation given that they only eat when they work. Thanks to the already existing decentralised infrastructure, it is however very easy to identify those most in need. Indeed, Rwanda has a very well structured decentralised system from village leaders, to cell-sector-district-provisional level. This has made distribution of food and basic supplies to those that need it the most really fast.

What are your recommendations to the decision-making bodies?

Looking at the global trends, it seems this pandemic will not end soon despite anybody’s best efforts. The government should be thinking about how it will slowly but carefully open up the economy. It is indeed a very difficult balance, especially for the developing countries. They unfortunately have to consider the risk of opening the economy, which may lead to more cases and potential death of 1% of the people that catch the virus, versus the risk of death from hunger. 

Rwanda, already known for its great leadership, will have to work closely with the entire continent to fight this pandemic as a block. Winning this war requires collaboration at a continental and global level. Africa needs to be united if we are to successfully fight the pandemic, as we are as strong as our weakest link.

 

Copyright : Simon Wohlfahrt / AFP

 

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