The Government of Rwanda in July 2023 approved the 4x4 Reform, a strategy aimed at quadrupling the number of healthcare workers in the country within the next four years. This was in line with meeting the World Health Organization recommendation of at least four healthcare professionals per 1,000 people. It also builds upon the groundwork laid out in the National Strategy for Health Professionals Development (NSHPD) 2020-2030.

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Under the 4x4 reform, the health sector is projected to expand its pool of health professionals, including residents, fellows, general practitioners, dental surgeons, pharmacists, nurses, midwives, and allied health sciences personnel. By the year 2028, the plan aims to increase the health workforce by a total of 32,973 personnel.

Progress made so far

Over the past eight months, the Ministry of Health (MoH) has fast-tracked the implementation of the 4x4 Reform.

Data from the Ministry shows that by the end of 2023, in terms of education, the enrolment of healthcare professionals increased by 146 per cent compared to historical average data.

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During a session on the progress of the 4x4 Reform on March 28 at Kigali Convention Center, Prof. Abraham Mitike, the Acting Principal of University of Rwanda-College of Medicine and Health Sciences (UR-CMHS), noted significant increases in student intake across disciplines. He said that in medicine, the usual intake of about 100 students per batch has surged to 369.

Mitike noted that similar trends were observed in pharmacy, where the intake rose from 80 to 150 students per batch, and in clinical psychology, increasing from 50 to 120 students per batch, while nursing and midwifery programmes have seen a rise from over 400 students to 800 plus.

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Data from the Ministry of Health highlights a demand for health professional programmes, mainly considering the number of applications received in 2023. UNFPA received 295 applications for just 50 available scholarships, while USAID Ireme/MSH received 3,859 applications for only 500 scholarships, and an anonymous donor received 4,942 applications for 1,290 scholarships.

The expected enrolment for 2024 is currently 4,849 students from a total target of 12,352 students, according to the data.

Despite the advancements, there is a current gap of 7,503 students lacking scholarships, along with a need for equipment in the expanded UR-CMHS labs and teaching hospitals across the country.

Recognising the challenges, Dr Yvan Butera, the Minister of State in the Ministry of Health, emphasised the importance of collaboration, stating, "We met with stakeholders from the government, private sector, and development partners to discuss how we can continue to work together towards achieving the goals [for the 4x4 strategy]."

New medical programmes introduced

By 2023, five new training programmes (Medical Oncology Fellowship, Neonatology Fellowship, Renal Transplant Fellowship, Clinical Athology Residency and Ophthalmology Residency) were launched in partnership with the University of Rwanda, expediting the implementation of the 4x4 strategy.

This followed the signing of a synergy memorandum of understanding between the Ministry of Health and the Ministry of Education with 31 institutions including 13 higher learning institutions, 14 teaching hospitals and four professional councils in November 2023. The involved parties aimed to commit to work together and share knowledge and resources where needed to increase Rwanda’s health workforce.

More programmes are on the way. According to the Ministry of Health, the first cohort of an expanded Obstetrics and Gynecology (OBGYN) residency programme at UR-CMHS is set to commence in April 2024, aiming to admit an additional 40 residents across 10 level 2 teaching hospitals for the next four years. Africa Health Sciences University also plans to initiate its first cohort in September 2024, enrolling 24 residents at Kibuye and Kibungo teaching hospitals, along with 40 midwives at Muhima and Kacyiru hospitals.

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As part of the 4x4 Reform initiative, 16 new specialty programmes are scheduled to launch in 2024. These include Interventional Radiology, Body Imaging, Neuroradiology, Musculoskeletal Radiology, Pulmonology, Pediatric Critical Care, Pediatric Hemato-Oncology, Pediatric Anesthesiology, Rheumatology, Adult Critical Care, Cardiothoracic Surgery, Colorectal Surgery, Breast Surgery, Oral and Maxillofacial Surgery, Master’s in Dental Public Health, and Nurse Anesthesiology.

Butera said that investing in 4x4 initiative will enhance socioeconomic well-being by positively impacting health indicators, enabling Rwandans to live longer and healthier lives, and empowering them to contribute to the development of both themselves and their country.

The projected improvements include increasing life expectancy to 80 years by 2035 and 90 years by 2050, reducing mortality by 60 per cent from infectious diseases and maternal and child health complications, and preventing 41 per cent of deaths from non-communicable diseases, among other benefits.

It is important to note that the 4x4 reform is being implemented alongside other strategic initiatives including strategic acquisition of medical equipment, revamping of the Community Health Workers programme and retention of healthcare workers, among others.