Availability of a pool of medical specialists in the country has been elusive due to multiple factors including cost of training, brain drain, limited local training facilities among others.

Rwanda’s biggest referral facility, King Faisal Hospital—currently undergoing expansion—is in the process of launching a training programme aimed at addressing the deficit of specialists.

The upgrade includes construction of a new outpatient facility, set up of a premium services clinic, renovation and expansion of the older facility, installation of a ramp connecting the new building and the older one as well as procurement of equipment.

The upgrade will now see the hospital have 45 consolation rooms from about 20 rooms previously.

The New Times’ Collins Mwai spoke to Prof. Miliard Derbew, the Chief Executive of the hospital, on the ongoing process to improve the hospital in various aspects.

Excerpts below:

Last year, the hospital commenced an infrastructure upgrade whose completion has been delayed due to the pandemic, when is it likely to be completed?

The Government of Rwanda has invested a lot in developing the infrastructure of King Faisal Hospital to make it a Centre of Excellence as a referral hospital not only to serve Rwanda but across the region.

Based on that, some work has been done to expand the infrastructure. This involves increasing the consultation rooms from 20 to 45. We also have a section for premium clients or VIP patients.

We are also renovating the entire hospital and building a new ramp.

This was supposed to have been completed by June 2020. Immediately the construction activities began, the whole world went into a lockdown, which affected completion plans. We rescheduled with the project advisors to September. Although the lockdown had eased, most of the construction materials coming in from outside the country were delayed due to lockdown in various countries.

Despite the delays, we are now in the completion process. We have begun provisional handover of some of the aspects of construction.

The expansion will also require new equipment, how is that going?

Rwandans have been spending a lot of money going for referral services outside the country often due to lack of equipment. One of the equipment we have added is a catheterization laboratory, having it in the country is helping save lives. We have also embarked on capacity building.

We have also purchased a state of the art  1.5 Tesla Magnetic Resonance Imaging Machine that has clear imaging and also reduces the time taken which is ideal for children. We also have Gastroenterology equipment for procedures such as endoscopy.

We are now working on human resource development with partners in the country and outside to avoid the need for patients to travel outside.

Speaking of human resource development, how many new specialists have you since hired?

We are still pursuing goals to increase the number of specialists in Rwanda. We would like to attract Rwandans abroad to return here. We are in touch with them and following up. We have managed to attract specialists from other African countries.

We have managed to recruit a Specialist on Minimal Invasive Surgery from Cameroon previously working in Belgium, Interventional Cardiologist from Ethiopia, Nephrologist from Ethiopia, and a Pediatric Surgeon from Congo.

The recruitment process is ongoing and we remain open to working with specialists from Rwanda, Africa and across the world.

Any plans of locally developing our own specialists?

We are closely working with the University of Rwanda to set up a sustainable training programme to increase availability of specialists across the country. All the training programmes we are planning are programmes offered by the University of Rwanda.

Even though the immediate need is to have specialists, it is important to roll-out a training programme in different areas and as long as we work together in training and service, it will be impactful.

The programme will be sustainable in that we seek to build the internal capacity of the country. The problem which we have seen is a shortage of specialists which can be solved this way. Specialists will not only be found in Kigali, but across the country.

The quality of care across all hospitals will also consequently go up. We need the specialists to conduct training and roll-out of services as well. The world is fast-changing, previously in Africa we were looking for just any medical service, now we are seeking quality medical services, this requires working with higher education to produce the skills we need. We have a wide plan for training specialists with the University of Rwanda.

As someone who has previously run such programmes, what are the pre-conditions for a successful training strategy?

When you think of training, you have to work with a higher education institution. Some specialities cannot emerge on their own, training is a cascade. When you have some specialists in the programme, they also train other specialists who in turn train medical doctors.

When you have the hierarchy and cascade, it becomes continuous, not only in the number of doctors but also quality of training. By using this approach, we can expand the programme and bring on more people to the medical workforce.

That is the ultimate goal. It all depends on capacity building of institutions. We want the champions from the training to be Rwandans who will lead the programme to ensure that we have a number of local doctors.

For example, I am a pediatric surgeon, I do not lead the pediatric surgery training programme, Dr. Edmund from CHUK does, I train him and he runs the programme.

It’s one thing to train them, it will be another to retain them locally. Given the high demand for specialists across the world are they likely to leave for greener pastures?

This is not a Rwandan challenge solely, it’s a global problem, British Specialists want to work in America, and Americans want to go to Scandinavian countries. The reason for brain drain has to be identified. While finance might be among them, it’s not the main reason.   There are some factors that come later that lead to the brain drain.

When you have a local training programme, you can retain a high number of specialists. In most cases, if you stay abroad for more than 2 years, the chances of you coming home reduces, studies have shown. You are likely to get settled elsewhere.

Expanding our training programme has a big opportunity and chance of retaining Rwandan doctors and specialists.

Does your training programme plan to work with other facilities in the country?

Our target is not to isolate King Faisal Hospital in the training programme. All the training programmes are in partnership with 4 top hospitals including CHUK, CHUB and the Military Hospital. The training is not only at King Faisal but some of them are spread out in the other facilities. For instance, the Minimal Invasive Surgery Training is underway at CHUK. It is a joint development programme. While there are some services that will be led by King Faisal such as open-heart surgery as we have already been doing that, a number of them will be done in the other referral facilities.

Some may say that a health facility is only as good as its affordability, any attempts to make services more affordable?

We have committed that if any Rwandan needs to access our services which are not available in any other hospital, finance will not be a limiting factor. We have established a King Faisal Foundation for this purpose. I would like to call on the public to support the foundation.

We have an ongoing discussion with insurance companies. This hospital is not functioning at its full capacity. We have space to accommodate more patients. While some of the services may be considered expensive due to investments made, we are open to negotiating with insurance companies to work out payment models.

While we might limit special services which we cannot go lower price-wise, we are working on our tariff revision to see how we can attract Mutuelle de Santé patients and RAMA patients. With RSSB we have agreed to start with select services where we can allow patients to pay the same they pay at a facility such as CHUK.

From studies we have made, we are not as expensive as people thought, it’s more of perception but we are working to bring down the cost.

We have not seen much with regard to research coming out of King Faisal Hospital in recent years, is this likely to change going forward?

One of our pillars in the development of King Faisal is to boost our research capacities. We are working to build the capacity of our staff to undertake research mainly to address local problems. In 2020, we supported 5 research projects through a stimulus fund. We are also working on establishing an office for research administration. We are also starting to attract research projects such as addressing Covid-19.

To boost capacities in radiology all x-rays taken in any part of the country will be reported using artificial intelligence. That way, we are trying to address health problems and at the same time build capacities. As we develop our training institution, we expect to see research activities increase.