Digital health systems are increasingly helping Rwanda identify high-risk pregnancies earlier, improve patient monitoring and connect health workers to specialist support, measures that officials say are contributing to a decline in maternal deaths. Rwanda has reduced maternal mortality by 30 per cent over the past two years, according to Minister of State for Health Dr Yvan Butera, who says technology has strengthened the country’s ability to detect risks and respond to complications before and during delivery. ALSO READ: Why maternal deaths remain a challenge Speaking at the opening of the fifth Africa HealthTech Summit in Kigali on Wednesday, September 30, Butera said electronic medical records linking community health workers, health centres and hospitals have improved how patients are monitored across the health system. Rwanda has more than 54,000 community health workers equipped with smartphones running a locally tailored electronic medical record system. The system has reduced reliance on multiple registers used by different health programmes and allows community health workers to collect patient information, identify people at risk and follow up on cases, particularly among pregnant women and children. “From my office, I’m able to quickly scan the entire country — what’s happening, where do we have stock-outs, where do we have high-grade fever, where do we have a concentration of high blood pressure in a certain area of the country,” Butera said. “We all see that through the data that our community health workers get to us, and I think it has transformed, big time, our system.” Detecting high-risk pregnancies earlier Butera said patient information is linked across different levels of care, allowing health centres to access records collected by community health workers, while hospitals can monitor information from their catchment areas. This enables health workers to identify potential complications earlier and determine which mothers may require closer monitoring. Health centres are also using ultrasound machines alongside information on conditions such as high blood pressure and diabetes to identify high-risk pregnancies. According to Butera, such early detection gives health workers more time to prepare for complications before delivery. “Just in these two years that have passed, we have reduced maternal mortality by 30 per cent,” he said. He added that Rwanda has reduced maternal mortality by 85 per cent over the past 20 years, although high-risk pregnancies remain a major concern. The government expects maternal mortality to fall further as digital health systems and specialist support are expanded. Butera said Rwanda is targeting a further 30 per cent reduction in maternal mortality over the next year. Virtual hospital links doctors to specialists Another digital intervention is Rwanda’s virtual hospital system, which connects doctors at district hospitals with specialists elsewhere in the country. Butera said most district hospitals have general practitioners but limited access to specialists such as gynaecologists. Through the virtual hospital system, district hospitals are connected to specialist centres where gynaecologists provide round-the-clock support. Specialists can remotely follow procedures being carried out in district hospitals and guide general practitioners in real time. “They can see live what a general practitioner is doing in a remote hospital. So they go through surgery together,” Butera said. He said the system has helped doctors manage critical maternal cases that might otherwise have required transferring patients to specialist hospitals. “They usually save about 15 deaths of mothers since we started this programme,” he said. The approach is intended to bring specialist expertise closer to patients, particularly in areas where specialist doctors are not permanently available. Using health data for faster decisions Beyond maternal health, Rwanda is increasingly using data collected digitally at community and health-facility level to guide decision-making. Information from community health workers can help authorities identify disease patterns, shortages of medicines and other emerging health concerns. The ability to monitor such information centrally, Butera said, allows health authorities to respond more quickly to problems detected in different parts of the country. Rwanda is also working with other African countries to expand the use of health intelligence systems. Butera said 11 countries are setting up health intelligence centres, including Tanzania, Nigeria, Ethiopia, Liberia and the Central African Republic. The Health Intelligence Centre for Africa has also been established as a network through which countries can share experiences and collaborate on the use of health data and digital technologies. Its headquarters are in Kigali. “It is an exciting time on the continent. We believe that technology will take human care further, will help communities live longer, and a health system that can reach people sooner, that can respond further and faster, will take us to greater heights,” Butera said.
