Submission ID 131193
| Issue/Objective | Access to safe, timely, and affordable surgical care remains a major challenge in low- and middle-income countries, especially at district-hospital level where infrastructure and workforce gaps are most pronounced. Rwanda's first National Surgical, Obstetric, and Anesthesia Plan (NSOAP 2018-2024) prioritized decentralization of surgical care. This study aimed to assess post-implementation surgical infrastructure, workforce availability, and service readiness across Rwanda's district hospitals and Level 2 teaching hospitals, and to generate evidence to inform national surgical planning and equity-focused health systems strengthening. |
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| Methodology/Approach | We conducted a nationwide cross-sectional facility-based survey from May to June 2025 across 43 hospitals, including all 34 district hospitals and 9 Level 2 teaching hospitals in Rwanda. Data were collected using the WHO Situational Analysis Tool for Emergency and Essential Surgical Care (SAT-EESC), complemented by facility walk-throughs and operating room register review. Five domain-specific informants per hospital contributed information on infrastructure, workforce, and service delivery. Descriptive analysis was performed, with rural-urban comparisons and spatial mapping of workforce distribution. |
| Results | All facilities had at least one functional operating room. Continuous electricity and running water were available in 93% of facilities, and oxygen was consistently available in 88%. However, blood banks were available in only 32.6% of hospitals and oxygen concentrators in 58%. The median specialist surgeon-anesthesia-obstetrician (SAO) density at district level was 0.54 per 100,000 population. Only 40% of hospitals had a full-time surgeon, and 5% had no anesthesiologist. Task-sharing was substantial, with general practitioners performing more than 80% of obstetric surgeries in several rural hospitals. |
| Discussion/Conclusion | Rwanda's district surgical platform demonstrates relatively strong basic infrastructure readiness and an operational task-sharing model, but major inequities persist in specialist workforce distribution, diagnostics, and advanced surgical capacity. These findings highlight the need for context-driven strengthening of district surgical systems through specialist scale-up, infrastructure investment, and equitable decentralization. This aligns most strongly with Sub-theme 2: Equity in action, while also speaking to upstream governance and planning under Sub-theme 1. |
| Presenters and Affiliations | Alexander Habtemariam University of Global Health Equity Marie Merci Cyuzuzo University of Global Health Equity Sarah Derichs University of Global Health Equity Alice Umutoni University of Global Health Equity Anteneh Gadisa University of Global Health Equity Victor Mithi University of Global Health Equity Mulugeta Tenna University of Global Health Equity Emmanuel Nkusi Rwanda Military Hospital Pierrette Ngutete Mukundwa University of Global Health Equity Barnabas Alayande University of Global Health Equity Abebe Bekele University of Global Health Equity Sabin Nsazimana Ministry of Health Rwanda Nobhojit Roy University of Global Health Equity Georges Bucyibaruta University of Global Health Equity |
