Infection Prevention and Control Strategic Plan 2024–2029

Objectives

Rwanda’s 2024–2029 Infection Prevention and Control (IPC) Strategic Plan implements the national IPC policy and seeks a safe, sustainable and infection-free environment for people receiving care, health workers, visitors and communities. Its mission is to reduce acquisition and transmission of healthcare-associated infections through evidence-based IPC practices in healthcare settings, public places and communities.[1][2]

• Establish functional IPC leadership, governance, regulation, coordination and accountability from national to community level.[2][3]
• Institutionalise and strengthen IPC programmes across public and private facilities, public places and communities.[2][3]
• Improve safe facility design, water, sanitation and hygiene, electricity, isolation capacity, staffing, equipment, supplies and environmental protection.[2][4][5]
• Promote equitable, inclusive and people-centred IPC practices to prevent healthcare-associated infections, outbreaks, pandemics, occupational exposure and antimicrobial resistance.[2][6][7]
• Strengthen advocacy, behaviour change, communication, community engagement, professional education, academic capacity and research.[2][6][8]
• Develop surveillance, laboratory capacity, monitoring and evaluation for healthcare-associated infections, antimicrobial resistance, outbreaks and pandemics.[2][9]

The plan responds to the burden of healthcare-associated infection, communicable disease and antimicrobial resistance, and builds on national experience from COVID-19 and the Marburg outbreak. A cited Rwandan study found hospital-acquired infection prevalence of 15.1% among hospitalised patients and 50.0% in intensive care units.[1][10][11]

Implementation

Implementation uses a whole-system, multimodal model combining national policy and standards, decentralised planning, facility IPC programmes, workforce development, risk management, surveillance, quality improvement and community participation. The Ministry of Health coordinates the response, while the Rwanda Biomedical Centre implements daily IPC activities and integrates them into health programmes.[11][12]

• Establish an IPC directorate, steering committees, technical working groups and IPC committees at national, decentralised and facility levels, with committees reporting to senior management and overseeing programme delivery and evaluation.[13][14][12]
• Assign referral, university teaching and provincial hospitals specialised roles in mentorship, supervision, research, evidence generation and technical support to districts and facilities.[4][15]
• Extend IPC committees, focal persons and trained leads to district hospitals, private facilities, health centres, health posts, Sectors, Cells and communities, including Community Health Workers.[12][16][17]
• Develop, consult on, approve and disseminate national guidelines, standards, standard operating procedures, training curricula, audit tools and implementation frameworks.[13][18][19]
• Integrate IPC into facility operational plans, district development planning, procurement, budgeting, accreditation, induction, pre-service and in-service education, mentorship and supportive supervision.[12][16][19]
• Engage public and private providers, civil society, faith-based organisations, professional bodies, academic institutions, communities, investors and One Health partners in implementation.[12][20][17]

At facility level, implementation includes risk-rating clinical areas, applying standard and transmission-based precautions, hand hygiene, appropriate personal protective equipment, aseptic technique, injection safety, environmental cleaning, safe linen, sharps and waste management, device reprocessing, safe specimen handling, patient flow and antimicrobial stewardship.[21][22][23][24]Facilities are to use risk-management frameworks and accreditation standards, maintain infection-control committees, educate staff during induction and continuously, engage patients and visitors, and take corrective action when non-compliance or safety gaps are identified.[14][25][15]

The delivery model also prioritises safe-health-facility design, mapping and upgrading existing infrastructure, accessible communication and inclusive equipment, harmonised procurement, domestic production of IPC commodities, and occupational-exposure prevention including post-exposure prophylaxis and workforce immunisation.[6][26][12]

Monitoring combines facility audits, accreditation, surveillance, data analysis, feedback and routine reporting. The plan calls for an IPC indicators matrix integrated into Health Management Information Systems, electronic reporting tools and a national healthcare-associated infection surveillance system for antimicrobial-resistant and outbreak-prone pathogens.[9][27]The proposed trajectory is selected secondary and tertiary facility surveillance by 2028 and nationwide implementation by 2029, alongside a functional national IPC programme and more than 75% of facilities meeting World Health Organization minimum requirements by 2028.[27][28]

Facilities and districts are expected to report surveillance and implementation information through existing health-sector channels, with district hospitals and private facilities submitting monthly healthcare-associated infection surveillance reports and facilities submitting quarterly surveillance reports to the Ministry of Health in specified arrangements.[15][29]Monitoring activities include monthly and six-monthly IPC audits, regular data review, publication and dissemination of findings, and feedback to senior management and health workers.[9][28]

Resource mobilisation includes Ministry of Health advocacy and equitable distribution of resources, facility and district budgeting within approved ceilings, public-private partnerships and support for domestic manufacturing. The source identifies specific investments in infrastructure, laboratory capacity, staffing, supplies and training, but the supplied material does not provide a consolidated total programme budget or funding gap.[12][15][30][31][32]

Monitoring & Evaluation

The monitoring and evaluation framework is intended to track implementation of infection prevention and control (IPC) activities, compliance with national standards and progress towards a safe, sustainable environment that minimises infection transmission. It combines surveillance of healthcare-associated infections (HCAIs), outbreaks, pandemics and antimicrobial resistance (AMR) with audits, accreditation, routine reporting, feedback and quality-improvement processes.[1][33][34][27]

• Integrate an IPC indicator matrix, data-management tools and updated data elements into the existing Health Management Information System, covering HCAIs, outbreaks, pandemics and AMR.[9][34][27]
• Develop electronic reporting tools, HCAI notification forms, audit forms, standard operating procedures for tracing and early detection, and harmonised reporting across facility and national levels.[9][27]
• Establish a national HCAI surveillance system for antimicrobial-resistant and outbreak-prone pathogens, with implementation in selected secondary and tertiary facilities by 2028 and nationwide implementation by 2029.[28]
• Conduct IPC audits and feedback monthly and every six months, analyse data regularly, disseminate and publish findings, and use the evidence for decision-making and programme improvement.[9]
• Require district hospitals and private facilities to submit monthly HCAI surveillance reports, while facilities identify and report community-level infectious-disease events through health centres, health posts and district structures.[16][29]
• Submit quarterly surveillance reports on HCAIs and outbreaks to the Ministry of Health, supported by facility alert systems and review of surveillance data.[15]
• Monitor compliance with hand hygiene, sharps safety, disinfection, sterilisation, waste management, laundry safety, environmental cleaning and standard precautions, and take corrective and preventive action when gaps are identified.[21][25][15][16]
• Use accreditation, risk assessment and inspection mechanisms to assess IPC, water, sanitation and hygiene, infrastructure, electricity, personal protective equipment, sterilisation and infectious-waste disposal.[35][14][20]
• Assign facility IPC committees responsibility for programme delivery and evaluation, with reporting lines to the highest management level; establish committees and focal points from national to community level.[14][12]
• Assess progress through annual health-facility and public-place assessments, IPC compliance surveys, knowledge, attitudes and practices surveys, quarterly evaluations with feedback, national HCAI surveys and research.[26][31][36][32]

Existing information systems record neonatal, post-operative and post-caesarean-section infection rates, but IPC data have not been fully integrated into the Health Management Information System and comprehensive facility-level surveillance for HCAIs, AMR and outbreaks remains incomplete.[37][35][38]The framework is expected to define indicator definitions, data sources, collection methods, responsible teams and collection frequency, including output, process and outcome measures.[34]It includes baseline and target information for 2025, 2027 and 2029, although some values are still to be determined.[3]

Costing & Financing

The plan identifies IPC financing as necessary for infrastructure, workforce capacity, equipment, commodities, surveillance, laboratory systems, research, training and safe water, sanitation and hygiene. It calls for mobilisation and equitable allocation of resources through Ministry of Health planning and budgeting processes, with district and facility plans submitted for budget allocation and approval.[12][15][16][30]

• Allocate adequate budgets for IPC policy, strategy, interventions and implementation, including financial budgets prepared by referral and provincial hospital IPC committees and dedicated budgets at district hospitals and private facilities.[12][16][29][30]
• Mobilise support through public-private partnerships, investor engagement, domestic production of IPC commodities and advocacy for tax exemptions on imported equipment and consumables.[13][30][36][32]
• Strengthen financing for IPC-compliant infrastructure, equipment, consumables and supplies, including isolation capacity, handwashing stations, waste treatment and medical-waste transport.[39][32]
• Support laboratory personnel, testing capacity, biosafety cabinets, surveillance equipment, information systems, training, waste-management materials and research capacity.[26][9]
• Address the absence of a financing mechanism for IPC research and innovation and the sustainability risks associated with time-limited donor funding.[38][40]

The source identifies a health-financing framework combining treasury transfers to districts and facilities with insurance-based payment, and reports that Community-Based Health Insurance covers 90% of the population.[39]It also reports a Government health-sector allocation of 17% of all budgets, distributed among programmes according to need.[39]

Explicit allocations are included for selected advocacy, guidance, training, safe-design, infrastructure, waste-management and private-sector activities, but their currency, financing period, total plan budget, funding sources, funding gap and economic assumptions are not specified in the supplied material.[36][32]