Noncommunicable Diseases Policy

Objectives

Rwanda’s Non-Communicable Disease (NCD) Policy seeks to protect the population from premature NCD-related morbidity and mortality and to alleviate the NCD burden through integrated prevention, diagnosis, quality care, treatment and rehabilitation for all people in Rwanda.[1]It supports national development priorities under Vision 2020, the Economic Development and Poverty Reduction Strategy II and the Millennium Development Goals, while integrating chronic care within existing health programmes.[2]Its wider purpose is to promote a healthy population able to contribute significantly to national development.[3]

• Create health-promoting environments and strengthen community action to reduce exposure to modifiable NCD risk factors and injuries.[2][1]
• Mainstream prevention, diagnosis, care, treatment and rehabilitation for NCDs within the national health system.[2][1]
• Document national NCD trends and determinants through monitoring, evaluation and research, using findings to guide evidence-based interventions.[2][1]
• Address cardiovascular diseases, chronic respiratory or pulmonary diseases, cancers, diabetes, kidney disease, injuries and disabilities, and oral and eye diseases.[2][4]
• Promote people-centred, integrated, sustainable and equitable services, guided by universal access, community participation, decentralisation, multisectoral involvement, capacity-building, cost-effectiveness, evidence use and domestic resource mobilisation.[1]
• Prioritise health promotion and prevention actions including community information, education and communication; regulation of tobacco, sweetened drinks and alcohol; occupational and road safety; household air-pollution reduction; food safety and aflatoxin control; immunisation-related cancer prevention; and action on infectious contributors to NCDs.[5]

Implementation

The policy adopts an integrated, decentralised health-system model, embedding NCD prevention and control within existing structures from central to community level while building on current infrastructure, workforce and institutions.[1][6]It seeks to expand access beyond referral and university teaching hospitals, where provision has been concentrated, towards simplified and integrated services across the system, including quality treatment and palliative care.[7][5]

• Lead the national response through the Ministry of Health, responsible for overall coordination, leadership, governance, advocacy, fund mobilisation, equitable resource distribution, multisectoral action and partnerships.[4][6]
• Implement and coordinate activities through the Rwanda Biomedical Centre, with its NCD Division managing day-to-day implementation.[4][6]
• Establish multisectoral collaboration involving government ministries and institutions, communities, the private sector, professional associations, civil society, faith-based organisations, academics, and national, regional and international partners.[5][8]
• Integrate NCD prevention and control into the priorities of sectors including education, local government, environmental regulation, injury prevention, family awareness, agriculture, law enforcement, sport, youth activities and product standards.[8]
• Equip facilities with appropriate supplies, medicines, standards, guidelines, protocols and infrastructure, while addressing identified shortages of basic equipment, specialised infrastructure, essential medicines and advanced treatment.[7][5]
• Increase workforce capacity by training health professionals and community health workers in NCD management, particularly because many doctors and nurses at district hospitals and health centres have not yet received such training.[7][5]
• Strengthen specialised services and centres of excellence, which were identified as not yet established, while improving the integration and accessibility of NCD services.[7]
• Deliver community-level adherence support, education, counselling, active case finding and referral alerts to health centres.[6]
• Organise chronic-care teams at health centres to supervise community health workers, identify cases and follow up uncomplicated patients.[6]
• Enable district and provincial hospitals to confirm diagnoses, provide moderately specialised diagnostics and medicines, manage follow-up, refer complicated cases, and train and mentor lower-level providers.[6]
• Provide specialised care at referral hospitals, alongside training and mentorship for lower levels, development of management tools, and documentation of best practice.[6]
• Use the Health Management Information System to integrate NCD indicators and support evidence-informed planning and decision-making, while improving data capture because NCD data are not comprehensively recorded.[1][6]
• Assess NCD intervention performance through output and outcome indicators at quarterly and annual intervals, conduct routine reviews, share results, and revise targets or interventions where needed.[8][3]
• Identify research priorities, partner with academic institutions, and use research findings to inform planning, decisions and practice.[6]
• Report chronic-care and NCD-care activities between designated levels of the health system, with referral hospitals reporting to the central level and contributing to monitoring tools, protocols, curricula and updated guidelines.[6]

Monitoring & Evaluation

Monitoring, evaluation and research are intended to document national non-communicable disease (NCD) trends and determinants, generate evidence for planning and decision-making, and support evidence-based interventions.[2][4][1][6]The proposed national system is country-led and unified, covering collection, analysis and sharing of NCD data, routine assessment of intervention performance, periodic dissemination of results, and revision of targets and interventions where needed.[8]

• Integrate NCD indicators, harmonised data-management tools and identified data sources into the existing Health Management Information System and wider monitoring and evaluation system.[6][8]
• Improve NCD data capture, as not all NCD data are currently recorded in the health information system.[1]
• Assess NCD output and outcome indicators quarterly and annually against national objectives and targets, supported by routine performance reviews.[8][3]
• Identify and pursue research priorities, use findings to inform planning, decisions and practice, and work with academic partners to strengthen NCD prevention and control research.[6]
• Require health centres, district and provincial hospitals, and referral hospitals to evaluate and report chronic-care or NCD-care activities to the next designated level; referral hospitals report to the central level.[6]
• Support lower levels of care through referral hospitals’ contributions to monitoring and evaluation tools, treatment protocols, training curricula, updated guidelines and documented best practice.[6]
• Supervise management, monitoring and evaluation of implemented activities through existing national health-system organs and structures, with the NCD Division involving all levels in the monitoring system.[4][8]

Available situation measures include the 2012/13 STEPwise approach to Surveillance (STEPS) survey, which reported tobacco use of 12.9%, low physical activity of 21.4%, heavy episodic drinking of 23.5%, and current alcohol use of 41.3%.[7]The survey found that 99.1% of respondents consumed fewer than five daily servings of fruit and/or vegetables, while 16.1% were overweight and 2.7% were obese.[7]In 2013, NCDs accounted for at least 51.86% of district-hospital outpatient consultations and 22.3% of district-hospital hospitalisations.[7]The supplied text does not provide a complete indicator framework, numerical programme targets, surveillance findings beyond these measures, or detailed accountability procedures and reporting schedules.[9][7][6]

Costing & Financing

Financing arrangements centre on Ministry of Health responsibility for fund mobilisation and equitable distribution of resources for the national NCD response.[4][6]The policy promotes domestic resource mobilisation, public-sector financial ownership, private-sector and civil-society investment, and cost-effective interventions, particularly health promotion, communication and prevention.[1]

• Distribute government health-sector funding across disease-specific programmes, including NCDs, while maintaining functional health-insurance schemes.[7]
• Address insufficient available funding for all NCD prevention and control needs.[7]
• Improve financial access to NCD care, noting that people insured through community-based health insurance, Mutuelle de Santé, do not generally access some private and higher-level NCD services.[7]
• Mobilise resources to address needs for basic equipment, specialised infrastructure, essential medicines, advanced treatment and a trained health workforce.[2][7]
• Strengthen resource-mobilisation frameworks, which are identified as lacking at global, regional and national levels.[2][7]

NCD services and treatment are characterised as costly, and service delivery is constrained by shortages of equipment, infrastructure, essential medicines and specialised treatment capacity.[2][7]The supplied text does not specify a quantified budget, costed implementation plan, unit costs, expenditure estimates, funding allocations by programme, financing-gap amount, economic assumptions or resource-mobilisation targets.[4][1][5][6][8][3]