Ebola virus disease preparedness and response in Rwanda

World Health Organization Regional Office for Africa

The current outbreak of the Ebola Virus Disease (EVD) in the Democratic Republic of the Congo (DRC) poses a high risk of introduction into neighbouring countries, including Rwanda. An Ebola outbreak in eastern Democratic Republic of Congo is likely to spread over tens of kilometres.

Countries with land borders adjoining the DRC have been advised by the World Health Organization (WHO) to urgently strengthen their surveillance and alert systems for early detection of potential cases, and overall preparedness for timely and effective response.

As part of prevention, Rwanda has increased awareness and community engagement by using different communication channels, such as television, radio, and billboards in public places, including main roads, borders, and airports. Also, interpersonal communication in health facilities, hotels, and public gatherings is ongoing.

The Head of Division Epidemiology and Surveillance Response, Dr José Nyamusore, says Ebola case management training for medical staff at health facilities, security organs, Red Cross volunteers, and community health workers is in place. Meanwhile, Ebola screening is ongoing at all border posts to Rwanda, including the high risk zones.

The Rwandan National EVD Preparedness and Response Plan was consolidated by the Government, the Ministry of Health, and national experts namely from the Epidemic Surveillance and Response Division, National Referral Laboratory, Rwanda Health Communication Centre (Risk communication and Community Engagement), University Teaching Hospitals (Clinicians and IPC), Gisenyi District Hospital, the Directorate General of Immigration and Emigration) and various key partners such as the CDC Country Office and the Rwanda Red Cross. From WHO's side, the WHO Regional Office for Africa (AFRO), the departments of Country Health Emergency Preparedness (CPI), Emergency Management (EMO) and the WHO Country Office for Rwanda are acting in synchronized collaboration to scale up the efficiency of joint interventions.

A number of activities and field interventions are being undertaken including continual monitoring and assessment of high risks zones, namely Rusizi, Burera, Gicumbi Nyagatare Districts, the Rwandan capital Kigali (Gatsata District) and Rubavu (Rugerero District), where a functional Ebola Treatment Center has rapidly been implemented.

The support included capacity building and training via the deployment of a Rapid Response Team (RTT) Training. It was provided by AFRO's Health Emergency Programs (WHE), EVD experts from Sierra Leone, Kenya, Gambia and WHO Lyon. The training was attended by the Ministry of Health, Rwanda Health partners and WHO Country Office Risk Communication and Community Engagement Team. Its objective was to evaluate knowledge, assess gaps, and provide the needed capacity for National Risks Response. An operational RRT team was later deployed in the high risk zone of Rubavu for review and finalization of specific laboratory Standard Operation Procedures (SOPs). They provided technical support on the adaptation of SOPs in collaboration with the Ministry of Health.

In terms of surveillance, laboratory and epidemiology, the inventory of essential laboratory materials for sample collection, transport, and testing has been reviewed with the National Reference Laboratory. Local suppliers were also contacted to assess the local availability of the material. Regarding case management and IPC, WHO's current PPEs stored in Rugerero/Rubavu were declared adequate to be used for national preparedness and response. Finally, support and strengthening surveillance activities at points of care, POEs, community levels and laboratories have been undertaken and joint activities have been put in place by WCO and the MOH to scale up preparedness and response at the community level.

The Emergency Operation Center (EOC) and the WCO Multi Sectoral Risk Communication and Community Engagement Task Team are operating from Kigali, in tight collaboration with an Incident Manager deployed from WHO Head Quarters, an EVD preparedness specialist, and a logistician who helped define EVD Preparedness Key Performance Indicators, notably in the sectors of multisectoral partnerships, RRTs, surveillance for early detection, laboratory diagnostic capacity, case management including safe and dignified burial, risk communication, social mobilization and community engagement. The team is also collaborating with an IPC specialist who conducted an assessment of the RUBAVU Health Center, the Risizi and District and the Refugees center (Nyarushishi transit center). This assessment resulted in tailored technical advice on the zoning (red & green zones) of patients and ambulance entries and exits, hand hygiene and foot bath points, human resources, and medical and equipment supply requirements.

For now the Rwandan two border districts with the DRC currently at risk are namely Rubavu and Gisenyi as well as the urban district of Kicukiro, where an international airport is located. However, the country has the following existing safety locks: a robust coordination mechanism for disasters and other public health emergencies, a multi-hazard public health preparedness and response plan, and an updated and budgeted national EVD preparedness and response plan.

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