Kigali - When the fourth COVID-19 wave hit the country in early 2022, Rwanda went through a surge in the number of new cases with a spike in the number of deaths. To avoid reliving the experience seen during the third wave with a very high number of deaths daily in July 2021, something had to be done, but what? Rwanda’s response to the COVID-19 pandemic had already been rapid, cross-cutting, structured, and well-coordinated.  

Meanwhile, away from the official communication platforms of the National COVID-19 Joint Task Force,  a thought-provoking conversation was taking place on the WhatsApp group of the Rwanda Medical Association (RMA). With over 200 Doctors discussing this health crisis, a solution had to be found. This is how Operation Save the Neighbor was conceived. 

“There are calls that nothing can keep you from responding to, not even a hard-earned, long-awaited, and peaceful retirement. When you are a medical professional and there is a Health emergency in your community it is your responsibility to be part of the solution.” Dr Emile Rwamasirabo said.

Dr Rwamasirabo is a Urological Surgeon, recipient of the American Society of Reproductive Medicine (ASRM) Arnold P Gold Award for Humanism in Medicine, and a consultant for the World Health Organization (WHO). Like the other doctors in RMA he was paired with community Health workers (CHWs) and assigned COVID-19 patients to follow up on in Home Based Care.

The idea behind Operation Save the Neighbor is simple. It is a cost and time-efficient way to support the existing structure to save lives at the community level rather than further burdening already overwhelmed hospitals. With over 2500 cases in 501 villages, Gasabo District had the highest COVID-19 infection rate in the country. The task at hand was challenging but a comparative mapping of patients versus Doctors’ geolocation showed that there was a possible solution. Doctors took on an off-duty task that had to be performed after hours within a walking distance. The approach changed from one CHW looking after 100 people with COVID-19 to a team with doctor neighbors contributing to the care.

 “As CHWs our knowledge and skills are limited and the population is aware of that but knowing we could just pick up the phone and ring a renowned Doctor for support boosted our confidence and created trust in the population. The support system built around us made the crisis bearable.” Rutagarama Wendislas said.   

Rutagarama, the Lead CHW in Gisozi Sector, recalls an acute case he managed with the help of a doctor: “It really felt like we were a team. The doctors were helpful in the analysis of the information we shared and made quick decisions when they noticed the patient could plunge into critical condition.” 

Operation Save the Neighbor was launched in Gasabo with the support of the District officials and the Joint Action Development Forum (JADF), a multi-stakeholder platform ensuring sustainable socio-economic development and improved service delivery for Rwandan communities through active participation, dialogue, and accountability. Within 2 Days, CHWs were trained, equipped, and guaranteed the support of high-profile Doctors. 

This was a first and it helped to manage an unpreceded situation. CHWs could now check the vital signs of patients at home and monitor the percentage of oxygen in their blood using pulse oximeters. A daily report was shared at 7 PM on the RMA Whatsapp group. Two weeks into the Operation, Doctors noticed dramatic changes. Visits had increased from 30% to 92% coverage and 82% of the patients in Home Based Care had had their oxygen saturation monitored regularly. This allowed early referrals and a decrease in the number of deaths. 

“The greatest asset of Rwanda’s health system is its people and an innovative spirit. This is a country with limited resources and yet it is making it to the top of a number of global rankings. This is facilitated by the country’s belief in home-grown solutions. As a result, WHO finds it easier to provide technical support to the country in meeting its national objectives and targets. We hope that Operation Save the Neighbor will be replicated elsewhere, even beyond crisis times” said Dr Brian Chirombo, WHO Representative in Rwanda. 

In Sept 2020, COVID-19 Home Based Care (HBC) was introduced to relieve pressure on Health Facilities. Guidance on home-based COVID-19 care issued by WHO was adapted to the country context with technical support from the WHO country office. The guidelines produced were instrumental in shaping the country’s response. As of end-March 2022, 98% of cumulative COVID-19 confirmed cases in Rwanda are being treated from their homes.