On a quiet weekday morning in Kigali, Marie-Chantal Byukusenge reflects on a journey that once felt uncertain, expensive and emotionally draining.

Between 2019 and 2020, she travelled to India in search of a kidney transplant.

At the time, her decision was far from unusual. For years, Rwandan patients in need of complex procedures had accepted that some aspects of care, especially specialised diagnostics lay beyond the country’s borders.

What disrupted her plans, however, was not the surgery itself, but a missing laboratory test.

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A crucial compatibility test had not been carried out before she left Rwanda. When doctors in India eventually performed it, the results showed that the donor and recipient were not compatible.

The procedure could not go ahead. Her trip ended abruptly, after significant spending on flights, accommodation, medical consultations and hospital coordination.

"When I reached India, they told us we were not compatible based on a test that had not been done before I left,” she recalls. "That meant I had to return home. The expenses were already incurred.”

The setback revealed a deeper truth about healthcare systems: advanced treatment is only as reliable as the diagnostics that come before it. Surgery may command headlines, but laboratory precision determines eligibility, risk, timing and outcomes.

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Relief closer to home

When Byukusenge returned to Rwanda, she made a discovery that changed her trajectory. The specific compatibility test she needed had since become available locally.

"When I came back, I found that the test I needed was now being done here. I gave my sample at Cerba Lancet Rwanda and waited about two weeks,” she says. "When I returned to India with the results, they repeated the test there — and the results were exactly the same.”

That confirmation mattered. "Some people think results from Rwanda cannot be trusted,” she adds. "But in my case, they repeated the test in India and the findings were identical.”

For Byukusenge, the experience was not only about avoiding another wasted trip. It was about confidence that advanced diagnostics could be accessed locally and that those results could stand up to international scrutiny.

Her story reflects a broader, quieter shift unfolding within Rwanda’s healthcare system. Over the past decade, laboratory medicine has steadily evolved from a background service into a central pillar of clinical decision-making.

From oncology diagnostics to transplant monitoring, viral load testing to antimicrobial resistance surveillance, the laboratory is increasingly where treatment decisions begin.

Building a diagnostic backbone

Cerba Lancet Rwanda began operations in 2015, entering a landscape where most laboratory services were embedded within hospitals.

Independent, specialised diagnostic centres were few, and complex tests were often sent abroad at considerable cost and delay.

Ten years on, the laboratory reports having conducted more than 1.4 million tests for roughly 480,000 patients. For General Manager Protais Bizimana, the figures represent more than growth in volume.

"Over the past decade, we have performed more than 1.4 million tests,” he says. "That represents hundreds of thousands of patients whose clinical decisions were guided by laboratory evidence.”

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The defining shift, he explains, was structural. "Traditionally, laboratories operated within hospitals or clinics. We introduced an independent, specialised laboratory model focused purely on diagnostics. That meant heavy investment in quality systems, advanced testing platforms and skilled personnel.”

That investment required patience. According to Laboratory Manager Valens Karenzi, building systems capable of international accreditation was a gradual process.

"We started in 2015, but it took five years to reach the standards we have today,” he explains. "We invested in staff training, acquiring advanced analysers, calibrating equipment, validating test methods and implementing strict quality management systems.”

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In 2020, the laboratory achieved ISO 15189 accreditation through the South African National Accreditation System, signalling that its processes met internationally recognised standards.

"Accreditation means our testing methods, controls and reporting meet global benchmarks,” Karenzi says. "If a quality control fails, we stop processing patient samples until the issue is resolved. Accuracy cannot be compromised.”

From referrals abroad to confidence at home

Advanced diagnostics have been particularly transformative in oncology and renal care — areas historically associated with foreign referrals.

"For tumour diagnostics, we were among the first in Rwanda to introduce advanced platforms capable of diagnosing different cancers,” Karenzi says. "Many facilities now refer complex cases to us, especially for histopathology.”

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Bizimana notes that some patients previously travelled abroad solely for laboratory confirmation.

"We have cases where patients spent up to €5,000 travelling to India or Europe for a test that we now offer locally for around Rwf30,000,” he says. "That changes both cost and access.”

Beyond finances, local diagnostics bring continuity. Follow-up becomes easier, repeat testing becomes practical and treatment adjustments can be made without international travel.

For kidney transplant recipient Viateur Karerangabo, routine monitoring is part of daily life. He underwent his transplant in India but now conducts follow-up tests in Rwanda.

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"When you are living with a transplant, follow-up tests are not optional,” he says. "You need reliable results, and you need them on time.”

A private lab within a national system

The growth of private laboratory capacity has occurred alongside major reforms in Rwanda’s public laboratory network.

Dr Isabelle Mukagatare, Senior Biomedical Health Expert and Head of Biomedical Services at the Rwanda Biomedical Centre, says the changes are part of a wider transformation of the health system.

"In recent years, Rwanda’s laboratory services have evolved significantly,” she says. "We have improved infrastructure, strengthened quality systems, enhanced workforce skills and decentralised advanced testing.”

More than 20 facilities now perform advanced molecular testing, while viral load testing hubs for HIV monitoring have been strategically distributed nationwide, reducing turnaround times.

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"When clinicians receive results faster, they can make quicker decisions about treatment,” Dr Mukagatare notes. "That directly improves patient outcomes.”

Parallel investments in antimicrobial resistance surveillance have expanded bacteriology and susceptibility testing at district level, a critical step in addressing drug-resistant infections.

The power of networks and persistent challenges

As part of a network operating across 14 African countries, Cerba Lancet Rwanda can process rare tests regionally while keeping patients at home.

"Some tests are requested only once or twice a year,” Bizimana explains. "It doesn’t make sense to install every platform locally. Instead, we process those samples within our network, and the patient continues care here.”

Despite progress, challenges remain particularly around pricing. Laboratory tariffs were set in 2017 and have not been adjusted to reflect rising operational costs, most of which are tied to imported equipment and reagents paid for in foreign currency.

"Quality diagnostics are capital-intensive,” Karenzi says. "But even under financial pressure, quality cannot be compromised.”

Trust, evidence and a changing mindset

Technology and decentralisation are reshaping how patients interact with laboratories. Digital reporting now allows results to be shared electronically, reducing unnecessary travel and speeding up consultations.

Expansion beyond Kigali including facilities in Musanze and Rubavu is improving access outside the capital.

For patients like Byukusenge, the transformation is deeply personal.

"In my case, the result from Rwanda was repeated abroad and matched exactly,” she says. "That gave me confidence.”

Years of dependence on foreign referrals shaped scepticism toward local services. But as results prove consistent, that mindset is slowly shifting.

"When people know accurate testing is available closer to them, they are more likely to seek care early,” Dr Mukagatare says. "That strengthens trust in the system.”

Laboratory medicine rarely draws attention like surgery or new drugs. Yet it underpins both determining transplant eligibility, cancer staging, infection control and chronic disease monitoring.