Rwanda has spent three decades making significant progress in the fight against infectious diseases. Malaria, HIV and child mortality have all declined dramatically. But the country’s healthcare sector is changing. Non-communicable diseases (NCDs), including heart disease, cancer, diabetes and chronic respiratory diseases, are now responsible for a growing share of deaths.

In 2024, NCDs accounted for 47.7 per cent of deaths recorded in health facilities and 59.3 per cent of deaths occurring in communities, according to the National Institute of Statistics of Rwanda. The question is how Rwanda can act to prevent this growing burden from becoming an even greater threat to the health and well-being of people.

No longer a disease of old age

NCDs are often assumed to strike late in life, but the data challenges that assumption. Weight gain is rising, particularly in urban populations, while the effects of high blood pressure and blood sugar can accumulate silently for years before diagnosis.

This silence is compounded by a screening gap: only 47.9 per cent of adults have ever had their blood pressure checked, while 88.5 per cent have never had their blood sugar tested. Many Rwandans may therefore be living with undetected hypertension or elevated blood sugar, unaware until a stroke, heart attack or diabetic complication occurs.

The national NCD risk-factor survey (STEPS 2021–2022) offers a revealing picture. Some risk factors are improving: physical inactivity fell from 25.9 per cent to 5.6 per cent of adults, while tobacco use declined from 12.9 per cent to 7.1 per cent.

Yet other trends are moving in an unfavorable direction. Overweight increased from 14.3% to 18.6% of adults, while obesity rose from 2.8 per cent to 4.3 per cent. Kigali recorded particularly high levels, with 34 per cent of adults overweight and 12.1 per cent obese.

Diet is another concern. Adults consumed vegetables on an average of four days per week and fruit on two days, while average salt intake was 8.8 grams per day, well above the WHO recommendation of less than 5 grams. Alcohol use has also increased since 2013. As Rwanda urbanises and diets change, these risks require greater attention.

Rwanda already has important structures for addressing NCDs, including national strategies, primary healthcare services and a strong community health worker network.

The opportunity now is to use these systems more deliberately for prevention, early detection and long-term follow-up, not only when people become seriously ill.

The Finland experience

In the 1970s, Finland’s North-Karelia region had exceptionally high cardiovascular mortality. Instead of relying primarily on hospitals, health authorities launched a population-wide intervention involving local leaders, health services, schools, community organisations and the media.

The programme promoted healthier diets, reduced salt and saturated fat intake, encouraged greater vegetable consumption, and supported tobacco cessation. It also worked with food producers and manufacturers to make healthier choices more available. Importantly, the programme continuously monitored risk factors and mortality to assess progress.

Following the project, coronary heart disease mortality among working-age men fell by more than 80 per cent over the following decades, with changes in major risk factors accounting for much of the decline.

Rwanda does not need to copy Finland. But it can learn from its approach: NCD prevention works best when responsibility extends beyond the clinic.

Rwanda should strengthen routine NCD screening within primary and community-based care, particularly for blood pressure, diabetes, cancers and cardiovascular risk, while using community health workers to connect people to follow-up care. Prevention must extend beyond the health sector.

Health, agriculture, education, local government, the private sector and civil society should work together to make healthier choices easier, reduce excessive salt consumption, promote responsible alcohol use and create environments that support healthy living.

Rwanda has already demonstrated that coordinated action can transform health outcomes. The next task is to bring that same determination to diseases that often begin quietly, long before a patient reaches a hospital.

The writer is a global health specialist and healthcare mission curator at African Leadership University.