The upgrade of Ngarama District Hospital in Gatsibo District is 70% complete, according to the hospital director, Dr Jean Bosco Nzambimana.

He was speaking during a visit by the minister of state for health Dr Yvan Butera on September 9.

The upgrade of the hospital is expected to cost Rwf15 billion, as previously announced.

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Butera said the hospital could become a teaching hospital after the upgrades are completed.

"We want the hospital to become a teaching hospital. That is why intensive care unit rooms should be ensured amid the ongoing construction works,” he said.

Intensive care units (ICUs) are specialised hospital units for patients who are seriously ill or need close monitoring and advanced medical care.

Due to the lack of such units at the hospital, patients used to be referred to other hospitals.

The Ministry of Health is upgrading various hospitals to the level of university teaching hospitals.

Hospitals already included in the initiative are Ruhengeri, Kibungo, Rwamagana, Kabgayi, Butaro, Kibogora, Kibagabaga, Nyamata and Byumba.

The new university teaching hospitals will join five existing ones: University Teaching Hospital of Kigali (CHUK), Rwanda Military Hospital, University Teaching Hospital of Butare (CHUB), King Faisal Hospital and Neuro-Psychiatric Hospital Caraes Ndera.

The efforts to train more health professionals are in line with the National Strategy for Health Professions Development (2030), which seeks to improve access to high-quality health services in the country.

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"The number of university teaching hospitals has increased from around five in the past to 15 currently. We want more university teaching hospitals so that people can access specialised health services locally without going to other hospitals,” he noted.

These new facilities will not only serve patients but also help train the next generation of Rwandan health professionals, he said.

Maternity ward at Ngarama Hospital complete

The first phase of the Ngarama District Hospital upgrade, which focuses on the maternity ward, is now operational.

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The move expands the hospital’s maternity ward capacity from the current 36 beds to 140 beds, nearly quadrupling its capacity.

The first phase was estimated to cost Rwf4.8 billion, while the second phase, which will cover hospital infrastructure other than the maternity ward, is projected to cost Rwf10 billion.

Serving refugees

The hospital upgrade is part of the Jya Mbere project, which involves the Ministry of Emergency Management and aims to improve access to basic services and economic opportunities for both refugees and host communities, while also supporting environmental management in targeted districts.

The hospital, which serves both the host community and more than 15,000 refugees in Nyabiheke Camp, had ageing infrastructure that required urgent renovation and expansion.

Health system digitisation

On Wednesday, the State Minister also toured Mimuri Health Centre in Nyagatare District after visiting health facilities in Rwamagana District on Tuesday.

He will also visit health services in Musanze and Gakenke districts.

Butera said health system digitisation is at 90%.

"We are at 95% in training community health workers on the digital system, with the remaining 5% being those from Gatsibo. The digitised system has reduced the time needed to consult and serve a patient from 30 minutes to just a few minutes,” State Minister Butera said.

Vedaste Nsengiyumva, the head of Mimuri Health Centre, which serves about 20,000 people, said the facility has gone paperless in terms of service delivery through three systems: Electronic Medical Records (EMR), eBuzima and cEMR.

These systems are designed to digitise the health system, move away from paper records and improve patient care at all levels.

eBuzima is an electronic medical record system used at health-centre level.

Community health workers (CHWs) use cEMR to register households, record local treatments and coordinate patient referrals directly with primary health centres.

For years, much of the CHWs’ work relied on paper registers.

Community health workers across Rwanda are replacing paper registers with the Community Electronic Medical Records (cEMR) system, strengthening digital health services for mothers and children.

"Currently, we only record patient information during consultation and registration in the system, which takes one minute, while it could take five minutes on paper. If we receive between 80 and 120 patients daily, it could take a long time. There is also cashless payment, which has reduced long queues,” he said.

However, he said the three systems need to be integrated to further improve services.

"There is a need for interoperability among the three systems. During referrals, it can be easier to track records at every level without registering a patient again,” he said.

Butera pledged that the three systems would be integrated to also ensure counter-referrals, where a patient who has been referred to a higher-level health facility is sent back to the original or lower-level facility for continued treatment or follow-up care.

The rollout of cEMR is intended to strengthen digital health systems and improve the way community health data supports decision-making and service delivery.

Every day, community health workers walk from one household to another, checking on pregnant women, monitoring children’s health and supporting families with information on nutrition, disease prevention and referrals to health centres.

Smartphones have been provided to community health workers.

"We have the smartphones. We were trained on some of the services they can help with, but have not been trained on others,” said Leopord Uzamukurikiza, a community health worker in Gatsibo.

At least 58,567 community health workers are expected to have been trained and to be using the system by the end of 2026.

The system is expected to improve real-time data use, decision-making, and the quality and continuity of maternal, newborn and child health (MNCH) care.

How cEMR operates

For years, much of the CHWs’ work relied on paper registers.

Each service had its own register: one for pregnancies, one for newborn follow-ups, another for childhood illnesses, and others for nutrition monitoring and referrals.

During household visits, CHWs often carried several registers to record data.

As registers accumulated, finding past information during follow-up visits took time.

Monthly reporting meant manually counting and summarising entries across multiple books.

Health-centre supervisors often had to wait for paper reports before they could review community health data.

The Government of Rwanda therefore introduced the Community Electronic Medical Records (cEMR) system to improve how community health information is recorded, shared and used.

Through cEMR, CHWs can now record services directly on smartphones.

Instead of using multiple paper registers, information on pregnancies, child illnesses, nutrition and follow-ups can be entered into one digital system.

The mobile application allows CHWs to register households, record services and retrieve information during follow-up visits, helping them manage their workload more efficiently.

It also enables health-centre supervisors to review information earlier and provide targeted support when needed.