Government is seeking to decentralise specialised ear, nose and throat (ENT) services to make them more accessible to patients outside major hospitals, health officials said.

This is part of efforts to integrate specialist care into rural district hospitals and primary healthcare facilities by increasing number of specialised health workers.

Dr Menelas Nkeshimana, Head of the Health Workforce Development Department at the Ministry of Health, said Rwanda has about 29 Ear, Nose and Throat (ENT) doctors serving a population of about 14 million, highlighting a shortage of specialists, particularly in rural areas.

He said the country had made progress in expanding specialised healthcare but continued to face challenges caused by a shortage of trained personnel.

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"In 1997, ENT started with two doctors. Today, there are around 29 for a population of 14 million. You can understand the heavy burden each of these doctors is carrying," he said.

The country has a target to quadruple the number of healthcare workers to meet the WHO recommendation of at least 4 healthcare professionals per 1,000 population density.

"If you look at Eastern Province, which has more than three million people, we have only one doctor," he said, describing the situation as a legacy of insufficient training in previous years.

He said Rwanda has prioritised ENT services under its 4x4 health workforce development programme, increasing student enrolment and expanding opportunities for specialist training.

The country has 10 ENT hubs, which provide specialised services while also serving as training centres for healthcare workers.

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Nkeshimana said the government expected the number of specialists to rise as more graduates complete their training and join regional hubs and level-two teaching hospitals.

The goal, he added, was to ensure that people could receive specialised ENT services closer to where they live, rather than travelling long distances for treatment.

By the year 2028, this ambitious plan aims to increase the health workforce by a total of 32,973 personnel.

Shortage of specialists affects health services

Dr Jean Claude Munyemana, Director General of Kibungo Level Two Teaching Hospital, said referral hospitals receive patients from several other hospitals, which increases their workload.

"Limited staffing and equipment create challenges in providing continuous services. Some equipment can only be operated by one trained staff member, meaning services may be interrupted when that person is absent," he noted.

He added that partnerships have supported screening activities, but hospitals still bear the cost of managing the patients identified through those programmes.

Need for increased screening

One 2025 study found that about 13 per cent of the 24,000 children screened for ear and hearing problems in primary schools in Gasabo District had ear-related conditions, highlighting the need to strengthen early diagnosis and treatment, according to Dr Kaitesi Batamuliza Mukara, Chair of the Scientific Committee of the Rwanda Otolaryngology, Head and Neck Surgery Society.

The findings of the study, titled "Addressing Pediatric Hearing Loss through School-Based Ear Care: Lessons from Gasabo District", were presented at a scientific conference on Sunday, 25 October.

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The screening project aims to raise awareness about ear and hearing health among learners, parents and educators, while equipping teachers to recognise early signs of hearing impairment in the classroom.

Dr Batamuliza said many ENT conditions could be identified and treated early at community level, but a shortage of trained personnel means many patients are referred to district and tertiary hospitals.

Most of 24,019 children screened in Gasabo had healthy ears. 86 per cent of right ears and 87 per cent of left ears appeared normal on examination. Earwax was by far the most common issue, affecting about 13 per cent of ears on each side. Foreign bodies were found in roughly 1 per cent of ears, infections in under 1 per cent, and eardrum perforations in about 0.1 per cent.

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Most problems could be treated on the spot, according to the study. Ear irrigation was the most common intervention (2,293 times, or 10 per cent of cases), followed by wax removal (9 per cent). Foreign bodies were removed in 161 cases and medication given in 115. Only 36 children (0.2 per cent) needed referral for further care.

Health experts stressed the importance of early detection and timely intervention, noting that expanding screening could reduce the long-term economic cost of delayed treatment while supporting children&039;s development.

The study recommends scaling up screening in schools and strengthening collaboration between the education and health sectors so that affected children are identified and referred for care.

It also suggests that community health workers help identify people with hearing problems, and that health workers be trained to use otoscopes to spot earwax, discharge and other visible conditions.

Cochlear implant services

Parents have praised cochlear implant services but called for specialised ENT care to be extended to rural district hospitals.

"We realised our child had hearing loss when he was eight months old, in 2020. After several hospital visits, he received a cochlear implant at King Faisal Hospital. Today, he can hear but still struggles to speak," said Jean Paul Ngabo, a parent.

The Lalla Asmaa Foundation, an organisation of Moroccan Prince Lalla Asmaa that supports deaf and hard-of-hearing children and young people, is providing cochlear implants in Rwanda.

"We are here not only to provide implants and hearing aids, but also to share our experience and collaborate with our Rwandan colleagues," said Prof. Abdelaziz Raji, Head of the ENT Department at the Mohammed VI University Hospital (CHU) in Marrakech.

"Rwandan ENT residents and doctors have joined us in the operating theatre to learn how to perform the surgery."

He said the team had carried out 50 cochlear implantations in Rwanda and would also provide 100 hearing aids for children with hearing loss.