2014: The highs and lows in the health sector

The year 2014 will pass as a transformative one for the health sector. It was peppered with disease eradication and general wellbeing campaigns, commissioning of health facilities, hosting of global conferences and foreign medical teams, among others.
Liberian nurses remove an Ebola victim from a street on the outskirts of Monrovia, Liberia in August last year. Ebola ravaged the continent like never before. (Net photo.)
Liberian nurses remove an Ebola victim from a street on the outskirts of Monrovia, Liberia in August last year. Ebola ravaged the continent like never before. (Net photo.)

The year 2014 will pass as a transformative one for the health sector. It was peppered with disease eradication and general wellbeing campaigns, commissioning of health facilities, hosting of global conferences and foreign medical teams, among others.

But that is just as far as Rwanda is concerned. A peek into the distance, however, reveals some scenarios hard to fathom. What with Ebola wreaking havoc in West Africa and, for the first time in history, the haemorrhagic fever reached the US and parts of Europe.

Back home, last January saw the launch of the second phase of the 1,000-Day Malnutrition Campaign, a three-year initiative seeking to improve feeding among children under five, pregnant and lactating mothers, as well as school going children, to reduce morbidity and mortality related to malnutrition.

While the first phase, which started in September, last year, aimed at creating awareness about the programme, the second one which lasted six months, saw the start of real work.

“For instance, in March alone, 91 per cent of children under five and women who had recently given birth got vitamin A drugs, while 94 per cent of children in the same age bracket got deworming drugs. Other nutrition supplements given out included zinc, iron and folic acid,” said Alexis Mucumbitsi, the head of nutrition department at the Ministry of Health.

The third phase, a 26-month exercise, launched in July aims at helping parents understand their stake in fighting malnutrition, ensuring that every school has special lessons on nutrition, besides introducing a demonstration garden and livestock farm.

The entire malnutrition campaign, expected to end in October 2016, is a welcome move considering that stunted growth stands at 44 per cent for children under five, way above the World Health Organisation’s minimum target of 20 per cent.

Arguably, one of the best things to happen to the health sector in the country during 2014 was the drastic measure to help cut the red tape in distribution of medicines from the central medical store to the various health facilities countrywide, when the Ministry of Health started rolling out a web-based drug distribution system in March.

Some 42 district hospitals, 30 district pharmacies, five referral hospitals and over 400 health centres are today connected to the Electronic Logistics Management Information System (eLMIS). This has not only reduced bureaucracy in drug distribution but also improved efficiency in delivery as well as curbing loopholes that would see abuse of resources thrive.

“In the past, it would take about two weeks to get deliveries from the central medical store to a health unit, but now it takes only two days,” Clement Rurangwa, the director of Bugesera District pharmacy, said.

These innovations were soon followed by the commissioning of a multi-million modern central medical store in May, an important element in health logistics.

The mega structure, located in the Kigali Special Economic Zone is not only spacious but also fashioned to allow mechanisation and technological development, resulting in less human contact with medical supplies.

The facility that cost Rwf1.4 billion has seen the total number of main medical warehouses countrywide reduce from 10 to three.

The year also saw various health units improve in accreditation. For instance, by the end of November, the National Reference Laboratory (NRA) had acquired a five-star status following a rating done by the East Africa Public Health Laboratory Network.

The development, which made  the facility move from the three-star rating it held last year, also saw five other satellite (upcountry) laboratories, including Gisenyi, Gihundwe, Byumba, Nyagatare and Kibungo, attain four-star status.

Officials said the position makes the laboratory a world class facility with ability to host international clinical trials and operational research once accredited by global assessors. The ranking was done in line with the World Health Organisation standards check list.

Ebola shakes the world

In December 2013, some patients in West Africa tested positive for Ebola haemorrhagic fever. It looked like an isolated case, but the most deadly disease was just incubating slowly.

In March 2014, it struck with the force never seen before. By December, WHO estimates showed that more than 7,500 people had succumbed to the virus that kills within days of infection and has no cure.

Medics, including doctors, constituted hundreds of casualties in Sierra Leon, Liberia and Guinea.

The epidemic spilled over to several West African states such as Senegal, Nigeria, among others. Then some cases were reported in northern DR Congo, but it was the spill-over to the Western world that saw attention jerk to effect.

For the first time in the history of the haemorrhagic fever, the disease spread to the US, Europe and, within the same week, cases were being reported in London.

World over, awareness about precaution were heightened as many countries took drastic measures to try and protect their citizens from the disease. Several airlines, including national carrier RwandAir, briefly suspended flights to the Ebola-affected countries.

The Ministry of Health was fast in taking measures, including at one point making a decision to even screen US citizens entering the country. Screening centres were erected at all border points, Kigali International Airport, Kanombe, and more than 3,400 healthcare workers were trained in handling the deadly disease in case of an outbreak by the end of October.

The Ebola burden saw scientists spend sleepless nights in the laboratories to try and find a cure. By October, vaccines were being tried on some patients with varied degrees of results.

This week, WHO announced that millions of doses of experimental Ebola vaccines will be produced by the end of 2015, adding that several hundred thousand would be produced in the first half of the year. WHO also said the vaccines could be offered to health workers on the frontline in West Africa as soon as December 2014.

In response to the largest epidemic of the disease in history, the WHO is accelerating the process of vaccine development. It normally takes years to produce and test a vaccine, but drug manufacturers are now working on a scale of weeks.

Two experimental vaccines, produced by GlaxoSmithKline (GSK) and the Public Health Agency of Canada, are already in safety trials. The GSK vaccine is being tested in Mali, the UK and the US. Research on the Canadian vaccine is also under way in the US with further trials expected to start in Europe and Africa soon.

Well, let us hope the cure for Ebola is found sooner. That should be one of the priority areas for scientists since having another incurable deadly disease like HIV/Aids that has wrecked havoc on the planet for  the three decades is the last thing one would want to imagine.

Given the scale of the current Ebola scourge, and knowing that plagues have a tendency to lie dormant for several years before they find themselves in our midst again, finding a cure in 2015 should be the penultimate test.

The plague’s devastation of West Africa and its spread to the Western world can only signal that its reoccurrence in the near future.

Youth march to mark International Condom Day in 2013. (File)

Any Aids cure soon?

As scientists peer into several equipment containing test specimens in their quest to find the cure of Ebola, those aligned to the HIV/Aids cause entered the New Year thinking of how they can make a breakthrough as far as the HIV/Aids cure is concerned. It is beginning to look promising, especially with what was hailed as the most significant breakthrough against the virus in a generation.

Scientists managed to produce Truvada, a drug that provides pre-exposure prophylaxis, a new HIV prevention method for people without the virus, but are at substantial risk of getting it. The drug is said to reduce risk of infection by up to 93 per cent.

The pill contains two medicines, Tenofovir and Emtricitabine, both used in combination with other medicines to treat HIV. When an individual is exposed to the virus through sex or injection, these medicines can work to keep the virus from establishing a permanent infection.

Truvada can be combined with condoms and other prevention methods to provide greater protection, but those taking the drug must get the approval of their doctor.