Kigali is not just the energetic hot spot that gives the Rwandan economy a good name – it is also the attitude that has created one of the most remarkable malaria and NTD success stories that Africa has seen to date. African political will has played a crucial role in the fight against these two diseases that have plagued the continent for decades. In a region long ravaged by these illnesses, the remarkable results achieved in Kigali – the democratic heart of Rwanda – serve to illustrate just how decisive that will can be. This article explores how political will led to accelerated action against these two public health scourges, illustrates the strategies that were applied, and illustrates how they played an important role in the achievement of these remarkable results.
The Burden of Malaria and Neglected Tropical Diseases
Malaria and NTDs remain major health burdens in many regions of low- and middle-income countries (LMICs) such as Rwanda.
Malaria is a disease that is caused by a parasite transmitted by the Anopheles mosquito. Its symptoms are fever, chills, and flu-like illness that can sometimes be fatal if not properly treated. In more than half of sub-Saharan Africa, control measures have failed and malaria is the major cause of morbidity and mortality.
Some examples of NTDs are lymphatic filariasis, schistosomiasis, and soil-transmitted helminthiasis – all diseases common in marginalized populations. NTDs cause a range of chronic health problems, which in turn can compromise quality of life and economic productivity.
Kigali’s Political Will: A Driving Force
1. Strategic Vision and Policy Framework
And addressing malaria and NTDs is part of Kigali’s broader commitment and strategic vision. The policy is there. The commitment is there. The vision is there, too. Rwanda has robust policies for tackling disease control and health systems strengthening, through multi-sectoral approaches.
- National strategy: Rwanda has a comprehensive national strategy to fight malaria. It contains the provision of insecticide-treated nets (ITNs), indoor residual spraying (IRS), and prompt treatment with artemisinin-based combination therapies (ACTs). The strategy is revised cyclically with new evidence and technologies.
- The National NTDs Strategic Plan also aims to control and eliminate neglected tropical diseases (NTDs) through mass drug administration (MDA), health education, and community engagement
2. High-Level Political Commitment
For health initiatives to have their most impact, you need political commitment at the highest levels of government. Rwandan leaders – from President Paul Kagame to the prime minister and the national assembly – especially on malaria, but on NTDs as well, have publicly committed to the campaign. High‐level political commitments lead to resource allocations, supportive policies, and international aid.
- Public Statements and Advocacy: High-level political leadership entails appealing to the public about the critical importance of disease control. Government leaders can generate important discussions, awareness, and political momentum for health programs, domestically and internationally.
- Integration into Development Goals: The fight against malaria and NTDs is integrated into existing national development goals. This placement within overarching national economic and social development strategies makes health initiatives a priority within the broader national framework.
3. Funding and Resource Allocation
Only adequate funding guarantees effective control of the disease. Kigali shows its commitment to increasing investment in health infrastructure and programs.
- Domestic Funding: Since 2011, domestic spending in Rwanda has markedly increased especially on NTDs and malaria control measures, contributing toward medical and support supplies, as well as training of health workers and implementation of intervention strategies.
- Kigali has grabbed at international partnerships and funding with both hands By establishing a government system that controls most of the country’s entry routes, Kigali has been able to grab at international partnerships and funding with both hands. First, persuading international organizations like the Global Fund, the World Health Organization (WHO), and countless NGOs to provide additional resources and technical support has been relatively easy.
4. Strengthening Health Systems
A sound health system is the underlying precondition for making disease control programs function effectively. Kigali’s political will is fronted in health system strengthening, reflected in the triad of:
- Increased capacity to detect, treat, and manage NTDs. 3. Infrastructure Development: Investments to improve infrastructure development (e.g., building or upgrading healthcare facilities, laboratories, and diagnostic equipment) strengthen the capacity to detect, treat, and manage malaria and NTDs.
- Human Resources: Efficient and reliable training and capacity-building programs for healthcare workers help to ensure that they are equipped to implement control measures.
- Two: Better and more focused health information systems can improve epidemic response. Robust surveillance, virus monitoring, clinical data collection, and social network data are key elements for an improved response to epidemics. Big data might indeed be our ticket to safety.
Strategies and Initiatives in Kigali
1. Malaria Control Programs
- Insecticide-Treated Nets (ITNs): In Kigali, distribution of ITNs to people has become their top priority to suppress mosquito bites. Rwanda’s government organizes various mass distribution campaigns of ITNs each year, particularly pregnant women and children under five who are most susceptible to malaria.
- Indoor Residual Spraying (IRS) kills malaria-transmitting mosquitoes when they come into contact with treated surfaces in buildings. Government-implemented IRS programs have significantly reduced malaria transmission in endemic areas.
Case Study: The Impact of ITNs and IRS in Kigali
Here in Kigali, combining ITNs with IRS has gone a long way to push malaria off the agenda. Fewer people get the disease and die from it.
2. NTDs Control Initiatives
- Mass Drug Administration (MDA): MDA constitutes anti-helminthic campaigns that treat large communities against parasitic diseases. In Kigali, MDA takes the form of large-scale treatment against two major NTDs: lymphatic filariasis and soil-transmitted helminths.
- Community Health Education: Health education programs help raise awareness about NTDs, and the importance of preventive measures. In Marinduque, many community health workers are women who serve as rural health workers and are highly respected in their communities. They disseminate information about good hygiene and sanitation and encourage people to participate in community MDA campaigns when they return.
Case Study: MDA Programs in Kigali
MDA programs have brought the prevalence of NTDs down to zero. For instance, large-scale deployment of MDA has led to a drastic drop in lymphatic filariasis, which is now on track to be eliminated.
3. Research and Innovation
- Local research: The government supports local research and operational studies to improve the diagnosis, prevention, and treatment of NTDs and malaria. This research can be undertaken by research institutions or universities, to come up with new tools, treatments, and strategies that fit the local context.
- Innovation is also taking a masterclass in Vector/Disease Control Story 1.6An innovative city puts efforts into the promotion and development of new approaches for disease control: These include new insecticides, genetically modified mosquitoes, and novel diagnostic tools for identifying and ways of controlling people infected with such diseases. The federal government actively supports and financially promotes the efforts of researchers. Kigali is currently funding innovative approaches to developing new ‘smart’ vaccines for disease control.
Case Study: Research Collaboration in Kigali
There have also been collaborations between Rwandan research institutes and international partners to develop vector control technologies, most notably new insecticide formulations and new insights on mosquito genetics that could potentially improve malaria control efforts.
Impact of Kigali’s Commitment
1. Reduction in Disease Burden
These commitments by Kigali to malaria and NTD control have borne fruit, with reductions in the burden of disease. Malaria cases, deaths, and improved surveillance have all declined, as have NTD prevalence.
2. Enhanced Health Outcomes
This is evident in Kigali: political will, combined with effective disease control programs, have led to significantly better health results for people living there. Decreased disease incidence means improved quality of life, greater productivity, and better health.
3. Strengthened Health System
The attention to health system strengthening therefore not only contributes to a health system with a better ability to cope in the long run, but it is also a requirement for the effective delivery of disease control intervention now and for a better capacity to respond to future health threats.
Future Directions
1. Sustaining Political Will
However, political will must be maintained to sustain this progress. Maintaining high-level support and public advocacy as well as integrating disease control into wider development strategies will be key to ensuring success.
2. Addressing Emerging Challenges
As the disease shifts, the city will need to get out in front of changing patterns through novel programs and new forms of research and innovation. Now that the city is aware of its place in the landscape of mosquito behavior, it’s up to the people of Kigali to bring the mosquitoes firmly back under human control.
3. Expanding Community Engagement
The embracement of community engagement and participation will certainly make these initiatives for disease control more effective, as it would empower local communities to take a more active role in health interventions.
The story of Kigali’s fight against malaria and neglected tropical diseases illustrates what is possible when politicians join forces with an improved and practical public health approach to plan and implement a strong prevention and control program. With clear policy decisions, high-level political support, investment in staff and equipment, and innovation in implementing malaria and NTD programs, Kigali has demonstrated the transformative role of political will in public health. As Kigali continues to fight malaria and neglected tropical diseases, it needs to take advantage of the lessons learned from success and failure to ensure its program remains at the cutting edge of malaria and NTD prevention and control efforts. As other regions with higher prevalence face continuing challenges, Kigali’s arsenal of lessons and tools to fight these diseases could serve as a model and source of encouragement.
