Play audio version
Rwanda’s Bold Initiative to Transform Healthcare Accessibility for Persons with Disabilities
September 6, 2023
For decades, persons with disabilities in Rwanda faced significant challenges in accessing healthcare services. The country’s health centers often lacked the necessary accommodations. Physical, material and communication barriers, in addition to stigma against persons with disabilities and a lack of understanding among healthcare providers, were some of the obstacles. However, in 2017, the Rwanda Ministry of Health, in partnership with WaterAid and UPHLS (the Umbrella of Organizations of Persons with Disabilities in the fight against HIV/AIDS and for Health Promotion), initiated an ambitious plan to renovate outdated healthcare centers, prioritizing accessibility for persons with disabilities across the country.
The effort aligns with Rwanda’s 2021 National Policy on Disability and Inclusion, which outlines a specific objective of promoting access to health care and rehabilitation for persons with disabilities. The policy designates over 4.4 billion Rwandan francs (3.6 million US dollars) to the provision of disability-related healthcare services to persons with disabilities through 2024/2025.
Since 2017, the Ministry of Health and UPHLS have physically renovated dozens of health centers, targeting accessibility improvements for persons who are blind and/or persons who use canes and wheelchairs. The program will continue until all health centers in Rwanda are accessible to all persons with disabilities, with a goal of renovating six centers per year. As of August 2023, 30 of the 513 health centers in Rwanda have been renovated.
“Having access to health services to persons with disability in Rwanda is like dreams that we all wish to be true,” says Aimable Irihose, executive director of the Rwanda Organization of Persons with Physical Disabilities and Wheelchair Users. Widely held stigma against disability has contributed to the limited access to health services. “Persons with disability were hidden [so] that no one would know that a family has a person with disability,” he says.
In general, persons with disabilities are poorly served at inaccessible health centers, often deterring them from seeking medical assistance, says Irihose. As a result, some Rwandans with disabilities opt to take medicine on their own – without medical consultation – with potentially fatal consequences.
Rwandans with disabilities have been waiting for accessible health care for a very long time, says Irihose: “We are going to enjoy services [at] the renovated [health centers], and I hope that it’s going to give a significant change in service delivery.”
Donatien Bajyanama, health facility development specialist at Rwanda Ministry of Health and a point person for the promotion of inclusion and access to services for persons with disabilities, says that most Rwandan health centers and hospitals were built many years ago without the needs of persons with disabilities in mind. The project is now updating these facilities with accessibility as a priority, ensuring all surfaces are well-cemented, changing stairs into ramps, adding Braille signage and tactile indicators for blind persons, updating parking, and rebuilding bathrooms according to new building codes that include persons with disabilities. In accordance with the 2021 National Policy on Disability and Inclusion, advocates say the development of future building codes must involve the direct consultation of persons with disabilities.
All new health centers and hospitals will be built according to Rwandan building code, which was recently revised with accommodation requirements for persons with disabilities.
Typically, a health center is identified to be upgraded based on an assessment of its existing accessibility features and the number of persons with disabilities who use the facility, says Francois Xavier Karangwa, UPHLS executive director. Throughout the process, it is critical that health center leaders remain willing and flexible to work with UPHLS.
“We started with one upgraded health center in every province of Rwanda as exemplary of others, and we hope that persons with different physical disabilities and blind persons are enjoying services to the renovated centers,” says Bajyanama.
Christine Uwingabiye says the renovated health center she works at in Kigali-Gasabo has eliminated physical barriers to accessing care. They built a ramp at the entrance to the building, making services more accessible to persons with physical disabilities and to persons who are blind or have low vision. UPHLS also rebuilt the center’s bathrooms and parking to be accessible for wheelchair users, she says.
“It is really a good thing [for] the persons with disability, as they are entering every door without any barrier,” says Uwingabiye. “In addition, this renovation has eased our services, as we no longer lift up anyone; people with disabilities are accessing services without anyone’s help as [they required] before.”
Though the health center is now physically accessible, its signage and information still need to be more accessible to all persons with disabilities. Hospital staff should be trained in sign language, and prescriptions and other medical information should be made available in Braille, Uwingabiye says.
Karangwa says some of the challenges to renovating the health centers include insufficient funds for remodeling and limited participation from certain communities. Some local authorities and civilians are reluctant to support the project due to stigma against disability, believing the upgrades will only benefit persons with disabilities. Advocates working to make other spaces more accessible face similar challenges in Rwanda. Even some offices for some organizations of persons with disabilities (OPDs) are not accessible to all of their members.
Bajyanama stresses that widespread support and contribution are still needed to make health services fully accessible for Rwandans with disabilities. “This is a journey started to make accessible health services to [persons with disabilities] in our country,” he says. “If we remember that everyone is a candidate for disability, we should contribute and need more partners in this task.”
Francine Uwayisaba is a contributing writer with the Disability Justice Project and a field officer at Rwanda Union of Little People (RULP). At RULP, she is in charge of the organization’s communications. She writes grants, manages RULP’s social media, and composes articles and weekly updates for the website. @2023 DJP. All rights reserved.
News From the Global Frontlines of Disability Justice
For decades, Rwandans with disabilities faced significant challenges to accessing health care. Now the country has embarked on an ambitious plan to renovate all of its outdated facilities, with accessibility as a priority. Thirty health centers have been updated so far, changing stairs into ramps, adding Braille signage and more. “Having access to health services to persons with disability in Rwanda is like dreams that we all wish to be true,” says Aimable Irihose of the Rwanda Organization of Persons with Physical Disabilities and Wheelchair Users.
Terubeimoa (Ruby) Nabetari has been using the skills she learned as a composer of music and drama to help her organization, Te Toa Matoa, get their messages across about the rights of persons with disabilities in Kiribati. When she first became disabled from an accident, “I felt sad and confused … because I was well-known as a person who composed music and drama in my country,” she says. “But as time went on, I thanked God that I changed my mind and started to realize what I have to offer people with disabilities.”
DJP Fellow Melvina Voua is advocating for the full inclusion of Solomon Islanders with disabilities in all aspects of climate change adaptation and mitigation. “When the crisis or the disaster happen, we always find it difficult to evacuate or access or even get prepared or respond,” she says. “All … plans must be inclusive and not excluding people with disability, like when designing evacuation centers or developing policies for climate change or disasters.”
DJP Fellow Ari Hazelman is drawing on his region’s rich storytelling history to further the cause of disability rights. “When we think about our myths and legends that we have in our Pacific culture, that’s part of the stories that we grow up with,” he says. “So when you put it to the disability field, using the stories that we can document through the knowledge that we learn in this [DJP] workshop will help us to tell our stories and use those stories to make a positive change in our society.”
DJP Fellow Isoa Nabainivalu is a Deaf disability rights advocate for his country of Fiji. Since 2019, he has been focusing on advocating for the rights of one of the more marginalized groups in the Pacific – LGBTQI+ persons with disabilities. “First and foremost for us is for our members to come out, to feel comfortable, to know their rights and know how to use them in different spaces,” he says.
Faaolo Utumapu-Utailesolo is a program officer for the Pacific Island Countries with the Disability Rights Fund. She is a longtime disability rights activist in Samoa. “As an advocate, you get knocked down by things,” she says, “and you keep going because you know that there are other people with disabilities who need a lot of support and who will need you to be paving the way.”