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with Disabilities in the fight against HIV/AIDS and for Health Promotion), initiated an ambitious plan to renovate outdated healthcare centers, prioritizing accessibility for persons with disabilities across the country.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
DJP mentor Kishor Sharma is known for his long-term photography and film projects exploring community and change. Over the last 12 years, he has been documenting the nomadic Raute people in mountainous Nepal. With any project, Sharma aims to actively engage participants, sharing photography and videography techniques. In September, Sharma became a mentor to DJP fellow Chhitup Lama. He was eager to connect “this idea of sharing the visual technique with the storytelling idea and the issue of disability inclusion.”
Over the summer the DJP trained Indigenous activists with disabilities from the Pacific on the iPhone camera to create a documentary series on disability and climate change. With VoiceOver, the iPhone provides image descriptions for blind and low-vision filmmakers and offers other accessible features. “If you think about it, it doesn’t make sense for a blind person to use a camera,” says DJP filmmaker Ari Hazelman. “The iPhone gives you more avenues to tell your story in a more profound way as a blind person.”
For Rwandans with DeafBlindness, critical services like healthcare and educational systems rarely offer necessary accommodations like assistive devices and tactile sign language interpretation. Naomi Uwizeyimana shares her experience with inaccessible infrastructure: “You need a person to help you to communicate everywhere you go and to get every service you want, which cannot always be possible.” Her mission is to bridge the gaps and support the DeafBlind community to fully participate in society.
DJP Fellows Esther Suubi and Kinanty Andini both advocate for the rights of persons with psychosocial disabilities through their art and filmmaking, working to create a world free from stigma and discrimination. “I hope that people will realize that mental health is really important, and I hope that many people will not be ashamed if they find out their friends or their family or maybe themselves have mental illness,” says Andini. “We must speak up and prove that the stigmas are wrong.”
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.”