In 2011, Rwanda's Ministry of Health set a goal of universal access to palliative care by 2020. Toward this audacious egalitarian and humanitarian goal, the Ministry of Health worked with partners to develop palliative care policies and a strategic plan, secure adequate supplies of opioid for the country, initiate palliative care training programs, and begin studying a model for integrating coordinated palliative care into the public health care system at all levels. It also initiated training of a new cadre of home-based care practitioners to provide palliative care in the home. Based on these developments, the goal appears within reach.

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A survey was conducted among 474 (213 female and 261 male) students (mean age 21 years) in three secondary schools in rural Rwanda in order to evaluate their attitudes towards condoms. Male students and those with sexual experience had more favourable attitudes towards condom utilisation than female students and those without prior sexual contacts. Of the 44% with reported sexual experience, reported age at first encounter was lower in boys (16.8 years) than in girls (18.3 years; p=0.03); 73 students (36%) reported regular use of condoms. Having more than one sexual partner was reported by 42 (9%), of whom 20 (48%) claimed regularly using a condom. Intention to use condoms was reported by 77% of the male and 53% of the female students (p=0.001). In addition, those with prior use of condoms and those having multiple partners were more likely to report future use intentions than others. Future campaigns in Rwanda should therefore focus on sensitising adolescents to a more positive attitude towards condoms and include modules to reduce condom misconceptions and stigma.

Background and context: Almost two-thirds of the 7.6 million deaths every year from cancer worldwide occur in low-income and middle income countries, making cancer a leading cause of mortality in these settings. In Rwanda, we are focused on the development of the tools needed to perform social and health service delivery in addition to policy research in resource-limited settings. There is a real need for qualified staff members who are able to ask appropriate questions, to make relevant hypotheses, develop research protocols, and conduct effective studies to identify innovative approaches in social and health service delivery. Cancer patients undergoing end-of-life care suffer from physical pain, mental illness and psychological trauma. Aim: The aims of this project are to identify cancer patients at end-of-life care at the community level without appropriate support through a mobile clinic, to mobilize existing resources to introduce home based care at the community level with participation of community health workers and to sensitize the population in cancer prevention and supportive care of patient using African socio-cultural perspectives. Strategy/Tactics: This project, the first kind in Rwanda, bring at home the same services cancer patients receive at the hospital level except for access to chemotherapy or radiotherapy. And it's where all those services provided and patients' family are counseled and reduce the burden and challenges they used to have going to hospital. Program/Policy process: During this project patients are visited in their homes and are treated mostly with pain management and their complaints are listened to together with other issues related to cancer, then their families are also approached to clearly explain to them the case of the patient and how to well console him/her and support in their sickness, all these are done periodically with assessment of past visits. Outcomes: Before this project, many people used to die early due to lack of pain management, counseling and follow-up, and also patient families used to abandon them at home or at health facilities. With this current project people have already started to understand that cancer can be treated like other diseases and this awareness helps in the advocacy for pain treatment and availability of pain killers for cancer patients. What was learned: The lessons learned from this project is that home based end of life care for oncology is an important tool to care for oncology patients and to reduce the burdens they have such as pain and depression and also the burdens for their families such as loss of money in the cost of treatment. This program can be expanded to reach as many as possible patients and their families.

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