We are often asked what challenges Rwanda has faced in the development of palliative care and its integration into the healthcare system. In the past, patients have been barred from accessing strong analgesics to treat moderate to severe pain, but thanks to health initiatives, this is slowly changing. Rwanda is an example of a country where only a few years ago, access to morphine was almost impossible. Albert Einsten said ‘in the middle of difficulty lies opportunity’ and this sentiment could not be more relevant to the development of palliative care programmes. Through advocacy, policy, and staunch commitment to compassion, Rwandan healthcare workers are proving how palliative care can be successfully integrated into a healthcare system. As a global healthcare community, we should be asking what opportunities exist to do this across the African continent. Champions of palliative care have a chance to forge lasting collaborations between international experts and African healthcare workers. This global network could not only advocate for palliative care programmes but it would also help to create a culture where palliative care is viewed as a necessary part of all healthcare systems.

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.

Background: Rwanda Ministry of Health in collaboration with partners has initiated an innovative initiative named Home Based Care Practitioners (HBCPs) to respond to the burden of long-term hospitalization for end of life patients. Aim: The program aims at providing home-based care to accompany patients and their families in their home, reduce unnecessary pain and suffering for those with chronic or terminal conditions, provide counseling to the patients and their families, early diagnosis of NCDs and improve awareness on prevention of NCDs risk factors and effectively refer them to either health facilities or community-based resources that can be of further help. Methods: The HBCPs is implemented into phases; phase one has started with a pilot of 200 HBCPs in 100 cells surrounding nine provincial and referral hospitals of Rwanda; 2 practitioners for both gender in each cell, with a criteria of completion at least secondary school. They have undergone a training of 120 credits (900 hours), equivalent of four months for theory and two months of practice. After training they have been deployed into the community with a supervision of health centers in collaboration with hospitals and Rwanda Biomedical Center. Results: During the implementation period of 6 months, 1663 NCDs patients have been transferred from health facility (OPD) to HBCPs for routine follow-up, 482 palliative care patients have been reported on end of life care by HBCPs, there is a remarkable linkage between facilities and community care ensured by supervisory relationship between health services providers and home based care practitioners, long-term admission has reduced the cost for the family and the facility due to the discharge of care from hospital to home. Conclusion: In a limited setting of social and economic cost of providing frivolous care in an expensive hospital for chronic or terminal conditions that would be better managed through treatment or palliative care at home (or less acute setting) home based care effort can better meet the needs of Rwandans at the community level and has started to show the efficiency in providing quality care to people in need of palliative care.

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