How Rwanda is fighting the “silent killer”

Despite progress in the detection and management of hypertension, it is still the leading risk factor for cardiovascular disease (CVD)—the main cause of death globally. This “silent killer” often does not present with symptoms, making regular screening and diagnosis imperative to prevent severe complications.

In Rwanda, around 15 percent of people have hypertension, with most cases being uncontrolled, resulting in heart damage.1 In partnership with the Ministry of Health and the Rwanda Biomedical Centre, AstraZeneca, and PATH have brought the successful Healthy Heart Africa program to Rwanda to lead the transformation in improving access to hypertension screening and care.

According to World Health Organization estimates from 2016, noncommunicable diseases (NCDs) accounted for 44 percent of total annual deaths in Rwanda, with cardiovascular diseases and injuries accounting for more than half of these fatalities. The Rwanda nationwide NCD STEPwise survey estimates that only 80,000 out of 1 million people with hypertension are enrolled at clinics, revealing a gap between diagnosis and treatment.

Cardiovascular disease is a growing problem in Rwanda due to several contributing factors, associated with an increasing prevalence of risk factors, including hypertension, obesity, and diabetes. Changes in lifestyle are also contributing to the rise in cardiovascular disease in Rwanda. Inadequate access to health care and limited awareness of cardiovascular disease prevention and management among the general population further exacerbate the problem.

PATH has been working with AstraZeneca to implement its Healthy Heart Africa (HHA) program since 2019, when the program launched in Ghana. The program is a comprehensive, community-centered initiative aimed at preventing and managing hypertension and cardiovascular disease. HHA aims to address some of the key barriers to CVD prevention, diagnosis, and management; to strengthen the health system’s capacity to address it; and to raise awareness among the public.

To achieve these objectives, PATH, in partnership with the Rwanda Biomedical Centre and other stakeholders, has implemented a range of interventions, which include identifying individuals at risk of CVDs and ensuring their access to the necessary care and treatment, health care worker training, a focus on data use and data quality, and linkage strategies to improve evidence-based decision-making and overall patient care. The Rwanda program is integrated with diabetes care to provide support for screening, linkage, and management for hypertension and diabetes given the comorbidity of these two conditions.

To date, HHA has conducted over 125,000 screenings across three districts (Nyarugenge, Gakenke, Gatsibo) in Rwanda, effectively connecting individuals with elevated blood pressure to follow-up care and support.

The program is implementing strategies to improve screening, linkage, and treatment adherence, including training for health care workers, the use of patient team leads, dedicated NCD clinic days, the use of volunteers to support follow-up, and peer groups.

The comprehensive approach of the Healthy Heart Africa Program, led by PATH, is highlighted as crucial in CVD prevention and management. This program distinguishes itself by taking a holistic approach, emphasizing not just treatment but also working to prevent CVD through community-based interventions and health system strengthening.

Niyonsaba Marcelline, a client of the program, shares her journey of managing her cardiovascular health. "Before I participated in the community screening campaign, I did not know anything about hypertension and its risk factors," she says. "But now, I am more aware of the risk factors and how to manage my blood pressure. I feel much better and more in control of my health."

Mukeshimana Marie Jacqueline, a health care worker, attests to the program's impact, noting that it has provided health care workers with diagnostic equipment and continuous training. This support has bolstered their confidence in promptly confirming diagnoses and delivering appropriate management, thus mitigating the development of complications associated with hypertension and diabetes.

Nanthalile Mugala, MD, MMed, PATH’s Chief of Africa Region, emphasizes the importance of partnerships in achieving the program’s goals. "The Healthy Heart Africa program is a testament to the power of collaboration," she says. "By working together with Rwanda Biomedical Centre, other nonprofit organizations, and the private sector, we are able to achieve far more than we could on our own."

Partnerships have been critical to the success of the HHA program. The deep involvement of the Rwanda Biomedical Centre and a person-centered focus allows the program to reach more people with lifesaving information and care.

Since AstraZeneca launched HHA in Kenya in 2014, the program is now active in Ethiopia, Tanzania (including the Zanzibar Archipelago), Ghana, Uganda, Côte d'Ivoire, Senegal, and Nigeria, in addition to Rwanda. As of the end of 2022, over 32 million screenings had been conducted, with over 6.3 million elevated blood pressure readings recorded; over 10,600 health care workers trained; and over 1,200 health facilities activated to provide hypertension services.

Implementing access programs like Healthy Heart Africa are the future of our work to build health system resiliency and achieve universal health coverage. Its focus on person-centered care at the primary level is at the heart of PATH’s primary health care strategy.

Dr. Mugala notes, “PATH’s Africa Region has a strong vision for high-performing primary health care systems in Africa and a mission that uplifts African capabilities to align with and advocate on behalf of community and ministry of health priorities. Investing in cardiovascular disease prevention, diagnosis, and care is an important part of that.”