This scoping study assessed the realization of the rights for persons with disabilities in Rwanda since the signing of the United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) in 2008. Underpinned by the five-stage framework of Arksey and O'Malley, the scoping study examined peer-reviewed literature published between 2008 and 2017. Nine electronic databases were searched using keywords specific to disability in Rwanda. Data were charted by three reviewers according to pre-determined and emergent categories. Descriptive statistics were used to describe the data sources. A total of 60 scholarly articles met the inclusion criteria. Within the research, studies pertaining to the UN CRPD Articles of health, awareness raising, accessibility, and children with disabilities were the most published. The literature identified a movement towards the realization of the rights for persons with disabilities in Rwanda since the country signed the UN CRPD. Despite efforts to meet these rights, discrimination against persons with disabilities still exists and greater investment in the disability sector is needed, particularly for justice, social protection, and mental health services. Given the state of the evidence, concerning research gaps also exist in regards to deinstitutionalization and protection issues (i.e., violence and abuse). This consolidation of evidence may help to inform the decision-making priorities for government and civil society organizations in policy and programming and also direct future research.

/pdf/realization-of-the-rights-of-persons-with-disabilities-in-grncojzfe8.pdf

Realization of the rights of persons with disabilities in Rwanda.

BACKGROUND: Universal access to Primary Eye Care (PEC) is a key global initiative to reduce and prevent avoidable causes of visual impairment (VI). PEC can address minor eye conditions, simple forms of uncorrected refractive error (URE) and create a referral pathway for specialist eye care, thus offering a potential solution to a lack of eye health specialists in low-income countries. However, there is little information on the population need for PEC, including prevalence of URE in all ages in Sub-Saharan Africa. METHODS: A national survey was conducted of people aged 7 and over in Rwanda in September-December 2016. Participants were selected through two-stage probability proportional to size sampling and compact segment sampling. VI (visual acuity<6/12) was assessed using Portable Eye Examination Kit (PEEK); URE was detected using a pinhole and presbyopia using local near vision test. We also used validated questionnaires to collect socio-demographic and minor eye symptoms information. Prevalence estimates for VI, URE and need for PEC (URE, presbyopia with good distance vision, need for referrals and minor eye conditions) were age and sex standardized to the Rwandan population. Associations between age, sex, socio-economic status and the key outcomes were examined using logistic regression. RESULTS: 4618 participants were examined and interviewed out of 5361 enumerated (86% response rate). The adjusted population prevalence of VI was 3.7% (95%CI = 3.0-4.5%), URE was 2.2% (95%CI = 1.7-2.8%) and overall need for PEC was 34.0% (95%CI = 31.8-36.4%). Women and older people were more likely to need PEC and require a referral. CONCLUSIONS: Nearly a third of the population in Rwanda has the potential to benefit from PEC, with greater need identified in older people and women. Universal access to PEC can address unmet eye health needs and public health planning needs to ensure equitable access to older people and women.

/pdf/population-need-for-primary-eye-care-in-rwanda-a-national-1spud6nsn2.pdf

Population need for primary eye care in Rwanda: A national survey.

Visual impairment is a global public health problem, with an estimated 285 million affected globally, of which 43% are due to refractive error. A lack of specialist eye care in low and middle-income countries indicates a new model of care would support a task-shifting model and address this urgent need. We describe the features and results of the process evaluation of a national primary eye care (PEC) programme in Rwanda. We used the Medical Research Council process evaluation framework to examine the implementation of the PEC programme, and to determine enablers and challenges to implementation. The process evaluation uses a mixed methods approach, drawing on results from several sources including a survey of 574 attendees at 50 PEC clinics, structured clinical observations of 30 PEC nurses, in-depth interviews with 19 key stakeholders, documentary review and a participatory process evaluation workshop with key stakeholders to review collated evidence and contextualize the results. Structured clinical assessment indicated that the PEC provided is consistent with the PEC curriculum, with over 90% of the clinical examination processes conducted correctly. In 4 years, programme monitoring data showed that nearly a million PEC eye examinations had been conducted in every health centre in Rwanda, with 2707 nurses trained. The development of the eye health system was an important enabler in the implementation of PEC, where political support allowed key developments such as inclusion of eye-drops on the essential medicines list, the inclusion of PEC on insurance benefits, the integration of PEC indicators on the health management information systems and integration of the PEC curriculum into the general nursing school curriculum. Challenges included high turnover of primary care nurses, lack of clarity and communication on the future funding of the programme, competing priorities for the health sector and sustained supervision to assure quality of care. A model of a national primary eye care programme is presented, with service delivery to all areas in Rwanda. Key learning from this evaluation is the importance of strengthening the eye health care system, together with a strong focus on training primary care nurses using a PEC curriculum.

/pdf/process-evaluation-of-a-national-primary-eye-care-programme-48lan5a0zb.pdf

Process evaluation of a National Primary Eye Care Programme in Rwanda

Purpose: To explore the fear of cataract surgery experienced by the residents of the Kwale district of southern Kenya. Methods: The Kwale Eye Centre (KEC) is the only stationary specialist hospital...

Assessing the fear of cataract surgery in rural Kenya

Background: In order to gather evidence to guide eye care policy changes in Rwanda, a national population-based blindness and visual impairment survey was undertaken in 2015. Aim: To influence and direct policy changes using blindness survey findings. Setting: Nationwide sampling. Methods: Standard Rapid Assessment of Avoidable Blindness (RAAB) survey methodology was used across to examine 5065 (97.5% response rate) people aged 50 years and older. This is a case report of how the government used the evidence from the survey. Results: The age- and sex-adjusted prevalence of blindness was 1.1% (0.7–1.4) of which 83.9% was avoidable, with cataract being the major cause. The age- and sex-adjusted prevalence of visual impairment at the 6/18 level is 4.4% (3.7–5.1), with refractive errors and cataract being the major causes. The prevalence of all refractive errors was 4.3%, the majority of which was uncorrected. The cataract surgical coverage (CSC) was 68.4%, with 45.4% of surgeries performed at the secondary level. Difficulty in reaching surgical facilities (33.3%) was the main barrier to surgery. These results informed policy changes aimed towards an increase in the number of cataract surgeons, the volume of cataract surgery performed and broader spectacle provision. Conclusion: The prevalence of blindness in Rwanda is low compared to the previous estimates, although a considerable proportion is avoidable and the majority of refractive errors were uncorrected. The CSC and surgical outcomes are improving. The government, informed by this evidence, has introduced targeted initiatives to improve eye-care delivery in Rwanda.

/pdf/the-rwanda-national-blindness-survey-trends-and-use-of-the-3bvjfffya8.pdf

The Rwanda National Blindness Survey: Trends and use of the evidence to change practice and policy

Problem Visual impairment affects nearly 285 million people worldwide. Although there has been much progress in combating the burden of visual impairment through initiatives such as VISION 2020, barriers to progress, especially in African countries, remain high.Approach The Rwandan Ministry of Health has formed partnerships with several nongovernmental organizations and has worked to integrate their efforts to prevent and treat visual impairment, including presbyopia.Local setting Rwanda, an eastern African country of approximately 11 million people.Relevant changes The Rwandan Ministry of Health developed a single national plan that allows key partners in vision care to coordinate more effectively in measuring eye disease, developing eye care infrastructure, building capacity, controlling disease, and delivering and evaluating services.Lessons learnt Collaboration between stakeholders under a single national plan has ensured that resources and efforts are complementary, optimizing the ability to provide eye care. Improved access to primary eye care and insurance coverage has increased demand for services at secondary and tertiary levels. A comprehensive strategy that includes prevention as well as a supply chain for glasses and lenses is needed.

/pdf/improving-eye-care-in-rwanda-1ncktwco80.pdf

Improving eye care in Rwanda

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Improving eye care in Rwanda