Rwanda: Score Justification Summary

1.1.1a National plan for AMR priority pathogens

Score: 100

There is publicly available evidence that Rwanda has an AMR plan, as outlined in its National Action Plan on Anti-Microbal Resistance for 2020-2024 (NAPAMR). The plan covers aspects of surveillance, detection, and reporting. The Ministry of Health has published a National Action Plan on Antimicrobial Resistance for 2025-2029. This document includes plans to improve the national antimicrobial surveillance program and developing an integrated system tool for AMR surveillance. Strategic Objective 2 is dedicated to improving the national antimicrobial surveillance program using a One Health approach (Section 2.3.2, p. 18; Section 4, p. 23). The plan details interventions to build laboratory capacity for AMR surveillance, establish national and subnational microbiological services, and standardize testing methods across sectors (Intervention 2.1.1, p. 23). The plan includes equipping sentinel laboratories with modern diagnostic technologies and standardizing antimicrobial susceptibility testing (AST) methods (Section 1.2.2, p. 9; Intervention 2.1.1, p. 23). There are 17 sentinel laboratories (12 human, 5 animal) supporting AMR surveillance and detection (Section 1.2.2, p. 9). The plan mandates the collection, analysis, dissemination, and sharing of surveillance data through routine clinical sampling in human, animal, and environmental health sectors (Intervention 2.1.2, p. 23). It outlines the development of an integrated reporting system and regular publication of surveillance findings (Activities 2.1.2.2, 2.1.2.5, p. 35-36). The Monitoring and Evaluation framework includes indicators for the proportion of sentinel sites generating and reporting AMR surveillance data (Section 7.1, Table 6, p. 49-50). The plan references surveillance of key bacterial pathogens (e.g., Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus) and mentions the need to identify high-risk and high-burden resistant strains (Section 1.2.3, p. 10; Intervention 5.3.1, p. 30) ¹. A national epidemic surveillance system is in place in both human and animal sectors, however there is no national plan for the surveillance of infections caused by resistant pathogens or designated sentinel sites for surveillance of AMR pathogens. Laboratories exist to conduct AMR detection (Situation Analysis 1.2, p. 5). There is a plan to establish a joint reporting mechanism (Education and Training 3, Objective 1, p. 9) and to train media on such reporting (Implementation Plan Matrix 3.4, p. 31) ².

1.1.1b Capacity of national lab/lab system to test for AMR priority pathogens

Score: 50

There is publicly available evidence that Rwanda has a national laboratory/laboratory system which tests for some priority AMR pathogens, as outlined in the National Action Plan on Antimicrobial Resistance 2025-2029. There are 17 sentinel laboratories with 12 dedicated to human health and 5 to animal health (Healthcare Structure 1.2.2, p. 9). There are still gaps in the laboratory system dedicated to testing for human health, especially in supply chain management for laboratory supplies and maintenance of laboratory equipment. The laboratory capacity in the animal health sector is known to be significantly lower due to a lack of funding (Extent of Antimicrobial Resistance in Rwanda in Animal Health 1.2.3, p. 12) Priority AMR pathogens that are tested for include Klebsiella, E. coli, Pseudomonas, Acinetobacter isolates, Staphylococcus aureus and Enterococcus (Extent of Antimicrobial Resistance in Rwanda in Animal Health 1.2.3, p. 10). ³ A 2025 Food and Agriculture Organization (FAO) media report details Rwanda's progress toward establishing a state-of-the-art National Reference Veterinary Laboratory (NRVL). The article reports on a two-day workshop held on April 24-25, 2025, in Nyamata, Bugesera district, which brought together technical experts from national health institutions and universities. The workshop focused on reviewing and validating the Terms of Reference for a feasibility study concerning the new NRVL. ⁴.

1.1.1c National environmental surveillance for AMR residues/organisms

Score: 0

There is no publicly available evidence that the Rwandan government conducts detection or surveillance activities for antimicrobial residues or AMR organisms. The 2025-2029 National Action Plan on AMR notes that there is an "absence of environmental regulations" (Background 1.1, p. 7) ⁵. This is despite the One Health Policy signed in 2021 aimed at promoting collaboration across the human, animal, and environmental sectors ⁶. In addition, the Food and Agriculture Organization of the United Nations published guidelines for AMR monitoring in food-producing animals in East Africa, however they do not specifically relate to the general environment ⁷. There is also no further evidence from the Ministry of Health, Ministry of Defence and Ministry of Agriculture and Animal Resources ⁸⁹¹⁰.

1.1.2a National law(s) requiring prescription for antibiotic use (humans)

Score: 50

There is publicly available evidence that Rwanda requires prescriptions for antibiotic use for humans in accordance with Law No. 47/2012 of 14 September 2013 'Relating to the Regulation and Inspection of Food and Pharmaceutical Products'. However, there are gaps in enforcement. The National Antimicrobial Stewardship Guidelines for healthcare Settings published by the Rwanda Biomedical Centre in 2022 notes that "legislation or regulation are actively implemented and enforced that requires antibiotics to be dispensed only on prescription by a qualified health-care professional" (Chapter 3, Regulations and Guidelines, p. 13) ¹¹. Antibiotics are included in the list of "controlled pharmaceutical products" according to Law No. 47/2012 of 14 September 2013 'Relating to the Regulation and Inspection of Food and Pharmaceutical Products' ¹². However, a study conducted in 2020 at the University of Rwanda showed that 49% of respondents were able to purchase antibiotics without a prescription ¹³. The Rwanda Food and Drugs authority released a formal statement in December 2024 on its website, stating that it has "noticed that certain human retail pharmacies have been dispensing medicines including antibiotics and narcotics to patients without presenting a medical prescription", reminding them that this is in violation of the abovementioned law ¹⁴.

1.1.2b National law(s) requiring prescription for antibiotic use (animals)

Score: 50

There is publicly available evidence that Rwanda requires prescriptions for antibiotic use for animals in accordance with Law No. 47/2012 of 14 September 2013 'Relating to the Regulation and Inspection of Food and Pharmaceutical Products'. However, there is no evidence that this legislation is being enforced. Law No. 47/2012 of 14 September 2013 'Relating to the Regulation and Inspection of Food and Pharmaceutical Products' requires a prescription for all antibiotics. There is no specific mention about whether the antibiotics are for human or animal use ¹⁵. There are also no further details about prescriptions for antibiotic use for animals on the websites of the Ministry of Health and the Ministry of Agriculture and Animal Resources, the agencies in charge of regulating pharmaceutical products ¹⁶¹⁷. A study from 2017 showed that 97% of farmers use antibiotics in their animals with 55.6% using over-the-counter antibiotics, with the majority of farmers lacking expertise in antibiotic use in food animals . A study from 2024 showed widespread misuse of antibiotics in dairy farming and disregard for antibiotics withdrawal symptoms in the Nyabihu district of Rwanda ¹⁸. Another study from 2024 showed that three quarters of respondents (animal health field professionals) reported at least one case of misuse of antibiotics over a 12-month period .

1.2.1a Laws/plans on zoonotic disease

Score: 100

There is publicly available evidence that Rwanda has a strategy document on zoonotic disease, which is contained within the Ministry of Health's One Health Policy from 2021. The policy sets out a strategy to prevent and control zoonotic diseases, notably Avian Influenza, Rabies, Ebola, Rift Valley Fever, and COVID-19. The policy specifies significant institutional gaps in this regard that need to be filled, including those in cross-sectoral training, preparedness and prevention of zoonotic diseases, detection and limited staff (Process to develop One Health Policy 1.3, p. 9-13) ¹⁹. The Food and Agriculture Organization of the United Nations mentioned in 2023 that it has been working with partners in Rwanda towards the goal of eliminating rabies by 2030 on the basis of the Ministry of Health's One Health Policy ²⁰.

1.2.1b Laws/plans on zoonotic disease spillover from animals to humans

Score: 100

There is publicly available evidence that there are national policy documents which includes measures for risk identification and reduction for zoonotic disease spillover events from animals to humans. These are contained within the Ministry of Health's One Health Policy from 2021. The One Health Policy notes that the Ministry in charge of Agriculture and Animal Resources will "provide regular information and risk maps on disease epidemiology indicating areas prone to particular zoonotic diseases in animals (domestic, wildlife)" (Partnership and Stewardship 4.1.3, p. 23). The One Health Secretariat is also charged with the "development and dissemination of risk communication materials. (Partnership and Stewardship 4.1.3, p. 22) ²¹ Nevertheless, a small-scale study from 2025 focusing on smallholder livestock farmers in the Bugesera district of Rwanda showed that only around half of respondents were aware of disease transmission from animals to humans and only 13.5% recognised that the reverse was possible. In addition, the study found that there was a prevalence of risky attitudes and practices that further raise the risk of zoonotic diseases in the country ²².

1.2.1c Laws/plans for surveillance & control of multiple zoonotic pathogens

Score: 100

There is publicly available evidence that Rwanda has national plans that account for the surveillance and control of multiple zoonotic pathogens of public health concern, as mentioned in the Ministry of Health's One Health Policy from 2021. One of the policy objectives mentioned in the document is to "put in place a joint surveillance system to prevent, early detect, respond rapidly to and recover from zoonotic diseases" (Specific Objectives 3.4.2, p. 15) ²³. In addition, the Food and Agriculture Organization of the United Nations stated in a May 2025 press release that there are plans for a state-of-the-art National Reference Veterinary Laboratory dedicated to testing for zoonotic pathogens, including a collaboration between the Food and Agriculture Organization of the United Nations, Ministry of Agriculture and Animal Resources (MINAGRI) and Rwanda Agriculture and Animal Resources Development Board (RAB) ²⁴. Nevertheless, progress on this issue seems to be limited. A study from January 2025 on rift valley fever, a zoonotic disease, shows that there are "gaps in local evidence", an "urgent need for prospective research to inform evidence-based health policymaking, strategic planning, and the development and implementation of cost-effective preventive and control measures, including diagnosis and surveillance for early detection and response", and "the institutionalization of a cost-effective, multi sectoral, and transdisciplinary One Health strategy for reducing the burden and risk of climate climate-sensitive and zoonotic diseases" ²⁵.

1.2.1d Cross-ministerial department/agency/unit for zoonotic disease

Score: 100

There is publicly available evidence that Rwanda has a department dedicated to zoonotic disease functioning across ministries, as mentioned in the Ministry of Health's One Health Policy from 2021. The Ministry of Health's One Health Policy states that it adopts a multi sectoral approach through the One Health Multi-sectoral Coordination Mechanism (OH-MCM) (One Health Multi-sectoral Coordination Mechanism (OH-MCM) 4.1.1, p. 21), previously known as the One Health Steering Committee. The following bodies within Rwanda have been involved in the development of the One Health Policy: Ministry of Health, Ministry of Agriculture and Animal Resources, Ministry of Education, Ministry of Environment, Ministry in Charge of Emergency Management, Ministry of Finance and Economic Planning, Rwanda Development Board, Rwanda Biomedical Centre, Rwanda Environment Management Authority, Rwanda National Police, Rwanda Food and Drugs Authority, Rwanda Agriculture and Animal Resources Development Board and Rwanda, University of Rwanda and University of Global Health Equity, University Teaching Hospitals (CHUK, CHUB) ²⁶. According to the One Health Strategic Plan 2021-2026, the One Health Multi Sectoral Coordination Mechanism is composed of heads of government institutions and representatives of development partners involved in One Health (Executive Summary, p. 6) ²⁷.

1.2.1e Presence of One Health strategic plan

Score: 100

Rwanda has implemented its second One Health Strategic Plan II (2021–2026) in 2021. The second One Health Strategic Plan for Rwanda (ROHSP II) 2021-2026 is meant to provide and re-assure partners but also the stakeholders of the re-commitment of all sectors to One Health. This Strategic Plan will bring to the fore its commitments and priorities for the coming six years. ROHSP II will contribute to the country’s commitment expressed in the National Constitution, National Strategy for Transformation (NST-1) and the aspirations of the different sector policies. ROHSP II has taken into consideration all key documents and it is anticipated that this time it will be implemented.²⁸

1.2.2a Surveillance/reporting mechanism for zoonotic disease for livestock owners

Score: 100

There is publicly available evidence that Rwanda has a national mechanism (either voluntary or mandatory) for owners of livestock to conduct and report on disease surveillance to a central government agency. Livestock owners are required to report suspected cases of animal diseases to local veterinary officers, according to the United Nations in Rwanda and the Rwanda Agriculture and Animal Resources Development Board. Officers, known as Sector Animal Resources Officers (SAROs), are responsible for collecting and reporting data on animal health to the Rwanda Agriculture and Animal Resources Development Board (RAB) ²⁹³⁰. The Rwanda Biomedical Centre is also involved in gathering information from livestock owners, as evidenced in March 2022 when animal owners reported a sudden increase in the abortion rate among livestock, following which the Rwanda Biomedical Centre launched an investigation ³¹. Another example of livestock owners communicating issues to the authorities is also from 2022, during the outbreak of the Rift Valley fever. Livestock owners were able to report issues to community health workers who act as intermediaries between local communities and the health authorities ³²³³.

1.2.2b Laws/regulations on data confidentiality to protect livestock owners

Score: 0

There is no publicly available evidence that Rwanda has legislation and/or regulations that safeguard the confidentiality of information generated through surveillance activities for animals (for owners) in accordance with Law No 058/2021 as outlined by the Rwanda Data Protection and Privacy Office. Rwanda enacted Law No 058/2021 in September 2021 relating to the protection of personal data and privacy was officially gazetted. This law protects personal data and ensures privacy of individuals in Rwanda ³⁴. There is no specific reference to animal owners, despite mentioning that all personal data within the country is protected ³⁵.

1.2.2c Wildlife zoonotic disease surveillance

Score: 0

There is evidence that Rwanda conducts surveillance of zoonotic disease in wildlife and livestock, however, there is insufficient evidence to suggest that Rwanda conducts surveillance specifically for poultry. The 2018 Joint External Evaluation (JEE) of the Republic of Rwanda, conducted in May 2018, states that "zoonotic surveillance systems are in place for some zoonotic priority diseases in wildlife and domestic animals" ³⁶. Another JEE was conducted in 2025, but the reports have not been published as of August 2025 ³⁷. According to the Ministry of Health's One Health Policy from 2021, the wildlife and agriculture and human health sectors, that have well-equipped laboratories to monitor and control risk of epidemics" (Situational Analysis, p. 11) ³⁸. There is no specific mention of poultry in the 2018 Joint External Evaluation nor in the One Health Policy nor in the National Action Plan on Antimicrobial Resistance 2025-2029 ³⁹⁴⁰⁴¹. There is no further evidence in the OIE PVS Evaluation Report, the Fourth Health Sector Strategic Plan (2018-2024) or the Six Year Strategic Plan for The Epidemic Infectious Diseases Division 2012-2018 ⁴²⁴³⁴⁴. There is no further evidence in the Ministry of Health or in the Ministry of Agriculture and Animal Resources (MINAGRI) ⁴⁵⁴⁶.

1.2.3a Annual reporting to OIE on zoonotic disease incidence

Score: 100

There is publicly available evidence of a mechanism for reporting notifiable diseases to The World Organisation for Animal Health (WOAH). According to the WOAH's database, Rwanda has reported relevant diseases on 7 occasions between 2020-2024 ⁴⁷. However it is important to note that there is no information about the mechanism through which the reporting is carried out on the pages of the Ministry of Health, Rwanda Biomedical Centre or the Ministry of Agriculture and Animal Resources ⁴⁸⁴⁹⁵⁰.

1.2.4a Number of veterinarians per 100,000 people

Score: 8.59

1.2.4b Number of veterinary para-professionals per 100,000 people

Score: 32.67

1.2.5a Inclusion of private sector in national plan/law on zoonotic disease

Score: 0

There is no publicly available evidence that the Rwandan government has mechanisms for working with the private sector in controlling or responding to zoonoses. Although the Ministry of Health's One Health Policy and One Health Strategic Plan 2021-2026 both mention the need to involve the private sector, they have not outlined the mechanisms through which the private sector may contribute to this process ⁵¹⁵².

1.3.1a Updated national records of especially dangerous pathogen/toxin inventories

Score: 0

There is some evidence of facilities being tracked, but insufficient evidence of a record with details on inventory management within the last five years, as mentioned by the Rwanda Environment Management Authority in the National Survey on Chemicals and Hazardous Wastes and Undertaking an Institutional Capacity Assessment form 2023. The REMA 2023 report provides comprehensive inventories and management assessments for chemicals and hazardous wastes such as mercury, POPs, asbestos, medical waste, expired chemicals, and industrial waste in Rwanda (Chapters 8 and 9). It includes information on interim storage, disposal facilities, and waste categories, but its scope is strictly chemical and hazardous waste, and not biological pathogens or toxins of specific biosafety/biosecurity concern (Chapter 8). However, the REMA 2023 does not mention pathogens or biological toxins, nor does it list biosafety-level laboratories, facilities handling especially dangerous pathogens (e.g. Ebola, anthrax, high-toxicity biological agents), or any standardized inventory management system for such materials. ⁵³. There is no further evidence of a specific reference of a record of facilities for the storage of dangerous pathogens or a requirement for such a record within the Rwanda Biosafety and Biosecurity Organization or the National Biosafety Framework (NBF) ⁵⁴⁵⁵. There is no further evidence in the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the National Reference Laboratory, in academic papers or in the VERTIC database ^565758596061.

1.3.1b Biosecurity laws on facility security for especially dangerous pathogens

Score: 50

There is evidence of legislation related to biosecurity, and they include requirements such as physical containment and operation practices but not failure reporting systems and cyber security of facilities. Law n° 025/2024 Governing Biosafety ("biosafety law") outlines the provisions related to biosafety and biosecurity in Rwanda. Article 2 Section "e" refers to "contained use, which refers to "an operation undertaken within a facility or other specific place designated, which involves living modified organisms that are controlled by specific measures that effectively limit their contact with and their impact on the external environment". The majority of the other articles refer to operation practices. Nevertheless, failure reporting systems and cyber security of facilites are not directly mentioned ⁶². There is no further evidence from the Rwanda Biosafety and Biosecurity Organization of the Rwanda Biomedical Centre ⁶³⁶⁴. There is also no further evidence from the Ministry of Health, Ministry of Defence and Ministry of Agriculture and Animal Resources ⁶⁵⁶⁶⁶⁷.

1.3.1c Agency for enforcement of biosecurity laws/regulations

Score: 0

There is no evidence of established agencies responsible for the enforcement of biosecurity regulations. Law n° 025/2024 Governing Biosafety outlines the provisions related to biosafety, but not biosecurity, in Rwanda. There is one mention of biosecurity in Strategic Objective 11, in which it states the objective to "adopt biosecurity measures in laboratory and in use other sensitive infrastructure or equipment (Strategic Objective 11, p. 54-55). Article 4 of the law designates the "Authority in charge of management of environment" as the Competent National Authority. This refers to the Rwanda Environment Management Authority (REMA). REMA is tasked with coordinating the enforcement of the Biosafety Law, serving as the national focal point for the Cartagena Protocol, and managing national biosafety information through the Biosafety Clearing House. Article 5 establishes a Registrar of Biosafety, who heads the biosafety secretariat within REMA. The Registrar is responsible for maintaining documentation and official records related to living modified organisms, including applications, risk reports, decisions, and registers of permitted or exempted activities. Article 6 mandates the creation of a National Biosafety Committee. This committee is mandated to advise REMA on technical and scientific matters related to biosafety, provides expert review of applications, and can recommend the establishment of Institutional Biosafety Committees within specific institutions. The law does not make a specific reference to biosecurity ⁶⁸. The Government of Rwanda has built a series of multi-sectoral partnerships with the Coalition for Epidemic Preparedness Innovations, Ginkgo Bioworks, BioNTech, and IQVIA in this regard ⁶⁹. Moreover, the Rwanda Biosafety and Biosecurity Organization is an NGO established in November 2020 that tackles biosafety and biosecurity issues in the country. This organisation supports other organisations, professionals and institutions in biosafety and biosecurity matters, but itself is not responsible for the enforcement of biosecurity regulations. ⁷⁰ In addition, in 2023, the Rwanda Biomedical Centre collaborated with Ginkgo Bioworks, a US-based biotech firm, on a one-year pathogen monitoring program at Rwanda’s Kigali International Airport (KGL) to identify new and emerging variants of SARS-CoV-2 ⁷¹.

1.3.1d Consolidation of especially dangerous pathogens into minimum # of facilities

Score: 0

There is no publicly evidence to confirm that Rwanda has taken action to consolidate its inventories of especially dangerous pathogens and toxins into a minimum number of facilities. There is no mention of a plan to consolidate Rwanda's inventories of dangerous pathogens and toxins into a minimum number of facilities in the Ministry of Health's 2021 One Health Policy, the One Health Strategic Plan 2021-2026 and the National Action Plan on Antimicrobial Resistance 2025-2029 ⁷²⁷³⁷⁴. There is also no evidence presented by the Ministry of Health, Ministry of Defence, Ministry of Agriculture and Animal Resources or Rwanda Biomedical Centre ^75767778.

1.3.1e Capacity to conduct tests for anthrax/Ebola without culturing live pathogens

Score: 0

There is no public evidence of in-country capacity to conduct Polymerase Chain Reaction (PCR)-based diagnostic testing for Ebola or for anthrax that precludes culturing a live pathogen. In 2024, during the outbreak of the Marburg virus disease, from the same family as Ebola, the National Reference Laboratory of the Rwanda Biomedical Center took samples from infected individuals using real-time reverse transcription polymerase chain reaction (RT-PCR) ⁷⁹. However there is no mention about whether it precludes culturing a live pathogen. No evidence on PCR for anthrax could be found from the Ministry of Health, Ministry of Defence, Ministry of Agriculture and Animal Resources, the National Reference Laboratory, the One Health Policy or the National Action Plan ^808182838485.

1.3.2a Biosecurity training using a standardised, required approach

Score: 0

There is no publicly available evidence that Rwanda requires biosecurity training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. Law n° 025/2024 Governing Biosafety makes no mention of biosecurity training ⁸⁶. The Rwanda Biosafety and Biosecurity Organization, an NGO based in Kigali, makes infrequent posts about biosecurity and biosafety-related trainings, which are by and large held in neighbouring countries and not in Rwanda, in addition to being voluntary ⁸⁷. The Joint External Evaluation (JEE) for Rwanda conducted in May 2018 mentions that biosecurity training is provided by each institution, but there is no common curriculum ⁸⁸. There is no further evidence either through the unavailable (as of August 2025) JEE conducted in 2025 or from the Ministry of Health or Rwanda Biomedical Centre ⁸⁹⁹⁰⁹¹.

1.3.3a Personnel checks for permission to access to especially dangerous pathogens

Score: 0

There is no publicly available evidence that Rwanda has any regulation or licensing conditions specifying that security and other personnel with access to especially dangerous pathogens, toxins, or biological materials with pandemic potential are subject to drug testing, background checks, and psychological or mental fitness checks. The Government of Rwanda has made steps towards developing the biosecurity sector, with NGOs such as the the Rwanda Biosafety and Biosecurity Organization tackling biosafety and biosecurity issues, however they do not show any evidence of relevant regulations or licensing conditions ⁹²⁹³. Such evidence is also not available from the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the National Reference Laboratory, the One Health Policy or the National Action Plan ^949596979899.

1.3.4a National transport regulations for Category A and B infectious substances

Score: 0

There is no evidence that national regulations for the safe and secure transport of specifically Categories A and B infectious substances are in place in Rwanda as outlined in the "Guide Technique" developed by the Rwanda Biomedical Centre. The Rwanda Biomedical Centre, under the Ministry of Health, developed a "Guide Technique" developed which contains guidelines regarding the safe and secure transport of infectious substances. Appendix 1.4 includes protocols for packaging, storing, and transporting laboratory samples for a range of infectious diseases, focusing on the prevention of contamination and ensuring specimen viability. ¹⁰⁰ However, there is no specific mentions of Categories A and B infectious substances. Adherence to strict guidelines and protocols regarding sample transportation and biological waste management, as designed and validated by the National Research Laboratory under the Rwanda Biomedical Centre, played an important role in handling the Marburg Virus Outbreak in 2024 ¹⁰¹. There is no further relevant information shared by the Rwanda Environment Management Authority, Transport Department, the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the Rwanda Biomedical Center, One Health Policy or National Action Plan ^{102103104105106107108109}.

1.3.5a Laws/regulations on cross-border transfer and end-user screening

Score: 0

There is no publicly available evidence that Rwanda has legislation and/or regulations in place to oversee the cross-border transfer and end-user screening of especially dangerous pathogens, toxins, and pathogens with pandemic potential. Rwanda has a National Strategy for Implementation of Biosafety Framework, published in September 2020, however it does not provide any mention of cross-border transfers and end-use screenings of dangerous pathogens ¹¹⁰. There is no further relevant information shared by the Rwanda Environment Management Authority, Transport Department, the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the Rwanda Biomedical Center, One Health Policy or National Action Plan ^{111112113114115116117118}.

1.4.1a Biosafety laws/regulations

Score: 100

There is publicly available evidence that national biosafety legislation and/or regulations are in place in Rwanda. Law N° 025/2024 Governing Biosafety was enacted in February 2024. The "law establishes an adequate level of protection in the field of the safe transfer and use of living modified organisms, resulting from modern biotechnology that may have an adverse effect on the conservation and sustainable use of biological diversity while taking into consideration the effect of this transfer and use on human health" ¹¹⁹. This represents the culmination of progress made on the basis of the National Strategy for Implementation of Biosafety Framework that was outlined by the Rwandan Government in 2020 ¹²⁰.

1.4.1b Agency for enforcement of biosafety laws/regulations

Score: 100

There is publicly available evidence that there exists an established agency responsible for the enforcement of biosafety legislation and regulations. The Rwanda Environment Management Authority (REMA) is the designated competent authority that handles all matters pertaining to biosafety in Rwanda ¹²¹. Article 4 of Law N° 025/2024 Governing Biosafety designates the "Authority in charge of management of environment" as the Competent National Authority. This refers to the Rwanda Environment Management Authority (REMA). REMA is tasked with coordinating the enforcement of the Biosafety Law, serving as the national focal point for the Cartagena Protocol, and managing national biosafety information through the Biosafety Clearing House. Article 5 establishes a Registrar of Biosafety, who heads the biosafety secretariat within REMA. The Registrar is responsible for maintaining documentation and official records related to living modified organisms, including applications, risk reports, decisions, and registers of permitted or exempted activities. Article 6 mandates the creation of a National Biosafety Committee. This committee is mandated to advise REMA on technical and scientific matters related to biosafety, provides expert review of applications, and can recommend the establishment of Institutional Biosafety Committees within specific institutions ¹²² Activities related to living modified organisms (LMOs) require a permit require a permit issued by REMA ¹²³. Representatives from the Ministry of Environment, Rwanda Food and Drugs Authority (FDA), Rwanda Agriculture Board (RAB) have together been involved in the process of development and implementation of biosafety policy ¹²⁴.

1.4.2a Biosafety training using a standardised, required approach

Score: 0

There is no publicly available evidence that Rwanda requires biosafety training, using a standardized, required approach, such as through a common curriculum or a train-the-trainer program, for personnel working in facilities housing or working with especially dangerous pathogens, toxins, or biological materials with pandemic potential. Law n° 025/2024 Governing Biosafety makes no mention of biosecurity training ¹²⁵. The Rwanda Biosafety and Biosecurity Organization makes infrequent posts about biosecurity and biosafety-related trainings, which are by and large held in neighbouring countries and not in Rwanda, in addition to being voluntary ¹²⁶. The Joint External Evaluation for Rwanda conducted in May 2018 mentions that biosecurity training is provided by each institution, but there is no common curriculum ¹²⁷. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre ¹²⁸¹²⁹. Rwanda has not submitted Confidence Building Measures under the Biological Weapons Convention, and therefore does not make information available through this source ¹³⁰.

1.5.1a Evidence of national assessment of dual-use research

Score: 0

There is no public evidence that the country has conducted an assessment to determine whether ongoing research is occurring on especially dangerous pathogens, toxins, pathogens with pandemic potential, and/or other dual use research. No evidence was found from the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the Rwanda Biomedical Center, or the National Council for Science and Technology ^{131132133134135}. The Ministry of Health's 2021 One Health Policy stipulates that such research will be promoted, however there is no evidence that an assessment has been conducted ¹³⁶. Rwanda has not submitted Confidence Building Measures under the Biological Weapons Convention, and therefore does not make information available through this source ¹³⁷.

1.5.1b National law/regulation on oversight of dual-use research

Score: 0

There is no public evidence of a national policy requiring oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research. There is no mention of such a legislation on website of the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources or the Rwanda Biomedical Center Reference Laboratory. ^138139140141. There is no reference to such a policy in the Ministry of Health's 2021 One Health Policy or 2025-2029 National Action Plan ¹⁴²¹⁴³. Rwanda has not submitted Confidence Building Measures under the Biological Weapons Convention, and therefore does not make information available through this source ¹⁴⁴.

1.5.1c Existence of agency responsible for oversight of dual-use research

Score: 100

There is evidence that there exist multiple agencies responsible for oversight of research with especially dangerous pathogens, toxins, pathogens with pandemic potential and/or other dual-use research, as evidenced by the Rwanda Biomedical Centre. The Rwanda Biomedical Centre is tasked with overseeing all public health programmes, including research on dangerous pathogens ¹⁴⁵. In addition, the Rwanda National Ethics Committee, under the Ministry of Health, was established to enhance ethical oversight and governance of research activities in Rwanda ¹⁴⁶. Moreover, the National Council for Science and Technology published regulations in 2024 that establish comprehensive guidelines for conducting research in Rwanda named "Regulations of the Executive Secretary No 001/NCST/2024 of 07/11/2024 Governing Research". The NCST is the central regulatory authority, empowered by Chapter II, Article 5 of the regulations to “monitor the implementation of treaties ratified by Rwanda” and regulate all forms of scientific research, including biomedical, biological, and potentially hazardous research. NCST issues research permits, prepares and disseminates relevant regulations, sets research standards, and oversees compliance. The NCST’s mandate includes the oversight of research that may involve dual-use potential, biological agents, and pathogens of pandemic concern, requiring ethical approval, rigorous authorisation, and continuous monitoring as specific in Chapter III (Articles 7–10). ¹⁴⁷.

1.5.2a Requirement to screen synthesised DNA against list prior to sale

Score: 0

There is no public evidence of a national legislation, regulation, policy, or other guidance, requiring the screening of synthesized DNA before it is sold. The Biosafety Law N° 025/2024 adopted in 2024 does not specifically address the screening of synthesized DNA sequences against lists of known pathogens and toxins before sale ¹⁴⁸. There is no mention of such a legislation on the websites of the Ministry of Health, the Ministry of Defence, the Ministry of Agriculture and Animal Resources, the Department of Transport or the Rwanda Biomedical Center ^{149150151152153}. There is no reference to such a policy in the Ministry of Health's 2021 One Health Policy or 2025-2029 National Action Plan ¹⁵⁴¹⁵⁵. Rwanda has not submitted Confidence Building Measures under the Biological Weapons Convention, and therefore does not make information available through this source ¹⁵⁶.

1.6.1a Immunization rate for humans (measles/MCV2)

Score: 50

1.6.1b Availability of vaccination figures for livestock (FMD) through OIE database

Score: 100

There is evidence that official foot-and-mouth disease (FMD) vaccination figures for livestock are publicly available through the OIE database. The most recent statistics are from May 2023 ¹⁵⁷.

1.6.1c Equitablenature of national immunization strategy/plan

Score: 100

There is evidence that Rwanda has a national immunization strategy that ensures equitable distribution and is aimed at overcoming inequalities across the country called the National Expanded Program on Immunization launched in 1980 ¹⁵⁸. It is now called the Vaccine Preventable Disease Program ¹⁵⁹. The Rwandan Ministry of Health and Rwanda Biomedical Centre have a vaccination calendar that outlines all the vaccinations available to from pre-birth until 12 years of age ¹⁶⁰. A report published by the Ministry of Health and UNICEF in 2021 analysed the level of coverage of immunization within the Rwandan population and found that around 95.5% of children had received all basic vaccinations and 84.4% had received all age-appropriate vaccinations in 2019/20 (Immunization coverage and trends 3.1.1, p. 5). The report stated that there did exist inequities in child immunization and that location and wealth were significant factors, however these inequities have been narrowing ¹⁶¹. According to a 2019 report by the Reach Project entitled "Near-universal Childhood Vaccination Rates in Rwanda", Rwanda had a 98% rate for child immunizations (Preface, p. 4) ¹⁶². A study from 2017 noted that National DTP3 coverage in Rwanda was at 97.1% and MCV coverage was at 94.9%, significantly higher than the rates of its African counterparts ¹⁶³.

1.6.1d Vaccine hesitancy and build public trust coverage in vaccines in national immunization strategy/plans

Score: 0

There is no evidence that the national immunization strategy includes measures to address vaccine hesitancy and builds public trust in vaccines. The Vaccine Preventable Disease Program does not include any information regarding vaccine hesitancy ¹⁶⁴. A study completed in 2021 comparing service providers’ and caregivers’ perspectives in both rural and peri-urban settings found that there were confidence-building structures in place that have positively affected vaccine uptake across the country. They identified three specific factors that were conducive to vaccine uptake: (i) high trust in vaccines and service providers based on personal relationships with health centre staff; (ii) the connecting role of community health workers; and (iii) a strong sense of community ¹⁶⁵. There is no further evidence from the Ministry of Health, Rwanda Biomedical Centre, 2021 One Health Policy or 2021-2026 One Health Strategic Plan ^166167168169.

1.6.1e National advisory group for immunization strategy/plan

Score: 0

There is no evidence that there is a national advisory group that provides technical guidance and advice on the immunization strategy to the Rwandan government. The immunization program is implemented by the Ministry of Health and Rwanda Biomedical Centre with support from UNICEF ¹⁷⁰. However there is no evidence from the Ministry of Health of Rwanda Biomedical Centre that a separate advisory group exists ¹⁷¹¹⁷².

1.6.1f Presence of an immunization programme for influenza

Score: 0

There is no evidence that Rwanda has an immunization programme for influenza. The Ministry of Health's vaccination calendar includes vaccinations for Haemophilus Influenza (DTOP-HepB-Hib) at the ages of 6 weeks, 10 weeks and 14 weeks ¹⁷³. Nevertheless, there is no evidence of a dedicated immunization programme. No such evidence was found from the Ministry of Health or Rwanda Biomedical Centre. ¹⁷⁴¹⁷⁵. The World Health Organization's Naitonal Immunization Advisory Mechanism shows no evidence of an immunization programme for influenza ¹⁷⁶.

1.7.1a Strategy/plan for resilience of health system

Score: 50

There is evidence that Rwanda has a strategy to develop a health system that is resilient to the challenges that climate change and changing seasonal weather patterns pose that includes the threat of infectious diseases. The Rwanda Environment Management Authority (REMA)'s 2022 Green Growth and Climate Resilience National Strategy (GGCRS) for Climate Change and Low Carbon Development, which is a revised version of the 2011 GGCRS following an evaluation conducted in 2018, includes considerations that specifically address evolving threat of infectious diseases, changing weather patterns and acute events following extreme weather events. For instance, the effect of drought on the spread of diseases (Enhancing agro-ecology, crop variety development, and promoting climate-resilient cultivars and animal breeds, for local and export markets 4.1.1, p. 52), the effect of increasing rain levels on respiratory diseases (Section 5, p. 63), the effect of increasing temperatures on plant diseases (Section 5, p.64) are relevant examples ¹⁷⁷.

2.1.1a Capacity of national lab system to conduct 5 or more WHO core tests

Score: 100

There is publicly available evidence that the national laboratory system in Rwanda has the capacity to conduct diagnostic tests for at least 5 of the 10 WHO-defined core tests. According to the Joint External Evaluation for Rwanda, conducted in May 2018, "Rwanda has a network of laboratories carrying out core tests for disease pathogens under the IHR (2005)" (Laboratory testing for detection of priority diseases D.1.1, p. 22); indeed the national laboratory system can perform the following tests: PCR for Influenza virus; Virus culture for Poliovirus; Serology for HIV; Microscopy for Mycobacterium tuberculosis; Rapid diagnostic test for Plasmodium spp and Bacterial culture for Salmonella enteritidis serotype Typhi ¹⁷⁸¹⁷⁹. There is no publicly available evidence that the country has defined the country-specific tests in the Ministry of Health's 2021 One Health Policy or 2025-2029 National Action Plan ¹⁸⁰¹⁸¹.

2.1.1b Plan to conduct testing during a public health emergency

Score: 0

There is no evidence of a national plan for conducting testing during a public health emergency under the Public Health Surveillance and Emergency Preparedness and Response Division. There is insufficient evidence that a plan exists that includes considerations for testing for novel pathogens, scaling capacity, and defining goals for testing. The Public Health Surveillance and Emergency Preparedness and Response Division, which exists under the Rwanda Biomedical Centre, prevents and controls epidemics and other public health emergencies in Rwanda by implementing the Integrated Disease Surveillance and Response (IDSR) system, a comprehensive regional framework for strengthening national public health surveillance and response. It plays a special role in disease detection and response ¹⁸². However, there is no direct mention of testing. The Ministry of Health and Rwanda Biomedical Centre published a National Health Emergency Response Operations Plan in September 2024. The plan was drafted following a risk assessment that identified 26 hazards facing Rwanda and ranking them in order of likelihood of occurrence. The plan acts as a reference document for multi sectoral preparedness and response to priority hazards identified. It is designed to serve as a guide, outlining a robust set of strategies, protocols, and actions that will ensure a rapid, coordinated, and effective response to a wide range of health emergencies, from infectious disease outbreaks to natural disasters. Section 1.3.1 of the plan enumerates “priority hazards” including covid, influenza (new subtypes), ebola, marburg, rift valley fever, and other pathogens with epidemic and pandemic potential. The national risk assessment and contingency planning explicitly cover emergent and novel agents. ¹⁸³. However, there is no direct mention of testing. Rwanda has also recently conducted its second joint external evaluation in May 2025 with support form the World Health Organization, the Pandemic Fund and other regional partners. It included an evaluation of emergency preparedness and brought together entities Ministry in Charge of Emergency Management ¹⁸⁴¹⁸⁵. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre ¹⁸⁶¹⁸⁷.

2.1.2a Existence of an accredited national lab serving as a reference facility

Score: 100

There is publicly available evidence to confirm that the National Reference Laboratory (NRL) in Rwanda is accredited (1). On April 4th, 2020, the NRL received the accreditation from the International Organization for Standardization [ISO] 15189:2003 ¹⁸⁸. Four additional Rwandan medical laboratories received ISO 15189:2022 accreditation in 2024 ¹⁸⁹.

2.1.2b External quality assurance of a national lab serving as a reference facility

Score: 100

There is publicly available evidence that the National Reference Laboratory (NRL) is subjected to external quality assurance review. Within the laboratory, there is an External Quality Assurance and Quality Control (EQA/QC) unit. The EQA program for laboratories ensures that the needs of all laboratory clients/patients are met. It serves as an evaluation method for laboratory performance and has a marketing advantage in the region ¹⁹⁰. Also, on April 4th, 2020, the NRL received the accreditation from the International Organization for Standardization [ISO] 15189:2003. This procedure of accreditation involved an independent assessment of the medical laboratory that includes an examination of personnel qualifications and competence, equipment, reagents and supplies. Quality assurance was also one of the criteria examined ¹⁹¹.

As per Section 4.1.2 of the National Health Emergency Response Operations Plan (NHEROP), published in September 2024, NRL actively participates in external quality control programs through collaboration with several international reference laboratories. These partnerships include the Uganda Virus Research Institute (UVRI) in Uganda, the Institute of Tropical Medicine Antwerp (ITMA) in Belgium, the National Institute of Public Health (NIPH) in South Africa, and the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta. Specialized samples (e.g., suspected polio, multidrug-resistant TB) are sent to these external reference laboratories for confirmation testing and quality assurance review. ¹⁹².

2.2.1a Nationwide specimen transport system

Score: 100

Rwanda has a nationwide specimen transport system as described in its National Health Emergency Response Operations Plan (NHEROP, September 2024).

As per Section 2.2.3 "Laboratory Networks" of the NHEROP, published in September 2024, Rwanda has a three-tier laboratory network: national (National Reference Laboratory—NRL), district (hospital laboratories), and peripheral (health centers' laboratories). This network connects sample transfer systems from peripheral facilities to district and national levels for both routine and emergency needs. According to Section 4.1.3 "Shipment modalities of pathogens inside and outside the country", human pathological specimens are routinely and safely transported from collection sites to analysis facilities across the country. Health centers send their specimens to district hospitals, often using motorbikes or ambulances, while dedicated NRL vehicles collect samples from hospitals on a weekly basis for delivery to the NRL. For highly pathogenic materials, standard operating procedures, including triple packaging, are strictly followed to ensure biosafety and security during transportation within Rwanda ¹⁹³.

The World Health Organization notes that collected specimens are transported safely and securely to accredited laboratories from the majority (at least 80%) of subnational levels/districts in the country ¹⁹⁴. There is no further evidence of a nationwide specimen transport system from the Ministry of Health, Ministry of Transport or MInistry of Agriculture and Animal Resources ^195196197.

2.2.2a Plan to rapidly authorize/license laboratories to scale-up testing during an outbreak

Score: 50

Rwanda has a plan in place to rapidly authorize or license laboratories to supplement the capacity of the national public health laboratory system and scale-up testing during an outbreak. Section 4.1 (pages 20–21) of the National Health Emergency Response Operations Plan (NHEROP, September 2024) states that the National Reference Laboratory (NRL) oversees the licensing, certification, and accreditation of both private and public health laboratories. In emergencies, the plan allows for additional laboratories – such as private labs (e.g., Lancet, BMC), university teaching hospitals, referral hospitals, and satellite laboratories in all provinces – to be engaged to supplement and boost the NRL’s testing capacity. These facilities are prepared to support sample reference services and advanced testing needs (such as genomic sequencing and PCR) when the national capacity needs scaling. However, the NHEROP does not directly mention any process or procedure by which laboratories are given swift authorisation to supplement the capacity of the national public health laboratory system to scale-up testing during an outbreak. It does mention that the Disaster Preparedness Plan provides a framework in the event of a disaster for testing related to blood collection (Blood Banks 2.2.5, p. 13) ¹⁹⁸. There is no further evidence in the Ministry of Health's 2021 One Health Policy or the 2025-2029 National Action Plan ¹⁹⁹²⁰⁰.

2.3.1a Evidence of ongoing event-based and indicator-based surveillance and analysis

Score: 50

There is evidence of ongoing event-based surveillance and analysis for notifiable and novel infectious diseases, however there is no evidence that the data are being analysed on a daily basis. The Public Health Surveillance and Emergency Preparedness and Response, which operates under the Ministry of Health's Rwanda Biomedical Centre, provides a weekly epidemiological bulletin that covers all developments related to contagious diseases that affect Rwanda. The updates are carried out weekly rather than daily. In addition, the latest updates are from January 2025 ²⁰¹. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre that analyses are carried out on a daily basis ²⁰²²⁰³.

2.3.1b Evidence of a mechanism (such as IHR focal point) for reporting notifiable diseases to the WHO within the set timeline

Score: 0

There is no publicly available evidence that a mechanism for reporting notifiable diseases to the WHO exists. The IHR status of Rwanda is marked as "approved" by the World Health Organisation as of 2025 in reference to reporting concerning the Marburg virus outbreak ²⁰⁴. The 2020-2024 National Action Plan for Health Security mentions the establishment of a reporting system that complies with WHO requirements (Reporting, p. 76). Notifiable diseases in recent times have been reported to the WHO, such as COVID-19 and the Marburg virus, although it is not clearly stated through which mechanism they were communicated ²⁰⁵²⁰⁶. The Rwanda Health Communication Centre, under the Rwanda Biomedical Centre, also exists to manage and organise communication related to public health issues. ²⁰⁷ Nevertheless, there is no specific description of a mechanism for reporting notifiable diseases to the WHO. The 2020-2024 National Action Plan for Health Security mentions that there is a target to "establish a collaborative multidisciplinary reporting system on the health of humans, animals’ interface that comply with WHO requirement" and that "there is need of protocols and tools for reporting to WHO". In addition the "person functioning as the IHR NFP has not yet been trained in reporting public health emergencies of international concern (PHEICs)" (p. 76). ²⁰⁸

2.3.2a Electronic national and sub-national reporting surveillance system

Score: 100

There is evidence that the Rwandan government operates an electronic reporting surveillance system at both the national and the sub-national level. The Electronic Infectious Disease Surveillance and Response system (eIDSR) was set up in 2013 with the support of the U.S. Centers for Disease Control and Prevention ²⁰⁹. in 2024, the Rwanda Biomedical Centre, in cooperation with Africa CDC, launched Event-Based Surveillance guidelines to complement the surveillance system that was already in place ²¹⁰.

2.3.2b Collection of ongoing/real-time lab data by electronic surveillance system

Score: 50

There is publicly available evidence that an electronic reporting surveillance system collects ongoing or real-time laboratory data. However there is no available evidence that the data are disaggregated by age, ethnicity, or other demographic factors. The Electronic Infectious Disease Surveillance and Response (eIDSR) System was established in Rwanda in 2013 and data is collected by the Rwanda Biomedical Centre ²¹¹²¹². The Public Health Surveillance and Emergency Preparedness and Response Division, operating under the Rwanda Biomedical Centre, releases weekly bulletins, providing updated data on public health issues affecting the country. However, the data only shows the number of cases and geographical distribution of those cases across the country and does not contain demographic disaggregating. ²¹³

2.3.3a National wastewater surveillance programme or initiative

Score: 50

There is evidence of some wastewater and environmental surveillance (WES) activity within Rwanda. The WHO and GPEI Q4 2025 Polio ES Bulletin lists the country as having 4 ES sites as of Q4 in 2025, although it is unclear whether these are at the national level and are ongoing.²¹⁴

Moreover, the he Rwanda Pathogen Monitoring program, based on wastewater-based epidemiology (WBE), was launched in May 2023 by Ginkgo Bioworks and the Rwanda Biomedical Centre. The aim of the program is to implement WBE at the Kigali International Airport, the main international airport in Rwanda, to detect and monitor variants of severe acute respiratory SARS-CoV-2 among international travelers. However, it is unclear whether this partnership is ongoing.²¹⁵

2.4.1a Common usage of electronic health records

Score: 50

There is publicly available evidence that electronic health records are in use. There is also evidence to confirm that they are commonly in use. The Rwandan Ministry of Health launched the "One Patient, One Record" project in 2020 with the aim of digitising patients' health records ²¹⁶. The system called "e-Ubuzima", which enables Rwandans to hold a single digital health record, is active in 15 districts across the country ²¹⁷. The Ministry of Health aims to fully digitize all health records by December 2025 ²¹⁸.

2.4.1b Public health system access to individual electronic health records

Score: 0

There is no evidence that the national public health system has access to individuals' public health records. However, this access must be in accordance with Rwanda's National Data Protection Law. The large majority of health centers in Rwanda now use electronic health records ²¹⁹. The public health authorities are planning to make all health records digital by the end of 2025 ²²⁰. The Rwanda National Data Protection Law was enacted in 2021 and so access to private information must be provided at the individual patient's discretion ²²¹²²². Nevertheless, there is no evidence that the national public health system or the Ministry of Health have direct access to these records. There is no further evidence from the Ministry of Health. ²²³

2.4.1c Existence of data standards for health record data comparability

Score: 100

There is evidence that there are data standards to ensure that data is comparable. The Ministry of Health has developed the Rwanda Medical Procedure Coding (RMPC) system to harmonize procedure coding with an international standard. A subset of ICD-10 codes have been proposed for disease coding ²²⁴. The World Health Organization has worked with the Ministry of Health and key stakeholders, the Rwanda Biomedical Centre in particular, to develop health-related data systems in the country ²²⁵. These developments came on the back of the Data Quality Assessment Procedures Manual drafted by the Ministry of Health in 2016 in view of improving data quality procedures ²²⁶.

2.4.2a Data sharing mechanisms

Score: 0

There is no publicly available evidence of established mechanisms at the relevant ministries responsible for animal, human and wildlife surveillance to share data. The One Health Policy 2021-2026 notes that "limited regular communication and information sharing between animal and human health sectors makes it difficult to have an organized response or recovery if there was to be an outbreak such as Ebola" ²²⁷. Recently in May 2025, the Rwandan Government approved a National Data Sharing Policy, published by the Ministry of ICT and Innovation ²²⁸. The policy is said to "shift towards more coordinated, transparent, and effective data use across government institutions" ²²⁹, however the document itself does not explicitly mention any existing data sharing mechanisms across ministries ²³⁰.

2.4.3a Availability of de-identified health surveillance data on disease outbreaks

Score: 0

There is insufficient public available evidence that the country makes de-identified health surveillance data on disease outbreaks publicly available via reports on government websites. The Rwanda Biomedical Centre publishes weekly reports on health-related issues in the country, however it does not include de-identified data ²³¹. The Ministry of Health runs a Rwanda Integrated Health Management Information System (HMIS), which ostensibly store health surveillance data, however the data are not publicly available and they require a login ²³². Furthermore, the Ministry of Health ran a Electronic Infectious Disease Surveillance and Response (eIDSR) System with the support of U.S. Agency for International Development (USAID) as part of the the Rwanda Health Systems Strengthening (RHSS) Project (2014-2019), however there is no evidence that this project has since continued and the system itself is not currently publicly available ²³³. There is no further evidence from the Ministry of Health or on the HMIS website ²³⁴²³⁵.

2.4.4a Confidentiality legislation/regulations for identifiable health information

Score: 100

There is evidence that legislation exists that safeguards the confidentiality of identifiable health information for individuals, such as that generated through health surveillance activities. Law Nº 058/2021 of 13/10/2021, relating to the Protection of Personal Data and Privacy (commenced 15 September 2021), governs all processing of personal data in Rwanda, including health information and surveillance data. This law defines both "personal data" and "sensitive personal data" -with health and medical records falling under sensitive personal data (Article 38) ²³⁶.

2.4.4b Inclusion of cyber protections in health data confidentiality law/regulation

Score: 0

There is no evidence that legislation exists that safeguards the confidentiality of identifiable health information for individuals that includes any mention of cyber attacks. Legislation exists that safeguards the confidentiality of identifiable health information for individuals, however it does not mention cyber attacks. The Data Protection and Privacy Law No 058/2021 of 13/10/2021 protects all personal data, which is legally protected and considered confidential, including health-related information, however it makes no mention of cyber attacks ²³⁷.

2.4.5a Cooperative commitments or agreements within regions

Score: 50

There is publicly available evidence that the government has committed to sharing surveillance data during a public health emergency with other countries in the region for one disease, but no evidence for more than one disease. According to the Africa Centres for Diseases Control and Prevention, Rwanda is one of 12 countries that have joined together in collaboration to respond, prevent and control disease outbreaks, especially the recent monkeypox outbreaks, which includes "data-sharing mechanisms". It is unclear whether this is just for one or multiple diseases, and there is no evidence of any implementation of mechanisms yet ²³⁸. Rwanda is also a member of the East Africa Public Health Laboratory Network Project, a World Bank funded project whose aim is to "to establish a network of efficient, high quality, accessible public health laboratories for the diagnosis and surveillance of Tuberculosis and other communicable diseases". This includes the East African Integrated Disease Surveillance Network, which aims to harmonize "integrated disease surveillance systems in the region"^{239 240}. There is also no such mention of sharing surveillance data in other inernationally led policies that Rwanda is involved in, for instance in the One Health Policy or the WHO Rwanda Country Cooperation Strategy ²⁴¹²⁴². There is no further evidence from the Ministry of Health or the Rwanda Biomedical Centre ²⁴³²⁴⁴. Neither is there evidence from the Ministry of ICT and Innovation's 2025 National Data Sharing Policy ²⁴⁵.

The country's adherence to the International Health Regulations (IHR 2005) serves as a primary legal and operational commitment. As a signatory, Rwanda is obligated to notify the World Health Organization (WHO) of public health events that may constitute a public health emergency of international concern. This legally binding framework necessitates the sharing of surveillance data with the WHO but does not specify provisions to share with other countries. ²⁴⁶

2.5.1a National support to conduct contact tracing in the event of a public health emergency

Score: 100

There is evidence that Rwanda has a national system in place to provide support at the sub-national level to conduct contact tracing in the event of a public health emergency. There is evidence to show that there are plans in place to prepare for future health emergencies. Rwanda has faced two major public health emergencies in the past 5 years – COVID 19 and the Marburg virus. In both cases, the health authorities had successfully implemented a contact tracing campaign to mitigate the spread of the viruses ²⁴⁷²⁴⁸. In general, there exists a Rapid Response Team (RRT) that supports with risk assessment, outbreak investigation, emergency management and outbreak control. During an emergency, the RRT is deployed within 24 – 48 hours (Section 2.1.2) ²⁴⁹. In addition, there are Emergency Medical Teams (EMT) that provide direct clinical care to people affected by emergencies and support local health systems (Section 2.1.2) ²⁵⁰. Furthermore, the Rwanda Biomedical Centre, in collaboration with Africa Centres for Disease Control and Prevention (CDC), the African Field Epidemiology Network (AFENET) and the University of Rwanda, implements 3 tiers of Field Epidemiology Training Program (FETP) training (advanced, intermediate and frontline). These competency-based workforce development training programs aim to improve the capabilities of frontline workers to prevent, detect, investigate and respond to emergencies (Section 2.1.1) ²⁵¹.

2.5.1b Provision of wraparound services to enable self-isolation/quarantine as recommended

Score: 50

There is evidence that Rwandan health services provide wraparound services to enable infected people and their contacts to self-isolate or quarantine as recommended. However, the available evidence suggests that infected and quarantined individuals receive only medical attention and not economic support. During both the COVID-19 pandemic and the outbreak of the Marburg virus, self-isolated individuals received medical attention at no extra cost to themselves ^252253254255. Nevertheless, there is no further evidence from the Ministry of Health, Rwanda Biomedical Centre or Ministry of Finance and Economic Planning that such individuals received economic support ^256257258. Economic support was instead provided to businesses affected by the COVID-19 pandemic ²⁵⁹

2.5.2a Strategy for tracing and quarantining international travelers

Score: 0

There is no publicly available evidence of a joint plan or cooperative agreement between the public health system and border control authorities to identify suspected and potential cases in international travelers and trace and quarantine their contacts in the event of an active or future public health emergency. There is no evidence from the cases of COVID-19 or the Marburg virus that there was any joint plan or cooperative agreement between the public health system and border control authorities ^260261262263. In the case of the Marburg virus outbreak, the U.S.-based Centers for Disease Control and Prevention performed health screenings on arriving travelers. There is no evidence of national Rwandan agencies involved ²⁶⁴. There is no further evidence from the Ministry of Health, Rwanda Biomedical Centre, or the Rwanda Directorate General of Immigration and Emigration ^265266267.

2.6.1a Access to field epidemiology training program in country and/or abroad

Score: 100

There is publicly available evidence that Rwanda has an applied epidemiology training programme available in the country. The Rwanda Field Epidemiology and Laboratory Training Program is a two-year postgraduate training in field epidemiology and field-oriented public health laboratory practice that was established in May 2010 to enhance the Ministry of Health’s capacity to conduct effective public health surveillance and allow timely response to endemic and emerging public health threats in Rwanda ²⁶⁸. There is no evidence that resources are provided by the government to send citizens to another country to participate in applied epidemiology training programs in the One Health Policy ²⁶⁹. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre ²⁷⁰²⁷¹.

2.6.1b Existence of field epidemiology training for animal health professionals

Score: 100

There is evidence that field epidemiology training programs are explicitly inclusive of animal health professionals or that a specific animal health field epidemiology training program is offered. Rwanda's field epidemiology and laboratory training program (FELTP) is also made available to animal health professionals. According to the Joint External Evaluation for Rwanda, conducted in May 2018, this program accepts both epidemiologists and laboratory personnel, and 34 field epidemiologists have graduated, included four veterinarians, since 2010. ²⁷²²⁷³ According to the University of Rwanda School of Public Health, upon completion of the FELPT, graduates can be placed in the Ministry of Agriculture and Animals. ²⁷⁴ There is no publicly available evidence of a specific animal health field epidemiology training program offered (such as FETPV). ^275276277

2.6.2a Evidence of at least 1 trained field epidemiologist per 200,000 people

Score: 100

There is evidence that Rwanda has at least 1 trained field epidemiologist per 200,000 people. A study from March 2025 notes that a total of 523 epidemiologists have been trained by the Field Epidemiology and Laboratory Training Program ²⁷⁸. This would mean that there are 7.5 epidemiologists per 200,000 people.

3.1.1a National emergency response plan for diseases with pandemic potential

Score: 100

The National Health Emergency Response Operations Plan (NHEROP, September 2024) is an overarching, publicly available national public health emergency response plan directly addressing planning for multiple communicable diseases with epidemic and pandemic potential.

Section 1.3.1 (“National health emergency risk assessment,” pp.7–8) and Section 1.3.2 (“Priority hazards identified for contingency planning,” p.8) enumerates a broad set of hazards, including epidemic-prone diseases like covid, influenza (new subtypes), ebola, Marburg, rift valley fever, poliomyelitis, and antimicrobial resistance. Section 3.3 (“Plans, Strategies and Guidelines,” p.17) identifies the NHEROP as the central reference document, confirming its public availability and function as a national planning tool. Section 2.3 (“Financial Resources,” p.15) provides direct evidence of a dedicated funding mechanism: the Ministry of Finance maintains an emergency fund for unplanned expenses, with resources mobilized by the Ministry of Health and managed for emergency operations. ²⁷⁹.

3.1.1b National public health emergency response plan published in past 3 years

Score: 100

There is evidence that the overarching national public health emergency response plan has been updated in the last three years. The National Health Emergency Response Operations Plan (NHEROP) was published in September 2024 ²⁸⁰.

3.1.1c One health principles by covering multiple threat types

Score: 100

There is evidence that the overarching national public health emergency response plan covers multiple threat types. The 2024 National Health Emergency Response Operations Plan (NHEROP) in its Section 1.3.1 (“National health emergency risk assessment,” pp.7–8) and Section 1.3.2 (“Priority hazards identified for contingency planning,” p.8) enumerates a broad set of hazards—including epidemic-prone diseases like covid, influenza (new subtypes), ebola, Marburg, rift valley fever, poliomyelitis, and antimicrobial resistance ²⁸¹.

3.1.1d Vulnerable populations in national public health emergency response plan

Score: 100

The Rwandan national health emergency plan contains considerations for vulnerable populations and health equity impacts.

Section 1.1.1 (page 2) and 1.1.3 (pages 3–4) of the 2024 National Health Emergency Response Operations Plan (NHEROP) present population demographics and refer to past emergencies that disproportionately affected rural residents, refugees, prisoners, and those in disaster-prone districts. Section 4.2, "Risk Communication and Community Engagement" (RCCE) Strategy (pages 22–26), sets out guiding principles and operational strategies for inclusive communication, specifically targeting groups of lower socioeconomic status, different ages, and minority ethnic groups. The strategy mainstreams community engagement, equity, and participation, with activities designed to reach marginalized and hard-to-reach groups in every district and village. Emergency response actions, including deployment of surge staff and Rapid Response Teams (Section 2.1, pages 12–13), are prioritized in areas with demonstrated greater vulnerability based on social, economic, and health indicators. Past incidents and risk profiles (Section 1.3.2, pages 8–11) repeatedly identify refugees, rural poor, older adults, and ethnic minorities as at higher risk, and planning for contingency measures such as vaccination and food aid in refugee camps (e.g., Mahama Camp) and prisons is described ²⁸².

3.1.2a Mechanism to engage private sector in outbreak preparedness/response

Score: 0

There is insufficient evidence to suggest that a specific mechanism for engaging with the private sector to assist with outbreak emergency preparedness and response exists. The 2024 National Health Emergency Response Operations Plan (NHEROP) simply mentions that private health facilities exist, but does not specify whether there is any specific mechanism to engage them during an emergency response ²⁸³. The 2024 National Guidelines for Disaster Emergency Response and Recovery does mention the role of private clinics and cooperation with the Private Sector Federation during disasters, however it does not specify any mechanism by which this is undertaken ²⁸⁴. Responses to the Marburg virus outbreak and COVID-19 pandemic also do not show the implementation of any mechanism that engaged the private sector during those emergencies ^285286287.

3.1.3a Policy/plan/guidelines in place to implement non-pharmaceutical interventions (NPIs)

Score: 100

There is evidence that Rwanda has guidelines in place to implement non-pharmaceutical interventions (NPIs) during an epidemic or pandemic for more than one disease. The 2024 MPOX Strategic Preparedness published by the Rwanda Biomedical Centre, Readiness and Response Plan includes procedures for hygiene, sanitation, safe burials, mental health and psychosocial support. ²⁸⁸. Rwanda has a Coronavirus Disease 2019, National Preparedness and Response Plan which includes language referring to NPIs such as social distancing, hygiene practices and isolation. However, it is specific to COVID-19 and can't be used for other diseases ²⁸⁹. Rwanda also has some language referring to NPIs in its Ebola Virus Disease (EVD) Contingency Plan such as hygiene, sanitation and disinfection services, however, it is also specific to this disease ²⁹⁰.

3.2.1a Completion of biological-focused IHR exercise with the WHO in past year

Score: 100

There is evidence that Rwanda has activated their national emergency response plan for an infectious disease outbreak in the past year. However there is no evidence that Rwanda has completed a national-level biological threat-focused exercise (either with WHO or separately) in the past year. Rwanda's Ministry of Health activated its National Incident Management System after the outbreak of the Marburg virus disease was officially declared in September 2024. Rapid response teams were deployed to manage the outbreak, using surveillance, contact tracing and case management. The teams operated alongisde the World Health Organization (WHO) and the Africa Centres for Disease Control and Prevention (CDC) teams, with integrated support at Kigali University Teaching Hospital and King Faisal Hospital ²⁹¹. The last known national-level biological threat-focused exercise to have been conducted in Rwanda was the simulation exercise to ensure Ebola preparedness, undertaken by the Ministry of Health and Rwanda Military Hospital on 25 September 2018 in partnership with the Rwanda Defence Force ²⁹².

3.2.1b Evidence of bio-focused exercise to identify gaps/best practices

Score: 100

There is evidence that the country in the past year has identified a list of gaps and best practices in response (either through an infectious disease response or a biological-threat focused exercise) and developed a plan to improve response capabilities. Section 5.3 (“After Action Review,” p.32) of Rwanda’s National Health Emergency Response Operations Plan (NHEROP, October 2024) describes the formal use of After Action Reviews (AARs) as a standard mechanism for evaluating the effectiveness of outbreak responses. These reviews aim to identify best practices, successes, and critical gaps experienced during real-world health events. Annexes and introductory sections (Foreword and Section 1.3.1, pp.iii–8) provide additional background, referencing a nationwide multi sectoral risk assessment conducted in January 2023 and the resultant prioritization of hazards, which helped shape targeted national preparedness actions and resource allocation. The NHEROP explicitly states that these processes—including lessons learned from recent infectious disease outbreaks (e.g., COVID-19 and Marburg)—inform the continuous refinement and improvement of Rwanda’s outbreak response systems and guide new strategic plans, protocols, and operational enhancements ²⁹³. The last after-action review to be published is the After Action Review (AAR) of Marburg Virus Disease Outbreak Response in Rwanda, published in May 2025 ²⁹⁴.

3.2.2a Evidence of national-level biological threat-focused exercise that includes private sector

Score: 100

Rwanda has undergone a national-level biological threat-focused exercise in the past year that included private sector representatives. In September 2024, Rwanda’s Ministry of Health, in collaboration with Ginkgo Bioworks, IQVIA, BioNTech, CEPI, and the Rwanda Biomedical Center, conducted its first tabletop exercise for the 100 Days Mission, focusing on a hypothetical, highly contagious Rift Valley Fever Virus variant. This exercise engaged a range of partners—including those from the private sector such as IQVIA (clinical trial surge capacity), Ginkgo Bioworks (pathogen detection and biosurveillance), and BioNTech (mRNA vaccine manufacturing)—as well as regulatory, clinical, and laboratory institutions from across Rwanda. The exercise featured public-private partnerships, joint scenario planning, and live regulatory preparedness components with the Rwanda Food and Drug Administration and CEPI. It was designed to stress-test national preparedness, build trusted working relationships, and improve coordination between public health authorities and private sector entities in vaccine development, rapid diagnostics, and outbreak response, with a commitment to follow-up “live demonstration” exercises in manufacturing and public health response the following year ²⁹⁵.

3.3.1a Existence of Emergency Operations Center (EOC)

Score: 100

There is evidence that Rwanda has an Emergency Operations Center (EOC) in place. The National Health Emergency Response Operations Plan (NHEROP) mentions the existence of Public Health Emergency Operation Centers (PHEOC) at the national and district levels (Section 5.2.1) ²⁹⁶.

3.3.1b Requirement for EOC to conduct/evidence EOC conducts at least annual drills

Score: 0

There is no evidence that Rwanda's Emergency Operations Center (EOC) conducts a drill at least once a year. There is no mention of conducting drills in the National Health Emergency Response Operations Plan (NHEROP) ²⁹⁷. The last known national-level biological threat-focused exercise to have been conducted in Rwanda was the simulation exercise to ensure Ebola preparedness, undertaken by the Ministry of Health and Rwanda Military Hospital on 25 September 2018 in partnership with the Rwanda Defence Force ²⁹⁸. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre ²⁹⁹³⁰⁰.

3.3.1c EOC activation within 120 minutes of identification of emergency/scenario

Score: 0

There is no evidence that the Emergency Operations Center (EOC) has conducted within the last year a coordinated emergency response or emergency response exercise activated within 120 minutes of the identification of the public health emergency/scenario. The last known national-level biological threat-focused exercise to have been conducted in Rwanda was the simulation exercise to ensure Ebola preparedness, undertaken by the Ministry of Health and Rwanda Military Hospital on 25 September 2018 in partnership with the Rwanda Defence Force ³⁰¹. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre ³⁰²³⁰³.

3.4.1a Joint exercise/procedures for potential deliberate biological events

Score: 100

There is no evidence that public health, animal health, the private sector and national security authorities have carried out an exercise to respond to a potential deliberate biological event (i.e., bioterrorism attack). Nevertheless, there is evidence of standard procedures and guidelines between the public health, animal health, private sector and security authorities to respond to a potential deliberate biological event. The 2020-2024 National Action Plan for Health Security notes that training for simulation exercises on biosafety and biosecurity practices need to be implemented, however they have not yet been carried out (Indicator P.6.1, p. 58) ³⁰⁴. Simulation exercises to tackle the spread of diseases have been conducted, for instance the Ebola simulation exercises conducted in 2018 ³⁰⁵³⁰⁶. Nevertheless, these were not linked to deliberate biological events. Regarding procedures and guidelines in response to potential deliberate biological events, the 2019 National Contingency Plan for Managing the Emergency Consequences of Terrorist Incidents, published by Rwanda's Ministry in Charge of Emergency Management, accounts for chemical and biological terrorism hazards, outlining potential targets and procedures for detection, warning and containment ³⁰⁷.

3.5.1a Risk communication plan for specific use during a public health emergency

Score: 100

There is evidence that the national public health emergency response plan contains a section detailing a risk communication plan that is specifically intended for use during a public health emergency. The National Health Emergency Response Operations Plan (NHEROP) contains a section entitled "Risk Communication and Community Engagement (RCCE) Strategy" . The main objective of the strategy is to contribute to "the national multi-hazards preparedness and response activities by fostering community engagement in preventing, controlling and curbing the burden of frequent health hazards identified in Rwanda", in addition to outlining a number of more specific objectives (Section 4.2, p. 22). It also provides an operational structure of the strategy as well as communication mechanisms during phases of emergency ³⁰⁸.

3.5.1b Inclusion of different population & sector needs in risk communication plan

Score: 100

There is evidence that the risk communication plan will cover different communication needs across the country. The plan states that "communication materials used should be mainly in Kinyarwanda language generally to ensure maximum reach of intended audiences but otherwise, the National Health Emergency Response Operations Plan (NHEROP) Risk Communication and Community Engagement RCCE task team can determine the appropriate language and channels. The NHEROP RCCE task team will ensure that the communication materials are inclusive, gender sensitive and adapted to the literacy level of the targeted audience including those living with disabilities." (Communication mechanisms during phases of emergency Section 4.2.5, p. 24) ³⁰⁹

3.5.1c Designation of a specific government spokesperson during a public health emergency

Score: 0

There is no evidence in the risk communication plan that a specific position in the government serves as the primary spokesperson to the public during a health emergency. No evidence was found in the National Health Emergency Response Operations Plan (NHEROP) or the National Guidelines for Disaster Emergency Response and Recovery ³¹⁰³¹¹. Nevertheless, taking the example of the Marburg virus outbreak, the Minister of Health declared both the start and the end of the emergency, along with the WHO Country Representative to Rwanda ³¹²³¹³.

3.5.2a Government use of media platforms to share info on public health emergencies

Score: 50

There is publicly available evidence that in the past year the public health system has actively shared messages via online media platforms (e.g. social media, website) to inform the public about ongoing public health concerns and/or dispel rumors, misinformation or disinformation. However, the public health system only shares information through media platforms during active emergencies, but does not regularly utilize online media platforms. The latest public health emergency in Rwanda was the outbreak of the Marburg virus in 2024, and the Rwandan public health authorities employed risk communication strategies to stem the spread of the virus ^314315316. During the outbreak of the Marburg virus, the Ministry of Health used its Facebook, X and Instagram accounts to provide updates on the epidemiological situation of the Marburg virus, sharing information on the number of cases, the measures to implement etc ³¹⁷³¹⁸. There is however no information aimed at dispelling misinformation or disinformation.

3.5.2b Evidence that senior leaders have shared mis/disinformation on infectious diseases

Score: 100

There is no publicly available evidence that senior leaders (president or ministers) have shared misinformation or disinformation on infectious diseases (in the past two years). Evidence of misinformation or disinformation on infectious diseases could not be found on the website of the Ministry of Public Health, the national reference general hospital or in one of the main newspapers of the country, the Rwanda News Agency ^319320321.

3.6.1a Percentage of households with Internet

Score: 37.91

3.6.2a Mobile-cellular telephone subscriptions per 100 inhabitants

Score: 49.46

3.6.3a Gender gap in access to a mobile phone (percentage points)

Score: 43.33

3.6.4a Gender gap in access to the Internet (percentage points)

Score: 70.83

3.7.1a Restrictions on export/import of medical goods due to an infectious disease outbreak

Score: 100

There is no publicly available evidence that Rwanda has implemented restrictions in the past year on export/import of medical goods due to an infectious disease outbreak. There is no mention of any restrictions on the export/import of medical goods as a result of the outbreak of the Marburg virus in Rwanda over the course of 2024-2025 in the Ministry of Health's National Guidelines for Management of Marburg Virus Disease nor in the report by the Social Science Humanitarian Action Platform (SSHAP) on the outbreak of the Marburg virus ³²²³²³. There is no further evidence in the Ministry of Health, Rwanda Biomedical Centre or Ministry in Charge of Emergency Management ^324325326.

3.7.1b Restrictions on movement and/or exports/imports due to disease outbreak

Score: 100

There is no publicly available evidence that Rwanda has implemented restrictions in the past year on export/import of non-medical goods due to an infectious disease outbreak. There is no mention of any restrictions on the export/import of non-medical goods as a result of the outbreak of the Marburg virus in Rwanda over the course of 2024-2025 in the Ministry of Health's National Guidelines for Management of Marburg Virus Disease nor in the report by the Social Science Humanitarian Action Platform (SSHAP) on the outbreak of the Marburg virus ³²⁷³²⁸. There is no further evidence in the Ministry of Health, Rwanda Biomedical Centre or Ministry in Charge of Emergency Management ^329330331.

3.7.2a Evidence of travel ban due to an infectious disease outbreak

Score: 100

There is no evidence that Rwanda implemented inbound or outbound travel restrictions due to an infectious disease outbreak in the past year. The absence of restrictions may be based on international recommendations. During the outbreak of the Marburg virus in Rwanda, the public health authorities did not impose inbound or outbound travel restrictions, as they are not mentioned in the Rwanda National Guidelines for Management of Marburg Virus Disease, nor are they mentioned by the Ministry of Health or the Rwanda News Agency ^332333334335. The World Health Organization advised against travel restrictions in Rwanda in response to the Marburg virus outbreak, arguing that it would be detrimental to economic recovery and would hinder the sharing of critical public health data ³³⁶. The Africa CDC also advised against imposing travel restrictions in order to avoid obstructing the flow of medical goods and to prevent spreading fear among the population ³³⁷.

3.7.2b Risk-based approach to international travel-related measures

Score: 0

There is insufficient evidence that Rwanda uses a risk-based approach to international travel-related measures. Rwanda's Ministry of Health has implemented measures that include travel advice and restrictions, particularly during disease outbreaks, guided by the World Health Organization (WHO) and the International Health Regulations (IHR). These measures often involve assessing the risk posed by travelers and implementing appropriate restrictions or guidance based on that assessment ³³⁸. During the Marburg virus disease (MVD) outbreak, Rwanda implemented measures such as restrictions on hospital visits and attendance at funerals, as well as specific advice for educational settings, places of worship, and meetings. Furthermore, travelers going to affected areas were advised to stay updated on the outbreak, avoid contact with symptomatic individuals, and avoid contact with infected people's bodies, including during funerals. These measures align with the International Health Regulations (2005), which calls for risk-based approaches to travel restrictions to minimise interference with international traffic ³³⁹.

4.1.1a Doctors per 100,000 people

Score: 0.79

4.1.1b Nurses and midwives per 100,000 people

Score: 11.45

4.1.1c Updated health workforce strategy to address human resource shortfalls

Score: 100

Rwanda has a national health workforce strategy that was updated within the past five years and addresses both the identification of workforce gaps and the development of strategies to remedy these shortcomings. Rwanda’s Health Sector Strategic Plan V (HSSP V, 2024–2029) and its National Strategy for Health Professions Development (NSHPD) contain the national health workforce policy ³⁴⁰³⁴¹.

HSSP V’s Health Workforce Pillar (Pillar 1, pp.8–9 of HSSP V) is dedicated to quadrupling the number of skilled health workers over four years to meet World Health Organization (WHO) recommended workforce density. The strategy is informed by recent labor market analyses and specialty-specific surveys and identifies persistent shortages in clinical fields (general practitioners, specialists, nurses, midwives, allied health sciences, radiology, anesthesiology, and others) as well as disparities in rural versus urban distribution and retention rates ³⁴²³⁴³.

4.1.1d Health system capacity for essential health services

Score: 0

There is insufficient evidence that Rwanda has sufficient capacity within the health system to deliver essential health services. In the Ministry of Health's 2024 executive summary of the 4×4 Reform, it states that Rwanda still falls behind the WHO recommended healthcare worker density of 4.45 healthcare workers per 1,000, having a rate of 1 healthcare worker per 1,000 people ³⁴⁴. The 2019-2020 Demographic and Health Survey notes that "more than 4 in every 5 Rwandan women and men age 15-49 (83% each) have health insurance" ³⁴⁵. The Health Minister noted in 2023 that over 90% of Rwandans have health insurance ³⁴⁶. The WHO notes that essential and life-saving health services have enjoyed improvements across the country in recent years ³⁴⁷. Significant healthcare investments in recent years have allowed for the installment of health posts across the country, improving access to healthcare for more isolated communities ³⁴⁸. The International Growth Centre asserts that "Rwanda has a highly functional healthcare system with features that serve the short and long term" ³⁴⁹.

4.1.1e Essential health services continuity plan for public health emergencies

Score: 100

Rwanda has a national plan to ensure continuity of essential health services during a public health emergency. The National Health Emergency Response Operations Plan (NHEROP, October 2024) provides comprehensive strategies for preserving access to healthcare across all levels—community, district, and referral facilities—when emergencies disrupt usual service delivery. Section 2.1.2 details the deployment of Rapid Response Teams (RRTs) and Emergency Medical Teams (EMTs) to support health system functions during crises, while Section 2.1.3 outlines surge mechanisms for mobilizing additional human resources and logistical support to maintain essential health services when demand increases or local systems are overwhelmed. Section 2.2 describes essential logistics, including buildings, equipment, medicines, and mobile resources such as ambulances, ensuring healthcare facilities remain operational during emergencies ³⁵⁰.

4.1.2a Hospital beds per 100,000 people

Score: 15.41

4.1.2b In-country capacity to isolate patients with highly communicable diseases

Score: 100

There is evidence that Rwanda has the capacity to isolate patients with highly communicable diseases in a biocontainment patient care unit located within the country. Investments in healthcare infrastructure, including the expansion of isolation centers and testing facilities, provided a strong foundation for the effective containment of the Marburg virus ³⁵¹. Early detection and isolation allowed for the successful containment of the Marburg virus in 2024 ³⁵². The Rwandan government is continuing to take steps to increase the level of outbreak preparedness. It has recently signed an agreement with the German Ministry of Health "to construct a new high-level isolation unit in Rwanda, the first in East Africa, and implement a training program for Rwandan healthcare workers to equip them with the necessary skills and knowledge for medical management of patients under high-level isolation conditions, including intensive care treatment" ³⁵³.

4.1.2c Demonstrated capacity / evidence of plan to expand isolation capacity

Score: 100

There is evidence that Rwanda has demonstrated capacity to expand isolation capacity in response to an infectious disease outbreak in the past two years. There is also evidence that Rwanda has developed a plan to expand isolation capacity in response to an infectious disease outbreak in the past two years. The response to the COVID-19 pandemic paved the way for the development of isolation capacity that was then tested and used during the Marburg virus outbreak. Investments in healthcare infrastructure, including the expansion of isolation centers and testing facilities, provided a strong foundation for the effective containment of the Marburg virus ³⁵⁴³⁵⁵. Early detection and isolation allowed for the successful containment of the Marburg virus in 2024 ³⁵⁶. The Rwandan government is continuing to take steps to increase the level of outbreak preparedness. It has recently signed an agreement with the German Ministry of Health "to construct a new high-level isolation unit in Rwanda, the first in East Africa, and implement a training program for Rwandan healthcare workers to equip them with the necessary skills and knowledge for medical management of patients under high-level isolation conditions, including intensive care treatment" ³⁵⁷.

4.2.1a National procurement protocol for the acquisition of routine laboratory/medical supplies

Score: 50

There is evidence that Rwanda has a national procurement protocol in place which can be utilised by the Ministries of Health, but not the Ministry of Agriculture, for the acquisition of laboratory and medical supplies. Law No. 62 of 2018 Governing Public Procurement mentions in Article 2 that it applies to "all procurement of works, goods or supplies and consultancy or non-consultancy services ordered by the procuring entity" ³⁵⁸. The Ministry of Health's "Health Supply Chain Management Module for RMS branches and Central level" published in 2021 lays out the standardized procedures for procurement of supplies ³⁵⁹. The Medical Production and Procurement Division (MPPD) under Rwanda Biomedical Centre (RBC), performs the procurement, storage, and distribution of health commodities to public health institutions and it is regarded as central medical store. MPPD is the main supplier of all pharmaceutical commodities ranging from essential medicines to laboratory reagents ³⁶⁰. There is no evidence from the Ministry of Agriculture and Animal Resources that it is involved in the procurement of laboratory or medical supplies ³⁶¹.

4.2.2a Stockpile of medical supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that Rwanda has a stockpile of medical supplies for national use during a public health emergency. There is no evidence that the plan ensures equitable distribution in an emergency. The 2024 National Health Emergency Response Operations Plan (NHEROP) mentions that "the Rwanda medical supply (RMS) under the Ministry of Health is in charge of the procurement and supply of health commodities. It is also responsible for the services of warehousing, and delivery. It also has subordinate branches in all 30 districts of Rwanda to facilitate timely delivery. The Expanded Program of Immunization within RBC is in charge of procuring, storing, and distributing vaccines countrywide." (Strategic health stockpiles 2.2.4, p. 13). The plan does not mention specifics of the stockpile, nor does it note that it would ensure equitable distribution in an emergency ³⁶². The Medical Production and Procurement Division (MPPD) does not have its own website.

4.2.2b Stockpile of laboratory supplies for national use during a public health emergency

Score: 0

There is no publicly available evidence that the country has a stockpile of laboratory supplies (e.g. reagents, media) for national use during a public health emergency. The 2024 National Health Emergency Response Operations Plan (NHEROP) published in September 2024 does not explicitly mention the existence of a stockpile of laboratory supplies ³⁶³. As part of the Rwanda COVID-19 Emergency Response Project in 2020, the Rwanda Biomedical Centre procured laboratory testing supplies and commodities, suggesting that the country did not previously have any stockpile ³⁶⁴. There is no further evidence from the Ministry of Health or Rwanda Biomedical Centre . The Medical Production and Procurement Division (MPPD) does not have its own website.

4.2.2c Annual review of national stockpile to ensure sufficient supply

Score: 0

There is no publicly available evidence that the country conducts or requires an annual review of the national stockpile to ensure the supply is sufficient for a public health emergency. Such evidence could not be found from the Ministry of Health or Rwanda Biomedical Centre ³⁶⁵³⁶⁶. No evidence could be found in the 2021 One Health Policy or 2024 National Health Emergency Response Operations Plan (NHEROP) ³⁶⁷³⁶⁸.

4.2.3a Plan/agreement to produce/procure medical supplies during a public health emergency

Score: 100

There is evidence of a plan to leverage domestic manufacturing capacity to produce medical supplies or to expedite them through points of entry during a public health emergency, as well as evidence of a plan to procure medical supplies in such situations. There is no evidence of a plan/mechanism to expedite medical supplies (e.g. MCMs, medicines, vaccines, equipment, PPE) through points of entry.

The Health Ministry's Health Supply Chain Management Module for RMS branches and Central level from 2021 lays out a plan for manufacturing capacity to produce medical supplies ³⁶⁹. Rwanda is heavily dependent on international drug manufacturers and medical imports. Calls have recently been made to develop local manufacturing in order to reduce the dependence on medical imports, especially in cases of emergencies. ³⁷⁰³⁷¹. The 2024 National Health Emergency Response Operations Plan has an Incident Management Structure, which includes procurement, managed by the Admin, Finance, Logistics Cell ³⁷². Rwanda Medical Supply is a government-owned company dedicated to the procurement, storage and delivery of medical supplies ³⁷³. There is no evidence from the Ministry of Health or Rwanda Biomedical Centre that there is a plan to expedite medical supplies ³⁷⁴³⁷⁵. There is no evidence from the Joint External Evaluation for Rwanda, conducted in May 2018, to expedite medical supplies through points of entry ³⁷⁶.

4.2.3b Plan/agreement to produce/procure lab supplies during a public health emergency

Score: 100

There is evidence that Rwanda has a plan/agreement to leverage domestic manufacturing capacity to produce laboratory supplies (e.g. reagents, media) for national use during a public health emergency and a plan/mechanism to procure laboratory supplies (e.g. reagents, media) for national use during a public health emergency or a plan/mechanism to expedite laboratory supplies (e.g. MCMs, medicines, vaccines, equipment, PPE) through points of entry. Rwanda has initiated key investments to strengthen domestic manufacturing, particularly for vaccines and diagnostics. The World Bank-supported Health Emergency Preparedness, Response, and Resilience Project specifically mentions efforts to expand local capacity for developing and producing quality diagnostics for priority health threats. This includes plans for the Rwanda Biomedical Centre to become a Diagnostics Development and Research Centre to help support innovation in affordable diagnostic solutions for epidemic-prone diseases and supporting local manufacturing for both domestic use and export ³⁷⁷. Rwanda also participated in regional pooled procurement initiatives coordinated by Africa CDC and EAC, designed to expedite acquisition of health products and improve resilience of supply chains in emergencies, including mechanisms to move supplies swiftly through points of entry ³⁷⁸.

4.2.3c Mechanism emergency logistics and supply chain management

Score: 100

There is evidence of a system in place for emergency logistics and supply chain management, and of specific considerations such as cold chain management for vaccines. The system covers the public sector, but not the private sector. There is no evidence that it is updated on a regular basis. The National Health Emergency Response Operations Plan (NHEROP) contains a section on logistics, outlining the use of physical resources, health facilities, laboratory networks and health stockpiles during an emergency (Section 2.2.). It covers the use of public health institutions, namely the Ministry of Health, in the procurement and supply of medical supplies during an emergency ³⁷⁹. The Rwanda Food and Drugs Authority provides guidelines on cold chain management for vaccines and other biopharmaceutical products ³⁸⁰. There is no further evidence from the Ministry of Health of Rwanda Biomedical Centre of a regular updating process for this system ³⁸¹³⁸².

4.3.1a Plan/program/guidelines for dispensing MCMs during a public health emergency

Score: 0

There is no public evidence that the country has a plan, program, or guidelines in place for dispensing medical countermeasures for national use during a public health emergency (i.e. antibiotics, vaccines, therapeutics and diagnostics). The 2024 National Health Emergency Response Operations Plan (NHEROP) makes no mention of dispensing medical countermeasures during a public health emergency ³⁸³. The 2020-2024 National Action Plan for Health Security indicates that the system in place for "Sending and receiving medical countermeasures during a public health emergency" is at 17% implementation (Indicators score and NAPHS implementation status 3.5, p. 21) ³⁸⁴. There is no further evidence from the Ministry of Health, Rwanda Biomedical Centre or Ministry in Charge of Emergency Management ^385386387.

4.3.2a Plan to receive foreign health personnel during a public health emergency

Score: 100

There is evidence of a public plan in place to facilitate workforce surge in an emergency. The National Health Emergency Response Operations Plan (NHEROP) includes a section on Human Resources and notes that mechanisms are "in place for recruiting surge staff to affected areas". There is a dedicated multi sectoral team trained by the Ministry of Health, WHO and Africa CDC who are prepared for "rapid deployment to respond to emergencies". This team is called the AVoHC-SURGE team ³⁸⁸. AVoHC-SURGE teams were involved in tackling the Marburg virus outbreak in Rwanda in 2024 ³⁸⁹.

4.3.2b Plan to facilitate workforce surge in an emergency

Score: 0

There is no evidence of a public plan in place to receive health personnel from other countries to respond to a public health emergency. The 2020-2024 National Action Plan for Health Security has an indicator for establishing a system for sending a receiving health personnel during a public health emergency, and none of the objectives under this indicator have been implemented (System is in place for sending and receiving health personnel during a public health emergency R.4.2, p. 99-101) ³⁹⁰. The National Health Emergency Response Operations Plan (NHEROP) has a section on surge staff, however there is no mention of receiving health personnel from other countries (Surge Staff 5.4.4, p. 36) ³⁹¹. There is no further evidence from the Ministry of Health, Rwanda Biomedical Centre or Ministry in Charge of Emergency Management ^392393394.

4.3.2c Plan to redeploy existing health personnel within the country

Score: 100

There is evidence of a public plan in place to redeploy existing health personnel within Rwanda. The National Strategy for Health Professions Development 2020-2030 outlines the deployment of various health personnel to various types of hospitals across the country (Section 10 Implementation Strategies by Academic Program), including the deployment of midwives, pediatrics, neonatal nurses, obstetricians, gynecologists, physicians, nephrology nurses, oncology nurses, critical care nurses, non-physician anesthetists, medical surgical nurses, anesthesiologists, ENT physicians, general surgeons, neurologists, orthopedic surgeons, urological surgeons, mental health nurses, psychiatrists, biomedical laboratory scientists, occupational therapists, pathologists, radiologists, dental therapists, dental surgeons, audiologists, speech therapists, ophthalmologists according to facility staffing norms ³⁹⁵. The 4X4 Reform: Executive Summary also mentions that there is a plan to "to redeploy local health professionals from public and private health facilities to attributed teaching roles at teaching hospitals and training sites" (p. V) ³⁹⁶.

4.4.1a Constitutional guarantee of citizens’ right to medical care

Score: 0

There is no evidence that the constitution explicitly guarantees citizens' right to medical care. The constitution mentions that Rwandans have "the right to good health", and that the State has the duty to "mobilise the population for activities aimed at good health and to assist them in the realisation of those activities". However, there is no explicit mention of right to medical care specifically ³⁹⁷.

4.4.1b Access to skilled birth attendants (% of population)

Score: 91.18

4.4.1c Out-of-pocket health expenditures per capita, PPP (current international $)

Score: 98

4.4.1d Coverage of essential health services through universal health coverage

Score: 45.83

4.4.1e Total population pushed below a relative poverty line by household health expenditure (60% of media daily per capita consumption or income)

Score: 88.45

4.4.1f Rate of mortality amenable to health care

Score: 66.86

4.4.2a Guaranteed paid sick leave

Score: 66.67

There is evidence that workers are guaranteed paid sick leave. However there is no evidence that mental health problems are also covered. The Labour Law (No. 66/2018) stipulates two forms of paid sick leave: short-term sick leave (Article 54) and long-term sick leave (Article 55). Workers are entitled to 15 days of paid sick leave with proof from a doctor. Workers can claim long-term sick leave (up to 6 months) with given proof from three doctors. There is no specific mention of sick leave covering mental health problems ³⁹⁸. No further evidence was found from the Ministry of Health and Ministry of Public Service and Labour ³⁹⁹⁴⁰⁰.

4.4.3a Government prioritisation of care for healthcare workers during response

Score: 0

There is no public evidence that Rwanda has issued legislation, a policy or a public statement committing to provide prioritised healthcare services to healthcare workers who become sick as a result of responding to a public health emergency. No such evidence could be found within the 2024 National Health Emergency Response Operations Plan (NHEROP), the 2020-2024 National Action Plan for Health Security or the 2021 One Health Policy ^401402403. No further evidence was found from the Ministry of Health, Rwanda Biomedical Centre or Ministry in Charge of Emergency Management ^404405406.

4.5.1a Existence of system for communication during a public health emergency

Score: 100

There is evidence of a system in place for public health officials and healthcare workers to communicate during a public health emergency. The National Health Emergency Response Operations Plan (NHEROP) has a section on risk communication, and it includes the operational structure of the Risk Communication and Community Engagement (RCCE) team, which includes members of relevant ministries as well as workers in the healthcare sector (Risk Communication and Community Engagement operational structure 4.2.4, p. 22). It also includes a strategy activity plan that would be implemented in response to a public health emergency (The RCCE strategy activity plan 4.2.6, p. 24) ⁴⁰⁷.

4.5.1b Inclusion of public and private sector in healthcare communication system

Score: 0

There is no evidence that a system exists for public health officials and healthcare workers to communicate during an emergency in both the public and private sectors. The National Health Emergency Response Operations Plan (NHEROP) contains a risk communication strategy which expresses the need to develop a risk communication task force. However there is no clear mention of communication between officials and workers in the public and private sectors ⁴⁰⁸. Neither the Ministry of Health nor the Ministry in Charge of Emergency Management share relevant information via public websites ⁴⁰⁹⁴¹⁰.

4.6.1a Evidence of national public health system monitoring and tracking of HCAIs

Score: 0

There is no publicly available evidence that the national public health system is monitoring for and tracking the number of healthcare associated infections that take place in healthcare facilities. A study from February 2024 looking at healthcare-associated infections in Africa includes an analysis of Rwanda. All data used referred to other studies rather than the Rwandan national public health system ⁴¹¹. There is also no evidence from the Ministry of Health or Rwanda Biomedical Centre that they are monitoring for and tracking the number of healthcare associated infections that take place in healthcare facilities ⁴¹²⁴¹³.

4.6.1b Infection prevention and control programme

Score: 100

There is evidence of an infection prevention and control programme in place nationally in Rwanda. The Infection Prevention and Control Rwanda Organization (IPCRO) is tasked with preventing and controlling the spread of infection in the country ⁴¹⁴. There is an Infection Prevention and Control Strategic Plan (2024-2029) that outlines the strategic framework and management of infection prevention and control ⁴¹⁵. A study from May 2024 of 25 health facilities across Rwanda showed that they all had "some degree of Infection Prevention and Control Assessment Framework implemention", reflecting an intermediate level of implementation ⁴¹⁶.

4.6.1c National plan to ensure a safe environment in health facilities

Score: 100

There is evidence of a plan to ensure a safe environment in health facilities nationally. Rwanda's 2020-2024 National Action Plan for Health Security outlines the ways in which the health authorities ensure a safe environment in health facilities nationally, including WASH in healthcare facilities, including appropriate infrastructure, materials and equipment for Infection Prevention Control (IPC); as well as standards for reduction of overcrowding and optimization of staffing levels in healthcare facilities, according to WHO minimum requirements ⁴¹⁷.

4.7.1a Requirement for ethical review before beginning a clinical trial

Score: 100

There is public evidence of a national requirement for ethical review (e.g. from an ethics committee or via Institutional Review Board approval) before beginning a clinical trial. The Rwanda National Ethics Committee is responsible for reviewing all health research proposals before any health research begins ⁴¹⁸. Moreover, The Rwanda Food and Drugs Authority published guidelines on good clinical practices in Rwanda in September 2024 and it mentions that "A trial shall be conducted in compliance with the protocol that has received prior ethical clearance from the Rwanda National Ethics Committee in accordance with the relevant law governing research on human beings and the Approval from the Authority." (GCP Principles in the Rwandan Context 1.2, p. 12) ⁴¹⁹.

4.7.1b Expedited approval for clinical trials of unregistered MCMs during epidemics

Score: 0

There is no publicly available evidence that there is an expedited process for unregistered medical countermeasures to treat ongoing pandemics or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics or epidemics. The Rwanda Food and Drugs Authority has approved Guidelines on Good Clinical Practices in Rwanda, but it does not mention any expedited process for unregistered medical countermeasures or mutual recognition of clinical trial results taking place elsewhere to treat ongoing pandemics ⁴²⁰. There is no further evidence from the Ministry of Health of Rwanda Biomedical Centre ⁴²¹⁴²².

4.7.2a Existence of agency responsible for approving new human MCMs

Score: 100

There is publicly available evidence that in Rwanda there is a government agency responsible for approving new medical countermeasures for humans. The Rwanda Food and Drugs Authority, established by Law No.003/2018 of 09/02/2018, is responsible for regulating human and animal drugs; human and animal vaccines and other biological products used in the clinic as drugs as stated under Article 3: 1° human and veterinary drugs; 2° human and animal vaccines and other biological products used in clinical as drugs; 3° processed food for humans and animals, food supplements and fortified foods ⁴²³.

4.7.2b Expedited approval for human MCMs during public health emergencies

Score: 0

There is no publicly available evidence of an expedited process for approving medical countermeasures for human use or recognition of approval decisions taking place elsewhere during public health emergencies. The Rwanda Food and Drugs Authority does not mention an expedited process for approving medical countermeasures for human use during public health emergencies. There is no additional information related to approving medical countermeasures specifically during public health emergencies from the Rwanda Food and Drugs Authority ⁴²⁴. There is no further evidence from the Ministry of Health, Rwanda Biomedical Centre or the National Health Emergency Response Operations Plan (NHEROP) ^425426427.

5.1.1a Submission of IHR reports to the WHO in past year

Score: 100

Rwanda has submitted an IHR Self-Assessment Annual Report (SPAR) to the WHO for the last calendar year, with the latest submission in 2024.⁴²⁸

5.1.2a Existence of specific risk reduction strategies for epidemics and pandemics

Score: 100

There is evidence of a standalone national risk reduction strategy for epidemics and pandemics. The National Disaster Risk Reduction and Management Policy, published in 2023 by the Ministry in Charge of Emergency Management, sets out the policy and legal framework for the risk reduction for epidemics, but not pandemics ⁴²⁹. The National Health Emergency Response Operations Plan (NHEROP) set the foundations for the development of a national risk communication and community engagement strategy that focuses on 6 specific hazards, including Rift Valley Fever, Mining/Quarries accidents, Cholera/ Acute Watery Diarrhea, COVID-19, Influenza (new subtypes) and Antimicrobial-resistant microorganisms (National health emergency risk assessment 1.3.1, p. 7) ⁴³⁰.

5.2.1a Existence of public health emergency agreements with regional neighbors

Score: 50

There is evidence to suggest that Rwanda has cross-border agreements, protocols or MOUs with neighboring countries with regards to public health emergencies, however there is evidence of gaps in implementation. Rwanda is a party to the African Union and so is part of the Statue of the Africa Centers for Disease Control and Prevention (Africa CDC) of 2022, which includes a Framework of Operation that includes cross-border measures in the event of public health emergencies ⁴³¹. Nevertheless, there is no clear evidence of implementation on the part of Rwanda. There is one recent case of a tentative agreement between 12 African countries, including Rwanda, to tackle the spread of mpox across the continent. The countries involved include DRC, Angola, Burundi, Malawi, Rwanda, Uganda, Sao Tome and Principe, South Sudan, Zambia, Kenya, Republic of Congo and Central African Republic. The meeting was convened by the World Bank, in collaboration with the Africa Centres for Disease Control and Prevention (Africa CDC), the World Health Organization (WHO), and other partners including UNICEF and the International Organization for Migration (IOM) ⁴³²⁴³³. There is no further evidence of any agreements between Rwanda and regional countries from the Ministry of Health ⁴³⁴.

5.2.1b Existence of animal health emergency agreements with regional neighbors

Score: 0

There is no evidence to suggest that Rwanda has cross-border agreements, protocols or MOUs with neighbouring countries, or as part of a regional group, with regards to animal health emergencies. Rwanda is a member of the East African Community (EAC), which has a mandate to "undertake joint action towards the prevention and control of communicable and non-communicable diseases and to control pandemics and epidemics of communicable and vector-borne diseases that might endanger the health and welfare of the residents of the Community". Nevertheless, the two projects currently implemented in the EAC, as part of the Disease Prevention and Control unit, are specifically related to disease surveillance, prevention and emergency preparedness, rather than dealing with animal health emergencies ⁴³⁵. While the Joint External Evaluation (JEE) for Rwanda, conducted in May 2018, notes that Rwanda is ìa signatory to a number of cross-border agreements such as the East African Community (EAC) Protocol on Health and the EAC Act of One Border Post", the Protocol on the Establishment of the East African Health Research Commission (the only EAC protocol related to health issues), and the EAC Act of One Stop Border Post, do not make any reference to public health emergencies ^436437438. There is no further evidence in the 2021 One Health Policy, the 2024 National Health Emergency Response Operations Plan (NHEROP) or from the Ministry of Health or Rwanda Biomedical Centre ^439440441442.

5.3.1a Biological and Toxin Weapons Convention status

Score: 100

There is evidence that Rwanda has signed and ratified the Biological Weapons Convention. The Biological Weapons Convention National Implementation Measures Database shows that Rwanda is a signatory to the convention and that it has ratified it ⁴⁴³. In addition, Law No. 56/2018 relating to arms includes biological weapons in the definition of arms provided for in article 2 (8). Article 2 (7) defines “illegal arms” as those prohibited by Rwandan laws and international conventions. Article 66 of this law prohibits the manufacturing, possession, importing, storing, trafficking or proliferation and use of prohibited arms. Penalties for violation of these provisions range from 20 to 25 years imprisonment and a fine. Articles 99 and 101 of the Penal Code prohibit the use of poisonous weapons. Article 66 of Law No. 56/2018 relating to arms prohibits participatory offences. According to Articles 9, 10, 11 and 13 of the Penal Code, the aforementioned prohibitions apply on Rwanda’s territory as well as for actions committed by a national of the country. Article 61 Law No. 56/2018 relating to arms authorizes seizure of arms linked to offences, and also allows for their destruction ⁴⁴⁴.

5.3.1b Submission of CBMs to the Biological and Toxin Weapons Convention

Score: 0

There is no publicly available evidence that Rwanda has submitted confidence building measures for the Biological Weapons Convention in the past three years. No Biological Weapons Convention (BWC) CBM reports by Rwanda were found in the eCBM platform maintained by the BWC Implementation Support Unit ⁴⁴⁵. No further evidence was found from the Ministry of Defence ⁴⁴⁶.

5.3.1c Submission of UNSCR 1540 reports

Score: 100

There is evidence that the state has provided the required United Nations Security Council Resolution (UNSCR) 1540 report to the Security Council Committee established pursuant to resolution 1540 (1540 Committee). Rwanda submitted its national report to the 1540 Committee in 2011 ⁴⁴⁷.

5.3.1d Extent of UNSCR 1540 implementation on public health emergencies

Score: 25

5.3.2a Membership in global health security and/or biological weapons agreements

Score: 0

There is no evidence that Rwanda is a member of Global Partnership Against the Spread of Weapons and Materials of Mass Destruction (GP), Australia Group (AG) or the Proliferation Security Initiative (PSI) ^448449450.

5.4.1a Completion and publication of JEE (or GHSA pilot external assessment) report

Score: 0

There is no evidence that Rwanda has completed a Joint External Evaluation (JEE) or precursor external evaluation (e.g., GHSA pilot external assessment) and published a full public report in the last five years. The last JEE completed by Rwanda was in 2018 ⁴⁵¹. It recently completed its second JEE in May 2025, however it has not yet been published ⁴⁵².

5.4.2a Completion and publication of PVS report (past five years)

Score: 0

There is no evidence that Rwanda has completed and published a Performance of Veterinary Services (PVS) assessment in the last five years. The last PVS assessment that Rwanda completed was in 2019 ^453454455.

5.4.2b Completion and publication of PVS gap analysis (past five years)

Score: 0

There is no evidence that Rwanda has completed and published a Performance of Veterinary Services (PVS) gap analysis in the last five years. The last PVS gap analysis conducted by Rwanda was in 2010 ⁴⁵⁶⁴⁵⁷.

5.5.1a Evidence of allocated national funds to improve capacity to address epidemic threats

Score: 0

There is no evidence that Rwanda has allocated national funds to improve capacity to address pandemic or epidemic threats within the past three years. Recent budget reports from the Ministry of Finance and Economic Planning do not mention any allocation of funds to improve capacity to address pandemic or epidemic threats ^458459460461. Only the July-December 2024 budget report mentions extra spending specifically dedicated to tackling the Marburg virus, specifically FRW 20.5 million (USD 14,155), however spending to improve general capacity is not mentioned ⁴⁶². No further evidence was found in the 2024 National Health Emergency Response Operations Plan (NHEROP), 2021-2026 One Health Strategic Plan or the Ministry of Health or Rwanda Biomedical Centre ^463464465466.

5.5.2a National budget to address gaps identified in JEE, NAPHS or GHSA roadmap

Score: 0

There is no evidence that the Joint External Evaluation (JEE) report, National Action Plan for Health Security (NAPHS), and/or national GHSA roadmap allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. The last JEE report is from 2018 and so not from within the past five years ⁴⁶⁷. The NAPHS of 2020-2024 does mention budgets allocated to certain activities, however it does not describe specific funding from the national budget ⁴⁶⁸.

5.5.2b National budget to address gaps identified in PVS assessment or gap analysis

Score: 0

There is no evidence that the Performance of Veterinary Services (PVS) gap analysis and/or PVS assessment allocate or describe specific funding from the national budget (covering a time-period either in the future or within the past five years) to address the identified gaps. The last PVS assessment that Rwanda completed was in 2019 ^469470471. The last PVS gap analysis conducted by Rwanda was in 2010 ⁴⁷²⁴⁷³.

5.5.3a Emergency public financing during a public health emergency

Score: 100

There is evidence of a special emergency public financing mechanism and funds which the country can access in the face of a public health emergency. In the National Health Emergency Response Operations Plan (NHEROP), it is mentioned that "there is a system in place that ensures funding is available to cover emergency response operations". The Ministry of Finance works with other ministries involved in an emergency to "mobilize and manage available and needed resources for the emergency management activities". This budget is reserved by the Ministry of Finance and in the event of a health emergency, the Ministry of Health mobilizes those funds through the Ministry of Finance and Economic Planning ⁴⁷⁴. Rwanda has also received emergency funding from international organizations on several occasions, during the COVID-19 pandemic and the Marburg virus outbreak. Funds have been received from the World Bank, African Development Bank, OPEC Fund, and Global Fund ^475476477478. However there is no evidence that there are established agreements between Rwanda and those entities. Furthermore, Rwanda is listed as an International Development Association (IDA) eligible borrowing country ⁴⁷⁹.

5.5.4a Commitments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is evidence to suggest that senior leaders seek to improve the country’s domestic capacity to address pandemic or epidemic threats by expanding financing or requesting support to improve capacity, but not to support other countries. The Health Sector Strategic Plan V with a section of health financing ⁴⁸⁰. The estimated cost of implementing HSSP V is between RWF 5.9 trillion (USD 4.2 billion) and RWF 6.9 trillion (USD 4.9 billion), with a projected financing gap of 21% to 32% over the next five years. Efforts to bridge this gap will focus on increasing domestic funding and private sector investment. The implementation of HSSP V will be integrated into the national annual planning and budgeting processes under the Ministry of Finance and Economic Planning ⁴⁸¹. Rwandan President Paul Kagame has made corresponding statements in the past, noting at the UN that "external funding must go hand in hand with increased domestic financing for health" ⁴⁸². Health Minister Dr Sabin Nsanzimana has echoed similar sentiments, especially in light of recent cuts to USAID. He noted in March 2025 that "even as financing declines, we must find ways to increase it – whether through domestic sources or partnerships with those who see health as an investment in humanity" ⁴⁸³. There is no evidence in the Health Strategic Plan V or from the Ministry of Health in general that there is any public commitment to support other countries to improve their capacity to address pandemic or epidemic threats ⁴⁸⁴⁴⁸⁵.

5.5.4b Investments to improve domestic or foreign capacity for epidemic threats

Score: 100

There is no evidence that Rwanda has provided other countries with financing or technical support to improve capacity to address epidemic threats in the past three years. However, there is evidence that Rwanda has requested financing or technical support from donors in the past three years to improve the country’s domestic capacity to address epidemic threats. Rwanda received substantial financial and technical support to tackle the outbreak of the Marburg virus in 2024. The World Health Organization (WHO) and United Nation Children's Fund (UNICEF) were heavily involved in the response to the outbreak of the Marburg virus. The WHO deployed a surge team, provided technical guidance, supplied 12,000 pieces of personal protective equipment, and trained 520 healthcare workers on Infection Prevention and Control (IPC) measures ⁴⁸⁶. UNICEF helped train 50,000 community workers in Marburg risk communication, childcare and violence prevention ⁴⁸⁷. The European Union (EU) provided Rwanda with EUR 850,000 worth of funding to tackle the virus ⁴⁸⁸. The UK deployed trained NHS medics as part of a UK Emergency Medical Team ⁴⁸⁹. Furthermore, the Global Fund provided USD 5 million in assistance to support Rwanda's response to the mpox virus ⁴⁹⁰. In addition, the World Bank has provided financial support as part of the "Access to Finance for Recovery and Resilience Project" aimed at relieving the economics impacts of the COVID-19 pandemic on Rwandan business ⁴⁹¹.

5.5.4c Evidence that the country has fulfilled its full WHO contribution within the past two years

Score: 0

There is no evidence that Rwanda has fulfilled its full contribution to the WHO within the past two years. Between 2023-2024 Rwanda had an outstanding balance of USD 28,710 while between 2024-2025 the country's outstanding balance amounts to USD 17,230 ⁴⁹²⁴⁹³.

5.6.1a Sharing of genetic/biological data and materials beyond influenza

Score: 0

There is no publicly available plan or policy for sharing genetic data, epidemiological data, clinical specimens, or isolated specimens (biological materials) with international organizations and/or other countries that goes beyond influenza in Rwanda. The National Health Emergency Response Operations Plan (NHEROP) and National Action Plan on Antimicrobial Resistance both note a lack of information sharing systems in place, with the latter outlining a timeline to develop such a system, however there is no mention of any plan to develop a system wherein such data would be shared with international organizations or other countries ⁴⁹⁴⁴⁹⁵. There is no further evidence of such a plan in the One Health Policy or from the Ministry of Health or Rwanda Biomedical Centre in general ^496497498.

5.6.1b Evidence of non-compliance with sample sharing element of PIP framework

Score: 100

There no public evidence that Rwanda has not shared samples in accordance with the Pandemic Influenza Preparedness (PIP) framework in the past two years. The most recent publicly available instance where samples were shared is from 2017, wherein a WHO report notes that Rwanda did share influenza samples ⁴⁹⁹. There is no further evidence from the WHO or international media reports that Rwanda has shared samples ⁵⁰⁰.

5.6.1c Evidence of non-sharing of pandemic pathogen samples during an outbreak

Score: 100

There is no public evidence that Rwanda has not shared pandemic pathogen samples during an outbreak in the past two years. Although pathogen samples were collected during the Marburg virus outbreak, there is no public evidence either way that these samples have or have not been shared ⁵⁰¹. There is no further evidence from international media reports.

6.1.1a Policy formation

Score: 75

6.1.1b Quality of bureaucracy

Score: 50

6.1.1c Excessive bureaucracy/red tape

Score: 75

6.1.1d Vested interests/cronyism

Score: 25

6.1.1e Corruption

Score: 57

6.1.1f Accountability of public officials

Score: 50

6.1.1g Human rights risk

Score: 0

6.1.2a Orderly transfers of power

Score: 0

6.1.3a Risk of social unrest

Score: 75

6.1.4a Risk of terrorism

Score: 50

6.1.4b Level of illicit arms flows within the country

Score: 50

6.1.4c Risk of organized criminal activity

Score: 75

6.1.5a Presence or risk of armed conflict

Score: 50

6.1.6a Government territorial control

Score: 100

6.1.7a International tensions

Score: 0

6.2.1a Adult literacy rate (15+ years old, both sexes)

Score: 83.48

6.2.2a UNDP Gender Inequality Index score

Score: 64.46

6.2.3a Poverty gap at $1.90 a day (2011 PPP) (%)

Score: 27.86

6.2.3b Share of employment in the informal sector

Score: 0

6.2.3c Coverage of social insurance programs (% of population)

Score: 0

6.2.4a Public confidence in government

Score: 50

6.2.5a Robust, open, diverse local media and reporting

Score: 0

6.2.6a Gini coefficient

Score: 56.3

6.3.1a Adequacy of road network

Score: 25

6.3.2a Adequacy of airports

Score: 25

6.3.3a Adequacy of power network

Score: 25

6.4.1a Urban population (% of total population)

Score: 96.16

6.4.2a Change in forest area (percentage points)

Score: 81.6

6.4.3a Natural disaster risk

Score: 50

6.5.1a Total life expectancy (years)

Score: 60.43

6.5.1b NCD mortality rate

Score: 64.94

6.5.1c Population aged 65+

Score: 82.91

6.5.1d Tobacco use (% of adults)

Score: 46.78

6.5.1e Level of adult obesity (%)

Score: 79.53

6.5.1f Age-standardised prevalence of mental health disorders (per 100 000 people)

Score: 60.39

6.5.2a Access to potable water

Score: 60.95

6.5.2b Access to at least basic sanitation facilities

Score: 80.97

6.5.2c Percentage of health-care facilities with no access to any electricity supply

Score: 100

6.5.3a Domestic general government health expenditure per capita (PPP)

Score: 6.63

6.5.4a Trust medical and health advice from the government

Score: 100

6.5.4b Trust medical and health advice from medical workers

Score: 50