DOI: 10.3886/e237121v1-190433
title: Strengthening the sustainability of neglected tropical disease programs in Rwanda

description: <b>Strengthening the sustainability of neglected tropical
disease programs in Rwanda: An assessment of access and utilization of
domestically-financed services for Soil-Transmitted Helminthiases and
Schistosomiasis </b>

<b> </b>

<b>Introduction</b>: Soil-transmitted helminth (STH)
and schistosomiasis (SCH) infections remain some of the most prevalent
neglected tropical diseases (NTDs), causing significant morbidity in most of
sub-Saharan Africa (SSA), including Rwanda. With dwindling international
funding for NTD services and recent commitments focused on other diseases
considered easier to eliminate as a public health problem, it is essential to
assess domestic financing sources' scale, efficiency, and effectiveness. The study aims to strengthen domestic efforts towards
sustainable financing for neglected tropical disease programs in Africa,
particularly in Rwanda.



<b>Method:</b> Up to 235 patients from 24 health
centers in four districts of Rwanda were sampled for this survey. The districts
selected had the highest number of STH and SCH based on routine data from June
2021 to December 2022, which is the window period of the study. We estimated
affordability using the lowest-paid government worker (LPGW) and then compared
this with household income and expenditure obtained from patients participating
in the survey. Data was collected from August to September 2023. Limited
secondary data were collected to complement primary data. Descriptive
statistical analysis was used to present the findings.

<b>Results and
Conclusions: </b>The
most available drugs were mebendazole, with 100% of facilities reporting no
stockout. Praziquantel (PZQ) was the most unavailable drug, reporting 92%
stockout at the time of the survey, mainly due to delays in getting supplies
from MDA-implementing health facilities. Diagnostics for SCH are the most
inaccessible lab services. On average, the total cost (both direct and
opportunity cost) to access and utilize STH and SCH services was USD 0.72 (RWF
861.92) and USD 0.96 (RWF 1136.41) for male and female patients, respectively.
Although the assessment revealed that treatment for STH and SCH was affordable
for the LPGW, women pay a 33% higher cost than men to access NTD services.
While services are generally satisfactory, the reimbursement processes are
slow, hindering timely access and utilization of SCH and STH services at the
health facilities in Rwanda. 

While
the access and utilization of STH and SCH services in health centers are
generally promising, the findings underscore the potential for improvement. By
addressing the efficiency in the supply of praziquantel drugs and enhancing
reimbursement timelines, we can ensure the continuity and effectiveness of
these services, offering hope for a brighter future in the fight against
neglected tropical diseases.
description: N/A
description: Response Rates: 85%
description: Presence of Common Scales: N/A
description: Up
to 235 patients from 24 sampled health centers in four districts of Rwanda were sampled
for this survey.
description: N/A. Smallest Geographic Unit: Districts
description: coded on-site observation; face-to-face interview; on-site questionnaire; N/A