Presentation (CTI)

Problem Statement: Despite Rwanda’s progress toward universal health coverage, critical disparities persist in access to cancer screening and diagnostic services. Breast and cervical cancer remain leading causes of mortality among women in sub-Saharan Africa, where delayed detection, limited oncology workforce capacity, and long travel distances to referral centers constrain timely diagnosis and treatment. Traditional screening pathways require up to four separate patient visits and extensive travel, leading to loss to follow-up and increased economic burden. To address these barriers, the World Telehealth Initiative (WTI), supported by Pfizer, sought to strengthen Rwanda’s health system by integrating telehealth and mobile diagnostic technology into population-level cancer screening programs.
Description: Building on lessons from a successful Nigerian pilot, WTI implemented a cloud-based, hub-and-spoke telehealth model across Rwanda in collaboration with the Ministry of Health, Rwanda Military Referral and Teaching Hospital, and IRCAD Africa. The program deployed Teladoc Lite v3 telehealth robots paired with Butterfly iQ portable ultrasound devices at referral and remote sites, enabling real-time imaging review and remote consultation during clinical breast exams. A “train-the-trainer” framework equipped five Rwandan clinicians to lead ongoing upskilling of peers nationwide. This approach aimed to reduce redundant clinic visits, increase screening throughput, and accelerate diagnosis. Early implementation data indicate capacity to screen more than 50,000 women—5,000 of whom will avoid additional visits—and to detect an estimated 500 cancers earlier than current pathways allow. The program also reduced the average travel burden of 4-6 hours per patient visit by combining imaging and consultation in a single encounter.
Lessons Learned: Telehealth-enabled workflows can measurably improve access, efficiency, and early detection in resource-constrained settings. Government partnership and IRB alignment were essential to navigating regulatory complexity and ensuring sustainability. Despite delays caused by the Marburg virus outbreak and protocol approvals, stakeholder engagement and local training accelerated adoption. Integrating mobile ultrasound within telehealth platforms proved more feasible than traditional imaging in low-resource environments. The initiative demonstrates that technology-supported task shifting and workflow redesign can deliver high-value population health outcomes without requiring major infrastructure expansion.
Stakeholder Perspective: This initiative was conducted from a government and provider perspective, integrating public-sector leadership (Rwanda Ministry of Health) and clinical delivery partners (WTI, Rwanda Military Referral and Teaching Hospital, and IRCAD Africa). The collaboration demonstrates how industry-supported HEOR implementation can inform sustainable health policy, provider training, and technology adoption strategies across low- and middle-income countries.