Rwanda’s Transformation in Mental Health Care
In a recent address to the Senate, Dr. Yvan Butera, the Minister of State for Health, highlighted Rwanda’s remarkable progress in mental health care since 1995, when the country adopted its first national mental health policy. This marked a turning point after the 1994 Genocide against the Tutsi, which left millions with deep psychological wounds. At that time, the country had only one psychiatrist, making it nearly impossible to address the widespread trauma.
The initial response was the establishment of the Service de consultation psycho-sociale (SCPS) in Kigali, a small unit dedicated to helping trauma victims. This was also when Rwanda began training its own mental health professionals. Over the years, the Human Resources for Health initiative under the Ministry of Health played a crucial role in building a robust mental health workforce. Today, over 900 psychologists operate in Rwanda, with 400 working in the public sector. Others collaborate with organizations like Ibuka and Avega, which support Genocide survivors.
By 2023, the number of students entering mental health programs had increased to 300. Currently, Rwanda has 16 psychiatrists, including Dr. Charles Mudenge, who was among the first to benefit from post-Genocide psychiatry training. He explained that partnerships with Belgium and Switzerland helped launch a program that initially sent a few students abroad. However, local training eventually became possible through collaboration between the Ministry of Health and the University of Rwanda. There are now 31 students in psychiatry training, with 10 in their second year and 15 in their first.
Dr. Charles Nkubiri, Director General of Ndera Neuropsychiatric Teaching Hospital, noted that the government’s 4×4 reform to increase medical personnel by four times is showing results. District hospitals are now equipped to provide mental health services, and some facilities refer only one or two patients a year to Ndera, indicating improved local capacity.
Senator Jean Pierre Dusingizemungu, a psychology professor, acknowledged the immense demand for mental healthcare before and after the Genocide. He recalled that before 1994, there was no national mental health policy, and people with mental illnesses were often taken to Ndera or imprisoned. Families would sometimes chain or abandon their mentally ill relatives. Today, Rwanda has made significant strides in both general and mental healthcare.
In 2011, Rwanda revised its mental health policy to emphasize accessibility through community-based health insurance, geographic access via district hospitals, and community-based care. The policy also focused on special groups such as children, people living with HIV, and substance users.
By 2020, recognizing evolving mental health needs, Rwanda launched the Mental Health Strategic Plan 2020-2024. This plan brought private facilities into the fold and expanded mental health services to schools, national rehabilitation centers, and correctional facilities. Fred Mufulukye, Director General of the National Rehabilitation Service, emphasized the importance of early detection, noting the link between drug use and mental health issues.
Minister Butera pointed out that globally, one in eight people experiences a mental health condition, but in Rwanda, due to its unique history, the figure is one in five. Major causes include depression, anxiety, and trauma, with drug and alcohol use contributing significantly. Epilepsy is also prevalent, especially among those aged 26–35 and 46–55.
To address these challenges, mental healthcare was integrated into the Health Sector Strategic Plan (HSSP) 2024–2029, the National Health Policy, and the Healthcare Service Law. The National Strategy for Transformation (NST2) also emphasizes mental health, giving it political and legal priority.
Butera added that education plays a protective role in reducing mental health problems. In Rwanda, mental health issues are more common among those without formal education. Promoting education is a long-term strategy for prevention. At the village level, trained community health workers identify symptoms and refer cases to higher-level facilities. Health centers now carry over 20 medications, up from eight, and district hospitals have expanded their supply of psychiatric drugs from 15 to 45.
Jane Abatoni Gatete, Executive Secretary of ARCT-Ruhuka, stressed the importance of raising the quality of counseling providers. Even a neighbor’s conversation can be therapeutic, but all levels from family to health workers must be assessed and supported to ensure effectiveness.
Despite ongoing challenges, including transgenerational trauma from the Genocide against the Tutsi, concerted efforts can help deal with them. Trauma can be passed from parent to child, but resilience can also be transmitted. If today’s generation intervenes effectively, they can break the cycle and prevent it from becoming permanent.
