Rwanda Using Decentralized Health System to Overcome COVID-19 Vaccine Hesitancy

Rwanda Using Decentralized Health System to Overcome COVID-19 Vaccine Hesitancy
A nurse vaccinating student in GS St. Michel Ntarama, Musanze District (Photo credit:

Rwanda’s decentralized community-based care, an approach aimed at bringing health workers closer to the population at the village level, has played a crucial role in tackling the COVID-19 pandemic and countering vaccine hesitancy in this East African nation.

The proposed approach by the World Health Organization (WHO) recommend that the effectiveness of immunization programmes, including COVID-19 vaccines delivery should rely on population uptake and acceptance of vaccines, achieved through a range of strategies.

According to Olivier Ndererimana, in charge of Monitoring and Treating Infectious Diseases at Ruhengeri referral Hospital from Northern Rwanda, there was higher levels of fear among the public, because of lack of sufficient information about the pandemic.  

Ruhengeri referral hospital, among the most equipped for covid-19 response (Photo credit:

“The only trustable response to COVID-19 back then was to impose lockdowns,” he said.

Rwandan health officials take delighting in noticing that CHWs played an important role in vaccine promotion and acceptance: whether through community dialogue and engagement, education, trust-building, myth-busting, on- and offline social listening, or facilitating community entry.

Thanks to this mobilization, Rwanda, which has led the race from the start, has since achieved over 60 percent of the entire population fully vaccinated as of April 2022, according to official estimates

Deployment of covid-19 vaccine

Apart from the initial setup of command posts comprising of representatives from local government entities, security organs, Non-Government Organizations, and others agencies, Rwanda received the first batch of vaccines in 2021.

During the implementation phase, vaccines doses have been immediately dispatched to districts outside the Rwandan capital of Kigali and administered to eligible and priority community members.

While some people felt relieved during the campaign others were hesitant about accepting COVID-19 vaccines because they were rolled out without enough time to assess their safety and efficacious in clinical trials.

Since first vaccination campaigns against Covid-19 began, the overall number of vaccines administered globally has risen dramatically, but so has the inequality of the distribution, pushing Rwandan health officials to give priority to those at high risk of infection, including physicians and other categories of individuals exposed to COVID-19.

For almost three years, under these effective COVID-19 responses, churches have also tried to connect the dots between their theology and how their followers should understand how vaccines are a critical tool in the battle against the pandemic, but the reluctance of people to receive safe and recommended available vaccines has remained a growing concern. 

“If this vaccine is not related to the mark of the beast, why people are being forced to be vaccinated? It’s their lives!” questioned a man in his 60s.

Many excuses not to be vaccinated …

A man in Muhanga, a district from Central-Southern Rwanda, told reporters that he needed time to understand that vaccine thing.

Some people in the Western Province's Ngororero district cited warnings from religious leaders as their reason for not getting vaccinated. Members of a Pentecostal Church, who rejected the vaccine, claimed that they were held for a week by the military, police and local leaders trying to sensitize them to take the jabs.

"We completely refused to take the jabs and instead asked the soldiers and police to shoot us or drown us to death. We put up a demonstration, but they said they won't shoot us.” They said.

However, Dr. Martin Ndinzwenimana from Kirinda hospital in Karongi district, western province of Rwanda affirms that even some intellectuals refused to be vaccinated convinced that they could prefer to leave their jobs instead of getting the mark of the beast through vaccines.

Others question just the booster jabs

There are some other people who say that since they received the booster shot they started to have various health problems including chronic back pain, dizziness, weakness etc; there are also women who experienced some side effects of the covid-19 vaccine including pain in the low abdomen.

Dr. Ndinzwenimana says that some people just present symptoms that were foreseen by the vaccine manufacturer, but also some different symptoms were detected.

“When different symptoms are detected on a vaccinated person, we report it to Rwanda Biomedical Center; they might help in researches about the side effects of vaccine.” He said.

Even so, Dr. Ndinzwenimana affirms that side effects were never severe, and advises all people who have not taken the full vaccinations including those boosters that they hurry to get vaccinated because it is the way to protect their health and that of others.

CHWs and youth volunteers in the process

Rwanda’s national Community Health Workers (CHW) program is one of this East African nation's home grown solutions at village level, to complement existing health services delivery beyond established health posts and health centers which have been set up to take care of transitional situations, and then the district and provincial hospitals of which core mandate is to care for patients referred by the above-mentioned primary-level facilities.

(Image credit: Ministry of health)

On top of all these established health facility, comes the National Referral Hospitals and/or University Teaching Hospitals that have to report to the ministry of Health at national level.

During COVID-19, another unity of youth volunteers was created where they played an important role in helping the government and the community to take appropriate measures against the spread of COVID-19 by taking some simple precautions such as staying at home, social distancing, and wearing facemasks among others.

Axelle Kamanzi, the Vice Mayor in charge of social affairs in Musanze district, explains that the vaccination process would not have been as fast as it was without the participation of youth volunteers.

“I remember when we started mass vaccination, we could vaccinate up to ten thousand people a day, and do it in the stadium; this would not have been possible without youth volunteers to help in protocol. Apart from injecting vaccines, all other tasks such as welcoming people, filling out forms, data entry because we had to enter them into the system, were all done by youth volunteers.” she said.

“Meanwhile, CHWs together with other health workers continue to encourage communities to participate in the vaccination program. In the villages where they live, day by day they train locals about the benefits of getting immunized,” said Daniel Mugenga, head of Munzanya health center located in Karongi, a district from Western Rwanda.

According to him, communities are also educated about the importance of getting vaccinated not only against COVID-19 pandemic, but also other diseases.

Donatha Nyirarukundo, a CHW from Gakome, a remote village from Karongi district, Western Rwanda says that until now there are still people who still refuse to be vaccinated based on religious beliefs; some have even fled their homes once to escape vaccinations.

A CHW in Karongi district explaining to the journalist how they deal with vaccine hesitancy (Photo credit:

“We are still trying to mobilize them by explaining the benefits of vaccination, Slow by slow some accept it and are vaccinated, while we continue to mobilize others,” she says.

Elie Habarurema, a resident of Karongi district who is fully vaccinated, affirms that it’s not that easy to change someone’s religious beliefs.  

Habarurema says that after the first vaccine shot he had a fever and a swollen hand, but soon after he was back to normal. These days there is vaccination for children, he says that he has no worries and he has already signed up his children to be vaccinated. He urges those who refuse to be vaccinated to listen to the advice given by the health authorities and protect their lives and those of their loved ones.

Gervine Nyiramugisha, a mother of one from Musanze sector, Musanze district in Northern Province says that at the beginning she didn’t want to be vaccinated because she heard people saying that the vaccine makes you sick and weak, but with consistent mobilization of CHWs she got the vaccine; after all she was prohibited to go anywhere because none was allowed to take public transport without being vaccinated.

According to the Ministry of Health sources, the country currently operates a well-functioning, decentralized healthcare public service system comprising 1700 health posts, 500 health centers, 42 district hospitals, and five national referral hospitals; an estimated 45,000 trained CHWs operating at the village level to provide the first line of health service delivery. There are three CHWs in each village.


“This reporting was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunization in Africa.”