Article July 8, 2021

Digital leaders found in surprising locations

Africa is full of surprises and Rwanda’s emergence as a digital leader is one that has caught many people off-guard. From its digital-first healthcare system to its electronic COVID-19 passports, the country is leading the way in the digital health sector and has developed a model that others are keen to follow.

Creation born out of crisis

In 1994, Rwanda was torn apart by a civil conflict that erupted into mass genocide, which left around 800,000 people dead in just a matter of months. It was a point from which the country had to rebuild or face collapse and in the ensuing 25 years it has transformed itself – nowhere more so than in its healthcare system.

The government has invested heavily and its expenditure on healthcare has risen from 3.2% of GDP in 1998 to 7.5% in 2018.

Some of the money has been used to train a network of 58,000 healthcare workers to educate and support the country’s rural population. Each village elects four healthcare workers and once trained they provide quick and accurate information to their community.

This approach helped to educate hundreds of thousands of Rwandans about the Ebola outbreak in the neighbouring Democratic Republic of the Congo and take measures to prevent its spread.

The investment in community-based healthcare workers was built on the back of a mandatory health insurance scheme that began in 2008. By 2018, the scheme covered 90% of the country’s 12.5 million people.

Drive to digital

In addition to the investment made in healthcare, Rwanda has put a focus on technology and internet connectivity. Despite its remote and mountainous nature, 90% of the country is covered by 4G and it will be the first country in Africa to embrace 5G.

In 2008, less that 20% of people in Rwanda owned a mobile phone. In 2018, that figure had jumped to almost 80%, driven by the improvements in the cellular technology networks.  

The combined focus on healthcare and technology infrastructure has enabled Rwanda to create a digital-first primary healthcare service that is now the envy of countries around the world.

Today, primary healthcare in Rwanda is delivered almost entirely through telehealth services. The scheme is supported by UK-based telehealth partner Babyl, which has gained 2 million subscribers since 2016 and delivered 1.3 million consultations via text and voice call.

The service is paid for through the national health insurance scheme and entitles anyone over the age of 12 access to consultations with doctors and nurses.

Where necessary, blood, medicines and medical supplies are delivered by autonomous aircraft. This integrated service is run by a company called Zipline and ensures deliveries can be made to even the most remote parts of the country.

The results have been stunning. Death in childbirth was a massive problem for Rwandan women, largely because in an emergency, blood transported by road could not get to where it was needed in time. Over the last decade, Rwanda has reduced maternal mortality rates by 60%.

The country has cut deaths from HIV, TB and Malaria by 80% and life expectancy has jumped from 49 years in 2000 to 69 years in 2000.  

Further developments enable scans to be sent from provincial hospitals to those in the capital city of Kigali and for analysis to be returned within minutes. Similarly, video conferencing is being used to collaborate with experts from the biggest hospitals on patient surgeries and alternative options.  

Technology is ensuring the available medical expertise and equipment is being used to support the greatest possible number of the population.  


The outbreak of COVID-19 has forced healthcare systems around the world to revise their operating models and many of the changes will be permanent.

The digital-first approach deployed in Rwanda overcomes the problems associated with in-person healthcare delivery while trying to suppress an infectious viral pandemic. As others have turned to this digital health approach, they have looked to Rwanda’s tried and tested model and implemented many aspects of its system for themselves.

Rwanda has also led the way in implementing a digital health passport for COVID-19. Travellers upload their test results from a validated laboratory to their mobile phone 72 hours before departure.

Airport and border officials can then scan data from the digital passport, ensuring people have the requisite test results to travel. RwandAir was the first African airline to trial such a system.

Rwanda also implemented real-time mapping to monitor the spread of COVID-19, as part of a project funded by the World Bank. At the time of writing, the country had recorded fewer than 500 deaths from COVID-19, underscoring the success of its digital-first approach.


As a specialist insurer CFC Underwriting works with thousands of forward-thinking and innovative organisations in the healthcare sector. The inspiration drawn from those in Rwanda is immense and reminds the whole world that learning and leadership is often found in unexpected locations. Click here for more information about digital healthcare and our eHealth policy.