Inside Rwanda’s push to eliminate cervical cancer ahead of WHO targets

In April, a door-to-door cervical cancer prevention campaign was launched in Kicukiro District. Among the residents who took part was 55-year-old Emmerance Niyonagira, who lives in Murambi village, Karugira cell, Kigarama Sector. ALSO READ: What Rwanda is doing to eliminate cervical cancer by 2027 Before the campaign, Niyonagira knew very little about cervical cancer beyond the general idea that it is deadly, like other cancers. The doctors and community health workers involved in the campaign provided vital education on how cancer spreads and the importance of prevention, which motivated her to act. “I was afraid of getting vaccinated against cervical cancer at first, but they explained why it is important to get tested, and I decided to do it. I was diagnosed with HPV, even though I had no symptoms.” Medical experts say Human Papillomavirus (HPV) primarily spreads through intimate skin-to-skin contact, mostly during sexual activity. It is very common, and most sexually active people will contract HPV at some point in their lives. ALSO READ: How far has Rwanda gone in eliminating cervical cancer? Following her diagnosis, Niyonagira began a three-month treatment programme to manage the infection. She continues to be monitored at a local health facility and will be re-tested after one year to assess progress and determine the next steps. She also received the HPV vaccine to protect against other strains, as the vaccine is preventive and not used to treat existing infections. “They protected me, and I felt confident that cervical cancer is preventable. Since then, I have encouraged other women in my village to get tested, because early detection makes treatment possible,” she said. Niyonagira’s two daughters were also screened and found to be free of the virus; they were subsequently vaccinated. Reaching WHO elimination goals early Rwanda aims to eliminate cervical cancer by 2027, three years ahead of the World Health Organiszation’s “90-70-90” cervical cancer elimination targets. The target means that 90% of girls are fully vaccinated with the HPV vaccine by age 15, 70% of women are screened by ages 35 and 45, and 90% of women diagnosed with cervical disease receive treatment. Cervical cancer is a leading cause of cancer deaths among Rwandan women, with 600 to 800 new cases and nearly 600 deaths annually, according to the latest National Cancer Registry (2022). So far, six districts in Rwanda, including Kicukiro, Gicumbi, Karongi, Nyabihu, Bugesera, and Nyamasheke, have already met the WHO elimination goal thanks to concerted efforts by the Community Health Workers (CHWs) and doctors conducting door-to-door awareness campaigns, diagnosis, vaccination, and treatment. Kwizera Matabishi, a Community Health Worker in Kicukiro, described the campaign’s approach: “From April to July, we visited households to raise awareness about HPV vaccination and cancer screening. We worked closely with village and cell leaders to reach as many people as possible.” He explained that special attention was focused on girls who were out of school. The team went door-to-door to find them, and once identified, doctors followed up to offer testing. After receiving accurate information about the cancer risks and prevention methods, most of the girls agreed to be screened. Matabishi noted that the campaign also reached women in public spaces, such as markets and churches, where information was shared and doctors conducted on-site testing. “The training we received gave us the confidence to speak clearly about how serious cancer is; because of that, people listened and agreed to be tested,” Matabishi said. Mobilising communities through health workers Follow-up visits were part of the process. “If someone was tested or diagnosed, we would check if they had gone for vaccination or further care, and encourage them to continue,” Matabishi added. Using the door-to-door method, the campaign covered about 70% of Kicukiro. Doctors were key in managing treatment for women diagnosed with cervical or breast cancer, supporting better outcomes, he explained. Reaching 70% of eligible women was an uphill task, as some local leaders and health staff were slow to engage, and socio-cultural beliefs led some women to believe that the absence of symptoms meant they were healthy, Matabishi observed. National efforts and district achievements The ongoing community mobilisation and vaccination campaigns are part of the Rwandan government’s grand plan to reduce or eliminate cervical cancer by improving early detection nationwide, vaccination, and treatment. The Rwanda Biomedical Centre (RBC) is leading the mass screening campaigns and has deployed Women Cancer Early Detection (WCED) mentors at health facilities to guide and support local staff. After the campaigns ended, trained staff continued regular screenings to sustain progress. Awareness and insurance impact “HPV infection often doesn’t show symptoms until it is at an advanced stage, so awareness is critical,” said Dr. Theoneste Maniragaba, the Director of the Cancer Programme at the RBC and a physician at the Rwanda Cancer Centre at Rwanda Military Referral and Teaching Hospital, Kanombe. He explained that in high-performing districts, local leaders collaborated with Community Health Workers to dispel common myths, such as the misconception that the absence of symptoms means the absence of disease, and to encourage women to come forward for screening. “The deployed WCED mentors to health facilities during mass screening campaigns trained volunteers to provide on-site support and mentorship to local healthcare providers, ensuring that screening continued long after the campaigns ended.” The experts noted that misconceptions about the disease, vaccine hesitancy, and reluctance by some community leaders to cooperate with healthcare workers to tackle the disease are some of the factors affecting the cervical cancer elimination efforts in some districts. The cost of cancer services has also been a challenge. However, the health insurance reforms have addressed the problem. “With cancer services now covered under Mutuelle de Santé, Rwanda’s community-based health insurance, more women can afford the costly tests, scans, and chemotherapy needed to complete treatment”, Dr Maniragaba assured. He added that Rwanda aims to be the first African country to eliminate cervical cancer by 2027 through widespread HPV vaccination, advanced screening, and timely treatment, supported by strong community-driven mobilization and multi-sector partnerships involving public institutions, civil society, private healthcare providers, and NGOs. HPV vaccination strategy and progress “The country’s fight against cervical cancer began in 2011 with the HPV vaccine. Since then, it has achieved over 93 percent vaccination coverage among eligible girls. In 2024, Rwanda transitioned from a two-dose to a single-dose HPV vaccine, currently targeting 12-year-old girls through a school-based programme. The vaccine is free of charge,” he said. Hassan Sibomana, the Director of the Vaccine Programmes Unit at RBC, says Rwanda switched to a single-dose HPV vaccine to address cost challenges, since one dose is more affordable while still being over 90% effective. The communication efforts involve teachers, parents, and radio campaigns to raise awareness. “Each year, about 150,000 girls are vaccinated, with nearly 300,000 vaccinated across two cohorts so far. To reach those who missed their doses, catch-up campaigns during school holidays focus on girls aged 12 to 17, encouraging them to get vaccinated at health centers,” he explained. “Some schools still require written parental consent, which can slow the process, but ongoing communication with parents and school leaders aims to address this challenge,” Sibomana said. Cervical cancer burden, Rwanda’s elimination plan WHO defines cervical cancer elimination as reducing annual new cases to four or fewer per 100,000 women, achievable by meeting the 90-70-90 targets through a “screen-and-treat” approach starting at health centers, using high-performance HPV DNA tests to identify at-risk women and manage precancerous conditions promptly. HPV DNA tests are laboratory tests that detect the presence of human papillomavirus (HPV) genetic material (DNA) in cervical cells. As of 2023, six HPV vaccines are globally available, all protecting against the high-risk HPV types responsible for most cervical cancers. The WHO affirms that these vaccines are safe and effective, and critical to disease elimination. While some countries vaccinate boys to reduce HPV prevalence and related cancers in men, Rwanda’s current focus is on vaccinating girls. This is a gap that should be filled to achieve the country's ambitious, noble goal of eliminating cervical cancers.

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