Rwanda plans nationwide expansion of legal abortion services after health centre pilot

**RWANDA—**The Rwanda Biomedical Centre (RBC) is planning to expand legal abortion services to health centres nationwide after a year-long pilot programme in four districts showed that the services could be delivered closer to communities.

The pilot operated in 43 health centres across Musanze, Karongi, Rwamagana and Ruhango districts.

It aimed to improve access by allowing patients to receive initial assessments at health centres rather than travelling directly to hospitals.

Dr François Régis Cyiza, Director of the Health Facilities Programmes Unit in RBC’s Maternal, Child and Community Health Division, said the pilot’s findings were informing plans for national implementation.

However, the expansion remains at the planning stage, and the agency has not set a rollout date.

Pilot expands access through trained health workers

During Rwanda’s 2025/26 fiscal year, approximately 3,200 women and girls sought legal abortion services, according to Cyiza.

Of these, between 900 and 1,000 received services at health centres participating in the pilot between July 2025 and June 2026.

Under the model, trained nurses and midwives receive patients, conduct assessments and arrange the necessary tests.

They enter the results into an electronic system for review by a hospital-based doctor, who discusses the case with the attending nurse or midwife before deciding whether the service can be provided.

The arrangement distributes responsibilities between health centres and hospitals, potentially reducing the need for patients to travel to hospitals for initial assessments.

It also relies on trained personnel, electronic records and clinical oversight to support service delivery.

Regulatory changes enable health centre services

The planned expansion follows a regulatory amendment published in Rwanda’s Official Gazette on 9 December 2024.

The ministerial order revised the rules governing which health facilities could provide abortion services.

Under the amended framework, authorised public and private hospitals, health centres and polyclinics may provide the services.

The Ministry of Health may also authorise clinics that meet the required standards.

The previous ministerial order, issued in 2019, specified hospitals and polyclinics as eligible facilities.

The 2024 amendment therefore widened the range of facilities that may provide legal abortion services, subject to authorisation and applicable requirements.

Expanding delivery through health centres could increase the role of primary healthcare facilities in reproductive health services.

Implementation will require appropriate staffing, clinical supervision, referral arrangements and compliance with regulatory standards.

Faith based facilities remain part of referral arrangements

RBC is also considering how to work with faith-based health facilities, some of which do not provide abortion services because of religious beliefs.

Cyiza said these facilities continue to work with the government to deliver healthcare, while patients requiring services they do not offer are referred elsewhere.

“When a person needs a service that cannot be provided at a clinic managed by a religious organisation because of its beliefs, the patient is directed to another facility where they can receive that service,” he said.

The referral approach allows faith-based providers to maintain their institutional practices while directing patients to facilities that can provide the required care.

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