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Sex Reprod Healthc. 2016 Mar;7:46-51. doi: 10.1016/j.srhc.2015.11.006. Epub 2015 Nov 26.

HPV vaccine introduction in Rwanda: Impacts on the broader health system.

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Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK. Electronic address:
School of Medicine, Department of Obstetrics & Gynaecology, University of Rwanda, Rwanda; Department of Clinical Research, University Teaching Hospital of Kigali, Rwanda.
Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
Maternal and Child Health Department, Ministry of Health, Kigali, Rwanda.



Rwanda was the first country in Africa to introduce the human papillomavirus (HPV) vaccine. This was achieved through multi-year school-based campaigns. Our study evaluated the impact of the HPV vaccine introduction on the country's immunisation programme and health system.


Thirty key informants were interviewed at national and district levels, and in participating schools. Twenty-seven health facilities completed a questionnaire exploring the effects of the new vaccine introduction on six health system building blocks, as defined by the World Health Organization. Routine service activity data were collected during a 90-day period around the introduction.


Routine vaccination activities were not disrupted during the delivery, likely due to a strong Expanded Program on Immunization, appropriate planning and a well-resourced operation. Opportunities were seized to co-deliver other interventions targeted at children and adolescents, such as health promotion. Collaboration with the Ministry of Education was strengthened at national level. Although there were some temporary increases in staff workload, no major negative effects were reported.


Despite its delivery through school-based campaigns, the HPV vaccine integrated well into the immunisation programme and health system. The introduction had no major negative effects. Some opportunities were seized to expand services and collaborations.


Adolescent health; HPV; Health systems; Rwanda; Vaccination

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