Understanding HPV Vaccination Policymaking in Rwanda: A Case of Health Prioritization and Public-Private-Partnership in a Low-Resource Setting.

Abstract

Abstract Background Rwanda was the first African nation to initiate a nationwide HPV vaccination program in 2011 where the incidence of cervical cancer was reduced from 34.5 cases to 28.2 cases per 100,000 women and the mortality rate declined from 25.4–20.1% from before 2011 to 2020, respectively. This study sought to clarify the HPV vaccination policymaking process in Rwanda and the lessons policymakers in other low-income settings can learn.Methods Kingdon's multiple stream framework and Foucault’s concept of governmentality were used as lenses to understand the Rwandan policymaking process that hastened the introduction of a national HPV vaccination program in 2011. Perspectives of policy makers engaged in HPV vaccination policy were gathered from published sources, along with key informant interviews.Results Rwanda presents a valuable case study of Kingdon’s multiple streams model clarifying how governmental priority setting (policy stream) for cervical cancer prevention (problem stream) along with public and private incentives and policy entrepreneurship (politics stream) aligned to foster program implementation. Rwanda’s track record of successful vaccination programs enabled by a culture of local accountability referred to as Imihigo created public and private sector incentives. Effective stakeholder engagement, health priority setting, and resource mobilization garnered locally and through international development aid, reflect indicators of policy success. The national HPV policymaking process in Rwanda unfolded in a relatively cohesive and stable policy network.Conclusion Although peripheral stakeholder resistance and a constrained national budget can present a threat to policy survival, the study shows that such factors as the engagement of policy entrepreneurs within a policy network, private sector incentives and international aid were effective in ensuring policy resolution.