Surgical conditions account for nearly 30% of the global disease burden, yet billions still lack timely, safe, and affordable care. The Lancet Commission on Global Surgery shows surgery is central to universal health coverage and highlights the role of non-urban facilities. Rwanda has expanded access, but unmet needs remain in rural districts like Burera. With about three surgeons, obstetricians, and anesthesiologists per 100,000 people; well below the global minimum of 20; training and new ways of delivering care are essential. The University of Global Health Equity (UGHE), Butaro Level II Teaching Hospital, Inshuti Mu Buzima, as Partners In Health is known in Rwanda, and the Rwanda Ministry of Health address this through education, innovation, and direct integration into clinical care. Health is a human right, and that includes the right to surgery. 

The Four Delays 

Across Rwanda, many patients face what health professionals call the ‘four delays’: First, seeking care can be slowed by limited knowledge, social pressures, or cost. Second, reaching care can be difficult because of distance, transport, or referral gaps. Third, receiving care at the facility may be held back by workforce shortages, operating room constraints, or supplies. Fourth, remaining in care can falter when follow-up is hard to maintain. 

At Butaro Level II Teaching Hospital, the third delay; receiving care, was most visible in a growing surgical waiting list. 

The Campaign 

From July 7–11, 2025, partners led by the Butaro Level II Teaching Hospital joined forces to clear the backlog. Teams tackled staff, stuff, space, systems, and social support. They reached out to patients and accompanied them to address the delays, then welcomed everyone on the surgical waitlist. A multidisciplinary group mobilized: Plastic, pediatric, general, and colorectal; specialist obstetricians/gynecologists and gynecologic oncologists; anesthesia providers; perioperative nurses; operating room staff; and UGHE medical students from the Intare Surgical Interest Group. Collaboration spanned academic surgeons, clinical fellows, military and civilian hospitals, and local teams. 

In five days, 69 surgeries were completed; general and pediatric procedures, plastic and oncologic operations, including mastectomies and other breast surgeries, sarcoma resections, hernia repairs, haemorrhoidectomies, and reconstructive interventions. The work restored timely access to care and strengthened trust in the public system. 

Leadership and Learning 

This initiative was envisioned and championed by the Director General of the hospital, Dr. Eulade Rugengamanzi, and the UGHE’s Department of Surgery, under the leadership of Dr. Anteneh Gadisa Belachew. Dr. Jean Paul Majyambere, head of surgical services at the Butaro hospital played a key leadership role in the effort. The support from the Clinical Division, chaired by Dr. Natalie McCall, UGHE’s Centre for Equity in Global Surgery, chaired by Dr Barnabas Alayande, and the Office of the Dean of School of Medicine, Professor Abebe Bekele, was vital.   

The campaign deepened inter-institutional mentorship, reinforced perioperative safety and surgical standards, and showed how national and academic partnerships can reduce surgical delays. It offers a scalable model for Rwanda and beyond; built on radical collaboration and moral imagination; and reflects a preferential option for the most vulnerable by delivering high-quality care in a rural setting. 

Beyond the Campaign 

This was not a single event. Guided by the Partners In Health model of accompaniment, UGHE and partners are walking with the public sector to build stronger systems from within. A five-year plan is underway to improve services at Butaro beyond surgery. Through the UGHE’s Centre for Equity in Global Surgery, quality improvement research is focusing on reducing operating room delays, improving surgical safety checklist use, and strengthening informed consent. 

A Step Toward Equity 

This project cleared the surgical waiting list at Butaro Level II Teaching Hospital. It reaffirmed Rwanda’s strong and growing leadership in global surgery. It also highlighted its commitment to delivering equitable, high-quality surgical care at all levels of the health system. We have collaboratively put equity into action, ensuring that no one was denied care due to geography, poverty, or structural barriers.