A health professional at work. Rwanda’s 4×4 reform aims to expand and strengthen the country’s medical workforce.
Two years after Rwanda launched its 4×4 health workforce reform, early results show a dramatic expansion in medical training and a deliberate effort to close long-standing gaps in specialist care.
Designed to quadruple the number of health professionals in key cadres over four years, the reform is reshaping the country’s training pipeline and laying the groundwork for a more resilient, high-quality healthcare system.
New data from the Ministry of Health shows that average annual enrollment across major health training programs has surged since the reform began in 2023.
In general medicine, enrollment rose from an average of 203 students per year before the reform to 362 between 2023 and 2025. Dental surgery increased from 37 to 52 students annually.
Even more striking gains are seen in midwifery and nursing, where annual enrollment jumped from 72 to 1,050 and from 648 to 2,374, respectively, reflecting a strong push to strengthen frontline maternal and primary care services.
Allied health professions also recorded significant growth, rising from 229 to 1,058 trainees per year. Pharmacy enrollment nearly tripled, from 77 to 228 students annually.
Residency training, central to producing medical specialists, expanded from an average of 52 residents annually before the reform to 288 during the reform period. Subspecialty fellowships, introduced more recently, have enrolled 157 fellows since 2022.
Across residency programs, most specialties have more than doubled their intake. Internal medicine enrollment increased from 22 to 97 residents, obstetrics and gynecology from 25 to 161, and pediatrics from 9 to 78. General surgery rose from 5 to 73, anesthesiology from 7 to 72, emergency medicine and critical care from 12 to 51, and orthopedic surgery from 10 to 44.
Projections indicate that by 2028, Rwanda will graduate an average of 351 medical residents annually—nearly seven times higher than the pre-reform average of 52.
Health leaders say this scale-up is essential for improving clinical coverage, strengthening teaching hospitals, and reducing reliance on foreign-trained specialists. Health Minister Dr. Sabin Nsanzimana described the milestone as both a collective effort and a national priority.
“Two years of ‘4×4’: growing Rwanda’s health workforce. Grateful for everyone’s support,” he said.
The 4×4 reform emerged in response to persistent workforce shortages, uneven specialist distribution, and growing demand for complex care. By investing in training capacity, the government seeks to match infrastructure expansion with human resource development.
Jenipher Niyonziza, a resident doctor at Kibuye Hospital in Karongi District, said the increased enrollment is building confidence in the system and strengthening her ability to serve communities effectively.
“Being part of the 4×4 reform has changed the way we train and deliver care. Across the country, more residents in different specialties mean patients receive timely attention, and we learn from a broader range of cases,” she said.
Rwanda’s broader health gains over the past two decades—including expanded insurance coverage and improved maternal and child health indicators—have increased pressure on the system to provide more advanced services locally.
Officials note that sustaining this rapid scale-up will require continuous financing, adequate teaching faculty, and well-equipped training sites. Yet early results suggest a health system moving steadily toward self-sufficiency.
Two years in, the 4×4 reform is a visible expansion of classrooms, hospital wards, and residency programs—an investment in people that could redefine Rwanda’s healthcare landscape for decades to come.
