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Global Perspectives in Otolaryngology

(512) Improving Otolaryngology Care at the Primary Healthcare Level: A Survey of Rwandan Primary Care Providers

Saturday, October 17, 2026

Presenting Author(s)

Trinithas J. Boyi, MD MA

Resident Physician
Southern Illinois University
Springfield, Illinois, United States

Co-Author(s)

Kamala Pullakhandam, BA

Ms.
Kamala Pullakhandam
Boston, Massachusetts, United States

Co-Author(s)

MX

Mary Jue Xu, MD

Assistant Professor
University of California San Francisco
San Francisco, California, United States
Gabrielle L. Cahill, MD, MPH

Dr.
University of California, Los Angeles Department of Head and Neck Surgery
Los Angeles, California, United States
NP

Nina Patel, MS, MPhil

Ms.
University of California San Francisco Department of Otolaryngology, United States

Senior Author(s)

Gratien Tuyishimire, MD

Dr.
University of Global Health Equity,Rwanda Otology & Neurotology Fellow ,Max Subspeciality Hospital-New Delhi
Kigali, Kigali, Rwanda

Introduction: In Rwanda, 30 OHNS clinicians serve the country’s population of 14 million. With low subspecialist density, primary care providers (PCPs) become the first line of otolaryngologic triage and care. However, it is unclear if Rwandan PCPs are equipped to bridge OHNS care gaps.

Methods: We conducted a cross-sectional qualitative survey-based study among Rwandan PCPs. Surveys were co-developed with Rwandan OHNS clinicians. PCP surveys evaluated diagnostic and management confidence of common head and neck conditions. Responses were collected between November 2024 and May 2025 and analyzed with descriptive statistics.

Results: Forty-four PCPs completed the survey. PCPs most frequently encountered sinonasal, pediatric, and ear/hearing diseases, (mean of 10.5, 9.7, and 6.7 presentations/week, respectively). However, confidence in sinonasal skills was low (mean confidence score of 2.9 out of 5). Diagnostic and management confidence scores were stable across disease categories. Barriers to care were common among PCPs. Eighty-eight percent and 83% of PCPs identified limited training/knowledge and limited equipment as barriers to patient care, respectively. Ninety-seven percent of PCPs agreed that further emphasis of otolaryngology training should be conducted in medical school.

Conclusions: This study highlights training gaps and systemic barriers affecting the Rwandan primary care workforce. Targeted hands-on training is needed to improve PCPs’ skills. Furthermore, evaluation of PCP recognition and management confidence did not reveal specific areas of deficit, indicating that training topics should be comprehensive and diverse. Finally, limited training/knowledge/skills was a common barrier to care, highlighting the importance of PCP-focused continuing medical education. This survey framework could be utilized in other LMIC settings to identify areas of reduced confidence in otolaryngology provision.