Critical Care Access in Rwanda: What the Data Tells Us
How do hospitals in low-income countries decide who gets access to an intensive care bed when there are far fewer beds than patients who need them? A new prospective cohort study from the University Teaching Hospital of Butare in Rwanda, published in Critical Care Explorations (August 2025), sheds light on this question — and the findings are sobering.
Between January and June 2024, 318 critically ill adults met ICU admission criteria. Yet only 27.7% were admitted to ICU within 24 hours. Nearly three out of four patients who required intensive care never received it in time.
Patient recruitment
The data showed that certain groups were more likely to be admitted: patients needing postoperative recovery and obstetric patients had significantly higher odds of ICU admission than those with acute medical conditions. In contrast, socioeconomic status, gender, and social connections did not significantly influence admission decisions. Outcomes were poor among those admitted to ICU - overall inpatient mortality was 44%, and interestingly, rapid ICU admission did not improve survival.
Factors Associated With ICU Admission Within 24 Hours of Screening Positive
This paints a stark picture of the unmet need for critical care in Rwanda — one that is echoed across many low- and middle-income countries. The study underscores how health systems under strain must make impossible choices including who should access intensive care.
So where does Essential Emergency and Critical Care (EECC) fit into this picture? EECC is the baseline bundle of low-cost, low-complexity interventions that all critically ill patients should receive in all hospitals, regardless of whether an ICU is available. These include monitoring vital signs, providing oxygen therapy, giving intravenous fluids, and ensuring timely recognition and response to deterioration.
This study highlights the importance of EECC. Patients who never reach the ICU need life-saving emergency and critical care — and EECC provides a structured, evidence-based framework to deliver it throughout health facilities.
Notably, this Rwandan study cited research by EECC Global’s founders twice, including the Delphi Consensus to define the basics of life-saving critical care; and the African Critical Illness Outcomes study in The Lancet. This recognition signals that EECC is not only a practical response to resource constraints but is also shaping the academic discourse on critical illness care worldwide. The evidence is growing: implementing EECC offers a powerful strategy to reduce preventable deaths.
In Rwanda and beyond, the message is clear. Critical illness is common, deadly, and too often untreated. ICU scarcity makes the challenge more visible, and the real solution lies in ensuring that every hospital, in every setting, delivers essential emergency and critical care for all.