Understanding needs and solutions to promote healthy ageing and reduce multimorbidity in Rwanda: a protocol paper for a mixed methods, stepwise research study.

introductionAgeing is often accompanied by chronic diseases, multimorbidity and frailty, increasing the need for clinical and social care to support healthy ageing and manage these conditions. We are currently in the UN Decade of Ageing, and there is a growing focus on the need to prevent or delay some of these conditions through the 'Healthy Ageing' initiative of the WHO. However, there are limited data available to inform prioritisation of interventions, particularly for countries in sub-Saharan Africa. METHODS AND ANALYSIS: This study will use a mixed-methods, stepwise approach to identify the current needs for older people in Rwanda, health system capacity and possible solutions to unmet need. First, we will conduct a household survey in the City of Kigali (predominantly urban) and Northern Province Burera district (predominantly rural) to determine the burden of multimorbidity, frailty, access to care, and experiences and responsiveness of care in older people. This work will be supplemented by secondary analysis of data from the Rwandan STEPwise approach to non-communicable disease risk factor surveillance (STEPs) survey of 2021. Second, we will conduct a health facility readiness assessment and healthcare provider survey to assess health system capacity and gaps to deliver effective primary care to older people in Rwanda. Third, to capture the voices of older people, we will explore the quality of healthcare as experienced by them using in-depth interviews. Fourth, we will synthesise data using mixed methods to understand barriers to access to quality of care among people of older ages based on a Three Delays framework (seeking, reaching and receiving quality healthcare). Finally, the project will culminate in a stakeholder workshop to ensure results are contextually appropriate and disseminated, and gaps identified are prioritised to design novel interventions to promote healthy ageing in Rwanda and the region. ETHICS AND DISSEMINATION: The study has received ethics approval from the Rwanda National Ethics Committee, Northwestern University, USA, and the University of Birmingham, UK. This study will deliver impactful research by using multiple methodologies and working with in-country partners to develop a deep knowledge and understanding of healthcare systems experienced by older people in Rwanda. It will also provide a framework for sustainable healthy ageing research and policy engagement to benefit older adults living in Rwanda and inform similar work in low- and middle-income countries during this Decade of Healthy Ageing and beyond.