Spotlight on Global Health Initiative Plus Countries: Rwanda

Spotlight on Global Health Initiative Plus Countries: Rwanda

Part three of the blog series: Spotlight on Global Health Initiative Plus Countries

Health Financing is Helping Rebuild Rwanda’s Health Sector

It's been over 15 years since the Rwandan genocide; few would know of the tremendous successes in health that the country has experienced. Rwanda has made good progress towards meeting the Millennium Development Goals since they were identified. These impressive achievements are due to an increase in essential health interventions and the implementation of new health financing mechanisms.

In the area of health financing, Rwanda has implemented and scaled-up two promising initiatives: 1) community-based health insurance (CBHI) to improve financial access to health care particularly for the very poor (demand side), and 2) a performance-based financing scheme (PBF), developed to reward health facilities and staff for good performance (increased utilization and quality of services). Financial access to health care has greatly improved with the CBHI scheme, allowing the majority of the rural population access to healthcare services. PBF, introduced nationally in 2006, has achieved considerable success in improving the quality of health care services as well.

Although the membership level of the CBHI has increased enormously over the last few years, all Rwandans have not joined the CBHI and national budget does not allow the Ministry of Health to subsidize all those who cannot afford to pay the CBHI contribution themselves. A substantial number of poor people are left without access to health services. The budget of the pooling risk fund, the amount of money allocated to the health insurance fund that is paid in by the members of the CBHI, is insufficient and at the district level - most pools are unable to pay hospitals timely for costs incurred.

External funding assistance has contributed significantly to rebuilding Rwanda’s health sector.  But most of the assistance is still used for vertical programs, for example only focused on HIV & AIDS, instead of targeting the entire health system, which would in the long run produce a greater impact on mortality and morbidity reduction.  Rwanda is currently dependent on development partner funding for the provision of some of its most essential services, and continuous support from donors is still necessary. 

Funds should be allocated based on clear criteria such as efficiency and equity. The additional resources with the Global Health Initiative should be put towards further strengthening and supporting these two national initiatives (PBF and CBHI).

Sufficient funding should be devoted to expand the PBF program at the community level and support the community health workers to conduct community health interventions, a way of bringing services closer to the people and increasing coverage with basic curative and preventive care. Also, more funding should be allocated to regular supervision and monitoring to sustain motivation and delivery of quality services at the community level. For CBHI, more funding is needed to subsidize the premiums for the very poor.

Technical assistance should focus on building financial management and procurement capacities of health care provider organizations and build capacity of health managers in areas of financial management, accounting and audit, costing, monitoring & evaluation and quality assurance instead of focusing on service provision.

Jean Kagubare, MD, MPH, PhD, is a Principal Technical Advisor at MSH.

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