Ensuring Sustainability of Rwanda's Health Financing Systems

Dr. Cedric Ndizeye, IHSSP senior PBF advisor (left) works with the Ministry of Health’s Health Financing Unit (Dr. Joseph Ntibiringirwa (center) and Mr. Augustin Dushime (right). {Photo credit: C. Tran Ngoc/MSH.}Photo credit: C. Tran Ngoc/MSH.

Performance based financing (PBF) and community based health insurance (CBHI) are powerful health financing systems in Rwanda.

Implemented by the Rwandan Ministry of Health (MOH) with support from USAID through the previous HIV/PBF project and the current Integrated Health Systems Strengthening Project (IHSSP)—both implemented by Management Sciences for Health (MSH)—PBF has empowered Rwanda to increase the quality of health services by providing incentives to well-performing health workers. IHSSP also helped the MOH increase access to healthcare through the implementation of CBHI, which reached 90 percent coverage in 2011.

But mere implementation of the health financing systems wasn’t enough; both the Ministry and IHSSP had to think about the sustainability of the schemes. To that end, IHSSP worked with the MOH’s Health Financing Unit to develop a team within the Ministry to manage the health financing systems.

Through extensive working sessions, IHSSP and the Health Financing Unit collaborated through data analysis, development of policies, procedures, and guidelines, and creation of new tools. This helped the MOH staff understand and manage both the PBF and CBHI databases, which are crucial for the systems to run smoothly.

Since the capacity transfer, the Health Financing Unit has been able to run CBHI operations. Augustin Dushime and Olivier Kayiranga are respectively MOH’s PBF data analyst and CBHI data manager. They said that the technical exchange with IHSSP has enabled them to do their job well, and they feel more confident in their skills. “They [IHSSP staff] are always there when we need them. They taught us a lot of things, and we are still learning.”

The capacity transfer will help ensure country ownership of activities and sustainability of both PBF and CBHI schemes, long after the project ends.