Rwanda health sector achievements
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Rwanda health sector achievements






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  • Household expenditures as % of Total Health Expenditures: this represents the total contribution by households to the healthcare expenditures. This include copayment, funds spent by patients who choose to go to private clinics; funds spent by non-insured individuals, etc. This figure can also include more indirect costs such as costs to travel to hospitals. <br /> Household Out-of-Pocket as % of Total Health Expenditures: this refers to the direct cost of accessing health services. It includes things like the copayment, expenditures on drugs, etc. It does not however include any indirect cost such as transportation costs to health facilities. <br /> OOP per capita (constant 2009/10): The direct expenditures of households including gratuities and in-kind payments made to health practitioners and to suppliers of pharmaceuticals, etc. It includes co-payment and any form of user charge. <br />
  • Co-payment account for 12% of medical expenditures for members of RAMA and CBHI –approximately 95% of the population in 2011/12. The remaining 88% was covered by GoR, insurance schemes via revenues and donors. <br />
  • - Co-payment i.e. a fixed proportion of the total cost of care that patients are required to pay when accessing health services. In some place co-payments are fixed fee while in other are proportion of total costs, as they are for CBHI and RSSB; <br /> - Members are required to pay a co-payment every time they visit a health facility to receive medical assistance. <br /> For CBHI members the co-payment rate is 10% and the remaining 90% is reimbursed by CBHI; for RSSB members it is 15% of the total cost of care. The remaining 85% is reimbursed by RSSB. <br />

Rwanda health sector achievements Rwanda health sector achievements Presentation Transcript

  • Republic of Rwanda Kivu 2010 Leadership Retreat Rwanda Health sector achievements Reporting on progress since the Leadership Retreat, and looking ahead to the next quarter (case scenario) Domestic Funding; Saving lives
  • Building a Health System WHO-recommended health worker density: 2.3 per 1,000 pop. Co mp le xit y of ca re Rwanda’s health worker density: 0.84 per 1,000 pop. Referral Hospital (5) Physician Specialist (150) District Hospital (34 to 42) Health Center (234 to 469) New : 3 Referral 4 Provincial Physician Generalist (475) Nurse Generalist (8,273) Health post Community Level (0 to 14,837) ~80% of burden of disease addressed here Community Health Workers (45,011) 2
  • Health Financing system • Rwanda put together all collective effort aiming at increasing innovative domestic resource to finance in the health sector • In order to ensure long term sustainability of interventions, Rwanda has been ensuring increase in budgeting every year: e.g 2012-2013:16.05%, 2013-2014: 17.36% This is above the 2002 Abuja declaration set target of proportion of national budget used for Health.
  • Why efficient management of funds • Comply with GOR Aid policy : Accountability for all • Ensure efficient use of GOR & Partners funds • Proceed with sub sector comprehensive planning process linked to the Sector Strategic Plan & Funds mobilisation : Synchronisation , synergy & sustainability • Set up an Implementation framework of health Subsector strategic plans : Define who is doing what ? , how? , when? With which Means/ressources ? Measurement of achievments(frequency, tools ,external verification ?
  • Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for 5
  • 6 275 178 183 170 154 133 156 108 87 82 73 112 109 60 63 54 53 51 Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print]. 59 52 29
  • Progress Against Child Mortality and Health Expenditure Per Capita Around the World* Rwanda Botswana Estonia Cambodia Liberia Malawi Ethiopia Belarus Oman China Brazil Portugal Ireland MDG 4 cutoff: 4.4% *Only countries with populations greater than 500,000 included. Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from 7 Success.” British Medical Journal 346(f65): [e-pub ahead of print].
  • Annual Rates of Decline in Child Mortality by Wealth Quintile and Residence, DHS 2010 (measures 10 years preceding survey) National Institute of Statistics of Rwanda, Macro International, Inc. (2012). Rwanda Demographic and Health Survey 2010. 8 Calverton, MD: Macro International, Inc.
  • Towards reducing premature death in Rwanda Malaria (reported deaths) 2005 – 11 Decline in Mortality 85.3% HIV/AIDS (rate) 2000 – 09 78.4% Tuberculosis (rate) 2000 – 10 77.1% Child mortality (rate) 2000 – 11 70.4% Maternal mortality (ratio) 2000 – 10 60.0% All-cause mortality (rate) 2000 – 10 50.0% Cause Non Communicable diseases Timeframe ???? Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from 9 Success.” British Medical Journal 346(f65): [e-pub ahead of print].
  • SAMU/PHECS (Pre-Hospital Emergency Care Service) • 912 – call center • 223 ground ambulances nationwide • 10 resuscitation ambulances in CoK • 1 water ambulance in Lake Kivu.
  • Health Financing sustainability • Community based health insurance (CBHI) – Coverage rate of 90.7% in 2011/12, 78.55% in 2012-2013 • 16 billions contribution • National budget • Performance based financing (PBF) – Increased quality of care (hygiene, customer care and financial management) • Innovation in financial management – Equalization fund to incentive providers to work and stay in rural areas – Professional hospital managers – Self sustained community care PPCP (Public Private Community Partnership) • Health post – drugstores and paid for point of care • 420 CHWs Cooperatives 70% indivisible benefices paying for care
  • Household and Out of Pocket Spending 1998 Household expenditures as % of Total Health Expenditures Household Out-of-Pocket as % of Total Health Expenditures OOP per capita (constant 2009/10) 2000 2002 2003 2006 2009/10 32 % 26 % 31 % 20 % 26 % 15 % 33 % 25 % 25 % 17 % 23 % 11 % RWF 1,994 RWF 1,371 RWF 1,436 RWF 1,664 RWF 4,510 RWF 2,378 $3.43 $2.35 $2.47 $2.86 $7.75 $4.09 Figures from the 2010 DHS and the table below show that Rwanda has made tremendous progress in reducing out-of-pocket expenditure both as a percentage of total health expenditure and in absolute terms
  • • Under all health insurance schemes members are required to contribute to the cost of care by paying a co-payment • In 2011/12 the total amount of co-payment paid by CBHI members was RWF 1.851.275.515,30. • In the same year RSSB members paid RWF 1.621.804.892,29 in copayment
  • Contribution to Global Fund. • As a country, we pledged and contributed to the third replenishment of the Global Fund equivalent amount of usd 1.000.000 I thank you for your kind attention.