1. 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
2. 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
3. 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.
4. 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 ?
5. Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for
5
7. 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].
8. 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.
9. 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].
10. 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.
11. 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
12. 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
13.
14. • 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
15. 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.
Editor's Notes
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.
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.
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.
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.
- 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;
- Members are required to pay a co-payment every time they visit a health facility to receive medical assistance.
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.
