The document discusses Rwanda's progress and goals for its health sector. It provides statistics showing that Rwanda has made significant improvements but still has progress to make to meet WHO recommended health standards. It outlines Rwanda's community-based health system and efforts to increase domestic funding sources and reduce out-of-pocket costs for citizens. Specific achievements highlighted include large declines in mortality rates from HIV/AIDS, malaria, tuberculosis and other diseases. Rwanda aims to continue expanding insurance coverage and improving quality of care across all levels of its health system.
Declare no conflict of interest.
All information presented are my own analysis with information abstracted from:
MoF, Financial reports (2010-2017)
MoF, Budget speeches (2010-2018)
MoH, National Health strategic plan (2011-2016)
MoH, National Health strategic plan (2017-2021)
WHO, Global Health Expenditure database (http://apps.who.int/nha/database/Select/Indicators/en
Health financing and budgeting practices in the Philippines - Ivor BEAZLEY, OECDOECD Governance
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The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
This presentation by Akiko MAEDA and Cheryl CASHIN was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
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Overview of UNDP’s work on sustainable financing of HIV responses in selected countries of Eastern Europe and Central Asia.
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Event: 7th Regional HIV and AIDS Conference, Sarajevo, Bosnia and Herzegovina – 28-29 May 2015
Declare no conflict of interest.
All information presented are my own analysis with information abstracted from:
MoF, Financial reports (2010-2017)
MoF, Budget speeches (2010-2018)
MoH, National Health strategic plan (2011-2016)
MoH, National Health strategic plan (2017-2021)
WHO, Global Health Expenditure database (http://apps.who.int/nha/database/Select/Indicators/en
Health financing and budgeting practices in the Philippines - Ivor BEAZLEY, OECDOECD Governance
This presentation was made by Ivor BEAZLEY, OECD, at the 13th Annual Meeting of OECD-Asian Senior Budget Officials held in Bangkok, Thailand, on 14-15 December 2017
The Ministry of Health and Family Welfare developed the National Health Accounts (NHA) in 2001–02 to support the governance of health systems and enable the design of more effective health policies. This report provides an estimate of the total health expenditure for 2004-05 (taking into consideration the launch of the National Rural Health Mission in 2005), and gives provisional estimates of the health expenditure from 2005-06 to 2008-09.
In the computation of NHA, the World Health Organisation’s (WHO) definition of health expenditure was adopted. NHA includes expenditure on inpatient and outpatient care, hospitals, specialty hospitals, health promotion centres, rehabilitative care centres, capital expenditure on health, medical education, and research and training. It excludes expenses on water supply, sanitation, environmental health and the mid-day meal programme.
This presentation by Akiko MAEDA and Cheryl CASHIN was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
DELSA/GOV 3rd Health meeting - Mads Bager HOFFMANNOECD Governance
This presentation by Mads Bager HOFFMANN was made at the 3rd Joint DELSA/GOV Health Meeting, Paris 24-25 April 2014. Find out more at www.oecd.org/gov/budgeting/3rdmeetingdelsagovnetworkfiscalsustainabilityofhealthsystems2014.htm
Making Anticipated Results Possible (MARP): Expanding the HIV Responses – Tra...UNDP Eurasia
Overview of UNDP’s work on sustainable financing of HIV responses in selected countries of Eastern Europe and Central Asia.
Presenter: Dr. Christoph Hamelmann, HIV, Health and Development - Regional Team Leader (Eastern Europe and Central Asia) and Senior Advisor (Arab States)
Event: 7th Regional HIV and AIDS Conference, Sarajevo, Bosnia and Herzegovina – 28-29 May 2015
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Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
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USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
Making Quality Healthcare Affordable to Low Income GroupsIDS
This is a presentation on the Hygeia Community Health Plan Model that was given to a meeting hosted by Future Health Systems in Abuja in January 2009 www.futurehealthsystems.org.
This presentation was made by Ana Maria Ruiz, OECD, at the 2nd Health Systems Joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Investing in Nigeria with Homestrings: Healthcare project by Crystal ThorpeHomestrings
Crystal Thorpe (CT) has issued a privately place 2 year note in conjunction with First National Bank to finance the construction of a general hospital in Lagos. This loan is meant to set the stage for new health care services in Nigeria and take advantage of favorable policies and financing incentives. Afreximbank is a project guarantor and is expected to secure bondholders fixed returns 2 years from the date of issue. Target returns are 12% per annum.
Budget execution - Eva Zver, Josar Dusan, SloveniaOECD Governance
This presentation was made by Eva Zver and Josar Dusan, Slovenia, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Olamide Okulaja_Creating synergy for PPP_PPP Conference2019Atinuke Akande
At the health policy dialogue organised by PharmAccess Foundation and Nigeria Health Watch on the 11th April 2019, Olamide Okulaja discussed Creating Synergy for public-private partnership in Nigeria.
Central coordination for Financing UHC in Nigeria: Progress and Next StepsHFG Project
Presented during Day One of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
Policy framework for health care financing reform in NigeriaHFG Project
Presented during Day Three of the 2016 Nigeria Health Care Financing Training Workshop. Presented by Dr. Francis Ukwuije. More: https://www.hfgproject.org/hcf-training-nigeria
Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop
Domestic Financing for Health in Africa: The Road of Sustainability and Owner...Linda Mtambo
Presentation delivered by Prof Alan Whiteside at the 17th ICASA Conference in Cape Town, South Africa as a panel participant on ‘The End of AIDS: Myth or reality?'
How can health accounts inform health sector investments? Lessons from countr...HFG Project
Countries must have a firm grasp on their health financing landscape in order to ensure sufficient and effective use of resources. Health Accounts—an internationally standardized methodology that allows a country to understand the source, magnitude, and flow of funds through its health sector—provide a wealth of information on past spending. When combined with macroeconomic, health utilization, and health indicator data, Health Accounts provide powerful insights for health financing policy.
USAID’s Health Finance and Governance (HFG) project supports countries to institutionalize their Health Accounts so that they are produced regularly and efficiently, and are a useful tool for policymakers. In this technical briefing webinar, held June 29, 2016, HFG experts used country examples to demonstrate how Health Accounts have been (and can be) used to inform national health financing decisions. The experts also provided perspectives on the future of Health Accounts.
The Role of Health Insurance in UHC: Learning from Ghana and EthiopiaHFG Project
USAID’s Health Finance and Governance (HFG) project works with partners around the world to support their progress towards universal health coverage (UHC). Protecting families and individuals from catastrophic health costs is one of the pillars of UHC. Health insurance is a key mechanism for providing financial protection. In this technical briefing, HFG shared lessons learned and technical insights from our work in piloting and scaling up community-based health insurance in Ethiopia and supporting Ghana’s National Health Insurance Authority to improve the financial sustainability of its National Health Insurance Scheme.
On Wednesday, March 2nd, the HFG project hosted a webinar featuring technical experts: Hailu Zelelew (Senior Associate/Health Economist, HFG Project), Chris Lovelace (Senior Health Governance Expert, HFG Project), and Jeanna Holtz (Health Insurance Specialist, HFG Project).
More:https://www.hfgproject.org/health-insurance-and-uhc-ghana-ethiopia/
Making Quality Healthcare Affordable to Low Income GroupsIDS
This is a presentation on the Hygeia Community Health Plan Model that was given to a meeting hosted by Future Health Systems in Abuja in January 2009 www.futurehealthsystems.org.
This presentation was made by Ana Maria Ruiz, OECD, at the 2nd Health Systems Joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
Investing in Nigeria with Homestrings: Healthcare project by Crystal ThorpeHomestrings
Crystal Thorpe (CT) has issued a privately place 2 year note in conjunction with First National Bank to finance the construction of a general hospital in Lagos. This loan is meant to set the stage for new health care services in Nigeria and take advantage of favorable policies and financing incentives. Afreximbank is a project guarantor and is expected to secure bondholders fixed returns 2 years from the date of issue. Target returns are 12% per annum.
Budget execution - Eva Zver, Josar Dusan, SloveniaOECD Governance
This presentation was made by Eva Zver and Josar Dusan, Slovenia, at the 2nd Health Systems joint Network Meeting for Central, Eastern and Southeastern European Countries held in Tallinn, Estonia, on 1-2 December 2016
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"Providing Health in Difficult Contexts: Pre-pilot Performance-Based Financing Experiences in Adamawa State in North-East Nigeria" on April 24, 2014. It highlights the experiences from the Adamawa Performance-based financing (PBF) Pilot, the challenges faced, the early results and how the pilot is leading the way for improved coordination and sustainable health system changes.
Dr Magure investigates the role of health delivery systems and looks at how health can be delivered in the future.
Presented at 'Moving Forward with Pro-poor Reconstruction in Zimbabwe' International Conference, Harare, Zimbabwe, (25 and 26 August 2009)
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During the coldest months, Italy transforms into a winter wonderland, providing visitors with a very unique experience. From the Settimana Bianca ski event to the lively Carnevale celebrations, Italy's winter festivities provide something for everyone. Enjoy hot cocoa, eat hearty comfort foods, and buy during winter deals. Explore the country's rich cultural past by participating in Settimana Bianca, and Carnevale, sipping hot chocolate, shopping during winter deals, and indulging in winter comfort foods. Visit our website https://timeforsicily.com/ for more information.
Its running cost is among the diverse vital aspects you must consider before buying an electric scooter. Calculate the cost of getting e-scooter charge for your regular usage to calculate its economic efficiency, similar to people who investigate the mileage of petrol or diesel-driven scooters.
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Discover Palmer, Puerto Rico, through an immersive cultural tour that unveils its rich history and vibrant traditions. Experience lively festivals, savor authentic cuisine, and explore local markets. Visit historical landmarks, museums, and stunning colonial architecture. Engage with friendly locals, enjoy live music, and hike scenic nature trails, all while participating in cultural workshops and discovering unique artisan crafts.
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TRAVEL TO MT. RWENZORI NATIONAL PARK WITH NILE ABENTEUER SAFARIS.docx
Rwanda health sector achievements
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.