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.
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 ?
Vaccination Coverage in Rwanda
100%
80%
BCG
DTP (3)
60%
Measles
Polio (3)
40%
20%
0%
1990
1995
2000
2005
Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for
2010
5
6
Child Mortality in Rwanda, 1990 – 2011
300
275
Rwanda
Sub-Saharan Africa
250
200
World
183
178
170
154
Probability of child
dying by age 5 per 150 156
1,000 live births
133
108
112 109
100
87
82
50
73
60
63
54
53 51
59
52
29
0
1990
1995
2000
2005
2010
2015
MDG Target
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].
Progress Against Child Mortality and
Health Expenditure Per Capita Around the World*
12%
Rwanda
Botswana
Estonia
10%
Belarus Oman
Cambodia
8%
China
Brazil
Portugal
Liberia
Child mortality
annual rate of
6%
decline,
2000-2011
Malawi
Ethiopia
Ireland
MDG 4 cutoff: 4.4%
4%
2%
0%
$10
$100
$1,000
$10,000
Total health expenditure per capita, 2010 (log)
*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
7
from 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)
18.5%
15.1%
15.2%
15.1%
11.9%
5.7%
3.6%
Lowest
Second
Middle
Fourth
Highest
Rural
Urban
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
Timeframe
Decline in
Mortality
Malaria (reported deaths)
2005 – 11
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
????
Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons
9
from 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
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
Household expenditures as %
of Total Health Expenditures
Household Out-of-Pocket as
% of Total Health
Expenditures
OOP per capita (constant
2009/10)
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
Household expenditures as % of Total Health Expenditures (as a
source)
35%
30%
25%
20%
Household expenditures as % of
Total Health Expenditures (as a
source)
15%
10%
5%
0%
1998
2000
2002
2003
2006
2009/10
Proportion of Co-payment on total healthcare expenditures for
CBHI and RAMA patients
3,473,080,407.59
Paid by Insurance
schemes/GoR/Donor
s
Copayment
25,851,707,360.70
• 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.