Healthcare in Rwanda

In the pre-genocide era before 1994, Rwanda's healthcare was supported by the Bamako Initiative which was sponsored by UNICEF and WHO and adopted by African ministers of health in 1987."Bamako initiative" Archived from the original on 2006-11-28. Retrieved 2006- 12-28Caroline Kayonga towards universal health coverage in Rwanda. Summary notes from briefing Brookig Institution Washington D.C 2007 Progress was started towards decentralising the health management system, first to the Province level and then to the district level. Unfortunately this was disrupted by the 1994 genocide, which crippled the healthcare system alongside the economy. In the post genocide period, Rwanda has had an uphill climb in the recovery of its health system as well as its economy. It has since built one of the best healthcare systems in the region. In 2008, the government spent 9.7% of national expenditure on healthcare, compared with 3.2% in 1996.{{sfn|WHO|2009|p=10}}

Health insurance became mandatory for all individuals in 2008;{{sfn|WHO|2008}} in 2010 over 90% of the population was covered.{{sfn|McNeil|2010}} In 2012, only about 4% were uninsured.

President Kagame made healthcare one of the priorities for the Vision 2020 development programme,{{sfn|Evans|2014}} boosting spending on health care to 6.5% of the country's gross domestic product in 2013,{{sfn|World Bank (V)}} compared with 1.9% in 1996.{{sfn|World Bank (VI)}} The government has devolved the financing and management of healthcare to local communities, through a system of health insurance providers called mutuelles de santé.{{sfn|WHO|2008}} The mutuelles were piloted in 1999, and were made available nationwide by the mid-2000s, with the assistance of international development partners.{{sfn|WHO|2008}} The mutuelles are owned and managed at the level of Rwanda's thirty districts. There are separate national health insurance schemes for public servants and soldiers.{{cite news |title=Rwanda prescribes compulsory healthcare |url=https://www.ft.com/content/cec52ffa-bfe2-11e8-84cd-9e601db069b8?emailId=5bbb26708faec70004dffd94 |access-date=13 November 2018 |publisher=Financial Times |date=10 October 2018}}

Premiums under the scheme were initially US$2 per annum; since 2011 the rate has varied on a sliding scale according to wealth, with the poorest citizens entitled to free health insurance and wealthiest paying premiums of US$8 per adult. {{As of|2014}}, more than 90% of the population was covered by the scheme.{{sfn|USAID (II)|2014}} The government has also set up training institutes including the Kigali Health Institute (KHI), which was established in 1997{{sfn|IMF|2000|p=34}} and is now part of the University of Rwanda. In 2005, President Kagame also launched a program known as The Presidents' Malaria Initiative.{{cite web|url=http://www.rw.one.un.org/mdg/mdg6|title=HIV/AIDS, Malaria and other diseases|publisher=United Nations in Rwanda|access-date=20 May 2016|archive-url=https://web.archive.org/web/20160515111753/http://www.rw.one.un.org/mdg/mdg6|archive-date=15 May 2016|url-status=live|df=dmy-all}} This initiative aimed to help get the most necessary materials for prevention of malaria to the most rural areas of Rwanda, such as mosquito nets and medication.

Rwanda follows a universal health care model, which provides health insurance through the mutuelles de santé. The system is a community-based health insurance scheme, in which residents of a particular area pay premiums into a local health fund, and can draw from it when in need of medical care. Premiums are paid according to a sliding scale, with the poorest members of society entitled to use the service for free, while the wealthiest pay the highest premiums and are charged copays for treatment.{{cite web|url=http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/?_r=0|title=In Rwanda, Health Care Coverage That Eludes the U.S.|first=Tina|last=Rosenberg|date=4 July 2012 }}

In 2012, about 45% of the system was funded by premium payments, with the rest coming from government funding and international donors.

As of 2014, Rwanda's healthcare system operated 499 health centers, 680 health posts mainly involved with the outpatient programmes such as immunizations and family planning services, a number of dispensaries, and 42 district hospitals.http://hrhconsortium.moh.gov.rw/rwanda {{Webarchive|url=https://web.archive.org/web/20141102180017/http://hrhconsortium.moh.gov.rw/rwanda |date=2014-11-02 }} - at - a - glance The country's villages are served by a network of thousands of community health workers. There are four national referral hospitals,{{cite web|url=https://medicine.yale.edu/intmed/global/sites/rwanda.aspx|title=Rwanda > Office of Global Health - Internal Medicine - Yale School of Medicine|website=medicine.yale.edu}} which are Kigali University Teaching Hospital, Butare University Teaching Hospital, King Faisal Hospital Kigali and the Rwanda Military Hospital. The most advanced of them is King Faisal Hospital, which is operated on a for-profit model by the government but participates in the national health insurance system, and therefore accepts patients referred to it by other hospitals and clinics. It is the most advanced hospital in Rwanda, equipped with a CT and MRI machine, two dialysis machines, and a wide range of surgical capabilities.

Rwanda's clinics are equipped with basic medical equipment and a cupboard of essential medications. The district hospitals offer basic surgical services, and all have a minimum of 15 doctors. Those in need of more advanced and specialized care are referred to one of the four national referral hospitals. There are five cancer treatment centers in the country, the Rwanda Cancer Centre at Butaro Hospital and facilities at the four national referral hospitals.[https://www.uicc.org/case-studies/strengthening-advanced-breast-cancer-care-rwanda-through-improved-care-coordination Strengthening advanced breast cancer care in Rwanda through improved care coordination]

There is a network of 58,286 community health workers who provide primary care in the 14,837 villages and make referrals.

Rwanda has a shortage of medical professionals, with only 0.84 physicians, nurses, and midwives per 1,000 residents in 2013.{{sfn|Partners In Health|2013}} The United Nations Development Programme (UNDP) is monitoring the country's health progress towards Millennium Development Goals 4–6, which relate to healthcare. A mid-2015 UNDP report noted that the country was not on target to meet goal 4 on infant mortality, despite it having "fallen dramatically";{{sfn|UNDP (II)|2015}} the country is "making good progress" towards goal 5, which is to reduce by three quarters the maternal mortality ratio,{{sfn|UNDP (III)|2015}} while goal 6 is not yet met as HIV prevalence has not started falling.{{sfn|UNDP (IV)|2015}}{{Cite journal |last=Tuyisenge |first=D |date=19 February 2021 |title=Quality improvement strategies to improve inpatient management of small and sick newborns across All Babies Count supported hospitals in rural Rwanda. |journal=BMC Pediatr|volume=21 |issue=1 |page=89 |doi=10.1186/s12887-021-02544-z |doi-access=free |pmid=33607961 |pmc=7893907 }}

Rwanda is participating in a seven-year program begun in 2013 that sees hundreds of medical educators and clinicians from 25 American medical institutions, including Harvard Medical School, Yale Medical School, and Duke Medical School, training Rwandan medical personnel and establish training and residency programs, which, after seven years, will be run by the Rwandan government with its own budget, teachers, and clinicians.{{cite web|url=http://www.pih.org/blog/how-rwanda-is-changing-medical-education|title=Rwanda Launches Bold Medical Education Partnership|access-date=2016-05-27|archive-date=2017-06-13|archive-url=https://web.archive.org/web/20170613005825/http://www.pih.org/blog/how-rwanda-is-changing-medical-education|url-status=dead}} Also to improve with better training.

• Health in Rwanda
• List of hospitals in Rwanda
• HIV/AIDS in Rwanda
• COVID-19 pandemic in Rwanda
• University Teaching Hospital of Kigali (CHUK)
• King Faysal Hospital Kigali
• Ndera Neuropsychiatric Teaching Hospital

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• {{cite news |last=Evans |first=Ruth |date=20 January 2014 |title=Rwanda's health service evolution – podcast |work=The Guardian |location=London |url=https://www.theguardian.com/global-development/audio/2014/jan/20/rwanda-health-global-development-podcast |access-date=27 July 2015 }}
• {{cite web|author=International Monetary Fund (IMF)|title=An approach to the Poverty Reduction Action Plan for Rwanda: The Interim PRSP|date=November 2000|url=https://www.imf.org/external/np/prsp/2000/rwa/01/110100.pdf|access-date=10 November 2015|ref={{sfnRef|IMF|2000}}}}
• {{cite news |last=McNeil |first=Donald G. |date=14 June 2010 |title=In Desperately Poor Rwanda, Most Have Health Insurance |work=The New York Times |url=https://www.nytimes.com/2010/06/15/health/policy/15rwanda.html?_r=1 |access-date=26 April 2012 |location=New York, N.Y. }}
• {{cite news |author=Partners In Health |date=20 November 2013 |title=Rwanda Launches Bold Medical Education Partnership |author-link=Partners In Health |location=Boston, Mass. |url=http://www.pih.org/blog/how-rwanda-is-changing-medical-education |access-date=20 August 2015 |archive-date=13 June 2017 |archive-url=https://web.archive.org/web/20170613005825/http://www.pih.org/blog/how-rwanda-is-changing-medical-education |url-status=dead }}
• {{cite news |last=Rosenberg |first=Tina |date=3 July 2012 |title=In Rwanda, Health Care Coverage That Eludes the U.S. |work=The New York Times |location=New York, N.Y. |url=http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/?_r=0 |access-date=19 August 2015 }}
• {{cite web |author=United Nations Development Programme (UNDP) (II) |year=2015 |title=Millennium Development Goal 4: Reduce child mortality |url=http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg4/ |access-date=20 August 2015 |ref={{sfnRef|UNDP (II)|2015}} |url-status=dead |archive-url=https://web.archive.org/web/20150915063425/http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg4/ |archive-date=15 September 2015 }}
• {{cite web |author=United Nations Development Programme (UNDP) (III) |year=2015 |title=Millennium Development Goal 5: Improve maternal health |url=http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg5/ |access-date=20 August 2015 |ref={{sfnRef|UNDP (III)|2015}} |url-status=dead |archive-url=https://web.archive.org/web/20150915024952/http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg5/ |archive-date=15 September 2015 }}
• {{cite web |author=United Nations Development Programme (UNDP) (IV) |year=2015 |title=Millennium Development Goal 6: Combat HIV/AIDS, malaria, and other diseases |url=http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg6/ |access-date=20 August 2015 |ref={{sfnRef|UNDP (IV)|2015}} |url-status=dead |archive-url=https://web.archive.org/web/20150915021048/http://www.rw.undp.org/content/rwanda/en/home/mdgoverview/overview/mdg6/ |archive-date=15 September 2015 }}
• {{cite web |author=United States Agency for International Development (USAID) (II) |date=8 December 2014 |title=Health Insurance Expands Care For Rwanda's Poorest |author-link=USAID |url=https://www.usaid.gov/results-data/success-stories/community-based-health-insurance-expanding-care-rwanda%E2%80%99s-poorest |access-date=10 October 2015 |ref={{sfnRef|USAID (II)|2014}} |url-status=dead |archive-url=https://web.archive.org/web/20160304112040/https://www.usaid.gov/results-data/success-stories/community-based-health-insurance-expanding-care-rwanda%E2%80%99s-poorest |archive-date=4 March 2016 }}
• {{cite web |author=World Bank (V) |title=Health expenditure, public (% of GDP), 2010–2014 |url=http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS |access-date=19 August 2015 }}
• {{cite web |author=World Bank (VI) |title=Health expenditure, public (% of GDP), 1995–1999 |url=http://data.worldbank.org/indicator/SH.XPD.PUBL.ZS |access-date=19 August 2015 }}
• {{cite book |author=World Health Organization (WHO) |year=2009 |title=WHO Country Cooperation Strategy, 2009–2013: Rwanda |isbn=978-92-9031-135-5 |author-link=World Health Organization |url=https://www.who.int/countryfocus/cooperation_strategy/ccs_rwa_en.pdf |archive-url=https://web.archive.org/web/20101019194126/http://www.who.int/countryfocus/cooperation_strategy/ccs_rwa_en.pdf |url-status=dead |archive-date=October 19, 2010 |ref={{sfnRef|WHO|2009}} }}
• {{cite journal |author=World Health Organization (WHO) |year=2008 |title=Sharing the burden of sickness: mutual health insurance in Rwanda |journal=Bulletin of the World Health Organization |issn=0042-9686 |volume=86 |issue=11 |pages=817–908 |url=https://www.who.int/bulletin/volumes/86/11/08-021108/en/index.html |archive-url=https://web.archive.org/web/20081113032750/http://www.who.int/bulletin/volumes/86/11/08-021108/en/index.html |url-status=dead |archive-date=November 13, 2008 |ref={{sfnRef|WHO|2008}} }}

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