Republic of Rwanda

Kivu 2010 Leadership RetreatReporting on progress since the Leadership

Retreat, and looking ahead to the next quarter

Domestic Funding; Saving lives

Rwanda Health sector Rwanda Health sector achievementsachievements

(case scenario)

Building a Health SystemBuilding a Health System

2

Referral Hospital

(5)

District Hospital(34 to 42)

Health Center(234 to 469)

Community Level(0 to 14,837)

~80% of burden of disease addressed here

Physician Specialist(150)

Physician Generalist(475)

Nurse Generalist(8,273)

Community HealthWorkers(45,011)

Com

plex

ity o

f car

e

WHO-recommended health worker density:

2.3 per 1,000 pop.

Rwanda’s health worker density:

0.84 per 1,000 pop. New : 3 Referral4 Provincial

Health post

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 declarationset 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 ?

5Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for Rwanda.

87 8273

6353 51

156

275

183

108

6054

178170

154

133

112109

29

5259

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].

6

7

*Only countries with populations greater than 500,000 included.

Rwanda

Cambodia

BotswanaEstonia

Oman

Brazil

Portugal

ChinaBelarus

Ireland

Liberia

MalawiEthiopia

MDG 4 cutoff: 4.4%

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 Progress Against Child Mortality and Health Expenditure Per Capita Around the World*Health Expenditure Per Capita Around the World*

Annual Rates of Decline in Child Mortality by Annual Rates of Decline in Child Mortality by Wealth Quintile and Residence, DHS 2010Wealth Quintile and Residence, DHS 2010

8National Institute of Statistics of Rwanda, Macro International, Inc. (2012). Rwanda Demographic and Health Survey 2010. Calverton, MD: Macro International, Inc.

(measures 10 years preceding survey)

9

CauseTimefram

eDecline 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%

Non Communicable diseases

????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].

Towards reducing premature death in RwandaTowards reducing premature death in Rwanda

SAMU/PHECS (Pre-Hospital Emergency Care Service)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 sustainabilityHealth 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

Household expenditures as % of Total Health Expenditures

32 % 26 % 31 % 20 % 26 % 15 %

Household Out-of-Pocket as % of Total Health Expenditures

33 % 25 % 25 % 17 % 23 % 11 %

OOP per capita (constant 2009/10)

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.