Financing Health in Africa - Le blog
  • Home
  • Bloggers
  • Collaborative projects
  • Join our COPs
  • Resources
  • About Us
  • Contact Us

Health Financing for universal health coverage: the interesting case of Rwanda

2/17/2015

13 Commentaires

 
Picture
Alex Hakuzimana

In the following blog, Alex Hakuzimana presents a summary of results of a study on mapping of health financing schemes in Rwanda.  He provides a comprehensive description of existing schemes in Rwanda, analyses their different combinations and draws a comparison between twelve other Francophone African countries involved in a multi-country collaborative research on the fragmentation of health financing schemes as described in a previous blog.

Rwanda is hailed for being one of low income countries able to reach health MGDs 4, 5, and 6. The country is also hailed for being on the right track towards progressive realization of universal health coverage. A combination of many factors can help explain this. These include various sector reforms within and outside the health sector in a context of strong national ownership, cross sector collaboration, decentralization and the sector-wide approach. In health sector, a lot of literature is available on the role played by two health financing innovations including performance-based financing and community-based health insurance in Rwanda. However this focuses only on their outcomes. It does not tell anything about the whole architecture, about the health financing schemes, their size, benefits and coverage. As the country is moving towards universal health coverage, it is very important to map existing health financing schemes with a view to contributing to the evidence base for programming and planning purposes. For this exercise we have applied the methodological framework of the “Muskoka study”.

Mapping of health financing schemes in Rwanda

By using this methodology, I had a two-fold objective (i) contribute to Rwanda’s universal health coverage path by providing a comprehensive overview on the existing health financing schemes in order to inform policy makers on possible reforms and (ii) compare with the situations in 12 Francophone African countries and identify differences and commonalities that may help appreciate how Rwanda is progressing toward universal health coverage.

This study was a document review by collecting data with guidance and adaptation of the research instruments developed for the multi-country collaborative research project. For each scheme, data was collected on following features: target population, benefit package, financing, payment methods, institutional design and organizational practices. It is worth noting that out-of-pocket payment as a scheme was excluded. The description, analysis, and comparison were made on the basis of findings by focusing on the synergies and/or overlaps between the schemes.

So what are our main findings?

There are commonalities and differences between Rwanda and Francophone African countries on the architecture of their respective health care financing systems. For instance, the fragmentation of their health financing systems is ubiquitous but with lesser extent in Rwanda. While these countries have on average 23 schemes ranging from 15 to 32, Rwanda has only 11. This may be due to the highly external dependence of health sector funding in all these countries. However, the Rwanda government’s emphasis on cross-sector collaboration, decentralization, sector-wide approach framework and strict alignment of donor projects to national priorities has promoted accountability for both government and donors, which might explain the lower number of schemes in Rwanda contrary to other countries. Unsurprisingly for low income countries, the better-off benefit more of the system than the worse-off by using both exemption schemes and insurance benefit. In targeting programs, women and under five children are the main target groups of the schemes contrary to Rwanda where health insurance is compulsory to all residents. Pro-poor programs are operational countrywide in Rwanda while not in those countries. There is an appalling difference on out-of-pocket expenditure that was 11% in 2009/10 in Rwanda while the lowest was 65% in 2011 in Burundi. Benefit package is also partially found in all countries including Rwanda but not to the same extent. There is also a mixed use of provider payment mechanisms in all these countries proportional to the number of schemes.

Box: Health Financing schemes in Rwanda


Picture
Conclusion

Our study has revealed that the Rwanda health system, like in other 12 Francophone African countries, is fragmented because of a mix of health financing schemes. Rwanda's health sector, like that of other low income countries, is also highly dependent on external funding, with a large share of the Global Diseases Initiatives such as The Global Fund and PEPFAR. This study shows the importance of not only financing a health system to function but also of managing it.  Given the relevance of health financing for universal coverage, it is important to launch wide consultations and dialogue with stakeholders in order to discuss on how the health system should be financed while looking for overall efficiency and quality.

This study was carried out as a dissertation in partial fulfilment of requirements for the degree of Master of Science in Public Health at the Institute of Tropical Medicine (ITM) of Antwerp during the 2013/2014 academic year. You can access it by clicking here.


13 Commentaires
GNIGNINANJOUENA Oumarou
2/18/2015 03:52:45 am

Très pertinent Alex

Répondre
Willis Adero
2/18/2015 05:39:20 am

This was a very good study that should be extended to other countries including Kenya that is now headed towards a Universal health scheme. The study will help in identifying available gaps so as to ensure that the universal health scheme is a success. Good work

Répondre
Alex Hakuzimana link
2/20/2015 02:57:49 am

Dear Willis,
Definitely, that would be very nice to do the similar work in your country. or even in English-speaking countries. A quite similar mapping in Ghana some years ago has contributed to the knowledge base for the current reforms of its health financing system, Re: NHIA.

Répondre
Umuhoza Therese
2/18/2015 11:07:33 am

Very good work Mr.Alex. I appreciate your analysis and recommendation.

Répondre
Chhiay Song
2/18/2015 09:13:55 pm

Dear Sir/Madam,
The summary looks good but I could not get access to the document. I would be grateful if I could get access to it.

Kind regards,

Chhiay

Répondre
Alex Hakuzimana link
2/20/2015 02:59:04 am

Thanks for your interest. Pleased to share the full version.

Répondre
LOUIS RUSA U.
2/21/2015 07:20:35 am

Congratulations to Alex for this interesting study. I do recognize that it is not easy to look through health financing in our systems, however what I wanted to raise is that the exempted scheme is not free. It is important to highlight their source of funding. The government is participating in the Vaccines cost, in malaria program, TB and HIV, maternal and child health and in financing indigents through Community based health insurances. External funding from PEPFAR, GAVI, One UN, Global Fund and other bilateral donors. What is important i think is to show how pulled are those sources (eg through a Coordinated Procurement and Distribution System, which is a model of integration and harmonization). In the exemption group you can also add Blood transfusion. Note that you are close to the reality and I encourage you to continue after your master's degree.

Répondre
Duong Lot
2/22/2015 07:34:59 pm

Congratulation Alex,
It's a useful study, especially for low income countries. However, don't forget to share a full version with we could not reach it right now.
Thanks in advance,
Duong Lot

Répondre
Alex Hakuzimana link
2/23/2015 12:05:59 am

Thanks all for your comments. Of course this study had some limitations which you can find in the full version of the report. Unfortunately you were not able to access the full version at the link provided. You can now access it at the following:
https://www.dropbox.com/s/tordlu6n2rezdcv/150201ITM_MPH_Thesis_Final_Alex.pdf?dl=0

Répondre
Devadasan
2/23/2015 12:09:13 am

Dear Alex
Thanks for a nice overview of your study. Looks quite interesting. Unfortunately, am not able to access your thesis, the ITM server blocks me out when I click on the link. So would appreciate if you could send me a soft copy of your thesis - so that I can try out something similar in India. My email id is deva@iphindia.org

with warm regards

Devadasan

Répondre
Dr. Bamgboye M. Afolabi link
3/10/2015 05:54:33 am

Dear Alex,
My name is Dr. BM. Afolabi, CEO/Director of Research at Health, Environment and Development Foundation (HEENDEF) based in Lagos, Nigeria. Personally, I am proud of you for this work. I think this should be emulated in other parts of Africa, most especially Nigeria. A multicenter study including Kenya, Tanzania and maybe Malawi or Uganda in the East and Nigeria, Ghana and The Gambia should be conducted.

Répondre
Alex Hakuzimana link
11/1/2017 05:05:02 pm

Dear Dr Bamgboye, apologies for delay in reverting to you. This could be very useful for cross-learning. Why not starting now?

Répondre
Esther
3/10/2015 07:02:28 am

Hi Alex,
I lived in Rwanda for two years about a decade ago. What I was most impressed about is the universal health insurance scheme which is rare in Africa. I am not surprised that Rwandans co- pay 11% out of pocket and the other countries' residents co-pay over 65%. In some cases out of pocket expenses is 100%. Thank you for highlighting this so brilliantly. There is a lot other countries can learn from Rwanda here. Have a blessed day. Esther

Répondre



Laisser un réponse.


    Our websites

    Photo
    Photo
    Photo

    We like them...

    SINA-Health
    International Health Policies
    CGD

    Archives

    Septembre 2019
    Juin 2019
    Avril 2019
    Mars 2019
    Mai 2018
    Avril 2018
    Mars 2018
    Février 2018
    Janvier 2018
    Décembre 2017
    Octobre 2017
    Septembre 2017
    Août 2017
    Juillet 2017
    Juin 2017
    Mai 2017
    Avril 2017
    Mars 2017
    Février 2017
    Janvier 2017
    Décembre 2016
    Novembre 2016
    Octobre 2016
    Septembre 2016
    Août 2016
    Juillet 2016
    Avril 2016
    Mars 2016
    Février 2016
    Janvier 2016
    Décembre 2015
    Novembre 2015
    Octobre 2015
    Septembre 2015
    Août 2015
    Juillet 2015
    Juin 2015
    Mai 2015
    Avril 2015
    Mars 2015
    Février 2015
    Janvier 2015
    Décembre 2014
    Octobre 2014
    Septembre 2014
    Juillet 2014
    Juin 2014
    Mai 2014
    Avril 2014
    Mars 2014
    Février 2014
    Janvier 2014
    Décembre 2013
    Novembre 2013
    Octobre 2013
    Septembre 2013
    Août 2013
    Juillet 2013
    Juin 2013
    Mai 2013
    Avril 2013
    Mars 2013
    Février 2013
    Janvier 2013
    Décembre 2012
    Novembre 2012
    Octobre 2012
    Septembre 2012
    Août 2012
    Juillet 2012
    Juin 2012
    Mai 2012
    Avril 2012
    Mars 2012
    Février 2012
    Janvier 2012
    Décembre 2011
    Novembre 2011
    Octobre 2011

    Tags

    Tout
    2012
    Accountability
    Aid
    Alex Ergo
    Assurance Maladie
    Bad
    Bamako Initiative
    Bénin
    Bruno Meessen
    Burkina Faso
    Burundi
    Civil Society
    Communauteacute-de-pratique
    Communauté De Pratique
    Community Of Practice
    Community Participation
    Conference
    Cop
    Course
    Couverture Universelle
    CSU
    Déclaration De Harare
    Divine Ikenwilo
    Dr Congo
    économie Politique
    élections
    équité
    Equity
    Fbp
    Financement Basé Sur Les Résultats
    Financement Public
    Fragilité
    Fragility
    Free Health Care
    Global Fund
    Global Health Governance
    Gratuité
    Gratuité
    Health Equity Fund
    Health Insurance
    ICT
    Identification Des Pauvres
    Isidore Sieleunou
    Jb Falisse
    Jurrien Toonen
    Kenya
    Knowledge-management
    Kouamé
    Leadership
    Mali
    Management
    Maroc
    Maternal And Child Health
    Médicaments
    Mise En Oeuvre
    Mutuelle
    National Health Accounts
    Ngo
    Niger
    Omd
    OMS
    Parlement
    Participation Communautaire
    Pba
    Pbf
    Plaidoyer
    Policy Process
    Politique
    Politique De Gratuité
    Politique De Gratuité
    Post Conflit
    Post-conflit
    Private Sector
    Processus Politique
    Qualité Des Soins
    Qualité Des Soins
    Quality Of Care
    Recherche
    Redevabilité
    Reform
    Réforme
    Research
    Results Based Financing
    Rwanda
    Santé Maternelle
    Secteur Privé
    Sénégal
    Société Civile
    Uganda
    Universal Health Coverage
    User Fee Removal
    Voeux 2012
    Voucher
    WHO

Powered by Create your own unique website with customizable templates.