Universal Health Coverage in Rwanda

Rwanda is the country with the highest enrolment in health insurance in Sub-Saharan Africa. The implementation of health insurance schemes is guided by the National Health Insurance Policy(NHIP) of Rwanda.

Accordingly, the specific financing policyinterventions that Rwanda implemented to expandcoverage of healthcare include the following:

  •  Social Health Insurance (SHI)
  • Community-Based Health Insurance (CBHI)
  • Private Health Insurance (PHI)
Pivotal in setting Rwanda on the path to UHC isthe CBHI, which covers more than three-quarters of the population. The scheme has evolved from a pure form of voluntary CBHI to one based on obligatory enrolment and subsidies from the formal sector, thus paving the way to a national health insurance model. Before the scheme became compulsory in 2006, it was already recognised as one of the rare successes of wide CBHI coverage in Sub-Saharan Africa.

Rwanda’s impressive level of coverage and/or progress towards UHC has been achieved through government policy efforts that have proven tobe cogent. The systematic reforms that Rwanda implemented addressed critical areas including health infrastructure development, Human Resources for Health, and health financing.

  • Public health education campaign. The Rwandan government established andeffectively implemented a public education campaign system. The campaign focused on theimportance of using modern healthcare services - forexample, mother and child healthcare
  • Health infrastructure development. The Rwandan government has made significant investments in health infrastructure development. First, deliberate efforts were made by the government to establish and equip health facilities to reduce physical distances to healthcare, as prescribed in its national health policy. The government of Rwanda also invested in specially programmed mobile phones to strengthen the referral system
  • Human Resources for Health (HRH). Rwanda designed and effectively implemented a HRH strategic plan and programme. As a result, Rwandan health facilities including those in rural areas are fully staffed with critical cadres
  • Health financing. As in Uganda, a significant amount of foreign aid is used to finance the health sector in Rwanda. However, the Rwandan government (both thecentral government and MoH) has a very strong level of commitment to financing healthcare using domestically mobilised resources.