Page 254 - GHES-3-3

Global Health Economics and
Sustainability

ORIGINAL RESEARCH ARTICLE
Long-term financial sustainability of Rwanda’s

universal health coverage model: Challenges
and solutions (2011 – 2021) and Vision 2050

1
Médard Nyandekwe * and Jean Baptiste Kakoma 1,2
1 Department of Health Policy, Economics, and Management, School of Public Health, College of
Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
2 Department of Health Policy and Management, Schools of Medicine and Public Health, University
of Lubumbashi, Haut-Katanga, Democratic Republic of Congo

Abstract

Since 2000, Rwanda has prioritized universal health coverage (UHC) and universal
health insurance, achieving significant health gains. Its UHC model – centered on
Community-Based Health Insurance (CBHI) and supported by public and faith-
based providers – now faces financial sustainability challenges. Under Vision 2050,
Academic editor: Rwanda aims to meet upper-middle-income country health-care standards by
Mihajlo Jakovljevic M.D. Ph.D. MAE 2035 and high-income country (HIC) standards by 2050. This study assesses the
*Corresponding author: financial sustainability of Rwanda’s UHC model from 2011 to 2021, with projections
Médard Nyandekwe through 2041 under four scenarios: Scenario I (status quo, fee-for-service): Projects
(nyandekwem@gmail.com)
growing deficits reaching Rwandan Franc (RWF) 89.71 billion and a cumulative
Citation: Nyandekwe, M., Kakoma, RWF 913.03 billion by 2040/2041. Scenario II (Fully Active Strategic Purchasing):
J.B. (2025). Long-term financial
sustainability of Rwanda’s universal Project net income of RWF 81.61 billion and cumulative reserves of RWF 516.94
health coverage model: Challenges billion by 2040/2041. This approach supports near-free health care, aligns with
and solutions (2011 – 2021) and SDG 3.8 and WHO’s UHC Cube, and promotes reforms such as tariff adjustments,
Vision 2050. Global Health Econ medical tourism, dual practice, and a comfortable package integrated with Ejo
Sustain, 3(3):246-272.
https://doi.org/10.36922/ghes.5842 Heza Pension benefits. Strategic purchasing could eliminate 56.89% of undue
costs, enabling 70% prepayment for facility plans: 45% for health service delivery,
Received: November 11, 2024
10% for prior co-payments, and 15% for staff incentives. The remaining 30%
1st revised: March 14, 2025 (post-verification) would fund additional essential medicines, inpatient nutrition,
2nd revised: April 9, 2025 financial sustainability, and resilience initiatives. Scenario III (1% UHC-HRV 2050
tax): Forecasts RWF 849.41 billion in net income and RWF 6,985.66 billion in
Accepted: April 16, 2025
reserves. Scenario IV (equity and modernization): Aims to expand clinical capacity
Published online: June 20, 2025 12-fold by 2041. Leveraging a strengthened CBHI system and a modest 1% levy
Copyright: © 2025 Author(s). for UHC and HRV 2050, Rwanda could promote clinical capacity strengthening up
This is an Open-Access article to 12-fold by 2041, retention and repatriation of specialized professionals, health
distributed under the terms of the
Creative Commons Attribution infrastructure modernization, and meet HIC health-care standards by 2036 – 2040,
License, permitting distribution, ahead of 2050 initial milestone, saving up to USD 922.86 per capita in health
and reproduction in any medium, expenditure. Rwanda’s robust UHC commitment provides a replicable model for
provided the original work is
properly cited. sustainable health reform across Africa.
Publisher’s Note: AccScience
Publishing remains neutral with Keywords: Rwanda; Community-Based Health Insurance; Financial Sustainability;
regard to jurisdictional claims in
published maps and institutional Universal Health Coverage; Vision 2050
affiliations.

Volume 3 Issue 3 (2025) 246 https://doi.org/10.36922/ghes.5842