Page 257 - GHES-3-3

Global Health Economics and
Sustainability
Sustainability of Rwanda’s UHC: 2011–2021 and vision 2050

with similar income levels and those in the middle- and prioritizing health in national development, alignment
upper-middle-income groups. In the post-COVID-19 era, and harmonization of interventions by key stakeholders
amid global inflation, Rwanda has continued to prioritize (both national and international), and intersectoral
health care, contrasting with many countries that have collaboration.
reduced health care spending. According to Sabiiti (2024), Other contributing factors include the wide coverage
Rwanda has made significant investments in health care of priority health programs, infrastructure expansions,
since 2023. Key initiatives include the introduction of and improved geographical access to health care. Public
BioNTech’s mRNA vaccine manufacturing facility, the and community awareness, which is fundamental to the
Research Institute Against Digestive Cancer, and the 4 × primary health-care system, also plays a crucial role. In
4 Reform, aiming to increase the health care workforce addition, the information and communication technology,
from 1.15 to 4.45 workers per 1,000 people within 4 years. the strong network of public/agree (faith-based) health
Additional projects include the USD 12 million Regional infrastructure across the country, along with robust
Pharmaceutical Project and the expansion of King Faisal financial access and high CBHI coverage, are key drivers
Specialty Hospital from 167 to 600 beds. These investments for success. Other hidden factors contributing to Rwanda’s
highlight Rwanda’s commitment to improving health- UHC success are presented in the discussion section.
care access and infrastructure, positioning it as one of the
leading countries in health-care development in Africa. 1.2. Aim of the study
Inspired by the success of Vision 2020, the GOR This study aims to address the persistent financial
launched health-related Vision 2050 (HRV 2050) in 2020. sustainability challenges of Rwanda’s UHC model (CBHI
This long-term development plan outlines the nation’s goal and health-care system) by identifying additional funding
to become an upper-middle-income country (UMIC) by primarily from internal resources while contributing to
2035 and a high-income country (HIC) by 2050. In terms the achievement of Rwanda’s UHC goal and the effective
of health care, HRV 2050 aspires to elevate Rwanda’s health- implementation of HRV 2050.
care system to the standards of current UMIC systems by
2035 and to HIC standards by 2050, offering universal 1.3. Study significance
access to specialty and super-specialty care, respectively. The significance of this study includes:
However, achieving these goals appears unlikely based on (i) Achieving financial sustainability for Rwanda’s
the initial analysis. UHC model (CBHI and the health-care system) by
2030/2031
According to a meta-analysis, Rwanda will need an
additional 22.65 years from 2024/2025 to reach UMIC (ii) Ensuring full compliance with the WHO’s UHC
CUBE and SDG Target 3.8 (UHC Index) by
health-care standards instead of the initial target of 2030/2031
11 years. Similarly, the timeline for meeting HIC standards (iii) Modernizing Rwanda’s UHC model from 2030/2031
extends to 49.14 years instead of the original 26-year (iv) Achieving the effective implementation of HRV
goal (see costing framework section) from 2024/2025. To 2050 by 2040/2041, ahead of the initial 2050 target.
bridge the gap, Rwanda would need to invest significantly
more funds. For example, to meet the UMIC standard, an 1.4. Study statements
additional USD 149.83 per capita is required, and to meet The statements of this study include:
the HIC standard, an additional USD 569.83 per capita (i) Rwanda’s UHC model (CBHI and P/A health-
is needed. This gap is beyond Rwanda’s current financial care facilities) can achieve financial sustainability
reach.
without additional CBHI financing through reforms
The ex ante analysis suggests that Rwanda can close and the adoption of cost–control measures
this gap by emulating Thailand’s health-care system (ii) Effective implementation of HRV 2050 requires
under normal conditions, applying the international substantial additional funding for the UHC model
macroeconomic health expenditure per capita metric. through CBHI as a third-party payer
Another viable approach is to build on the existing CBHI (iii) Based on their expertise in Rwanda’s health-care
system, which has already produced remarkable results in system and global practices, the researchers believe
achieving Vision 2020. Researchers are confident in this HRV 2050 is achievable, provided that funding
approach based on supporting factors, such as the GOR’s is scaled up to 4 times the adjusted 2024/2025
prioritization of health. Indeed, according to the 2021 CBHI spending capacity (RWF 72.51 billion) for
HSSP IV Midterm Review, the factors enabling Rwanda’s UMICs and 8 times for HICs. Two higher funding
health sector success include strong national leadership targets, 12 times for self-reliance and 16 times for

Volume 3 Issue 3 (2025) 249 https://doi.org/10.36922/ghes.5842