Page 258 - GHES-3-3

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

sovereignty, are proposed to show that the HRV restructuring of CBHI and the health-care system into
2050 goals are attainable rather than aspirational. a unified Community and Health-care Financing Plan
(CHFP) – harmonizing risk pooling between the demand
1.5. Objectives side (CBHI) and the supply side (health-care providers) –

1.5.1. General objective necessitates their joint oversight.
The objectives of this study are to address the persistent 2.1.2. Study time frame
financial deficit of Rwanda’s UHC model and to
modernize it by promoting resilience and ensuring long- The survey for primary data collection was conducted
term institutional and financial sustainability while also from June to July 2014, focusing on FYs 2011/2012 and
contributing to the effective implementation of HRV 2050. 2012/2013. From 2013/2014 to 2023/2024, longitudinal
tracking and secondary data collection were carried out.
1.5.2. Specific objectives
2.1.3. Study design
The specific objectives of this study include:
(i) To assess the financial sustainability of CBHI from The study design was mainly quantitative, cross-sectional
2010/2011 to 2020/2021 and derive the lessons (June – July 2014), analytical, documentary, comparative,
learned longitudinal (2011/2012 – 2020/2021), prospective, and
(ii) To identify gaps and deficiencies during UHC modeling (from 2021/2022 to 2040/2041).
implementation and propose solutions 2.2. Sampling framework
(iii) To evaluate the necessary reforms and alternative
financing mechanisms required to modernize A stratified simple random sampling technique was applied
Rwanda’s UHC model, ensuring its long-term using the 2014 database from the “Cellule Technique d’Appui
financial sustainability and sovereignty aux Mutuelles de Santé/CTAMS.” The national pooling risk
(iv) To design a long-term financial sustainability plan (100%) was automatically selected at the central/national
for HRV 2050 (2021/2022 – 2040/2041), based on level. Since there is no CBHI structure at the provincial
the lessons learned from the CBHI system and the level, a first simple random sampling was conducted at the
completion of HRV 2020 intermediate district level.
(v) To highlight the study’s contribution to economic 2.2.1. Sample size and selection criteria
gains, social health benefits, and overall impacts.
The inclusion and exclusion criteria for enrolment in the
2. Materials and methods survey required that the CBHI schemes have coverage and
The methods used in this study were built upon those operational status for at least 2 years. A total of 30 CBHI/
from the previous study (Nyandekwe et al., 2020), with the Mutuelles districts were grouped into five sets, with six
current focus primarily on quantitative aspects. districts in each set, numbered sequentially from one to
30. Fifteen districts (50%) were selected for inclusion in the
2.1. Study setting survey by randomly choosing three districts from each set,
corresponding to the first, third, and sixth positions within
2.1.1. Study area each stratum.
This study was conducted across Rwanda, including A second simple random sampling was conducted
Kigali City, and all four provinces: Southern, Northern, using the 2011/2012 CBHI coverage status to select
Eastern, and Western Provinces. Initially, the research 60 CBHI sections (13.33%) from a total of 450 CBHI
focused on 481 CBHI structures, consisting of 450 mutual sections located in rural or peripheral areas. This selection
sections in rural areas, 30 district “Mutuelles”/CBHI at the corresponds to four CBHI sections per district. To choose
intermediate level, and the national risk pooling system in the four CBHI sections from each district, the first, last,
2014. Upon completion of the study, the number of CBHI and two sections located at the median position of all listed
structures has increased to 558, with 527 mutual sections, CBHI sections (based on the 2011/2012 CBHI coverage
30 districts “Mutuelles,” and the national risk pooling status) were selected. This process resulted in a total of 60
system, which is managed by the Rwanda Social Security CBHI sections across 15 districts, all of which were initially
Board (RSSB) headquarters. eligible for enrolment in the survey. After data cleaning,
In the near future, the implementation of the HRV 2050 one CBHI district and nine CBHI sections were excluded
plan will enhance mutual accountability and transparency due to incomplete questionnaires for one or both FYs
between the two interconnected systems. Indeed, the 2011/2012 and 2012/2013.

Volume 3 Issue 3 (2025) 250 https://doi.org/10.36922/ghes.5842