Page 259 - GHES-3-3

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

2.2.2. Geographical distribution (i) Applying a combination of traditional and modern

The geographical distribution of the CBHI entities retained management techniques
in the study was as follows: one unique risk pooling entity (ii) Complementing these methods with Rwanda’s
at the national level and 14 (93.33%) of the 15 selected UHC radical reforms, which focus on transitioning
from a fee-for-service (FFS) model to a “fully
CBHI districts. The distribution of these districts was active-strategic purchasing (FASP) mechanism.”
as follows: 1 (6.67%) in Kigali City, 3 (20.00%) in the This strategy, renamed “inputs-based financing,”
Eastern Province, 2 (13.33%) in the Northern Province, is designed to ensure the long-term financial
6 (40.00%) in the Southern Province, and 2 (13.33%) in the sustainability of Rwanda’s UHC within existing or
Western Province. Out of the 60 selected CBHI sections,
51 (85.00%) were retained in the study, distributed as similar circumstances and contributory financing
mechanisms
follows: 5 (8.33%) in Kigali City, 12 (20.00%) in the (iii) Transforming the political vision into a
Eastern Province, 11 (18.33%) in the Northern Province, macroeconomic health expenditure per capita,
11 (18.33%) in the Southern Province, and 12 (20.00%) in aligning it with the required clinical capacity, and
the Western Province.
translating it into actionable health interventions in
2.3. Data collection line with HRV 2050
(iv) Revaluing national social capital by reintroducing
The online Lime Survey software (https://www.limesurvey. solidarity through the compulsory “minimum
org/) was used to develop the questionnaire template 1% specific tax for UHC and HRV 2050,” which
and for online self-administration. This followed a 1-day acts as a home-grown national read health and
training focused on the survey’s objectives, as well as the social protection risk-equalizer tool? This strategy,
explanation of both general and detailed information. The renamed “target-based financing,” integrates
training also covered how to fill out, save, and reopen the Rwanda’s UHC and HRV 2050 contributory
questionnaire in case of a postponed exercise and submit financing mechanisms, benefiting from additional
the completed questionnaire once it was correctly filled out. financial resources derived from the “minimum

2.4. Data analysis 1% specific tax for UHC and HRV 2050.” These
complementary resources are intended to accelerate
The data analysis in this study includes: the implementation and achievement of HRV 2050
(i) The net income, i.e., total income minus total (v) Strengthening CBHI spending capacity per capita,
expenditure (surplus or gap), was the core metric prioritizing internal resources over the international
utilized to analyze, assess, and track progress and macroeconomic health expenditure per capita
performance on CBHI’s financial sustainability option to effectively implement and accelerate the
(ii) Financial thresholds defined by the researchers for achievement of HRV 2050 in a sustainable manner.
respective UMIC and HIC health-care standards
were used to quantitatively and financially monitor The study consolidated these five approaches into two
and track the trend toward their attainment. main dual-track strategies, presented as follows:
2.5. Techniques Strategy A: Cost-Neutral and Efficiency-Oriented
Reforms for Innovation and Sustainability (Input-
2.5.1. Management techniques applied Based Approach)
The research applied modern and traditional management This strategy prioritizes enhancing operational
techniques, such as management by objective strategy, efficiency and system governance without necessitating
streamlining/rationalization, optimization, prioritization, additional financial resources. It involves the adoption of
sustainable budget equilibrium (more than 5 successive Fully Active Strategic Purchasing (FASP), which replaces
years), allocative efficiency, effective usage, transparency, the conventional fee-for-service model with performance-
accountability, and the learning-by-doing approach based payments based on Diagnosis-Related Groups
(Reese, 2011). (DRG) pricing, thereby ensuring alignment between
service reimbursements and actual service delivery
2.5.2. Conceptual framework for ensuring long-term outputs. Additionally, it eliminates co-payments for all
financial sustainability in Rwanda’s UHC and HRV 2050
members of the Community-Based Health Insurance
Five approaches were leveraged to achieve long-term (CBHI) scheme to enhance access to and utilization of
institutional and financial sustainability for Rwanda’s UHC health services, reduce financial barriers, and promote
and HRV 2050. These strategies include: resilience initiatives.

Volume 3 Issue 3 (2025) 251 https://doi.org/10.36922/ghes.5842