Page 261 - GHES-3-3

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

2.6.3. Derived logarithmic equation health-care services to meet the health needs of specific

The above equation is supported by the derived logarithmic populations.
equation used to determine one of the unknown elements 2.7.4. Health sector reform
of the following formula:
According to Roberts et al. (2004), reform involves
V a significant and purposeful effort to enhance the
ln n
V 0 = n1− (IV) performance of a health-care system. Reforms differ in
r at least two dimensions: (i) the number of health-care
system components being modified and (ii) the extent to
Where ln designates the natural logarithm. which these changes deviate from established practices.
The authors emphasize that successful reform often
2.7. Concepts and operational definitions involves introducing a set of interdependent and mutually

This section provides the details for the concepts and supportive interventions, particularly when significant
operational definitions used in this study. changes are made to a single component of the system.
Additional definitions are provided in Section 1 of the
2.7.1. Financial viability and sustainability Supplementary File.
According to Hayes (2013), an organization is considered 2.8. Ethical considerations
viable when, under normal service conditions, it generates
sufficient resource inflows to at least offset all operational The ethical considerations of this study are:
costs, strategic expenditures, and anticipated risks, thereby (i) Scientific approval for the study, required as a
enabling it to achieve its strategic objectives and meet prerequisite for ethical review, was obtained from
stakeholder expectations in the short to medium term. the Public Health (Ref: 037/UR/CHMS/SPH/2013)
Viability becomes sustainable when the organization can on January 11, 2014
reasonably maintain its balance of inflows and outflows (ii) Ethical approval (Ref: 001/UR/CMHS/SPH/2014)
over the long term, typically beyond 5 years, despite was obtained from the UR/CMHS/SPH Institutional
changing conditions. Review Board (IRB) on February 11, 2014
(iii) Research authorization was granted by the Rwanda
2.7.2. Net income Ministry of Health (Letter No. 20/1522/PHIS/
According to Investopedia (https://www.investopedia. ME&R/2014)
com, accessed April 03, 2025), net income, also known (iv) Finally, all managers of CBHI structures
as net profit, is a key profitability metric that represents participating in the survey signed informed consent
a company’s overall earnings after deducting all expenses forms before their enrolment.
and costs from total revenue. It may also include additional 2.9. Tools
income sources, such as interest from investments or
income from asset sales. Net income provides insight Four self-administered questionnaires were developed
into a company’s financial performance and operational for different levels: CBHI-section level (60 participants),
efficiency, helping investors and managers evaluate CBHI-district level (district’s “Mutuelles de santé”) (15
profitability and identify areas of financial strength or participants), national pooling risk (one participant), and
for qualitative primary data collection from CBHI-section
weakness.
key informants and CBHI-district levels.
2.7.3. Health-care system The questionnaires were developed in French/English,
According to the WHO, a health-care system consists of completed (transcribed) in either language and ultimately,
all organizations, people, and actions primarily aimed at all were retained or translated into English.
promoting, restoring, or maintaining health. This includes The Cleeland, J. (2012). LimeSurvey (Version 1.92),
efforts to address health determinants as well as direct Company of manufacturing: Jason Cleeland and Country:
interventions to improve health outcomes. A health-care Australia was used for data recording and entry. Quantitative
system, therefore, encompasses more than just publicly data were exported to IBM Corp. (2012). IBM SPSS Statistics for
owned facilities that deliver personal health services; it also Windows, Version 21.0. IBM Corp. IBM (International Business
includes the institutions, people, and resources involved in Machines Corporation), Country: United States, for statistical
delivering health-care services to individuals. Similarly, analysis of data on the following key variables: demographic
Wikipedia defines a health-care system as an organized data (population), health services utilization/consumption, and
structure of people, institutions, and resources that deliver financial data (CBHI income and expenditure).

Volume 3 Issue 3 (2025) 253 https://doi.org/10.36922/ghes.5842