Page 267 - GHES-3-3

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

to address them. As a result, the GOR continues to pay 3.4.3. Costing framework for implementing HRV 2050
accumulated arrears to health-care facilities dating back to in the health sector
2015, straining the operations of health-care facilities and This section outlines the framework for implementing
worsening relations between the CBHI system and the HRV 2050.
contracted facilities. The CBHI’s financial deficit is projected a. Introduction
to grow from RWF 22.56 billion in 2020/2021 to RWF
89.71 billion by 2040/2041. Cumulative losses are expected This research paper focuses on Rwanda’s UHC model
to reach RWF 913.03 billion by 2040/2041, indicating a and HRV 2050 long-term institutional and financial
persistent deficit that threatens CBHI’s sustainability and aspirations, with an emphasis on achieving effective
st
could lead to the collapse of the P/A health-care system. For health universalism in the 1 year of the FASP PPM
comparison, the first 10 years of the assessment serve as the implementation. It also examines health-care standards
baseline for all four scenarios, with projections beginning for UMIC by 2035 and HIC by 2050. The analysis suggests
in July 2021 and ending in June 2040/2041. Given global that the original targets were unrealistic, considering
inflation and declining external funding for the health Rwanda’s current limitations in securing additional
sector, cost–control measures, budget cuts, and optimal financing for CBHI resources, the health sector, and
practices for cost containment are essential. This research its projected economic and health-care expenditure
emphasizes the need for a FASP PPM to mitigate the risks capacities.
of overbilling and to build a solid foundation for CBHI’s b. Context of Rwanda’s GDP per capita, health
financial sustainability and Rwanda’s UHC, in line with expenditure per capita, and health system score
WHO’s UHC CUBE and SDG Target 3.8 (UHC index).
In addition to the literature reviewed, relevant meta-
3.4.2. Projection of the CBHI system’s income for the analyses and ex ante assessments within the HRV 2050
practice of a fully active strategic purchasing PPM costing framework indicates that Rwanda’s GDP per
under Scenario II (2021/2022 – 2040/2041) capita rose significantly—from USD 255 in 2000 to USD
826.39 in 2020, USD 948.27 in 2022, and USD 1,004.22 in
Figure 2 and Table S8 illustrate Scenario II, which 2023 (World Bank, 2020; Macrotrends, 2025). However,
simulates the implementation of the FASP PPM practice. alternative estimates from Statista report a GDP per capita
This includes reforms, innovative management techniques, of USD 966 for 2022 (Statista, 2023).
optimal practices, such as the abolishment of 10%
co-payment, and alternative financing mechanisms to Rwanda also increased its health expenditure per capita
address issues identified in this study. In the baseline FY from USD 9 in 2000 to USD 57.5 in 2020. Currently,
2021/2022, the CBHI income statement is forecasted to Rwanda’s per capita health expenditure is USD 57.50,
show a positive net income of RWF 2.18 billion, increasing projected to reach USD 81.17 by 2024/2025.
to RWF 81.61 billion by FY 2040/2041. A cumulative In 2023, Rwanda ranked 70 globally for health-care
th
reserve of RWF 516.94 billion is also expected from quality, with a score of 58.2, improving from 172 among
nd
2021/2022 to 2040/2041. 190 WHO member states in 2000.
Scenario II demonstrates the significant benefits of c. Context of Rwanda’s HRV 2050 targets
the FASP PPM by addressing previous deficiencies and
challenges. It achieves a 31% cost saving by preventing The HRV 2050 targets include:
over-quantification (Table S5) and 25.89% by preventing • The UMIC target by 2035: The goal is for Rwanda
overcharging (Table S6). This scenario ensures the long- to achieve a health-care system with standards
term financial sustainability of Rwanda’s CBHI and comparable to the current UMIC standards, which
public health-care system through allocative efficiency require a per capita GDP between USD 4,256 and
and effective resource usage in both systems. The saved USD 13,205, and a per capita health expenditure of
funds will be directed toward unmet services and the approximately USD 569.67 (World Bank on Health)
modernization of the CBHI and health-care delivery • The HIC target by 2050: The objective is to achieve
systems. A comparison of the cumulative net incomes health-care standards comparable to those of current
from Scenario I and Scenario II shows that the government HIC systems, which have a per capita GDP exceeding
will earn a gross profit of RWF 1,429.97 billion (RWF USD 13,205 and a per capita health expenditure
516.94 billion minus RWF 913.03 billion) due to the of USD 6,180.35 (World Bank, 2020. Currently,
reforms, optimal practices, and innovations introduced Rwanda’s per capita health expenditure is USD 57.50
by this study. This is one of the expected macroeconomic (World Bank, 2020) projected to reach USD 81.17 by
contributions of the FASP PPM. 2024/2025.

Volume 3 Issue 3 (2025) 259 https://doi.org/10.36922/ghes.5842