Page 269 - GHES-3-3

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

h. Health financing model Rwanda’s broader economic goals. These approaches will

The researchers advocate for utilizing CBHI as a be critical in ensuring Rwanda’s health system evolves
sustainable funding model. The adjusted 2023/2024 CBHI sustainably while advancing its UHC objectives and
funding threshold is set at RWF 72.51 billion, aiming to achieving its HRV 2050 targets.
cover 94% of the population, which corresponds to an To proceed cautiously, this study divided the total RWF
adjusted per capita amount of USD 4.47 (RWF 5,233, 174.44 billion by three, yielding adjusted annual figures:
based on an exchange rate of 1 USD = RWF 1,170.6 as of RWF 58.69 billion (2024/2025), RWF 122.66 billion
July 21, 2023). This adjustment is illustrated by Scenario II (2025/2026), RWF 192.39 billion (2026/2027), RWF 230.31
with strategic cost-control measures applied. billion (2027/2028), and RWF 298.26 billion (2030/2031).
The decision to prioritize CBHI funding, financially Additional mobilized funds through 2040/2041 are
strengthened by the “minimum 1% specific tax for UHC and detailed in Table S9.
HRV 2050,” over broader international macroeconomic health 3.4.5. Financial preparedness for the execution of the
expenditure per capita options is based on Rwanda’s past HRV 2050 in Scenario III
success in achieving HRV 2020 with CBHI. This approach has
the potential to advance UHC toward the HRV 2050 target. Figure 3 and Table S9 illustrate that the CBHI recorded a
net income of RWF 2.18 billion in 2021/2022, projected
i. Revised milestones and projections to rise to RWF 849.41 billion by 2040/2041, driven by the
Instead of focusing on the original 2050 goals, this study “minimum 1% specific tax for UHC and HRV 2050.” The
proposes more achievable milestones based on Rwanda’s cumulative net income is expected to reach RWF 6,985.66
progress, context, and the potential of leveraging CBHI. billion, including RWF 516.94 billion from previous periods,
These milestones include: resulting in a net cumulative saving of RWF 6,468.72 billion
(i) Achieve UMIC standards by 2030/2031, ahead of (92.6%). Notably, these figures exclude the revenues from
the original 2035 target the Comfortable Package membership, IGA_HS, and
(ii) Achieve HIC standards by 2035/2036 – or by 2040/41 medical tourism in the faith-based health sector.
at the latest – well ahead of the original 2050 target, The combined 13 funding sources are projected to exceed
enabling a 10-year HRV 2050 implementation the financial threshold of RWF 290.04 billion for UMIC
period (excluding a 5-year lag) health-care standards by 2027/2028, reaching RWF 313.55
(iii) Achieve, under a pessimistic scenario, self-reliance billion. The threshold for HICs of RWF 580.08 billion is
between 2040 and 2045 at the latest expected to be surpassed by 2035/2036, with RWF 621.91
(iv) Achieve health-care sovereignty by 2045 – 2050 at billion, 15 years ahead of the 2050 target. Rwanda’s health
the latest. care self-reliance target of RWF 870.12 billion (12 times the
The revised financing model recommends a fourfold baseline) is projected to be met by 2039/2040, with a recorded
increase in base funding to meet UMIC standards, an amount of RWF 897.77 billion. By FY 2040/2041, CBHI
eightfold increase to reach HIC standards, a twelvefold income is expected to reach RWF 984.57 billion, 13.58 times
increase (pessimistically) to achieve Rwanda’s health care the initial threshold of RWF 72.51 billion. The UHC
self-reliance, and a sixteenfold increase (pessimistically) to sovereignty threshold of RWF 1,160.16 billion (16 times the
attain health-care sovereignty. baseline) is forecasted to be surpassed in 2042/2043, with
total CBHI income reaching RWF 1,183.98 billion.
3.4.4. Strategic framework for securing additional
funding sources to support the effective 3.4.6. Effective implementation of health-related
implementation of HRV 2050 (2024/2025 – 2040/2041) measures under Scenario IV (2021/2022 – 2040/2041)
This section outlines the framework for securing additional Figure 4 illustrates that the CBHI system recorded a net
funding sources essential for the successful implementation income of RWF 2.18 billion in 2021/2022, projected to
of Rwanda’s HRV 2050. The framework emphasizes the rise to RWF 418.88 billion by 2040/2041. Furthermore,
need for innovative financing strategies to address the Figure 4 and Table S10 illustrate Scenario IV, showing net
identified funding gap, as the current health expenditure accumulated revenue (reserves) of RWF 3,470.34 billion
trajectory falls short of the required levels to meet the (Figure S10) allocated to all specialist-care costs and other
UMIC and HIC targets by 2035 and 2050, respectively. unmet needs related to social health protection. Of the total
Key mechanisms for mobilizing additional funds include RWF 6,985.66 billion in accumulated reserves illustrated
leveraging domestic resources, strengthening the CBHI in Scenario III, RWF 3,515.66 billion (50.33%) is allocated
system, and exploring new funding models that align with to improving universal access to primary, hospital, and

Volume 3 Issue 3 (2025) 261 https://doi.org/10.36922/ghes.5842