Page 273 - GHES-3-3

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

USD 922.86 – derived from USD 976.50 minus USD 53.64. 3.5.4. Ultimate impact
At 16 times (Rwanda’s UHC system sovereignty level), it The ultimate impacts include:
sums to USD 1,230.48 – calculated from USD 1,302 minus (i) Improved health and welfare: Better health
USD 71.52.
outcomes, enhanced welfare, and increased life
3.5.2. Strengthening of the CBHI system and health expectancy
care delivery systems in line with the HRV 2050 (ii) Increased productivity: A healthier population
will boost productivity, leading to higher GDP and
The 1 year of the implementation of FASP PPM-related economic growth, aligned with Rwanda’s HRV 2050
st
reform increased the AGR of community health workers (iii) Sustainable stakeholder engagement: All
from −5% to 206%, the AGR of provincial hospitals from stakeholders in the UHC and HRV 2050 model
10% to 40%, and the AGR of contracted private specialty can confidently ensure long-term institutional and
health establishments from 10% to 20% (see Scenario II). It financial sustainability
also clinically strengthened all P/A health-care facilities by (iv) Health sector vision: Rwanda envisioned for 2050
upgrading tariffs from the 2024/2025 base level to fourfold will be realized by 2040/2041 at the latest
by 2030/2031 (UMIC level), eightfold by 2035/2036 (HIC
level), and, in a pessimistic scenario, twelvefold (self- 4. Discussion
reliance level) by 2040/2041, at the latest. The accumulated The discussion will focus on: (i) CBHI’s persistent financial
reserve is projected to reach RWF 6,985.66 billion, to be deficit during the assessed period, (ii) the simulated
efficiently allocated to CBHI, modernization of the P/A financial sustainability of CBHI from 2021/2022 to
health-care delivery system, and other unmet social-health 2040/2041, (iii) key factors contributing to Rwanda’s UHC
programs and services (Figure 5).
success, (iv) experiences from Ghana (low-middle-income
3.5.3. Contribution to national priorities country), Indonesia (formerly middle-income country,
now UMIC), and Thailand (UMIC), which implemented
This study aligns with the priorities of the national health bundled payment methods as cost-containment measures
sector, including the completed National Strategy for in their UHC systems, and (v) the rationale for abolishing
Transformation 1 (NST1, 2017 – 2024), particularly Pillar the 10% co-payment.
18 in the Social Transformation section, and its successor,
NST2 (2025 – 2029). 4.1. Financial viability of the CBHI system during the
Although it does not directly address poverty (national assessed longitudinal period and prospective period
priority no.1), malnutrition (national priority no.2), or health This section outlines the CBHI’s financial viability during
sector priority no.1, this study aims to assist all Rwandans to the assessed period.
withstand financial hardship due to illness, support vulnerable
groups in coping with health-related shocks, and contribute 4.1.1. Financial viability of the CBHI system during the
to poverty reduction through socioeconomic empowerment assessed longitudinal period
and targeted support for combating malnutrition among Financial deficits persist in the CBHI scheme despite
elderly vulnerable sub-groups. regular financial interventions from the GOR to settle debts
This study indirectly supports the three key cross- owed to public and faith-based health facilities. The latest
cutting areas of the NST1 – capacity development, HIV/ top-up of RWF 22.63 billion, disbursed through the prime
AIDS and non-communicable diseases, and disability and minister’s order in FY 2020/2021, aimed to address CBHI’s
social inclusion – by allocating a portion of the accumulated financial gaps and prevent system collapse. However, the
reserve (RWF 6,985.66 billion) to these programs. It deficit increased from RWF 19.21 billion in 2019/2020 to
also reinforces the 9 Resolution of the 16 National RWF 19.67 billion in 2020/2021. This worsening deficit
th
th
Leadership Retreat (March 2019), which emphasized the occurred despite no significant changes in CBHI, health-
financial sustainability of CBHI. Furthermore, it addresses care utilization, or national and global health trends before
the concerns raised in the HSSP IV midterm review the COVID-19 pandemic. The ongoing financial distress
(2020/2021) regarding insufficient financing for the second highlights the need for coordinated national action and
term (2021 – 2024), which could impede the success of cost-control measures, including introducing a cost-
HSSP V. In addition, the study indirectly contributes to control culture in CBHI’s financial management.
the development, outputs, outcomes, and impact of the This research emphasizes the importance of strategic
4×4 Health Reform while also supporting health sector purchasing and the PPM as cost-control tools. These
priorities, such as SDG Target 3.8 (UHC Index). mechanisms can prevent overbilling, support CBHI’s

Volume 3 Issue 3 (2025) 265 https://doi.org/10.36922/ghes.5842