Page 274 - GHES-3-3

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

financial sustainability, and contribute to Rwanda’s goal quality health care and innovations. A closer look at Table
of achieving UHC in line with WHO’s SDG Target 3.8 S9 and the “subtotal income from 2 GOR top-up” in
nd
(UHC index). However, the health sector continues to Scenario III reveals that, with current funding sources, the
face challenges, including modernizing infrastructure 1% specific tax alone is projected to generate RWF 773.62
and equipment, addressing competing priorities, such as billion (Table S9) by 2040/2041 – 133% of the RWF 580.08
workforce expansion, and navigating the decline in external billion required to meet HIC’s health-care standards. These
funding. Adopting effective cost-control measures, such as additional funding sources alone could enable Rwanda to
an active PPM, is crucial in this context. achieve the HRV 2050 targets. This highlights Rwanda’s
potential to leverage its social and human capital to
4.1.2. Financial viability of the CBHI system during the overcome health-care challenges and achieve financially
prospective period sustainable development, including HRV 2050.
This section outlines the CBHI’s financial viability during d. Scenario IV: Effective implementation of the
the prospective period. “minimum 1% specific tax for UHC and HRV 2050”
a. Scenario I: Financial viability of the CBHI system The implementation of Scenario IV is expected to yield
under the continuation of the fee-for-service PPM significant economic, health, and social protection
The simulation results show a significant worsening of benefits, potentially surpassing initial expectations. With
the persistent deficits, putting the CBHI at risk of bankruptcy the implementation of the “minimum 1% specific tax for
and threatening the collapse of the public health-care system. UHC and HRV 2050”, all anticipated benefits, outcomes,
Consequently, the GOR is forced to regularly settle arrears and impacts outlined in the related sections become more
owed to health facilities since 2015. This situation disrupts feasible, as our assumptions and results do not account for:
the functioning of public health-care facilities and strains (i) This study took a cautious approach by dividing the
relationships between CBHI and contracted facilities. As a 2024/2025 mobilized amount by three and spreading
government-sponsored insurance scheme, CBHI relies on it over the next 3 financial years
the Ministry of Finance and Economic Planning to settle (ii) Additional financing sources will be introduced
arrears directly from the national general budget. beyond the initial 13 listed above
(iii) A 6 – 9% AGR for 2024/2025 to 2030/2031 and a 10%
b. Scenario II: Projected financial viability of the CBHI
system under the fully active-strategic purchasing PPM AGR for 2040/2041 were used instead of Rwanda’s
actual AGR of 9.7% and 9.8% for the first and second
Scenario II simulates the reform’s implementation, terms of 2024
demonstrating CBHI’s financial sustainability from (iv) Revenues from the Comfortable Package membership
2021/2022 to 2040/2041. The reforms and innovations were excluded. Income-generating activities related to
are projected to lead CBHI to achieve the study’s target of health services (IGA_HS) and revenues generated by
long-term financial sustainability. the medical tourism strategy were also not considered

Regarding the P/A health-care system, it is assumed that in the simulations.
timely reimbursement of claims upon invoice submission 4.2. Key factors contributing to the success of
and verification will incentivize public/agreed health-care Rwanda’s UHC
providers contracted with CBHI to gradually enhance
their self-sufficiency. In addition, the government could The key factors include:
utilize the accumulated reserves of RWF 1,429.97 billion (i) Rwanda’s HRV 2050: Achievability and potential
to improve health-care quality, invest in health sector as revealed by the current study findings and
priorities, and address unmet needs, such as covering the conclusions.
10% co-payment for P/A health-care facilities, maintaining (ii) Rwanda’s HRV 2050 is ambitious but attainable,
the average annual prepayment fee of RWF 3,000, and grounded in its demonstrated and projected
expanding universal access to specialized care nationwide. capacities.
(iii) Government-Sponsored Health Sector Performance.
c. Scenario III: Projected financial sustainability of Rwanda continues to advance its healthcare system,
the CBHI system under the fully active-strategic particularly in investment and equity, aligning with
purchasing PPM with revenues from 1% specific tax HRV 2050, despite national and global fluctuations.
The simulation excludes revenue from the 1% specific (iv) Rwanda has sustained gains in its health system,
tax and focuses on Rwanda’s financial readiness to especially in equity and public investment,
mobilize, collect, and allocate funds for HRV 2050-related consistent with HRV 2050’s strategic vision.

Volume 3 Issue 3 (2025) 266 https://doi.org/10.36922/ghes.5842