Page 277 - GHES-3-3

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

guide decision-making. The “minimum 1% specific tax for the achievement of this study’s objectives and have
UHC and HRV 2050” is a reform with minimal limitations; validated the initial hypotheses. They proposed strategic
however, limited information for decision-makers remains solutions to address the five key challenges from our
a challenge. previous study (Nyandekwe et al., 2020), which presented
the CBHI system and other unmet health programs and
4.8. Lessons learned services.
The lessons learned from this study include: Through innovative methods, social capital, and human
(i) A country’s health-care standard is influenced more capital, Rwanda’s HRV 2050 for health care – once considered
by the organization of its health-care system and utopian – has been realized ahead of schedule, achieving a
political will than by its GDP per capita or health modernized UHC model 10 years before the 2050 milestone,
expenditure
(ii) Rwanda’s experience serves as an inspiration for despite economic constraints. This study recommends
adopting Scenarios II and IV for long-term institutional
other low- and middle-income countries pursuing
UHC, with equity at its core and financial sustainability. Successful implementation will
(iii) While Rwanda’s homegrown strategies, especially require strong governance, political will, and a commitment
the multi-sectoral national solidarity funding to equity at the heart of UHC. Other African nations are
mechanism, were effective, they may not be easily encouraged to draw inspiration from Rwanda’s UHC model.
replicated elsewhere 5.1. Recommendations
(iv) A transitional equitable cost-recovery system is
necessary to encourage proactive prepayments to A summary of the recommendations is as follows:
mutual health organizations or CBHI a) To the GOR and the Ministry of Finance and Economic
(v) Decision-makers should be aware that the 1% Planning:
specific tax for CBHI and Ghana’s 2.5% National (i) Grant CBHI full administrative and financial
Health Insurance contribution represent symbolic autonomy
grants due to limited national resources (ii) Leverage the expertise of current CBHI staff
(vi) Abolishing co-payments and promoting proactive (iii) Advocate for the adoption of Strategy A: a cost-
visits to primary health care is a right that offers neutral, efficiency-driven reform model that
long-term financial and social benefits to CBHI remains commendable even without additional
members and their relatives. This approach relieves financial inputs (input-based).
employees from the burden of costly health care (iv) Advocate for the adoption of the 1% UHC–HRV
and co-payments, as highlighted by Nyandekwe 2050 tax as the foundation of Strategy B: A cost-
et al. (2020). conscious, target-based reform model supporting
innovation and long-term HRV 2050 objectives.
5. Conclusion
b) To the MoH:
While Rwanda faces significant challenges in achieving its (i) Implement the FASP PPM and regular tariff
HRV 2050 health-care targets, with strategic investments updates
in CBHI, utilization of internal resources, and drawing (ii) Ensure data access and transparency for CBHI
inspiration from countries such as Thailand, which offers managers and planners
near-free health-care services, it can meet or exceed UMIC (iii) Strengthen clinical capacities, especially in
and HIC standards. It is confident that the introduction of district and provincial hospitals, and improve
the “minimum 1% specific tax for UHC and HRV 2050” on-the-job training programs through proximity
and other enabling factors will allow Rwanda to leverage and outreach coaching.
these resources to achieve HRV 2050 by 2040/2041, c) To the RSSB and CBHI:
surpassing expectations and overcoming emerging UHC (i) Remove the confusing budget line of “13% MOH
challenges. budget” from the CBHI budget
The revised target for 2040/2041 aligns more realistically (ii) Implement Scenario II and adopt DRG pricing
with Rwanda’s current economic growth and health system with regular tariff updates
projections. This study’s findings, including cost-control (iii) Integrate financial innovations and optimal
strategies, provide a solid foundation for addressing health practices from Scenario III
sector priorities and global UHC challenges. Rwanda’s (iv) Monitor health posts and provincial hospitals to
model could serve as a guide for other low- and middle- ensure quality care at the provincial hospital level
income countries. In addition, the results have confirmed and reduce fraud at the health-post level.

Volume 3 Issue 3 (2025) 269 https://doi.org/10.36922/ghes.5842