Improving health through inter-sectorial actions: lessons from health financing in Rwanda
Rwanda has registered significant progress in many social sectors, such as: health, poverty, combating hanger, and illiteracy, which have had direct effects on improving health ((NISR), 2011). Moll was able to attain most key health targets that were set over the last 10 years (Rwiyereka, 2013). The infant mortality ratio decreased from 86 per 1000 live births in 2004 to 50 per 1000 live births in 2010 and the under five mortality ratio declined from 152 to 76 per 1000 live births over the same period (RDHS; 2010). If the rate of this decline continues, Rwanda will most likely meet the maternal and child mortality MD6s targets by 2015.
This case study is intended to examine how intersectoral actions (ISA) have contributed in improving health insurance financing and UHP.
The case study spans from 2005 to 2012, when key health financing policy innovations were adopted and others scaled up from pilots to cover the whole country through the decentralization policy.
Purpose and Objectives: The purpose of this case study is to examine how intersection activities have improved key health targets (national and international) through implementation of innovative health financing policies.
Methodology: Document Review and Stakeholder Meeting: The documents reviewed mainly involved international and national policy, strategic plans, and peer reviewed papers as well grey literature. Individual stakeholder meetings were conducted to ascertain the views of implementers in the ISA.
Policy Processes for Intersectoral Action: The intersectoral collaboration has contributed greatly in achieving the above results. The MINECOFIN has been increasing its budget share to health over years and is still committed to increasing. The Ministry of Local Government has strengthened governance structures at all level to ensure that strong administrative structures are in place to support implementation processes for most government programs, including those of health. With structures in place, the implementation of various health innovations was possible. Due to CBHI, Community-Based interventions have improved access to health services greatly through creation more feeder road networks to reduce physical barriers and CBHI.
Under high level political leadership (presidents' office, Ministry of Local 6overnment, and Ministry of Finance and Economic Planning) and with support from development partners, the country engaged in national scale up of CBHI and by 2004, enrolment rate had reached about 85%, and by end of 2011, the enrolment rate hit record 92%. The informal sectors are all covered by formal insurances and the package is relatively good. The organizations such as the USAID provided technical support during the policy design and financially and technically supported evaluation studies to inform the policy makers. Particularly, Management Science for Health (MSH) has greatly supported and promoted CBHI from pilots to countrywide scale up.
Conclusion: Through the support of other sectors, the Moll has managed to develop innovative health financing policies and effectively implemented. The results have been applauded by the many in the international community calling for other LMIC with similar context to learn more about Rwanda in reforms. In span of 10 years, Rwanda's 92% of its 11 million population was insured and protected from catastrophic health care expenditures. The PBF payment has a bit stabilized the health workers because of PBF payment system. The health outcomes especially the priority targets have been on the steady increase, and Rwanda is on clear path to achieve the MD6 # 4.
Whereas the achievements have been outstanding, the sustainability remains a big challenge for both the government and donors.