In modern healthcare systems worldwide, medicines are a central component of effective treatment and patient care. Although not every patient encounter results in the administration of medicines, every step of a patient’s journey — from triage and consultation to diagnostics, treatment, and follow-up — depends on having the right medicines and medical supplies available.

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Laboratories without reagents are meaningless. Imaging without contrast cannot deliver accurate diagnostics. Simply put, care cannot happen without medicines and medical supplies. Now imagine walking into a health facility only to be told that the medicine you need is not available. This undermines trust in health facilities — not because health workers lack expertise, but because financing the medicines supply system has long been a challenge. At the heart of this challenge lies the way medicines have traditionally been paid for.

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In Rwanda, medicines are supplied by Rwanda Medical Supply (RMS) to health facilities, where they are dispensed to patients. Under the old fee-for-service system, facilities would bill Rwanda Social Security Board (RSSB) for reimbursement and only settle their invoices with RMS after receiving payment. While structured, this system often resulted in delays that disrupted procurement. Prescriptions went unfilled, and patients felt the impact directly.

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It is against this backdrop that Rwanda is changing the game. Through capitation — a prepaid financing model for health facilities that covers both clinical services and medicines — the country is introducing a more predictable system. This promising reform, aimed at improving the availability and affordability of medicines, was launched on February 24 by the Minister of Health, alongside new reforms to our Community-Based Health Insurance (CBHI), popularly known as Mutuelle de Santé, as the scheme marks 25 years.

The importance of this shift becomes even clearer when viewed through Rwanda’s structural realities.

First, as a landlocked country, Rwanda depends on medicines traveling long distances, where delays are common. Upfront payments allow procurement to begin early, reducing the risk of stock-outs and ensuring medicines are on the shelves when patients arrive.

Second, Rwanda lacks domestic pharmaceutical manufacturing and relies entirely on international suppliers. Predictable health financing enables RMS to secure suppliers, negotiate better prices, and plan timely procurement orders.

Third, procurement cycles are long — often six months or more. Upfront funding allows for accurate forecasting and timely ordering, preventing supply gaps from compounding an already lengthy process. It also enables RMS to place full, strategic orders rather than rely on costly emergency purchases, helping to keep medicines affordable.

Fourth, international suppliers — like any business — value reliable buyers. Prompt payment strengthens Rwanda’s negotiating position, increases purchasing power, and lowers costs. Suppliers are more willing to offer favourable prices and terms to buyers who pay on time, ultimately benefiting the health system and patients.

Fifth, Rwanda is a small market. Demand for medicines is lower than in larger countries, meaning emergency orders or small, ad hoc shipments are disproportionately costly. Upfront financing allows facilities to place larger, well-quantified orders, avoid last-minute purchases, and benefit from economies of scale.

Finally, inflation erodes the real value of delayed payments. For example, if a health facility delays paying RMS for several months, global medicine prices or exchange rates may rise during that period. Funds that could have purchased a full stock six months earlier may now buy significantly less. This not only reduces availability but also increases unit costs, forcing RMS to scale back orders or rely on expensive emergency procurement. Ultimately, patients feel the impact first.

As a pharmacist, I see this reality every day: financing decisions directly shape what is available on the shelves and whether patients receive their medicines on time. Upfront financing addresses Rwanda’s unique challenges — its landlocked geography, reliance on international suppliers, long procurement cycles, inflation pressures, and the limitations of being a small market.

By securing funds early, health facilities can place bulk, strategic orders, negotiate better prices, and prevent stock-outs — ensuring medicines remain both available and affordable.

Amon Nsengimana is a pharmacist and public health and research enthusiast.