Rwanda’s health system has witnessed a number of transformations that have translated into significant improvement in geographical and financial access to medical services in the country.
Of the countless achievements; today, Rwanda stands as the number one country on the continent as far as health insurance coverage is concerned - 90 percent of all Rwandans are currently insured while life expectancy has increased from 49 years in 2000 to 66.7 years in 2017. Maternal Mortality Ratio dropped steadily from 476 per 100,000 live births in 2010 to 210 per 100,000 live births in 2015; infant Mortality Rate also dropped from 50 to 32 per 1,000 live births in 2015; and over 90% of children are immunized in Rwanda.
These and more achievements hinge on efficient health service delivery.
The government has made it a top priority to reach out to the citizens with good, effective health services when needed. This has been done through establishment of structures and systems that facilitate easy accessibility and affordability and effectiveness of health services in the country.
Infrastructures and facilities
Currently, Rwanda has 406 health posts, 499 health centers, 44 district hospitals, and 4 referral hospitals countrywide.
Covering an average catchment area population of 255,000, each district hospital provides government defined “Complementary package of activities” (CPA) which include C-section, and treatment of complicated cases, among others. They also provide care to patients referred by the primary health centers as well as carrying out planning activities for the district health and supervise district health personnel.
At the sector level, Health centres provide government defined “minimum package of activities at the peripheral level (MPA). This includes complete and integrated services such as curative, preventive, promotional, and rehabilitation services. H.Cs also supervise health posts and community health workers (CHWs) operating in their catchment area. In the 416 sectors in the country, there are 499 health centres, each covering a target catchment area population of 23,000 people.
The cell level is also well covered with 406 health posts for the 2,148 cells in the country, established in areas which are far from health enabling people in these areas easy access to the health centres. Services provided here are similar, albeit reduced from those by Health Centers. They include curative out-patient care, certain diagnostic tests, child immunization, growth monitoring for children under five years, antenatal consultation, family planning, and health education.
Community health workers at the village level
Rwanda has 45,516 Community health workers (CHWs) providing health services at the village level. Each village has three CHWs. Serving an average target catchment area of 250 people, the CHWs carry out community-based prevention, screening and treatment of malnutrition;Integrated Management of Child Illness (CB-IMCI); Provision of family planning; Maternal Newborn Health (C-MNH), DOT HIV, TB and other chronic illnesses, as well as sensitization for behavior change.
Rwanda has 216 ambulances distributed in all districts of the country and 4 marine ambulances.
Interventions Administrative and financial decentralization
Administrative and financial decentralization has been established in districts with procurement autonomy for health facilities, managing funds, hiring and retiring personnel.
Innovations in financial accessibility:
By innovation, more health insurance schemes (RAMA, MMI, CBHI and others) are in place, a factor that has seen the adherence to Community-Based health insurance increase from 7% in 2003 to 91% in 2010, and after the revision of the policy in 2011, the adherence is currently around 90%.
Public budget allocation to Health:
Currently, the public budget allocation for health is at 16.05%, meeting the Abuja Declaration.
No mobile phones at work:
In regard to its commitment towards good health service delivery, the ministry of health has banned medics from using mobile phones at work so that they concentrate on the services they provide to the patients.
The number of hospitals increased from 34 in 1994, to 46, including 4 national referral hospitals (CHUs, RMC and KFH) and 42 district hospitals.
The number of Human Resources for Health (HRH) has dramatically increased during the last 7 years. The number of doctors deployed in the public health sector grew from 112 in 1996 to 709 by May 2015, including 174 medical specialists.
A total of 8933 Nurses are working in the public sector, up from 949 in 1990 and 742 in 1996. Also, 692 Midwives are deployed in public health facilities, and this category of staff did not exist before 1994 Genocide against the Tutsi. Under the current programs for the development of Human resources for health priority is given to training specialized doctors and upgrading A2 nurses to A1 level.
For Specialized Doctors, most of them are trained in Rwanda through an MoU signed with American Universities, and others are sent outside. Currently, over 250 doctors are being trained on clinical specialties (59 abroad, 191 in country).
Specialties offered in Rwanda
Cancer services are offered in Rwanda Military and Butaro Hospital.
Dialysis services are offered in CHUK, CHUB, Gihundwe Hospital and Gisenyi District Hospital.
Muhima Centre of Excellence in maternal health and child health care.
Ophthalmology Kabgayi District hospitals
Rwanda achieved MDG 4 and 5 related to reducing child mortality and improving maternal health.
Rwanda was the first country in Africa to introduce the HPV vaccine and the coverage is over 97% ;
To address Health inequalities, Rwanda created an extended community based insurance of which the coverage have already reached 84%;
Rwanda is the 2nd Country to achieve Step 3 accreditation, the top most level by the Africa Society for Blood Transfusion (AfSBT);
Rwanda was the 1st Country in the world to use drone for medical delivery services.
HIV prevalence among adult population (15-49 yrs.) has remained stable at 3% for the last seven years; • Males circumcision have increased from 13% to 30% from 2010 to 2015. • 96% of all Health Facilities Countrywide of Antiretroviral Viral Therapy countrywide • Mobile Condom kiosks were dispatched in high risk areas to prevent HIV spread. • Currently, a total of 510 public health facilities offer HIV counselling and testing services;
TB Tuberculosis diagnostic and treatment is free of charge in Rwanda; prevalence in general population was 91/100,000 population lower than what WHO estimated in 2014 (114/100,000) based on the result of National TB prevalence survey; According to Drug Resistant survey (DRS) conducted in 2005, 3.9% new TB cases and 9.6% of previously TB cases have been developed TB MDR while the recent result DRS conducted in 2015 revealed that 1.4% of new case and 10.7% for previously TB treated which is significant decrease among the new TB cases. The combined TB MDR prevalence decrease from 4.6% to 2.1%. • The Treatment success rate for bacteriologically confirmed new and relapse and MDR TB cases are at 90% and 85% respectively. This good result decrease transmissions of TB to healthy people.
Malaria: Severe Malaria cases declined by 50% between November 2016-March 2017. More than 4 million Long Lasting Insecticide Nets (LLINs) were distributed between November 2016-March 2017 countrywide. The community-based management of Malaria is rolled out in October 2016 in all 30 districts of Rwanda to provide early diagnosis and treatment for malaria. Routine Indoor Residual Spraying is done in 5 districts with a high malaria burden. From November 2016, people under the household social economic categories Ubudehe category 1 and 2 social cluster access free Malaria treatment.