Healthcare in Rwanda was historically of poor quality, but in recent decades has seen great improvement. Rwanda operates a universal health care system, and is considered to have one of the highest-quality health systems in Africa. [1]
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Healthcare in Rwanda was historically of poor quality, but in recent decades has seen great improvement. Rwanda operates a universal health care system, and is considered to have one of the highest-quality health systems in Africa. [1]
In the pre-genocide era before 1994, Rwanda's healthcare was supported by the Bamako Initiative which was sponsored by UNICEF and WHO and adopted by African ministers of health in 1987. [2] [3] Progress was started towards decentralising the health management system, first to the Province level and then to the district level. Unfortunately this was disrupted by the 1994 genocide, which crippled the healthcare system alongside the economy. In the post genocide period, Rwanda has had an uphill climb in the recovery of its health system as well as its economy. It has since built one of the best healthcare systems in the region. In 2008, the government spent 9.7% of national expenditure on healthcare, compared with 3.2% in 1996. [4]
Health insurance became mandatory for all individuals in 2008; [5] in 2010 over 90% of the population was covered. [6] In 2012, only about 4% were uninsured. [1]
President Kagame made healthcare one of the priorities for the Vision 2020 development programme, [7] boosting spending on health care to 6.5% of the country's gross domestic product in 2013, [8] compared with 1.9% in 1996. [9] The government has devolved the financing and management of healthcare to local communities, through a system of health insurance providers called mutuelles de santé. [5] The mutuelles were piloted in 1999, and were made available nationwide by the mid-2000s, with the assistance of international development partners. [5] The mutuelles are owned and managed at the level of Rwanda's thirty districts. There are separate national health insurance schemes for public servants and soldiers. [10]
Premiums under the scheme were initially US$2 per annum; since 2011 the rate has varied on a sliding scale according to wealth, with the poorest citizens entitled to free health insurance and wealthiest paying premiums of US$8 per adult. [11] As of 2014 [update] , more than 90% of the population was covered by the scheme. [12] The government has also set up training institutes including the Kigali Health Institute (KHI), which was established in 1997 [13] and is now part of the University of Rwanda. In 2005, President Kagame also launched a program known as The Presidents' Malaria Initiative. [14] This initiative aimed to help get the most necessary materials for prevention of malaria to the most rural areas of Rwanda, such as mosquito nets and medication. Rwanda follows a universal health care model, which provides health insurance through the mutuelles de santé. [15] The system is a community-based health insurance scheme, in which residents of a particular area pay premiums into a local health fund, and can draw from it when in need of medical care. Premiums are paid according to a sliding scale, with the poorest members of society entitled to use the service for free, while the wealthiest pay the highest premiums and are charged copays for treatment. [1]
In 2012, about 45% of the system was funded by premium payments, with the rest coming from government funding and international donors. [1]
Rwanda's healthcare system operates 499 health centers, 680 health posts which are mainly involved with the outpatient programmes such as immunizations and family planning services, a number of dispensaries, and 42 district hospitals. [15] The country's villages are served by a network of thousands of community health workers. There are four national referral hospitals, [16] which are Kigali University Teaching Hospital, Butare University Teaching Hospital, King Faisal Hospital Kigali and the Rwanda Military Hospital. The most advanced of them is King Faisal Hospital, which is operated on a for-profit model by the government but participates in the national health insurance system, and therefore accepts patients referred to it by other hospitals and clinics. It is the most advanced hospital in Rwanda, equipped with a CT and MRI machine, two dialysis machines, and a wide range of surgical capabilities.
Rwanda's clinics are equipped with basic medical equipment and a cupboard of essential medications. The district hospitals offer basic surgical services, and all have a minimum of 15 doctors. Those in need of more advanced and specialized care are referred to one of the four national referral hospitals. There are five cancer treatment centers in the country, the Rwanda Cancer Centre at Butaro Hospital and facilities at the four national referral hospitals. [1] [17]
There is a network of 58,286 Community Health Workers who provide primary care in the 14,837 villages and make referrals.
Rwanda has a shortage of medical professionals, with only 0.84 physicians, nurses, and midwives per 1,000 residents in 2013. [18] The United Nations Development Programme (UNDP) is monitoring the country's health progress towards Millennium Development Goals 4–6, which relate to healthcare. A mid-2015 UNDP report noted that the country was not on target to meet goal 4 on infant mortality, despite it having "fallen dramatically"; [19] the country is "making good progress" towards goal 5, which is to reduce by three quarters the maternal mortality ratio, [20] while goal 6 is not yet met as HIV prevalence has not started falling. [21]
Rwanda is participating in a seven-year program begun in 2013 that sees hundreds of medical educators and clinicians from 25 American medical institutions, including Harvard Medical School, Yale Medical School, and Duke Medical School, training Rwandan medical personnel and establish training and residency programs, which, after seven years, will be run by the Rwandan government with its own budget, teachers, and clinicians. [22]
Health care reform is for the most part governmental policy that affects health care delivery in a given place. Health care reform typically attempts to:
Rwanda, officially the Republic of Rwanda, is a landlocked country in the Great Rift Valley of Central Africa, where the African Great Lakes region and Southeast Africa converge. Located a few degrees south of the Equator, Rwanda is bordered by Uganda, Tanzania, Burundi, and the Democratic Republic of the Congo. It is highly elevated, giving it the soubriquet "land of a thousand hills", with its geography dominated by mountains in the west and savanna to the southeast, with numerous lakes throughout the country. The climate is temperate to subtropical, with two rainy seasons and two dry seasons each year. It is the most densely populated mainland African country; among countries larger than 10,000 km2, it is the fifth most densely populated country in the world. Its capital and largest city is Kigali.
A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.
Health insurance or medical insurance is a type of insurance that covers the whole or a part of the risk of a person incurring medical expenses. As with other types of insurance, risk is shared among many individuals. By estimating the overall risk of health risk and health system expenses over the risk pool, an insurer can develop a routine finance structure, such as a monthly premium or payroll tax, to provide the money to pay for the health care benefits specified in the insurance agreement. The benefit is administered by a central organization, such as a government agency, private business, or not-for-profit entity.
The Millennium Development Goals (MDGs) were eight international development goals for the year 2015 that had been established following the Millennium Summit of the United Nations in 2000, following the adoption of the United Nations Millennium Declaration. These were based on the OECD DAC International Development Goals agreed by Development Ministers in the "Shaping the 21st Century Strategy". The Sustainable Development Goals (SDGs) succeeded the MDGs in 2016.
Healthcare in Singapore is under the purview of the Ministry of Health of the Government of Singapore. It mainly consists of a government-run publicly funded universal healthcare system as well as a significant private healthcare sector. Financing of healthcare costs is done through a mixture of direct government subsidies, compulsory comprehensive savings, national healthcare insurance, and cost-sharing.
Tropical diseases, especially malaria and tuberculosis, have long been a public health problem in Kenya. In recent years, infection with the human immunodeficiency virus (HIV), which causes acquired immune deficiency syndrome (AIDS), also has become a severe problem. Estimates of the incidence of infection differ widely.
As literacy and socioeconomic status improves in Ethiopia, the demand for quality service is also increasing. Besides, changes in the demographic trends, epidemiology and mushrooming urbanization require more comprehensive services covering a wide range and quality of curative, promotive and preventive services.
Kenya's health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units.
Rwanda faces a generalized epidemic, with an HIV prevalence rate of 3.1 percent among adults ages 15 to 49. The prevalence rate has remained relatively stable, with an overall decline since the late 1990s, partly due to improved HIV surveillance methodology. In general, HIV prevalence is higher in urban areas than in rural areas, and women are at higher risk of HIV infection than men. Young women ages 15 to 24 are twice as likely to be infected with HIV as young men in the same age group. Populations at higher risk of HIV infection include people in prostitution and men attending clinics for sexually transmitted infections.
Niger is a landlocked country located in West Africa and has Libya, Chad, Nigeria, Benin, Mali, Burkina Faso, and Algeria as its neighboring countries. Niger was French territory that got its independence in 1960 and its official language is French. Niger has an area of 1.267 million square kilometres, nevertheless, 80% of its land area spreads through the Sahara Desert.
Tanzania has a hierarchical health system which is in tandem with the political-administrative hierarchy. At the bottom, there are the dispensaries found in every village where the village leaders have a direct influence on its running. The health centers are found at ward level and the health center in charge is answerable to the ward leaders. At the district, there is a district hospital and at the regional level a regional referral hospital. The tertiary level is usually the zone hospitals and at a national level, there is the national hospital. There are also some specialized hospitals that do not fit directly into this hierarchy and therefore are directly linked to the ministry of health.
A landlocked sub-Saharan country, Burkina Faso is among the poorest countries in the world—44 percent of its population lives below the international poverty line of US$1.90 per day —and it ranks 185th out of 188 countries on UNDP's 2016 Human Development Index .Rapid population growth, gender inequality, and low levels of educational attainment contribute to food insecurity and poverty in Burkina Faso. The total population is just over 20 million with the estimated population growth rate is 3.1 percent per year and seven out of 10 Burkinabe are younger than 30. Total health care expenditures were an estimated 5% of GDP. Total expenditure on health per capita is 82 in 2014.
Examples of health care systems of the world, sorted by continent, are as follows.
The quality of health in Rwanda has historically been very low, both before and immediately after the 1994 genocide. In 1998, more than one in five children died before their fifth birthday, often from malaria. But in recent years Rwanda has seen improvement on a number of key health indicators. Between 2005 and 2013, life expectancy increased from 55.2 to 64.0, under-5 mortality decreased from 106.4 to 52.0 per 1,000 live births, and incidence of tuberculosis has dropped from 101 to 69 per 100,000 people. The country's progress in healthcare has been cited by the international media and charities. The Atlantic devoted an article to "Rwanda's Historic Health Recovery". Partners In Health described the health gains "among the most dramatic the world has seen in the last 50 years".
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