Universal Health Coverage in Rwanda: Dream or Reality

ABSTRACT

Introduction: Universal Health Coverage (UHC) has been a global concern for a long time and even more nowadays. While a number of publications are almost unanimous that Rwanda is not far from UHC; very few have focused on its financial sustainability and on its extreme external financial dependency. The objectives of this study are (i) To assess Rwanda UHC based mainly on Community-Based Health Insurance (CBHI) from 2000 to 2012; (ii) to inform policy makers about observed gaps for a better way forward. Methods: A retrospective (2000-2012) SWOT analysis was applied to six metrics as key indicators of UHC achievement related to WHO definition; i.e. (i) health insurance and access to care; (ii) equity; (iii) package of services; (iv) rights-based approach; (v) quality of health care; (vi) financial-risk protection; and (vii) CBHI self-financing capacity (SFC) was added by the authors. Results: The first metric with 96;15 of overall health insurance coverage and 1.07 visit per capita per year versus 1 visit recommended by WHO; the second with 24;8 indigent people subsidized versus 24;1 living in extreme poverty; the third; the fourth; and the fifth metrics excellently performing; the sixth with 10.80 versus ?40 as limit acceptable of catastrophic health spending level and lastly the CBHI SFC i.e. proper cost recovery estimated at 82.55 in 2011/2012; Rwanda UHC achievements are objectively convincing. Conclusion: Rwanda UHC is not a dream but a reality if we consider all convincing results issued of the seven metrics