Innovations in Rwanda's health system: looking to the future.

Rwanda is making substantial progress towards improvement of health and is working towards achievement of the Millennium Development Goals, which is a challenging task because the country has had genocide in 1994, has few natural resources, is landlocked, and has high population growth. Like many impoverished sub-Saharan countries, Rwanda's health system has had an uncoordinated plethora of donors, shortage of health staff, inequity of access, and poor quality of care in health facilities. This report describes three health system developments introduced by the Rwandan government that are improving these barriers to care-ie, the coordination of donors and external aid with government policy, and monitoring the effectiveness of aid; a country-wide independent community health insurance scheme; and the introduction of a performance-based pay initiative. If these innovations are successful, they might be of interest to other sub-Saharan countries. However, Rwanda still does not have sufficient financial resources for health and will need additional external aid for some time to attain the Millennium Development Goals.

Strengthening the health claims of the poor: promoting social inclusion and redistribution in the health sector.

The problems for poor people generated by 'disorganised health care markets' in the developing world have grave consequences for their health. In many countries, processes of liberalisation and commercialisation have generated a number of dilemmas for policy-makers, non-governmental organisations and individuals seeking health care. Complex markets for health care provision and financing exist, regulation is lacking and rates of exclusion are high due to the effects of prices and a lack of concerted efforts to make health systems more accessible to the poor. Analysis of health systems and the problems they create for the poor should lead to responses that protect and enhance the rights of poor people to health.