Can innovative health financing policies increase access to MDG-related services?: evidence from Rwanda

Can innovative health financing policies increase access to MDG-related services?: evidence from Rwanda

Innovative health care financing policies in Rwanda

Ensuring financial access to health services is a critical challenge for poor countries if they are to reach the health Millennium Development Goals (MDGs). This article examines the case of Rwanda, a country which has championed innovative health care financing policies.

The paper argues that the Rwanda experience provides a useful example of effective implementation of policies that reduce the financial barrier to health services, hereby contributing to the health MDGs. The document provides the following findings:

  • between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilisation of health services and reduced out-of-pocket payments for health care.
  • part of this achievement is likely linked to innovative health financing policies, particularly the expansion of micro-insurance and performance-based financing.
  • in this sense, Rwanda has combined decentralisation and performance-based financing with a strategy to pool private spending.

The authors underscore the integration of strong mechanisms to evaluate the impact of its policies as an important lesson learned from the Rwanda experience. Additional conclusions are as follows:

  • the unusual route chosen by Rwanda yields promising results could be emulated by other low-income countries in search of models to reduce financial barriers to health care.
  • however, a key issue for the future is sustainability and the necessary evolution of the institutional support for the health financing approach of Rwanda.
  • this calls for sustained efforts from the donor community to the health system strengthening agenda.
  • there is a need for the government and donors to subsidise the enrolment of the poorest and to ensure equitable access to quality services.
  • nevertheless, ensuring the equitable access implies ensuring the regulation of the package benefits and the provider payments mechanisms.
  • introducing pro-poor financing policies needs to be systematically evaluated using rigorous metrics and standardised benchmarks.

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