The 1994 genocide in Rwanda devastated much of the socio-economic fabric of country as well as its health infrastructure. The healthcare system is still suffering in its aftermath. Although the health status of the Rwandan population has improved significantly in recent years, it remains insufficient. Training health workers to advanced levels has taken time and has not been rapid enough to meet the needs of the Rwandan population.
The health system in Rwanda is a decentralized, multi-tiered system. It is composed of the following tiers and associated packages of health services:
- 18 dispensaries (primary health care, outpatient, referral),
- 16 prison dispensaries,
- 34 health posts (outreach activities – immunizations, antenatal care, family planning),
- 442+ health centers (prevention, primary health care, inpatient, maternity),
- 48 district hospitals (inpatient and outpatient) and
- 4 national referral hospitals (specialized inpatient and outpatient).
The 4 referral hospitals are: Centre Hospitalier Universitaire de Kigali (CHUK), Centre Hospitalier Universitaire de Butare (CHUB), King Faisal Hospital (KFH) and the Kanombe Military Hospital (KMH).
Rwanda’s health system is financed both by state funds and by individuals’ contributions through health insurance and direct fees for services. Health insurance is provided through a variety of programs. The largest is the Community-Based Health Insurance Scheme, which is primarily comprised of a social health insurance program called Mutuelles de Sante. Members pay annual premiums of approximately USD $6 per family member (increased in 2011 from USD $2 per person) with a 10% service fee paid for each visit to a health center or hospital. Membership is voluntary and payment of premiums is based on economic status. The program was first introduced in 2004. By 2010, 91% of the Rwanda population was insured through Mutuelles de Sante. Rwandans can access health care at all public and non-profit health centers in Rwanda, but the Mutuelles de Sante member’s package does not include coverage at private health centers.
Rwanda Health Indicators
DOCTORS PER 1000 POPULATION:
NURSES PER 1000 POPULATION:
UNDER 5 MORTALITY:
91 per 1,000 live births (SSA = 70; USA = 6.8)
540 per 100,000 live births (SSA = 640 per 100,000 live births; USA = 24 per 100,000 live births)
BIRTHS ATTENDED BY SKILLED HEALTH PROFESSIONALS:
69% (SSA = 44%). Of all assisted deliveries, 69% took place in a health facility (2010).
2.9% (urban = 7.3% vs. rural = 2.2%)
HEALTH EXPENDITURE PER CAPITA:
9% of GDP, USD $48 per capita (SSA = $76; USA = $74).
Source: CIA World Factbook (2012), WHO (2006), World Bank World Development Indicators (2011), Government of Rwanda, Ministry of Health (2011)