"Go to the People"

Building Health Systems for Better Health in Rwanda

To improve the health of its population, the Rwandan government places a strong emphasis on building the information, human resources, quality improvement, and financial systems necessary to support a well-functioning health system. MSH has supported these efforts by leading several USAID-funded projects: the HIV Performance-Based Financing Project (2004–2009), the Integrated Health Systems Strengthening Project (IHSSP, 2009­–2014), and now the Rwanda Health Systems Strengthening (RHSS, 2014–2019) Project. RHSS works, as did IHSSP, at all levels of the health system, from the community through the national Ministry of Health, to ensure all residents’ access to high quality services. 

Since 2005, Rwanda’s 45,000 community-based health workers have provided preventive and curative care. In 2010, IHSSP worked with the Rwandan government to provide performance-based financial incentives (payments based on results) to the country’s 45,000 community health workers and helped them form cooperatives that invest their income in local businesses, creating a stable income stream for each member. 


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To ensure access to facility-based care, in 2004 Rwanda launched one of the first national community-based health insurance programs in the region covering the majority of its population. The program increased use of services, but was financially unstable and the payment scheme was inequitable. 

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In 2009, IHSSP worked side-by-side with the Rwandan Ministry of Health to revise the system’s structure, creating a sliding-scale for premiums. The project also helped build a database that allows the government to assign each Rwandan household to one of three economic groups. Those in the poorest group, about 25 percent of the population, do not pay an insurance premium or service fees at any public facility. The new system was rolled out nationwide in 2011. Since then, the number of outpatient consultations at all Rwandan facilities has increased by nearly 25 percent. The revised system helped more than triple the total amount of contributions from health insurance members, strengthening the system’s financial standing.

With IHSSP support, Rwanda developed a computerized system to gather, store, and analyze health information. IHSSP trained health workers at all levels—from rural health centers through the National Ministry of Health—to use data to help better understand the health of the population and design interventions to address local health needs.

Above photo: Todd Shapera