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Abstract
Introduction Rwanda, an East African country with a 12.9 million population, is committed to sustaining significant health gains of the MDG era while tackling the emerging challenges including the COVID-19 pandemic. The past achievements were thanks to Rwanda’s universal health coverage (UHC) model, characterized by expansion of health service delivery at all levels, with emphasis on primary health care, f; and more than 85% health insurance coverage through the Community Based Health Insurance (CBHI). The challenge now for Rwanda is to ensure CBHI sustainability and coverage of more services, which requires both more resources mobilization and priority setting systems that maximize health outcomes within available resources. This paper was prepared to document and share the Rwandan experience of priority setting reforms for UHC.
Methods This is a policy analysis case study, describing the context, process, and key actors in the priority setting reforms for CBHI in Rwanda, using a policy analysis triangle by Walt and Gilson. Information was collected through observation and desk review.
Results The priority-setting reforms for UHC were dictated by the increasing pressure on the resource-constrained CBHI to cover more tertiary-level services. In 2019 stakeholders led by the Rwanda’s Ministry of Health and Rwanda Social Security Board (managing the CBHI scheme) started discussing how health-economic evidence can contribute to priority setting decisions for CBHI. After several meetings and workshops, the Government decided, through a ministerial instruction published in August 2021, to change the process of defining CBHI benefits packages, and established new criteria and an appraisal committee. In November 2021 a 3-days workshop was organized to develop 1-year implementation roadmap, after learning from other country’s experiences.
Discussion The initiation of Rwanda’s priority-setting reforms was characterized by Government ownership and stakeholder engagement. The next steps will require strong coordination, and long-term capacity building through learning by doing.
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