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174:oral Paving the road for the institutionalization of a national priority setting mechanism to advance UHC
  1. Kahsu Bekuretsion1,
  2. Parfait Uwaliraye2,
  3. Angeline Mumararungu3,
  4. Alexis Rulisa4,
  5. Siyabonga Ndwandwe5,
  6. Regis Hitimana6
  1. 1Senior Country Health System Technical Advisor, Ministry of Health, Rwanda
  2. 2Head of Planning, MandE and Health Financing Department, Ministry of Health, Rwanda
  3. 3Director of Planning and Health Financing, Ministry of Health, Rwanda
  4. 4Health Community Based Health Insurance, Rwanda Social Security Board (RSSB)
  5. 5Senior Associate – Sustainable Health Financing, Clinton Health Access Initiative, Inc
  6. 6Deputy Director-General in charge of benefits, Rwanda Social Security Board (RSSB)


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.

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: .

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