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NEW THIS SATURDAY: CAN INNOVATIVE HEALTH FINANCING POLICIES INCREASE ACCESS TO MDG-RELATED SERVICES? EVIDENCE FROM RWANDA

Thursday, 1st of August 2013

• CAN INNOVATIVE HEALTH FINANCING POLICIES INCREASE ACCESS TO MDG-RELATED SERVICES? EVIDENCE FROM RWANDA

Health Policy Plan. (2011) 26 (suppl 2): ii52-ii62. doi: 10.1093/heapol/czr070 This article appears in:User fee removal in the health sector in low-income countries: lessons from recent national initiatives

Claude Sekabaraga1, Francois Diop2 and Agnes Soucat3,*

+ Author Affiliations

1Director of Policy and Planning, Ministry of Health, Republic of Rwanda, 2Senior Health Economist, Abt Associates, USA, 3Director, Human Development, African Development Bank

↵*Corresponding author. Director, Human Development, African Development Bank. E-mail: a.soucat@afdb.org

Accepted September 6, 2011.

Abstract below; full text is at http://heapol.oxfordjournals.org/content/26/suppl_2/ii52.full

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. Between 2000 and 2007, Rwanda has improved financial access for the poor, increased utilization of health services and reduced out-of-pocket payments for health care. Poor groups utilization has increased for all health services, sometimes dramatically. Use of assisted deliveries, for example, increased from 12.1% to 42.7% among the poorest quintile; payments at the point of delivery have also been reduced; and catastrophic expenditures have declined. Part of these achievements is likely linked to innovative health financing policies, particularly the expansion of micro-insurance (mutuelles) and performance-based financing. The paper concludes 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. Todays main challenge is to build the sustainability of this system. Finally, the paper proposes a simple set of rigorous metrics to assess the impact of health financing policies and calls for implementing rigorous impact evaluation of health care financing policies in low-income countries.