Republic of Rwanda Kivu 2010 Leadership Retreat Reporting on progress since the Leadership Retreat, and looking ahead to the next quarter Domestic Funding; Saving lives Rwanda Health sector achievements (case scenario)

Building a Health System 2 Referral Hospital (5) District Hospital (34 to 42) Health Center (234 to 469) Community Level (0 to 14,837) ~80% of burden of disease addressed here Physician Specialist (150) Physician Generalist (475) Nurse Generalist (8,273) Community Health Workers (45,011) Complexity of care WHO-recommended health worker density: 2.3 per 1,000 pop. Rwanda’s health worker density: 0.84 per 1,000 pop. New : 3 Referral 4 Provincial Health post

Health Financing system Rwanda put together all collective effort aiming at increasing innovative domestic resource to finance in the health sector In order to ensure long term sustainability of interventions, Rwanda has been ensuring increase in budgeting every year: e.g :16.05%, : 17.36% This is above the 2002 Abuja declaration set target of proportion of national budget used for Health.

Why efficient management of funds Comply with GOR Aid policy : Accountability for all Ensure efficient use of GOR & Partners funds Proceed with sub sector comprehensive planning process linked to the Sector Strategic Plan & Funds mobilisation : Synchronisation, synergy & sustainability Set up an Implementation framework of health Subsector strategic plans : Define who is doing what ?, how?, when? With which Means/ressources ? Measurement of achievments(frequency, tools,external verification ?

5 Adapted from: World Health Organization. (2012). WHO-UNICEF vaccination coverage estimates time series for Rwanda.

Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print]. 6

7 *Only countries with populations greater than 500,000 included. Rwanda Cambodia Botswana Estonia Oman Brazil Portugal China Belarus Ireland Liberia Malawi Ethiopia MDG 4 cutoff: 4.4% Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print]. Progress Against Child Mortality and Health Expenditure Per Capita Around the World*

Annual Rates of Decline in Child Mortality by Wealth Quintile and Residence, DHS National Institute of Statistics of Rwanda, Macro International, Inc. (2012). Rwanda Demographic and Health Survey Calverton, MD: Macro International, Inc. (measures 10 years preceding survey)

9 CauseTimeframe Decline in Mortality Malaria (reported deaths)2005 – % HIV/AIDS (rate)2000 – % Tuberculosis (rate)2000 – % Child mortality (rate)2000 – % Maternal mortality (ratio)2000 – % All-cause mortality (rate)2000 – % Non Communicable diseases ???? Farmer PE, Nutt CT, Wagner CM, Sekabaraga C, Nuthulaganti T, et al. (2013). “Reduced Premature Mortality in Rwanda: Lessons from Success.” British Medical Journal 346(f65): [e-pub ahead of print]. Towards reducing premature death in Rwanda

SAMU/PHECS (Pre-Hospital Emergency Care Service) 912 – call center 223 ground ambulances nationwide 10 resuscitation ambulances in CoK 1 water ambulance in Lake Kivu.

Health Financing sustainability Community based health insurance (CBHI) – Coverage rate of 90.7% in 2011/12, 78.55% in billions contribution National budget Performance based financing (PBF) – Increased quality of care (hygiene, customer care and financial management) Innovation in financial management – Equalization fund to incentive providers to work and stay in rural areas – Professional hospital managers – Self sustained community care PPCP (Public Private Community Partnership) Health post – drugstores and paid for point of care 420 CHWs Cooperatives 70% indivisible benefices paying for care

Household and Out of Pocket Spending /10 Household expenditures as % of Total Health Expenditures 32 %26 %31 %20 %26 %15 % Household Out-of-Pocket as % of Total Health Expenditures 33 %25 % 17 %23 %11 % OOP per capita (constant 2009/10) RWF 1,994 RWF 1,371 RWF 1,436 RWF 1,664 RWF 4,510 RWF 2,378 $3.43 $2.35 $2.47 $2.86 $7.75 $4.09 Figures from the 2010 DHS and the table below show that Rwanda has made tremendous progress in reducing out-of-pocket expenditure both as a percentage of total health expenditure and in absolute terms

Under all health insurance schemes members are required to contribute to the cost of care by paying a co-payment In 2011/12 the total amount of co-payment paid by CBHI members was RWF ,30. In the same year RSSB members paid RWF ,29 in copayment

Contribution to Global Fund. As a country, we pledged and contributed to the third replenishment of the Global Fund equivalent amount of usd I thank you for your kind attention.