Find Health and Medical expertise in Rwanda

Rwanda’s health and medical sector is well resourced, with health centres, clinics and dispensaries, as well as government-owned and private hospitals. The health system consists of three levels of service provision – central, intermediary and peripheral. The central level includes the central directorates and programmes of the Ministry of Health and the national referral hospitals. The main hospitals include the University Central Hospital and King Faisal Hospital, both located in Kigali, and the University Central Hospital of Butare, in Rwanda’s second city. There are 43 district hospitals. The Ministry of Health maintains a registry of all Rwandan health facilities.

Rwanda relies entirely on imports to meet its pharmaceutical requirements. The Pharmacy Task Force of the Ministry of Health is responsible for the protection of the population by supervising the availability, effectiveness and quality of pharmaceutical products.

The Rwandan Constitution states that all citizens have rights in relation to health. The overall objective of the current National Health Policy is to strengthen policies, resources and management mechanisms of health support systems to ensure the optimal performance of the health programmes.

Health insurance

Rwanda’s health system is paid for by state funds and individuals’ contributions through health insurance and direct fees for services. The biggest health insurance scheme is the Community-Based Health Insurance Scheme (Mutuelles de Sante), estimated to cover 91% of the population. The very poorest, however, struggle to pay even the modest fee (US$2 a year) required to join the scheme. Rwanda also suffers from a shortage of doctors and other health professionals, mainly stemming from the genocide, during which white-collar workers were targeted.

The WHO Country Co-operation Strategic Agenda (2009–13) identified the need to put in place a responsive, client-centred, technologically driven and sustainable health system to allow Rwanda to move towards universal access to demand-driven, quality health services, with protection from catastrophic health expenditure. Other priorities are to improve maternal and child health, as well as reducing the burden of communicable diseases.

Communicable diseases along with maternal, perinatal and nutritional conditions in Rwanda accounted for an estimated 63% of all mortality in 2012. The prevalence of HIV in Rwanda, as a percentage of people aged 15–49 years, stood at 2.9% in 2013. Although still at general epidemic levels, HIV prevalence has halved from 5.9% to 2.9% in the period 1990–2013. In 2012 there were 483,470 cases of malaria in the country; rates have remained largely the same in the period 2006–12, although there has been considerable fluctuation. The number of deaths from malaria has shown a significant overall decline in 2006–12. The estimated incidence of and estimated mortality (when mortality data excludes cases comorbid with HIV) from tuberculosis (TB) has seen a significant decrease in the period 1996–2013, and an overall decrease since 1990. Non-communicable diseases (NCDs) in Rwanda accounted for an estimated 29% of all mortality in 2008. The most prevalent NCDs in Rwanda are cardiovascular diseases, which accounted for 12% of total deaths across all age groups in 2008. Cancer, non-communicable variants of respiratory diseases and diabetes contributed 5%, 3% and 2% to total mortality, respectively (2008).

Infant mortality in Rwanda was 33 deaths per 1,000 live births in 2014, with an under-five mortality rate of 52 deaths per 1,000 live births in 2012. There has been an overall decline in the under-five mortality rate since 1994, with consistent reduction seen from 1998. Prior to this date there was an increase in under-five mortality from 152 deaths per 1,000 live births in 1990 to 288 deaths per 1,000 live births in 1994, coincident with the Rwandan genocide. The recent decline is encouraging, with the under-five mortality rate approaching the country’s target of 51 deaths per 1,000 live births as defined by Millennium Development Goal 4 (MDG 4).

Government expenditure

In 2013 government expenditure on health was 6.5% of GDP. In the most recent survey, conducted between 1997 and 2010, there were six doctors, and 69 nurses and midwives per 100,000 people. Additionally, in 2010, 69% of births were attended by qualified health staff and in 2013, 97% of one-year-olds were immunised with one dose of measles. In 2014, 76% of people were using an improved drinking water source and 61% had access to adequate sanitation facilities. The most recent survey, conducted in the period 2000–11, reports that Rwanda has fewer than 0.5 pharmaceutical personnel per 100,000 people.

More than two-fifths of health care in Rwanda (43%) was paid for by patients or funded by other non-governmental entities – such as private insurers, charities or employers – in 2012. Total health expenditure constituted 10.7% of GDP in 2012, of which 57% (US$38 per capita) was covered by the government.

Rwanda was not an original signatory to the International Covenant on Economic, Social and Cultural Rights, but acceded to it in 1975 and has written the covenant into law. It includes ‘the right of everyone to the enjoyment of the highest attainable standard of physical and mental health’. The covenant commits signees to providing healthy and hygienic environmental conditions, controlling epidemic diseases, improving child health and facilitating access to health services without discrimination.