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Commonwealth Health Partnerships 2015

C ommo nwe a l t h memb e r c o u n t r i e s Health MDGs: The Millennium Development Goals (MDGs) mature in 2015, but monitoring of progress is ongoing due to the time it takes to collect and analyse data from each country. For Rwanda to achieve its targets for the reduction of child mortality, which form MDG 4, it should have reduced under-five deaths per 1,000 live births to 51 and increased measles immunisation to 100 per cent when the 2015 data is analysed. In 2013 under-five mortality stood at 52 deaths per 1,000 live births and measles immunisation at 97 per cent, so both parts of this target are close to being met. The global MDG 5 target for maternal health is to reduce the number of women who die in pregnancy and childbirth by threequarters between 1990 and 2015. For Rwanda, the maternal mortality rate should fall to 228 cases per 100,000 live births. In 2013 Rwanda had an adjusted maternal mortality ratio of 320 deaths per 100,000 live births (this figure was estimated at 340 deaths per 100,000 by UN agencies/World Bank in 2010), so Rwanda is unlikely to meet this target. Part of the goal also stipulates that 100 per cent of births must be attended by a skilled health professional. In 2010 this figure stood at 69 per cent, making it unlikely that this target will be met. MDG 6 aims for a reduction in the prevalence of HIV, malaria and other diseases. Since 1990, prevalence of HIV has shown a continuous decline and by 2011 the figure had halved. In 2013 the percentage of the population affected by HIV was 2.9 per cent. There was a significant overall reduction in the estimated incidence of TB between 1996 and 2012. The number of deaths from malaria in the country has also shown a significant overall decrease in the period 2001–11. Consequently, Rwanda may achieve MDG 6. For definitions, sources and explanations on the Millennium Development Goals see page 314. Universal health coverage More than two-fifths of health care in Rwanda (43 per cent) 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 per cent of GDP in 2012, of which 57 per cent (US$38 per capita) was covered by the government. 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. 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 per cent 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) identifies 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. 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. Care of the elderly: Around 380,000 people in Rwanda are over the age of 65 – two per cent of the total population (2013). At the age of 60 a person living in Rwanda can be expected to live for an additional 18 years, on average (2013). Overall, public pension spending is equivalent to 0.7 per cent of the country’s total economic output (2005). Traditionally, elderly people were cared for by extended family members, but the genocide has left some older people without families. The Christian not-for-profit organisation Bird of Paradise Ministries Rwanda runs a care home for the elderly in Kigali. Charitable organisations like the Duhozanye also provide support to vulnerable widows. Further information Ministry of Health: www.moh.gov.rw Commonwealth Health Online: www.commonwealthhealth.org/health/africa/rwanda 242 Commonwealth Health Partnerships 2015 Population over 65 2%


Commonwealth Health Partnerships 2015
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