Utilization, Cost, and Financing of District Health Services in Rwanda. Technical Report No. 61

摘要

Growing concerns over rising poverty and the sharp drop in demand for health services during the post-genocide period motivated the Rwandan government to seek innovative ways to assure access to quality health care. The Ministry of Health (MOH) decided to look for local, alternative methods of financing health care by pilot testing prepayment schemes in three of the country's 40 health districts. The MOH spearheaded the design of the scheme and encouraged a highly participatory process. A steering committee, headed by the Director of Health Care and including government and civil society representatives from the central and regional levels, was established to coordinate the activities. The 54 prepayment schemes, each affiliated to a health center and managed by the scheme members, enrolled more than 88,000 members during their first year, and continue to do so. A quasi-experimental design was used to evaluate the schemes' impact on the MOH objectives to improve quality of care, strengthen community participation, improve health facilities' financial sustainability, and at the same time improve the population's financial accessibility to care.