Impact of Prepayment Pilot on Health Care Utilization and Financing in Rwanda: Findings from Final Household Survey

摘要

This household survey conducted by Partnerships for Health Reform (PHR) and the Rwandan Ministry of Health evaluates the impact of prepayment schemes on access to health care for poor households. Rwanda is one of the poorest countries in the world: approximately 70 percent of the population of 8 million lives below the poverty line. During the humanitarian assistance period that followed the genocide in 1994, public health care services were financed by donors and the government and provided free to patients. In 1996, the Ministry of Health reintroduced pre-war level user fees in health facilities. Following this, utilization of primary health care services dropped from a national average of 0.3 annual consultations per capita in 1997 to 0.25 in 1999. This sharp drop in demand for health services, combined with growing concerns about rising poverty and poor health outcome indicators, motivated the Rwandan government to develop prepayment schemes to assure access to the modern health system for the poor. In early 1999, the Ministry of Health in collaboration with the local communities and the technical support of PHR started the process to pilot test prepayment schemes in three health districts.