The World Health Organization (WHO-Rwanda) and the African Union (AU) have urged health partners in Rwanda to shift to new health financing strategies to curb non-communicable diseases now increasingly claiming more lives.
The call was made during a two-day National Health Financing Dialogue organized by the Rwanda NGO Forum that brought together government representatives, development partners, civil society, the private sector, and academia to discuss strategies for scaling up domestic health financing.
The dialogue was aimed at evaluating Rwanda’s progress in implementing commitments made by Heads of State through the Africa Leadership Meeting (ALM) Declaration which required increasing health financing budgets, aligning stakeholders towards achieving Universal Health Coverage (UHC), and increasing private sector investment and collaboration in health at different levels of the health systems.
Participants exchanged views on how to prioritize health financing initiatives and agreed on actions, timelines, and responsibilities in a dialogue aimed at building consensus on health financing reform priorities and actions that are technically feasible and politically achievable.
Through a series of high-level panels, the dialogue looked at expanding access to health through innovative health solutions by breaking down financial barriers; sustainably attracting and retaining health workers; improving quality of care through access to medical technology and the digitization process; encouraging private sector investment in health to promote equity and access to health; and sustainable HIV financing.
Officials commended Rwanda for implementing that ALM commitments especially in health financing with 16% of national budget allocated to health (meeting the Abuja targets), domestic resources allocation increased from 56% (in 2018) to 61% (in 2021), building a strong primary health care system by putting in place health infrastructure, Community based health financing (CHBI).
However, they raised concerns in Rwanda facing the double burden of NCDs increase even when life expectancy has increased to 70 years (as of 2022 data) and per capita increased to $58 (in 2020/21).
For instance, Ministry of Health statistics show that over the past 10 years, the NCD mortality has become prominent while infectious diseases- these accounted for 20 deaths per 1,000, while NCDs accounted for 30 deaths per 1,000 (between 2010-2020).
Globally, according to the WHO, NCDs kill 41 million people each year, equivalent to 74 percent of all deaths.
Dr. Donald Kaberuka, AU representative of financing the Union, ALM and Special envoy Covid-19 said Rwanda’s success comes with a price of increased NCDs.
“That means we have to look for resources for communicable disease but also for non- communicable disease. How do we get the balance of the two? This is so complicated; I leave it to Nsanzimana (Rwanda’s Minister of Health.” Kaberuka said.
Kaberuka said that the example of Rwanda can be used in focusing on the available resources and working models in health instead of focusing on how much to invest or generate and target per capita.
The Executive Director of the Global Fund (GF), Peter Sands said the GF is not going to be around all time and yet the gap between needs and available resources is still wide, which raises the issue of value for money investing where it is working and ensuring no single dollar is wasted.
Considering that Rwanda is one of the countries where GF has seen value for money spent on reducing the burden of infectious disease, Sands said that the fund can take that off as a big driver.
Since 2002, The Global Fund has invested over $1billion in Rwanda’s healthcare sector and systems, which have enabled the country to build a profound primary healthcare system.
However, key health financing indicators (2016-2021) show that private expenditure in health has stalled (25%), external spending dropped from 49%-39% and domestic expenditure gradually increased from 26% to 36%.
WHO Rwanda Country Representative, Dr. Brian Chirombo said that there is need, especially for donors like the GF, to have a balanced approach in health financing in a way that it caters for both communicable and non-communicable diseases as the latter is an emerging concern.
“Our big challenge at the moment is there is very little going to NCDs and determinants of health because remember there are risk factors that are causing people to get NCDs, and these have to be addressed,” Chirombo said.
Health Minister Dr. Sabin Nsanzimana said that Rwanda is investing quickly and in pressing issues
“The faster the better because it makes people healthy and productive. For us we ask the question of the money or the plan? In Rwanda we believe that once we have an ambition and a great plan then money will come,” Nsanzimana said.
He stated that the easy goals and plans don’t attract funding and the new 4by4 Rwanda plan to increase medical capacity and all dimensions that was seen ‘crazy’ at the beginning but aimed at achieving something hard funding.
Nsanzimana said that available data resources and going digital will help Rwanda to invest with impact and thus spending less. “We need to embrace these tools quickly so as to cover the gaps in the system. The tech will equalize this quickly to cover the 50 years gap.”