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Rwanda

Last Updated: August 31, 2011

Senior Program Officer:

Hélène Mambu-ma-Disu, MD

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Program Activities:

  • June 2009: Program Director Michael McQuestion and Senior Program Officer Hélène Mambu-ma-Disu conduct introductory meetings in Kigali.
  • April 2010: Senior Program Officer Mambu-ma-Disu attends an Interagency Coordinating Committee and Ministry of Health meeting in Kigali.
  • October 2010: Mambu-Ma-Disu conferred with national EPI Manager during a GAVI Regional Conference in Kigali.
  • February 2011: Senior Program Officer Hélène Mambu-ma-Disu conferred with government counterparts in Kigali.

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    Health Sector Architecture:

    • Public health services are delivered through 360 health facilities in 30 health districts covering the country’s four provinces.
    • Rwanda is moving toward a SWAp financing arrangement. Basic health services are integrated except for EPI and a few other highly donot-dependent vertical programs.
    • Rwanda is an International Health Partnership country. It signed an IHP+ Compact in 2009. Read more here.

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      Health Financing:

      • In 2006, the government met 19 percent of total health expenditures, which averaged US$34 per capita. External partners met over half of this amount. In 2007, health represented 9.1 percent of the government’s budget. (Source: Rwanda Health Financing Policy (2010))
      • In 2007, Rwandans spent US$90 per capita on health. Health accounted for 20% of recurrent government expenditures. (Source: Countdown to 2015 Report, 2010)
      • Rwanda is a leader in budget reforms, fiscal decentralization and community-based insurance. A performance-based health budget system has been implemented nationwide. Budgets are managed down to the district and health facility levels. By 2010, 91% of Rwandans had access to the national health insurance system (mutuelles). Enrollment became compulsory in 2008.
      • Rwanda’s Health Financing Policy (2009) paper states the government will increase its health budget to achieve the Abuja Declaration target of 15% of total government spending. It also aims to apply performance-based budgeting methods to EPI and other essential reproductive and child health services.
      • In 2008, Rwanda received US$141.2m in Official Development Assistance for health, up from US$60.2m in 2007. (Source: OECD Creditor Reporting System)

      • Highly Indebted Poor Countries (HIPC) / Multilateral Debt Relief (MDR) Initiatives: Rwanda began receiving HIPC debt relief credits in December 2000. As of mid-2009, the country had received credits totaling US$529m (of a total commitment of $1.85b). As per the Poverty Reduction Strategy Paper (PRSP), the government has used these savings to invest more in poverty-reducing programs, including PHC delivery (from $90.6m in 2001 to $391.5m in 2007). (Source: IDA/IMF. HIPC and MDRI-- Status of Implementation: September 15, 2009.)

      • National Immunization Program:

      • According to the World Health Organization, the Government of Rwanda spent US$1.4m on its routine EPI program in 2000, representing 64 percent of all routine EPI expenditures. For 2001 the figure was $1.5m (58 percent). The country received its first GAVI vaccine grant in 2002. In 2006, the government spent $1.6m on its routine immunization program. The figures for 2007-2009 were, respectively, $1.6m, $2.5m and $1.6m.
      • According to its 2006-2010 cMYP, Rwanda spent US$6.6m on its routine EPI program in 2005 ($19 per infant). Adding in shared health services expenditures to support EPI increases this to $7.1m ($20 per infant). The government financed $1.0m of the specific routine EPI expenditures (29 percent), about $6 per infant.
      • Amount spent (USD) by the government of Rwanda on routine immunization per infant (2000-2010)
        Rwanda routine imm spending 2000 2010.jpg

      • Source
        1. WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Rwanda. All data derived from the WHO/UNICEF Joint Reporting Form as follows:
        a: C_6450. This % excludes any external financing from donors.
        b: C_6490. This % includes all recurrent, immunization-specific spending financed solely with government funds. This includes vaccines, injection supplies, salaries, and per diems of health staff working full-time on immunization, transport, vehicles, and cold chain maintenance, training, social mobilization, and monitoring and surveillance.
        "NA" indicates data not available.

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    Budgeting:

      Coming Soon!
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      Budget Flows and Reporting:

        Coming Soon!

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        Budget Performance:

        • In 2008, Rwanda's routine EPI Program immunized 334,998 children with DTP3 and spent around US$7.5 per DTP3 immunized child (US$2,466,353 total), down from $16 per DTP3 immunized child in 2007. (Source: GAVI Annual Progress Report, 2008 and GAVI Annual Progress Report, 2007)
        • Country Policy and Institutional Assessment:
          The World Bank 2007 CPIA gave Rwanda's budget and financial management systems (Indicator #13) a score of 4.0, up from 3.5 in 2005. (mean 2007 score for all IDA countries: 3.2) Read more here.
        • Open Budget Index: Rwanda scored 0% out of a possible 100% on the Open Budget Index 2008. This indicate that no information is provided to the public regarding the central government’s budget and financial activities during the course of the budget year. Read more here.

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        Parliamentary Notes:

        • Rwanda's current Parliament was elected in 2008. It consists of a Senate and a Chamber of Deputies.
        • The Chamber of Deputies consists of 80 deputies. Fifty-three are elected for 5-year terms by proportional representation, 24 are elected by provincial councils, 2 are appointed by the National Youth Council, and 1 by the Federation of the Association of the Disabled.
        • The next parliamentary and subnational legislative elections will be held in 2011 (Source: ElectionGuide).
        • Chapter I, Article 41 of the Rwandan Constitution states: “All citizens have the right and duties relating to health. The State has the duty of mobilizing the population for activities aimed at promoting good health and to assist in the implementation of these activities.”
        • As a member of the East African Community, Rwanda agreed to abide by the EAC Charter. Chapter 21 (Health, Social and Cultural Activities), Article 118 (Health) binds Member States to work together to prevent epidemics, strengthen health systems, harmonize health policies, share health information and develop common procurement practices for pharmaceuticals.

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          Immunization Performance Indicators:*

          Percent of districts reporting at least 80% coverage (DPT3), 2008*: 97%

          Percent of districts reporting at least 80% coverage, DPT3, 2001-2008

          *Source:
          WHO Vaccine Preventable Disease Monitoring System, 2008. Immunization Profile: Rwanda. Data derived from the WHO/UNICEF Joint Reporting Form, Indicator GSA17ap. "NA" indicates data not available.

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          Disease Burden:

          Population (2008): 9,721,000
          Births (2008): 403,000
          U5 Deaths (2008):
          - total 41,000
          - preventable by routine EPI: 5,7401
          - preventable by routine EPI and new vaccines: 10,2502

          (Source: UNICEF "State of the World's Children" 2009 )

          1 Assumes use of BCG, DPT, polio, and measles vaccines prevent 14% of U5 deaths.
          2 Assumes use of BCG, DPT, polio, measles, HepB, Hib, yellow fever, and pneumococcal antigen-containing vaccines prevent 25% of U5 deaths.

          Note: Vaccine preventable death estimates assume that force of infections, individual susceptibility, and probability of exposure are constant at all mortality levels.

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          Useful Links:

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