Skip to main content

Free Content Paying for health in two Rwandan provinces: financial flows and flaws

Download Article:

You have access to the full text article on a website external to Ingenta Connect.

Please click here to view this article on Wiley Online Library.

You may be required to register and activate access on Wiley Online Library before you can obtain the full text. If you have any queries please visit Wiley Online Library



The study intended to analyse the financial flows in two provinces within the Rwandan health system through the review of all available documentation and through interviews with key informants, to assess the scope for improved resource allocation. In Rwanda, there exists a large deficit of available financial resources in the health sector in general, and more specifically at health centre level. To improve this situation, it is considered to cover a large proportion of the entire population by mutual health insurance schemes. The schemes are able to pool certain risks, and they definitely improve financial access to health services. Nonetheless, they are inaccessible to the ‘very poor’, and – due to their limited financial base – they are unable to cover a complementary health care package. It is unlikely that they will mobilize substantial additional resources for health. External long-term commitments are required to cover this gap. A reassurance and readjustment system between the various insurance schemes should be established in order to increase financial protection provided. It might link up with insurance schemes in the formal employment sector. The combination of such a support for health insurance with performance-related incentives for health staff has the potential to increase both equity and quality of health services simultaneously and substantially.

Keywords: Africa; Rwanda; financial sustainability; health financing; insurance schemes; performance-related incentives

Document Type: Research Article


Affiliations: 1: GTZ Health in Rwanda, Kigali, Rwanda 2: School of Public Health, Butare, Rwanda 3: Directorate for Health, Gender and Social Affairs, Butare, Rwanda 4: CERMES, Villejuif, France

Publication date: 2005-09-01

  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more