Rwanda

Q: Strategic purchasing

Rwanda has embedded strategic purchasing at the heart of its health financing reforms. The country uses Results-Based Financing (RBF) to reward health facilities for meeting performance targets linked to quality, efficiency, and NCD outcomes—particularly in rural areas.The government also contracts private healthcare providers to deliver specialized services such as oncology and cardiology at regulated prices, expanding access while maintaining quality standards. Pharmaceutical procurement is centralized through Rwanda Medical Supply Ltd., which bulk-purchases essential NCD medicines to reduce costs and ensure a stable national supply.Additionally, capitation and fee-for-service (FFS) models are applied under CBHI and RAMA to balance cost control with service quality. Rwanda’s integration of capitation with performance-based financing represents a promising innovation, supporting primary-level NCD services and rewarding facilities for achieving measurable health indicators.

Rwanda’s population stands at approximately 14.4 million people. Between 2000 and 2018, average life expectancy increased from 47 to 69 years, reflecting both positive health gains, as well as a growing burden of noncommunicable diseases (NCDs).

Rwanda has become a regional leader in decentralizing NCD care and integrating chronic disease management into primary health systems. It was among the first countries to implement the WHO PEN-Plus strategy, expanding diagnosis and treatment of major NCDs at primary health facilities.

The country also stands out for its near-universal health coverage, nationally scaled performance-based financing, integration of vertical health programs, and costed NCD strategies—all supported by a robust digital health and health management information system architecture.

The Cost of NCDs in Rwanda

After years of persistent, evidence-based advocacy, Rwanda secured earmarked funding for NCDs—proving that data-driven engagement with the Ministry of Finance can reshape national priorities and set a precedent for others to follow.

Health financing for NCDs: Progress in Rwanda

Rwanda has consistently prioritized health in its national development agenda and remains one of the few African countries to meet and sustain the Abuja target of allocating 15% of its national budget to health. The government’s investment in data systems and decentralized health financing has strengthened its ability to manage NCDs through more equitable and efficient resource allocation.

In 2023, Rwanda established the National Health Intelligence Center to enhance data-driven decision-making and improve tracking of health and NCD expenditures. By triangulating data from community to tertiary levels, the Center helps transform information into actionable insights that guide evidence-based policy and budget design.

Rwanda has pursued a deliberate strategy to strengthen domestic resource mobilization for health and NCD financing. The government continues to increase national health budget allocations while reducing reliance on external funding.

A cornerstone of this effort is the Community-Based Health Insurance (CBHI) scheme, known as Mutuelles de Santé, which pools contributions from households, employers, and government subsidies. Covering over 90% of the population, the CBHI system has dramatically reduced out-of-pocket spending and improved access to essential NCD services. In January 2’25, the government revised health service tariffs, substantially lowering costs for CBHI beneficiaries.

Complementing CBHI, the Rwanda Social Security Board (RSSB) manages Rwandaise d’Assurance Maladie (RAMA), a national health insurance scheme for formal sector employees that also covers chronic disease care. To boost domestic revenue, the government has introduced health taxes on alcohol, tobacco, and sugar-sweetened beverages, both to discourage unhealthy consumption and to help fund NCD control efforts.

Furthermore, Rwanda has engaged in Public Private Partnerships (PPPs) to attract private sector investment in healthcare infrastructure and NCD service delivery. These combined efforts have strengthened Rwanda’s ability to fund NCD prevention, treatment, and care domestically.

Rwanda has implemented robust risk-pooling mechanisms to enhance financial protection and equitable access to NCD services. Through CBHI, resources are shared across income groups, with government subsidies ensuring that the most vulnerable groups have access to essential care. In addition to CBHI, the NHIS pools resources from formal sector employees and employers, ensuring sustainable financing for chronic disease management, including NCD care.

Social protection programs such as Vision 2020 Umurenge complement these efforts by covering indigent populations through government and donor co-financing.

Rwanda’s model demonstrates how integrating external donor contributions into national pooling mechanisms can enhance efficiency and reduce fragmentation. The unified structure increases bargaining power in procuring medicines and services, improving affordability and sustainability of NCD care.

Despite these gains, challenges remain around long-term financial sustainability—particularly for costly NCD treatments. Even modest co-payment requirements can be a barrier for low-income households, highlighting the continued need for targeted subsidies and efficient purchasing mechanisms.

Rwanda has embedded strategic purchasing at the heart of its health financing reforms. The country uses Results-Based Financing (RBF) to reward health facilities for meeting performance targets linked to quality, efficiency, and NCD outcomes—particularly in rural areas.

The government also contracts private healthcare providers to deliver specialized services such as oncology and cardiology at regulated prices, expanding access while maintaining quality standards. Pharmaceutical procurement is centralized through Rwanda Medical Supply Ltd., which bulk-purchases essential NCD medicines to reduce costs and ensure a stable national supply.

Additionally, capitation and fee-for-service (FFS) models are applied under CBHI and RAMA to balance cost control with service quality. Rwanda’s integration of capitation with performance-based financing represents a promising innovation, supporting primary-level NCD services and rewarding facilities for achieving measurable health indicators.