NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Friday, September 16, 2016

Standing outside her home in central Rwanda, 19-year-old Ernestine Ituze describes falling ill last year. She was coughing violently and had lost her appetite. A community health worker diagnosed tuberculosis and Ituze was treated at the nearby government hospital, a few kilometres down a red dirt road lined with banana and mango trees. A few months later, she is healthy and continuing her studies to be an accountant.

Ituze’s treatment cost her almost nothing under Rwanda’s national health insurance programme, Mutuelles de Santé, which covers 81% of the population of 11m. Another 10% are covered by government insurance for soldiers and civil servants. At 91%, the proportion of Rwandans who have health insurance is by far the highest in Africa. Those lacking it are mostly hard-to-reach rural poor.

From the ashes of the 1994 genocide Rwanda has emerged as an unlikely public-health exemplar (see chart). In 1990 some 1,400 women died for every 100,000 live births. By 2015 that figure had dropped to 290, making the country one of just a few in Africa to meet the Millennium Development Goal of cutting it by three-quarters. Rwanda has made similar strides in curbing infectious diseases and infant mortality. Between 2000 and 2011, the mortality rate for tuberculosis fell from 48 per 100,000 cases to 12. The health-insurance programme was a big part of the reason for all these successes.

How did a poor, rural country (income per head is $690 a year) manage to create a reasonably effective national health system? Aid helped: half of Rwanda’s health budget still comes from foreign donors. But similar volumes of aid have yielded scant results in other countries, so that cannot be the whole story.