Opinion: How public-private partnerships boost health tech in Rwanda

Public-private partnerships have played a key role in Rwanda’s impressive digital infrastructure expansion, supporting the country’s transformation into a regional health and high-tech hub. So how have PPPs worked in the country, and can this approach be replicated in other places?

First, creating concrete and appropriate policy frameworks and setting policy goals are indispensable in the context of global development projects. Government-led national growth strategies have been central to Rwanda’s economic success.

A key point of success for Rwanda was that the government used digitalization and information communication technology to increase efficiencies in other sectors. Instead of considering ICT as a market in itself, it has been used as a tool to reform and open other markets.

In Rwanda, a mountainous country with over 80% of the population living in rural areas, authorities smartly prioritized digitalizing its largely rural territory. The ultimate goal was expanding tech and connectivity to transform the agrarian economy into a highly digitalized, middle-income country.

Officials figured that the state or international aid alone could not achieve the country’s development goals and digitalization. They therefore switched focus to PPPs. The World Bank defines a PPP as a long-term contract between a private party and a government entity to provide a public asset or service. The private party “bears significant risk and management responsibility,” and remuneration is linked to performance.

In pursuit of these goals, the government launched its VISION 2020 framework in 2000, aiming for Rwanda to become a middle-income country within two decades. A key aspect of VISION 2020 was, unsurprisingly, to develop a private sector-led economy. The decision-makers had the political will to quickly adapt the regulatory framework to encourage innovative business models and create a breeding ground for startups to accelerate the process.

One of the main goals was to attract startups that wanted to try innovative products and business models before entering large markets in and around Africa. For these purposes, Rwanda implemented significant reforms to improve its business environment and the ease of doing business for the private sector in partnership with the government.

These reforms included the development of a comprehensive PPP framework with guidelines for the private sector, as well as the implementation of new laws and reduced costs and requirements for big companies and small startups. As a result, health tech companies have undertaken new efforts in the country.

In addition to regulations and legal frameworks, the government launched initiatives to increase digital literacy and entrepreneurship across the nation. For instance, youths are sent to the countryside to train older people who are excluded from the information technology society. In return, the young people receive a sum of money from the state to start their own business. This system leads to not only digital literacy but also financial inclusion. As of 2020, the level of financial inclusion in Rwanda is 93%.

The positive impacts of PPPs are best demonstrated in the health care sector. Rwanda is one of the few low-income countries to have universal health coverage. Its community-based health insurance program includes more than 90% of the population.

One game-changing example of a PPP is the government’s collaboration with Babylon Health, a remote consultations provider that is headquartered in the U.K. The service launched in 2016, and its success paved the way for the government to begin another collaboration with Babylon Health in early 2020. It has gained millions of registered users and now completes up to 4,000 consultations every day.

Together, they aim to create the world’s first primary health care service that is both digital and universal. The goal is for everyone older than 12 to have access to consultations with doctors or nurses via their mobile phones within minutes. In addition to benefits in the health sector, the partnership has created hundreds of digital health jobs for local people.

Another example from the health sector is the partnership between the government and the Silicon Valley-based Zipline in 2016. This collaboration aims to deliver blood and vaccines to hospitals and clinics via drones.

This system carries out some 500 deliveries daily. Before this initiative, most hospitals outside of the capital, Kigali, would have to travel several times a week to procure blood from the primary source in Kigali. Research shows that, in general, patient survival may increase to 80% with this kind of system, compared with 8% when traditional modes of transportation are used for delivery.

There are more success stories across different sectors that show the positive impacts of PPPs in Rwanda. These examples and improvements in people’s lives provide other countries with opportunities to learn and improve. Other governments could consider developing a clear and encouraging policy and legal framework for PPPs to achieve sustainable and better results in development and digitalization processes.

Still, implementing new policies and increasing the volume of PPPs brings some challenges. For instance, an aggressive negotiation and allocation of risk — with private entities expected to bear almost all the risk — in a PPP project pushes them away. The policy framework, therefore, should ensure an optimal allocation of risk between the public and private entities.

Yet as seen in Rwanda, embedding the appropriate government support mechanisms, especially in pioneer PPP projects, plays a key role as a driver of development — a lesson for other countries seeking to achieve high digitalization across sectors.