Universal health coverage represents the aspiration for all people in the world to receive the health services they need without suffering financial hardship. Such a proposition may sound utopian — even impossible — but I believe we can achieve it.
Lessons from my country, Rwanda, show that with determination, leadership, and investment, we can go far.
Twenty-five years ago, Rwanda went through a horrific genocide, which took more than 800,000 lives across the country. We lost almost everything — infrastructure, human resources, even the confidence of the people. We had to rebuild the country from scratch.
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Even without big sources of wealth, we have come a long way in delivering better health for our people. These improvements were only possible because we have leaders who decided to invest in the people and to build upward from the community level; and, in the past two decades, we have turned around the health infrastructure of Rwanda.
The real turning point came in 2004, when we adopted the Health Sector Policy, allowing the Ministry of Health to develop its first strategic plan. A strong determination to deliver that plan helped us to make great progress in improving the health of the population. Here is a snapshot of our achievements: Average life expectancy rose from 54 years in 2004 to 68 years in 2017; by 2015, 91% of births were assisted by a skilled health provider, up from 52% in 2005, according to the country’s “2015 Demographic and Health Survey.”
Vaccination coverage among children ages 12-23 months rose from 75% in 2005 to 93% in 2015, the survey shows. As a result, under-5 mortality dropped to 50 deaths per 1,000 live births in 2015 compared to 152 deaths per 1,000 live births in 2005. Maternal mortality ratios dropped from 7.5 deaths per 1,000 live births in 2005 to 2.1 deaths per 1,000 live births in 2015.
Rwanda has now set its sights on achieving sustainable universal health coverage for all citizens. To attain this objective, we are aware that we must increase our own investments in health. We are making notable progress on that front. Since 2004, government health expenditure per capita on health has almost doubled, from $ 77 to $130 in 2016.
My country also follows a universal health care model, which provides health insurance through a system called Mutuelles de Santé. The system is a community-based health insurance scheme, in which Rwandans pay premiums into a local health fund and can draw from it when in need of medical care.
With support from the Global Fund and other partners, we continue to strengthen the health systems by providing integrated services in health facilities and subsidizing insurance premiums and copayments for over 2 million of the poorest.
Despite the enormous progress we have made, there is still much to do on many fronts, including ending the epidemics of HIV, tuberculosis, and malaria. To ensure that we meet the health targets of the Sustainable Development Goals, we shall continue our efforts to increase domestic financing for health. At the same time, we shall need to retain the support of our development partners.
The Global Fund remains a key partner in sustaining the gains we have made in our health sector. To date, the Global Fund has disbursed $1.38 billion to Rwanda; and my country will need the continued support of the Global Fund to stay on course to deliver health care to all our people.
The forthcoming sixth replenishment of the Global Fund in Lyon, France, on Oct. 9-10, is therefore of vital importance both to the Global Fund and to implementing countries. I am proud that my president, His Excellency Paul Kagame, was requested to champion the sixth replenishment.
I encourage all leaders in the health sector across Africa to express their commitment to working to increase domestic financing and to voice the importance of the Global Fund for ongoing and planned health programs in their countries. As we step up to the fight to achieve UHC, the success of the replenishment of the Global Fund this year will be pivotal.
Update, Sept. 25, 2019: This article has been updated to clarify per capita government health spending.
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About the author
Diane Gashumba
Diane Gashumba is the minister of health in the Republic of Rwanda and has been since October 4, 2016. Prior to this position, she served as the minister of gender and family promotion from March 29, 2016. Gashumba is a pediatrician by profession bringing 17 years' experience in global maternal, newborn and child health with focus to gender issues. She worked with USAID-funded Rwanda Family Health Project as senior team leader for quality and as deputy chief of party focusing on improving the quality of and access to services in maternal, child and newborn health, family planning, reproductive health, HIV, nutrition, malaria and gender equality.
