National Health Insurance Improves Maternal Mortality, Other Public Health Indicators In Rwanda

Despite being one of the world's poorest nations, Rwanda has a national health insurance program that covers 92% of its 9.7 million citizens, the New York Times reports. Agnes Binagwaho, permanent secretary of Rwanda's Ministry of Health, said since the program's inception 11 years ago, deaths from childbirth and malaria have decreased sharply and the average life expectancy has increased from 48 years to 52 years.

For a $2 annual premium, Rwandan citizens receive basic coverage, including maternity care and treatments for the country's most common causes of death: diarrhea, infected cuts, malaria, malnutrition and pneumonia. Local health centers typically carry generic versions of brand-name drugs included on the World Health Organization's list of essential medications, and many laboratories perform routine blood and urine tests.

One the biggest practical obstacles to creating a national health insurance system in developing countries is that people with very low incomes "resist what they see as the unthinkable idea of paying in advance for something they may never get," according to the Times. Copayments also present a challenge, particularly for maternity care. For example, the $5 copay for a caesarean section is too costly for residents in some regions.

Rwanda relies on foreign aid for about 53% of its health expenditures, which total about $307 million per year, according to a study published in Tropical Medicine & International Health. The U.S. is the largest donor country to Rwanda, while the Global Fund to Fight AIDS, Tuberculosis and Malaria pays premiums for 800,000 Rwandans officially rated as the "poorest of the poor," the Times reports (McNeil, New York Times, 6/14).


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