How Rwanda is demonstrating that sustainable health financing is possible through political commitment, innovation and accountability.

With declining global health support and abrupt funding cuts from major donors African countries are increasingly turning inward to secure the future of their health systems. Rwanda is emerging as a continental leader in this shift. As the African Union Champion on Domestic Health Financing, President Paul Kagame is not just calling for reform he using Rwanda as a best practice for others to follow. showing the continent how it’s done.

While many African Health Ministers operate with just $40 per capita, Rwanda has taken bold steps to ensure that every FRANC is maximised through efficient systems and people-centred policies. At the recent Kigali High-Level Health Financing Conference, Rwanda reinforced the urgent need to build sustainable systems that reduce reliance on external aid.

Health Insurance for All.

Perhaps one of Rwanda’s most notable achievements is its near-universal health insurance coverage. As of 2022, 97.3% of the population is covered, with the Community-Based Health Insurance (CBHI) scheme playing a significant role. The CBHI model pools contributions from government, households, and even private sector levies, enabling even the poorest citizens to access healthcare without catastrophic costs.

The success of this model is reflected in outcomes: households with insurance are four times less likely to face catastrophic health expenditure and report higher service utilisation, including preventive care.

Innovative Financing and Accountability Mechanisms.

Rwanda’s Health Financing Strategic Plan (HFSP) 2018-2024 outlines clear priorities in domestic resource mobilisation, revenue pooling and strategic purchasing. Performance-Based Financing (PBF) systems ensure that public funds are tied to measurable health outcomes, especially in maternal and child health.

Public Financial Management (PFM) reforms have strengthened transparency, while program-based budgeting links spending directly to service delivery outcomes. Districts receive timely disbursements from central government while maintaining autonomy in local health spending.

A Blueprint for the Continent.

The Kigali High-Level Health Financing Conference in 2024, hosted by President Kagame, brought together Ministers of Health and Finance, Heads of State and multilateral partners to advance Africa’s health security agenda. With a clear focus on sustaining the HIV response, strengthening regional manufacturing and operationalising Regional Health Financing Hubs, Rwanda used the platform to share its lessons and call for action.

From pioneering digital health taxes to embedding gender-responsive budgeting in law, Rwanda’s example illustrates that it is possible to build a resilient health system that is African-owned, politically protected, and financially sustainable.

As the Amref Health Group CEO, Dr Githinji Gitahi, aptly stated during the Africa Health Agenda International Conference (AHAIC): “We cannot afford healthcare for everyone, but we can afford health.”

Rwanda’s story is proof that with the right policies and unwavering political commitment, the continent can move from vision to implementation and from dependence to determination.