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Healthcare Business Opportunities In Rwanda Africa

The 2014 Fourth Rwanda Population and Household Census established that the country has a population of 10 515 973 people; with one in two persons being under 19 years old and only 3% being above 65. Slightly more than half of the population is of working age. Life expectancy is 65 years for both sexes, and the literacy rate was 65.9% in 2012.

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Definition / Scope

Why Rwanda?

  • From 2000 to 2013, Rwanda was the fastest-growing African nation with a yearly growth average of 7%.
  • The Ministry of Health (MoH) has started a public health scheme and set up training institutes, such as the Kigali Health Institute (KHI) and the College of Medicine and Health Sciences, University of Rwanda, Butare.
  • In 2013, 73% of the population was covered under public health insurance. The MoH is the major provider of primary, secondary, tertiary, and preventive health services.
  • To improve the current situation, the government has increased national expenditure on health care by around 350% (from 1996 to 2013). Over the same period, Rwanda was able to drastically reduce mortality rates due to diarrhoea (23%) and maternal/neo-natal conditions (37%).
  • Rwanda’s health profile remains dominated by communicable diseases. The World Health Organization (WHO) classifies the HIV/AIDS prevalence in Rwanda as a generalized epidemic with a current prevalence of 2.9% for the total population aged 15-49, which has declined from 3.5% in 2004.
  • There is a serious shortage of health care professionals in the country, with only 2 doctors and 2 paramedics per 100,000 people.
  • About 80% of the health sector in Rwanda is public (55% is GoR owned and 22% are faith-based with GoR funding) and there are very few private clinics. Despite this, the private sector is believed to be the future – offering plenty of business and partnership opportunities

Market Overview

Rwanda Healthcare Profile

Total population (2013)[1]

11,777,000

Gross national income per capita (PPP international $, 2013)

1,430

Life expectancy at birth m/f (years, 2012)

63/66

Probability of dying under five (per 1 000 live births, 0)

not available

Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012)

253/212

Total expenditure on health per capita (Intl $, 2012)

144

Total expenditure on health as % of GDP (2012)[2]

10.7

  • The 2014 Fourth Rwanda Population and Household Census established that the country has a population of 10 515 973 people; with one in two persons being under 19 years old and only 3% being above 65. Slightly more than half of the population is of working age. Life expectancy is 65 years for both sexes, and the literacy rate was 65.9% in 2012.[3]
  • There is a significant need for POC diagnostics and preventive care in Rwanda as almost 80% of the total deaths are caused by communicable diseases.[4][5]
Burden by disease category [DALYs/1000 capita], per year[6]
  • Rwanda is facing a shortage of specialty care private hospitals.
  • As of 2012, the country had 114 private dispensaries and 60 private clinics.[4]
  • The Nyarugenge and Gasabo districts have the largest number of private health facilities.
  • In 2013, Dr. Agarwal’s Eye Hospital, opened a facility in Rwanda to house 30 residential patients and handle complicated eye cases, such as retinal and hi-tech cataract surgery, glaucoma, paediatric ophthalmology and corneal transplantation.[7]
  • In 2013, Rwanda’s first fertility clinic, Kigali IVF & Fertility Clinic, was opened offers in-vitro fertilization (IVF), sperm washing, intra–uterine insemination (IUI), egg freezing, and storage services.
  • From 2000 to 2012, per capita total expenditure on health increased by 576%
  • $203 million (Rwf140 billion) has been allocated for the health sector under the recent budget framework paper for 2014/15 – 2016/17.
  • The major drivers for the increase in per capita total expenditure are the universal health scheme, the rising prevalence of chronic diseases, the growing middle class, and the augmented consumer awareness about health issues.

Key Metrics

Metrics Value Explanation
Base Year 2016 Researched through internet


Top Market Opportunities

Health Insurance in Rwanda

Due to poverty, citizens are not visiting health care facilities when being sick or about to deliver. The GoR therefore developed a Community Health Based Insurance in 2004 – the Mutuelle de Santé – that would enable the subsidization of annual premiums and pooling of risks. Mutuelle subscribers will be assigned to one of three categories: the well-to-do who pay Frw 7000 per year, the less-well-off for whom the fee is Frw 3000, and the very poor who will be covered by the Government at Frw 2000.

These different fees, however, do not reflect different coverage: all three categories are entitled to the same services (Ministry of Health).

Grants from the Global Fund and funds from the Belgian Development Agency were used to pay the fees for Mutuelle for the poor and very poor.

Membership is voluntary, but it is estimated that 78% of the population are insured through Mutuelle. The insurance does not include coverage at private health centers (Ministry of Health).

15% of the medical bill is paid by the patient at the health center or district hospital if being referred there. Should a person seek care at a district or referral hospital without a referral note from the health center, then he or she must pay the full bill.

Other types of insurances are La Rwandaise d’Assurance Maladie (RAMA), the Military Medical Insurance (MMI), and private insurances. These insurances are commonly used by households in the city of Kigali, other urban areas and among the richer citizens.

Industry Challenges

  • At present, only a handful of specialist doctors exist across Rwanda. The country has only 3 oncologists and 5 fully trained cardiologists, while an estimated 1 million people suffer from heart related diseases.[8]
  • Usually, patients requiring open-heart surgery are referred to other countries, such as Kenya or India, where the cost of care ranges from $10,000 to $30,000 per patient.
  • At present, the latest medical technologies are not accessible in Rwanda. King Faisal Hospital in Kigali is the only hospital certified for international standards in Rwanda.
  • NHI records are poorly maintained. Public facilities use this as an excuse to not offer free treatment.
  • The University of Rwanda, College of Medical and Health Sciences, is the only training institution for doctors, admitting approximately 100 students every year. Research and innovation is minimal due to lack of funds for the same.
  • Rwanda is improving the number of doctors and nurses by enrolling a higher number of medical students. However no additional resources such as more the professors etc. have been added, indicating that the quality of the education cannot be maintained

Competitive Landscape

Rwandan stakeholders in the health sector (public and private)

The health sector in Rwanda is led by MoH. The MoH supports, coordinates and regulates all interventions within the health sector.

Other important ministries are: Ministry of Trade and Industry and Ministry of Finance and Economic Planning. The RDB was created in 2008 by bringing together the following agencies: Rwanda Investment & Export Promotion Agency (RIEPA), Rwanda Information and Communication Technology Authority (RITA), Rwanda Office of Tourism and National Parks (ORTPN), Centre for Support to Small and Medium Enterprises (CAPMER), Rwanda Commercial Registration of Service Agencies (RCRSA), a unit of Human Resource and Institutional Capacity Development Agency (HIDA), a unit of Rwanda Environmental Management Authority (REMA), and the Privatization Secretariat.

The aim of creating RDB was to enable private sector growth and to make it easier for private sector companies to invest in Rwanda. They work with all aspects related to the development of the private sector by working with and addressing needs of companies of all sizes and both local and foreign investors.

International stakeholders in the health sector

Global Fund: has invested more than USD 900 million to support the fight against HIV, TB and malaria in Rwanda. In 2014 they signed a grant agreement for the implementation of Rwanda’s national strategic plan for HIV. The support is aligned with existing national systems and strategy and ties future disbursements directly to outcome and impact indicators. This is the first time that the Global Fund is using this approach, and Rwanda has been chosen because of its track record of success in health program and financial management.

United States of America International Development (USAID): HIV/AIDS (PEPFAR), malaria (PMI), and TB; increase the quality and use of family planning and reproductive health services; improve maternal newborn and child health; and strengthen the overall health sector. The United States is the leading donor of bilateral HIV/AIDS assistance to Rwanda. The HRH project aims to build capacity of Rwandan medical staff. The Centers for Disease Control and Prevention are working on HIV, malaria and noncommunicable diseases.

The Belgian Development Agency (BTC): accessing primary healthcare, through the construction and rehabilitation of infrastructure and through institutional strengthening of the central level and of decentralized instances.

Other international organizations working with health in Rwanda are: UN (UNDP, UNAIDS, UNFPA, UNICEF), the WHO, WB, Clinton Foundation, PiH etc.

References

  1. National Institute of Statistics of Rwanda and Macro International Inc: Rwanda Demographic and Health Survey
  2. World Bank. DataBank: development indicators. http://data.worldbank.org/indicator
  3. Ministry of Health. The National Health Research Agenda 2014-2018. April 2014
  4. 4.0 4.1 MoH Rwanda
  5. WHO Non-communicable Diseases (NCD) Country Profiles Rwanda, 2014
  6. Ministry of Health. Expand the Global Burden of Disease Study. Immunization Program 2011-2015
  7. Dr. Agarwal’s eye hospital. http://www.dragarwal.com/
  8. Binagwaho A. et al. The Human Resources for Health Program in Rwanda — A New Partnership. The New England Journal of Medicine. Downloaded from nejm.org on September 15, 2014
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