A Formula for Health Equity
by Agnes Binagwaho-KIGALI – Imagine a country where some 90% of the population is covered by health insurance, more than 90% of those with HIV are on a consistent drug regime, and 93% of children are vaccinated against common communicable diseases including HPV. Where would you guess this enchanted land of medical equity is? Scandinavia? Costa Rica? Narnia?
Try Africa – Rwanda, to be precise.
In my native country, health care is a right guaranteed for all, not a privilege reserved for the rich and powerful. Rwanda remains poor, but, over the past 15 years, its health care advances have gained global attention, for good reason. In 2000, life expectancy at birth was just 48 years; today, it’s 67. International aid has helped, but our achievements have come primarily from other, non-financial innovations.
For starters, Rwanda has established a collaborative, cluster approach to governance that allows us to achieve more with the same amount of funding. Moreover, our civil servants embrace problem solving, demonstrating a level of resourcefulness that has produced many localized solutions to human development challenges such as ensuring food security and adequate supplies of clean water and housing.
But perhaps the most important factor behind our dramatic health-care gains has been the national equity agenda, which sets targets for supporting the needy and tracks progress toward meeting them. Since implementing this approach, Rwanda has managed to decrease the percentage of people living in extreme poverty from 40% of the population in 2000 to 16.3% in 2015
Aside from the obvious benefits, these gains matter because, as UNICEF recently noteda country’s potential return on investment in social services for vulnerable children is two times greater when the benefits reach the most vulnerable. In other words, Rwanda has achieved so much so fast because we are enjoying higher rates of return by investing in the poorest.
In working toward health equity, Rwanda has made accessibility a top priority. As of 2016, nine out of ten Rwandans were enrolled in one of the country’s health insurance programs. The majority of the population is enrolled in the Community-Based Health Insurance (CBHI) scheme, which has increased access to health care for Rwanda’s most vulnerable citizens by waiving fees.
As a result, the reach of health-care coverage in Rwanda is high by global standards – all the more remarkable for a country that suffered the horrors of genocide a generation ago. Consider the situation in the US: while the rate of uninsured Americans has dropped precipitously under the 2010 Affordable Care Act, the insured face rapid increases in premiums and out-of-pocket expenses. Perhaps the US should consider adopting a CBHI-type program, to reduce further the number of Americans facing financial barriers to medical care.