New policy brief outlines how public–private partnerships can expand health care access in Rwanda

Communities in Rwanda, particularly those in rural and remote areas, continue to face barriers in accessing health care services ; a challenge that undermines health outcomes and the country’s overall development goals. A new policy brief highlights how the private sector can be effectively engaged through Public–Private Partnerships (PPPs) to expand access to essential health services, showcasing the progress made so far and the challenges that remain.

New policy brief outlines how public–private partnerships can expand health care access in Rwanda

Despite Rwanda’s remarkable health achievements over the past two decades including an increase in life expectancy from 47.5 years in 2000 to 69.6 years in 2022, and health insurance coverage reaching 97.3% of the population ; rural communities still lag behind. The country, home to 13.8 million people of whom 82% live in rural areas, continues to grapple with significant access barriers. Around 23% of rural residents live more than five kilometers from a health facility, making it difficult to seek timely care.

Human resource shortages compound the problem, with health-worker density standing at 1.1 per 1,000 people ; far below the World Health Organization’s recommended 4.45 per 1,000 for achieving universal health coverage (UHC). Although out-of-pocket health care spending dropped from 28% in 2010 to 11.6% in 2020, rural households continue to bear proportionally higher financial burdens.

Closing these last-mile gaps is critical for Rwanda to achieve its UHC goals. PPPs in Rwanda have already played a key role in driving progress, strengthening community-level health workforces, expanding infrastructure, improving service quality, enhancing digital innovation, and building local maintenance capacity.

However, the policy brief notes that challenges remain. These include the need for stronger regulatory frameworks, sustainable financing mechanisms, and safeguards to prevent the development of a two-tier health system that could marginalize vulnerable populations. Continued focus on equity and inclusivity is essential to ensure that PPPs benefit all communities, particularly those in hard-to-reach areas.

The policy brief was developed by researchers at the University of Rwanda under the African Health Observatory Platform on Health Systems and Policies (AHOP) — a regional partnership hosted by the WHO Regional Office for Africa (WHO AFRO). AHOP connects centers of excellence across the continent to promote evidence-informed health policy-making and support countries in advancing equitable health systems.

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