Rwanda : Fiscal Space for Health and the MDGs Revisited

This paper revisits the issue of fiscal space requirements for achieving health millennium development goals (MDGs) in Rwanda. The paper updates and extends work on financing for the health MDGs prepared by the Ministry of Health (MoH) in 2006. It draws on papers prepared by World Bank staff for a comprehensive health sector review and information collected during a field visit to Kigali in March 2008. The context is one of large recent increases of financing from development partners (donors) combined with far reaching reforms of health sector management. The paper aims to provide a concise summary of the key issues for policymakers in Rwanda, development partners, and to inform a broader international audience of the prospects for scaling up financing for health in order to substantially raise the health status of low income country populations. The plan of the paper is as follows: section one describes the demographic and health context, the strategic objectives through to 2015, and recent and prospective progress towards achieving these objectives; section two briefly explains the distinctive features of health financing with an emphasis on primary and secondary services needed to achieve strategic objectives; section three considers financial flows in the health sector; section four elaborates a forward-looking fiscal space for health scenario; section five compares projections of fiscal space and alignment of health spending with a costing scenario developed using the marginal budgeting for bottlenecks (MBB) tool; section six concludes with a discussion of the uses and potential of government-development partner compact for health sector financing in support of a long term health strategy.

Bibliographic Details

Main Author:	Lane, Chris
Format:	Working Paper biblioteca
Language:	English en_US
Published:	World Bank, Washington, DC 2009-11
Subjects:	ACCESS TO HEALTH CARE, ACCESS TO HEALTH CARE SERVICES, ACCESS TO HEALTH SERVICES, AGED, AID, AIDS RELIEF, ALLOCATION OF RESOURCES, ALLOCATIVE EFFICIENCY, BEHAVIOR CHANGE, BLOCK GRANT, BUDGETARY RESOURCES, BURDEN OF DISEASE, CAPACITY BUILDING, CAPITAL SPENDING, CAPITATION, CHILD HEALTH, CHILD MORTALITY, CHILD MORTALITY RATE, CHILD MORTALITY RATES, CHILDREN PER WOMAN, CHRONIC MALNUTRITION, CLINICS, COMMUNITY HEALTH, CONDOM, CONDOM USE, COST EFFECTIVENESS, COST-EFFECTIVENESS, DEATHS, DELIVERY OF HEALTH SERVICES, DISEASE CONTROL, DISEASES, DRINKING WATER, DRUGS, DYING, EXPENDITURES, FAMILY PLANNING, FAMILY PLANNING SERVICES, FEE FOR SERVICE, FEMALE, FEMALES, FERTILITY, FERTILITY RATE, FERTILITY RATES, FINANCIAL RESOURCES, GENDER, GENOCIDE, GLOBAL HEALTH, GROSS DOMESTIC PRODUCT, HEALTH CARE, HEALTH CARE COSTS, HEALTH CARE DELIVERY, HEALTH CARE FINANCING, HEALTH CENTERS, HEALTH CENTRES, HEALTH COSTS, HEALTH EXPENDITURE, HEALTH EXPENDITURE PER CAPITA, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH FINANCING, HEALTH FINANCING SYSTEM, HEALTH INSURANCE, HEALTH INTERVENTIONS, HEALTH OUTCOME INDICATORS, HEALTH OUTCOMES, HEALTH PLAN, HEALTH PLANNING, HEALTH PLANS, HEALTH POPULATION, HEALTH PROGRAMS, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH SHARE, HEALTH STATUS, HEALTH STRATEGY, HEALTH SYSTEM, HEALTH SYSTEM FINANCING, HEALTH TARGETS, HIV, HIV INFECTION, HIV POSITIVE, HIV/AIDS, HOSPITALS, HUMAN DEVELOPMENT, HUMAN RESOURCES, IMMUNIZATION, IMMUNODEFICIENCY, IMPROVEMENT OF HEALTH, INCOME, INCOME HOUSEHOLDS, INFANT, INFANT MORTALITY, INFANT MORTALITY RATE, INSECTICIDE TREATED BED NETS, INSTITUTIONAL CAPACITY, INSURANCE SYSTEM, INTERVENTION, LIFE EXPECTANCY, LIFETIME RISK, LIVE BIRTHS, LOCAL GOVERNMENTS, LOW BIRTH WEIGHT, LOW INCOME, MALARIA, MARGINAL COSTS, MARRIED WOMEN, MATERNAL & CHILD HEALTH, MATERNAL MORTALITY, MATERNAL MORTALITY RATE, MATERNAL MORTALITY RATES, MEDICINES, MILLENNIUM DEVELOPMENT GOALS, MINISTRIES OF HEALTH, MINISTRY OF HEALTH, MODERN CONTRACEPTIVE PREVALENCE, MODERN CONTRACEPTIVE TECHNIQUES, MODERN FAMILY, MODERN FAMILY PLANNING, MODERN FAMILY PLANNING METHODS, MODERNIZATION, MORBIDITY, MORTALITY, MORTALITY REDUCTION, MOTHER, MOTHER TO CHILD, MOTHER TO CHILD HIV TRANSMISSION, MOTHER TO CHILD TRANSMISSION, NATIONAL DEVELOPMENT, NATIONAL HEALTH, NATIONAL PLAN, NEEDS ASSESSMENT, NUTRITION, NUTRITIONAL STATUS, OFFICIAL DEVELOPMENT ASSISTANCE, PATIENTS, PERIPHERAL HEALTH FACILITIES, PHARMACISTS, POPULATION DENSITY, POPULATION GROWTH, PREGNANCY, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE CLINICS, PRIVATE FINANCING, PRIVATE FINANCING FOR HEALTH, PRIVATE SECTOR, PRIVATE SECTORS, PRIVATE SPENDING, PROGRESS, PROVIDER INCENTIVES, PUBLIC EXPENDITURE, PUBLIC EXPENDITURE ON HEALTH, PUBLIC HEALTH, PUBLIC HEALTH CONCERN, PUBLIC HEALTH SPENDING, PUBLIC HOSPITALS, PUBLIC SECTOR, QUALITY OF HEALTH, QUALITY OF SERVICES, REDUCING MATERNAL MORTALITY, REPRODUCTIVE HEALTH, RESEARCH CENTERS, RESOURCE ALLOCATION, RISK SHARING, RURAL AREAS, RURAL DEVELOPMENT, SERVICE PROVISION, SERVICE QUALITY, SHARE OF HEALTH SPENDING, SKILLED HEALTH PERSONNEL, SOCIAL DEVELOPMENT, SOCIAL HEALTH INSURANCE, SOCIAL MOBILIZATION, STRESSES, SUSTAINABLE GROWTH, TECHNICAL ASSISTANCE, THERAPY, TRADITIONAL HEALERS, TUBERCULOSIS, UNDER-FIVE MORTALITY, URBAN AREAS, VACCINES, VOLUNTARY TESTING, VULNERABILITY,
Online Access:	http://documents.worldbank.org/curated/en/2009/11/12305919/rwanda-fiscal-space-health-mdgs-revisited http://hdl.handle.net/10986/13637
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