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.
Summary: | 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. |
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