The quality of healthcare in Rwanda has historically been very low, both before and immediately after the 1994 genocide. In 1998, more than one in five children died before their fifth birthday, often from malaria.
President Kagame has made healthcare one of the priorities for the Vision 2020 development programme, boosting spending on health care to 6.5% of the country’s gross domestic product in 2013, compared with 1.9% in 1996. The government has devolved the financing and management of healthcare to local communities, through a system of health insurance providers called mutuelles de santé. The mutuelles were piloted in 1999, and were made available nationwide by the mid-2000s, with the assistance of international development partners.
Premiums under the scheme were initially US$2 per annum; since 2011 the rate has varied on a sliding scale, with the poorest paying nothing, and maximum premiums rising to US$8 per adult. As of 2014, more than 90% of the population was covered by the scheme. The government has also set up training institutes including the Kigali Health Institute (KHI), which was established in 1997 and is now part of the University of Rwanda. In 2005, President Kagame also launched a program known as The Presidents’ Malaria Initiative. This initiative aimed to help get the most necessary materials for prevention of malaria to the most rural areas of Rwanda, such as mosquito nets and medication.
The country’s progress in healthcare has been cited by the international media and charities. The Atlantic devoted an article to “Rwanda’s Historic Health Recovery”. Partners In Health described the health gains “among the most dramatic the world has seen in the last 50 years”.
Despite these improvements, however, the country’s health profile remains dominated by communicable diseases, and the United States Agency for International Development has described “significant health challenges”, including the rate of maternal mortality, which it describes as “unacceptably high”, as well as the ongoing HIV/AIDS epidemic. According to the American Centers for Disease Control and Prevention, travelers to Rwanda are highly recommended to take preventive malaria medication as well as make sure they are up to date with vaccines such as yellow fever.
Rwanda also has a shortage of medical professionals, with only 0.84 physicians, nurses, and midwives per 1,000 residents. The United Nations Development Programme (UNDP) is monitoring the country’s health progress towards Millennium Development Goals 4–6, which relate to healthcare. A mid-2015 UNDP report noted that the country was not on target to meet goal 4 on infant mortality, despite it having “fallen dramatically”; the country is “making good progress” towards goal 5, which is to reduce by three quarters the maternal mortality ratio, while goal 6 is not yet met as HIV prevalence has not started falling.