Rwanda is the only East African country that is experiencing extremely fast rates of child mortality reduction while virtually eliminating disparities in survival chances between poor and rich children, Save the Children’s Lottery of Birth report says.
The country has fast and equitable pathways towards ending preventable child deaths.
The report says Rwanda is among the few sub-Saharan African countries on track to achieve MDGs 4 and 5. Malawi and Ethiopia are also on the list of African countries on the right track.
The report shows that child deaths in Rwanda fell rapidly between 2000 and 2013 from 182 to 52 deaths per 1,000 live births. Maternal mortality also fell from 1,000 deaths per 100,000 live births to 320.
“Rwanda has also seen a significant reduction in health inequalities — both in mortality rates and coverage of services,” says the report. “Disparities in child mortality rates have reduced significantly between socioeconomic groups as well as between rural and urban areas over the past decade.
“Impressive improvements have also been made in the coverage of services — 98 per cent of one-year-olds received the DTP3 vaccine in 2010, higher than in the UK.”
Equity gaps in Rwanda have also been closing between rural and urban areas and socioeconomic groups across a wide range of indicators. In 2000, women in the richest economic group were three times more likely to give birth in the presence of a skilled attendant.
“By 2010, this ratio had reduced to 1.4, with coverage among the poorest group rising from 22 per cent to 64 per cent. There is a still a long way to go, but this trend is encouraging,” notes the report.
Rwanda’s achievements in health outcomes are linked to improvements across a range of sectors and programmes, including its National Social Protection Strategy and significant progress in water, sanitation, education and gender equality.
Rwanda has increased health spending to six per cent of GDP, far beyond the average of two per cent in other sub-Saharan African countries. It is one of just six African countries that allocated more than 15 per cent of its budget to health, meeting the Abuja Declaration of 2001.
A national health insurance system, Mutuelles de Sante covers more than 98 per cent of the population with a comprehensive benefits package.
The compulsory scheme includes national subsidies for the poorest. It has both dramatically reduced out-of-pocket spending and increased utilisation of health services.
Rwanda also uses performance-based financing, which seems to have had a positive effect on the utilisation of maternal health services by all.