Rwanda has made great strides towards universal health coverage in recent years. Its Community Based Health Insurance (CBHI) Scheme has one of the highest insurance enrolment rates on the continent, and paired with health insurance schemes for civil servants and military, over 80% of the population is insured. Rwanda’s National Health Financing Strategic Plan outlines ambitious goals to move towards financial sustainability, inspite of the expandingservice provision demands on the national budget.
The iDSI network began its support for introducing health technology assessment (HTA) in Rwanda in 2019 as part of a government effort to improve the financial sustainability of the CBHI scheme. Since 2019, the network – including partners from CGD, CHAI, and HITAP – has been supporting various requests for capacity building, analytics, and institutionalisation of HTA from both the Rwanda Social Security Board (RSSB), the largest insurer targeting the poor and which sits under the Ministry of Finance and Economic Planning (MINECOFIN) and the Ministry of Health (MoH).
iDSI has supported:
Supported Rwanda’s national rapid HTA on dialysis for patients with Acute Kidney Injury, informing price negotiations and better procurement
Trained key stakeholders in HTA processes and methods including policy makers, academics, and clinicians
Sourced and analyzed key local data to inform various HTA activities
Supported Rwandan policy makers to formulate HTA institutionalisation plans
Rapid HTA Pilot: Haemodialysis vs Peritoneal Dialysis for Acute Kidney Injury in Rwanda
Rwanda conducted a national rapid HTA pilot analysing the cost-effectiveness and budget impact of adult patients with acute kidney injury receiving haemodialysis (HD) or peritoneal dialysis (PD). The HTA pilot took a ‘learn by doing’ approach where stakeholder consultation and training was continuous throughout the pilot as a mechanism for capacity building. The team provided on the ground support to key government officials and conducted broader HTA trainings and consultative meetings for academic, technical RSSB/MoH, and clinical staff.
Dispelling the myths of providing dialysis in low- and middle-income countries: https://pubmed.ncbi.nlm.nih.gov/32814894/
Results of the pilot were presented to key stakeholders and the pilot impacted various activities. First, it informed government price negotiations for key dialysis consumables. It also raised important issues regarding the need for better prevention of acute kidney injury at lower levels of care. Second, it led to demand for a costing study of HD treatment which not only helped to better understand the cost of delivering HD in tertiary care facilities, but also to build capacity in conducting costing studies and uncover data sources, needs, and gaps for future conduct of HTA. Finally, work associated with the pilot informed an article published in The Lancet by iDSI partners on Dialysis in Africa: the need for evidence-informed decision making.
Supporting HTA institutionalisation
Recent HTA activities in Rwanda have garnered a lot of interest from both RSSB and the MoH for building the frameworks and governance to institutionalise HTA. iDSI has begun to support such activities through developing a landscape analysis to better understand existing priority setting processes, data, and capacity in country; developing methods and processes to test for making the use of HTA more systematic e.g. formalized topic selection; and engaging key stakeholders in HTA-related activities.
This work is in early stages. As it has progressed, it has received interest from wide-ranging stakeholders in government and academia for the routine use of HTA.