Rwanda: Domestic Financing and Sustainability of Neglected Tropical Diseases Programs

Sustainable Financing • 2026

Deep Dive Overview

The Government of Rwanda and the Ministry of Health, supported by the Rwanda Biomedical Centre (RBC), are the primary architects of the nation's transition towards health sovereignty. To mitigate dependency on dwindling foreign aid (which covered approximately 92% of NTD funding), the Ministry established a domestic resource mobilisation (DRM) target to cover at least 40% of the NTD budget.

A radical shift was made in 2022/23 when Rwanda moved from a donor-financed model to absorbing NTD treatments into domestic publicly subsidised insurance packages. The government increased its contribution from RWF 126 million (USD 0.12 million) in 2021/22 to RWF 1,100 million (USD 1.07 million) in 2022/23 — a tenfold increase. The program was designed and integrated into the Community-Based Health Insurance (CBHI) scheme, ensuring affordability and accessibility for low-income households with out-of-pocket costs under USD 1 per visit.

Cross-Sectional Survey Design

235 Patient Exit Interviews

24 Randomly Selected Health Centres

Secondary Data & Descriptive Analysis

Policy Recommendations

Sustain and deepen domestic budget growth for priority disease services. Sustainability of programs requires constant and adequate domestic ﬁnancing. Including a formal budget line for them in the relevant government budgets ensures this
Budgets should account for cashﬂow requirements of programs to avoid delays in payments and reimbursements that interfere with the availability of drugs and services
Strengthen supply chains and make reimbursements predictable so facilities can restock essential NTD commodities on time
Integrate NTD services into routine primary healthcare and insurance-supported service delivery, so prevention and treatment are part of the regular health system rather than stand-alone campaigns
Program design should be approached from an equity lens. Considering factors such as income, gender and access gaps to ensure inclusion of the target population
Take measures to increase efficient use of resources, such as policies promoting collaboration of NTD actors, devolution of program management to lower health governance units, quality of care
Bringing care closer to communities by constructing health posts and deploying community health workers improves physical access to services and reduces clients’ out of pocket expenses

Key Numbers

10x

increase in domestic NTD budget allocation

<$1

out-of-pocket cost per visit under CBHI

95%

patient satisfaction rating

health centres assessed in the study

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Deep Dive Summary

Examining how Rwanda transitioned Neglected Tropical Disease (NTD) services to community insurance and domestic funding, dramatically increasing the national budget line to achieve domestic self-sufficiency and health equity.

Content Type

Case Study

Region

Eastern Africa

Author

Research Team

Read Time

10 min

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Key Findings

Rwanda increased its domestic contribution to NTD programming tenfold, from USD 0.12 million to USD 1.07 million in one fiscal year.
Integrating NTD services into the subsidised Community-Based Health Insurance (CBHI) scheme ensured out-of-pocket costs remained under USD 1 per visit.
The mebendazole program achieved 100% drug availability across facilities, though praziquantel experienced a 92% stockout rate.
A 95% customer satisfaction rating was recorded from patients visiting health clinics, primarily attributed to professionalism and care quality.
Women faced opportunity costs that were 33% higher than those of men, largely due to increased barriers to access.