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.