Health Tables
Mortality and life expectancy figures reveal the
terrible state of the country’s health - Rwanda is significantly worse than
the Sub-Saharan Africa (SSA) average. For instance, the infant mortality rate
was 131 in 1996 compared to 91 for SSA, a rise from 119 in 1992. While life
expectancy was 48.5 years in 1996 compared to 54 for SSA, again a rise
following the war from 49 in 1992.
Estimates of the ‘burden of disease’ suggest that
malnutrition and malaria are the two biggest killers. The 1995 nutritional
survey found a very high level of chronic malnutrition (41.9% of children
under 6) and so a great effort must be made to improve food security. The
prevention and treatment of malaria is also critical.
HIV/AIDS comes next in order of importance, with an incidence rate of
12.8% in the population aged 15-49. The low level of contraceptive use 21%
must be lifted.
In terms of the service coverage of the population,
although Rwanda has traditionally done well with vaccination rates and
achieved a high coverage in 1996, it has since declined at an alarming rate.
For instance, BCG vaccinations for Tuberculosis of children less than one year
old have declined from a national average of 93% in 1996 to 79% in 1997 and
44.3% in 1998. There is also poor coverage in terms of family planning, the
delivery of ANC3, and the coverage of deliveries.
Notwithstanding the above service
coverage problems, the health system infrastructure is in a relatively good
state, which is a testament to the amount of resources poured into the health
sector by the international community. There is a health centre within one
hour walking distance, and there is a good implementation rate of those
elements of the Minimum Package (Oral Dehydration) that are of major
importance. Equally, there is a high implementation rate by hospitals of the
Complementary Package. The principal constraint to the improvement of the
quality of health services is therefore the lack of qualified human resources:
there is a significant shortage of trained health workers and the ratios of
population to doctors and nurses are significantly higher than the averages
for sub-Saharan Africa. They also
show significant regional disparities.
Low levels of sanitation and hygiene must not be
forgotten as another major cause of the country’s poor health.
The Ministry of Health has set various targets to
improve the health status of the nation, and is setting up a health management
information system that will assist in monitoring progress. Furthermore, in
line with its priority on primary health care, it is putting in place a
decentralised health system of health districts. However, the major challenge
to the Government is the financing of the health system, since public
recurrent health expenditure as a percentage of GDP is particularly low (0.3%
in 1997 compared with almost 2% sub-Saharan Africa). This reflects the massive
dependence of the system on external finance, which makes it highly vulnerable
to declines in donor support. Although the Government is committed to raising
the health budget (to 0.4% of GDP in 1999, with further significant increases
programmed for 2000 and beyond) it also has to look into a cost recovery
system that ensures access by poor.
