Report on the Health Care Sector and Business Opportunities in Rwanda Kristina Leuchowius for SWECARE FOUNDATION September 2014 Table of Contents Abbreviations ..................................................................................................................................................................................... I Preface .............................................................................................................................................................................................. II 1 EXECUTIVE SUMMARY ............................................................................................................................................................ 1 1.1 General .......................................................................................................................................................................... 1 1.1.1 Why Rwanda? ........................................................................................................................................................... 1 1.1.2 Health is a prioritized sector ..................................................................................................................................... 1 1.1.3 Health sector bottlenecks and needs ....................................................................................................................... 1 1.1.4 Perception of Swedish technology and health sector .............................................................................................. 2 1.1.5 Competitive situation ............................................................................................................................................... 2 1.2 Main findings and possible areas for investment .......................................................................................................... 3 1.2.1 Capacity building ...................................................................................................................................................... 3 1.2.2 Hospital management .............................................................................................................................................. 3 1.2.3 Hospital facilities and development, incl. specialist hospitals .................................................................................. 4 1.2.4 Medical equipment ................................................................................................................................................... 4 1.2.5 Manufacturing .......................................................................................................................................................... 4 1.2.6 Diagnostics centers ................................................................................................................................................... 4 1.2.7 Community based medical insurance system ........................................................................................................... 4 1.2.8 Mobile clinics and e-health ....................................................................................................................................... 5 1.2.9 Public Private Partnerships (PPPs) ............................................................................................................................ 5 2 Introduction ............................................................................................................................................................................ 6 2.1 Objective of the report .................................................................................................................................................. 6 2.2 Methodology ................................................................................................................................................................. 6 2.3 Structure of the report .................................................................................................................................................. 6 3 Rwanda – background and country facts ................................................................................................................................ 7 3.1 Rwanda at a glance ........................................................................................................................................................ 7 3.2 Historical perspective .................................................................................................................................................... 8 3.3 Political situation ........................................................................................................................................................... 8 3.4 Economy and financial stability ................................................................................................................................... 10 4 Health situation in Rwanda ................................................................................................................................................... 12 4.1 Major diseases and disease patterns .......................................................................................................................... 12 4.2 Determinants of health ............................................................................................................................................... 14 4.2.1 Poverty and malnutrition ........................................................................................................................................ 14 4.2.2 Living conditions ..................................................................................................................................................... 15 4.3 Mother and child health .............................................................................................................................................. 15 4.4 Infectious diseases ...................................................................................................................................................... 16 4.4.1 HIV/AIDS ................................................................................................................................................................. 16 4.4.2 Tuberculosis (TB) .................................................................................................................................................... 17 4.4.3 Malaria .................................................................................................................................................................... 17 4.4.4 Diarrhea .................................................................................................................................................................. 18 4.4.5 Infection control ..................................................................................................................................................... 18 4.4.6 Respiratory diseases ............................................................................................................................................... 19 4.5 Non-communicable diseases ....................................................................................................................................... 19 4.5.1 Cancer ..................................................................................................................................................................... 19 4.5.2 Cardiovascular diseases .......................................................................................................................................... 22 4.5.3 Hypertension .......................................................................................................................................................... 23 4.5.4 Obesity .................................................................................................................................................................... 23 4.5.5 Diabetes .................................................................................................................................................................. 23 4.5.6 Mental health ......................................................................................................................................................... 24 4.5.7 Disabilities............................................................................................................................................................... 24 5 Overview of the health care sector in Rwanda ..................................................................................................................... 26 5.1 The health system ....................................................................................................................................................... 26 5.2 Health insurance in Rwanda ........................................................................................................................................ 27 5.3 The Ministry of Health ................................................................................................................................................. 28 5.4 Rwanda Biomedical Center ........................................................................................................................................