Socioeconomic inequalities in health and health care in Rwanda

Introduction: After the 1994 genocide, the government of Rwanda rebuilt the country's health system and focused on mobilizing and distributing resources equitably and efficiently to ensure that those with health needs have access to health care. Currently, Rwanda has a population of about 9 million, of which about 60% live below the poverty line. The life expectancy at birth is 46 years and the under-5 mortality rate is 203 per 1,000. In 2004, the total health spending was about 7.5% of GDP and US$ 16 per person.

Purpose: To investigate the socioeconomic inequalities in health and health care, and to make a cross-regional comparison on health care coverage over time.

Method: The Rwanda Demographic and Health Surveys (RDHS) 2000 and 2005 are used in this study. RDHS are nationally-representative surveys that include information such as health status, use of basic health services, and other sociodemographic variables. Regression methods are used to examine the effects of socioeconomic characteristics on individual health status and access to care. A fixed-effects model with aggregated panel data from RDHS is applied to regional analysis.

Results: The health of the poor is notably worse than that of the better-off. The poor use health service less. Sizable differences in health care coverage across regions and over time are observed. Individuals with insurance have better access to health care.

Conclusion: The poor do not share fully in health care improvements. Providing public health insurance to the poor can be an effective method to ensure their access to health care.