title: Universal health coverage in Rwanda: dream or reality.
abstract: BACKGROUND
  Universal Health Coverage (UHC) has been a global concern for a long time and even more nowadays. While a number of publications are almost unanimous that Rwanda is not far from UHC, very few have focused on its financial sustainability and on its extreme external financial dependency. The objectives of this study are: (i) To assess Rwanda UHC based mainly on Community-Based Health Insurance (CBHI) from 2000 to 2012; (ii) to inform policy makers about observed gaps for a better way forward.
  
  
  METHODS
  A retrospective (2000-2012) SWOT analysis was applied to six metrics as key indicators of UHC achievement related to WHO definition, i.e. (i) health insurance and access to care, (ii) equity, (iii) package of services, (iv) rights-based approach, (v) quality of health care, (vi) financial-risk protection, and (vii) CBHI self-financing capacity (SFC) was added by the authors.
  
  
  RESULTS
  The first metric with 96,15% of overall health insurance coverage and 1.07 visit per capita per year versus 1 visit recommended by WHO, the second with 24,8% indigent people subsidized versus 24,1% living in extreme poverty, the third, the fourth, and the fifth metrics excellently performing, the sixth with 10.80% versus ≤40% as limit acceptable of catastrophic health spending level and lastly the CBHI SFC i.e. proper cost recovery estimated at 82.55% in 2011/2012, Rwanda UHC achievements are objectively convincing.
  
  
  CONCLUSIONS
  Rwanda UHC is not a dream but a reality if we consider all convincing results issued of the seven metrics.
authors.affiliation: School of Public Health, National University of Rwanda, Butare, Rwanda.
authors.forename: Médard
authors.initials: M
authors.lastname: Nyandekwe
authors.affiliation: School of Public Health, National University of Rwanda, Butare, Rwanda.
authors.forename: Manassé
authors.initials: M
authors.lastname: Nzayirambaho
authors.affiliation: School of Public Health, National University of Rwanda, Butare, Rwanda.
authors.forename: Jean
authors.initials: J
authors.lastname: Baptiste Kakoma
mesh_terms: D003695:Delivery of Health Care / Q000191:economics; D005102:Health Expenditures; D006295:Health Resources / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012432:Rwanda / Q000453:epidemiology; D019472:Universal Health Insurance / Q000592:standards / Q000706:statistics & numerical data
keywords: Community-Based Health Insurance; Rwanda; Universal Health Coverage