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Strengthening healthcare system resilience for all
Project

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Project start date
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Status
Ongoing
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Project end date
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Project duration
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3 years
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AFD financing amount
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39 000 000 €
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Country and region
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Location
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National and Northern Region
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Beneficiaries
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Government of Rwanda
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Type of beneficiary
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State
AFD supports Rwanda’s health reforms with results-based financing to strengthen primary care, expand the health workforce, and develop climate-resilient facilities, ensuring quality care and access for all.
Context
Over the past two decades, Rwanda has achieved remarkable progress in health: life expectancy has risen from 51 years in 2002 to nearly 70 in 2022, health insurance covers over 90% of the population, and child and maternal mortality have fallen sharply. These results stem from strong public health policies, decentralised care, and an extensive network of community health workers.
As part of its long-term vision—upper-middle-income status by 2035 and high-income status by 2050 under Vision 2050—the government places quality and resilience at the heart of its health system. The Health Sector Strategic Plan V aims to halve child stunting, further reduce maternal and neonatal mortality, and strengthen specialized care, while addressing the challenges of climate change.
Description
To support this vision, AFD is supporting Rwanda’s health reforms through the Results-Based Financing (RBF) Programme, with €35M in funding and €4M in technical assistance implemented by Expertise France. The programme focuses on two key reforms:
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The Primary Health Care reform, which aims to bring quality health care closer to all communities by upgrading health centers and district hospitals, strengthening referral systems, and more formally integrating community health workers with better training, pay, and equipment. It also reinforces emergency medical services (SAMU) with new ambulances, trained staff, and faster response times, while integrating climate-resilient infrastructure and services tailored to the needs of women and vulnerable groups.
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The “4 by 4” Strategy, which seeks to quadruple the annual number of trained health professionals by 2029, while improving quality, equity, and inclusiveness. This involves modernizing teaching hospitals, creating “smart classrooms” for practical training, and focusing on key roles such as nurses, midwives, and anesthetists, with measures to promote gender balance and ensure staff retention in all regions.
Impacts
By 2027, AFD financing will have helped deliver stronger, more equitable, and climate-resilient health services nationwide. Under the Primary Health Care Reform, communities will benefit from:
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A 2.5-fold increase in the share of facilities with continuous access to water and electricity, improving safety and reliability of care;
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Stronger emergency medical services, with better-equipped ambulances, trained staff, and faster response times;
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15% fewer caesarean sections resulting in hemorrhage, reflecting improved quality of care;
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Rehabilitation of health infrastructure to climate-resilient standards, and definition of a National Strategy on Climate Health Vulnerability in partnership with the Clinton Health Access Initiative (CHAI).
In parallel, the “4 by 4” Strategy will boost the health workforce, setting Rwanda on track to quadruple annual graduates by 2029. By 2027, AFD’s support will have helped to:
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Enrol 1,000 additional students each year in health training programs;
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Complete the 250-bed maternity and surgical block at Kibagabaga Teaching Hospital, expanding maternal and child health services and serving as a national training hub;
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Equip nine teaching hospitals with “smart classrooms” to improve practical training and encourage staff retention outside Kigali.
Overall, the program will ensure that all Rwandans have access to quality care, supported by a skilled and climate-resilient health system, while strengthening central and decentralized capacities through the support of Expertise France.
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