CHALLENGES

In Rwanda, 72% of the population reside in rural areas and are widely dispersed across its mountainous landscape, making access to health care services difficult (World Bank, 2015). A major goal for the Rwandan Ministry of Health is to provide access to entry-level care within the radius of a 30-minute walk, and to open 1548 new health posts (small primary care clinics) by 2017.

INTERVENTION

One Family Health (OFH) aims to increase access to primary health care services for people living in the mountainous rural areas of Rwanda. In partnership with the Rwandan Ministry of Health, OFH has established a network of rural franchise health posts, owned and operated by local nurses. Grade A2 College graduated nurses with five to eight years of clinical experience are eligible to join the OFH network. Upon joining, each nurse gains access to a rent-free community-owned building within his or her residing village in which to provide care. Nurses have the option of accessing a low-interest loan for infrastructure renovations, furniture, fittings, essential medical equipment and medicine stock purchases. Nurses receive training in Rwandan primary care disease protocols, basic financial management, and medicine stock management using the OFH mobile platform. This training is followed by one week of work alongside a top-performing franchisee nurse in the network. Within each district, supervisors are available to provide nurses with continual guidance and supervision, and manage the delivery of the required essential medicines to health posts. Basic feature mobile phones, coupled with real-time analytics, support multiple service delivery functions including electronic patient records, stock ordering, monitoring, and billing.

Nurse-franchisees generate their own income through providing primary care services to the people of their village. In return, they are reimbursed for their services through the national community-based insurance scheme (Mutuelle de Santé) and by co-payments received from patients at point-of-service. Patient volume can be as high as 40 patients per day. As the OFH network is regarded as an extension of the public health care system, complicated cases are referred to the local district public hospital.

In 2015, 92 health posts were in operation in 11 of the 30 districts, providing employment for over 300 health and support workers, including the nurse franchisees. Since 2012, OFH has been able to provide basic health services for common primary care conditions to 550 000 patients in 850 000 consultations. An independent evaluation, commissioned by OFH in 2015, described a reduced travel time from 74 minutes to 14 minutes.

CASE INSIGHTS

The OFH case illustrates the role of entrepreneurial health models in supporting government service delivery priorities. Universal health coverage goals are being advanced through a public-private partnership between the Rwandan Ministry of Health and OFH, a low-profit organization. The partnership leverages the national health insurance fund to finance private nurse practitioners operating in rural areas. This increases access to health services in rural areas at the same user cost as comparable public services.