Building a Healthier Rwanda: Linking Social Priorities to the National Budget, 2011–2016


Rwanda’s public health system was among the many casualties of the country’s 1994 genocide. In the aftermath of the violence, health workers were in short supply, maternal and child mortality rates spiked, and infectious diseases such as HIV/AIDs and tuberculosis often went untreated. By 2011, Rwanda had made enormous progress in remedying the situation, but much more remained to be done. From 2011 to 2016, officials in the finance ministry and health ministry worked together to develop five-year plans for public health, translate their new priorities into annual budgets, and monitor spending so as to ensure progress toward national goals. They revised the budget calendar to improve the planning process, helped local authorities build medium-term public-health strategies, and refined the tools used for tracking spending in the health sector. They met or surpassed more than half of the top targets they set for 2015, cementing the gains Rwanda had made since 1994.

Simon Engler drafted this case study with the assistance of Louise Umutoni Bower, based on interviews conducted in Kigali, Rwanda in March, April and August 2018. Case published September 2018.

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public health systems
medium term public health strategies
health ministry
per capita expenditure on health
Focus Area(s)
Centers of Government
Financial Management
Critical Tasks
Accounting systems
Aligning policy and budget
Budget laws & practices
Expenditure frameworks
Fiscal policy
Follow-up & monitoring
Performance budgeting
Public investment management
Revenue collection
Strategic planning
Core Challenge
Capacity (capability traps)
Country of Reform
Case Studies
Simon Engler