Improving Access and Affordability through Universal Health Coverage: A Comparative Analysis of Rwanda and Uganda

Achieving Universal Health Coverage (UHC) is a critical policy goal for low- and middle-income countries (LMICs), yet implementation varies widely due to political, economic, and systemic challenges. This paper examines the contrasting approaches of Rwanda and Uganda, two nations with similar socioeconomic conditions but divergent health policy outcomes. Rwanda’s Community-Based Health Insurance (CBHI) model has driven near-universal coverage, dramatically reducing out-of-pocket (OOP) expenses and improving key health indicators, including child mortality rates. Conversely, Uganda’s reliance on fragmented healthcare financing and external aid has limited access to essential services, exacerbating financial vulnerability among underserved populations. This study employs a comparative framework to assess the governance, fiscal sustainability, and systemic capacity underlying UHC success. Findings reveal that beyond reducing financial barriers, UHC effectiveness depends on institutional resilience, equitable resource distribution, and long-term infrastructure investment. By evaluating Rwanda’s successes and Uganda’s challenges, this paper offers policy insights for designing sustainable, inclusive healthcare systems in resource-constrained settings.