The transformation of the health system in Rwanda – from reconstruction to universal healthcare

Introduction and Aim. The health system in Rewanda is often cited as an instructive case of post-confl ict reconstruction in Sub-Saharan Africa. After the 1994 genocide, its infrastructure was damaged and much of its medical workforce lost. This review describes the reforms, focusing on fi nancing, primary health care and community health workers (CHWs). Materials and methods. A structured narrative review. Literature from 2018 to 2025 was searched in PubMed, Scopus and Web of Science databases, with reference-list screening and targeted retrieval. Screening was not duplicated and no formal quality assessment was undertaken. Indicator data came from UN and WHO estimates and Rwandan national statistics. Of 41 publications included, 24 report original analyses and 8 are evidence syntheses. All 41 were grouped into fi ve themes: reconstruction, fi nancing, primary health care, CHWs and emerging challenges. Brief summary of current knowledge. Over three decades Rwanda has extended access through decentralisation, community-based health insurance (CBHI) and primary health care, with CHWs delivering much preventive and basic care in rural areas. Maternal and underfive mortality fell steeply over the same period, although this study cannot identify which reform produced which outcomes. The outcomes are uneven, and fi nancing, non-communicable diseases, ageing and workforce capacity remain unresolved. Summary. Rwanda’s experience is consistent with the view that fi nancing reform, primary care and community engagement can support recovery and progress toward Universal Health Coverage (UHC). How far it translates depends on the political settlement, administrative capacity and external support.