Financial sustainability.
hypertension
CERVICAL CANCER, HYPERTENSION, HEPATITIS B INFECTION, INTESTINAL PARASITES
The SGHPs were established and evaluated during a global pandemic; however, the number of services provided during the establishment year, especially outpatient visits, exceeded those provided at the health centers. An average SGHP was financially profitable even during its first (establishment) year. By the second year, it was also profitable on economic grounds, including the value of the in-kind subsidies. Rwanda’s system of UHC ensures that SGHPs should continue to have an adequate revenue stream indefinitely as long as they continue to deliver quality care efficiently. As of mid 2022, almost 3 years since the SGHPs were established, they remain in operation and, to our knowledge, are financially viable.The FGDs and survey data identified several areas where the SGHPs could fill gaps in health services: 1) access to iron tablets and insecticide-treated nets for pregnant women; 2) misoprostol for women delivering at home; 3) case management services and medication for chronic conditions, especially hypertension (currently covered only at health centers and higher levels), for adults ≥ 50 years; 4) laboratory tests for diagnosing intestinal parasites; 5) facility-based deliveries in lieu of at-home deliveries; 6) screening of women for cervical cancer, children for hepatitis B infection, and adults ≥ 50 years for hypertension; 7) increasing patients’ privacy, especially for women delivering at SGHPs; and 8) ensuring the availability of needed materials and equipment.Preventive services often require outreach services and face difficulties in attracting user payments. It would be quite sensible, however, for the government of Rwanda and donors to subsidize SGHPs, particularly in their provision of preventive services, as contributions to Rwanda’s public health goals. In the same way, other public institutions, such as CHWs, health centers, and schools receive public subsidies for their contributions to important societal goals.