INTRODUCTION
Universal health coverage (UHC) aims to enable all individuals to access health-care services of sufficient quality when needed, without financial hardship. Most African countries have included UHC as a goal in their national health strategies. Achieving UHC requires overcoming many challenges.Rwanda’s Vision 2020,These initiatives helped Rwanda improve the health of its population. Rwanda’s economy also grew, with real (inflation-adjusted) income per capita (in 2019 U.S. dollars) increasing from $261 in 2000 to $820.Rwanda’s health system has three major levels. The central level develops overall strategies, technical frameworks, and health policies; monitors and evaluates operational programs; and operates national referral and teaching hospitals that offer tertiary care. The intermediate level consists of referral and provincial hospitals established to relieve the burden on national referral hospitals resulting from the ever-increasing demand for specialized care. The lowest (peripheral) level consists of the 30 administrative districts. Each plans, manages, coordinates, and evaluates the district’s activities that encompass district hospitals, primary health-care (PHC) facilities (health centers and health posts), and a network of community health workers (CHWs).Despite this progress, challenges persisted in infrastructure, finance, and technical resources.In 2019, as part of a public–private partnership, Rwanda’s Ministry of Health, in collaboration with Abbott, Inc., inaugurated eight second-generation health posts (SGHPs) in rural cells in the Bugesera District (∼1 hour by road from the capital) to improve access to PHC. Second-generation health posts added a new layer of health facilities by offering the same services provided at first-generation health posts and added laboratory services, and, in some cases, maternity services and dental care. Abbott funded the buildings, equipment, initial supplies, and staff training for eight SGHPs on behalf of the Ministry of Health. For laboratory services, each SGHP was staffed with a full-time laboratory technician, and equipment and supplies to support antenatal testing and routine primary care.Both professional and laboratory services are billed on a fee-for-service basis. Most patients are This prospective controlled trial aimed to 1) assess the effect of SGHPs on access to PHC in Rwanda and the change in the quality of care, 2) examine the financial sustainability of SGHPs, and 3) evaluate the cost-effectiveness of SGHPs. The results could inform policy leaders in other sub-Saharan African countries when considering implementation of SGHPs in rural areas.