E-healthcare solutions
E-healthcare solutions
Business Model Description
Provide affordable e-health services, such as online consultations, telemedicine and self-diagnosis, together with a system for gathering and sharing medical data of patients with healthcare personnel.
Expected Impact
Reduce inequalities in health services accessibility between urban and rural communities.
How is this information gathered?
Investment opportunities with potential to contribute to sustainable development are based on country-level SDG Investor Maps.
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Country & Regions
- Rwanda: Countrywide
Sector Classification
Health Care
Development need
Important work remains in Rwanda for achieve on-track status in all targets for SDG 3 - Good Health and Well-being).(1) A child born in Rwanda today will be only 37% as productive as they could be if they enjoyed complete education and full health.(2)
Policy priority
Via the introduction of Mutualles de Danté in early 2000, known today as Rwanda Community-Based Health Insurance, Rwanda aims to give access to all the citizens not covered by other healthcare schemes.(3) The 4th Health Strategic Sector Plan 2018-2024 aims to ensure all Rwandan citizens have equal access to high quality maternal, neonatal, child and community health services.(4)
Gender inequalities and marginalization issues
A substantial investment has been made in healthcare human capital development. However, significant improvements are still needed for Rwanda to achieve sufficient health staff with all requisite human and technical skills, as well as to distribute the health providers in remote rural areas.(4)
Investment opportunities introduction
Increasing private sector participation in healthcare will increase overall access to health services and population wellbeing, and boost Rwanda's economic growth.(4)
Key bottlenecks introduction
Rwanda's healthcare sector faces a number of challenges, including a deficit of skilled personnel (only 1.3 physicians per 10,000 people), limited access to health services (only 16 hospital beds per 10,000 people), and financial and operational problems.(3)
Health Care Providers
Development need
Rwanda has approximately 15,000 villages, and about 45,500 community health workers spread throughout the country.(5) Most health workers lack any medical education and can provide only the most basic medical services.(6) The country needs access to diagnostic services and consultations with specialists, which in turn allows for more accurate treatments.
Policy priority
The Rwandan Government aims for a comprehensive health care system. The importance of improving the quality of services as well as expanding service coverage has been emphasized in many policy documents. Rwanda aims to deploy a digital-first universal primary care services system.(7),(8)
Gender inequalities and marginalization issues
In Rwanda, around 59% of women experience at least once a problem in accessing healthcare services.(9)
Investment opportunities introduction
According to case studies, the hospitals introducing telemedicine can increase their profit by USD 1-3 million by investing approximately USD 100,000.(10)
Key bottlenecks introduction
Rwanda offers an accelerated depreciation rate of 50% over the first year of operations.(16) Digital decision support tools and strategies helping with diagnosis and treatment, as well as clinical algorithms recognized as an important adjunct to healthcare quality, are often still in their infancy.(7),(8)
Health Care Delivery
Pipeline Opportunity
E-healthcare solutions
Provide affordable e-health services, such as online consultations, telemedicine and self-diagnosis, together with a system for gathering and sharing medical data of patients with healthcare personnel.
Business Case
Market Size and Environment
USD 559 million total healthcare spending in the country.
In 2016-17, approximately 67% of Rwandan households owned a mobile phone, translating to over 2.7 million households.(14)
Rwanda's community-based health insurance program (Mutuelle de Santé) covers over 90% of the population. The government aims to ensure universal healthcare access.(15)
Out-of-pocket payments currently constitute 18% of total expenditure on health.(16)
Indicative Return
20% - 25%
Benchmark statistics for the e-healthcare sector estimate a return rate between 20.8% and 24.8%. This rate is a benchmark calculated as the cost of equity with a country risk premium, reflecting an average return required by investors.(17)
Available case studies indicate hospitals introducing telemedicine can increase profit by USD 1-3 million by investing around USD 100,000.(10)
Investment Timeframe
Medium Term (5–10 years)
On average it takes 5 years to achieve return on telemedicine investment, but small standalone solutions can achieve returns within a shorter timeframe.(18)
A medium term timeframe is expected for large-scale digital healthcare project, with an expected payback period of up to 9 years.(18)
Ticket Size
USD 500,000 - USD 1 million
Market Risks & Scale Obstacles
Business - Supply Chain Constraints
Capital - CapEx Intensive
Business - Supply Chain Constraints
Market - Volatile
Impact Case
Sustainable Development Need
In 2019, the subjective wellbeing of Rwandans ranked only 3.3 on a 1-10 scale (1 being the worst and 10 being the best).(22)
In 2017, the universal health coverage (UHC) index of service coverage was 57.0 (out of 100), indicating less than two-thirds of coverage. This result highlights the need to improve access to healthcare services among the population, especially in rural areas.(22)
Rwanda's health system is constrained by limited staff, including a severe shortage of qualified medical personnel. The country has only 1.3 physicians per 10,000 people, compared with the recommended minimum of 2.5 healthcare providers per 10,000 people.
Gender & Marginalisation
Approximately 59% of women experience at least once a problem in accessing healthcare services.(9)
The number of new Human Immune Virus (HIV) infections is a challenge, with 0.3 cases per 1,000 uninfected population.(22)
Expected Development Outcome
Improved healthcare delivery and access to healthcare for communities living in remote areas
Improved diagnosis of disease, access to medication and quality of human capital; increased access to preventive medicine and healthcare services, positively impacting the number of visits and need for secondary and tertiary healthcare services
Reduced number of non-emergency consultations in secondary and tertiary healthcare facilities due to online consultations, impacting positively the time and cost for healthcare facilities, workers and patients
Gender & Marginalisation
Investments can improve access to quality healthcare service provision for all segments of society, focusing on women and rural communities.
Primary SDGs addressed
1.a.2 Proportion of total government spending on essential services (education, health and social protection)
Health: FRW 197,351,473,973 Education: FRW 240,486,878,694 Social protection: FRW 91,075,669,292 (38)
N/A
3.8.1 Coverage of essential health services
3.8.2 Proportion of population with large household expenditures on health as a share of total household expenditure or income
3.c.1 Health worker density and distribution
57 (40)
1.15% (40)
1.34 per 10,000 (40)
N/A
N/A
N/A
5.6.1 Proportion of women aged 15–49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care
84.2% (40)
N/A
Secondary SDGs addressed
Directly impacted stakeholders
People
Gender inequality and/or marginalization
Corporates
Public sector
Indirectly impacted stakeholders
Corporates
Outcome Risks
Possible systems fragmentation, poor communication and poor interoperability (23)
Security, privacy and confidentiality issues may arise (risk of data security and privacy breaches).(24),(25)
Impact Risks
Execution risk: Activities may not be delivered as planned and do not result in the desired outcomes in the absence of careful planning.
External risk: External factors may disrupt delivery of expected impact by distorting the supply chains in medical consumable manufacturing and distribution.
Stakeholder participation risk if services exclude certain regions
Impact Classification
What
Investment in up-scaling the provision of e-health services e.g. online consultations, telemedicine and self-diagnosis, addressing the limited access to healthcare services in rural areas.
Who
Communities inhabiting remote areas, society as a whole, national health system, pharmaceutical companies, healthcare employees.
Risk
An inefficient, fragmented system and potential privacy and confidentiality issues may decrease trust in the deployed solutions.
Impact Thesis
Reduce inequalities in health services accessibility between urban and rural communities.
Enabling Environment
Policy Environment
Health Sector Policy: This policy identifies a need for improved access to and use of the Rwanda Health Information Management and its related systems.(26)
4th Health Sector Strategic Plan 2018-2024: This plan states e-health initiatives such as telemedicine shall be expanded nationwide, and contribute to improved efficiency in service delivery, better emergency management and expansion of the clinical outreach programs in peripheral health facilities.(27)
Health Sector Information and Communication Technology (ICT) Security Policy: This policy defines the healthcare sector ICT security policies and provides an communication and implementation framework to support these policies.(28)
Vision 2050: This policy outlines telemedicine and advanced health technologies as a means to universally accessible, high quality health services. According to the document, telemedicine should reduce operating and administrative costs.(29)
Financial Environment
Fiscal incentives: For investments equivalent to at least USD 50 million, investors receive with a corporate income tax holiday of up to 7 years.(36) IT equipment needed for establishing e-health operations is exempt from value added tax.(37)
Other incentives: Foreign enterprises that invest at least USD 250,000 can employ 3 foreign workers without performing a labor test.(36)
Regulatory Environment
Ministerial Instructions governing Private Health Facilities 2020: This regulatory document provides a framework for private health institutions, their obligations and requirements.(30)
Licensing Standards for Private Health Facilities: These standards provide a framework for obtaining a license by a private health facility and requirements that must be met.(31)
Health Post Management Manual: This document is a guideline to managing healthcare facilities in accordance with current laws and regulations in Rwanda.(32)
Ministerial Order N° 20/31 of 18/04/2012: This order determines the modalities for deploying medical staff in the health sector. It states that all doctors and other health professionals must be registered under appropriate health professional bodies.(33)
Rwanda's Ministry of Health provides laws, regulations and policies for the healthcare sector.(34) The Rwanda Biomedical Centre provides guidelines for healthcare operators to achieve the goals set out in the 4th Health Sector Strategic Plan 2018-2024.(35)
Marketplace Participants
Private Sector
Babyl, E-Heza, VitalHealth Solutions BV
Government
Rwandan Ministry of Health (MOH), Rwanda Development Board (RDB)
Multilaterals
International Monetary Fund (IMF), European Union (EU), European Investment Bank (EIB), African Development Bank (AfDB), World Health Organization (WHO)
Non-Profit
World Economic Forum (WEF), United States Agency for International Development (USAID), German Corporation for International Cooperation (GIZ), KfW Development Bank, Agence Française de Développement (AFD)
Target Locations
Rwanda: Countrywide
References
- (1) Sachs, J., Schmidt-Traub, G., Kroll, C., Lafortune, G., Fuller, G. and Woelm, F. (2020). The Sustainable Development Goals and COVID-19. Sustainable Development Report 2020. Cambridge: Cambridge University Press.
- (2) United Nations Development Programme. Briefing note for countries on the 2019 Statistical Update: Rwanda.
- (3) Nyandekwe, M., Nzayirambaho, M. and Kakoma, J.B. (2020). 'Universal Health Insurance in Rwanda: Major Challenges and Solutions for Financial Sustainability Case Study of Rwanda Community-Based Health Insurance Part I', Pan African Medical Journal 37.
- (4) Ministry of Health. 4th Health Strategic Sector Plan 2018-2024.
- (5) Ministry of Health. 4th Health Strategic Sector Plan 2018-2024.
- (6) Schurer, J.M., Fowler, K., Rafferty, E., Masimbi, O., Muhire, J., Rozanski, O. and Amuguni, H.J. (2020). Equity for health delivery: Opportunity costs and benefits among Community Health Workers in Rwanda. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236255
- (7) Mitchell, M. and Kan, L. (2019). Digital Technology and the Future of Health Systems. Health Systems and Reform. https://www.tandfonline.com/doi/pdf/10.1080/23288604.2019.1583040
- (8) Nawrat, A. (2020). 'Setting An Example: Rwanda As A Digital Health Success Story - Medical Technology', Medical technology, 28. https://medical-technology.nridigital.com/medical_technology_jun20/rwanda_digital_health
- (9) National Institute of Statistics of Rwanda (2015). Rwanda Demographic and Health Survey 2014-15. https://www.statistics.gov.rw/publication/demographic-and-health-survey-20142015-final-report
- (10) Marks, J., Augesnstein, J. et al. (2019). A Framework for Evaluating the Return on Investment of Telehealth. Manatt Health Strategies, LLC.
- (11) Barbor, M. Building Improved and Sustainable Health-Care Systems Through Telemedicine
- (12) Babyl (2020). Rwanda's ambitious aims for digital health. https://healthcare-in-europe.com/en/news/rwanda-s-ambitious-aims-for-digital-health.html
- (13) Educational Management Information Systems (EMIS) database.
- (14) National Institute of Statistics of Rwanda. The EICV5_Utilities and Amenities Thematic Report. https://www.statistics.gov.rw/publication/eicv5-thematic-report-utilities-and-amenities
- (15) Medical Technology (2020). Setting an example: Rwanda as a digital health success story. https://medical-technology.nridigital.com/medical_technology_jun20/rwanda_digital_health
- (16) World Health Organization (2017). Primary Health Care Systems (PRIMASYS). https://www.who.int/alliance-hpsr/projects/AHPSR-PRIMASYS-Rwanda-Abridged.pdf?ua=1
- (17) PwC analysis based on Prof. A. Damodaran data, 2020.
- (18) Drury, P., Roth, S., Jones, T., Stahl, M. and Medeiros, D. (2018). Guidance for Investing in Digital Health. Asian Development Bank.
- (19) Piette, J., Moura, L. and Lun, K. (2012). Impacts Of E-Health On The Outcomes Of Care In Low- And Middle-Income Countries: Where Do We Go From Here? World Health Organization. https://www.who.int/bulletin/volumes/90/5/11-099069/en/
- (20) Rwanda Development Board (2013). Broadband for an inclusive digital society. https://unctad.org/system/files/non-official-document/Broadband%20for%20an%20inclusive%20digital%20society%20-%20Rwanda.pdf
- (21) European Union Agency For Network And Information Security (2015). Security and Resilience in eHealth https://www.enisa.europa.eu/publications/security-and-resilience-in-ehealth-infrastructures-and-services/at_download/fullReport
- (22) United Nations Development Programme (2020). Sustainable Development Report 2020. https://unstats.un.org/sdgs/report/2020/The-Sustainable-Development-Goals-Report-2020.pdf
- (23) Piette, J., Moura, L. and Lun, K. (2012). Impacts Of E-Health On The Outcomes Of Care In Low- And Middle-Income Countries: Where Do We Go From Here? World Health Organization. https://www.who.int/bulletin/volumes/90/5/11-099069/en/
- (24) Zriquat, I. and Altamimi, A. (2016). 'Security And Privacy Issues In Ehealthcare Systems: Towards Trusted Services', International Journal of Advanced Computer Science and Applications, vol. 7. https://www.researchgate.net/publication/308803282_Security_and_Privacy_Issues_In_eHealthcare_Systems_Towards_Trusted_Services
- (25) Sahama, T. and Simpson, L. (2013). Security And Privacy In Ehealth: Is It Possible? https://www.researchgate.net/publication/269329631_Security_and_Privacy_in_eHealth_Is_it_possible
- (26) Ministry of Health (2015). Health Sector Policy. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/policies/Health_Sector_Policy___19th_January_2015.pdf
- (27) Ministry of Health (2017). 4th Health Sector Strategic Plan 2018-2024. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/Docs/FINALH_2-1.pdf
- (28) Ministry of Health (2016). Health Sector Information And Communication Technology (ICT) Security Policy. Republic of Rwanda. http://moh.gov.rw/fileadmin/templates/policies/Aproved_ICT_Security_Policy_forMOH.pdf
- (29) Ministry of Finance and Economic Planning (2015). Vision 2050. http://www.minecofin.gov.rw/fileadmin/templates/documents/NDPR/Vision_2050/Vision_2050_-Full_Document.pdf
- (30) Republic of Rwanda (2020). Ministerial Instructions governing Private Health Facilities 2020. http://moh.gov.rw/fileadmin/Publications/Policies/MINISTERIAL_INSTRUCTIONS_2020.pdf
- (31) Republic of Rwanda. Licensing Standards for Private Health Facilities. http://moh.gov.rw/fileadmin/Publications/Policies/Licensing%20Standard%20for%20PHF.pdf
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- (33) Republic of Rwanda (2012). Official Gazette nº 25 of 18/06/2012. http://moh.gov.rw/fileadmin/templates/HLaws/Appoinntment-of-medical-staff-AM.pdf
- (34) Ministry of Health. About Ministry. https://www.moh.gov.rw/about
- (35) Rwanda Biomedical Centre. Who We Are. https://www.rbc.gov.rw/index.php?id=629
- (36) Rwanda Development Board. Incentives to support Health sector. https://rdb.rw/investment-opportunities/health-services/#tab-1-3
- (37) Rwanda Development Board. Special incentive packages provided to ICT firms. https://rdb.rw/investment-opportunities/ict/#tab-1-3
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