What We Do
A health post is only as sustainable as the person running it.
316
5M+
1,222
2,148
The challenge
Rwanda has made extraordinary progress toward Universal Health Coverage — expanding health insurance to over 90% of the population, building a network of more than 45,000 Community Health Workers, and driving down maternal and child mortality. At policy level, the creation of health posts at cell level represents one of Rwanda's most significant primary healthcare reforms.
Yet for years the growth of health posts outpaced their functionality. The number grew from 670 in 2018 to 1,222 in 2021, with the projection that every one of Rwanda's 2,148 cells will eventually have a primary healthcare facility. But building a health post is only the beginning. The harder question — the one that determines whether it truly changes lives — is who runs it, how it stays open, and whether it can deliver quality care consistently without depending entirely on donor funding or government subsidy.
In Rwanda's rural communities, distance to the nearest facility has historically determined outcomes that should never depend on geography. Before health posts reached many of these communities, people died at home from treatable conditions. Mothers in labour walked for hours, or gave birth on the way. Children with fever spent nights in danger because there was no nurse nearby.
Health posts are the lowest level of Rwanda's healthcare system, the link between Community Health Workers and health centers. They provide curative outpatient care, growth monitoring, antenatal care, family planning counselling, health education and basic laboratory services. Second-generation posts go further, offering prenatal consultations and deliveries, microscopic laboratory investigations, and dental and ophthalmology care.
But without sustainable financing, qualified management, entrepreneurial leadership and structured support, health posts risk becoming facilities that exist on paper and underperform in practice — inadequately stocked, understaffed, and unable to retain the nurses who are essential to their function.
Our approach
The Nurse Entrepreneurship Model is a locally driven response to this structural challenge. At its core it is a Public–Private–Community Partnership: the public sector provides leadership and integration, nurse entrepreneurs own and operate health posts as social enterprises, and community members use, protect and sustain these facilities as their own.
Clinical competence and entrepreneurial potential
The model begins with selecting nurses who have both the clinical competence and the entrepreneurial potential to lead a health post as a sustainable enterprise, then investing heavily in developing them — not just as healthcare providers, but as business leaders and community anchors.
Running a health post requires more than clinical knowledge. You must know how to manage staff, keep records, and budget — just like any other business. But at the end of the day, it is about people. Seeing a mother and baby leave healthy makes it all worth it.
The investment that makes independence possible
Beyond training, nurse entrepreneurs receive the startup support they need to open and operate from day one, without the financial burden that would otherwise make quality service delivery impossible in the early months.
We invest heavily in training — both clinical and managerial — so nurses can run these facilities as viable enterprises. That way, when donor funding ends, the services continue. Sustainability is built in from the start.
Three partners. One shared goal.
The Ministry of Health provides the policy framework, regulatory standards and national priorities. Local government provides community accountability, land and infrastructure support, and the political will that makes community buy-in possible.
Nurse entrepreneurs are the beating heart of the model. They own their health posts as social enterprises, responsible for clinical quality, staff management, financial sustainability and community trust.
Community members are not passive recipients. They use the health post, advocate for it among their neighbours, protect the facility and its staff, and hold the nurse entrepreneur accountable to the standard of care they deserve.
This model has transformed the health system. It ensures that health services are not just accessible but sustainable. Communities are engaged, nurses are empowered, and the government's health priorities are realized at the grassroots.
We do not open health posts and walk away
Our impact
| Indicator | Achievement |
|---|---|
| Health posts operational | 316 SFH-supported health posts serving communities across Rwanda |
| Population reached | More than 5 million people served through the health post network |
| Health post growth in Rwanda | From 670 health posts nationally in 2018 to 1,222 in 2021, with SFH Rwanda contributing significantly |
| Geographic reach | Health posts across Rwanda and South Sudan, reaching some of the most underserved areas |
| Services delivered | Maternal care, dental care, eye care, family planning, child health, vaccination, HIV testing, malaria diagnosis and treatment |
| Catalytic grants | Startup grants to private health posts through the Strategic Investment Facility — medicines, salaries, digital infrastructure and capacity building |
| Model recognition | Recognized as a replicable, scalable approach to sustainable primary healthcare in Rwanda and beyond |
Going forward
We are committed to scaling this model until every Rwandan cell has access to a functional, sustainable, community-owned health post. Going forward this work will:
Expand the health post network in underserved areas, focusing on hard-to-reach and rural communities
Scale second-generation health posts so communities do not travel to district hospitals for services that can safely be delivered closer to home
Deepen digital integration through EMR, CMR and Blue Room connectivity, so no patient falls through the cracks
Strengthen the entrepreneurial foundation, investing continuously in business development skills so health posts become increasingly self-sufficient
Extend the model beyond Rwanda, building on our experience in South Sudan
We want every Rwandan to have access to quality care delivered by empowered professionals who live within their communities. This is how we build a health system that lasts.
From the community
Marie Musabyimana once gave birth on her way to a hospital two hours away. Today, with a health post at Batima minutes from her home, her story — and the stories of thousands like her — has changed completely.
Before, people died at home because the hospital was too far. Now, we have care right here. Mothers in labour, children at night — they can all be treated immediately.
