Community-based Health Insurance Extending Access to Chronic Diseases Care in Rwanda

 {Photo credit: MSH/Candide Tran Ngoc}Diogène shows his CBHI card.Photo credit: MSH/Candide Tran Ngoc

Thirty-seven year-old Diogène lives in the Eastern province of Rwanda. In March 2012, he began to feel ill. He was short of breath, couldn’t walk uphill, and had chest pains. Diogène held community-based health insurance (CBHI), which enabled him to see a doctor at the Ngarama district hospital, where he was diagnosed with heart disease.

Historically called “diseases of the rich,” chronic diseases are emerging as critical health problems in low-income countries. According to the World Health Organization (WHO), cancers, diabetes, and cardiovascular and chronic respiratory diseases account for nearly 25 percent of Rwanda's burden of disease. This represented a major financial burden for the poorest, who could not afford health care for chronic illness at the tertiary level, and consequently didn’t receive appropriate treatment.

The Government of Rwanda, which aims to increase access to health services for all people, has increased access to chronic health care services in recent years. The new CBHI policy, established in 2010, introduced a system which stratifies the population according to their revenues. The poorest citizens, who are about 25 percent of Rwanda’s population, have now been identified and receive free medical care through CBHI. The referral hospitals at the highest level have also been included into the scheme, which now allows the poorest citizens with chronic diseases to afford specialized treatment.

The USAID-funded Integrated Health Systems Strengthening Project (IHSSP), led by Management Sciences for Health, supported the Rwandan Ministry of Health in the implementation of its new CBHI policy, by providing both technical and financial support and training.

Prior to the inclusion of specialized hospitals in the CBHI scheme, persons diagnosed with NCDs had to pay out of pocket for their care or were not financially able to receive essential treatment and services. Patients with illnesses, such as diabetes, cancer, or heart disease can now more easily access all levels of the health system.

At Kigali University Teaching Hospital, approximately 80 percent of patients referred to the NCDs consultation of the outpatient department use CBHI. Like many others, after his diagnosis, Diogène was referred to the hospital where he received specialized advice, tests, and appropriate drugs not currently available at the district level in his community. Without CBHI, he would not have been able to receive even basic health care. Now he receives the quality health services his life depends on.