Community-based Health Insurance Saves Lives in Rwanda

Photo credit: C. T. Ngoc/MSH.

Eugénie is a widow and farmer living in the southern province of Rwanda, who struggles to provide for her three children. For many years, Eugénie suffered from a renal tumor. Although she had community-based health insurance (CBHI) that covered 90 percent of her medical fees, Eugénie was unable to pay the remaining 10 percent. Her health deteriorated.

In 2004, the Rwandan government implemented community-based health insurance (“Mutuelles”) to improve access to health care for the poorest and most vulnerable segments of the population. But, like Eugénie, many could still not afford necessary care and treatment.

After six years, the government reformed the CBHI contribution system so that members could pay on a sliding scale, based on their income. Now the government and its partners cover the contributions of the poorest and most vulnerable residents. To manage the revised CBHI system, the USAID-funded Integrated Health Systems Strengthening Project (IHSSP), led by Management Sciences for Health (MSH), helped the government to develop a national database that stratifies Rwandan citizens by income. With support from MSH, IHSSP also helped to train and supervise data-entry staff and provide technical assistance to government staff managing the CBHI database.

To date, more than 10 million resident records, representing 96 percent of Rwanda’s population, have been entered into the database. These records have helped to inform the new CBHI scheme and, in turn, improve health care access and equity throughout Rwanda by protecting the nation’s most vulnerable people. Over time, contributions from higher-income groups are expected to generate increased revenue to support CBHI.

The Government of Rwanda and its partners will continue to use this national database to improve health and social welfare programs for years to come. Last year, when this change came to Eugenie’s village, she and her children were classified into the most vulnerable economic group. With free health insurance, Eugenie was able to receive the medications and treatment she needed. In January 2012, Eugénie underwent surgery at the Kigali University Teaching Hospital and is now free of her tumor. She thanks the Rwandan government and its partners for giving her free medical care, and a new start in life.