Increasing Community-Based Health Insurance in Rwanda

In order to achieve the Government of Rwanda's long-term health vision to "provide sustainable financial resources for the delivery of primary health care for all" by 2020, specific long-term objectives related to health have been set and defined. The objectives are to establish a fair and efficient universal health financing system based on national solidarity, capacity-to-pay, prepayment, and financial protection for all. With support from Management Sciences for Health (MSH), the Government of Rwanda has increased Community-Based Health Insurance (CBHI) adhesion rates from 7% in 2003 to 93% at the end of June 2010. The USAID-funded Integrated Health System Strengthening Project (IHSSP) is supporting the Ministry of Health in the implementation of this new major policy.

The Government of Rwanda created a Mutual Health Insurance Policy in 2004. The main objective of the policy was to assist communities in establishing a health insurance system that improved financial accessibility to health services and protects households against the financial risks associated with becoming ill. Mutual health care insurance programs are supported by household-based contributions. From 2006, the head of the household paid a collective contribution for all dependents equal to $1.70US (per household member). Service providers are currently reimbursed through fee-for-service payments in which the provider receives a payment from the mutual pool after producing an invoice. In this model, different household social and economic categories are not taken into account for payments. The poor and rich were contributing the same amount into the fund. 

To address this discrepancy, a new Community-Based Health Insurance (CBHI) stratification approach was adopted by the Government of Rwanda in 2010. In this new approach the population is subdivided in different socio-economic categories (based on the incomes of each household). Their category determines the amount the household pays into the insurance fund.  All households are categorized in a category from very poor to very rich (six categories were defined).

CBHI is owned by the community and managed by the community to ensure that their needs are met and risks minimized. The stratification process is helping the Government of Rwanda to strengthen their health system and to provide affordable, quality health services to its people.

IHSSP is assisting the Rwanda Ministry of Health in widening its scope to the strengthening of information systems and human resources management in a decentralized structure. Institutionalizing the practice of systematic quality improvement, the Project is working to support the government's efforts to extend quality public health services to the entire country.