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THE COMMUNITY BASED HEALTH INSURANCE
(CBHI)
MoH/Health Financing Unit
Presented by :MIGISHA Benjamin
In charge of Health Insurance Policy
Mob(+250)788526557
Email:[email protected]
GOALS AND OBJECTIVES
Goal
 To provide the population of Rwanda with a universal
and equitable access to quality health services
Objective
 To give orientations for the development and
strengthening of the community based health insurance
(CBHI ) in Rwanda in order to improve the financial
accessibility of population to health care, protect
households against the financial risks associated to
diseases and strengthen social inclusion in the health
sector.
SPECIFIC OBJECTIVES



Favor the membership in CBHI for people
in the informal sector and rural areas;
Strengthen the financial viability of the
CBHI;
Strengthen management capacities of the
CBHI system
BACK GROUND OF RWANDA CBHI

1994 - 1997: Free Care
1998, Reintroduction of the system of cost
recovery
1999, Introduction to the formal approach to
mutual health (pilot in 3 health Districts :
District Kabgayi, Byumba and Kabutare: 52
health centers and 3 hospitals
In 1999, Development of management tools,
modules and awareness brochures, manuals and
training management
CONT’D
In 2004-2005, development of the strategic document
"Policy of mutual health insurance in Rwanda’’
ministerial directive of the Ministry of Health,
expansion of health insurance schemes .
 CBHI is regulated under the law n°62 / 2007 of
30/12/2007 relating to the creation, organization,
functioning and management of CBHI and published
on March 20th, 2008 in the official gazette.
 At the same time, utilization of health services
increased considerably from 30.7% in 2003 to 85% in
2008 (HMIS).
 Presently, all operational health centers of the country
shelter a CBHI section; which presumes 100 %
geographic coverage

WHY CBHI SCHEME IN RWANDA?

Reasons to start CBHI in Rwanda:

Very low levels of utilization (0.3 visits/C in 2001) and
studies show that financial barriers to access are
causing this.

Financial losses in health facilities due to unpaid bills

Need of Social Protection for all population especially
the poor category

Need to create a mechanism for Health Insurance for
those in informal employment
INCREASE OF CBHI COVERAGE RATE
Année
2003
2004
2005
Coverage rate
7%
27% 44%
Utilasation rate
30.7% 39%
46.8%
2010
2011
2012
85% 86%
91%
83%
90.7%
85%
95%
2006
2007
2008
73%
75%
60.7%
72%
2009
91%
Financial sources
1) Contributions from beneficiaries;
2)Contributions from Government and development
partners;
3) Contributions from RSSB and MMI;
4) Contributions from private Insurance companies;
CBHI FUNDING
CBHI POPULATION CATEGORIES AND
PREMIUMS
UBUDEHE
Categories
CBHI Categories
Amount per capita
(RwF)
1&2
Very poor
1
2,000 (To be paid by
Government)
3 &4
Middle category
2
3,000
5 &6
Rich
3
7,000
ESTIMATION OF POPULATION/ CATEGORY
(SOURCE: NEW POLICY)
Categories
Estimated %age
1
26
2
58
3
16
Total
100%
COVERED HEALTH SERVICES PACKAGES
 Health
Center Level: Minimum Health
Services Package
 District
Hospital: Complementary
Package
 Referral
Hospital: Tertiary Package
 Ambulances
cost is also covered
ACHIEVEMENTS
The law n°62 / 2007 of 30/12/2007 relating to the
creation, organization, functioning and management of
CBHI.
 Elaboration of Ministerial Instructions relating to the
organization, functioning and management of CBHI at all
levels and their publication.
 Revision of CBHI policy and its implementation
 Sensitization program made across the country
 Utilization of all media (radio, television, news papers etc.)

CONT.
Elaboration of the new management procedures
manual of CBHI and its implementation.
 Trainning of all CBHI Districts Directors,
Sections managers and accouantants on the new
management procedures manual of CBHI

CHALLENGES
Lack of computerization system and internet access of
CBHI sections for good reporting system
 Lack of facilities( offices, electricity, …) for some
CBHI Sections.
 Some case of fraud by persons not yet covered by any
medical insurance scheme;
 Misanderstanding on CBHI scheme for some
individuals

PERSPECTIVE OF COMING YEARS
Magnetic cards;
 Computerization of all sections;
 CBHI infrastructure.

conclusion
The objectives of the development policy of CBHI
are clearly defined and well shared. They
strongly reflect the ambition of the Rwandan
government to promote the accessibility of
quality health care to all Rwandans, particularly
the most destitute.
 This determination is shown by the implication of
local authorities in the improvement of the
coverage by CBHI and the involvement of
development partners in the development of
CBHI. The challenges are certainly numerous,
but the adherence and participation of Rwandans
in the development of this policy will favor its
success.

THANK YOU