Rwanda’s national under-five mortality rate decreased by 56 per cent between 2004 and 2011, with a rate of 41.7 in 2015. This decline has been realised in part through the development of a National Policy for Community-Based Health Insurance (CBHI) scheme, or Mutuelles de Santé, introduced in 2010 by the Government of the Republic of Rwanda to encourage equal access to health care for the informal sector. The Ministry of Health manages 426 Mutuelles de Santé through a decentralized approach relying on existing community-based health structures.
Membership in the CBHI scheme is accessible to working-age Rwandans in the informal sector with a one-time contribution fee per family member, which varies based on an income categorization of households, and a 10 per cent co-payment fee for all services at health care facilities. Membership fees are divided into three categories: 1) no-cost membership for those unable to pay and no co-payment (25 per cent of the population), 2) RWF 3,000, or USD 4.65, for those who can afford to pay (70 per cent of the population) and, 3) RWF 7,000, or USD 10.85, for those who are determined as able to pay (2 per cent of the population). Household categorisation is based on the collection of nationwide socio-economic and demographic information collected through a participatory approach at the local level through the Ubudehe programme, a series of local consultations initially organised to involve communities in the design of a national proverty reduction programme. CBHI covers all services and drugs at local health centres and more specialised services at district and national hospitals by referral from local health centers. Membership in CBHI grew from 27 per cent in 2003 to 91 per cent in 2010, thus reaching 7.9 million people; and, with 6% of Rwandans covered under other schemes, a total of 97 per cent of Rwandans have improved access to health care.
Rwanda’s CBHI scheme is based on a long history of insurance schemes dating back to the 1960s. Building on experience, the Government of the Republic of Rwanda competed a series of pilot projects in the 1990s to assess financial viability and standardise insurance schemes nationwide. Consequently in 2004 it adopted a national policy to extend schemes to all 30 districts in the country. The official launch of CBHI in 2010 further enhanced delivery of services with an improved implementation structure and stable financial management. Investments in income security, such as the CBHI are essential in building Rwanda’s social protection floor to ensure that all in need have access to basic income security, including all permanent and temporary residents and registered migrants.
Further Reading:
Theophile Ruberangeyo, et. al. (2011). ‘Social Protection: An Ongoing Process’. In Sharing Innovative Experiences: Successful Social Protection Floor Experiences Vol. 18. United Nations Development Programme, New York. Accessed from http://www.ilo.org/wcmsp5/groups/public/---ed_protect/---soc_sec/documents/publication/wcms_secsoc_20840.pdf on December 2016, on page 333.