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.
Policy options to deal with these disparities in accessing to health care are limited. Among them, alternate mechanisms of community financing based on pre-payment and on risk pooling, such as Community Based Health Insurance (CBHI) have proven to be strong options, reconciling an improvement in the financial accessibility to health care and the necessity to mobilize the internal resources necessary to ensure the financial viability of health services.
In Rwanda, CBHI is identified as a privileged channel for the growth of financial accessibility to health services in both rural settings and in the informal sector.
In the CBHI system, beneficiaries are covered at all three levels of health service provision:
1) Health centres
2) District hospitals
3) Referral hospitals
Goal of CBHI
The goal of the CBHI development policy is to provide the population of Rwanda with universal and equitable access to quality health services. CBHI complements other existing social insurance systems such as RAMA and MMI, in addition to private insurance schemes which target workers from the formal and private sector of the economy.
- Strong political commitment by central and decentralized government (CBHI coverage is an important indicator in district performance contracts).
- A decentralized health system
- An excellent network of health facilities in all districts
- Insufficient funds at both district and national risk pooling level
- Weak pooling mechanisms
- Insufficient staff and limited management capabilities
- Possible abuse at different levels in the system
- Large numbers of people in the informal sector with limited capacity to make contributions and who are difficult to identify.