Community based health insurance cbhi in rwanda
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COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA. INYARUBUGA Hertilan CBHI Coordinator. Kampala, 15-16 june 2005. OUTLINE OF THE PRESENTATION. Introduction Evolution of health « mutuelles » Organization and management of health « mutuelles » Partners et Role of the goverment

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COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA

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Community based health insurance cbhi in rwanda

COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA

INYARUBUGA HertilanCBHI Coordinator

Kampala, 15-16 june 2005


Outline of the presentation

OUTLINE OF THE PRESENTATION

  • Introduction

  • Evolution of health « mutuelles »

  • Organization and management of health « mutuelles »

  • Partners et Role of the goverment

  • Keys resultats

  • Opportinities

  • CBHI challenges

  • Interventions strategies

  • CBH and information for management and decision - making

  • Conclusion


Introduction

Introduction

The health « mutuelles » in Rwanda are associations which are not for commercial purposes and that are based on solidarity of beneficiaries for forseing financial risks in term of access to health care services


Introduction1

Introduction

In setting up the health  »mutuelles », the principal objectives are those determined in rwanda government targets:.

  • To Improve the population financial access to the health care services

  • To Improve health state of the population

  • To Improve the financial capacity of the health structures

  • To Strengthen community participation in health care management


Community based health insurance cbhi in rwanda

Health Financing Challenge 1: Health services are dependent on external resources and (household) out-of-pocket payments


Community based health insurance cbhi in rwanda

Health financing challenge 2:Low financial access and utilization of modern health care as a consequence of the levels of out-of-pocket payments


Evolution of health mutuelles in rwanda

Evolution of health « mutuelles » in Rwanda

  • Between 1996 and 1997, only one « mutuelle » existing,

  • In 1998, 6 health « mutuelles » were functional

  • From 1999 to 2000, 54 « mutuelles » were operating

  • From 2001 to 2004, 228 « mutuelles »

  • Later in may 2006, 378 « mutuelles » were operational


Community based health insurance cbhi in rwanda

BEFORE 1999:

RUHONDO CBHI: AN ISOLATED INITIATIVE

RUHENGERI:

1 CBHI


Community based health insurance cbhi in rwanda

1999-2000: IMPLEMENTATION OF A PILOTE PHASE

54 CBHIs IN 3 HEALTH DISTRICTS

RUHENGERI:

1 CBHI

BYUMBA

22 CBHI

KABUTARE:

15 CBHI

KABGAYI

17 CBHI


2001 2004 228 cbhi 2 500 000 beneficiaries march 2005

2001-2004: 228 CBHI : 2.500.000 BENEFICIARIES (March 2005)

Ruhengeri:

11 MS

Ngarama

5 MS

Byumba

28 SPP

Umutara:

1 MS

Kibuye:

7 MS

Kibungo:

36 MS

Mibilizi:1MS

Mushaka1MS

Gihundwe 4MS

Nyamasheke 3

Ruli:

10 MS

Nyamata:

10 MS

Rulindo

9 MS

4 MS

Gikongoro

Gakoma:

4 MS

Kibilizi:

7 MS

Kabutare:

15 SPP

Nyanza:

1 MS

Gitarama

37 SPP


Later in may 2006 378 mutuelles with an enrollement rate at 47

Later in May 2006: 378 « Mutuelles » with an enrollement rate at 47%.

(17)

(12)

(11)

(8)

(15)

(20)

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(15)

(12)

(8)

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(15)

(13)

(5)

(10)

(10)

(16)

(13)

(14)

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(11)

(16)

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Community based health insurance cbhi in rwanda

Organization and Managemt

  • At the cell and sector level there are health « mutuelles » committees in charge of the sensitization and mobilization

  • At the health center level a agent is in charge of the administrative and financial management of the « mutuelle » ; at this level, a management committee elected among the members; this committee is mainly in charge of the monitoring.

  • At the district level, an agent in charge of the coordination of the « mutuelles » within the district


Organization management

Organization Management

At the national level, there is a technical support cell in charge of:

  • Of the capacity building for « mutuelles » managers

  • Of the development of policy, strategies and legal frameworks

  • Of development of management modules and tools

  • Of the Monitoring


Organization and management

Health Center level:

Unlimited access to all services and drugs

Referral by (ambulance) to District Hospital

District Hospitallevel: all healthcare packages

Reference Hopital: all healthcare packages

Organization and Management


Organization and management1

Organization and management

  • Variables:

  • Subscriptions of 2 to 7 households vary between 2.500rwf and 11500rwf

  • Per capita subscriptions vary between 600rwf and 1000rwf

  • Ticket    »moderateur » is between 100rwf and 150rwf per episode, and from 5% to 25% in co-payments


The partners role of government

The partners & role of Government.

  • Ministry of Health (MINISANTE)

  • Ministry of Local Goverment (MINALOC)

  • Donors and NGOs

  • Rwanda Popular Banks, Cooperatives

  • Health centers and districts

  • Role of government:

  • Providing Management tools to Health Mutuelle.

  • Providing facilitating equipments to Health mutuelle.

  • Providing Budget for Training and Monitoring.

  • Providing Budget for Indigenous.

  • Providing Budget pooling risks.


Key achievements

Key Achievements

  • Increased financial accessibility to health care

  • Improved financial sustainability of primary health services

  • Strengthened community participation in healthcare


Community based health insurance cbhi in rwanda

Result 1: Improvement of financial accessibility:

Members of CBHI seek care earlier and use services more frequently than non-members


Community based health insurance cbhi in rwanda

Result 2 Financial sustainability of basic health care services


Financ ing of bungwe hc by the cbhi

FINANCING OF BUNGWE HC BY THE CBHI

2000 2001 2002 2003


Opportunities

Opportunities

  • - the existence of the culture of social solidarity in the country (protective sacking, pastoral hammock, work jointly)

  • - the existence of political will

  • - the existence of the development of the co-operatives

  • - the existence of at least a medical structure in a district

  • - facility of communication (language, road, radio etc.)


Main challenges

Main challenges

  • Gap between the premiums of contribution and the care costs

  • A large number of « indigents »

  • Problem of quality of the care provided by the public medical staff

  • Lack of mobile access to healthcare services throughout the country


Strategic interventions

Strategic Interventions

  • Study on the real costs of providing health services

  • Development of a policy and a strategic framework for the mutual insurance companies

  • Development of a legal framework

  • Development of a set of training modules on CBHI management and training of trainers (TOT)

  • Harmonization des tariffs


Strategic interventions cont

Strategic Interventions (cont)

  • Development of approaches for the improvement of health care quality

    • (PAQ, Quality assurance and contractual approach)

  • Development of a risk pooling system for support to mutuelles for district and reference hospitals

  • Increase health services packages in hospitals


Cbhi and information for management and decision making

CBHI and Information for management and decision making

Up to now three indicators are used for decision-making at the community, and institutions levels:

  • 1. Number of mutuelles beneficiaries

  • 2. Enrollement rate

  • 3. Health services utilization rate


Cbhi and information for management and decision making1

CBHI and Information for management and decision making

Soon, with the BIT/STEP,we will implement a software before the end of this year . This software will allow us to capture indicators on :

Mutuelles Finances

  • Premium recover rates

  • Health care costs

  • Re-enrollement rates

    These indicators would allow an appropriate management of the system


Conclusion

Conclusion

The health « mutuelles » are a useful tool for the provision of financial access to health services for the poor people, however, its sustainability and strength sare focused on:

  • The existence of a good quality of health care services for the beneficiaries

  • The existence of an appealing package of health services for the beneficiairies

  • The existence of a continued sensitization of the population and the utilization of the witness statements from the benficiairies.


Conclusion1

Conclusion

  • de la participation des beneficiaires dans la gestion des mutuelles de santé

  • de la bonne gestion administrative et financière du système

    MERCI


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