THE COMMUNITY BASED HEALTH INSURANCE (CBHI)

1. MoH/Health Financing Unit Presented by :MIGISHA Benjamin In charge of Health Insurance Policy Mob(+250)788526557 Email:benjamigisha@yahoo.fr THE COMMUNITY BASED HEALTH INSURANCE (CBHI)

2. 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.

3. 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

4. Back ground of rwandacbhi • 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

5. 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

6. 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

7. INCREASE of cbhi COVERAGE rate

8. 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;

9. CBHI Funding

10. CBHI population categories and PREMIUMS

11. Estimation of Population/ Category (source: New Policy)

12. Covered Health Services Packages • Health Center Level: Minimum Health Services Package • District Hospital: Complementary Package • Referral Hospital: Tertiary Package • Ambulances cost is also covered

13. 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.)

14. 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

15. 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

16. Perspective of comingyears • Magnetic cards; • Computerization of all sections; • CBHI infrastructure.

17. 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.

18. Thank you