Community based health insurance cbhi in rwanda
Download
1 / 28

COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA - PowerPoint PPT Presentation


  • 129 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA' - brina


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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


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


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


BEFORE 1999:

RUHONDO CBHI: AN ISOLATED INITIATIVE

RUHENGERI:

1 CBHI


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)

(14)

(12)

(19)

(15)

(12)

(8)

(6)

(15)

(13)

(5)

(10)

(10)

(16)

(13)

(14)

(13)

(12)

(11)

(16)

(13)

(11)

(12)

(12)

(13)


Organization and Managemt enrollement rate at 47%.

  • 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 enrollement rate at 47%.

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 enrollement rate at 47%. 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 enrollement rate at 47%.

  • 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. enrollement rate at 47%.

  • 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 enrollement rate at 47%.

  • Increased financial accessibility to health care

  • Improved financial sustainability of primary health services

  • Strengthened community participation in healthcare


Result 1: Improvement of financial accessibility: enrollement rate at 47%.

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


Result enrollement rate at 47%. 2 Financial sustainability of basic health care services


Financ ing of bungwe hc by the cbhi
FINANC enrollement rate at 47%.ING OF BUNGWE HC BY THE CBHI

2000 2001 2002 2003


Opportunities
Opportunities enrollement rate at 47%.

  • - 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 enrollement rate at 47%.

  • 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 enrollement rate at 47%.

  • 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 enrollement rate at 47%.)

  • 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 enrollement rate at 47%.

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 enrollement rate at 47%.

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 enrollement rate at 47%.

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 enrollement rate at 47%.

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

  • de la bonne gestion administrative et financière du système

    MERCI


ad