Protecting Families through Community-Based Health Insurance in Rwanda

The USAID-supported, MSH-led Rwanda Health Systems Strengthening (RHSS) Project works to reinforce the Rwandan government’s capacity to plan, lead, and implement strategic interventions to strengthen key health system structures and processes, all while building sustainability and country ownership.

The project and its predecessor have been working with the government of Rwanda for years on its community-based health insurance program (CBHI) program. Introduced in 2004, CBHI is recognized at health facilities across Rwanda for improving access to services and promoting a culture of prevention to save lives.

In 2015, the RHSS, launched a high-profile awareness campaign throughout the country to educate communities about the benefits of community-based health insurance (CBHI). This campaign prompted a 7 percent increase in enrollment, from 76.3 percent in fiscal year 2014/15 to 81.6 percent in 2015/16.

CBHI is a key strategy toward achieving Rwanda’s goal of universal health coverage (UHC) for its nearly 12 million people. Introduced as a pilot project in 1998 and implemented nationally in 2004, CBHI ensures access to affordable health services and reduces out-of-pocket payments at the point of care for the country’s informal sector. CBHI is accepted at all public health facilities and guarantees access to a subsidized package of health services in exchange for premiums. Premiums are based on financial status, with the government subsidizing the full cost for the lowest income families. CBHI members must re-enroll on an annual basis to receive these benefits.

Prior to the launch of the awareness campaign in 2015, the Ministry of Health (MoH) had transferred management of the CBHI program to the Rwanda Social Security Board (RSSB) to consolidate the management of the country’s insurance schemes and to improve both the efficiency of the scheme and reduce administrative costs. During the time of this transition, there was widespread concern about a possible drop in CBHI enrollment rates and uncertainty among beneficiaries as to whether they would receive the same benefits.   

To mitigate these potential challenges, MSH, in partnership with the Ministry of Local Government (MINALOC) and the RSSB, designed and launched a mass media campaign called  “CBHI: a family pillar.” The campaign featured some of Rwanda’s biggest names in entertainment who traveled to all five provinces of the country, using music and drama to educate people about protecting family health through insurance.

The RHSS Project continues to support RSSB and MINALOC to sustain and increase CBHI membership, improve the CBHI’s financial sustainability and management, and address data challenges for monitoring and evaluating CBHI’s performance. The RHSS Project also supports an integrated membership management and payment database, which is designed to be implemented in all districts and integrated with key performance monitoring payment mechanisms at the RSSB.