Rwanda’s Health Financing Sustainability Policy of 2015 states that the country ‘has achieved close to universal population coverage of health insurance through the innovative design and implementation of a combination of mandatory insurance schemes tailored to fit the needs and financial capacities of different segments of society’.
Currently, the country has four insurance schemes:
- Community Based Health Insurance (CBHI also known as Mutuelle de santé);
- Private health insurance;
- Military Medical Insurance (MMI) for armed forces; and
- La Rwandaise d’Assurance Maladie (RAMA) for civil servants.
The country’s achievements through the above schemes are attributed to a number of factors:
An elaborate legal and policy framework
Rwanda has a set of policies, laws and procedure manuals which guided the establishment and subsequent management of health insurance schemes. The laws are regularly revised basing on lessons learnt during implementation and the changing socio-economic context of the country. The laws make it mandatory for any person, whether Rwandan or foreign national, who is on the Rwandan territory to have health insurance.
According to the CBHI law of 2015, any person who fails to enrol into a health insurance scheme while he/she does not fall within the category of the needy eligible for assistance, is liable to an administrative fine of five thousand Rwanda Francs (Rwf 5,000) to ten thousand Rwanda francs (Rwf 10,000). In addition, any person who incites others to refrain from enrolling into CBHI scheme is liable to an administrative fine of fifty thousand (Rwf 50,000) to two hundred thousand Rwanda francs (Rwf 200,000).
Political will and commitment
The commitment of both national and district level political leaders to deliver on their promises drives them to mobilise the population to participate in development programs including enrolling for health insurance. Local leaders right from village level have a duty to mobilise people to pay annual premiums.
The CBHI law also provides for establishment of mobilisation committees elected by the people at village, cell and sector levels. The committees are responsible for coordinating CBHI scheme activities and evaluating the scheme coverage rate at their level. They submit periodic reports to the next administrative level above them.
A reliable national population database
Rwanda boasts of robust bottom-up and top-down mechanisms for stratifying the population into four different socio-economic categories. The mechanisms have facilitated creation of a national database where every resident is identified according to the socio-economic category they belong to and can be traced back to village level. The database makes it possible for Rwanda Social Security Board to set appropriate health insurance premiums for each population category. There is cross-subsidisation of health insurance schemes from richer to poor categories while the indigent are paid for by the government and development partners.