The secret ingredients in Rwanda’s journey to achieving UHC
At a plenary sessions at the recently held Africa Healthcare Agenda International Conference (AHAIC 2019) organized by AMREF which held in Kigali, the Executive Secretary of the Community-Based Health Insurance, Dr Solange Hakiba, ascribed the success of the nation-wide community-based health insurance scheme to a strong political will and the leadership’s emphasis on transparency, accountability and social mobilization.
In the post-genocide period after 1994, Rwanda has made good progress with their health system and health indicators, thus providing an inspiring story to Africa and the rest of the world that Universal Health Coverage (UHC) is achievable in African countries.
Rwanda made comprehensive reforms in their health insurance in 2011 and now leads many other countries in both coverage of the population and coverage of services offered. One of such reforms was to tie payment of premiums by citizens to their socioeconomic status. With this method, each community member is assessed and classified collectively by other community members into a socioeconomic category. The poorest categories are subsidized fully by the government.
Christened Mutuelle de Santé, the community health insurance scheme now has more than 85% coverage of the Rwandan population. Each citizen of Rwanda that is covered by the health insurance scheme is one more Rwandan who is able to access healthcare without paying out of pocket and is thereby protected from the ruinous effect of ill-health. The community-based health insurance scheme, also called , pools funds together from monthly contributions/premiums paid by the citizens for the purchase of health services in Rwandan hospitals.
Everyone covered by this scheme can access care at any of the public hospitals and do not have to pay more than 100-200 Rwandan francs (10–20 US cents) as copayments. Universal health coverage is impossible if economic barriers to accessing health care is not eliminated, and in this context, Rwanda is a trailblazer as many African countries that launched some form of health insurance in the same decade are still struggling, unable to cover a high proportion of the population.
Speaking at a plenary session during the AHAIC 2019, Dr Solange spoke on reaching the last 15% of Rwandans and ensuring that all those enrolled remain confident in the scheme by prioritising transparency and accountability. Each year, meeting the targets set by the Rwanda president, Paul Kagame, for district-level coverage is a deliverable for each mayor in Rwanda. Each mayor signs a pledge with the president on the expected targets for that year and in turn signs pledges with local community leaders, thus creating an effective chain of responsibility and accountability.
Supply-side accountability is also important to maintaining the confidence of the public, so monitoring the quality of care provided at the hospitals is also key to the growth of the insurance scheme. As the scheme continues to consolidate on the strong foundation it has built by mobilizing more resources for the scheme and monitoring quality of care at the hospitals, it is hoped that it will continue to blaze a trail for financing UHC in Africa.