The challenge
Out-of-pocket fees kept many Rwandan families from seeking health care.
The case
Community-based health insurance in Rwanda, known as Mutuelles, began in pilot districts in 1999, and a national policy was approved at the end of 2004. From 2007 members paid an annual premium of 1,000 Rwandan francs each, and donors such as the Global Fund paid the fees of the poorest. Community health workers and performance-based payments to clinics were rolled out alongside. An evaluation of the first eight years found that Mutuelles improved use of medical care and protected households from catastrophic health spending, although the poorest members still used less care. Membership grew from 27 per cent in 2003 to 91 per cent in 2010.
Why it worked
Using community structures to enroll people gave the scheme reach and legitimacy. Coverage later fell, to an estimated 75% of those eligible in 2015, so affordability has to be watched constantly.
Sources
- Lu, C., et al. (2012). Towards universal health coverage: An evaluation of Rwanda Mutuelles in its first eight years. PLoS ONE.
- ILO Social Protection toolbox: Rwanda's Community Based Health Insurance
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