THE COMMUNITY BASED HEALTH INSURANCE (CBHI)

1
THE COMMUNITY BASED HEALTH INSURANCE (CBHI)
MoH/Health Financing Unit Presented by
MIGISHA Benjamin In charge of Health Insurance
Policy Mob[phone] Emailbenjamigisha_at_yaho
o.fr
2
GOALS AND OBJECTIVES

• Goal
• To provide the population of Rwanda with a
  universal and equitable access to quality health
  services
• Objective
• To give orientations for the development and
  strengthening of the community based health
  insurance (CBHI ) in Rwanda in order to improve
  the financial accessibility of population to
  health care, protect households against the
  financial risks associated to diseases and
  strengthen social inclusion in the health sector.

3
SPECIFIC OBJECTIVES

• Favor the membership in CBHI for people in the
  informal sector and rural areas
• Strengthen the financial viability of the CBHI
• Strengthen management capacities of the CBHI
  system

4
Back ground of rwanda cbhi

• 1994 - 1997 Free Care 1998, Reintroduction of
  the system of cost recovery 1999, Introduction
  to the formal approach to mutual health (pilot in
  3 health Districts District Kabgayi, Byumba and
  Kabutare 52 health centers and 3 hospitals In
  1999, Development of management tools, modules
  and awareness brochures, manuals and training
  management

5
Contd

• In 2004-2005, development of the strategic
  document "Policy of mutual health insurance in
  Rwanda ministerial directive of the Ministry of
  Health, expansion of health insurance schemes .
• CBHI is regulated under the law n62 / 2007 of
  30/12/2007 relating to the creation,
  organization, functioning and management of CBHI
  and published on March 20th, 2008 in the official
  gazette.
• At the same time, utilization of health services
  increased considerably from 30.7 in 2003 to 85
  in 2008 (HMIS).
• Presently, all operational health centers of the
  country shelter a CBHI section which presumes
  100 geographic coverage

6
WHY CBHI Scheme IN RWANDA?

• Reasons to start CBHI in Rwanda
• Very low levels of utilization (0.3 visits/C in
  2001) and studies show that financial barriers to
  access are causing this.
• Financial losses in health facilities due to
  unpaid bills
• Need of Social Protection for all population
  especially the poor category
• Need to create a mechanism for Health Insurance
  for those in informal employment

7
INCREASE of cbhi COVERAGE rate
Année 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Coverage rate 7 27 44 73 75 85 86 91 83 90.7
Utilasation rate 30.7 39 46.8 60.7 72 85 91 95
8
Financial sources

• 1) Contributions from beneficiaries
• 2)Contributions from Government and development
  partners
• 3) Contributions from RSSB and MMI
• 4) Contributions from private Insurance
  companies

9
CBHI Funding
10
CBHI population categories and PREMIUMS
UBUDEHE Categories CBHI Categories Amount per capita (RwF)
12 Very poor 1 2,000 (To be paid by Government)
3 4 Middle category 2 3,000
5 6 Rich 3 7,000
11
Estimation of Population/ Category (source New
Policy)
Categories Estimated age
1 26
2 58
3 16
Total 100
12
Covered Health Services Packages

• Health Center Level Minimum Health Services
  Package
• District Hospital Complementary Package
• Referral Hospital Tertiary Package
• Ambulances cost is also covered

13
ACHIEVEMENTS

• The law n62 / 2007 of 30/12/2007 relating to the
  creation, organization, functioning and
  management of CBHI.
• Elaboration of Ministerial Instructions relating
  to the organization, functioning and management
  of CBHI at all levels and their publication.
• Revision of CBHI policy and its implementation
• Sensitization program made across the country
• Utilization of all media (radio, television, news
  papers etc.)

14
Cont.

• Elaboration of the new management procedures
  manual of CBHI and its implementation.
• Trainning of all CBHI Districts Directors,
  Sections managers and accouantants on the new
  management procedures manual of CBHI

15
CHALLENGES

• Lack of computerization system and internet
  access of CBHI sections for good reporting system
• Lack of facilities( offices, electricity, ) for
  some CBHI Sections.
• Some case of fraud by persons not yet covered by
  any medical insurance scheme
• Misanderstanding on CBHI scheme for some
  individuals

16
Perspective of coming years

• Magnetic cards
• Computerization of all sections
• CBHI infrastructure.

17
conclusion

• The objectives of the development policy of CBHI
  are clearly defined and well shared. They
  strongly reflect the ambition of the Rwandan
  government to promote the accessibility of
  quality health care to all Rwandans, particularly
  the most destitute.
• This determination is shown by the implication of
  local authorities in the improvement of the
  coverage by CBHI and the involvement of
  development partners in the development of CBHI.
  The challenges are certainly numerous, but the
  adherence and participation of Rwandans in the
  development of this policy will favor its
  success.

18
Thank you