Nyarurenzi health center in a Kigali suburb
KIGALI — Rwanda has approved sweeping changes to its community-based health insurance scheme, raising annual premiums for most households while exempting the poorest citizens from paying anything, in what officials describe as a necessary step to keep the system financially sustainable.
The reforms affect the country’s widely used Rwanda Social Security Board-managed Community-Based Health Insurance program, commonly known as Mutuelle de Santé.
The new structure, published Tuesday in the National Gazette, links annual contributions more directly to income categories under the national social classification system.
Under the revised rates, households classified in the lowest income bracket will pay zero francs, with the government covering their full contribution.
Those in the next category will pay Rwf 3,000 per person annually. Contributions then rise progressively — Rwf 5,000, Rwf 8,000, Rwf 10,000 and up to Rwf 20,000 per person per year for the highest income group.
The increases, say officials, are designed to reflect citizens’ ability to pay, reduce pressure on the national budget and strengthen the long-term viability of the scheme, which covers the vast majority of Rwanda’s population.
The principle is equity and sustainability. Those with greater means contribute more, while the most vulnerable are fully protected.
The government argues that the previous flat-rate model no longer matched the rising costs of health care, expanded service packages and population growth.
Over the years, the benefits covered under Mutuelle have widened significantly, increasing reimbursement pressures on the system.
Rwanda’s health insurance system is dominated by Mutuelle de Santé, the community-based scheme that covers about 93 percent of insured citizens and underpins the country’s near-universal coverage.
The RSSB scheme, including coverage for civil servants and formal workers, accounts for roughly 4 percent, while MMI for security forces and private insurers together cover less than 3 percent.
Overall, more than nine in ten Rwandans have health insurance.
The lateet announcement comes as Rwanda marks 25 years of Community-Based Health Insurance, a flagship policy credited with dramatically expanding access to health care since its introduction in the early 2000s.
Two major public events are scheduled today February 24 to mark the anniversary and explain the reforms.
In Kayonza District, in eastern Rwanda, the Minister of Health Dr Sabin Nsanzimana, the chief executive of the Rwanda Social Security Board, Regis Rugemanshuro, and local leaders were expected to meet citizens to discuss the new contribution structure and recently added services.
In Kigali’s Gasabo District, the Minister of Local Government and senior RSSB officials are holding a parallel engagement.
The anniversary events are also being used to introduce a new payment reform known as capitation — a model in which health facilities receive funds in advance based on the number of patients they serve, rather than being reimbursed per service.
The pilot phase has already begun in parts of eastern Rwanda, including Kayonza, as authorities test whether pre-payment to facilities can improve efficiency and cost control.
The reforms arrive at a delicate moment. Rwanda’s health system is often cited by international institutions as a model for expanding coverage in low-income countries.
But sustaining universal coverage has required increasing financial discipline as demand for care rises.
While officials have emphasized that no one in the poorest category will pay any premium, some middle-income households will see noticeable increases in their annual contributions.
The government maintains that the new graduated model ensures fairness and shields the most vulnerable from additional burden.
