A Lifeline for All: For 25 years, the CBHI system has ensured that every Rwandan, regardless of their socio-economic status, has access to professional medical care and life-saving treatments.
Rwanda’s Community Based Health Insurance (CBHI) turns twenty-five. After more than two decades of standing between Rwandans and ill health, the system now looks to Rwandans to increase its capability to take on ever more life threatening diseases.
Over the next few days, Rwandans will be hearing much about the new reforms in CBHI, colloquially known as Mutuweli, a corruption of Mutuelle de Sante. There is something of an irony in borrowing a French term to describe what is a quintessentially Rwandan concept of mutual support.
The new reforms will include a slight increase in individual contributions, but while some complaints will be inevitable, even the loudest of complainers will nonetheless be thankful that that the government continues to bear the greatest burden of the costs to ensure the nation’s health.
The basic contribution will rise from Rwf 3,000 to 4,000 with government subsiding Rwf 1,000 for those on the lowest incomes, and the full amount for those with no income.
As much as anything else, the CBHI system is a reflection of the new Rwanda, a country that remains mindful of ancient Rwandan values as it modernises, the better to “leave no one behind” as the oft repeated refrain goes.
The system draws from Rwanda’s value system of community mutual support, where the stronger supports the weaker, and the more fortunate the less so. It is a partnership between government and governed, for the good of the nation. It is noteworthy for instance that the system first targeted coverage to informal workers, and vulnerable groups for whom prayer was the only recourse when they fell ill.
But individual contributions have remained static for fifteen years, during which time costs increased, as Rwanda’s healthcare capacity has expanded and advanced. Costly treatments such management of non communicable diseases (NCDs), cancer treatments, chronic dialysis, and lately kidney transplants, were now covered.
The Face of Progress: As Rwanda moves toward world-class health standards, the CBHI remains the primary pillar of support for millions, bridging the gap between community needs and modern medical solutions.
The announced increase in contributions, although still modest, added to creative revenue sources under Prime Minister’s Orders, introduced between 2019 and 2021, to maintain the system’s affordability, is expected to narrow the gap between increasing costs and revenue in the healthcare system.
Under the revised structure, premiums will continue to be based on socio-economic classification rather than a flat, or to put it more simply, on ability to pay.
Health facilities, which until now have been reimbursed for each service provided, will be moved to a capitation payment model, a fixed payment for each member enrolled. The new structure is designed to put greater emphasis on prevention and early intervention, continuity of care while making costs more predictable and simplifying billing.
Long regarded as the leading community-based health insurance model on the African continent, the system continued reforms may yet elevate to among the best globally.
