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  • 11/20/00
  • 11/20/00 Rate of utilization was very low 30% and studies showed that the first reason was finance – the population couldnot afford health care The health center had many debt of the patient The health financing was in difficult
  • In Rwanda we have a HSSP is and how it is linked to the mandate of the global, the basis of the Round 5, we based on the HSSP, what could be solved by vertical projects and what was cross-cutting and could be solved vertical and looked at the linked betwe
  • 11/20/00
  • 11/20/00 1. Capacity Creation (Pre – service training) Strengthened institutions that train General MD, Nurses and Paramedics, Public Health Supported the internship program (revising the curricula to integrate new norms, procdures for HIV, TB and Malaria programs, they come to the system when they are full equipped to serve) , HIV, will benefit, Malaria benefit , which would not have happened with vertical programs 2. In-service training District hospital managers; health district supervisors; Health Center managers;deputy mayors i/c of health affairs.
  • 11/20/00
  • 11/20/00

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  • NATIONAL HEALTH CARE IN RWANDA THE COMMUNITY BASED HEALTH INSURANCE (CBHI) NGAMIJE Daniel Coordinator of Project management Unit of Global fund and MAP projects Mexico , 03 – 8 AUGUST , 2008
  • Outline of the Presentation
    • 1. Economic and Health situation in Rwanda in 2000
    • 2. Why did the Government set up a Universal CBHI in 2000 ?
    • 3. Principal objectives and organisation of the CBHI
    • 4. CBHI Main results
    • 5. The sustainability of CBHI in Rwanda
    • 6. Conclusion
  • I.Economic and Health situation in Rwanda in 2000 Key Economic Characteristics Key Health Characteristics
    • Economic recovery since 1994 Genocide, but still low per capita income ($235) and widespread poverty (60% of population)
    • Largest number of people active in agriculture (>90% of population) with high population density
    • Very high under 5 mortality (196/1000) and maternal mortality (1071/100,000)
    • Primary causes of morbidity: malaria, respiratory infections and diarrhoeal diseases and low utilization of health services .
    • Formal sector employees are covered in health insurance
    • First community based health insurance (CBHI) schemes launched in 1999 as pilots
  • Rwanda Health System : Programs and sub-programs The Health System Public Health Functions Infrastructure, human- and material resources, and health care financing Public Health Services and High Impact Health Interventions Goal of the Health System To Guarantee the Wellbeing of the Population To Ensure and Promote the Health Status of the Population IMCI Reproductive Health EPI Nutrition Malaria HIV / AIDS / STI Tuberculosis Epidemics and Disasters Mental Health Blindness & Phys. Hand. Environmental Health IEC / BCC Health Care Financing Quality of and Demand for Health Services and Efforts to Control Disease Human Resource Development Drugs, Vaccines and Consumables Infrastructure, Equipment & Laboratory Network National Referral Hospitals & Treatment and Research Centres Institutional Capacity
  • II.Why did the Government set up a Universal CBHI ?
    • Rate of medical utilization was very low (30%) and study showed that the main cause was the finance aspect
    • Health facilities had accumulated debts from patients with impact to their financing system especially after the progressive withdraw of post Genocide Health Donations
    • Equity issue after launching of health insurance for the formal sector
    • Low level of population ownership to health facilities management’s issues
  • III.Principal objectives and organization of the CBHI
    • To Improve health status of the population by supporting the financial access to the health services
    • To Improve the financial capacity of the health facilities
    • To Strengthen community participation in health facilities management
            • Payment source of finance
            • Payment finance
            • Payment finance
    Health Center Sector Level District Hospital Referral Hospital District Level Contributions from : -Voluntary contribution of Pop -Sector revenu -Donors DISTRICT POOLING RISK Contribution from : - Sections of CBHI of HCs - District revenu -National Pooling Risk -Donors NAT POOLING RISK Contributions from : MOH ; Civil Insurance; Military Insurance; FARG Private Insurances; Donors MOH/ Desk CBHI Organization
  • Organization : How the CHBI is financed ?
    • Subscription1000rwf( 2$ US ) per capita per year
    • Ticket « moderateur» is 0.4 $ US per episode at the health center level , and 10 % for co-payment Hospital ‘s bill.
    • District Pooling risk fund : Budget is 2 $ US per member who paid his Subscription:
    • 0.4 $ US from district revenu and Health Center
    • 1.02 $ US from Donors and the national poling risk
    • National Pooling risk fund: Budget is 1$ US per member by the paiement of 1% of annual revenu of national public and private insurances
  • Organization : Roles of Partners in CBHI
    • Technical assistance during pilot period :GTZ ,PH
    • Mobilisation of funds: The Global fund case
    • “ Assuring Access to Quality Care: The Missing Link to Combat AIDS,
    • Tuberculosis and Malaria in Rwanda”
    • Budget 33,945,080 USD (2006-2010 )
  • Obj 1: Improve Access to health care to vulnerable groups
    • Pay membership fees for the very poor( indigents);
    • Pay 50% of membership fees for the District pooling risk
    • Pay membership fees for PLHIV and Orphans
  • Obj2:Improve the Quality of Health Care services
    • 1. Strengthen Capacity for medical students (Pre – service training)
    • 2. In-service training of health providers and managers
    • 3. Revising Policies
    • 4. Operational Research/M&E
    • 5. Infrastructure and equipment
  • IV.CBHI Main results : Annualy increasing membership
  • Active vs passive Contribution to CBHI
  • Primary Health Care cost covered by CBHI
  • Proportionnal Malaria morbidity in Health Centres vs Health Utilization Rate
  • Pourcentage of delivery in health facilities
  • Maternal mortality ( Per100.000) Source DHS 2000 &2005
  • V.The requirement of a sustainable CBHI Central and local Government Contribution Development Partner Contribution
    • Clear goal: to achieve universal coverage of health insurance
    • Commitment to engage in institutional reform & Policy to achieve goals
    • Specific budget for supporting CBHI by C.Gvt and local Gvt contribution
    • Conduct Studies on the real costs of health services provided at different levels
    • Strong engagement in Sector Wide Approach in health
    • Strong technical contributions
    • Engage in long term projects addressing CBHI issues
  • Conclusion “Health Insurance for all” : Right choice at right time and Solidarity with vulnerable groups