Presented at “Financial Protection and Improved Access to Health Care: Peer-to-Peer Learning Workshop Finding Solutions to Common Challenges” in Accra, Ghana, February 2016. To learn more, visit: https://www.hfgproject.org/ghana-uhc-workshop

1. Financial
Protection and
Access to Health
Care Workshop
CBHI Rwanda experiences

2. CBHI Summarized in phases
Phase 1
(1999-2003)
Phase 2 & 3
(2004-2008 -2009)
Phase 4
(2010-2015)
Enrollment 7% 27% - 86% 91% - 76.4%
Premiums Not harmonized in different pilot
schemes
Flat fee:
• Contribution by the
government: 50%
• Contribution by
members 50%
• Subsides for the
poorest
• Stratification: Premiums
according to Socio
Economic categories:
• Indigents fully subsidized
around 25%
Pooling Section levels • Sections (more than
450)
• Districts (30)
• National Pooling Risk
• Sections (more than 450)
• Districts (30)
• National Pooling Risk
Benefit
Package
• Health center (Primary
Care)
• Limited package at District
Hospital level (C section,
non-surgical pediatrics
services, malaria)
• Health center (Primary
Care)
• District hospital
(Secondary care)
• Tertiary health care
• Health center (Primary
Care)
• District hospital
(Secondary care)
• Tertiary health care
• Patient Roaming

3. CBHI: Expanding Coverage
practical strategies
Political will & Local
Leader
Engagement
Stratification of the
population into
socioeconomic
categories & subsides
for indigent
Attractive benefit
package
Intensive awareness
campaigns
Financial accountability

4. Financial Sustainability
Practical strategies
• Increased Resources:
– Diversification of resources (Population contributions,
Government, SHI & PHI);
• Cost containment measures:
– Control on abuse & over-utilization: Co payment &
mandatory referral system;
– Mitigation of insurance risks:
• Adverse selection: Enrollment by HH and no Individuals
• Overbilling: Rigorous bills verification
• CBHI sustainability study scenarios: Revision of
premium levels, universal mandatory enrollment

5. Move of CBHI scheme from
MoH to RSSB:
• Rationale:
– Separation of functions: Providers Vs
Purchaser;
– Improve CBHI management: Financial
management and enhanced insurance
management skills;
– Move from fragmented pools to one pool.

6. Thank you