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COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA

COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA. INYARUBUGA Hertilan CBHI Coordinator. Kampala, 15-16 june 2005. OUTLINE OF THE PRESENTATION. Introduction Evolution of health « mutuelles » Organization and management of health « mutuelles » Partners et Role of the goverment

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COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA

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  1. COMMUNITY BASED HEALTH INSURANCE (CBHI) IN RWANDA INYARUBUGA HertilanCBHI Coordinator Kampala, 15-16 june 2005

  2. OUTLINE OF THE PRESENTATION • Introduction • Evolution of health « mutuelles » • Organization and management of health « mutuelles » • Partners et Role of the goverment • Keys resultats • Opportinities • CBHI challenges • Interventions strategies • CBH and information for management and decision - making • Conclusion

  3. Introduction The health « mutuelles » in Rwanda are associations which are not for commercial purposes and that are based on solidarity of beneficiaries for forseing financial risks in term of access to health care services

  4. Introduction In setting up the health  »mutuelles », the principal objectives are those determined in rwanda government targets:. • To Improve the population financial access to the health care services • To Improve health state of the population • To Improve the financial capacity of the health structures • To Strengthen community participation in health care management

  5. Health Financing Challenge 1: Health services are dependent on external resources and (household) out-of-pocket payments

  6. Health financing challenge 2:Low financial access and utilization of modern health care as a consequence of the levels of out-of-pocket payments

  7. Evolution of health « mutuelles » in Rwanda • Between 1996 and 1997, only one « mutuelle » existing, • In 1998, 6 health « mutuelles » were functional • From 1999 to 2000, 54 « mutuelles » were operating • From 2001 to 2004, 228 « mutuelles » • Later in may 2006, 378 « mutuelles » were operational

  8. BEFORE 1999: RUHONDO CBHI: AN ISOLATED INITIATIVE RUHENGERI: 1 CBHI

  9. 1999-2000: IMPLEMENTATION OF A PILOTE PHASE 54 CBHIs IN 3 HEALTH DISTRICTS RUHENGERI: 1 CBHI BYUMBA 22 CBHI KABUTARE: 15 CBHI KABGAYI 17 CBHI

  10. 2001-2004: 228 CBHI : 2.500.000 BENEFICIARIES (March 2005) Ruhengeri: 11 MS Ngarama 5 MS Byumba 28 SPP Umutara: 1 MS Kibuye: 7 MS Kibungo: 36 MS Mibilizi:1MS Mushaka1MS Gihundwe 4MS Nyamasheke 3 Ruli: 10 MS Nyamata: 10 MS Rulindo 9 MS 4 MS Gikongoro Gakoma: 4 MS Kibilizi: 7 MS Kabutare: 15 SPP Nyanza: 1 MS Gitarama 37 SPP

  11. Later in May 2006: 378 « Mutuelles » with an enrollement rate at 47%. (17) (12) (11) (8) (15) (20) (14) (12) (19) (15) (12) (8) (6) (15) (13) (5) (10) (10) (16) (13) (14) (13) (12) (11) (16) (13) (11) (12) (12) (13)

  12. Organization and Managemt • At the cell and sector level there are health « mutuelles » committees in charge of the sensitization and mobilization • At the health center level a agent is in charge of the administrative and financial management of the « mutuelle » ; at this level, a management committee elected among the members; this committee is mainly in charge of the monitoring. • At the district level, an agent in charge of the coordination of the « mutuelles » within the district

  13. Organization Management At the national level, there is a technical support cell in charge of: • Of the capacity building for « mutuelles » managers • Of the development of policy, strategies and legal frameworks • Of development of management modules and tools • Of the Monitoring

  14. Health Center level: Unlimited access to all services and drugs Referral by (ambulance) to District Hospital District Hospitallevel: all healthcare packages Reference Hopital: all healthcare packages Organization and Management

  15. Organization and management • Variables: • Subscriptions of 2 to 7 households vary between 2.500rwf and 11500rwf • Per capita subscriptions vary between 600rwf and 1000rwf • Ticket    »moderateur » is between 100rwf and 150rwf per episode, and from 5% to 25% in co-payments

  16. The partners & role of Government. • Ministry of Health (MINISANTE) • Ministry of Local Goverment (MINALOC) • Donors and NGOs • Rwanda Popular Banks, Cooperatives • Health centers and districts • Role of government: • Providing Management tools to Health Mutuelle. • Providing facilitating equipments to Health mutuelle. • Providing Budget for Training and Monitoring. • Providing Budget for Indigenous. • Providing Budget pooling risks.

  17. Key Achievements • Increased financial accessibility to health care • Improved financial sustainability of primary health services • Strengthened community participation in healthcare

  18. Result 1: Improvement of financial accessibility: Members of CBHI seek care earlier and use services more frequently than non-members

  19. Result 2 Financial sustainability of basic health care services

  20. FINANCING OF BUNGWE HC BY THE CBHI 2000 2001 2002 2003

  21. Opportunities • - the existence of the culture of social solidarity in the country (protective sacking, pastoral hammock, work jointly) • - the existence of political will • - the existence of the development of the co-operatives • - the existence of at least a medical structure in a district • - facility of communication (language, road, radio etc.)

  22. Main challenges • Gap between the premiums of contribution and the care costs • A large number of « indigents » • Problem of quality of the care provided by the public medical staff • Lack of mobile access to healthcare services throughout the country

  23. Strategic Interventions • Study on the real costs of providing health services • Development of a policy and a strategic framework for the mutual insurance companies • Development of a legal framework • Development of a set of training modules on CBHI management and training of trainers (TOT) • Harmonization des tariffs

  24. Strategic Interventions (cont) • Development of approaches for the improvement of health care quality • (PAQ, Quality assurance and contractual approach) • Development of a risk pooling system for support to mutuelles for district and reference hospitals • Increase health services packages in hospitals

  25. CBHI and Information for management and decision making Up to now three indicators are used for decision-making at the community, and institutions levels: • 1. Number of mutuelles beneficiaries • 2. Enrollement rate • 3. Health services utilization rate

  26. CBHI and Information for management and decision making Soon, with the BIT/STEP,we will implement a software before the end of this year . This software will allow us to capture indicators on : Mutuelles Finances • Premium recover rates • Health care costs • Re-enrollement rates These indicators would allow an appropriate management of the system

  27. Conclusion The health « mutuelles » are a useful tool for the provision of financial access to health services for the poor people, however, its sustainability and strength sare focused on: • The existence of a good quality of health care services for the beneficiaries • The existence of an appealing package of health services for the beneficiairies • The existence of a continued sensitization of the population and the utilization of the witness statements from the benficiairies.

  28. Conclusion • de la participation des beneficiaires dans la gestion des mutuelles de santé • de la bonne gestion administrative et financière du système MERCI

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