The Assurance of Insurance: Community-based Health Insurance Saves Lives in Rwanda


Eugénie is a widow and farmer living in the southern province of Rwanda, who struggles to provide for her three children. For many years, Eugénie suffered from a renal tumor. Although she had community-based health insurance (CBHI) that covered 90 percent of her medical fees, Eugénie was unable to pay the remaining 10 percent, and her health deteriorated.

Initiated by the Rwandan Government in 2004, CBHI was implemented to improve access to health care for the poorest and most vulnerable segments of the population. After six years, however, the government reformed the CBHI contribution system so that all members could pay on a sliding scale, based on their income. The contributions of the poorest and most vulnerable residents are now covered by the government and its partners. Over time, contributions from higher-income groups are expected to generate increased revenue to support CBHI.

Eugénie shows her child's CBHI card.
Eugénie shows her child’s CBHI card.

To manage the revised CBHI system, USAID’s Integrated Health Systems Strengthening Project (IHSSP), supported under the U.S. President’s Emergency Plan for AIDS Relief, helped the government to develop a national database that stratifies Rwandan citizens by income. With support from its implementer, Management Sciences for Health (MSH), IHSSP also helped to train and supervise data-entry staff and provide technical assistance to government staff managing the CBHI database.

To date, more than 10 million resident records, representing 96 percent of Rwanda’s population, have been entered into the database. These records have helped to inform the new CBHI scheme and, in turn, improve health care access and equity throughout Rwanda by protecting the nation’s most vulnerable people. The Government of Rwanda and its partners will continue to use this national database to improve health and social welfare programs for years to come.

Last year, when this change came to Eugenie’s village, she and her children were classified into the most vulnerable economic group. With free health insurance, Eugenie was able to receive the medications and treatment she needed. In January 2012, Eugénie underwent surgery at the Kigali University Teaching Hospital and is now free of her tumor. She thanks the Rwandan Government and its partners for giving her free medical care and a new start in life.