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APHA Scientific Session and Event Listing

Recorded presentation

Ben Karenzi, MD, Rwanda Ministry of Health, c/o IntraHealth International/Twubakane Project, PO Box 4585, Kigali, Rwanda, Laura Hoemeke, MPH, Twubakane Project, IntraHealth International, PO Box 4585, Kigali, Rwanda, and Claude Sekabaraga, MD, Director of Policy and capacity Building, Ministry of Health, P.O. Box 84, Kigali, Rwanda, 250 577458, Sekabaragac@moh.gov.rw.

To promote universal access to health care in post-genocide Rwanda, the government has wholeheartedly supported the creation of community-based health financing pre-payment schemes known as mutuelles. Although similar programs have been introduced in several countries in Africa with little national impact or extended coverage, in Rwanda the mutuelles movement has gained considerable momentum--growing from one in 1998 to 60 in 2001 to 354 in 2005. Advocacy, partnering and sensitization campaigns initiated by the Ministry of Health, with support from IntraHealth International, have resulted in significant growth in membership and improved quality and use of services. Mutuelles have contributed to stronger financial capacity at partner health facilities, with some generating up to 75% of total revenue for their local health center. Most importantly, data show that mutuelle members access services--including preventive services--earlier and more often than non-members who pay out of pocket for care. Despite these encouraging gains, the mutuelles movement is still fragile, with many challenges to overcome. The extreme poverty of more than 60% of Rwandans makes paying the average $2 membership per family member difficult for many. The impact of providing extensive coverage for people living with AIDS needs additional attention and financial support. Other issues--including standardization of membership fees, expansion of the services covered, open year-round enrollment and the involvement of mutuelles in health promotion and advocating for improved quality--must be addressed to ensure mutuelles continue to enhance accessibility and quality of services.

Learning Objectives:

• • List factors contributing to national expansion of the community-based insurance program in Rwanda
• • Describe contribution of mutuelles movement in Rwanda to use of health services
• • Discuss challenges in scaling up mutuelles movement to ensure increased access to quality care in the face of extreme poverty

Keywords: Community-Based Partnership, Health Insurance

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation