SUBSIDIZED COMMUNITY HEALTH INSURANCES FOR UNIVERSAL ACCESS TO HEALTH CARE IN RWANDA Claude SEKABARAGA, MD, MPH Director of planning, policy and capacity building Ministry of Health BACKGROUND When modern health care was introduced in Rwanda, it was free of charge and was given as public subsidies (Infrastructures, equipments, personnel, drugs and other consumables) to health facilities. This system was established with an assumption of availability of all necessary means as well as its good management, which in reality was very difficult to happen ideally. BACKGROUND (Con’t) A dilapidation of health care‘s quality similar to most of the developing countries during the period of 1980 to 1990 was the consequence of this situation. In 1992, Based on the Bamako Initiative, Rwanda introduced community participation for financing and management of health care. In 2001, utilization of primary health care cut down to 23% (EICV 1*); Demand side strategies were developed by strengthening prevention interventions and health insurance for all. *Households conditions survey VISION Investment in strong prevention interventions of major diseases by public subsidies; Universal access to curative care for all people living in Rwanda through universal coverage of health insurances; Performance based financing of public health facilities to improve quality of care. STRATEGIES Developing many types of health insurances such as social insurances by solidarity among workers; Mobilizing subsidies contributions for the poorest; Contribution of the Government to strengthen national solidarity; Advocacy of all health sectors’ partners for support of community health insurances CURRENT SUBSIDIES GOR: National: 814,020,309 Rwf; Transfers to Districts: 536,000,000 Rwf; Traditional justice judges: ??? GLOBAL FUND: 1,510,000,000 Rwf; USG through many NGO’s: ???; RWANDA NGO’S; FAITH BASED ORGANIZATIONS:??? ► Those subsidies represent 25% of community health insurances budget SUSTAINABILITY OF FINANCING TO SUBSIDY POORS 13% from the Ministry health annual budget; 12% will come from the Civil servant social insurance annual budget, 12% will from the Military social insurance annual budget; 12% from the genocide victim’s fund annual budget; 12% from the private’s health insurances annual budget; Partners will bring additional support; Currently, Funds at national and local government’s are under development to manage the subsidies. CONCLUSION To ensure universal coverage of health insurance in poor countries, subsidies to cover prevention, investment and law socio-economic categories is crucial; National and international solidarity is necessary; Sustainability strategies must be elaborated for sustainable development.