JOINT HEALTH SECTOR REVIEW

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					        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.

				
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