Rwanda’s health system reforms started in 1999 when the Ministry of Health implemented a pilot program of 54 community-based health insurance (CBHI) schemes across three districts within the country. Each scheme partnered with a health center and local populations began to enroll. Management of each scheme was placed in the hands of its members, who elected a five person executive committee. Each district had a District Federation of Prepayment Schemes (DFPS) with responsibility over district policies.
Enrollees must wait one month after enrollment before receiving care. The schemes covered a basic package that included all services and drugs provided by the health center as well as ambulance transport to the district hospital where limited services were included. Each scheme reimbursed the health center with a capitation payment while district hospitals were paid per episode by the DFPS.
In 2002, a strategy to scale-up and build technical capacity was implemented by the Ministry of Health, Ministry of Local Affairs, and external partners. By 2005, CBHI schemes covered the entire country. Premiums and co-payments vary from scheme to scheme. The government covers these costs for the indigent population as well as other vulnerable groups.
There are two facets to the benefits package. The Minimum Package of Activities (MPA) covers all services and drugs provided at the health centers including pre- and post-natal care, vaccinations, family planning, minor surgical operations, and essential and generic drugs. The Complementary Package of Activities (CPA) covers a limited number of services at the district hospitals, including the cost of hospitalization, caesarian operations, minor and major surgical operations, medical imaging, and all diseases afflicting children ages 0 to 5 years. As of 2006, the CPA benefits package was extended to cover select services in national hospitals.
Coverage has increased from 1% in 2000 to 90% in 2009