A Thousand Hills of Health Insurance - Including the poorest groups in Rwanda through community based health insurance

Abstract

Community based health insurance is a hot-topic in the academic world of development experts. There are a lot of different insurance systems, empirical studies are scarce and comparative studies are especially hard to carry out as no health insurance system and no context is the same. Based on field research done in Rwanda and a theoretical comparative study of health insurance system in five other developing countries, the status of the health insurance system in Rwanda is analyzed, with a special focus on the poorest groups in society. The research which focuses on three different geographical spaces in and around Kigali tries to find the bottlenecks in the community bases health insurance system. In the developing world Rwanda’s health insurance system is famous for reaching adhesion rates covering almost the entire nation and with that reaching the poorest groups in society.

Results of the field research and the theoretical comparative study show that the poorest groups in Rwanda are more included in the health insurance system than poor groups in other developing countries. Although one-third of the poorest groups is still not insured in Rwanda, specific pro-poor policies have beneficiated many of the intended target groups. The achievement of such high adhesion rates, even if they are lower than what the government claims them to be, is remarkable for a developing country. Although Rwanda has several context specific advantages that make health insurance policies and specific pro-poor policies easier to implement, different parts of the Rwandan system could be tried in other developing countries.