Analyzing Challenges Associated with the Implementation of Community Based Health Insurance (CBHI) in Rwanda

Abstract

With the aim of achieving the fourth, fifth and sixth Millennium Development goals, since 2000 Rwanda has been striving to put much effort in reinforcing the Community Based Health Insurance scheme (CBHI). The scheme is known to be covering the largest percentage of the poorer population. Its implementation had recorded success from year to year, whereby the trend went from 1% of coverage in 2000 to 91% in 2010. However, the quick recovery of Rwanda and the success in achieving global goal of healthcare for all, there are undocumented facets of health system management that need to be documented (health care standards and poor services offered to people under CBHI policy and the mismanagement of CBHI funds). Through various documentations (local newspapers, researches), this study has addressed the roots of the above healthcare ethical issues and strategies to mitigate the extent of the problem. Firstly, Rwandan education system should train more nurses and doctors in order to increase the number of workforce in Rwandan health system. Secondly, put in place incentive mechanism to retain the existing health professionals and attract the new ones working in rural areas. Thirdly, offering more ethics related training programs to nurses and other health facilities’ staff who deal with patients. Finally, Rwandan government with other key stakeholders should rethink CBHI structure by formalizing relationship between CBHI sections at local level and the national board in charge (RSSB) as a well-structured institution in order to avoid a bizarre and recurring mismanagement of CBHI funds.