Towards Realizing the Human Right to Health Care for Rwandan Rural Communities through Community-Based Health Insurance (CBHI): The Case of Gisagara District

This study is about the contribution of Community-Based Health Insurance Schemes (CBHI) to realizing the human right to health care in Rwanda. Through the example of Gisagara District, the study explores experiences of rural community households with the CBHI scheme in Rwanda. The study uses a mix of qualitative and quantitative approaches, drawing on interviews with twenty rural households, and a number of interviews with officials and health workers from the District and Ministry of Health. The key findings of this study were that the rate of enrolment is high, and this has helped many rural Rwandans access health care. However the study also found a challenge of sustainability, since around a quarter of rural households were found not to be enrolled, due to their limited financial means. One finding was that the local communities contribute over 65 per cent of all contributions, and donors and government only 35 per cent. For most rural people, although the CBHI system is compulsory, they support it. This includes those who cannot pay because they lack means; this suggests that CBHI seems to be genuinely viewed by those in rural areas as being of importance for their own access to health care. Another finding was that there was a strong political will on the part of government, aimed at improving the existing system. Some modest recommendations at the end of the study seek to improve levels of access in rural communities like Gisagara and elsewhere in Rwanda.