Community-based health insurance for urban refugees and refugee students in Rwanda
The project in brief
Ministry in charge of Emergency Management (MINEMA), Rwanda
Started July 2019 but full implementation in October 2019.
Based on the Memorandum of Understanding (MoU) the project ends on June 2020, but it is renewable through consent by the concerned parties.
The Government of Rwanda has committed to the inclusion of urban refugees including students in the boarding schools to the national Community Based Health Insurance (CBHI). Currently, more than 50% of the target refugees are enrolled and the rest are being progressively enrolled subject to the verification and issuance of national documentation.
Normally the CBHI is open to nationals who pay premiums according to their socio-economic profiles. In the context of the Comprehensive Refugee Response Framework (CRRF), the Government of Rwanda, participating in the Leaders’ Summit (2016) in New York, made commitments for refugees’ inclusion to national systems. This prompted the signature of a tripartite MoU between the Ministry in charge of Emergency Management (MINEMA), UNHCR and the Rwanda Social Security Board (RSSB). This has paved the way for the inclusion of urban refugees and refugee students to the national CBHI. Aware of the cost and gaps of urban refugees access to healthcare, and that only the most vulnerable were supported by UNHCR, UNHCR has financially supported and pushed this project as a more cost-effective and sustainable approach to meeting health needs for urban refugees and refugee students who are away from their camp based families. Refugees are considered as a special category, but pay the same premium rate as nationals do.
The objective of the MoU between UNHCR, MINEMA and the RSSB is “to establish a framework defining the modalities of cooperation between MINEMA, RSSB and UNHCR in order to provide medical insurance for urban refugees and refugee students”. The CBHI will allow urban refugees and refugee students to access primary health services, and to an extent, secondary and tertiary health care within the government health facilities across the country on par with Rwandan nationals.
- Ministry in Charge of Emergency Management (MINEMA)
- Rwanda Social Security Board (RSSB)
- Africa Humanitarian Action (AHA-health partner)
- United Nations High Commissioner for Refugees (UNHCR)
How challenges were overcome
- The Government of Rwanda made the CBHI related pledge alongside the other one of ensuring 100% of refugees have proper documentation issued by the competent government body. As documentation is still being issued after verification, about 50% of the target refugees are still progressively being enrolled.
- Some principal applicants (PA) were registered as asylum seekers – pending refugee status determination (RSD) procedure, while their dependents were registered as refugees. Initially, dependents could not access the CBHI but the Government of Rwanda later authorized their access irrespective of the PA’s status.
- The list of enrolment was based on the verification data for urban refugees (conducted 1 year ago), making it difficult to establish whether the cases that did not turn up for CBHI enrolment are still on the territory or are not aware or have voluntarily repatriated.
- There are some cases of persons of concern (PoCs) who have non-communicable diseases (NCD) and whose medicines may not be covered by the CBHI, thus requiring a supplementary budget to meet such needs.
How they were overcome
The challenges were, and are, being addressed through continuous consultations and discussions with different stakeholders (MINEMA, RSSB, UNHCR, health partners and refugee executive committees) working and mitigating on the gaps and challenges. Moreover, another round of CBHI card distribution for children under the age of 16 has been scheduled at camp level during the current school break (December 2019) in order to cover most, if not all, children under 16 years old. Two health centers in Kigali were selected to provide primary health care services for PoCs who are not yet enrolled in CBHI (asylum seekers and others not in the CBHI system).
Results of the Good Practice
With the CBHI, refugees in urban areas and refugee students have access to any government health facility where they live and wherever they are in the country just like Rwandan nationals. This allows urban refugees to focus on their livelihood activities and students on their studies. This paves the way for their future livelihoods and human capital, which are useful in any possible durable solution a refugee may have access to.
The project will continue and be enhanced. The MoU will be revisited before the end of its validity. In addition, subject to the progress in livelihood intervention, the GoR and UNHCR may explore possibilities for better-off refugees to pay the premium for CBHI through engagement in livelihood opportunities.
To find out how his project has responded to the COVID-19 pandemic, please read here.
Veneranda, SPIU Coordinator, Ministry in charge of Emergency Management (MINEMA), Rwanda
Jonathan Calbayan, Public Health Officer, UNHCR Rwanda