Introduction: Community-based health insurance for urban refugees and refugee students in Rwanda
This project focuses on the long-term protection of refugees by ensuring their inclusion in health care systems. Amid the global outbreak of COVID-19, with more than 798 cases currently in Rwanda, the inclusion of refugees in health care systems is particularly relevant and important. The extension of the national Community Based Health Insurance (CBHI) to urban refugees and refugee students from the camps studying in urban areas is an inspiring step to ensure the health care of refugees.
In this interview, a refugee student enrolled in the CBHI and a project manager share their experiences of the pandemic.
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A refugee's experience amidst COVID-19
A female Burundian refugee aged 28, living in Kigali, who has been a refugee in Rwanda since 31 January 2018, shares her thoughts.
How have you and your community been affected by the coronavirus situation so far?
The virus has affected all aspects of life. We no longer have jobs we used to have. We are concerned on how we are going to pay for rent, food and other needs if we don’t get back to those small jobs we used to have.
Are you facing challenges in accessing appropriate health care?
Yes, it was interesting that the first time I went at the medical center for the transfer, they saw me in the CBHI system but when I got the transfer to Kibagabaga hospital, they didn’t find me in the system. So, I called UNHCR to ask what was wrong but the medical center still saw me. And I was told that in UNHCR they can see me in the system.
They gave me another transfer to another hospital. At Kanombe hospital, they saw me in the system and sent me back to Kibagabaga hospital for the results. I had to pay for my consultation as they could not find me on the system initially, but the rest of the treatment was covered by the insurance. I was treated as any other patient and got right medication.
Another challenge I have faced at the time of COVID-19 related lock-down, is that I couldn’t get transport to hospital as we were in total lock-down. I went to both those hospitals on foot and it was a very long distance. If I was very ill, my health could have worsened.
Hospitals asked me for my photocopy documents but I couldn’t get them photocopied as all shops were closed, so I managed to ask in a pharmacy for help.
How long have you been covered by the Community Based Health Insurance?
I got the insurance in September 2019 and used it for the first time in April during lock-down.
How does the Community Based Health Insurance support you amid the coronavirus outbreak?
The COVID-19 response is accessible to nationals and refugees alike. Like Rwandans, we are following the government rules on how to protect ourselves.
Sustaining Community-Based Health Insurance in response to COVID-19
Views from the project managers
How has the Community Based Health Insurance program been affected by the coronavirus situation?
COVID-19 has delayed the enrollment of urban refugees and students in the Community Based Health Insurance (CBHI) initiative. Enrollment is a rolling exercise.
When the COVID-19 lock-down began in Rwanda in March, about 78.5 % of urban refugees were enrolled in the CBHI program. In order to increase enrollment, UNHCR and the Government of Rwanda had planned further outreach by using local government channels such as community work and religious gatherings. These could not be implemented because mass gatherings were not allowed.
As a consequence, basic primary health care services for urban refugees who are not yet enrolled is supported by UNHCR and health partners through the designated urban health centers.
How is the program contributing to an effective, refugees-inclusive COVID-19 response in Rwanda?
The CBHI is inclusive of urban refugees and students, and so is the Government of Rwanda’s COVID-19 response.
Both the CBHI and the response to COVID 19 make it easier for urban refugees and nationals to access public healthcare – there is no discrimination in services provided.
What challenges have you faced and what steps have you taken to address them?
At the moment, urban refugees who are not yet enrolled may face challenges with private access to healthcare – this does not concern boarding school students with camp-based families because they access healthcare in respective camps. However, the operation has devised strategies to ensure that vulnerable urban refugees are facilitated.
The health partner has identified and entered into agreement with some health centers in the urban areas to offer health services for urban refugees who are not yet enrolled to the CBHI.
The services are paid by UNHCR through the health partner. However, COVID-19 services are free to all populations living in Rwanda including refugees and asylum seekers.
What are the lessons learned by your project for protecting refugees in the future and finding long-term solutions in line with the Global Compact on Refugees?
The GCR is about providing support for countries that host refugees, who in turn ensure that refugees have access to national systems through inclusive policies. The fact that urban refugees have the same access to the CBHI as nationals do is a huge step towards that inclusivity, one that could be replicated in the region.
- Official commitments of the Government of Rwanda are a confirmation of the already supportive refugee protection environment. There is need for continued dialogue, negotiation and support from different humanitarian and development stakeholders to fulfill these commitments.
Official documentation (such as refugee IDs) are essential in ensuring refugees inclusion in national systems. Lack thereof makes some refugees remain uncovered while others are already benefiting from national services; this is being addressed.
Communicating with urban refugees about their enrollment in CBHI and general outreach needs to be improved. Bulk SMS messaging has just been activated; this will be a useful tool to reach out.
Progressive access: As in any program when it is rolled out after a short period of time, the CBHI for urban refugees hasn't reached 100% access yet. This requires UNHCR and partners to keep the parallel systems and phase these out in a progressive manner for everyone to be covered.
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