Community-based health insurance gives urban refugees and students in boarding schools in Rwanda a sigh of relief

When Betty and her family arrived in Rwanda in 2001 after fleeing war in the Democratic Republic of Congo (DRC), they were relieved when they finally found safety. But without easy access to essential services such as health care, life was far from ideal.

Having left everything behind, Betty, her husband, and their children were hosted by a Rwandan family at first. After a while they started rebuilding their lives in Rwanda and moved to a rented house. According to the 57-year-old Congolese refugee, living in Kigali, starting over was not easy.

“Just after arriving in Rwanda, one of my children got very sick. He was 3 years old at the time and we didn’t have the means to afford medical services, we relied on neighbors to support us. It was not easy,” Betty recalls. “Having health insurance today, this could not happen again.”

Before the introduction of the Community Based Health Insurance Scheme, Betty’s family used to access health services through a clinic run by UNHCR’s partner- African Humanitarian Action (AHA).

In 2019, the Government of Rwanda and UNHCR agreed to ease challenges related to healthcare access for urban refugees (such as Kigali and Huye) and students in boarding facilities. It resulted in including them in the national Community-Based Health Insurance (CBHI), at par with nationals.  Today, 98% of urban refugees have access to healthcare through CBHI, which makes Rwanda one of a few countries to ease healthcare access for refugees.

“Since I got health insurance, it has become easy to access services. When we go to the health center, we just have to show our refugee ID, and then they check if the ID number is in the system. Once they confirm, we can access all services, and can also get referrals to the hospital if needed, at par with nationals,” Betty says.

Through this scheme, she explains, UNHCR covers 90% and urban refugees have to contribute 10% of the health care cost.

Betty explains that she used to have no difficulties in paying her share of the health insurance cost  using some of the income she brought in from a small trading business. Due to the COVID-19 pandemic, however, her business collapsed highlighting how even affording just this small amount is difficult for vulnerable refugees.

Despite these challenges, Betty prioritized the health for herself and her family.

“We are grateful for the inclusion of refugees in the health insurance scheme. It makes access to medical care easier for us,” she says.

Learning from the lessons, UNHCR and the Government of Rwanda are exploring possibilities of piloting the CBHI in refugee camps. Once it is achieved, it will ease access to healthcare through inclusion, and mobility across the country, which indirectly affects livelihoods and self-reliance efforts; refugees can move and work anywhere in the country, go to the nearest health facility when they fall sick.