As Rwanda’s Community-Based Health Insurance (CBHI), popularly known as Mutuelle de Santé, marks 25 years of expanding access to affordable healthcare, the government has introduced a revised contributions framework. The new system determines each household’s payment based on a combination of income and socio-economic profiling. ALSO READ: Mutuelle de Sante: Government to start paying health centres in advance The reforms, announced in a February 23 joint brief by the Rwanda Social Security Board (RSSB), the Ministry of Health, the Ministry of Local Government (MINALOC), and the Ministry of Finance and Economic Planning, introduce a new income-based premium structure and expand benefits to strengthen long-term sustainability. ALSO READ: Govt mulls Mutuelle de Santé review to improve access to medicines Currently, Mutuelle de Santé contributions are Rwf3,000 or Rwf7,000 per person per year, depending on socioeconomic levels. New premium structure Under the revised system, contributors are grouped into five income levels. Individuals with no income fall under level assigned Rwf4,000 per year, an amount expected to be fully subsidised by the government. This group represents about 7 per cent of the population, according to the brief. Level two includes people earning below Rwf30,000 per month. They must contribute Rwf4,000 and receive a government subsidy of Rwf1,000. This category accounts for 23 per cent of the population. Those earning between Rwf30,000 and Rwf60,000 per month are classified under level three. They have to contribute Rwf5,000 without any subsidy and make up the largest share at 35 per cent. Level four covers individuals earning between Rwf60,000 and Rwf120,000 per month. They contribute Rwf8,000 with no government support and represent about 27 per cent of the population. At the top, level five consists of individuals earning above Rwf120,000 per month. They contribute Rwf20,000 without subsidy and account for 8 per cent of the population. The reform seeks to improve fairness by aligning contributions more closely with income while strengthening the financial sustainability of the scheme, according to the government. ALSO READ: Drugs covered by Mutuelle double with Rwf20bn more funding How classification works The premium reform is based on household profiling data collected by the Ministry of Local Government using 17 socio-economic indicators. In collaboration with the National Institute of Statistics of Rwanda, a composite score was developed to classify households into different socio-economic levels. Income data from RSSB and the Rwanda Revenue Authority (RRA) complements the social registry information and takes precedence where discrepancies arise, as it better reflects actual income or its closest proxy. Household information from MINALOC, RSSB, and RRA is regularly updated to ensure classifications remain accurate. Citizens can check their household information, including their contribution category, through the MINALOC system by dialing *195#. Contributions can be paid through the RSSB system using *876# or through the Irembo online service platform. ALSO READ: Banks, insurance firms to contribute to Mutuelle de Santé as government looks to increase scheme services Progress toward national coverage Mutuelle de Santé was introduced around 2000 following a sharp decline in healthcare utilisation. The current law governing CBHI – which was enacted in 2015 – strengthened its financial base by requiring other health insurance companies to contribute to the scheme. Coverage expanded rapidly, rising from about 7 per cent in 2003 to more than 88 per cent in 2025, making CBHI central to Rwanda’s universal health coverage strategy, according to Rwanda Biomedical Centre and RSSB. The scheme also helps members to get access to treatment before their conditions worsen. Financial sustainability under pressure In 2015, management of CBHI was transferred from the Ministry of Health to RSSB to enhance accountability and ensure long-term viability. Over the past decade, CBHI revenues increased from Rwf26.9 billion to Rwf107.2 billion – annually – underscoring sustained commitment from households. However, expenditures grew faster, rising nearly 300 per cent to Rwf149.1 billion, driven by new services and revised medical tariffs in the 2025/26 financial year, according to the brief. This trend increased reliance on government and external funding. Following the premium reform, member contributions are projected to reach Rwf69.8 billion in the 2026/27 financial year, representing about 48 per cent of anticipated revenues. Government financing is expected to decline from 67 per cent to 52 percent, improving the scheme’s funding balance. Expanded benefits and payment reform The CBHI benefit package has been expanded to include high-cost specialised services such as dialysis for chronic kidney disease, cancer treatment, kidney transplantation, major orthopedic and spine surgeries, total hip replacement, and assistive technologies, according to RSSB. ALSO READ: Rwanda moves to make cancer treatment more affordable for population A capitation payment model has also been introduced at health centre level, replacing the fee-for-service system. Under capitation, facilities receive fixed payments per enrolled member in advance. The pilot was launched in Eastern Province in December 2025. The reform is expected to improve cost predictability, increase efficiency, enhance continuity of care, and strengthen accountability, according to RSSB. Health cost coverage details Under the scheme, members pay Rwf200 per visit to health centres and 10 per cent of hospital bills, while 90 per cent is covered by the scheme – but this excludes drugs bought by patients at external pharmacies. Services are provided at facilities that have agreements with RSSB, and only approved drugs and procedures defined by the Ministry of Health in collaboration with RSSB are reimbursed. Coverage becomes effective once all household members are registered and contributions paid, except those covered by other insurance schemes. Except for emergencies, referrals are required to access higher-level hospitals.
