The Political Path to Universal Health Coverage: Elite Commitment to Community-Based Health Insurance in Rwanda

Chemouni, Benjamin

doi:10.2139/ssrn.2893122

Cited by 9 publications

(12 citation statements)

References 34 publications

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“…In this context, imposing new economical burdens on the electorate without guaranteed improved access to services within a short time horizon is risky. In this, it differs from less democratic countries like Ethiopia and Rwanda, which have introduced ambitious schemes (Chemouni, 2016;Lavers, 2016).…”

Section: Discussion: the Future Of Health Insurances In A Changing Pomentioning

confidence: 94%

Social Protection in an Electorally Competitive Environment (2): The Politics of Health Insurance in Tanzania

Pedersen

Jacob

2018

SSRN Journal

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This paper analyses the introduction and expansion of health insurance schemes in Tanzania. Health insurances were introduced around year 2000 as part of a more general health reform process aimed at improving access to health services. The paper argues that the health insurances were driven by a policy coalition of bureaucrats and transnational actors, who, inspired by international trends, framed reforms as a way for the ruling party to live up to one of its core priorities since independence, namely, improved and, eventually, universal access to health services. The introduction of insurances was expected to help mobilise funds and improve the working of the health care system for this purpose. However, judged by their modest design and slow implementation, the ruling political elite remained ambiguous about health insurances. Politically, a fast rollout was perceived to be risky. Similar political considerations may explain the reluctance to expand health insurance coverage through a mandatory scheme that bureaucrats and development partners have propagated recently. The rejection of the initial design for such a scheme came as a surprise to the policy coalition, which did not enjoy the same access to key decisionmakers as in the past. Concurrently, and driven by increased electoral competition, the ruling party has increasingly focused on improving access through the expansion of physical health infrastructure. This has the additional advantage of being highly visible among the rural majority of the population, who overwhelmingly vote Chama Cha Mapinduzi (CCM). This is our second paper on social protection in Tanzania.

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Section: Discussion: the Future Of Health Insurances In A Changing Pomentioning

confidence: 94%

Social Protection in an Electorally Competitive Environment (2): The Politics of Health Insurance in Tanzania

Pedersen

Jacob

2018

SSRN Journal

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“…Mutuelles in several West African countries are voluntary, small-scale, lacking in government support and, with no specific provisions for the poor, tend to favour relatively wealthy groups. In contrast, Rwanda's scheme is a nationwide initiative with strong government support that has achieved unprecedented enrolment rates of 76 percent (Chemouni 2016 In 2008, the Council of Ministers approved the health insurance strategy that presented an enormously ambitious timetable to make both schemes operational within the year, reflecting a high degree of political support and pressure for quick implementation (int. respondent EG13).…”

Section: Securing Support For Health Insurance (2005-10)mentioning

confidence: 99%

“…respondents EG11, EC9, EC12). Furthermore, influential ideas in Rwanda regarding the importance of self-reliance and working towards independence from foreign aid(Chemouni 2016), are likely to have resonated with paradigmatic ideas underpinning the Ethiopian political settlement. 5 Unlike CBHI, designs for SHI drew on a range of experiences from these study tours, with no single policy model.…”

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confidence: 99%

Social Protection in an Aspiring Developmental Statee: The Political Drivers of Community-Based Health Insurance in Ethiopia

Lavers

2016

SSRN Journal

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“…Enrolment in pilot wereda reached 41 percent in 2012 and 48 percent in 2013 (Mebratie et al 2015). This constitutes a more rapid early expansion than that of the mutuelles de santé in Rwanda, generally acknowledged as the most successful CBHI scheme in Africa (Chemouni, 2016). At present, Ethiopia's CBHI covers approximately 7 million people, while the government has also been preparing to launch social health insurance (SHI) to cover civil servants and workers in the formal sector.…”

Section: Introductionmentioning

confidence: 99%

“…Nonetheless, this type of state capacity may well be necessary for CBHI to be successful. There are strong similarities between the Ethiopian experience to date and the implementation of the Mutuelles de Santé in Rwanda's dominant coalition political settlement, where similar forms of state capacity have proven essential to achieving and maintaining high enrolment rates (Chemouni 2016). …”

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confidence: 99%

Social Protection in an Aspiring 'Developmental State': The Political Drivers of Ethiopia's PSNP

Lavers

2016

SSRN Journal

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Social protection in an aspiring 'developmental state': The political drivers of communitybased health insurance in Ethiopia.2 AbstractEthiopia has been piloting and scaling up a community-based health insurance scheme for the informal sector since 2011, alongside preparations for the launch of a social health insurance scheme for the formal sector. This paper examines the political drivers of the adoption and implementation of the scheme, based on key informant interviews with key figures involved in its elaboration. The paper argues that efforts to extend access to healthcare are linked to the ruling coalition's longstanding focus on delivering tangible socioeconomic progress as a means of building its legitimacy and securing political support. Health insurance, meanwhile, has secured elite commitment, primarily due to the 'ideational fit' between this policy idea and core paradigmatic ideas underpinning the ruling coalition.

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The Political Path to Universal Health Coverage: Elite Commitment to Community-Based Health Insurance in Rwanda

Cited by 9 publications

References 34 publications

Social Protection in an Electorally Competitive Environment (2): The Politics of Health Insurance in Tanzania

Social Protection in an Electorally Competitive Environment (2): The Politics of Health Insurance in Tanzania

Social Protection in an Aspiring Developmental Statee: The Political Drivers of Community-Based Health Insurance in Ethiopia

Social Protection in an Aspiring 'Developmental State': The Political Drivers of Ethiopia's PSNP

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