Rwanda has lived one of the most tragicmoments of its history with the genocide of 1994, whichresulted in nearly one million deaths, and the destructionof the social fabric of the country. Mutual aid andcommunity solidarity value systems have remained resilienttraits of Rwanda's society, and continue to betranslated in coping strategies in the health care area.After the 1994 war, however, mutual aid initiatives haveemerged in the health sector as community responses to thereintroduction of user-fees in public, and mission healthfacilities. Building on these community initiatives, healthauthorities, and non-government organizations have movedthese emerging strategies to a deliberate strategy ofbuilding community-based health insurance schemes in thehealth sector. Community-based health insurance schemes(CBHI) provided also a platform for the compilation ofinformation to support the assessment of CBHI schemes, andto familiarize health sector actors, and partners with thestrategies needed to support their implementation on a largescale. CBHI schemes in Rwanda are health insuranceorganizations based on a partnership between the communityand health care providers. As consensus built-up on thebenefits of the CBHI schemes, a multi-level leadershipdeveloped in the country to provide support to theadaptation, and extension of the schemes. Political leadersat the central level, starting from the Presidency, calledfor the mobilization of all actors to support theimplementation of CBHI schemes throughout the country.
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