IDEAS home Printed from https://ideas.repec.org/a/eee/wdevel/v106y2018icp87-98.html
   My bibliography  Save this article

The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda

Author

Listed:
  • Chemouni, Benjamin

Abstract

Rwanda is the country with the highest enrolment in health insurance in Sub-Saharan Africa. Pivotal in setting Rwanda on the path to universal health coverage (UHC) is the community-based health insurance (CBHI), which covers more than three-quarters of the population. The paper seeks to explain how Rwanda, one of the poorest countries in the world, managed to achieve such performance by understanding the political drivers behind the CBHI design and implementation. Using an analytical framework relying on political settlement and ideas, it engages in process-tracing of the critical policy choices of the CBHI development. The study finds that the commitment to expanding health insurance coverage was made possible by a dominant political settlement. CBHI is part of the broader efforts of the regime to foster its legitimacy based on rapid socio-economic development. Yet, CBHI was chosen over other potential solutions to expand access to healthcare because it was also the option the most compatible with the ruling coalition core ideology.

Suggested Citation

  • Chemouni, Benjamin, 2018. "The political path to universal health coverage: Power, ideas and community-based health insurance in Rwanda," World Development, Elsevier, vol. 106(C), pages 87-98.
    • Handle: RePEc:eee:wdevel:v:106:y:2018:i:c:p:87-98
    DOI: 10.1016/j.worlddev.2018.01.023
    as

    Download full text from publisher

    File URL: http://www.sciencedirect.com/science/article/pii/S0305750X18300330
    Download Restriction: Full text for ScienceDirect subscribers only
    File URL: https://libkey.io/10.1016/j.worlddev.2018.01.023?utm_source=ideas
    LibKey link: if access is restricted and if your library uses this service, LibKey will redirect you to where you can use your library subscription to access this item
    ---><---

    As the access to this document is restricted, you may want to search for a different version of it.

    References listed on IDEAS

    as
    1. Frederick Golooba-Mutebi, 2013. "Politics, political settlements and social change in post-colonial Rwanda," Global Development Institute Working Paper Series esid-024-13, GDI, The University of Manchester.
    2. Habyarimana, James & Humphreys, Macartan & Posner, Daniel N. & Weinstein, Jeremy M., 2007. "Why Does Ethnic Diversity Undermine Public Goods Provision?," American Political Science Review, Cambridge University Press, vol. 101(4), pages 709-725, November.
    3. Karima Saleh & Bernard F. Couttolenc & Helene Barroy, 2014. "Health Financing in the Republic of Gabon," World Bank Publications - Books, The World Bank Group, number 20411.
    4. Alberto Alesina & Reza Baqir & William Easterly, 1999. "Public Goods and Ethnic Divisions," The Quarterly Journal of Economics, President and Fellows of Harvard College, vol. 114(4), pages 1243-1284.
    5. Tom Lavers & Sam Hickey, 2015. "Investigating the political economy of social protection expansion in Africa: At the intersection of transnational ideas and domestic politics," Global Development Institute Working Paper Series esid-047-15, GDI, The University of Manchester.
    6. Armando Barrientos & Sony Pellissery, 2012. "Delivering effective social assistance: does politics matter?," Global Development Institute Working Paper Series esid-009-12, GDI, The University of Manchester.
    7. Rachel Sabates‐Wheeler & Samantha Yates & Emily Wylde & Justine Gatsinzi, 2015. "Challenges of Measuring Graduation in Rwanda," IDS Bulletin, Blackwell Publishing, vol. 46(2), pages 103-114, March.
    8. repec:ilo:ilowps:487627 is not listed on IDEAS
    9. Tom Lavers, 2016. "Social protection in an aspiring ‘developmental state’: The political drivers of community-based health insurance in Ethiopia," Global Development Institute Working Paper Series esid-071-16, GDI, The University of Manchester.
    10. Gisselquist, Rachel M. & Leiderer, Stefan & Niño-Zarazúa, Miguel, 2016. "Ethnic Heterogeneity and Public Goods Provision in Zambia: Evidence of a Subnational “Diversity Dividend”," World Development, Elsevier, vol. 78(C), pages 308-323.
    11. Miguel, Edward & Gugerty, Mary Kay, 2005. "Ethnic diversity, social sanctions, and public goods in Kenya," Journal of Public Economics, Elsevier, vol. 89(11-12), pages 2325-2368, December.
    12. Karima Saleh & Bernard F. Couttolenc & Helene Barroy, 2014. "Health Financing in the Republic of Gabon," World Bank Publications - Reports 24580, The World Bank Group.
    13. Niamh Gaynor, 2014. "'A nation in a hurry': the costs of local governance reforms in Rwanda," Review of African Political Economy, Taylor & Francis Journals, vol. 41(sup1), pages 49-63, October.
    14. Jehu-Appiah, Caroline & Aryeetey, Genevieve & Spaan, Ernst & de Hoop, Thomas & Agyepong, Irene & Baltussen, Rob, 2011. "Equity aspects of the National Health Insurance Scheme in Ghana: Who is enrolling, who is not and why?," Social Science & Medicine, Elsevier, vol. 72(2), pages 157-165, January.
    15. Alexander S. Preker & Guy Carrin, 2004. "Health Financing for Poor People : Resource Mobilization and Risk Sharing," World Bank Publications - Books, The World Bank Group, number 15019.
    16. Saksena, Priyanka & Antunes, Adélio Fernandes & Xu, Ke & Musango, Laurent & Carrin, Guy, 2011. "Mutual health insurance in Rwanda: Evidence on access to care and financial risk protection," Health Policy, Elsevier, vol. 99(3), pages 203-209, March.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.
    1. Benjamin Chemouni, 2016. "The political path to universal health coverage: Elite commitment to community-based health insurance in Rwanda," Global Development Institute Working Paper Series esid-072-16, GDI, The University of Manchester.
    2. Hollard, Guillaume & Sene, Omar, 2020. "What drives the quality of schools in Africa? Disentangling social capital and ethnic divisions," Economics of Education Review, Elsevier, vol. 74(C).
    3. Gershman, Boris & Rivera, Diego, 2018. "Subnational diversity in Sub-Saharan Africa: Insights from a new dataset," Journal of Development Economics, Elsevier, vol. 133(C), pages 231-263.
    4. Nishant Chadha & Bharti Nandwani, 2017. "Ethnic fragmentation and school provision in India," WIDER Working Paper Series wp-2017-176, World Institute for Development Economic Research (UNU-WIDER).
    5. Christophe Muller, 2016. "Ethnic inequality and community activities in Indonesia," WIDER Working Paper Series wp-2016-170, World Institute for Development Economic Research (UNU-WIDER).
    6. Nishant Chadha & Bharti Nandwani, 2017. "Ethnic fragmentation and school provision in India," WIDER Working Paper Series 176, World Institute for Development Economic Research (UNU-WIDER).
    7. Christophe Muller, 2016. "Ethnic inequality and community activities in Indonesia," WIDER Working Paper Series 170, World Institute for Development Economic Research (UNU-WIDER).
    8. Porten, John & Rhee, Inbok & Gibson, Clark, 2022. "Ethnicity is not public service destiny: The political logic of service distribution in South Africa," World Development, Elsevier, vol. 159(C).
    9. Yonatan Dinku & Dereje Regasa, 2021. "Ethnic Diversity and Local Economies," South African Journal of Economics, Economic Society of South Africa, vol. 89(3), pages 348-367, September.
    10. Klaus Desmet & Ignacio Ortuño-Ortín & Romain Wacziarg, 2009. "The political economy of ethnolinguistic cleavages," Working Papers 2009-17, Instituto Madrileño de Estudios Avanzados (IMDEA) Ciencias Sociales.
    11. Gerring, John & Thacker, Strom C. & Lu, Yuan & Huang, Wei, 2015. "Does Diversity Impair Human Development? A Multi-Level Test of the Diversity Debit Hypothesis," World Development, Elsevier, vol. 66(C), pages 166-188.
    12. Desai, Raj M. & Olofsgård, Anders, 2019. "Can the poor organize? Public goods and self-help groups in rural India," World Development, Elsevier, vol. 121(C), pages 33-52.
    13. Christophe Muller, 2017. "Ethnic Horizontal Inequity in Indonesia," Working Papers halshs-01508026, HAL.
    14. Zhang, Zhe & Zhang, Xu & Putterman, Louis, 2019. "Trust and cooperation at a confluence of worlds: An experiment in Xinjiang, China," Journal of Economic Behavior & Organization, Elsevier, vol. 161(C), pages 128-144.
    15. Anand Sahasranaman & Henrik Jeldtoft Jensen, 2018. "Ethnicity and wealth: The dynamics of dual segregation," PLOS ONE, Public Library of Science, vol. 13(10), pages 1-22, October.
    16. Remi Jedwab & Adam Storeygard, 2019. "Economic and Political Factors in Infrastructure Investment: Evidence from Railroads and Roads in Africa 1960–2015," Economic History of Developing Regions, Taylor & Francis Journals, vol. 34(2), pages 156-208, May.
    17. Rachel Glennerster & Edward Miguel & Alexander D. Rothenberg, 2013. "Collective Action in Diverse Sierra Leone Communities," Economic Journal, Royal Economic Society, vol. 0, pages 285-316, May.
    18. David Hugh-Jones & Carlo Perroni, 2015. "Why are heterogeneous communities inefficient? Theory, history, and an experiment," Working Paper series, University of East Anglia, Centre for Behavioural and Experimental Social Science (CBESS) 15-08, School of Economics, University of East Anglia, Norwich, UK..
    19. repec:dau:papers:123456789/11437 is not listed on IDEAS
    20. Gisselquist, Rachel M. & Leiderer, Stefan & Niño-Zarazúa, Miguel, 2016. "Ethnic Heterogeneity and Public Goods Provision in Zambia: Evidence of a Subnational “Diversity Dividend”," World Development, Elsevier, vol. 78(C), pages 308-323.
    21. Andreoni, James & Payne, A. Abigail & Smith, Justin & Karp, David, 2016. "Diversity and donations: The effect of religious and ethnic diversity on charitable giving," Journal of Economic Behavior & Organization, Elsevier, vol. 128(C), pages 47-58.

    Corrections

    All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:eee:wdevel:v:106:y:2018:i:c:p:87-98. See general information about how to correct material in RePEc.

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: Catherine Liu (email available below). General contact details of provider: http://www.elsevier.com/locate/worlddev .

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.

    IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.