Management and Social Factors On Sustainability of Mutual Health Insurance in Musanze District 2008 - 2011

ABSTRACT Rwanda like other countries is facing the financial challenge for accessing health services. The Government has resorted to the promotion of mutual health organizations; however the sustainability of these deserves a particular attention. The general objective is to assess the sustainability of mutual health insurance in Musanze district. Specifically this study aims at identifying the roles played by the management and social factors on sustainability of mutual health insurance in Musanze, assessing whether mutual health has improved the access to healthcare, and finally proposing solutions. Different reports from sections of mutual health, interview with heads of sections and medical care providers, as well as a questionnaire addressed to heads of households served as a source of data. The choice of respondents at different levels was based upon a random sample. The sample size required number of 601 household heads. The organs of Musanze mutual health organization are all operational. Membership amounted to 66.6% in 2010. The use of medical care services for adherents was the triple the one observed in non-adherents. The premium and the proportion of medical expenses payable are affordable for patients, according to 86% and 96.4% of respondents respectively. Only 46.9% adhere because they appreciate services provided by mutual health organizations, while 48.4% adhere following the interventionist approach. However, due to the growing advantage offered by mutual health organizations, 89.2% members of MH are willing to adhere without any pressure. The financial situation has proved to be frail. There is unbalance between incomes and expenses. 76.7% of respondents recognize the advantages offered by risk sharing. Unfortunately, members are less involved in Mutual health activities. 46.3% of respondents attended at least a half of the meetings organized by Mutual health organizations. On the whole, the health risk- sharing policy in Rwanda is promising. The interventionist approach is only viewed an educational method which will ultimately end into members attitude change. Expenses incurred by mutual health organizations are superior to incomes. Competent authorities are recommended to gradually replace the interventionist approach with awareness campaign and marketing and to reduce the pooling risk rate. To other researchers, we suggest conducting a survey on the role that the involvement of prevention activities may play as a component of mutual health organizations.

TABLE OF CONTENT

DECLARATION A

DECLARATION B

APPROVAL SHEET

DEDICATION

ACKNOWLEDGEMENTS

ACRONYMS

TABLE OF CONTENT

LIST OF TABLES

ABSTRACT

CHAPTER ONE

THE PROBLEM AND ITS SCOPE

Back ground to the study

Statement of the Problem

Purpose of the study

Objectives of study

General objective

Specific objectives

Research questions

Scope of the study

Significance of the study

CHAPTER TWO

REVIEW OF RELATED LITERATURE

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1

1

1

4

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5

6

6

8

9

9

Concepts, Ideas, Opinions from Authors/ Experts

Demand side of mutual health

Supply side of mutual health

Determinants of viable mutual health insurance

Sustainability of a mutual health

Mutual health insurance in Rwanda

Theoretical perspective

Related studies

Challenges faced by mutual health insurance

CHAPTER THREE

METHODOLOGY

Research Design

Research Population

Sampling Procedures

Research instrument

Validity of the research instruments

Data gathering procedures

Data analysis

Ethical Considerations

Limitations of the study

CHAPTER FOUR

PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA

Introduction

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Demographic and socio-economic characteristics of heads of households surveyed 32

Factors of the sustainability of Musanze mutual health 38

A.Factors of sustainability of the mutual health related to the design 38

B. Factors of sustainability of the mutual health related to the management 43

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C. Factors of sustainability of the mutual health insurance related to the socioeconomic status of beneficiaries 48

D. Factors of sustainability of the mutual health related to environment of

healthcare service providers

CHAPTER FIVE

SUMMARY OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS

SUMMARY OF KEY FINDINGS

CONCLUSIONS AND RECOMMENDATIONS

REFERENCES

APPENDIX I: TRANSIMITAL LETTER FOR THE RESPONDENTS

QUESTIONNAIRES

APPENDIX 2: INTRODUCTORY LETTER

APPENDIX 3: APPOINTMENT LETTER

APPENDIX 4: CURRICULUM VITAE