The Award offers worldwide recognition of a country’s exceptional commitment and achievements in the field of social protection in line with the ISSA’s vision of Dynamic Social Security. The award is presented every three years at the World Social Security Forum, which this week gathered 1300 social security leaders and experts from around the world in Brussels, Belgium.

Universal health coverage in record time

The 2019 ISSA Award for Outstanding Achievements in Social Security went to the Government of Rwanda for achieving almost full health insurance coverage in less than 20 years and reaching the highest health coverage rates in Sub-Saharan Africa. “Rwanda has achieved something truly unique in moving towards universal health coverage in record time, and this Award is in recognition of the impressive work done by Rwandan authorities over the last two decades”, said ISSA Secretary General Marcelo Abi-Ramia Caetano.

Rwanda lived through a traumatic genocide in 1994 and a subsequent breakdown of the health system. Based on sound political commitment, good governance and management, along with long-term planning, Rwanda made impressive strides towards universal health coverage starting with a pilot in 1999 and reaching more than 90 per cent coverage in 2018.

Innovative community based approach

The success of Rwanda lies in its innovative model of a “national community based health insurance”, characterised by:

• Complementary community-based health insurance schemes combined with the advantages of compulsory health insurance;
• Combining community-level schemes with the professional management structures of the existing social security scheme;
• Important domestic financing input complemented by donor funds instead of the other way around;
• Compulsory coverage of community-based schemes based on the realization that voluntary coverage cannot achieve universal coverage;
• Compulsory contributions and co-payments, even if at a low level.

In presenting the Award to Rwanda, the ISSA also signaled the belief that several aspects of this approach can serve as model and inspiration to other countries.

Impressive results

The universal health coverage scheme of Rwanda contributed significantly to the improvement of several key social development indicators, including reduced emergency health expenditures and therefore poverty; reduced infant and maternal mortality rates by two-thirds since the year 2000, increased health education and family planning for women, and increased social equality and equity.