OBJECTIVES: Coverage of Rwanda CBHI increased from 7% in 2003 to 87% in 2022. The scheme is credited for improvements in key health outcomes including reduction in maternal and infant mortality, and overall increase in utilization. To sustain these gains, this client survey was commissioned to assess members satisfaction of the scheme including the services they received at facilities.

METHODS: The survey employed a mixed methodology mainly questionnaire survey, Key Informant Interviews (KIIs) and Focus Group Discussions (FGDs). Applying systematic sampling, 6,086 households were surveyed across the 30 districts. The survey sample size was calculated at 95% Confidence Interval. 20 FGDs and 11 KIIs were conducted in selected districts.

RESULTS: 18% of current CBHI members are dissatisfied with the CBHI services. The perception of poor quality of services is higher among current CBHI respondents (16.5%) compared to 9.8% of respondents who have never enrolled in the CBHI. 76.4% of the current CBHI members indicated that that prescribed drugs are not always covered by CBHI while 37.8% indicated that the CBHI related drugs are not always available at the facility. 16.7% of respondents indicated that the skills of healthcare personnel are low, and 20.1% indicated they do not have access to specialized healthcare services. This feedback was corroborated during the FGDs and KIIs. The FGDs raised concerns of limited staffing, lack of certain services at PHC facilities resulting in indirect costs associated with referrals, and difficulty in adding or checking eligibility of members. The top 3 major challenges faced when visiting a health facility are long waiting time, drugs stockout, and long travel time to the nearest facilities. 33.6% of the respondents mentioned that the current CBHI premiums are unaffordable.

CONCLUSIONS: The study recommended that the general quality of healthcare at facilities should be improved especially availability of medicines and clinical staff at PHC facilities.