Financing Noncommunicable Disease Care in Rwanda Assessing the Responsiveness of Community-Based Health Insurance to Chronic Health Needs

Background: Non-communicable diseases (NCDs) are growing as major cause of death worldwide, disproportionately impacting low-and-middle income countries (LMICs). Although chronic illnesses are becoming more prevalent in Rwanda, the country’s health financing system is still centered around acute and infectious care. This study examines whether Community-Based Health Insurance (CBHI) and Performance based Financing (PBF), Rwanda’s falgship financing mechanisms are well positioned to provide long-term NCD care in the context of universal health coverage (UHC) Methods: The study used a mixed-methods approach, combining a narrative evaluation of peer reviewed and grey literature with secondary analysis of national mortality and finance data from 2023-2024. The analysis assessed how Rwanda’s CBHI and PBF models matched the requirements for chronic disease care, as well as the burden of NCDs by age and data source. Results: Findings show that in Rwanda, NCDs are responsible for 59.3% of fatalities reported by the community and 47.7% of deaths recorded in facilities. Despite a nationwide expansion, CBHI coverage is still insufficient for chronic care, with minimal coverage for lifelong drugs and diagnostics. PBF incentives provide little assisstance for managing NCDs and instead favor shortterm, volume based treatments. Integrated chronic care is challenged by structural misalignment betwen CBHI and PBF, which disproportionately affect low-income and rural populations. Conclusion: The structure of health financing in Rwanda is still out of step with the country’s changing disease burden. Restructuring financing methods to include chronic care and preventive treatments, modifying actuarial models, and implementing NCD specific performance incentives are all necessary to meet the mounting issues associated with NCDs. Rwanda has the chance to set an example for adapting UHC frameworks to the realities of chronic care in LMICs thanks to its solid policy base it has.