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

The study shows that pursuing UHC is an eminently political process but explanations solely based on objective “interests” of rulers cannot fully account for the emergence and shape of social protection programme. Ideology matters as well. Programme design compatible with the political economy of a country but incompatible with ideas of the ruling coalition is likely to run into political obstructions. The study also questions the relevance for poor countries to reach UHC relying on pure CBHI models based on voluntary enrolment and community management.