Community-Based Health Insurance as a Determinant of Maternal Health Outcomes: Evidence from a Retrospective Cohort Study in Rwanda

Abstract: Community-Based Health Insurance (CBHI) has become one of the most important health financing reforms for improving healthcare access in low- and middle-income countries. Rwanda’s Community-Based Health Insurance scheme, locally known as Mutuelles de Santé, has contributed significantly to the achievement of universal health coverage and improved healthcare utilization. However, the empirical data on how CBHI affects maternal health services utilization and maternal and neonatal outcomes is still limited. This study assessed the influence of CBHI on maternal healthcare services utilization and maternal and neonatal outcomes at Kibungo Level Two Teaching Hospital in Rwanda. The study used quantitative method design. A retrospective cohort approach was employed involving 375 well completed maternity records from 2023 to 2025 that were purposively selected. Data were entered into Microsoft excel, coded and cleaned, analyzed using SPSS version 26 through descriptive statistics, chi-square tests, and logistic regression analysis. Findings showed that 91.2% of women were enrolled in CBHI, while 16.3% possessed supplementary insurance schemes such as RAMA, MMI, Sanlam, and Old Mutual. Women enrolled in CBHI demonstrated significantly higher utilization of antenatal care 84.2% compared to 39.4% for uninsured, skilled birth attendance 96.8 vs 72.7%, and postnatal care services 88.6% vs 45.5% of uninsured women. Maternal complications and neonatal admissions were significantly lower among insured women. Logistic regression analysis indicated that insured women were 8.20 times more likely to experience favorable maternal and neonatal outcomes than uninsured women (OR = 8.20, p < 0.001), where insured women 93.3% had no maternal complications compared to 69.7% of uninsured, and neonates with ≥7 Apgar score 95.0% vs 70%. The study concludes that CBHI significantly influence maternal healthcare utilization and improves maternal and neonatal outcomes in Rwanda. Keywords: Community-Based Health Insurance, maternal healthcare, maternal outcomes, neonatal outcomes, Rwanda. Title: Community-Based Health Insurance as a Determinant of Maternal Health Outcomes: Evidence from a Retrospective Cohort Study in Rwanda Author: Pierre NDAYIZEYE, Dr. Eugenia Nkechi Irechukwu International Journal of Healthcare Sciences ISSN 2348-5728 (Online) Vol. 14, Issue 1, April 2026 - September 2026 Page No: 300-317 Research Publish Journals Website: www.researchpublish.com Published Date: 26 -June-2026 DOI: https://doi.org/10.5281/zenodo.20849623 Paper Download Link (Source) https://www.researchpublish.com/papers/community-based-health-insurance-as-a-determinant-of-maternal-health-outcomes-evidence-from-a-retrospective-cohort-study-in-rwanda