Governance and Domestic Resource Mobilisation: Lessons from Rwanda’s mandatory corporate Contributions to Community-Based Health Insurance

Low- and middle-income countries face persistent challenges in financing universal health coverage, making domestic resource mobilisation (DRM) a critical priority. Governance systems are increasingly recognised as central to ensuring effective and sustainable mobilisation of resources. It is also widely documented that governance systems in many developing countries are weak and fragmented. Rwanda is one of the few low income countries that performs well in governance indicators. This article examines how Rwanda’s governance structures support DRM through mandatory corporate contributions to the Community-Based Health Insurance (CBHI) scheme.Using a qualitative case study design, we conducted key informant interviews of relevant individuals from different government institutions, NGO representatives and multinational corporations from the telecommunications and Oil& gas sector. The analysis focused on governance dimensions including policy design, institutional arrangements, accountability mechanisms, and enforcement processes. Rwanda’s governance system demonstrates a clear legal mandate for corporate contributions, strong institutional coordination between government agencies, and accountability mechanisms that ensure compliance. These governance features have enabled consistent mobilisation of domestic resources, significantly strengthening CBHI financing. However, challenges remain, including balancing trade-offs with corporations and ensuring long-term sustainability.Governance plays a pivotal role in facilitating DRM for health. Rwanda’s experience with mandatory corporate contributions to CBHI offers valuable lessons signalling other low- and middle-income countries seeking to enhance domestic health financing to prioritise strengthening of governance frameworks.