Augustin Ngabonziza, 40, a resident of Kimironko Sector in Gasabo District, pays Rwf12,000 annually as premium for community-based health insurance scheme, commonly known as Mutuelle de Santé, for his family of four.

However, Ngabonziza says him and his family members rarely use the service when they go to hospital because "the scheme mostly helps accident victims and expectant mothers.”

"For most other illnesses, you will be asked (by medics) to go and buy medicine from private pharmacies, which are expensive. I think many people are discouraged to subscribe to Mutuelle de Santé for such reasons,” Ngabonziza told The New Times last week.

Mutuelle de Santé, which provides medical cover to the majority of Rwandans, especially rural folks, has been blighted by decreasing subscriptions and debts.

This has compelled government to devise measures to overhaul the management of the health insurance scheme.

The scheme is one of the country’s most successful social protection programmes.

One step toward restoring the scheme is the amendment of the law that governs it, with the main objective being the mainstreaming of the scheme into Rwanda Social Security Board (RSSB).

Parliament is primed to pass the draft law within the next three days, according to the senatorial Standing Committee on Social Affairs, Human Rights and Petitions.

"This law should be passed before Parliament goes into recess (by the end of next week),” Thérèse Bishagara Kagoyire, the chairperson of the committee, said last week.

The committee made its would-be-final amendments last week, sending the Bill governing community-based health insurance to the Senate for final revision and approval.

It is understood that once it is enacted into law, it will allocate tasks to each responsible public body that is aimed to save the falling Mutuelle de Santé subscription.

Patrick Ndimubanzi, the state minister for public health and primary health care, said the amendment was necessitated by the need to ensure the health scheme’s financial sustainability and, institutional and organisational arrangements.

"We need this law enacted as soon as possible so that by the next financial year, we do not have these issues again. Subscription to Mutuelle de Santé scheme has been fluctuating,” said Ndimubanzi.

Subscription stats

An estimated 73 per cent of Rwandans subscribed to Mutuelle de Santé for their health insurance in the last financial year, down from 80.7 per cent and 90.7 per cent in the financial years 2012/13 and 2011/12, respectively.

The New Times understands that errors and uncoordinated management, among other issues, have characterised the health insurance scheme over the past few years.

The Director-General of RSSB, Daniel Ufitikirezi, told The New Times last week that although there are other things that have changed regarding social security and health insurance, the transfer of Mutuelle de Santé to RSSB [as the fund’s manager] was the main reason for the amendment of the law.

"The major reason for the amendment of this law is the transfer of Mutuelle de Santé to RSSB, although there are other reasons as well,” said Ufitikirezi.

The community-based health insurance law is being amended simultaneously with the law governing RSSB in order to accommodate the new changes.

"There are other reasons that sparked the amendment of the two laws, but the main one is management of Mutuelle de Santé and it’s functioning,” Ufitikirezi said.

The development means that RSSB will be responsible for the financial management of the insurance scheme, while the Ministry of Health will be in charge of running healthcare issuance as well as determining insurance packages.

"Subscribers of the scheme have not been getting good service because of low subscription turn-up. This has in one way or another, had a negative implication toward services offered by health centres and district hospitals. This is something we want to solve,” he added.

A review of the health scheme conducted by the Senate committee last year indicated that the government had accumulated over Rwf2.3 billion in arrears owed to district hospitals and more than Rwf400 million to national referral hospitals and health centres.

A big debt owed to district hospitals has since been cleared with the government promising to clear the balance this financial year.

It is understood that the new law will use rather a more coherent approach to get citizens subscribe to the affordable health care.

Currently, community-based health insurance is under a decentralised financial management—whereby every section of Mutuelle de Santé at different health centres across the country has its own bank accounts and signatories—making the scheme’s coordination at the national level challenging.

Ufitikirezi admitted that community-based health insurance was characterised by lack of clear records which has been a hindrance for report consolidation. The deployment of electronic medical records for the community-based health insurance’s beneficiaries by RSSB is also expected to trace subscribers to the scheme.

"This will also reduce on cases of fraud in the insurance scheme,” he said.

Article 12 of the draft law on community-based health insurance states that, "An order of the Minister in charge of health insurance shall determine medical services provided at each level of health facilities referred to.”

The government’s contribution to community-based health insurance scheme is equivalent to 13 per cent of the domestic annual budget of the Ministry of Health, as stated in Article 13 of the Bill.

The annual Mutuelle de Santé premiums range between Rwf3,000 to about Rwf7,000.

Kamonyi mayor Jacques Rutsinga told The New Times that the new law would ease financial management of the community-based health insurance, hence relieving local government entities of many tasks regarding the scheme.

"We are happy with the new system [that will be introduced after the law has been enacted]. The new finance manager–RSSB has experience in this sector, and we hope citizens will access quality services in health insurance, unlike the current one,” Rutsinga said.

Ninety-five per cent of Kamonyi District residents have already subscribed to Mutuelle de Santé for the Financial Year 2014/15, according to the mayor.

"People have different insurance packages, and since we will be having a single financial manager, then we expect proper coordination of insurance packages, for quality healthcare,” Rutsinga said.