The government is looking for new sources of funding to boost the Community Based Health Insurance (CBHI) scheme as it seeks to increase its medical services coverage.

Commonly known as Mutuelle de Santé, the medical insurance scheme is a solidarity health insurance system in which persons (families) come together and pay contributions for the purpose of protection and receipt of medical care. Established in 2003 in order to help people with low-income access medical care at affordable cost, it now covers more than 90 percent of the population it has to cover.

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With new funding sources such as banks and general insurance, the Rwanda Social Security Board (RSSB) estimates that at least Rwf25 billion, per year, could be collected as additional finance for the scheme. The proposal is in response to the government’s plan to expand medical services under Mutuelle de Santé by including specialised healthcare such as cancer treatment and kidney transplant services, in the package covered by the scheme, a move expected to start in 2025.

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It was discussed on Monday, February 5, as officials from the Ministry of Health and RSSB appeared before the Lower House’s Committee on Unity, Human Rights and Fight against Genocide to respond to issues highlighted in the report of the National Commission for Human Rights for the fiscal year 2022/2023. From July 2015, the management of the Medical Insurance Scheme was moved from the Ministry of Health to RSSB to improve the fund’s accountability and ensure quality health care for subscribers.

The Deputy Chief Executive Officer of RSSB, Louise Kanyonga, told lawmakers that the institution worked closely with the Ministry of Health and other partners, to consider new ways to address the potential funding deficit of Mutuelle de Santé that could occur as the government implements a plan to offer increased and quality services to Rwandans.

Overall, she said, the different proposed sources of extra funding for Mutuelle de Santé could result into about Rwf25 billion or Rwf28 billion per year as additional resources for the scheme. She indicated that the plan could be implemented in 2025. Normally, new sources of funding for the scheme are established and governed by a Prime Minister’s Order which is approved by the Cabinet.

The move, she said, is intended to ensure the sustainability of the scheme by preventing a situation whereby it could face a loss – funding deficit compared to expenses it has to cover – of about Rwf17 billion for the next three years.

This anticipated deficit could stem from the coverage of extra and costly treatments such as cancer medication, and kidney transplants which started being performed in Rwanda in 2013, and the rising cost of healthcare in general, she pointed out.

The financial sector has the potential to contribute to Mutuelle de Santé, Kanyonga pointed out.

She estimated that the scheme could get more than Rwf5 billion from banks and about Rwf4 billion from insurance companies, every year.

"There is one sector that we realised was profitable, working well, but not contributing.

That is the financial sector, meaning banks and insurance companies,” she said, explaining that currently, only the health insurance subsector – as a component of the insurance sector – was contributing to the scheme.

Currently, one of the entities that contribute subsidies to the scheme are telecommunication companies. According to a Prime Minister’s Order related to the community-based health insurance scheme subsidies, which was published in the Official Gazette on July 26, 2019, a telecommunication company had to pay 2.5 per cent of its annual turnover as subsidy to Mutuelle de Santé in the first and second year after the publication of the Order, and 3 per cent of its annual turnover from the third year of its publication.

Underscoring the solidarity, nature of the scheme, Kanyonga pointed out that though employees in the formal sector were already contributing to Mutuelle de Santé, there might be an increase in the amount they put in, which could support additional resources for the scheme.

Looking at that category of members, Kanyonga said, "we realise that we can get more than Rwf10 billion per year if we make a change on contribution.”

She did not give details on how this will be done but indicated that it has to be done without burdening the member, but rather, by look at their capacity to pay.

According to Kanyonga, in 2023, Mutuelle de Santé collected Rwf85 billion in contributions, while it paid Rwf75 billion in benefits – to cater for the scheme’s subscribers’ health insurance.