Recent reforms to expand cancer treatment under the community-based health insurance scheme (Mutuelle de Santé) were expected to ease access for patients, but gaps remain. Critical medications especially those that stop cancer from advancing to the metastatic stage are still not covered, leaving many patients unable to afford lifesaving treatment.

This gap poses health risks, as timely access to such medications can be lifesaving. Without early treatment, patients may face far more severe health outcomes.

Speaking at a recent press conference, Regis Hitimana, Chief Benefits Officer at the Rwanda Social Security Board (RSSB), addressed the issue while the institution management was presenting highlights of its performance for the 2024/2025 financial year and its five-year strategic plan (2021–2025), which concluded in June.

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Hitimana explained that while implementation of many new health services was progressing well – such as surgeries requiring implants like total hip or knee replacements – there have been delays specifically related to cancer medications.

For surgeries involving implants, he said they began implementation even before the reforms were announced, indicating that they now have a sustainable supply chain in place.

But for cancer, although most services are available and RSSB is committed to cover them, the issue lies with medication supply, he stated.

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According to Hitimana, integrating cancer drugs into the system has proven challenging because it is a new area for Rwanda Medical Supply (RMS), the agency responsible for procuring medical products for public health facilities in the country.

He said that it’s a specialised supply chain not commonly found in many markets. RMS had to go directly to manufacturers to negotiate, which has taken more time than expected

"But on the medicine, it was a new area for the Rwanda Medical Supply to enter into the cancer supply chain. And it's a supply chain you don't find in many markets. So, you need to go to the manufacturers and negotiate. It has taken more time than we anticipated,” he said.

However, he assured that progress was being made.

"Soon we will start having cancer medicines procured by RMS and RSSB will be able to cover,” he said.

In the meantime, he said that RSSB continues partnering with Butaro Cancer Center of Excellence to continue with the treatment they were providing.

He said that, soon, more public health facilities will be able to offer cancer medications under Mutuelle de Santé.

Building a cancer drug supply chain

RMS Deputy CEO Diana Mutoni told The New Times that the public entity in charge of drug supply had already procured some oncology drugs, and there is a pipeline expected to arrive in about two weeks. The importation is progressive as not all the products are coming at once.

In about two months, the rest of the oncology products are expected to have been received, she said.

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Regarding challenges, she cited those related to the availability of biosimilars – highly similar copies of an existing biological drug.

She indicated that since the use of biosimilars is also the case in oncology, RMS was looking for those approved by the World Health Organization (WHO) for safety purposes.

With most products needed being biologics, she said that they are not manufactured and stored due to short shelf life.

"Therefore, when an order is made, the production starts, and this takes a long time which is why the lead-times have been long,” she stated.

Another challenge, she said, is that most of the oncology drugs are not yet registered in Rwanda and it is mandatory to import products registered with Rwanda Food and Drugs Authority (RFDA) or registered elsewhere with competent authorities.

Meanwhile, she said that Rwanda FDA is supportive in the registration process.

Efforts to address the identified challenges include approaching more manufacturers around the world to get a big pool of approved products registered in stringent regulatory authorities (SRAs).

She pointed out that RMS has embarked on supporting manufacturers to register products in Rwanda, citing pharmaceutical firm Philex.