Rwanda’s choice to expand Mutuelle de Santé to include brain surgery, orthopaedics, kidney transplants, cancer care, among other complex treatments, is a significant step in the country’s health journey. For years, Community-Based Health Insurance (CBHI) has been recognized as one of Africa’s most successful models for improving access to basic healthcare. Now, it is expanding beyond primary care to include critical procedures that were once available only to a select few.

The addition of neurosurgery and hip and knee replacements, for instance, represents more than just medical progress; it represents equity. A farmer in Gakenke or a motorcycle rider in Kigali facing epilepsy or a traumatic injury should not have to sell land or raise funds abroad to survive. By broadening the benefits package, the government reinforces the idea that universal health coverage must include access to quality specialized care, not just consultations and basic medications.

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At the same time, the new income-based premium structure shows a necessary acknowledgment of sustainability. With expenses rising to Rwf149.1 billion while revenues lag, reform was essential. The tiered contributions, with full subsidies for the most vulnerable, strive to balance solidarity and responsibility. Those who earn more contribute more, while those with little or no income are protected. This principle was the foundation of Mutuelle when it started 25 years ago.

However, policy reform alone isn’t enough. The real challenge is in public uptake. Expanded benefits will only save lives if Rwandans enroll, renew their memberships on time, and understand their entitlements. Local leaders, community health workers, and citizens need to view membership as a lifeline rather than a bureaucratic task.