In 2018, Celestin Niyonsaba, 75, a resident of Rusera Cell in Kabarondo Sector, Kayonza District, feared he might have to sell his house and farm to raise over Rwf3 million for life-saving medical treatment.

That would have been his only option, had it not been for Rwanda’s Community-Based Health Insurance (CBHI) scheme, commonly known as Mutuelle de Santé.

"I had stomach pains that I had suffered from for a long time. Fortunately, I was paying Mutuelle de Santé premiums and could receive treatment without having to struggle with overwhelming medical bill payment,” Niyonsaba said.

Unfortunately, his condition later worsened.

"I could not even eat. I was vomiting blood,” he recalled.

He was then referred to the University Teaching Hospital of Kigali (CHUK), where he underwent a successful surgery and fully recovered.

"I only paid Rwf52,000 for the operation and my recovery. I was told that without insurance I would have paid more than Rwf3 million. Without it, I would have sold my house or my farm, but, instead I only sold a goat. I always pay my premiums because I understand their importance,” he said.

Niyonsaba shared his testimony in Kayonza on February 24, as Rwanda marked 25 years of the scheme’s existence and launched reforms to strengthen its services.

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Niyonsaba’s experience mirrors that of many Rwandans whose livelihoods have been shielded from catastrophic health costs by Mutuelle de Santé.

François Rutabana, also from Kayonza District, paid just Rwf2,400 during a two-week hospital stay following an accident that required surgery. Without insurance, he would have had to pay Rwf240,000. Over the year, he had contributed Rwf9,000 to cover three family members.

"The Rwf240,000 I would have paid without health insurance is not a small amount that everyone can afford,” he said, commending the significance of Mutuelle de Santé, which he joined when it was first launched.

"Before Mutuelle, there were many deaths in the community. We commend the government’s decision to introduce the health insurance scheme. With Rwf250, you can be consulted and receive medicines at a health centre,” Rutabana said.

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He said that awareness campaigns conducted through savings groups help mobilise citizens to pay premiums for this critical scheme on time.

"We are pleased that the scheme will now cover more services such as cancer treatment and kidney transplants, which were previously unavailable. I know a neighbour who was required to pay Rwf40 million for dialysis and a kidney transplant. With these services now included, she will find relief,” Rutabana said.

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At the community level, Immaculée Nyiranizeyimana, a community health worker, said the scheme has significantly reduced maternal and child deaths.

"Many children, mothers and other community members are saved by Mutuelle de Santé, especially during malaria outbreaks. Mothers who deliver at health centres pay very little. Diarrhoea, pneumonia and other diseases affecting children are treated promptly,” she explained.

Life expectancy rises to 70 years

Mutuelle de Santé was introduced around 2000 following a sharp decline in healthcare utilisation after the 1994 Genocide against the Tutsi. In 2015, management of the CBHI scheme was transferred from the Ministry of Health to the Rwanda Social Security Board (RSSB) to enhance accountability and ensure long-term sustainability.

Over the past 25 years, the scheme has transformed access to healthcare across Rwanda.

According to Régis Rugemanshuro, Chief Executive Officer of RSSB, coverage rose from about seven per cent in 2003 to more than 88 per cent in 2025.

"Over the years, coverage has never fallen below 85 per cent. Life expectancy has increased significantly,” he said.

Life expectancy has increased from 49 years in 2000 to nearly 70 years today. About 90 per cent of the population can now access medical care, ensuring that no one dies at home for lack of financial means, according to RSSB.

The CBHI scheme is central to Rwanda’s universal health coverage strategy. Under the arrangement, members pay Rwf200 per visit to a health centre and 10 per cent of hospital bills, while the remaining 90 per cent is covered by Mutuelle de Santé.

Reduction in maternal and child mortality

Rugemanshuro said "the scheme has reduced various causes of death in addition to improving life expectancy."

The maternal mortality rate has fallen from 1,000 to 149 deaths per 100,000 live births, while under-five mortality has declined from 196 to 36 deaths per 1,000 live births, as per official figures.

These improvements reflect sustained investment in primary healthcare and financial protection for vulnerable households.

Expansion of covered services

Rugemanshuro said reforms were necessary to strengthen the scheme.

"Healthcare services available to members have been expanded to include specialised treatments in line with advancements in medical care in Rwanda,” he said.

Newly covered services include kidney transplants, dialysis, neurosurgery, cardiac treatment, cancer screening and treatment, orthopaedic surgery, and assistive devices for persons with disabilities.

The reforms also cover minimally invasive surgeries, hip and knee replacements, blood products, and an expanded essential medicines list—from 845 medicines to 1,450.

"In the past, many of these services were not available in the country. Expanded coverage protects members from falling into poverty,” he added.

ALSO READ: Rwanda moves to make cancer treatment more affordable for population

Why premiums were revised

New premium adjustments were introduced to ensure sustainability amid rising healthcare costs, according to RSSB.

"The new reforms are aimed at improving service delivery and ensuring universal access,” Rugemanshuro said.

Expenditure by the Mutuelle de Santé fund increased from Rwf39 billion in the 2015/16 financial year to Rwf98 billion in 2024/25, driven by the rising cost of healthcare and living expenses, as per RSSB data.

Community contributions, however, had not increased during that period. Annual contributions currently stand at Rwf3,000 or Rwf7,000 per person, depending on socio-economic status.

"Since 2011, most community members have paid Rwf3,000 each. Last year, the fund spent Rwf98 billion, but members contributed only Rwf31 billion which is about 33 per cent. The government covered the remaining 67 per cent through various funding sources. That is why reforms were introduced,” he explained.

Under the new system, members will contribute up to 48 per cent of required funding, while the government will provide 52 per cent. Member contributions are projected to reach Rwf69.8 billion in the 2026/27 financial year.

Contributors are grouped into five income categories:

• Individuals with no income will pay Rwf4,000 per year, fully subsidised by the government (about seven per cent of the population).
• Those earning below Rwf30,000 per month will pay Rwf4,000, with a government subsidy of Rwf1,000 (23 per cent).
• People earning between Rwf30,000 and Rwf60,000 per month will contribute Rwf5,000 without subsidy (35 per cent).
• Those earning between Rwf60,000 and Rwf120,000 per month will pay Rwf8,000 (27 per cent).
• Individuals earning above Rwf120,000 per month will contribute Rwf20,000 without subsidy (eight per cent).

"Around 70 per cent of Rwandans will contribute no more than Rwf5,000 each. Those paying Rwf20,000 represent less than eight per cent,” Rugemanshuro said.

Citizens can check their household information via the MINALOC system by dialling *195#. Contributions can be paid through the RSSB system using *876# or via Irembo.

Introduction of a capitation payment model

In collaboration with the Ministry of Finance and Economic Planning and RSSB, a capitation payment model—an advance financing system for health facilities—has been introduced. Previously, facilities were reimbursed after delivering services, often causing delays.

Dr Sabin Nsanzimana, the Minister of Health, said: "The new approach aims to improve healthcare quality, strengthen facility planning, maintain adequate stocks of medicines and essential supplies, prevent delays in reimbursement, and enable uninterrupted service delivery.”

The system was launched in health centres in the Eastern Province in January 2026 and will be rolled out nationwide.

Fidel Shyaka, Director of Kabarondo Health Centre, said that under the previous model, invoices could take up to two months to process.

"We could not receive funds on time to purchase medicines. Patients sometimes had to buy drugs from private pharmacies at high cost. Now we receive funds promptly and can purchase medicines in advance. We require more than Rwf4 million every month,” he said.