“I have been seeking medical care at Kibungo Hospital and spending about Rwf3,000 monthly for transport and medical services. The expenditure has affected my well-being and has led to financial constraints in my family,” says Elisee Ingabire, a patient at the hospital in Ngoma District, Eastern Province. It is argued that Rwanda’s well-built healthcare system should also tackle health inequity among socially and economically disadvantaged people by ensuring the highest standard of health is within the reach of everybody. World Health Organisation (WHO) defines health equity as the absence of avoidable differences among people, whether the difference is social, economic, demographic, or geographic. “Leaving no one behind” is the founding concept for the SDG agenda that aims to achieve the Universal Health Coverage goal. It seeks to enhance healthy lives and the well-being of all ages, and also highlights health equity as a core crosscutting theme and that no one should miss out on the opportunity to attain their full health potential because of economic and other determined circumstances. Health inequities are reflected in the differences in length of life; quality of life; rates of disease, disability, and death; severity of disease; and access to treatment. The prolonged treatment needed and the high cost of non-communicable diseases raises the equity problem caused by both economic and social barriers. Even in Rwanda’s insurance system, some patients still face barriers to access adequate care, leading to increased expenditure to access services at hospitals and affecting them in the long run. FROM POLICY TO ACTION Rwanda has taken an imperative shift to ensure healthcare access to all patients is achieved by improving healthcare services at centres and enabling people with low income to access prevention and care services. “I used to walk a very long distance every month and spend a lot on medication, the cost and distance made me miss some appointments. Now, it is a five-minute walk to the health centre and I pay only Rwf200 for services and medication,” says Mrs Nikuze who was diagnosed with hypertension in 2015. Diane Muhoza, a trained healthcare provider in Kibungo Hospital, says that the economic burden of non-communicable diseases affects the treatment outcome of patients resulting from poor compliance to medication and appointments. HEALTH CENTRES ARE A PILLAR IN THE SYSTEM Dr Gilles Ndayisaba points out that the health services package for non-communicable diseases within the centre range from prevention services to care and treatment. Trained healthcare providers conduct prevention awareness campaigns in the community like early detection and treatment of diabetes and asthma. The task shifting process that includes training of healthcare providers ensures patients get quality care at the centre and reduces the financial burden that has been hindering the compliance of patients, hence, improving treatment outcome. “We also encourage people to have annual medical check-ups at their nearest health centres and take prevention measures for non-communicable diseases,” he adds. Health centres have played a big role in curbing the mortality rate caused by diseases like HIV and malaria and they continue to work to improve the health of all Rwandans.
