Healthcare professionals in Rwanda will be required to have medical professional liability insurance once the newly passed healthcare services law takes effect. The law aims to advance the country’s health sector and address long-standing gaps in patient protection. ALSO READ: Parliament revives push for mandatory medical liability insurance Approved on August 4, it replaces three outdated and fragmented pieces of legislation. One of its most notable provisions mandates liability insurance for all healthcare providers, including doctors, nurses, and medical institutions. Medical liability insurance provides coverage for healthcare professionals and institutions against financial losses that may result from claims of negligence, errors, or omissions in the course of treating patients. ALSO READ: Enforcement of medical liability insurance law hits snag In an interview with The New Times, Dr. Kenneth Ruzindana, a senior consultant obstetrician and gynecologic oncologist at Kigali University Teaching Hospital (CHUK), said the reform offers important protections for both patients and practitioners. “As a medical practitioner, this law enhances our protection by offering financial and legal safeguards we previously lacked,” he said, explaining that under the previous system, doctors often had to pay out of their own pockets.The law clarifies accountability by defining whether the healthcare professional or the institution is responsible and how compensation should be allocated when needed. This can reassure patients, as formal compensation mechanisms help build confidence in the healthcare system and reduce conflicts. However, he noted that it comes with challenges, particularly the cost of premiums. He explained that insurance adds a financial burden on healthcare providers, whose salaries are constrained. He added that the law provides for shared responsibility for premiums in some cases, with both professionals and institutions contributing when a practitioner works in more than one facility. He noted that affordability could be an issue if the premiums are not funded by the Ministry of Health or the government. Dr. Ruzindana said that while the law aims for firm enforcement, its rollout will require clear regulations and careful supervision. He added that healthcare institutions, particularly larger ones, may face additional administrative tasks such as verifying coverage, managing documentation, and ensuring compliance. “On doctor-patient trust, the law could have both positive and negative effects. It may increase confidence, but there is also a risk of more suspicion if it is not implemented carefully,” healthcare professional said. He added that patients may feel more secure knowing there is a formal mechanism to address harm. When compensation is provided through insurance, patients are likely to see the system as fairer and safer, which can make them more willing to seek care, follow medical advice, and share sensitive information openly. “Doctors may feel less defensive knowing a financial safety net is in place. This can encourage more open communication, allowing them to admit errors and discuss complications without fear of personal financial loss.” Hospitals that publicize their compliance with the law may improve their reputation, as patients are likely to view them as more professional and well-regulated. “But without proper public education, this provision could raise suspicion. Some patients might see malpractice insurance as evidence that mistakes are common, and if they focus on the legal aspect, they may be quicker to consider legal action, which can make consultations feel more confrontational,” he noted. Dr. Ruzindana noted that defensive medicine can occur when doctors over-order tests or avoid complex cases to protect themselves from potential claims. This approach can make patients view care as indecisive or driven by profit. He said insurance can help build trust when used effectively. For example, if a woman undergoing a cesarean section experiences a rare complication, she may feel reassured when the hospital’s insurance covers her additional stay and part of her lost income. She leaves confident that the doctor cared, the hospital took responsibility, and the system supported her, making her more likely to recommend the hospital to others. “The insurance can also promote transparency. Fear of personal financial loss has often made practitioners hesitant to admit mistakes. For example, during a postnatal visit, if a stitch is accidentally left in place and causes discomfort, the doctor can explain the unintended outcome, provide prompt correction, and assure the patient that insurance will cover any related costs. This honesty and quick action can raise patient loyalty, even after a complication.” He noted that the insurance could also undermine trust if misunderstood. Without proper public education, some patients might wonder why insurance is needed unless mistakes happen frequently, leading them to question every procedure and potentially distracting from their care. The health practitioner added that being overly cautious can backfire. For instance, if a woman with mild abdominal pain is sent for three imaging studies “just in case,” even though guidelines recommend simple observation, she may see it as overcharging or uncertainty, which can reduce her confidence in the care. “In medicine, especially in high-risk areas like obstetrics and gynecology, there is always a possibility that a patient may experience harm during treatment, even when evidence-based protocols are followed. Such undesirable outcome can arise from the severity of the condition, the complexity of the procedure, or the patient’s comorbidities or physiological response. When it occurs, the immediate priority is ensuring patient safety, stabilizing the situation, and addressing the complication without delay. “It is essential to activate institutional review processes, such as morbidity and mortality meetings, root-cause analysis, or quality-assurance reviews, to evaluate both human and systemic factors. These processes promote accountability, foster transparency, and help identify ways to improve clinical practice, patient education, and safety protocols,” he said. For Dr. Ruzindana, the impact of the law will depend on its implementation, while the law is neutral, its rollout, communication, and effect on daily doctor-patient interactions will determine whether it strengthens trust or creates suspicion.
