For 25 years, the Community Based Health Insurance scheme, popularly known as Mutuelle de Santé, has stood as one of Rwanda’s most transformative social innovations. What began as a modest, community-driven initiative to enable citizens access basic healthcare has evolved into a robust national safety net covering millions of Rwandans, including some of the most complex and costly medical interventions. The recent slight review of premiums under Mutuelle has understandably sparked debate, mostly from an uninformed viewpoint. Any adjustment that touches household finances will do so. But this is a moment that calls for reflection, perspective and good faith. When Mutuelle was introduced, its core objective was simple yet profound: ensure that no Rwandan would be denied primary healthcare because of inability to pay. Over the years, that promise has not only been fulfilled but expanded. Today, beneficiaries of the scheme can access specialised services, advanced surgical procedures, and even cancer treatment that in many parts of the world would remain out of reach for ordinary citizens. This did not happen by accident. It is the result of steady policy refinement, collective responsibility, and the consistent contributions of millions of Rwandans who understood that solidarity is the bedrock of sustainable healthcare. The small premiums citizens contribute, when pooled together, have done wonders. They have saved lives, shielded families from catastrophic health expenditures, and strengthened confidence in our national health system. As the cost of healthcare rises globally due to new technologies, specialised treatments, and growing demand, it is only realistic that financing mechanisms must occasionally be reviewed to ensure sustainability. What would be irresponsible is to pretend that a scheme of such magnitude can remain static while the healthcare landscape continues to evolve. The most important news is that the subsidies for vulnerable households remained untouched and they will continue having their premiums paid by government. Equally commendable in the latest review is the flexibility introduced to ensure that citizens are not unduly constrained. This responsiveness to public concerns demonstrates that the system listens and adapts. However, flexibility must be implemented cautiously. If poorly enforced or abused, it could undermine the financial stability that has taken decades to build. Safeguards and clear guidelines will be essential to ensure that accommodation does not translate into regression. Mutuelle de Santé is a homegrown gem rooted in our culture of solidarity and shared responsibility. Few countries can point to such broad-based coverage built largely on community participation. It is a model that has attracted admiration beyond our borders. Supporting the premium review in good faith is not about blind endorsement. It is about recognising that sustainability requires realism, and that the benefits we enjoy today were made possible by collective sacrifice. If we are to preserve and expand these gains for the next 25 years, continued commitment from all of us is not optional; it is indispensable. Let us protect what we have built together.
