When health is compromised, everything else is affected. When illness strikes, a person may spend all their possessions to recover, without worrying about what remains afterward — trusting that once health is restored, everything else can be regained. ALSO READ: Brain surgery, orthopaedics among new services added to Mutuelle de Santé Indeed, even maintaining good health comes at a cost — one that often rises beyond household earnings. Public policy prioritizes healthcare, education, and social support as public goods that cannot be neglected by any government seeking a thriving economy. When people are healthy, economic activities — trade, savings, and investment — flourish uninterrupted. ALSO READ: Mutuelle premium prices revised as scheme marks 25 years Rwanda’s Community-Based Health Insurance (CBHI), locally known as Mutuelle de Santé, stands as a testament to this vision. For 25 years, the scheme has ensured that vulnerable communities are fully covered by the government, while low-income households benefit from a largely subsidized system of medical support. This differs from the formal working class, whose coverage is secured through employer-employee contributions. The government has consistently injected billions of Rwandan francs annually to supplement citizens’ contributions to the scheme. For a country aspiring to attain middle-income status, there is arguably no better strategy to guarantee equitable access to medical services, prevent financial ruin due to unpredictable global health costs, reduce poverty, and improve overall population health security. It is, in many ways, a preventive shield against public health crises. Challenges after 25 years Despite these achievements, challenges have continued to emerge — not from subscription compliance, but from rising global medical costs and emerging health conditions that were unforeseen nearly three decades ago when the scheme was introduced. While policies were revised and new laws enacted in response to evolving realities, Rwanda has endured economic pressures to remain on track toward universal health coverage. Local savings groups have incorporated Mutuelle de Santé contributions into their annual planning to ensure members remain covered. As medical needs expand and expectations grow, citizens continue to place trust in a government that has demonstrated care and commitment. Will subscriptions continue unhindered? Any increase in contributions often meets resistance — and this reality remains as new adjustments are set to take effect in June 2026. However, Rwanda’s preparedness provides reassurance. The country has invested heavily in a national socio-economic registry that classifies households according to financial capacity. This system simplifies targeting and ensures fairness. The most vulnerable — approximately 6.89 percent of the population — are fully covered by the government, while an additional 23.2 percent receive a government subsidy covering one-fifth of their subscription fees. Through the Social Registry, individuals without other forms of health insurance can easily identify their subscription category online when making payments. The contribution of telecommunication companies has further simplified digital access to health insurance services. Community mobilisation and local leadership Local authorities play a critical role in mobilising communities and raising awareness. Rwanda’s strong social cohesion and consistent engagement between local leaders and citizens remain effective tools for policy implementation. Even as government services increasingly move online, community dialogue remains vibrant. Many citizens participate in local savings groups and tontines, which often prioritise welfare issues — including Mutuelle de Santé subscriptions — within their financial planning. Rising cost of advanced care High-end medical services such as cancer treatment, haemodialysis, kidney transplants, and other specialised interventions come at substantial global costs. As demand for these services grows, questions arise about whether subscription contributions can sustainably meet expanding coverage expectations. Rwanda’s approach has always been practical: once a goal is envisioned, it is pursued. However, policymakers should remain vigilant and avoid waiting another 25 years before reassessing the sustainability of the scheme. Non-state actors also have a role to play. Good health forms the foundation of human capital development and a competitive economy. Citizens cannot fully invest in innovation, entrepreneurship, and economic growth if their primary concern is medical survival. As the government continues to strengthen this universal insurance model, citizens can increasingly focus on savings, investments, and innovative ventures. The journey toward middle-income status depends on a healthy population. See you there. Richards Kagabo Rwamunono is the Vice Mayor in charge of Economic Development, Rwamagana District.
