How Rwanda has driven up access to healthcare

A patient is given her health insurance card. Mutuelle de santé has enabled universal access to healthcare services at cheaper costs. / Net photo

In the years following the 1994 Genocide against the Tutsi, significant strides have been made in the healthcare sector. One of them has been the introduction and implementation of community health insurance, commonly known as Mutuelle de santé, which has enabled universal access to healthcare services at cheaper costs.

According to Alexis Rulisa, the head of Community-Based Health Insurance Department Institution, Rwanda Social Security Board, Mutuelle de santé was introduced in 1999 as a pilot phase in three health zones; Byumba, Butare and Kabgayi. An assessment conducted in 2001 concluded that the pilot phase was successful and the structure was recommended to roll out countrywide. 

Rulisa says that with the territorial reform in place, as of January 2006, Mutuelle de santé was established with financial and administrative autonomy at each and every administrative district, with a national coordination mechanism in the Ministry of Health.

A young woman displays her health insurance card at an RPF party campaign rally. / Net photo

The management of Mutuelle de santé was moved to Rwanda Social Security Board (RSSB) in July 2015.

Immaculate Niyonsaba, the head of Kiramuruzi sector, says since the new health year started on July 1, most people are done paying for their health insurance, however, those who haven’t paid yet are still accessing health services, but are encouraged to pay soon.

Rulisa notes that since 2010, in order to solve the issue of equity, the premium structure is based on the national social economic classification, whereby the premium of Rwf 2,000 for the first category is totally covered by the Government, the members of the second and the third category pay Rwf 3,000 while the fourth category pay Rwf 7,000. Before that, the premium was a flat fee of Rwf 2,000 shared equally between the Government and the population. 

“Mutuelle de santé members seek treatment from all public health facilities, starting from health posts, health centres and hospitals through a referral system. This scheme removed the barrier of financial accessibility to quality healthcare services, and improved on services utilisation as early as possible,” he explains.

Rulisa adds that before the introduction of Mutuelle, the population had to pay medical services out of pocket 100 per cent. This led to some patients seeking treatment too late or even not visiting health facilities at all. The clear indicator is the services utilisation which was very low at that time.

“We thank the Government for this great opportunity, that even the poor people can be treated at a low-cost price or for free, if you possess the insurance cards, for instance; the service you could have paid Rwf 10,000 for without a health insurance card, can instead go down to Rwf 1,000 if you have the health insurance card,” Niyonsaba notes.

Rulisa states that Mutuelle is now covering over nine million members, and the payment is done through e-payment platforms like Irembo, MTN Mobile Money, and Airtel Money, among others. The idea of Mutuelle came as a solution to the financial barrier hindering the population, for them to easily and timely access healthcare services.

This year, Dr Diane Gashumba, the Minister for Health, said that the Government plans to fund Community-based Health Insurance to a tune of Rwf10 billion to Rwf12 billion every year.

More Rwandans, especially those from rural communities, will have access to health services if the proposal by the Ministry of Health to increase subsidies for Community-based Health Insurance is approved.

Figures from RSSB show that contributions to Mutuelle were estimated at over 13.3 billion from July to December 2018, but expenses in benefits to subscribers totalled to over 27.4 billion in the same period. By that time, Mutuelle had a coverage rate of 84.5 per cent.

Josiane Mukakimenyi, a resident of Gisozi says that her child has been sick for a long time and when she went to the doctors, they discovered that she is suffering from a skin condition. However, with her health insurance card, she is assured that her child will get the necessary treatment at a lower price.

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