In 2015, Jean Baptiste Ntakirutimana, a resident of Gisagara District lost his wife at the University Teaching Hospital of Butare. She died from kidney failure, in part, because they could not afford the Rwf60, 000 bill for the drugs she had been prescribed for, despite having health insurance cover, mutuelle de santé. “The doctors prescribed medicine for the kidney disease that my wife was suffering from. But we were told to fully pay for it by our own because mutuelle de santé does not cover such medicine,” Ntakirutimana says. Thanks to mutuelle de santé, Rwanda is considered to have one of the most successful community-based health insurance in the world. However, with funding shortfalls, the scheme has encountered various challenges including limitations on the drugs that can be purchased with it. This prompted the government to think of more innovative ways to increase funding for the scheme so it can benefit more people. According to statistics from Rwanda Social Security Board (RSSB), public funding for mutuelles de santé has now been increased by an extra Rwf17 billion every year thanks to more subsidies. The Rwf17 billion, RSSB says, will be generated from charges on fuel sales, parking fees, salaries for private and public sector workers, RSSB/RAMA schemes and charges on tourism revenues sharing. The government will also commit part of the fees on change on motor vehicle ownership to mutuelle de santé. This is in addition to the increase of fees on marshland, hillside and radical terraces as well as increased government contribution for indigents. Like many Rwandans who rely on community-based health insurance for their medical care services, the increased funding has raised Ntakirutimana’s optimism. “The funding should ensure that people have access to more healthcare services,” he says. Laurence Mukampunga, a resident of Gicumbi District, suggests that there should be enough drugs at health facilities and mutuelle de santé beneficiaries get timely treatment. How the funding deficit is being bridged Before the subsidies, annual general public contributions to mutuelle de santé were Rwf32.8 billion yet the total expenditure on the scheme was 47.4 billion. This reflects a financial funding deficit of 14.6 billion, according to figures from RSSB. Meanwhile, previous subsidies to the scheme that were determined by the Prime Minister’s Order published in July 2019, would contribute over Rwf10 billion to the scheme. The 2019 subsidies included those from health insurance entities operating in Rwanda, Rwf6 billion direct financing from the government’s treasury, fees collected on vehicle mechanical inspection, road traffic fines, medical research fees, and those levied on telecommunication companies’ annual turnover. Dr Solange Hakiba, the Deputy Director-General in charge of benefits at RSSB, said that community-based health insurance will use the extra funds to strengthen the sustainability of the scheme and accelerate the country’s efforts towards universal health coverage. According to RSSB officials, even though the identified sources of funding could be harnessed to sustain the scheme, there’s need to leverage on efficient use of health services and digitalisation of the healthcare system I order to bridge the financial gap in the scheme. The scheme covers healthcare services for more than 80 per cent of Rwanda’s 12 million people. As of February 13, 2020, the scheme’s coverage rate was 78.6 per cent with more than 9 million beneficiaries. Established in 2003, mutuelle de santé seeks to offer medical cover to people with low incomes and those who are in informal employment.
