Senators want Mutuelle de sante to cover chronic diseases

Senators have called for expansion of community based health insurance scheme, known as Mutuelle de Santé, the largest health insurance policy in the country, to cover non-communicable diseases (NCDs).
Mothers  pose in a group photo with their Mutuelle de Sante cards. File.
Mothers pose in a group photo with their Mutuelle de Sante cards. File.

Senators have called for expansion of community based health insurance scheme, known as Mutuelle de Santé, the largest health insurance policy in the country, to cover non-communicable diseases (NCDs).

NCDs are diseases that are non-transmissible and often last long periods of time.


Senators are concerned that the threat of non-communicable diseases is growing by the day and there is need to make their treatment more affordable.


Members of the Standing Committee on Social Affairs, Human Rights and Petitions in the Upper House made the call on Tuesday during a tour of Nyarugenge District and University Teaching Hospital of Kigali (CHUK) health facilities.


The field visit was planned to help the lawmakers better understand the extent of NCDs in the country and what is being done to tackle such diseases.

In fact, the senators observed, non-communicable diseases have not been given enough attention as is the case with infectious diseases.

The World Health Organisation’s 2014 global status report showed that NCDs were the leading cause of deaths globally, accounting for 38 million (68 per cent) of the world’s 56 million deaths in 2012.

Almost three quarters of all NCD deaths (28 million), and the majority of premature deaths (82%) occur in low- and middle-income countries.

In Rwanda, according to a Ministry of Health’s 2015 report, over the period of January–December 2013, NCDs accounted for at least 51.86 per cent of all District Hospital outpatients’ consultation and 22.3 per cent of District Hospital admission cases.

Last year, CHUK received 4,860 hospitalised internal medicine patients with NCDs, including hypertension, diabetes, kidney, cardiovascular diseases (mainly asthma) and cancer.

Of those patients, 3 per cent had hypertension, 3.6 per cent had diabetes, heart attack was at 5 per cent, while cancer was at 6.5 per cent.

Before visiting Nyarugenge District hospital and CHUK, the lawmakers had visited Butaro Cancer Hospital in Burera District, Ruhengeri Hospital in Musanze District, and Rwinkwavu Hospital in Kayonza District.

The committee vice-president Marguerite Nyagahura said the issue of NCDs had been identified as cross-cutting problem, necessitating Mutuelle de Sante expansion to cover the diseases.

The lawmakers said there are special clinics taking care of such diseases but which are out of reach for vulnerable people because of prohibitive treatment costs.

“There are medicines not covered by Mutuelle such as for NCDs. It is a big problem and we will push those concerned to look into the issue,” said Nyagahura.

Medical screening was also reported to be out of reach for many people.

“There is really a problem of check-ups, where it is covered say under RAMA (insurance policy especially used by civil servants and their families), they concentrate on adults, yet we have realised that even young people suffer from such diseases. But since Mutuelle de Sante has recently been put under Rwanda Social Security Board (RSSB), we think there should be ways they can handle that check-up problem,” senator Nyagahura said.

RSSB also manages RAMA

The senators also called for healthy feeding habits and physical exercises both in schools and communities.
Poor feeding and not doing physical exercises have been blamed for diabetes.

Indeed, senators said the first remedy is to prevent NCDs as they are highly expensive to treat and claim many lives or render the victims unproductive.

The committee visited all the four provinces of the country and the City of Kigali. They were divided in teams of three each and their outreach activity, which started last week, ended yesterday.

Dialysis high cost

But Dr Theobald Hategekimana, the Director General of CHUK, urged caution as treatment for chronic diseases is expensive.

Only Medical and Health Insurance (RAMA) and the Military Medical Insurance (MMI) insurance policies cover chronic kidney disease in the country, he said.

“We have the [dialysis] equipment but payment of medical bills is a big problem,” he said.

Dialysis is a treatment that does some of the functions normally done by healthy kidneys and it is needed when one’s own kidneys can no longer function.

A single treatment costs between Rwf100,000 and Rwf120,000.

If there are 100 patients with chronic kidney disease, with each patient receiving treatment three times a week, translating to Rwf1.2 million-Rwf1.5 million a month, the total cost will amount to Rwf16 billion a year.

Hategekimana said, given the costs involved, it was not feasible to cover NCDs under Mutuelle de Sante arrangement.

“If we treat 100 kidney patients, other patients having other health complications, estimated to be 90 or 95%, cannot be treated as they should; [and] Mutuelle de Santé fund can collapse,” Hategekimana noted.

He said kidney transplant could be an alternative but it is also costly as the patient needs immunosuppressive drugs – which lower the body’s ability to reject a transplanted organ – for the rest of their lifetime at a cost of $500 a month.

“It is understandable that a strategy has to be devised at the high level to find an answer to NCDs treatment, especially in the case of kidney diseases,” he said.

RSSB CEO Jonathan Gatera told The New Times that, until now, NCDs, including cancer, liver disease, kidney disease and diabetes, as well as medical check-ups are not on the list of diseases that Mutuelle insures.

He said, “If they are to be put on the list, then there should be a study on premiums because they are very expensive.”

Vulnerable people who get government support to access Mutuelle services pay Rwf2, 000 per year while those in the second category pay Rwf3,000 per person.

Gatera said RAMA subscribers aged at least 35 years (women) and at least 45 years (men) are allowed to undertake screening for all diseases once a year.

“As long as the Mutuelle de Sante has not yet got sustainable means or Mutuelle premiums have yet to be increased to cover these kinds of diseases, other means should be sought, say to set up a fund that would help people suffering from NCDs to get treated, because it is possible,” he said.


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