Canika was a fringe outpost tucked away in the northernmost corner of Rwanda. The area was shared between Rwanda and Uganda, one as the Canika of Rwanda and the other, of Uganda.
The two Canikas were overshadowed by the imposing presence of Mount Muhabura and were hardly noticeable.
In fact, in 1994 when I visited this area that used to be my home before I went into exile, it was clear that the Rwandan central government before that was unaware of the existence of its Canika!
It was still bearing the name of Canika, which is in the local dialect variety of Kinyarwanda. And, just as it did in 1959 when we went into exile, it still depended on other countries for everything.
In our time, for my few siblings who were born in hospitals, it was either Mutorere Hospital in Uganda or Rwankuba Hospital in Belgian Congo (today’s D.R. Congo).
This is the Canika that I knew when I visited the area again in 2005 and found a lady who was in labour. That is why I suggested to her husband that I drive them to Uganda or D.R. Congo. He just burst out laughing.
This is a new Cyanika (now in the national dialect variety), he explained as we rushed the lady to a clinic in Kabyiniro, six kilometres inside Rwanda.
As I talked to him before bidding him bye, a midwife emerged from the clinic to announce the arrival of a baby boy.
When I offered pecuniary help as a way of congratulating him, he politely declined.
“You’ve already helped, stranger,” he said to me, “thank you very much.
And don’t worry about me, I have mitweri.” He was talking about ‘mutuelles de santé’, a community-based health insurance that has redefined life among the poor of Rwanda.
Where any form of financing for health care was inexistent in a country whose big part of the population lived literally on less than a dollar a day, today mutuelles count 93% adherents.
The RPF government took over when Rwanda had no form of meaningful health insurance.
The new government had to devise its own form of insurance. It set up ‘Rama’ (a French acronym for Rwanda Health Insurance) for civil servants and private sector workers involved in the formal economy.
The insurance was a success and Government devised a similar one for men and women in the security services. Today, all employees in the security service sector are covered by MMI (Military Medical Insurance).
Private companies and well-to-do persons had their own insurances.
Now the worry for Government was the vulnerable and poor of the population who had no monthly earning to talk about.
That is how mutuelles as an idea was mooted in 1999, but it did not immediately take off as people saw a yearly payment for anything as a burden.
Government had to make the cost as low as possible and mobilise the masses and popularise its benefits.
And being of miserly means, she had to find funds to subsidise curative health care and fully finance preventive health services.
Also, for the scheme to impress everybody, it had to be community owned and managed.
Still, by 2003 a paltry 7% had seen its value. Slowly, however, communities were taking it up and by 2007 it had attracted a membership of 75%.
Today, the member premiums of 93% of them are responsible for funding 50% of mutuelles, with every person giving a yearly contribution of the equivalent of $1.8.
When a citizen cannot pay individual premium up-front, microfinance institutions provide a loan at a rate of 15% of interest.
Government and donor programmes support mutuelles by paying fees for those who cannot afford them. The second 50% of mutuelles is funded by Government; health ministry annual budget; civil servant social insurance; military medical insurance; Genocide victims’ fund; private health insurance; and development partners.
The ministry of health says that members are entitled to three complementary benefit packages.
Primary care is at the lowest level via clinics run by Government or non-governmental organisations.
On the secondary level, specialised care is at the district level via district hospitals and specialists. On the national level, tertiary care is delivered via national medical institutions and referral hospitals.
Over all, then, for that villager in today’s Cyanika, mutuelles mean that he didn’t need my ‘pecuniary’ sympathy!
If his wife had got complications during child delivery, an ambulance would have rushed them 27 km to Musanze, at the district hospital.
If they got worse, the ambulance would have shuttled them 96 km to CHUK, the national referral hospital in Kigali.
And well, now it will mean more. Now that there is going to be a new Frw120m health centre in Cyanika, if his wife gets severe complications, a military helicopter will whizz them both right from his local health centre to King Faisal Hospital, the specialised public hospital in Kigali.
His wife will be given a bed where bed sheets are changed every day and she will be given four square meals a day.
That, and much more, is what mutuelles mean for every poor Rwandan on every square inch of Rwanda!