Editor, I would like to thank The New Times for the article, “Mutuelle de Santé: What is behind falling subscriptions?” (The New Times, July 29). It reveals major problems dogging Mutuelle de Santé. People are really concerned about the sustainability of the Mutuelle de Santé, provided all the reported endless issues (mismanagement, mistreatment…). That is the reason why I thank Rwanda Social Security Board (RSSB) for commissioning a study which hopefully will help identify the root causes of low adherence to or subscriptions for this popular community-based health insurance scheme. We must remember that Mutuelle de Santé is such an affordable public health insurance scheme that significantly helped Rwanda achieve some of her development goals, and that made this country stand out from the crowd among African nations. Without attempting to influence the hypothesis of the research that’s due to be undertaken, I would like to mention some factors that I think may have contributed to lower performance of the scheme: One of the main factors is the low awareness of local community about the Mutuelle de Santé; if it was not the case, how could someone say she is not able to pay for five family members while she has a good number of goats until local leaders come and take some by force as a way for her to pay for the insurance? Another factor is possibly the social categorisation (Ubudehe) with citizens confused about which category they are classified in. If someone has a neighbour who is classified in the very poor category— for whom the government subsequently pays the health insurance premiums – while the former thought they were at the same economic level, the other one becomes reluctant to pay thinking he or she will also eventually be considered as poor and thus access free access to Mutuelle de Santé. There is also the quality of services rendered to patients who use Mutuelle de Santé by health workers in different facilities across the country. It was reported that those patients are not treated equally compared to those with private medical insurance cover. Mutuelle de Santé patients are said to be unfairly treated and inexplicably subjected to long and sometimes unnecessary processes. It’s so demoralising. My advice to the researchers who will conduct the study: Please, carry out a thorough study and avoid biases, the research should also cover all the available data. Pierre Hakizimana, Rwanda
