The health system in Rwanda is used as a best-case scenario by many health experts. It is also famed for its success in implementing the community health insurance program which has improved access to quality health for citizens.
With more than 90 per cent of Rwandans covered under the community-based health insurance scheme locally known as Mutuelle de Santé, Rwanda is one of the few developing countries in the world that have successfully achieved universal healthcare.
What is Universal Healthcare?
Universal healthcare coverage is a broad concept that can be implemented in several ways. The common denominator for all such programs is some form of government action aimed at extending access to health care as widely as possible and setting minimum standards.
Usually some costs are borne by the patient at the time of consumption but the bulk of costs come from a combination of compulsory insurance and tax revenues.
Universal Healthcare in Rwanda
Rwanda operates a system of universal health insurance through the Ministry of Health called Mutuelle de Santé (Mutual Health), a system of community-based insurance where people pay premiums based on their income level into local health insurance funds, with the wealthiest paying the highest premiums and required to cover a small percentage of their medical expenses, while those at the lowest income levels are exempt from paying premiums and can still utilize the services of their local health fund. In 2012, this system insured all but 4% of the population.
The community-based health insurance scheme has in recent years encountered challenges of low real uptake numbers, inflated numbers by local leaders and poor service delivery in health centres and district hospitals, prompting the government to transfer management of the scheme to the Rwanda Social Security Board (RSSB) under the Rwandaise d’Assurance Maladie.
According to the Ministry of Health, management of the scheme which was initiated in 2000 but was operationalised in 2004 has improved since it was moved to RSSB in 2015 but some citizens say the quality of services given to subscribers is still wanting.
“It is not easy to secure a transfer from a district hospital if you need to go to a referral hospital,” says Sarafina Mukasarasi, 40, a card holder, though she says services at the district hospitals have improved, despite the long queues.
Ms Mukasarasi however says that thanks to the insurance scheme, which she pays about $3.36 (Rwf3,000) a year based on her household income, she does not pay a single coin when she falls ill or child birth. She delivered all her three children in a district hospital at no cost.
The scheme has been touted as one of the most successful on the continent and it is credited for the country’s lower maternal and infant mortality rates of 77 per cent and 70 per cent respectively, since 2000.
A recent study conducted by the Management Sciences for Health (MSH) and the University of Rwanda-College of Medicine and Health Sciences-School of Public Health, supported by The Rockefeller Foundation also showed that Rwanda’s Community-Based Health Insurance (CBHI) scheme has greatly increased access to health care services and reduced the burden of health care costs, especially for the poor.
Currently the community based health insurance scheme is used as an example of affordable universal healthcare schemes for poor countries.
© Africanexponent, theeastafrican, msh.org
