For many, remitting health insurance cover, locally known as Mutuelle de Sante, could be a long call due to financial constraints. However, with the country trying to ensure 100 per cent cover, informal saving groups, commonly referred to as Ibimina, came in handy to bail the majority lot as they now rely on group savings to remit medical insurance cover. IMAGINE A SITUATION when you are at home, unwary of anything and, unfortunately, you get a call informing you that one of your children has been hospitalised after an accident or a sudden illness. It might sound weird, but illness is normal, though regrettable and a sad reality that people live with.That is why Beatha Mukakarangwa remits her contribution towards the community health insurance scheme, better known as Mutuelle de santé.Mukakarangwa is a relatively poor farmer, who hails from Cyahinda sector, Nyaruguru District in the Southern Province. She derives her livelihood from her small plot of land on which she grows mainly subsistence crops."Subscribing to the health insurance scheme is beneficial,” she says, adding that she always remits her family’s contributions on time."I know I or my child can fall sick anytime. It will be bad if this happens when I have not subscribed to the Mutuelle de Sante. I will not afford the heavy medical bill,” Mukakarangwa says."Whenever I have the (Mutuelle) card, I feel safe as I know I can access health services at a subsidised and affordable cost,” she adds.Mukakarangwa associates the community health scheme that was initiated about a decade ago to affordability, accessibility and quality healthcare. Health officials say population adherence to community-based health insurance has increased from about seven per cent in 2003 to the current 81 per cent.Currently, the districts of Kirehe, Gatsibo, Nyagatare (all in the East), Gakenke (North) and Kamonyi in the South rank highest in people’s adherence to the Mutuelle de Sante scheme, respectively.  Karongi, Ruhango, Rubavu, Gasabo and Rutsiro are trailing in that order, according to recent figures from the Ministry of Health.While delivering his State of the Nation and End of the Year  address, President Paul Kagame said the target is to ensure that every Rwandan has access to quality health care.‘Magical’ IbiminaOfficials say adherence to the community-based health insurance scheme has been continuously on the rise over the past years and attributed the trend to several reasons, including strong mobilisation strategies like door-to-door mobilisation and public campaigns, as well as evident benefits for the population."The best strategy is to always remain closer to residents and involve some of them in the mobilisation efforts,” says Jacques Rutsinga, the mayor of Kamonyi District, one of the top districts in the country with regard to Mutuelle subscription.Leaders and residents, however, have lauded informal saving groups, commonly referred to as Ibimina for tremendously facilitating subscription to the scheme.Ibimina are small, mutual support associations that usually bring together between 20 and 30 families living in the same village. They operate on the basis of contributions from members and rely mostly on mutual trust among them as they have no legal personality and their activities are not approved by the central bank."In the past, I struggled to remit my mutuelle premiums but ever since I joined Ibimina, it has become easy,” says Marcelline Nyiranshuti, a member of Twizerane group which operates in Rutobwe cell, Cyahinda sector. "I can raise enough money for my family of five,” Nyiranshuti says.Initially, the groups started as a result of various non-governmental organisations which in some cases financially supported members. However, they have evolved to become stronger entities, fully managed by members themselves."These groups are helping residents to save money, hence making it easier for them to raise enough to subscribe to the health insurance scheme,” Rutsinga says.Ibimina has spread throughout Rwanda, with several districts reporting that it has made it possible for many residents to fully pay their premiums months before the start of the next financial year. The ‘magical’ power of these groups is simple. They help residents manage well their resources and enable them meet their  contributions in advance by encouraging them to save some little money which they use later to pay their contributions.Simple calculations prove how this method could facilitate adherence to the health scheme, officials say.  If each individual could start saving a Rwf50 coin weekly, or Rwf250 monthly, they would easily raise the Rwf3,000 individual subscription fee, explains Joseph Shema of the Health Financing Unit at the Ministry of Health.In some parts of the country, leaders have invested a lot of efforts in the communal associations–like in Nyamagabe District, Southern Province, where authorities organised a special mobilisation week which focused on the groups.Last October, Huye District mayor Eugene Kayiranga Muzuka, told The New Times  that the informal saving groups "have proven to be a successful strategy and ideal mobilisation forum”, while Jean Louis Mukunzi, the head of health financing at the Ministry of Health, said the cooperatives have become "an ideal method to collect subscription without any conflict.” In the past, residents have been embroiled in conflicts with some grassroots leaders over what they termed as forceful methods used to collect Mutuelle premiums.Early in February 2013, Prime Minister Pierre Damien Habumuremyi, warned local leaders that forced people into paying Mutuelle subscription, saying it is illegal and that leaders who do so should be punished. More than 80% of Rwandans are said to be part of the Mutuelle de Sante arrangement.  However, the programme has faced some challenges.Lack of strong awareness mechanisms and strategies as well as limited mobilisation skills among some grassroots leaders are cited among the major challenges that have affected subscription to the health scheme.FACT FILEThe community health insurance scheme was introduced about a decade ago with the overall aim of easing access to health services and ensuring that all Rwandans access timely and affordable treatment. The health insurance system in Rwanda is arguably one of the most extensive, elaborate and successful community-based health insurance schemes in the world. •Mutuelle, unlike other health insurance schemes where a single premium takes care of all family members, is paid on individual basis.•Residents pay between Rwf2,000 and Rwf7,000 annually according to the Ubudehe category they belong to.•Those in category one and two (considered as extremely poor) have their premiums of Rwf 2,000 per individual met by government. The other categories pay between Rwf 3,000 and Rwf 7,000 per each individual.•To facilitate citizens, residents are allowed to pay their subscriptions in instalments. Officials say one can pay the first instalment by September, and the second one by December.  editorial@newtimes.co.rw