Subscribers of the community-based health insurance, Mutuelle de Santé, have called for a new approach in handling the scheme ahead of the anticipated reforms that will see the service put under the Rwanda Social Security Board (RSSB). 

A law that will guide the takeover of Mutuelle de Sante by RSSB is currently in its final stages of being passed by Parliament before the transfer can be effected, probably by the next fiscal year, starting in July.

The community-based health insurance law is being amended simultaneously with the law governing RSSB in order to accommodate the new changes

According to different subscribers, the current law that sets up the scheme to which majority Rwandans subscribe, has a lot of loopholes that need to be fixed before it is transferred to the pension body.

Jacques Munyakazi, a resident of Busasamana Sector, Nyanza District, said the law under review should define well the kind of medicine offered to a user Mutuelle de Santé.

"Sometimes we are told to buy medicine in pharmacies whereas those using other insurance covers get the same medicine at the same health facility which I think is unfair. It would be better for the law to clearly show which kind of medicine can be accessed by Mutuelle users,” Munyakazi said.

Esperance Mukamuhoza, a resident of Kabeza in Nyarugunga Sector, said the revised law should also consider establishing a partnership with private health facilities like hospitals, health centres and even clinics.

"Like other services, private health service providers are being established closer to us. It will be better if the reviewed law provides a partnership framework with those private health service providers in order to ease access to health services,” she said.

Validating card

Gervais Gasasira, a teacher who plies his trade in Kamonyi District, said the validation of the Mutuelle card could be done on a six-month basis to facilitate those with less income to afford it, mainly for those with larger families to pay for.

He said: "To validate the card it is compulsory for the family to have paid the total contribution. If the reviewed law enables people to pay in two installments, one for the first six months and the other for the rest, that would make it accessible to many.”

For Donat Gakwenzire, a trader in Nyabugogo, the Mutuelle de Santé should have more premiums to include one that can have the beneficiaries access services from all facilities.

The current premiums range from Rwf3,000 to Rwf7,000 depending on the financial standing of the family. However, the services accessed remain uniform.

It is understood that the new law will use rather a more coherent approach to get citizens subscribe to the affordable health care.

Currently, community-based health insurance is under a decentralised financial management whereby every section of Mutuelle de Santé at different health centres across the country has its own bank accounts and signatories, making the scheme’s coordination at the national level challenging.

Dr Daniel Ufitikirezi, the chief executive of RSSB, said Mutuelle de Santé was characterised by lack of clear records, which has been a hindrance for report consolidation.

The deployment of electronic medical records for the community-based health insurance’s beneficiaries by RSSB is also expected to trace subscribers to the scheme.

"Subscribers of the scheme have not been getting good service because of low subscription. This has in one way or another, had a negative implication toward services offered by health centers and district hospitals. This is something we want to solve,” Dr Ufitikirezi said, adding that the new management scheme will reduce fraud in insurance scheme.

Article 12 of the draft law on community-based health insurance states that, "An order of the Minister in charge of health insurance shall determine medical services provided at each level of health facilities referred to.”

The government’s contribution to community-based health insurance scheme is equivalent to 13 per cent of the domestic annual budget of the Ministry of Health, as stated in Article 13 of the Bill.

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