Finding a society where everything is in order is akin to finding an igloo in a desert. Every society has individuals who are loyal, trustworthy, hardworking, and individuals that work had to deprive others of their rights. To the latter, individual interests come first.

They create loopholes and manipulate systems to reach at the pinnacle of their intent. Along the way, they end up ‘killing the goose that lays the golden egg’.

Fifteen years ago, the Government of Rwanda through the Ministry of Health put in place one the best health insurance system-the Community Based Health Insurance (CBHI) commonly known Mutuelles de Santé that has made Rwanda unique in its approach to fostering Universal Health Coverage.

Going by the recent media reports, it looks like the ‘golden goose’ is headed for slaughter, but I beg to differ.

I beg to differ for the reason that taking into account the current annual premium for the groups or categories of mutuelles de santé (group 1 comprised of the most vulnerable and poor pays Frw 2000, mainly contributed by government and Development Partners, group three where the biggest segment of the Rwandan population falls pays Frw 3000, and group 3 that pays Frw 7000), simple economics indicate that if each family in the 3 categories paid their premium promptly mutuelles de santé would be able to generate profits and accumulate reserves.

Certainly, the golden goose has lived to its promise of laying the golden egg. To ordinary Rwandans, mutelles de santé has curbed the catastrophic out of pocket expenditures for health care services. It has promoted the culture of seeking early treatment. Before, people were hesitant to seek early treatment because of the high cost associated with health care services.

Today, a patient at a health centre in Rwanda pays only Frw200 after getting treatment. It includes fees for consultation and medicine. At the district hospital the subscriber pays only 10 percent of the total cost. A subscriber to mutuelle de santé health insurance can be treated at any health facility in Rwanda.

Mechanisms to facilitate the refund of invoices in cases involving the mobility of access for beneficiaries are in place and have been strengthened. Such mechanisms allow the refund of health care invoices between sections in the same district or the refund of invoices for health care services received by a subscriber of mutuelles de santé in a district other than the one with which they are affiliated.

Mutuelles de santé has been able to generate profits and accumulate reserves and these are ploughed back into the system to cater for the districts that garner less contribution.

Saving the ‘golden goose’

As indicated by Dr. Agnes Binagwaho in her article ‘Beyond MDGs: Why we need to strengthen our institutions’ published in The New Times on February 18 to save the ‘golden goose’ we need to create systems that reinforce honesty, accountability and reassure Rwandans their interests are protected.

As earlier mentioned, societies have individuals that are egocentric and will always strive to put first their individual interests in lieu of the general population and Rwanda is not an exception. Therefore, every Rwandan needs to take a bold move and expose the wrongdoers that antagonize mutuelles de santé.

There is also a need to harness the coordination of validating and reimbursing invoices at both health centre and district hospital, better coordination of patient roaming, and above all shift from the use of manual procedures to use IT based procedures especially for collecting the premiums.

More so, the success of mutuelles de santé depends on the total funds pooled, therefore this calls for an increase in number of the subscribers. Increasing the number of subscribers requires combined efforts of all the concerned stakeholders.

And a shift from the awareness phase to selling the benefits of mutelles de santé to the beneficiaries. In addition, the decision to move mutuelles de santé from the Ministry of Health to more experienced health financing specialists at the Rwanda Social Security Board is an important move toward saving the ‘golden goose’. We should be rest assured that their investment into their health insurance will not be lost.

Alleged discrimination

At Kagbayi Hospital Philomene Mukamusoni 33 emerged from the hospital entrance, from a distance she looked to be in her mid twenties, with a baby on her back carrying a  handmade cloth handbag that seemed to weigh her down.

She took each step with zeal and determination, a referral from the nearest Health Centre marked the genesis of her journey to Kagbayi Hospital. Asked whether she managed to see the doctor, she answered in the affirmative, but complained about the long queue at the hospital, adding that she got all the medication prescribed by the doctor for her two year old son from the hospital pharmacy.

Interviews with patients at the same hospital and Health Centres in the catchment area revealed that pharmacies at District hospitals and Health Centres are stocked with essential drugs. Reports provided by the Pharmacy Task Force/Desk of the Ministry of Health indicate availability of drugs at pharmacies in public health facilities.

The example of Peter Nkurunziza et el mentioned in an article published in The East African lastweek, is a rare occurrence that cannot be used to measure the satisfaction of the mutuelles de santé subscribers. However, it should not be ignored but rather be dealt with in accordance with the measures in place. This can only be attained if the clients/patients take a bold move and expose the wrongdoers.

Mutuelles de Santé is the best available channel for the growth of financial accessibility to health services in both rural settings and in the informal sector. It is built on a structure that permits the most vulnerable segments of the Rwandan population to be fully integrated into the health insurance system, consequently guaranteeing contribution of the whole community and avoiding any stigmatization.

It is strongly rooted on the foundation for the concept of equity in access to various packages supplied by the health system. It is designed as a supplement to other existing health insurance systems. Subscribers to Mutuelles de Santé must be accorded the same treatment and customer care when seeking health care services.

The writer is Head of Division, Health Communication Centre, at Rwanda Biomedical Centre .