Two decades ago, in the hilly places of Gakenke District, when diseases hit the area, fear of reaching a medical facility engulfed the patients.

People walked long distances to reach the nearest health facility, with some dying along the way.

"We could only get medical services from Coko or Kirambo Sectors far from our home area. Due to long distance, we could not dare to go there at night even when someone was in a very bad condition,” said Esperance Mukarwasa, a mother and resident of Minazi Sector.

"That night would be a nightmare as the sick person waited for morning before being taken to a health centre.”

Twenty one years later, the residents are happy that access to health services has increased tremendously, with health centres spread across the district; some located a stone throw away from people’s homes.

With several health centres set up in the district, residents say they no longer carryout self medication or use traditional medicine.

According to officials, there are 16 health posts in the district, 23 health centres which supplement Ruli and Nemba main hospitals.

"Today anytime we feel unwell we visit Minzazi Health centre without any problem,” Mukarwasa said.

Minazi Sector residents say that previously, they could not pay health insurance subscriptions (Mutuelles de Sante) as they didn’t access health services in their areas, exacerbating the problem in the process.

Seeking medical services from neighbouring sectors was a burden, but now we pay medical insurance because access to health facilities increased, added Mukarwasa.

Cleophas Ahishakiye, a resident of Murambi cell said many people have access to health services.

"The government should be commended on social protection as it has extended medical services near our homes. Initially, it was very challenging. Imagine a pregnant woman walking 25 kilometres down the hills to reach the health centre. It was very risky,” Ahishakiye recalled.

"It was terrible. Transport was costly and very few people could afford it. A motorcycle to the health centre was very expensive, only very few people could afford Rwf4000 to and fro. Many people preferred to remain at home and carry out self medication or visit traditional healers, Ahishakiye added.

Phocas Uwimana, the executive secretary of Minazi Sector, said access to health centres presented a great challenge for them to mobilise residents to pay health insurance leading them to rank poorly during district evaluations.

"The construction of Minazi health centre has eased our work of mobilising residents on health insurance. The health centre has increased medical insurance payment rate in the sector with 95.3 per cent of residents insured from 71 per cent previously,” Uwimana said.

Health centre per Cell

Officials have committed to build 97 health posts in all cells of the district to ensure increased access to health services.

The Rwanda Health Demographic Survey 2015 shows that 91 per cent of deliveries take place at health facilities in the country, compared to 69 per cent in 2010, owing to concerted efforts of the Community Health Workers.

At least 93 per cent of children in Rwanda receive all the 11 vaccines, 83 per cent of lactating women exclusively breastfeed, 80.3 per cent of children under five sleep under a mosquito net, while 88 per cent of pregnant women sleep under a mosquito net.

Zephylin Ntakirukimana, the Gakenke District Vice Mayor in charge of social affairs said, "Our wish is to have healthy residents. We are pleased with the health facilities in place and if everything goes according to plan our target is to set up health facilities in every cell.”

"Most Gakenke residents can now access medical services using medical insurance. It has reduced mortality rate of mothers and children.”

Government policy is to have at least one district hospital per district, one health centre per sector, a health post and Community Health Workers at the village level.

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