Rwandans who use community health insurance, commonly known as Mutuelle de Santé, have noted improved service delivery ever since the Rwanda Social Security Board (RSSB) took over the scheme’s management six months ago.

In separate interviews conducted in different parts of the country by The New Times, last week, several residents said since the current financial year started in July they have been getting better attention at health centres and hospitals and more access to the drugs they need.

The current situation is different from the previous financial year when many Mutuelle users would feel unwelcome while trying to get medical attention and would often be referred to private pharmacies to get drugs.

Mutuelle de Santé, which is the country’s community-based health insurance (CBHI) scheme that covers the majority of Rwandans, was placed under the management of RSSB since July last year as part of efforts to improve its services.

Now, users report a remarkable improvement in the last six months with RSSB paying users’ medical bills on time, which prompted healthcare providers to receive Mutuelle users with open arms, treat them, and give them the drugs they need because they are able to procure them from pharmacies using the money paid by RSSB.

"The Mutuelle card we got in June is different from the ones we had before, that’s why we are now received well at our health centre in Muyumbu (Rwamagana District) unlike in the past when we would be ignored. Nurses used to prefer serving patients with other insurance plans or private means over Mutuelle card holders,” said Melanie Mukamasabo, a 58-year-old mother.

As she waited to get medical attention at the University Teaching Hospital of Kigali (CHUK), Mukamasabo said she was happy with Mutuelle service since the current financial year started, explaining that customer service has improved in the last six months.

"Before, it was as if no one cared about patients holding Mutuelle cards but today we are even given phone numbers we can call in case we are not happy with the service,” she said.

Views about how Mutuelle de Santé has improved its service are shared by many people across the country.

They mostly point at the fact that it’s now possible to use the Mutuelle card from any public health facility in the country unlike in the past when patients could only access medical attention from their home districts.

They also cited about improved customer care by healthcare providers and more access to drugs at hospital pharmacies.

"Things are much better today. Now one can use the Mutuelle card in any hospital in the country, but before, it was very difficult to get medical attention in a hospital outside the district hospitals. Mutuelle is not only recognised but is also respected everywhere in the country,” said Janvière Uwambaje, a resident of Batsinda in Kigali City’s Gasabo District.

Overall, users said that they expect better management of Mutuelle de Santé under RSSB and to fully enjoy the scheme’s benefits.

"RSSB seems to be the answer. It was inconceivable to be told that the money we paid ended up in pockets of greedy people. Corruption and misuse of the insurance money was leading us to a very bad future,” said Jean Claude Mugiraneza, a resident of Ngoma District in the Eastern Province.

Healthcare providers laud RSSB

Public health centres, hospitals, and district pharmacies across the country have also appreciated RSSB for its efforts to make timely payments for medical bills for Mutuelle de Santé users.

"A Mutuelle de Santé worker based at the hospital prepares the medical receipt, then the hospital management endorses it and sends it to RSSB which clears it within one month,” said Dr Annick Bamurange, the acting Director of Kabutare Hospital in the Southern Province.

Dr Augustin Sendegeya, the Director of the University Teaching Hospital of Butare (CHUB), Huye District, Southern Province and Dr Léon Hakizimana Kagabo who leads the Nyanza District Hospital, also in the South lauded RSSB for timely payments.

"After the health insurance scheme moved to RSSB, there have been remarkable changes. RSSB is paying us on time,” said Dr Sendegeya.

Dr Hakizimana illustrates what would be at stake in case patients’ medical bills were not paid on time, explaining that it would simply lead to medical stock-out at hospitals.

"Before RSSB took over, you would give receipts and four or five months would elapse without payment being made. In the end, you realised that we owed money to district pharmacies while Mutuelle de Santé owed us money too. This resulted in lack of medicine and we were urged to send patients elsewhere to look for some medicine because they could not get it at the hospital,” he said.

In the Eastern Province, Dr Fulgence Nkikabahizi who heads the Rwinkwavu Hospital in Kayonza District, also commended RSSB for paying medical bills on time.

"The trend is positive. In the past, we were paid in not less than six months after serving patients. This would delay general infrastructure development and medicine stock supply in health centres and hospitals. Since RSSB took over, we are paid in not more than two months,” he said.

In the City of Kigali, RSSB was also commended for settling medical bills on time, with Dr Theobald Hategekimana, who heads CHUK, and Dr Osée Sebatunzi who heads the Kibagabaga Hospital, acknowledging that RSSB is paying medical bills for Mutuelle de Santé users very well.

In the Northern Province, many users of Mutuelle de Santé also noted improvement and expressed optimism for improved management of the scheme under RSSB.

"I think the government took the right decision to transfer Mutuelle de Santé to RSSB. The Fund’s arrears are being paid and if the arrears are cleared everything will be done effectively,” said Théogène Hakuzimana, the Director of the Gakenke District Pharmacy.

Pre-RSSB Mutuelle debts

However, even if healthcare providers appreciate being paid on time under RSSB’s management of Mutuelle de Santé, they haven’t forgotten about money that the scheme owes them as part of debts accumulated over the years when it was still under the management of districts and the Ministry of Health.

When RSSB took over the management of Mutuelle de Santé in July 2015, there was about Rwf13 billion in arrears owed by the scheme to health facilities and pharmacies across the country.

RSSB did not inherit the debts and officials agreed that the central government would clear the debts with three ministries, including the Ministry of Health, Local Government and that of Finance agreeing to work together to see that the debts are cleared.

Since then, the government has been making efforts to pay the debts but it was unclear by press time how much out of the Rwf13 billion had been cleared so far.

But going by the situation in some hospitals and health centres, it is fairly clear that the debt remains heavy. For example, Dr Sendegeya said that Mutuelle de Santé still owes over Rwf1.3 billion to CHUB.

The scheme owes Rwf450 million to Nyanza District Hospital, according to Dr Kagabo, while it owes over Rwf229 million to Kabutare Hospital, according to Dr Bamurange.

The director of Huye District Pharmacy, Egide Muziganyi, says that the pharmacy still claims more than Rwf200 million in arrears by Mutuelle de Santé.

Healthcare providers say that the delay in clearing the debts affects their operations such as their ability to get the medicine they need or expand the infrastructure at their health facilities.

But hospital managers who spoke to The New Times expressed hope that pre-RSSB Mutuelle debts will be cleared, explaining that they have promise from the three ministries that they will get paid.

Neither the Ministry of Finance nor RSSB were willing to talk to this newspaper about the progress to clear the debts, with either refering us to the other for a comment.

While RSSB took over the management of Mutuelle de Santé as a response to a steady drop in subscriptions to the scheme and poor management of its funds. The last six months have seen increased Mutuelle de Santé subscription rate, at 79 per cent, improved timely payment of medical bills, and improved service to patients.

Reporting by Eugene Kwibuka in Kigali, Emmanuel Ntirenganya in Huye, Jean d’ Amour Mbonyinshuti in Musanze & Stephen Rwembeho in Rwamagana.

editorial@newtimes.co.rw