The Government is pushing for changes in the law governing the Community Based Health Insurance Scheme, best known as Mutuelle de Santé, as it seeks to raise billions of Francs to fix the shortfall in the scheme’s financing and ensure its sustainability.

Government is looking for a staggering Rwf16 billion to finance the health scheme, according to the Minister for Finance and Economic Planning, Dr Uzziel Ndagijimana.

While tabling the proposal before the Lower House yesterday, the minister said that although Mutuelle de Santé has helped the Government to achieve universal health coverage, its sustainability is threatened by financial constraints.

To fix this, Ndagijimana said, Government needs new sources of financing instead of overly relying on contributions from Mutuelle subscribers.

"If we were to fix this based on the contribution from subscribers, we would have to increase their subscription fee up to at least Rwf5,500. But we considered the subscribers’ abilities and realised that most cannot afford it and we decided to take another route,” he said.

Proposed changes

Under the new proposal, Government plans to raise money from registration of imported medicine, monies paid by medical researchers and monies paid for vehicle inspection.

"The Government will continue to support the scheme but, besides that, we propose that money is raised from traffic fines, fines levied on drugs dealers, sellers of illegal or expired food, making calls, contributions from insurance companies that provide health insurance and money made from betting companies,” he said.

Over the last three years, the scheme faced an estimated deficit of between Rwf10 to Rwf13 billion and accumulated a debt of about Rwf9 billion, the minister said.

"The good news is that the Rwanda Social Security Board has recovered Rwf6 billion in arrears. All factors remaining constant, the new alternative source of funding could bring in some Rfw16 billion. ”

Besides looking for alternative funding methods, the proposed reforms also seek to fix the issues that came with a subscriber being required to have paid at least one month prior to be eligible for treatment.

The proposed changes suggest a fixed deadline, which falls on September 30of every fiscal year. The fiscal year begins on July 1.

The other proposed change is that anyone of 18 years and above, who is no longer living with a family under which he or she had subscribed, is free to register as an individual.  

If passed, the law will eliminate challenges where a family was required to register as a unit despite whether one member was living with them or not.

MPs react

MP Julianna Kantengwa commended the Government for listening the citizens’ calls to review the law.

"I support this draft because for, so long, everywhere we go during our field work, the issue of Mutuelle has been coming up over and over again. I am glad that this proposal is coming,” she said.

MP Pierre Claver Rwaka pointed out the issue of Mutuelle scheme’s inability to cover most medication saying that it constituted a burden for beneficiaries. 

"There is still a serious issue of Mutuelle failing to cover medication prescribed by health centres yet the patients cannot afford it. This should also be looked into,” he said.

Every year, slightly over 10 million people in Rwanda are expected to subscribe for the country’s community-based health insurance (CBHI) scheme, which by far covers the majority of citizens, especially those living in rural areas without regular paid work.

Subscription to Mutuelle de Santé is paid every year and expires at the end of the country’s fiscal year in June.

With a subscription rate of 82.7 per cent as of January 2018, Mutuelle is by far the largest health insurance cover in the country.

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