Insurance:Questions arise over drop in remittances GISAGARA – Civil society organisations have started debate on the challenges met by the public in submitting their remittances for the community-based health insurance scheme, commonly known as Mutuelle de Santé.    In discussions which lasted for about three-and-half hours on Wednesday, members of the civil society platform in Gisagara District exchanged ideas on to expand the scheme. It was observed that members of the public had not paid their contributions as much as they had done in the past, since the introduction of new premiums that are based on household income. In the past contributions were uniform.The session was attended by representatives of NGOs, faith-based organisations, local cooperatives and grassroots leaders in the district.Some of the civil society members blamed the low levels of contributions to the way residents were classified this year in the scheme.Statistics in Gisagara district indicate that 74.4 percent of all residents have remitted their contributions. Prior to the introduction of new premiums, compliance was at over 95 percent.In the past the public paid an annual contribution of only Rwf 1000 per individual but recently the contribution increased. Currently, Mutuelle subscribers are assigned to one of the three categories: The well-to-do who pay Rwf 7000, relatively modest families pay Rwf 3000 and the vulnerable whose contributions are covered by the government at a cost of Rwf2000 per individual each year.The new policy seeks to improve the quality of services accorded to mutuelle subscribers at various health facilities.In addition, the "mutuelle” coverage was extended to special cases including diabetes, cancer or heart diseases with the possibility of being admitted to well-equipped health hospitals.According to the government, the categorisation was conducted at village level, with each and every resident involved in the process.However, for some members of the civil society in Gisagara the process was riddled with irregularities in some areas."The problem was about who did it. Some people who were involved in the process were not qualified to do it. For example, someone who lives in a thatched house will view a primary school teacher as prosperous when in actual sense he is not,” said a participant, Philemon Uwihanganye.Another contributor, Francoise Nyirarukundo said: "It is clear that in some areas the categorisation process was not properly conducted. Some families were categorised as well off when they are not. In other areas, the public did not participate in the process.” For Frederiko Rutihunza, a farmer from Gishubi sector, there is hope that the numbers of mutuelle subscribers will continue to increase."Yes, some mistakes were made. But as days go by, they are being rectified and I can see that people are now paying their contributions. I hope that by next year, the numbers will be higher,” he said.Sakufi Musonera, the Director of Health Insurance in Gisagara, said a lot is being done to correct the mistakes."We are currently undertaking a new process of grouping people into categories. In areas where people were not happy, the process is being revisited with the participation of the residents. We are sure that this will bring more subscribers for next year,” he assured.The participants also raised the issues of poor service delivery in some health facilities and lack of strong sensitisation strategies, among others, as impediments to the success of the scheme.It was agreed that civil society organisations should be more active in sensitising residents in the benefits of the scheme.