Residents in the Northern Province are still reluctant to pay this year’s contribution for the community medical insurance cover commonly known as mutuelle de santé.On average, available statistics show that less than 10 percent of the total population in the province has so far paid their annual premiums.According to John Gasaraba, an official in charge of the insurance scheme at the province, Gicumbi District leads with 13 per cent of the total population while Musanze lags behind with only six percent."We have not received full statistics from all the districts but the performance is still relatively low,” Gasaraba said.He could not specify whether the situation was exacerbated by a recent payment increase or the residents are deliberately reluctant to adhere to the stipulated directives.Each individual was supposed to have paid health cover at the end of June 2012 but the grace period was extended for an extra month.The Director of Health in Musanze District, Celestin Gasana, said that a sensitisation campaign is underway to create awareness about the value of medical insurance.Health workers allege that the delay in payment is occasioned by patients shying away from seeking medical attention at health centres and hospitals.Officials at Ruhengeri Hospital told The New Times yesterday that most of the patients received on a daily basis do not have medical insurance cover."Most of the cases we have received in recent times lack medical insurance cover including expectant mothers and accident victims, while the rest fear to seek medical care,” said a nurse who preferred anonymity because she is not authorised to speak to the press on behalf of the hospital.She said that in case of such an occurrence, patients are treated and pay later as their health is considered as the first priority.Meanwhile, Dr. William Namanya, the Director of Kibungo Hospital confirmed a fall in the number of patients visiting the hospital."Our average daily patients reduced by 60 percent...we used to handle at least 100 patients daily, but now we deal with not more than 40 patients a day. I am not yet sure of the reasons,” he said.A number of nurses at Rwamagana Hospital, who talked to The New Times also said the number of patients had drastically reduced."We at last got time to relax...in the afternoons there are no more patients to treat. Most of malaria cases who formed a majority of our patients are nowadays handled by community health workers,” said one nurse.Mutuelle de Santé holders have access to all public and private non-profit health centres in the country.The Director General of Mutuelle de Santé in the Ministry of Health, Andre Makaka told The New Times that the number of people visiting health facilities was expected to reduce further after the enhancement of the status of community health workers.Reacting to reports that the low turn up of patients in health centres was due to the public’s failure to pay for mutuelle de santé cover, Makaka said the idea of health insurance was well conceptualised, adding that the most risky groups had paid their medical cover in advance.He noted that the government’s commitment to bolster the health sector targets the construction of 20 health centres annually."There is no more ignorance...delays in payments are experienced when people are busy attending to their farms (in rural areas). This is common and has nothing to do with failure or ignorance about health insurance."We have developed strong community healthcare (structures), malaria tests are done by community health workers. Very soon, they will also handle family planning issues so that people do not need to go to hospitals. I was in Nyamata hospital at 11.00am and there were no more patients,” he noted.Makaka further disclosed that the government annually uses a total of $4 million to subsidise the mutual health insurance programme, The Global Fund chips in with about $5million, while the population contributes about $30 million.He noted that excellent performance of the medical insurance scheme in the country had attracted the attention of many countries across the world wishing to learn further about it."Challenges are there, but benefits supersede them by far. We broke the financial barrier to healthcare hence improving people’s livelihoods.”There are three categories of medical insurance cover. These include  people considered to be very poor who pay an annual charge of Rwf2,000 that is settled by government on their behalf.  The rest are expected to pay for themselves with charges standing at Rwf3,000 and Rwf7,000, respectively based on category.