Mutuelle: Why health scheme was moved to pensions body

The National Leadership Retreat directed that medical insurance scheme, Mutuelle de Sante, be moved from Health ministry to Rwanda Social Security Board (RSSB). Explaining the decision during a media briefing yesterday, Cabinet ministers said the move was aimed at improving the fund’s financial accountability. Introduced in 2004, Mutuelle de Sante seeks to ensure that citizens – regardless of their financial status – access quality health care. The coverage of the scheme, which requires fresh subscription every financial year, currently stands at 93 per cent, according to officials figures. Membership to the scheme is voluntary and payment of premiums is based on one’s economic status, with government paying for the most vulnerable of society. Premiums were supposed to be collected by local authorities and paid to hospitals through the Ministry of Health. But this was not always the case. The Retreat instructed the Health ministry and RSSB to fast track the handover process. Local Government minister James Musoni said at a post-Retreat media briefing at the Prime Minister’s office yesterday that the decision was taken in light of past mismanagement of the scheme and to ensure transparency. “There were cases of poor management of the funds,” Musoni said. He said the idea of moving the scheme to the pensions body was first mooted way back in 2011 following the merger of then social security fund of Rwanda (previously, Caisse Sociale du Rwanda) and Rwanda Medical Insurance (Rama) – to form present-day RSSB. Rama is an insurance scheme for mainly the working class. At the time, Mutuelle de Sante was left out of the merger mainly because its structures were not well defined and lacked clear sustainability strategy, officials said. In 2008, about Rwf1 billion collected as in Mutuelle premiums was reportedly embezzled, leading to the arrest of several local government officials. Later, Mutuelle de Sante was streamlined and subsequently drew billions in collections. The improvement in collections prompted the central bank to demand for a clear financial management channel and a caretaker institution for the scheme. Musoni also cited some anomalies, including cases where a health centre would collect the premiums and offer services to the beneficiaries at the same time. “That’s conflict of interest and it could lead to mismanagement of the premiums. There is no way an institution can be in charge of receiving and spending the same funds at the same time,” Musoni said. RSSB will now be responsible for the financial management and accountability,” Musoni said. The Minister for Health, Dr Agnes Binagwaho, admitted that her ministry lacked capacity to manage the Mutuelle premiums, explaining that the latest changes were designed to improve health financing. Rwanda adopted a new Community Based Health Initiative contribution scheme based on soci0-economic stratification in 2010. Under the approach, the population is divided into different categories based on household income. Premiums are paid depending on the stratification, which is made of six categories. Those in category one and two are paid for by government since they are considered poor. The government pays Rwf2, 000 annually for everyone in the two categories.Those in category three and four pay Rwf3, 000 a year while subscribers in the remaining two categories part with Rwf7, 000. “About 25 per cent of Rwandans are in categories one and two, and the fund collected Rwf17 billion in 2012. This is a lot of money but we lack the expertise to manage it. That’s why RSSB is taking over,” admitted Binagwaho. She added that plans to move Mutuelle de Sante to RSSB are in earnest. “We have worked on all the required legal instruments and starting next financial year, July 1, Mutuelle will be under RSSB,” she said. The fund is also weighed down by a heavy debt, ruining into billions of Rwandan Francs. Available reports indicate as of November, 2013, Mutuelle’s debts stood at about Rwf2.3 billion, owed to district hospitals, some Rwf1 billion owed to health centres, and about Rwf431 million owed to national referral hospitals. By press time, it was not clear whether RSSB had finalised plans to take up the scheme as Moses Kazoora, the public relations and communications director, said he could not comment because he was in a meeting.