Success of Mutuelle de Sante requires focus on changing attitudes and perceptions

To improve efficiency and augment access across the country, the Government of Rwanda has decided to move the management of Community Based Health Insurance (CBHI) scheme, (popularly known as Mutuelle de Santé) to Rwanda Social Security Board. Among other factors for moving the scheme to RSSB was cited the need to scale up its reach and ensure maximum coverage where all Rwandans have a medical insurance and can therefore access healthcare easily. Thus to effectively execute the mandate, RSSB embarked on strengthening awareness creation on Community Based Health Insurance against the knowledge most people did not subscribe because they lacked financial means to but because they did not understand why they need to have medical insurance. In most cases, such individuals have panicked in the face sickness, struggling to pay their medical insurance and get their accounts operational in the shortest time possible. Some have succeeded, but it is important that mobilization campaigns be scaled up so that people appreciate why everyone in a household needs to have Mutuelle de Santé all the time. The aim RSSB’s awareness campaigns is to attract more subscribers to the insurance scheme and to promote adherence to timely payment of insurance premiums. To achieve these goals, it is inevitable to employ a combination of awareness creation and education, considering that surveys conducted since its inception have mainly pointed towards attitude and perception. As an illustration, between 2004 and 2012, subscription to Mutuelle de Santé increased from 27% to over 90%. This was attributed to concerted mobilization efforts by all concerned stakeholders, ruling out the generally perceived issue of constraints in household incomes or poverty levels, considering that the Government and partners cater for the vulnerable, and pointing firmly to mindset issues. Besides government support, a 5% contribution by public and private health insurance schemes to Mutuelle de Santé also contributes to ensuring that the scheme remains generally affordable by subsidizing the rates. Against this backdrop, RSSB has embarked on four months of awareness campaigns with the aim of devising ways of changing people’s attitudes and affect the trend of subscriptions. This is a government of Rwanda priority that all Rwandans have medical insurance because of the many promises of improved socioeconomic well-being that have one presents. And no doubt, Mutuelle de Santé has demonstrated these impacts for all over the past decade. Universal health insurance has had significant impact on improving the standards of living in Rwanda by enabling the largest segment of the population gain access to preventive, curative, rehabilitative and palliative health services which they would hitherto not easily access. The scheme has also been credited with mitigating the catastrophic out-of-pocket expenses on health care and promoted the culture of seeking early treatment, consequently reducing the burden of health bills on households and minimising the use of unorthodox treatment respectively. According to the Rwanda Demographic Health Survey 2015, hospital utilization and uptake of health care services, including delivery at health facilities increased sharply over the last decade. Mutuelle de Santé has been cited among major factors that have led to these milestones. Over 15 years from 2,000 to 2015, the RDHS 2015 statistics recorded significant drop in infant mortality rate decreasing from 107 deaths per 1,000 live births to 32 deaths. This is a more than 214% decline in the number of children who die before their fifth birthday. With regards to proper care during pregnancy and delivery which is deemed important for the health of both the mother and the baby (and is the fifth Millennium Development Goal (MDG), the 2014-15 RDHS results show that practically all women (99 percent) who gave birth in the five years preceding the survey received antenatal care from a skilled provider at least once for their last birth. Forty-four percent of women had four or more ANC visits. This is a clear indication that as a result of Mutuelle de Santé, Rwandans seek health care services more often than ever because it is affordable. The author is the Director of Communications at RSSB.

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Success of Mutuelle de Sante requires focus on changing attitudes and perceptions