Why Rwanda’s health sector is unique in East Africa

Recently, I read in The New Times that the Rwandan health sector is ranked top in East Africa. This is not because the country has the most brilliant health professionals in the region but its strong health insurance coverage makes its health sector stand out.In Rwanda, we have Mutuelle du Sante, RAMA, the Military Medical Insurance (MMI), Medi-plan, among other health insurance covers.Most importantly is that most of the health insurance services are offered by the government to cover medical services for its citizensm mostly the vulnerable. Mutuelle de Santé serves various grades of people irrespective of their job status.RAMA is offered to people in public service and MMI covers military families.Since its inauguration over 10 years ago, Mutuelle du santé now covers over 90 per cent of the total population.The government and its partners have strongly promoted the Mutuelle de santé services, a community health insurance scheme that has proven to be a sustainable solution to the problem of access to quality health care.Through Mutuelle du Santé, low income earners are able to access quality and expensive medical care that cannot be easily attained without health insurance coverage.You think of a situation where your monthly income is less than Rwf100,000 and your child is diagnosed of a cancerous tumefaction. The Rwf100,000 cannot take the child for radiotherapy or chemotherapy. But the availability of the universal insurance scheme in Rwanda has solved such complex health problems.Having health insurance is important because coverage helps people get timely medical care and improves their lives and health. Some may believe that people always have access to medical care because they can always go to an emergency room. But even countries with well supported safety health care do not remove barriers to access the same extent as does having health insurance.People who live in countries without an extensive health insurance get fewer preventive and screening services and on a less timely basis. For example, massive health services such as screening for cervical and breast cancer, countrywide, would be expensive without health insurance because all people cannot afford the cost.Some conditions like most of cancer diseases are more likely to be diagnosed at a later stage of illness, when treatment is less important. Uninsured pregnant women use fewer prenatal services, and uninsured children and adults are less likely than their insured counterparts to report having a regular source of medical care.Also regular visits to medical care providers and early treatment can be difficult without insurance cover.Challenges are normally notable for chronic conditions especially for people with heart diseases, diabetes and many others where a patient needs to stay on drug therapy for a long time.However, some people, especially those from areas without health insurance, can decide not to obtain insurance precisely because they expect no need for regular medical care and this is the basis of untimely death in many underdeveloped or developing countries in the world.Lack of insurance is a fiscal burden to families. People without health insurance do not benefit from the discounted medical prices that are routinely negotiated through private health plans or provided through public programmes.Under certain circumstances, some patients might qualify for charity care but there are others who are dunned by lack of money to cover their medical costs. In many countries where public insurance does not exist, families without insurance normally report medical bill problems at a rate higher than those insured.There is no doubt that expansion of health insurance coverage would help improve health, lengthen lives, reduce disability, control communicable diseases, and raise productivity in the country.The author is a doctor at the Rwanda Military Hospital – Kanombe.