How Gishamvu attained early Mutuelle de Santé subscription

WHEN he took his two kids to a hospital to consult a dentist last May, Theodore Musana got surprised by the way he was received: a medical doctor took him outside the consultation room and presented him to a group of waiting patients. What struck the doctor, according to Musana, was the fact that he found this 54-year-old father with a health insurance card (Mutuelle de Santé) for the 2013/2014 fiscal year, just a month before the beginning of the fiscal year. “He was surprised so he took me to the other waiting patients and asked them who else had paid their health insurance subscriptions for the next year and he found none,” said the resident of Busoro village in Southern Province’s rural Sector of Gishamvu. “I felt very proud of myself.” Indeed, not many people among the general public manage to pay their Mutuelle de Santé (or health insurance) premiums months before the beginning of the fiscal year. Some have even found themselves struggling to foot their bills after they fell ill before paying for their Mutuelle. But, at least for the last two years, that has never been the case for Musana and 29 other members of his informal saving group because they always pay their Mutuelle premiums months before the end of the year, giving them assurance that they will continue to access cut-price health services. About two years ago, 30 residents in Gishamvu’s Busoro village came together and started an informal saving group they named Turwanye Ubukene by its Kinyarwanda words that mean “Let’s Fight Poverty”. Since then, the residents meet every week to give their contributions towards the group and the money is put together and deposited to an account opened at a local savings and credit cooperative (Sacco). “We use the money to give loans to our members for them to carry out income generating activities and also to pay for their Mutuelle premiums,” says Musana, who is also the head of the Turwanye Ubukene group. “None of us has ever failed to pay their Mutuelle subscription funds on time since we joined our hands.” Members of the group say it has helped them to meet their basic needs, including their Mutuelle de Santé premiums. “One day I fell ill and I had to pay Rwf 20,000 in cash to clear my bills. I felt very sad and decided to immediately join this group,” said Turwanye Ubukene member Marianna Musabyimana. Musabyimana , 45,had always struggled to raise money to pay for premiums for her five children. Every year she would raise more than Rwf20, 000 in cash for her 7-member family and often she had to wait for months before she could pay her dues. “I have regularly paid my Mutuelle premiums on time ever since I became part of the group about two years,” she said with a smile. Informal saving groups helped reach early 100% Mutuelle subscription At a time when local authorities across the country are still busy devising mechanisms to ensure 100 per cent subscription to the community health insurance, leaders in Gishamvu Sector are sitting relaxed as they have attained that level. Nearly three months since the fiscal year 2013/2014 kicked off in July, Mutuelle subscriptions in the sector have attained a level well over 100 per cent. Sector statistics actually indicate that 104 per cent have now paid their premiums to the health scheme if a surplus of about 100 casual labourers who are employed at various new construction sites in the sector are counted in. According to the Executive Secretary of Gishamvu Sector, Emmanuel Bizimana Ruti, informal groups commonly referred to as Intambwe have been very instrumental in boosting the numbers of people who subscribe to the health insurance programme. There are about 95 such groups in Gishamvu and each brings together between 25 and 30 families, Bizimana said. The sector has more than 13,000 residents, according to official figures. “The groups have been very helpful since residents organise themselves and deposit their contributions for the health insurance on time. We have seen some remitting their contributions months ahead of the new fiscal year,” Bizimana said in an interview this week. He encouraged other leaders to consider initiating the informal groups in their respective areas because they are very instrumental in stimulating positive change within communities. Jean-Louis Mukunzi, the in charge of health financing in the Ministry of Health, agrees with the idea of forming the groups. “Districts that have proved to perform well with regards to Mutuelle de Santé subscriptions are those with large numbers of such groups,” he said in an interview, highlighting that informal saving groups have proved to be a successful strategy to boost Mutuelle de Santé. Current figures from the Ministry of Health indicate that subscription to the community health insurance scheme in the current fiscal year is still low, especially in the category of those who pay for themselves. The government has divided citizens into different social categories under the Ubudehe programme, on which varied social protection programmes base. Category 1 and 2 constitute the very poor and their premium of Rwf 2,000 per individual is paid by government. The other categories pay Rwf 3,000 and Rwf 7,000 per each individual. Mukunzi told The New Times that subscriptions stood at around 38 per cent last week for the last categories while the government had already deposited remittances for people in categories 1 and 2. Put together, statistics of those already subscribed to the community health insurance scheme across the country stands at about 50 per cent of the total Rwandan population, Mukunzi said. This means that thousands and thousands of Rwandans are yet to pay for their Mutuelle subscriptions since the beginning of the 2013/2014 fiscal year. But Mukunzi said that the government has done everything to facilitate citizens, including allowing them to pay in different instalments. People can pay the first instalment by September, and the second one by December, he said. As efforts to raise the numbers of those who remitted their premiums to the scheme continue, those who already paid, such as all the residents in Gishamvu Sector, are enjoying discounted health services.