Sharing the burden of sickness: mutual health insurance in Rwanda

Abstract

Mandatory participation in mutual health insurance schemes and public subsidies for poor have led to considerable improvement in public health and health care in Rwanda, but even at US$ 2 a year, price for some members of population remains prohibitively high. Aimable Twahirwa reports from Kigali. [ILLUSTRATION OMITTED] Rwanda's Ministry of Health plans, to boost community participation in financing of health-care services in 1980s and 1990s, were hampered in immediate aftermath of war and genocide of 1994. But since those dark days, Rwandan authorities have engaged in an effort to strengthen communities' role in managing and co-financing health-care provision. One of ways it has done this is through mutual health insurance schemes, known in as mutuelles de sante or mutuelles. Mutuelles were reinitiated as pilot projects in in 1999 and uptake accelerated sharply in 2004-2005 with adoption of a national policy on mutuelles and a roll-out of schemes with financial and technical support of development partners. As of April this year, every Rwandan is obliged by law to have some form of health insurance. There are currently several health insurance programmes in targeting specific groups of However, biggest in terms of membership is mutuelles scheme, participation in which is organized on a per household basis, with an annual payment of 1000 Rwandan francs (US$ 2) per family member. [ILLUSTRATION OMITTED] For WHO's Laurent Musango, former director of School of Public Health at National University of Rwanda, growth of mutual health insurance system has been a great success from point of view of affordability of programme, and fact that all comers are covered: Rwanda is only country in sub-Saharan Africa in which 85% of population participates in mutual insurance programmes for their health coverage, he says, adding that coverage is afforded to, the rich as well as poor, young as well old, urban as well as rural population. Musango argues that mutualization has also led to a reduction in health-care costs, and increased use of healthcare services. Taken together with other reforms such as decentralization of health-care services, performance-based financing, quality insurance and improvements in quality control through supervision, Musango believes mutualization has made a significant contribution to well-being of But there have been suggestions that people are being pressured into participating in a scheme they can ill-afford. In poorest regions of there are people who are finding it difficult to pay for mutuelle, but government is doing a lot to help, says Didi Bertrand Farmer, director of community health and social development with Partners in Health, a nongovernmental organization that is working in eastern Rwanda. …