The New Times (Kigali)

23 June 2011

Rwanda: A Sweet Pill in the Health Sector

opinion

This week, a team of 22 professionals from Nigeria's National Health Insurance Scheme (NHIS) visited Rwanda on a study tour of our numerous health schemes, both public and private.

Of particular interest was how Rwanda managed to roll-out a country-wide health insurance scheme (Mutuelle de santé) not seen or tested anywhere on the continent, and yet seems to be working seamlessly.

The team led by Nigeria's former Health Minister Prof. Eyitayo Lambo is charged with designing a similar scheme to cater for nearly 70 percent of Nigeria's population, mainly falling within the informal sector.

Nigeria has something similar to our own RAMA. The only difference is that RAMA caters for the entire Rwandan civil service while theirs caters for a small fraction of public servants working for the Federal government mainly in Abuja and Lagos.

In total, their equivalent of RAMA covers only 5 million people in a country of 150 million people.

From their facial expressions, the group seemed astonished. They wondered how an ordinary rural person without use of any coercive measures would appreciate the value of voluntarily contributing to an insurance scheme.

This, according to one of their colleagues who confided in me, was something that he had believed could only happen in the west.

Even more mind boggling was the new proposal, in which contributions for mutuelle would increase significantly based on the stratification that categorizes Rwandans according to their household incomes.

They wondered how the ordinary Rwandan would readily accept this new policy without any form of resistance.

The success, the Minister of Health Dr. Agnes Binagwaho said, lies in the lessons, experience, immense value and contribution that Rwandans have seen in the policy over the past 10 years of its existence.

Indeed, over the 10 years, Mutuelle de santé has marked a revolution in the health care system of this country and is probably one of the most significant policies that was introduced in post genocide Rwanda.

That is why, taking it to the next stage of ensuring its sustainability based on equity and fairness is something that any Rwanda would readily embrace.

A system that is heavily subsidized by government and donor funded cannot be sustainable for the future unless Rwandans themselves take full ownership of the process.

This ownership can only be achieved if we widen the base for benefactors and make contributions in accordance to our income levels. It makes no sense for a muturage in Rusizi to pay the same amount as a business man in Kigali's Mateus.

Therefore, the new policy that comes into effect this July or August is aimed at cutting down on the imbalance but also open up the scheme to more people, especially the middle income earners and hence ensure its sustainability.

And this is why we should be proud of this scheme.

The latest Rwanda Demographic and Health Survey (DHS) statistics show that with the enormous investments made to the sector especially facilitated by the ease to access health care services, Rwandan lives are changing in a dramatic way.

This year's DHS results show that under-five mortality rate for every 1,000 live birth has significantly dropped from 152 in 2005 to 76 in 2010. Infant mortality rate is also showing a downward trend from 86 deaths in 2005 to 50 deaths by 2010 recorded at birth.

At least more and more Rwandan children are guaranteed a future devoid of any chronic diseases thanks to an ambitious vaccination program.

The rate of immunization for children aged between 12-23 months stood at 90 percent in 2010 compared to75 percent in 2005.

Today, 70 percent of the Rwandan mothers deliver from a health facility while 98 percent receive antenatal care. The percentage of the mothers who delivered from health centres stood at 30 percent in 2005.

One of the success stories of Rwanda's Health care programs has been the family planning measures. And as such, fertility rates have dropped from 6.1 children for an average Rwanda woman to 4.6 by 2010.

This reduction can partly be attributed to the fact that more Rwandan mothers are beginning to use modern methods of family planning as the latest DHS results show.

More Rwandans will live to celebrate their 50th birthday, thanks to a life expectancy that has doubled in the last 15 years from 29 years in 1995.

The reasons for this remarkable progress are a matrix of so many factors. But the most outstanding innovation is the Mutuelle that has made health care affordable and accessible to all.

No doubt the journey still remains long. As progress is made in combating communicable diseases and as more and more Rwandans live longer, the attention shifts to resurgence of non-communicable diseases like cancer and diabetes.

Therefore, the next big challenge is designing policies and programs that deal with segment of diseases. The good news is that the foundation has been laid and if the momentum is maintained, then Rwanda's health care system will continue to be a sweet pill to swallow.

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