Back in the days the challenges that faced the health system in Rwanda mostly was how to reconcile within the context of poverty the objective of improving financial accessibility to healthy care and equity to health systems on the other hand.
The need to mobilize domestic resources for improving the financial viability of health services on the other hand, but with the government of Rwanda introducing community based health insurance in 1999, all Rwandan have access to health services now.
This policy has been enshrined into the law and intends to offer social protection to the Rwandan population. Health insurance therefore is obligatory in Rwanda. Introduction of mutual health insurance across the country especially in the rural community which forms the majority of the Rwandan population and the informal sector has ensured equitable access to quality services, to the Rwandan population.
According to Makak Andrew the director of finance at ministry of health and head of metuelle department, all Rwandans are entitled to metuelle de santé, adding that it's a government policy which was put in place as a poverty reduction scheme and a health payment mechanism for people who couldn't afford paying for their health bills. About 90percent of the population of Rwanda use this medical insurance.
Rwandans found it difficult to meet their health care costs, and therefore there was little utilization of health services due to high spending from their pockets, so the government came up with the metuelle de santé idea, where now every Rwandan can have access to health facilities at a low cost.
"I get all my treatment and antenatal care here at kimironko healthy centre at a low cost as compared to other health centers, because of metuelle de santé.
If I compare what I pay and what I would pay if I were to go for health services to any other health centre, I find this very suitable for me and my family, says Nyirasangwa Marie Claire a pregnant woman who had come to the health centre for her laboratory tests, adding that even when they find that your case is serious and need a bigger hospital, they refer you to that hospital but still you get treatment on a metuelle, so you don't pay high bills. This arrangement is like a real savior to most of us, says Nyirasangwa.
To determine how much every person is supposed to pay for the metuelle,the district gets information from the ministry of local government about the Rwandans and how they can be able to support themselves that is the rich, the middle class, and the poor, so they categorize them according to that.
"After getting this information, we then can know how much each individual can pay. For the rich, they have to pay 7000 per head in the family, the middle class pays 3000, and those ones who can not afford are paid for by the government, says the director of metuelle at the district of gasabo Richard Rutagwenda.The only work the district does is to determine how much each individual is supposed to pay for metuelle de santé per year.
"We have to know how many you are in the family and the category you fall into to determine how much you have to pay, "adds Eric Ngabonziza, the manager of metuelle de santé section at kimiranko health centre, adding that people then have to pay that amount accordingly and then they have to pay 200rwf every time they come for treatment as a participation in the health service provision for everyone in the country.
He adds that if a person's case can not be handled at the health centre, then that person is transferred to the district hospital but still gets treatment on the metuelle,so they do not have to pay much money still.
Mbabazi James a student from Groupe Scolaire Kimironko in secondary two who has had eye problems for sometime says there is nothing much she can say about the metuelle."As we know health services here in our country are so expensive if one doesn't have a health insurance. But with my metuelle de santé of 3000 per year, I can even get eye treatment which would be so expensive for me otherwise," adds the student.
The director of kimironko health centre Mushatsi Joseph says, most patients they receive at the health centre are on this medical insurance about 89%.These people come here get the services from us an then us we are paid by the metuelle de sante department from ministry of health.
" The 200rwf they pay here is called Inyunganira Musanzu, which they do not pay to the hospital but to the metuelle section still .Some people think that this is the hospital's money but its not. Our work here is to deliver services and for free then we wait for our payments, "adds the director.
Nshimimana Ephraim says the only thing he has to do is come with his 200rwf, pay it and then he gets the treatment he needs for his back pain which he has had for quit some time now. Even when my children are sick, that is the only money I have to pay and they get the treatment, so for my entire family, health cost are no longer much for us.
Uwase Christine a lady in her late 20's says one time she got a Nairobi fly bite and it was so severe, but when she went for treatment she was asked for a consultation fee of 10000rwf,minus the medicines, which she couldn't afford, not until she decided to use her metuelle de santé for the first time.
"I thought using it was a very long process that is why I had opted to go to another health centre, but on reaching my health centre I was told to pay only 200rwf. They gave me my fiche which I use to get all the treatment I needed, and in just two days I was back to my normal health from just 200rwf.It is so good for especially people who can not afford the health costs of here,' adds the lady.
Despite the long cues people have to make for the services, they still appreciate this government policy and believe it will even get better in the near future than it is now.