29 December 2012

Rwanda: How Health Insurance Has Closed Gap in Quality Health Care


The Government of Rwanda has worked tirelessly to develop and promote the health sector by ensuring increased and valuable access to quality health services.

The existence of universal healthcare (Mutuelle de Santé), the military insurance scheme MMI, and RAMA has relieved people from high costs of medical treatment irrespective of their income status.

Mutuelle de Santé is meant for all citizens, RAMA is used by people in public service, while MMI is used by military families.

People have been sensitised to join the Mutuelle du Santé to enable them access quality medical care services and this has greatly reduced the mortality and morbidity rates amongst the Rwandan population.

Ever since this universal public health system was introduced several years ago, the number of people joining its services has increased presumably and is estimated to be at over 60 per cent.

Under this public health system, low income earners have been able to pay costs for highly valuable medical care services such as orthopedic surgeries and expensive drugs for cancer therapy.

The urgency of health care system, especially in sub-Sahara Africa, where there is a mixture of health hazards that claim large numbers of people every year, health effects of income inequality has been a big problem.

The association of income inequality and accessibility of quality medical care services brings a serious debate to the table. This is due to the fact that non-communicable or chronic diseases, such as diabetes and cancers, are on the rise in our societies.

The biggest question is how the poor can access pricey drugs and expertise to treat such health threatening conditions.

The health sector is one of the most challenging aspects on the world economy and the availability of quality medical care services correlate with the economy of the country.

Many drugs for chronic diseases are imported at very high prices in Africa and in low quantities, thus sold at high prices and not everybody can afford them.

Application of expertise to overcome most of these chronic infections is also not affordable for most of our people.

Income inequality is accompanied by many differences in conditions of life at the individual and population levels, which may adversely influence health. This begins with the structural causes of inequalities, and not just focusing on perceptions of that inequality.

In Rwanda, access to quality healthcare has been eased through these various insurance schemes, particularly Mutuelle de Santé.

In so doing, the government has sought equitable distribution of public and private resources.

Income inequality brings associations between income and health at the individual level. It also indicates that individual's income may be less important in understanding variation in health across aggregated units.

Normally there are policies on wages, investments and taxes that help determine the extent of unequal income distribution across the population; this distribution then influences individual incomes.

Now the availability of health insurance scheme in Rwanda is greatly independent of the unequal income distribution.

On the other hand, the psychosocial interpretation of income inequalities and accessibility of quality medical care services has been an aspect of great concern. This is because access to medical care conflates the structural sources. This also has subjective consequences of inequality and reinforces the impression that the impact of psychosocial factors on health can be understood without reference to the material conditions that structure day to day experience.

It does not also fully reveal the ambiguous health consequences of tight social networks and greater social cohesion as regards health and income of the population. Strong social networks can be coercive and can be sources of strain as well as support in various relationships. Therefore, social network can work towards enhancement of good health, but on the other hand, can be detrimental.

There has been an increase of public health infrastructure due to construction of many health centres in various parts of the country. The availability of health centres in society is a great determinant to accessibility of health care services.

If such infrastructures are not adequate, then the poor face rough measures to get access to quick and required medical care service.

The writer is a doctor at the Rwanda Military Hospital - Kanombe.

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