With more than 90 per cent of Rwandans covered under the community-based health insurance scheme locally known as Mutuelle de Santé, Rwanda is one of the few developing countries in the world that have successfully achieved universal healthcare.
The scheme has in recent years encountered challenges of low real uptake numbers, inflated numbers by local leaders and poor service delivery in health centres and district hospitals, prompting the government to transfer management of the scheme to the Rwanda Social Security Board (RSSB) under the Rwandaise d'Assurance Maladie.
According to the Ministry of Health, management of the scheme which was initiated in 2000 but was operationalised in 2004 has improved since it was moved to RSSB in 2015 but some citizens say the quality of services given to subscribers is still wanting.
"It is not easy to secure a transfer from a district hospital if you need to go to a referral hospital," says Sarafina Mukasarasi, 40, a card holder, though she says services at the district hospitals have improved, despite the long queues.
Ms Mukasarasi however says that thanks to the insurance scheme, which she pays about $3.36 (Rwf3,000) a year based on her household income, she does not pay a single coin when she falls ill or child birth. She delivered all her three children in a district hospital at no cost.
The scheme has been touted as one of the most successful on the continent and it is credited for the country's lower maternal and infant mortality rates of 77 per cent and 70 per cent respectively, since 2000.
It is also used as an example of affordable universal healthcare schemes for poor countries.