Rwanda has in the past two decades taken the world by surprise for its rapid socioeconomic transformation, scoring highly in several reports and gaining popularity for its ambitions in pursuing quality life for all its citizens.
The country has among others been named one of the safest places to be. According to the 2015 Gallup Report, 85% of people who participated said they felt safe to walk at night in Rwanda, one of the highest scores in the rankings, with the best mark being 91% for Singapore and Hong Kong.
Rwanda’s safety however goes, or at least is envisioned to go deeper than just walking without second-guessing one’s security.
As the nation has vowed in its shared Vision 2020, the target is to create a country where citizens have the best services and where life is valuable and worth living.
One pillar central to achieving this vision is creating a social security system that caters for the needs of everybody, especially the most vulnerable. As Rwanda’s 2003 constitution stipulates, the value of its citizen is non-violable.
Taking a closer look at the country’s social security landscape, Rwanda, a country on a continent that is home to most countries categorized as third world has managed to create a universal medical Community Based Health insurance (CBHi) scheme popularly known as Mutuelle de santé marvelled world over.
To harmonise and consolidate these efforts in building an all-inclusive social security system, a one-stop kind of institution for all developments in the sector was set up since 2010, when former Caise Sociale du Rwanda (Social Security Fund of Rwanda) and La Rwandaise d’Assurance Maladie (Rwanda Medical Insurance) were merged to create the Rwanda Social Security Board (RSSB).
Until recently, RSSB was managing the national pension scheme, medical insurance scheme for Rwanda’s workforce, and an occupation hazards insurance scheme.
Recently, precisely in the course of this year 2015, the earlier mentioned CBHi, has been moved from local administration to RSSB, while the anticipated Maternity Leave Benefits Insurance scheme will also be operational under the same flagship institution in the near future.
Looking in the past at reasons that prompted government of Rwanda to move CBHi’s management, two areas were cited as needing extra efforts to improve; contribution collection procedures and reimbursement to healthcare facilities that provide services to the scheme’s subscribers, and addressing attitude issues that challenge the achievement of universal subscription to Mutuelle de Santé despite government’s efforts to make health insurance affordable and equitable through the scheme.
With the scheme now under RSSB, the board is already making strides to address these and other challenges that existed in the past so as to deliver on the promise of quality healthcare for which CBHi was introduced in order to guarantee affordability and accessibility for all Rwandans.
Concerning contribution collections and prompt reimbursement of partner service providers, RSSB is leveraging on its already existing expertise in the area.
With improved contribution collection mechanisms, RSSB will also leverage its expertise acquired through many years of managing similar schemes to ensure prompt reimbursement of healthcare service providers so that quality services continue to be rendered to Mituelle subscribers.
Past delays in fund disbursement to healthcare service providers that existed in Mutuelle de santé’s management were largely responsible for the inaccessibility of medicine to the scheme’s beneficiaries.
At a recent press conference where official documents of CBHi were handed over from Rwanda’s Ministry of Health to RSSB, the boards recently appointed Director General Jonathan Gatera affirmed that this lack of medicine is a story of the past.
“Leveraging our existing structures and building on the experience acquired over many years of managing social security schemes in Rwanda, we promise to maintain timely payment of bills from health service providers so that Mutuelle de santé beneficiaries receive quality services including among others getting all medication as prescribed.”
On the issue of mind-set change towards Mutuelle de santé, RSSB is rolling out a series of sensitisation campaigns to encourage universal and timely subscription to the scheme.
Among others, a mobilisation campaign involving executive secretaries of cells (Akagali) from across Rwanda to equip them with skills and tactics to attract compliance is on-going.
RSSB intensifies mobilisation to increase subscription to Mutuelle de santé
Since the end of July 2015 when Mutuelle de santé was legally transferred to RSSB, several mobilization efforts have been made towards influencing increased and timely subscription by citizens to the scheme.
Among others, a nationwide health insurance campaign was on September 26th 2015 launched by Rwanda’s Prime Minister Anastase Murekezi and is expected to run until December 27th.
Objectives of the nationwide mobilisation campaign
The health insurance campaign will run under the theme “MITIWELI ISHEMA RY’UMURYANGO”, loosely translating “Mutuelle: Pride of the Family”.
This nationwide campaign is aimed at mobilizing people to subscribe on time and assure them of quality services under the reloaded Mutuelle de santé management. During awareness talks, benefits of the new operations of health insurance are discussed and new features that make Mutuelle even more advantageous shared.
Advantages of the reloaded Mutuelle de santé as shared in the campaigns include:
• A subscriber to mutuelle de santé has easy access to health services in the whole country; in over 368 health posts, 502 health centers, 42 district hospitals and 5 referral hospitals. Treatment is sought from anywhere in any of the mentioned health facilities.
• Paying subscriptions is easier than ever before. Members can pay through SACCOs and banks and soon mobile money transfer and e-payment platforms will also be introduced.
• In case a member is not satisfied with provided services, a toll free helpline is now in place. Dial 4044 and your complaint will be logged and dealt with in the fastest manner possible.
• Everyone pays according to their social status “Ubudehe” category (Rwf3000 and 7000 for respective groups). Medical insurance premiums for the most poor, which is 2000 per individual, are met by government and its various partners.
Planned activities during the mutuelle campaign
During the campaign period, several sensitization activities aimed at driving increased subscription to medical insurance are planned.
The campaign that intends to revamp the reputation of the program is focusing on heads of households and the youth.
For campaigns targeting heads of households, slogans such as; Mutuelle, pride of the family; insure your family by paying on time; and; a good inheritance is caring for your family’s health are being used to entice people to reflect on and appreciate the necessity of medical insurance for every Rwandan family.
Under this target group, campaigns are being held in churches and mosques, Radios, markets, community service, among others.
For the youth target group, “A good youth is an insured one” is being used as the main slogan for the sensitisation.
Concerts, road shows, dramas, sports, and youth competitions are among other channels used to pass the key messages of campaigns.
Also mass communication channels like Radio, TV ads and scrolls, popular shows, interviews with government officials, testimonials of beneficiaries, football matches as well as songs by musicians in vogue are being used to further the sensitization campaigns.
In similar efforts, a documentary “A day in the life of an insured Rwandan” will air on different Radios (public, private and community). Social media campaigns are also ongoing.
Outdoor campaigns
In order to amplify the reputation of the Mutuelle de santé insurance scheme, a new logo, colors, banners, stickers, posters have been developed and placed in public spaces including at bus stops, markets, schools, public gatherings, etc.
The launch of health insurance campaign was conducted at the village level with Ministers, local leaders, members of parliament and other government officials, civil society, among others enlightening the masses on the advantages of the improved Mutuelle de santé and encouraging them to pay their premiums on time.
Mutuelle campaigns involve everyone
While RSSB is taking lead in the campaigns geared towards increasing awareness on the importance of Mutuelle de santé health insurance, several other government institutions have been allocated responsibilities and every partners in invited to play a role.
It is a shared conviction that achieving universal subscription to medical insurance will significantly boost socioeconomic wellbeing of Rwandans as has been observed over the last two decades of the insurance’s existence.
According to the Rwanda Demographic Health Survey 2015, hospital utilization and uptake of health care services, including delivery at health facilities increased sharply over the last decade.
Mutuelle de Santé has been cited among major factors that have led to these milestones.
Over 15 years from 2,000 to 2015, the RDHS 2015 statistics recorded significant drop in infant mortality rate decreasing from 107 deaths per 1,000 live births to 32 deaths. This is a more than 214% decline in the number of children who die before their fifth birthday.
With regards to proper care during pregnancy and delivery which is deemed important for the health of both the mother and the baby (and is the fifth Millennium Development Goal), the 2014-15 RDHS results show that practically all women (99 percent) who gave birth in the five years preceding the survey received antenatal care (ANC) from a skilled provider at least once for their last birth. Forty-four percent of women had four or more ANC visits.
This is a clear indication that as a result of Mutuelle de Santé, Rwandans seek health care services more often than ever because it is affordable.
Owing to the impact that mutuelle de santé has had on the lives of Rwandans over the last two decades, everyone from local and central government authorities, civil society, and all partners, is involved in the nationwide campaign to yield universal and timely subscription of all Rwandan families to medical insurance.
More specifically, the Ministry of Local Government, Ministry of Health, District authorities and of course the Rwanda Social Security Board are taking the lead.
A glimpse in RSSB’s performance for financial year 2014-2015
Comparing end financial year 2014-15 to 2013-2014, RSSB scored growth in all the schemes under its management, growing both in numbers of contributors and the contributions thereof.
Contributions collected under the pension scheme were recorded at about Rwf60 billion for the fiscal year 2014-2015 a more than 7% increase compared to Rwf55.5billion collected in 2013-2024.
Also, collections from the medical insurance grew by 7.5% increasing from Rwf33billion to about Rwf36 billion during the same period.
The increased contributions are mostly attributed to increase in number of contributors in both schemes thanks to the unwavering efforts that have further made paying contributions swifter and member friendly.
Contributors for both pension and medical schemes increased from 380,001 and 131,389 to 394,367 and 135,252 respectively during the same period.
Also, the institution’s investment portfolio grew further during this period.
From about For instance, the contributions collected under the pension scheme were recorded at about Rwf60 billion for the fiscal year 2014-2015 a more than 7% increase compared to Rwf55.5billion collected in 2013-2024.
Also, collections from the medical insurance grew by 7.5% increasing from Rwf33billion to about Rwf36 billion during the same period.
The increased contributions are mostly attributed to increase in number of contributors in both schemes thanks to the unwavering efforts that have further made paying contributions swifter and member friendly.
Contributors for both pension and medical schemes increased from 380,001 and 131,389 to 394,367 and 135,252 respectively between fiscal year 2013-2014 and 2014-2015.
