Rwanda is overhauling its medical insurance scheme, which covers over eight million citizens particularly in rural areas, in a bid to improve health financing amid allegations of corruption and falling subscriptions.  

Specifically, the community-based cover commonly known as Mutuelle de Sante, will now be managed by the Rwanda Social Security Board (RSSB), the country’s pension body, instead of the Health Ministry, whose capacity to manage the scheme has been questioned.  

The transition is expected to be completed when a law currently before parliament is enacted to facilitate the asset transfer to RSSB, which will also have a new structure. 

Every Rwandan is obliged by law to have some form of health insurance. Mutuelle de Sante has in recent years been marred by decreasing subscriptions and accumulation of debts, threatening the existence of the scheme, which has been credited with improving the country’s health care. 

In addition, failure to provide timely payments to service providers, in particular public hospitals and pharmacies, has compromised the quality of healthcare in the country, putting many lives at risk.

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“The main problem had to do with financial management — the contributions were being collected from individuals by local government authorities. But some of that money never reached the coffers of Mutuelle de Sante,” said Daniel Ufitikirezi, director-general of RSSB.

The financial management of the scheme will now be centralised as opposed to the existing structure managed by the 30 districts across the country, making co-ordination at the national level challenging. 

Recently, several local government officials have been arrested over fraud and embezzlement of Mutuelle premiums following government investigations into the scheme. 

This came after shortages in funds triggered an assessment audit that unearthed major shortfalls and inconsistencies in Mutuelle de Sante funds, estimated at above Rwf2 billion ($2.9 million) in Western Province.

Last week, the former mayor of Rusizi district in Western Province, Oscar Nzeyimana, his former deputy in charge of social affairs Basil Bayihiki and three other district officials were arraigned in court and charged with forging documents with the aim of misleading government authorities.

Prosecutors accused Mr Nzeyimana and the trio of deliberately conniving to forge documents on April 14, 2014 to reflect an increase in the uptake of the healthcare insurance scheme from 69 per cent to 77.5 per cent. The former mayor of Karongi in Western Province, Bernard Kayumba, was also arrested on similar charges — misusing or misappropriating Mutuelle de Sante funds.

Similarly, on Tuesday, the former mayor of Nyamasheke district, Jean-Baptiste Habyarimana was arrested on suspicion of embezzlement of public funds meant for Mutuelle de Sante.

“People would refuse to contribute on time but when they or their family member would get sick they would bribe the officials who collect contributions, and their payment date would be backdated,” said Dr Ufitikirezi, adding that contributions will now be tracked electronically.

Available statistics show subscriptions have been decreasing gradually — with an estimated 73 per cent of Rwandans subscribed to the scheme in the past fiscal year 2013/14, down from 80.7 per cent and 90.7 per cent in the financial years 2012/13 and 2011/12 respectively.  

According to a 2012 report by Rwandan legislators, the government had accumulated over Rwf2.3 billion ($3.3 million) in arrears owed to district hospitals and over Rwf400 million ($580,000) to national referral hospitals and health centres, indicating that the scheme is not self-sufficient. This has created concerns about the scheme’s financial sustainability.   

Launched in 2004, Mutuelle de Sante was rolled out to ensure that all Rwandans have access to healthcare; coverage requires fresh subscription every financial year.