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The Rwandan government and its partners have strongly promoted mutuelles de santé, community health insurance schemes that have proven to be a timely solution to the problem of access to quality health care. IntraHealth has assisted Rwanda's Ministry of Health in mutuelles development and support since 2000, most recently through the Twubakane Decentralization and Health Program.
According to Clarisse Utamuliza, nurse in charge of neonatology at the Muhima Hospital in Kigali, children born before term spend between 30 and 60 days in the hospital. The medical bill can climb to 200,000 Rwandan Francs (370 USD). Mutuelles members each pay 1000 Rwandan Francs a year (about 2 USD) for health care coverage. Utamuliza estimates that between 100 and 150 of the 200 people they receive each day are members. With membership, women receive maternity care at 10% of the usual cost. The mutuelles system also makes it easier for health facilities to recoup costs.
"Among the health insurance plans that we have in Rwanda, mutuelles are the only ones that pay regularly on time, and this allows us to cover our expenses," says Utamuliza. "I think that this is because mutuelles are decentralized—it is the local district that pays us."In the past Muhima Hospital detained women who could not pay for their maternity services. Women who were concerned about their ability to pay frequently avoided seeking care. Twubakane has been working to address this issue. According to Utamuliza, there are no women currently being detained at the hospital for not paying their bill.
"Mutuelles are very important for us," says Chantal Murebwayire, whose baby was born prematurely at Muhima Hospital. "I'm no longer afraid to come to be treated or have my children be treated. With my mutuelles card I am sure to have all the care needed. If I weren't a mutuelles member, I would have had problems paying the bill after such a long hospitalization stay."
The Twubakane program's activities to strengthen mutuelles include providing tools to build the capacity of mutuelles managers and support to help mutuelles ensure that all members can pay their annual dues.