With more than 90 per cent of the population covered under the community-based health insurance scheme Mutuelle de Santé, Rwanda is one of the few developing countries that have successfully achieved universal healthcare.

Our constitution provides for the right to health and the universal care system as a way to fulfil this mandate.

Under the scheme, the government subsidises cost by one-third. However, Rwanda Today has learnt that some patients, mostly from vulnerable households are failing to top up their medical insurance resulting in being temporarily detained in hospitals after being discharged.

Now caretakers and patients are calling for government to come up with a financing mechanism that allows them to pay the bills later.

While there is no silver bullet to funding healthcare, there is a need to explore innovative ways to finance out-of-pocket expenditures for our vulnerable population to sustain the gains in universal healthcare coverage.

Research by international experts, including some from the World Health Organisation, has shown that direct, out-of-pocket health payments, including payments for medicines, are barriers for access to health services.

Households that face difficulties paying medical bills may delay or even forgo needed health care.
According to WHO, reducing the reliance on direct, out-of-pocket payments will lower the financial barriers to access and reduce the impoverishing impact of health payments.

Increasing the level and share of revenues channelled through prepaid and pooled mechanisms, reducing fragmentation to increase the redistributional capacity of the pooled funds, and using the pooled funds to cover the health care costs for those in need, are key elements of the broad strategy that countries need to rely on to move towards universal coverage.

Barriers

However, some people will still face financial barriers to access even if direct payments are eliminated; transport and accommodation costs to obtain treatment might still prove prohibitive.

The government should consider options, including providing an alternative for vulnerable people to borrow at zero or low interest to pay for medical care.

Vulnerable families can also be given an option to provide casual labour at public construction works, where payments can be recovered to pay for their medical bills.

Our private sector can also offer temporarily employment or through their corporate social responsibility set up a fund that caters for out-of-pocket expenditures by vulnerable members.

It is not only unacceptable to detain vulnerable people when access to quality healthcare is a birthright guaranteed by our constitution, it also deprives them of their dignity.