Sharing the burden of sickness: mutual health insurance in Rwanda.

Mandatory participation in mutual health insurance schemes and public subsidies for the poor have led to considerable improvement in public health and health care in Rwanda, but even at US$ 2 a year, the price for some members of the population remains prohibitively high. Aimable Twahirwa reports from Kigali. Rwanda’s Ministry of Health plans, to boost community participation in the financing of health-care services in the 1980s and 1990s, were hampered in the immediate aftermath of the war and genocide of 1994. But since those dark days, Rwandan authorities have engaged in an effort to strengthen communities’ role in managing and co-financing health-care provision. One of the ways it has done this is through mutual health insurance schemes, known in Rwanda as mutuelles de santé or mutuelles. Mutuelles were reinitiated as pilot projects in Rwanda in 1999 and uptake accelerated sharply in 2004–2005 with the adoption of a national policy on mutuelles and a roll-out of the schemes with the financial and technical support of development partners. As of April this year, every Rwandan is obliged by law to have some form of health insurance. There are currently several health insurance programmes in Rwanda targeting specific groups of the population. However, the biggest in terms of Co ur te sy o f P ar tn er s in H ea lth