Nelly Bassily | July 16, 2012
In Rwanda, having health insurance is no guarantee of receiving medical treatment. Rwandans are required to pay 10% of the cost of medical care. Those who cannot afford modern treatment are turning to traditional healers or self-medication.
Patients are not as keen as earlier to phone 912, the toll-free number for Service d’aide Médicale d’Urgence, or SAMU. SAMU was launched in 2009 to provide emergency support for accident victims and the seriously ill. But since early 2011, SAMU has required that people demonstrate an ability to pay for transportation and medical aid before an ambulance is dispatched.
Patients must pay 10% of the cost of travel — the equivalent of 40 Rwandan francs per kilometre — plus the cost of care during the trip. A villager in Kabuga, 20 kilometres from the capital city of Kigali, says, “When I called the ambulance to rescue my son who had just burned his whole body, I was told that I must first pay FRW 2600 (US $4.30), of which FRW 800 were for the ambulance and the remainder for first aid.” The villager chose not to go to the hospital, knowing that the same amount would need to be paid before his son received any treatment.
At the hospital, the patient must pay 10% of the cost of all materials needed for examinations, treatments, and operations, including syringes, gloves, gauze, disinfectant, serum and even scalpels. A nurse at the University Hospital of Kigali said, “Even in the case of an operation, all equipment must be provided by the patient. If he is not able to buy it, he cannot have medical examinations, let alone medication.” The nurse explained that patients must go back and forth between health insurance and pharmacies to find the necessary papers and medications.
Since mid-2011, Rwandans have been paying more for health insurance. Annual premiums rose from FRW 1000 per person to FRW 7000, FRW 3000 or FRW 2000, depending on income. This is in addition to the 10% user fees. A nurse in Bugesera in eastern Rwanda says, “A family of six persons in the second category makes annual payments of 18,000 FRW ($30). It is almost impossible for them to pay extra user fees.”
Health insurance covers treatment in public facilities only, not in private establishments. But there are often drug shortages in public pharmacies, and patients must cover the cost of purchasing these medications themselves.
Those in rural areas must pay for transport to hospitals – which are usually in towns – plus lodging. Kantarama lives in Rwamagana, a village in eastern Rwanda. When his son suffered an eye injury, he was transferred to Kabayi in the south of the country. Kantarama says that, because he knew no-one in the region, he had to sell the entire year’s harvest to pay for the cost of transport and lodging.
In 2010, hospitals lost huge sums because many people received medical care but were unable to pay. To limit their losses, the authorities decided that all services must be prepaid. Some institutions will even return an injured person who is unable to pay on arrival. A Kigali-based human rights activist says, “This requirement discourages people and pushes them to go to traditional healers or practice self-medication.” He thinks it would be better to raise premiums than demand money from villagers with little cash to spare.