In Rwanda, Your Health Premium Depends on Your Ubudehe Category — Epoche B1
Subject of this report Almost every Rwandan carries a card for Mutuelle de Santé, the community health insurance scheme that pays most of the cost of a visit to a health centre. This report sets out who pays what, what the card covers, and where its protection stops. 1. Who pays what Households are sorted into Ubudehe categories, a national ranking of household wealth. The word ubudehe is old: it once meant neighbours arriving to dig one another's fields. The idea carried across. The poorest category. Their premium is paid from public funds and donor support, so these families pay nothing. The middle categories. A modest annual sum for each member of the family, low enough that one harvest can cover it. The better-off. A higher band, still small beside private insurance. The categories have been redrawn more than once and the amounts revised, so treat any figure as approximate. 2. What the card covers At the health centre the member pays a small share of the bill — roughly a tenth as of this writing — and the scheme pays the rest. Consultations, common medicines, births and basic tests are included. 3. Where it stops Care must begin at the local health centre. A patient who walks into a district hospital without a referral loses much of the protection. Some drugs and treatments sit outside the list. And the premium must be paid before illness arrives, not after. Conclusion Coverage here is higher than in countries many times richer. A proverb repeated across the region says that if you want to go far, go together. Rwanda did not wait until it was rich. It collected very little from very many, and made joining the rule rather than the choice. That is a design decision, not a stage of development. References Ministry of Health, Republic of Rwanda (2010). Rwanda Community Based Health Insurance Policy. Kigali: Ministry of Health. Republic of Rwanda (2015). Law No. 03/2015 of 02/03/2015 governing the organisation of the community-based health insurance scheme. Official Gazette of the Republic of Rwanda. Lu, C., Chin, B., Lewandowski, J. L., Basinga, P., Hirschhorn, L. R., Hill, K., Murray, M. & Binagwaho, A. (2012). Towards universal health coverage: an evaluation of Rwanda Mutuelles in its first eight years. PLoS ONE, 7(6), e39282.