Mutuelle Users: PM’s Plan for Better Medicine Access

Government Unveils Strategy to Combat Persistent Medicine Shortages in Public Health Facilities

Kigali, Rwanda – In a significant move to address chronic medicine shortages plaguing public health facilities, Prime Minister Justin Nsengiyumva has announced a multi-faceted strategy aimed at ensuring consistent access to essential medications, particularly for members of the Community-Based Health Insurance (CBHI), widely known as Mutuelle de Santé. The announcement came during a joint parliamentary session where the government presented its recent activities under a “citizen-centred approach.”

Lawmakers had voiced strong concerns regarding ongoing gaps in medicine availability, even following a recent adjustment in Mutuelle contributions. The issue directly impacts the affordability and accessibility of healthcare for a substantial portion of the population.

Legislators Highlight Gaps in Access

Members of Parliament brought to light the persistent challenges faced by citizens. MP Pie Nizeyimana stated, “There is a shortage of medicines in health facilities, especially in provinces. Patients are consulted and then referred to private pharmacies where CBHI does not apply, making treatment unaffordable for some.” This referral process effectively bypasses the insurance coverage, placing an undue financial burden on patients who cannot afford private sector prices.

Echoing these sentiments, MP Christine Mukabunani emphasized the disparity in medicine access for Mutuelle users compared to beneficiaries of other insurance schemes. She noted that Mutuelle members often encounter limitations, particularly when seeking medications from private pharmacies. Furthermore, Mukabunani raised issues concerning the Imibereho social registry system, where misclassification can lead to incorrect contribution levels, further complicating access to services.

Addressing Financial Constraints and Introducing New Financing Models

Prime Minister Nsengiyumva acknowledged the validity of these concerns, attributing the shortages to financial constraints within the Mutuelle de Santé scheme. He explained, “Especially at health posts, there are sometimes shortages of medicines, and this has been linked to insufficient contributions that did not match the actual cost of services.”

To counter these financial limitations and improve procurement timeliness, the government has introduced a novel financing model for primary healthcare facilities operating under CBHI.

• Advance Funding Mechanism: Under the new system, health facilities will receive funds in advance. This disbursement will be calculated based on the number of members registered and served by each facility. The intention is to empower facilities to procure necessary medicines and equipment proactively, thereby preventing stockouts.
  • This proactive approach aims to mitigate the delays experienced under the previous reimbursement system, which often left facilities with insufficient operational funds, leading to service delivery disruptions. Prime Minister Nsengiyumva elaborated, “There were delays in payments, which caused some facilities to run out of funds, affecting service delivery.”
• Accountability and Disbursement: Facilities will be required to provide clear accountability for the utilization of these disbursed funds before any subsequent disbursements are made. This ensures financial transparency and responsible management.
• Pilot Program and Nationwide Rollout: This innovative financing model was initially piloted in the Eastern Province in December 2025. Early results from the pilot phase have indicated positive developments in service delivery, prompting plans for a nationwide rollout.

Expanding Coverage and Increasing Medicine Availability

Beyond the financial reforms, the government is significantly broadening the scope of services covered by Mutuelle de Santé. This expansion is designed to encompass costly but prevalent conditions affecting a large segment of the Rwandan population.

• Inclusion of High-Cost Treatments: The enhanced coverage now includes treatments for serious illnesses such as various forms of cancer, kidney diseases, heart conditions, and complex bone and spinal surgeries.
• Support for Mobility and Rehabilitation: Coverage has also been extended to include vital medical interventions like hip replacements, prosthetics, and essential assistive devices for individuals with disabilities.
• Substantial Increase in Medicine Formulary: The number of medicines available under the Mutuelle scheme has seen a dramatic increase, more than doubling from 850 to an impressive 1,450. This wider availability of medications is crucial for effective treatment and patient recovery.

Prime Minister Nsengiyumva underscored the direct relationship between expanding benefits and the need for robust financial backing. “This expansion of services and medicines requires stronger financial capacity. That is why increasing contributions goes hand in hand with expanding benefits,” he stated.

The financial impact of these expansions is evident. Expenditure under the Mutuelle scheme has more than doubled over the past decade, escalating from Rwf39 billion in the 2015/2016 fiscal year to Rwf98 billion in the 2024/2025 period.

Strengthening Healthcare Infrastructure

Complementing these reforms, the government has also made substantial investments in enhancing the country’s healthcare infrastructure. Rwanda now boasts a comprehensive network of health facilities designed to serve its population effectively.

• Primary Healthcare Network: The nation has 518 health centres strategically located at the sector level. Among these, eight high-volume facilities have been upgraded to function as medicalised health centres, offering more advanced services.
• District and Referral Hospitals: At the district level, there are 34 hospitals. These are supplemented by three provincial hospitals, a dedicated hospital for Kigali City, five referral hospitals, and five specialised hospitals spread across the country.
• Recent Infrastructure Development: Since 2017, a concerted effort has led to the construction or significant upgrade of at least 10 hospitals. These include Gatunda, Gatonde, Munini, Nyabikenke, Byumba, Nyarugenge, Masaka, Kabgayi, Kibogora, and Shyira hospitals, demonstrating a commitment to modernizing healthcare delivery capacity.