Rwanda: Mutuelles Increase Access
to Improved Services
Provided by PRIME II VOICES
"Before, if we got sick
and didn't have any financial resources we used to have
to sell our livestock or our land. Now, once we pay
our contributions to the mutuelle we receive a membership
card that we show to the health center, and we are treated
without any constraints."
For many residents of Bungwe,
Rwanda, family planning and reproductive
health care has improved through participation in a
community prepayment
health insurance scheme, or mutuelle. By pooling their
resources, all
mutuelle members receive services at their designated
health center.
Encouraged by Rwanda's Ministry of Health, mutuelles
are designed to
enhance the performance of primary health care providers
while reversing
the low usage of services, especially family planning
and reproductive
health care, a trend due in large part to widespread
poverty.
The PRIME II Project has been
assisting the Ministry of Health since 2000
to strengthen and sustain 62 mutuelles in the health
districts of
Bugesera, Byumba, Kabgayi and Kabutare, home to approximately
15% of
Rwanda's population. Administered by community representatives
in
collaboration with local health care providers, mutuelles
become
increasingly sound as financial risk is spread over
a larger and larger
membership. Using the Performance Improvement approach
to identify and
overcome barriers to increasing membership and improving
services, PRIME
has designed and facilitated campaigns to involve local
officials and
community leaders as partners in mobilizing community
members to join
mutuelles. The mutuelles foster dialogue between communities
and service
providers on the quality of services, allowing communities
to hold
providers accountable for the services they offer. In
turn, the mutuelles
offer a reliable revenue stream for participating health
centers, creating
an important incentive for providers to deliver quality
care.
To make it easier for community
members who lack financial resources to
join mutuelles, PRIME helped facilitate short-term microcredit
loans from
rural banks in Bungwe and some of the other participating
communities. In
addition, PRIME assisted in revamping the organizational
structure of the
mutuelles and conducting training workshops on administrative
and
financial management for 216 people involved in daily
management. PRIME's
work with the mutuelles complements its other activities
in Rwanda,
including the development of national reproductive health
policy and
service guidelines.
The advocacy, partnering and
sensitization campaigns initiated by the
Ministry of Health and PRIME II are resulting in encouraging
gains for
participating mutuelles, including significant growth
in membership,
increased contributions to health center revenues and
improved quality and
use of services. As of September 2002, membership in
the Bungwe mutuelle
had increased 124% in just two years. With 16,020 members,
the Bungwe
mutuelle includes 43% of its target population. Overall,
mutuelle
membership in the PRIME project districts has increased
by 63% from
initial levels. These mutuelles have contributed to
stronger financial
capacity at their partner health facilities, with some
mutuelles now
generating up to 75% of the total revenue for their
health center.
Most importantly, data show that
mutuelle members access family planning
and reproductive health services more often than non-members
who must pay
for services on a case by case basis. The mean yearly
health consultation
rate for Bungwe mutuelle members is 1.3 visits, as compared
to a rate of
0.3 for non-members. "People are coming more often
for preventive care,
which decreases further disease complications"
says Sister Yvette Vincent,
director of the Bungwe Health Center. "The mutuelles
unify the population,
creating an assembly that promises a better quality
of life."
The PRIME II Project works around
the world to strengthen the performance
of primary care providers as they strive to improve
family planning and
reproductive health services in their communities.
For more success stories, visit
Prime
II Voices.
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