PM’s Mutuelle Plan: Better Medicine Access

Government Tackles Persistent Medicine Shortages in Public Health Facilities

Addressing critical gaps in medicine availability within public health facilities, particularly impacting members of the Community-Based Health Insurance (CBHI), commonly known as Mutuelle de Santé, Prime Minister Justin Nsengiyumva has announced a multi-pronged strategy. The Prime Minister presented these government initiatives during a joint parliamentary session, focusing on a “citizen-centred approach” to governance. The announcement comes amid ongoing concerns raised by lawmakers regarding continued medicine access issues, even after recent adjustments to Mutuelle contribution rates.

Members of Parliament have voiced significant unease about the persistent shortages. “There is a shortage of medicines in health facilities, especially in provinces,” stated MP Pie Nizeyimana. “Patients are consulted and then referred to private pharmacies where CBHI does not apply, making treatment unaffordable for some.” This sentiment was echoed by MP Christine Mukabunani, who highlighted that Mutuelle beneficiaries still face limitations when accessing medications, especially in private facilities, unlike individuals covered by other insurance schemes. Further compounding the issue, she pointed to discrepancies in the Imibereho social registry system, which can lead to incorrect classification and affect contribution levels.

Prime Minister Nsengiyumva acknowledged these challenges, attributing them largely to financial constraints inherent within the CBHI scheme. “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,” he explained.

New Financing Model for Enhanced Procurement

To directly combat these procurement issues, the government is implementing a novel financing model for primary healthcare facilities operating under CBHI. Under this new system, health facilities will receive funds proactively, calculated based on the number of members they serve. This forward-looking approach is designed to ensure that facilities have the necessary capital to procure essential medicines and equipment in a timely manner.

• Advance Funding: Health facilities will receive disbursements in advance.
  • This funding will be determined by the patient population they serve.
• Accountability Measures: Facilities will be required to provide a detailed account of how the disbursed funds were utilised before any subsequent disbursements are made.
• Pilot Success: This model was initially piloted in the Eastern Province in December 2025, yielding promising early results that indicate an improvement in service delivery. The plan is to roll out this system nationwide.

The Prime Minister further elaborated that the previous reimbursement system often resulted in significant delays in payments. “There were delays in payments, which caused some facilities to run out of funds, affecting service delivery,” he stated, underscoring the detrimental impact on operational capacity and patient care.

Expanded Coverage and Increased Medicine Access

Beyond financial reforms, the government has significantly broadened the spectrum of services covered by CBHI. This expansion aims to include costly medical conditions that disproportionately affect the Rwandan population.

• High-Cost Conditions Included:
  • Cancers
  • Kidney diseases
  • Heart conditions
  • Bone and spinal surgeries
• Rehabilitative and Assistive Services: Coverage has also been extended to encompass hip replacements, the provision of prosthetics, and assistive devices for individuals with disabilities.

The number of medicines available under the scheme has also seen a substantial increase, rising from 850 to an impressive 1,450. “This expansion of services and medicines requires stronger financial capacity,” Prime Minister Nsengiyumva emphasized. “That is why increasing contributions goes hand in hand with expanding benefits.”

This commitment to enhanced benefits is reflected in the scheme’s financial trajectory. The Prime Minister noted that 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 2024/2025.

Strengthening Healthcare Infrastructure

In parallel with these reforms, the government has made substantial investments in strengthening the nation’s healthcare infrastructure. Rwanda currently boasts a robust network of healthcare facilities:

• Sector Level: 518 health centres.
  • Eight of these are designated as high-volume facilities that have been upgraded to offer enhanced services, functioning as medicalised health centres.
• District Level: 34 hospitals.
• Higher Tiers: This is complemented by three provincial hospitals, the Kigali City hospital, five referral hospitals, and five specialised hospitals operating nationwide.

Since 2017, a significant number of hospitals have either been constructed or undergone substantial upgrades. Notable among these are Gatunda, Gatonde, Munini, Nyabikenke, Byumba, Nyarugenge, Masaka, Kabgayi, Kibogora, and Shyira hospitals, all contributing to improved healthcare access and quality across the country.