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By Annonciata Byukusenge
Persons with disabilities say they continue to face difficulties in accessing healthcare because community-based health insurance (Mutuelle de Santé) does not adequately cover their needs. Instead, they end up paying for treatment fully out of pocket, as doctors often tell them that the medicines, prosthetics, orthotics, and other forms of treatment they require are too expensive to be covered.
Some people with disabilities who spoke to Forefront Magazine receive treatment at Gatagara Hospital.
Mukashema Liberate, a 60-year-old woman with a disability caused by paralysis, explained that her main challenge is not the effort made by doctors, but the fact that she cannot afford the medicines prescribed for her.
She said: “In 2022, I suddenly fell ill, collapsed, and lost consciousness. I was taken to the hospital, where I was told I had been in a coma for a week and had lost the ability to speak. When I recovered, I was left with paralysis, which caused my disability. To regain my ability to speak and walk with the help of crutches, I had to sell my cow to cover medical expenses. But the money was too little, and it was wasted.”
She added that, considering how long she has been under treatment, she should have recovered by now, just like others who came after her, but managed to heal because they could afford treatment without relying on Mutuelle.
“A patient using Mutuelle can only visit the hospital once a year, while someone with private insurance can go once every two months—just like those who pay for their treatment entirely out of pocket. Since I cannot afford it, I go to the hospital, receive some care, and leave feeling a little better. But because I cannot buy the prescribed medicine, I have to wait until next year for another visit, which makes my condition worse.”
Iradukunda Deborah, a 22-year-old woman, also expressed concern that her main barrier to treatment is financial, since Mutuelle does not adequately cover her needs.
“Even though doctors provide us with specialized care such as physiotherapy, prosthetics, and orthopedic devices, these services are extremely expensive. Many patients who cannot afford private treatment end up dying despite being Mutuelle members, because they are unable to access the necessary care.”
She added that since Mutuelle does not cover critical services needed by persons with disabilities, many who could recover remain disabled, while others die because poverty prevents them from receiving timely care.
Marie Jeanne Nyirandayisaba, who receives orthopedic treatment, said many patients are discharged before full recovery because Mutuelle only covers treatment for a limited period.
“For example, they give you about 20 days of physiotherapy, but if you can’t afford to pay for extra sessions, you are sent home without being fully healed.”
She added that prosthetics and orthopedic support devices are very costly and are not covered by Mutuelle.
“Mutuelle helps with other services, but here the costs are extremely high. Also, prosthetics are not paid for under Mutuelle. The government really needs to help us address this problem.”
Isaac Rukundo, head of the Prosthetics and Orthopedic Devices Department at Gatagara, confirmed that the lack of insurance coverage for these services remains a major challenge.
“It is painful to see patients discharged before they recover. Once they go home, most cannot afford to continue treatment, and their condition worsens, making it as if they never received care at all.”
These challenges continue to affect patients seeking medical services because Mutuelle has not yet included some essential services that persons with disabilities need.
However, on January 17, 2025, during a Cabinet meeting held at Village Urugwiro and chaired by His Excellency President Paul Kagame, it was resolved that additional medical services would be covered under Mutuelle de Santé.
According to the Ministry of Health statement, 14 new services have been added to Mutuelle’s coverage, including cancer treatment and medication, treatment and surgery for heart diseases, advanced surgical procedures, dialysis and kidney transplants, as well as treatment and surgery for spinal conditions.
The expanded package also includes prosthetics and orthotics, knee surgery and replacement, hip joint surgery and replacement, blood services, nutritional supplements, and an extended list of medicines that will now be covered under community-based health insurance.
