Rwanda’s health system
Through investments in the development of its health sector infrastructures, human resources, quality of services, as well as in effective policies and programs aiming at increasing access to care, Rwanda has made tremendous progresses in increasing universal access to health care for its population. An essential tool in that success, is the Rwanda’s Community-Based Health Insurance scheme (CBHI/Mutuelle) that has greatly increased access to health care services and reduced the burden of health care costs, especially for the poor (Saksena, Antunes, Xu, Musango, & Carrin, 2010). 97% of Rwandan households have access to health insurance through the CBHI/Mutuelle scheme (National Institute of Statistics, 2014).
Rwanda’s health system is comprised of public and private facilities, with the Ministry of Health (MOH) responsible for developing policies and the Rwanda Biomedical Center (RBC) coordinating the implementation of health programs at the central level for the public sector.
Geographic equity lies at the forefront of the system’s structure and national facility layout, allowing the population to reach the closest health center in an average of 56.5 minutes or less. In terms of accessing care, the patient starts their journey at the community level through engagement with a community health worker (CHW) or by seeking care at health posts or health centers. Each level of health facilities treats patients according to a distinct package of services and refers patients who need advanced management to the next level (Ministry of Health Monitoring & Evaluation Plan, 2014).
Solid ‘Africa is a non-profit organization, operating in Rwanda since 2011, with the mission to help vulnerable patients in public hospitals. Through five programs, the organization provides food, hygienic products and other services with the goal to accelerate patient recovery process and preserve patient’s dignity.
Solid ‘Africa: the programs
This initiative was the first program launched by Solid ‘Africa in 2011. Rwandan public hospitals offer access to affordable care to insured patients. Unfortunately, to date, the public hospitals do not provide meals to hospitalized patient. They are considered responsible for their nutritional needs. This is highly challenging for the most economically vulnerable patients, who can’t afford a meal every day and this can sometimes affect their recovery process.
Observing this gap, Solid ‘Africa’s founders decided to offer meals to vulnerable patients and created a system that today provides one nutritionally balanced meal to 400 patients every day. In addition, Solid ‘Africa provides appropriate food to about 50 patients with specific dietary requirements every day.
Since the program inception, meals were cooked in the kitchen of dedicated Solid ‘Africa members and transported with vehicle owned by the organization. Food and other ingredients are either produced by Solid ‘Africa employees, purchased or donated.
Solid ‘Africa acquired land in Kigali to build a professional kitchen that will produce 15,000 meals a day and employ 32 people. Starting from early 2019, the kitchen will enter into production; a portion of the meal produced will be sold to ensure sustainability.
Kiza (medicine and diagnostics)
CBHI/Mutuelle covers the cost of drugs and diagnostics tests for products listed on the Rwanda Social Security Board (RSSB) list, however, not all medications are covered, which impairs patient's access to treatment. To reduce this barrier, Solid ‘Africa launched an initiative supporting vulnerable patients in procuring and financing prescribed drugs and diagnostics that are not listed by RSSB.
To promote hygiene and maintain dignity of vulnerable hospitalized patients, Solid ‘Africa provides a variety of hygiene products, such as soap, toilet paper, toothbrushes and sanitary pads. In addition, Solid ‘Africa installed 3 water tanks and a water purification system. The tanks are installed in 3 public hospitals in Kigali (CHUK - Kanombe Hospital - CHUB) and produce 2000 liters of safe filtered drinking water for the entire hospitals population.
Gombora (hospital bill assistance)
The CBHI/Mutuelle system covers patients according to their socio-economic category. The Rwandan population is divided in four categories or Ubudehe, going from Ubudehe 1 to Ubudehe 4, Ubudehe 1 being the most vulnerable.
Ubudehe 1 patients are fully insured by CBHI/Mutuelle, but to access care, a contribution is expected from all other Ubudehe categories. This is sometimes a barriers to access care for Ubudehe two members who are living in poverty. To promote equity in access to health services, Solid ‘Africa assists Ubudehe 2 patients in financing their hospital bills and supplements transportation fees from the hospital.
Menya (advocacy and awareness)
Solid ‘Africa built the first Rwandan public hospital’s playroom in the pediatric yard if the Kigali Teaching Hospital (CHUK). The initiative is known as Kina U’Kire (Play while healing). It aims to improve the stay of in-patient children by offering a happy and safe space for them to play together, build social connections and receive play therapy.
Rwanda’s health system
Through investments in the development of its health sector infrastructures, human resources, quality of services, as well as in effective policies and programs aiming at increasing access to care…