Assicurazione Sanitaria in Rwanda

English follows

Sextantio Onlus, tramite la “Mutuelle de Santé”, ha l’obbiettivo di pagare l’assistenza sanitaria di base alle persone che non possono permettersela e che quindi possono anche morire per patologie facilmente curabili, a basso costo.

Dopo il genocidio del 1994 in Rwanda, il governo ha avviato una capillare diffusione dei servizi sanitari aprendo centri sanitari ma, per molto tempo, l’accesso alla salute è rimasto precluso ad un’alta percentuale di popolazione.

Nel 2005, per la prima volta, il governo Rwandese ha introdotto il progetto della Mutuelles de Santé (assicurazione sanitaria).

Oggi, oltre l’81% della popolazione ha la Mutuelle de Santé e il 9% possiede altre forme di assicurazione. Si stima che per il restante 10%, una metà può curarsi privatamente, mentre l’altro 5%, circa 550.000 persone, non può permettersi un’assistenza sanitaria di base in quanto non può pagare il costo della Mutuelle (circa 4 $ a persona).

Avere l’assicurazione sanitaria vuol dire ricevere l’assistenza di base; nello specifico, con 200 Franchi Rw (circa 30 centesimi di Dollaro), è possibile effettuare una visita sanitaria, gli esami del sangue e ottenere le medicine per le malattie più comuni.

Per identificare gli indigenti non in grado di pagarsi l’assicurazione sanitaria, lo stato Rwandese (che è impegnato in alcuni progetti di sostegno) e la Caritas (che fanno controlli per conto nostro) usano criteri estremamente empirici: la composizione familiare, la terra e gli animali di proprietà, le condizioni igienico sanitarie delle persone e delle case, l’impossibilità di soddisfare i bisogni primari o pagare l’educazione per i propri figli, etc.

L’identificazione dei beneficiari aventi le suddette caratteristiche è valutata e sancita, per alzata di mano, durante assemblee pubbliche delle “comunità di base” alla presenza di tutti i membri del villaggio o della comunità di riferimento nelle situazioni più urbanizzate.

L’attività dell’Associazione Sextantio, di cui il presidente onorario è Tari Gandhi, è iniziata, con mezzi propri, nel 2008 e il progetto pilota ha coperto 8.000 persone. Nel 2009 siamo intervenuti in tutto il paese coprendo 80.000 assicurazioni mentre nel 2010 sono state date 125.457 assicurazioni e, nel 2011, siamo arrivati a coprire 161.000 beneficiari (pari al 30% circa degli indigenti impossibilitati a pagarsi l’assicurazione).

Grazie per il tuo aiuto!

Daniele Kihlgren, Sextantio Onlus.

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The Sextantio Onlus project is the result of a series of personal experiences on the African territory, crossed by land by personal means, through different countries, with the aim of doing something tangible, able to improve the quality of life of the population.

As in a too complex situation we thought we lacked the suitable cognitive means, our interventions do not propose models of socio-economic organization, but, noticing that the emergency – both more serious and preventable for Africa – is the great number of human beings dying because of pathologies curable with trifling expenses, we have limited our project strictly to the sanitary field.

In the project we are carrying out we will always try to quantify the intervention on a clinical point of view with a reliable research institution validating the most empirical local valuations: in this operation we intend to make use of the help from the School of Qualification for contagious and tropical diseases of the Hospital San Raffaele of Milan. Every intervention will be examined according to an expenses-benefits valuation (the economic resources are meant as expenses and technical results as benefits).

According to our Statute, both in Italy and in the country where the project is carried on, the general expenses are to be paid by the President of the Sextantio Onlus Association, so that all the funds raised are intended only for the health insurances. To say the truth up to now the President of the Association has more or less supported the whole economic project (till 2012). We have tried to verify all the procedural aspects, systematically checking also ‘a posteriori’ the path and destination of the funds on the whole territory of the first state where we have been present, Rwanda.

So the peculiarity of the project is a great clearness in the path of the funds. To give a concrete example, the economical resources are transferred from the Italian current account to a dedicated account of the Caritas and from here or to indigent people (as an insurance) by means of the parishes, basic communities, or straight to health structures.

The state of Rwanda has developed a health insurance System on the base of the Belgian model of the “Mutuelle de Santé” the cost of which is partly paid by the beneficiary and, according to a few sources, those who can’t afford such insurance are about 5% of the population. We were thinking of an objective manner to determine who the extremely indigent people unable to pay for their dues are. Technically our lists of indigent people started locally by means of the institution more diffused on the territory: the parishes, and through them, the Basic Communities, made up by about one hundred people. By means of the Parishes and Basic Communities we got a list signed both by the Political and Medical Power. The administrative iter has been studied by Lino Zanardi, who has lived for more than 30 years between Rwanda and Burundi always devoting himself to the no-profit field.

So in 2008 the pilot project covered a little less than 10.000 people, in 2009 we were present all over the country covering 80.000 insurances, in 2010 about 125.457 insurances, and finally in 2011 we went as far as covering about 40.089 beneficiaries (1,5% of the population equivalent to 30% of the indigent people who can’t afford to pay for their insurance). In 2012 we covered 12.662 because of depletion of funds. In 2013 the insurance starts from mid-year. In all the Health Centres where we went for our ‘a posteriori’ controls, people gave the same answers: those who before couldn’t go to these Centres, thanks to the insurance at the first symptom of a pathology were able to go there, with a consequent considerable reduction of mortality or chronicisation.

Our purpose to penetrate the whole country with such a functional preventive project helping the weakest and therefore more vulnerable people on a sanitary point of view is as elementary as effective in the field of international cooperation, a field marked by the unreality of its projects, by huge general expenses, by losses of money and all the problems about which by now there’s a vast literature.

With an articulate fund-raising politic, Rwanda could become the first state in sub-Saharan Africa where everybody could have a free access to Health. Moreover we are trying to organize a similar project in Burundi, comparable on several variables to Rwanda, to understand if such a model could be a possibly repeatable example as a kind of National Health Service for the countries of the “South” of the world.

Thank you for your donation!

Daniele Kihlgren, Sextantio Onlus