IGIHE

Category: Health

  • Mutuelles de Santé: Clear the fog to see reality

    By Supreetha Gubbala

    KIGALI CITY–Since its drafting in 2001, the community-based health insurance plan known as mutuelles de santé, or more commonly as mutuelles, has been an extremely effective tool for medically insuring the majority of Rwandan citizens in an affordable way.

    Currently over 85% of Rwandans partake in the program, the highest percentage in all of sub-saharan Africa. Neighboring countries such as Burundi are looking to Rwanda’s medical insurance miracle.

    However, what many have looked past in praising the universal plan is truly what lies ahead for the remaining 15% that are uninsured and the effects of this upon the public healthcare system.

    In February of this year former Health Minister, Dr. Richard Sezibera, announced along with many improvements to the programme, a minimum premium price increase.

    Prior to this revision, those on the lowest tier of the program were paying a minimum of Rwf. 1000, with the extreme poor often being marginalized and unable to pay even this amount.

    The few micro financing NGOs available to help this population could not significantly aid this population, especially with interest rates often as high as 15% on loans given.

    Unfortunately, for the extreme poor, the situation just got worse, to be exact. With the minimum now standing at Rwf 3000. By raising this bar, more poor will be unable to join the plan in the upcoming years.

    Although the ministry has outlined financial support programmes for this population there, lies the question of how many will be reached by the programmes, and ultimately what will happen to those who simply cannot meet this minimum.

    Well more likely than not in Kigali, they will end up at the doors of CHUK, the University Teaching Hospital of Kigali.

    CHUK is currently the largest public hospital in Kigali city, and therefore often end up caring for many who are not in the mutuelles program, and cannot provide the premium, simply out of Hippocratic Oath.

    Unfortunately, the Hippocratic Oath does not exactly stock the shelves of CHUK.

    Dr. Florence Umurangwa working in Ward 6 of CHUK is a post-graduate of surgery.“We don’t wait to see whether or not the patient has mutuelle de santé, because we care for them first,” she explained to Igihe.com”

    “It is a bit difficult because some people who couldn’t afford to pay Rwf. 1000, and are now being asked to pay three times that amount. It is hard for the hospital to continue operating because so many people are being treated that do not pay for the new mutuelle de santé.”

    “When we go to the stock and take medicine, yet the patient is not paying, it will be a big challenge to the hospital,” she concluded.

    With the recent two month extension for those still not updated to the new mutuelles plan, this further means that the new and improved mutuelles services must be open to everyone.

    Arthur Asiimwe Director General of Rwanda Health Communication Centre, and the communications officers for the Ministry, however was incredulous at the idea of any potential issues with the new plan.

    “As far as the ministry is concerned there are no problems with the new plan, sustainability or supplies of medicine. If this exists, there must be some mismanagement in the hospital,” he told Igihe.com in an interview.

    In regards to the population of people who will be left unable to pay, Asiimwe stated confidently that, “All those who are unable to pay for mutuelles will be paid for by the government through the national budget which ultimately comes from taxes.”

    In fact, with the new plan Asiimwe deemed it impossible for someone not to be covered and also reassures that any doubts of financial stability of the plan as fruitless.

    “In fact, the new plan improves the future sustainability and enrollment in the programme,” he told Igihe.com.

    For those on the ground however, it seems the story still is playing out quite differently.

    Although the CHUK Hospital Director Dr. Theobard Hatekamana feels the majority of the plan has been beneficial to patients, as well as for everyone in the health sector, he does assert that there are still further issues to be addressed on the health care delivery level to enable sustenance of healthcare to the entire population of Rwanda.

    He told Igihe.com more specifically, “We have some issues with people who can’t pay 10% of fees, so the hospital loses this money. Since we cover Rwf. 100,000 for these kind of cases, and there is currently no mechanism for recovery of this money.”

    Furthermore, patients hospitalized in Ward 2 of CHUK had mixed reactions toward the new price increase in the mutuelles plan.

    Grace Murekatete a 22-year old with swollen limbs on her right side from the Mparanyondo sector has been sick for 16 months. She told Igihe.com, “I have been here in the hospital for only four months. But I have not yet improved. I don’t know what I will do if they increase the price to Rwf 3000 because I am alone here no one is looking after me.”

    Despite Asiimwe’s confidence, it seems even those currently hospitalized are not aware that they will be covered by the government if they are unable to pay.

    This viewpoint was further confirmed by other patients such as Francoise Yankurije of the Kimindu sectors who explained to Igihe.com, “It’s right, but the problem we are having is capacity. Which results from low income, and we don’t know whether we can manage to buy it [new medical insurance].”

    As we leave, CHUK confused about the true effects of the new plan on the rural and poor populations surrounding Kigali city, the receptionist of CHUK alerts us to even larger emerging problem.

    The poor that often abuse their health insurance, overusing consultations and supplies, and once again restraining the capacity of the public hospital.

    At the end, where to lay the sympathy or blame in this situation remains ambiguous. However, it is clear that the ministry’s rose coloured glasses must be cleared of their fog to see the reality that is occurring on the ground.

    As with all economically based plans, the mutuelles is heavily based upon well-calculated predictions. Due to the great praise the plan is currently receiving, it may be easy to forget that these numbers are still predictions and that many holes are still present.

    The great overconfidence provided by Asiimwe, although reassuring, does not erase the fact that these issues still exist. In fact, it is probably much better for the Ministry to resolve issues faced by hospitals early on, so as not to face larger issues down the road.

    Of course, they don’t have to take my word for it and they probably won’t. But at least, try taking a trip to Ward 2 of CHUK and seeing Grace and Francoise yourself. You may find out more than numbers can tell you.

  • Mutuelles Increase causes panic in Public Hospitals

    In February of this year, Rwanda’s world renowned universal healthcare policy (Mutuelle de Sante) took a price increase in premiums. The then Minister of Health, Dr. Richard Sezibera, announced the annual premium increased from a range of Rwf 1,000-7,000 to Rwf 2,000- 7,000 Rwandan francs.

    To explain the 100% increase for those in the lowest sectors of the plan, Sezibera pointed to an increased in the cost of health per person in Rwanda from Rwf 2,000 to Rwf 2,900-3,400.

    The new Mutuelle de Santé will be based upon a similar three-tier system based upon member’s financial capacity to pay the premium.Government programme, Ubudehe, will categorize members on various gradients within the system with the extremely poor now requiring to pay the minimum of Rwf. 2,000.

    Prior to this price increase, despite the 85% enrollment in the plan, the extremely poor contained within the remaining 15% remained marginalized due to their inability to pay the former annual premium of Rwf.1000. Now it seems this population will be asked to pay double this amount.

    For patients residing in the University Teaching Hospital of Kigali (CHUK) this increase has brought about mixed reactions.

    Yankurije Francoise from the village Buha (Kimundu Sector/Nyamasheke District) arrived at CHUK late in June to receive an operation on her stomach. She used to pay Rwf. 1000 for her mutuelle.

    “According to the explanations they give us about the new medical insurance, we all understand the situation, but the problem we are having is capacity. Which results from low income, and we don’t know whether we can manage to buy it [new medical insurance].”

    For some like 22-year old Grace Murekatete from Mparanyondo sector (Nyamata District), this could mean the end of care.

    “I’ve been sick for 16 months. I have been here in the hospital for only four months. But I have not yet improved. I don’t know what I will do if they increase the price to 3000 because I am alone here no one is looking after me,”she told Igihe on Sunday.

    More than the patients, however, it seems public hospitals are facing the greatest challenges due to the price increase.

    Dr. Umurangwa Florence (Post-graduate CHUK surgery RMC 1164) told Igihe, “We don’t wait to see whether or not the patient has mutuelle de santé, because have to take care of them first.”

    “It is a bit difficult because some people who couldn’t even afford to pay Rwf. 1000 before are now being asked to pay three times that amount. Moreover it would be difficult for the hospital to continue operating because so many people will be treated that have not paid for the new mutuelle de santé.”

    “When we go to the stock and take medicine, and the patient is not paying, it is a big challenge to the hospital.”

    CHUK Hospital Director Dr. Theobard Hatekamana told Igihe more specifically, “We have some issues with people who can’t pay the 10% of fees, so the hospital loses this money. Since we cover Rwf. 100,000 for these kinds of cases, and there is no mechanism for recovery of this money,”

  • Youths urged to stay away from illicit drugs

    A 14-day campaign aimed at fighting aganist ilicit drugs has kicked off in Kigali city.

    Samuel Hakuzimana the National Youth Forum Coordinator in Gasabo district explains, “We organized this campaign because the problem is prevalent among the youth and we also find that if we as youth do not have sustainable life, our country is heading nowhere. We are the country’s future leaders”.

  • First Aid reduces infant mortality

    Applying first aid to infants before taken to hospital would save their lives especially to those with less access to health centers. In this respect the Belgian Development Cooperation (BTC) in collaboration with the Ministry of Health is training pediatric nurses on how to deal with emergency cases.

    Despite the fact the nurses should be aware of first aid skills, the lessons builds their capacity particularly in attending to patients in rural areas. Another advantage is that while in the field they can use medical equipments for instance to conduct minor surgeries.

    The 30 trainees are from Kibagabaga and Muhima hospitals which deal with the majority of pediatric cases in both the city and outskirts.

    Commenting on the efficiency of the training, Samuel Van Steirteghem a pediatric expert from BTC noted that the same skills would also be applied to teenagers.

    Steirteghem further pointed out that they also intend to train more in first aid skills as a way to reduce infant mortality. In this regard more capacity building will be conducted to physicians in various disciplines.

    Dr Anaclat Ngabonziza who’s among the trainees from Muhima hospital highlighted that the lessons would improve his attendance to patients. “We will now do our best to ensure that babies in critical conditions are stabilized before being admitted,” he remarked.

    He further advised parents to rush their kids to hospital whenever they got sick since negligence was among the reasons that complicate the infants’ health conditions.

  • Contraceptives likely to cause low sexual urge

    Research indicates that some women using contraceptive pills have
    lesser libido and decreased symbols of sexual arousal as well as less
    vaginal lubrication.

    Women often use the pills as way of birth control; the medication
    reacts by holding back a woman’s natural cycle of ovulation.

    Alphonse Butoyi, a gynaecologist at Kigali’s la Croix du Sud hospital, explains the effects of contraceptives. “There two types; oral combined pills (OCP) and progestin oral pills (POP) which if used for a long time are likely to reduce a woman’s sexual urge,” he says.

    However, women using OCP have less risks of losing their sexual urge
    since the pill doesn’t affect their virginal lubrication during sex,” Butoyi advises.

    He further advises women to consult physicians before they use
    contraceptives since high cases of side effects hail from patients who
    didn’t have a doctor’s prescription. “The effects are even worse to
    those who use POP without a doctor’s guidance and the majority are
    young girls who take the pills out of panic of getting pregnant after
    having sex,” he remarks.

    POP based pills are considered harmful since they contain chemical substances. “The progestin virginal epithelium, for instance, interferes with the woman’s hormones which leads to swelling in the vagina, the effects include vaginal pain during sex and later blood discharge if the symptoms persist.” explains the doctor.

    Even those who have prescribed contraceptive pills from a doctor are also advised to report cases of side effects since some pills might either be counterfeit or the woman might develop some allergy at a later stage while using the pills.

    He further explains that a woman using POP for quite some time is likely to face similar problems.

    Gloria Uwase is among the women who suffered from the effects of contraceptives use. She discloses that she first experienced vaginal pain while having sex, the signs followed by signs of depression. “As soon as I gave birth to my first son, I switched to contraceptives but after using the pills for weeks I had to consult my doctor after the appearance of the weird symptoms I was experiencing and he prescribed another type of medication which I’m now comfortable with,” she remarks.

  • Final trial of microbicide ring to be conducted in Rwanda

    Rwanda is in the third and final phase of testing a vaginal ring containing antiretrovirals, which, if successful, could provide an important female-controlled method of HIV prevention. 

    Malawi, Rwanda, South Africa and Zimbabwe have all been selected to conduct the final phase of the trial. Phases I and II – conducted in Kenya, Malawi, Rwanda, South Africa – assessed the safety and acceptability of a daily application of a gel containing the ARV,dapivirine. 

    “Phases I and II were completed successfully ; this means that the microbicide has been evaluated and found to be safe and acceptable,” Gilles Ndayisaba, the principal investigator at Project Ubuzima. “Even if in Rwanda we conducted phase I and II on the gel, these phases have been done with the ring in several others [countries] and they were successful,” he added. 

    Phase I trials involved small numbers of women, followed by expanded safety trials, Phase I/II, which gathered additional safety data among more participants over longer periods. Once the safety trials are complete, longer-term safety and efficacy trials begin. Phase III trials are conducted among high-risk participants so that researchers can see if there is a difference in infection rates between women who use the active microbicide product versus those who use a placebo. This phase looks specifically at the efficacy and gathers information to proceed with putting the product on the general market. 

    In Rwanda, the trials are being conducted by a local NGO, Project Ubuzima, with the International Partnership for Microbicides. The project has carried out safety trials for dapivirine gel among more than 60 women and has conducted an HIV incidence study among 1,250 female VCT clients and 800 high-risk women in the capital, Kigali, in preparation for the final phase. 

    An estimated 3,000 HIV-negative women aged between 18 and 40 will participate in the trial in all selected countries – between 400 and 600 will come from Rwanda ; the trial is expected to last three years. 

    “Potential participants are well-educated on clinical research in general and first have to sign an informed consent form which includes all information concerning risks and benefits while participating in the study,” said Marie-Michelle Umulisa, the community outreach manager at Project Ubuzima. “These are reviewed by the Rwandan National Ethics Committee to protect participants’ rights.” 

    Each participant will use the ring for a minimum 15 months or a maximum 33 months. “It is likely that products that can be applied less frequently like the ring will be more acceptable and will achieve better adherence,” Ndayisaba said. “Vaginal rings need only to be replaced every four weeks and may therefore have benefits over dosage forms that need to be used more frequently.” 

    The researchers say dapivirine is advantageous because it is not used in current HIV/AIDS treatment regimens so there is less potential for drug resistance. They say the vaginal ring is cheap to manufacture, comfortable, flexible and can be self-inserted ; it is intended to provide long-term protection during anticipated and unanticipated sexual intercourse. Uncertainties 

    According to Evelyn Kestelyn, executive director of Project Ubuzima, there are advantages to being one of the countries conducting a trial. “When the products finally come on the market… countries that were selected to implement phase III will get the products for free or will purchase them at a subsidized price.” 

    However, women in Kigali remain uncertain about whether they would use a microbicide ring should the ongoing trial prove successful. 

    “I would need to be extremely sure it works well before I can entrust my life with such a thing ; I mean I would want to be sure it doesn’t have any particular side-effects,” said Agatha Ingabire. 

    Should the product make it on to the market, Project Ubuzima plans a major campaign to sensitize Rwandans on the microbicide’s function. 

    “We intend to undertake a huge sensitization process, starting with community leaders and gradually we shall trickle this down to the other masses,” said Umulisa. “Community acceptability of this project is key for its success.” 

    Globally, a number of microbicide trials are ongoing, testing gels and rings. In 2010, the biggest success was recorded in a study by the Centre for the AIDS Programme of Research in South Africa, which found that a vaginal gel containing the ARV tenofovir was 39 percent effective in reducing a woman’s HIV risk when used for about three-quarters of sex acts and 54 percent effective when used more consistently. 

  • Sex and coffee raise risk of brain rupture


    If you have a brain aneurysm, drinking coffee, having sex or even getting angry may boost the risk of it rupturing, a new study suggests.

    Although the risk is extremely small, people who have aneurysms should be careful, said Dr Sahil Parikh, assistant professor of medicine at University Hospitals Case Medical Centre in Cleveland.

    “For those patients who do have aneurysms, it would be advisable to avoid those behaviours,” said Parikh, who’s familiar with the study findings.

    Aneurysms occur when the wall of an artery weakens and bulges out.

    They can occur anywhere in the body, but are particularly dangerous in the brain, where they can cause a haemorrhagic (bleeding) stroke if they burst.

    In the study, published online May 5 in the journal Stroke, researchers asked 250 patients who had suffered a ruptured brain aneurysm about their exposure to 30 possible triggers before the haemorrhage.

    The investigators found that being startled raised the risk of burst aneurysm in someone who already has an aneurysm by the highest level — 23-fold. Anger boosted the risk by 6 times.

    Other things raised the level, too : Coffee (2 times), cola (3 times), straining for defecation (7 times), sexual intercourse (11 times), nose blowing and vigorous physical activity (both 2 times).

    Seems to be higher blood pressure, said study lead author Dr. Monique H.M. Vlak, since all eight activities cause blood pressure to rise.

    Vlak said about two per cent of the population has a brain aneurysm. They are often symptomless and frequently harmless.

    “You shouldn’t be scared because the likelihood of this happening is extremely rare,” said Parikh. “I would encourage patients not to worry excessively about it and consult with their doctor if they feel at risk of an aneurysm.”

    Even if you do have an aneurysm, it’s unlikely to bother you. “We think most aneurysms never rupture,” said Vlak, a neurologist at the Utrecht Stroke Centre at University Medical Centre in Utrecht, the Netherlands.

  • Number of AIDS patients on ARV treatment rises

    Additional 4,187 AIDs patients in Rwanda have registered for Anti-Retroviral treatment since 2009.

     This has increased the number of patients on ARVs by 5.8% to 76,726, this year, from 72,539 in 2009, according a recent report released by the National AIDS Commission (CNLS).

     CNLS officials attribute the increase to the nationwide sensitisation programs aimed at creating more awareness on HIV/AIDS.

    Rwandans living with HIV are estimated at 3 percent or 300,000 in a population of 10 million plus, the report says.

     Currently, the number of sites that offer ARVs is estimated at 517 countrywide.

     The report further shows that out of 1,393,081 people who took HIV test, 34,239 were positive.

     The report says that women aged between 30-44 years are increasingly taking the lead in accessing treatment.

     The report says that the ABC strategy, which means Abstinence, Faithfulness and Condom, is bearing fruits in educating Rwandans about the HIV spread.

  • No need for mistrust in legalising marijuana for medical purposes

    June last year laid the groundwork for The drafting of a law seeking to establish the rules and regulations in the use of narcotics in our healthcare system. This provoked a lot of controversy due to the implications behind using marijuana for medical purposes, a substance that is illegal in many countries around the world.

    The use of the drug in the medical sense proposed the possibility of it having inadvertent consequences in its regulation and control, perhaps promoting the use of recreational marijuana.

    This move undoubtedly raised a couple of eyebrows with claims of Rwanda being the only nation in Africa to do so. However, the draft law is nothing out of the ordinary. This would be because of the very well known and widespread use of narcotics in the medical world. Morphin and Opium, which are both illegal substances are drugs whose properties are used occasionally to relieve pain or anesthetise.

    Such drugs have resultantly made a substantial contribution to the pharmaceutical industry. Despite its negative reputation, marijuana has been proven to have medical properties that are used in the treatment of many diseases and conditions such as cancer or AIDS.

    “Marijuana is classified as a psyhoctropic drug and the healthcare system in Rwanda, which is under the convention with the International Narcotics Control Board (INCB) in Vienna, simply drafted a law in the parliament that would help in the regulation and control in the use of this drug,” says Alex Ruzindana, the officer in charge of Pharmaceutical Information Pharmacy Task Force within the Ministry of Health.

    “It has completely nothing to do with the legalisation of marijuana. It is strictly for medicinal and research purposes. In fact, it is not even administered as a herbal drug , but rather its components are used and integrated into other substances making its administration come in other forms. ”

    According to Ruzindana, the law is in concord with the INCB, and its infringement would therefore go beyond the realm of the medicine thus leaving the issue to be dealt with by the authorities. He adds that medical Marijuana would only be prescribed by a specialised physician and its use would be significantly limited.

    “Other countries across the world have taken a further step by establishing pharmacies that specialise only in the sale of medical marijuana that come in various forms. But we have not implemented that at all. The use of this drug is only exclusive to the prescription given out by the doctor according to the patients needs,” says Ruzindana.

     He advises that due to the strictness in the prescription of the medicine, misconceptions should not arise when it comes to the consummation of this drug. Marijuana remains highly illegal outside the medical world and its distribution in limited dosages will continue to remain exclusive to the medical domain.