Last week, a pregnant mother who had traveled a long way to be at Kasonga Health Center II ended up delivering a beautiful baby boy on the floor of the hospital. She had no choice but to go to the hospital and face the reality.To many within and outside the refugee camp, it’s normal. Yet, many of us who have gotten the chance to come and live in the United states or Canada, or any other modernized country, it is all history. But the biggest question is: what may be the best solution to solving health catastrophes like the one that just happened at Kituutu?

Experience has shown that in many cases, the well wishers will rush to think of something that is very common these days, fundraising. To put up the tragic story of this woman and ask those with a good heart to donate what they may be having to help her and the newborn baby. It is also evident that this does not usually solve the problem because that is just one among thousands of cases that occur in the Kyangwali area alone yearly. Indeed in the long run, this is not even close to a solution. It is not even a fraction of a solution. We are talking about birth mortality rates, deaths due to accidents and denied treatment due to lack of money. If this is the picture we can all generate in our minds, then we can easily craft a durable solution to such health disasters in this area and Africa as a whole.

The challenge this area has is that many people are either small scale traders or subsistence farmers. They don’t work for Walmart or Amazon but they are not immune to severe medical complications. What I am trying to illustrate here is that they don’t earn like we do in overseas countries yet when they get injured or develop a sickness due to poor hygiene or from farm work, they can not afford quality treatment and they can not even pay for the treatment options that are cheaper and available within Kikuube and Hoima. It is absurd!

What this means for Kyangwalians is that once you sign up, if at all this initiative is brought there, you will never spend like you did on pharmacy or hospital bills (expenses)

But maybe they can afford premiums and qualify for a health insurance plan, maybe. No one has decided to collect data, or even ask what people think of setting up a pool to help solve the issue of money and costs of medical expenses. When Kyangwali News first brought this issue up for discussion, those involved pointed to refugees and non refugee residents not cooperating and they would not be able to pay the premiums. Others simply said people would not understand it, and therefore found it difficult to implement. These may all be true suggestions, but the fact remains there was fear and lack of commitment to solving Africa’s health problems, lowering medical costs.

We were prompted to dig deep into the matter and see if there was a possibility of a local medical insurance scheme working in Kyangwali. Our findings led us to Rwanda, where they have a model that we could easily adopt, “Mituelle de Sante” or community-based health insurance program.

According to The Lancet , a prestigious medical journal, Rwanda’s community-based health insurance program had very significant statistical findings. There findings revealed that, “over the first decade, national Mutuelle de Santé covered more than 90% of the population, has reduced out of-pocket spending for health from 28% to 12% of total health expenditure, and increased service use to 1·8 contacts per year” (The Lancet). This was a significant change especially on health spending, about 16% in 10 years. So it worked and it can work for Kyangwali or even Uganda. The other question that remains is the way to make it work. This is the most difficult work, but not quite. This same journal also talks of the difficulties Rwanda faced at the beginnings of this wonderful initiative: “Comprehensive insurance reform enacted in mid-2011 transformed Mutuelle de Santé to a system of tiered premiums to make it more financially progressive and sustainable” (The Lancet). We can generate the answers to some of the questions raised above. One, the Rwandan example is that it works and more importantly, the idea that people will not be able to pay the premiums is also not true. Even rural Rwandans were able to pay the premiums. What is important here is that the premiums be financially progressive and affordable, that’s all it requires. With the data from The Lancet and using Rwanda’s Ubudehe information, we get a clear picture of how the initiative may work, but the question remains who is ready to take up the challenge ?

According to Mr. Ephrem who interacted with Kyangwali News’ Chief Editor via email, it’s our time to wake up. The interpretation of Mr. Ephrem’s words, “It is our time to wake up” is that we need to act now before another mother has to deliver a baby on the floor of a hospital without a midwife’s attention. It’s a sad story that should not continue to repeat. He is a strong supporter of the Mutuelle de Sante and would like it to be implemented.

Who will implement it ?

Refugee resettlement comes with a lot of benefits and according to him, resettled refugees living overseas should be at the center of this new innovation. This is because they have the capital to invest and understand the system better than those that will sign up for premiums as clients. They also have the resources to mobilize Kyangwali residents to sign up for community based or private health insurance coverage. All this is possible, but what champions it all is the commitment. Once individuals are up for the challenge, just like in Rwanda, community members will find higher medical spending something of the past. For those that will be reading this for the first time, health insurance means paying monthly premiums or small amounts of money and being guaranteed by a company or mutual fund that they will cover full or a percentage of your medical bill whenever you get sick or visit a hospital or pharmacy. Many in the United States, Canada, Australia, Sweden, Norway, Belgium etc have these coverages through their employers or governments. What this means for Kyangwalians is that once you sign up, if at all this initiative is brought there, you will never spend like you did on pharmacy or hospital bills (expenses). Public opinion matters a lot here, please let us know what you think about Mutuelle de Sante for your refugee camp.

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