How medical expenses are forcing millions of people into extreme poverty

By The Inspirer staff

Callixte Shabani, resident of Kacyiru Sector in Gasabo District, was left dismayed after being knocked down by a car in his residential place in 2002, which inflicted a crippling injury on his leg. That condition needs advanced treatment which he could not afford.

He was earning about Rwf40,000 per month from the waiting job he was carrying out in a bar prior to the incidence.

This salary could help him survive, and make some savings to be able to run an income generating activity for him to lead a decent life in the future.

However, chances did not go his way as, despite his spending on treatment of the money he had saved from his wages that he accrued over time when he was still employed before the accident, his crippling injury has not healed.

He is asking for effective treatment support to recover from such a medical condition as he cannot afford it by himself.

“I live by the contribution from well-wishers. I feel tired as I have used all my savings trying to get a remedy for my medical condition. But, instead, it is worsening. I need assistance so that my leg can cure from the condition, or get amputated,” he said in a very desperate tone suggesting he is fed up of living in such a troublesome situation.

Indeed, Shaban’s case is an example of millions of instances of people worldwide who find themselves in a dire situation where they face a stack choice whether to forego food to get health care, or verse versa.

Tracking Universal Health Coverage: 2017 Global Monitoring Report, a joint report from the World Bank and the World Health Organization (WHO) found that at least half of the world’s population [estimated to over 7.7 billion] still cannot obtain essential health services.

And each year, the report revealed, close to 100 million people are being pushed into extreme poverty – which World Bank defines as  living on less than $1.90 (over Rwf1,500) per day – because they must pay for health expenses out of their own pockets, while some 800 million people spend more than 10 per cent of their household budget on health care, which it said is unacceptable.

Ensuring that all people can access the health services they need – without facing financial hardship – is key to improving the well-being of a country’s population, the report stated highlighting the importance of universal health coverage.

The publication is a sobering wake-up call if countries are serious about reaching the global goal of UHC by 2030.

The Director of Social Protection Department at International Labour Organization (ILO), Isabel Ortiz   said that it is very terrible to have people being pushed into poverty because of using their own money to cover expensive medical bills, which underscores the need for social protection and universal healthcare.

Social security, ILO says, is the protection that a society provides to individuals and households to ensure access to health care and to guarantee income security, particularly in cases of old age, unemployment, sickness, invalidity, work injury, maternity or loss of a breadwinner.

Ortiz was in Kigali in November, 2018, attending a two-day East and Central Africa Social Security Association (ECASSA) Policymakers’ Conference in Kigali.

“What happens is that many people face with disease and they might get indebted to pay. So that is unacceptable because people may fall into poverty, they are in a poverty trap because of that. That’s why ideally you need a public system for health, especially social insurance system by which you pay little, little amount when you go to the doctor,” Ortiz observed.

One of the main challenges facing communities is chronic diseases – also known as non-communicable diseases – such as cancer, diabetes, kidney failure, hepatitis, and heart attack among others, which health experts contend are costing people a lot of money, and the vulnerable citizens are burdened by the medical bills they have to cover.

“Such chronic diseases are expensive in terms of treatment, and they are costing the country, and even the insurance sector (firms) a lot of money, said the Rwanda Minister of Health, Dr. Diane Gashumba.

Though Rwanda has Community-based Health Insurance Scheme – Mutuelle de Santé introduced in 2005 – which the Minister of Health said covers the majority of the population (almost 81 percent), this initiative does not help the subscriber get  treatment for chronic diseases which are expensive.

So, how effective and helpful is this initiative in terms of social protection if the financially vulnerable people have to pay for the expensive medical treatment on their own?

“This is the most critical scheme we need to protect,” Gashumba said of Mutuelle de Santé, adding that under this scheme, the government is fully subidising health contributions for the vulnerable Rwandans, who account for 16 percent of the country’s [12 million] population.

“I urge the Rwanda Social Security Board (RSSB), which is in charge of the management of pension and the health insurance plan, to use its expertise to will review Mutuelle de Santé healthcare packages so that it covers all medical conditions for subscribers for them to have complete healthcare,” Gashumba said.

For the civil servants, and other people employed in the formal sector, they have social security protection as they are insured by RAMA – a health insurance scheme for public servants; and different private insurances.

Some main statistics from ILO on social protection

Only one in five people in the world has adequate social security coverage., with more than half the world’s population lacks any type of social security protection.

In sub-Saharan Africa and South Asia, the situation is far bad as only an estimated 5% to 10% of the working population has some social security coverage.

In middle-income countries, social security coverage generally ranges from 20% to 60% of the population.

In most industrialized countries, coverage is close to 100%, although increasing informalisation of work results in lower levels of coverage, especially in countries in economic transit


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Elias Hakizimana

Elias Hakizimana, CEO&Founder of The Inspirer Ltd,( is a professional Rwandan Journalist with Bachelor’s Degree in Journalism and Communication, received from University of Rwanda’s College of Arts and Social Sciences (CASS) in 2014. He served various media houses in Rwanda including Rwanda Broadcasting Agency (RBA) in 2013 and became passionate with English Online and Print Media Publications where he exercised his talent as a Freelance News Reporter for The New Times, The Independent, The Rwanda Focus, Panorama and more before he became a Self-Entrepreneur as the CEO and Founder of The Inspirer Limited in early 2017.

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