Mali aims to improve access to health care through a strategy to extend community based health insurance, or mutuelles, to 80% of Malians who lack health coverage. As part of peer sharing opportunities provided to MLI countries, officials from the Ministry of Health and Ministry of Social Development,  civil society representatives and political leaders from Mali (along with colleagues from fellow MLI country, Senegal) participated in a study tour to Rwanda to observe its experiences with scaling up mutuelles nationwide.

Among participants was Cheickna Touré, Deputy Director of L’Union Technique de la Mutualité Malienne (UTM). UTM is a health insurance network in Mali that will play an important role in the expansion. Touré reflects on key lessons from Rwanda he hopes can aid Mali in its endeavor to provide health care access to the country’s poor populations.

Cheickna Touré. Photo credit MLI.

The visit to Rwanda provided clear and detailed information highlighting the overall progress made by the Rwandan health system. Rwanda has achieved remarkable improvements in overall population health in terms of increased use of health services, reduction of infant and child mortality and improved health worker motivation. The lessons from Rwanda provide a model for Malian leaders to share with their constituents and development partners.

From our exchange visit to Rwanda and information gathered on health insurance systems in other countries we have identified three main lessons for Mali’s reforms:

-Leadership capacity and commitment are required for a successful large scale health coverage program, especially in a context of widespread poverty

-Patience, conviction and determination are required in leading the process of introducing health insurance. Indeed, large scale coverage of poor populations must be part of a systemic medium and long term vision that secures its sustainability;

-Broad health insurance must be paired with a significant improvement in the quality of health services provided to patients.

When we traveled to Rwanda, Mali had already embarked on a process to develop a framework for mutuelles as a means of financing health care in the informal sector and rural areas. The visits have been an excellent source of inspiration for more mature reflections on the scale up of health insurance. We used the lessons learned from these visits to better define the organizational structure of health insurance and to further integrate mutuelles into the health system through creating very strong ties with health facilities. We also used data from the Rwandan system to refine projections based on different scenarios of mutuelle expansion.

More than willingness, the commitment and leadership of the Rwandan authorities to provide health insurance to all Rwandans have been for us the factors that enabled Rwanda to be at the forefront of African countries in terms of improving access to health care. Rwanda also integrated quality improvement in health services through results-based financing for health centers. The results are spectacular and Rwanda is on the right path to achieve the Millennium Development Goals.

Mali can replicate the Rwandan experience if authorities are strongly committed to promoting equal access to health care for low-income populations and if our country’s leaders adopt a comprehensive policy of health care financing, especially for the poor. Clear and intensive communication of the policy must be conducted with decision makers, technical and financial partners, and the general population so that it is well understood by the whole nation and people are able to measure the impact of the policy on their health. We must create the right conditions for the initiation and emergence of the health insurance scheme in pilot sites where populations lack social protection mechanisms and are experiencing enormous difficulties receiving proper treatment in health facilities. Donors will be convinced to support the expansion of mutuelles if the involvement of our authorities is strong and determined. People will believe in it once they have a guarantee that a sustainable system is in place.