PILLAR OF HEALTH

Making health coverage possible and sustainable for youth and children with Type 1 diabetes in Rwanda.

THE PROBLEM

Medical Care for the Children and Youth in Rwanda

A 100 years after insulin discovery, the survival of youth/children with type 1 diabetes (T1D) is still determined by the country of birth. In some parts of Sub-Saharan Africa, being diagnosed with type 1 diabetes is like a death sentence. However, there has been a significant improvement in other areas, such as Rwanda. This improvement in medical care within Rwanda needs to be sustained.

Especially now during trying times with the COVID-10 outbreak, health insurance is of the utmost importance.

Many children die undiagnosed, or just after being diagnosed, while others suffer from various complications due to inadequate diabetes care due to not having health insurance. Health insurance allows individuals to go to the hospital in a timely fashion avoiding complications and have less worry about the cost.

For the past few years, the nonprofit, Life for A Child (LFAC) has made significant inroads by providing insulin and other needed items for youth with T1D. Unfortunately, LFAC can only support youth and children who are under 26 years old. Due the positive results of these programs, the patients are living longer, leaving more than 600 young adults who are no longer supported by LFAC.

THE OPPORTUNITY

Giving children a brighter tomorrow.

Rwanda has made tremendous progress since the 1994 genocide against the Tutsi. The country now has an innovative type of health insurance, mutuelle de sante. It is family-based health insurance, in which each family member has to pay $4 per year. Since this is family-based health insurance, each family member has to pay before anybody can receive medical care. Rwandan families are large (average=6) and some families are unable to afford such an amount, and in that case, the one with diabetes becomes a victim.

If the family is able to afford the health insurance, once the family is insured, their overall medical cost becomes only 10% of the original total cost. For instance, a diabetes patient will pay $2 for 2 bottles of insulin each month instead of $20, a largely unaffordable amount to the general Rwandan population. In other words, $25 per year will cover insulin for an entire year. The average cost of the round trip to hospital is also $2, therefore we estimate that $50 can cover both insulin and transport per a year. However, based on our experience, some families are unable to pay the $50, and PoH will help them until they can do so.

Health insurance is not just for diabetes, but also for other frequent endemic diseases such as malaria, along with other medical needs like maternal and child issues or accidents. The Health Insurance also injects cash into health systems and makes easier for all the stakeholders involved in diabetes care.

By covering health insurance and annual expenses, this allows the child to attend his/her monthly checkup, and families to get more involved in their child’s care, and increase their communication with the medical providers, therefore contributing to a better blood sugars control of the child.

PoH will also support the nurses to visit families and directly get to know the family situation in order to better help the child(ren) with T1D.

TYPE 1 DIABETES:

results from the pancreas’ failure to produce enough insulin for the body.

THE MISSION STATEMENT

We put children first.

The mission of Pillar of Health is to have every child/youth living with type 1 diabetes in Rwanda to have health insurance.

Due to Rwanda’s unique history of genocide, war, and HIV a high number of orphans are in the country. Since these orphans are now surviving into young adulthood, they are able to start families and have increased responsibilities.

These increased demands on their bodies along with aging out of the medical care can put them at a higher risk for diabetes-related complications.

During difficult times such as the COVID-19 pandemic, health insurance remains of prime importance to families in Rwanda. Between the loss of income, death, and loss of international support, having health insurance gives these people the best chance of survival for their families.

How We Accomplish Our Goals

Our Approach

Pillar of Health will employ a two-phase solution. The first phase consists of raising funds to provide free health insurance to those families who cannot afford it. This is an immediate need and helps the current situation. The second phase is to help these families sustain the health insurance in the years to come. This involves local solutions, such as agriculture business and animal husbandry. We will provide livestock to each family depending on its ability to care of the animal. We expect the families to sell some for cash and /or share with their neighbors as the animals multiply.

The country has developed a centralized website that includes a national ID for the head of the family, which indicates the family size and age of each family member. Using the family’s national ID, mutuelle de sante, the health insurance plan, is paid at any bank or cash transfer agency anywhere in the country. This ensures the beneficiaries are getting the insurance and there is no cash transfer between parties.

How We Accomplish Our Goals

Sustainability.

Pillar of Health will focus on the development of local solutions. These can include businesses in agriculture and farming. By developing the local solutions the goal is to have more people able to pay for their health insurance in subsequent years.