{Photo credit: Todd Shapera}Photo credit: Todd Shapera

Raissa Iradukunda and her two children live near Remera-Rukoma District Hospital, about one hour from Kigali, Rwanda. The family is covered under Rwanda’s community-based health insurance (CBHI) program, known locally as Mutuelle de Santé. “We are farmers,” she explains, “but we can afford to pay the required 3,000 Rwf [USD 3.45] per year because we know that Mutuelle de Santé has enabled us to access health care even in situations where we did not have enough money for some services.”

{Photo credit: Todd Shapera}Photo credit: Todd Shapera

When Ruhengeri Hospital in northern Rwanda upgraded from a district to a referral hospital in 2014, it began receiving cases from 15 health centers in its own district and five hospitals in surrounding districts. In 2015 alone, the hospital had nearly 6,000 monthly outpatient visits—about 25% above previous levels and among the highest in the country. While these numbers indicate how important the status upgrade was in relation to local health needs, the facility struggled to consistently meet those needs.

{Photo Credit: Irene Nambi, MSH}Photo Credit: Irene Nambi, MSH

Linda* arrived at Kibagabaga Hospital exhausted and desperate. Referred by a smaller health center, she had already been in labor for more than 24 hours. A midwife admitted Linda and put her on an IV. There, she waited for several hours until an obstetrician examined her. Realizing that the baby had an accelerated heartbeat, which is a sign of distress, the doctor ordered a Cesarean section (C-section). When the baby emerged, he was not responsive. Hospital staff worked to help him breathe and eventually, he let out a wail.