KIRUMBA, DEMOCRATIC REPUBLIC OF THE CONGO — Communal living is a hallmark of rural DRC.
When someone builds a home, one neighbor brings the wood, and another brings the straw. When an elderly person falls ill, her neighbors build a stretcher and carry her to the nearest health center. No money changes hands.
Now, a new campaign looks to take advantage of local community reliance to promote a new mutual aid fund for health care called Mutuelle de Santé Communautaire, or MUSACOM.
An initiative of the Community of Baptist Churches in Central Africa, the fund seeks to make health care more accessible, says Kakule Lusenge, a doctor and coordinator of MUSACOM.
The fund came to the Lubero territory, a rural region of eastern DRC, in late 2017 and has so far garnered more than 380 members.
“People are coming to understand the need and importance of this community-based health mutual fund,” Lusenge says.
Merveille Kavira Luneghe, GPJ DRC
Since 1996, this region of DRC has been plagued by violence. Many have suffered physical and economic hardships as a result. Yet health insurance plans are uncommon here.
In 2001, lawmakers in DRC drafted a universal health care bill, but it was never adopted by Parliament. A 2014 World Bank report on health financing in the country found that 80 percent of health care expenses are paid by international aid groups or individuals. Government assistance makes up much of the remaining 20 percent; few are covered by health insurance.
Given the lack of familiarity with health insurance, Lusenge says she knew MUSACOM would have to be simple and relatively inexpensive for community members to take part.
Individuals become members of the fund by investing just $1, then they pay an annual membership fee of $12. In case of illness, a patient pays 15 to 20 percent out of pocket, and the fund covers the remaining costs.
Janvier Muhindo Kataliko, a resident of Kirumba, says MUSACOM is life-changing.
“I’ve been a member of MUSACOM for nearly one year,” he says. “When I came down with malaria and racked up $15 in medical bills, guess what? I paid $1.50 only, and MUSACOM did the rest.”
Potifare Kasereka Tamuwite says his neighbors convinced him to join.
“We’ve all seen that, in my village, it’s impossible for people to foot their medical bills alone,” he says.
But not everyone supports the fund. A common criticism cites the fund’s limited coverage. Critics also say the cost, while an improvement, is still out of reach for many here, where the average person earns less than $400 per year.
MUSACOM doesn’t cover treatment expenses for chronic conditions, HIV or cancer. Lusenge says the dues would have to be much higher if the fund accepted patients with these conditions.
While MUSACOM has nearly 400 people on its roster, Willy Kambale Muhutsa, a nurse and head of the Referral Health Center of Kirumba, says that most of the 120 to 150 people admitted to the center every month are not covered by the fund.
“Only 42 members of MUSACOM … have sought services from our health center,” Muhutsa says of the time period since the fund launched here.
Still, Muhutsa says if more people joined, it would be in the interest of the whole community.
“Today, we’re informing people in Kirumba and the surrounding areas in an attempt to get a substantial number more to join,” he says. “If they join en masse, the quality of people’s health care will improve.”
But health care workers are going to have to wrestle with another factor of daily life here – mistrust and corruption. Many residents say they haven’t joined because they don’t trust MUSACOM to manage their money.
Clovis Malekani, who works as a secretary, says he is skeptical of the fund.
“I’ve listened to the radio awareness-raising campaigns without getting many details,” he says. “I ended up with doubts.”
Ndahayo Sylvestre, GPJ, translated the article from French.