Rwanda’s Healthcare System: Community Health Insurance, Hospitals, Emergencies and Health Risks

The Rwandan healthcare system combines public facilities, approved partner facilities and a private sector. France Diplomatie passes no judgement on the quality of the system and lists no facilities, but it recalls the essentials: an assistance contract covering medical costs and medical repatriation is imperative, and the French embassy cannot cover any costs.

The main health insurance scheme is the community-based health insurance (CBHI), managed by the RSSB. For a French resident, everyday use combines a first-contact doctor in Kigali, planned care in suitable facilities and insurance that organises evacuation. See also living in Rwanda.

The RSSB states that all Rwandan citizens and residents not covered by another health insurance scheme may enrol. Enrolment is per household, registered in the national social register, and the category depends on the household’s income classification. The page does not say expressly whether foreigners may enrol: an expatriate’s situation is confirmed with the RSSB.

• Category I (no income): RWF 4,000 per person per year, fully subsidised by the State.
• Category II (less than RWF 30,000 a month): RWF 4,000, of which RWF 3,000 borne by the member and RWF 1,000 by the State.
• Categories III, IV and V (RWF 30,001 to 60,000, 60,001 to 120,000 and more than 120,000 a month): RWF 5,000, 8,000 and 20,000 a year, paid by the member.
• Benefits: care in approved public and partner facilities, from RWF 200; some private facilities may accept it under agreement. Payment by mobile money, bank or Irembo agent.

The first-contact doctor is chosen in Kigali; the French embassy (KN 33 St) can point you towards practitioners and facilities. France Diplomatie advises checking your cover before departure and keeping your contract reference and the insurer’s contact details. As roads outside Kigali are often poorly lit and rescue services sometimes slow, the journey time to the nearest facility enters into the choice of place of residence.

Emergencies: the SAMU ambulance service answers on 912, 24 hours a day, and manages nearly 600 ambulances in the country. The national police give 112 for emergencies, 111 for the fire brigade, 113 for road accidents and 110 for incidents at sea. The France Diplomatie pages list no emergency number; the embassy can be reached on +33 5 24 09 23 79.

France Diplomatie recommends bringing only the medicines that are strictly necessary, in their original packaging with the labels, together with a prescription giving the names as international non-proprietary names. You must check that the medicines are authorised in Rwanda and never buy medicines in the street, because of counterfeits. For a chronic treatment, a sufficient reserve and the prescription ease checks; the conditions for reimbursement are confirmed with the insurer before departure.

Malaria is transmitted by mosquito bites; mild flu-like forms, severe forms sometimes fatal. Prevention combines protection against bites and preventive treatment, after consulting a doctor or a travel medicine centre; a prompt consultation is essential in case of symptoms during the stay or in the following weeks.

• Marburg virus disease: haemorrhagic fever transmitted by bats or by contact with the fluids of infected people, sometimes fatal, with no specific treatment or vaccine; prevention: avoid bushmeat, wash your hands often, avoid the secretions of sick people and funeral rites involving direct contact.
• Others: chikungunya, dengue, Zika (risk for pregnant women or those planning a pregnancy), cholera, typhoid, hepatitis A, meningococcal meningitis, mpox and rabies.

France Diplomatie recommends being up to date with the French vaccination schedule (diphtheria, tetanus, poliomyelitis, whooping cough, measles). Depending on the situation: hepatitis A and typhoid, hepatitis B (frequent or long stays), meningitis ACWY (dry season or epidemic), tuberculosis (children under fifteen on frequent or prolonged stays), rabies (young children, stays in rural areas), chikungunya, dengue and mpox (at-risk exposure).

Yellow fever: vaccination is compulsory for travellers coming from an endemic country, to be done in an approved centre before departure; it is not required of a traveller coming from France. The appointment is booked well before departure to spread out the injections.

With no social security agreement between France and Rwanda (list of the CLEISS, the French liaison centre for international social security), no coordination exists between the schemes: the choice is between the employer’s insurance, the CFE (Caisse des Français de l’étranger, the French social security fund for French nationals abroad) and international insurance. Rwandan immigration asks for local health insurance for the K permit of residents living on assured income. Reference points can be found in the pages on expat health insurance and repatriation and assistance; Expavy helps you weigh these options against your situation. See also healthcare reimbursement in Rwanda.

Abroad, the CFE reimburses according to a rate or flat amount specific to the country of care, applied to actual expenses: a GP consultation under the national agreement at €25 in France is reimbursed at 70%, i.e. €21. The plans have contributions that depend on age and the plan chosen, for the main plan, the youth plan (under 30) and the retirees’ plan. Care is covered immediately if enrolment takes place before departure or within three months of settling; beyond that, a waiting period of three months before age 45 and six months from age 45 applies. A seconded employee keeps the French scheme for 3 years, renewable once, with reimbursement on paid invoices and form S 3125c (CLEISS).

Before signing a contract, several points are compared: the annual ceiling, direct billing in suitable facilities, evacuation and repatriation, maternity, paediatrics, the handling of medical history and the exclusions. It is useful to keep, with your identity papers, the contract number, the number of the assistance platform and a list of current treatments, which you share with a relative and with the employer.