Following the withdrawl of donor support for health services after the emergency period, the government of Rwanda introduced user fees. This led to a decrease in the demand for health services, and it is from this background that Mutuelle emerged. Introduced in 1999, Mutuelle is a community based health insurance scheme. It is a risk-sharing mechanism, where people pay a premium for the right to treatment at the local health centre and the district hospital. This paper evaluates the technical support given by NPA (Norwegian People's Aid) to Mutuelle. The evaluation, based on NPA's terms of reference, provides a number of recommendations, which may contribute to the financial sustainability of the insurance scheme. It also provides recommendations on the health services supported, both in terms of general recommendations as well as specific recommendations related to the Mutuelle. The main recommendations include:
ensure improved and sustained quality of health services to allow for adequate preventive and curative services
restructure the Mutuelle programme to ensure gradual compliance with the most successful Mutuelles - thereby increasing enrolment rates and improving reporting procedures for monitoring and evaluation.
The paper also lays out specific recommendations for Mutuelle, NPA and for the health services in the region under study. [adapted from author]