Tin roofs and medical insurance: Rwanda’s small miracles

In every country, one finds citizens who preoccupy themselves with “change.”

There are the changes that people see and those that they feel. One of my preoccupations for well over a decade and a half now, has been to figure out how one country I observe closely, Rwanda, has changed since power changed hands from its previous leaders to those in charge today.

There are, of course, things that simply don’t change or change in such insignificant ways that people hardly notice the change, in which case they see them as unchanging.

A good vantage point from which to observe or inquire into change is the rural context. Here even seemingly mundane change can have such impact or elicit such interest that it becomes the subject of regular discussion among locals and with outsiders who happen to pass by.

It has been a while since I last ventured into rural Rwanda and engaged local people in conversation regarding how they feel about their country and their lives.

Readers who are familiar with the Rwanda story would have read and heard about how things here have changed and how fast, something that induces visitors and observers to wonder how the Rwandans “do it.”

This question is usually about how and why Rwanda has achieved things that wealthier countries with longer post-colonial histories of peace and political stability have so far proved incapable of achieving.

The other day, I returned to the Rwandan countryside. At every opportunity, I asked my interlocutors what it has really changed in their lives over the past two decades or so. There has been much talk over this period about the “New Rwanda” (U Rwanda rushyashya). What does it mean to them? Well, it means quite a lot.

There are many things rural Rwandans who think of themselves as poor will not fail to mention if they choose to engage in a bit of boasting about how their lives have changed in recent years. They will talk about tangibles – housing, health, education, roads, cows – and intangibles – umutekano (security), ubwiyunge (unity), amahoro (peace), and even the abstract: Agaciro (dignity).

The housing story started rather controversially as many radical changes in Rwanda do, with human-rights groups and others kicking up a fuss. A few years ago, the government decided that mud and wattle, grass-thatched houses, usually symbols of rural existence and deprivation in much of Africa and the rest of the developing world, were no longer suitable dwelling places for its citizens. They were to be got rid of.

The decision’s implementation and the speed at which it happened were such that a few mistakes were made, thus the loud noise generated by would-be defenders of the poor.

At the end of about two years, however, grass-thatched houses had been eliminated, their former occupants now living in new tin-roofed houses built with tougher material than the mud and wattle of old, for the most part at the government’s expense. Today the beneficiaries of the initiative can hardly talk about the change they see and feel without emphasising how they now live dignified lives.

Some own cows which, they will again emphasise, they received free of charge from the government and which have made a real difference to their lives courtesy of the milk and manure they produce. The milk has improved their diets while the manure has boosted the fertility and productivity of their fields.

If you are familiar with the story of health services in Africa’s rural contexts, the issue of access and the centrality of money in determining who gets them and who doesn’t, is ubiquitous. In some contexts, services at government-owned health facilities are supposed to be free of charge.

In theory, this means that the poor are assured of access. In reality, however, supposedly free services are usually non-existent, courtesy of understaffing and lack of medicines and other necessities. In such circumstances, one cannot talk of access for the poor.

Over a decade ago, the government of Rwanda came up with something of a magic bullet solution to the problem. It is in the form of community health insurance or what rural Rwandans call mitiweri, a derivation of its French appellation, mutuelle de santé.

Ask a rural Rwandan what they do when they are ill. You’re likely to hear “nfite mitiweri” (I have health insurance). How do the poor pay for it? They do not. There is a whole range of arrangements through which they get it for free and graduate from whichever scheme pays only when they can afford it.

The story of education is less straightforward, except in the sense that ever larger numbers of children of school-going age are in school, including those from Rwanda’s once “forgotten” community, the Batwa, who now feel as obliged and as entitled to send their children to school as everyone else.

A combination of all this means that when Rwandans say “tugeze kuri byinshi” (we have achieved a lot), they are doing more than simply sloganeering or repeating mantras they have heard from someone else.

Frederick Golooba-Mutebi is a Kampala- and Kigali-based researcher and writer on politics and public affairs. E-mail: [email protected]