Coverage Limits Leave Disabled Persons Facing Recovery Costs Alone

At HVP Gatagara, the country’s oldest and largest orthopedics and rehabilitation hospital, patients report that treatment often ends not because they are healed but because insurance runs out. Under current policy, health insurance covers only three months of care or 40 therapy sessions. After that, patients must pay entirely on their own.

A 2022 national survey estimated Rwanda has nearly 392,000 persons with disabilities, with more than a quarter of adults experiencing functional difficulty. Children make up about 20 percent of that population, underscoring the need for accessible, continuous rehabilitation services.

Founded in 1983 and run by the Brothers of Charity, Gatagara treats around 4,000 patients annually, including 1,500 children who live at the center for long-term care and education. Recognised in 2018 as a specialised hospital in orthopedics and rehabilitation, it serves as a national referral point. Yet insurance restrictions leave many stranded mid-recovery.

“My body was halfway paralysed and I have spent two months here,” said Donatha Nikuze, 46, from Ruhango district. “The treatment helped me improve, but my insurance does not cover all the services I need, like a wheelchair. Once coverage ends, we are told to pay everything ourselves. Many of us simply can’t afford it.”

Beatrice Maniiragena, a mother of three from Nyabihu district, voiced the same concern after spinal surgery. “After three months I will be sent home, even when I am not fully recovered,” she said. “When I return for further treatment, I must pay 100 percent from my own income. I am not financially stable. That is a big challenge.”

Hospital staff say the system itself creates these barriers
“Insurance only covers certain conditions like spinal cord injuries, cerebral palsy or post-surgery rehabilitation,” said Beatrice Byukusenge, head physiotherapist at Gatagara. “After 40 sessions or three months, patients are sent home on home therapy. If they return, they must pay entirely from their income. Elderly patients face the same limitation.”

Isaac Rukuundo, head of the Prosthetics and Orthotics Department, said the rules often undermine the purpose of rehabilitation. “Patients are not fully recovered when they go home, but because insurance coverage ends, families face heavy financial pressure,” he said.

Patients also point to unmet government promises. A cabinet decision earlier this year pledged that essential equipment such as wheelchairs would be covered by insurance starting in July. Months later, nothing has changed.
“Patients come expecting wheelchairs under insurance because the government said it would be covered,” Rukuundo said. “When we explain it is not yet in effect, they accuse us of denying them their rights.”

Rwanda’s legal framework already provides for state support. A 2009 ministerial order requires that persons with disabilities rated between 50 and 100 percent disability have their Mutuelle de Santé premiums fully paid by the state. Those rated 30 to 49 percent qualify for partial coverage, and the order guarantees free prosthetics and orthotics for patients with severe disability. In practice, however, implementation remains uneven.

Many patients say medicines are either out of stock or not covered under Mutuelle. A study by the International Society for Pharmacoeconomics and Outcomes Research found that 18 percent of members are dissatisfied with services, 76 percent said prescribed drugs are not always covered, and 38 percent reported that essential medicines are unavailable at health facilities.

For patients at Gatagara and thousands of others across Rwanda, the gap between policy and practice remains wide. But with stronger advocacy, informed reporting, and responsive insurance reforms, experts and patients alike hope that rehabilitation can finally match the medical and human potential of those seeking to recover.