Mutuelle Survey

Name: Elizabeth Mitchell

Position: Reporting & Communications Coordinator

With CCHIPs Since: August 2010

Project Update:

Recently, I’ve been working on writing a report about the Mutuelle Survey conducted by CCHIPs in 2009.

This report seems to capture the strong teamwork aspect of CCHIPs...Mike (a volunteer in 2009) designed and launched the survey with the help of Consolate, Elie, and 74 Shingiro Health Center Community Health Workers (CHWs). Each of the CHWs interviewed 10 households (5 enrolled in Mutuelle, 5 not enrolled in Mutuelle) in their village about why they were or were not enrolled in Mutuelle. Then, the 740 hand-written surveys were distributed amongst the entire CCHIPs team for inputting the data into Excel. Mike started the analysis and report-writing, including preparing a presentation for a District workshop that was unfortunately delayed. Lauren (a volunteer in 2010) continued the analysis and report writing, and handed it over to me when she left in September. I’ve been working on the report ever since, with the help of Celestin, who has been working on the Kinyrwanda presentation so that the CHWs can understand the findings from their hard work.

Ultimately, our goal is that this report will help inform the Rwanda Ministry of Health (MoH) on policy decisions that relate to Mutuelle. Mutuelle is the national public insurance program. Technically, all Rwandans are required by law to obtain Mutuelle – but this does not happen in practice. In 2009, only 52% of the Shingiro Health Center population was enrolled in Mutuelle. (The good news is that with some targeted strategies by CCHIPs and Shingiro Health Center, this number jumped to 88% in 2010!) The objective of the survey was to understand why people do not enroll in Mutuelle. Mike designed the survey such that “poverty” would not be the ultimate reason for lack of enrollment. The report, instead, focuses on concrete barriers to enrollment that can be addressed with targeted programs and specific policy changes. These barriers include timing of cash flows, financial aid policies, and lack of understanding of the financial benefits of Mutuelle. In the report, we make specific recommendations for what the community, District, and MoH can do to address these barriers.

Even though the report is being finalized a year after the survey was conducted, I believe the findings will still be very relevant, and benefit policy-makers in Rwanda. We are currently in the process of reviewing our findings with the proper entities, in hopes of the report reaching the National level in time for it to affect 2012 Mutuelle policies.

I’ve really enjoyed working on this report. The large sample size has allowed for advanced analysis – including some things I never expected to see after my Econ classes in college. It is also exciting to work on something that could ultimately have a huge impact at the National level. This report is just one example of how CCHIPs makes use of the specialized skills of volunteers to benefit Rwanda, outside of our direct interventions. In 2011, we hope to conduct similar projects on the cost-effectiveness of health centers and the potential of a patient follow-up system at health centers.

A sample finding from the Mutuelle Survey shows that households Not Enrolled in Mutuelle are more likely to grow "Season B" crops. This finding helps support the argument that cash flows are not aligned with Mutuelle enrollment cycles, and helps inform the MoH which households to specifically target for Mutuelle enrollment.

Highlight of the Week: Christmas celebrations with Jeanne d’Arc’s family and New Year’s celebrations with Elie’s family!

Best Meal of the Week: I made Baked Ziti with a few Peace Corps volunteers, using Cheddar Cheese brought from the US by Ro…mmmmm