Rwanda’s inclusive health system makes healthcare possible for refugees

It was a painful time when, in 2020, Muneza Jules Mario, 39, a Burundian refugee, started feeling himself very weak, his back hurting, high blood pressure, and legs started swelling.

As an urban refugee living in Kigali before he got sick, Muneza relied on his income as an electronics technician to support his family. He used to repair phones, computers, and even medical equipment like incubators. But as his health got worse, he could no longer work.

“I went for treatment at CHUK [University Teaching Hospital of Kigali], and after some tests, it was confirmed that my kidneys were completely damaged,” he recalls.

The father of five started feeling like a burden to his family as he could no longer provide for his children. When things became very hard, he moved from Kigali to Bugesera because he could no longer afford rent.

“It was very difficult because I had to go for dialysis three times a week,” he says. “I had no strength, and I could not eat well.”

He received this dialysis treatment since his diagnosis, but this treatment alone wasn’t enough.

“If you are suffering kidney failure, and don’t get another kidney, you only wait for death,” he says.

Through the national referral pathway, he learned that King Faisal Hospital was offering kidney transplants. With this information, he was able to secure a willing donor and proceed with the surgery under national community-based health insurance (CBHI) coverage.

Muneza’s story underscores how Rwanda’s progressive approach to refugee inclusion includes not only key building blocks of self-reliance, such as the right to work, but also vital public services such as access to healthcare. In 2019, the Government of Rwanda and UNHCR began including urban refugees and refugee students in boarding schools in the CBHI that nationals use as well. Through this initiative, urban refugees like Muneza were enrolled into the national community-based health insurance (CBHI), locally known as Mutuelle de Santé.

CBHI enrolment makes a huge difference: instead of paying the full cost of the medical services they receive, patients are only billed a 10% co-payment. For example, the full cost of a kidney transplant would have been USD 7,600, whereas the 10% co-payment was USD 760. Such significant cost savings is one reason why refugee inclusion is pragmatic; including refugees in CBHI not only reduces costs but also improves health outcomes and reduces reliance on parallel humanitarian health systems.

In Muneza’s case, unfortunately, even the co-payment was beyond his financial means at the time. UNHCR, the UN Refugee Agency, intervened to cover that cost – thanks to the generous contributions from donors such as Eaglecom Foundation, the United States of America. Still, in light of funding cuts in recent years, even UNHCR would have struggled to find the budget to cover the full cost of the procedure.

“If I had to pay 100% of the kidney transplant cost, I couldn’t afford it,” Muneza explains. “The tests alone are many and very expensive. The surgery is expensive. Even after the transplant, there are many follow-up tests. For a refugee, it is impossible because there is no financial means to afford it.”

Four months after getting the new kidney, Muneza is still in healing process. He continues going to the hospital regularly once every one or two weeks to do follow-up tests. He must take medicine for the rest of his life.

“Now I feel my body getting better. I am recovering,” he explains. “I can even walk 3 km, while before I could not even walk half a kilometre. But I am not yet fully strong. They told me that after six months I will be much better.”

Rwanda continues to invest in their inclusive approach to hosting refugees. In 2026, the Government is looking to partner with UNHCR to start expanding access to CBHI to all camp-based refugees as well. Meaningful levels of international support is vital to implementing this giant step forward to making the overall refugee response more sustainable by expanding sustainable access to healthcare for refugees across the country.

“That support restored my hope to live. It made me very happy,” Muneza points out. “It made me strong again. I had reached a point where I thought I was no longer alive, but now I feel like I have started a new life.”