A medical officer checks the blood pressure of a patient. Physical contact makes treatment and care for NCDs a challenge amid COVID-19.

A painful tale of huge costs of treatment amid restrictions on travel and stigma

Generally, people living with Non-Communicable Diseases such as kidney disease, diabetes, breast cancer, heart diseases, and others, need uninterrupted treatment care and support, which may sometimes last throughout life. To ensure sustained and optimal care, people living with NCDs require regular and long-term quality clinical care. This makes it very costly to manage the patients and foot the medical bills.

This financial burden was escalated by the COVID-19 pandemic that adversely affected treatment and delivery of care to people living with NCDs as well as household incomes.

First of all, it became challenging to get to hospitals for treatment and to find medication due to travel restrictions. As a result, some people living with NCDs could not receive medication or other treatment on time.

During the pandemic, many lives of people living with NCDs were threatened according to Mr. Elias Nambaje, 52, who is living with a severe kidney condition in Kigali City.

Mr. Nambaje, who is a Member of Rwanda Kidney Organization, says he has been living with kidney disease for the last 15 years. He says lack of health insurance cover is a massive disadvantage for people living with NCDs.

“One of my main challenges is that community-based health insurance doesn’t cover the high treatment cost of kidney diseases, and the situation was worsened when COVID-19 affected my income. For instance, dialysis treatment requires at least Rwf1 million per month and for patients with transplanted kidneys, it requires about Rwf150,000 per month to buy drugs, which is unaffordable. This cost is not covered by Community Based Health Insurance (Mutuelle de Santé), a solidarity health insurance system used by Rwandans for the purpose of protection and receiving medical care in case of sickness,” says Mr. Nambaje.

Regarding restrictions posed by COVID-19, he says: “I faced other challenges such as lack of medicine during the total lockdown when getting a vehicle to go to the hospital was difficult. Sometimes, I traveled, and security guards stopped me even without checking my medical documents. The pandemic also led to an increase in the price of medicine. For instance, the price of a tablet rose from Rwf 1,000 to Rwf 3,000 due to the effect of COVID-19 on the logistics of health commodities.”

People with NCDs are required to feed well and to ensure a balanced diet in order to boost the body’s immunity. However, the COVID-19 pandemic affected household incomes.  “I have a family to support, so I cut down on the number of daily meals to help balance the family budget and save money for treatment,” Mr. Nambaje narrates.

“I am worried that my weakened immunity could increase the chance of contracting COVID-19. However, following all preventive measures, on the other hand, is the best option to stay free from the Coronavirus,” he stressed.

On behalf of people living with NCDs, Mr. Nambaje advocates for Universal Health coverage for all NCDs. He points out for example that community-based health insurance (CBHI) should cover the entire cost of kidney disease treatment to prevent out-of-pocket expenditures. He appeals to the Government to subsidize the cost of therapy because dialysis and medications (immunosuppressants) taken to prevent kidney rejection after transplant are overpriced.

Fighting NCD stigma

On tackling the issue of social discrimination and stigmatization of people living with NCDs, he reiterates that it is totally wrong. He says it is always important to remember that anyone (young or old) can suffer from an NCD.  “In society, some people think that the life of a person living with NCD has ended, and he/she is just waiting to die. This is totally wrong because people living with NCDs have the ability to do great things to improve their standard of living. People living with NCDs need your support, love and care,” he pleaded.

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