The Sextantio Onlus project is the result of a series of personal experiences on the African territory, crossed by land by personal means, through different countries, with the aim of doing something tangible, able to improve the quality of life of the population.
As in a too complex situation we thought we lacked the suitable cognitive means, our interventions do not propose models of socio-economic organization, but, noticing that the emergency – both more serious and preventable for Africa – is the great number of human beings dying because of pathologies curable with trifling expenses, we have limited our project strictly to the sanitary field.
In the project we are carrying out we will always try to quantify the intervention on a clinical point of view with a reliable research institution validating the most empirical local valuations: in this operation we intend to make use of the help from the School of Qualification for contagious and tropical diseases of the Hospital San Raffaele of Milan. Every intervention will be examined according to an expenses-benefits valuation (the economic resources are meant as expenses and technical results as benefits).
According to our Statute, both in Italy and in the country where the project is carried on, the general expenses are to be paid by the President of the Sextantio Onlus Association, so that all the funds raised are intended only for the health insurances. To say the truth up to now the President of the Association has more or less supported the whole economic project (till 2012). We have tried to verify all the procedural aspects, systematically checking also ‘a posteriori’ the path and destination of the funds on the whole territory of the first state where we have been present, Rwanda.
So the peculiarity of the project is a great clearness in the path of the funds. To give a concrete example, the economical resources are transferred from the Italian current account to a dedicated account of the Caritas and from here or to indigent people (as an insurance) by means of the parishes, basic communities, or straight to health structures.
The state of Rwanda has developed a health insurance System on the base of the Belgian model of the “Mutuelle de Santé” the cost of which is partly paid by the beneficiary and, according to a few sources, those who can’t afford such insurance are about 5% of the population. We were thinking of an objective manner to determine who the extremely indigent people unable to pay for their dues are. Technically our lists of indigent people started locally by means of the institution more diffused on the territory: the parishes, and through them, the Basic Communities, made up by about one hundred people. By means of the Parishes and Basic Communities we got a list signed both by the Political and Medical Power. The administrative iter has been studied by Lino Zanardi, who has lived for more than 30 years between Rwanda and Burundi always devoting himself to the no-profit field.
So in 2008 the pilot project covered a little less than 10.000 people, in 2009 we were present all over the country covering 80.000 insurances, in 2010 about 125.457 insurances, and finally in 2011 we went as far as covering about 40.089 beneficiaries (1,5% of the population equivalent to 30% of the indigent people who can’t afford to pay for their insurance). In 2012 we covered 12.662 because of depletion of funds. In 2013 the insurance starts from mid-year. In all the Health Centres where we went for our ‘a posteriori’ controls, people gave the same answers: those who before couldn’t go to these Centres, thanks to the insurance at the first symptom of a pathology were able to go there, with a consequent considerable reduction of mortality or chronicisation.
Our purpose to penetrate the whole country with such a functional preventive project helping the weakest and therefore more vulnerable people on a sanitary point of view is as elementary as effective in the field of international cooperation, a field marked by the unreality of its projects, by huge general expenses, by losses of money and all the problems about which by now there’s a vast literature.
With an articulate fund-raising politic, Rwanda could become the first state in sub-Saharan Africa where everybody could have a free access to Health. Moreover we are trying to organize a similar project in Burundi, comparable on several variables to Rwanda, to understand if such a model could be a possibly repeatable example as a kind of National Health Service for the countries of the “South” of the world.
Daniele Kihlgren
SEXTANTIO ASSOCIATION ONLUS RUNS TWO SEPARATE BANK ACCOUNTS, ONE FOR MONEY WHICH IS USED FOR THE NGO ADMINISTRATION, ANOTHER FOR OUR NON-PROFIT PROJECTS. The first is financed by the president, the second via donations.
Bank account:
BANCA ETICA FILIALE DI ROMA IBAN: IT42C0501802600000011219318
Sextantio Ltd will contribute money to the Sextantio Association Onlus Project from its corporate earnings and its cultural and artistic projects. It will also welcome independent donations and contributions.
GoFund campaign: https://gofund.me/cede4005
Since 2008, we have invested resources to provide annual health insurance to the most disadvantaged individuals in certain areas of Rwanda.
The necessary funds have been raised through contributions from profit-oriented companies (our hotels in Italy), which allocate a portion of their profits to social projects as per their statutes. The aim is for the resort in Rwanda, which is now ready (despite a bribery attempt we firmly rejected to obtain the operating permit), to become the primary and continuous source of funding for health insurance for the poorest segments of the population. This will be managed under the framework of a local Community Benefit Company.
The Health Insurance Program, implemented by the Rwandan government (Mutuelle de la Santé – Mutual Health Insurance, MHI), is widely regarded as highly promising. Published data indicate a significant positive impact on access to healthcare for the Rwandan people.
For example, WHO reports published on USAID highlight that child mortality for children under 5 years old decreased from 15.2% to 5% over ten years (2005–2015) thanks to health insurance. This implies that providing health insurance for 100 children for 10 years (equivalent to 1,000 insurance policies) can save approximately 10 lives.
From 2008 to 2024, our intervention has funded 337,649 annual health insurance policies through the Mutuelle de la Santé. About 30% of these policies covered children under the age of 5. The overall impact on reducing child mortality has been significant. Furthermore, the improved access to healthcare facilitated by these insurance policies has contributed positively to other health parameters, many of which are interconnected.
National data and reports from international projects show that, thanks to the Mutuelle, early diagnosis and treatment have significantly improved the prognosis for many diseases. One particularly compelling example is malaria: in a district supported by Caritas, among 1,000 cases diagnosed and treated early, no deaths were recorded this year among children under 5 years old.
Other diseases have also seen improvements, as evidenced by the following data:
However, health insurance in Rwanda shows a weakness in diagnosing and treating neoplasms (cancers). Cancer represents a major health emergency across Africa, and the high costs of diagnosis and treatment (imaging diagnostics, medical, physical, and surgical therapies, early detection) are beyond the scope of current insurance coverage due to the complexity and financial resources required to address the issue.
Where the network of healthcare facilities implemented by the Rwandan government offers efficient diagnosis and treatments, highly ambitious goals can be set. It is worth noting that funding insurance for the poorest segments of the population, who have the greatest needs, yields the most significant cost-benefit results.
In summary, while the credit for the evident improvement in the health conditions of Rwandan citizens belongs primarily to the Rwandan government—which, despite foreign policy challenges, has done much for the country’s development and healthcare system, ensuring access for 92% of the population through insurance—our project has demonstrated excellent cost-effectiveness.
Looking ahead, we plan to establish ourselves as a foundation, with the primary goal of continuing to fund health insurance for the most disadvantaged. We will also seek institutional funding to support this initiative. Additionally, we plan to establish a qualified research center to plan and monitor specific investigations related to our project, identifying parameters to be examined through ex post research or targeted clinical studies to be developed in subsequent years.
Thank you for your attention.
Final Note: This project is an experimental healthcare initiative in Africa, with the goal of making it replicable in other countries in the Global South.
We intend to re-purpose the identity concept behind the projects in the village of Santo Stefano di Sessanio and the Sassi in Matera with the same philosophy in another place of “marginality”, slightly further away, Nkombo Island, in Rwanda. A border island in Rwandan territory, inhabited mostly by Congolese populations dedicated to fishing, agriculture and sheep farming, whose economy is purely for livelihood. www.sextantiorwanda.com
The island’s inhabitants speak a specific dialect of this area, Mashi. Verbal memory maintains that pregnant but unmarried, or married but somewhat liberal Rwandese girls were thrown into the lake near the Fisherman’s Island. Some would be saved by these, but sentenced to an existence between domesticated collaborators and veritable slaves. The current population of the island was formed from the unions between the Congolese fishermen and these Rwandan girls.
The project for building huts starts on and is based on the material present in the Ethnographic Museum of the French-speaking capital of Rwanda, Butare. This is a museum that belonged to the King of Belgium and is now owned by the Rwandan state. These huts are not dissimilar to many others found in the mountains of the equatorial rainforest.
The area where the huts are built is located at the northern end of the island, the one furthest from the mainland, with the lowest population density and inhabited by a Muslim minority which, despite poverty, is characterized by some particularly graceful women’s clothes. As in the whole island, even in our huts the population will live on self-subsistence through agricultural production on our land and breeding activities that characterize the family’s economy. A very deep rooted tradition that goes beyond basic needs is the production of “banana beer”, a local fermented product that’s present in many areas of the western equatorial rainforest.
The only small trade will be the purchase of fish from local fishermen or the opportunity to take fish soups with them which are prepared for daily meals. Compared to the typical African resort, the local anthropological element becomes the element around which the whole experience revolves. The attempt, even in this third experience and even more dramatically than the previous two, is to prevent tourism from disrupting the subtle socio-cultural balance of the area. In an island that saw western operators linked to NGOs come only a few times a year, the socio-economic dimension of the project will articulate in dispensing health insurance policies which prevent, at very low cost treatable diseases, but which still have a high mortality rate.
Funded entirely by the members of the Sextantio Onlus Association, the management profits from this activity will go to the Association to support the project that’s been in place for more than a decade, providing health insurance to the most indigent people in the state of Rwanda, starting from the poor of the island.
The hut project will finance Health Insurance, but since paying for Insurance is considered to be the worst welfare economy in Rwanda, at the same time the objective pursued should be supporting local cooperatives for all purchases for the inhabitants of the huts. Goods such as, for example, the mats that serve as a mattress and the traditional furniture still produced by artisan carpenters’ shops can be requested from the numerous Cooperatives, asking that all their members purchase Health Insurance.
This operation would be very well seen by the existing paradigm, both in Rwanda and more generally in International Cooperation, for many reasons, because it would mean generating revenue through the insurance purchased.
I am perhaps a bit old-school and with “Illuminist” heritage, because I think that at least for some groups of people who are objectively in economic difficulty, health insurance should be an inalienable right from birth.
When the hotel becomes operational, the cooperatives will be able to give us the food products that we will not be able to produce directly on our land.
All these operations will be aimed at the most important objective of maintaining intact the socio-cultural balance originated, so as to preserve the dignity of the local populations, not transforming them into masses of beggars, as it happens in many African resorts. This will be the most difficult and fundamental challenge of a project that starts with the best intentions but that is highly experimental and with uncontrollable variables.