President Kagame has made healthcare one of the priorities for the Vision 2020 development programme, boosting spending on health care to 6.5% of the country's gross domestic product in 2013, compared with 1.9% in 1996. The government has devolved the financing and management of healthcare to local communities, through a system of health insurance providers called ''mutuelles de santé''. The ''mutuelles'' were piloted in 1999, and were made available nationwide by the mid-2000s, with the assistance of international development partners. Premiums under the scheme were initially US$2 per annum; since 2011 the rate has varied on a sliding scale, with the poorest paying nothing, and maximum premiums rising to US$8 per adult. , more than 90% of the population was covered by the scheme. The government has also set up training institutes including the Kigali Health Institute (KHI), which was established in 1997 and is now part of the University of Rwanda. In 2005, President Kagame also launched a program known as ''The Presidents' Malaria Initiative''. This initiative aimed to help get the most necessary materials for prevention of malaria to the most rural areas of Rwanda, such as mosquito nets and medication.