A health centre in Rwanda
Rwanda currently operates a well-functioning, decentralized healthcare public service system comprising 1700 health posts, 500 health centers, 42 district hospitals, and a dozen of referral hospitals.
Following the successful implementation of the Community based Health Insurance (CBHI) “Mutuelle de Sante” policy that has seen subscriptions go beyond 95% today, Rwanda’s plan is to increase healthcare infrastructure within.
With these numbers of health posts across the country however, statistics presented by the ministry of Health at the National Dialogue Council (Umushyikirano) 2024 showed that 9% of them (privatised) are not functional.
The Minister of Health Dr. Sabin Nsanzimana said back then that this was a result of private owners abandoning their responsibilities, but new regulations have been put in place to manage the operations of the privately owned health posts.
“These nine percent will, in collaboration with districts, get new abled owners who can utilize them optimally,” Nsanzimana assured.
However, it has emerged that some health posts across some districts in the country remain idle (unused) due to many reasons but foremost the costs of service and working relationship with Rwanda Social Security Board (RSSB)- which manages the health insurance.
For instance, in Gisagara District located in Southern Province, there are 47 health posts but 6 of them are not working. In Rubavu District located in Western Province, there are 34 health posts but 9 of them are not operating.
In Burera District, Northern Province, out of 50 health posts, 13 are not working, while in Rulindo District, 14 health posts out of 39 health posts are not used.
Rwandans who spoke to Kigali Today say that even those functioning, open once in a while because the health centers themselves do not have enough staff.
An Executive Secretary of one of the cells in Northern Province, when asked why the health facilities in their area he manages is no longer functioning said: “The health posts here have been closed for a year. The health centers’ staff who are supposed to come and serve them said that they are understaffed and will no longer send someone for intervention.”
Private health facilities have also closed their doors due to claims of bankruptcy, as a result of dealing with the RSSB, according to another cell executive secretary in the Northern Province.
“In the past, we had a medical practitioner who was coming from time to time, but it came to the point where he didn’t come back. When I called, he told me that he will not come back because there is something he does not agree with RSSB,” he said.
A resident of Gisagara district says that in some private health posts, they charge a hundred per cent to the patients while in their mandate, they are supposed to accept the community health insurance.
“They will treat, only if you are on a private heatlth insurance other than mutuelle de sante you,” said the Gisagara resident.
RSSB Costs and Partnership in Focus
Members of community-based health insurance schemes receive primary medical care from health centers or from a health post anywhere in the country and pay 10% of the total bill.
Though RSSB of recent told the parliament that they were set to resolving most of the issues that come with revising the billing regime, some partners say that they are closing due to high billing regime.
Bikorimana* (not real name) says that the medical cost remained the same (as of 2003) but that what RSSB reimburses them is lesser than the effort put on one patient.
Coupled with delayed bills reimbursement by RSSB, health facility owners say that sometimes they offer poor medical services to avoid losses.
For instance, a patient who comes to be treated and malaria plus cough are diagnosed, the medics will treat malaria which is covered by RSSB and leave out cough- which is not covered and cannot be reimbursed.
Regis Mugemanshuro, the CEO RSSB said that
“The problem is that there is a violation of these regulations and prices set by the Ministry of Health,” he said.
“If there is a service or drug that they want to be considered on our list, we advise them to appeal to the ministry of Health (MoH).”
Mugemanshuro stated that if there is a situation where RSSB staff refuses to pay for the service or medication they will follow up.
On the other hand, Julien Mahoro Niyingabira, Health Communications Division Manager at Rwanda Biomedical Centre/ MoH says that the problem of prices in health facilities is known, and a solution is being sought.
