Senate delegation is led by Vice President Solina Nyirahabimana (in black).
At a Senate hearing last week, Health Minister Dr. Sabin Nsanzimana admitted that there were serious challenges within the primary healthcare system, telling lawmakers that at least 20% of the health posts had been abandoned by contractors.
Rwanda currently operates a decentralized healthcare public service system comprising about 1,700 health posts at the cell level, 500 health centers at the sector level, 42 district hospitals, and 12 referral hospitals.
Health posts, the lowest form of health facility in Rwanda’s healthcare system, now lead the country’s healthcare network, constituting 57.5% of all health facilities nationwide, with a total of 1,280 facilities, including 102 second-generation health posts (SGHPs).
This means that the vast majority of the country’s population depends on health posts for first-line medical treatment. As a government policy, the running of health posts has been relinquished to private contractors, who bid for them and operate them as businesses. They usually have a medical officer and nurses.
However, recent reports from Parliament and the Auditor General have indicated that every other year, the number of non-operational health posts keeps growing. As a result, communities in rural areas are forced to walk long distances for basic medical treatment.
Parliament wants answers, which is why a Senate delegation led by Vice President Solina Nyirahabimana is touring health posts in Nyaruguru District, rural southern Rwanda. Their findings so far are difficult to take in for the delegation.
Costasie Nyiramahoro, the manager of the Mishungero health post in Mishungero cell, Nyabimata sector, told Senators visiting Nyaruguru District that among the challenges they face—which often lead to closure—are the high costs of treating patients, which don’t match the reimbursement from the health insurance scheme run by the Rwanda Social Security Board (RSSB).
The Senate outreach activity aims to observe the efforts in promoting health posts, specifically focusing on their accessibility to the population, the quality of health services provided, and whether these services are effectively reaching the citizens.
Costasie Nyiramahoro, the manager of the Mishungero health post in Mishungero cell, Nyabimata sector
Nyiramahoro informed the Senate delegation that, for example, when they carry out a stool test, RSSB reimburses Rwf203, while the actual market cost of the equipment used is Rwf1,000 for the disposable bottle, gloves, and a screening frame—all one-time-use tools.
A report by the Office of the Auditor General (OAG) of State Finances (year ended 30 June 2023) shows that there were 134 idle health posts in 25 districts, and 126 health posts in 13 districts are partially idle, operating between 1 and 5 days instead of 7 days.
The report also shows that there were 90 idle assets worth Rwf15.86 billion not put to use in 22 institutions, including the health sector.
While the Ministry of Health announced new plans to review the costs of treatment under the Community-Based Health Insurance (CBHI) scheme, Nyaruguru residents told Senators that the fact that primary health centers do not work with the Rwanda Social Security Board (RSSB) is a constraint for government employees and their residents.
Another obstacle is taxes: the head of the post said that they pay annual taxes of 3%, while health centers that also provide health services are not taxed. This has resulted in making losses and losing staff over time.
The health post manager highlighted above illustrated that when they invest for example Rwf 2m, earning an additional Rwf 400,000, the tax and operating costs consume it all.
The Senate delegation told local media that they will advocate for the concerns to be considered by the relevant authorities.
