At a Senate hearing last week, Health Minister Dr. Sabin Nsanzimana acknowledged significant challenges in Rwanda’s primary healthcare system, revealing that contractors had abandoned at least 20% of health posts. Rwanda’s decentralized healthcare network includes about 1,700 health posts, 500 health centers, 42 district hospitals, and 12 referral hospitals. Health posts, which constitute 57.5% of the country’s healthcare facilities, serve as the first point of contact for most Rwandans seeking medical care.
Despite their critical role, the functionality of health posts is increasingly under threat. Reports from Parliament and the Auditor General highlight a growing number of non-operational and partially operational health posts, particularly in rural areas. According to the Auditor General’s report for the year ending June 2023, 134 health posts in 25 districts were idle, while 126 health posts in 13 districts operated only a few days a week. This has forced rural communities to travel long distances for basic healthcare.
A Senate delegation led by Vice President Solina Nyirahabimana recently visited health posts in Nyaruguru District to assess their challenges. Costasie Nyiramahoro, manager of the Mishungero health post, explained that financial losses are a major issue. She cited the disparity between treatment costs and reimbursements from the Rwanda Social Security Board (RSSB), which undermine their ability to sustain operations. For example, RSSB reimburses Rwf203 for a stool test, while the actual cost of equipment for the procedure is Rwf1,000. High taxes further compound the financial strain, unlike tax-exempt health centers, leaving many health posts unable to operate sustainably.
The Ministry of Health has announced plans to review treatment costs under the Community-Based Health Insurance (CBHI) scheme, but other issues remain. Residents and health post managers have pointed out the lack of RSSB partnerships with primary health centers and the burden of annual taxes, which drain the limited revenue generated. Senators have pledged to advocate for reforms to address these systemic challenges and improve access to quality healthcare for rural communities.