Civil society organisations have highlighted that health posts face challenges in many parts of the country. Ministry of Health says 5% are not functional at all while another big number operates below capacity.
By Alexis Ngarambe
In 2009, the government of Rwanda following the decentralisation model began constructing health posts at cell level as the lowest locations of delivering health care. Government aimed to solve a problem that existed where people would walk more than 70 minutes to reach a health center, thus targeting areas without a hospital or health center nearby.
With time 1,282 were constructed and become part of district performance targets (imihigo). However the capacity to build moved faster than equipping and staffing, leading to a situation where currently 5% are not working at all, while a big number is underperforming.
In an analysis by the organisation IDA Rwanda in collaboration with the Rwanda Civil Society Platform (RCSP), in Nyaruguru district, found that many health posts were working a few days a week, while others not operational at all.
Among the challenges is that Health Posts are in hard to reach areas, isolated far off places which make it hard for medical workers to accept to work there. Another noted concern is that nurses who run the do not have business skills, explaining why private investors are encouraged as long they have qualified medical staff.
According to Dr Corneille Ntihabose, the head of Clinical Services in the Ministry of Health, efforts are being made to reduce the challenges government is well aware of. He pointed out that some health posts are successful and make more money than some health centers.
Speaking on a show on Radio Rwanda, Dr Ntihabose said that about one fifth of all patients (more than 5 million) are served by health posts underscoring their impact. Health Posts now provide regular medicine for non-communicable disease when a patient has prescription from a doctor.
The civil society representative, Alliance Ishimwe, the associate Director of Community Outreach at Health Development Initiative, said that they are lobbying government to improve the capacity of health workers. She noted that her organisation works to inform the public on which services are provided at what health post or center, pointing out that some reproductive health services are available at health posts.
According to a recent Rwanda governance score card, it showed health posts scored the least confidence among all health providers well below community health workers and hospitals.
As per the resolution of the recent national dialogue, Umushyikirano, government has moved to improve health service provision across the board. The ministry has begun deploying surgeons at health centers, already at Gatenga, Remera, Kinyinya health centers in Kigali having permanent doctors.
Health providers have complained for long that insurance payment rates do not match the cost of services. Currently, RSSB is revising national health insurance rates since the current contribution of 200Frw per patient were introduced in 2012 and cannot meet the cost of treating patients. With review of the rates, there is expectation that more investors will be attracted into the sector especially in rural areas.
