Rwandan Health Sector today – who is accountable for what happens?
Services of the Rwandan public health system remain suboptimal and coercive as patients are held captive in certain centers when they fail to pay their medical bills and civilians are arrested for not paying their health insurance.
One does not need to be fully acquainted with the direct responsibilities of the Rwandan minister of health to be able to detect the failures of the public health system. Already from last year, messages on Twitter and in local newspapers exposed the rising practices in Rwanda where hospitals were slowly becoming prisons. Up until today, these problems remain.
There have been many cases where individuals were detained in hospitals’ sickbays because they failed to pay the hospital’s services. This was usually done by the hospital’s management and reported on by local newspapers. Some of the hospitals involved were Rwamagana District Hospital, Kinazi Hospital, Nyagatare District Hospital and Gisenyi Hospital.
Strikingly, during the weekend of September 17, 2016, Paul Kagame’s regime reinforced such behavior. In Cyuve, a sector of Musanze District, government’s officials similarly imprisoned 27 people, representatives of several households, together with their livestock (goats and chickens) for not having paid their health insurance.
Inhabitants with their livestock ridden to Cyuve Sector to be detained. (Source igihe.com)
In a subsequent interview on the matter, Manzi Jean Pierre, executive secretary of the Cyuve sector, acknowledged that the arrest was illegal and argued that the government made the arrest with the purpose to educate the population on the importance of health insurance.
My point of view is clear. The government’s behavior is brutal, cruel and inhumane. Paul Kagame’s regime has never held the people of Rwanda as a foremost priority. Accountability are seemingly not part of the characteristics of Kagame’s governance style.
Failures of the health sector
The list of what has gone wrong in the Rwandan health section is long, therefore I will only recall a few past events. In 2015, Rwanda astonishingly had more than 2 million cases of malaria which means that at least one out of five Rwandan citizens was diagnosed with malaria in this year. Death cases of malaria doubled, with all its consequences on the general population.
Rwandans are well aware of the necessity of having a health insurance and the risk of being imprisoned by government officials for not paying for it. Therefore there can only be two reasons why some households prefer not to pay for the 12 months’ health insurance. First, there are those that do not have enough financial means because they are poor. For these households, health insurance is a second or last priority. Second, those household that have the means to subscribe choose not to do so. This is because they are aware of the pitfalls of a corrupted health system which collects money but does not offer health services in return.
Since 2011, we have seen health facilities in Rwanda which failed for different reasons such as drug stock out, lack of medical personnel , delayed or outstanding salaries and others, because the Ministry of Health (MoH) failed or delayed to send subsidies.
As such, the Rwanda Community Based Health Insurance (CBHI) scheme, that stipulates the policies for the public health sector and its funding, has proven to be an accumulation of errors, corruption cases and dysfunctions since its initial stages. It was initially under MoH and was later shifted to the Ministry of Local Government in collaboration with MoH. Recently it has been shifted again to be a responsibility of the Rwanda Social Security Fund (RSSF).
Whom to hold accountable?
Currently, there is no minister of health in Rwanda, and by the looks of things, none will be held accountable for the brutal behaviors encountered by the people of Rwanda from local authorities. It is outrageous that the country can spend two months or more without a minister in charge of the health sector while the government of Rwanda seems to assume all is well in this domain. If this could be the case, then Rwanda might as well disband the entire Ministry of Health for future sake and put all its duties under another ministry of choice.
The reasons for the delay in looking for a replacement for Dr Agnes Binagwaho, the former Minister of Health who was exempted with immediate effect by Paul Kagame, remain unclear. Did the president fail to find a qualified person amongst 11 million Rwandans, or is he still searching for a certain compliant character to aid him maintain a corrupt and dysfunctional system?
Furthermore, in the past 22 years, Rwanda has seen many officials come and go in its ministries. The ministry of education has seen 13 different ministers, and the MoH has had 7 different ministers. The prime minister has changed no less than five times. Yet the president has remained the same while the government continues its unlawful acts. Stretching this idea further, am I wrong to suspect that President Kagame could be the origin of the failures Rwanda is experiencing in, among others, the health sector?