Rwanda: District Health Facilities Worth Millions Lie Idle

22 October 2020

Some districts are struggling to make use of health posts due to the lack of investors and inadequate planning, limiting citizens access to healthcare services, it has emerged.

This comes after the Auditor-General's report for 2018-19 revealed that districts spent over Rwf804 million to construct some 70 new health posts in the same financial year.

However, 54 of the health posts, which are worth more than Rwf609 million, were idle.

Health posts offer a reduced package of services, including curative outpatient care, child immunisations, growth monitoring for children under five years, antenatal care and family planning counselling, health education and a few laboratory tests.

Health centres provide oversight to the health posts.

Idle health posts were identified in the districts of Burera, Gicumbi, Karongi, Ngororero, and Rusizi.

Even as they are constructed on taxpayers' money, the government expects private operators to provide medical services to the citizens.

The Auditor General's report, which was scrutinised by the Parliament's Public Accounts Committee (PAC) from September 14 to October 7, 2020, noted that the idle health posts are attributed to lack of proper planning.

PAC tasked the ministries of local government and health to follow up and ensure that the health posts are put to use.

Ngororero District Mayor, Godefroid Ndayambaje, said that the health posts were constructed in response to the needs of citizens who were trekking long distances to seek treatment from health centres.

"The district is hilly and you realise that a citizen makes a long distance to reach a health centre. So, it was necessary that health posts be constructed," he said.

Ndayambaje said that the district constructed 26 health posts.

Yet, he added, getting private operators to put the health posts to use was a challenge, and that only those located in the vicinity of [trading] centres attracted investors. Twelve of them, which are located in remote areas, are yet to get investors.

Talking about why the private operators were not available to utilise them, he cited a concern that such health facilities in rural areas would get few patients (clients) compared to urban centres, a situation that would limit their income.

The district has engaged the ministry of health, which has given them 12 healthcare workers to offer health services in the idle health posts.

The medics, he disclosed, are staff of health centres who will be deployed in health posts.

Given that providing health service would require more than one healthcare provider, one medic is not enough to carry out various functions including consultations and treating people.

Ndayambaje said that the district was working on an arrangement to be able to get support staff for the medic.

Burera District Mayor, Marie Chantal Uwanyirigira, also told The New Times that the delay in operation of the health posts resulted from lack of private operators to manage them.

She said that the district decided to seek the help of the nearby health centres to manage them instead, as it continues to look for the private operators.

She indicated between March and April 2020, the Ministry of Health sent the district 29 among 46 medics that it had promised and were assigned in health centres so that they can help in the management of health posts.

Of the six health posts which were not operational, she said, five of them started working thanks to one medic deployed to a health post from a health centre.

"Since those are personnel from health centres who go to serve in health posts, they work a few hours than we want. Sometimes they do not get a medic on Sundays because of a tight schedule, yet, what we want is that every health post works all days, and even 24 hours each," she said.

To make the health posts fully operational, she said that the district has started doing internal recruitment of full-time medics.

According to the Fourth Health Sector Strategic Plan by the Ministry of Health which runs from July 2018 to June 2024, together with the private sector and the community, construction of health posts will be expanded to all cells to provide proper and adequate care as close to the village as possible.

The plan envisages that the number of health posts constructed, or rehabilitated in a cell which does not have any is projected to increase from 473 in 2016 (baseline) to 623 in 2024.

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