Health centres and posts could start getting paid in advance for medical services in July under a pre-payment model called capitation, with a view to improving cash flow for these primary healthcare facilities, according to the Minister of Health. Dr Sabin Nsanzimana said this on Wednesday, January 22, when he appeared in Parliament to answer MPs’ queries about delays in paying health facilities. The minister was in the Lower House's Committee on Governance and Gender Affairs, along with the director general of Rwanda Social Security Board (RSSB) to respond to issues laid out in the 2023/2024 report by the Office of the Ombudsman. ALSO READ: Mutuelle de Sante: Government to start paying health centres in advance We plan that [the capitation model] will be rolled out in all health facilities countrywide, and health posts,” Nsanzimana said, adding that they wanted to implement it under a phased approach to assess its performance. He said that it will first be implemented in health centres and health posts “because they are the ones with major issues related to cash flow.” “The new system we are introducing in partnership with the RSSB, means that instead of paying them upon submitting a medical invoice, you give them money in advance because you know their expenses based on current records,” he observed. There are more than 500 health centres, and 1,280 health posts countrywide, according to data from the Ministry of Health. ALSO READ: Senators embark on tour to assess health posts With the use of technology by RSSB, Nsanzimana said, good progress has been made within the last two years in terms of paying medical bills for services provided by health facilities to patients, who use health insurance. Currently, he said, with a paperless system, payment for a medical invoice is being processed in less than a month, and sometimes in two weeks, which is a shorter period compared to an average of three months before. However, he said that for health centres, even a one-week delay in medical bill payment has an impact on patients because these health facilities have limited resources for buying medicines, and meeting other essential expenses. “When you delay paying them, patients lack medicines because there is drug stock-out,” he said. He said that expenditure in health facilities does not change frequently, estimating that the typical health centre spends Rwf1 million to Rwf2 million on acquiring medicines, reagents for carrying out tests, and water. As key items on which health centres spend money are known, Nsanzimana said that there is no major change in medical invoices, estimating that it may be one or two per cent, “unless there is an epidemic.” The new approach will be basing on previous records in health centres’ medical bills to determine how much money to provide them to enable them to have means for timely drug procurement and effective planning. Then, they will be justifying, say after one quarter, how they spent the money before getting funds for the following quarter. He added that the justification for funds use will be done electronically for efficiency purposes. Officials said that there will be strict monitoring measures to ensure that patients get the appropriate treatment. Nsanzimana warned health facilities against diverting the use of the funds.
