The implementation of Rwanda’s new healthcare capitation model, a prepayment approach for health facilities, has been delayed due to recent adjustments in medical service tariffs, according to the Rwanda Social Security Board (RSSB). RSSB manages the community-based health insurance scheme, commonly known as Mutuelle de Santé – which is the focus of the new payment model for services provided by health facilities. ALSO READ: Mutuelle de Sante: Government to start paying health centres in advance Capitation is a payment model in which healthcare providers receive a predictable, upfront, fixed amount of money to cover the expected cost of providing specified healthcare services to patients over a defined period of time. During a press conference on the fund’s 2024/2025 performance and the review of its 2021–2025 strategic plan, RSSB Deputy CEO Louise Kanyonga said that the initial rollout of the capitation model was scheduled for July 2025. However, the government recently revised the 2017 health service tariffs – with new ones becoming effective in July – to account for rising healthcare costs and to support greater investment in the health sector. As a result, RSSB had to adjust the capitation funding allocations (which were considered earlier) to align with the new tariffs. “We had to review the figures to ensure the pre-allocated funds match the revised tariffs and are not below the cost of services,” Kanyonga said, pointing out that the review was in its final stages. ALSO READ: What you need to know as new medical tariffs come into force Willson Gashumba, the National Dean of Health Centre Managers, told The New Times that they expected the capitation model to start in Eastern Province in July, but the coincidence with new tariffs held the progress back. Overall, he said, medical tariffs were revised to reflect the current market realities, citing a normal baby delivery – birth attended by a healthcare worker, without caesarean section – at health centre, whose price rose to Rwf11,000 currently from Rwf1,200 in the old tariffs (of 2017). ALSO READ: How revised medical tariffs are reshaping healthcare access With the needed adjustments nearly complete, the capitation model is now set to launch in October 2025, beginning with a pilot phase in all health facilities across Rwanda’s Eastern Province, Kanyonga said. She stated that the capitation model is intended to improve both cost control and fraud prevention in the healthcare system. Capitation is one of the key initiatives we are implementing to address unsustainable increases in healthcare costs and potential fraud, Kanyonga pointed out. In the past, health facilities were reimbursed for each service or item. This created opportunities for inflated invoices in some health facilities and made it difficult to control costs. Under the capitation model, RSSB will allocate a fixed amount of funds to health facilities in advance, based on detailed analysis of historical data. This includes reviewing past expenditures and the number of members (patients) served by each facility. “We conducted very robust data analytics using historical data to understand how facilities have been spending and how many patients they serve. This allows us to determine how much funding each facility will need in advance,” Kanyonga observed. In addition to improving financial oversight, the capitation model is designed to promote preventive healthcare, according to Kanyonga, encouraging health facilities to focus on keeping people healthy rather than only treating illnesses. “We will closely monitor the implementation of the pilot, assess areas for improvement, and collaborate with healthcare providers to refine the approach before rolling it out nationwide,” Kanyonga stated. Tackling payment delays Willson Gashumba, the National Dean of Health Centre Managers, told The New Times that the capitation model is expected to address long-standing payment delays, which have contributed to shortages of medicines at health facilities. Cash flow problems affecting health facilities have resulted in a situation where they owe arrears to Rwanda Medical Supply (RMS), from which they source medicines through district pharmacies, he said. These arrears led to partial drug deliveries. “In some cases, RMS would supply fewer medicines than needed, and health facilities were left struggling to serve their populations adequately,” he said. This often forced health centres to ask patients to buy some medications from private pharmacies. That, in turn, discouraged people from contributing to Mutuelle de Santé – the community-based health insurance scheme – because they were not receiving the full benefit they expected, he added. According to Gashumba, these challenges were among the key factors that led to the adoption of the capitation model, in which RSSB will pre-finance health facilities based on the population they serve rather than reimbursing them per service rendered. ALSO READ: Govt to roll out new health facility pre-payment model by July Gashumba said the capitation model will allocate funds based on the number of people a health facility serves. He added that facilities were informed such payments would be made on a quarterly (three-month) basis. “Under this model, we will receive funds every term – covering three months – which we can use to buy medicines and essential medical equipment in bulk,” Gashumba said. Each term, health facilities will report on how the funds were used, and if all is in order, RSSB will release the next round of funding. Gashumba said that this model could significantly improve the financial stability of health facilities. “With capitation, we can plan ahead, maintain adequate stock levels, and deliver better services to patients. It promises to offer a practical solution to the persistent financial challenges we've been facing,” Gashumba concluded.
