The Ministry of Health (MoH) and affiliated agencies have recently been in the media for all the wrong-reasons.
However, the Health ministry Permanent Secretary, Dr Jean-Pierre Nyemazi said there is a new “holistic plan” to revamp the ministry, increase collaboration with affiliated agencies and district hospitals for efficient healthcare delivery.
Nyemazi was on Monday appearing before the parliamentary Public Accounts Committee (PAC) to answer queries raised in an Auditor General’s report.
Several other ministerial officials accompanied him, and directors of district hospitals of Kibilizi, Muhororo and Ruhango, for a public hearing at the Parliamentary Building in Kimihurura.
Auditor General Obadiah Biraro’s 2014/15 report highlights several challenges the ministry and public hospitals face ranging from “chronic stock-out” of drugs and medical supplies, omission of transactions from the books of account; unreconciled balances; unjustified suspense accounts; and unsupported transactions to gaps in management of internally generated revenue.
The report shows that most district hospitals continue to face weaknesses in accounting and management of funds at their disposal.
As if that wasn’t bad enough for the health sector, the audit identified cases of stock outs for drugs and medical supplies at University Teaching Hospital of Kigali, which it says affects operations of the referral hospital.
The report says that lack of medicine in public hospitals has become a “big challenge” affecting 80 per cent of the University Teaching Hospital of Kigali (CHUK) patients who are mainly from Ubudehe category 1 and 2 that use community-based health insurance scheme and cannot afford to pay for themselves.
“The hospital has experienced stock outs of drugs and medical supplies for periods ranging from 14 to 458 days. This is a very big challenge for clients using Mutual Health Insurance because they are not reimbursed money paid when purchasing drugs in private pharmacies,” Biraro’s report further reads.
Juvenal Nkusi, the chairperson of PAC, noted that some administrators “may be careless while the others do not have financial management background resulting in poor handling of accounting and financial management activities.”
MP Médiatrice Izabiriza blamed the stock out of drugs and medical supplies in public hospitals on “unseriousness on the part of some of the hospital administrators.”
MP Jean-Thiery Karemera said that, “I am so certain that with good collaboration and transparency, we wouldn’t be seeing these accountability issues in CHUK and several district hospitals.”
Earlier on Monday, officials from Rwanda Biomedical Centre (RBC)— an agency affiliated to the Ministry of Health—had been grilled by the same parliamentary committee on failure to recover around Rwf960 million in debt, failure to justify Rwf2.5 billion in unsupported expenditure, and Rwf 183 million posted in fraud cases, to mention but a few.
Nyemazi acknowledged that indeed, there were “lots of issues” but assured lawmakers that plans are in place to restructure the health sector operations for efficient services.
Health sector transformation plan underway
“I would be lying if I denied that we do not have challenges in the health sector,” Nyemazi said, “But four months ago we met all health sector stakeholders and talked about the issues to seek lasting solution. We came up with the Health Sector Transformation Plan.”
“The plan is at the beginning process and the intention is to look into what we are experiencing as a sector; identify the bottlenecks, and design strategies to overcome them.”
Nyemazi said that the plan would be implemented in the near future to improve healthcare delivery services.
“We are looking at how we can we make healthcare more accessible and efficient, improve the welfare of the health professionals, and make the health sector more accountable. Our gains are fragile; we need to keep doing stuff the right way, thus the holistic plan and process to revamp the entire healthcare system,” Nyemazi explained.
He said he was confident that the challenges identified in the sector “can be overcome” once the stakeholders improve access to specialised care.
“In Rwanda we have done well in providing primary and essential healthcare. But now, we need to go an extra-mile and start looking into more complex cases such as cancer, and heart and kidney diseases. Again, we need to first sustain what we have achieved so far,” Nyemazi added.
On drug stock-out in public hospitals, Nyemazi said that the ministry would investigate to find out the cause.
“The bottom line is that there shouldn’t be medicine stock-out,” he says.