Rwanda health sector faces tough times should donors exit
Residents of Gakenke District, Northern Province, use traditional methods to get a patient to Nemba Hospital due to lack of ambulances in the area. There are concerns that donors may slash their support to the health sector or even pull out.
IN SUMMARY
- Plans by donors to reduce or even withdraw funds allocated to health, 55 per cent of whose expenditure has been relying on external funding, has triggered fears that the sector could be hit.
- According to a report filed by a standing committee of parliament in charge of budget and patrimony to the plenary, the Ministry of Health has disclosed a Rwf19.5 billion funding gap for its projects.
- Reports indicate that the total health sector budget expenditures — including government and donors’ allocations — are roughly Rwf673 billion per annum going by figures from the last fiscal year.
On Wednesday, Members of Parliament expressed their concern regarding the fate of the health sector after major funders hinted on the possibility of scaling down funding due to shocks from the global financial crisis.
The concern came up as parliament was discussing major areas likely to be affected in the next fiscal year should the government fail to effectively address the funding gaps amounting to Rwf50 billion across all sectors.
According to a report filed by a standing committee of parliament in charge of budget and patrimony to the plenary, the Ministry of Health has disclosed a Rwf19.5 billion funding gap for its projects.
According to legislators, slightly more than half of the sector’s expenditure has so far been mainly funded by external donors.
Reports indicate that the total health sector budget expenditures — including government and donors’ allocations — are roughly Rwf673 billion per annum going by figures from the last fiscal year.
While presenting the report, Constance Rwaka Mukayuhi, the chairperson of the standing committee, said the government should be on standby to promptly devise ways of addressing the funding gaps should the donors decide to exit.
“We understand that some of the donors might decide to pull out, although we don’t know when, but it should be a wake-up call on the way forward to avoid major shakeups in health projects,” said Ms Mukayuhi.
However, despite the budget deficit in the sector, the likely projects to be affected weigh less than those supported by external donors, which are believed to be significant and critical in the field.
According to the report, the funding gap in the next fiscal year, which will commence on July 1, was supposed to finance nutrition programmes, removal and replacement of asbestos, as well as salaries and wages for Rwanda Biomedical Centre (RBC) staff and district health facilities.
Critical projects
On the other hand, national projects believed to be critical are the health insurance scheme widely known as Mutuelle de Sante, procurement of highly subsidised medicines such as anti-retroviral drugs and establishment of health facilities which have been heavily financed by donors.
One of the major funders in the programmes who are feared to reduce or pull out his funds is the Global Fund Initiative, which has been working with the ministry for more than 10 years.
Efforts to talk to officials at the Global Fund on the issue were futile by press time but Rwanda Today understands that, at least by last year, the donor had committed more than Rwf620 billion ($900 million) in the past decade.
Of late, the donor had developed a new model of financing the sector through what is called Result Based Financing (RBF) after the government registered positive track records in addressing health programs.
In the upcoming fiscal year 2015-2016, should the budget be approved by parliament, the foundational cluster which accommodates social welfare sectors — including health, education and justice — are to be financed to the tune of Rwf645 billion, which is equivalent to 37 per cent of the total budget.
Talking to Rwanda Today, however, Nathan Mugume, who is the head of Rwanda Health Communication Centre at RBC, said so far no donor had announced withdrawal of funding although some of them had communicated budget cuts citing the global crisis.
“The Global Fund is among donors who are likely to reduce their budgets after they expressed issues regarding the global financial crisis, but they have not said that they will withdraw funding to the sector,” said Mr Mugume. “However, so far we don’t know how much will be deducted — although on the other hand the government has begun laying out various proposals to mitigate the gap should the donors’ funds reduce.”
According to Mr Mugume, as one of the effective methods to handle the budget vis-a-vis the need in place, government might slash allocations to health infrastructure, human resources and sensitisation campaigns.
“For example, the government might decide to use two project managers instead of four, which will reduce wage expenses; this might apply as well to sensitisation programmes, which can be carried out through the available systems in place.”
This equally comes following major concerns by both parliament and the executive on arrears and mismanagement that have heavily grounded the National Health Insurance Scheme.
Though the government has commissioned a survey to determine the arrears it owes health service providers, it was said not have paid more than Rwf2.6 billion as at 2013.
When the government discovered that close to Rwf800 million of the arrears comprised inflated medical bills from rogue hospitals, it put its disbursement on hold. The findings of the survey are yet to be made public.
