Hospitals are seeking ways such as a pre-treatment surcharge on patients to stem losses resulting from patients failure to pay bills and delays by RSSB to pay mutuelle de sante claim.

As an example, Ruhengeri Referral Hospital recently announced that patients seeking health services should pay a caution fee of Rwf10,000 for Mituelle de sante holders, Rwf20,000 for holders of other insurances, while non-insured patients have to pay Rwf50,000 to be attended to.

Upon learning of this, Jean Marie Vianney Gatabazi, the Governor of Northern Province – where this hospital is located - denounced the decision, saying that it should be withdrawn because it is against the Rwandan laws regarding access to health services.

Heads of some public hospitals have said lack of funds to facilitate the hospitals have forced them to take drastic measures for the hospitals to survive.

The director-general of Ruhengeri referral hospital Dr Philbert Muhire, said they came up with the decision after realizing that patients were disappearing from the hospital without paying their bills.

“Losses resulting from patient’s failure to pay the bills, arrears, and delays by the District to provide funds on time put the hospitals in critical condition to provide necessary health services, “said Dr Muhire.

The problem of arrears, delays of insurance funds meant for all public hospitals from Rwanda Social Security Board (RSSB) does not only affect Ruhengeri hospital but ostensibly common in all public referral hospitals in the country.

Although there have been many healthcare reforms over the years, and a willingness for government to extend financial risk protection and service coverage for the poor and vulnerable groups, there still gaps to be fixed.

These reforms include the free provision of Mutuelle de santé, to the poor people in the first Ubudehe category, free family planning services and free vaccination of endemic and epidemic diseases in parts of the country and accessible public health facilities.