Senate calls upon Prime Minister over challenges in primary health centers

By The Inspirer 

Kigali, March 26, 2025– The Rwandan Senate has resolved to summon Prime Minister Dr. Edouard Ngirente to provide oral explanations regarding persistent issues in primary health centers (Postes de santé), which require intervention from multiple government agencies.

The decision was reached during a Senate plenary session on March 25, 2025, following an in-depth assessment of the situation. A field visit conducted from January 21 to January 30, 2025, revealed that if these challenges are not addressed, they could hinder the development of healthcare services in the country.

Achievements and Ongoing Challenges

Despite existing difficulties, Senate Vice President Solina Nyirahabimana acknowledged that primary health centers have played a significant role in improving maternal health. The maternal mortality rate has decreased from 203 deaths per 100,000 live births in 2020 to 105 in 2024.

Additionally, these centers have contributed to improving healthcare-seeking behavior among citizens. The number of primary health centers has increased from 670 in 2017 to 1,280 in 2024, while patient visits surged from 71,212 in 2017 to 3,963,545 in 2024.

However, senators noted that several critical issues remain unresolved, necessitating clear policy direction from the Prime Minister.

Key Issues Identified

During their visits, senators identified major gaps, including:

– Some villages lack primary health centers, community health posts, hospitals, or private clinics.
– Nurses are reluctant to work in rural-based health centers.
– Many primary health centers operate only two to three days a week under the supervision of health centers, limiting access to healthcare services.
– A shortage of specialized healthcare professionals, particularly ophthalmologists and dentists.
– Regulations restricting ophthalmologists from working in more than one primary health center.
– Limited training opportunities for nurses working in these centers.
– Restricted working hours, from 7:00 AM to 5:00 PM, despite public demand for 24-hour services.

Financial and Administrative Bottlenecks

Another major concern is the exclusion of primary health centers from the Rwanda Social Security Board’s (RSSB) insurance scheme, formerly known as RAMA. This limits access for insured patients.

Additionally, while the time taken to process health center payment claims at RSSB has improved, it still takes between 15 and 30 days to complete payments when there are no disputes—falling short of the ideal timeframe.

The Senate also raised concerns about the administrative process for managing primary health centers. Nurses who wish to run a health post must first resign from their current jobs, discouraging many from applying due to the risk of unemployment if their applications are denied.

Furthermore, 50% of primary health centers are managed by health centers that already face staff shortages. These centers often operate only two to three days a week due to limited human resources.

For private operators managing health centers, their contracts with RSSB are limited to one year, making it difficult to secure loans from financial institutions for expansion and investment.

Senate’s Call for Government Action

Hon. Clotilde Mukakarangwa emphasized that summoning the Prime Minister is a necessary step, as resolving these issues requires coordination across multiple government institutions.

“We previously engaged the Minister of Health, who acknowledged these challenges. Now, the Prime Minister will clarify how they will be resolved to ensure universal access to quality healthcare,” she stated.

The upcoming session with the Prime Minister is expected to outline strategic solutions to enhance primary healthcare services across the country.