Insufficient ambulances have been delaying the transfer of patients to hospitals for treatment, a problem that the Ministry of Health has embarked on addressing.

Talking about the number of current ambulances in Rwanda, and their capacity, Dr Tharcisse Mpunga, the Minister of State in charge of Primary Healthcare at the Ministry of Health told The New Times that there are 277 ambulances in Rwanda.

However, he indicated that 150 are reported to be in good conditions while 105 are functional but not in good condition as they are getting older and need replacement soon.

He pointed out that the ratio is one ambulance for 45,715 people.

"The target in the Health Sector Strategic Plan [by 2024] is to have one ambulance per 40,000 people,” he said.

Patience Mazimpaka, the coordinator of Community Health Workers in Karongi District said that there are six health centres that directly refer patients to Kirinda Hospital in the same district for further treatment, but none of them has an ambulance.

In case of transfer of a patient for advanced therapy, he said, the health centres wait for an ambulance which is at the hospital, adding that things get worse when an ambulance has undergone a breakdown.

Kirinda Hospital currently has two ambulances.

"If a patient has an emergency condition such as acid intake and needs urgent treatment at the hospital, the treatment will be delayed in case an ambulance is in Kigali or Butare,” he said.

"If a pregnant woman is in labour yet there is no nearby ambulance to quickly take her to hospital, they might die because of delays in access to healthcare,” he said.

Mazimpaka said that the issue of a limited number of ambulances is coupled with some of the feeder roads that are in poor condition in remote areas of the country especially during the rainy season, where an ambulance might be damaged and unable to move which results in transporting a patient in a palanquin (traditional carrier).

He said that roads should be upgraded to ease the movement.

Increasing ambulance

Minister Mpunga said that the Government is planning to achieve that target by different ways including to continue resource mobilisation through different partnerships in order to acquire a new fleet and improve ambulance management, as well as gradual ownership of District in the acquisition of new ambulances to bridge the gap and renew the fleet.

"Through different partnerships, we expect [that] close to 50 ambulances can be acquired during this FY 2020-2021 but the ministry will continue to mobilise,” he said indicating that one ambulance costs between Rwf65 million and Rwf70 million.

"It has been agreed with all districts to consider putting ambulances in annual budget and performance contracts, so far 19 ambulances have been purchased [by 18 districts] under this framework,” he said.

Engaging private sector

During the 2020/2021 budget hearing, the Ministry of Health told lawmakers that there is a private company that is going to offer ambulance transport services to patients in Rwanda, starting with 35 ambulances from the Western Province.

However, Mpunga said that it is not appropriate to disclose the name of the company as the move is still under feasibility analysis.

 "The MOH (Ministry of Health) is exploring the possibility of a Private Public Partnership (PPP) Model but this has to pass through all legal processes and per PPP Law and related guidelines,” he said.

"There is a private company that expressed interest, both pre- and feasibility studies have been completed. The PPP Steering Committee will analyse and guide next steps considering all implementation modalities and source of funds,” he explained.

Sometimes, when patients from remote areas are discharged from hospitals, they struggle to reach home because no cars provide transport services there or they cannot afford the cost alone, a situation which makes it necessary to adopt ambulance transport to and from hospitals.

Mpunga said that as per government policies, critically ill patients are referred using ambulances, the same also applies for counter-referral when the patient is not yet stable to use another transport means such as public or private transport.

The payment of the ambulance transport service is covered under community-based health insurance (CBHI) – Mutuelle de Santé.

Currently, the tariff of an ambulance is Rwf400 per kilometre for CBHI members. The patient pays 10 percent while the health insurance covers 90 percent.