Hospitals have said that they are owed five-year-old arrears under the community-based health insurance scheme – Mutuelle de Santé.

They exposed the issue on Monday, September 28, during a Public hearing with the Parliament’s Public Accounts Committee (PAC) that sought explanations on public finance mismanagement cases identified in the Auditor General’s report for the 2018/19 financial year.

According to the report, the Ministry of Health did not settle Mutuelle de Santé arrears amounting to more than Rwf2.6 billion.

It indicated that the financial statements of the hospitals of Muhima, Ruhengeri, Masaka, and Kabutare showed that these arrears were still outstanding.

Hospitals argued that the arrears were not considered in the audit that was carried out in 2015 by the Ministry of Finance and Economic Planning (MINECOFIN) before the community-based health insurance scheme (CBHI) was handed over to RSSB as a new administrator.

Before RSSB, the Ministry of Health – in partnership with districts – was the administrator of the scheme.

For instance, Masaka Hospital in Kigali was owed Rwf417 million in Mutuelle de Santé arrears, but was only paid Rwf117 million, meaning that more than Rwf300 million is still an outstanding amount.

Dr Marcel Uwizeye, the Director General of Masaka Hospital, told PAC on Monday that the money was not counted as Mutuelle de Santé arrears during the assessment of the CBHI outstanding invoices. Currently, he said, the hospital has supporting documents for such arrears.

"Because the verification was taking long, the arrears were recorded in the following fiscal year (compared to that in which MINECOFIN performed the audit) ... We were informed that they [MINECOFIN] did not get records related to such money. It has not yet been paid thus far,” he said.

The Director of Finance and Administration at Kibungo Hospital in Ngoma District, Placide Amani said that the Hospital was owed about Rwf135 million by [patients from] three districts of Ngoma, Kirehe and Kayonza, under Mutuelle de Santé.

"The reason is that the audit was made when there were invoices that the hospital had not yet submitted to Mutuelle de Santé [managers], and were not counted in the assessment,” he said.

Reacting to such concerns, Marcel Mukeshimana, Accountant General at MINECOFIN said the assessment was carried out in all districts to establish total arrears that Mutuelle de Santé owed to hospitals and other health facilities so that they get paid, adding that the payments were made.

Mukeshimana said that in case of claims of more arrears that were not accounted for, the issue can be considered so as to find a solution.

However, in previous parliamentary sessions, officials from MINECOFIN estimated that about Rwf13.5 billion that was identified as amount outstanding under Mutuelle de Santé was paid to health facilities, but an issue emerged: some hospitals got extra money while others got less as a result of inadequate data management.

They said that the hospitals that were given a surplus were told to reimburse it in installments so that it is given to those that received less, adding that the last installment was made in March 2020.

The Permanent Secretary at the Ministry of Health, Zacharie Iyakaremye, said that it is difficult that the Ministry of Finance and Economic Planning and the RSSB consider the arrears that were not indicated during the handover of Mutuelle de Santé.

But, he said, hospitals continue to get supporting documents that were not available by the time of the audit.

"So, we think that there is a need for discussions between the Ministry of Health, MINECOFIN and RSSB so as to look for a solution to this issue,” he said.

MP Mediatrice Izabiliza said that if hospitals have supporting documents, the arrears should be settled so that hospitals are enabled to offer good health services to the patients.

"The remedy to this issue should be found because it has effects on hospitals to the point of lacking money to buy medicine. As a result, patients subscribed to Mutuelle de Santé are told to cover the entire cost of medicine in pharmacies,” she said.