The CARAES Ndera Neuropsychiatric Hospital has raised concerns over its patients who continue to face transportation challenges since the government imposed a strict ban on inter-district movements and those to and from the City of Kigali. The hospital’s in charge of quality health, Michel Nshimiyimana, says that the fact that most patients cannot currently travel to Kigali means that a number of them have put treatment on hold. Official statistics indicate that one in four Rwandans suffers from posttraumatic stress disorder and nearly one in every six adults suffers from depression. Although the government plans to integrate mental health into the primary health care package and decentralize care to the district hospitals, health centres, and community levels in order to make it accessible to rural populations, CARAES Ndera Neuropsychiatric Hospital remains the only facility in the country dealing with serious mental health conditions. Nshimiyimana explained that even those who have made it to the hospital narrated complicated ordeals that they had to go through to make it to the hospital. As a result, this has significantly reduced the number of patients that the hospital is receiving and brings the number to a half. “We used to receive between 250-300 patients on a daily basis but that number has significantly reduced to about 150. We are concerned that this is going to take some of the patients’ progress some steps back and aggravate the progress some had made,” he said. Patients stuck Giselle Uwera parted with Rwf10,000 to make it from Kamonyi District to the City of Kigali to seek urgent medical attention. She says that while she has managed to see the specialist she needed, she is unsure of how she will make it back home. “I don’t have any more money to spend. I don’t know how I will make it back home and I am worried because I left my children with a neighbour,” she said. The Director of the Kigali Teaching Hospital (CHUK) Theobald Hategikimana said that the hospital is only liable for patients who were admitted and later discharged. “If you found means to get here, I am sure that you will use the same means to get back home. Our primary responsibility right now is to the patients who either came by ambulance or were admitted in this hospital, discharged but have no way of getting home,” he said. To fix the issue of patients that were discharged but are stuck, Hategikimana says that his hospital makes a comprehensive list of each person and the district that they come from and the ambulances from their home areas transport them. Dr Corneille Ntihabose is the Head of Clinical and Public Health Services Department at the Ministry of Health says that a solution has been worked on, where any patient that needs urgent support in Kigali is transported by the district ambulance. “It could be an ambulance coming to Kigali on another program, like for instance, collecting oxygen cylinders. It is obliged to transport these patients to Kigali,” he explained. Not enough ambulances By August last year, the country had only 277 ambulances. In an exclusive interview with The New Times at the time, the Minister of State in charge of Primary Healthcare at the Ministry of Health Dr Tharcisse Mpunga, said that of these, 150 are reported to be in good condition 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. Engaging the private sector During the 2020/21 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 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 transferred 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 per cent while the health insurance covers 90 per cent.
