Even as Rwanda reviews the remuneration of medical officers, the scrapping of a bonus payment system has led to murmurs of discontent, leading to fears that the country’s doctors could emulate their colleagues in the region and go on strike.
The review will see health officials working in remote rural areas under difficult conditions receive a better financial package than their counterparts working in urban areas.
Currently, doctors earn a minimum of Rwf350,000 ($531) with the highest paid getting Rwf900,000 ($1,500).
Under the Performance-Based Financing (PBF) programme initiated in 2007 to improve service delivery in the health sector, health workers are entitled to bonus payments based on appraisals done on a quarterly basis.
The bonuses are paid out of hospital revenues, government and donor funding.
However, in a circular dated March 15, Minister of Health Agnes Binagwaho instructed district hospital directors to halt the bonus payments with immediate effect, prompting outrage among medical officials, with some threatening to lay down their tools.
“PBF has been around for five years and we thought it wise to review it. We have divided the country into four zones based on the difficulty faced by health practitioners in their work, meaning that doctors in easy postings like Kigali where infrastructure is in place, will be receiving lower incentives than their colleagues who work in rural areas,” Dr Binagwaho told the press last week, noting that the Ministry of Health has put in places a committee of district doctors to review it.
She added that hospital revenues were being diverted to paying bonuses instead of catering for the needs of hospitals.
“This money can be put into things that benefit the hospitals such as simple renovations, hygiene and day to day running of the facilities, without waiting for the government to come in,” Dr Binagwaho said.
Dr Binagwaho insisted there was no cause for alarm as there was a general consensus among doctors, nurses, midwives and district pharmacists countrywide on how it would be done.
Comparatively, while Rwandan doctors at $531 take home slightly more than their colleagues in the region, the country’s relatively higher cost of living makes their salaries relatively modest, forcing the majority of professionals to seek employment outside the medical profession.
Currently, Rwanda has only 664 doctors, among them 128 specialists such as cardiologists, oncologists and gynaecologist, and some 9,000 nurses and midwives, according to the Rwanda Biomedical Centre.
Doctors in Kenya on average take home a minimum package $470, Ugandan doctors take home a minimum of $400 and Tanzanian doctors an estimated $500 monthly.
Rwanda has a doctor-patient ratio of 1/17, 000.
The country has five referral hospitals, 40 district hospitals, 438 health centres and 108 health posts, the smallest health units.