As it makes progress in the provision of healthcare, the Rwanda is now grappling with the hydra-head of provision of food for in-patients. In an attempt to match care with the quality of food patients eat, major hospitals in Kigali have signed up external contractors to provide meals.
Regardless of its merits, the move to bar food from outside is being seen as a ruse to protect private business interests. Such sentiments are to be expected and should not simply be dismissed because they represent how a public policy is perceived by those it affects.
Considered against the role nutrition plays in treatment outcomes, the move is a necessary evolution of the healthcare system. But like all things good or necessary, it comes with a flipside that may not always have been anticipated or good for those it affects.
Not surprisingly therefore, the adopted approach to provision of food for in-patients has run into early headwinds. This is happening first because it does not encompass the overall philosophy of shared costs and secondly because, inevitably, there will always be those that lack the social means to cope with it.
As an official policy, it is being implemented with all the force of officialdom and hospitals are simply compelling patients and their caregivers to buy food from authorised vendors. Besides cost, in some cases, patients also feel they could have gotten a better deal in a liberalised market place.
Without doubt, a daily food bill of Rwf5,000 can be steep for many in a country that does not have a minimum wage. It also makes it more challenging to ascertain individual patients’ capacity to pay.
This dilemma forms part of the wider challenges Africa’s gradual evolution towards privatised healthcare faces. Income gaps make real the danger of having significant sections of the population locked out of healthcare access. The solution is a middle path that allows paid care systems to gestate alongside lifeline policies that protect those in danger of exclusion.
In Rwanda’s case, leaving the window of family supplied food open alongside private providers could serve the goal of social equity while also creating the competition that would keep food vendors on their toes.
A more difficult approach would require the introduction of a social tax collected through insurance schemes, to bring the consumer price of meals to a level affordable by all social classes.
Fortunately, Rwanda has a lot of experience to draw on.
The Mutuelle universal insurance scheme is one example. Despite the main challenges, well considered responses have resulted in a social policy that works for the majority.
The misgivings about the way the hospital feeding policy is being implemented should be treated with the same level of patient introspection and continuous refinement.