Rwanda's Members of Parliament have faulted Health Ministry officials for mismanagement.
As the Parliament’s Public Account Committee scrutinises the 2014/15 Auditor-General’s Report, it has emerged that the Ministry of Health was unaware of the goings-on in the hospitals, where colossal sums of money went unaccounted for.
Missing funds were mostly those transferred directly to hospitals by the Ministry of Health, meant for construction and rehabilitation of crucial health infrastructure and purchase of medical equipment, among other things.
However, despite these facilities falling under the Ministry of Health, accountability regarding the use of the funds remained questionable.
Ministry officials put the blame on district authorities, arguing that they are in charge of day-to-day oversight over the hospitals, health centres and posts under them.
“Management of hospitals is done by the districts as per our laws. We go through the mayor whenever we have something to communicate to the hospitals,” said Jean Pierre Nyemazi, Permanent Secretary at the Ministry of Health.
“There hasn’t been full decentralisation, leading to confusion in terms of who their oversight body is. Second, in terms of administration, the new structure for hospitals hasn’t yet been gazetted to clearly indicate who takes responsibility of financial management.”
In the report, Kibilizi, Muhororo and Ruhango hospitals received disclaimer audit opinion, while 15 others obtained adverse audit opinion as they were found to have weaknesses in accounting and management of funds.
As a result, health facilities of Kamonyi, Ngoma, Gitwe, Nyagatare, Ngorero, Huye and others suffered delayed construction, rehabilitation and refurbishment.
Ministry officials could not provide details on the use of grants and funds transferred to the hospitals, including Rwf89 million sent to hospitals of Munini, Rutongo and Kabutare.
Poor medical service delivery
Lawmakers expressed particular concerns about the negative impact this has had on the standards of medical services offered across the country.
MPs link the mismanagement of funds at the hospitals to lack of drugs and medical supplies, sending citizens on mutual health insurance to private pharmacies.
The Auditor-General’s report had revealed that 80 per cent of affected patients at the Kigali-based University Teaching Hospital were mainly from Ubudehe Category I and II, who cannot afford to pay for the services.
“These concerns have been there for so long. We wonder why you wait for so long to fix this, and who is responsible for such things when they affect the medical service delivery,” asked MP Theoneste Karenzi.
Details coming from some implicated hospitals point to lack of skills and efficient accounting and financial management software as having led to the funds mismanagement.
MPs however, blame most issues on lack of co-ordination between the ministry and institutions they should be working with to make things better in hospitals.
The Rwanda Biomedical Centre (RBC), government’s medical supply unit under RBC known as the Medical Procurement and Production Division (MPPD) as well as King Faisal Hospital (KFH) were also cited by the Auditor-General for mismanagement.
The AG report pointed out that drugs and medical consumables worth Rwf1.2 billion expired between 2010 and 2015, while donor stock under the management of RBC worth Rwf2.7 billion ($3.4 million) expired between 2012 and 2015.
The report also indicated that medicine worth Rwf172.7 million ($220,600) and wooden boxes worth Rwf25 million ($31,940) stolen at RBC have not been recovered, which further points to drug storage and management flaws at the body.