Monday, 25 March 2013

Lawmakers push for Mutuelle de santé autonomy


Patients in a hospital. Mutuelle de Santé is a public health insurance scheme.
The Senate has requested the government to set up an independent organ to manage the country’s community-based health insurance scheme (Mutuelle de Santé) to improve its services, end its debt to healthcare providers, and ensure a better management of its funds in the future.

This is among the recommendations to be submitted in a report to the Cabinet before the end of this week. It follows an assessment by the Senatarial Committee on Social Affairs and Human Rights and Petitions of the scheme’s performance across the country from late last November to mid January.

“There is no Mutuelle at the national level. That the scheme does not have its name at the national level is in itself a problem, there is no special organ for Mutuelle,” said Gallican Niyongana, the Vice-President of the Senate’s Committee on Social Affairs who presented its report to the Senate last week together with the committee’s president, Thérèse Kagoyire Bishagara.

The senators have documented that the Ministry of Health, through its employees in charge of Mutuelle, the Ministry of Local Government (Minaloc) through districts, and the central government, through the Ministry of Finance (Minecofin) and the Central Bank (BNR) are all guessing how to help the Fund without the latter having a national coordination level to maximise its efficiency.

Their review has unearthed that the scheme has issues in both mobilisation of funds from the general population and the disbursement of the funds to health care providers, a situation that is confirmed by Mutuelle’s current debt of about Rwf 2.3 billion owed to district hospitals, some Rwf 1 million owed to health centres, and about Rwf 431 million owed to national referral hospitals.

The Senators have noted that having a national organ that coordinates the scheme can probably help since it remains difficult to address its issues with its current administrative structure.

“The fact that Mutuelle’s management institutions are mixed with those of the Ministry of Health and those of the districts does not make it easy for the BNR and the Minecofin to assess and advise Mutuelle in terms of regulation,” the senators wrote in their findings.

They call for the institution of the organ as it is stipulated by the Law n° 62/2007 of 30/12/2007 establishing and determining the organisation, functioning and management of the mutual health insurance scheme.

“Mutuelle should be an autonomous institution in terms of managing its resources and staff and should have efficient institutions from the local levels up to the national level,” they urgued.

They have also given the government a deadline of three months to set up an oversight mechanism to represent the interests of Mutuelle contributors.

“Within three months the government should set up executive and representative institutions that defend  the interests of Mutuelle contributors and other stakeholders at each level of the Fund as stipulated in the law and they should carry out their responsibilities,” the lawmakers recommended.

Under the current Mutuelle law (Law n° 62/2007 of 30/12/2007), the mutual health insurance Fund is guaranteed a legal personality and administrative and financial autonomy. 

But it hasn’t so far been given that autonomy and has been dependent on the Ministry of Health for coordination, leaving the ministry’s employees with little time, resources, and expertise to manage the Fund. The senator’s concerns were echoed by an official in the Ministry of Health, who is associated with the Fund.

Special organ 

“You find that ministries have other tasks and they are not responsible for managing the Mutuelle business,” said Andrew Makaka, the Director of Health Financing in the Ministry of Health who is also in charge of Mutuelle de Santé.

Even as the law also says that the Fund shall be supported by a guarantee Fund attached to the Ministry in charge of health, Makaka says the scheme needs a special organ to take care of its business since the ministry has a lot on its plate and should only be intervening in Mutuelle for regulation.

“It (the organ) can be a national coordination of Mutuelle,” he said, also hinting that the government and other stakeholders have been in consultations for nearly three months to explore how to improve Mutuelle’s performance.

Makaka said the organ would help in a better management of the scheme’s funds by paying hospitals on time, ensuring that good services are offered to its clients, and focus on improving policies that govern the fund.

The senators, however, noted positive achievements of Mutuelle in their report, such as helping more people to access medical care and reducing child and maternal mortality.

But they also warned that delays in paying Mutuelle contributions mainly due to a late calendar for paying the Fund’s contributions in comparison to the start of the fiscal year as well as constant delayed payments to health care and medicine providers remain problematic since it often leads to medical stock-out at hospitals. 

The report also recommends that Mutuelle branches across the country use some Rwf1.2 billion they saved from the last fiscal year (2011-2012) to pay their debts to hospitals and pharmacies within one month, and the central government to pay any remaining balance from the branches’ debts within the next three months. About 90 per cent of Rwandans use Mutuelle de Santé for their health insurance.


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