COLLEGE OF MEDECINE AND HEALTH SCIENCES

HUYE CAMPUS
SCHOOL OF NURSING AND MIDWIFERY
DEPARTMENT OF GENERAL NURSING
HUYE CAMPUS ACADEMIC YEAR: 2019-2020
PROGRAM: ADVANCED DIPLOMA(A1) YEAR: THREE CLASS: A
ACTIVITY: GROUP WORK GROUP NUMBER: 2
MODULE NAME: HEALTH SERVICE MANAGEMENT

ASSIGNMENT ON CASH BANK BOOK AND

CURRENT HEALTH CARE FINANCING IN
RWANDA HEALTH CARE SYSTEM

N/O NAMES REG. NUMBER SIGNATURE

1. UWAMARIYA Jeannette 218004317
2. NSABIMANA Alphonse 218001590
3. RUGAMBA Jean De Dieu 218000904
4. KWIZERA Pacifique 218004568
5. MUNYABARAME Denys 217119514
6. MUHAYIMANA Christophe 217244866
7. KARAGIRE Vedaste 218000718
8. NKURUNZIZA Emmanuel 218001177
9. NUBAHUMPATSE Joseph 218000308

Facilitator: UWISHIMYE Ernest

Done at Huye on 4th December, 2019

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Table of Contents
PART: I ........................................................................................................................................................ 3
1. CASH BANK BOOK ...................................................................................................................... 3
a. DEFINITION .............................................................................................................................. 3
b. ROLES ......................................................................................................................................... 3
c. PROTOCOLS ............................................................................................................................. 3
e. TYPES.......................................................................................................................................... 4
PART: II ...................................................................................................................................................... 5
1. CURRENT HEALTH CARE FINANCING IN RWANDA HEALTH CARE SYSTEM ........ 5
a. FINANCIAL ACCESSIBILITY TO THE HEALTH SERVICES PROGRAMME ............ 5
b. MEDICAL HEALTH INSURANCE SCHEMES. ................................................................... 5
i. Mutuelles de santé (community-based health insurance)........................................................ 5
ii. Rwandaise d'assurance maladie (RAMA) ................................................................................ 6
iii. Private health insurance ......................................................................................................... 6
REFERENCES ............................................................................................................................................ 6

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PART: I
1. CASH BANK BOOK
a. DEFINITION
It is a ledger for keeping track of small cash purchases. Some small businesses such as restaurants
find cash books especially useful because these companies tend to need small quantities of easily
available supplies to make up for unpredictable shortfalls. Others, like tech companies, usually use
their cash books less frequently because they are less likely to have urgent needs for tangible items
that can be conveniently purchased at a location such as a corner store.
b. ROLES
 It is useful for accounting because it enables a business to keep track of small cash
purchases that could easily slip through the cracks.
 A cash book should be part of a company's petty cash fund, which is a sum of money set
aside for inexpensive purchases that are inconvenient to make with either a check or credit
card. Some vendors such as farmers' market booths may not accept cash or credit cards, so
it is necessary to use the petty cash fund when purchasing from them.
c. PROTOCOLS
To keep a cash book, list the sum of money you use to start your petty cash fund, and then list and
subtract the amount of each purchase that comes out of the fund. When you use up the amount you
used to start your petty cash fund, add more money, and note the amount you have added in your
petty cash book. Periodically reconcile the account by making sure the amount in the fund matches
the balance noted in the book.
d. BOOK KEEPING
Your cash book should be a record of transactions that are legitimate business expenses such as
materials and supplies. Because they are legitimate business expenses, you will need to transfer
the records of these transactions from your cash book to your general ledger in order to claim these
expenses as deductions. Allocate these expenses in the appropriate categories. Also record the
sums that you withdraw from your bank account to transfer to your petty cash fund by noting them
in your banking ledger.

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 e. TYPES
There are two types of cashbooks:
i. Cash in hand cashbook, which records the cash transactions in the firm or business.
ii. Cash at bank cashbook, which records the transactions at/with, the bank.

The cashbook is the most important book of prime entry because it forms part of the general ledger
and records the source documents as receipts and cheques. The cash at bank cashbook and cash
in hand cashbook are combined together to get a two-column cashbook. The format is as follows:
Two-column cashbook.
CASH BOOK
Date Details Cash Bank Date Details Cash Bank

Additional columns for discounts allowed and discounts received can be included with the cash at
bank columns to get a 3 – column cashbook. The format is as follows:
Three– column cashbook
Date Details Discount Cash Bank Date Details Discount Cash Bank
allowed received

The balance carried down (Bal c/d) for cash in hand and cash at bank will form part of the ledger
balances and the discounts allowed and discounts received columns will be added and the totals
posted to the respective discount accounts. The discount allowed total will be posted to the debit
side of the discount allowed account in the general ledger and the total of the discount received
will be posted to the credit side of the discount-received account of the general ledger.
Cash at bank can have either a credit or debit balance. A debit balance means the firm has some
cash at the bank and a credit balance means that the account at the bank is overdrawn.

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PART: II
1. CURRENT HEALTH CARE FINANCING IN RWANDA HEALTH CARE
SYSTEM
a. FINANCIAL ACCESSIBILITY TO THE HEALTH SERVICES PROGRAMME
The objectives of the financial accessibility programme are:
i. to increase total financial resources for the health sector.
ii. to improve efficiency, allocation and utilization of resources.
iii. to reduce financial barriers through the expansion of community-based health insurance.
iv. to remove financial barriers for the very poor through block grant transfer to community-
based health insurance schemes.
v. to develop a pricing policy on high-impact health services receiving public subsidies.

The main agents that are responsible for transferring and allocating the public health budget
include the MINECOFIN, the MOH, Rwanda Biomedical Centre and Districts. Through these
institutions, the public health budget supports health worker salaries, facility capital and operating
costs. Rwanda has achieved close to universal population coverage of health insurance through the
innovative design and implementation of a combination of mandatory insurance schemes tailored
to fit the needs and financial capacities of different segments of society. The difference in the
scheme(s) financial mechanisms has led to inequities in per capita spending amongst the schemes.
To mitigate these inequities and improve pooling across income groups, the government is actively
engaging in cross-subsidization across the insurance pools. private insurance firms and the
government schemes, RSSB and MMI have been mandated to contribute one percent of their
revenues. This percent contribution is expected to increase the management to RSSB in order to
maximize its efficiency.
b. MEDICAL HEALTH INSURANCE SCHEMES.
i. Mutuelles de santé (community-based health insurance)
i.1. Rationale
Community-based health insurance has been successfully tested in Rwanda since 1999 under the
name of mutuelles de santé, or simply mutuelles. According to national policy, the mutuelles were
introduced to provide health insurance for the informal sector which was excluded from a

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prepayment and risk-pooling scheme. In Rwanda, mutuelles are also intended, with the support of
public subsidies, to provide health insurance coverage for poor and very poor people. As such, the
mutuelles also act partly as equity funds.
ii. Rwandaise d'assurance maladie (RAMA)
ii.1. Rationale
RAMA was created to provide health insurance services to public health servants and their
dependents. RAMA has also an objective to provide insurance services for the private sector. As
such, RAMA provides a formal health insurance scheme for the entire public sector (excluding
military forces) and for the majority of the formal private sector.
It is important to note that RAMA's original vision was to extend its services to the majority of
the population, through the coverage of the formal sector as a first step and in the long term
through the extension of its services to the informal sector.
iii. Private health insurance
iii.1. Rationale
Private insurers started to provide health insurance services for private companies in 2006, as an
alternative to the RAMA scheme. Three companies currently provide health insurance services in
Rwanda: The Société rwandaise d'assurance (SORAS), the Compagnie rwandaise d'assurance et
de reassurance (CORAR), and the Africa Air Rescue (AAR). Certain private employers also
reimburse the medical expenditures of their employees to a certain extent.

REFERENCES
1. DEVRA, G. (2019). “The importance of a cash book in accounting”. California
2. Black, E. L., Burton, F.G., Traynor, A.M., and Wood, D.A. (2005). “Entrepreneurial
Success: Differing Perceptions of Entrepreneurs and Venture Capitalists”. International Journal
of Entrepreneurship & Innovation.
3. Republic of Rwanda, Ministry of Health. (January 2015). “Health Sector Policy”.
4. Republic of Rwanda, Ministry of Health. (2013). “Rwanda Annual Health Statistics
Booklet”.
5. Republic of Rwanda, Ministry of Health. (November 2013). MoH Annual Report.

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