Small Mission Hospital in Uganda

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Small Mission Hospital in Uganda

• Funding at the Grass-roots level with a focus
  on malaria
• Kabale, Uganda

Dr Rachelle Sanderson
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Summary

• Introduction
• 1. Funding infrastructure
• 2. Funding recurrent costs
• - malaria epidemic
• - insurance scheme
• 3. Funding specific projects
• Access to Project funding
• Conclusion

Uganda
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Kabale, South West Uganda

• Population of 38,000
• No malaria before 1960, due to high altitude and
  climate
• Now malaria endemic

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Kabale District

• Average monthly income 15
• Do not have savings so any costs in excess of
  about 15 would often be met by selling capital

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My role in the Project

• Church Missionary Society
• 2000-2005
• Medical Superintendent
• Financial Controller,
• under Management
• Committee, with
• external auditors.

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Rugarama Health Centre

• Infrastructure necessary to run malaria programme

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2000 46 inpatient beds
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Funding Infrastructure

• Grants awarded in 2000/01
• Truro Episcopal Church, Virginia, USA
• Lions Clubs
• International,
• Sight First
• Campaign

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November 2000 land cleared
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June 2002 local fundraising
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Community involvement enabling ownership
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Open to the public Sept 2002
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Opening of Children and Maternity unit in
December 2003
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Staff Accommodation Unit
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May 2004 accommodation complete
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Needed Dental and Xray Block
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June 2005 Unit completed
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Funding infrastructure

• All capital costs from Outside organisations
• Christoffel Blinden Mission
• Lions Clubs International
• Trusts
• Missionary Organisations
• Churches
• Well wishers/supporters

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Funding infrastructure

• Transparent and timely accountability
• Low costs mostly within or under budget
• Minimal sideway movement of money
• Tight schedule
• Approaching donors before use money in different
  way to primary request
• Impact on society

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20,000 people made use of services of Rugarama
Health Centre in 2004/05
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Funding recurrent costs

• 75-83 User fees, including Private patients
• Working towards sustainability
• However reduced accessibility to the poor, even
  with Good Samaritan Fund and innovative ways of
  helping those who cannot pay.

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Funding recurrent costs

• 5 income from Government grant
• Remaining costs covered by donations and some
  small income generating projects

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Funding recurrent costs

• Expenditure kept low mainly by keeping salaries
  low (trying to keep perks high)
• But low morale
• high staff turn-over

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Funding recurrent costs

• 5 Government Grant for Primary Health Care
• Negotiated to gain (mini) Hospital Status (Health
  Centre IV), awarded in November 2004, put into
  effect July 2005.
• Grant up to 50 budget.
• Enabled salaries to (nearly) come in line with
  Government equivalents

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Malaria Epidemic

• November 2000 February 2001
• RHC 46 beds at 200 bed capacity
• (Normal capacity between 20 60)

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Effects on Hospital

• Staffing levels
• Staff with malaria
• Medicine supply
• Equipment
• Space/capacity

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Effects of Patients of getting malaria

• Various options
• 1. Be treated when first get sick.
• Cost
• Chloroquine/Fansidar - 2.00
• But resistance, so malaria returns
• Quinine/Fansidar - 4.25
• But unpleasant treatment for 1 week.
• Artenam/Fansidar - 7.00

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Patient Options

• 2. Wait to see if will get better
• Get better probably did not have malaria
• Get worse do have malaria

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Now need Hospital admissionCost minimum 10
(per person)Risk of sequelae or death
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Patient Options

• 3. Avoid getting malaria Buy Mosquito net
• Cost 4.50

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Insurance Scheme

• Set up in 2003
• Dairy Farmers Cooperative
• Funding from USAID via NGO Health Partners
• Started with 200 families of 4 or more members.

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Insurance scheme

• Quarterly pre-payment
• Paid 0.5 per visit
• Included general health check, dental checks and
  treatment, eye check up
• Health Promotion Workshop included malaria
  training
• Subsidised mosquito nets

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Limited success?

• Cooperatives did not pay in time
• Employ extra personnel to run the scheme,
  primarily to chase payments
• Extra staff to keep Cooperative members motivated
  and educated
• Whilst keeping costs down, who pays for the extra
  staff?

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Insurance scheme

• The Clients, when using the services, wanted
  Private Style care
• And yet wanted subsidised services
• Culture not familiar with
• insurance concept
• Culture not familiar with
• planning for the future
• When they did use the
• services, very pleased!

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How to get people to change?
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Funding of Specific Projects

• Sexy subjects - HIV/AIDS, Youth

Positive living Club
Post test Club for Adolescents
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RHC Malaria Projects

• 1. Compassion International
• mosquito nets to their children
• training of volunteers to spray houses
• equipment and insecticide for spraying (only
  their villages)

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training of Community Health Workers in
diagnosing malaria and treating with CQ/fansidar
their villages
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RHC Malaria Projects

• 2. Care International
• Training Volunteers in use of HOMEPAK
• 3. Poverty Alleviation Fund and others
• Free chloroquine and fansidar

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4. Primary Health Care GrantVillage based
training about malaria
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Occasional hitch.
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RHC Malaria Projects

• 5. Church Donations
• Provision of mosquito nets for the Hospital
• During Hospital stay they would be taught how to
  use nets
• Subsidised nets to Pregnant women and to
  malnourished children

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Funding specific projects

• Lions Sight First Campaign
• Funding for 1 workshop per month over 3 years.
• sensitisation/mobilisation of the population
  about eye service availability
• Training of low level health workers in eye
• care issues

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Lions Eye Training

• Successful sensitisation/mobilisation of the
  population, using community leaders and local
  health workers
• Training has to be ongoing, not only to cover
  whole District, but also to maintain awareness
  over time

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Access to Funding

• Dissemination of information about available
  grants and how to apply for them was poor
• Often find out about grants too late
• Right place at right time

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Access to funding

• Global Fund application
• Not rewarded
• No feedback as to why

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Access to funding

• Para-medical and administrative Staff lack
  training
• How to assess need
• How to write a Project Proposal
• How to implement the project
• How to be accountable to the donors
• Each new wave of workers needs training

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Conclusions

• Disseminate information about grants to
  grass-root level
• Incorporate training in seeing projects through
  from proposal writing through to accountability

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Conclusions

• Subsidise prevention and control measures, to
  make them affordable
• Do by example! Get nets into Education and
  Health Establishments

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Conclusion

• Sensitise/mobilise community about malaria
  prevention and control
• Encourage early treatment Community Health
  Workers, Homepak.
• Educate, educate, educate population and health
  workers over time, with aim to create cultural
  shift

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Summary

• Help those on the ground to do what they want to
  do, to do more of what they are already doing, to
  do it better, and to be able to offer it
  subsidised or free to those who need it.

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