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ealth service delivery and healing are central to the mission of the Church. Jesus Christ whose teaching and example Christians emulate had a ministry that included preaching, teaching and healing. His ministry was non-discriminatory and transcended the cultural and traditional barriers of those days to provide compassionate service and healing to all particularly the poor, deprived and vulnerable.

When He commissioned His disciples, Jesus sent them out to the world to teach, preach and heal the sick. He told them: “As you go, preach the message, heal the sick, raise the dead, cleanse those who have leprosy” (Mathew 10:7).

Church health services are established in response to the mission of Christ. Their main motivation is to reach out and serve the sick and needy as part of evangelism and outreach. The missionaries who brought Christianity to Africa had a wholistic Gospel which involved preaching, evangelism, education, training, health service delivery, social services and economic empowerment of local communities.

Older mission hospitals in Africa are usually part of a larger complex that includes a church, school and the hospital. Examples in Kenya include PCEA hospitals in Kikuyu, Tumutumu and Chogoria, AIC Kijabe, Litein and Kapsowar Hospitals, Maua Methodist Hospital, Friends Hospitals in Kaimosi and Lugulu, Anglican Hospitals in Maseno and St Lukes Kaloleni and the AGC Tenwek Hospital.

T h e f o u n d a t i o n o f c h u r c h h e a l t h services is grounded in Christian teaching and values. The quality of services provided is further enhanced by the compassionate approach and desire to express the love of Christ to all patients. Church health services also have the attribute of good stewardship in trying to do the most with the resources enstrusted to them by God.

T h i s a p p r o a c h t o h e a l t h s e r v i c e s d e v e l o p m e n t w a s feasible when the cost of health care was low and significant external

subsidies were readily available. In those days of plenty, church health facilities received missionary expatriates, essential drugs, medical equipment and unrestricted funds from sister Churches abroad. In addition, they received substantial grants from the Government.

Today, the situation has dramatically changed. The cost of health service provision is escalating with every passing day while regulatory standards have become very demanding. In addition, there is a high level of human resource migration and none or very few missionary expatriates. Subsidies from Government are very limited.

Despite these challenges presented by the operating environment, the mission of the Church in health has not changed. Church health facilities remain a key source of service delivery to communities, particularly in the rural areas of Africa. In these areas, financing of health care is difficult due to the high poverty levels.

However despite all these challenges, the Church must remain true to its mission which was founded by Christ. We must therefore explore innovative ways of continuing to attract resources to support Church health service delivery.

This issue of CHAK Times showcases some innovations in health care financing to address the sustainability challenge. We wish you enjoyable reading and welcome your feedback.

The mission of the Church

in health care

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photo: CHAK

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HAK has launched a health systems strengthening initiative for member health institutions. The project is being implemented in partnership with CHF International and Capacity Project and with funding from CDC.

The purpose of this initiative is to address weaknesses in the health service delivery support systems in Church health facilities in Kenya. Health systems strengthening has been identified as a key pillar for improvement of health services quality and sustainability.

The need for the Health Systems Strengthening initiative was identified from the report of the comprehensive situational analysis study of the Faith Based Health Services in Kenya vis-à-vis Government Health Services that was conducted jointly by MOH and CHAK & KEC through the MOH-FBHS-TWG in 2007.

The study identified the weakness and vulnerability of health services support systems especially as regards governance, human resource management, financial management, infrastructure, medical equipment, planning and Monitoring & Evaluation (M&E). These are further complicated by the high human resources turnover and challenges of inadequate resources.

The study observed that whereas many faith based health facilities were strategically located in areas where health services delivery was inadequate, utilization of services was declining. The Government of Kenya has also gazetted a policy on health facility governance and financial management

known as the Health Sector Facility Fund Policy.

CHAK will support improvement of health systems in its member network through;

1. Development of health systems strengthening policy documents

2. Capacity building on governance and management to be achieved through training, mentorship, technical support and networking

3. Continuing to ensure an efficient and affordable Essential Drugs and Medical Supplies procurement system through MEDS

4. Continuing to support sourcing, installation and maintenance of Medical Equipment through the Health Care Technical Services (HCTS) Programme

5. Development and endorsement of a partnership policy framework between Faith Based Health Service providers (CHAK, KEC, SUPKEM) and Government

6. Promoting partnerships at both facility and national levels that provide technical support and inputs

Several health systems strengthening policy documents have been developed through a participatory process involving CHAK secretariat, partners, member health facilities and CHAK Executive Committee (Board). The development process involved the following key steps:

u Identification of policy gaps and issues

u Review of the issues and discussion on scope of the policy needed through a workshop attended by CHAK Secretariat and representatives of member health facilities

u Development of draft policy documents through appropriate technical support

u Review of the draft policy documents in a workshop of policy makers from the Secretariat, Executive Committee, partners and representatives of member churches and member health facilities

u Approval of the final policy documents was given by the Executive Committee (EXCO) during its meeting held on November 19, 2008.

u Dissemination of the policy documents at the National Health Systems Policy Documents Dissemination Forum held at CHAK Guest House and Training Centre on November 20, 2008

u Capacity building and technical support for policy documents adoption and implementation The policy documents developed include:

u A governance policy manual for hospitals

u A governance policy manual for lower health facilities (dispensaries and health centres)

u Human resource management

CHAK members

to benefit from

health systems

initiative

Participants at the National Health Systems Policy Documents Dissemination Forum held at CHAK Guest House and Training Centre on November 20, 2008.

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policy manual and HRM tools

u HIV workplace policy

u M&E framework and manual for CHAK Strategic Plan 2005-2010

u Financial management and procurement policy manual

u Strategic and operational planning guidelines

The policy documents were developed by CHAK with technical support from the Capacity Project and consultants from the University of Nairobi.

CHAK is grateful to CDC for providing the funding through CHF International. The funding has also been used to equip CHAK Secretariat with ICT hardware and software to enhance efficiency in operations and M&E.

The policy documents were launched by CHAK Chairman Bishop Joseph Wasonga at the National Health Systems Policy Dissemination Forum, held at CHAK Guest House & Training Centre on November 20, 2008.

The Policy Documents can be downloaded from CHAK Website (www.chak.or.ke) for use by CHAK member health facilities. Any other individual or organization wishing to quote or reproduce any part of these documents must seek authorization from the General Secretary, CHAK.

A programme for dissemination of the policy documents and capacity building has been launched in all the four CHAK regions.

The dissemination strategy also involves building linkages with the Ministry of Health (MOH) to strengthen collaboration and mobilize member health facilities to participate in the Annual District Health Planning. Site-based mentorship support shall also be provided. A capacity building workshop focusing on governance has already been held for the new St. Lukes Hospital, Kaloleni, Board using these tools with very positive results.

The Hospital Board and management are already implementing an action plan to strengthen health systems and improve quality of services.

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hurch health services remain a major contributor in health services delivery in most of the Sub-Saharan Africa countries. The motivation for church involvement in health services delivery is firmly grounded in the Biblical mandate illustrated by the example of Christ.

Churches participate in health promotion and treatment of the sick in response to the great commission to go out in to the world to teach, preach and heal the sick. In addition, medical care creates opportunity for evangelism and practicing Christ’s love and compassion.

Historically, church health facilities in Kenya enjoyed support from a variety of sources, enabling them to provide quality, affordable and accessible services to meet the health care needs of poor and underserved communities. Such support included:

u Financial and in-kind donations from sister churches abroad

u Missionary expatriates who formed the bulk of senior staff in church health facilities

u Government grants from the National Budget u Donated drugs, medical supplies and equipment uUser fees, which was the least significant source of

funding

Today, the situation has completely reversed posing a huge sustainability challenge. The main sources of funding for Church health services include:

u Revenue generation from patients fees. This contributes over 70 per cent financing of the recurrent expenditure. u Donations are irregular and mostly designated to capital

development, equipment or special programmes like HIV&AIDS

u There are very few missionary expatriates who tend to be highly specialized

u There are no Government grants. Most government support tends to be in the form of medical supplies and few seconded staff. Among the medical supplied are vaccines, TB drugs, family planning commodities, anti-malarial drugs, HIV test kits and ARVs and dispensary drug kits.

The sustainability challenge

facing church health services

By Dr Samuel Mwenda-General Secretary, CHAK

NHIF 9% Others 7% GOK 0% Donors 14% User fees 70%

Sources of funding for FBHS in 2004

Source: FBHS situational analysis study report

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Financial sustainability has thus become a major challenge with the situation being further complicated by the high costs of health care inputs and declining utilization.

In an effort to remain faithful to their mission of serving the poor, Church health facilities have accumulated a huge debt burden. The situation analysis study of faith-based health providers vis-à-vis Government health facilities conducted in 2007 revealed that the main sources of financing for faith based health facilities in Kenya were patient fees (71 per cent), donations (13 per cent) and National Hospital Insurance Fund (NHIF) (9 per cent). (see chart below).

The study further revealed that the trend of revenue generation from patient fees is on a downward trend due to poverty, decline in patient numbers, competition and the impact of HIV&AIDS. This trend unfortunately triggers the vicious cycle of human resource migration that further compromises quality of service delivery.

In order to survive the crisis created by this scenario and ensure long term sustainability of our mission and services, Church health facilities in Kenya have to be proactive in embracing innovative approaches to health care financing. We must also identify strategies for enhancing motivation and staff retention.

CHAK is excited by the various lessons on best practices in resource mobilization and staff motivation. Churches have a Biblical mandate and obligation to continue providing health services. This foundation makes church health services an key partner to MOH in health service delivery. In order to sustain the good work which church health facilities are doing and expand their coverage, CHAK recommends several sustainability enhancing strategies.

Strategies to enhance sustainability

Special attention should be given to our human resources by endeavoring to learn from best practices within the Faith Based Health Facilities. By scaling up and sustaining advocacy to

the Government and donors for substantial commitment to human resource support, Faith Based Health Facilities can cut down on operating costs, releasing funds for other uses. Such assistance needs to be supported by MoUs or contracts to cushion church facilities where a change of guard occurs in Government.

Governance of Church health facilities should be strengthened and professionalized to ensure that it has the essential competence and skills mix. There is also need to ensure that our governance focuses its business on strategic planning, resource mobilization and performance monitoring. The operations of the Board and its relationship with management should be guided by a governance policy manual or by-laws to enhance synergy and avoid conflicts. CHAK has provided a Governance Policy Manual which could be adopted to ensure best practice.

Every health facility should identify a niche or brand for which it will be recognized in its wider catchment area. The niche service should be well developed, packaged and marketed. Some examples that are working well in Kenya include Kikuyu Hospital (Specialized Eye Care services), Kijabe Hospital (Orthopedic surgery and medical training), Tenwek Hospital (Endoscopy, oesophageal cancer management and cardiothoracic surgery) Maua Methodist Hospital (trauma management and community HIV programmes), St Lukes Hospital (community-based health care (PHC)), LightHouse for Christ and Sabatia Eye Hospital (Specialized Eye Care services).

Faith-based health services should consider including salary support and human resource development in every project proposal submitted to donors in order to expand training opportunities for their staff. Along these lines, it may be time to lobby donor partners to support scholarship funds to benefit staff in church health facilities. Endowment funds can also provide much-needed resources for staff development.

To enjoy an edge over their competitors in the private sector and MOH, faith based health service providers need to develop human resource policies that give priority to staff housing, medical cover including HIV/ AIDS treatment, care and support. Supporting staff credit

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North-South partnerships have over the years provided experienced and highly skilled manpower in the form of missionaries and staff supported by FBO partners abroad.

photo: Wesley Health Centre, Nakuru

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Every health facility

should identify a niche

or brand for which it

will be recognized in

its wider catchment

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he cost of purchasing medicines comes second after staff salaries among recurrent budget items in most health facilities. It therefore follows that, to the extent that is possible, cutting expenditure on this major budget item could have a profound effect on overall costs.

Providing optimum care for patients remains the first priority in any health care set-up. Cutting on expenditure while providing optimum health care calls for innovation.

Fortunately, there are time-tested systems and approaches for achieving this. They come in two major forms - proper management of medicine resources, including procurement, stock control and internal medicine distribution systems, and efficient (rational) use of medicines and other medical resources by the health care providers and patients.

Management of medicine resources

This rather ambiguous term becomes clearer once examined in its various components which are selection, procurement, stock control and storage, and use of the medicines.

Selection

Proper medicine selection involves making informed choices on what to approve for stocking in a medical facility set-up.

The choice is based on common disease patterns, effectiveness of various medicines to treat them, safety of the medicines and cost among other criteria.

Since it is not easy for individual health facilities to gather all the information needed to make these choices, it is advisable to be guided by the choices that have been made by those with resources and credibility. Thus, the world Health Organization (WHO) essential medicines list, Kenya Essential medicines list (KEDL) and MEDS’ stock list are good starting points in developing a list of medicines to stock. Most concerns about effectiveness, safety e.t.c. will usually have been dealt with before a drug finds its way into these lists.

Procurement

Procurement should be based on the list of drugs that is compiled. One of the greatest benefits that CHAK member units and other church facilities have is a centralized drugs and medical supplies procurement channel, MEDS.

Purchasing through MEDS automatically addresses the thorny issue of quality of pharmaceuticals since MEDS tests most stocked items to ensure acceptable quality standards. Thus, health facilities don’t have to worry about fake drugs and counterfeits that are common in the market.

Another benefit of this centralized procurement system is low prices due to the bulk purchase discounts that are passed on to health facilities through MEDS.

Distribution and storage

While it’s easy to see the link between poor storage and drug deterioration, wastage, theft or even contamination, the contribution of poor stock control to increased expenditure on medicines and by extension, patient care, has not always been appreciated. In its simpler form, stock control involves stocking just enough to avoid stock-outs while also avoiding

over-stocking and wastage of resources.

In an established stock control system, the quantity of an item to order is the difference between the maximum stock level and the quantity in stock at that time. The maximum stock level is determined by adding up the following:

u Safety stock: This is the stock that you plan to insulate you against temporary upsets such as delay in supply of what is ordered or an increase in the usage of an item during a period. It is sometimes taken to be one month’s stock of the item.

u Amount of the item that is used as you wait for your order to be supplied (lead time): This waiting or lead time depends on the distance between you and the suppliers and is derived from past experiences

u Quantity of the item that is used between placing one order and the next (order interval): Orders can be placed weekly, monthly, bi-monthly etc depending on units’ preferences.

Thus, the maximum stock level is the sum of the above three estimates. For example, a unit that uses about ten

Enhancing

efficiency in drug

use and supply

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tins of amoxicillin in one month, waits two weeks for their medicines after placing an order and makes it’s order every two months will have it’s maximum stock level for this item as 10 (safety stock) + 5 (amount used as order is awaited) + 20 (quantity used between placing one order and placing the next order) = 35. Thus if they want to place an order and they have 60 tins in stock, they should order for 60 – 35 = 25tins.

Stock control is also important in the other user departments including wards and the dispensing pharmacy. Large savings on drug costs have been achieved by simple stock control measures in these units such as converting from a system of supplying medicines to the wards as ward stocks to supplying to individual patients in the ward.

Efficient use of medicines and other medical resources Normally referred to as rational use of medicines, this approach advocates for use of medicines that are:

u Appropriate for the medical condition

u At doses that are appropriate and at the appropriate period

u Reasonably priced

u Accompanied by adequate and accurate information about these medicines and the diseases they are used to treat.

The first requirement calls for vigilance on the part of the clinician to arrive at the right diagnosis during each encounter. This is probably the most challenging part. Besides calling upon clinicians to always have current knowledge on diseases, skills and the right attitude are fundamental to success.

Laboratory and other diagnostic support are also key

schemes and/or micro financing has proved a useful way of retaining and motivating workers.

North-South partnerships have over the years provided experienced and highly skilled manpower in the form of missionaries and staff supported by FBO partners abroad. Intense advocacy can dispel assumptions that the FBHS in Kenya are self-sufficient and do not need support from partners abroad.

It may also be prudent to build strategic partnerships with health financing initiatives and professionals in various specializations to ensure our clients have access to specialized medical services. Promotion of FBO-private partnerships involving members of sponsoring churches of our health facilities can also assist us to tap expertise in the private sector.

Other strategies to improve and expand health care financing include:

u Building capacity in financial management to enhance efficiency in revenue generation and allocation

u Computerization of health information and financial management systems to enhance efficiency and ensure accurate and timely information to support decision making

photo: CHAK

elements as is the right working atmosphere (environment). Other requirements present a typical case for the need for teamwork among clinicians, pharmacy personnel and the larger management.

Achieving efficient use of medicines and other medical supplies in a health unit calls for concerted efforts among clinicians and other staff. This is most often achieved through a Medicines and Therapeutics Committee (MTC).

A Medicines and Therapeutics Committee is an educational and advisory body whose members include representatives from the clinicians, pharmacy, nursing and hospital administration. The chairman is usually a respected clinician

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u Evidence-based costing of our services to identify full cost for recovery. This should recognize any in-kind donations. Service users should be provided with full information to appreciate the cost of the service they have received and the subsidy which has been extended through partner or government support. The full cost information should be used for advocacy and for negotiating funding support and insurance compensation.

u Promoting community enrollment in social insurance schemes such as NHIF and community-based health financing initiatives.

u Supporting staff welfare and team building and micro-finance community initiatives for economic empowerment uFostering good relations with MOH and other

stakeholders

uIntroducing Income Generating Activities (IGAs)

u Demanding that partners desiring to work with us provide meaningful support including financial, human resource, commodities or capacity building

The mission health sector needs to utilize available information to reflect on its performance and future. Church health services can weather the current storm if they respond strategically to changes in their operating environment and maintain their focus on their mission and faith in God who has commissioned them.

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A benefit of the centralized drugs procurement system through MEDS is low prices due to bulk purchase discounts passed on to health facilities.

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on-governmental organizations (NGOs) providing health services in Africa face sustainability challenges. In 2008 and five years going forward, it is predictable that mission hospitals that do not change their business models will close down. Assessing costs and fees charged for services will be a critical sustainability strategy.

Understanding cost

A cost is what you give up in order to gain something. It is the value of the alternative that one forgoes. It is the price we pay to enjoy a service or acquire a good. A patient pays transport, stops his regular work including providing services for the family and pays at the hospital cash point to get treatment. Such a patient pays cash and foregoes opportunities. The sum total of all these cash payments and value of forgone alternatives is the total cost of the treatment that he gets.

A hospital must be able to assess with this level of precision all its costs and recover the same in the provision of its services, within some margin, either directly from the cash that patients pay, from donations or government grants. A claim to national health insurance funds and health management organizations must be based on the average cost of service provision arrived at carefully by knowledgeable people, involving hospitals

to determine those costs in aggregate and then determining averages.

Donors will need to get reports on how much the service costs to reimburse the same. The PEPFAR grant is closing phase 1, and five years after it was started, only a few if any hospitals in Africa PEPFAR countries can make claims to the grant based on well calculated per service costs. All stakeholders in health financing will appreciate data and processed information on service costs.

Global economic meltdown

The global economic melt down that started in 2008 is projected to go on for another four years or so. Grants and donations to the health sector in developing countries will diminish in frequency and size. Governments and communities in Africa and other developing countries will need to shoulder a greater share of the costs of providing health services to communities. Largely, rural and urban communities have high poverty levels.

In Kenya, 54 per cent of the population lives in abject poverty out of a population of 36 million; Nigeria has 60 per cent of its population of 160 million people living in poverty while Rwanda has 52 per cent with a population of 10 million. These countries show how critical the need to support the health system as a method of poverty alleviation is. Needless to say, disease, poverty and illiteracy are found in the same households.

Mission hospitals provide close to 40 per cent of health services in developing nations. To survive, they will have to come up with new business models. They will need to determine capital and service costs, market their services, differentiate pricing, raise funds, negotiate better rates from insurers and have strong governance structures.

Strategic plans will have to be restructured to ensure survival and sustainability. Concepts that were used to found mission hospitals and raise funds from abroad will need to be reviewed drastically and new concepts crafted from the necessity of the current times.

Costing medical services in

mission hospitals

By Moses Mokua

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One cannot determine the cost of a service without recognizing the cost that comes with fixed assets and recurrent costs such as equipment maintenance.

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Fixed assets

A hospital requires land, buildings, pavements, waiting areas, fencing, vehicles, among others, to be operational. These are called fixed assets and require large capital outlays. One cannot determine the cost of a service without recognizing the cost that comes with fixed assets.

A small portion of the capital costs needs to be calculated and spread over clients who seek services. Since capital assets are acquired at different times and depreciate at different rates, good records are vital in cost evaluation. Land costs, construction costs among others must be based on existing records.

Some of these assets were acquired many years ago and values may have appreciated. It may therefore be important to revalue such assets and represent balance sheets in a ‘true and fair’ manner. Most mission hospitals have grossly undervalued their assets due to lack of funds to revaluate them, the costs involved and lack of appreciation of the importance of this exercise. This is part of the new thinking that the governance of mission hospitals must adopt. Valuing assets correctly can, for example, enable a hospital to take out a loan for equipment financing.

A hospital that wants to raise funds from the public should show that it is doing business as a modern, rational businessman should, making prudent decisions, presenting up to date financial data that can stand the test of scrutiny and professional review.

Recurrent costs

Recurrent costs should be added to capital costs to arrive at the value of what a hospital forgoes to provide treatment. Recurrent costs include variable and fixed costs.

Variable costs increase or decrease based on activities. Drug consumption, food costs, laundry and nursing costs, water and electricity are based on the number of patients and are a variable cost.

Fixed costs do not change with the volume of activity. However, they increase or decrease based on other factors like passage of time, agreement revisions or statutory pronouncements. They include rent, licence fees, repair and maintance.

Importance of evidence-based costing

Medicine is an evidence-based profession and its financing and costing needs to borrow from this idea.

Costs should be verifiable, current, reasonable, and fair. There should be third party documentation that fully accounts for the cost which should have been arrived at after due process. Costs incurred by an all powerful procurement officer who has the backing of an even more powerful hospital administrator may not be useful in assessing costs as intended.

It is recommended that costs be based on evidence. The following are some advantages of evidence-based costing: u Controls costs: If we identify where expenses are most

incurred, management can target action to reduce wastage and costs.

u Assess current levels of cost recovery: Knowing current costs will assist a hospital to compare them with the fees charged and determine if a loss or gain is being made.

u Advocacy: Evidence-based costing can assit hospitals to advocate for increased funding from donors and Ministries of Health.

u Building capacity: Staff of mission hospitals and national Christian organisations should be trained in costing techniques. Capacity building specifically involves transfer of skills in project planning, data collection techniques, tool development, analytical approaches and interpretation/ presentation of data. These techniques can be retained and used in subsequent cost analyses at facility level.

u Dissemination of the technique: Local staff trained should be engaged in discussions of results to enable them develop skills to explain the data and answer questions. Such questions will come in handy when negotiating for donor and insurance funds. These organizations will usually test the rationale of the methods used in costing.

u Identify services being subsidized by member institutions and determine the level of subsidy: Hospitals provide services in reproductive health, surgical, maternity and so on. Each of these service have different costs and fees. Per service analysis of cost helps to identify services that

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photo: CHAK/courtesy of Kiandegwa Health Centre

Patient Flow Analysis follows the patient from entry to a hospital to exit and costs all services given in the process.

Medicine is an

evidence-based profession and its

financing and costing

needs to borrow from this

idea.

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are being subsidized and to what extent. One can also tell which services are making gains to subsidize the loss making ones. Hospitals can then use such information to make sustainability decisions.

u Identify causes of financial deficits: A hospital that is consistently making deficits in income statements will use costing to identify causes and take corrective action.

Methods of costing

There are many costing methodologies based on the principles that the method should be simple, consistently used and consider all costs. Two approaches to costing are:

Patient flow analysis (PFA)

This method follows the patient from entry to a hospital to exit and costs all services given in the

process. For example, costs of clinical personnel – which usually are the largest component of total costs - are calculated using this approach. Patient Flow Analysis provides data on the amount of time spent by providers on different types of client visits. This should be done for several patients presenting similar conditions for an average to be determined.

Costs of visit-specific medicines and supplies should be collected via key informant interviews conducted with service providers. Current price

lists of national suppliers of drugs would be useful. Other information collected would include administrative data such as clinic and support staff payroll, expenditure data, service utilization statistics and inventories of clinical equipment and furniture.

Homan et al (2002) explain that calculating the economic cost of a service involves four processes:

1) Identification of the resources used to produce the service, regardless of who pays for them

2) Valuation of the resources

3) Allocation of the resources to specific services

4) Dividing costs assigned to a service by volume of services provided to obtain the unit cost estimate.

Inputs can be classified as direct (defined as directly involved in the production of the service) or indirect (playing more of a supporting role in producing the service). The identification stage involves making a comprehensive list of all the direct and indirect resources (such as clinical and support staff labor, medicines and supplies, operating and maintenance inputs, and capital inputs including infrastructure and equipment) that are used in providing each service.

The next stage is to assign an economic value to the inputs. If the hospital purchases these inputs, the economic value will normally be the same as the financial expenditure. In the case of donated inputs, an economic value is assigned based on the market value of the resource. Once the resources have

...continued from page 9 been identified and valued, their costs are allocated to different

services in line with the amount of the input used, and summed to produce the estimate of unit cost per service.

Average costing

This will enable one achieve the following: uDetermine the average cost of outpatient care

u Determine the average cost of in-patient surgical care u Determine the average cost of inpatient non-surgical care Random sampling is used to select facilities from strata, based on location and size to be used to determine the averages. As an example, one may select small hospitals within districts, big hospitals within districts, small hospitals in province capitals and big hospitals in province capitals. Cost and financial data is collected by the hospital staff, verified by a third party, then centrally entered into a spread sheet for analysis.

Data is entered into excel analysis templates which are designed to generated average costs per patient per day for surgical, non-surgical and outpatients, for each facility.

Administrative and clinical data is used to allocate overheads to the three cost centers (OPD, surgical and non-surgical). Physical measures and appropriate allocation keys are used to charge costs to the cost centers. These keys may include square footage, direct costs, mileage, client volume, and number of lighting points and so on.

Conclusion

Financial sustainability is achieved though income generation (i.e., cost recovery, donor and government contributions) and control of costs. Most mission hospitals currently do not know the costs of the services they provide. Thus, there are no economic benchmarks to use to evaluate efforts to control costs; there is no denominator to use to calculate cost recovery for different services; and there are no empirical data on service costs that could be used to approach donors and the Government with requests for funding. Information on cost of services is crucial for organizations that are serious about improving financial sustainability.

About the writer

The writer has worked in Chogoria mission hospital, Nairobi Womens hospital and is currently a Grants and Compliance Manager in Nigeria, working on a $40 million PEPFAR project for mission hospitals that offer HIV treatment. He has also served as a CHAK Board member and been involved in more than four costing studies as a senior consultant.

References

Homan, Rick K., Caroline West, Sathiyavan, A.K. Ganesh, Sri Priya, P. Duraisamy, Benjamin Franklin, Dr. Sunti Solomon, Chris Castle (2002). Estimating the Cost of Services at YRGCARE. Unpublished.

Mokua M et al (2004). Cost analysis of Essential Curative Health Services in Church Health Facilities, Christian Health Association of Kenya (CHAK) P.O. Box 30690 – 00100, Nairobi, KENYA

Information on

cost of services

is crucial for

organisations that

are serious about

improving financial

sustainability

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aua Methodist Hospital is owned by the Methodist Church in Kenya. The Methodist Church had identified health care as an essential need of the local community and in 1928, the British Methodist Church approved the construction of a 50-bed hospital at Maua.

Since then, the hospital has grown into a 275-bed facility providing health services such as dental, surgical, physiotherapy, palliative, among others.

Why credit control unit was started.

The Kenyan health sector has undergone many changes since independence. Before and immediately after independence, Kenyans were promised free medical care in public health facilities.

Medical supplies were always available in mission facilities with generous Government support through grants and external donor funding. Following a declining economy, the Government began a gradual reduction of its grants which stopped altogether in 1996. At the same time, external funds dwindled as donor fatigue set in.

The generous grants and donations had with time caused a dependence syndrome within our catchment area. When the missionaries eventually pulled out, the hospital found itself in a situation with no money to support services formerly offered through support by mission partners through donor agencies. This situation forced the management to request the local community to meet the full cost of medical services offered to them.

This did not go down well with the community who resisted this change. The hospital therefore began educating the community to ensure they understood that the subsidized medical care formerly offered by the mission partners could not be sustained, given that donor and Government support had been withdrawn. The

management learned from this experience that a number of people within the catchment area were capable of meeting their healthcare expenses but were unwilling to do so as they had got used to highly subsidized services made possible by missionaries’ support.

The hospital at this point had incurred a huge debt burden which made it difficult to meet

its overhead and operational costs. It therefore became necessary for the management to come up with a system that could help reduce the increasing debt burden to avoid the hospital’s closure.

Thus a debt control unit headed by the debts controller was established. A committee comprising the CEO, Financial Controller, Chaplain, Nursing Officer In-charge, Internal Auditor, all wards unit In-charges and MCH departmental head was formed to regulate debt with regard to patients admitted at the hospital. The committee would identify patients who were unable to pay for medical care and whose expenses needed to be written off as bad debts.

Since 1999, the hospital has been working to make itself sustainable though reduction of general debts from 30 per cent to 15-20 per cent and improve cash payment and NHIF cover.

Debt control strategies

Among the strategies developed by the hospital to control inpatient debt are:

(1) All admissions are required to pay Ksh4,000 for surgical patients and Ksh3,000 for other wards. Those unable to pay are considered for transfer to a Government hospital once their medical condition has stabilised.

(2) Red flags and home visits:

Patients who are unable to pay a deposit for admission at the out-patient unit are considered as red flags after taking their social and economic history. When a patient’s social and economic history is determined as poor, the case is called a red flag and a home visit is done to alert the relatives. Inpatients are required to pay

Strategies used by Maua Methodist Hospital

Credit control and debt recovery

(11)

...continued from page 11

1

MAUA METHODIST HOSPITAL DEBT CONTROL MEASURES FLOW CHART

OBJECTIVE

Have as many apatients as possible pay their hospital bills in cash, NHIF or institutional invoice

STEP I OPD

1ST day during admission process demand full deposit.

• Treat as OPD if not very sick

• accommodate to bring money the following day.

• Transfer to GH if money is not paid or institutional committal.

-Admit

-Give Estimated cont -Give estimate days. -Full guarantors form -Inform or progressive payment

Do not admit if not very sick Accommodate for transfer of very sick

Ask for full deposit to stop transfer.

STEP II WARD DAY 1-5 TO DOD

• Constantly demand progressive payment.

• Transfer non payers

• Do home visits

• Daily cash paid by IP report

• Regular provisional statement and discuss with patient and relatives.

List be produced daily

-assign different senior officers to Interview continuously

- Involve chiefs -Introduce NHIF -Home visits

-Give them encouragement by reminding of cash discounts -Introduce NHIF to them.

-List to be discussed with in-charge -case with>30,000/= list for HMT weekly.

-Introduce NHIF

STEP III – DISCHRAGES Daily aged schedule

Pester them to pay the bills Cluster tem in Days – 0-3 day 4-6days 7-10days 11days inform HMT. Value difficult cases>Kshs.30,000 category able but refusing to pay.

Poor and destitute Not visited/known

-Demand payment daily list involve the chief .

Use different

People to talk to them i.e. w i/c debts controller

Accountant, I.A Matron, CEO, etc Introduce NHIF

Encourage them to pay and get 5% cash discount-Introduce NHIF

Look for somebody to either be responsible -Home visit -Encourage chief to involve the community in harambee

-look for NGO to support e.g. church etc -NHIF information

STEP IV – INVOCING PROCEDURE

Home visit form fully filled by ward debt clerk and discussed with debts controller.

Schedule of proposed cases to be discussed by debt clerk, w i/c and debts controller, for invoicing the following day. Case with>30,000 refer to HMT weekly and

recommendations

Chiefs letter and sworn affidavit to be provided Cases approved to be signed by debts controller or accountant.

ASSESS THE OUTCOME= CASH SUMMARY

Able but refusing to pay Poor and destitute

Willing and able to pay

Recommended for transfer but not affected poor and destitute case

ASSESS THE OUTCOME =CASH SUMMARY

(12)

CHAK TIMES issue 31

Call for Articles

The topic for the next issue of CHAK Times is “Lifestyle diseases”

We invite articles, photographs, experiences and letters from our readers on this subject. CHAK member health units are also invited to send information about the services they offer, training activities, new projects, job

va-cancies and other developments that they wish to share with the rest of the network.

Send your articles to: The Editor, CHAK Times P.O. Box 30690 - 00100 GPO, Nairobi

Email: communications@chak.or.ke To reach the editor by April 2009

their bills progressively as they continue with treatment. A red flag case is identified using the following pointers: u When the patient is not visited on the first, second to the

third day.

u When the patient was bought to the hospital by a good Samaritan

u When the progressive payment is not honoured as agreed upon

u When the patient or relatives indicate they intend to organize a harambee to pay the hospital bill

u When the patient is an RTA case and the owner of the vehicle is expected to pay the bill, and has committed himself/herself in writing.

In all the above cases home visit is done to establish the truth on the ground. The patient is also considered

for transfer to a Government hospital. The red flag and home visit strategy is able to control debt at the source. Under this strategy, the hospital is able to filter patients into various groups such as:

u Those to be transferred to a general hospital

u Those to treat and wait for payment before release

u Those to be allowed to pay a portion of the bill with the difference being paid as per agreement written by a lawyer. u Those to treat as bad debt abinitial.

u Those to keep in the ward till payment is made in full. This is especially in cases where the family has the means but is refusing to pay.

u When to involve the provincial administration, the church or relatives.

(3) Ward interview

The hospital has employed a debts control clerk for each ward. The clerk is usually in the ward during visiting hours to interview specific relatives on the progress of payment regarding particular patients. Before the visiting hours, the clerk interviews the patient to compare the two versions of the story to ensure the proper decision is made with

regard to the patient.

(4) Involvement of church pastors, chief or assistant chiefs. Where the information is very clear regarding the patient, the hospital may involve the pastor or the provincial administration i.e. assistant chief, chief or District Officer as need be.

(5) Transfer to a general hospital.

Those not able to pay their medical bills are transferred to a Government hospital to continue treatment. Such transfers are done twice a week i.e. Thursdays and Tuesdays and have continued since 1999.

(6) The NHIF self-employed registration

The hospital has been struggling to mobilize the community to enroll in NHIF since 1999. We thank the Almighty God because the Government has supported this effort and MMH has a comprehensive cover. In view of this, every patient who is released on an invoice has to register with the NHIF self-employed scheme. The hospital has set aside a vehicle and prepared a schedule in order to conduct NHIF enrollment within its catchment. We aim to register over 70 per cent of the eligible households in our catchment area in the next three years.

Open days

The hospital organizes regular open days to cultivate loyalty within the local community. The community is also updated on services offered by the hospital. Clinicians in the catchment area are involved in organising the open days, hence forging closer working relationships. Interdenominational open days are also held and churches operating in the catchment area involved. The provincial administration is roped in.

We have also reached out to the local community with the message that:

uMedical bills must be paid without fail.

...continued from page 12

The red flag

and home visit

strategy controls

debt at the

source

(13)

uEvery household needs to register with NHIF (self employment scheme)

u Patients must produce an NHIF card on admission. u Patients who are not enrolled in NHIF must pay a deposit

of Ksh20,000. This money should be replenished once Ksh15,000 has been used up.

u Patients without an NHIF card and unable to raise Ksh20,000 within the first two days after admission will be transferred to a government hospital.

The HMT reviews these strategies from time to time.

Debt control is done through teamwork of admitting clinicians, OPD nurses, who have the first contact with the patients, ward nurses, ward doctors, debt control staff, administration and chaplaincy, all of who work towards debt reduction.

Debt recovery strategies

In general, debt recovery is major problem in all businesses. At the national level, poor countries have over the years

pleaded with the rich nations to write off their national debts.

Maua Methodist Hospital carries a huge debt owed by patients or general debtors which has accumulated to over Ksh100 million and continues to grow by about Ksh2 million monthly.

In view of the above, the hospital has employed the following debt recovery strategies:

1) A member of staff has been assigned to follow involved debts as they fall due. All debts should be paid within 90 days. The hospital has also allocated a vehicle for this exercise. Area chiefs accompany our staff to the homes of the debtors and where necessary intervenes to ensure the debt is paid.

2) Engaging the services of lawyers: Durin the process of invoicing, debtors swear an affidavit, undertaking to pay the entire debt in three months. It is disappointing that over 90 per cent of these debtors do not honour the affidavit. The hospital has engaged the services of a lawyer to recover the outstanding debt. However, this strategy is yet to bear fruit.

3) Encouraging debtors to organise harambees: During the home visits and ward interviews, some relatives have been encouraged to organise harambees and have been invoiced on this strength. Initially, money raised did not reach the hospital, forcing MMH to send staff to such harambees.

Challenges

Debt control challenges

Admission deposits and guarantee for payment of medical bills:

There is a remarkable improvement since 1999 and the community is fully aware that:

u If no deposit is paid upon admission, the patient shall be transferred to a government hospital the following Tuesday or Thursday. Here, challenges arise if a patient is admitted on Thursday after 11am given that the next transfer day will be the following Tuesday, five days after.

u Most patients are bought to the hospital at night and very sick hence it may not be possible to transfer them. Patients are not usually denied treatment.

u Most people who accompany the patients allege that they are good Samaritans and not responsible for the bill. u Most patients from marginalised areas allege that they

cannot afford to pay their bills and want the government or the church to pay for their medical expenses.

u Illiteracy and low levels of education within the catchment

turn to page 15

c

...continued from page 13

photo: Maua Methodist Hospital

Clients waiting for registration outside the NHIF office.

Medical workers attend to a young patient at Maua Methodist Hospital.

(14)

population

u A belief that mission hospitals are fully supported by the missionaries seen within the hospital compound, hence there is no need to pay for services.

Ward interview and home visits

During admission the patient and the guarantor are expected to give information to enable informed decision making. Both are required to produce their national identification cards but many claim not to have these.

As exemplified in the following instances, information given or recorded on the guarantors form is sometimes inaccurate.

uA lady who separated with her husband over 10 years ago put his name down as the person footing her bill, yet he did not recognise her as his wife.

u An adult who left home 20 years ago and has not been seen since recorded that the parents were responsible for paying the bill.

u In several incidences, patients have given wrong names and even intentionally cheated as regarding their locations, sub-locations and villages and therefore cannot be easily traced.

u To avoid being transferred to Government hospitals, patients and relatives indicate they are wealthy, only for the hospital to discover they are poor and destitute during visits or after discharge.

In summary, dishonesty among clients is a major challenge and denies the hospital accurate information needed for decision making.

Debt recovery challeges

In 1997, non-payment for hospital services (debts recovery) was identified as a major challenge for sustainability. Hence, the Hospital Board asked the Health Management Team to address the issue urgently. Strategies were formulated but the following challenges are being experienced:

Field debt recovery

In 1999, the hospital intensified field debt collection by assigning one vehicle and one staff, who worked closely with the provincial administration to recover debt. Debtors’ schedules were worked on according to location. u It was and still is very difficult to trace the debtors

because many of them give wrong information regarding their identities

u Those found in most instances allege that they are not

responsible for paying the debt but allowed their names to be put in the records so the patient could be discharged. u Some debtors have died.

u Some debtors are extremely poor.

u In some instances, the chief refuses to assist the hospital recover its debt despite the debtor having property that can be attached.

u Sometimes the community hides the debtor (s).

Engagement of lawyers

The field debt collector has compiled a list of debtors who are in a position to pay but refuse to do so. The HMT has recommended engagement of the lawyer to recover the hospital debts through the courts. However, the process of litigation has proved quite tedious.

The lawyers have not delivered as expected, sending a negative message to the community that the only way the hospital can attempt to recover debt is through the provincial administration.

Way forward for sustanablity of Church health faclities

Mission hospitals played a key role in health provision before independence in developing countries. Today, Church health facilities are also expected to contribute in the achievement of Millennium Development Goal number five (averting maternal deaths and disability) and millennium goal number one by providing health services for the world to have healthy and strong workers in order to reduce extreme poverty and hunger by 2015.

Church health facilities must be run as sustainable business entities governed by the principle of competitiveness and able to address the five market forces of Michael Porter’s theory - competitors, new entrants, substitutes, suppliers and consumers. In order to achieve sustainability, practical credit control and debt recovery strategies must be developed. Revenue generated needs to be adequate to meet operation costs and improve facilities, hence improving service delivery and attracting and retaining clients.

A board showing patient fees charged by the hospital.

Dishonesty among clients

is a major challenge

and denies the hospital

accurate information

needed for decision

making

(15)

turn to page 17

c

Historical background of Kijabe Hospital

O

n October 17, 1895, a mission team arrived at the port of Mombasa from the USA. The team led by young Peter Cameron Scott pressed inland to plant missions and share the gospel. Margaret, Peter’s sister, was also part of the group.

A few years earlier, Peter had led a team of seven young Christians that included his brother, John, into the Congo to share the gospel. John died of malaria within a few months and Peter personally buried him. Peter himself was sick and had to go to England to recuperate. However, God’s call for Peter was strong enough to overcome extreme difficulties and come back to Africa in 1895.

His own death at the age of 29, within 14 months of his arrival in Kenya, would ordinarily have discouraged others from venturing into Africa’s interior. Scott was a very determined and single-minded man. He is reputed to have walked 2,600 miles in one year during his work1. His grave stone at Machakos, Kenya is a reminder of the many missionaries who gave their lives in order to bring the gospel to Africa.

With God’s help, many missionaries followed soon afterwards and a mission station was established at Kijabe in 1903. Kijabe is 2,700 meters above sea level and also above the malarial zones.

A small medical facility was started at the station in 1915. Over a period of 93 years, the facility has developed to become A.I.C Kijabe hospital with an inpatient capacity of 260 beds currently. It is 60 kilometers west of Nairobi in rural Kenya. The bed occupancy ranges between 90 per cent and over 100 per cent. The outpatient receives an average of 300 on regular working days.

Medical facilities and programmes

1. The hospital runs a growing HIV/AIDS care program that is currently taking care of 5,400 patients. The staff in this program have developed links with the community so that many work and live in the community. Patients have formed support groups to encourage one another. This model of care has been developed with the technical input and expertise of missionary staff specialized in internal medicine and with a vast interest in holistic healthcare. 2. The hospital runs a rehabilitation program that is focused

on alleviating the suffering of children with disabilities. Many with hydrocephalus, spina bifida and other deformities receive surgical interventions that are followed up in clinics near their homes spread all over Kenya and in refugee camps in northern Kenya. One of the missionary

staff in this program has devoted his entire medical career to this work and many lives have been transformed in the process. Myths regarding disabilities have been dispelled. The major portion of costs are defrayed using funds donated by individuals and organizations.

3. There are five Operating rooms that managed to accommodate about 8,400 surgical procedures in 2008. Six of our nine surgeons are missionary staff. Apart from the technical skills, our missionary staff are able to source for valuable supplies and equipment that come to us as donations.

4. Working in the communities around us, we have developed neo-natal programs that empower mothers in the reproductive age to manage their pregnancies better and prepare for safer deliveries in health facilities. This preventive healthcare is only possible due to donations. 5. Pathology services: Our laboratories provide pathology services to more than 40 hospitals that are mostly CHAK member units. A group of pathologists provides this service throughout the year. Using a donated web camera and software, a pathologist is able to seek a second opinion from colleagues around the world from his/her desk. Responses come instantly depending on time zones. More recently, we have acquired computer software that enables one to speak directly into a microphone and produce a written report while working on gross materials instead of changing gloves frequently.

6. Kijabe Hospital is committed to sharing the Good News of Jesus Christ with each patient in a caring and compassionate manner. The spiritual health of our staff

The role of missionaries in sustainability

AIC Kijabe Hospital whose staff has consisted of missionaries since its

inception shares its experience

By Justus Marete - Executive Director, Kijabe Hospital

(16)

...continued from page 16

and patients is crucial. An average of forty patients make a commitment to invite Jesus Christ into their lives each month in the hospital. Some of the activities of the chaplaincy department include daily devotions in the wards and for the general services staff, Monday morning senior staff devotions, Wednesday morning devotions, Friday and Sunday evening fellowships, Bible studies and prayer meetings held during the week. The chaplaincy organises outreach ministries in various parts of the country and spiritual emphasis week for the staff.

Education programmes

1. The longest running education program is training of high school graduates in nursing care. Since the launch of this program in 1980, our school of nursing has trained more than 700 students. Initially, the faculty was entirely missionary staff. Some of the students eventually become excellent tutors and the quality of graduates has been maintained at fairly high standards. The setting and maintenance of these standards was possible through selfless service by missionaries.

2. The hospital accepts medical officer interns for a one year training program from the medical schools. Each year there are eight positions available and many of the doctors who have passed through these programs have advanced quickly both in the public service, church health sector and private practice. Many of our missionary doctor specialists have vast interests in education and continue links with their home country universities and medical facilities. In this way, we are able to keep abreast of most recent developments in medical care.

3. Working with Moi University and other government authorities, the hospital initiated a master’s level training of doctors in Family medicine after nearly ten years of dialogue. This specialty of medicine has been in the western countries for many years and it is through the efforts of our missionary partners that it is now in Kenya.

4. Beginning 2007, the hospital has been training registered

Community health nurses in providing anesthesia in operating theatres. Given the regional shortage of this cadre of staff, this is a major development that has been made possible by the leadership of a missionary staff in the field of anesthesia. We had nine KRCHN graduates with a post graduate Diploma in KRNA in September 2007. The second batch of nine students is due to graduate later this year.

5. Apart from providing HIV/AIDS care to many patients, the hospital receives many health care workers for short courses in HIV/AIDS care. Working with the University of Mary land in the USA, we have on going training and technical support available to more than 25 health facilities in Kenya that are providing HIV/AIDS care.

Hospital budget

About 85 per cent of hospital operations are financed using patients fees and a significant 15 per cent is composed of donated services by our missionary staff. In the year 2007, the human component of donated services was approximately Ksh45,862,080 (573,276 US dollars). Many bring in significant amounts of supplies and equipment.

By policy, our capital budget is financed through donations. Major fixtures such as staff housing development, theatre equipment and other medical equipment, plants and installations, and major renovations are financed by friends of our missionary staff and organizations. In this way, we are able to keep our fees low enough so as to reach poor people who would ordinarily find it difficult to decide to come to us.

Cultural exchange

One of the strongest points in having missionary staff with us in Kijabe is the appreciation of cultural diversity and the quick realization that the commonness that we have as Christians far transcends the vast differences that there are in cultures. Many have come to realize that diversity and the deliberate building of tolerance of people with different culture can greatly enrich life.

Theater staff examining a patient (left) while (left) a nurse and a school of nursing student taking vitals from a patient.

(17)

Introduction

L

ighthouse for Christ Eye Centre was founded by Doctor Bill Ghrist, an American ophthalmologist in 1969. His desire when he moved to Mombasa was to help the needy in the entire coastal region. The vision he worked by was to heal physical and spiritual blindness in the coastal region. All people who came regardless of their tribe, race or religious background were welcome. However, as a charitable organization, financing was and has remained a real challenge. At the onset, he sought help from friends and donor organizations who shared the same burden.

Psalms 123: 1 which says “Unto thee I lift up my eyes…..” was his faith statement. This has remained Lighthouse For Christ’s faith statement to date. Evangelism to share the good news about our Lord Jesus Christ and offering

excellent specialized eye care are our goals. The cost of services and dwindling donor funds over time demanded a rethink of how to finance the eye centre services. To make the founder’s dream of making professional eye care accessible and affordable to all who visited the clinic a reality, a way to raise more funds had to be sought.

Among those who visited the clinic included a few people who were able and willing to pay for services received albeit on certain conditions. This offered an excellent opportunity for internal local fundraising.

The appointment or private clinic was therefore established in the late 1990s and later relocated to our new facility in 2003 as special program. Before the construction of the new wing, all clinical services were carried out in the old clinic building. The new facility was built to improve on service delivery. The centre is situated in the busy city of Mombasa.

Challenges or opportunities?

The challenges faced offered an opportunity to establish the appointment clinic. Among such challenges were:

u Availing adequate privacy for clients who needed to see the doctors in the absence of other patients

u Catering for busy scheduled patients who were only

available at specific convenient times

u Providing patients with an opportunity to see doctors of their preference

u Constant demand for the latest ophthalmic services The new facility had to put into consideration these challenges.

The Appointment Clinic

A dedicated unit at the centre to serve as appointment clinic has been able to serve the “busy and no time to waste” demanding clients who find it difficult to join or wait on long queues at the general clinic.

Since the introduction of the appointment clinic, it has proved to be popular for this group of clients as they are served

at convenient times within the working hours.

The new wing is built on the ground floor putting into consideration the disabled, the blind and the partially blind

Ensuring affordable services through

internal fundraising

Lighthouse for Christ Eye Centre, Mombasa, turned challenges into

opportunities by establishing an Appointment Clinic to cater for the high-end

market while rasing money to fund the operations of the general clinic

By Emmanuel Mbaga - Nurse, Lighthouse for Christ Eye Centre

Front view of the appointment clinic.

turn to page 19

c

(18)

patients. The neatly arranged flower beds, grass and palm trees on the front view give the entire place a fine ambience.

The clinic is fully furnished with excellent and modernized eye care facilities to help provide efficient effective service to our clients.

A major challenge with the clinic’s clientele is the demand for immediate attention and constant pressure for the latest services which are generally costly. The clients also tend to need personalized attention with visits taking much more time than with other clients.

High demand for services at the appointment clinic has resulted in constant appraisal of the quality of services offered

to clients at Lighthouse for Christ Eye Care Centre. Although fees charged at this unit are higher than that at general clinic, it is much cheaper than most health facilities offering eye care services in the open market. Clients have an added advantage of being able to see their preferred doctor, whether resident or visiting.

Services offered

The Appointment Clinic offers a wide range of specialized eye care services from general complete eye examination, glaucoma, diabetic, hypertension, infections including HIV & AIDs, paediatric, squints and cataracts evaluation and management among others. Eye services at the centre are of international standards.

Orthoptics and refractive services which deals with focusing, position and eye movement assessment is also offered. Optical services including a wide range of spectacles

are available as are laser surgery and counseling. Visual field assessments and laboratory services are all under one roof.

The Appointment Clinic is open between 8am and 4pm. Clients fix appointments at their convenience either by telephone or on a walk-in basis. All preliminary evaluations are done before the patient sees his or her preferred doctor. Due to the excellent facilities at the clinic, examination and basic procedures are all performed under one roof.

The patient is afforded adequate time for examination, treatment and discussion of their condition to their satisfaction. This is referred to as client managed or oriented care. Adequate reading materials are provided and gospel music played at low volume for both entertainment and evangelism.

Beneficiaries

Income from the clinic provides much-needed funds to subsidize the cost of services provided in the general clinic.

The Appointment Clinic has assisted in raising funds to aid in running of the entire institution. With the rising costs of living, this unit has been able to enhance and sustain the low-fee out patient clinic by providing medical and surgical requirements. It has also catered for staff up keep, maintenance of equipment, vehicles and daily overheads without service fee adjustments.

LightHouse for Christ Eye Care Centre has also been able to stretch its hand and extend services to the needy and less privileged in the community during mobile clinics and outreach campaigns. Patients coming from poor communities outside the city are transported to the centre where they are provided with ‘free’ eye care, surgery and post operative follow up.

The income from the Appointment Clinic contributes significantly to the running of the centre and it is considered a ‘local donor’.

The excellent services offered together with the accessibility of modern eye care equipments at this new private wing has seen its popularity increase since its inception in 2003. The quiet environment and the availability of doctors have also built confidence in patients. The facility has proved to be helpful to the community in many ways.

References

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