Onderstaand bericht had ik onlangs op de Engelstalige versie van onze blog gezet. Ik schreef het met name om mijn gedachten een beetje te ordenen.
By MarkThe RCZ Health Department that I work for consists of five rural clinics,
two hospitals and a specialised Eye Unit. These institutions are situated in a
rural setting and the catchment area consists mainly of people who are
struggling to feed their families. Morgenster, also because of its proximity to
Masvingo, is attracting people from Masvingo town, of which many are better
off.
At clinics currently no fees are charged.
The hospitals strive to assist all visiting patients, and
each patient is encouraged to pay the fair drug and consultation fees. Quite a
few patient groups, however are (by GoZ regulations) exempted from paying
consultation fees. Those that are supposed to pay fees are struggling.
For some patients the Poof People Fund is covering the cost of treatment, but
this is limited to $500 per month. As a result, the hospitals every month incur
a loss of about $5000 (any realistic estimate available?) for invoices not
paid.
Morgenster has a monthly income of about $23,000 and Gutu
about $15,000 which is not sufficient for a proper running of both
institutions. Consequently both hospitals fail to replace obsolete equipment
and maintain it properly. Houses and wards are hardly maintained, gutters have
corroded away and stocks have not been as planned.
The hospitals have not been able to develop any plans to
improve this situation and the Health Services and Community Development Board
and the Health Manager have not been able to offer quick solutions. If the
Health Department wants to shake of the last bits of its donor dependency
syndrome, approaching foreign partners
might not be the best way. On top of that, it has become harder and harder to
get such funding and worldwide economic conditions have not been good.
Raising more funds
within Zimbabwe seems to be a more sustainable approach. Various options
exists; Government of Zimbabwe, who used to give grants, drugs and salaries, is
a very logical partner, but has only decreased its support to (mission)
institutions. Through schemes like RBF and HTF some funding has come, but in
much lower levels than a decade ago.
Generating more
income via current patients is a very difficult approach. First of all, the
health services are offered as part of a missional vision and is focused on the
marginalized, the poor. Accessibility is very important. Knowing that current
patients are often not able to pay for services excludes the option of
increasing prices or use debt collectors. A second path is increasing the number of services to current customers who are able
to pay. Morgenster increased its lab services, both hospitals have started
accepting medical aid schemes and are now doing some more small surgical
procedures in their theatres. Improving services is considered a viable way.
Attracting more
clients with current and new services is another mode that has been
proposed by the Board. Gutu has established a private ward and Morgenster and
the Eye Unit have been pushed to do the same. It has to be observed that this
is not in line with the Health Department focus on vulnerable groups and poor
people, but can be explained as means to an end. The challenge is that strategy
requires financial and human resources, which are not available. Taking these
out of the current operational setting is negatively affecting the service
delivery to the poor. A risk is also that one might forget the original reason
to start private care services and will see this as a core business in itself.
Besides increasing revenue, any organisation should always
strive to reduce cost and improve efficiency. Given the fact that no cost
reduction exercises have been done in the last decade, it is very likely that
the organisation can still reduce significant cost by improving the way
business is done.
Now what should be the focus of the Church of the
institutions be? Should limited (human) resources be spend on cost reduction,
income generation, networking to get more funding partners or improving
services to the target population (the poor and vulnerable) without knowing
where the means to do provide these services will come from?
As a manager, sent as a missionary to a partner church
organisation in a Sub-Saharan setting, this is the challenge I face. Should I
join an evangelism outreach team where I will be confronted with abject poverty
and evident physical, social, and spiritual needs? This would likely be the
perfect time and place to assess how the Church’s Health ministry can assist in
its ministry.
Yet the business manager in me will be worried that we will
decide to start building a clinic, 650
kilometers from head office, a nightmare of a project to embark on,
especially as the communities should really be supporting this project and
taking ownership. This will be difficult if the Church would also like to plant
its flag, logo etc on it and proudly call it ‘our mission clinic’.
