By: Clea Meynell
Senior level staff at International Medical Group (IMG) are in the process of developing a model of healthcare that is closely aligned with the district level services, ensuring cross-sector collaboration and capacity building as well as clear coordination with government and NGO services currently on offer in the District. Central to this model is the use of Village Health Teams (VHTs) and a well functioning referral network with close ties to other service providers in the area. Through strengthening the link between the private sector and the District Health Team, innovative public-private partnerships will be forged, addressing a key gap highlighted in the new Health Sector Strategic Plan (HSSP) III for 2010/11-2014/15.
The aim would be for a private facility at health centre IV level to provide care and treatment to a catchment area of 50-100,000 much the same as a government HCIV is supposed to do at present. This facility would be linked into the government network, essentially taking on the role of a government facility, thereby taking the burden off of the Regional Referral Hospital.
The Lira IMC Service Model
Charis International Medical Centre (IMC) is an outfit operating through a partnership between IMG and Dr Joel Okullo. The facility was built by Fields of Life and donated to Dr Joel. IMG employs and manages all of the staff at this centre and it has full responsibility for the day-to-day clinical governance and operations management.
IMG is keen to pilot this sustainable private-not-for-profit model of healthcare at Charis IMC in Lira, with a view to rolling it out across other facilities available through the IMG network in the future. It is hoped that this pilot will demonstrate the potential which exists in forging these public-private partnerships, therefore increasing the government’s ability to provide high quality healthcare to those most in need in Uganda.
The model is characterised by an approach which is focussed on tackling the most prevalent acute health issues occurring in the surrounding communities. In Lira, as is the case in most Ugandan communities, the majority of maternal and infant mortality (and morbidity) can be overcome by interventions which address these acute issues such as malaria, diarrhoea, respiratory tract infections, and maternal health complications. This coupled with an emphasis on preventative and promotive health rather than purely reactive, curative healthcare, as is seen in most health facilities across the country, would go a long way to tackling the vast health inequalities currently found in Uganda.
Pricing for these services has been developed with input from consultations with members of the target communities as well as with other service providers active in the area. The resulting price scheme is a simple one which is underpinned and made possible by the relationship with IMG. The International Air Ambulance (IAA) healthcare schemes are a central element of the IMG model, and in Charis IMC IAA clients represent 60% of patients that pay for service and account for 75% of the money received. Charis IMC will continue to treat IAA clients as in other IMG facilities, however under the new model, the profits from these clients are used as a cross-subsidy to provide a much reduced price for community clients. The community prices which are being trialled at present are as follows (full list included as Annex 1):
- Children under 5 years: 5,000 UGX.
- Adults (anyone over 5 years): 12,000 UGX. This covers initial consultation, testing, resulting treatment costs (including drugs) and admission to the ward if required.
- Antenatal Services: 20,000 UGX for an antenatal package (including medical consultation, all ANC visits, baseline tests, tetanus immunisation, blood grouping, HIV, syphilis, routine triage and IPT).
- Delivery Services: 30,000 UGX for a normal delivery. At present, without operating facilities, if any complications arise referral to the Regional Referral Hospital or Lira Medical Centre is made.
There are certain exceptions to these rules, for instance some services will be covered by community-based projects implemented by the International Medical Foundation, the NGO arm of IMG. These include care and treatment of HIV/AIDS patients (under the Aldo Project) and provision of contraceptives (under the new Yer Yotkom Project, summary included in Annex 2).
This latter project is of some interest to this proposal as it aims to provide an integrated sexual reproductive health (SRH) service focussing on the first two WHO pillars of PMTCT (primary prevention of HIV and preventing unwanted pregnancies, particularly amongst women with HIV/AIDS). Currently the third pillar (PMTCT of HIV during pregnancy and birth) is not available at Charis IMC, and referrals to the over-burdened Regional Referral Hospital are the only option. The long-term aim is therefore to extend services available at Charis to include this through the construction and equipping of an operating theatre to perform life-saving C-sections for the surrounding communities.
Bridging the gap – Construction and equipping of an Operating Theatre
At present the facility is operating at Health Centre III level, however plans are underway to upgrade it to level IV and operate it as a small community hospital. In order for this to happen, a number of structural developments are required, principally an operating theatre must be built, equipped and staffed to enable the facility to provide EmOC and C-sections. In time, IMG would also like to extend the facilities to include a microbiology lab (to enable rapid TB diagnostic services) and possibly a maternal waiting home.
With the addition of an operating theatre, the focus would sit firmly on provision of maternal and child healthcare for the surrounding community, thereby working to address a large proportion of the most acute health issues found in these communities.
Creating an operating theatre is in fact already more than a mere idea as IMG has secured a promise of funding to cover the equipment required for the operating theatre, including a new ultra-sound and additional related equipment, from an American donor, Direct Relief International. At present the key gap in moving this project forward, is funding for the construction of the theatre.