This and other posts that follow are taken from an interview with Dr. Ian in the Summit Business Review.
Summit Business Review: You have set up IHK successfully and you have been prominent in providing affordable healthcare in the country. How have you managed to achieve all that?
Dr. Ian Clarke: I am a Ugandan citizen, although I come from Northern Ireland. I have lived in Uganda for 22 years now. I have therefore experience in both a developing and a developed country. My passion is for accessibility and sustainability of healthcare delivery. If I had continued spending all my time seeing individual patients, I would not have had time to develop and facilitate, the systems and the people as part of International Medical Group. My vision has been to set up facilities that are recognised as a centre of excellence in the provision of health services and because I have chosen to do this in the private sector, I also have to make the model work commercially so that I can pay my staff and run the infrastructure.
We have three things that drive our business decisions: First, is the normal bottom line of being commercially viable – you have to make some money to do that. Second is social impact i.e. to make a difference to people through our delivery of medical services. And third is advocacy – to influence policy for the better. Those are the values that have influenced our strategy and business model.
In health care, one must be willing to sacrifice. I started off from the village treating people under a tree deep in Luwero, just after the war that brought the current Government to leadership. From there, we started a mission hospital – Kiwoko hospital. After 6 to 8 years, I saw a gap in health care delivery in Uganda – especially the provision of quality health services. We have built up the infrastructure of International Medical Group and with my team, we have also been finding ways to use our own infrastructure to reach out to the poor. We do sort of cost sharing – whereby we charge the middle class, and channel some resources to the poor through International Medical Foundation. We have actually used the private sector to develop the facilities which are then also used to reach out to the poor. (an example of this is our clinic in Lira, Northern Uganda)
This and other posts that follow are taken from an interview with Dr. Ian in the Summit Business Review.
Summit Business Review: Comment on the state of the Government Hospitals in terms of service provision compared to the private sector.
Dr. Ian Clarke: The government allocates funds towards to the public hospitals. The private sector gets no support at all. We are currently in the process of lobbying to get more incentives towards the provision of health care by the private sector. The private sector providers take care of the health of around 50% of the population thus saving the government money. However when one invests in advanced medical equipment which is expensive, the service provider must then charge a relatively high fee in order to recoup the investment. This equipment is also often purchased through a bank loan at high interest rates. Often the general public cannot afford to pay for such services, hence the Government could subsidize the cost of the equipment in order that we charge less when they send us patients.
We are currently advocating public private partnerships (PPPs) and Ministry of Finance is currently looking at the best operating modalities. One practical proposal is where government, for example, could contract a private hospital to deliver a basket of services in a region, to a specified number of people on the basis of capitation fees, i.e. a fee per person per year. And the hospital can be audited on the fulfilment of the services by a reputable audit body which is beyond being compromised.
There are different models that can be used to organise the health sectors if somebody thought outside the box.
Facilities including furniture, equipment and space.
Staffing for Hope Ward, Physiotherapy and Cancer charity including consultant surgeons, physician and other specialists.
Commitment to at least 30% of every bill, UGX 12m from IAA, 60% of total Hope Ward costs in 2009 (a total of UGX 399m in 2009).
Investigations, treatment of infections and surgery for cancer patients.
Other Partners’ Inputs:
Suubi Trust - chemotherapy as well as donations to cover a percentage of Hope Ward costs (31% of costs in 2009) UGX 21m in the first half of 2010.
Four bed sponsorships (worth UGX 33m per bed for one year) from: Muvule Trust, Narrow Road, Bead for Life & Stanbic Bank.
UGX 5m from MTN as well as UGX 3m collected from the fun run they sponsored.
Project Outcomes and Impact:
On this project in 2009 we provided 248 admissions for very poor people in need of complex in-patient medical care including life saving surgeries and admissions to the Intensive Care Unit. In the first half of 2010 we received 127 admissions.
On average Hope Ward provides treatment for about 24 people every month.
This and other posts that follow are taken from an interview with Dr. Ian in the Summit Business Review.
Dr. Ian Clarke: Chairman International Medical Group
Summit Business Review: Quality health care is very expensive in Uganda. What do you think should be done to make it affordable? What is IHK doing in this regard?
Dr. Ian Clarke: Good health care is not necessarily expensive, but private healthcare is just perceived by the public to be expensive. This of course depends on where they have gone for treatment and the drugs which have been prescribed. At International Medical Group (IMG) which operates International Hospital, International Medical Centres, IAA health care, International Health Science University and International Medical Foundation there are different ways of accessing medical care. International Medical Foundation takes care of charity and community projects and is non-profit. International Hospital provides secondary and tertiary level care. International Medical Centres provide primary and family practice care. IAA Healthcare is a health maintenance organization (HMO) which provides prepaid schemes for both individuals and companies at affordable prices. For example a company would generally pay not more than 350,000 per person per year for the delivery of medical services which includes ambulance in emergency situations, general practitioner (GP) services, drugs, consultations, investigations and hospitalisation. I would say that this kind of package is affordable for many people, but Ugandans are not good at budgeting, especially planning for their medical care and the related emergencies. It is only after they are involved in an accident and are taken to the intensive care unit (ICU), that they find it expensive, but such emergencies would be covered if they were on an insurance of a prepaid health scheme.
At IHK, our fees are below the industry rates, considering the nature of treatments we provide. Some of them are complex diagnoses and obviously the pricing is a bit higher, although affordable. IMG seeks to provide a complete medical service, with compassionate nursing and excellent patient conditions at an affordable price. This is achieved by using modern medical equipment and the highest standard of medical expertise.
IHK and the IMC centres seek to provide quality healthcare to the middle income segments of the market. For the very low end market, we operate the foundation, People who have complex medical conditions like heart related diseases can be taken care of through IMF and Hope Ward.
My Name is Nagawa Beatrice from Mukono District, Nakisunga sub-county, Kakuba Village. I am a widow. I learned of IAA RVZ services in 2008 from a community based volunteer attached to the clinic. He took me to the clinic and I was enrolled in the HIV program.
In May 2010, I developed cough, severe chest pain, diarrhoea and weakness. My son supported me on his bicycle to the clinic. I was weak, in severe pain, I couldn’t walk, and I was in a confusion state. People in the Village thought that I was not going to come back alive.
The clinic staffs organized for my transport and I was rushed to Hope Ward. I am grateful to Management of IMF, I was treated freely, fed and well taken care of. I thank Management of Royal Van Zanten and clinic staffs for their support. I can now work in my garden and take care of my children.
The environment in Hope Ward brought a smile in my face.
Hope Ward gave me hope to carry on.
The Chairman LC1 had this to say;
I thank IMF, Royal Van Zanten and the clinic staffs for the Good work they are doing in our community. Most of our people are affected with HIV and treatment is very expensive of which they cannot afford. Thank you for helping Nagawa, you gave her hope to continue taking care of her children.
We are pleased to announce that after the first six months we now have 24 Bataka Groups with 4,663 members.
eQuality Health is an innovative health scheme that seeks to enable all members of the community in Bwindi to access sustainable and quality health services.
You can read about this scheme by clicking on the image above or read some earlier postings by clicking here.
1 week after the bomb blasts, we have 2 patients still in ICU.
A third patient has been moved to IPD 2 in a stable condition (She has regained her vision, but still see things/people as double. Headache is reduced and is taking food by mouth)
Both ICU patients continue to be in critical condition.
M1 has shown some improvement and has been mostly out of ventilator for last 2 days. He opens right eye some times. But still is unconscious and and has fever. CT scan repeated here yesterday showed extensive brain injury. ENT review today after noon for review of trachestomy and possible bronchoscopy.
M2 also had a great progress with his body swelling significantly reduced and able to use both upper limbs. He had been in good spirits and had been communicating by writing. Still draining air and fluid through right pleural drain. Running high temperature. Still paraplegic. Saliva is leaking through the tracheostomy wound. He is very sick and has refused to have feeding(through the N/G tube). ENT surgeon to review today after noon.
My Name is Regina, I am 22yrs from Namaiba Village, Nakisunga sub-county, Mukono District. I used to fall sick most of the times, a concerned neighbour who is also a peer educator from Royal Van Zanten advised me to visit their clinic for HIV blood test. I went to the IAA RVZ Mukono clinic in 2009 October and I was diagnosed HIV positive. I was enrolled in the HIV program and I was able to access free treatment.
In July 2010, I developed severe diarrhoea, fever and vomiting. I was rushed to the clinic in bad state. I could not walk, eat or drink. I was very weak and had lost hope in life. I knew I was going to die.
Royal Van Zanten management arranged for my transport and I was rushed to International Hospital Kampala Hope Ward. With support from IMF, I was treated, fed and well taken care of freely. I stabilized after a few days and was discharged in good condition. I can now walk and eat.
I thank Management of IMF, Royal Van Zanten management and the clinic staff for their support.
Regina’s mother had this to say:
I had lost hope. I thought my daughter was going to die but when I reached the hospital I knew she will survive. I thank the Management and all the staffs of hope ward for their spirit of hospitality.
Here’s a short piece that went out on NTV Uganda; it shows Dr. Ian doing some ward rounds at IHK and an excerpt from an interview with Kevin in which he discusses the offer of payment by the Uganda government.
10 weeks from empty hanger to 4 new lecture rooms; students started today, we will build another 2 floors later see pix http://bit.ly/9swKcF - 4 days ago
Africans do not want or need Britain’s development aid; debate sparked by letter to Telegraph from Andrew Mwenda et al. http://bit.ly/aboC4c - 4 days ago
Short piece published in Metro Magazine gives overview of International Hospital Kampala - Healthcare with a difference http://bit.ly/9A3sIu - 5 days ago
IHK Security team received training from senior members of Uganda's anti-terrorism unit. They look smart in the IHK Ts http://bit.ly/bKgbQl - 5 days ago
Uganda’s maternal health among worst in Africa. Current maternal mortality rate 435 deaths per 100,000 live births. Target for 2015 is 131. - 6 days ago
Concerns about ARV stock-outs and MoH only supplying government centres; this increase in PEPFAR funding might help http://bit.ly/b9ZeHO - 6 days ago
McKinsey report on Africa from Poverty to Power by Duncan Green » Africa’s four different kinds of economies http://bit.ly/94MudE - 6 days ago
New studies in Uganda; married or co-habiting couples stand higher risk of contracting HIV than single or young people. http://bit.ly/bK2tTD - 1 week ago
Probs in Katine with Village Health Teams; we're hoping to work with Lira VHT so will need to learn lessons from Amref. http://bit.ly/9vVML0 - 2 weeks ago
