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From: Sustainable healthcare – Footsteps 37

Working together to establish health priorities and improve local healthcare provision

by Nyangoma Kabarole.

Two case studies of health centres – one which inherited a difficult situation and another which is a real success story

The Adranga Health Centre - Case Study

The Adranga Health Centre is in Aru health district. It was built in 1970 with funding from the United Nations High Commission for Refugees (UNHCR) to help Ugandan refugees in Aru. At first this health centre was equipped both in materials and in medical supplies by the UNHCR without any assistance or support from the local population. Case Study

After the departure of the UNHCR, this health centre was handed over as a free gift to the community. Unfortunately they had no experience in managing a health centre. Materials and equipment were stolen by uncaring people, leaving the centre in chaos. A health committee was created but it soon ran into difficulties, because people were used to receiving free healthcare and did not want to pay the fees that were now demanded. Local people claimed that because the health centre had been a free gift to the community, healthcare should continue to be free of charge. Finding they were unable to manage this health centre properly, the people handed it over to the Anglican Church.

Two responsible and well educated people from Aru took the responsibility and the initiative of closing down both the Adranga Health Centre and the old health committee and its activities. Instead they elected a new, small committee made up of three local people whose role was…

Only once this is done will the Adranga Health Centre reopen with the freedom to evolve and progress.

In conclusion, I believe that the evolution of a successful health centre depends particularly upon…

Nyangoma Kabarole is Director of the Medical Service of the Anglican Church in Boga Diocese.

The Mabuku Health Centre- Case Study

Until five years ago, the Mabuku Health Centre in North Kivu province was just another rural health centre, struggling financially and depending on outside funding for major needs. They averaged 5–10 consultations a day, and 20 deliveries a month. Today it is very successful, both with curative care and in reaching out to the population with an effective community health programme.

There are now 25–30 consultations each day, 130–150 deliveries a month and a team of 28 community health workers, locally trained and based in the 14 surrounding villages, as well as a programme for over 100 malnourished children. It is hard to pinpoint the causes exactly, but a combination of factors seem to have come together so that today the busy curative side of the work is now able to support almost fully an expanding community health programme to the 25,000 people in its ‘catchment area’.

Factors for change…

More than a dream

All of this has resulted in a high degree of ownership by the population, both of the health centre and the community health programme. When local people finished building a new brick maternity ward (completely on their own and with health centre receipts) they insisted on calling it Maternité Wetu (Our Maternity)!

Needless to say, there are still plenty of problems to overcome, but we have been greatly encouraged by this integrated approach and see that a project like this – with well trained community health nurses and an initial helping hand to get it off the ground – can make the word ‘sustainability’ a bit more of a reality than a dream, even in one of the world’s poorest countries.

Compiled by Maggie Crewes, Co-ordinator of North Kivu Medical Service, CAZ Boga, PB 21285, Nairobi, Kenya.

Creative community involvement

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