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…
- to educate the population
- to encourage the spirit of self financing.
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…
- the initiative of the local community
- a leader who believes a health centre is necessary, important and valuable for the people
- nurses with training in community health, who know how to work well with the community
- good supervision and advice from experienced medical personnel.
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…
- A head nurse with a vision for integrated healthcare, keeping a good balance between the immediate and pressing demands for curative care and the more long-term vision of preventative care and community issues.
- The allocation of a community health nurse (helped by Tearfund), with sole responsibility for getting out into the community and establishing and expanding various community health programmes. This nurse has no responsibility for curative work.
- A population which has real confidence in its nurses because they provide a quality curative service, with the result that people will listen to advice from these same nurses when they give health education or help people explore some of the underlying causes of ill health in their community.
- An active health committee that meets regularly with good representation from all levels of the population. This committee has a certain degree of creativity that has encouraged community involvement (see box).
- Building maternity waiting homes where up to 50 mothers who either live far from the health centre or have ‘high risk pregnancies’ can wait for delivery.
- Accepting that people who don’t have cash, can pay their bills in produce or livestock which is either sold or given as part of staff salaries.
- Some outside assistance from Tearfund was used to establish different nutritional projects in the community. This focused on families with malnourished children. For example, there is a soya bean project which gives practical food demonstrations to mothers and provides seeds for each family with a malnourished child, for planting in their own fields.
- A policy to keep costs down and encourage patients to come to the centre. As prices were reduced, the number of patients increased and so the income increased. As income grew, the centre was able to add another full-time community nurse and to buy a secondhand motor bike for the health staff, particularly to collect vaccines.
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.