June 08, 2009
Making an Impact: Patients First
This past Friday, we had an office-wide meeting at the headquarters in Kigali. It was a refreshing and inspirational time for me. One of the biggest reasons why I decided to join the Access Project and come to Rwanda despite my qualms about living in the villages was its mission to increase access to and quality of healthcare in Rwanda by increasing knowledge, skills, and capacities of healthcare management staff. This meeting certainly spurred me on even more.
In our work, we evaluate 8 core competencies of health centers and make recommendations -
1. Management of Human Resources
2. Management of Physical Infrastructure
3. Management of Finances
4. Management of Mutuelle (a national insurance plan for non-military personelle and those without private insurance)
5. Management of Pharmacy
6. Management of Health Services Statistics
7. Supervision and Community Involvement – Planning and Coordination
8. IT Management
Some of the challenges that we face at that Access Project is not a government/authoritative identity. A little background on the government: Since the inception of the new government, Rwanda runs a decentralized government and health care system. Each province, district, sector, and cell are delineated clearly (although I am still unclear as to whether power is also clearly delineated as well).
The District Health Advisors (DHA) are employed by the Access Project to conduct these audits and make recommendations. Thus, the DHA are often required to build relationships with the district authorities. When district authorities are uncooperative, it makes our job 10 times harder. Rwandans are very much an obedient culture (one of the reasons contributing to the “success” of the genoside in 1994). They also do not like people coming in and telling them what to do. It takes a lot of people (besides the intellectual elites) a long time to change their practices. Often times, I have to spend hours demonstrating one basic skill and in about 10 minutes, they’ll return to their old habits.
Recently, I’ve found my niche in my work. Although patient flow isn’t one of the areas that we measure, I am in the process of helping the health center in my umudugudu (village) - Nemba Centre de Sante with decreasing wait time for consultation. Although I have anecdotal information from patients that they’ve waited up to 6 hours for consultation, I recently started having the staff at the receptionist table collect data for me. It’s astonishing that not only is there no organizational system in which patients are seen by order of arrival, there’s no clinical triage system as well! A quick look at the Fiche D’inscription (Patient sign-in) that I developed, I noticed that someone with a simple flu was seen in 20 minutes while someone else with a gapping wound did not receive a consultation for 4 hours.
Dr. Blaise is completely on-board with my work and he thinks it’ll be very valuable to implement in different districts. Therefore, I will be moving from my current village – Gakenke to another one – either in Musanze or Bugesera in the coming week. It’s always a waiting game in Rwanda. You have to be EXTREMELY flexible – ready to pack up any moment and leave and do something else. But his intentions are for me to help plan a new health center that the Access Project is building in Goshora (Bugesera) in July and work at head quarters with planning and coordination between all of the DHAs. I will definitely like the big-picture view of the organization and the opportunity to work so closely with Dr. Blaise.
For this coming week, my goal is to make a tangible impact at Nemba health center, which is directly next to the hospital. They see more than 300 patients a day from 7:30 – 4pm. Even though that might seem like a lot, there are many more that are turned away at the end of the day or sent to the hospital’s emergency services. My goal is to increase this total number of patients seen in a day and decrease their wait times.
Posted by khytam at 05:38 AM | Comments (0)
May 31, 2009
A Health Center that Needs Major Help
At the worst centre de santé I’ve ever seen….
My week started with the usual site visits to one of the remote health centers, Bushoka, riding for 40 minutes (not so bad) on bumpy roads, up the side of a mountain. This site was an abomination. I do not think I have ever imagined that organization can be so bad and it makes realize all the more how important my job here in Rwanda is – to teach business management skills to health workers.
When we arrived on site, it shocked us to see the waiting area filled with patients. When we arrived at 10, there were more than 40 patients waiting, and by the time it was noon, we find that patients have been waiting since 7am. We checked in their sign in book for mutuelle (a form of national health insurance that they have, which families would enroll and only pay 200RFW every time they visit the centre de santé) and in 5 hours, they saw 15 patients – averaging 3 per hour!!!!
The cashier arrived late to work (and it’s common here….they’re never punctual), so the pharmacist had to take over the cashier/receptionist job. Since the pharmacist was covering for the Cashier, the titulaire (health center director) had to cover for the pharmacist. The wound care room doubled as the janitor’s room. General hygiene and infection control procedures were close to non-existent. (This is actually a huge problem for the country.) In the malnutrition/HIV testing room, a bucket of syringes, used cotton balls, etc. was sitting outside of the room uncovered where babies and children were crawling/walking all over the place with their mothers barely paying attention to them.
When we examined the metrics that we were looking for – pharmacy management, accounting and finance, and planning and coordination, they were just the worse out of all the district health centers. At the crux of it was the incompetence of the titulaire. Many organizations including the Access Project have given her suggestions in regards to how to handle patient flow, daily oversight, etc, but she’s unwilling/unable to learn it. After that center, Ahmed and I were just totally discouraged and didn’t know how it was possible to have people that run health centers not consider the needs to the people!
My plan is to focus on patient flow, staff management, and planning and coordination for Access Project. These are only the beginnings of the many management skills these health centers and directors (titulaires) need to improve quality and access to healthcare.
Posted by khytam at 12:06 PM | Comments (0)
