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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 May 31, 2009 12:06 PM