What challenges do we currently face? (5)

While we have come a long way on our journey towards eliminating barriers to a healthy community, but we are still facing many challenges. I will only highlight five key areas: space, personnel, intelligence, self-sufficiency and access to genuine medicines.

Space:

Figure 1 The Health Centre, Mayo-Lope, Gembu, Taraba State

·        The current health centre as you can see in Figure 1 above, is an old building in relatively poor condition (e.g. leaking roof) which is unsafe, costly to repair (rectifying uses up member contributions), being on rental/short-term tenancy also risks our long-term sustainability.

·        It is also small and is not purpose-built as a hospital. We have received donated hospital beds, laboratory and diagnostic equipment (including mobile x-ray and ultrasound scan machine) that will improve our diagnostic capability but we are unable to install due to the limited space.  See Figure 2.

·        We also have delivery beds and other equipment that will support the provision of emergency obstetric care and staff with relevant skill, however, there is no available space for admission to enable us to commission this service, which is a major area of need for the community.

·        As mentioned above, we also want to expand the membership of the health cooperative to 1000 (and 10,000 longer-term), and so desperately need a larger space to be able to provide high-quality healthcare services that can meet the needs of all individual and sponsored members. See Figure 3, floor plan of the proposed new site.

Figure 2 Health worker training on operating and interpreting readings on pulse oximeter monitor

Figure 3 Floor plan of the proposed new site

Personnel:

·        We had challenges with our ability to recruit and retain health workers, improve patient safety, expand services, and increase satisfaction rates, thereby growing and sustaining our cooperative membership.

·        The cost of the health workers is by far the largest proportion of our cost, see Figure 4 and Figure 5. On average this is 75% of our cost.

·        Our remote location also makes it difficult to recruit and fill up personnel gaps needed for high-quality services

Figure 4 Total monthly cost compared to total monthly income

Figure 5 Monthly staff cost compared to other costs

Intelligence:

·        Effective use of electronic records (EMR) enables remote support for health workers on the ground to be increase responsiveness to the changing healthcare needs of the community and keep pace with global trends in healthcare quality and safety. Figure 6 shows the performance of the scheme produced using manually entered data on an Excel spreadsheet, valuable information for decision-making.  A full EMR can make real-time evidence-based decision-making a lot easier.

Figure 6 Performance chart

Self-sufficiency:

·        While we are on course to reach our target of 1000 paying and sponsored members by the end of September as shown in Figure 7, we face a major challenge in getting our members to renew their monthly contributions as shown in Figure 6 where Renewals only accounted for between 7% and 21% of monthly income.  The scheme can only achieve self-sufficiency with sustained contributions.

Figure 7 Growth in cooperative membership

Access to genuine medicines:

·        As I speak, we have a carton of medicine seized by NAFDAC undermining a key component of our business model of getting donated medicines from our partners to bring down the cost. This happened despite applying more than six months in advance without knowing the outcome. Figure 8.

·        There is no easy and effective procurement platform for genuine medicines in Nigeria, which is a major gap for the enterprising ones among us. Buying locally at the site of the health centre means higher cost and no certainty about the quality of what you are buying.

Figure 8 Medicine cabinet at Dechi Health Centre

Next time…


A step-by-step journey of how we got to this point and the challenges along the way.

To find out more: misaddiq@gmail.com