Bataka Twetambire. let us heal ourselves

Transcription

1 Bataka Twetambire let us heal ourselves A plan for a health scheme that enables all members of the community in Bwindi to access sustainable and quality health services Fabulous idea for a health scheme. This is all wonderful stuff Stephen Fry, actor. Dr Birungi, Principal Medical Officer December 2009

2 The Challenge of Sustainable Health Care in Bwindi How do poor people living in rural Africa afford the quality of health care that they need? They cannot rely on Government. By the time cash trickles down from the capital city much of it has been lost. At Bwindi Community Hospital we receive less than 1% of our funding from Government. They cannot afford the full cost of each service. User fees force payment upon those who are least able to afford to work to pay hospital bills, leading to catastrophic health expenditure when people have to sell land or animals to pay for treatment. They cannot rely on donors forever, as support will eventually dry up leaving the community with no health care. equality the the solution Bwindi Community Hospital has worked together with a Ugandan partner, International Medical Group, to design a sustainable solution to the funding of health services in Bwindi. We are starting a health scheme called equality Health Bwindi. This innovative scheme will help the community to help itself, and if it works in Bwindi it can be replicated in other parts of Africa. equality Health Bwindi needs an initial investment of money from supporters, but should become locally sustainable after about five years. Teaching at an outreach clinic near Bwindi

3 Health workers on the children s ward equality Health Bwindi is a new health scheme for an established Ugandan Community Hospital which: Enables all people in the remote Bwindi area to pay for their health care before they get sick through an annual payment of only $3 for each person aged five or over, and with free care for children under five years Defines quality through the equality Health Framework which guaranteed a minimum level of service, measures patient satisfaction, protects the poor and the Batwa and incentivises prevention as well as cure Independently measures access and quality so that the Hospital is not judging itself and gets paid according to the quality of care equality Health Bwindi shares the burden of payment for health care and enables people to take responsibility for their own health with: 50% from community members 50% from donors Over time the community contribution will increase and donor support will diminishes until the community are funding all of the cost

4 Services covered under this health scheme Services available to 45,000 people Outpatient clinics for people aged 5 or over Admissions to Hospital for adults and children over 5 Dental care Surgery Byumba Health Centre II Chronic care clinics All necessary drugs Part of the equality scheme Annual outputs 30,000 people a year seen as outpatients or on outreach 1,500 admissions for very sick people each year 2,500 dental treatments 150 major and 400 minor operations 24 hour care in the Batwa settlement of Byumba Clinics for eyes, diabetes, epilepsy, mental health, skin, high blood pressure and orthopaedic problems 50,000 prescriptions a year The Hospital has other programmes that are not part of equality. Health care for children under five, our HIV service and our maternity and family planning programmes are all supported in other ways. They could all be assimilated into the equality Health Bwindi scheme in the future. Bwindi Community Hospital at night

5 How the funding works? We are looking for donors who would consider matching the contribution to this scheme that the community are making for themselves: 45,000 community members x $3 each = $135,000 Donor support = $135,000 Total cost of Hospital services (2010) = $270,000 Queue for the eye clinic in Bwindi Nobody will be left out. Communities will join in groups and make their payments to equality through existing Burial Societies. equality will make an annual capitation payment to the Hospital of $6 per person (for the first year). The Hospital has to meet the quality standards of the scheme whilst maintaining expenditure on health care at $6 per person covered per year. Bataka Groups Groups Burial Societies The funeral is a very important social event in Ugandan culture. During the worst days of the HIV epidemic it was hard for families to keep up with the cost of burying people with dignity as death rates increased. Communities came together to share these expenses by contributing monthly to burial societies. These democratic groups run at a village level, are wellorganised, and are trusted by the people. We are engaging with them to collect the premiums for the equality scheme.

6 Predicted uptake of equality Health Bwindi scheme in ,000 45,000 Cumulative members 40,000 35,000 30,000 25,000 20,000 15,000 10, % uptake 80% uptake 60% uptake 5,000 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec By the end of 2010 we plan to have 45,000 paying members of the scheme in the Bwindi area. We have held focus groups to set the price ($3 per person over the age of 5) and almost everyone has said that this is affordable. People will earn the money to pay for this largely by working the land. Our database (a sample of which is shown below) will help us to ensure that the poorest are not left behind as we keep the scheme affordable for all.

7 In 2010 the scheme will cost $135,000 ( 90,000) from the Community $135,000 ( 90,000) from Supporters In subsequent years the community contribution increases and donor support gradually reduces. By 2015 the scheme should be self-sufficient. How will I be able to donate money if I want to support equality? We have charities in the United Kingdom and the United States through which 100% of money donated and earmarked for equality will be transferred to the scheme. Please contact us at BwindiHospital@gmail.com if you are interested in helping. How will I know if this solves the problem? Bwindi Community Hospital will publish full information about the use of this scheme on our website The equality page already has a presentation about the scheme and the full equality Framework. We will publish monthly financial and activity data on this page. Most of the population of the Bwindi area are already registered on our database and we will track their uptake of this scheme. We have collected GPS data and indicators of poverty and ill health. Our monitoring will especially focus on making sure that the poorest in this society, including the Batwa pygmies, are accessing the health care that they need. Chart showing the relative contibutions of the community and donors to the cost of the equality Health Bwindi scheme $10 $8 $6 $4 $2 $0 Donor support Locally generated income cost per person per year

8 Our Vision A healthy and productive community free from preventable disease and with excellent health services accessible to all Dental education equality Health Bwindi already has 30,000 community members who have showed an interest in the scheme. We start collecting payment from Bataka groups in January They are showing their commitment to help themselves towards better health care. We are ready to begin... Bataka Twetambire let us heal ourselves x =