Access to Use

09Aug09

The support mechanisms in developed countries are intangibles we should not take for granted.  For example, when a teenager opens a bank account, the bank manager spends time to teach the teenager the basics of saving and the use of credit and withdrawals.  When a family purchases a refrigerator, it is assumed the house is connected to the electricity grid and the local government ensures supply.  It is also assumed that the family will be able to afford the monthly electric bill to enjoy the daily benefits that the refrigerator brings.

Message of the Day:

When investing in capital expenditures for development, one must ensure there is adequate funding for OPERATIONAL USE.

In a hospital setting, it is important to remember that quality machines need quality maintenance and quality consumables to produce quality results and accurate diagnoses.  If you have a CT machine in the radiology department, it is important to have reagents, contrast dyes and film on hand to print images for medical radiologists to analyze.  Therefore when deriving the cost of a CT scan, the hospital must consider the cost of machine use, direct labour costs of staff (nurses to prep the patients, radiographer, radiologist), reagent and medical consumable cost (direct materials) and hospital overhead to run the department.  Ultimately, the revenue charged per patient should be adequate to at least cover the costs and this price point should be ACCESSIBLE for PATIENTS to USE who are in need.

Here are some thoughts along the development front:

When NGOs or charities donate capital expenditures for hospitals in developing countries (for example: a dental lab facility, a ultrasound machine or the like) is future funding provided for USE? Is there part of the funding budget set aside to hire qualified dentists to use the equipment, disposable latex gloves and cleaning supplies?

When volunteers fundraise and build a school in developing villages, is there part of the budget allocated to hire qualified teachers to staff the school? Pay for general maintenance (ie. roof repairs), install a Lunch @ School program to poor ensure kids are fed a meal at this school? Who will continue to fund the operational expenditures once the bricks and mortar are set and ensure the school is not left empty and barren?

The funding of operational expenditures within an annual budget for an on-the-ground Not-for-Profit entity such as hospitals and schools then becomes an essential part of strategic planning.  Sure, “strategic planning” and “accurate budgeting” may not be glamorous in any country, but intangibles of knowledge support and guidance should be built into development projects.  The “donations” should not be additional burdens on already over-stretched operating cycles.  There must be sustainable sources of operational funding for use once the capital projects are completed.

Final end users and recipients of these donated capital projects should be able to afford utilization to be able to access the benefits.

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One Response to “Access to Use”

  1. 1 Ramona

    I think that you have written about a really important point Jules – planning for operational use – which is a lot to do with being practical. There is no point in designing and developing a good or a service (e.g. equipment, policy, financial products) if it cannot meet the need that it was designed to satisfy.

    I think working on the ground and talking to the people who encounter the problem is the best way to avoid being operationally useless – in addition project plans should cover all stages of the problem & solution from start to end (i.e. identifying context, defining the problem, designing a solution, then planning implementation, monitoring and review).


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