Healthcare Model Outside Kigali

14Aug09

Visit to a District Hospital

In our second week in Rwanda, we made a trip to the District directly East of the capital, Kigali – called Rwanagana and visited a District Hospital.  The Rwanagana district hospital services a catchment area of 262,000 people and is split into 14 sectors.  Each sector is serviced by a health centre (well, in this case the district is 3 health clinics short as there are only 11 at the time being).  The Healthcare model can be approximately described as such:

Villager –>  Community Health Worker –>  Health Centre à District Hospital  –> University Hospital (CHUK – Kigali or CHUB – Butare) ——-> tertiary referral hospital (King Faisal Hospital, Kigali).

The most common form of medical insurance for the villager is to belong to “MUTUELLE” which at 1000 RWF allows coverage for a family for one year.  At each level of healthcare service covered by Mutuelle de Sante, the patient must be referred up to each level.  At first – you wonder why the villager does not directly approach a district hospital.  Then you remember in a rural setting where geographic distance represents a formidable challenge, the community healthcare worker and the local health centre represent much greater advantages for accessibility.  We first met a girl carrying her Mutale card at the cashier along with a form of referral from her local sector Health centre to district hospital Rwanagana.

Rwanagana is a 200-bed facility staffed by 10 medical doctors – all general practioners called upon for all procedures.  In partnership with NGOs and other organizations, 2 specialists (one pediatrician, one casualty doctor) come into the hospital to help out every week.  Our tour was led by the Director of Nursing, who looked about 18 – but was wise beyond his years in both English and French.

Some interesting notes of the Tour:

–       The design of the hospital layout was amazing.  It was very modular. Different bungalow houses encased departments – ie. the outpatient bungalow, the female ward, the male ward, area tent to treat prisoners, the emergency ICU area, etc.

–       Different modules allowed for great ventilation and airflow. It reminded me of an open-California mall design with lots of sunshine and few walls.

–       One thing has impressed me about Rwandan hospitals is the distinct lack of the “hospital smell”.  I attribute this advantage to the open design.

–       The demand for this hospital is there – patients are lined up and down the steps of each bungalow and according to our tour guide, occupancy of beds is always near full.

–       When I asked the Director of Nursing – what does the hospital need more of? More doctors? More beds? He simply answered “More of everything”.  Demand > Supply in global health and it’s no different in Rwanagana.

–       There are approximately 42 district hospitals in Rwanda

–       The staff proudly showed off their latest machine – a Siemens x-ray machine.  Proud of its presence and when asked how long they waited for the machine, the reply was “two years”.

  • I thought to myself if I were the CEO of Siemens Medical and I went on tours of district hospitals and health centres, I could donate a machine or two out of my annual “CSR” (corporate social responsibility) budget.
  • And then I was immediately angry at myself for that thought.
  • It was at that moment when I was reminded of the pressing problem we are asked to “solve” in Kigali – how to model affordable “USE” of capital expenditures and improve Access to Use.
  • Sustainable healthcare services is not only about CSR and charity only – it’s about increasing Access for the operating scope of the machine
  • THEN I changed my thought as step-in the shoes of Siemens Medical – if I were to donate a X-ray machine to a District Hospital, I would set alongside a small endowment fund (perhaps investment in a social VC group – ie. Acumen Fund) where the returns can be used to train nurses and local medics on the use of the machine and purchase consumable-supplies such as film, reagents, disinfectant, etc. to ensure the operational access tarriffs for patients are low as possible.
  • Which if you think about it as Siemens Medical CEO, would increase my overall long-term demand for X-ray machines (skilled workers knowing how to operate them) and make my co-suppliers happy in the medical consumables business.  =)District Hospital
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One Response to “Healthcare Model Outside Kigali”

  1. 1 Ronke

    thought-provoking indeed! CSR and VC…the world of possibilities!


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