Demand for health care is not unlike demand for any household service - plumbing for example; we base our choice of provider on numerous factors including cost and reputation, and if the barriers are too high we are quite likely just to try and do it ourselves – sometimes with disastrous consequences.
With this in mind, I have been touring the health centres this week, holding semi-formal meetings with the health centre staff and the elders of the village or suburb. This represents the (almost) final stage in a communication strategy that has spanned several weeks, involving radio messages and meetings with health authorities, mayors and representatives of each community. The aim of these meetings is to minimize the barriers to accessing the health centres we are supporting. Given that the community have used the MSF hospital – which assured free, high quality care – for so long, we must now convince them that the Regional General Hospital is functional once more; that the care will be acceptable, effective and free (assured by the presence of our teams).
So these meetings have felt worthwhile. We have assured the communities that their children will be seen for free at their local health centre, and that if they are referred to hospital the costs will be covered. Fortunately there are various partner organisations involved, such that MSF will only be reimbursing a small percentage of these costs. At the end of these meetings I have the impression that the message will spread, and that the community will at least give the hospital a try. It now remains to be seen if we can deliver what we have promised.
Why should this be such a challenge? I think it is us – our wishes and expectations – that make this task enormous. The hospital has always been functional to some extent, even when there were no drugs and almost no patients. Now all of the ingredients are there – staff, drugs, patients - albeit in limited quantities. The challenge is born of the fact that we wish to achieve a standard of care close to that which we delivered in Bon Marché – in a hospital that survives on one tenth of the ‘inputs’ that we had at Bon Marché. So we invest in the hospital, in training, in providing tools for organisation of services (such as the pharmacy), in equipment and in searching for partners to provide the drugs.
The bottom line is that all of this involves a big injection of cash into the hospital. This seems like cheating in a way – we congratulate ourselves that we are improving standards of care, but the biggest difference between us and the hospital is that we have a bigger bank account. And yet it is not at all obvious how to invest this money for maximum benefit – and I hope that we do bring a certain degree of public health expertise to the fray. If not, what are we doing here?
I just hope the results in two months time vindicate our actions!