Hope Clinic Lukuli
Not for profit For the community
Strategic Direction 2006 – 2008
Outcomes, Objectives and Targets
Hope Clinic Lukuli
Lukuli-Nanganda Parish
Makindye Division
PO Box 4290
Kampala
UGANDA
www.hcluganda.org
clinic@hcluganda.org
+256 (0)712 200449
Section of Document Page
1 Introduction............................................................................................................................... 3
1.1 The organisation..................................................................................................................... 3
1.2 The Purpose of the organisation.............................................................................................. 3
2 Overarching Strategy................................................................................................................. 6
2.1 Key areas of effort................................................................................................................. 6
2.2 Recognising progress and success........................................................................................... 6
3 Outcome I: Developing Ugandan Management Structure................................................... 7
3.1 Why we are doing this............................................................................................................ 7
3.2 Objective 1: Recruit full-time senior medical professional to develop in-house skills.................. 7
3.3 Objective 2: Share Strategic Direction with founding trustees and current partners.................... 8
3.4 Objective 3: Staff and Committee members manage specialist collaboration programmes......... 8
4 Outcome II: More utilisation of the General Practice services........................................... 9
4.1 Why we are doing this............................................................................................................ 9
4.2 Objective 4: Clinic Staff to gain understanding of client attitudes to the clinic........................... 10
4.3 Objective 5: Utilise Government and District supervisory mechanisms to support
quality.................................................................................................................................. 10
4.4 Objective 6: Address age, sex, ethnicity and other imbalances in client mix............................. 10
5 Outcome III: Continued collaboration with specialist services.......................................... 12
5.1 Why we are doing this.......................................................................................................... 12
5.2 Objective 7: Strengthen and expand the recognition of the clinic by Government
and Kampala........................................................................................................................ 13
5.3 Objective 8: Strengthen and expand medical collaborations with Ugandan groups
(non Government)................................................................................................................ 14
5.4 Objective 9: Support non-medical collaborations through coverage and participation
of corporate supporters........................................................................................................ 14
6 Outcome IV: Develop external management and supervision........................................... 15
6.1 Why we are doing this.......................................................................................................... 15
6.2 Objective 10: Identify specific supervisory tasks that will be required from external
body.................................................................................................................................... 15
6.3 Objective 11: Review of supervisors present in Uganda in the health sector............................ 16
7 Our path and commitment........................................................................................................ 17
7.1 Our Staff – understanding their role and demonstrating commitment....................................... 17
7.2 Learning and Sharing – quantifying our impact and informing others........................................ 17
7.3 Managing and Achieving our Objectives and targets.............................................................. 18
7.4 Continuing our successes as a permanent organisation........................................................... 18
Hope Clinic Lukuli was formed to address an apparent under-provision of health services appropriate for the community surrounding Lukuli-Nanganda in Makindye Division, Kampala. Beginning in April 2000, it worked from a small building with one examination room and a delivery room with a small ward in an adjacent structure. In the following five years it became a registered NGO and undertook construction of a new site, also in Lukuli parish.
In July 2005, the Hope Clinic Lukuli Maternal and Youth Health Centre was opened and a new company limited by guarantee took on the former clinic equipment. It continues to grow as a primary health care facility offering General Practice services.
“That people living near the clinic receive the medical information and treatment they require at a price they can afford and thereby have an improved medical history and general lifestyle”.
The Hope Clinic Lukuli utilises a concept of philanthropic trustees to create linkages with other providers of health information and health services. These trustees are active in identifying gaps in the services sought by the population that live in that area but are not currently available from Hope Clinic Lukuli. The existing or potential implementers of that service, or keepers of that information and guidance, are then engaged to work at the clinic and so provide physical access for the community. Where a cost is incurred in providing that service or information, either the philanthropic trustees or a separate funding organisation is sought to minimise costs to a level which combines sustainability with accessibility. The milestones in the clinic’s growth include:
§ Registration with the NGO Board, as a charity with the tax authorities and with the Medical Registrar responsible for non-governmental health providers (based at the Ministry of Health);
§ Regular meetings are held between the trustees management committee and the on-site medical staff to ensure emerging service needs are noted for the future;
§ Coordination is maintained with the host zone of Kalule and adjoining zones and parishes as well as with the Divisional Medical Officer for the LC III administrative level of Makindye Division;
§ National immunisation policy is supported through weekly child vaccinations using vaccines and consumable equipment provided by the Kampala City Council;
§ Accreditation as a HIV Treatment Centre by the Ministry of Health, Director General of Health Services (April 2006) which allows receipt of free HIV test kits freely from the Ministry;
§ Formalised referral agreements with the St. Francis Nsambya Hospital for general cases and with the International Hospital Kampala for admission cases requiring subsidised charges;
§ As at September 2006, it has existing agreements with national organisations to mobilise the community through peer educators, to provide mosquito nets and water containers to clients tested as HIV positive and is offering paediatric specialist services on a fortnightly basis.
The clinic maintains a General Practice focus. This will enable it to continue to provide services to the community at prices which allow access to as many people as possible and yet, on a month to month basis, enable receipts to match the costs of staff and medical consumables.
The provision of health services in Uganda is by an informal collaboration of Government, for-profit private sector and not-for-profit non-governmental sector. This latter category includes many faith-based organisations and humanitarian relief organisations. The Government tends to operate large referral hospitals, although there are some large church hospitals too. Private for profit is often urban rather than rural in setting and is either an up-market multi-medic facility or a smaller, basically equipped sole practitioner. NGOs work across the spectrum but often specialise.
Hope Clinic Lukuli is unusual as a General Practice NGO facility, rather than being just for orphans, or those with HIV. It is also located in an underserved part of city with no Government hospital, and a Government Health Centre IV situated 5km from the clinic on the Salaama Road. Within 2km radius of the clinic live 53,000 people based on the recent Census. Their health service provision is by a few for-profit private health facilities, many sole practitioners and the potential to use services elsewhere in the city involving travel cost and time as well as formal and informal user charges.
Hope Clinic Lukuli provides a multi-topic location for the sharing of information. Patients visit the premises for preventative child immunisation and antenatal care discussions, as well as curative treatment for malaria and other ailments. It also assists in maternity cases, neonatal care and provides a free HIV counselling and testing service. It therefore has a broad range of people to whom messages can be addressed on topics other than those the person was thinking of when they came to the clinic – eg malaria topics to a pregnant mother, family planning to youth.
To maintain a General Practice medical
service which is welcomed by the community who therefore continue to use the
clinic and promote its use to friends and neighbours.
The recurring assessment and treatment of ailments provides
an income stream for the clinic. The income generated from GP services is
derived from a pricing structure which is slightly above wholesale cost for
drugs and consumables plus an element for the cost of the medical staff (their
salaries). This is levied through a very low consultation fee and lab testing
costs to ensure that the clients can be accurately assessed for an ailment
of symptoms and be able to pay for that care.
The clinic functions on a 24-hour basis and has a staff compliment which permits at least two medical staff on duty at any time. In the daytime, these are accompanied by laboratory and counselling staff as well as cashier, administrator/dispenser and cleaning/security staff. These positions are all salaried and recruitment is based on professional training and ability to support the philanthropic purposes of the NGO and the welcoming style that is key to the clinic’s growth.
Other services are offered to all patients on a “free to the client” basis. These services include child immunisation and HIV counselling and testing. The consumables utilised are provided free of charge by the Government of Uganda, through the Ministry of Health or the Kampala City Council, and include the vaccines, syringes and test kits used by the clinic staff. The staff members who provide these free services and who organise the youth group and peer educators outreach have salary costs. These costs are sought from sponsoring organisations and from collections paid to a UK registered charity called HCLUganda.
Additional services are offered and sought for implementation at Hope Clinic Lukuli on the basis that a separately funded and managed organisation brings its staff, equipment and consumables and deliver their service from the clinic’s premises. These include distribution of magazines such as Straight Talk, or leading youth discussions through the Government’s Youth Truck. The clinic benefits from such collaboration with medical service providers as the clinic can become publicly recognised as a source of their services, and can share their funding resources, as well as utilising the implementation as a form of marketing and visibility for the clinic itself and its GP services.
The clinic approaches non-medical companies with a corporate responsibility programme and offers training or medical services to the community on a topic of relevance to that company. The funding is used partly for fixed asset purchases, partly for consumable items used in the implementation and partly for staff costs or additional staff resources.
The clinic can be contacted at clinic@hcluganda.org and viewed online at www.hcluganda.org
The new facility opened in July 2005. The planning and construction was indicative of the collaborative nature of Hope Clinic Lukuli’s growth. Charitable architects designed the building, the plot of land was granted under a 25 year lease without rent or premium and a charitable builder was on site everyday to oversee the construction. Cement, steel, windows and paint were provided by Ugandan companies with significant discounts. Donations of plumbing fittings, glass blocks and all interior doors were also provided in support of the NGO and its objectives. Grants were provided for a solar hot water system, a large power back-up which is necessary in Uganda, and the medical furniture and equipment to prepare the wards and examination rooms.
The Hope Clinic Lukuli has expanded since April 2000 to a multi-discipline health facility. It is recognised by the community it serves and by the Division and City Council as a provider of health services in Makindye. Having entered the new facility in July 2005, the emphasis has been to develop internal management and client service processes which will allow the NGO to continue to function and maintain an appropriate level of growth in the future.
In the coming three years, concluding December 2008, Hope Clinic Lukuli will:
§ Maintain the core medical and support staff employed in Hope Clinic Lukuli thereby ensuring a continuity of relationship with the community and shared understanding of the Purpose of the NGO;
§ Identify and recruit a Clinical Officer or Doctor to become a full-time medical practitioner based at Hope Clinic Lukuli responsible for the continuing professional development of the other medical staff;
§ Develop the management participation by the founding trustees and other Ugandan leaders living near the clinic to ensure it continues to have supervision within the community;
§ Increase the number of out-patients and non-maternity admissions who attend the clinic each month whilst improving the collection rate for fees charged, thereby increasing the financial contribution from GP services to the overall maintenance of Hope Clinic Lukuli;
§ Develop and maintain collaboration agreements to raise the capacity of Hope Clinic Lukuli to provide family planning, reproductive health, maternity and neonatal services;
§ Continue the collaboration agreements with HIV counselling, care and support providers to enable free advice, testing and prophylaxis provision to be available at Hope Clinic Lukuli;
§ Expand the visits by medical staff and counselling staff to households, schools, religious establishments and other groups within 2km of the clinic (ie outreach) to deliver health and welfare messages and increase the awareness of and accessibility to the clinic’s services.
On opening the new facility (July 2005) out-patients numbered 350 per month with an additional 50 clients for either ANC check-ups or admitted for deliveries. In the year to July 2006, the average monthly out-patients, excluding maternity, was 450 clients; averaging 610 in the final three months. Maternity cases were 75-80 women per month in the three months to July 2006.
The attainment of the strategy will include maintaining these patient numbers, across a broad range of ailments, ages and gender. Growth can be estimated at 15-20 additional attendances month on month for OPD and 2-3 additional maternity cases month on month, including births.
Through the outreach and discussions with the community leaders and members of the religious organisations, schools, LC councils and others, we will be able to establish the comparative reputation and perception of Hope Clinic Lukuli. This should include medical staff performance, state of the facility infrastructure, availability and suitability of information and advice and the continued General Practice emphasis of the health unit.
§ The Hope Clinic Lukuli must be managed at a strategic level and on a day to day basis by Ugandans living among the community it serves or employed full-time at the clinic;
§ The off-site management and strategic direction from the founding trustees must be reduced from a dependency to part of the wider collaboration framework;
§ Sustainability combines financial day to day operations with indigenous drive to manage the clinic and continue its philanthropic purpose with fee based and free-to-the-client services;
§ Emphasising the long term and well managed nature of Hope Clinic Lukuli will help gain supportive interest from other health practitioners and so promote collaborations.
The clinic has Registered Nurses and Registered Midwives as the senior grades of full time professional staff. Four days out of seven, and no nights, have a Doctor on duty, one night has a Clinical Officer/ part trained Doctor on duty. Most liaisons with new organisations for medical collaboration and all linkages with non medical organisations (potential funders) are by the philanthropic trustee management, some of whom are non-Ugandan.
The Ugandan members of the founding committee provide a key relationship with the local church and community leaders as well being conduits for patient feedback. The Administrator based at the clinic is responsible for continuing the collaboration relationships with the medical partners including reporting and financial records. The medical and administration staff receive planned and un-announced visitors and potential collaboration partners and describe the work and needs of the Hope Clinic Lukuli but do not have access to strategic direction plans.
§ Existing collaboration partners will be introduced to senior medical staff and other members of the founding trustees;
§ Founding trustees to receive the Strategic Direction document and personally take on the role of developing new collaborations with medical partners and also funding partners;
§ Existing financial partners will be introduced to the administrator of the clinic as well as the co-Chair, both of whom will be encouraged to make new contacts in other organisations;
§ External medical and health unit management staff will be used to build internal capacity for team working, collaboration and strategic thinking (eg VSO, Electives programmes, HVO);
§ Senior medical staff at the clinic will receive copies of the Strategic Direction document.
The post will combine the skills inherent in a trained Doctor/ Clinical Officer necessary for a General Practice facility with a role of building medical and team capacity among the other members of Hope Clinic Lukuli. It will require an appreciation of delivering medical services in a resource-limited setting, both from the point of view of the equipment within the clinic, and the cultural, educational and financial constraints experienced by the patients and their caretakers. The post holder will develop easy reference guides for other grades of medical staff, and support staff, to be able to safely manage patients, prepare the clinic and instruments for new clients and maintain the equipment and consumables stores. Developing a robust referral system will also be important as well as networking with community organisations which can benefit from the clinic’s medical facilities.
The medic will be recently qualified, but with the commitment to the profession that suggests they have considered alternative places of work to practice medicine but identify with the purpose and ethos of Hope Clinic Lukuli. Candidates may be identified from existing health providers or through the recruitment procedures of those other organisations. Open advertising is a later option as filtering of respondents would be technically and administratively difficult.
The clinic staff have varied educational and social backgrounds which affect the extent to which they intend to have ongoing employment with Hope Clinic Lukuli. The senior medical staff member will need to determine the capacity for further medical training and client service training among the trained medical staff. It will also be important to assess the non-medics who have a key role in client service delivery and to identify training needs and to raise their appreciation of medical matters relevant to their effective job delivery and the success of the clinic as a whole.
The committee members who continue to be active in the management and promotion of the clinic will each receive drafts of this document and offer amendments to the extent that the final document will be something they can endorse and implement.
A key role to be identified is the liaison person who will engage with the local community (as individuals), the local council, Kampala City Council and other non-health organisations.
The General Practice operations of the clinic require support and supervision from people not involved in the day to day functioning of the clinic. This overview enables management to observe and notice issues and strengths which may also be observed by patients and partners and so should be addressed or learned from. As part of the transition to this role, the management and clinic will be the key contact and supervisors for am existing collaboration – Stay Alive.
Most collaboration have arisen from one or two committee members although the receiving of the initial visitor to the clinic or implementation of the collaboration is almost entirely handled by the clinic staff. The challenge for this coming period is for the trustees and the staff to identify new opportunities to collaborate with a specialist or expand a GP service. Once identified, they can then continue to broker that link and determine how it will operate.
The General Practice nature of the clinic is part of its original purpose and also represents part of its competitive advantage enabling it to continue its steady growth. By offering a broad range of primary health care services, members of the community can rely on a single site for all health advice, information and treatment. It should not have barriers based on religious affiliation, gender, household structure or HIV status – but will focus on low cost treatment as a core activity. The advantage of such a model is that the General Practice out-patients, admissions and maternity service are a source of revenue to Hope Clinic Lukuli. That revenue is intended to cover the staff and drug costs relating to those GP services, including maternity and admissions.
The General Practice service also provides a surplus of revenue over costs, which is primarily used to enable sufficient staffing for free-to-client services to be offered – eg child immunisation and counselling. There is an overlap between this Strategic Direction component and that of Specialist Collaborations as these collaborations can begin as an external initiative but be continued as part of the General Practice free-to-client programme.
The General Practice service is growing in terms of patient numbers seen per month. The key measure is the monthly diagnostic report to the Ministry of Health/ Division (HMIS #105) which is a summary of the actual treatment records. The services are largely unchanged, in terms of the technical areas which are offered, since the new facility opened in July 2005.
There is insufficient information among the clinic staff or management as to the quality perceived by the clients in terms of personal service, timeliness, effectiveness of treatment and whether all needs are met. There is also no clear understanding of the return visit pattern of clients we see and whether quality or other factors arising from their prior visits could negatively impact on their return. Equally, the positive elements are not sufficiently understood so that they can be reinforced, shared and publicised. There is a threat to the sustained growth of the clinic’s General Practice service if these factors and measures of performance are not investigated and improved upon.
The parties to work with are patients as individuals and with the groups in which they circulate and discuss their health or other services they have received. These groups may be employment based, neighbours or a religious or other activity grouping; such as Mothers’ Union or a sports team. The Local Council system is already used to inform the community of events and services but is not yet used as an effective source of information on the clinic’s performance.
The range of services, for which a fee is charged, is not expected to change in the medium term, although the grades of staff providing them may be raised – largely for perception reasons. There will be complementary services for which a fee is not charged and these will need to fulfil a clear need among the community and preferably one that they have expressed and hence value in its provision. Increased use of services is expected to result from: greater awareness that the services exist; understanding of the quality and price positioning compared to other health providers; and identification of, and the addressing of, staff-client relationship issues. These factors affect the likelihood of a client recommending the staff member or the clinic as a whole to another person who then becomes a client.
Whilst some staff live in the zones of Lukuli parish, others will require invitations to attend LC 1 meetings and other gatherings. Throughout a month there are sports group, Fathers’ and Mothers’ meetings as well as the opportunity for theme sessions at the clinic (such as nutrition) through which we engage with the community. These meetings will represent the local level Health Unit Management Committee that was recommended to ensure coordination and that needs are served.
The client registration form gathers neutral information (age, gender) and some socio-economic information as well as maternal history. A more specific survey tool is required to establish service strengths from the view of infrastructure, operational practices and staff interaction. This may be best conducted by out-sourcing to a trusted group or by peer discussions.
An action plan will be required to publicise and continue the strengths which have been revealed from the gaining of client attitudes. Where these differ from expectations or experience of other providers, the findings should be reviewed for external contributing factors. The weaknesses will require analysis as to whether they are systematic in nature or unique to times and individuals or developed from a specific event. The specific weakness will require corrective action for current evidence and also appropriate announcement or presentation of changes in systems to prevent recurrence.
The Yellow Star Programme assesses infrastructure quality and staff performance in terms of technical skills and manner with clients. The clinic will organise for an assessment of the Yellow Star grading of Hope Clinic Lukuli and its staff and for training to the staff in how to improve that grading. A programme of quarterly follow-up visits will be planned with the intention of achieving 100% attainment by the end of this plan period – December 2008.
The Health Sub-District is tasked with supervision and periodic inspection of health facilities and active engagement by the clinic will be required to ensure those visits are meaningful. This will be with the HC IV as well as the Divisional Medical Officer situated at the Division offices. The associations for family planning (FPAU), midwives (UPMA), Aids support organisations (UNASO), counselling (AIC or TASO) will also be encouraged to make one visit per quarter.
The analysis of patients visiting Hope Clinic Lukuli shows that half the patients are over 20 years old and that 66% of all patients are women. Among the under 20 year olds, teenagers are greatly outnumbered by those in their first five years and overall teens (11 to 19 years) are under 15% of all clients. These clients are particularly at risk to infections arising from sexual activity as well as being less likely to fully interpret information from schools or parents compared to information from less-informed friends and media.
The Youth Group model, specific programmes targeting out of school children of primary and secondary age and addressing any non-youth-friendly aspects of the clinic’s structure, operations or staffing will be an important part of this objective. Attainment will be evident through increased patient numbers in the age group and a growing proportion among the overall patient population.
The population of Lukuli is predominantly working/ trading and living through use of Luganda and hence information materials and outreach campaigns must be tailored to their language needs, literacy levels and timed to match their working day/ week. The outreaches must be timed to suit women working a garden, children returning from school, people collecting water, men seeking meals, youth at sports events, groups at church or bars and organised events.
The clinic-funded materials will require Luganda translation and collaborations entered into must ensure that if not already in Luganda, then local language versions are included in the implementation costs.
The community served by Hope Clinic Lukuli has various health needs beyond General Practice. These may require specialist medical training, hard-to-develop materials and literature, or be costly to implement. Given that the clinic relies on recovery of the cost of services it provides as the means to replenish medical stocks and pay staff salaries, services which are not cost-recovery in nature will require external collaborations.
Collaborations can be of two main types: grant funding or service-hosting at the clinic. Grant funding is either activity specific or open in nature, being for staffing, equipment or a particular GP service of the clinic. Service hosting describes the specialists using Hope Clinic Lukuli as a venue for their work and yet using their own staff and consumable items and hence incurring no cost for the clinic.
The collaborations allow free of charge services to be offered – such as child vaccinations or HIV testing – and can offset the cost of consumables which Hope Clinic Lukuli staff would dispense and thereby allow a patient to receive the service free of charge. This is a key part of the overall purpose of Hope Clinic Lukuli as it brings a service from elsewhere in Uganda, or a costly service, to the community around the clinic and at a lower price and involving less time for the patients.
The clinic has informal (un-documented) collaborations with Straight Talk foundation and YEAH which each provide youth-oriented newspapers and magazines which are on display and freely distributed from the clinic. Related to this, both organisations also offer visits to update displays and can be invited to make structured presentations. The Ministry of Gender, Labour and Social Development has oversight of the National Youth Council and also manages the Youth Truck which has GTZ technical support. The Youth Truck is a full multi-media and staffed resource which has visited the clinic to support the youth group.
Medical consumables are received from Kampala City Council (City Hall clinic) in the form of syringes and vaccines for the weekly child immunisation collaboration. The obligation on the clinic is for reporting on vaccines used and to maintain the Child Health Cards which are held by the guardian of each child. An agreement is also in place with CDC through the PSI project for the ‘Basic Care Package’ targeting HIV positive clients. The BCP comprises two mosquito nets, water container, water purification product and condoms which are given free to the clinic and to clients tested at the clinic and found positive. There is supporting literature based on the Positive Living theme. The distribution volumes of the BCP is the required return from the clinic and its continuation is partly reliant on CDC funding to PSI.
Documented agreements exist with PSI and JCRC. The PSI agreement relates to their funding of meeting of ‘Peer Educators’ who meet on the topic of HIV testing and post-test support. The Joint Clinical Research Centre agreement runs from July 2006 and represents the intention of JCRC to use Hope Clinic Lukuli as a satellite location for the TREAT programme of medical assessment of HIV positive clients, laboratory services and dispensing of JCRC-funded ARTs.
Financial collaborations in the form of tied grants exist with Rotary International (closing October 2006) and Until There’s A Cure (started August 2006). The Rotary International matching grant funded specific equipment purchases for the new clinic facility as well as 1,500 LLIN mosquito nets for free distribution to mothers and young children. The UTAC grant has purchased HIV prophylaxis and also enabled the funding of a HIV/AIDS youth education programme called Stay Alive. This is in itself a collaboration as Reach the Children are delivering Stay Alive using the clinic as a host venue and UTAC are funding that.
Other funding from Aggreko Plc has been for counselling and nursing staff and consumables and is more open in nature.
The collaborations which are in place during 2006 should all be maintained. The grant from UTAC is their first release but, as with the Rotary grant, a successful first grant can lead to a second application being considered by the grant provider. We will also use these grants to demonstrate our ability in managing funds as part of new grant applications.
Hope Clinic Lukuli has been granted second grants by Aggreko Plc and Belgian Technical Cooperation and such recurrent support is an important goal for the clinic. Whilst only 1 in 100 ‘cold call’ requests for support are expected to be successful, there is a 1 in 10 success with repeat supporters largely because the recipient’s ability has now been proved.
The existing partnerships can also be expanded, particularly those that involve the Kampala City Council and Ministry of Health. In April 2006 the clinic was accredited by the Ministry as a HIV Treatment Centre which will enable Government of Uganda support for HIV to be channelled to Hope Clinic Lukuli. The first result of this was the provision of free HIV test kits which represents a direct cost saving as the clinic has previously been buying the tests but, as a policy, does not charge clients for testing.
The collaboration with the Uganda Protestant Medical Bureau, provides an administrative supervisory body which also helps Hope Clinic Lukuli to receive financial support from the Government for sectors other than HIV. Since July 2006, there has been a financial transfer from the Government under the Primary Health Care (PHC) grant which is channelled through Kampala District. From January 2007 this collaboration is being expanded to include a line of credit to receive drugs from the clinic’s normal supplier but with the Government paying for about Shs 250,000 per month. In addition a further quantity of anti-malaria drugs will be available from November 2006.
The Hope Clinic Lukuli is already receiving vaccines from Kampala City Council and is recognised by UPMB as a member; it is featured on their website. These links have not previously led to financial support in cash or commodity supplies. The clinic should be included in the 2006-07 financial year and future years as a Health Centre II with a higher grading having financial implications, for Government, and hence being difficult to secure.
The clinic has sought collaborations with various medical implementers but is normally the party seeking the linkage and offering the community of Lukuli and Makindye. In the period of this strategy document, Hope Clinic Lukuli should be recognised and approached by the Ministry of Health or Kampala District to participate in programmes channelled through Government.
Government and its donor funding partners are focussing on HIV management with less resources and international support for key areas of child health, maternal health, adolescent reproductive health, malaria management and hygiene/ nutrition recommendations. The clinic works in these areas from a treatment viewpoint but will seek recognition by Government as a partner in policy implementation and also as a recipient of commodities and literature. This will require lobbying by the clinic in the first year of the strategy period but should become driven by Government by the end of the strategy period.
The commodities received from several organisations in Uganda will become standard services provided to clients and hence their continuation and increased volume for a given item must be ensured to meet patient demands. The informal collaborations for drugs and literature will be formalised and reporting used as a means of promoting continued support year on year.
The implementation of a specialist services, at their expense, from the clinic premises provides required access to the patients and benefits the staff at the clinic in terms of on-the-job training. The recognition by patients of the clinic as a specialist provider also improves their perception of the General Practice services which remain the core source of operating resources.
Linkages to date are HIV related in terms of literature, support groups and commodities with additional literature available for general youth topics but without staff back-up. In the strategy period Hope Clinic Lukuli needs to attract and support collaborations by NGO and specialist units in the areas of maternal health, youth, family planning and malaria management.
The support from companies is desirable as it can be utilised in operational costs, particularly staffing, to expand General Practice services as well as staffing free-to-client services. The annual funding will be reliant on identifiable returns to the funder in the form of media publicity, staff participation and alignment of Hope Clinic Lukuli with their target audiences. This will require action by the clinic staff and management and needs to recognise the planning cycle of these funders to ensure the new year is arranged as part of the general corporate budgeting process.
New corporate funders will be identified, both cash and commodity, to help maintain the physical structure of the clinic and also prepare for withdrawal of any existing funders. All supporters of the clinic will be named on the website and will be offered the clinic website for inclusion on their site to reflect their corporate responsibility actions. The clinic will also display a list of supporters since its foundation.
The Hope Clinic Lukuli has developed in services and stature through a combination of medical staff that are committed to a friendly and philanthropic service, alongside non-medical management offering business, development and marketing techniques. These techniques will be developed among the medical and administrative staff during this strategic period. The implementation of these new techniques and the maintenance of medical standards in the day to day functions of the clinic will rely on a supervision mechanism with an external entity.
The strategy, for implementation by the end of 2007, is to identify an organisation or team of individuals who can provide the medical and management oversight role in a structured form.
The clinic operations have grown from a small sole-practitioner facility to a large unit with 15 full time staff and seeing over 600 clients a month with a broad range of services. The maintenance of medical quality and ensuring treatment is up to date requires day to day supervision from within the clinic and support from outside. The existing relationships with external medical bodies is driven by the co-Chair and Secretary and will need to transfer to an externally-driven system with the external organisation adopting Hope Clinic Lukuli as part of their wider implementation programme.
The linkage to an external party to provide supervision will require greater oversight than is currently provided by the Ministry of Health, the Kampala City Council or the Uganda Protestant Medical Bureau. Options include becoming a fully Government operated facility or retaining ownership in the trust but with active supervision by one of these entities. The supervision would include staff management, oversight of collaborations and approval of decisions on pricing and service provision which these organisations do not currently offer in any of their sites.
This element of the strategic direction of Hope Clinic Lukuli is not yet mapped in terms of what will be the supervising body. The achievement of the outcome is therefore phased.
The present operations of the clinic require greater external supervision but the existing management oversight can be documented and hence form the requirements from the new supervisory body. These will be modified following the appointment of the senior medical staff, the greater action from the Ugandan members of the management committee and the potential future collaborations. Each task will require determination of the recipient of that supervision or support and the measures of improvement or maintained performance which would be assessed. Frequency of existing reviews and whether they are sufficient will also be considered.
The clinic lacks external medical and management supervision. Whilst medical tasks could be partly covered by senior medical staff, the communications, reporting, marketing, human resources and other supervision is not available from an external body at present. These areas are currently provided in an ad hoc basis by the Secretary and as part of medical collaborations.
The possibility exists for a current health unit management entity to be encouraged to adopt Hope Clinic Lukuli into their wider organisation. It may include becoming a partner with a health unit in another part of Kampala. The objective will include identifying the perceived and documented reasons that the entity operates the other sites and considering commercial or goal-oriented justification for including Hope Clinic Lukuli in their coverage.
The clinic may be of interest to organisations with a social services or community service programme but not yet operating a health centre or seeking an established one to take over. The identification will utilise NGO and Government collaborators to offer the clinic as a target for take-over and then negotiate how the overall purpose can be safeguarded.
Those in the position of strategic management and with responsibilities of staff and operational management on a day to day basis will have clear understanding of the Strategic Direction of Hope Clinic Lukuli. They will be able to explain this to colleagues and help all staff to plan their work, improve cooperation in teams and strengthen the provision of services to clients in the context of the Objectives and Targets of the clinic.
Target statement: All management will have a copy of the Strategic Direction and a group awareness workshop will be held for all staff by the end of the first year of the strategy period.
The staff who are employed at Hope Clinic Lukuli will be able to express how their work contributes to the overall purpose of the clinic and helps achieve the Objectives. They will be able to discuss their roles and the operations of the clinic in an open and informed forum that enables them to be supported and for management to be promptly aware of issues that require attention.
Target statement: Employees of the clinic, and volunteers working regularly with it, will have been briefed and can prepare personal action plans for the following year to assist in their working towards the Objectives and Targets.
Hope Clinic Lukuli will maintain and be able to present data records on the patients it sees for a range of services and utilise that information to focus efforts on service improvement and addressing barriers to access. Data will be drawn from everyday operations and records but may include specific surveys and the offering of results in a confidential matter to city and national organisations.
Target statement: The clinic will maintain socio-economic and demographic data alongside medical data of the clients it serves and be able to present meaningful summaries for future planning and feedback to collaboration partners.
The clinic’s strength is based on the support it receives from the community. This is in terms of customer usage and advocacy for the clinic by positive endorsement or more general acknowledgement of its presence and services. This will be enhanced if we engage with the community to ensure that their needs are correctly identified and appropriately addressed. The Strategic Direction has been developed with reliance on input from those already linked to the clinic and hence requires wider consideration and adapting where necessary.
Target statement: The clinic will hold a strategy information session at the village council and population level in the second year of the strategy period (2007).
The Hope Clinic Lukuli will implement financial management, inventory recording and staff development systems which are simple to implement and yet address the key risk areas of the clinic as a business and a service provider. The systems will draw on regulatory requirements in Uganda and practices advocated by collaboration partners. Staff will be trained in them and compliance will be a key measure of quality and an area of supervisory attention.
Target statement: Systems will be developed and documented which are necessary and appropriate based on the business risks and compliance environment of the clinic.
Financial accounting and cash management will be monitored through day to day senior medical staff and administration staff. The ability to manage separate funds against defined activity plans will be a key performance measure for the clinic and its administration.
Target statement: The financial recording processes will be designed to enable income, actions and expenses to be matched to objectives and hence funding source.
Hope Clinic Lukuli’s strengths include its management structures and intention of understanding the implementation milestones and reporting requirements of those it works with. Using the HMIS data as a basis and agreeing other requirements and analysis during the planning of collaboration will allow efficient reporting and trouble-free funding and implementation by collaborating partners.
Target statement: We will be able to meet the reporting and operational monitoring requirements of collaborating partners.
The maintenance of General Practice services as the core of our operating model will ensure the sustainability of the entity. The retention and development of staff will strengthen that GP service and so ensuring their quality of performance and the satisfaction they receive from their work will be critical to our success and sustainability.
Target statement: Staff will be able to express their needs and concerns as a key part of the GP service and management will endeavour to provide explanations and effective responses.
Hope Clinic Lukuli seeks to be recognised as a successful model of integrated GP services offering primary health care to mixed income communities. The services provided to clients must be as broad as those available in a similar sized government or for-profit facility, but of a higher quality and at a lower per-patient cost. That recognition will prompt other sites to follow the collaboration model of the clinic and so endorse the clinic for future collaborators.
Target statement: The clinic will be recognised as an integrated GP service centre during the second year of the strategy period and named as an example of public private partnership success.