Medical fellowship Programs as drivers of Community Health Support and Delivery
Emmanuel Kivanyuma Waiswa
I must first admit that my interest in community health care is based on the belief that the lack of a healthy population even at the smallest level of society impedes the progress of that society at all levels. While attending the launch of the white paper on Global Health in Norway – Oslo , David Broom – Harvard School of Public Health made quite interesting remarks about health care as a pre-condition for economic growth making it clear that a healthy populace is one that can work , save and invest , I could not agree more given my neo – classical mode of thought. Over the past many years, public health in Uganda has been dynamic, at the national level one could say we boost of 3 main regional referral hospitals supplementing the main national referral in Kampala – this truth contrasts greatly with the poor service delivery evident at the afore mentioned levels with high incidences of low funding from government , some cases of mismanagement of resources as well the lack of political will and priority on medical care service provision. Why has such little success if any been a failure at community level? . We have seen USAID and other International development partners invest a lot of money in public health but with little transition from donor support to sustainable community ownership of such interventions – the moment the money stops flowing , everything gets back to the whole some state or even worse. Well there could be many factors failing the transition and none of the stakeholders deserves blame. I feel community based approaches by small Organisations at the grass roots are being over looked and or even neglected from inclusion in such interventions . I do not intend to rebuke the generosity that such partners but I feel its time we invented an alternative or supplementary discourse to counter balance the ills of donor driven cycles. My vision is of medical fellowship programs or what some can term as medical volunteer placements or internships. I can tell of many medical fellowships , some of which I have been part of , heard of or even from an experienced level implemented , monitored and evaluated. One can imagine how some tweaks can make big differences that are sustainable and yet easy to replicate country wide.
What are medical fellowship programs? – call them self-help initiatives that can be locally powered through mobilizing local talent and training them in health care service
delivery support or mobilizing international medical students and volunteers to participate in internships at the grass root levels. These programs have been here for decades and many more spanning given their need. They donot require too much funding, carry with them little supervision but yet defy the conventional way of donor driven impact which has proven prone to embezzlement and mis management. A case in point is the Global fund support to Uganda and the story behind it all though might not be deserving mention in this academic piece but resonates a learning point. Most if not all of these programs generate active youth contribution, social change and sustainability – a triple bottom line not so familiar with many conventional projects. I would regard these programs as the bet form of support that community health care requires to take off and in a more efficient and modern fashion that puts the community in the Centre with linkages from the outside – this could be donors financing the costs related to participation, reimbursements to costs as well as any other costs deemed relevant for the project. There are many of such initiatives in our neighborhood and most times we do not take time to think about the impact they cause or even how they complement mainstream interventions – I will mention some of examples here and I wish you could read in detail on at least one or two of them. FK Esther program, Iganga Village project and other medical fellowship programs organized by Organisations and academic institutions. There are many benefits that make this kind of program work more sustainable, cost effective and desiring of young economies like Uganda and the rest of East Africa. On one hand is the fact that these programs award young people the once of being active citizens with a duty to care and support, in an economy like Uganda where unemployment is high and yet a very big young track of talent – the planners need to think of alternative ways of engaging such labor or else we lose their productive sense to the country. Cost effectiveness ,Is funding a 5 year project with 20 staff members more efficient than supporting the costs of 20 young medical fellows – local and international selected by professional medical bodies ?. These young people have the urge to learn which most of our current medical workers have lost along the way. This also comes with less supervision and monitoring which takes almost 30% if not more of the donor project budgets. Sustainability and replication, just add a small element of village health teams or supplement international fellows with a few locals who could continue even after there is no funding or with the minimal funding possible. These are local individuals who understand their realities, have passion for their communities and taking their work to be a source of fulfillment. These are equally easy to replicate and this saves the
competition for grants that has led to duplication of proposals and concepts that carry very little impact.
At the start of 2013 , while working at AIESEC( The largest youth led Organisation in the world – present in 113 countries ) including Uganda I received an email from a college student in Maastricht University in the Netherlands seeking my support in implementing a medical exchange program for medical students in their 3rd year of study. The original plan was to attach 10 students to rural health facilities in the districts of Kamuli , Jinja and Iganga ( Why these districts ?),well it was a pilot and given the fact that these districts lie in the eastern region – most portrayed as the poorest in the country it made sense having the project run therein. The goal was for these students to experience hospital life and have a few practical exposure as well as support the delivery of services under supervision of an experienced medical personnel. We thought that supplementing these rural facilities that are under staffed would increase on their capacity to deliver and handle over whelming numbers of community members in need of such services. The results were unique and challenging in their own right. We received 15 students and with the help of colleagues from Active Youth Africa where am co – founder we implemented the project in collaboration with other Organisations like Arise and Shine Uganda based in Jinja , Iganga hospital , Reproductive Health Uganda – Iganga branch Kamuli Hospital and Jinja Hospitals. Though there were no locals integrated as fellows in the program I now have belief that if just the medical institutions in Jinja and Iganga get involved the project would impact more communities and even be replicated in other areas of the country at the minimal cost ever seen in the new era. The challenges ranged from low capacity given the few participants, Project design was a big challenge. We would go out to try different things and find out what actually works. I’ll skip through some other things, but there are two points I can’t skip. The first is the youth engagement and contribution – I saw young people both fellow colleagues at Active Youth Africa and the international students get immersed in social work that impacted the lives of more than 1,000 people at the grass root levels and I compared their work with what another donor based initiative would deliver even with grants and funding beyond 5 million dollars. I may not say exactly what the individuals spent on the project but let’s agree that it was not that near to the amount mentioned above. Community Ownership – the communities were at the Centre of all interventions and they were integrated at all levels. First before posting the management committees of some of the health centres in the rural areas had to determine how viable such a move would be and decide accordingly, the rural population was engaged in other activities that were a part of the project and related with the volunteers in total manner an aspect that spurred sustainability and now there are marks to leverage in case of any
subsequent programs in the same line. We made every effort possible to recruit local young people as part of malaria prevention campaigns and they received trainings from volunteers and now they support their communities in drug and net distribution, the attitude change also engineered project acceptance.
Well at last, the question on many minds shall always be if we can do much without donor support and I wish not to destruct any one from focus on funding but can we do it differently?. May be there also cost effective ways that the same donors and governments can look into given their sustainability and easy replication.