A summery of our hospital, the achievements recently made and challenges to overcome. July 2009

1. Dr Christian van Rij Presentation of July 2009 – but additions were made before uploading to Slideshare.net in April 2010

2. Intro Christian & Mariska van Rij Christian: Tropical Doctor at Wasso: Aug ’07 – July ’10 Hospital Director between: Dec ’07 – Oct ’09 Mariska: Registered Nurse Two ‘Wasso born’ children: Quinten & Marnix Send by Tweega Medica

3. Presentation Overview

5. Wasso Hospital History Part of the RC Archdiocese of Arusha 1995: District Hospital status 2005: Austrian government pulls out as donor and huge debts develop in next 2 years 2006: Several NGOs link up 2008: New management starts emphasizing on cost reductions and improving services

6. Wasso Hospital History 2005: New ward buildings as UAE donation 2005: Tweega Medica sends first doctor 2006: Watschinger Foundation initiates support 2007: EGPAF starts supporting HIV program 2007: Cordaid starts pay for performance and flat feel programs

7. Mission & Vision Our Mission: Wasso Hospital exists to fulfill the call of Christ in the healing ministry by improving the health Status of all, especially those most in need Our Vision: To undertake all efforts to contribute towards a better health status of the people in the area, by improving the quality of the health services and by making them accessible, acceptable and affordable

8. Where we are

9. Ngorongoro District 14 036 km2 ≈ ⅓ of Switzerland or Holland Remotely situated: in between the Serengeti; Ngorongoro Crater; Lake Natron and Kenya People mainly live dispersed over small bomas Drought is often a burden Nowhere tarmac roads No connection to power grid

10. Who we serve

11. Many in need 186 000 people in the district -> 13 per km2 Income/capita ⅓ of Tanzanian average ≈ 320 Euro / year Life expectancy ≈ 50 years Median age 18 years Tanzanian age distribution

12. Ethnic Diversity 80% Maasai Pastoralists with cows Strong cultural habits Often not educated Many do not speak Swahili

13. Ethnic Diversity 80% Maasai 15% Watemi Strong cultural habits Living around Digodigo Agriculturalists

14. Ethnic Diversity 80% Maasai 15% Watemi 5% Other Tribes Living in the few larger villages

15. Disease Burden

16. Common Infections Malaria Tuberculosis Typhoid HIV/Aids Amoebiasis & Worms Brucella Brucellosis Enchinococcus Rheumatic Fever Pneumonia Meningitis Urinary Tract Infections

17. Non-infectious Conditions Malnourishment Severe Burns Obstetrics Abortions, Eclampsia, Caesarians Fractures and other trauma: Lion, Leopard, Buffalo and Snake injuries Car, Bullet, Arrow and Machete injuries Increasingly also ‘modern world’ diseases: Asthma, Hypertension, Cancer, Diabetes

18. Wasso Hospital

19. Medical & Paramedical units OPD: 5 doctor rooms 158 admission beds: 36 Pediatric 6 ICU 32 TB 5 Private 24 Female 20 Male 36 Maternity Additional units: Laboratory Radiology CTC (HIV/Aids care) Theatre Physiotherapy Pharmacy Dental Family & Child Health

20. Supportive units Administration & Accountancy Workshop: garage, power, water, carpeting Guesthouse: Rooms and Canteen Security & Environment Cleaning & Laundry Patient Kitchen

21. Digodigo Dispensary Satellite from Wasso Hospital Outpatient Department and HIV-clinic 16 Beds for Labour, Male & Female admissions

22. Staffing 150 staff, among which: 3 Medical Officers 1 Assistant Medical Officer 8 Clinical Officers 25 Nurses 20 Nurse Assistants 3 Technicians (lab/rad.) 1 Dentist 1 Physiotherapist

23. Flat Fees System Predictable affordable costs creates accessibility One fee for everything according to category: 3 € for all care as outpatient 20 € for all care as inpatient without surgery 7 € increment for minor surgery 20 € increment for major surgery Free: children < 5 years, TB & pregnant patients

24. Recent Performance

25. Community Outreaches Services given: 1st line treatment of illnesses Antenatal & Pediatric Check ups + Vaccinations HIV: Sensitization, testing, follow up 36 Sites visited every month: 18 sites by flight 18 sites by car

26. Outpatient Department Almost 17 000 patients treated in 2008 7 000 were under five years Slight increase compared to ’07 22% less referrals were required

28. Maternal Care Antenatal checks from 10 weeks onwards 1335 mothers checked in 2008 Admitting mothers at 38 weeks if they live far

29. Maternal Care 16% increase in hospital deliveries in 2008 608 deliveries 34% reduction of perinatal mortality 8% delivered by Caesarian section Family planning options available All maternal care is free of charge

30. Theatre Major Theatre 250 major surgeries in 2008 Minor Theatre 4500 procedures in 2008

31. Administrative Improvements Emphasis on good communication & teamwork Hospital organogram developed New staff contracts signed New archive with a new filing method Also initiation of electronic archiving Increased efficiency with huge cost reduction Debt reduction of ± 100000 USD in 18 months

32. New Hospital Information System Energy saving computers running on Linux WebERP: Free, web based accounting Care2X: Free, web based medical registration (initiating phase)

33. Continuing Medical Education Upgrading of our library Linking with Tanzanian Telemedicine project Regular lectures and seminars for staff Supporting people to be trained as nurses and clinical officers, or other medical upgrades

34. Medical Internships Medical Internships at Wasso are highly appreciated by the students and by us Every 2 months 2 medical students Creates an atmosphere of teaching and learning Gives additional benefits plus international linkages to our hospital

35. SWOT Analysis + way forward

36. Strengths Trust of our community Good level of care Affordable Services Ethical work with compassion

37. Weaknesses Remotely situated with high running cost Lack of equipment / medicines Shortage of good staff / High staff turnover Knowledge / experience levels Administrative transparency, reports & budgets

38. Opportunities Developing protocols: Medical and administratively Straight forward, well thought, routinely checked and clearly reported Developing incentives/approaches to retain staff Improving income by: Improving our efficiency Increasing our patient income Becoming more donor attractive

39. Threats Protocols made, but possibly: Not transparent, not adapted or too complicated Will neglected without follow up Administrative overwhelms Medical issues Poorly predictable funds & supplies Financial and Human resource shortages

40. Way forward More Project based working Administratively and Medical Developing output monitors More Follow up: Checking and Reporting while Adjusting Creating more Accountability & Efficiency Routine communication with all stakeholders Continuing planning for the future!

41. help us help the People Maybe You or Somebody you know

42. Ways to assist us With your know-how: Medical, technical or administrative With a donation In kind: like a microscope, laptop, or an oxygen-machine In cash: we are still running financially short for normal running cost, drugs and education! With your connections: You might know somebody else who also wants to assist

43. Contact Wasso Hospital Approach the management directly mo-ic@wasso-hospital.org Watschinger Foundation Assist with an integrated approach Regina.watschinger@elisabethinen.or.at Tweega Medica Foundation Assist to send a new tropical doctor Tweegafoundation@gmail.com

44. Thank you for your interest in Wasso Hospital Same patient as shown in slide 14 But now recovered! Dr Christian van Rij christian@vanrij.org