Advent: Day 21 eQuality Health Bwindi

In the last year we have been working with the management team at Bwindi Community Hospital to establish a community based health scheme, which we refer to as eQuality Health. Community groups, such as the Bataka pictured above, organise themselves to make payments of $3 per group member per year. This small contribution entitles each member to a wide range of services at the hospital and at the community based outreaches.

Our role is to work with the community leaders to help mobilise the members, bank the collections and to make payment on a regular basis to the hospital, but only after we have performed a 25-point quality assurance review of its services.

Clearly this contribution only covers a small part of the overall costs of service and BCH continues to rely on its many donors and supporters.

Such community based schemes are an important means of financing health service delivery, but these can never be expected to raise all of the monies that are needed to provide even the minimum healthcare package. The WHO estimate that cost at almost $40 per person per year, a great deal more than the $3 which eQH raises. Our experience to date indicates that it will be difficult for this community, which is very poor and living essentially a non-cash subsistence lifestyle, to contribute much more than this, perhaps no more than $5-$6 each in a few years time.

The gap in funding will either need to continue to be met by donor countries and international supporters or perhaps in time the Government of Uganda may be able to pay more to the health budget from either an increasing tax-base or hopefully the future oil revenues.

eQuality Health: now at 4,663 members

We are pleased to announce that after the first six months we now have 24 Bataka Groups with 4,663 members.

Click here to read "eQuality - Case For Support"

eQuality Health is an innovative health scheme that seeks to enable all members of the community in Bwindi to access sustainable and quality health services.

You can read about this scheme by clicking on the image above or read some earlier postings by clicking here.

Is the AIDS War Falling Apart?

The battle against AIDS in Africa is beginning to fall apart. Money is running out. While middle-income countries like India and Brazil may be able to save themselves, the future here (Africa) looks bleak.

The following video from The New York Times discusses recent developments in the fight against HIV/AIDS in Uganda.

It includes interviews with two members of staff from Bwindi Community Hospital.

Dr. David Apuuli, Uganda Aids Commission, comments about this epedemic in Africa over the last 30 years:

  • In the 1st decade there was death everywhere
  • In the 2nd decade drugs were discovered but only available in rich countries
  • The 3rd, which brings us up to present, was the decade of hope during which donors (largely USA) made ART available
  • How the 4th will be remembered is being defined today.

The data are very sobering; for every 1,000 put on ART 2,500 are getting infected; there are 33m infected across the globe today with only 4m on treatment; in 5 years time, even using optimistic projections,  only about 10m will be treated; that’s not nearly enough…

eQuality Health: first 1,000 members

We now have 1,000 members of eQuality Health Bwindi.

The Kanyashande Bataka Group A has joined, adding 295 members. Some of these members can be seen in the picture below taken at a community meeting, held in the local church, a few weeks ago. During this meeting community members heard more about how eQuality Health will ensure their access to quality care and services at Bwindi Community Hospital. There was a lively discussion, with many questions seeking to clarify particular points. As a result we will be creating FAQ posters with these questions and answers that can be displayed across the region in many other Bataka meeting places.

Kanyashande Bataka Group A join eQuality Health

A scheme for staff at Bwindi Community Hospital started in March and in April a scheme was started for 465 Batwa.

These are still early days for this programme but we are encouraged by progress so far.

Please read the Case for Support to learn more…

Bataka Twetambire
“let us heal ourselves”

Bwindi Community Hospital

Some of you will know that Dr. Richard and Pat Feinmann have returned to Uganda for three months to help us with the planning for our HCIV in Lira (a Health Centre 4 is a small community hospital, the equivalent to what we used to call a Cottage Hospital). Richard is keeping his Blog up to date and here’s a recent posting about our trip to Bwindi.


In the bottom left hand corner of Uganda where Winston Churchill’s ‘Pearl of Africa’ meets Joseph Conrad’s ‘Heart of Darkness’ is Bwindi Hospital. You can see on my picture, taken from the hospital, a little tree on the top of the hill and this is The DRC.
We visited Bwindi with Kevin and Pamela to see a really effective hospital. What an Inspiration.

Their Vision
The staff and management collaborated together to produce this shared vision. The Hospital believes that prevention is better than cure, and that if a disease is preventable we should be out in the community trying to stop it from occurring rather than just treating cases as they come to us. However, when people do become sick, we aim to provide them with the high quality care they need.
At many other Hospitals in Uganda health workers are absent or have low morale, drugs are out of stock more often than they are present, and patients wait for hours in queues. At Bwindi Community Hospital, staff members are on duty 24 hours a day, we plan ahead so that no drug is ever out of stock, and we make sure all patients are attended to quickly. We strive to serve our patients well and to achieve excellence.
Accessibility for All is the most important part of our Vision. We believe that all people, rich or poor, have an equal right to access health care, and that those living high in the mountains need care just as much as those living next to the Hospital, which is why we send teams into the community on seven days a week.

Over the last 4 years Paul, a doctor and Vicky , a nurse both volunteers for VSO have changed the hospital from a little centre with 5-6 staff to a large hospital serving 40,000 with 60-70 staff.

Deep in the impenetrable forest of Bwindi where there are 350 species of bird, 310 butterflies (many got squashed on our windscreens!),200 trees, and 120 types of mammal including the famous 340 MOUNTAIN GORILLAS. Since many rich and famous visit the gorillas, Paul and Vicky have tapped this rich source of donors to really deliver something special.

Both treatment of HIV and also a very active prevention programme.

We found that they have virtually no malaria deaths because of their net programme to all their catchment area .

Perhaps best of all is the motherhood programme. All pregnant ladies have four antenatal visits and then because travel is so difficult in this mountainous area they are admitted 2 weeks prior to delivery. They all stay in a mothers hostel and are examined by a midwife each day. The curse of Uganda, an appallingly high maternal and neonatal death rate is largely prevented. The women are offered health education +++, including contraception advice and judging by the singing from the hostel when a new baby is borne they have a good time.

I’m sure this is a programme we will want to copy.

The power supply is from generators but a small hydroelectric scheme is nearly ready. We are a bit worried that the water channel taking the water to the turbine is going up hill?
Anyway a great visit and lots of ideas. One of them is a scheme to make the care not too reliant on donors. The population have groups called Bataka’s which collect 1000 shillings(30p) per month to pay for funerals. Running the hospital requires 12,000 shillings per month(£4). The Batakas are being asked to collect 6000 shillings from each of their members and IMG the organisation Pat and I work for will put in another 6000 shillings. These people are very poor but they understand they can’t just rely on outside donors and must take some responsibility for their own healthcare. It will work I think and hopefully then will be reproducible in Lira.
Look at Bwindi hospital website

eQuality Health Bwindi

A plan for a Health Scheme that enables all members of the community in Bwindi
to access sustainable and quality health services.

The Challenge of Sustainable Health Care in Bwindi

How do poor people living in rural Africa afford the quality of health care that they need?

  • They cannot rely on Government. By the time cash trickles down from the capital city much of it has been ‘lost’. Bwindi Community Hospital receives less than 1% of its funding from Government.
  • They cannot afford a fee for service. User fees force payment upon those who are least able to afford to pay hospital bills, leading to catastrophic health expenditure when people have to sell assets, such as land or animals, to pay for treatment.
  • They cannot rely on donors forever, as support will eventually dry up leaving the community with no health care.

“Fabulous idea for a health scheme. This is all wonderful stuff” Stephen Fry, actor.

eQuality Health – the solution

International Medical Foundation is working with Bwindi Community Hospital to design, implement and manage a sustainable solution to the funding of health services in Bwindi (SW Uganda). We are starting a Health Scheme called eQuality Health Bwindi.

All members of the Bwindi community have the chance to ‘subscribe’ to this scheme by making a single annual payment of UGX 6000 (£2) per person which entitles them to use Hospital Outpatient and Inpatient services including investigations, drugs and even operations at a cost of only UGX 1000 (30p) per visit. This scheme enables people to pay for health care collectively and in advance, instead of waiting until they become sick and fearing the cost of care. It protects the poor, and enables them to have some control over their health care. It also maintains high quality services for the people of the Bwindi area for the future.

eQuality Health Bwindi already has 30,000 community members who have shown an interest in the Scheme. This is a very poor region and our initial research has indicated that each member can only afford £2. Bwindi Community Hospital has estimated that the cost of care will be at least £4 and so we need to work together with sponsors and supporters of Suubi Trust to help meet the difference.

Please read the Case for Support to learn more…

Bataka Twetambire
“let us heal ourselves”