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Hospital in Tanzania makes great progress

Female entrepreneurship

There was an urgent demand for health care in the area around Makambako – in Tanzania – but no hospital nearby. Therefore, sisters of the Benedictine order decided to establish St. Joseph Hospital Ikelu. The number of patients was growing fast, so fast that the staff feared that they would not be able to keep up with things on an organisational level. With help from PUM expert Yvonne van Ameijden, a strategic plan was drawn up. Yvonne: "With relatively simple solutions, a lot could be achieved."

Before the establishment of St. Joseph Hospital Ikelu, patients had to travel more than forty kilometres to get to the nearest hospital. Yvonne: "Sisters often run a small nursing home, but running an entire hospital is not common. Ten doctors work at this hospital. They even have an operating theatre where caesarean sections can be performed."

When Yvonne travelled to Tanzania, the hospital existed for four years and employed 105 people. Yvonne: " The hospital was doing well, but the sisters had organisational questions. How can we ensure that our hospital continues to grow? Moreover, what if the number of patients suddenly drops, how do we ensure that we can still pay our employees’ salaries? "

"Women come from far and wide to give birth here"


Together with the sisters Yvonne made a strategic plan. The first step was to set up an accounting system. Yvonne: "With relatively simple solutions, a lot could be achieved. The sisters had an A4 sheet on which they kept track of their income and expenses. They did not have any annual figures. Neither were they aware whether or not a treatment caused financial loss or additional income. I advised them to keep a more detailed financial administration and taught them the principles. In addition, one of the sisters attended an accounting course."

The sisters themselves do not collect salary or profit; therefore, prices at the hospital remain low. Yvonne: "There is a small restaurant at the hospital. As far as I was concerned, a little bit of profit could be made on the meals. This was a difficult subject for the sisters. However, I showed them that making a small amount of profit would enable them to hire a gynaecologist for a few days a month."

Another quick-win was achieved by reducing the hospital’s inventory. "A big part of their financial means was used to purchase stock-in-trade. This made it impossible for them to purchase equipment. In Tanzania, it regularly happens that certain medication is temporarily unavailable. However, they could do with stocking smaller amounts of several items. On top of this medicine also has an expiration date."

"Thanks to Yvonne's advice, the number of qualified doctors has increased and we have managed to reduce maternal mortality to zero"

Vital functions

The PUM expert also saw improvements in the area of ​​care provision. "It is important to monitor the vital functions of patients with infections. That is why we established a 'Medium Care (MC)'. A number of sisters also followed a course in monitoring and treating patients in an MC unit. "

Upon returning to the Netherlands, Yvonne applied for a grant from the Hans Blankert Fund, PUM's fund for small investments. "The grant was assigned, and with it a mobile operation lamp – that also works on batteries because the power is often lost - could be purchased for the operating theatre and the delivery room. Also, an ECG device could be bought." After the purchase, PUM expert and cardiologist Dick Haan visited the hospital to train the sisters on the use of ECG. "I was impressed by their motivation and organisation. There is a clear vision and the team works constructively."

Now, three years after Yvonne's mission, the mortuary of the hospital has a cooling system, there is a fence around the hospital and the sisters have opened an eye clinic.

Sister Neema Mwinuka: “Yvonne’s advisory mission taught us how to make a strategic plan and budget the money we have in a way that we can implement the planning, even if the money is not enough. Because of Yvonne’s advice, we managed to implement many activities: we bought a mortuary refrigerator, increased the number of qualified doctors - now we have six – and we have managed to reduce the maternal mortality rate to zero for the past 1.5 years. We have managed to draft a strategic plan for the next five years and draft an action plan for one year. All in all we thank PUM Netherlands senior experts.”
Yvonne van Ameijden (55) is a business administration professional and physical therapist. The PUM expert worked as a consultant and director in the healthcare for many year, both in the Netherlands as well as abroad. "At St. Joseph Hospital Ikelu met the most enthusiastic staff I have ever encountered in a hospital. I experienced so much gratitude."

Text: Elise Mooijman Photos: Yvonne van Ameijden & Dick Haan