A window into St Joseph's Mission Hospital

St Joseph’s Mission Hospital, in Sakubva Mutare is one of the 35 mission hospitals in the country. The mission hospital charges $7 for admission which is the fee as charged by Government hospitals. The motivation is to serve the community. This like most other mission hospitals is not a profit seeking institution.

A change of purpose but not structure

The mission hospital is presently run by the Dominican Sisters who took over the hospital from the ‘Dutch’ Catholic Sisters (Catholic Sisters of Charity of Our Lady Mother of Mercy who originaly came from Holland) in 1997. Prior to that the hospital was a dedicated TB hospital until 2010 when it was changed to a general hospital. The ministry of Health felt TB patients could be treated from/at home and the structure was better utilised to attend to broader health issues. The structure was not changed but rather only the purpose. 

Unfortunately the structure was not modernised to suite its new role as a general hospital. Presently it caters for different categories, under 5s who come for immunisation, ill under 5s, general unwell patients and chronic patients who come for treatment and medication as well as HIV/Aids patients who presently number over 2 800 patients. There is no laboratory. Some of the essential machines are presently not working. 

There is only one male ward with 6 beds but no hand washing basins and sinks. Ill patients need a hand basin sink unlike the case with TB patients who simply can access water and washing elsewhere as they are mobile. The wards should have been modified to suite the current requirements.

The female ward needs renovations. Maternity ward is very busy almost always full averaging about 70 to 100 deliveries each month. Delivery bookings are on the increase. Caesarean procedures are also done at the hospital but the theatre is too small. There are no recovery rooms and private changing rooms. Basically the theatre is inadequate to meet requirements. Funding is a major problem.

Unfortunately about 50 percent of St Joseph’s Mission Hospital patients cannot afford this amount as they are coming from marginalised and poor societies in Sakubva, Chikanga, Hob House and Dangamvura. 

Even a small amount like $7 is hard to come by for urbanites and villagers. It, however, is reasonable when compared to medical bills and charges in private hospitals and health centres in urban setups.

In the past some rural mission hospitals like Howard Mission Hospital in Chiweshe have relied on a health insurance system for locals who sometimes bring in maize to the hospital and are registered in a kind of insurance that will allow them to be attended to without paying any money should they get sick. 

This system is almost impossible to replicate in an urban set up.

There is a big challenge with indigent patients. There was a 2016 incident in which a Mutare- based civil rights group petitioned Parliament after two years waiting for a response from the ministry of Health on why council and mission hospitals were not recognising referrals from social welfare. 

Service Delivery and Government Support 

The general perception is that service delivery is far much better at mission hospitals and medicine is readily available as compared to government hospitals. This is confirmed by over 90 percent of patients who are very happy on the basis of research on service delivery done by the Catholic based organisation follow up on patients.

The situation at St Joseph’s Mission Hospital is a replica of what could be happening at many mission hospitals in the country, including other mission hospitals doted around the country. 

While mission hospitals in the country are generally reputed for having highly skilled doctors who offer top quality service and are also well resourced they still face some challenges. Government gives financial support to mission hospitals on a monthly basis in the form of salaries and allowances for medical personnel. Presently St Joseph’s Mission Hospital has 3 full time doctors and 21 nurses. The hospital has added another two nurses who are midwives paid through its own resources to improve nurse to patient ratio and improve service delivery. The current staff compliment represents 50 percent of the required staff. To effectively service the area the mission hospital requires another 2 doctors and 20 more nurses.

This establishment is too low to adequately serve the hospital’s catchment area of 27 000 people. A deliberate policy made years ago to increase the number of doctors is bearing fruit by producing more doctors although the main challenge is retention of senior ones. 

The other operational challenge is transport and ambulances. Presently the mission hospital has one ambulance which was procured by friends of the Dominican Sisters in whose absence due to breakdown and other reasons ordinary cars with mattresses come to the rescue.

Funding    

The Sister in Charge at the hospital Sister Andrea Mazhunga of the Roman Catholic Dominican Sisters Order reported that the hospital faces problems in accessing financial resources and they have to rely on donors. 

Funding is 60 percent donors, 30 percent patients and 10 percent government. Almost all of the personnel’s salaries and wages are wholly funded by government through the ministry of health. 

As is the case with all government hospitals the level of support to mission hospitals has not yet reached desired levels. It is however critical that government sets out a deliberate policy framework that deals directly and speaks to the challenges of mission hospitals because they constitute a critical component of Zimbabwe’s health delivery system. 

While there are systems in place to coordinate activities and relationship with mission hospitals it appears there is much more required. For example the provincial medical director visits the mission hospital at least once every quarter other areas need attention. There are positives from such visits as last year the visit resulted in the construction of a staff room for the hospital staff. 

The infrastructure requires upgrading in the form of new equipment and buildings. Some patients end up being referred to Mutare General Hospital when in fact they would prefer to be served at St Joseph’s Hospital because of distance. In addition mission hospital is unable to conduct more complicated procedures because of equipment unavailability and space.

The hospital has a total bed capacity of 50 which is inadequate especially when this includes male, female (including expecting mothers) and children. It is possible to expand the health facility as there is enough land for further expansion. The existing facility is too small to cater for 27 000 people in its catchment area.

Drugs and Medicines

The challenges do not end there. Availability of drugs and medicines remains critical. Chronic drugs for blood pressure and Asthma. Natpharm has been supplying some drugs up to December 2018. Unfortunately Natpharm does not have Medical Sundries such as Surgicals, Syringes and Cannulas and this must be bought from outside. For cannulas a box of 50 costs about $240 (Bond) at consumption of one box a day. Antibiotics are cost $15 to $18 and taken 4 times a day. 

Income from consultation is what the hospital uses to buy drugs and medicines although the Friends of the Dominican Sisters assist with much of the drugs and medicines but presently stocks are low. They also assist with some equipment. For example the hematology analyser equipment has not been working since last year. It costs about 8 000 Euro and donors are expected to assist although it takes long. 

Since last year the hospital cannot internally do some procedures for caesarian mothers because its own equipment is not functional. This must be done at Mutare General Hospital and at times 3 to 4 trips must be made for this purpose daily. It is the running up and down that is costly in terms of fuel. Pregnant mothers do not pay for services because of the Results Based Fund Support.    

The institution receives               $10 000 (Bond) which in most cases is directed towards various drugs, medicines and various other critical consumables. For this purpose it is clearly insufficient especially that it is a quarterly allocation.

Meals for patients are another challenge together with bills for Electricity and Municipal rates. St Joseph’s Mission Hospital must pay for these. Sometimes donations come through but not always. At one time a patient had to be ferried using a private car which is risky. The mission hospital always assists maternity mothers to come to the hospital using their own ambulance in urgent cases. 

Space and Improvements

Space to accommodate patience is a major challenge. One room is used for under 5s another for adults one for men and another women. Presently, injections, screening and observations are done in one room. There is no privacy at a time patients are on the increase.  

To alleviate the problem a new bigger hospital is long overdue and plans are currently underway to expand through donor funding. The plan is to construct a maternity wing, paediatric wards and general wards which should start happening by end of the year. Friends of Dominican Sisters mostly based in Germany have indicated interest to support this project. 

Government needs to urgently consider various options at its disposal to ensure facilities are improved in the interim. For example there are no basins and sinks in the wards and privacy to patients is compromised as there are no screens either.  

With the health sector currently having a weakened health management system as a result of brain drain over the past decades there is a negative impact on supervision and monitoring as evidenced by reduced quality of service. To this end the ministry of Health needs a clear policy position that is able to quickly pick challenges faced by mission hospitals and respond.

Things like limited drug availability, obsolete and non-functional equipment that compromises diagnoses, ambulances, and shortage of personnel etc. A new National Health Strategy may need to be implemented to address and devise a new approach to these perennial challenges. 

What is clear is that mission healthcare institutions play a pivotal role in healthcare delivery. The onus is for government to adopt a more comprehensive strategy and policy framework that ensures that institutions like St Joseph’s are fully supported as they play a major role in ensuring that indigents and marginalised communities in both the urban and rural settings access healthcare. 

St Joseph’s Mission Hospital is an interesting case where government needs to demonstrate in practical terms the desired change in health delivery. It is simply unacceptable that in 20 years the structure has not been modified to serve the requirements of a fully operational hospital. 

The issues regarding the development of St Joseph’s Mission Hospital demands that those in political office get a grounded appreciation of the needs of the facility as it serves their constituency. In the last 5 years not elected representative has visited the hospital.

λ Gwinyai and Majongwe are from Health Decisions Consulting (Private) Limited. Website: healthdecisionsconsulting.org

    Post a comment

    Readers are kindly requested to refrain from using abusive, vulgar, racist, tribalistic, sexist, discriminatory and hurtful language when posting their comments on the Daily News website.
    Those who transgress this civilised etiquette will be barred from contributing to our online discussions.
    - Editor

    Your email address will not be shared.