Ch-Ch-Changes

 Change is in the air at Ilula Lutheran Hospital (ILH). I will try to outline a few things as best I understand them. I expect that the Tanzanians have been aware of the coming changes for some time.

The Administrator, Kikoti and the Doctor in Charge spent the last couple days in a planning meeting for the Kilolo District.

Starting in April, ILH will no longer be the Kilolo Council designated hospital.  The government has built a new hospital at Kilolo which will have that designation. I thought they were going to split this very large district, but that is not what will happen. 

Now there will be two hospitals sharing the same amount of the Kilolo District budget. Formerly, ILH received about 20% of the total district budget; in the future ILH will get only 10%. I do not know how much this amounts to. Regardless, it will make everything tighter here.

They use ICD-10 for coding here as we do in the US. And just as in the US, if coding is incorrect or missing, it is not reimbursed.  A volunteer doctor, not yet assigned has been working here reviewing all the outpatient visit coding. He is paid out of the money he saves the hospital, which happens at home too. We have coders.  Of course, it is important for the doctors to learn how to code correctly and the Tanzanians have not been taught.  And this really only affects the patients who have insurance. The plan is for all Tanzanians to be covered by insurance by sometime in 2020. We should be so lucky in the US!

Although the budgetary changes will have substantial impact. Assuming that coding is done correctly, it could be a boon for ILH to get paid for services delivered. 

The new Kilolo Hospital is a long way from Ilula, so essentially the catchment population will stay the same. Patients who want to try out the new hospital will need to pay for transportation to get there, likely needing lodging too, and food. The Kilolo Hospital may siphon some patients away from the Regional Hospital, but that will be to the benefit of the Regional Hospital. It is imperative that Ilula patients like (love) Ilula Lutheran Hospital, however.

I think that ILH staff morale is a big consideration in making our patients happy. The staff are loyal despite being paid less than at government hospitals. Sovelo and Kikoti are working on the morale, but this is not easy when they are underpaid and there is no money available to improve wages. I do not know the answer.

Earlier in the month, Dr. Moody and Dr. Tessmer-Tuck, et al, had a tour of the Regional Hospital and I did also last week. It is a sprawling place. Most buildings are single story. It has 377 active beds if I have got the number correct, so for ILH’s 70 – 100 beds, it is nearly 4 – 5 times Ilula’s size. They average 14 deliveries per day; ILH averages 6 – 7 births per day, 2400 per year.  They do have a pretty nice L&D unit, pretty open and not cramped.

While there we looked at the commercial-size washer(s) they use.  They have three new looking 16-kg capacity washers. The parentheses above are because currently, only one works.  I am not sure how many horsepower these are, I just know that ILH washers are hand-power.

Tanzania uses a “Star Rating” system of one to five stars for its hospitals. Ilula gets three stars.  Although the rating document is long, there are three major items that keep us from getting five stars.

1.     No X-Ray. OK, we are working on that, but still only about half-way.

2.     No canteen. This would provide food paid for and served by families for their loved ones in the hospital and would ensure nutritious and safe food.

3.     No mortuary, the bane of our fund-raising. OK, the other things first.  How does someone generate enthusiasm for building a mortuary? Do you suppose our mortuary companies at home would be interested?  Maybe that is worth a shot!  Anyone know a wealthy undertaker?