Day 6: Public-Private partnerships and all that jazz

The rain has not stopped. It's shaping everything here and dictating my days. It isn't even the rainy season. For the first few days, I thought, this is good for the farmers. There has been a terrible food shortage here and the government has been providing hand outs, but barely meeting 70% of the basic food needs. The rains were welcomed. Now, after a full week of pounding rain, it seems the farms may be flooded. It may be too much. I really hope it will let up today so I can get to the village without being covered in mud.

I am beyond impressed, if I do say so myself, with the progress that we have made here in the past three years since I was last here. We have grown. There are more classrooms, more teachers, a beautiful and working farm!, a bigger school kitchen, a nearly complete basketball court. We have developed. The classrooms are covered in paint, posters, and are stocked with XO laptops and more teaching materials, the teachers are diverse and well educated, our farm hosts all kinds of greens, a huge water well and water tank, and 750 pole pine tree seedlings that will grow to provide wood for new construction or future profits for the school when sold. Our Clinic is bustling. There wasn't a moment when the Nurse or his assistants weren't helping a new patient, even in this rain. The Community Health Workers are independent, meeting together to figure out monitoring and evaluation for their community unit outreaches.

In a place where change happens slowly, we have made major advances and are headed in the direction we need to be.

Yesterday morning, Kate, our Head Nurse Valerian, and I met with the Minister of Health of the area to discuss our working together to open a new clinic in Mavueni. Mavueni is a “town” between Takaungu and Kilifi whose residents when sick, must make their way to Takungu for treatment. It is a two hour walk. In the rain, impossible. Can you imagine if you or your child are sick and you have to walk two hours to and from a clinic for treatment? Until now, we have addressed the needs of this far reaching community by ensuring that our Community Health Workers travel to this area every week. However, they are not nurses and are not able to treat every issue.

Three years ago, the Local Authority Fund, which as far as I can tell is like some sort of local group that is non-government but supports the government in various ways, raised the money to build a new clinic in Mavueni. They made arrangements with the Ministry of Health (MOH) that if they built and outfitted the clinic, they would hand it over to the MOH who would staff and supply in with medicine, opening it's doors as an operational clinic. For three years it has sat unfinished.

In the past three years, the Takaungu Dispensery (the local public clinic) has opened and been operating. It is serving many of the needs in Takaungu. Besides it's distant location by the beach, there are usually long waits, not always because of lines, but of the pace of operations, but it is still a fine and functioning clinic. Since it has opened, we have talked about closing or scaling down our clinic.

It is one of our goals, not to create parallel services to those of the government, but instead, to fill the gaps in this far reaching area until the government provides services there. Thus, in line with our goal of supporting the government and ensuring more access to health in this remote area, we have decided to complete what was started at the clinic in Maveuni. We hope to have the building up to code and fully furnished by March so that the clinic, fully paid for and operated by the MOH, can open in the spring.

Over half of our patients will use this clinic and the rest can use the Takaungu Dispensery. We will continue to use the clinic we have now as base for the local Community Health Unit.

I like the Minister of Health. He is a genuine man who has the interests of his district's health in mind. He spoke fondly of the partnership and even seemed excited that this clinic was finally going to be operational. We stressed our concern that we would put in this work and shift our operations there and the doors wouldn't open right away, leaving a gap in services and he assured us this wouldn't happen.

So, we are collecting the inspections and the list of needs for furniture for the clinic. We will visit it next week and then meet with the Local group who first laid the foundation and began construction on the building to get them to hand over the project to us. Then we can get moving!

The MOH will pick up our staff and run the clinic, saving us money and moving us toward more locally owned and more sustainable programs and services. I am glad we will still have an influence there, but the MOH in Kenya is possibly their best Ministry, very functional and less corrupt, so we are comfortable with supporting them in this way.

The Ministry of Education is a whole other story and is why it is going to be a greater challenge to continue to create a sustainable, locally run, junior school. Raising the money to cover those costs without any support from the government is our next hurdle. We are brainstorming ways to make it more sustainable. The farm will provide food for the students and teachers each day saving $5,000 a year. We hope to be done building classrooms and offices and adding any staff after 2013, but will still have to find a way to ensure their salaries can be paid and the school can be maintained. There is a too great a need for quality education in the area and there is no potential for a meaningful public option on the horizon.

Today, I will be at the school, meeting with all the teachers to discuss the school, this issue of sustainability and to ask the question I am getting to ask all our staff, “What are the challenges to your work? How can we support you in your work.” So far on my list are educational posters with graphics, a microscope so clinic staff can identify malaria, bicycles, and trainings. Everyone wants training.