Olorte Mobile Clinic

Proposal

Document Details
Document name Version Date Summary Olorte Mobile Clinic Proposal Draft 0.5 22nd October 2008 This document sets out a proposal to establish a mobile medical clinic for the Olorte region of Southern Kenya for approval by the Narok District health authorities. Olorte Community Development Trust Walking with Maasai organisation Potential funding sponsors or contributors in kind Narok District health authorities Mr John Sankok

Readership

Amendment History
Version 0.1 0.2 0.3 0.4 0.5 Date 22 Apr 07 30 Apr 07 02 Nov 07 24 July 08 22 Oct 08 Comments Document draft First review Second Review Third Review Fourth Review Amended by Fadi Barrak Ed Pask Fadi Barrak Fadi Barrak Fadi Barrak

Contents
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Summary 3 Services proposed 3 Method of provision & scope specifications 4 Governance 5 Funding 5 Performance indicators 7 Dependencies 7 Risks and constraints Error! Bookmark not defined. Future considerations 7 Proposed Schedule 7

Summary
Objective To provide outreach health promotion and healthcare services by means of a mobile clinic in the Olorte region of Loita Hills in the Narok district.

Context The ongoing changes in the Maasai way of life have resulted in an escalation of sanitationOlorte related and water-borne diseases, infant and childhood diseases, and HIV/AIDS. There is no current AIDS program in the region nor is there an oral/ dental healthcare provision. Access to healthcare is a critical issue, hence the need for the mobile clinic in order to improve access for the remote villages. There are currently no baseline health statistics to provide an accurate assessment.

The clinic already has the support of the community through the Olorte Community Development Trust. It also has the support of other health organisations working in the area such as Narok Health Ministries.

The clinic model will be reviewed after one year and its replication in other regions in need of a similar service will be considered.

In the long term, it is hoped that small facility purely for in-patient care with a capacity of up to 6 beds could be set up in Olorte. It would be ideal for treating acute conditions such as severe malaria, dehydration, malnutrition and conditions needing intravenous antibiotics or round the clock care.

Services proposed
The remit of the clinic will be well defined to cover the most pressing medical needs of the patients it will serve. These will include: Provision of treatment for minor clinical ailments Oral healthcare facility (education and emergency treatment)

Treatment of Malaria, Tuberculosis, Brucellosis, Typhoid and other tropical and preventable diseases Health promotion and education (including sanitation and general body hygiene) Mother and child health care (child immunization, child weight evaluation, antenatal care to expectant mothers, prevention of mother to child transmission) Identification of community problems, provision of relevant support services and creation of links with other organisations Management of HIV/AIDS including: Education and prevention Counselling and testing Antiretroviral treatment Support systems in the community for affected families and orphans Home based care programmes

Method of provision & scope specifications

The mobile clinic will be run by a local experienced nurse (already identified) and a dedicated trained driver from the local community. Both the nurse, guard and the driver will be employed by Walking with Maasai, a sister charity. The clinic will visit 5 key areas in Olorte on a weekly rota, spending one day at each of the following sites: Enchorro Naibor Olpusare Enairebuk Osinoni Emporr Narok Oldarpoi This will make the clinic easily accessible to more than 15 villages in the community. Specialists in appropriate medical and dental fields will be invited to visit and train the clinic staff. Quality Control processes will allow regular assessment (helping to identify training needs and opportunities for improvement) thereby protecting the highest service levels.

Out of scope of project

In order to offer a reliable service, the remit of the clinic will be well defined. This will ensure that the services provided can be relied upon and promoted to the local communities. Therefore, the following will not be available at this stage: In-patient facility Surgical procedures (unless minor) A regular doctor 24 hour service Ambulance service Regular visits to areas other than the specified five key villages Further project plans will be available once approval for the project to commence has been granted.

Governance
They key stakeholders for this service have been defined as: Narok District Health Officer (Ministry of Health) Mr John Sankok (Narok Health Ministries) Christian Missionary Fellowship The Olorte Community Development Trust Walking with Maasai organization Principal financial donors Approval has been granted from the Narok District Health Officer to initiate the project.

Funding
The budget for this project will be established at the outset and the funding will be secured before any major commitments are made (project stage 4, see below). It is planned that funds to cover the start-up costs and initial operating costs will be donated by churches, individuals and other organisations in the UK. Quarterly reports and feedback will be sent to all of the stakeholders to secure on-going operational funding. This inbuilt accountability will ensure transparency and maximum sponsor commitment to the service. It is expected that the eco-camp, run by Walking with Maasai, will subsidize the funding of the clinic costs within two years of the camp becoming fully functional.

It is also proposed that the operational costs will be offset in part by patients paying a flat nominal fee for any treatment received, assumed at this stage to be 100KSHS per adult and 50KSHS per child. Fees for future specialized services will be revised or decided on introduction of these services in future.

Operational costs
The on-going monthly funding needs have been established as follows:

Estimated Cost description Nurses salary Drivers salary Guards salary Petrol Vehicle maintenance Medical supplies and drugs Vehicle lease Total

KSHS 20,000 10,000 4,500 7,800 5000 40,000 78,000 87,300

GBP 148 74 35 58 39 296 600 650

Start-up costs In addition, a one-off lump sum will be raised from donations to cover the start-up costs required: Purchase of a suitable vehicle (14,000) Fit-out of the vehicle with the necessary facilities (10,000) Start-up medical supplies and drugs (to be confirmed) Building of store room and staff housing (to be confirmed) Legal costs (to be confirmed)

Performance indicators
At the outset, targets for treatment levels will be set and actual performance will be measured against these targets. These figures will be presented in the form of a quarterly report to all stakeholders. This will ensure accountability and transparency of the service to all the stakeholders. In order to meet stakeholders expectations, the service will be clearly defined and risks will be mitigated wherever possible.

The project dependencies, risks and constraints have been carefully evaluated and mitigated for. Future considerations
Future medical considerations are: To consider replicating the Olorte mobile clinic model in other regions in need of similar healthcare services such as Turkana, Kjiado, Suba. This consideration will take place one year after commencing the proposed service in Olorte. To consider building a small in-patient facility in Olorte. This would have a capacity of up to six patients who may require monitoring, intravenous antibiotics and rehabilitation with fluids.

Proposed Schedule
Q2
1. Provisional approval 2. Planning & fundraising 3. Training 4. Final approval 5. Implement operation 6. Commence service 7. Year One review 8. On-going service 9. Expansion

2007 Q3

Q4

Q1

2008 Q2 Q3

Q4

Stage one Initial approval Provisional project approval to proceed is required by the Narok Health Authorities. This will be taken as their response to this proposal and amounts to agreement in principle, subject to later compliance with stated operating processes.

Stage two Detailed process planning and fundraising This stage defines the operational systems and processes that the service will deliver. It will include matters such as: Treatment needs assessment of all the 15 villages Health and safety Training Quality control Treatment protocols Procurement of equipment Cross infection control Storage of medical supplies and drugs Record keeping Legal issues (e.g. confidentiality) Insurance Audit protocols Administration

This phase will also initiate the fundraising activities in the UK to cover the start-up costs and sufficient operational budget.

Stage three Training This stage coves the identification, appointment and training of clinic staff:

Completion of nurse training in HIV/AIDS programme Training of driver to be carried out by the Walking with Maasai team


Stage four Final approval This stage entails granting of approval to operate by the Narok District Health Authorities and the other project stakeholders subject to: Operational processes created in stage 2 Funding being in place Staff training complete (stage 3)

Stage five Implement operation This activity commits funding to acquire the required assets for operation: Sourcing of a vehicle for the mobile medical unit Equipping of mobile unit to agreed specification Acquire start-up stock of medical supplies and drugs Establish operational base Implement all agreed medical and administrative operational processes (stage 2)

Stage six Commence service This commences a twelve month trial service with reporting at the agreed frequency of key performance indicators to the project stakeholders.

Stage seven Year One review Report and evaluation of success with the project stakeholders. The output of this review is to document lessons learned and grant approval to establish it as an ongoing service.

Stage eight Establish on-going service in Olorte Implement lessons learned from the Year One review and establish on-going mobile health service.

Stage nine Expansion This final stage replicates the service in other remote areas of Kenya.