It took some time to get a rough idea how things work here, although it is clear that there are quite some challenges and shortages. In this post, I'll try to sketch a few organisational problems.

Until January I mainly just observed, to find out how things are working, to get to know the people, and to give a helping hand here and there. Actually, I'm still not having a real overview of how things work. What complicates running a (public) hospital in Tanzania is the fact that the hospital has no decisive power to run the hospital. Many things are decided upon at various higher levels, i.e. by regional, central and other authorities. An example: all employees are employed by the Ministry, and the Ministry appoints employees to the different health facilities in the country.

I started helping to improve the income from patient fees in our hospital. A part of the hospital's budget doesn't come from the government, but comes directly from patient fees. Although its portion is relatively small (about 25% of total income), this is the hospital's only source of income that is in its own hands (i.e. not dependent on the government). Patient fees are supposed to cover the expenses for medicines, laboratory tests and medical supplies and small equipment. Our prices haven't been reviewed for a while and I'm currently helping to review our price list. Besides these patient fees that are directly paid by patients, approx. 10% of Tanzanians have a health insurance (mainly because it's mandatory for all civil servants). So they don't pay at our hospital, but the hospital has to claim this money back from the national health insurance fund (NHIF). With some employees I am currently working on these claims. It is quite some work to complete all forms (one per patient), but we're managing to bring more money in.

Again some nice new photos on our 'Foto'-page, including the beach house we're we stayed for the last two months.