Most of our patients are always surprised at the affordable prices compared to the high quality services that they receive. Our customers usually recommend our facility to other people, and that is one of the reasons that has contributed to the growth in patient numbers.Tumaini Matron CEO
For its first four years of operation from 2008-2012, Tumaini TAG dispensary struggled. Its TZS 1.5 million monthly cash flow was not enough to pay premise rentals and staff salaries were paid in arrears. The dispensary also had inadequate drug stock which led to stagnating patient numbers. Health services at Tumaini remained limited in quality and range.
It was a viscious cycle—low quality constrained revenues; financial limitations constrained investment in quality. Then the situation worsened. When the landlord sold the property and severed Tumaini’s lease, dispensary owner Dr.Elisa Mshote was prompted to take out a TZS 10 million loan to purchase a small building nearby the decision that made the cash flow even tighter and Dr. Mshote needed a different solution to survive.
As a member of the Association of Private Health Facilities of Tanzania (APHFTA), Tumaini TAG was eligible for PharmAccess Foundation’s Medical Credit Fund Program. The program enables health facilities to access affordable loans while simultaneously improving their quality of services and business management through PharmAccess’ SafeCare methodology. Members must participate in quality improvement in order to participate in the loan programme.
SafeCare helps health facilities achieve internationally recognized standards of care that focus on patient safety, patient rights and effectiveness of care. PharmAccess trains and oversees umbrella health organizations like APHFTA in assessing their member facilities on hundreds of criteria across thirteen categories. Health facilities develop quality improvement plans and progress in a stepwise manner through five quality levels. Qualified technical advisors support facilities. When a health facility has completed at least 80% of its quality improvement plan, health centers are reassessed by an external SafeCare assessor. The rating is reevaluated.
Dr. Mshote joined the loan programme in 2011 to access an entry loan of ~$2,000 for purchase of basic equipment and minor refurbishment of his dispensary. He was initially wary of the Medical Credit Fund’s emphasis on quality. Dr. Mshote’s perspective changed as he saw improvements.
Tumaini TAG progressed from SafeCare Level One to Level Two. Patient numbers and revenues increased. The certificate of recognition made the Tumaini TAG staff proud of their work. Management could benchmark their performance in comparison with other APHFTA members.
With these encouraging results, Dr. Mshote became fully engaged in supporting his quality improvement team. The quality improvement plan indicated a need for a wider range of health services and better stock. He obtained a second loan of ~$39,000 for these investments.
Between June, 2011 and April, 2015, monthly patient visits increased 260% from 1,662 to 4,369 patients.
In 2015, Tumaini TAG dispensary applied to the Ministry of Health to be upgraded to health center status. To meet the requirements, Tumaini TAG needed to build wards for inpatient services as well as a labor and delivery unit for the provision of basic emergency obstetric care. Dr. Mshote developed a business plan and received a $71,000 loan to build a maternity wing and renovate the wards. In January 2017, the Ministry of Health upgraded Tumaini TAG to a health center. This categorization commands a higher rate of reimbursement from the National Health Insurance Fund.
As a result of expanded services, upgraded status and increased patient numbers, revenues are projected to double. Growth enables the facility to repay its loans while offering higher quality services to the community.
Dr. Mshote is determined to achieve the SafeCare Level 5 quality rating.
His near-term plans include establishment of an operating theater to enable the facility to offer comprehensive emergency obstetric care. By 2020, Dr. Mshote plans to expand the scope of services to become a fully-fledged hospital with a nursing school.
Dr. Mshote is confident that as his business performance improves, the expansion plans will be financed through loans from Medical Credit Fund. He credits SafeCare as critical to the success Tumaini TAG has experienced in the last five years.
In collaboration with the Ministry of Health, PharmAccess Foundation works with and through umbrella health organizations to improve quality standards and business performance of nearly 800 private health facilities like Tumaini TAG across Tanzania. PharmAccess collaborates with microfinance institutions and other financial firms to provide loans to this traditionally underserved market. Financed by DFID, the Human Development Innovation Fund has provided a grant for PharmAccess Foundation to scale up its innovative approach in Tanzania and transfer learnings to other countries where PharmAccess operates.