Overview
Most health projects are asked to set up clinics. This should always be carried out in partnership with local communities with the aim that they should eventually manage them.
Buildings can be built or rented. They should be as simple as possible, well designed, with careful patient-flow plans, and sufficient waiting area.
Clinics comprise various stations which patients visit in turn – registration, weighing, consulting, nursing, laboratory and pharmacy. At each point patients should be treated with respect and compassion. As well as offering curative care, health workers also discover and treat underlying needs of patients and their families. Health workers have opportunities to promote healthy practices. Clinics can be the local centres for national clinical programmes such as stop TB and the integrated management of childhood illness. Clinics should have systems in place to deal with simple emergencies.
Careful records must be kept, but registers and clinic reports should be few in number and easy to use. A fair method of payment needs to be set up so that the poor are not excluded. An effective referral system has to be established with close links between the project and its referral hospitals. Finally, clinics provide excellent opportunities both for teaching and creating health awareness. Mobile clinics can also become the focal point for community based health activities.
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Excerpt from setting up community Health programmes by Ted Lankester
Unless the clinic is part of a genuine community programme, the least needy may use it most, the most needy may use it least. This is known as the ‘inverse care law’.
The least needy who use it most may include:
1. Those with minor health needs wanting injections and pills.
2. Those ill for a long time who have already seen many doctors, and arrive clutching sheaves of reports.
3. Those living nearby who can easily attend.
4. Those well enough to reach the clinic or who have relatives able and willing to bring them.
5. Men, who in poor communities often have more time to attend, and are often less willing than women to tolerate pain.
The most needy who use it least may include:
1. The poor, the distant and the frightened.
2. Women unable to leave home.
3. Children too sick to walk, or with no one to carry them.
4. The very ill, the very old, the disabled.
Our projects must run clinics in such a way that the inverse care law is reversed. Clinics must therefore be priced sensibly and sited correctly, be user-friendly, and run in partnership with the community.
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