Friday, May 7, 2010

Should Mission Hospitals Be Self-Sustainable?

Is it reasonable for Mission Hospitals to operate such that patient fees are sufficient to cover all of the outgoing expenses?  Or simply put, should mission hospital be able to financially stand on their own two feet without help from outside donations? 


Christian mission hospitals should and must stay afloat on their own via patient fees without depending upon outside donations.  This is the only hope these hospitals have to last and provide any type of long term medical and spiritual impact on the community they serve.  

First, it is quite reasonable to expect that missions hospitals can be self-sustainable because payroll is low compared to the West.  Even for skilled workers like nurses, chaplains, and scrub technicians salaries of 250 dollars per month are very competitive. 

Second, in some countries there is national health insurance.  In Kenya as long as a patient is signed up for NHIF which costs less than 4 dollars per month all of their inpatient care and surgeries are paid for.   The reimbursements to the hospital are substantial and can more than cover patient expenses.  

Third, missionary doctors (who are free work and collect no salary) can not be counted on for the long term.  This is not an insult against lack of commitment by the missionary community but the realities of Westerners living in the developing world.  So many situations can arise including political instability, personal sickness, child-raising issues, lack of fund-raising, or change of mission focus are just a few reasons that may cause a sudden exit of a missionary doctor or the whole medical missionary staff.  What happens and at what level can a mission hospital function if the missionaries leave?  Mission hospitals must find a way to continue operating even if the missionary community leaves.    

Forth, mission hospitals can not rely on donations of finances, medical instruments, and supplies to stay afloat.  Donations are erratic for many reasons.   Financial donations rise and fall with the wayward economy of the West.  Some equipment is excellent and useable.  Other instruments are too technical and fragile to last in a dusty, high-use developing world environment without medical tech support. Some donated instruments are just plain out of date or non-functional and put in the category we call, “Junk for Jesus.”  Some donated items never arrive or are costly to import due to customs and taxes. Mission hospitals must find affordable streams of medical supplies in-country or in nearby places like India.

Fifth, mission hospital medical care in the developing world is often higher standard, more compassionate, and more expedient than the government hospitals. Certain patients will seek out the Mzungu (white) doctor for his or her expertise.   Some of these patients are middle class, have white collar jobs, and are able to pay for “private attention.”  Mission hospitals have a unique opportunity to capitalize off these “private” patients and charge fees that can subsidize the care for those patients that do not have the ability to pay.  


It is not reasonable nor should it be expected that a mission hospital could possibly be sustainable on patient fees alone.  Christian Mission Hospitals need and should be propped up by donations and the care given by missionary doctors for many reasons.  

First, the average Children’s Hospital in the USA relies on foundations and or donations at a rate of 30% of their overall budget.  If we don’t expect a hospital in the West to stand alone, how can we possibly expect our counterpart here in Africa to make it without help from outside donations.  

Second, operating a medical missions hospital is expensive.  Much more so than discipleship, church planting, or building a seminary.  It doesn’t make medical missions right or wrong, or better or worse just expensive.  Operating rooms, medicine, staff available 24 hours per day it all makes this type of ministry expensive.  To expect the meager fees to cover the operating expenses for things like hysterectomies, long term in-patient tuberculosis treatment, or out-patient medicines is not realistic.

Third, making the mission to treat “the least of these” in a hospital setting is a terrible financial decision, but glorious spiritual decision.  Mission hospitals target (as they should) the poor, the homeless, the jobless, the orphans, the widows, the rural farmers, the rejected (HIV+) who often have no income and no where else to go.  Patient fees are intentionally kept low such that no one is turned away.  Outpatient fees are often less than one dollar. A dental extraction costs less than 3 dollars.  A surgical c-section and in-patient stay is less than 100 dollars.   Despite honest work to round up money from family and community, patients often leave the hospital without paying and collection is rarely pursued (as expected).   Fifty percent of all Kenyans live as subsistence farmers on less than one dollar per day.   Keeping fees low to treat the poor and staying out of the red are diametrically opposite goals.  Business goals collide with spiritual goals.  Economics mixes strangely with ministry.   Biblical mandates (caring for the poor) contact paying the bills.     

Fourth, a noble goal of mission hospitals in nationalization.  That is training the national staff (nurses, doctors, administrators, technicians) to take over key positions in the hospital thereby replacing the missionary staff.  This is already happening at Kijabe.  Many of the consultants doctors, all the nursing staff, the CEO, and all the residents are African. This is a good thing!  But, no one wants to talk about the nasty hidden cost of nationalization of a mission hospital.  Missionary doctors (who work for free) are replaced with national doctors (who must be paid a reasonable salary or see them leave).  As mission hospitals become more nationalized they may rely further on donations to keep from sinking financially. 

I guess yes & no is the answer to "should mission hospitals be self-sustainable."  Likely, the right answer lies somewhere in between.  

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