Martha Primary Health Care Centre: how resilience and international collaboration is transforming a community
Figure 1. Martha PHCC Children’s Ward. Photograph courtesy of Poppy Spens, May 2015.
I worked in Yei from 2006 to 2011 with the Episcopal Church of South Sudan Diocese of Yei and visited again in June 2016 and November 2018. My role was to manage the expansion of the Martha Primary Care Unit (PCU) to a Primary Health Care Centre (PHCC). It was so encouraging to see the high-quality care the staff were giving to large numbers of patients as well as excellent ground and building maintenance, despite huge challenges.
Martha PHCC developed thanks to a very generous grant from Irish Aid. The new building for outpatients was constructed by the building company set up by the International Hospital in Kampala and was built in 2007. The Irish Aid funds included equipment, medicines and training of several staff. A mobile clinic funded by Basic Services Fund (UK Department for International Development) visited 5 villages each week that had no PCU.
Patient numbers for Martha PHCC reached 50,000 per year for several years and over 40 health staff have received training. Many cadres have been trained since 2007 including clinical officers, ophthalmic clinical officers, nurses (certificate, diploma and degree) laboratory technicians, healthcare managers and one doctor. Some were funded by Irish Aid and more recently by a small UK charity, The Brickworks. The Martha PHCC is capably led by a graduate in Health Management and managed by The Diocese of Yei Health Committee.
In 2009, it was identified that there was no specialist eye clinic in Central Equatoria other than in Juba. As a result, a neighbouring disused building was adapted to house a specialist eye clinic including a theatre, and other rooms and a paediatric ward. The eye clinic was very popular and treated a variety of eye disorders. It was able to offer cataract camps every six months until 2016.
The children’s ward was always overflowing so in 2012, a new, larger ward was constructed with funds from The Brickworks. This building is of a high standard and the care is well respected by the community.
Progress and challenges
Unfortunately, when the insecurity happened in 2016, many staff fled to refugee camps meaning that the eye clinic and children’s wards had to close. A few staff stayed in Yei so the main PHCC continued to offer outpatient, antenatal, immunisations, health education, postnatal, malnutrition, family planning, and HIV VCT and prevention of mother-to-child transmission (PMTCT) services. The PHCC includes a pharmacy and laboratory.
Figure 2. Bebe Godfrey, Laboratory technician internship student. (Credit Poppy Spens)
Currently, two student laboratory technicians and one clinical officer student from Kajo Keji Health Training institute are doing internships at Martha PHCC in conjunction with Yei State Hospital. Some non-governmental organisations have seconded a few staff and The Brickworks have agreed to pay several of the other staff salaries. County Health also kindly donated medicines, which has been very helpful. There are challenges purchasing many other medical supplies in Yei mainly due to insecurity on the roads. Martha PHCC is very grateful to County Health and the Yei State Health Department for all their support and has a good working relationship with them.
Since 2016, Martha PHCC has continued to be very popular, treating up to 200 patients a day. Staff numbers at Martha PHCC used to be over 40 and are now much less. The staff need congratulating for the hard work they do to offer a high-quality service.
In January 2019, one of the ophthalmic clinical officers agreed to return to Yei, but then funding had to be found to reopen it. We are grateful to a church near Bristol in the UK which has agreed to fund the basic needs of the eye clinic for two years. As a result of these two factors, the eye clinic has reopened. The list of patients needing cataract surgery is being developed rapidly and Martha PHCC is hoping that a cataract camp can be held in a few months’ time. However, funding for this needs to be secured as the eye clinic running costs exclude this.
It is hoped the children’s ward can open again soon but this depends on finances being found. Recently, it has been used by the midwives who are newly qualified and whose training was funded by The Brickworks. So far, twenty babies have been successfully delivered in the ward. The midwives are proving that they can identify high risk mothers in labour and are referring those to Yei State Hospital.
The main challenges for Martha PHCC include finding sufficient finances to keep running, to source all the medicines and supplies that are needed and to employ and retain competent staff who are willing to work on less than NGO salaries. The huge rate of inflation and the devaluation of the currency means patients cannot afford to pay much in cost sharing. The PHCC used to cover about 75% of its cost from patient contributions but this is now no longer possible. Having said that, the staff are committed and are doing well during these difficult times.
The Winchester (UK) Hospital has been developing a link with Yei State Hospital, Martha PHCC and Yei National Health Training Institute for several years. Since 2016 no visits have been possible. The link has been maintained however and offers occasional visits of clinical staff to teach at the Kajo Keji Health Training Institute, which is currently in Arua, Uganda. The next visit is planned for October and the Health Training Institute looks forward to welcoming the different health professionals that the link is able to send. We really hope it will not be long before the link can return to Yei.