Gates scholars suggest way forward for Rwanda's leading hospital

It says that improvements in planning and capital allocation to an operational fund which can subsidise patient use of equipment could help the hospital become a regional centre of excellence.

The report, Hospital Financial Improvement Project, is the result of a six-week intensive study over the summer by Gates Cambridge Scholars Julia Fan Li and Hannah Pincham and Kristal Fung from the University of British Columbia and has been presented to the hospital authorities who are considering action.

The students became involved in the project after President Paul Kagame delivered the Dr S.T. Lee Public Policy Lecture at Wolfson College, Cambridge, in December on the subject of "Building viable medical research communities in Africa: policy challenges".

After the lecture Julia, who has a background in accounting and Bioscience Enterprise and is now studying for a PhD in Engineering, was standing with a friend beside one of the President's advisers and the two mentioned that they were biotech students looking for a topic for their MPhil thesis. He put them in touch with Dr Clet Niyikiza, chairman of King Faisal Hospital in Kigali.

After various discussions, a number of projects were identified, but the two students did not get the project agreed for their MPhil theses. However, Julia never forgot it and looked around for other ways to carry it out. She found Hannah and Kristal and, with funding from the Gates Cambridge Trust for Hannah and Julia, they headed out to Rwanda in the summer.

Hannah, who is now doing a PhD in Education, had experience of working in Africa, having worked on several volunteer projects dealing with how education can reduce poverty. Kristal's background was in accounting and biology.

They were in Kigali for six weeks, living very close to the hospital and had access to all the senior managers in the hospital. They decided to focus on what they thought could be achieved in a short period and could benefit the hospital most. "We didn't want our report to sit on the shelf," said Hannah. They picked two areas: medical stock outs and capital funding projects, specifically, how MRI and hemodialysis were used at the hospital.

They found that, although the hospital had good capital funding to purchase MRI and hemodialysis equipment, there was little money available to pay for using it. Most Rwandese patients could not afford the full cost of treatment.

The report suggested that some of the capital money should be put into a fund to generate profits to subsidise use of such equipment and that it consider that only those patients who met certain criteria could receive subsidised treatment.

It could also offer its services to patients in neighbouring countries based on competitive pricing.

The students also found that there had been no patient demand studies done that year before medicines and supplies were ordered and suggested ways of improving hospital planning.

The report has been given to the hospital's Director of Finance, Director General and CEO and has received much positive feedback and the students say they are hopeful that many of its recommendations will be followed through.

In addition, word about the project has been spread internationally as the students established an international board of experts. As a result, the University of Michigan plans to send more students to Rwanda to continue project work there and Hannah and Julia believe a lasting relationship can also be established with Gates scholars.

Julia is also looking to set up a student enterprise competition in Rwanda with the Kigali School of Science and Technology to encourage technological entrepreneurship.

She commented: "Cambridge has an amazing ability to draw in leaders and speakers to facilitate global learning. President Kagame's one talk last year encouraged a research project that will hopefully make a long-term positive impact."