Dal doctor rises to Grand Challenge on HIV

The Infectious Diseases Institute (IDI) provides care to more than 10,000 patients in Uganda who are living with HIV. The challenge it faces: how to continue to support a community in need when international support can be unreliable and fickle.

With this goal in mind, IDI has put together a plan to charge wage-earning patients who can, and are willing, to pay for its services. In return, these patients would have access to certain benefits, like pre-booked appointments and evening-time appointment slots, and the income generated would guarantee care for the rest of the clinic’s patients,  

“No one would receive a lesser service than they already are,” says Tom Kakaire, senior manager of grants and conracts at IDI.

Dr. Walter Schlech, professor of Medicine at Dalhousie, has been visiting Uganda regularly since 2003 and has seen the clinic grow from its early stages when it was designed to serve merely 1,000 patients.

“Monies from the global AIDS funds will eventually dry up, and we have to be able to sustain the HIV effort without charitable donation,” says Dr. Schlech, who travels to Uganda two or three times each year for a month at a time.

Dr. Schlech was recruited by IDI to help investigate the feasibility of a pay-for-use model in improving patient care, and in April he received a “Grand Challenge Canada” research award to support IDI’s plans.

Funded by the Government of Canada, Grand Challenges Canada supports bold ideas with big impact in global health, funding projects that remove barriers to solving health problems in the developing world.

Understanding patients’ needs

Similar projects to this have already been carried out elsewhere, so part of the preparatory work being done is to gather feedback from those locations to find out best practices.

According to Dr. Schlech, preliminary data gathered from a survey of the clinic’s patients shows a large number of patients who would be both willing and able to pay a small fee for their care — more than 70 per cent, in fact.

“Some of our clients do have disposable income, yet they are coming in at 7 a.m., leaving at 4 p.m., and spending most of their time waiting,” says Dr. Schlech. For those that have the means, it is more practical and convenient to pay for a scheduled appointment time.

The funds raised would pay for two to three full-time employees at the clinic. It could also potentially be a source of funding for those patients in need of medication to combat more advanced stages of HIV.

Besides all of the data collected and research done, physical conversion of some of the institute space has already begun and extra equipment is on its way. “We are hoping and expect to see our first patient in this setting by the end of this summer,” says Dr. Schlech.