Monday, December 3, 2018

Hargeisa is the graveyard of hospitals in Somaliland - Photos

(For Medeshi by Mohamed Marty)-Hospitals and clinics in Hargeisa have a high mortality rate with many failing during the lifetime of their founders and many more after the demise of their founders.

New modern Emergency Rooms in Hargeisa Group Hospital

 Countless carcasses of once thriving hospitals and clinics now lie boarded up and crumbling in inner-city neighborhoods and high streets of Hargeisa. Fading signages serve as tombstones; memorials of once glorious practices which provided healthcare and jobs. There are only a handful of medical practices founded in the 1960s or 70s which remain in operation. Most practices in operation were founded in the 1990s or early 2000s. These are ageing along with their founders and likely to expire before or soon after the demise of their founders. After the founders’ demise, friends and relatives bury their bodies accompanied by elaborate ceremonies but soon afterwards in less elaborate and inauspicious moments without pomp or pageantry, employees and patients fizzle away and the practices are boarded up signalling the effective burial of such practices. This situation isn’t peculiar to Hargeisa; it is typical of the healthcare landscape in Somaliland, as all practices are subject to the same intrinsic and extrinsic factors which hinder their survival beyond the lifetimes of their founders.

New modern Emergency Rooms in Hargeisa Group Hospital

New modern Emergency Rooms in Hargeisa Group Hospital

 These factors include:
1.  Subsistence vision of founders
Most practices are set up to meet the subsistence needs of their founders. Rarely are practices set up primarily to meet market needs. Even more rare is to have a practice set up and resourced to track and meet growing market needs. Once the practice can continually meet the personal and family obligations of the founder, he/she never bothers about the posterity of the practice. This is especially true once the founder’s children have graduated and are gainfully employed.

2.  Lack of or inadequate separation between the identity of the founder and the organization

Prior to the onset of the National Health Professionals  Scheme in Somaliland in 2015 it was typical for practices to operate using the personal bank accounts of their founders and remain unregistered with the national business registry (Corporate Affairs Commission). These practices are usually named after their founders and in instances when the practices are not named eponymously, the founders are identified by the names of such practices. This co-mingling of the founders’ persona and the corporate identity of the practice makes it difficult to separate the assets of the founder from those of the hospital/clinic consequently after the demise of these founders who frequently die intestate squabbles or disputes associated with asset inheritance frequently cripple or render such practices inoperable. It also makes it difficult or impossible to achieve a sale of the practice during the lifetime or after the demise of the founder as the founders and their family members are emotionally and economically attached to the practice.

3.  Inadequate management expertise and organization structure
Many founders have minimal or no management expertise. Leadership is frequently confused with management capacity hence medical entrepreneurs rarely hire skilled management personnel to work with them. Even more rare is a partnership between a medical entrepreneur and a business co-founder consequently, these practices are poorly organized and operated. Staff are hired based on their affordability than their technical capabilities. Frequently staff operate without programme , job descriptions or performance reviews. All staff report to the founder and take instructions from him/her. Once the founders are weakened by old age, illness or at their demise, dysfunctional organizations emerge which are unable to function or survive.

4.  Lack of succession planning or unrealistic succession planning
Many medical entrepreneurs fail to articulate a succession plan that ensures the continuity of their practices. Some founders expect their children or close family members to become physicians and take over the management of their practices. In some instances, they succeed in achieving the first objective of having a second generation of physicians however these physician descendants may pursue different career paths within or increasingly outside the country. This unrealistic succession plan hinders the founders from growing and incentivizing successors within the ranks of their employees or seeking out non-family members as successors.

5.  Disruptions and harsh business climate
Medical entrepreneurs are rarely prepared nor open to social, technological, economic, and political changes. They are conservative and resist change, which in some instances may be of benefit to the industry or the population. The de-industrialization of the 1980’s resulted in the demise of practices which were dependent on the industrial corporates while the emergence of managed care industry has placed many practices on life support as robust.