Volunteering, health and the homeless – the cost of establishing a student-run primary healthcare clinic serving the inner-city homeless in South Africa

Abstract

Background: Those who are homeless are more prone to communicable, respiratory and cardiovascular diseases and are less likely to access healthcare services. In South Africa there are no specific public healthcare services tailored to the needs of these communities, particularly if they are immigrants. Trinity Health Services is a studentrun inner-city clinic providing free healthcare to the homeless of Johannesburg, South Africa. The clinic operates two nights per month and provides treatment for mainly acute conditions. The purpose of this study was to determine the costs of establishing and operating a student-run clinic for an indigent population. Methods: This costing analysis used a mixed-methods approach combining an ingredients-based and top-down methodology. The costs, capital and recurrent, pertaining to the establishment and operating of the clinic as well as the cost of treatment per patient were identified and quantified from 1st January 2016-31st December 2017. Results: The capital costs incurred in establishing the clinic were calculated to be £10,968.57 (ZAR 214157.08) and included building alterations, equipment purchased, installations, furniture, application for a pharmacy license, consumables and medications. The recurrent costs per annum were estimated at £17,730.72 (ZAR 346185.54) and comprised of overheads and maintenance, rental, personnel, pharmacy license, consumables and medication. The cost of treatment per patient, included medication dispensed and consumables used in the consultation, was estimated at £3.54 (ZAR 69.05) per visit. Conclusions: This study summarised the costs of establishing and operating a student-run clinic providing pertinent information essential to the sustainability of the service. It also provides a model for costs associated with free clinics in faith-based and university settings.

Understanding Student-Run Health Initiatives in the Context of Community-Based Services: A Concept Analysis and Proposed Definitions

“… 2 , 3 , 34 , 78 , 90 We discuss funding and resources for student-run initiatives later in this paper; however, the ability to provide free services was in large part due to the voluntary contributions of students, healthcare providers, educators, and other personnel. 28 , 48 , 71 , 82 , 86 , 87 As well, some student-run initiatives were supported by healthcare agencies and other partners to provide laboratory, diagnostic, pharmaceutical, and specialty services free of charge or at low costs. 20 , 28 , 35 , 86 , 91 …”

“… 6 , 54 , 61 , 71 , 72 Dependence on volunteerism seemed necessary to ensure viability and sustainability of some initiatives to enable regular operations, adequate staffing, and cost containment. 1 , 42 , 78 , 82 , 85 - 87 …”

“… 28 , 48 , 71 , 82 , 86 , 87 As well, some student-run initiatives were supported by healthcare agencies and other partners to provide laboratory, diagnostic, pharmaceutical, and specialty services free of charge or at low costs. 20 , 28 , 35 , 86 , 91 …”

“…1 , 14 , 19 , 20 , 50 , 68 , 87 , 89 , 94 , 109 , 110 Charitable organizations and foundations, such as the March of Dimes, non-profit agencies, and churches, were also identified as financial contributors for many initiatives 1 , 6 , 14 , 19 , 29 , 45 , 48 , 61 , 71 , 84 , 88 , 99 as were donations from sponsors and other benefactors. 4 , 20 , 28 , 71 , 78 , 82 , 86 In several student-run initiatives, the governance and leadership structure included volunteer roles dedicated to fundraising as part of the operational plan. 22 , 36 , 39 , 56 As previously mentioned, in-kind donations of resources by partner organizations or of material or labor by students and community members also accounted as a way to offset costs 35 , 36 , 42 , 68 , 87 , 94 , 99 , 103 and, in some student-run initiatives, cost recovery came through billing of clients who had health insurance coverage or on a sliding scale assessment.…”

“…Funding and other resources for the sustainability of student-run initiatives was identified as an important consideration by many authors, particularly where service provision was free. 14 , 30 , 56 , 86 , 98 , 103 , 109 While many initiatives were staffed through volunteers and spaces provided through donated or co-location with other services, 17 , 19 , 20 , 78 , 82 , 98 there was a need for paid support positions, operational costs, equipment, and other supplies. Paid support positions, such as clerical and medical assistants, provided day-to-day infrastructure for program continuity.…”