Generally, the Teasdale-Corti Foundation will not participate in large projects organised by major international development agencies. Nor will it respond to calls for proposals for such projects on behalf of the hospital without consulting the hospital.
St. Mary's Hospital makes its own decisions regarding participation. Factors supporting its decisions will take into account:
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The balance of benefits and drawbacks of the project;
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The workload involved and how it interferes with or complements regular operations;
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Who will do the work in terms of retaining knowledge and experience—in other words, projects led by "consultants" who analyse, create and generate new knowledge with minimal sharing with hospital professionals will not be prioritised.
Beware of large international projects
The hospital's primary mission is to care for the population. The first question that the Foundation and the Hospital will ask is how a major international project will help to care for the Hospital's patients.
Large international projects are generally extremely complicated. They contribute virtually nothing to the provision of care. One could even argue that their impact is negative, since medical resources are diverted from front-line care to the implementation of these projects. Professional staff cannot be replaced on a temporary basis. Replacement salaries are usually inadequate to replace the professionals participating in the project. And the Hospital is not a consulting organisation. It will not provide professional staff to a project simply because it has to hire other professionals to do the work required by its mission.
Furthermore, neither the Teasdale-Corti Foundation nor St. Mary's Lacor Hospital is in a position to manage national or regional-level projects. Involvement could be as a secondary partner.
More importantly, large international projects require a lot of work: several reports and supporting documents must be produced. Neither the Foundation nor the hospital is organised to manage such projects. The systems in place are geared towards running a healthcare hospital, not managing projects. Once again, the operational impact can be extremely negative.
The Hospital will never be at the forefront of major international projects. Its participation as a secondary partner must take the following points into consideration:
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The importance of the needs addressed by the project: are the project activities so necessary that the hospital would need to devote resources to them anyway?
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Large organisations are not particularly interested in funding what is already being done. They want to fill in the gaps: that is where they see the main value of their contribution (why should I pay for something you are already doing? What difference am I making in this case?).
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On the other hand, the hospital cannot afford to add new activities to those it already does without recurring funding. Adding services for the duration of a project makes no operational sense.
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The hospital's objective is to provide affordable healthcare to the less privileged members of the local population. This does not mean that the hospital does not consider developments in medical practice, but the addition of new services must not be at the expense of accessibility to care, an important aspect of the hospital's strategic plan.
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The Foundation's resources that will need to be used and whether or not they will be paid for by the project.
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The availability of direct support for the hospital's operations and under what conditions.
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The requirement for contribution or co-financing.
Some examples of issues that large international projects can pose
Training
Large organisations operate in "fashions". In recent years, the focus has been on reducing maternal and child mortality. It is often thought that the least expensive way to make an impact is through training.
In 2025, the hospital has two training projects underway and two others under discussion. Funding is earmarked for training in obstetric and neonatal emergencies and data management. The biggest challenge is that training is usually given in Kampala (360 km away, or a full day's travel). With a tight workforce, work and family obligations are sometimes difficult to balance. Project management often fails to notify management in advance that someone has been selected for training. Management thus “loses” staff without notice and without being able to arrange for a replacement. Hospital services are unexpectedly disrupted.
This problem is so widespread in the country that in 2024, the Ministry of Health issued a directive [FIN.86/407/01] to non-governmental organisations informing them that national health services are systematically disrupted because staff are absent to attend courses offered, one after the other, by their various projects.
Finally, the quality of the training offered must be addressed. It often consists of short courses for which the need has never been assessed. In addition, international instructors are "parachuted in" without context and without any subsequent evaluation of their performance or the impact of the courses on the performance of the professionals trained. As everywhere else in the world, the need for continuing and complementary training is always there. But who identifies the needs and who evaluates the impact of the training intervention? How do we know if the problem we are trying to solve is more related to a lack of knowledge than to a scarcity of financial and human resources? Are trained staff empowered to implement changes to improve the overall performance of the system in which they work? What about continuing education and the role of professional associations in this area?
And what about the cost-effectiveness of the training spend? Training provided by foreign experts on assignment is much more expensive than training provided by a local expert, who has often studied at the same universities as the foreign expert.
If we want to help, first and foremost we must not cause harm.
Donation of medical equipment
Pièces justificatives trop compliquées
The reality on the ground in sub-Saharan Africa is that it is generally impossible to obtain invoices for expenses such as motorcycle travel or participants' consumption during activities in rural areas.
The hospital is not a professional services organisation. None of its employees are required to submit timesheets. Imposing such a requirement for a project creates additional work for several managers and administrative staff. The costs of such a measure far outweigh the benefits, since everything has to be done manually. It is not worth installing software to meet this requirement, which is inappropriate to say the least, considering that the employees of the agencies that fund the projects requiring timesheets are not themselves required to submit timesheets.
Covering administrative costs
Project administration is not free. The hospital's administrative functions are not organised to manage projects but rather to support an organisation that provides healthcare. This is a fundamental difference that means that any project requires the Foundation and the hospital to recover their administrative costs.
