rapid social and economic changes and shifts in disease patterns require flexible and carefully considered strategic choices in order to maintain an adequate standard of care without compromising services for the poorest members of society.

The situation in northern Uganda is gradually improving, but the region remains one of the poorest in the country: for the majority of the population, covering the cost of hospital care can mean falling into poverty or extreme poverty.

This is why the hospital continues its policy of offering care at highly subsidised rates, particularly for mothers and children. This is only possible by supporting the entire hospital system with financial backing not only for medical care, but also for its logistical and administrative structure, so that everything runs smoothly, and by systematically collecting reliable data to evaluate results and guide choices and decisions in order to optimise the use of resources.

A significant commitment has been underway on these various fronts for more than three years. It is said that in Africa, it is easier to build a new hospital than to run an existing one. For 67 years, this has been the challenge facing Lacor Hospital.

To cover its running costs, i.e. those that enable the hospital to operate on a day-to-day basis, we offer the most sensitive and attentive donors an institutional funding programme based on results, implemented in a highly original way: Results-Based Financing (RBF).

The programme's objective is to base hospital support on merit, in line with the United Nations Sustainable Development Goals. Donors receive reports on the quantity and quality of care provided, based on transparent and reliable measurements. The operating expenses they cover become proportional to the results verified on a quarterly basis, and care remains financially accessible to the poorest, while strengthening and promoting the hospital's operational autonomy.

Here is how RBF works in practice:

1. Quarterly audits: the Hospital's Quality Committee, accompanied by two external auditors (including the RBF funding manager from the Ugandan Ministry of Health), monitors quantitative indicators (number of patients who have received a given service) and qualitative indicators (more than 200 indicators relating, for example, to facilities, hygiene, clinical and nursing processes, emergency preparedness and training). Based on the results obtained, the amount "earned" by the hospital is calculated.

2. "Second level indicators" are then assessed, enabling the caculation of a score on which donors can base their support, which may be enhanced.

3. An essential condition is the annual return to the Hospital of an "unqualified" audit opinion by a recognised international firm (currently BDO).

This system requires reliable data and efficient administration. For this reason, the hospital has implemented the following projects:

• Implementation of clinical information software: the process of improving clinical workflows and health reporting led to the selection of Stre@mline, a system developed in Uganda.

• Upgrade of the Microsoft Dynamics NA Enterprise Resources Planning system tto Microsoft Business Central: analysis of the current state of administrative and financial processes was completed, with the definition of module functionalities and the development of an integration plan.

• A comprehensive human resources audit was carried out under the guidance of the Human Resources Committee of the Hospital's Board, along with a management assessment of urgent and priority actions to be implemented during the 2025-2026 financial year.

• The Pharmacy Department has been reorganised into two sections: stores and clinical. Two senior pharmacists have been recruited to guide the improvement of activities and the implementation of the bove-mentioned IT systems.

Of course, infrastructure-related actions remain just as important:

• A three-year project to build 69 staff appartments has been completed.

• Work has begun on restructuring and strengthening the electrical network (scheduled for completion in 2026).

• Innovative equipment for shredding and sterilising hazardous medical waste has been installed, significantly reducing incinerator management costs.

• The EKOenergy label has been reconfirmed for the wise use of renewable energy (solar energy). In 2023, Lacor Hospital was the first energy user in Uganda to receive this certification for the sustainable use of electricity.

All this work, although far from the spotlight, requires constant and often invisible commitment to monitoring and improvement on the part of many members of hospital staff and the Foundation, as well as volunteers.