- Institutional & legal issues:
- Within the FLM:
SALFA, the health department of the Malagasy Lutheran Church was created by the General Synod of the Malagasy Lutheran Church (FLM) during one of its sessions: in September 1979. This same structure appointed Dr. Stanley Dwight QUANBECK to lead this new department.
In this way SALFA is like one of the departments of the Malagasy Lutheran and is ruled by the Constitution of this Church. This Constitution did not clearly state the kind of organization how SALFA should evolve; therefore it was up to Dr. Quanbeck to create this new structure.
From 1983 (effective starting date of SALFA’s activities) to 1999 (official decision of the General Synod of the MLC to replace Dr. Quanbeck by his close collaborator, Mr. ANDREAS Richard), SALFA was deeply shaped by its founder.
Today, to rule SALFA, it has been adopted a statute (see Appendix).
- With the Malagasy Government:
SALFA which is a NGO was officially recognized by the Malagasy Government in 1987 (re: MOH decree No 3857/87 SAN dated July 16, 1987).
This official text allows SALFA to do its work; actually this one is not shaped for SALFA’s business which is a kind of combination of “commercial” and social work, in which is added its main purpose: spreading the Gospel.
On one hand, not being a formal commercial organization, SALFA cannot borrow money from a bank. On another hand, being very active in its sector, SALFA is easily considered as a business group, so that he very often does not get tax exonerations. For the last containers from SOA and IDA, it was paid taxes. For the last 4 containers, the average for the tax paid was $ 2,500.
If SALFA registers as a commercial group, this will help for importing the goods but higher taxes would be paid.
To date, there is not a law suiting structures like SALFA.
- Funding of SALFA:
At the beginning, there were no specific funds allocated to SALFA. The group started by coordinating the activities of 5 places: Manambaro & Ejeda governed by the ELCA; Andranomadio (hospital installed during the XIXth century), Vangaindrano (small dispensary), Mangarano & Bekoaka (both leprosy) governed by the Norwegian Mission Society.
Dr. Quanbeck diligently created a path to funnel the support from many places abroad to SALFA.
SALFA has evolved from the bottom line to a group handling over $ 400,000 (SALFA’s asset). This amount does not actually show SALFA’s strength which most of the time handles two times this amount in terms of donation going through its funnel.
The group SALFA keeps growing and though more similar groups are now installed in Madagascar, the 25 years experience and expertise of SALFA put him in front.
This requires that the group has enough funding to care of all of the activities which develop.
- SALFA’s structure:
SALFA has two main components:
- SALFA Headquarters in Andohalo
- The 27 facilities. A location of the different places is given in Appendix B.
Even effort in coordinating the work is always done, the structure often does not mix in one due to the fact that:
- There are two different ways of evolution for SALFA headquarters and his health facilities.
- SALFA-HQ has his own Board of Directors and each health facility has their own.
C.1. SALFA Headquarters (SALFA-HQ): located in Andohalo Antananarivo, this place is in charge of coordinating the health activities through the 27 facilities and through the different projects called “vertical projects” as they treat a specific disease or a specific purpose (Tuberculosis, Malaria, AIDS, Primary Health Care, Dental prevention, …).
SALFA-HQ coordinates the different training to be allocated to its large technical staff.
SALFA-HQ ensures the flow of medicines and medical supplies to its health centers.
SALFA-HQ guarantees the link and assumes the relationship with the officials
SALFA-HQ follows up with the statistics.
His flow chart drawing is attached to this request (Appendix B). The executive departments concerned by the “Fitsinjo” are put in red in this chart; these concerned by the control level are put in yellow.
.C.2 The 27 facilities: there are 8 hospitals, 19 dispensaries, of which 10 are located in very remote areas.
Those facilities treat the patients with a variety of pathologies. They are good places for residencies, medical and biological researchers from international university students.
The health facilities care of any patient, there is no discrimination of sex, race, ethnicity, religion or political creed.
The main purpose for the SALFA group is to give appropriate treatment to the patient and to inform them about the Gospel of Jesus.
Important issues include structural ones, dysfunction of the supply system linked with poverty, leadership problems, and staff capabilities which require additional training …
Since 1995, the economical and social world in Madagascar has evolved; competition is now a master word. In fact this is an assumption that hides a bigger problem: inadequate distribution of the facilities (public, private, confessional, international). SALFA is still in an active position, assuming that in 50% of its place, the problem is more poverty than competition.
The last statistics compared with the national rates showed that SALFA cared for 5% of the total population. This seems very low but is still a good score compared to other groups.
SALFA would like to address two major issues that are closely linked: supply system and poverty.
The second problem addressed to GHM is now supported through a program called “Rural Clinics”.
The first request is the purpose of this business plan.