Abstract
The term “sustainability” has become a keyword of development economics. A system is sustainable if it fulfills its function in the present without sacrificing the equal chances of the future. An analysis of the costs of Lutheran hospitals in Tanzania demonstrates that these institutions can only provide their services today because they use up their own structure. Maintenance and depreciation are not existing, and thus future patients will not find the same services as they are offered to the needy of today. In addition, the hospital-based services have become so inflexible that they cannot respond to major changes of the economic and social environment. This inflexibility is likely to make hospital services unsustainable. It is argued that the steady flow of donations has made hospital leadership almost independent from hospital clients so that they have given much more attention to the transfers from overseas than to their own original function of providing services to the needy.
Abstract
Das Fachwort „Nachhaltigkeit” avancierte zu einem neuen Paradigma der Entwicklungsökonomik. Ein System ist nachhaltig, wenn es seine Funktion in der Gegenwart erfullen kann, ohne die Zukunftschancen zu reduzieren. Eine Kostenanalyse der Krankenhäuser der Evangelisch-Lutherischen Kirche in Tansania zeigt, dass diese Institutionen ihre Dienste heute nur anbieten können, weil sie ihre eigene Struktur konsumieren. Wartung und Abschreibungen existieren nicht, so dass zukünftige Patienten nicht die selbe Quantität und Qualität der Krankenhausleistungen erwarten können wie die heutige Generation. Zusätzlich wurden die Krankenhäuser so unflexibel, dass sie die groβen Veränderungen des wirtschaftlichen und sozialen Umsystems weder wahrnehmen noch daraufantworten können. Diese Unflexibilität verhindert eine dynamische Nachhaltigkeit. Die vorliegende Arbeit schlieβt, dass der stetige Spendenstrom aus Übersee die Führungskräfte der Krankenhäuser fast vollkommen unabhängig von der eigenen Basis, den Patienten, werden lieβ. Konsequenterweise beachten sie die Transfers aus Übersee mehr ais ihre eigene Funktion der Versorgung der Bedürftigen.
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Fleßa, S. Sustainability and Meta-Stability of Health Care in Africa. Z. f. Gesundheitswiss. 9, 349–363 (2001). https://doi.org/10.1007/BF02956505
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DOI: https://doi.org/10.1007/BF02956505
Keywords
- costing
- hospital management
- management of change
- meta-stability
- sustainability
- transfer-seeking mentality