Official administrative and financial staff began working for the Clinic in 1999, and we now have a strong department that works hard to ensure our medics are able to keep carrying out their life-saving work.
Prior to 1992, medical supplies were donated, and the clinic survived using various donations-in-kind. Fortunately, there were regular monthly and quarterly donations from organisations such as Médecins Sans Frontières (MSF) of rice and medicine. If patients were referred for treatment at Mae Sot Hospital, supportive church groups would pay the hospital directly. From 1993 onwards, funding for operating costs was donated by organisations such as the Burmese Relief Centre. This provided funding for basic necessities of the staff, phone bills, and other administrative costs. Eventually, other groups began to provide funding for costs as well.
In parallel, there was a need to develop medical administration. For example, there was initially only one medical record and logbook format that was used by all departments. Separate antenatal care, family planning and delivery records formats were developed in 1994. In 1995, the first annual report was published, with a small office team managing to reply to correspondence or requests to the clinic.
Official administrative and financial staff began working for the clinic in 1999. The first clinic administrator and accountant were appointed, and the first audit conducted. For many years, MTC didn’t keep its own records – all receipts and records were sent back to the donors, and MTC didn’t have its own finance system. Therefore, financial audits were done within the donor organisations. However, from 1999, the clinic started to keep its own receipts and financial records that could be audited.
The other change beginning in 1999 was the method of ordering supplies and medicine. From 1989 – 1999, there was a central ordering system, but increased grants with specific purposes caused MTC to begin catering to specific donor requirements. More staff members were required to monitor the supply and distribution of medicine and its accompanying expenses, and to match those to donor requirements. This development allowed each department’s programme manager to independently manage logistics, staffing and expenses. Furthermore, although each department was able to send requests to the central pharmacy, they also kept a separate pharmacy storage area, and in this way, individual departments operated like tiny hospitals.
Throughout the early years, MSF had been providing quarterly medicine donations-in-kind, but this eventually proved insufficient for the clinic’s caseload. From 1999 onwards, donors began providing grants that were used for quarterly medicine orders through a local supplier. Terre Des Hommes (TDH), for example, supported specific areas in the clinic. Due to growing donor requirements, MTC needed to change the ordering system. More people were needed to monitor medicine expenses and to ensure these matched donor requirements. As the clinical space grew, more coordination was needed. After 1999, departments were established as decentralised entities with some central coordination. Each department now has a programme manager who manages logistics, staff issues, budget and supplies. There is also a clinical supervisor, and shift leaders for the inpatient departments. In each department, one person manages the pharmacy – if there is enough staff, this is a separate person, but many times the programme manager does this in addition to their other duties.
When a new department is created, a new logbook and report format is created. At the outset, however, there was no consistency or complete data across the reporting formats, which made it difficult to consolidate information into an annual report. In 2002, a data coordinator was appointed to oversee logbooks, data entry, and data quality. This coordinator trained clinical staff to do data entry, but their clinical skill set was not suitable, and this resulted in high staff turnover. When the data department was finally established and data entry staff were hired, the data quality improved. From that time on, data quality has continually improved and obtaining consolidated figures across the clinic and reporting to donors has become easier and more accurate.
In addition to the establishment of the data department, a concomitant driving factor behind administrative developments in the clinic was the increasing role of MTC as a refugee advocate and social service provider and coordinator. From 2000 onwards, the increasing population of migrant individuals and health problems gave rise to more NGOs working with migrants. MTC decided to appoint its first migrant health coordinator. Until then, the clinic had restricted its activities to providing services, referring patients to other NGO services, and recording case counts. However, there was no system to monitor the quality of services provided. The Migrant Health Coordinator set out to monitor care in the migrant community, but this was just the beginning of a broader advocacy role the clinic would begin to play both locally and internationally.
The current department
Once MTC had set up the accounting system, changes and requirements began to increase exponentially. For example, some donors require separate financial reporting, in which case a specific accountant needs to be appointed to that project. Even though some projects have these standalone finances, the overall clinic finances must always be integrated for reporting purposes. Initially, an international volunteer was appointed, but each year a new person would take the role. The other challenges were that some donors required quarterly reports, while others required biannual reports. MTC needed to be able to strengthen the system to support timely reports containing both narrative and financial information. The strengthening of these processes continues to this day.
To support this initiative, a fulltime finance manager was appointed in 2005. The role encompasses auditing, reporting, and process improvements to ensure clear reporting. In 2007, a procurement team was established, which set a policy as well as managed the procurement and logistics of the clinic. In 2011, a fulltime fundraising and grants manager was appointed to mange and liaise with donors, as well as seek out new sources of income for the clinic.