The document proposes establishing a sustainable community medical clinic in Koindu, Sierra Leone to address health needs. The clinic would provide primary care, laboratory services, accommodations, and community education. It would be integrated into a larger community development platform including an agricultural food processing activity to promote sustainability. The clinic aims to improve health access for the marginalized region affected by civil conflict and Ebola, and would operate through generating revenues and community support after an initial two year subsidy period.

1. Proposal for a Sustainable Community Medical Clinic at Koindu,
Kailahun District in Eastern Sierra Leo
June 9, 2016
Usman F Daramy – Facilitator
1377 Keppen Blvd.
Lincoln Park, Mi. 48146
313-923-7261
540-414-1112
usman.daramy@gmail.com
Kollan Kissi Rural Development Agency (KKRDA) is a development oriented Non-Governmental
Organization registered in Sierra Leone and the United States whose mission is the development and
implementation of self-sustaining systems and community development platforms. KKRDA has
established a strategic collaborative partnership with globally willing individuals and institutions such as
the Henry Ford Health System Global Health Initiative in Detroit, Michigan, USA.
Our project focuses on the establishment of a sustainable model community clinic to serve one the most
marginalized rural areas in the World. In Sierra Leone, one region of great need is found at the border of
Guinea, Sierra Leone, and Liberia. This region has been dramatically affected by one of the worst civil
conflicts of the past century as well as the largest Ebola epidemic ever recorded. In fact, the 2014--2015
Ebola epidemic started in Guechedou, Guinea (a district adjacent to Koindu, Sierra Leone) and quickly
spread through the porous borders into the neighboring countries. Despite control of the Ebola epidemic

2. KOINDU MKRU CLINIC
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in Sierra Leone and other countries, devastation to the community in Koindu has been severe and continues
even to this day.
Based on a community health needs assessment performed in Koindu, we have determined the need for a
clinic is very critical. Yet, at the same time, we fully believe as do local residents, that this clinic must be
integrated with other community sustaining projects. For this reason, we propose the establishment of a
multi-disciplinary community clinic to serve as the nucleus of the community development platform. Key
initial components of this platform will include a self-sustaining clinic and agricultural food processing
activity. Once these activities are established, additional programs will be integrated and established in a
phased manner to ensure appropriate staffing and sustainability plans are in place.
The clinic, a central pillar of the platform, would address immediate and basic health needs of the
community. The clinic will have an outpatient primary care facility, laboratory, mini-research center,
pharmacy, and accommodations for visiting health care providers. The clinic facilities will also have
training facilities to promote community education, environmental and occupational health as well as
wellness and nutrition.
BACKGROUND
From 1991 to 2002, the people of eastern Sierra Leone were caught in a bitter and brutal civil war (subject
of movie THE BLOOD DIAMONDS) started in Liberia and then moved to Sierra Leone affecting Koindu
in the Kailahun district. Sierra Leone and the Charles Taylor’s Liberia rebel group survived throughout this
conflict by preying on the livestock, cash crops, and by kidnapping an estimated 100,000 children and
forcing them to become war soldiers. They committed some of the most outrageous atrocities known in
human warfare – cutting of hands and arms of innocent civilians, rapes,and the total destruction of property.
At its height, this bloody civil war displaced nearly 90% of the region’s population (2.0 million people). It
became one of the world’s worst humanitarian hot spots with the deployment of a large UN peace-keeping
contingent. The war ended in 2002, but the process of rebuilding eastern Sierra Leone has been a slow and

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an arduous one. Kailahun district remains one of the poorest districts in Sierra Leone. In March 2014, the
region was again invaded this time by the Ebola virus.
Prior to the Ebola epidemic, the under-five mortality rate for Sub-Sahara Africa in 2007 was 148 per 1000
live births resulting in 4.5 million children dying before the age of five. In Sierra Leone the under mortality
rate was 270 per 1000. In addition, due to years of disinvestment and out-migration, Sierra Leone had just
0.5 health workers per 1000 residents and the government spent 8% of GDP on health. Before the Ebola
epidemic, Sierra Leone recorded a total of 71,000 under five deaths.1
Unfortunately, billions of dollars of
the global goodwill funds that poured into the countries have had a minuscule impact on the front line
communities and people.
RATIONALE:
Koindu is now a typical sub-Saharan African rural village located in eastern Sierra Leone with little health
or community-based infrastructure. With neighboring sister villages in Liberia and Guinea located just a
few kilometers over the border, many residents migrate to visit
Koindu for the purposes of trade. At present, the 50000 residents
of Koindu, and its environs lack access to basic medical services.
In fact,the closest Regional Hospital is in Kailahun approximately
75 km from Koindu with residents required to travel by foot or
motorbike along challenging roads. Due to limited health-care
access,residents in this region suffer daily, and in some cases,die
needlessly because they do not have access to routine primary
health care or emergency health services.
1 www.wvafrica.org
Figure 1 A TYPICAL BORDER CROSSING
POST

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GOAL OF THE PROJECT
The goal of this project is to establish a sustainable clinic and help ensure the availability of preventive
health servicesfor all residents living in the Makona River Union (MKRU)areas.Sucha facility will benefit
residents in Koindu, Kailahun district. At the same time, the established clinic will be a center for health-
care service innovation by providing rapid, portable and affordable diagnostic services to residents such as
screening for eye diseases using a pocket-sized ophthalmoscope costing just US$8.00. This simple, field-
tested device offers a low-cost tool to improve medical care and provides a novel tool for training of health
professionals in developing countries.
Figure 4 Manual Cassava tuber preparation for bending to produce flour.
Figure 5. Potential dehydration feed stock products food powder production
before packaging.
Figure 6. Food produced from cor. Figure 7. Proposed packaging container for
mixture of edible gari, and corn meal.
OBJECTIVES
The overall objective of the project is to design and build a community development platform with a clinic
as the nucleus. This program is expected to help ensure the provision of basic quality health services,
preventive health education, and to identify appropriate technologies, renewable energy for the
establishment of mini agricultural industries, and to plants the seeds for research– including recordkeeping.
Specific objectives:
1. Establish procedures for ongoing assessments of health threats to the population in and around
Koindu particularly women and children’s vulnerability to malaria, water borne diseases, including
the Ebola or any endemic. Promote the Koindu clinic, as a model of the first integrated regional
health program.
2. Develop a training program in partnership with the Centre for Affordable Water and Sanitation
Technology (CAWAST) a non-profit organization that provides training and consulting to
organizations working directly with people in developing countries who lack
access to clean water and basic sanitation. The community would be educated to
understand that there are many factors that can affect health including exercise, diet, environment,
and heredity.
Figure 2 Cardio-pad
Figure 3 Pocket
Ophthalmoscope

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3. Establish a basic research program that would stimulate intellectual thoughts, and job satisfaction –
hence, enhance youth retention. Develop proactive measures for the handling of the next Ebola, or
any other epidemic.
4. Exploit available local resources,including the region’s strategic location for establishing a modern
food production, and processing for the domestic, regional, and the international market. Advance
the mini agricultural initiative to an integrated regional economic development program, by evenly
dividing the mini processes between the three countries.
Budget Tables
Item Year 1 Year 2 Year 3
Clinic $381,420
Cassava Flour
Bakery
Dehydration $
Corn/Gari meal
Packaging
Appendix 1 Project Timeline
Activity Year 1 Year 2
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
THE PROJECT PROGRESS AND GOALS TIMELINE.
Project Timeline for Activities
Budget & Components
activity
Responsible
(Party)
Cost Milestones Deliverables Completed date
 Sensitization
Programs
 Converging a 1 or 2
day regional meeting
at Koindu signing of
project support letter.
 International partner
rep.
U. Daramy &
Medical expert
$10,013 9/15/2016 Receive
written
endorsement
of the
project from
all the
relevant
authorities.
9/30/2016
Clinic Proposal& total
cost
3/1/2016 In progress

6. KOINDU MKRU CLINIC
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Complete business plan
for associated agricultural
industry
4/18/2016 In progress
Identify funding sources
Submit Funding
application
Administrative Costs
Total Project Costs
PROJECT OUTCOMES:
The Koindu clinic would be staffed by one doctor, assisted by two nurses, two employees, a medical
assistant,and a receptionist. Ongoing training, and support for these employees will be provided by national
Governments throughout the first and second year. The promotional events, all aimed at residents living
within a 40 mile radius. With only one hospital within that radius, we project a gradual increase in patient
load over the first two years as we find our place in the community. As patient volume increases,we will
begin supporting our expenses from revenues. At the end of the second year, the subsidies will cease,and
the resident doctors, including supports staff’s will become the clinic’s expenses. We expect to incur
operating losses in the first and second year, but have planned for a strong cash flow to keep the business
running. We will begin a small profit at the start of the third year. We will promote community pride, and
clinic ownership to facilitate affordable monthly premium payments – with free health services for the most
vulnerable community members.
PROJECT’S LASTING AND SUSTAINED IMPACT IN SIERRA LEONE:
The Koindu clinic has been designed strategically to disassociate it from the infamous white elephant
projects of the past. It is an integral of a total community development platform that encompasses income
generation, and employment. As part of the ongoing efforts to improve access to health care in rural areas,
several local Governments and international agencies are subsidizing the start-up and first year of
operations of a new family medicine practice, such as the Koindu Clinic. Throughout the first year, the
Koindu clinic will work closely with advisers from local and international medical experts to get the clinic
on a sound financial and operational footing, using this medical clinic business plan as a guiding
management tool. These strategies in addition to the anticipated increased community income earnings
would positively impact a lasting sustainability of the clinic, the community, Sierra Leone, and the region.

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KOINDU CLINIC MRU
Item Budget cost Detailed Info
Land purchase $ 3,500
Construction of clinic, living quarters and latrines $ 75,000
LOCAL-TRANSPORT
$ 21,000
Three bicycle, 2 Motorized Scooters, 1 delivery
vehicle
Rain water collection system $ 7,500
Solar power for clinic and dormitory $ 10,000
High temperature incinerator $ 7,500
Bore hole well $ 12,000
Clinic and dorm furnishings $ 3,500 Beds, cabinets, tables, chairs, linens
Diagnostic Laboratory Equipment
$ 15,000
EKG, patient monitor, BP, Oph/Oto/temp,
supplies – purchased from or donated by Medical
Teams Int'l, Welch Allyn and other partners
Medical equipment and disposables $ 12,000
Medications $ 20,000 Initial inventory of medicines and vaccines
Misc. travel, lodging, vehicle rental to complete
construction $ 7,200
Labor pre startup
$ 5,000
F/T at $500/month planning and construction
phase, ~ 8 months.
Total Construction / Startup Expenses $ 199,200
Total Cost Estimate for First Five Years
Construction and Startup Costs $ 199,200
Monthly Personnel Expenses for 60 months $ 77,505
Monthly Operating Expenses for 60 months $ 104,721
Estimated In-kind Donations $ -
Remaining Funds to be Raised for Clinic
Completion and Five Years Operation $ 381,426