Health Services

 

Departmental Vision

A healthy and productive population that contributes to socio-economic growth and national development

Mission

“Accelerate the attainment of sustainable standard of health by all the people in the district in order to promote a health productive life”

Departmental Goal

Reduced morbidity and mortality from causes of ill health and premature death and reduce disparity therein

Strategic Objectives of Health Department

To achieve this goal, the health sector shall focus on achieving universal coverage with quality health, and health related services through addressing the following strategic objectives.

 

Objectives of the department

·         To increase access to the minimum health care package.

·         To control communicable diseases through Preventive, Promotive, Curative and Rehabilitative Services.

·         To prevent non communicable diseases in the District

·         To increase demand, and utilization of health services through community involvement in Health care planning, implementation, monitoring and evaluation.

·         To strengthen Inter-sectoral collaboration with development partners, CBOs and line Ministries in essential Health service delivery.

·         To ensure Quality in health care delivery through Integrated Support Supervision, Technical supervision, Monitoring and Evaluation and staff motivation and strengthen health management information system (HMIS).

·         To develop Human Resource (HR) through upgrading and enhancing competences and performance of health workers and recruitment

·         To strengthen institutional capacity in health service delivery through infrastructure improvement and provision of medical supplies and equipment.

Achievements for financial year 2015/16

Indicator

Annual Target

Achieved by end of May 2016

Percentage achieved

Remarks

%of Villages with functional (existing,

trained, and reporting quarterly) VHTs.

99%

99%

100%

Partners like PACE supported their

Functionality

%age of approved posts  filled with qualified health workers

89%

84%

95%

Gaps filled plus partner support (Baylor &MSF)

Number of outpatients that visited the Gov’t health facilities

297,000

295,223

99%

 

Number of inpatients that visited the Gov’t health facilities

16,543

22,874

138%

Increase in staffing made facilities more functional with staff availability

No. and proportion of  deliveries conducted in the Gov’t health facilities

7,000

7,502

107%

Increase in staffing of Midwives made facilities more functional with staff availability

No. of trained health related training sessions held

20

19

95%

Partner supported

Number of trained health workers in health centers

376

349

92.8%

Partner supported

No. of children  immunized with Pentavalent vaccine in the Gov’t health facilities

13,500

13,392

99.2%

Improved mobilization through  mass campaigns

Value of medicines and health supplies delivered to facilities by NMS

552,924,000

440,086,774

79.6%

Emergence order worth UGX 112,837,226 made to NMS

Number of outpatients that visited the NGO Basic health facilities

38,000

50,093

131.8%

Under targeted this indicator

Number of inpatients that visited the NGO Basic health facilities

4,600

9,453

205.5%

Increase in admissions at Padre Pio HC III and Kicwamba HC II

No. and proportion of  deliveries conducted in the NGO health facilities

1,700

1,371

81%

Services are charged

No. of children  immunized with Pentavalent vaccine in the NGO health facilities

2,165

2,223

103%

Increase at Kyabenda HC III due to improvement in cold chain (repaired fridge)

(Source: DHIS2 2015/2017 FY)

 

Capital development projects progress

Indicator

Annual Target

Achieved by 3rd Quarter 2016

Remarks 

Payment of outstanding debts for maternity wards previously constructed at Kanara HC II and Kiyagara HC II, female ward at Ntara HC IV

2

1

Debts for Kiyagara HC II ward and Ntara HC IV female ward were paid off, now remaining with only that of Kanara HC II

Extension of general ward at Rukunyu HC IV

1

1

Construction works still ongoing at plastering level (Appendix 2)

Extention of children’s ward at Rukunyu HC IV

1

1

Construction works still ongoing at beam level(Appendix 3)

Construction of a pit latrine at Biguli HC III

1

1

(at Rukunyu HC IV)

There was an emergency at Rukunyu HC IV when their only latrine for patients collapsed. The District made an immediate response to put up a latrine to prevent deterioration of sanitation conditions at the facility. Water borne toilet awaits completion (Appendix 1)

Construction of Intensive Neonatal Care Units at Rukunyu HC IV and Ntara HC IV with support from Baylor Uganda

2

1

Ntara HC IV was completed and one at Rukunyu HC IV equipment was delivered and Construction site has been handed over to the contractor for works to commence.

 

 

FINANCIAL SUMMARY OF GOVERNMENT TRANSFERS

No

Item/ Category

Annual Budget

Actual Received

%

1

PHC Non-wage DHO's Office

56,248,864

56,248,432

100.0

2

PHC Non-wage Lower Level Gov't facilities

191,447,136

193,771,864

101.2

3

PHC Non-wage Lower Level NGO facilities

54,540,000

52,835,951

96.9

4

PHC Capital Development

39,215,000

39,215,286

100.0

5

PHC Rukunyu HCIV refurbishment

250,000,000

249,999,878

100.0

6

Medicines

552,986,000

440,086,774

79.6

 

TOTAL

1,144,437,000

1,032,158,185

90.2

 

Other key achievements registered

·         The department received the following items during the course of the financial year;

o   70 beds and their mattresses for high volume facilities

o   7 motorcycles from MoH-GAVI to strengthen routine immunization and they were allocated to: Rukunyu HC IV, Bunoga HC III, Ntara HC IV, Nyabbani HC III, Bwizi HC III, and Kamwenge HC III.

o   5 motorcycles from Institutional Capacity Building (ICB) project and they were allocated as: Biguli HC III-Incharge, Mahyoro HC III-Health Assistant, Ntara HC IV-In-charge, Rukunyu HC IV-In-charge, and Biostatistician.

o   7 refrigerators for strengthening cold chain for Immunization and were allocated as: 5 fridges at District Vaccine Store, 1 at Rwamwanja HC III, 1 at Kiyagara HC II

o   15 bicycles from MoH-GAVI to strengthen immunization outreaches in selected HC IIs 

o   10 gas cylinders from MoH-GAVI to strengthen cold chain for Immunization

o   20 vaccine carriers from MoH-GAVI to strengthen cold chain for Immunization

·         Post-treatment Onchocerciasis Quarterly vector monitoring in Kasyoha-Kitomi focus in which 33,446 crabs were caught, examined and all were negative; no Onchocerciasis vector was caught further confirming its elimination in the district

·         With support from MoH, there was introduction of a new vaccine (Inactivated Polio vaccine) for Polio. The district was also able to successfully switch from Tri-valent Polio vaccine to Bi-valent polio vaccine in all facilities

·         With support from MakSPH-METS program, the district completed development of a 5 year HIV and AIDS strategic plan 2015/16-2019/20 and its M&E Plan. These were approved by District Council, now awaiting printing process by METS program

·          Selected VHTs and health Workers were trained in provision of a new family planning method (Sayana Press) and Community family planning by VHTs is currently being implemented at Bigodi HC III, Busiriba HC II, Bunoga HC III, Bwizi HC III, Biguli HC III, Kanara HC II and Nyabbani HC III.

·         Construction works for face lifting Rukunyu HC IV were started with extension of general Inpatient ward and Children’s ward and construction of a water-borne toilet are ongoing.

·         Completion of construction and equipping of Neonatal Intensive Care Unit at Ntara HC IV with support from Baylor-Uganda

·         Completion of Maternity Ward at Kabambiro HC II and Staff house at Bigodi HC III with support from World Vision

·         Construction of a staff house at Kiyagara HC II is towards completion all with support from World Vision

·         Constructed one block of a 2 stance pit latrine for IPD at Rukunyu HC IV

·         Renovation of OPD, maternity and Inpatient blocks at Mahyoro HC III, Kicheche HC III and Bwizi HC III supported by Baylor-Uganda

·         Recruited more Health Workers with support from MoH and partners to raise staffing level from 75% to 83%. However, when Rukunyu HC IV is fully upgraded to hospital status, this staffing level will reduce to 60% due to hospital staffing requirements.

·         Medicine San Frontiers (MSF) started support to HIV/AIDS and TB services among Fishing communities along Mahyoro landing sites

·         Launched the district laboratory hub at Rukunyu HC IV with a motorcycle allocated to the hub rider with support from MoH through Baylor-Uganda  

 Status of Performance for 1st Quarter 2016/2017 financial year

Indicator

Annual Target 2016/17

Quarterly Target

2016/17

Achieved by end of 1st Qtr 2016/17

Percentage achieved in 1st Qtr

Remarks

%of Villages with functional (existing, trained, and reporting quarterly) VHTs.

90%

90%

95%

106%

Baylor supported their Functionality

%age of approved posts  filled with qualified health workers

70%

63%

63%

100%

Gaps filled plus partner support (Baylor &MSF)

Number of outpatients that visited the Gov’t health facilities

295,000

73,750

84,389

114%

 

Number of inpatients that visited the Gov’t health facilities

23,260

5,815

7,807

134%

Increase in staffing made facilities more functional with staff availability

No. and proportion of  deliveries conducted in the Gov’t health facilities

7,500

1,875

2,453

131%

Reimbursing for each delivery done by Baylor Uganda has improved numbers

No. of trained health related training sessions held

16

4

4

100%

50% of these were conducted at district level with ICB support

Number of trained health workers in health centers

360

360

346

96%

Target excluded Hospital staff requirement

No. of children  immunized with Pentavalent vaccine in the Gov’t health facilities

15,000

3,750

4,164

111%

 

Number of outpatients that visited the NGO Basic health facilities

23,260

5,815

6,771

116%

RBF for PNFPs has increased number due to subsidized services

Number of inpatients that visited the NGO Basic health facilities

7,500

1,875

2,344

125%

RBF for PNFPs has increased number due to subsidized services

No. and proportion of  deliveries conducted in the NGO health facilities

1,800

450

559

124%

RBF for PNFPs has increased number due to subsidized services

No. of children  immunized with Pentavalent vaccine in the NGO health facilities

3,400

850

638

75%

 

 

 

8Key investment priorities in FY 2017/2017- Output, targets and indicators

 

 

Key investment priority

outputs

Performance indicator

Target

1

Completion of the already started construction works at  Rukunyu HC IV

-General ward extended

-Children’s ward extended

-Water-borne toilet constructed 

-Number of wards extended

-Number of water borne toilets constructed

·         2 wards

·         1 water-borne toilet

 

2

Upgrade Rwamwanja HC III to a HC IV level

Rwamwanja HC III upgraded to a HC IV level

Number of HC IIIs upgraded to HC IV

1

3

Complete payment of outstanding debts on PHC-capital development

Outstanding debts for Maternity ward at Kanara HC II paid

Amount of funds paid for debts for capital works

1 health facility

4

Construction of a latrine at Biguli HC III

Latrines constructed

Number of latrine stances constructed

4 stances

5

Construction of bath shelter and a kitchen at Kamwenge HC III (Using District Discretionary Equalization Grant)

Bath shelter and a kitchen constructed

Number of bath shelters and kitchens constructed

1  bath shelter and 1 kitchen

6

Construction of 1 block with

three rooms for Counseling,

Laboratory and Clinical work at

Bukurungu HC II

1 block constructed

No. of rooms constructed

3 rooms

7

Construction of staff houses at

Rukunyu HC IV

3 housing units constructed each accommodating  4 staff with a 4 stance latrine

No. of housing units constructed

3 housing units

1 pit latrine

 

Service delivery priorities for next financial year 2016/2017

 

·         Strengthen provision of Uganda Minimum Health Care Package (UNMHCP) with special focus on Reproductive health, Environmental and Community Health, Control of Infectious Diseases and Human Resources for Health Interventions.

·         Functional Referral system-Take up the management of ambulance referral system from Baylor-Uganda. This will require support from all key stakeholders from district to community level. Absorption process of the ambulance drivers has already been started on by district. A district ambulance committee meeting was held 22nd June 2016 and  different proposals were made: (i) each sub county should allocate an agreed upon amount to the referral system using District Discretionary Equalization Grant allocation which funds will be consolidated and managed centrally at the district (ii) each district department should make a possible allocation to support the referral system including the Health sub districts (iii) a focal person at the district should jointly coordinate the management of the ambulances with Incharges of the two HSDs which will be centered at HC IVs

·         Treatment and management of people affected by podoconiasis in Busiriba and other sub counties

·         Strengthen family planning service coverage through mass mobilization and advocacy events starting with holding a District Family planning day on 17th august 2016 with support from Maries stopes-Uganda.

·         Scale-up Safe Male Circumcision Services in the district through SMC camps and outreaches in all Sub counties with support from Baylor-Uganda.  

·         Decentralize Data entry (HMIS) to 8 lower level health facilities to ease reporting to MoH.

·         The district has signed a Memorandum of understanding with Institutional Capacity Building (ICB) for the second phase of the project with special focus on result-based financing staring with PNFP facilities (Padre Pio HC III, Kyabenda HC III and Kicwamba HC II already selected) and plans are underway to assess and accredit some government facilities to also benefit from this funding based on performance.

Major constraints/challenges in service delivery

1.   Inadequate medicine supplies from NMS due to constrained budget allocation to medicines and supplies by government compared to the existing demand leading to recurrent stock outs in facilities most times.

2.   Poor Infrastructure especially staff accommodation at most facilities leading to staff renting accommodation far from the health facilities which indirectly contributes to absenteeism and late coming.

3.   Lack of transport means. None of the two HSDs have a motor vehicle to enable them effectively perform supervision and other support functions to lower facilities. The only vehicle in the department is a very old Land Cruiser whose maintenance costs are high amidst limited PHC fund allocation

4.   Upcoming disease of podoconiosis most especially in Busiriba and Kamwenge Sub counties yet the district has no capacity to control it without external support

5.   Poor seeking behavior among the population leading to poor health outcomes especially in Maternal and Child Health

 

Recommendations

1.   There is need for government and the district to make deliberate budgetary allocations to the health sector to close the glaring gaps in health supplies and infrastructure

2.   The district should lobby for transport means for HSDs to help fully functionalize performance of their roles

3.   There is urgent need to lobby MoH and Partners to allocate resources to interventions targeting control of the spread of podoconiosis before it becomes a serious menace to all Sub counties in the district. Malaria Consortium has promised to start on treatment and management of affected persons on a pilot project running up to December 2016.

4.   Resources for completion of unfinished capital projects should be identified

5.   Demand creation and sensitization for health activities must continue if the district is to match/achieve the SDG targets by 2020

 

 

 

Health facilities

 

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

2010

No. of Health units

13

16

18

24

24

26

27

27

27

30

33

Coverage by parish

29%

33%

38%

47%

47%

50%

53%

53%

53%

42%

44%

 Source: District HMIS 2010

Water and Sanitation

The rural water coverage in the District stands at 89%.   Despite this impressive coverage, a big area of the district is still water stressed and fewer technology options can be used to provide safe water. Deep drilling and rain water harvesting remain viable options but are expensive and require considerable investment. The affected areas here are Nkoma, Bwizi and Mahyoro.

Presently Sanitation in the District is at 72% and quality of latrines at house holds, markets and most schools is poor.   This calls for continued sensitization of communities on hygiene and sanitation.

Functionality of water and sanitation facilities in Kamwenge stands at 79% while that of water user/source committees is at 78%

Health

Kamwenge District has registered improvements in Health service delivery from number 72 to 39 in the national health league table but a lot need to be done for even better outcomes. All this has been possible with efforts of health workers and infrastructure as shown in table 1.14

Table 1.14 Government Health Units.

S/N

Name of Health Facility

Category of Health Facility

Parish

Sub county

Status: operational or incomplete

  1. 1.

Biguli

HC II

Biguli

Bwizi

Functional

  1. 2.

Bwizi

HC III

Bwizi

Bwizi

Functional

  1. 3.

Ntonwa

HC II

Ntonwa

Bwizi

Functional

  1. 4.

Malere

HC II

Malere

Bwizi

Functional

  1. 5.

Bihanga

HC II

Bihanga

Nkoma

Functional

  1. 6.

Rwamwanja

HC III

Nkoma

Nkoma

Functional

  1. 7.

Rukunyu

HC IV

Kyakanyemera

Kahunge

Functional

  1. 8.

Kiyagara

HC II

Kiyagara

Kahunge

Functional

  1. 9.

Busiriba

HC II

Busiriba

Busiriba

Functional

  1. 10.

Bunoga

HC III

Kinoni

Busiriba

Operational

  1. 11.

Bigodi

HC III

Bigodi

Busiriba

Functional

  1. 12.

Kyakarafa

HC II

Kyakarafa

Busiriba

Functional

  1. 13.

Kiziba

HC II

Kiziba

Kamwenge

Functional

  1. 14.

Nkongoro

HC II

Nkongoro

Kamwenge

Functional

  1. 15.

Kamwenge

HC III

Kamwenge ward

Kamwenge T.C

Functional

  1. 16.

Kimulikidongo

HC II

Kaburaisoke ward

Kamwenge T.C

Functional

  1. 17.

Kabambiro

HC II

Kabambiro

Kabambiro

Functional

  1. 18.

Kanara

HC II

Kanara

Nyabbani

Functional

  1. 19.

Rwenjaza

HC II

Rwenjaza

Nyabbani

Functional

  1. 20.

Nyabbani

HC III

Rwenkubebe

Nyabbani

Functional

  1. 21.

Ntara

HC IV

Ntara

Ntara

Functional

  1. 22.

Kicheche

HC III

Kagazi

Kicheche

Functional

  1. 23.

Kakasi

HC II

Kakasi

Buhanda

Functional

  1. 24.

Buhanda

HC II

Kitoma

Buhanda

Functional

  1. 25.

Mahyoro

HC III

Mahyoro

Mahyoro

Functional

  1. 26.

Bukurungu

HC II

Bukurungu

Mahyoro

Functional

                               

      Table 1.15 NGO Health Units.

S/N

Name of Health Facility

Category of Health Facility

Parish

Sub county

Status: operational or incomplete

1

Kyabenda

HC III

Rwenkuba

Kahunge

Operational

2

Padre Pio

HC III

Kitonzi ward

Kamwenge T.C

Operational

3

Kabuga

HC III

Kakinga

Kamwenge

Operational

4

Kicwamba

HC II

Kicwamba

Ntara

Operational

6

Kakasi COU

HC II

Kakasi

Buhanda

Operational

 Services Offered in the Health Sector.

  • Health Promotion, Environmental Health, Disease Prevention and Community Health Initiatives, including epidemic and disaster preparedness and response.
  • Maternal and Child Health.
  • Communicable Diseases.
  • Non Communicable Diseases.


Service gaps

Staff at the health facilities do not have staff accommodation resulting to them renting accommodation far from the health facilities.

No

Job title/Position

Approved posts

Filled

Vacant

1

District Health Officer

1

1

0

2

Asst. District Health Officer (Environmental Health )

1

1

0

3

Asst. Health Officer (Maternal Child Health/Nursing)

1

1

0

4

Principal Health Inspector

1

1

0

5

Senior Health Educator

1

0

1

6

Bio-statistician /Health Information Assistant

1

0

1

7

Stenographer/Secretary

1

1

0

8

Cold Chain Technician

1

0

1

9

Stores Assistant

3

0

3

10

Office attendant

1

1

0

11

Driver

3

5

0

12

Senior Medical Officer

2

1

0

13

Medical Officer

2

1

1

14

Senior Nursing Officer

2

2

0

15

Public Health Nurse

2

1

1

16

Nursing Officer (Nursing)

10

9

1

17

Nursing Officer (Midwifery)

2

2

0

18

Nursing Officer (Psychiatry)

2

2

0

19

Senior Clinical Officer

8

8

0

20

Clinical Officer

12

11

1

21

Ophthalmic Clinical Officer

2

0

2

22

Health Inspector

4

2

2

23

Public Health Dental Officer

2

2

0

24

Laboratory Technician

10

3

7

25

Laboratory Assistant

10

7

3

26

Assistant Entomological Officers

2

2

0

27

Assistant Health Educator

2

1

1

28

Anesthetic Officer

2

0

2

29

Anesthetic Assistant

2

2

0

30

Dispenser

2

1

1

31

Theater Assistant

4

2

2

32

Cold Chain Assistant

2

0

2

33

Health Assistant

20

11

9

34

Health Information Assistant

10

8

2

35

Office Typist

2

0

0

36

Enrolled Midwife

32

28

4

37

Enrolled Psychiatric Nurse

2

2

0

38

Enrolled Nurse

40

38

12

39

Nursing Assistant

54

53

1

40

Askari

42

18

24

41

Porter

42

39

3

 

TOTAL

345

267

88

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


Demographic Indicators

Total land area           2,375,3 km2
Total Population
(Projection 2014)
421,470
 Number of House holds    88,687
Total female (Projection 2014)   215,668
Total male (Projection 2014)    205,802
Population Density 173 Persons/Km

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