kitovu health care complex p.o. box 524

KITOVU HEALTH CARE COMPLEX

P.O. BOX 524MASAKA

In Christ We Serve

ANNUAL ANALYTICAL REPORT

2009/2010

COMPILED BYTHE MEDICAL SUPERINTENDENT

KITOVU HOSPITAL

Kitovu Hospital Annual Report 2009/2010

Kitovu Hospital Annual Report 2009/2010 2


TABLE OF CONTENTS:Abbreviations: ……………………………………………………….………... 4-6

Executive Summary: ……..…………………………………………………..…. 7-12

Introduction: ……………………………………………………………….……. 13

The Hospital and its Environment: ………………………………………...…… 14-16

The Community and Health Status: …………………………………………….. 17-18Health Policy and District Health services: ……………………………………………………....... 19-20

Governance and Management:…………………………………………….……... 21-23

Human Resource: ………………………………………………………..……… 24-29

Finance: ……………………………………………………………...……. 30

Activities: Curative: OPD: ……………………………………………………………..….…. 31-35

Wards:……………………………………………………..………. 35-45

Special Curative Services: Tuberculosis: …………………………………………………….….…. 46Obstetric Fistula Unit: ……………………………………….…….…... 47Chemotherapy: ………………………………………………………… 48 PMTCT: ………………………………………………..………….…… 48-49 HIV Counselling and Testing/VCT: ……………………..….………. 49-53

Supportive:Laboratory and Blood Bank: ……………………………...…………..... 54-57Pharmacy: ……………………………………………………....……… 57-60X – Ray: …………………………………………………..………..…… 61-62Ultrasound: ………………………………………………………....….. 62-63Domestic Services/hospital projects:……………………………….……. 63-69Pastoral Care and Social Care…………………………………………... 69-73

Preventive and Promotive Services:Community Based Health Care & Nutrition Unit:…………………..…. 73-75Kitovu Community Health Insurance Scheme: …………………….….. 76-81

Health Training Institution:Laboratory Training School: ………………………………………………...….. 82-84

Conclusion: ………………………………………………………………..…… 85-89 Future Plans: ……………………………………………………………..…... 90-91Acknowledgments: …………………………..…………….……….…… 92-94 Annexes:HMIS: …………………………………………………………… ………….…. iBoard of Governors: …………………………………………………………..... ii (a)Members of the Finance and Planning Committee ………………….………..… (b)Member of Management Team: ……………………………………………....… (c)



Hospital Staff by end of the Financial Year: ..…………………………..…..… iiiComprehensive Financial Report: ……………….……………………….….…. ivABBREVIATIONS:

AIDS - Acquired Immune Deficiency Syndrome

ANC - Antenatal Care

APSO - Agency for personnel services overseas. (Since 04/05 is

ASOT - Antistreptolysin O Titer

BS - Blood Slide

C VD - Cerebral - Vascular Accident

C.B.H.C - Community Based Health Care

CCF - Congestive Heart Failure

CHW - Community Health Workers

CPE - Clinical Pastoral Care

CS - Caesarian Section

CSF - Cerebral Spinal Fluid

DDHS - District Director of Health Services

DHO - District Health Offices

DHB - Diocesan Health Board

DM - Daughters of Mary

DM - Diebetes Mellitus

DOT - Direct Observation Treatment

E.D.P - Essential Drug Program

ENT - Ear Nose ThroatGA - General Anaesthesia

G.E - Gastroenteritis

GID - Gastrointestinal Disease



GYN - Gynaecology

HAART - Highly Active Antiretrovial TreatmentHb - Haemoglobin

HCG - Human Chorionic Ganadotropin

HCT - HIV counselling and Testing

HIV - Human Immune Virus

HSD - Health Sub District

HSSP - Health Sector Strategic Plan

HTN - Hypertension

IMR - Infant Mortality Rate

ISS - Immuno Supressed Syndrome

IV - Intravenous

KCHIS - Kitovu Community Health Insurance Scheme

LC - Local Council

LOS - Length of stay

LFT’S - Liver Function Tests

MMM - Medical Missionaries of Mary

MMR - Maternal Mortality RateMRC - Medical Research Council

NGO - Non Government Organisations

NMHCP - National Minimum Health Care Package

NSSF - National Social Security Fund

O.T - Operating Theatre

OPD - Out patient Department

PMTCT - Prevention of Mother to Child Transmission

PNFP - Private Not for Profit

PTB - Pulmonary Tuberculosis



PUD - Peptic Ulcer Diseases

RTA - Road Traffic Accident

RA - Rheumatoid Arthritis

RTI - Respiratory Track Infection

SCT - Sickle Cell Test

STD - Sexually Transmitted Disease

T.T - Tetenus ToxoidTASO - The AIDS Supportive OrganisationTB - Tuberculosis BacillaiU.N.F.P.A - United Nations Family Population AssociationUCBHFA - Uganda Community Based Health Financing AssociationUCMB - Uganda Catholic Medical BureauUGX - Uganda Shillings

UK - United KingdomUSA - United States of AmericaUTI - Urinary Tract InfectionVVF - Vesico Vaginal FistulaWCC - White Cell Count



1. EXECUTIVE SUMMARY:Kitovu Hospital was established by the Diocese of Masaka, about 55 years ago in Masaka District, Uganda. It is a two hundred (200) bed, Private Not For Profit (PNFP) hospital, operating under the umbrella organization of the Uganda Catholic Medical Bureau (UCMB).

Achievements that have been made in the year according to last year’s plan:

Achievements:We managed to:-

1. Solicit funds for fridges, microscopes and autoclave for laboratory.

2. Restructure the CBHC Programme as the main donor phased out

3. Install a solar system at Maternity ward.

4. Increase staff salaries so as to match with government salary scales; especially for the Enrolled Nurses and Midwives.

5. Monitor and document post caesarean infection rate and waiting time on OPD.

6. Segregate the data of FSB as per definition of UCMB

7. Separate midwives in two groups one to concentrate on admission and another

group on labour ward.

8. Closely monitor drug prescription by the Clinicians.9. Hire a Laboratory Technologist so as to improve on the quality of the service.

10. Regularly monitor sepsis on maternity ward.11. Acquire a new double cabin-truck as a donation from Netherlands.12. Conduct a two day capacity building workshops for all staff held on alternative days

Failures:

We failed to:-

1. Obtain heamatology analyzer so as to get more accurate results in heamatology.

2. To include Fansider and Septrin prophlexis in the antenatal package.

3. Carry out regular Medical Audit.

4. Revise terms and conditions between Kitovu Hospital and Nakasero National Blood Bank.

5. Put in place development plan for training of staff in the year we have just ended.



6. Solicit for funds for immunization for our staff against Hepatitis B, C and HIV prophlaxis; after needle prick from HIV infected patients, though discussions were held about it.

Other achievements:

1. Comprehensive Nurse Students from Villa Maria were added on the work force of Kitovu Hospital.

2. All the four qualified staff midwives that work in ANC had a two days workshop to orient them with basic knowledge on family planning and to enable them provide accurate F/P information and specifically natural F/P methods to couples that need it.

3. Engender Health sponsored our hospital staff for a 3 days’ workshop on Process and Tools for improving the Quality of Maternal Health services and another one week workshop on Quality Supervision.

4. Two members of staff attended courses of an introduction to pastoral care giving.

5. Eight members of staff attended a one week course at Mildmay on HIV and a cost centre workshop was given to our staff by UCMB

6. All laboratory staff have gone through a training for malaria diagnosis by Masaka District in Collaboration with Stop Malaria of MOH.

7. We have recently opened a Care Point for Early Infant Diagnosis for exposed children to HIV as a program of MOH..

8. We have established a room strictly for blood group and cross matching; fully equipped with a fridge for blood, compatibility requisition forms and standard operating procedures.

9. We have established a system of dispensing medicine per chart for inpatients as to curb on the big bills of medicine.

10. One Junior Radiographer completed his study.

11. We have reconstructed/renovated the hospital maternity and Labour ward roofs and

ceiling.

12. We have constructed the premature unit and a new pit latrine for OPD.

13. We have renovated of the hospital general kitchen, hospital canteen building and the

hospital mortuary.

14. 5 Acres of coffee were planted as an income generating Project for the hospital.



15. A tree nursery project was also started as an income generating project.

16. Through Dr. Maura and Dr. Una a donation of a Container with medical and non medical equipments was received from friends of Ireland.

17. An orderly central store is now in place.

18. With support of Dr. Una and friends Nutrition ward was re-painted and its Water System repaired.

19. The Rotary Club of Guernsery donated two Theatre lights and one spot light.

20. We have reviewed and followed up the drafted activity plans for the different projects.

21. Phase 1 for the construction of the Hospital Chapel is now complete.

22. Through the Government, The Laboratory Training School received bursary funds for 11 students.

Challenges:

1. Kitovu hospital has quite limited resources compared to its needs and prices of commodities on the market are steadily on increase..

2. Working as a referral unit/Hospital, raises the unit cost of managing her patients yet PHC grant is never increased. Widespread poverty in the community is also another challenge.

3. Lack of ART clinic and ARV’s is a challenge in that many patients put their trust in Kitovu Hospital and when they are referred to other organizations for the services, some of them refuse to go there.

4. No causality department yet the biggest emergencies are RTA’s

5. Lack of a second Surgeon to help our Senior Surgeon.

6. We do not have full time Surgeon or Gyneacologist for continuous obstetric fistula repair whereas there are many women who need this service.

7. Staff attrition.

8. Inadequate staff residences for medical staff.

9. Resistance by some staff against the new system of dispensing medicine according to charts has led to wastage of medicine and delay of medication for our patients.

10. The Nutrition unit now depends on friends who contribute towards food. And so, salary of staff is a problem.



11. Unreliable UMEME power supply has caused the hospital’s generator to be overworked. Then, huge electricity bills add to the problem.

12. The male medical ward is far from the nurses’ station, thus leading to a mix of sexes for patients who need close observation.

13. Lack of immunization for lab staff against infectious diseases like Hepatitis B.

14. The hospital fence needs replacement so as to contain security problems.

15. Lack of free contrimazole prophlaxis treatment for HIV+ clients

16. Lack of equipment such as Intra-osseous cannulas, full range of paediatric B/P caffs, complete set of otoscope/ opthalmoscope and suction machine on Children’s ward.

17. Very old x-ray machine which leads to a number of rejected x-rays.

18. The operating room for Ultra sound is quite small, dusty, hot and the roof needs repair.

19. The incinerator needs repair.

20. Lack of safety cabinet in Microbiology room.

21. Lack of computer in Laboratory.

22. Inadequate isolation rooms, lack of private rooms, and mixing of sexes on Medical Ward for closer observation of the very sick.

23. Urgent need for renovation and expansion of OPD, Pharmacy store, central store so as to meet the increased demand of services.

24. Non-compliance with medicines e.g. many patients with tuberculosis disease and HIV refuse to go to other Health facilities that provide ART’s.

25. As for the Early Infant Diagnosis program, caregivers don’t come back for results even when they are contacted on phone.

26. Self-sponsored laboratory students are unable to meet their school fees in time.

27. Extreme poverty among our clients, quite often make them fail to meet the hospital bills.

28. Construction projects are constrained by lack of funds; like the hospital chapel, which still needs a lot of funds to be completed.

29. There is absolutely need to provide the Nabulago farm with a constant and permanent source of water especially for the piggery project.



30. Lack of adequate accommodation rooms for our visitors, as some of them are sometimes referred to go and sleep out of the hospital.

Important recommendations and plans for the coming year:

Future Plans:

1. Continue to search for funds so as to work on the different projects; like, the multipurpose building complex and the Biogas sanitary system, Equipment for laboratory and children ward, provision of free Septrin of ANC mothers, renovation of main pharmacy store, construction of a casualty department and to build staff residences.

2. Lobby from the Government for more funding to the hospital so as to enable us to continue working as a referral unit.

3. Open an HAART Clinic (HIV clinic)

4. Pursue accreditation of Kitovu Hospital surgical services as a training centre for M/Med/Surgery and East African Fellowship in surgery.

5. Maintain Fistula Repair program and continue getting expatriates, while continuing to look for fulltime surgeon for the program.

6. Strive to increase our hospital income so as, to have capacity to pay our staff competitive salaries and be able to retain trained and experienced staff.

7. Continue sensitizing staff and patients about dispensing drugs/medicines per chart and to find ways to speed up the process of dispensing medicines so that the goal which led to the new system can be realized.

8. To solicit funds for Nutrition Unit as its future is at stake without donors’ support..

9. To find ways of having reliable/permanent power supply.

10. Reconstruct at least 2 private rooms in the main hall and establish a nurses’ station in the main hall so as to enable close monitoring of very sick male patients and also plan for more staff and more equipment; to enable establishment of a second nurses’ station.

11. Solicit funds for immunizing staff against Hepatisis B

12. Organise space for Paediatric intensive care unit to manage the very ill children.

13. Consider Paediatric private services

14. To ensure that we get the prophlaxis drugs for HIV+ Clients all the time in PMTCT.



15. Consider having ANC everyday.

16. To separate area and personnel for OPD and IP in the pharmacy to ease the work for staff.

17. To get new x-ray machine.

18. To find ways to keep the Ultra sound room cool and dust free.

19. To renovate some of the old buildings at the hospital especially the staff hostels and wards.

20. To renovate the hospital fence.

21. Buy a computer for Laboratory.

22. Refurbishment of the Hospital Incinerator.

23. Create space for first stage of labour

24. Provide ventouse vacuum to maternity as to decrease number o ceasarian section

Below are the two tables showing some of the activities and services rendered to the patients in the last five years.

Table showing the General Performance in five years

Year 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010OPD Attendance

33504 27904 28547 32622 40168

Admissions 13067 10453 9003 11032 16426Deliveries 1470 1397 1179 1863 2091Antenatal attendance

2150 1340 1844 1212 2246

Immunization

9185 6862 9232 11401 9650

DPT3 793 (87%) 30.5%

All the accessibility parameters are on increase except immunization because, number of outreaches were cut down due to decreased funding for CBHC.

Table showing other services rendered:2005/2006 2006/2007 2007/2008 2008/2009 2009/2010

X-Ray 1,654 2,011 1821 1796 1664Ultra Sound Scan 525 - 222 834 936Laboratory 61,372 64,696 51,966 55154 69396Psycho-social care & counselling 4,529 3,271 3,487 3830 5802Blood Transfusion 6,023 5,492 3,728 4878 7020Social work activities 4,182 3,917 3,927 3,946 5802Obstruct Fistula Repairs 312 296 236 229 280



The output of Ultra sound, Laboratory, Blood Bank and social work activities has increased tremendously.

2. INTRODUCTION:1. This report covers the period from July 2009 to June 2010.

2. The source of data has been the HMIS, hospital register, hospital medical records and Masaka Health Districts Offices. Data has also originated from the incharges of different departments and wards. Information has been analyzed by the incharges, management and chairperson of the Board.

3. This report shows the trends of hospital utilization in the past 5 years. which indicate that the number of patients is increasing, cost of living is steadily increasing but the source of income is stagnant or on decrease such as PHC grant and so, sustainability of the hospital in the future is uncertain,

4. The report conveys the hospital’s location, environment, Governance, activities, achievements, challenges and future plans.

5. Faithfulness to the mission is evaluated in terms of Accessibility, Equity, Quality and Efficiency using the standard unit of output (SUO), quality indicators (fresh still birth rate, maternity death rate and percentages of qualified staff).

6. During this period we had adequate number of Doctors and Clinical Officers though the majority were newly qualified. Regarding Midwives and Nurses, the majorities were newly qualified too.

Some of the problems experienced in writing this report were getting the information on time. We had many new incharges who needed a lot of help in producing presentable data and reports.

Giving feedback to the staff about data and reporting will be priority in the future, so as to make them aware, of the importance of the data.

Inspite of the difficulties experienced in writing this report, it is our hope and belief that our readers will find this document useful. We thank our readers e.g. UCMB for all the constructive feedback and we humbly request others to do the same so that we can improve our services in the coming years.

Any feedback and corrections shall be highly appreciated.



3. THE HOSPITAL AND ITS ENVIRONMENTKitovu Health Care Complex (KHCC), known as St Joseph’s Hospital was founded in 1955 by the late Arch Bishop Joseph Kiwanuka, the first African Bishop in the South of the Sahara who visited Ireland and asked the Irish Sisters of the Medical Missionaries of Mary to come to Uganda.

From its inception in 1955 up to 2001, it was administered by the Religious Congregation of the Medical Missionaries of Mary (MMM) Sisters. The Irish Sisters handed over the administration of the Hospital to the indigenous Congregation; the Daughters of Mary sisters (Bannabikira) on 15th Dec. 2001.

St. Joseph’s Hospital, Kitovu, was established by the Diocese of Masaka about 55 years ago in Masaka District, Uganda. It is a two hundred (200) bed, Private, Not For Profit (PNFP) Hospital, operating under the umbrella organization of the Uganda Catholic Medical Bureau (UCMB)

Kitovu Health Care Complex is a general Hospital with some specialized services such as Obstetrics/Gyneacology, Surgery and Obstetric Fistula Repair and prevention.

It is composed of:

A 200 bed Hospital (+ 28 beds for new fistula unit which are used at specific time) A community Based / Primary Health Care Programme A Nutrition Education/Rehabilitation Unit A Psychosocial and Counselling Unit A Regional Blood Bank Laboratory Assistant Training School A training centre for Doctors and Nurses for VVF repair and caring for VVF

sufferers; which started in November 2004 as semi-autonomous unit. Intern Doctors Training Programme (Makerere – linked)

Although officially it is not recognized as one of the referral hospitals, yet it shares that responsibility with Masaka Regional Referral Government Hospital that exists within the same Municipality and District. Some Health Centres in Masaka, Rakai, Sembabule, Kalangala and Mpigi, etc refer their patients to Kitovu Hospital.

The Hospital began with Out Patient Services, followed by a small in-Patient Unit. Over the years it has grown into a large hospital. Both curative and preventive services are offered by the hospital and an Outreach programme is associated with it.

The Community Based Health Care (CBHC) Programme was the first major outreach service. It was followed by the Mobile Home Care, Orphans and Education Program, which was



developed in response to the AIDS epidemic in this area. Now it is a separate entity located in Soweto – Masaka town.

Also in response to AIDS related problems, the Pastoral Care and Counselling Training Unit was established.

In November 2004 a unit center for training of Doctors and nurses for VVF repair and caring for VVF sufferers was established.

The Hospital, together with the outreach programme make up Kitovu Heath Care Complex, whose mission is, “To continue the Healing Ministry of Jesus, by proclaiming the Sacredness of life, providing services which foster the health and well being of the people, and caring in a special way for women, children and the poor.” This is done through the INTEGRATED ACTIVITIES of the various sectors, each with its specific Mission enfleshing the vision of the Complex.

We pursue this mission by: Providing INTEGRATED, HOLISTIC services, which are ACCEPTABLE,

ACCESSIBLE, AFFORDABLE AND SUSTAINABLE. Respecting the dignity of each person hence treating each one with compassion and

justice. Maintaining a high standard of PROFESSIONAL COMPETENCE, ETHICS AND

EFFECTIVENESS Assisting our staff to develop professionally and personally and providing them with

meaningful careers.

Location:It is located at Kitovu hill, within Masaka Municipality (which has a population of 72,400 people); within Masaka District (with a population of nearly 822,300 people); within Uganda which has a population of 30,000,000; 89% of which live in rural areas.

The district lies immediately below the Equator in the southern hemisphere zone of Uganda.

It is 130km south of Kampala, the capital city of Uganda and 3km from Masaka Town. The district boundaries are formed by the districts of Sembabule, Rakai, Kalangala and

the southern part of Mpigi, in the west, south, east and north respectively. The total regional population (for the districts mentioned above) is about 1,500,000

people. In terms of the area covered by the hospital curative services, Kitovu receives patients

from all the districts mentioned above. However, in terms of the population covered at a referral status, it shares responsibility

with Masaka Regional Referral Government Hospital located 4½ km away, which has a total of 330 beds.

For disease prevention and health promotion, a smaller catchment area has been defined nearest to the hospital for the hospital’s focus and concentration with the Primary Health Care interventions the impact of which can therefore be easily evaluated.



The target population for the hospital is estimated to be about 300,000 people.

Communication:Transport facilities are good. The hospital is partly linked to Masaka town by a tarmac road. There are commuter taxes and motorbike transport. Telephone communication; two landlines, call boxes/payphones and mobile phones are available.

Physical Environment:Masaka District covers an area of about 4,560sq km of which 30% is open water and swamps.

The months of March, April and May being the season for the long rains while October, November and December are months for the short rains.

Peaks of incidences and prevalence of malaria, the number one cause of ill health in the region, tend to follow the peaks of the rainy seasons.

The hospital is within an ever green region with some rain forests and many rivers traversing the districts, as they descend towards the east to join the freshwater lakes among which is Lake Victoria one of the world’s biggest inland lakes.



4. THE COMMUNITY AND HEALTH STATUS:The main ethnic group is the Baganda. Other ethnic groups include Banyarwanda, Banyankole and Bakiga. Luganda is the main language spoken followed by English. Language proves no barrier to provision and utilization of services because many staff can communicate in English or other Bantu languages.

There are some unique cultural practices that may affect health delivery such as

1. Belief in traditional healers. Many people come very late to seek medical help. They come after failing to get better with the traditional medicine.

2. Traditional treatment of the baby’s umbilical cord. Families may use cow dung or any other herbs to put on the umbilical stumps, thus the babies have high risk of sepsis and neonatal tetanus. We hardly miss a week without a neonatal tetanus case.

3. Many mothers during labour are given herbs which bring strong contractions which lead to ruptured uterus.

4. There is a belief that a mother should deliver naturally thus many women keep on pushing even when they cannot deliver naturally and end up with obstetric complication such as VVF.

Economic activity:The majority of the people are poor peasant farmers with small family incomes.

Principal economic activities include animal husbandry, fishing, coffee and banana farming. These are the main sources of income.

A small percentage of the population is engaged in small-scale industries, trade or salaried employment. The cost of living is quite high, whereas income is steadily decreasing; thus many people have very little to spend on health.

The main causes of ill health are: Communicable infectious diseases, malaria, respiratory tract infections including

pneumonia and T.B, diarrhoea, worm infestations and HIV/AIDS which underlies many other diseases.

Complications of pregnancy and childbirth Malnutrition and diseases associated with poor water supply and poor environmental

sanitation. High blood pressure, diabetes, cancer and other diseases of the affluent society are on

the increase as more people are adapting the western style of living.



Demographic data for Masaka Municipality, HSD, Masaka District and Uganda

Msk Municipality HSD Masaka District Uganda(A) Total Population (Projected for the year under report) 72,400 822,300 30,000,000

(B) Total expected deliveries (4.85% of population) = (4.85/100) x A

3,511 39,881 1,455,000

(C) Total Assisted Deliveries in Health Facilities 14,289(D) Tot. Assisted Deliveries as % of expected deliveries =(C/B)x100

35.80%

(E) Children <1 year (4.3%) = (4.3/100)xA 3,113 35,358 1,290,000Children < 5 years (20.2%) = (20.2/100) x A 14,624 166,104 6,060,000(F) Women in Child-bearing age (20.2%) = (20.2/100) x A

14,624 166,104 6,060,000

(G) Children under 15 years (46%)= (46/100) x A

33,304 378,258 13,800,000

(H) Orphans (≈ 10%) = (10/100) x A 7,240 82,230 3,000,000

. The percentage of assisted delivery in the District has increased from 28% to 35.80%.

Table showing Health indicators of community and country of UgandaHSD Masaka

DistrictUganda

Total Population 72400 822,300 30,000,000IMR 76/1000 76/1000Under 5 MR 137/1000 137/1000 National figuresMMR 435/100,000Rate of StuntingHIV Prevalence (UHSBS result) 7%

% Supervised deliveries 36%Total Govt. & PNFP Utilisation (newcases) per year = Total NewAttendants / Total Population

1.3

% Children < 1 yr fully immunized 90%

Children immunised in Masaka District has increased by 5%



5. HEALTH POLICY AND DISTRICT HEALTH SERVICES:The hospital is affiliated to the Uganda Catholic Medical Bureau and its activities are guided by the constitution of that umbrella organization.At the same time it adheres to the Government policies through the partnership with the Ministry of Health.

In 1999 the Uganda Ministry of Health adopted a 15 year health strategic plan which was launched in the year 2000 with the first 5 years Health Sector Strategic Plan (HSSP), now we are following HSSP III. The national health policy emphasized Primary Health Care as the basic philosophy and strategy to address the country’s major health and other social problems.

It went further to define a National Minimum Health Care Package (NMHCP) and made it the Primary Focus for the Health Care delivery system.

Among the major components of the National Minimum Health Care package to which Kitovu Hospital subscribes and contributes greatly are:

Control and treatment of communicable diseases e.g. malaria, STD – HIV/AIDS, T.B. Intergrated management of childhood illnesses, Sexual and reproductive health, Immunization Environmental Health Health Education Promotion School health Epidemic and disaster prevention, preparedness and response In the area of clinical care Kitovu Hospital goes beyond the provision of simple

essential clinical care to offering specialized medical, obstetrical/gynecological and surgical care at a regional referral hospital status.

In the areas of nutrition and blood transfusion services, the hospital is the regional center for nutritional education, as well as the Regional Blood Bank, serving 4 to 5 districts.

In so doing, the hospital greatly contributes to the operationalisation of the National Health policy on the government partnership with the Non Government Organisation (NGO) health care providers.

That policy recognizes the Non Government Organisation (NGO) Health Care providers as major partners in health, collaborating closely with the Government to promote the shared objectives of:

Increasing coverage Improving the quality of health care, Avoiding duplication of services, Improving equity in distribution of health care services, in a special way to reach

women, children and the poor which is in line with the hospital’s mission and vision.



In a way of strengthening this policy based collaboration, Government sends a financial grant (subvention) to the hospital annually, and at least one Government paid medical doctors have been seconded to work at the hospital. We have a seconded midwife from Masaka District who works at PMTCT programme. Recently a new programme of Early Infant Diagnosis of exposed infant to HIV was started by the Ministry of Health at Kitovu Hospital.

The status of Masaka District Health Services (current data not available) Number of health sub districts (sub divisions) each with at least one doctor – 8-9

Number of Government Regional Referral Hospitals – 1

Number of NGO hospitals (including Kitovu) – 2

Total number of hospital beds – 686

Average bed occupancy – 65 – 72%

Number of Health Centres (excluding hospitals) – 83

Percentage of health facilities that are NGO – 43%

Number of new rural operating theaters – 8 not fully operational

Doctors/population ratio – 1:20,044

Nurse/population ratio – 1:5000

Midwife/population ratio – 1:6,500

People living within 5km of a health facility – 65%

Deliveries conducted by trained staff 2005/2006 – 36%

Rural safe water coverage – 87 – 93.5 depending on technology

Average pit latrine coverage – 95.1%

Schools safe water coverage – 87.5 – 93.5 % depending on technology

Schools sanitation (stance/pupil) ratio – 1:40 pupils – 50.1%

DPT3 coverage (projection) – 93%

BCG coverage (projection) 80 – 119%

Fully immunized coverage 85%



7. GOVERNANCE AND MANAGEMENTBoard of Governors: (see Annex ii) (a)

“We live in an era of unprecedented change”

The delivery of health services has become turbulent, uncertain and demanding, this places new demands on the Governance and Management of health units especially the hospitals. Thus, the hospital has a structure, which influence its management and the management style of employees.

The hospital has a valid charter which guides it throughout the year. It helps the institution to plan with its staff.

Following the charter, the hospital has a board which examines, direct and approves the annual activity plans and budget for the Hospital. The Board monitored, examined implementation of the annual plans and redirected where it was necessary. We thank the Board for that great work done in the year under review.

Board meetings were held five times in the year under review. The members were very active and were monitoring all decisions made to see whether they were implemented in time according to the development programme.

Board Meetings held through the year:

Date of Board meeting Report presented Number of members present

10th October 2009 Hospital’s 1st Quarterly report July – September 2009

10

6th February 2010 Hospital’s 2nd Quarterly report October – December 2009

11

22nd May 2010 Hospital’s 3rd t Quarterly report January - March

7

12th June 2010 Budget for 2010/2011 1231st July 2010 Hospital’s 4th t Quarterly report

April - June11

Committees of the Hospital:

1. Finance and Planning committee: (see Annex ii) (b)This committee sat ten times in the year under review to monitor and to strengthen financial management in the health system.

2. Building Committee



Members held four meetings as required by the board to discuss issues on building and construction

3. The Training Committee: Members sat for six meetings to review bursary Funds and development of the school.

4. Grievance and Disciplinary Committee Members on this meeting held three meetings in the course of the year.

5. Interdepartmental meetings:Staff from various departments held meetings to evaluate their work. These meetings were held on Tuesdays in the second week of the month.

6. Management Team: (see Annex ii) (c)The Management Team held its meetings weekly to assess their work and what so far has been achieved.

The core Management also used to hold its meetings on Mondays and Fridays although some days it was not possible due to various workshops and external meetings.

Internal Auditor:The hospital has an Internal Auditor. Her work is to review and evaluate all health system. She provides reports to the concerned department about her findings. When she wanted to meet the Management, she made an appointment in writing especially when she wanted to make recommendations for improvements.

She has been reminding the health system to hold stock taking quarterly and a report/feed back is given to the respective department. In this way she helped the hospital very much to follow its budget, to detect errors and prevent fraud.

Manuals/Guidelines:The hospital has a finance and material resources manual plus an employment manual. The finance manual has helped us a lot to put in place all the documents recommended to ensure that proper accounting procedures are adhered to.

The employment manual has helped us to streamline the work of the Human Resource Manager and the recruitment committee. Job descriptions for each department are prepared and staff sign them on the day they start their new jobs.


KITOVU HOSPITAL ORGANOGRAM Board of Trustees of Masaka Diocese

Delegation of powers Ministry of Health

Board of Governors Kitovu Hospital UCMB

Advisory Assembly District Health Authorities

Management Team headed by a Chief Executive (Hospital Director/Financial Controller) and Consisting of Heads of the main Departments

Medical Senior General Services Human Resource CBHC/PHC Superintendent Nursing Officer Accountant Manager Manager Coordinator

Head of Nursing Assistant Head of Responsible for Head of preventive/ Head of medical doctors Services, Accountants, cleaning, staff recruitment, promotive services, and paramedical staff, Nurses and Cashiers, maintenance of welfare, nutritional education Pharmacy, Statistics Nursing staff Income generating infrastructure, personal issues and rehabilitation Rehabilitation. Laboratory, projects, equipment, and transport Regional Blood Bank, Kitovu Community ground, X-ray, Ultrasound scan Health Insurance security andTheatre, Chaplain, Scheme catering servicesPsychosocial,Counselling and y

Advisor/Head of Clinical Services

PrincipalTutor

Head of Lab. Training,Tutors and students.

Social work services

23

8. HUMAN RESOURCE (STAFF)At the close of the financial year, there was a total of 225 employees. Of those 128 were medical and 97 non-medical staff.

The table below indicates the total number of staff by designation as at this reporting time and a comparison with the previous four years.

Distribution of staff in the various categories over four years

Staff category 2005/2006 2006/2007 2007/2008 2008/2009 2009/2010Consultants 2 2 2 2 2M/O special grade 1 1 2 2 2Senior Medical Officer 3 3 2 1 0Medical officers 1 2 3 3 4Intern Doctors 2 2 1 2 1Dispenser 1 1 1 2 0Pharmaceutical Assistant 2 1 1 1 2Pharm. Store Assistant 1 1 1 2 2Drug billing nurse 1 1 1 1 1Dispensing Aides/Nurses 4 4 4 3 4Anaesthetic Officer 2 2 2 2 2Anaesthetic Assistant 1 1 1 1 1Darkroom Attendant 1 0 0 0 0Radiographer Assistants 1 1 1 1 0Radiographer 0 0 0 0 1Lab Technician 2 2 1 2 2Lab Assistants 11 12 10 11 10Lab Technologist 0 0 0 0 1Phlebotomists 2 3 3 2 2Blood Donor Recruiter 1 2 2Clinical Officers 3 3 3 3 5Chaplain 1 1 1 1 1Social workers 2 2 2 2 2Counselors 6 4 2 3 3Patients Care Attendant 1 1Senior Nursing Officer 1 1 1 1 1Double Registered nurse 3 2 2 3 3Registered Nurse 5 5 7 7 10Registered Comprehensive Nurse 1Enrolled Nurses 30 31 28 27 30Enrolled comprehensive Nurse 1 1 2Reg. Midwives 3 0 2 4 6Enrolled midwives 7 13 13 12 16Nursing assistants 8 8 9 9 10Nursery nurses (Nutrition) 4 4 3 3 3Theatre Assistants 2 3 3 2 2Clinical Instructors Lab. School 2 2 4 3 3Tutor Lab School 1 1Graduate Nurse/Midwife 0 0 0 0 0


Ward Attendants 6Complex Director 1 1 1 1 1Personnel Officer 1 1 1 1 1Supplies officer 1 1 1 1 1Accountant 3 2 2 2 2Accounts Ass. 5 7 6 6 6Cashiers 3 3 3 4 5Store keepers 2 2 2 2 2Internal Auditor 1 1 1 1 1Medical records Ass. 3 4 4 4 4Secretary (typists) 3 4 4 4 4Data Clerk 1 1 1Receptionist 1 1 1 1Field Officer 1 1Other Administrative staff 7 6 6 5 5Artisans 6 6 6 6 6Office Attendants 2 2 2 1 1Drivers 5 4 6 6 5Askaris 9 8 9 9 8Group workers/Casual laborers 29 29 23 0 0Cooks 6 6 7 7 8Other support staff 6 7Hospital IGA Project staff 7 8 10Grand Total 202 207 211 200 225

Pre-nurses 35 17 24 33 7

It is important to note that all the staff indicated in the table above were not directly working in the hospital. The staff working in the hospital were 197 only, and a total of 28 were offering services not directly related to hospital patients. The latter included 9 staff working in the Blood bank, 3 in Health Insurance Scheme and 10 in Hospital income generating projects.

Also, the bottom line is of pre-nurses who were on exposure; getting prepared to join Nurses Training Colleges. By the end of this reporting period they were 7 in number.

According to the hospital staff establishment, the desired number of medical staff is 148, which was done on the basis of the UCMB WISN tool. So there was a gap of 27 medical staff.

Attrition of staff: During the period under review, a total of 35 staff left the hospital. Most of these, to a rate of 35.3% joined public service, and 38.2% NGOs. In order to continue with the delivery of the service, the gaps were refilled. On the whole, a total of 60 staff were recruited and as mentioned above some new positions were created. The number of pre-nurses drastically reduced from 23 to 7. The plan is to eventually phase out this category and replace them with the new category of workers, namely Ward attendants, and for the start a total of 6 were recruited in April and May. The table below shows the details and a comparison of this against staff movements in the previous four years:



The table showing details of staff movements for the past four years

Category 2006/2007 2007/2008 2008/2009 2009/2010 No. of

DeparturesNo. of Replacements

No. of Departures

No. of Replacements

No. of Departures

No. of Replacements

No. of Departures

No. of Replacements

Medical Staff Medical Officer Special 1 1 0 1 0 0 1 0Senior Medical Officer 0 0 1 0 1 0 0 0Medical Officer 2 3 0 1 2 2 2 4Intern Doctors 5 5 4 3 4 5 5 4Dispenser 0 0 0 0 0 1 1 0Pharmacy Technician 1 0 0 0 0 0 1 1Dispensing Aide/Nurse 1 3 0 0 1 1 2Pharmacy store Assistant 0 0 0 0 0 1 0 0Anaesthetic Assistant 0 1 1 1 1 0 0Lab Technologist 0 0 0 0 0 0 0 1Lab. Technician 0 0 1 0 0 1 0 0Lab. Ass 2 3 1 0 3 4 3 1Blood Donor Recruiter 0 0 0 0 0 2 0 0Tutor Lab School 0 0 0 0 0 1 0 0Clinical Officers 0 0 0 0 2 2 1 3Radiographer 0 0 0 0 0 0 0 1Chaplain 0 0 1 1 0 0 0 0Counsellors 3 1 2 0 1 2 1 2Patients care Attendant 0 0 0 0 0 1 0 0Double Reg. - SNO 1 0 0 0 1 1 1Reg. Nurses 0 1 1 3 2 2 0 3Enrolled Nurses 9 11 10 8 5 4 2 4En. Comp. Nurse 0 0 0 1 0 0 1 2Reg. Comp. Nurse 0 0 0 0 0 0 0 1Reg. Midwives 2 0 0 1 1 3 0 2Enrolled Midwives 6 12 3 3 6 4 1 5Nursing Ass. 1 1 0 0 0 0 0 1Ward Attendant 0 0 0 0 0 0 0 6Theatre Assistant 0 1 0 0 1 0 1 1Clinical Instructor-Lab T Sc 0 0 0 3 3 2 0 0Graduate N/M 0 1 1 0 0 0 0 0Darkroom Attendant 0 0 0 0 0 0 0 0Complex Director 0 0 1 1 0 0 0 0Accountant 1 0 0 0 0 0 1 1Accounts Assistants 0 1 0 0 0 1 0 1Cashiers 1 2 1 1 0 0 0 1Store keeper/ Ass. 0 0 0 1 0 0 1 1Records Ass. 0 1 0 0 1 1 1Blood donor recruiter 0 0 0 1 0 0 0 0Secretaries 0 1 1 1 0 0 1 0Data Clerk 0 0 0 1 0 0 0 0IGA Manager 0 0 0 0 0 0 0 0



Administration Staff 1 0 0 0 1 1 1 1Receptionist 0 0 0 0 0 0 0 0Cooks 1 1 0 0 0 0 0 1Artisan 1 1 0 0 0 0 0 0Office Assistant 1 0 0 0 2 0 0 0Driver 1 0 1 3 0 1 0Askaris 1 0 0 0 2 3 1 0Other support staff 0 0 3 0 16 0 1 3Hosp. IGA project Staff 8 5 1 1 1 5 6Ward Attendants

Grand Total 50 55 34 36 55 45 35 61

Trend of Attrition of Nurse Cadre:The trend of turnover of the nursing cadre for the last 5 years has been calculated and the results are shown in table and graph below:-

Cadre 2005/06 2006/07 2007/08 2008/2009 2009/2010Total Staff 202 207 212 200 225No. of Enrolled Nurses and Midwives 37 44 42 39 48No. of Enrolled Nurses And Midwives Lost (combined) 10 15 12 11

5

Average No. of available Nurses between previous and current year 41.5 40.5 43 40.5

43.5

Trend i.e staff lost /Average 0.240 0.370 0.28 0.27 0.11

Graph showing the Trend of Turnover of Enrolled Nurses and Midwives (combined) during the past five years:-

Graph show ing the Trend of Turnover of Enrolled Nurses and Midw ives (com bined) during the past s ix years :-

00.050.1

0.150.2

0.250.3

0.350.4

2005

/06

2006

/07

2007

/08

2008

/2009

2009

/2010

Years

Turn

over

rate

Staff Loss Trend

As indicated in the table and graph above, the rate of nurses leaving our hospital has been varying. In 2005/06 the number was high. In 2007/08, fewer left and the highest number was in 2006/07. In 2008/09 fewer nurses left the hospital. In this particular period (2009/2010), the number of nurses who



left reduced even further. It is also expected that the number of nurses who will leave in the following year will reduce further since the plan to improve staff terms and conditions of service is still a priority.

Observations: The trend of turnover of Enrolled nurses has been declining in the last three years. (2007/2008 – 2009/2010). This is a positive trend which has resulted from improvement in the employment terms and conditions of services plus training our own staff.

Manpower planning:In the previous year, the training and recruitment committee was established and it started drawing manpower plans from a small scale and it is committed to continue doing so.Regarding staffing from local community, this has not been implemented yet.

Working hours: All staff work 8 hours a day, 5 days a week with two days off. In addition, duty rosters were made for nurses, doctors and allied health professionals to cover night duties, on calls, weekends and public holidays. These were compensated for by taking day offs or getting overtime payments.

The hospital has a Manual of Employment which was fully followed as a guide towards handling staff issues, for instance 60 working days of paid maternity leave and 4 days paternity leave were implemented and hence given to staff who delivered in the course of the year.

Regarding facilities and incentives, salaries were paid in time. Most Medical Staff are housed on hospital compound since they are required to do night duties. Houses are free and fully furnished with basic furniture. In addition the resident staff get free water and electricity. This free accommodation is a great benefit to those who get it.

The table below shows the categories and number of staff who benefit from this facility.

Human Resource Capacity

Category Available Recommended Gaps Number staying in a staff house

Comments



Medical Officers 9 14 5 9Anaesthetic Assistant 3 3 0 1Clinical Officer 5 3 0 5Registered Nurse or Midwife (RN, RM, RNM, RCM, other

18 17 0 9

Enrolled Nurse or Midwife(EN, EM, ENM, ECN, other)

48 60 12 29

Laboratory Technician 3 3 0 1Laboratory Assistant 10 14 4 5Theatre Assistants 2 3 1 1Grand Total 98 117 17 60

Comments on the Human Resource capacity

o Of the 9 Doctors available, 1 is an Intern Doctor.

o Of the 14 Doctors recommended, 4 are Intern Doctors

o The total number of recommended staff of the above named categories is 117; of which

at the close of the financial year there were 98 only, hence a gap of 17 staff.

o For the category of Clinical officers the recommended number is 3 but due to scarcity

of medical officers the management was forced to recruit extra clinical officers as an

attempt to close the gap.

o Of the 98 staff available, 60 were residents and 38 non residents.

Training:• School for Laboratory. Assistants : It was re-opened in 2004/2005, at present we have 44

students and 81 have graduated from the school.

• Other trainees are; Medical Doctors for VVF repair, Intern Doctors, Medical students from Makerere, Mbarara, Gulu University, UK, Ireland, Netherlands, German etc.. Clinical Officers, Student Nurses from Villa Maria and Masaka, Counsellors, Lab Assistants from Mbale and Fort Portal. Other students from Makerere, Muteesa and Kyambogo Universities for Industrial Training in Nutrition, Medical, Social work etc. We got a capacity building workshop and we have an on going training through carrier professional development weekly.

• During this financial year we have received quality improvement, facilitative supervision, EMOC, Family planning workshops etc. for our staff which were sponsored by Engender Health.

• At the moment some of our staff are on training namely; six midwives and nurses, one Theatre Attendant, one Sonographer and one Doctor for Obs/Gyn for Masters.

9. FINANCES (graphs and pie charts see Annex iv)Internal Budgeting



A detailed master budget was compiled by the accountantAll department heads were involved in the preparation of the budget

Cost CentresCost centre accounting is used on direct costs and income in the computer package.Indirect costs are to be apportioned to different direct cost centres.

Effort To Increase IncomeFor income generating projects we still have hope in our building which is located in Kampala because its income is constant. So, we need to put maximum use on land and this building as it is in a good strategic place.

We are also still developing land in “Nabulago” village and we have constructed a pig-stay thereon, to enable us look after animals as well as crops i.e. for sustainable development.

On the other hand however, we need to grow perennial crops which are not labour intensiveto enable us harvest more.

We are planning to grow mangoes as well as extend our eucalyptus forest. We shall also continue to grow annual crops; though sometimes we are hit by drought.

Challenges:

• Medicines: The system of dispensing Medicine according to patients’ charts which was started has shown some decrease in expenditure on medicines.

o We need to continue monitoring usage of drugs so as to reduce on costs.

10. ACTIVITIES



CURATIVE SERVICES:

OUT PATIENT DEPARTMENT

The staff of OPD are eighteen (18) in number; namely, 8 enrolled nurses, 2 registered nurses, 4 Clinical Officers, one cashier, one registrar of patients, one counselor, one Medical Officer and a team of Doctors who run Medical and Surgical clinics on specific days.

Special clinics:-

1. General Medical clinic …………………. operates on Thursdays

2. Diabetic clinic …………………………..operates on Tuesdays

3. Surgical clinic ……………………………operates on Wednesdays and Fridays

4. Gynaecological clinic ……………………operates on Mondays and other days when the Gynaecologist sees that it is necessary.

5. Paediatric clinic …………………………. operates on Mondays.

New and Re-attendances in the last 5 years

2005 –06 2006 –07 2007 –08 2008 - 09 09-2010

Female

New attendance

0 – 4 Years 5403 2601 2731 4255 7837

5 Years & above 74167360

7974 6500 8364

Re-attendance 0 – 4 Years 1966 1236 1231 2133 1797

5 Years & above 3062 3520 3191 3810 3145

Male

New attendance

0 – 4 Years 5368 2260 2581 4120 7334

5 Years & above 6023 6272 6491 6161 7291

Re-attendance 0 – 4 Years 1940 1248 1153 2002 15935 Years & above 2396 3107 3195 3641 2807

Total 33574 27604 28547 32622 40168Referral to Unit 1022 981 1134 963 1064Referrals from Unit 57 164

OPD attendance has increased by 23%. This could be due to better recording, prolonged malaria outbreak and non-functional of Masaka Hospital Theatre (which is condemned) SEASONAL VARIATION IN OPD UTILISATION

OPD Attendance By Months For The Last Three YearsCATEGORY YEARS



MONTHS 2007-2008 2008-2009 2009-2010

JULY 3244 2962 3508

AUG 2218 2452 2677

SEP 1757 2199 3113

OCT 2024 2632 2933

NOV 1946 2515 3206

DEC 2061 2554 3867

JAN 1996 2533 4758

FEB 2437 2437 4222

MAR 2394 2987 3230

APR 2378 2793 3080

MAY 2547 2974 2699

JUNE 2755 3584 2875

TOTALS 27757 32622 40168

OPD ATTENDANCE BY MONTHS FOR THE LAST THREE YEARS

0

500

1000

1500

2000

2500

3000

3500

4000

4500

5000

JULY AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUNE

MONTHS

TOTA

LS 2007-20082008-20092009-2010

According to the graph above overall OPD attendance has been above 3000; with December, February and January having the highest number of patients. During this period, we had many patients suffering mostly from malaria and anaemia.

• Factors influencing utilization:



1. Twenty four hours services.

2. Location: Kitovu is located on Masaka–Kampala high way; so many road traffic accident victims are brought at the hospital, especially on weekends and on public holidays.

3. Blood Bank: Kitovu has a Regional Blood Bank and so, many patients are referred here to receive blood.

4. The presence of specialists in Gynaecology/obstetric, surgery, Peadiatric and medicine attracts patients to come to the hospital.

5. V.V.F Services: Four workshops of Vesco Vaginal Fistula repair and training are carried out every year. And so, people coming for repair are increasing year after year, coming from even outside Uganda e.g. Rwanda, Tanzania, Democratic Republic of Congo and Sudan. Kitovu Hospital is the only one, offering this service in the Region.

6. Chemotherapy: Many cancer patients are referred here for treatment. These are mainly

children for Buktits Lymphoma and adults for Kaposis sarcoma.

7. Poverty: Because of poverty, some patients fail to come for services and others are brought in late, at terminal stage.

8. Cultural Beliefs: Some patients delay in coming to the hospital thinking that their diseases can only be treated with traditional medicines. Thus, delay in seeking proper health care.

9. Nearby Government Hospital and Health Units: Sometimes free medicine is available in Masaka Hospital and nearby Government Health clinics and this affects utilization of our services. But, as for this year, the number of Caesarian sections and Surgical cases increased tremendously because of non functional Theatre at Masaka Hospital.

10. Nutrition Unit: Kitovu Hospital is the only one with this service in the region.

11. Improvement in areas of patient satisfaction: There is an improvement in the areas of patient satisfaction. On Maternity ward, staff were divided in two (2) groups, one group attends to patients on admission and another is attached to labour ward. This has greatly improved patient care on Maternity.

12. Decreased delay at OPD: There is decreased delay at OPD, as the number of Clinical Officers was increased and a Medical Officer assigned for the department.

13. Referral to and from the hospital :Many patients are referred here from five districts of Masaka region. This is on account of the twenty four hour services.



• Most of the cases referred here are for obstetric emergencies, Gynaecological cases, Surgical and anaemia cases for blood transfusion. Referrals from this hospital are few and are mainly Neural, cardic and complicated orthopedic cases.

14. Quality Assurance :

14.1 The Quality Assurance Committee, Discipline and Grievances committee are all functional.

14.2 Measures are also in place to get information from the patients, their attendants and other clients about the services of Kitovu hospital. These include:-

o Patients satisfaction questionnaires.o Suggestion boxes which are opened monthly by Disciplinary and grievance

committee.o Patients also get opportunity to talk to staff or members of Management

Team about the services.o Some members of management once in a while hold meetings with

particular departments to iron out problems on the ground.

14.3 Inter-department meetings are held monthly.

All the above help management to know the positive and negative aspects of the hospital and this has helped us to improve; on the service delivery, cleanliness, communication, cooperation, team work etc.

14. 4 Maternal death audits are carried out and reports are sent to the District, though this year it was irregular due to staff attrition.

14.5 Prescription Survey is done annually.

14. 6 Medical audit is irregularly done

14.7 As for waiting time, we tried to reduce the waiting time by increasing numbers of Clinicians at the OPD.

• There is need for documented follow-up about waiting time.

TOP TEN LIST OF OPD DIAGNOSIS

2004-2005 2006-2007 2007-2008 2008-2009 2009-2010 Malaria 10,036 Malaria 8017 MALARIA 5165 MALARIA 6056 Malaria 12042GID 2540 Anemia 2761 ANEMIA 1865 RTI 2457 RTI 2411Anaemia 1283 HTN 1570 HTN 1037 HTN 2367 Anemia 2134HTN 835 Pneumonia 656 DM 624 ANEMIA 1534 HTN 2046



UTI 738 RTI 1261 PNUEMONIA 490 DM 1259 DM 997TB 614 UTI 702 UTI 420 GE 881 UTI 465DM 559 RTA 419 GE 367 PNEUMONIA 730 Pneumonia 432Skin disease 529 PTB 276 AIDS 324 ABORTIONS 245 PUD 317Pneumonia 417 ASTHMA 275 RTA 207 CCF 200 ISS 213AIDS 324 ABORTION 204 SKIN DISEASE 108 ASTHMA 186 STI 189

• Malaria and Anaemia are the most causes of morbidity and mortality followed by pneumonia, RTI.

• As for this year, the cases of typhoid and typhoid perforation has been noticed to be on an increase e.g. 29 cases were received in three months and the District authorities have been informed.

IN-PATIENT:

We have the following Units with their respective bed capacities.Medical ward 46 BedsChildren’s ward 64 BedsSurgical ward 39 bedsMaternity ward 37 bedsNutrition ward 14 beds* VVF ward 28 beds

Total 200 beds==============================================

* Please note that 28 beds of VVF ward are not included in 200 beds as these are not permanent. They are used at specific periods during the year.

IN-PATIENTS WARDS

Medical Ward:

MEDICAL WARD ( 46 Beds) 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admission 2504 1941 1686 2283 2665



In-patient days 13316 10622 8133 10420 11785

Average L.O.S 6 5 5 5 5

Bed Occup Rate 90% 63 48% 63% 70%

Deaths 210 183 120 179 187

Death rate 8% 9% 7% 8% 7%

Average Occup 37 29 22 29 32

Recovery Rate 92% 91% 93% 92% 93%

The utilization parameter of admission, bed occupancy rate have increased. Admission has increased by 17%, death rate has deceased by 1% and recovery rate has increased by 1%.

Referrals (out) : 45Self discharges (against medical advice) : 50Escapees : 9

Achievements:

• We received the following equipments from Donors;- Suction machine- Neublizer- Drip stands

• We have adequate number of staff.

Challenges:• The male ward is far from the nurses station, thus leading to a mix of sexes for those who

need close observation.

• We need to have adequate number of Glucostics to monitor Blood sugars as number of in-patients DM patients is on an increase.

• Lack of ART clinic and ARV’s . Many patients put their trust in Kitovu Hospital and when they are referred to other organizations for the services, some of them refuse to go there.

Future plans:

• Establish a nurses’ station in the main hall to enable close monitoring of very sick male patients.

• Plan for more staff and more equipment; to enable establishment of a second nurses’ station.

• Have a definite plan of monitoring Blood Sugar on the ward instead of sending samples to the laboratory.



• Strictly observe rules of accountability.• Construct and renovate the medical ward.• Reconstruct at least 2 private rooms in the main hall (medical ward).

Children’s ward:

CHILDREN WARD (64 beds) 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admission 6279 4301 2672 3773 8224

Inpatient days 26783 19276 11899 15693 31529


Bed Occupancy Rate 113% 83% 51% 67% 134%

Deaths 446 419 213 173 392

Death rate 7% 10% 8% 5% 5%

Average Occupancy 73 53 33 43 86

Recovery Rate 93% 90% 92% 95% 95%

The utilization parameter of admission, bed occupancy rate and average occupancy have increased. Admission has increased by 118%. Number of admission has increased due to an increase in malaria cases as a result of prolonged outbreak of malaria and shortage of coartem countrywide for some time.

Achievements:

• We were able to get the equipment needed such as the Oxygen concentrator, Nebulizers, the Beds and Mattresses.

Challenges:

• Lack of some equipment such as Intra-osseous cannulas, full range of paediatric B/P caffs, complete set of otoscope/ opthalmoscope and suction machine.

• Lack of pediatric formulars of medicine such as oral cephalosporis and macrolides.

• Lack of adequate space to perform procedures and high dependency area (intensive care unit).

Way forward:

• Solicit funds for adequate equipment for peadiatric ward.• Organise space for paediatric intensive care unit to manage the very ill children.• To open Neonatal unit.• Consider paediatric private services.

Maternity ward:



MATERNITY(37 beds) 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admission 2698 2437 2782 3245 3613

Inpatient days 15410 13081 13484 14965 16022


Bed Occup Rate 108% 97% 100% 111% 119%

Deaths 19 22 21 20 30

Death rate 0.71% 0.90% 1% 1% 1%Average Occup 42 36 37 41 44Recovery Rate 99.3% 99.10% 99% 99% 99%

The utilization parameter of admission, bed occupancy rate have increased. Average LOS, has decreased by 1%. Admission increased by 11% and bed occupancy rate by 8%. The recovery rate and death rate has remained the same for the last three years.

Surgical ward:

SURGICAL WARD(39 beds) 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admission 1446 1314 1347 1463 1569

Inpatient days 13181 8167 7670 8122 8750


Bed Occupancy Rate 83% 57% 54% 56% 61%

Deaths 48 75 66 74 93

Death rate 3% 6% 5% 5% 6%


Recovery Rate 97% 94% 95% 95% 95%

The utilization parameter of admission, bed occupancy rate have increased. Admission has increased by 7%, death rate has increased by 1% and recovery rate has remained the same as for last year.

Nutrition Unit:

NUTRITION UNIT 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admission 140 164 221 268 355

Inpatient days 2652 3099 4325 4503 5630



Average L.O.S 19 19 20 17 16

Deaths 16 12 17 23 39

Average Occup 7 9 12 12 15

Death rate 12% 7% 8% 9% 11%Recovery Rate 88% 93% 92% 91% 89%

Bed Occup Rate 50% 61% 84% 86% 110%

Both admission and bed occupancy rate have increased. Admission has increased by 2.6% and bed occupancy rate has increased by 24%. The rise in admission could be attributed to the persistent poverty and poor harvest for the year. There is an increase in death rate probably due to admission of very sick children at the nutrition unit as well as HIV related problems.

Overall utilization of 200 beds in 5 years

GENERAL TOTAL 2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Admissions 13067 10453 9003 11032 16426

In-patient days 71,34

2 57774 45511 53676 73716


Bed occupancy Rate 98% 79% 62% 74% 101%

Death 73

9 713 437 469 741

Death Rate 6% 7% 5% 4% 5%


Recovery rate 94% 93% 95% 96% 96%

Overall admission has increased by 49%. Average L.O.S. has remained the same for the last 3 years. Bed occupancy rate has increased by 27%, death rate increased by 1% and recovery rate remained the same for 3 years. Overall utilization is still good.

TOP TEN CAUSES OF ADMISSION

2005-2006 2006-2007 2007-2008 2008-2009 2009-2010Malaria 6456 Malaria 5461 Malaria 2336 MALARIA 3817 Malaria 8910Aneamia 2213 Anemia 2717 Anemia 1121 ANEMIA 1790 Anaemia 3898Pneumonia 832 RTI 595 Pnuemonia 621 PNEUMONIA 813 RTI 793HTN 681 Pneumonia 435 AIDS 313 RTI 650 Pneumonia 760AIDS 397 Abortions 258 Abortions 258 AIDS 469 AIDS 459



RTA 325 AIDS 247 RTA 224 ABORTIONS 336 Gastroentritis 273

PTB 297 RTA 246 HTN 190ACUTE DIARRHOEA 224 HTN 220

Resp. infections 248 PTB 202 PTB 185 PTB 223 Kwashiorkor 201DM 239 HTN 154 UTI 91 HTN 212 RTA 181Abortions 232 DM 140 HERNIA 87 ASSAULT 176 DM 177

TOP TEN CAUSES OF DEATH

2005-2006 2006-2007 2007-2008 2008-2009 2009 - 2010Malaria 548 Malaria 455 MALARIA 219 MALARIA 105 Malaria 379Anaemia 292 Anemia 282 ANEMIA 147 ANEMIA 66 Anaemia 239Pnuemonia 91 Pneumonia 106 PNUEMONIA 68 PNEUMONIA 62 Pneumonia 71AIDS 88 AIDS 47 AIDS 49 AIDS 62 ISS 71PTB 27 RTI 46 PTB 35 PTB 21 PTB 26DM 25 PTB 41 HTN 18 MENINGITIS 20 Kwashiorkor 23Reapiratory 18 RTA 20 ASSAULT 15 SEPTICAEMIA 18 CCF 22RTA 17 HTN 9 KWASHIRKOR 12 DM 11 HTN 11

Diarrhoe 14 HEANIAS 7 RTA 11GENITAL INFECTIONS 7

Neonatal Tetanus 10

CCF 12 ASTHMA 6 UTI 10 RTI 7 RTI 9

Malaria and aneamia are still the leading cause of morbidity and mortality. Both HTN and DM are still on increase. There is great concern regarding increased Mortality caused by Neonatal Tetanus.

The Organisation and Management of the Wards

Each ward has a ward Doctor and a ward nursing sister who are responsible for the complete management and organisation of the ward.

Patients are admitted from OPD by Clinical Officers, Intern Doctors, Junior or Senior Doctors.

Discharge is done by doctors. Admissions and discharges are recorded on the ward.

On every ward, rounds are done on Mondays, Wednesdays and Fridays. As for other days new admissions and patients in severe conditions are reviewed by Doctors.

Emergencies – Doctors are called to attend to emergencies as they arise.

Treatment schedules are based on National Treatment Guidelines.Work shifts on each ward: Nurses have three shifts

o 1st shift from 8:00am – 5:00pmo 2nd shift from 8:00am – 1:00p.m ando 3rd shifts (night duty from 8:00p.m to 8:00a.m)



Health care quality control mechanism: Quality control mechanism and medical audits are not regularly done. Patients’ condition on discharge, death rates, self discharges and runaway cases are recorded.

Appropriate prescription practices: Prescription survey is done every year. Good prescription behaviour is encouraged by the senior doctors to the prescribers in doctors meetings.

Patient satisfaction survey is done every year. Patient suggestion boxes are also in use and are regularly checked by grievance and disciplinary committee members.

Hospital infections: There is an active infection control committee. Visits of specialists: We get specialists for VVF repairs at least 4 times a year. We are also supposed to be visited by specialists from Masaka Referral Hospital, but are not regular.

Relative’ hostel: Is available and free. It is however, mainly used during the day for storage because relatives prefer sleeping on wards at night.

Pastoral care of patients: This is available 24 hours everyday.

Maternity ward (Additional information)

Maternity ward was designed to accommodate 37 beds, but the current improvised bed capacity is 50 beds.

It is a combined ward with both obstetric and Gynaecological patients. Bed occupancy rate of 119% simply tells the need for more bed space.

Deliveries Table showing Deliveries and Births

DELIVERIES AND BIRTHS

2005-2006

2006-2007

2007-2008

2008-2009 2009/2010

Admission 2515 2291 2565 3247 3613



Total deliveries 1470 1397 1548 1863 2091

Normal 1008 882 970 1101 1248

Abnornal (CS) 462 515 578 708 806

Live births 1333 1279 1395 1810 1955

Neonatal deaths 29 20 28 28 22

Maternal deaths 19 22 15 20 30 Still births 128 8 9 113 185Episiotomy 117 113 142 51Macerared still births 127 82 38 59

Forceps/ vaccum 19 6 0 30 9

Admissions:Total admissions have steadily increased every year as seen in the table more that 75% of admissions are emergencies, which means more demand for close patient attention and more resources than if the emergencies were fewer.

Deliveries:Total deliveries have also correspondingly increased annually as seen in the table. Nearly 60% of all admissions are for delivery; the statistics show a delivery rate of six (6) deliveries per day. Maternity ward has a 3 bed labour suite and currently mothers go through all stages of labour on these 3 beds. Therefore the delivery rate exceeds the capacity of the labour suite, and there is urgent need to create space for first stage of labour.

Ceasarian deliveries:The ceasarian section rate this year was 38.5%. The ceasarian section rate went up from 30% in the year before 2006, to the current rate (38.5%) mainly because of two factors:

i. There was been an increase in the number of referrals from smaller maternity units to Kitovu Hospital for ceasarian delivery

ii. To some extent, lack of reliable ventouse equipment for vacuum delivery has also contributed to rise in ceasarian section rate.

Ninety percent (90%) of the caesarian sections are emergencies, and the most common indications for emergency ceasarian section are obstructed labour and failed trial of labour.

Fetal outcome:Out of 185 still births this year, 59 were Fresh Still Births (FSB). This means a proportion of FSB to live births of 3%. This is compatible with the expected outcome. FSB according to UCMB criteria was 7%



Hospital neonatal mortality rate was 1%, but there is concern about the possible out of hospital neonatal mortality and morbidity consequent to low APGAR scores. It is therefore hoped that when the neonatal intensive care unit becomes operational, then neonatal out come will improve.

Maternal mortality:There were a total of 20 maternal deaths in a year. All maternal deaths were audited (Ref. Maternal mortality audit report)

Causes of maternal death at Maternity ward.

Disease No.Anaemia 4Peritonitis 4Puerperal Sepsis 4Ruptured Uterus 1Ante Partum Heomorrhage 1Post partum Hemorrhage 2Severe Obstructed Labour 1Endotoxic shock 1Placenta Accreta cardiac Arrest 1Steven’s Johnson syndrom 1Total 20

Theatre:

SURGICAL PROCEDURES



Table showing types of operations done

MAJOR SURGICAL PROCEDURES 2008/2009 2009/2010

Procedure NumberCaesarian sections 698 810Laparatomy 271 315Tracheostomy 0 0Evacuations 152 122Internal fixation 1 0Burr hole 0 0Thoracotomy 0 0VVF Repair 229 280Other Major 447 861Total Number Major Operations 1569 2388

N.B: The increase in Caesarian sections of 16% is mainly due to the non functional Theatre at Masaka Hospital.

MINOR SURGICAL PROCEDURES2008/2009 2009/2010

Procedure NumberDental extractions 0 0Herniorrhaphy 93 88Debridement and care of wounds and skin grafting

579 525

Incision and drainage of abscesses 119 115Plastic/ reconstructive surgery 2 8Ocular surgery 0 0ENT surgical procedures 59 63Other Minor 724 547Total Number Minor Operations 1576 1298

OPERATIONS DONE & ANAESTHESIA2005-2006 2006-2007 2007-2008 2008-2009 2009/2010

Major Operations general obs +Gyn 1240 1202 1123 1569 2056



Minor Operations O.T. labour, ward casualty 1258 1659 1344 1576 1298

Total operations 2498 2861 2470 3145 3354

Emergencies 942 854 917 1350 1135

%Emergencies of major operation 76% 71% 82% 86% 55%

Elective 1387 1450 1084 954 2219

%Elective 56% 51% 44% 30% 66%

General 1050 961 432 1140 255GA Tube 995 464 420 520 583

Spine 217 409 724 670 820Local ring block 30 20 57 30 38

Surgical Ward:Two major events had an effect on Surgical Unit this year.

1. In September our M.Med Surgeon was posted to Soroti and left Kitovu without replacement. This caused an enormous burden on our only Consultant Surgeon Dr. Maura Lynch. Dr. Lynch wrote to the head of Department Mulago/Makerere Med School asking for release of SHO Officers training for MMed surgery to come and spend time in Kitovu getting experience, while at the same time assisting the Surgeon overburdened with emergencies and routine work. We are still waiting for a response.

To help relieve the problem the Hospital Administration had to employ part time Surgeons who both helped out on weekends and calls during week days as needed We are very grateful to the Surgeons who came to help us.

2. A second major event was the unexpected and complicated Typhoid cases which became rampant through out the Districts of Ssembabule, Rakai, and Masaka between December 2009 to June 2010. We had 29 cases.

All patients presented with peritonitis and had perforated small bowels (most over 2 perforations) and required emergency surgery.Besides these two major occurrences we had increased number of Fistula women who attended the Obstetric Fistula Unit. See VVF report page 47.Challenges:

- Lack of a second Surgeon to help our Senior Surgeon.Future plans:

- Pursue accreditation of Kitovu Hospital surgical services as a training centre for M/Med/Surgery and East Africa Fellowship in surgery.

- Continue to look for a second Surgeon.SPECIAL CURATIVE SERVICE AND OTHER CLINICAL SERVICES:

Tuberculosis



The hospital uses the national T.B/Leprosy control program guidelines. Admissions are usually via OPD and discharges are usually by doctors on ward rounds.

The hospital follows the Ministry of Health, guideline of testing every patient who has T.B for HIV and also tests each patient who has HIV for possible T.B.

Some T.B statistics for 2007/2008 – 2009/2010

2007/2008 2008/2009 2009/2010Total admissions 185 223 201All T.B patients 196 210 166Pulmonary positive 87 87 74Pulmonary negative 80 46 72Pre-tested for HIV 19 97 100Defaulted 1 1 4Died 35 21 N/ARelapse 3 1 2Transfers in Nil Nil NilTransfers out 196 210 166Children 22 27 20x-rays 14 58 10No. smear done 15 19 26OPD new cases 131

N.B: • Pre-testing started on 13th March 2008.• Transfers out are many because patients are treated in their nearest health centers

following CB DOTS.

Detection rate: The implementation DOTS is done by lower Health Centres. Follow up activity should ideally be done after the initial phase and the continuation phase but few patients come back after each phase.

Obstetric Fistula Unit (VVF)



Obstetric Trauma , especially the occurrence of Fistula in women suffering trauma during delivery of their babies, continues to be a challenge but our achievements in this field must be highlighted too –

The Vesico Obstetric Fistula Unit has been recognized as a Training Unit for Fistula Repair, training for Doctors, Anesthetic Officers and Nurses since November 2004. It is financially supported by USAID through engender Health + UNFPA and private donors and recognized by Ministry of Health.

Table showing VVF patients registered and operated 2007/2008 – 2009/2010

Years 2007/2008 2008/2009 2009/2010No. of women operated 299 232 279No. of women registered 319 246 348

Table showing number of patients and operations done in the period of 2007/2008 – 2009/2010

Total Operations 2007/08 2008/09 2009/20101. Vesco Vaginal repair 161 143 1962. Recto vaginal Repair 6 11 243. Combined VVF / RVF 14 8 74. Others (Interventions) 55 67 53No. of operations 236 229 280

Table showing number of Trainees for Obstetric Fistula Unit 2007/2008 – 2009/2010:

Trainees 2007/08 2008/09 2009/2010Doctors 5 6 7Aneasthetic Officers 5 3 6Nurses/Midwives 10 4 16Total 20 13 29

According to the table above the number of women registered and operated has increased. The number of operations done has also increased by 22% and the number of trainees has increased by 123%as compared to last year. This indicates that many mothers are still suffering from VVF. We need to make more publicity through all possible ways.

Challenge:• Whereas there are many women who need the service, we do not have full time Surgeon or

Gyneacologist for continuous obstetric fistula repair. Chemotherapy/Palliative care services:



We provide chemotherapy/palliative care at Kitovu Hospital under the guidance of Uganda Cancer Institute.

Throughout the year 2009/2010 seventy two (72) patients received chemotherapy; 12 patients with Burkits Lymphoma, 1 with Non – Hodghins Lymphoma, 2 with endemic KS, 56 with skeletal KS, 12 with cutenious KS and 2 with Acute Hodghins Lymphoma.

Patients on ART responded positively on chemotherapy with good adherence especially on 2nd

time. Four cases had relapsed.

Most patients are referred to Kitovu Hospital by Kitovu Mobile/Palliative care, Medical Research Council, TASO and Uganda Cares. We are grateful for the collaboration with the above organisations in caring for our cancer patents.

Prevention of Mother to Child Transmission (PMTCT) Programme:

This programme has existed since Feb 2004 which is now (5 years).

Our objectives:• Promote awareness of HIV /AIDS.• Increase the understanding of the advantages of HIV testing.• Test and counsel all new ANC mothers and their partners; offer Niverapine tablets to

HIV Positive mothers, to be taken at the onset of labour, to protect their babies.• Counsel on feeding options.• Encourage all HIV positive mothers to start taking Septrin daily.• Counsel on nutrition, thus improving general Health.• Encourage women to become self sufficient in areas of general and health in respect of their children.• Encourage communication between women and their sexual partners.• Encourage natural family planning.• Involve males particularly spouses in health services relating to PMTC.• Encourage all mothers to make use of insecticide, treated mosquito nets which are provided

for free.

Table showing performance of PMTCT program.2005 - 2006 2006/2007 2008/2009 2009/2010

Total new ANC 1057 903 1014 890Total No. of ANC Counselled 1057 903 1014 890Total No. of ANC tested 912 961 981 776Total No. of ANC tested HIV+ 103 83 86 45Total No. of ANC HIV+ that acceptedNiverapine porgramme 27 73 84 39Total No. of live babies born to mothers onNiverapine before 6 months 16 68Total No. born to mothers on Niverapine &Tested after 6 months 2 9

Activities:



Years 2006 - 2007 2007 - 2008 2008-2009 2009-2010No. of Deliveries 1501 1548 1683 2091HIV+ mothers delivered and enrolled 73 86 50 113Mothers tested in labour 106 254 244 62Mothers tested HIV+ in labour 18 18 10 40Mothers tested HIV- in labour 68 236 234 20

Achievements:• Most of our clients were tested for the routine HIV test and other vital laboratory

investigations in ANC services.

• The intergrated Antenatal services register shows some improved recording of the required information.

• All the 4 qualified staff midwives that work in ANC had a 2 days workshop to orient them with basic knowledge on family planning and to enable them provide accurate F/P information and specifically natural F/P methods to the couples that need it.

• We have newly opened Care Point for Early Infant Diagnosis for children exposed to HIV.

Challenges:• Lack of free contrimazole prophlaxis treatment for HIV+ clients.• The plan of opening a HAART clinic is still in the planning stage.• Male involvement is still low.• Understaffing make the required services and activities incomplete.• Some staff do not keep the records of mothers tested during delivery.

Future Plans:• To consider opening an HAART Clinic.• To ensure that we get the prophlaxis drugs for HIV+ Clients all the time• Need to update ourselves on PMTCT programme happenings through workshops.• Consider having ANC everyday.• Solicit funds for free cotrimazole for HIV - Antenatal mothers.• Plan for adequate number of staff for ANC.• To continue sensitizing midwives of the value of testing and recording the women during

labour.

HIV COUNSELLING AND TESTING/VCT



• HCT/VCT service is run daily at the hospital. It is run by three trained counselors; and each of the counselors is attached to two wards; OPD inclusive.

• The department also runs the Early Infant diagnosis of HIV positive, introduced by Ministry of Health.

• The hospital does the diagnostic, RCT and VCT which are the types of HCT. The hospital has NO ART clinic at the time, and so the Sero-positive clients are referred to nearby ART clinics near their respective homes. We what to open up this clinic so that our clients receive full package of our service.

• Kitovu Mobile Aids organization located in Masaka town carries out its HIV tests in the hospital laboratory.

• The counselors also do psychosocial counseling on the wards and at the OPD.

• Laboratory staff do all tests of the hospital plus HCT/VCT tests.

The actual HCT/VCT hospital output for the year 2009/2010 as studied from gender, age-group, TB detection and Co-trimazole prophylaxis is given in the table below:

No. < 5yrs No. 5yrs < 18yrs 18yrs + AboveMale Female Male Female Male Female

No. Counseled 123 154 1799 2154No. Tested for HIV 227 267 117 147 1790 2146No. Received Results 220 259 116 142 1781 2124No. Tested +ve for HIV(from Lab.Reg) 65 73 17 24 416 511HIV cases with confined T.B 09 11 2 1 73 63Total TB cases tested for HIV 53 4 40 32 278 194TB cases tested +ve for HIV 09 11 2 1 7363% of TB cases testing +ve for HIV 17 17 5 3 27 33% of HIV cases confirmed having TB 17 17 5 3 27 33HIV cases started on Cotrimoxazol Prophylaxis 65 72 17 24 408 496

The hospital Laboratory tests HIV for Kitovu Mobile, Kitovu Hospital and Hospital PMTCT programme.

The table below showing the Dynamic of HCT/VCT in the past five years:2005/06 2006/07 2007/08 2008/09 2009/10


0

10

20

30

40

50

60

70

80

2005/06 2006/07 2007/08 2008/09 2009/10

Years

Num

ber

test

ed in

%

and

Num

ber

test

ing

posit

ive

in %

Males TestedFemales TestedMales testing positiveFemales testing positive


Number TestedMale 2001 (61.2%) 1100 (34%) 1153 (33.1%) 1279 (33.4%) 2134 (46%)Female 2528 (56%) 2171 (66.4%) 2334 (67%) 2551 (67%) 2560 (54%)Total (Tested) 4529 3271 3487 3830 4694Tested +ve for HIVMale 864 226 203 297 498Female 1190 396 416 463 600Total (+ve tests) 2054 622 619 760 1098Positivity Rates of HCTMale 43.2 21 18 22 23.3

Female 47.1 18.2 18 18.1 23.4

According to the table above, the number of people tested has an increase of 23% as compared to 18% of the previous year.

Below is a line graph which presents the number of clients tested and number of clients who tested positive as per percentages according to gender over a period of (5) years.

Since 2007/2008 the number of clients tested has been high in relation to our human resource. The number of positive clients among males was also high. This was probably caused by the discordance campaign. Also Males usually came alone for VCT to confirm their status while their partners got tests in PMTC clinics.

The number of children between the age group 0<5 years presents an increase in HIV testing in the five previous years. This is so because of PMTCT influence on mothers for a certain period of time. There was however, a period when the PMTCT programme was on hold on maternity ward, due to shortage of Testing Kits which led to a decrease of number of females tested in the year 2009/2010.

Thanks to existing Peadiatric clinic, routine HIV testing in Nutrition Unit, participation in early infant Diagnosis introduced by Ministry of Health; which has contributed a lot to the number of children tested for HIV.

The age group 5<18years present an increase in tests done for both sexes. In both sexes the positivity rate has increased. In spite of great campaign of ABC (Abstinence, Be faithful and Condom use) many teenagers still get infected with HIV/AIDS (see graph above).



Pre-marital counseling is done in OPD in preparation for marriage. The number of couples is increasing and there is a decrease of discordance among the prepared couples. This indicates a little bit of faithfulness.

In addition to that, OPD counselors received more individuals for HCT this year, and a bigger number of them are men. This is probably so because men take the decision to test for HIV in their respective families and this may also be due to extra-marital relationships.

Thanks to the government for all campaigns on Radios, televisions and Newspapers which play a big role in sensitizing people on HIV.Achievements:

• There is increased output in HCT services despite the fact that the human resources are static.

• We have maintained good relationship with various institutions e.g. Uganda cares, TASO etc. where we refer our clients who are tested positive in order to start ART.

• We have maintained support system of clients with other psychological counseling services along side HCT to individuals, students and families. HCT clients and others are referred to specialized doctors and to the nearby authorities.

• We continue to render quality services by qualified staff. This has lead to increased service utilization.

Challenges:

• The inability to provide ART to our Sero-positive clients, leads to inefficiency of our HCT services.

• Increased demand for HCT quality services has lead to increased work load on staff and strain on economic resources.

• Maintaining the quality staff amidst the prevailing economic challenges isn’t easy.

• Excessive poverty among our clients, sometimes make them to fail to meet the hospital costs.

• Limited number of service providers compared to the number of clients. This leads to an excessive workload in order to maintain the quality.

In conclusion, all the challenges rotate around economic problems. The HCT section needs separate funding so as to maintain quality services.

There is need for increased man power resource, by at least two more staff, so as to boost and maintain the quality of services rendered to our clients.



There is a need to train at least two members in the field of ART, psychiatry counseling as well as in palliative care. This is so because some counselors offer psychological counseling to clients with palliative care problems before referring them to the palliative care team. Limited knowledge on ART when our clients have trust in us, is also a challenge.

Alongside HCT/VCT and palliative counseling; we also handle clients with chronic anxiety problems, depression, suicidal attempts, family conflicts, social deviant behaviours, attempted abortion and so on.

The table below illustrates the above:

Year 2005/06 2006/07 2007/08 2008/09 2009/10No. counseled (Psychological) 1501 889 688 1146 1183No. of follow up sessions 1057 6223 4816 16278 11754

This supportive counseling is important to our HCT services and our clients often desire to do their HIV testing with us to get the chance of coming to terms with the rest of their problems. This clearly demonstrates unique concern by our clients. The challenge however, lies with following up our clients after discharge. There is steady progress in the section and there is need for increased funding for a better future.

Supportive Services

LABORATORY



The Hospital has a laboratory department which is able to work on several tests, as indicated below:

Table showing Laboratory tests:TEST 2004/20

052005/2006

2006/2007

2007/2008

2009/2010

PARASITOLOGY:Stool 1614 925 995 1485 917Urine 5459 3472 3672 4191 4639Blood Smear 17156 17084 13540 10183 23164HEAMATOLOGY:Hb Estimation 8943 14467 10590 8582 16869Film 1436 1794 1236 2872 5224SCT 194 222 151 164 113 TWCC D 1152 745 814 2086 8044ESR 168 907 505 970 882BIO-CHEMISTRY:Blood Sugar 2973 2896 2737 3186 3320Clinical tests, Urea, LFT’s & RFT’S 1118 996 389 1318 790BACTERIOLOGY:CSF 128 121 72 135 67Culture 188 125 128 216 247Sputum 1243 851 883 775 661SEROLOGY:Brucella 14 216 256 313 300Widal 596 1102 798 587 1170HIV 14640 13559 11949 6629 4877Syphilis 1617 1392 911 1226 1320RA 65 68 49 66 22ASOT 61 15 019 17 02HCG 303 415 331 628 770Total Lab. Staff doing tests 09 09 10 07 09Total crude (test) 59068 61373 50025 45629 69398Average tests per lab staff (crude) 6563.1 6819.1 5002.5 6518.4 7710.9

Year 2004/0 2005/0 2006/0 2007/0 2009/1



5 6 7 8 0Total tests 86965 87467 81451 53723 109007Malaria slides 17156 17084 13540 10183 23164Positive

40%6640

(38.9%)4723

(34.9%)2476

(24.3%)12257

(52.9%)T.B Sputum 1243 848 883 775 661Positive 142

(11%)82

(9.7%) 11.8%)83

(10.7%)56

(8.5%)HIV Test 14640 13559 11949 6627 4877Positive

49%1854

(13.7%)1854

(11.1%)1503

(22.7%)1171

(24.1%)Syphilis 1617 1392 911 1226 1320Positive

1.5%23

(1.7%)20

(2.2%)43

(3.5%)55

(4.2%)

Achievements:

• A standardized Sodium hypochlorite (Jik) disinfectant in correct dilutions can be prepared for daily use on work tables for the soaking of finished/infectious samples.

• All laboratory staff have gone through a training for malaria diagnosis by Masaka District in Collaboration with Stop Malaria of MOH.

• Availability of Chemicals/reagents, consumables and essential items almost all the time.

• Establishment of student fee for students from other institutions.

• A blood glucometer – Optimum Exceel Abbot was provided and ensure better services to diabetic patients.

• Establishment of pre-labeled sample bottles with space for patients’ information prepared by the lab staff.

• Having timers or stop watch in every room of the laboratory.

• Establishment a separate room strictly for blood group and cross matching; fully equipped with a fridge for blood, compatibility requisition forms and standard operating procedures.

• Renovation, re-arrangement of Laboratory rooms and labeling of shelves have been a great achievement as it has helped to ease the work for staff.

• Our chemistry analyzer is in good condition (Re-functioning).

• We got a laboratory Technologist.

Challenges:



• Inadequate number of microscope in haematology section.• The Calorimeter we have is unstable.• The centrifuges and two autoclaves are non functional.• Lack of safety cabinet in Microbiology room.• Lack of computer to ease the work for statistics and clerical work of the lab staff.• Arrival register book and monthly meetings are quite often not adhered too.• Majority of staff are newly qualified without much experience.• Lack of immunization for lab staff against infectious diseases like Hepatitis B.

Blood bank:The Blood Bank serves a wide range of Districts in the region including Kalangala, Ssembabule, Lyantonde Lwengo, Bukomansimbi, Kalungu and Masaka with safe blood that has been donated by voluntary non-remunerated blood donors, tested, processed into components i.e. packed cells for children, especially under 5 years, fresh plasma for surgical patients, whole blood etc.

All these processes and procedures of collection, testing/processing and dispatch/ distribution are undertaken by our competent and experienced staff some of whom go out to the field on blood donor sessions on a daily basis and others remain at the station to bleed, walk –in donors and as well screen blood that is always collected the previous day.

During the financial year 2009/2010, Kitovu blood bank managed to collect 7020 units of blood some which was processed to make packed cells and some was given to patients in 11 hospitals in the districts above.

In Kitovu Hospital alone, 18,233 units of blood (whole blood and packed cells) were transfused to patients in Peadiatric, Surgical, Nutrition Unit, Maternity, VVF Unit and Medical ward.

N.B: The number of transfusion is larger than the units collected because one unit of an adult can be divided into 4 units for children.

The following are the number of transfusion in Kitovu Hospital in comparisonwith 3 previous years

Years 2006/2007 2007/2008 2008/2009 2009/2010Total number of transfusion

5806 3925 4878 18,233

The majority of the blood donors that gave blood during this period were group O rhesus D (O rh D) with 46% followed by Group A rh D 26%, then group B rh D 21% and lastly AB rh D 7%, with a positive Rhesus factor of 99% and a negative Rhesus factor of 1% on average amongst all the blood donors.

Challenges



- We still have a challenge of blood shortages especially in school holidays as students are our major blood donor base.

Future Plan:

- We are planning to put more emphasis on blood donor clubs, reviving them and empowering them, in that when students are on holidays we can rely on them for safe and reliable blood donors. Although we have a limitation to this option as it has to be fully supported by Uganda Blood Transfusion Nakasero and other stakeholders i.e. Uganda Red Cross etc.

PHARMACY

Pharmacy staff:Pharmacy Assistant 2Enrolled Nurse 6Nurse Assistant 1Store keeper Assistant1Record keeper Assistant 1Cleaner 1

Pharmaceutical supplies:Most of the drugs are ordered from Joint Medical Store except a few items which sometimes are out of stock in J.M.S and are purchased from other pharmacies e.g (Meta, Abacus) in Kampala and Masaka Byansi Pharmacy.

Ordering System:We order drugs by fax , email and phone. We indicate the day to collect it.

Availability of Medicine supplies:Kitovu hospital pays for it. Sometimes we experienced stock outs; but were short lived because the hospital is trying its level best to see that drugs are available all the time. We had stock out of Coartem, due to Global crisis – Coartem is no longer supplied free by the Government to the hospital.

Amount of credit line orders:The credit line drugs is reducing each quarter. The drugs purchased using the credit line, their prices are higher compared to others, thus we end up purchasing few items.

Store keeping:The store has two store Assistants who take care of it. They report any damage of drugs and drugs needed to the in charge of the pharmacy.

The fridge was bought for cold items which is big enough to accommodate most drugs.

Drugs which are near to expire are exchanged at the near by health units.



Daily/routine information of drugs near to expire is practiced. We are using first expiry first out (FEFO) and first in first out (FIFO) methods.

We purchase drugs with long expiry dates.

Losses and loss reduction/prevention:Care is taken when handling drugs. To avoid breakage; labels showing how to handle drugs like (keep cool, fragile, handle with care, using different colours; red showing danger poisonous, harmful are put in place. By doing all the above we are trying to prevent misuse, breakage, spoilage, corrosion and irritation of eyes.

Frequency of stock taking:We carry out daily physical count before any supply is made in both sub-pharmacy and main pharmacy in order to see that the physical drugs correspond with the balance on the bin card.

We carry out stock taking which is organized by the accounts departments quarterly and with external auditors every end of the Financial Year.

Condition of the store:Generally the condition of the store is well maintained.

- The fridge is maintained and temperature monitored regularly.- Burglar proofing is installed.

Drug Committee:We have drug committee though some members who left need replacement

The work of the drugs committee:1. To develop and implement an efficient and cost effective formulary system which includes

consistent standard treatment protocols, a formulary list and formulary manual are needed.

2. To develop and implement interventions to improve medicine use by prescribers, dispensers and patients.

3. To investigate and monitoring of medicine use in the hospital for both outpatient and inpatient.

Control of expired drugs:We control the drugs expiry by using the method of first come first out (FIFO) and First expiry first out (FEFO).

Information/ Education on Drugs to Patients:Staff explains to the patients one by one on how to take each kind of medicine, how often, the side effects and give advice as needed.

Patients Compliance to Drugs Treatment:Patients are given explanations on the drugs given; this improves compliance of patients in taking the medicine.



List of essential drugs:The list of essential drugs is available in the pharmacy, OPD and wards. Most drugs in pharmacy are essential drugs and prescribers use them effectively. Treatment schedules:Most patients are given drugs for 5 or 7 days except for those with Chronic diseases e.g. Hypertensive, Diabetic, T.B etc. these get for 30 or more days.

Authority for prescription of certain drugs:Drugs like Narcotic such as Pethadine, Morphine and antibiotic are to be ordered by Doctors and Clinical Officers.

Problems of Drugs Resistance and availability of alternative:Drug resistance is no longer common since we started using coartem containing arthemeter 20mg and Halofentrine 120mg.Hospital production:Most drug productions are no longer done because the ingredients are not available at Joint Medical Store.

Table showing the twenty most used drugs June-July 2009/2010:

No. Name Unit Strength Cost1. Ceftriaxone Inj. 1 190,420,3002. Normal Seline Iv 0.9% 125,771,1203. Dextrose Iv 5% 12,475,6004. Quinine Iv 600mg 14,660,5305. Quinine Tabs 300mg 29,300,9606. Ampicillin Inj. 500mg 32,520,4707. Insulin Isophane Inj. 20,320,6408. Insulin soluble Inj. 37,817,3209. Metronidazole Iv 500mg 35,550,20010. Amoxycline Caps 250mg 27,309,54011. X-pen Inj. 1g 18,550,72012. Chlomphenical Inj. 1g 80,513,65013. Pethidine Inj. 50mg 50,149,23014. Metformin Tab 500mg 17,063,31015. Ringers lactate Inj. 8,370,68016. Gentamacin Inj. 80mg 34,660,72017. Erythromycin Tab 250mg 61,814,69018. Nifedipine Tab 20mg 35,050,90019. Omeprazole Cap 20mg 32,040,13020. Ciprofloxacin Tab 500mg 20,238,560Total expenditure 884,599,270

The percentage of the expenditure is 55%.



Cost of Drugs per outpatient contact and inpatient contact:The Cost of drugs per out patient is about 5,000/=.For inpatient is about 52,000/=.Possibilities of Economizing on drug expenditure:Most drugs are issued using charts for patient. Each patient gets her/his own medicines which are then kept in the Rockers of the patients.

All drugs are issued as per prescription, without a prescription no drugs are supplied from the pharmacy.

Drugs which are regularly monitored stock out monitoring:Drugs which are regularly monitored.We have Pethidine, morphine, anti-biotics.

Monitoring tools:The monitoring tools are prescriptions, bin card and medical forms.

The observations and outcome:The out come has been generally good this year.We hope to improve more next time, for the best possible cost effective and quality care.

Achievements:• Availability of adequate number of staff.• Establishment of dispensing medicine per chart for inpatient as to curb on the big bills of

medicine.

Challenges:• Medicines are very expensive in the market.• Problem of occasional stock out of essential drugs• Medicines stock out in the market, e.g. Pethadine and Morphine.• Resistance by some staff against the new system of dispensing medicine per chart has led

to wastage of medicine and delay of medication to reach the patient.• Main pharmacy stores and pharmacy need renovation.

Future plan:• To separate areas and personnel for OPD and IP in the pharmacy to ease the work for staff.• To solicit fund for renovation of Main Pharmacy Store and pharmacy.• To continue sensitizing the staff and patient about dispensing drugs per chart and to find

ways to fasten the process of dispensing so that the goal which led to the new system can be realized.


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2005/2006 2006/2007 2007/2008 2008/2009 2009/2010

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ChestLow er extrem itiesUpper extrem ities


X-ray/Imaging

Staffing: One Junior Assistant Radiographer

Number of X-rays done

2005/2006 2006/2007 2007/2008 2008/2009 2009/2010Spinal Column 55 110 56 38 6Skull and Mandible 5 20 18 6 4Abdominal Contrast 0 0 16 0 0Screening (chest and other) 0 0 28 13 0Abdominal - Plain 12 36 24 30 10Pelvis and hip 100 0 73 66 50Chest 1130 1239 1193 1400 1342Shoulder and Clavicle 22 79 57 33 30Upper extremities 104 54 80 133 76Lower extremities 225 285 248 258 146Total examination 1653 1823 1793 1977 1664

The commonest x-rays done:-• Chest x-ray• Lower extremities• Upper extremities

Table showing the top 3 commonest x-rays done in the past five years

2005/2006 2006/2007 2007/2008 2008/2009 2009/2010Chest 1130 1239 1193 1400 1342Lower extremities 225 285 248 258 146Upper extremities 104 54 80 133 76

Graph showing the top 3 commonest x-rays done in the past five years.

Reason for that pattern:-• Majority of our clients are mainly for Chest x-ray for various diagnosis e.g. PTB,

pneumonia and cardiac problems.



• X-rays upper and lower extremities are also common most of these are done on accident victims.

Achievements:• One Junior Radiographer completed his study.

Challenges:• Inadequate protection from radiation to the operators.• Very old x-ray machine which leads to a number of rejected x-rays.

Future Plan:• To get new x-ray machine with the following features:-

- Collimator, for radiation protection and improving the quality assurance.- Separate operating console, to safe guard the operator.- Dual machine in relation to the capacity of output.

• A new designed x-ray department purposely for Radiation protection to patients, to the operator and to the environment.

Ultrasound

There is one sonographer in the department.

Ultrasound investigation done in the last 5 years

2006/07 2007/08 2008/09 2009/10 Total for 5 YrsAbdominal 239 97 266 300 1195Pelvic/Gyn 146 54 244 275 841Obstetric 109 87 324 361 994Total 494 238 834 936 3030Hospital OPD/ Inpatient 408 216 762 916 2632Referrals to the Hospital 86 22 72 20 398



0

50

100

150

200

250

300

350

400

2005/06 2006/07 2007/08 2008/09 2009/10

YEARS

CL

IEN

TS Abdominal

Pelvic /GynObstetrical Scan

Obstetric scan has been the commonest this year as many mothers have developed interest in it, followed by abdominal scan and the Pelvic/ Gynae scan.

In all the three areas, there is increase of utilization of the service more than last year.

Achievement:• An up to date machine with a stabilizer was donated to us.• The number of patients have increased by 106 (11%). This came out by two factors; A full

time sonographer and the small U/S machine on maternity ward was out of order.• A second sonographer is in training in Mengo (ECUREI).

Challenge:• The operating room is small, dusty, hot and the roof needs repair.

Future plan: • To find ways to keep the room cool and dust free.

Domestic Services:

CateringThe Hospital prepares break tea for staff. Laboratory students, pre-nurses, private patients, needy patients and workshop attendants are provided with tea, lunch and super.

Achievements:• Two saucepans were bought.• Firewood has been provided in time compared to the past.



Challenges:• Lack of finance to complete renovation of the kitchen.

Future plan:• To buy new saucepans/stoves for the renovated kitchen.• Solicit funds to complete the renovation of the Kitchen.

CleaningThis work is done by contractor. The compound cleaning involves treaming fences, flowers, trees on the compound, slashing, sweeping, planting flowers and trees where necessary, cleaning toilets, bathrooms, washing bays, cleaning and emptying dust bins. The work is done by the contractor is appreciated very much.

Laundry servicesThere are two laundry attendants who wash all Theatre linen and those for private patients. These are assisted by one attendant who works in the Pastoral Care when one of the two is off duty. There is one seamstress who also washes bed sheets for people who come for the workshops.

Achievements:• Soap and Jik have been provided on time.

Challenges:• Lack of adequate protective gear for our casual staff working in Laundry.

Future plans:• Improve on protection/safety of our staff.

Sanitary FacilitiesThere is one functioning incinerator and one placenta pit.

Challenges:• The incinerator need repair.• Lack of adequate protective gear for the attendant.• Inadequate number of staff.

Future plan:Renovation of the incinerator.• Buy adequate protective gear for the staff.• Hire a second attendant for the incinerator.



MortuaryThe hospital mortuary is managed by an attendant who works on cleaning and making sure that the place is in proper order. In the year 2009/2010 the mortuary house was renovated and it is in good condition.

The hospital income generating projects:

CONSTRUCTION AND MAJOR RENOVATION PROJECTS:

Reconstruction of the Maternity and Labour wards roof and ceiling.The ceilings of both the maternity and labour wards were in a collapsing state and they developed grave cracks which were clearly visible within the wards. This posed a great danger to our mothers as the next stage would be the abrupt collapsing of the whole roof and ceiling structure.

With financial assistance from Dr. Tim Peet and Dr. Peter Doherty and the Trustees of the Femto Settlement, the hospital was able to reconstruct both the roof and ceiling of the two buildings. This work commenced on 13th July 2009 and was completed on 1st October 2009.

Upgrading and Refurbishment of the Hospital General Kitchen.In the financial year 2009/2010, the existing Hospital general kitchen building was also refurbished. The renovation work commenced on 18th August 2009 and was completed on 5th

November 2009.The main purpose of this renovation work was to increase the height of the roof for the kitchen, repaint the walls, modification of the drainage system and installation of a new roof over the kitchen. The existing building has also been modified to include an extra room that has been installed with terrazzo sinks and it will also be used for cooking.

Construction of the Premature Unit in the Maternity Ward.The old Labour ward was also modified and extended with one room to provide an Intensive care Unit for premature babies in the Maternity ward. The construction work of the unit commenced on 15th November and was completed on 16th April 2010.

Construction of a New Pit Latrine for Out Patient Department:A three rooms’ Ventilated Improved Pit Latrine with two rooms for females and one room for the males was constructed for OPD. The construction work was completed on 30 th August 2009.

Installation of a New Photovoltaic solar power system on the Maternity ward.The scope of work was primarily the installation of a suitably designed photovoltaic solar system for the maternity ward at Kitovu Health Care Complex. Being a critical location of patients, there was great need to provide a continuous supply of power at the ward. It was also noted that the power consumption at the ward was very high and there was a need for an immediate solution to cut on the high UMEME bills.



The work was contracted to Solar Energy Uganda and the installation commenced on 14th

December 2009 and was completed within a time frame of one week thereby completed on 19th

December 2009.

Construction of the New Hospital Chapel:The construction of the new Chapel for the hospital is underway and it is now on the concrete ring beam. This therefore marked the end of Phase 1 of the construction work for the chapel. The chapel was provided with arches on all the windows and doors using half and full size curved bricks.

Refurbishment of the hospital Canteen Building:The hospital Canteen was also renovated and the major scope of work was to clean and repaint all the walls of the canteen building as they were very dirty with the smoke that comes from the kitchen. The renovations were completed successfully and the canteen reoccupied. Renovation of the Hospital Mortuary:The hospital mortuary roof was renovated as it was leaking on the sides of the wall. The building was provided with a new roof and it is now in good condition.

Achievements:Reconstruction of the hospital maternity and Labour ward roofs and ceiling, construction of the premature unit and a new pit latrine for OPD.Renovation of the hospital general kitchen, hospital canteen building and the hospital mortuary. Progress in the construction of the hospital chapel up to the level of the beam and installation of a new photovoltaic solar system for Maternity ward.

Challenges:• The General kitchen was renovated but has not yet been put to use as the existing

stoves need to be refurbished before using them again and it also needs to be provided with one new stove.

• Construction projects are apparently constrained with lack of funds especially for the hospital chapel which still needs a lot of funds to be completed.

Future plan:• Complete Phase two for the construction of the Hospital Chapel.

• Refurbishment of the Hospital Incinerator.

• Renovation of all the old buildings at the hospital especially the staff hostels and wards.

• Provide the Renovated kitchen with stoves so that it can be put back to use.

• Continue sourcing out for more funds to work on the different projects. Especially for the OPD, medical ward, multipurpose building complex and the Biogas sanitary system.

• Renovation of the hospital fence.



INCOME GENERATING PROJECTS:

Walungi Farm:The farm has a total number of four cows with one milked cow, one castrate, one incalf and one calf. Two cows are for the Nutrition unit and two belong to the hospital. Namirembe which also belonged to the Nutrition Unit was sold as it was not producing any milk for the children and failed to conceive again after 5 Artificial Inseminations.Kitwe Eucalyptus trees Forest. The hospital has over seven acres of eucalyptus trees demarcated into three paddocks. The two paddocks of trees were sold out to generate income for the hospital and we have also started on cutting of the third paddock which is to be sold to the Hospital, VVF and the Laboratory school. The intention of cutting this paddock is to enable it to grow afresh with all the gaps filled with new trees.There is plan to refill the spaces in the plantation with more trees in the next financial year after all the trees have been cut and transported away from the site.

Nabulago Farm.This is also one of the Hospital’s income generating projects and the projects running at the farm at the moment are:The piggery project is running with a total number of 158 pigs as per the end of the financial year with 34 mothers, 10 castrated pigs, 4 males and 110 piglets. The project is growing with the rising number of pigs and their is great need to provide more pigunits for the piglets.

The banana project is subdivided into the old and new banana plantations. Though affected by the dry seasons the banana plantations are also moving on well and the Matooke from the farm is supplied to the Hospital General kitchen. A lot has been done to recoup the fertility of the soil by way of applying fertilizers to the banana plants and the progress is so far not bad. The new banana plantation with approximately 1,500 banana plants was also planted on 4 acres of land at the farm and the young banana plants are growing well with hope for positive returns.

Eucalyptus, mangoes and Coffee plantation. Approximately 20,000 seedlings of eucalyptus trees have been planted at the farm. These are at the extreme end of the farm towards the valley. Most of the trees now show signs of proper growth as the rains greatly helped them to takeoff well.

Coffee has also been planted at the farm and it is intended to cover approximately three acres of the slope from the valley. So far 1,200 Seedlings have been planted at the farm. Mangoes have also been planted at the farm. Over 200 trees were planted and we hope to plant more trees when the rain season starts.

Tree Nursery Project: Implementation of a tree nursery project is also under way at the Farm. The project mainly focuses on the establishment of a tree nursery that will produce a variety of seedlings for sale and at the same time train orphans in nursery establishment and management.The income from the project is to be used to pay medical bills for HIV/AIDS patients at the hospital and also purchase beddings for patients. It will also help to provide orphans with start up kit materials for their home nursery establishment.



So far the water reservoir for the nursery has already been dug and built, the tree nursery shed constructed, a temporary training shed and a store. The Coffee and mango plantations will work as mother gardens for the tree nursery project.

Pastoral Care (Meals and accommodation):This income generating project is also still running at the hospital, however we still have a problem of inadequate accommodation rooms to effectively run this income generating project. In the year 2009/2010, we received upto 65 visitors which included medical students, V.V.F trainees, CPE workshops and Engender health workshops.We also receive rental fees from the hospital canteen and the Kampala House which are also a great boost to our income generating projects.Achievements:

• Establishment of the eucalyptus, coffee and mango plantations at Nabulago Farm.• Expansion of the Nabulago banana plantation with more 4 acres.• Establishment and implementation of the tree nursery project at Nabulago.• Maintenance of the existing projects.• In the last half of the year; the income generating projects yielded a total income of Ug

Shs. 56,300,900/= and the total expenditure was Ug Shs. 25,372,250/=.

Challenges:There is great need to provide the Nabulago farm with a constant and permanent source of water especially for the piggery project.The changing weather patterns have also been a big hindrance in the productivity of the farms with heavy sunshine for long periods which affects our activity plan.Insufficient funds to invest in the projects as some have not yet started yielding any income for the hospital yet need to be maintained.Lack of enough accommodation rooms for our visitors as some of them are referred to go and sleep out of the hospital.

Way Forward:• Provision of more accommodation rooms for our visitors.• Provision of more equipment for our accommodation and meals. This will include the

buying of more utensils and beddings.• Construction of a permanent source of water for Nabulago Farm.• Reviewing and following of the drafted activity plans for the different projects.• Looking for funds to further inject in our projects.• Provision of demonstration place for parents/attendants with Malnourished children at

Nabulago farm

Maintenance:The hospital has full time maintenance staff which includes the hospital plumber, electrician, carpenter, and builder and pump attendant. These are tasked with ensuring that all the hospital buildings and all hospital equipments are kept in proper condition. They carry out the day to day maintenance and refurbishment work at the hospital.



Central Store:

The store is run by two staff.

The store is comprised of four sections, namely; the stationary, cleaning items, maintenance and food sections.Achievements:

- Creation of the new store for the food stuffs only for the different departments of the hospital.

- Grouping of the stock – items in small number, with their stock cards for landing quickly on the stock card required and easy counting of its items during the exercise of stock taking

- A decentralization of maintenance items e.g. electrical, plumbing, building and carpentry in one store which eases the work of the store especially in stock taking.

Challenges:

- Stocking a required number of different items due to inadequate finance.

Future plan:

- Renovation and extension of the store.- Buying computer for the store

PASTORAL CARE

Existing in Kitovu Hospital since 1986.Provided by a Clinical Pastoral Educated resident Chaplain. With two staff who attended oriented course of Clinical Pastoral Care of the sick.

Its organization is as follows; the staff have a daily meeting in the morning where they discuss their work. They share knowledge on challenging cases. From there they visit the sick; listening and discussing problems with them. They report to the chaplain, those who need to receive the sacraments. They also do social work by finding out with patients how they can improve his/her well being. They instruct them in how to communicate with their relatives who can provide help. They assist some patients on how to clear the hospital bills. At times they discover patients who have no access to food and help them to access food through social worker’s office.

Spiritual welfare of staff and students is catered for through sacraments, Lenten and advent retreats etc.



The hospital have realized the benefit of Pastoral work. The patients appreciate the services rendered to them. This can be observed as follows:-

• The number of patients attending the hospital is increasing. People hope to be catered for spiritually, socially, physically and medically.

• Vocationalism have been realized in hospital, two medical staff have joined the Religious Congregation of MMM (Medical Missionary of Mary).

The Pastoral care activities for the past five years.Activity / Indicator 2005/06 2006/07 2007/08 2008/09 2009/10

No. of patients visited or counselled 333 416 657 3181 3076No. of patients baptized 203 293 232 192 90No. of patients confirmed 02 02 15 20 4No. of patients given Sacrament of marriage 03 04 01 7 1No. of Holy communion 1938

N.B: The number of patients baptized, confirmed and given in marriage is lower than in previous years. The pastoral team was encouraged to let patients get, where possible, the above sacraments from their respective parishes.

Achievements: • Two members had attended courses of introduction to pastoral care giving.

SOCIAL CARE

In the year 2009/10, the two full time Social Workers of the Hospital continued to provide Social Care and support to our patients.

This of course, involved addressing various needs and problems of patients e.g relating to economic pressure(s) like inability to pay their medical bills, lack of basic support like food, soap, lack of transport money back home etc..

Anxieties, stress, depression and other psychological problems were also addressed and our patients managed to cope and adjust and were consequently enabled to respond to the prescribed medication.

The above, were organized through detailed assessments by way of interviewing, careful listening, probing, problem identification, making appropriate recommendations and involving clients in decision making. So techniques of counseling and guidance were quite often applied.



Some of such patients were helped to link with their family relatives, friends, local communities or employers; through telephone calls, Radio Announcements or written communication. And sometimes, it necessitated taking them back home i.e. to their local communities.

Many of the patients handled, were as a matter of routine, sensitized on the need for proper medication despite their socio-economic situation. They were similarly sensitized on methods and the need for proper use of their locally available resources e.g. “Bibanja”/Plot of land for future sustainability and improved welfare. Liaising and networking with patients family relatives, friends, local communities, employers and good Samaritans helped many of our patients/clients to sort out payments of their treatment bills.

Those who didn’t have any tangible means of support, were recommended and allowed to feed on hospital food so as to enable them respond to medical treatment. The emergency needy were similarly recommended for treatment; and plan(s) for payment at a future date made with them. And those who lost their children/relatives and had absolutely no means of taking the dead home for burial were assisted to have the dead buried in the hospital burial ground. Similarly, burials of the “No relative” patients who died in Hospital were organized through Social Workers’ Office.

Those who were abandoned in Hospital were assisted and enabled to return to their respective communities.

And so, by addressing the psycho-social and economic problems, our patients were ultimately, enabled to respond to the prescribed medical care; were relieved of pain and life was consequently prolonged.

So, considering the above, it looks certain that social work activities were directed towards the well being of our patients.



The table below gives a summary of social work activities for the past five years:-CATEGORY OF PATIENTS PERIOD /YEAR

2005/06 2006/07 2007/08 2008/09 2009/10(i) In-patients:Allowed to go with invoices 562 437 279 204 327Who later came back to clear their bills after discharge. 139 213 130 91 135Enabled to clear their bills on or before discharge. 911 1080 1153 1340 1447Partly waived 146 90 104 93 140Those who presented with socio-economic problems and were enabled to link with family system/ relatives for economic support and payment of the hospital bill

872 951 1023 1300 2610

Allowed to feed on hospital food 201 199 195 196 283Assisted with transport money back home 114 94 38 10 17Radio announcements to family relativesTelephone calls/written communication to patients’ relatives, employers or LCs

51 34 30 12 18

Home assessments 14 07 - 05 06Burials organized for needy/Destitute cases 13 10 09 03 12(ii) Out-patients:Completely unable to pay their medical bills 350 283 252 221 183Out-patients invoiced 450 328 410 193 352Out-patients who came back later and cleared their bills 177 130 216 166 196Out-patients who were partly waived 91 41 68 32 34(iii) Other Activities:Cross referrals i.e patients/clients referred to NGOs or other service providers for resettlement, rehabilitation or some other help 91 20 20 24 -Referrals to Good Samaritan(s) and had their bills cleared 48 42

Total 4182 3917 3927 3946 5802Impression of Progress over the last 5 years:

Analysis of the above data indicates the following:-• Total for in-patients and out-patients handled were on increase which was probably caused

by increased widespread poverty which leads to increased socio-econmic problems.

• There was increase in invoices issued for the year 2009/10 as compared to 2008/09 which was again due to increased poverty in the catchment area.

• There was steady increase in number of patients enabled to clear their bills on or before discharge. This was due to increased team work, sensitization of patients by social workers and networking with their relatives /employers for economic support and increased follow-ups.

• Steady decrease of the completely “unable” to pay cases due to increased sensitization of the care-takers.



Activities done to prepare patients return home:

• Discussions were held with the needy and deserving cases on the need for proper use of their locally available resources for improved sustainability and welfare.

• Plan(s) for payment of the Hospital bill(s) at a future date (where necessary) were made with patients who genuinely failed to meet the full cost of their medical bill.

• As for the abandoned, social workers endeavored to liaise with their relatives, friends, employers and local communities and sometimes assisted them with transport back home.

Outcome:• Due to sensitization and counseling, the needy (patients) were relieved of the socio-

economic pressure(s).

• The needy but chronically sick e.g. the diabetic, hypertensive, epileptic, Asthmatic etc. got to appreciate value for life as opposed to money and managed to comply with routine medication despite their socio-economic situation.

• Life was consequently prolonged.

Recommendation/ Way forward:

• Continue to assess all patients referred to the office so as to determine the proper course of Action.

• Strive to reduce on the number of patients invoiced.

• Continue to educate our regular clients on issues of sustainability and the need for proper medical care.

• Maintain team work and regular follow-ups of patients on Wards.

• Continue to collaborate and network with patients’ relatives, employers, friends and local communities over patients’ problems.

• Maintain a healthy relationship with Good Samaritans and other service providers.

• Encourage patients to join Kitovu Community Health Insurance Scheme in future.

Prevention and Health Promotion servicesCommunity Based Health Care and Nutrition unit

The Community Based Health Care Services for communities was scaled down until funds are available for those activities. The year 2009/2010 the programme concentrated on the Outreaches for immunization of under five, Ante-natal care, Health Education and Nutrition unit for Rehabilitation of severely malnourished children.



The programme has the following staff totaling to 11.

Outreach:- Programme Coordinator 1- Nurse 1- Children Nurse 1- Assistant Nurse 1- Driver 1Nutrition unit:- Registered Nurse 1- Children Nurses 3- Assistant Nurses 2

Immunization programme:The programme has 4 outreach Centres which are visited once a month per centre. It also participated in October child days.

A total of 2,257 children were immunized.Immunization:

The table below shows Antigen (vaccines) given in three years:-Vaccine Under 1 year 1 – 4 Years

2007/08 2008/09 2009/10 2007/08 2008/09 2009/10BCG 1804 2207 2257 40 71 13Polio 3430 4405 4181 46 61 40DPT, HEPB & HIB 2016 2555 2374 46 60 38Measles 576 651 538 46 50 23Tetanus Pregnant 1081 1091 1071 NA NA NA

Not pregnant 147 94 199 NA NA NA

Totals 9054 11003 9536 178 242 114

Table showing immunization in 2009/2010Vaccine Under 1 Year 1 – 4 YearsBCG 2257 9Polio 3 726 9DPT, HEPB & HIB 3 726 9Measles 338 6Tetanus 2 Pregnant 229 N/A N/A

Not pregnant 39 N/A N/A

Totals 268 2,611 33

The team participated in T.T mass immunization and child days. The report of mass immunization is directly submitted at the district Health Headquarters.The table shows child days report for October 2009:-



Children given Vit. A in 2009/2010 Total Children given deworming6 – 11 months 12-59months 1 – 5years 5 – 14years Total95 130 225 125 33 158

Health education:This is given at every immunization centre so that mothers / caretakers can go back with Key health message to their homes.

Vitamin A and Deworming on routine basis in four years:-2006/07 2007/08 2008/09 2009/2010

Vitamin A 406 1174 1557 1240

Deworming 1 – 4 yrs 406 1147 1056 847 5 -14 yrs 6 1130 562 615

The table below shows Antigens given for 5 years:-2005/2006 2006/2007 2007/2008 2008/2009 2009/2010

8603 7958 9232 11401 9650

Nutrition Unit:The Nutrition Unit has a bed capacity of 14 beds. The severely malnourished children are admitted and those with mild malnutrition are given nutrition education and advice plus food supplements as out patient.

Table shows utilization at Nutrition Unit for 4 years.

NUTRITION UNIT 14 beds 2006-2007 2007-2008 2008-2009 2009-2010Admission 164 221 268 355Inpatient days 3099 4325 4503 5630Average L.O.S 19 20 17 16Deaths 12 17 23 39Average Occup. 9 12 12% 15Death rate 7% 8% 9% 11%Recovery Rate 93% 92% 91% 89%Bed Occup. Rate 61% 84% 86% 110%

The number of children increased due to increased number of sick children due to epidemic of malaria. Food shortage in the area also contributed a lot.There was an increase in death rate because many of children were brought in critical condition when the chance of survival was minimal.

Event: Dr. Una and Friends Donated to Nutrition unit the following:-- Painting of the building and renovated the septic tank- Set up sensory room (play room)- Television set.- Baby clothes and shoes We are very grateful for the good work done. They also promised to fund the Nutrition Unit in the future.



Early Infant HIV Diagnosis:

This activity was strengthened in August 2009 as an activity component intergrated in health care package.A total of 83 infants were tested for HIV by PCR.

Table below shows different categories:-

1- Mothers/Care givers counseled and infants taken off DBS 832- Infants tested Negative 1st PCR 673- Infants tested positive 1st PCR 134- Infants referred to ARV centres 135- Care givers came back and picked results 296- Infants died after collecting 1st DBS before results 27- Caregivers contacted for results 46

Challenge:

• The major challenge is funds, the Nutrition unit still depend on friends who contribute towards foods but salary of staff is a problem.

• Caregivers don’t come back for results even though they are contacted on phone.Future plans:

• To start a farm at Nabulago where some food staff will be grown. To sell off a bull and replace it with milk goats.

• Continue contacting caregivers for continued follow ups.

KITOVU COMMUNITY HEALTH INSURANCE SCHEME

Kitovu community Health Insurance scheme (KCHIS) formally known as Kitovu patients pre-payment scheme (KPPS) was opened in 1998 with funding from DFID. It is one of the many schemes established in the country to enable the poor and low- income earners to access medical care without paying large sums of money. It aims at promoting equity in all classes of people whereby the poor can also access expensive medical care which they would not have afforded if they had not joined health insurance.

Area of operation The scheme is currently actively operating in Masaka and Ssembabule districts. The service providers are Kitovu Hospital and Nkoni in Masaka District and Katimba in Ssembabule district. All the service providers are under the supervision of Masaka Diocesan Health Office.

In other words Kitovu scheme (KCHIS) is currently made up of 3 sub schemes/branches:

1. Kitovu hospital scheme2. Katimba LLU scheme (H/C 111)3. Nkoni LLU scheme (H/C 111)



Kitovu branch was opened in 0ctober 1998, Katimba in October 2007 and Nkoni February in 2010.Benefit package The benefit package for all braches includes Outpatient (OPD) and Inpatient (IPD) services.In addition to the above, Katimba and Nkoni being LLU 111s, they have an additional package of:

• All referrals are sent to Kitovu hospital without an additional cost and,• There is transport refund for all emergency referrals

Kitovu branch covers all services offered at Kitovu hospital.

Exclusions: All the three branches have the following exclusions:Optical care and eye glasses; Dental care; Open heart surgery; Ambulance services; Meals for patients; circumcision; self inflicted injuries and private services. In addition to the above, Nkoni branch does not cover chronic diseases and Laboratory tests. However they will be considered in the second year when reviewing the premiums and provided the members are willing and ready to pay for them.

Sources of fundingExternal fundingCurrently the scheme is funded by CORDAID an organization based in Netherlands. This organization funds all the major activities of the scheme, i.e. operational; sensitization; prevention; and a full premium for the poorest of the poor. Local income:

• Premiums• Co-payments

Premium structure:A family of 1-5 people pays a full premium and each extra person pay half the premium as shown in the table below.

Table showing premium structure for the each of the 3 branchesScheme/branch Full premium/person

(1 to 5 persons )Annual premium 5persons

Annual premium each extra person

Premium for 6 persons

Kitovu 9,600/= 48,000/= 4,800/= 52,800/=Katimba 6,000/= 30,000/= 3,000/= 33,000/=Nkoni 10,000/= 50,000/= 5,000/= 55,000/=

Note: the premium for Nkoni branch is much higher than that of the other two branches.

The premiums for Nkoni were calculated after Inflation and the cost of drugs had increased on the market. However, new premiums for Kitovu and Katimba were calculated in May 2010. And the annual premium per person is 34,885/= for Kitovu branch and 15,633/= for Katimba branch. These will be effective right from July 2010.

Co-payments:



In Kitovu Co-payments were re-introduced on 11th April 2010 during the annual general assembly. Members agreed on these co-payments after providing all the information on income (from premiums and co-payments) and expenditure (from treatment costs). This was also done in Katimba on 16th April 2010 on their annual general assembly.

Table showing co-payment structuresOut patient

In patient (normal)

Surgery & C/section

Kitovu branch

Diabetes & hypertension

10,000/= 25,000/= 50,000/=

Malaria and others 2,000/= 15,000/= 50,000/=

Katimba branch

Diabetes &Hypertension

2,000/= 5000/= N/A

Malaria & others 5,000/= 5000/= N/A

Nkoni Diabetes &Hypertension

N/A N/A N/A

Malaria & others N/A N/A N/A

Provider paymentsAll the three branches pay flat rates to the health service providers. However in April 2010 Kitovu Hospital requested for actual costs saying that the cost of drugs was really very high.

Table showing flat rates for the 3 branchesKitovu (Hospital)

Katimba -H/C 111

Nkoni H/C 111

OPD 8,000/= 3,000/= 4,000/=IPD 40,000/= 17,000/= 20,000/=SURGERY 80,000/= N/A N/A

The rates are per a single visit or admission. However the scheme is in the process to review the flat rates. And this will be done after the calculation of the new premiums.

MembershipTable showing the membership trend for the period Dec 2006 thru July 2010Name of the branch

Dec - 2006 Dec -2007 Dec - 2008 Dec - 2009 30th June 2010

Kitovu branch 864 1053 1822 3127 3446Katimba branch 0 1997 1223 1034 1336Nkoni branch 0 0 0 0 420Note: registrations of members in Nkoni branch started in February 2010.

Income and expenditureThe scheme has two major sources of income. And these are Funds from cordaid and the premiums. And in Kitovu branch, the co-payments contributed some good money.



Kitovu community health insurance scheme

Jul - Dec 2008

Jan - Jun 2009

Jul - Dec 2009

Jan-Jun 2010

Beginning Balance

32,319,533 4,313,564-

7,396,323

5,116,953-

Premium income

6,914,000 9,491,633

12,001,310

11,949,900

KITOVU Income from Cordaid nil 48,450,000

87,060,000

39,654,500

BRANCHCo-payments nil

1,488,550

2,698,500

6,261,500

(Hospital) Refunds - from referrals 1,047

,500

Total income

6,914,000 59,430,183

101,759,810

58,913,400

Expenditure

Treatment costs

17,968,000 25,672,000

39,272,000

47,763,700

Operation costs

25,579,097 22,048,296

69,651,296

30,249,704

Nkoni feasibility study

-

- 1,

006,300

-

Deficit -Part payment - to Kitovu Hosp.

-

-

4,343,490

-

Total expenditure

43,547,097 47,720,296

114,273,086

78,013,404

Balance carried forward

4,313,564- 7,396,323

5,116,953-

24,216,957-

Jul - Dec 2008

Jan - Jun 2009

Jul - Dec 2009

Jan-Jun 2010

Beginning Balance

10,448,054

- 5,

395,400 12,880

,650 Income

Premium income

4,346,750 3,796,500

2,540,500

1,126,350

Income from Cordaid

- 10,000,000

26,360,750

7,384,833

co-payments

-

-

-

-



KATIMBA BRANCH

From Kitovu scheme - (to cover -deficit)

8,677,230

-

-

-

(H/C 111) Total income

13,023,980 13,796,500

28,901,250

8,511,183

Expenditure

Treatment costs

9,137,000 6,989,000

8,786,000

11,325,000

Operation costs

5,285,534 1,412,100

1,396,000

3,994,500

Deficit -Part payment - to Katimba H/C.

-

-

8,234,000

-

Investment cost

9,049,500

-

-

-

Prevention

-

- 3,

000,000

-

Total expenditure

23,472,034 8,401,100

21,416,000

15,319,500

Balance carried forward

- 5,395,400

12,880,650

6,072,333

Jul - Dec 2008

Jan - Jun 2009

Jul - Dec 2009

Jan-Jun 2010

NKONI BRANCH

( H/C 111 )

Beginning Balance - - 0 29,337,200

Premium income - - 0 1,690,000

Income from Cordaid - - 30,000,000 7,384,833

Co-payments - - 0 0

Total income - - 30,000,000 9,074,833

ExpenditureTreatment costs - - 0 1,112,000

Operation costs - - 662,800 2,790,150

Nkoni feasibility study - - 0 0Deficit -Part payment - to Kitovu Hosp.

- - 0 0

Total expenditure - - 662,800 3,902,150

Balance carried forward - - 29,337,200 34,509,883

Others- this money was paid to Katimba H/C to cover the deficits incurred by the H/C due to the low flat rates paid by the Scheme.



Nkoni LLU scheme: Activities in Nkoni LLU scheme started in June 2009 with a feasibility study. As there was no money allocated to Nkoni by that time, Kitovu mother scheme and Uganda Martyrs University Nkozi (UMU) undertook to pay for the feasibility study costs.In October 2009 Cordaid allocated UGX 30,000,000. (UGX 10,000,000 for operational costs, UGX 10,000,000 for capital investment and UGX 10,000,000 for prevention)

Achievements:• Members say that there has been significant improvement in the quality of their life.

This pertains directly to the members’ health, and their ability to cope with health care costs. They report reduced disease burden in their families.

• Members seek early treatment without selling their assets or enter debts. When treated early, many infectious diseases are much less dangerous and less expensive to treat.

• Disease prevention : The scheme provides insecticide treated mosquito nets to members at an advantageous price and at the same time gives health talks to help control malaria. The Percentage of Malaria reduced from 66% in Jan - June 2007 to 39% in Jan - June 2009.

• The scheme has expanded to two Lower Level Units: Katimba in 2007 and to Nkoni in 2009 and is currently preparing to expand to a third Lower Level Units in order to make a diocese-wide scheme.

• New premiums have been calculated for both Kitovu branch and Katimba branch and these will be effective right from July 2010. The new annual premiums are 34,616/= and 15,633/= respectively.Key challenges of the scheme:

• Low membership over the previous period• Low premium against a wide benefits package. • High treatment costs due to:

The high utilization of services by members with Chronic disease (diabetes, hypertension) and the high cost of health services resulting from the high cost of drugs

• Lack of agreements/Memorandum of understanding with service providers

• Insufficient capacity building trainings for the health service providers as regards patient care and health insurance

Way forward1. There will be improvement in the general management of the scheme. A special

committee will be formed to over look the activities of the entire scheme. General assemblies for the different sub schemes will be formed and these will represent the different communities during general meetings and decision making meetings. The scheme will prepare management tools which will help the running of the scheme. These will include:

• Memorandum of understanding with the service providers• Constitutions in all branches2. The scheme will invest in increasing membership and expansion to other areas.

The scheme will expand to two LLU in the diocese and we will be helped by the



diocesan health office to select these LLU. Every year the scheme will be expanding to one LLU.

3. The scheme will do capacity building trainings for both the scheme staff and the staff of the service providers.

4. The scheme will continue to centralize the management as advised by the CHI consultant. There will be a committee as indicated above. All payments will be handled centrally. E.g. the payment of treatment bills, salaries, and major purchases.

The central office will do regular monitoring and supervision of the braches and hold meetings frequently with the health service providers to avoid irregularity on either party.

11. HEALTH TRAINING INSTITUTION

Laboratory Training School:

Physical Address: 3 kms from Nyendo trading centre and 5 kms from Masaka town. The school is located within Kitovu Hospital compound 1 km from St. Henry’s College Kitovu. Kitovu Medical Laboratory Training School takes Senior Four (S.4) leavers who passed sciences, English and mathematics at S.4. The school trains Laboratory assistants (Technicians) for a period of two years. The school is licensed with MoES.

Kitovu Hospital is a 200-bed capacity. Our school started way back in 1986 by Sr. Davnet O’kane MMM sisters with four (4) students. The school started on the condition/ purpose of availing trained staff to the hospital laboratory. Later the demand for the staff increased and more were trained for health centres like Makondo H/C, Bikira H/C, Mushanga Dispensary, Kiteredde etc.

The school was operating on donor funds from its beginning to 1998; when the donors pulled out, the school could not continue since there were no more funders. A lot of thanks goes to CAFOD, MISEREOR and CEBEMO for the support given by then. The school stopped operating in 1999. Later in 2004 the ministry of Health wrote a letter to the hospital management requesting to revive the school.

The Hospital Management team and Board of Governors welcomed the idea and made arrangements for revival of the school.

In January 2005, the school officially started with 11 students, in August 2006, we had the first sitting, 10 students passed. Since the school’s revival 81 students have been trained. Students are performing well wherever they went.

Key events● Implementation of bursary scheme● Principal Tutor completed training at Mulago Tutor’s College



Type of CourseThe school has one type of course (Laboratory training Programme) only. So far, no changes have been made, we only hope to start diploma programme in the near future after establishing the personnel (trained tutors). There is also a plan to build a dining or multipurpose hall.

Total HTI CapacityThe total capacity of the school is 40 students. This was decided in comparison to tutor-students ratio and the buildings which were in place by the time of reopening the school (2004), but as per today the school is equipped with enough infrastructure i.e. hostels and classrooms with the capacity of 50 students. The school has trained two tutors.

Course No of students enrolled in the year (new intake)

No of students 2nd year

No of students 3rd year

No of students sat for final exams

No of students passed final exams

Success rate

Laboratory Assistants Course

24 20 N/A 19 Results not yet out

Results not yet out

Achievements● Trained a microscopist for Masaka Local government.● The computer laboratory is functional ● We have office Internet services ● Held RCT workshop with help from CPHL for finalist students. ● Recruited the 1st batch of bursary students. ● We procured 2 urinometers. ● The school is a training site for refresher courses for laboratory personnel in the

region

Constraints ● Self-sponsored students are unable to meet their school fees in time.● Price hiking of commodities on market

Faithfulness to the mission Indicator 2006/07 2007/08 2008/09 2009/10Access (percentage of total capacity used)

133% 133% 108% 115%

Equity (average student fee) 1,518,962 1,631,604 1,366,070 2,057,684Efficiency (average recurrent cost per student)

1,513,767 1,517,868 2,216,142 1,760,935

Quality (average rate of students 41% 91% 100% Result not



passing their final exams = success rate).

yet out

Quality (qualified tutor - student ratio).

0:53 0:53 1:43 2:23

Number of Tutors Employed last year: 2 TutorThe qualified tutor – students ratio is 2: 23The ratio of qualified teaching staff – unqualified teaching staff and support staff is 6: 3 hence 2:1

Training and workshops ● One teaching staff was enrolled for management course and fully trained and completed

it. ● Two staff were trained in TOT for RC/ logistics management. Governance and Management of the School The school is governed by Kitovu Health Care Complex. In every Board of Governor’s (BOG) meeting the hospital Chairperson School management committee Board member reports on the progress and issues of the school.

The school has a functional School Management team, which meets quarterly and discusses issues concerning the progress of the school.

Acting Principal Tutor attended 80% of the Hospital Management Team meeting.

The students cost increased due to the unbudgeted Uganda Allied Health Examination Board charges per semester. The school is a cost centre and compiles a feasible financial report and budget.

Plans• Hold 2nd graduation ceremony • To Train one other Tutor• Improve the quality of training by training more tutors.• Strengthen staff-students relationship by holding regular meetings and assembly.• To improve students’ co-curricular activities. • Hold RCT workshop with finalist students every year. • Increase on the school intake capacity.• Apply for starting up a diploma course.

Performance of the Health Training Institution

Course / subject 2007/08 2008/09 2009/10 2010/11Lab Assistants course No new admissions 21 20 24 25No lost during the year 0 0 0No dismissed during the year 0 0 3



Number of student who sat 22 42 23 19Success rate 41% 91% 96% Results

not yet outNo succeeded exam at first attempt 8 30 20 As aboveNo succeeded exam at second attempt 1 12 2 As above

12. Conclusion:The role of Kitovu Hospital is to provide prevention, promotive and curative services and Primary Health Care. We aim at providing a National Minimum Health Care Package (UMHCP) as stipulated in the 5 year Health Strategy Plan HSSP111.And in so doing we work hand in hand with the district, and the central Government.

We train health workers namely Intern Doctors, Medical Students, Nurses from Villa Maria Comprehensive Nursing School, Laboratory Assistants students and carry-out special training of Fistula Repair for Trainees.

The hospital is PNFP for Masaka Diocese, owned by the Board of Trustees, Governed by the Board of Governors and managed by the Management Team.

Human Resource Capacity:The hospital is run by a total of 225 employees; including qualified and non-qualified medical and non medical, plus support staff. Once in a while, we get expatriates from overseas who are of great help to us. We experience turnover of staff of Midwives and Nurses going for greener pastures which has however came down this year. Thus we end up with staff with low experience. And it is consequently hard to meet the desired quality service.

Finance:The source of income is from user fees which accounts for 42%, Donations 29% and for PHC Conditional grant from the Government is 11%. Without Donations and PHC grant the sustainability of the hospital is impossible.

Laboratory Training School:Our Laboratory Training School was re-opened in 2005. Since its revival many students have been trained. The capacity of this school is 40 students but could be raised to 50. Two Tutors have been trained. Quality education is emphasized and has been good for the last two years. We had a pass rate of 91% for 2008/2009 and 96% for 2009/2010.

Sustainability of the school is feasible so long as the majority of the students are sponsored by AMREF and Government bursaries. Self sponsored students however find it hard to meet their fees in time.

Achievements/Failures:



Achievements

1. Solicit funds for fridges, microscopes and autoclave for laboratory.

2. Restructure the CBHC Programme as the main donor phased out

3. Install a solar system at Maternity ward.

4. Increase staff salaries so as to match with government salary scales; especially for the Enrolled Nurses and Midwives.

5. Monitor and document post caesarean infection rate and waiting time on OPD.

6. Segregate the data of FSB as per definition of UCMB

7. Separate midwives in two groups one to concentrate on admission and another group on

labour ward.

8. Closely monitor drug prescription by the Clinicians.9. Hire a Laboratory Technologist so as to improve on the quality of the service.

10. Regularly monitor sepsis on maternity ward.

11. Acquire a new double cabin-truck as a donation from Netherlands.

12. Conduct a two day capacity building workshops for all staff held on alternative days

13. Comprehensive Nurse Students from Villa Maria were added on the work force of Kitovu Hospital.

14. All the four qualified staff midwives that work in ANC had a two days workshop to orient them with basic knowledge on family planning and to enable them provide accurate F/P information and specifically natural F/P methods to couples that need it.

15. Engender Health sponsored our hospital staff for a 3 days’ workshop on Process and Tools for improving the Quality of Maternal Health services and another one week workshop on Quality Supervision.

16. Two members of staff have attended courses of an introduction to pastoral care giving.

17. Eight members of staff attended a one week course at Mildmay on HIV and a cost centre workshop was given to our staff by UCMB

18. All laboratory staff have gone through a training for malaria diagnosis by Masaka District in Collaboration with Stop Malaria of MOH.

19. We have recently opened a Care Point for Early Infant Diagnosis for exposed children to HIV as a program of MOH..



20. We have established a room strictly for blood group and cross matching; fully equipped with a fridge for blood, compatibility requisition forms and standard operating procedures.

21. We have established a system of dispensing medicine per chart for inpatients as to curb on the big bills of medicine.

22. One Junior Radiographer completed his study.

23. We have reconstructed/renovated the hospital maternity and Labour ward roofs and

ceiling.

24. We have constructed the premature unit and a new pit latrine for OPD.

25. We have renovated of the hospital general kitchen, hospital canteen building and the

hospital mortuary.

26. 5 Acres of coffee were planted as an income generating Project for the hospital.

27. A tree nursery project was also started as an income generating project.

28. Through Dr. Maura and Dr. Una a donation of a Container with medical and non medical equipments was received from friends of Ireland.

29. An orderly central store is now in place.

30. With support of Dr. Una and friends Nutrition ward was re-painted and its Water System repaired.

31. The Rotary Club of Guernsery donated two Theatre lights and one spot light.

32. We have reviewed and followed up the drafted activity plans for the different projects.

33. Phase 1 for the construction of the Hospital Chapel is now complete.

34. Through the Government, The Laboratory Training School received bursary funds for 11 students.

Failures:

1. Obtain heamatology analyzer so as to get more accurate results in heamatology.

2. Consider including Fansider and Septrin prophlexis in the antenatal package.

3. Carry out regular Medical Audit.

4. Revise terms and conditions between Kitovu Hospital and Nakasero National Blood Bank.

5. Put in place development plan for training of staff in the year we have just ended.



6. Solicit for funds for immunization for our staff against Hepatitis B, C and HIV prophlaxis; after needle prick from HIV infected patients, though discussions were held about it.

N.B: Most of the failures were due to failure to secure enough funds.

Faithfulness of the Mission:The hospital demonstrated its faithfulness to the Mission as a Health Institution of the Roman Catholic Church in the year 2009/2010 as evaluated in the indicators below.

Accessibility:Accessibility improved by the increase in OPD attendance by 23% admission by 49 % deliveries by12%.

Equity:Still the majority of Admissions were on Paediatric and Maternity Ward, probably this is due to the flat fees on both Wards which are affordable. Equity went up, user fees per SUO increased from 3,368 to 3,583 (6%), but this did not affect the utilization. Fees per SUO increased probably due to inflation and high cost of living.

Efficiency:This has increased because expenditure per SUO has decreased from 10,454 to 8,191 a decrease of 21.6%. Probably this is due to increased number of patients and close monitoring of wastage.

Staff Productivity:Has increased from 1,050 – 1360 SUO/ staff. An increase of 30%. This can be due to an increased in a number of patients.

Quality Indicators:

• Recovery Rate - 96%

• FSB Rate - 7%

• Post Caesarean Infection rate - 3%

• MMR - 1%

• The number of qualified staff - 80%

However, maternity death audit have been carried out irregularly due to staff turnover

Quality Improvements tackled last year are:• Separation of midwives in 2 groups one to concentrating on Admissions and another on

Labour Ward. This has greatly improved patient care on Maternity.• Data of FSB were documented per UCMB definition.



• Monitoring and documenting of Post Caesarean infection was done. Measures were taken through sensitization of staff and review of infection control measures was done.

• Doctors and Clinical Officers were employed to care for the patients thus decreasing waiting time at OPD.

In addition during Malaria seasons registered Nurses were encouraged to see the children.

Quality Improvements to be tackled this financial year are:• Continue closely monitoring drug prescription by Clinicians.• Reviving Medicine Therapuatic Committee• Continue monitoring and documenting on Post Caesarean Infection.• Monitoring and documenting on waiting time at OPD mostly on Monday and Fridays

when Clinicians are having Meetings and CPE.

Contribution to HSSP, PEAP and MDG• The hospital contributes significant to the HSSP Indicators of the district by increased

OPD utilization, Immunization at the hospital, outreaches and involvement in child days, ANC and 24 hour Maternity services etc.

• Inadequate finance greatly affects the hospital’s contribution to PEAP and the Millennium Development Goals for example, the number of outreaches through the CBHC Program were cut down because of inadequate funds, the future and sustainability of the Nutrition Rehabilitation Program, is at stake as no constant source of funding is provided.

• We would recommend to Management, to solicit funds for the above HSSP, from the District and Central Government.

We request the Central Government of Uganda to connect the hospital on reliable/permanent power supply.

We appeal to the Government of Uganda to increase PHC grant to the Hospital to enable us to continue working as a referral unit.

Sustainability of the Hospital:

Financial Support:Inadequate funds is till a major problem. PHC grant is decreasing. Donations have decrease. The income generating projects are not self reliant yet and the cost of living is accelerating. Thus with unreliable resources of funds, sustainability of the hospital is at a stake.

Infrastructure: Though maternity ward had been expanded the space is not enough for increasing mothers delivering at our hospital.



Secondly there is a great need of renovation and expansion of staff residences.

Critical issues that need attention in the next Financial yearContinue lobbying and advocating for rights; partnership at district level; attention and intervention of UCMB with the Government and with developing partners.14. PLANNING FOR THE FUTURE:

Future Plans:

1. Continue to search for funds so as to work on the different projects; like, the multipurpose building complex and the Biogas sanitary system, Equipment for laboratory and children ward, provision of free Septrin of ANC mothers, renovation of main pharmacy store, construction of a casualty department and to build staff residences.

2. Lobby from the Government for more funding to the hospital so as to enable us to continue working as a referral unit.

3. Open an HAART Clinic (HIV clinic)

4. Pursue accreditation of Kitovu Hospital surgical services as a training centre for M/Med/Surgery and East African Fellowship in surgery.

5. Maintain Fistula Repair program and continue getting expatriates, while continuing to look for fulltime surgeon for the program.

6. Strive to increase our hospital income so as, to have capacity to pay our staff competitive salaries and be able to retain trained and experienced staff.

7. Continue sensitizing staff and patients about dispensing drugs/medicines per chart and to find ways to speed up the process of dispensing medicines so that the goal which led to the new system can be realized.

8. To solicit funds for Nutrition Unit as its future is at stake without donors’ support..

9. To find ways of having reliable/permanent power supply.

10. Reconstruct at least 2 private rooms in the main hall and establish a nurses’ station in the main hall so as to enable close monitoring of very sick male patients and also plan for more staff and more equipment; to enable establishment of a second nurses’ station.

11. Solicit funds for immunizing staff against Hepatisis B

12. Organise space for Paediatric intensive care unit to manage the very ill children.



13. Consider Paediatric private services

14. To ensure that we get the prophlaxis drugs for HIV+ Clients all the time in PMTCT.

15. Consider having ANC everyday.

16. To separate area and personnel for OPD and IP in the pharmacy to ease the work for staff.

17. To get new x-ray machine.

18. To find ways to keep the Ultra sound room cool and dust free.

19. To renovate some of the old buildings at the hospital especially the staff hostels and wards.

20. To renovate the hospital fence.

21. Buy a computer for Laboratory.

22. Refurbishment of the Hospital Incinerator.

23. Create space for first stage of labour

24. Provide ventouse vacuum to maternity as to decrease number o ceasarian section



ACKNOWLEDGMENT:

We deeply acknowledge donations of Finances, Sutures, Medical supplies and services from many friends of Kitovu Hospital namely:-

a) DONORS- Dr. Peter Doherty - U.K

- Mr. Tim Peet - Guernsey, U.K

- Dr. Brian Hancock - U.K

- Dr. Mike Bishop - UK

- Dr. Shane Duffy - U.K Ireland

- Dr. Chris Manning. - U.K

- Dr. John Kelly - U.K

- Dr. David Tibbutt - U.K

- Dr. Bill Goldthorpe - U.K

- Dr. Martin Radford - U.K

- Colin Legge - U.K

- Rotary Doctor Bank - G.B, + Ireland

- Rotary International - U.K – Guernsey

- Medical Missionaries of Mary - Ireland

- Electric Aid / Willie Roche, Cera Slevin - Ireland

- Orla Clery + Friends - Ireland

- Breda and Seamus Rogers + Family - Ireland

- Brendan Lynch + Family - Ireland

- Susan Begley + Family - Ireland

- Jane Byrne + Family - Ireland

- Janet + Conor Pitts - Ireland

- Sandra + Ronan Buckley - Ireland



- Tom Dooley Fund – Sheila Mc Glouglilin - Ireland

- Duleek Women’s Group - Ireland

- Staff of “Bubbles” Finglas Dublin - Ireland

- VMM - Ireland

- Hand in Glove - Channel - Isles

- Dee and Hughie Larkin - Ireland

- Deirdre + Hughie Larkin and Friends - Navan Ireland

- Nursing Tutors and Students - Dundalk Nursing College, Ireland

- Mary and Pat O Carroll - Ireland

- All Friends and Donors of Dr. Maura - Ireland, U.K, Germany & U.S.A

- Dr. Muris Fitzgerald Dublin - Ireland

- Medical Students U.C.D, T.C.D - Ireland / U.K.

- Dr. Linda Waters - U.S.A.

- Dr. Hilary Clegg & Soroptomists Club - U.K.

- Mrs. Rosa Lynch & Friends - Christ the King Parish, Chingford

London /U.K

- Michael Lomas and Friends - U.K.

- Mr. Werner Reiter and Family - Heiden – Germany

- Mrs. B. Walter and Friends - Heiden – Germany

- St. Elizabeth’s School - Germany

- Mr. Franz Neblich - Germany

- Mr. Helmut Cuntze - Germany

- Kristi Bullock - USA

- Dr. Mike Marks - USA

- Drs. H.E Van Aken - Miva Netherland

- Mr. Felix Lebromm - Germany

- Stefanie Barth - Germany

- Christoph Kneer - Germany

Organizations Internal funded- CORDAID - Netherlands

- AMREF - Uganda



- IMRS (Ireland) Irish Missionary Resource Services

- USAID- Engender Health - Fistula Funding- UNFPA

- Electric Aid - Inverter Emergency lighting system

- AFRICARA - Obstetric Fistula Funding

- Fentam Trust (UK) - Maternity Buildings/ Ob. Fistula Unit

- SCIAF - CBHC Programme

- UCMB - Human Resource Development & Technical support

b) The Management wishes to thank the Ministry of Health Government of Uganda for the continuous support of delegated funds and EDP credit line, which have enabled us to run the hospital in this financial year.

c) The Hospital Management also wishes to thank Uganda Catholic Medical Bureau (UCMB), JMS, Donors and the Bishop of Masaka Diocese, Rt. Rev. John Baptist Kaggwa for the wonderful spiritual, Financial, Material, Technical Support and Guidance which they have continually extended to this hospital.

d) Staff:The Hospital Management Team, finally wishes to appreciate the very good services rendered by all professional and non-professional (support) staff.


kitovu health care complex p.o. box 524

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