report 2014/2015 - dr. ambrosoli memorial hospital

Dr.Ambrosoli Memorial Hospital ,Kalongo

P.BOX.47, Kalongo

Agago

ANNUAL ANALYTICAL REPORT

2014-2015

By

Chief Executive Officer

Endorsement of Report

This annual analytical report for Dr Ambrosoli Memorial Hospital – Kalongo covering the

period of Financial Year 2014-2015 has been prepared by the management of Dr Ambrosoli

Memorial Hospital. I endorse that it represents management’s views on the position of the

hospital in the period under report.

Name: --------------------------------------------

: --------------------------------------------

Dr Ambrosoli Memorial Hospital

Date: -------------------------------------------------------

This is to acknowledge that I have received this annual analytical report for Dr Ambrosoli

Memorial Hospital – Kalongo covering the period of the Financial Year 2014-2015, I have read

it and endorse its authenticity and representativeness of the position of the hospital in the year

under report.

Name JOHN BAPTIST ODAMA

Chairperson of the Board of Governors

Date19th

December 2015

Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015

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FOREWORD

This Annual Analytical Report covers the period between July 2014 and June 2015 and portrays

the performance of Dr Ambrosoli Hospital in the various activities. The Hospital runs a wide

range of activities that include curative, preventive and rehabilitative services, training,

administrative, logistics and technical support services. Data presented are directly derived from

the Hospital’s activity and financial database.


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TABLE OF CONTENTS

ENDORSEMENT OF REPORT ............................................................................................................. I

FOREWORD ..................................................................................................................................... II

ACRONYMS ................................................................................................................................... VII

IMPORTANT INDICATORS AND DEFINITIONS .............................................................................. VIII

ACKNOWLEDGEMENT / APPRECIATIONS ....................................................................................... X

EXECUTIVE SUMMARY ................................................................................................................... XI

CHAPTER ONE ................................................................................................................................. 1

THE HOSPITAL AND ITS ENVIRONMENT ......................................................................................... 1

SOCIAL AND ECONOMIC ORGANIZATION .................................................................................................. 1

COMMUNITY AND HEALTH STATUS .......................................................................................................... 4

MORTALITY AND MORBIDITY .................................................................................................................. 5

NOTIFIABLE DISEASES AND EPIDEMICS .................................................................................................... 5

HEALTH POLICY AND DISTRICT HEALTH SERVICES .......................................................................... 6

HEALTH POLICY ...................................................................................................................................... 6

DISTRICT HEALTH SERVICES ................................................................................................................... 6

HUMAN RESOURCES ................................................................................................................................ 7

FUNDING ................................................................................................................................................. 8

HEALTH INFRASTRUCTURE ...................................................................................................................... 8

ESSENTIAL MEDICINES AND SUPPLIES PROVISION ................................................................................... 9

EQUIPMENT AND OTHER LOGISTICS .......................................................................................................... 9

TRANSPORT MEANS................................................................................................................................. 9

PREVENTION AND HEALTH PROMOTION SERVICES ................................................................................... 9

THE HC II FUNCTION OF THE HOSPITAL ................................................................................................... 9

CHAPTER THREE ............................................................................................................................ 12

GOVERNANCE ............................................................................................................................... 12

THE BOARD OF GOVERNORS .................................................................................................................. 12

MANAGEMENT ...................................................................................................................................... 13

STATUTORY COMMITMENTS COMPLIANCE ............................................................................................ 13

INTERNAL REGULATORY DOCUMENTS ................................................................................................... 13

ADVOCACY, LOBBY AND NEGOTIATION ................................................................................................. 14

CHAPTER FOUR ............................................................................................................................. 15

HUMAN RESOURCE ...................................................................................................................... 15

STAFF ESTABLISHMENT ......................................................................................................................... 15

TURN-OVER AMONG STAFF .................................................................................................................... 15

MANAGEMENT ...................................................................................................................................... 16

HUMAN RESOURCE DEVELOPMENT AND CAREER PROGRESSION ............................................................. 16


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CHAPTER FIVE ............................................................................................................................... 17

FINANCES ...................................................................................................................................... 17

INTERNAL AUDIT ................................................................................................................................... 21

EXTERNAL AUDIT .................................................................................................................................. 22

PROCUREMENT ...................................................................................................................................... 22

CHAPTER SIX .................................................................................................................................. 23

SERVICES ....................................................................................................................................... 23

A GENERAL OUT PATIENT DEPARTMENT ..................................................................................... 24

OPD STAFFING LEVEL ........................................................................................................................... 24

OPD ACTIVITIES .................................................................................................................................... 25

B.SPECIALIST OPD CLINICS ............................................................................................................ 30

1. ANTE NATAL CLINIC ................................................................................................................ 30

2. HIV / AIDS CLINIC ................................................................................................................... 32

ACTIVITIES WHICH ARE OFFERED UNDER HIV/AIDS PROGRAM INCLUDES: ............................................ 33

A) HCT / VCT ............................................................................................................................... 33

B) PMTCT SERVICES .................................................................................................................... 35

C) ANTIRETROVIRAL THERAPY ...................................................................................................... 36

3. ORTHOPAEDIC SERVICES ................................................................................................... 38

4. TUBERCULOSIS CLINIC ....................................................................................................... 38

5. MENTAL HEALTH CLINIC.................................................................................................... 41

6. DENTAL CLINIC .................................................................................................................... 42

7. PALLIATIVE CARE ................................................................................................................ 42

8. OPHTHALMOLOGY .............................................................................................................. 43

C. INPATIENTS DEPARTMENT................................................................................................. 43

1. SUMMARY OF BEDS AND QUALIFIED HEALTH PERSONNEL .......................................................... 43

2. INPATIENT UTILIZATION INDICATORS ........................................................................................ 43

3. INPATIENT REFERRALS.............................................................................................................. 46

4. THE TOP TEN CAUSE OF MORBIDITY IN ALL THE WARDS ............................................................ 46

5. THE TOP TEN CAUSES OF DEATH AMONG INPATIENTS ................................................................ 47

1.PAEDIATRIC WARD ..................................................................................................................... 48

1.1. STAFF COMPOSITION ................................................................................................................. 48

1.2. ADMISSIONS ............................................................................................................................. 49

2.MATERNITY WARD . ................................................................................................................... 51


2.2. MATERNITY WARD INDICATORS ................................................................................................ 51

2.3. ADMISSIONS ............................................................................................................................. 52

2.4. OTHER SERVICES/DEPARTMENTS IN MATERNITY ...................................................................... 54

3.MEDICAL WARD ........................................................................................................................ 55


3.2. KEY INDICATORS IN THE MEDICAL WARD ................................................................................. 56

3.3. ADMISSION IN MEDICAL WARD ................................................................................................ 56


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4.SURGICAL WARD ........................................................................................................................ 57

4.1. STAFFING COMPOSITION OF SURGICAL WARD ............................................................................ 57

4.2. KEY INDICATORS IN THE SURGICAL WARD ................................................................................. 58

4.3. ADMISSIONS IN SURGICAL WARD .............................................................................................. 58

5.THEATRE SERVICES ..................................................................................................................... 59

6.TB WARD .................................................................................................................................... 61

7. PRIVATE WARD .................................................................................................................... 61

D.DIAGNOSTIC SERVICES–LABORATORY AND BLOOD TRANSFUSIONS ........................................ 62

1.LABORATORY SERVICES ............................................................................................................. 62

E.DIAGNOSTIC SERVICES - X-RAY, ULTRASOUND .......................................................................... 63

1. X-RAYS DEPARTMENT .............................................................................................................. 63

2. ULTRASOUND INVESTIGATIONS ................................................................................................. 64

F.PHARMACY ACTIVITIES .............................................................................................................. 65

1. STAFFING LEVEL IN PHARMACY AND GENERAL STORE .............................................................. 65

2. PHARMACEUTICAL SUPPLIES ..................................................................................................... 66

3. PROCUREMENT SYSTEM ............................................................................................................ 66

G. INTRAVENOUS FLUID CONSUMPTION ............................................................................. 68

CHAPTER SEVEN ............................................................................................................................ 69

SUPPORT SERVICES ....................................................................................................................... 69

1.PASTORAL CARE ......................................................................................................................... 69

2.AMBULANCE SERVICE ................................................................................................................ 69

3.TECHNICAL SERVICES ................................................................................................................. 69

4.DOMESTIC SERVICES .................................................................................................................. 70

5.INTERNET AND INTERCOM TELECOMMUNICATION .............................................................................. 72

CHAPTER EIGHT ............................................................................................................................. 73

8.1.QUALITY AND PATIENT SAFETY IMPROVEMENT .................................................................... 73

1. AVAILABILITY OF CLINICALLY QUALIFIED STAFF IN THE HOSPITAL ............................................ 73

2. QUALITY OF CARE ..................................................................................................................... 73

8.2. HEALTH SURVEYS ..................................................................................................................... 75

8.3. PERSPECTIVES AND WORK PLAN FOR QUALITY IMPROVEMENT ................................................. 76

CHAPTER NINE .............................................................................................................................. 77

HEALTH TRAINING INSTITUTION ................................................................................................... 77

9.1. HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT ........................................................... 77

9.2. SCHOOL PERFORMANCE ............................................................................................................ 78


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9.3. SCHOOL FINANCES .................................................................................................................... 79

9.4. RELATIONS WITH EXTERNAL PARTNERS .................................................................................... 80

9.5. PHC ACTIVITIES ....................................................................................................................... 81

9.6. FAITHFULNESS TO THE MISSION ................................................................................................ 81

CHAPTER TEN .................................................................................................................................... 83

SUMMARY, CONCLUSION AND RECOMMENDATIONS ................................................................. 83

CONCLUSION ................................................................................................................................. 83

FAITHFULNESS TO THE MISSION REPORT (PERFORMANCE INDICATORS) ................................... 84

ACCESS ............................................................................................................................................... 84

EQUITY 85

EFFICIENCY ....................................................................................................................................... 85

QUALITY OF CARE ................................................................................................................................. 86

SUSTAINABILITY OF THE HOSPITAL ............................................................................................. 86

CRITICAL ISSUES ................................................................................................................................... 86

CHAPTER ELEVEN .......................................................................................................................... 88

PLANNING FOR THE FUTURE ........................................................................................................ 88

ANNEXES ....................................................................................................................................... 97

ANNEX 1. - HEALTH UNIT POPULATION REPORT (HMIS 109) FY 2014-2015 ......................................... 97

ANNEX 2. - MEMBERS OF BOARD OF GOVERNORS & DESIGNATION AS PER 30TH JUNE 2015 .................... 98

ANNEX 3. MEMBERS OF THE MANAGEMENT TEAM AND DESIGNATION AS PER 30TH JUNE 2015 ............. 99

ANNEX 4 - HOSPITAL STAFFING LEVEL AS PER 30 JUNE 2015 ............................................................... 100

ANNEX 5 - HOSPITAL STAFF DETAIL AS AT 30 JUNE 2015 .................................................................... 101

ANNEX 7: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF FINANCIAL

POSITION AS AT 30THJUNE 2015 ................................................................................................... 110

ANNEX 8: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF COMPREHENSIVE INCOME

FOR THE YEAR ENDED 30TH JUNE 2015. ............................................................................................... 111

ANNEX 9: ADMISSIONS AND DEATHS BY DIAGNOSIS IN FY 2014-2015 (HMIS 107) .............................. 112


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ACRONYMS

ACT Aids Care & Treatment

AIDS Acquired Immuno-Deficiency Syndrome

ALoS Average Length of Stay

ART Anti-Retroviral Therapy

BCG BacilleCalmette-Guerin

BOG Board of Governors

BOR Bed Occupancy rate

CEO Chief Executive Officer

DPT Diphtheria-Pertussis-Tetanus

FSB Fresh Still Birth

FY Financial Year

CHD Child Health Day

CO Clinical Officer

CRS Catholic Relief Services

C/S Caesarean Section

CH Health Centre

FY Financial Year

HIV Human Immunodeficiency Virus

HMIS Health Management Information System

HMT Hospital Management Team

HRM Human Resources Manager

HSD Health Sub-District

HSSP Health Sector Strategic Plan

IDP Internally Displaced People

ITN Insecticide Treated Nets

LLU Lower Level Unit

MO Medical Officer

MoH Ministry of Health

NSSF National Social Security Fund


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NTLP National Tuberculosis Leprosy Programme

NUHEALTH Northern Uganda Health Programme

OPD Out-Patient Department

PCH Primary Health Care

PHC-CG Primary Health Care Conditional Grants

PMTCT Prevention Mother To Child Transmission

PNFP Private Not For Profit

SNO Senior Nursing Officer

SUO Standard Unit of Output

TT Tetanus Toxoid

UCMB Uganda Catholic Medical Bureau

UEC Uganda Episcopal Conference

UNMEB Uganda Nurses Midwives Educational Board

IMPORTANT INDICATORS AND DEFINITIONS

1. Inpatient Day / Nursing Day / Bed days = days spent by patients admitted to the health

facility wards.

2. Average Length of stay (ALOS)

= Sum of days spent by all patients/number of patients

= Average length of days each in-patient during each admission. The actual individual

days vary.

3. Bed Occupancy Rate expressed as %

= used bed days/available bed days

= Sum of days spent by all patients/365 x No. of beds

=ALOS x No. of patients/365 x No. of Beds

4. Throughput

=Average number of patients utilising one bed in a year

=Number of patients/no. of beds

5. Turn over interval

=Number of days between patients

= (365 x no. of beds)-Occupied bed days/no. of patients

6. FSB (Fresh Still Birth): This is a baby born with the skin not pealing / not macerated. The

foetal death is thought to have occurred within the 24 hrs before delivery. However it is

important for us to know the trend of deaths of foetuses actually occurring in mothers who

have arrived already in the hospital (Foetal heart sound heard on arrival). For this purpose we

shall monitor FSB in total as well as FSB of fetuses who died in hospital. They have been


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separated in the table. The hospital should try to provide space to collect this information

from the maternity ward / delivery room.

7. Post C/S Infection Rate:

= (No. mothers with C/S wounds infected / Total No. of mother who had C/S operations

in the hospital) x 100.

= The rate if caesarean section wounds getting infected. It is an indicator of the quality of

post-op wound care as well as pre-op preparations.

8. Recovery Rate:

= % of patients admitted who are discharged while classified as “Recovered” on the

discharge form or register.

= (No. of patients discharged as “Recovered” / Total patients who passed through the

hospital) x 100

9. Maternal Mortality Rate (for the hospital):

= Rate of mothers admitted for delivery and die due to causes related to the delivery

= (Total deaths of mothers related to delivery / Total number of live deliveries) x 100

10. SUO = Standard Unit of Output. This is where all outputs are expressed into a given

equivalent so that there is a standard for measurement of the hospital output. It combines

Outpatients, Inpatients, Immunisations, deliveries, etc which have different weights in terms

of cost to produce each of the individual categories. They are then expressed into one

equivalent. As the formula is improved in future it may be possible to include Out-patients

equivalence of other activities that may not clearly fall in any of the currently included output

categories.

11. SUOop = SUO calculated with inpatients, immunizations, deliveries, antenatal attendance,

and outpatients all expressed into their outpatient equivalents. In other words, what would be

the equivalent in terms of managing one outpatient when you manage e.g. one inpatient from

admission to discharge? Please see the detail formula below or at the foot of Fig. 5.6.

12. TB case notification rate = total cases of TB notified compared with the expected number

for the population in one year =Total cases of TB Notified / Total population x 0.003.

13. OPD Utilisation = Total OPD New attendance in the year / Total population of the area.


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ACKNOWLEDGEMENT / APPRECIATIONS

We intend to thank all those who, in different capacities and forms, have supported the Hospital

during the Financial Year 2014-2015 and contributed to its sustainability. Notable among them

but not limited to are; the Government of Uganda, Dr Ambrosoli Foundation, Comboni

Missionaries, IDS- UEC/UCMB, the Japanese and the Uganda Red Cross Societies, the NU-

Health Programme, Wamba Athena Onlus ,IDEA Onlus, the Italian Cooperation, and Agata

Smeralda Onlus.

We have a special debt of gratefulness to UCMB for the continuous and valuable technical

support and guidance.

We would like to thank H.G. Archbishop John Baptist Odama and all the members of the Board

of Governors for the guidance and encouraging supervision given to the Hospital.

One special thanks is for all the employees of the Hospital and of the School who, at all levels

and with different qualifications and responsibilities, have been the makers of all achievements

that are presented in this report. This acknowledgement is certainly due but intends to be also an

encouragement to maintain and possibly enhance the same spirit for the future.


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EXECUTIVE SUMMARY

Dr. Ambrosoli Memorial Hospital is a 271 bed capacity serving a 27,121population of Agago

District. It is the referral facility of Kalongo HSD-Agago District, coordinating 33 lower level

health facilities.

The hospital provides both curative and preventive services.

Hospital Activity Performance

Table I – Summary of activity output in Dr Ambrosoli Memorial Hospital FY 2013-2014 and 2014-

2015

Activity Output for

FY 11-12

Output for

FY 12-13

Output for

FY 13-14

Output for

FY 14-2015

Variation (%) I:I

FY 13-14 & 14-15

Admissions Medical Ward 1,575 1,888 2,284 2,053 -10.1%

Admissions Surgical Ward 1,648 1,778 2,028 1,974 -2.7%

Admissions Maternity Ward 4,198 4,502 4,756 5,027 5.7%

Admissions Paediatric Ward 3,542 4,573 4,607 3,741 -18.8%

Admissions TB Ward 258 240 267 186 -30.3%

Admissions Private Ward 153 240 244 NA NA

TOTAL ADMISSIONS 11,374 13,221 14,186 12,981 -8.5%

Total Deliveries 2,805 2,727 2,981 3,247 8.9%

Caesarean sections 405 479 449 369 -17.8%

Minor operations / procedures 1,738 2,219 2,223 1,081 -51.4%

Major operations 730 798 663 565 -14.8%

OPD 1st visits 16,769 21,338 25,322 21,761 -14.1%

OPD total visits 23,714 31,225 29,306 25,526 -12.9%

Ante Natal Clinic 1st visits 2,958 2,290 2,033 1,817 -10.6%

Ante Natal Clinic 4th visits 1,235 1,199 1,249 1,217 -2.6%

Ante Natal Clinic total visits 7,936 5,312 6,664 5,909 -11.3%

Total HIV patients under care 1,996 2,219 2,087 2,285 9.5%

Immunization doses 20,807 19,294 16,654 26,632 46.3%

The OPD attendance has decreased by 12.6 % (total OPD attendances has decreased from 29,206

in FY 2013/14 to 25,526 in FY 2014/15). The Major cause of morbidity in OPD in the last FY

2014/2015 are also provided to the lower level unit such as Malaria, respiratory tract infection ,

acute diarrhoea etc.; this is most likely the cause of decline in OPD attendance, however The

community still have access to the facility however there is need to improve access through

strengthening referral system in order to make sure that patients are accessing services near their

village according to the condition; this can be achieved through reducing of waiting time,

accurate data recording and community sensitization.


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The OPD attendance among children under five has decreased by 4.6 % (from 30.8% in FY

2013/14 to 26.2% in 2014-2015) and Five years and above decreased by 11. 2% (from 95.6% to

84.4%).The hospital has contributed 9.0% of OPD attendance to the Agago district in FY 2014-

2015. Generally there is a fluctuation on number of patients who accessed care in the Hospital N

the last five years in different services.

In the area of antenatal care, the total ANC visit has declined by 11.3 % (form 6,664 in

2013/2014 to 5,909 in 2014-2015.Whereas ANC 4th visit increased in proportion by 2.0%,the

contribution to the district was 18% of ANC total visits and 18.2% of ANC 4th visit in the Agago

district.

This is a good indicator which shows that the mother and baby are most likely to minimise the

risk of maternal and neonatal death. The reduction of utilisation of the Hospital ANC services

should not necessarily be looked at as a problem of accessibility, considering that the LLUs can

offer equivalent and effective ANC services nearer to the residence of the mothers.

In FY 2014-2015 the total number of doses of immunisation antigens administered increased by

46.3%. The Hospital contributed 9.9% to the District immunisation coverage in FY 2014-2015.

The hospital is carrying out daily routine immunization services. The outreach services during

Family Health Days and Child Health Days has also contributed to higher number of

beneficiaries being immunized because of much effort from the VHT attached to hospital who

work tirelessly to mobilize the community so that they benefit from these services.

The total admission has decreased by 8.5% (from 14,186 to 12,981) in FY 2013/14 to FY

2014/15. The hospital contributed 67.8% of admission to the district. This is attributed to the

functional lower health units who are able to treat minor illness.

Deliveries increased by 8.9% in 2014-2015 compared to the last financial year. The hospital has

contributed 36.1% of the total deliveries in the district. This can be attributed to the good

services being offered to pregnant mothers. Caesarean Sections rate is at 8.8% which still below

WHO redline. This is due to Health education and waiting shelter provided to at- risk pregnant

mother on regular basis.

The year 2014-2015 compared to the previous year presents a slight decrease in access of

services by community (6.4%) in FY 2014/2015 as noted by decrease in the SUO from 258,014

to 241,573.

In FY 2014/2015, the OPD contacts decreased by 12.6%; In patient admission decreased by

8.5%; ANC total attendance decreased by 11.3%;however the deliveries increased by 9.0% and

Immunisation increased by 46.3%.


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The indicator Fee/SUO-OP increased by 14.6%. For the last 4 years this indicator has been

increasing however the user fees in Kalongo Hospital still remains very low among the PNFP in

UCMB network even in private hospital in the Country.

The staff productivity as a measure of efficiency has decreased by 19% in 2014/15(2,367 in

2013/14 to 1,917 in 2014/15).

The hospital economic efficiency has improved slightly by 1.5% because the cost of producing

one SUO has decreased from UGX 15,571 to 15,333

Maternal Death Rate has decreased. Infection rate for caesarean section also increased to 10%.

On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still Birth

Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.

Some of these negative trends may be explained by the high attrition rate of qualified staff

particularly the medical personnel that affected the quality of work in the hospital, especially in

Maternity Ward. The Stability and adequate qualification of human resources is a prerequisite to

introduce effective improvement measures and for more focused effort in quality improvement.

In FY 2014-2015 the hospital been ranked among the best for its performance and compliance to

requirement for accreditation under UCMB network .In addition, at national level following the

Health sector performance report the hospital has been ranked at number 18 among the 137

general hospitals in Uganda. The Hospital received “Golden Award” for “Outstanding

Performance in Logistics Management of HIV drugs and supply” for two consecutive years. In

addition the hospital has also been ranked as one of the best - most compliant institution in

remittance of NSSF in Northern Uganda for the year.

Dr. Ambrosoli Memorial Kalongo hospital laboratory has initiated a hub with support with MOH

and UCMB. It serves sixteen lower health unit laboratories in Agago and Pader health District.

The hub renders a complete ART care package for HIV infected patients in terms of laboratory

tests amongst which are CD4 testing, chemistry, haematology analysis and collecting Dry Blood

Spot for DNA-PCR, Viral load, and other samples that cannot be analysed at the hub hence the

need for referral to the central laboratory, All this processes are interlinked through the hub rider

who reaches all these facilities collects samples to the hub, Posta Uganda for despatch to the

central laboratory. He also collects results from Posta Uganda and the hub and subsequently

distributes to the respective health facilities. The hub has now existed for one and half years.

The strategies initiated for the quality of health care service were partially or fully implemented.

In particular, formation of quality assurance committee, drug therapeutic committee, Unit Dose


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System for dispensing treatments in the wards, infection control team, Maternal and neonatal

death audit, recruitment of qualified human resource, completion of the construction of the new

Theatre, the new Guest House Complex and three apartments for accommodation of staff.

Challenges

Human resources

The hospital has experienced high staff turnover leading to inadequate qualified staff. This is still

a big challenge in implementation of quality of health care services. In addition, many key

departments are still lacking qualified staffs notably; Radiographer, Anaesthetist, Dentist,

Orthopaedist, and Gynaecologist.

Financial resources

The cost of running the hospital has continued on the increase with Employment cost and

Drugs/medical sundries accounting for about 77% of total recurrent expenditure. The hospital is

able only to recover about 11.5% of its recurrent expenditure from user fees collection,

meanwhile Government provides subsidy which accounts to about 15% of the recurrent budget

and donors contribute about 68%, unfortunately donor funding has continued to decrease due to

the current global economic crises. In addition the user fees still low and is affecting the

sustainability of the hospital.

Infrastructure and Equipment

Renovation and/or repairs of hospital building and staff house has become a key priority focus

area. Some of the urgent works required are; Renovation of surgical and children ward to secure

the regular functionality of the hospital.

There is need for more spacious laboratory to accommodate all laboratory equipment for a wide

range of test profiles available in the laboratory.

Plans for the coming year

The Hospital intends to continue improving on the following key areas:

• Extending the working time in OPD from 8:00am to 9:00pm to improve accessibility.

• Recruiting key cadres like Anaesthetist and radiographer and other essential cadres

essential for enhancing clinical services.

• Develop a new Strategic plan 2016/2020 Recruiting essential cadres like Internal auditor

to help improvement in the implementation and compliance of best accounting practises

by also adopting a good finance management with the ultimate goal to secure the best

sustainability of the hospital and accountability to the major donors.


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• Ensure approval of the draft staff training and development plan and ensure its

subsequent implementation;

• Review and update the Employment manual and Financial and Material Resource

Manual

• Developing a website for the hospital through which the hospital can showcase itself.

• Infrastructural renovation especially the Old theatre to be converted into a new laboratory

• Quality and safety health care initiatives.

CHAPTER ONE

THE HOSPITAL AND ITS ENVIRONMENT

Dr Ambrosoli Memorial Hospital was founded in 1957 and its annex the Midwifery school was

established in 1959 by Fr Dr Giuseppe Ambrosoli of the Comboni Missionaries. The Legal and

Registered Owner of the Hospital is the Roman Catholic Diocese of Gulu. The Hospital is a

Private Not For Profit institution that is part of the network of Catholic health facilities under the

coordination of the UCMB.

Dr Ambrosoli Memorial Hospital is a general rural hospital with 271 bed capacity. It provides

curative services for outpatients and inpatients, preventive/promotive/ rehabilitative services with

special focus on maternal and child care. It also runs a comprehensive HIV/AIDS programme. It

is head of the Agago Health Sub-District and, in this capacity, supervises a total of 33 LLUs (25

HC2 and 8 HC3).

The Hospital is located in Kalongo Town Council (Oret Parish) within Agago County. Agago

county is the only County of the District which incidentally entails the entire District of Agago.

It is bordered by 6 Districts: Pader to the West, Kitgum to the North, Kotido and Abim to the

East, Otuke and Alebtong to the South. These neighbouring Districts do not have functional

Hospitals and, therefore, Dr Ambrosoli Memorial Hospital serves also their population for all

conditions requiring hospitalisation.

The District is still lacking good road network. All roads are murram and in poor maintenance

conditions, that occasionally disrupt routine field activities (transfer of patients for emergency

care, immunisation campaigns, supervision of LLUs, home visiting) and adds extra costs to all

transport activities.

Telephone and internet communication is available but quite poor, erratic and not fully reliable.

Availability of power supply, although not constant and regular, has been nevertheless quite

improving in the last year, at least in the major urban centres.

Social and economic organization

The level of literacy in the District population is still quite low and quite a large proportion of the

population, especially among women, do not speak or write English. Acholi is the main ethnic

group and the language spoken is Acholi with Langi being the other minority ethnic group

mainly to the southern extremities of the district borderingOtuke andAleptong.

Main economic activities of the population is mainly agriculture, predominantly practised is

subsistence farming. It absorbs about 85% of available labour force. The main crops grown in


2

the region are millet, sorghum, maize, beans, groundnut, simsim, cassava, and sweet potatoes

produced mainly for local consumption. Other crops include cotton, rice, soya beans and

sunflower produced mainly as cash crops. Most homesteads in the area rear cattle, goats, sheep,

poultry and pigs as additional source of income. There are no known industries in the district as a

whole and commercial activities are very limited.

This situation maintains large proportion of the population in a condition of poverty.


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Demographic data for the Hospital catchment area

The population of Agago District for the FY 2014-2015 amounts to 227,486 according to the

Annual Health Sector report 2014-2015.

Table 1.1: Demographic data for the Hospital catchment area (Kalongo Town Council and

Parabongo Sub County) compared to HSD and District for the FY 2014-2015

Population Group Formulae Catchment

Area

HSD District

(A) Tot. Population (Projected for the year

under report)

27,121 227,486 227,486

(B) Tot. expected deliveries (4.85% of

population) (4.85/100) x A

1,315 11,033 11,033

(C) Tot. Assisted Deliveries in Health

Facilities (A)*0.05

1,356 11,374 11,374

(D) Tot. Assisted Deliveries as % of

expected deliveries (C/B) x100

103 103.1% 103.1%

(E) Children <1 year (4.3%) (4.3/100) x A 1,166 9,782 9,782

(F) Children < 5 years (20.2%) (20.2/100) x A 5,478 45,952 45,952

(G) Women in Child-bearing age (20.2%) (20.2/100) x A 5,478 45,952 45,952

(H) Children under 15 years (46%) (46/100) x A 12,476 104,644 104,644

(I) Orphans (≈ 10%) = (10/100) x A 2,712 22,749 22,749

(J) SUSPECTED T.B IN THE SERVICE

AREA: (A) X 0.003 81 682 682

Community and health status

Table 1.2: Relative percentage of the top 10 causes of morbidity recorded in the HSD OPDs

in the last 5 FYs (HMIS – Form 105)

Diagnosis 2011-2012 2012-2013 2013-2014 2014-2015

1. RTI not Pneumonia 25.5 28.6 29.2 33.0

2. Malaria (included cases in pregnancy) 26.9 29.7 22.9 20.0

3. Intestinal worms 7.4 7.1 5.1 5.5

4. Acute Diarrhoea 4.8 4.8 4.5 6.2

5. Gastrointestinal disorders 2.6 3.3 3.2 3.9

6. Eye condition 2.8 2.9 2.5 2.1

7. Skin diseases 3.4 3.5 2.3 2.3

8. Trauma-injuries, wounds, burns 2.0 1.8 1.6 1.7

9. UTI 1.5 1.6 1.6 2.1

10. ENT conditions 2.3 2.3 1.6 1.7


5

Table 1.3: Relative percentage of the top 10 causes of mortality during the last four years in

the HSD (HMIS 108)

Diagnosis 2011-2012 2012-

2013

2013-

2014

2014-2015

1. Malaria 6.6 21.6 18.3 18.5

2. Pneumonia 9.5 15.6 12.9 17.8

3. Perinatal conditions n.a. n.a. 11.2 16.1

4. Cardiovascular Disease 5.8 13.1 7.5 8.6

5. Septicaemia n.a. n.a. 7.5 5.8

6. Anaemia 1.7 6.0 5.4 11.2

7. Typhoid fever n.a. n.a. 5.0 0.8

8. Gastrointestinal disorder not infection. n.a. n.a. 3.3 4.1

9. Severe Malnutrition 5.0 2.5 2.1 2.4

10. Road Traffic Accident 2.1 2.0 2.1 4.0

All others 60.2 12.1 24.9 10.7

Total Diagnoses 100.0 100.0 100.0 100.0

Mortality and Morbidity

Morbidity and mortality data are summarised in above Tables 1.2 and 1.3, presenting in

percentage the ten top causes of morbidity and mortality respectively.

In relation to morbidity in FY 2014-2015; RTI is still the major cause of morbidity at 33%

followed by Malaria at 20.3% in the pattern of diagnosis made in OPDs in the HSD.

In FY 2014-2015 about 52.4% of death recorded were attributable to only three diseases

(Malaria, Pneumonia and Perinatal conditions). It may be disputable the correctness of diagnosis,

especially when made at Health Centre level, but it is all the same significant that Cardiovascular

diseases are the 4th cause of death registered in this FY.

We are probably facing an epidemiological transition in the District that is not yet fully captured

by the HMIS data. Greater attention should be given to data collection to improve the quality

(completeness and accuracy) of our recording system. Non-communicable diseases are most

likely grossly under-reported and, therefore, the dimension of their role and impact may be

largely underestimated.

Notifiable diseases and epidemics

Weekly surveillance was regularly maintained throughout the year; in 2014-2015 the HSD did

not register any notifiable disease or an epidemic situation.


6

CHAPTER TWO

HEALTH POLICY AND DISTRICT HEALTH SERVICES

Health Policy

Dr Ambrosoli Memorial Hospital is guided by the framework set by the National Health Policy

and the Health Sector Strategic Plan (HSSP), to provide the major components of the Uganda

Minimum Health Care Package. It also adheres to the guidelines set by the Uganda Episcopal

Conference through the UCMB.

District Health Services

The District of Agago was established in July 2010 by separating Agago County from Pader District.

It comprises only the HSD of Agago. Dr Ambrosoli Memorial Hospital acts as District Referral

Hospital and as the Head of Agago HSD. Since its inception no review has been made despite the

new dynamics where the district and the HSD are one and the same area of jurisdiction.

Table 2.1: Distribution of Health Service points by Sub-county

Sub-Counties Total

Population

No of

Hospitals

No of

HC IV

No of

HC III

No of

HC II

Total

Immunizations

Static Stations

Kalongo Town Council 11,062 1 0 0 0 1

Omiya Pacwa sub-county 11,860 0 2 2

Paimol sub-county 13,905 1 1 2

Lapono sub-county 17,310 1 4 5

Adilang sub-county 22,973 1 3 4

Patongo sub-county 22,272 0 0 0

Patongo Town council 1 0 1

Kotomor sub-county 14,661 0 1 1

Omot sub-county 11,587 0 2 2

Arum sub-county 9,798 1 0 1

Lamiyo sub-county 11,530 0 2 2

Lira Palwo sub-county 21,235 1 3 4

Wol sub-county 24,648 1 2 3

Parabongo sub-county 16,059 0 3 3

Lukole sub-county 18,586 0 2 2

Agago Town council 1 0 1

Total for HSD 227,486 1 0 8 25 34

Total for the District 227,486 1 0 8 25 34


7

Dr Ambrosoli Memorial Hospital acts as District Referral Hospital and as the head of Agago

HSD. The Hospital participates in the planning process and Disaster Preparedness Taskforce at

the District level. As the head of the HSD, it coordinates with the District Health Office to

elaborate the HSD Annual Work plan and ensure its implementation.

The functionality of LLUs has significantly improved in the last years although has not yet

attained the ideal standard. Currently there are 8 HCIII and 25 HCII. They are all Government

Units except one HCII belonging to the Church of Uganda.

The limited resources available represent a major obstacle to successfully implement the required

activities and gradually expand their scope to meet affectively the growing needs of the

population.

The main factors that affected the performance in FY 2014-2015 include:

Human Resources

The inadequate and right qualified staff mix in most of the health facilities is a major constraint

and tends to affect the quality of services provided.

Table 2.2: Summary profile of population, health unit and staffing level in Agago District

for FY 2014-2015 by Sub-county

Sub-Counties Populations

2014-2015

FY

Health units (Level &

ownership)

Staffing levels Staffing

gap Staffing

Norm

No.

available

1. Lira Palwo 21,235

Lira Palwo HC III-Govt. 19 14 5

Acuru H/C II-Govt 9 5 4

Obolokome H/C II-Govt 9 6 3

St Janani H/C II CoU 0 0 0

2. Omot 11,587 Omot HC II-Gov 9 4 5

Geregere HC II-Gov 9 6 3

3. Adilang 22,973

Adilang HC III-Govt. 19 15 4

Ligiligi HC II-Govt. 9 6 3

Alop HC II-Govt 9 6 3

Orina H/C II-Govt 9 5 4

4. Lamiyo 11,530 Kwonkic H/C II-Govt 9 7 2

Lamiyo H/ II-Govt 9 6 3

5. Arum 9,798 Acholpii H/C III. 19 15 4

6. Kotomor 14,661 Odokomit H/C II-Govt 9 7 2

7. Omiya Pacwa 11,860 Omiya Pacwa H/ II-Govt 9 7 2

Layita H/C II 9 4 5

8. Lapono 17,310 Lira Kato HC III-Govt. 19 14 5


8

Lira Kaket HC II-Govt. 9 5 4

Ongalo H/C II-Govt 9 6 3

Amyel H/C II-Govt 9 6 3

Ogwangkamolo H/CII 9 5 4

Abilinino H/C II-Govt 0 0 0

9. Wol 24,648 Wol HC III-Govt. 19 10 9

Kuywee H/C II-Govt 9 7 2

Toroma H/C II 9 5 4

10. Paimol 13,905 Paimol HC III-Govt. 19 14 5

Kokil H/C II-Govt 9 6 3

11. Parabongo 16,059 Pakor HC II-Govt. 9 6 3

Pacer H/C II-Govt 9 6 3

Kabala H/C II-Govt 9 7 2

12. Lukole Sub-

County & Town

Council

18,586 Lapirin HC II-Govt. 9 6 3

Olung HC II-Govt. 9 6 3

Lukole HC III-Govt. 19 13 6

13. Patongo Sub- 22,272 16. Kalongo Town

11,062 Kalongo Hospital NGO

375 260 115

Table 2.3: Structure of the Health Sub District team at referral facility

Human resource Staffing norm Current No.

Nursing Officer

1

Sub Total 3

Administrative and Support Staff Office Typist

1

Sub Total 3

Grand Total 6

Funding

Funding for health services is quite inadequate compared to the needs and this inevitably affects

the performance. PHC Conditional Grant in the last financial year was fully realised according to

the expectation for every quarter.

Funds apportioned for the function of the HSD is hardly sufficient to secure even the very

minimum activities like supervision to the LLUs, the distribution of drugs and vaccines, and the

effective implementation of the HMIS. Therefore many essential and much needed activities

cannot be implemented and support supervision remains quite unsatisfactory.

Health Infrastructure

The major problem faced are; insufficient staff accommodation; lack of space for maternity and

lighting for some units in spite of the electricity lines passing near or through these units.


9

Essential Medicines and Supplies Provision

There has been a fairly good supply of essential medicines, but there is need to improve on the

management of the drugs and monitoring of the average monthly consumption to avoid the

issues of drug stock outs.

Equipment and other logistics

The units are still not well-equipped as they lack the basics for effective service delivery. The

available funds can hardly provide the resources needed to bridge the gap.

Transport Means

The HSD lacks transport means for its activities (supervision, outreaches, HMIS monitoring,

Cold Chain, TB Control Programme, referral of patients, etc.) and therefore rely on a limited

number of motorcycles and vehicles provided by the hospital, projects or other donors. The

government has never provided any Vehicle for the HSD activities. The Fund allocated is often

insufficient for the running cost (fuel and maintenance). Some of the vehicles that the hospital

supports the HSD in facilitating the implementation for its activities are in need of major repairs

and are in fact grounded. This affects the possibility to provide regular and meaningful

supervision to the LLUs.

Prevention and Health Promotion services

The Hospital carries out a variety of prevention and health promotion activities. They include the

activities connected with the HIV/AIDS projects, the immunisation programmes, health

education, and support supervision to the LLUs of the HSD.

In terms of organisational set-up of a public health department; the hospital is still in need of

dedicated personnel. This however is not fully operational.

The HC II Function of the hospital

The assigned catchment area of the Hospital for the HC II functions covers the Sub-County of

Parabongo and the Town Council of Kalongo, with a total population estimated for FY 2014-

2015 of 27,121 people.

The overall performance of the Hospital, in relation to Immunisation, ANC, and Family Planning

activities as proportion of the district coverage is summarised in the Tables 2.2 and 2.3.


10

Table2.4: Contribution of the Hospital as a HC II to the prevention and health promotion

services of the HSD/District in FY 2014-2015

Activity : TT to child bearing ages In the Hospital and

its catchment area

In the HSD

(=District)

Hosp. output as %

of HSD (=District)

Pregnant women

TT 1 1,992 7,281 27.4

TT 2 1,420 5,497 25.8

TT 3 78 2,625 3.0

TT 4 42 2,046 2.1

TT 5 27 1,795 1.5

Non Pregnant women

TT 1 640 7,293 8.8

TT 2 363 5,680 6.4

TT 3 203 4,647 4.4

TT 4 165 3,812 4.3

TT 5 74 3,296 2.2

Immunization in school

TT 1 765 3,378 22.6

TT 2 497 2,729 18.2

TT 3 313 2,136 14.7

TT 4 205 1833 11.2

TT 5 114 2130 5.4

Total TT 2 in all categories 2,192 13,906 22.6

Immunization in Children

BCG 3,385 10,325 32.8

Protection at Birth for TT (PAB) 2,795 48,160 5.8

Polio 0 3,385 10,325 32.8

Polio 1 1069 12,409 8.6

Polio 2 718 11,854 6.1

Polio 3 726 13,121 5.5

PCV 1 957 11,989 8.0

PCV 2 751 11,183 6.7

PCV 3 716 11,438 6.3

DPT-HepB+Hib 1 858 12,357 6.9

DPT-HepB+Hib 2 725 12,158 6.0

DPT-HepB+Hib 3 729 13,450 5.4

Measles 650 12,987 5.0

Total Immunisation doses in Children 17,464 191,756 9.1

Total Family Planning attendances 1,846 16,265 11.3

Total ANC attendance 5.909 33,180 17.8

Deworming 12,165 151,797 8.0

Vitamin A Supplementation 1,928 56,059 3.4


11

For the immunisation programme the Hospital clearly has played a major role in the

HSD/District of Agago accounting for 32.8% of BCG, 18.2% of all TT2, 5.5% of Polio3, 5.4%

of DPT3, 5% of the Measles, and 6.3% of PCV3 doses administered in the HSD/District. In the

new FY 2014-2015 the Hospital has contributed in promotion of natural FP method attendances

by 11.3%.

HSD Function –Role of the Hospital as Headquarter of the HSD

Kalongo Hospital has the responsibility of heading Agago HSD. This responsibility implies,

among other, the following main tasks:

1. Coordination of the planning process for the yearly HSD Work plan.

2. Ensure proper utilisation of PHC-Conditional Grant allocated to the HSD

3. Coordination with all stakeholders in the health sector actively involved in the HSD.

4. Coordination of main health programme in support to the LLUs (EPI, TB control

Programme, Essential Drug Programme, etc).

5. Support supervision of LLUs.


12

CHAPTER THREE

GOVERNANCE

The Board of Governors

The BoG is the supreme policy maker and controlling body of the Hospital and school, while the

Hospital Management is fully responsible for all operational aspects of the hospital and school.

The minimum number of Ordinary BoG meetings to be held in a year is two as enshrined in the

hospital Statute. In FY 2014-2015 the hospital held two ordinary and one extraordinary BoG

meeting.

The Statute enumerates key thematic committees that have to be in place and functioning

namely: Human Resources/Disciplinary Committee, Finance Committee, and School Committee.

The Board can appoint additional committees if need arises. Their role is to examine reports and

proposals from the Management in advance and to present comments and suggestions to the

Board during the plenary meetings. Although it is requested that each Committee meets at least

twice a year, it has been observed that this practice has not been followed regularly.

Table 3.1: Summary of BoG meeting held in FY 2014-2015

Dates of Board

meetings

Reports presented / Key issues handled / decision taken No of Members

present

25 April,2015 Extraordinary Meeting (Performance review &Forth coming

changes in key management of the hospital)

08/15

29 Jun,2015 Ordinary Meeting (Presentation of Budget Performance Report

2014-2015 and Annual Budget 2015-2016

10/15

23 Nov,2015 Ordinary Meeting (Presentation Faithfulness to the mission and

financial report 2014/2015)

11/15

The Board received and discussed the hospital management report that highlighted key issues

pertaining to the activities and challenges affecting the hospital and school. Furthermore the

report also highlighted successes and work in progress. Organisational and financial constraints

did not allow the Hospital Stakeholder Assembly for external accountability to be held.

Table 3.2: Functionality of the Board committees

Name of committee Required No. of No. of meetings Percent of required

Finance Committee 2 2 100%

School Committee 2 0 0%

Human Resources/ 2 0 0%


13

Management

The Hospital Management Team headed by the Chief Executive Officer (CEO) is the body

responsible for decision making on all matters regarding the Hospital and the Training School.

The Hospital Management Team collectively shares the task of achieving the strategic objectives

and the specific targets decided by the Board of Governor. It is granted operational autonomy

within the scope of the Hospital strategic plans, approved policies, manuals and procedures. The

Hospital Management Team meets at least once every month.

The core members of the Hospital Management Team are:

1. The Chief Executive Officer

2. The Medical Director

3. The Administrator

4. The Senior Nursing Officer

5. The Principal Tutor of the School

6. The Human Resources Manager

7. The Coordinator of Public Health Department

Table 3.3: Frequency of HMT meetings 2014/2015

No of planned

Management

meeting

No. of Management

meeting held

Average No. of

members present

Reports / key issues handled

12 (one per

each month) 8 100

Minutes of each meeting were

prepared and circulated by the CEO.

The Hospital Management Meetings formally held were only 8, but less formal meetings have

been held with higher frequency throughout the year.

Statutory Commitments Compliance

The Hospital has been regularly complying with all statutory commitments set by Government,

MoH and UCMB as displayed in details in Table 3.4.

The Hospital satisfied the accreditation requirement established in the accreditation programme

2014-2015 for Hospitals of the Catholic Health Network. This accreditation entitles the Hospital

to the full range of services provided by UCMB for the period ending on 31st December 2016.

Internal regulatory documents

The Hospital has in place some important manuals/guidelines (Employment Manual and the

Financial & Material resources manual). Some of these documents though need to be reviewed.

However, there is need for improving the respect of norms and procedures set in these


14

documents even in their current forms. Management intends to at least start these revisions of the

aforementioned policy documents in the new FY 2015-2016.

Table 3.4: Statutory Commitments Compliance

No REQUIREMENT Did you achieve it?

Yes, Partly, No

Comment

Government / MOH Requirements

1 PAYE YES Regularly observed

2 NSSF YES Regularly observed

3 Local service tax YES Regularly observed

4 Annual operational licence YES Regularly observed

5 Practicing licence for staff YES Regularly observed

7 Monthly HMIS YES Regularly observed

UCMB statutory requirement

1 Analytical Report end of FY year YES Regularly observed

2 External Audit end of FY year YES Regularly observed

3 Charter (still valid) YES Finalised revised version

5 Contribution to UCMB for the year YES Regularly observed

6 HMIS 107 PLUS financial report / quality

indicators ending FY

YES Regularly observed

7 Report Status of staffing as of end of FY YES Regularly observed

8 Manual of Employment (still valid) YES Planned for next FY

9 Manual Financial Management (still valid) YES Needs a revision

10 Report on Undertakings & Actions of FY YES Regularly observed

Advocacy, lobby and negotiation

The Hospital has not yet developed a formal advocacy agenda; however, it has maintained

constant contacts with local leaders, international NGOs, and major donors according to the

need. It plans to set up a website in the next financial year 2015-2016.


15

CHAPTER FOUR

HUMAN RESOURCE (STAFF)

Staff Establishment

During FY 2014-2015, there was a slight increment in the total number of employees especially

for the qualified staffs both clinical and not clinical staff.

Table 4.1: Total number of employees in the Hospital in the last 5 FYs

Category 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Clinical Qualified 86 100 88 97 108 Unqualified 35 19 28 26 18 Total Clinical 121 119 116 123 126

Not

Clinical

Qualified 16 13 32 41 86 Unqualified 82 81 72 48 27 Total Non-Clinical 98 95 104 89 113

Total Qualified 102 113 120 138 194 Total Unqualified 117 100 100 74 45 Grand Total 219 213 220 212 239

% of qualified clinical staff/ total staff 39.3% 46.9% 40.0% 45.8% 45%

N.B. Additional details on the staff composition are presented in Annex 4.

Most recruitment have been for nursing and clinical personnel (Nurses, Midwives, Clinical

Officers and Medical Officers) mainly replacement of those staffs that left the Hospital.

Turn-over among staff

The turn-over among enrolled cadres has been lower than the previous FY. The Hospital salary

scale and benefit packages are still not competitive with the ones offered by the Government and

this has contributed to the high attrition rate among employees. Other “internal” factors may also

have played a role (end of contract and personal interest for capacity building).

Table 4.2: Turn-over trends of key health personnel in the last 3 FYs

Cadres FY 2012-2013 FY 2013-2014 FY 2014-2015

Total staff 222 212 239 Enrolled cadres (all combined) 57 66 68 Turn-over for Enrolled cadres 98.3% 29.3% 19%

Table 4.3: Turn-over trends of key health personnel in the last 3 FYs

Cadres FY 2012-2013 FY2013-2014 FY2014-2015

Total staff 222 212 239

Total arrivals of key health personnel 64 40 48

Total departures of key health personnel 70 25 27


16

The turn-over in FY 2014-2015 was high compared to the previous FY, but it still denotes a

major difficulty the hospital faces in retaining its staff. Management has developed a new staff

training and development plan that is awaiting approval of the BoG to guide in retention of staff.

Management

The working hours for Administration and Technical Department employees are 40 per week.

Doctors, Nurses, Midwives and Nursing Assistants/Aides have 42 working hours per week. The

Hospital provides accommodation for a large proportion of its employees (56%) in houses

located in staff quarters within the Hospital premises. This housing facilitation includes also

availability of water and power supply (the latter when provided by PACMEC or by the Hospital

generator from 6.30 p.m. to 9.00 p.m.).

Salaries have been regularly paid before the end of every month. Statutory obligations are

regularly remitted (PAYE and NSSF) according to the current legislation.

Staffs are expected to elect their representative who coordinates with management through the

HRM office and facilitates the communication of requests, grievances, or other matters amongst

staff and to the Hospital Management.

Human resource development and career progression

The initiatives in the staff training and development plan include: provision of scholarship for

further studies, participation in workshops and short courses, organisation of CME sessions

within the Hospital.

The areas of main focus cover Maternal and Child Health, surgical services, administration,

Pharmacy, and the Midwifery School.

It is the intention of the Hospital to incorporate it within the 5-year Strategic Development Plan.

A programme for weekly sessions of CME is prepared by various departments of the Hospital

are encouraged to organise on rotation each session, with topics of relevance.

Table 4.4: List of Hospital Staff that attended courses in FY 2013-2014

Course attended Duration Institution

1 Master in General Surgery 3 yrs Completing in couple of mths Makerere University

2 Bachelor in Procurement and

Logistic Management

3 years Completing in the next

couple of months

Uganda Christian University

3 Bachelor in Nursing 3 years, on going Uganda Christian University

4 Diploma in Laboratory

Technology

2 years Completing in the next

couple of months

Nsambya School of Laboratory

5 Diploma in midwifery 2 years on going Kalongo Midwifery School

6 Diploma in Nursing 2 years - completed Lubaga School of Nursing & midwifery

7 Diploma in Midwifery 2 years completed Kalongo Midwifery School

8 Diploma in Clinical Mentoring 1 year completed Uganda Martyrs University

10 Diploma in Anaesthesia 2 years Lacor


17

CHAPTER FIVE

FINANCES

Dr Ambrosoli Memorial Hospital manages distinctly the finances of the School from the

finances of the Hospital and the financial statements are audited separately.

Table 5.1: Trend of Income by source over the last 5 years

Income over the Last 5 Years

FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

HOSPITAL

User Fees 199,655,029 277,428,212 320,211,091 399,799,594 429,341,811

PHC CG cash 495,182,241 455,045,373 494,261,142 494,379,756 506,731,434

Gov. donations

in kind

(Drug/Lab)

37,386,622 73,525,612 29,690,056 13,240,715 0

Other donations

in kind 126,226,392 323,937,510 852,245,261 1,019,614,218 1,091,058,978

Donations in

cash (including

project funding)

1,034,331,095 1,218,257,145 1,561,261,600 2,261,661,058 1,076,532,863

Others Financial

sources ( Deposit

Interests &

others)

60,164,680 100,706,070 56,767,272 119,265,960 82,600,220

Technical

Department 54,139,181 54,331,333 51,596,750 64,191,141 56,945,510

Sub-Total

Hospital 2,007,085,240 2,503,231,255 3,366,033,172 4,372,152,441 4,143,210,818

SCHOOL

Fees (private) 104,494,500 77,995,546 44,697,128 65,177,382 397,565,454

PHC CG School 56,843,759 49,083,184 58,935,060 56,468,241 55,634,813

Donations and

other income 244,933,341 303,496,320 341,583,977 355,379,665 138,908,527

Sub-Total

School 406,271,600 430,575,050 445,216,165 477,025,287 592,108,794

HSD


18

Income over the Last 5 Years

FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

HOSPITAL

Sub-Total HSD 98,343,106 90,772,200 98,669,600 98,668,800 12,356,576

Grand-Total 2,511,699,946 3,024,578,505 3,909,918,937 4,947,846,528 4,747,676,188

Table 5.2: Trend of Expenditure over the last 5 FYs

Expenditures over the Last 5 Years

Expenditure Item FY

2010-2011

FY

2011-2012

FY

2012-2013

FY

2013-2014

FY

2014-2015

HOSPITAL

Human Resource

cost 1,140,654,092 1,207,759,814 1,272,027,988 1,481,676,063

1,454,269,386

Administration 58,284,911 71,362,652 165,565,943 125,290,190 86,721,317

Medical goods and

supplies (included

drugs)

497,009,686 592,602,710 1,231,903,798 1,629,096,034

1,436,533,515

Non-medical goods

/ supplies 22,853,000 55,028,424 125,000,750 136,356,936

137,391,002

Property Costs 74,114,973 137,868,459 168,121,102 232,462,749 232,835,273

PHC 179,441,100 136,480,468 194,306,705 242,976,850 250,856,300

Transport & Plant

Costs 157,566,761 195,149,382 178,580,518 157,759,179

147,500,245

Capital

Development 0 0 0 112,542,651 42,812,692

Hospital Total

Expenditure 2,129,924,523 2,396,251,909 3,335,506,804 4,130,179,651 3,788,754,342

SCHOOL

Employment 124,229,697 170,609,669 180,326,141 204,087,584 204,361,178

Administration 59,141,420 48,646,463 78,195,938 78,545,960 77,132,419

Students costs 95,855,847 145,231,270 133,043,554 112,017,153 138,916472

Transport &

Travelling

23,147,484 34,161,377 59,511,250 41,110,050 34,442,227

Property, Supplies,

Services

8,414,198 28,405,798 17,737,723 7,061,219 12,821,329

Capital

Development

School Total 310,788,646 427,054,577 468,814,606 442,821,965 467,673,625


19

Expenditure

HSD

HSD Total

Expenditures 98,343,106 90,772,200 98,669,600 98,668,800 12,456,576

Grand Total 2,539,056,275 2,914,078,686 3,902,991,010 4,671,670,416 4,241,686,664

• The expected income for the hospital for the year was 4,244,039,944/=, the hospital was

though able to realise 4,143,210,818 (2.4% above expected amount).This was mainly

attributed to some additional donation received and an extension from NU Health funds.

• Major donors like NU-Health have come to an end. Attracting new donors has become

increasingly challenging.

• Government PHC Conditional Grants has been received promptly and consistently in full

for all the quarters.

• The fact that PHCCG has been disbursed every year for more than a dozen years, nothing

has been done towards incrementing.

• Income from user fees has increased from about 399,799,594 million to expectedly

429,341,811million (+7.4%). Fees are still very low; there is consideration for review and

possible adjustment next financial year.

• The no cost extension of the ACT project significantly affected service delivery

Table 5.3: Trend of Average user fees by department in the last 5 years (2010-2011to 2014-2015)

Average Fees

FY 2010-

2011

FY 2011-2012 FY 2012-

2013

FY 2013-2014 FY 2014-2015

OPD Adult Male 5,000 6,854 7,783 9,400 11,317

OPD Adult Female 5,000 6,854 7,783 9,400 11,317

OPD Children < 5yrs 1,000 1,583 1,885 3,300 3,499

OPD Children 5-13

yrs 1,000 1,583 3,750 4,800

6,507

IP Medical Male 24,400 23,611 20,860 18,868 25,149

IP Medical Female 23,400 22,511 20,860 18,868 24,276

IP Maternity 10,400 11,925 15,113 17,368 18,351

IP Paediatric < 5 yrs 3,500 4,212 4,821 6,343 8,300

IP Paediatric 5-13 yrs 3,500 4,212 4,821 6,343 8,300

IP Surgical Ward 30,400 25,350 25,832 27,689 19,306


20

Fig. 5.1: Average user fee applied per SUO-OP in the last 5 FYs

977

1,282 1,283

1,550

1,757

-

200

400

600

800

1,000

1,200

1,400

1,600

1,800

2,000

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

The indicator Fee/SUO-OP has increased by 13.4%. For last 4 years this indicator has been

increasing however the user fees in Kalongo Hospital still very low among the PNFP in UCMB

network.

Table 5.4: Trend of Cost Recovery from Fees in the last 5FYs

FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

Total User fees (a) 199,655,029 277,428,212 320,211,091 399,799,594 429,341,811

Total Recurrent

Expenditure (b) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,367,000 3,788,754,342

Cost Recovery Rate

= (a/b)x100 9.4% 11.6% 9.9% 10.0%

11.3%

The current cost recovery from fees collection has increased by 1.5% of all recurrent

expenditures. The recovery rate of 11.3% is still very low the target is to attain 30% in the next 3

to 5 years. There is need to revise the user fees in order to meet that target but this will be done

cautiously so us not to marginalised the vulnerable groups. The hospital will in the nest year

organise a stake holders meeting to highlight among other issues of sustainability and costs of

services.


21

Table 5.5: Trend of indicators of efficiency in use of financial resources

Indicator FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

Cost per bed 5,999,787 7,934,609 10,670,321 13,303,434 13,823,032

Cost per IP/day 29,318 38,438 43,339 51,588 55,668

Cost/SUOop 10,426 11,069 12,912 15,571 15,333

(NB: Total SUOop = Total OP + 15*IP + 5*Deliveries + 0.5*Total ANC + 0.2*Total Immunisation) Source:

UCMB


one SUO has decreased from UGX 15,571 to 15,333 but the cost of treating one inpatient per

day has increased by 0.2%.

Table 5.6: Trend of sustainability ratio of the hospital in absence of both donors and PHC

CG funding in the last 5 years

Without PHC CG FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

Total Local

Revenues (a) 313,958,880 432,465,615 428,575,113 583,256,695

568,878,543

Total Recurrent

Expenditures (b) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,637,000 3,745,941,650

Sustainability

Ratio = (a/b)x100 14.7% 18.1% 13.3% 14.5% 15.1%

Table 5.7: Trend of sustainability ratio of the hospital in absence of donor funding but with

PHC CG in the last 5 FYs

(Local Revenues refers to “in-country funding” and therefore includes user fees, PHC CG,

Local Govt contributions, IGAs, etc)

FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

Total Local

Revenues (c) 846,527,743 961,036,600 952,526,311 1,090,877,166

1,075,609,977

Total Recurrent

Expenditures (d) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,637,000 3,745,941,650

Sustainability

Ratio = (c/d)x100 39.7% 40.1% 29.6% 27.2% 28.7%

Internal Audit Since May 2012 the position of Internal Auditor in the Hospital has remained vacant. The

hospital has sent out an advert in one of Uganda Newspaper- the Daily Monitor for position of


22

Internal Auditor. We have received some applications which shall be shortlisted with the help of

a qualified technical person and interviews will be held in the within the shortest possible time.

External Audit Every FY the Hospital has an external audit conducted and the resulting Financial Statement and

Management Letter are presented for final approval to the Board of Governors (after in depth

analysis by the BoG Finance Committee). The hospital financial statement for the year 2014-

2015 has been audited by Thonna Associates Certified Accountants based in Kampala.

Procurement Currently the staff who was sponsored for bachelor course in procurement and logistics has

finished his study and he is working in the hospital there is need to make a procurement policy

and form a committee for procurement in order to strengthen this department by the beginning of

FY 2015-2016.


23

CHAPTER SIX

SERVICES

Currently the hospital offers the following

services:

Obstetrics & Gynecology Services

• Antenatal, Delivery & Postnatal care

• Prevention of Mother to Child

Transmission of HIV

• Emergency Obstetric and Neonatal care

• General and Specialized Obstetric and

Gynecologic Surgery

General Surgical Services

• Trauma and Emergency care

• Surgical Clinic

• Minor Orthopedics services

• Burns care

• Specialized Surgical Camps

• Anesthesia

• General surgical operations

Internal Medical Care

• HIV Care and Treatment

• General Adult Out-patient Clinic

• Private Out-patient Clinic

• Emergency medical care

• Electro Cardiogram(ECG)

• Medical Admissions and care

• TB Detection and treatment

• Communicable and Non-communicable

disease care and prevention.

Pediatrics & Child Health

• Young child clinic

• Malnutrition Therapeutic feeding.

• Neonatal intensive care

• Pediatric admissions and care.

• Immunization and health promotion

Community Health

• Health promotion out reaches.

• Immunization

• Health education

• Primary Health Care.

Health Training

• Midwifery training

• Internship for Medical Officers is

currently suspended but shall be

reintroduced soon. However, medical

students are given opportunity to learn

and practice under supervision of senior

medical officers and specialist.

• Opportunities also provided to other

cadres like Clinical Officers, Pharmacy,

Nurses, Midwives and laboratory

students for attachment during holidays;

guidance is usually under a senior staff

in the area of discipline.


24

A. GENERAL OUT PATIENT DEPARTMENT (OPD)

The Hospital runs a General Outpatient Department which is also the main entrance. The OPD

operates six days a week from Monday to Saturday from 8.00 am to 5.00pm excluding Sundays

and Public Holidays.

OPD Staffing Level The staffing composition of OPD consists of Clinical Staff; Nurse Staff and Non-medical staff.

The Nursing staffs works in shift i.e. morning hours from 8:00 am to 3:00 PM. Those coming

for evening starts at Midday to 5: 00 pm but some time they extend up to 6:00pm depending on

the number of patients in OPD on that day. However, the hospital is planning to expand the

working hours in OPD because in several occasion patients who delay to receive their result

from laboratory end up returning home without receiving treatment. The clinical officers are

available in OPD from 9.00 am to 5.00pm every working day. There is need to employ an

additional clinical officer who will be covering the evening duty to reduce delay in accessing

care and work load. The clinical Officers are still the main Medical personnel who review

patients in the OPD.

The presence and support of Medical Officer in OPD is limited due to few numbers of Medical

Doctors at the Hospital to cover the wards and OPD. The OPD has not yet attained the optimal

staffing level as required by the MOH due to lack of personnel in departments such as Dental,

Psychiatric, Ophthalmic and ENT Officers. The hospital still faces difficulty in finding and

attracting such cadres.

For next financial year the hospital is planning to introduce the Diabetes, Cardiovascular, Sickle

cell, mental health and cervical cancer clinics at least two times a week.

Table 6.1: The staff composition in OPD in the FY 2013/14 and FY 2014/2015

Cadre/ Discipline Qualification 2013/2014 2014/2015

Clinical officers Diploma in clinical medicine 4 4

Double Trained Nurse/Midwife Diploma in Nursing / Midwifery 2 1

Enrolled Midwife Certificate of Enrolment 1 2

Enrolled Nurse Certificate of Enrolment 3 2

Enrolled Comprehensive Nurse Certificate of Enrolment 6 1

Nursing Assistant Certificate 2 3

Cashier On job training 2 3

Nursing Aide Trained on Job 1 1

The staffing level in OPD dropped from 21 in FY 2013/2014 to 17 in FY 2014/2015 due to

increased staff attrition especially among qualified Health workers.


25

The clinical officers in OPD run Minor theatre for minor surgical under local anaesthesia,

including safe male circumcision. The investigation from OPD is done in collaboration with

other support service departments like X-ray, Ultrasound, Laboratory and others during the

investigation and diagnosis of patients’ complaints. The OPD has a functional Ultrasound

machine which operates from 8.00am to 5.00pm from Monday to Friday; while on Weekends

and Public holidays, the ultrasound in Maternity can be accessed on request by clinicians for

emergency cases only. The Laboratory is open 24 hours a day and on weekends and Public

holidays, while the X-ray is open from 8.00am - 5.00pm from Monday to Saturday excluding

Sundays and Public holidays.

OPD activities

During the FY 2014/2015, the Hospital registered a drop in OPD utilization with new OPD

attendance falling from 25,322 in FY 2013/2014 to 21, 761 (decrease of 14 % compared to the

previous FY). The Re-attendances also dropped from 3,884 in FY 2013/2014 to 3,765 (decrease of

3% compared to the previous FY). The downward trend in OPD Utilization in the Hospital is similar

to that experienced by the Lower health facilities in Health Sub District (decrease of 8% from

previous FY).

The spontaneous drop in OPD utilization in the Hospital and in the Lower Health facilities in the

HSD cannot be pointed out to a single factor. This requires a careful study to justify the decline.

Table 6.2 Trend Out-patient Attendance by gender & age group -FYs 2010/2011 to 2014/2015

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

FEMALE New

Attendance

0-4 yrs 2,744 2,321 3,068 3,217 2,642

5 yrs and Over 8,165 7,385 8,751 12,134 10,690

Re-attendance 0-4 yrs 470 346 375 212 122

5 yrs and Over 1,528 3,612 5,365 1,646 1,511

MALE New

Attendance

0-4 yrs 3,030 2,495 3,606 3,492 3,188

5 yrs and Over 5,486 4,568 5,913 6,479 5,311

Re-attendance 0-4 yrs 541 350 348 203 161

5 yrs and Over 1,132 2,637 3,799 1,823 1.971

All New Attendances 19,425 16,769

21,338 25,322 21,761

All Re-attendances 3,671 6,945

9,887 3,884 3,765

All attendances (new + re-attendances) 23,096 23,714

31,225 29,206 25,526


26

Fig 6.1: Trend of OPD attendance for the last 5 FYs

Fig. 6.2: Total OPD Attendances by Age Group

The disaggregated data of OPD attendance during FY 2014/2015 by gender shows that females

registered higher number of new OPD attendance (60% of New OPD attendance). The

dominance of new OPD attendance by female has been a continuous trend over the past years.

There is no significant dominance of re-attendance by either gender during the FY 2014/2015.


27

Fig. 6.3: proportion of OPD new visits to total OPD attendance

In the last two FYs, the total OPD attendances showed a progressive drop from 31,225 in FY

2012/2013 to 29,206 in FY 2013/2014 to 25,526 in FY 2014/2015(a decrement of 6.4 % in FY

2013/2014 and 12 % in FY 2014/2015 respectively). This drop may be interpreted as the

consequence of the reduction of malaria incidence that was one of the main causes for the seasonal

increment of attendances in the OPD and the strengthening of the Lower health units in the District

where Patients can now access a considerable proportion of primary health services care nearer to

them.


28

Fig. 6.4 (a): Trend of OPD 1st Visits in the last

FY

Fig. 6.4 (b): Trend of OPD 1

st Visits in the last 2 FYs

During FY 2014/2015 the OPD monthly attendances showed a more stable trend with irregular

fluctuations, except for the last quarter of the Financial Year when the District started experiencing

Malaria Outbreak. In past three FYs, OPD monthly attendances showed a characteristic of seasonal

variation with a sharp increase in the months of May to July and slower decrement from August to

October and a kind of plateau in the remaining months.


29

Table 6.3 Top ten diagnoses in OPD in the last three FYs (Source: HMIS 105)

Top 10 lists of OPD diagnoses FY 2012/2013 FY2013/2014 FY 2014/2015

No. % No. % No. %

01 RTI (excluded pneumonia) 4,355 13.5 4,316 14.3 3,562 14.3

02 Gastro-Intestinal Disorders (non-Infective) 3,081 9.6 2,354 7.8 2,255 9.0

03 All Injuries (any cause) 1,215 3.8 2,698 8.9 2,304 9.2

04 Malaria 3,609 11.2 1,908 6.3 957 3.8

05 Urinary Tract Infections (UTI) 1,063 3.3 1,286 4.3 993 3.9

06 Skin Diseases 1,234 3.8 1,020 3.4 869 3.5

07 Acute diarrhoea 264 0.8 992 3.3 1,020 4.1

08 Pneumonia 725 2.3 907 3.0 798 3.2

09 Typhoid fever 83 0.3 893 3.0 352 1.4

10 Eye conditions 741 2.3 688 2.3 399 1.6

11 All other diagnoses 15,778 49.1 13,167 43.6 11,450 45.9

Total diagnoses 32,158 100.0 30,229 100.0 24,959 100.0

Fig. 6.5: Top ten Diagnosis in OPD in the last 3 FYs

NOTE:

1. Top 10 Diagnosis contributed 54.8 % of Total OPD Diagnosis in 2012 – 2013




30

Major constraints observed in OPD

• Working hours, availability of staff and organizational set-up do not always allow provision

of quick service. Too often the waiting time is excessive (see further detail in Chapter 8).

• Due to the heavy workload in the Wards, Medical Officers seldom appear in the OPD except

in emergency situations. This inhibits the possibility to provide clinical guidance and support

to the Clinical Officers.

• Medical equipment for clinical examination is not enough or, at times, not in working

conditions.

B. SPECIALIST OPD CLINICS

1. Ante Natal Clinic (ANC)

Ante Natal Clinic (ANC) is an Outpatient Clinic which provides specialized services to pregnant

women and their unborn children and Non-pregnant women of child bearing age. ANC is open and

operational 5 days a week from Monday to Friday from 8.00 am – 5.00pm. The Clinic is closed on

Saturdays, Sundays and all Public holidays. ANC is autonomous from the General OPD and is hosted

in the same building with eMTCT Care point, Natural family Planning Clinic, HCT clinic and a

minor laboratory. These Clinics provide wide range of services to clients yet the rooms available are

clearly not sufficient for all these activities and, as a norm, are quite congested.

The structure was remodeled by breaking rooms to create space for additional services like

counseling, Cervical Cancer Screening, Baby-mother Care point and Natural Family Planning Clinic.

This endeavor provided a temporary space for offering quality care to the patients. With availability

of funding, the entire area needs to be re-designed and improved to provide adequate working space

and waiting shelter for the pregnant mothers attending the clinic.

ANC staffing level

The staff working in the ANC includes 8 Midwives who are also responsible for the running of the

Young Child Clinic and PMTCT programme. The Clinic lost 2 midwives who joined local

government. This gap is not filled considering the fact there are other departments like Maternity

which was hit more by staff attrition during the FY. Considering the ever high numbers of ANC

attendances in the Hospital, the available midwives in ANC are certainly not enough to cover the

current number of attendances hence the need for future plans for further expansion of these services.


31

Table 6.4 Antenatal and Postnatal indicators during the last three FYs

Indicators 2011-2012 2012-2013 2013-2014 2014-2015

ANTENATAL

A1-ANC 1st Visit 2,958 2,290 2,033 1,817

A2-ANC 4th Visit 1,235 1,199 1,249 1,217

A3- Total ANC visits new clients + Re-attendances 7,936 5,312 6,664 5,909

A4-ANC Referrals to unit n.a. 11 2 0

A5-ANC Referrals from unit n.a. 1 0 0

POSTNATAL P1-Post Natal Attendances 2,805 2,473 1,890 847

P2-Number of HIV + mothers followed in PNC 190 19 77 25

P3-Vitamin A supplementation 2,805 2,351 1,367 847

P4-Clients with premalignant conditions for breast n.a. 0 0 0

P5 Clients with premalignant conditions for cervix n.a. 0 0 0

Fig.6.6: ANC visits in last 3 FYs from FY 2011/2013 to 2014/2015

The decreasing trend in the number of ANC 1stvisit and subsequently ANC total Visit (New ANC +

Re-attendance) in the Hospital has progressively continued over the last 3 FYs. In FY 2014/2015, the

number of ANC 1st Visit dropped by 10.6%, while the Total ANC attendance also dropped by 11.3%.

This can possibly be explained by the fact that LLUs are also providing ANC services and may

represent a more convenient location for many mothers. However, the re-attendances have


32

substantially remained stable. This reaffirms the fact that some pregnant women who begin ANC

visit in the LLUs usually complete their ANC visit at the Hospital. This can be attributed to the good

response and other additional service provided by the Hospital such as Ultrasound scans, Waiting

Shelters for pregnant mothers amongst others.

2. HIV / AIDS Clinic

HIV/AIDS services in Kalongo Hospital are managed under the umbrella of the ACT Programme

(Aids Care & Treatment) funded by CDC through Uganda Episcopal Conference and UCMB. These

services were initiated in November 2005 and are substantially integrated into the Hospital services.

The Programme provides comprehensive HIV/AIDS care which includes Antiretroviral Therapy,

Prophylaxis for and Treatment of Opportunistic Infections, HIV Counseling and Testing, VCT,

eMTCT, and a Community Programme.

All these activities are located in two nearby but distinct areas: HIV Counseling and Testing and

PMTCT services are run within the ANC building, while all the other activities (ART and

Community and Outreaches Programme) are managed in a separate nearby building.

The HIV/AIDS program is headed by a Medical Doctor who coordinates the activities of the Clinic.

The personnel involved in the project activities in FY 2014-2015 included; 1 Medical Doctor, 1

Clinical Officer, 4 Support staffs, 4 counselors, 1 driver, 3 Information system staffs, 5

Nurses/Midwives, 1 community coordinator, 2 laboratory staffs, 3 Pharmacy staffs and 40

community health volunteers.

The Clinic registers an ever expanding number of HIV Clients every year. This is due to high

number of new HIV/AIDS infection and the increasing number of patients transferred from other

facilities. The new additions into HIV/AIDS care program of the Hospital imply an increased

demand for HIV/AIDS service which is not commensurate with the resources available.

The Clinic is located in a temporary structure used for dispensing drugs, nursing care,

counselling, clinical consultation, storage of files; and Data entry & Information Management.

The eMTCT component of HIV/AIDS services is provided in a distinct area adjacent to the

clinic. The Clients hardly have waiting space since the movable tent provided cannot provide

safe cover against rain and sunshine during clinic days.

During the first half of FY 2014/2015, the activities of the HIV/AIDS clinic was greatly affected

by the No-Cost extension instituted by CDC in late 2013/2014 FY due to change in the financial

year. This limited the capacity of the project to finance and run crucial programs such as PMTCT

follow up, HCT, EID sample collection and salaries of some staffs.


33

Activities which are offered under HIV/AIDS program includes:

a) HCT / VCT HCT/VCT is one of the strategies to fight HIV/AIDS. It seek to provide free access to HIV

Counseling & testing. It is also referred to as voluntary Counseling & testing. HCT/VCT services are

hosted in a structure adjacent to ART Clinic and under one roof with ANC and eMTCT programme.

Table 6.5 HIV/AIDS COUNSELING AND TESTING (HCT) DURING FY 2014/2015

Category

No of

individuals

No of

individual

No of

Individual

No of

individual

No of

Individuals

Total

0- <2 yrs 2 - <5 yrs 5- <15 yrs 15 – 49 yrs >49 yrs

M F M F M F M F M F

Number of Individuals counseled

16 30 854 1,427 17 42 2,386

Number of Individuals tested 16 14 18 22 18 30 858 1,435 17 43 2,471

Number of Individuals who received

HIV test results 15 14 18 22 18 30 854 1,427 17 43 2,458

Number of Individuals who tested

HIV positive - 1 1 1 3 - 40 84 3 1 134

H IV positive individuals with

suspected TB - - - - - - 7 9 - 1 17

HIV positive cases started on

Cotrimoxazole preventive therapy

(CPT)

- 2 1 1 2 - 46 85 2 - 139

Number of Individuals tested twice

or more in the last 12 months (re-

testers)

9 5 10 13 9 12 551 928 4 27 1,568

Counseled and tested together as

couple 722

Counseled and received results

together as couple 668

Concordant positive couple

26

Discordant couples

8

Individuals counseled and tested for

PEP -

2

2 1 10 3 1

19

Safe male Circumcision -

-

205

62

-

267


34

Table 6.6 Trend of HCT/VCT results in the last 5 FYs

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Number Tested

Male 3,323 1,031 1,095 1,632

927

Female 4,098 1,484 1,679 1,886

1544

TOTAL (Tested) 7,421 2,515 2,774 3,518

2,471

Tested +ve for HIV

Male 273 123 78 118

47

Female 298 166 117 138

87

TOTAL (+ve Tests) 571 289 195 256

134

Positivity Rates of HCT

Male 8.2% 12.0% 7.1% 7.2%

5.1%

Female 7.3% 11.2% 7.0% 7.3%

5.6%

Both sexes 7.7% 11.5% 7.0% 7.3%

5.4%

Fig.6.7: Trend of HIV positivity in HCT/VCT Clinic by gender

The trend of HIV positivity among HCT/VCT clients has continued to decline. The

disaggregation of the HIV Positive test results by gender shows that Females have the higher


35

number of positive test results than their male counterparts. This can be explained to the fact that

more females access HCT/VCT services than the males.

However, with the emergence of new strategies like Provider Initiated Testing & Counselling

(PITC), Rapid Testing & Counselling (RCT), Mandatory HIV testing in ANC and Maternity for

elimination of Mothers to Child Transmission (eMTCT), pre-operative HIV counselling &

testing during Safe Male circumcision (SMC), at total of 11,882 clients accessed HIV

Counselling & testing services during FY 2014/2014.

Table 6.7 HIV test by purpose during FY 2014/2015

Types of test HCT SMC PITC PMTC

T

Clinical Diagnosis

(RCT) Total

Number of clients tested for HIV 2,471 267 3,088 3,945 2,111 11,882

No. of HIV +ve tests 134 6 175 232 230 777

Positivity Rate (%) 5.4% 2.2% 5.7% 5.9% 10.8% 6.5% NB: The above figure are for total test done purely for HIV screening & excludes quality control tests done during the FY

2014/2015.

The general HIV positivity rate in FY 2014/2015 in the hospital stands at 6.5 % and at 5.4% in

HCT/VCT clinic alone. This represents a 47.6 % drop in the number of HIV positive test (from

256 in FY 2013/2014 to 134 in 2014/2015) in HCT/VCT clinic alone. The SMC program that

also helped to beef up the numbers of tests has been is not funded due to unavailability of funds.

b) PMTCT services in 2014-2015 FY

Table 6.8 Performance Indicators of the PMTCT Programme in FY 2014-2015

A. Antenatal No.

A1. Mothers re-tested later in pregnancy, labour or postpartum 716

A2. Mothers testing positive on a retest 9

A3. New pregnant and lactating mothers newly enrolled into psychosocial support groups. 59

A4. HIV positive pregnant women already on HAART before 1st ANC visit /Current

pregnancy 57

A5. Pregnant women who received services at the health facility after referral from the

community 0

A6. HIV (+) lactating mothers followed up in community for infant feeding, early infant

diagnosis, or linkage into chronic care 361

A7. HIV positive Pregnant women initiated on Cotrimoxazole 79

A8a. Mothers assessed using CD4 0

A8b. Mothers assessed using WHO clinical staging only 74

A9a. HIV + pregnant women initiated on HART (Option B+) for EMTCT - CD4 >350 or

Stage I and 1I (ART-T) 49

A9b. HIV + pregnant women initiated on HART (Option B+) for EMTCT - CD4 <350 or

Stage III and IV(ART-T) 0


36

B. Maternity No.

B1. HIV positive deliveries initiating ARVs in Labour 0

C. Postnatal No.

C1. Postnatal mothers newly tested for HIV 135

C2. Postnatal mothers testing HIV positive 32

C3. Postnatal mothers initiating ARVs in PNC period 1

D. Early Infant Diagnosis (EID) No.

D1. HIV-exposed infants (<18 months) getting a 2nd DNA PCR 185

D2. HIV-exposed infants initiated on Cotrimoxazole prophylaxis 178

D3a. 1st DNA PCR results returned from lab within 2 weeks of dispatch 131

D3b. 2nd DNA PCR results returned from lab within 2 weeks of dispatch 219

D4a. Total HIV-exposed infants who had a serological/rapid HIV test at 18 months or older. 189

D4b. Positive Number of HIV-exposed infants who had a serological/rapid HIV test at 18

months or older 0

D5. DNA PCR results returned from the lab that are positive 10

D6. HIV-exposed infants whose DNA PCR results were given to caregiver 211

D7. Number of referred HIV positive-infants who enrolled in care at an ART clinic 10

c) Antiretroviral therapy Table 6.9 PHAs eligible for ART and started on ART by age group and gender in the last 5 FYs

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

ELIGIBLE FOR ART

Male <5 yrs 1 2 0 2 0

5-<18 yrs 5 4 1 5 0

18 and above 87 20 24 102 20

Female <5 yrs 1 1 0 0 0

5-<18 yrs 7 3 0 1 0

18 and above 96 26 21 71 15

TOTAL ELIGIBLE FOR ART 197 56 46 181 35

STARTED ON ART

Male <5 yrs 7 11 7 18 4

5-<18 yrs 2 9 5 15 7

18 and above 76 112 117 142 108

Female <5 yrs 8 7 9 15 5

5<18 yrs 7 3 7 25 4

18 and above 105 140 268 282 169

TOTAL STARTED ON ART 205 282 413 497 297

ART Clinic operates as an outpatient clinic from Monday – Friday, 8.00am to 5.00pm excluding

weekends and all public holidays. ART (including ARVs, Counselling, HAART, Clinical care)


37

services are offered in the clinic. The number of patients started on ART dropped by 40% from

497 in FY 2013/2014 to 297 in FY 2014/2105. This is due to opening of ART sites in all the

eight HC IIIs in the District. The opening of the ART sites in the HC IIIs provided convenience

to patients in and around the areas served by these Health units.

The number of patients eligible for ART significantly reduced from 181 in FY 2013/2014 to only

35 in FY 2014/2015 due to improvement in timeliness in ART enrolment for all clients due for

ART.

Besides ART services, ACT project also runs community programs which includes:

a) Training of youths on life skills where abstinence is advocated for;

b) Training of married couples on being faithful in their marriages;

c) Adherence monitoring through home visits;

d) Community meetings for health talks;

e) Support to the orphans and vulnerable children (OVCs) which includes Educational support,

economic empowerment through IGA and apprentice trainings amongst others.

f) Gender Based Violence (GBV) support services to victims of GBV

g) Food security & livelihood support to PLWHA, especially to infected & affected Children.

Table 6.10 Number of PLHAs started on ARV by age group and gender in FY 2014/2015

CATEGORY NO. OF

INDIVIDUA

LS <

2YEARS

NO. OF

INDIVIDU

ALS

NO. OF

INDIVIDU

ALS 5-14

YEARS

NO. OF

INDIVIDUAL

S

TOTA

L

M F M F M F M F

NUMBER OF NEW PATIENTS

ENROLLED IN HIV CARE AT THIS

1 3 3 2 6 2 78 122 217

NUMBER OF PREGNANT WOMEN

ENROLLED INTO CARE DURING

0 49 49

CUMULATIVE NUMBER OF

INDIVIDUALS ON ART EVER

ENROLLED IN HIV CARE AT THIS

2 5 29 25 83 81 833 1,530 2,688

NUMBER OF HIV POSITIVE

PATIENTS ACTIVE ON PRE-ART

0 0 0 0 0 0 57 86 143

NUMBER OF HIV POSITIVE CASES

WHO RECEIVED CPT/DAPSON AT

LAST VISIT IN THE YEAR

3 5 24 18 68 71 713 1,305 2,236

NUMBER ELIGIBLE PATIENTS NOT

STARTED ON ART

0 0 0 0 0 0 20 15 35

NUMBER OF NEW PATIENTS

STARTED ON ART AT THIS FACILITY

1 3 3 2 6 4 109 169 297


38

3. ORTHOPAEDIC SERVICES

Currently the hospital is offering limited orthopaedic services due to lack of orthopaedic surgeon,

however the minor orthopaedic services is done by the orthopaedic officer, the main procedure

is the reduction of closed fracture and Physiotherapy, in several occasion the open fracture are

always referred to the specialised hospital.

Table 6.11 Main procedures in orthopaedics and physiotherapy done in the last 4 FYs

Procedures FY2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

1 Plaster (POP) 497 565 582 622

2 Physiotherapy 43 83 106 72

4. TUBERCULOSIS CLINIC

The Hospital runs a TB Clinic where TB patients are registered and given their treatment and

followed up. The management and running of TB Clinic is merged into Medical ward, though

the ward is located in a separate structure next to Medical ward. The staffs of Medical ward are

responsible for the treatment, management, follow up and reporting of Patients admitted in TB

ward.

All TB patients, once diagnosed, are admitted in the Hospital TB Ward for at least the first phase

of intense treatment or as long as general conditions allow them to go back home and come to

NUMBER OF PREGNANT WOMEN

STARTED ON ART AT THIS FACILITY

0 49 49


PATIENTS ASSESSED FOR TB AT

4 2 11 9 31 37 312 657 1,063


PATIENTS STARTED ON TB

2 0 0 0 1 1 38 13 55

NET CURRENT COHORT OF PEOPLE

ON ART IN THE COHORT

0 0 3 0 1 0 24 36 64

NUMBER OF CLIENTS SURVIVING

ON ART IN THE COHORT

COMPLETING, 12 MONTHS ON

0 0 2 0 0 1 8 10 21

NUMBER OF PEOPLE ACCESSING

ARVS FOR PEP

0 0 0 1 4 4 1 0 10

NUMBER OF INDIVIDUAL ON ART

FIRST LINE

3 5 24 18 66 69 627 1,193 2,005

NUMBER OF INDIVIDUAL ON ART

SECOND LINE

0 0 0 0 2 2 29 55 88


39

receive their treatment for the continuation phase. But for patients whose conditions allow and

who live at a short distance from the Hospital shorter period of admission is requested.

In a bid to enforce TB/HIV co-infection management policies, all TB patients were tested for

HIV. A total of 35 TB patients tested HIV positive and; 47 came with known HIV positive

results during FY 2014/2015. This put HIV positivity rate in TB clinic at 44% during FY

2014/2015.

The detection rate of new smear positive pulmonary cases diagnosed and/or referred to the

Hospital (the hospital catchment area, entire district of in Agago & neighboring district) was at

120% for FY 2014-2015. However, if this analysis is restricted to cases whose provenance is

Parabongo Sub County and Kalongo Town (the hospital catchment area), and then the actual

detection rate falls very low to 30% and far below the target of 70%.

Table 6.12 TB patients registered for treatment in the FYs 2011/12 to 2014/15

2011-12 2012-13 2013-14 2014-2015

No. of patients registered (all) 258 260 252 186

Children (< 5 yr.) 10 1 0 0

Disaggregation by Disease classification

New Pulmonary Positive 73 123 89 97

Relapses Pulmonary Positive 4 5 6 4

Failure Pulmonary Positive 7 2 7 8

Default Pulmonary Positive 9 21 17 9

New pulmonary Negative 141 53 91 26

Relapses Pulmonary Negative 4 7 3 4

Default Pulmonary Negative 3 15 6 4

Pulmonary no smear done n.a. 6 0 0

Extra Pulmonary 17 28 33 0

Disaggregation by Treatment Category

New Patients 231 208 213 161

Re-treatment 27 52 39 25

Other Patients

Transferred in 5 6 2 0

During FY 2014/2015, a total of 27 samples for Gene-expert were collected from the LHUs and

the hospital for MDR screening. Of these, 9 samples tested positive for TB with no Resistance;

and 4 tested Positive for resistance to Rifampicin and referred to Kit gum Referral Hospital for

Management. The Hospital does not have the facility to provide treatment to MDR patient; and

as required by the National TB control program.


40

Table 6.13 MDR/MTB Diagnosis during 2014/2015

Age group Samples

Collected

Samples

Tested

MTB

positive

Cases

MDR positive

(Rifumpicin

Resistant TB)

MDR cases

referred

< 15 years 04 04 0 0 0

15 yrs& above 23 23 9 4 4

Total 27 27 9 4 4

TB Treatment Outcome

Following the National TB Leprosy Program reporting system, the table below show treatment

outcome of TB patient registered and enrolled for TB treatment 12 months back. The success

rate of treatment (No. of cured and completed treatment over the total of diagnoses) calculated

for all the patients registered for treatment in FY 2013-2014 and reported in FY 2014-2015 was

only 36% (against 48.1% of the previous FY).

The success rate among new smear positive pulmonary cases diagnosed in the same period is

40% (against 45.5% in previous FY). This is less than target success rate of 85% required

attaining a meaningful control of the disease.

Table 6.14 Results of TB treatment of all TB patients reported in the last 4 FYs

Outcome of treatment 2011-12 2012-13 2013-14 2014-2015

No. No. No. No. %

Cured 17 22 52 32 12.7

Treatment Completed 88 67 73 59 23.4

Died 5 15 11 15 5.9

Failure 0 2 4 2 0.8

Defaulted 165 123 66 100 39.7

Transfer out 7 29 54 44 17.5

Total 282 258 260 252 100

Table 6.15 Results of TB treatment of cohorts of Smear positive Pulmonary TB patients reported in the last 4

FYs (diagnosed and registered for treatment in the 4 previous respective FYs)

Outcome of treatment 2011-2012 2012-2013 2013-2014 2014-2015

Cured 17 18 39 28

Treatment Completed 41 13 17 17

Died 2 6 5 8

Failure 0 2 4 2

Defaulted 48 27 32 42

Transfer out 1 7 26 22

Total 109 73 123 119


41

The number of treatment defaulters has remained high at 39.7% among TB patients registered in

FY 2013/2014 (against 25 % in the previous FY 2012/2013). The Hospital adopted a stringent

criterion for assessing outcome of treatment based on completeness of documentation in the TB

register. This explains why we report a high number of defaulters.

5. MENTAL HEALTH CLINIC

Mental Health Clinic in Dr. Ambrosoli Memorial Hospital -Kalongo is established and the

services run within the OPD where one room is allocated and the services run by a Registered

Psychiatric Nurse. Owing to the fact that mental health is a fundamental component of the health

service delivery system, the hospital provides mental health services in an integral part of

primary health care.

During FY 2014/2015, a total of 364 attendances have been registered against 676 attendances in

FY 2013/2014. The most common cases registered were epilepsy followed by depression and

post-traumatic stress disorder. The decline in the number of cases can be attributed to the

temporary interruption of AMREF support for specialised clinic.

Table 6.16 Mental health cases reviewed in OPD in the last 4 FYs

S/n Diagnosis FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015

No. % No. % No. % No. %

1 Epilepsy 1,093 89.7 907 90.9 455 69.0 194 53.3

2 Depression & post-traumatic stress disorder 49 4.0 33 3.3 15 2.3 38

10.4

3 Bipolar affective disorder 21 1.7 8 0.8 4 0.6 2 0.5

4 Attempted suicide 19 1.6 14 1.4 21 3.2 36 9.9

5 Learning disability & attention deficit,

hyperactivity disorder 12 1.0 1 0.1 1 0.2 1 0.3

6 Drug/alcohol abuse 16 1.3 32 3.2 57 8.6 12 3.3

7 Psychosis (schizophrenia) 09 0.7 3 0.3 3 0.5 3 0.8

8 HIV related Psychosis 30 4.6 18 4.9

9 Other mental illnesses 73 11.1 60 16.5

Total 1,219 100 998 100 659 100. 364 100

Challenges in mental health services

While the Hospital ensured continuity of mental health services, faced with the following

challenges that need to be taken into account to improve the effectiveness of the services:

• Admissions of mental patients in Medical Ward leads to the risk of violence to other

patients admitted.


42

• There is still some inadequacy in the availability of some essential drugs, such as

fluoxetine and second generation antipsychotics.

• Ignorance and inadequate awareness in the general population.

• Poor community sensitization on mental health services causing drastic increase of other

preventable conditions like alcohol abuse.

• Interruption of specialized clinic for mental health by AMREF

Recommendations

1. Increase public awareness on mental health issues to facilitate access to the service.

2. Improve financial support for mental health services and improve on availability of drugs.

3. Recruit additional mental health personnel for effective care of mentally ill patients.

6. DENTAL CLINIC

The dental Clinic in the Hospital is not fully operational due to lack of dental personnel and

sufficient equipment for dental care. Though there is a designated room in OPD for dental Clinic

with basic dental equipment, dental services in the Hospital are offered periodically by visiting

dental surgeons supported by AMREF through its outreach program.

7. PALLIATIVE CARE

The palliative care within hospital is covers a number of conditions where patients are suffering

from terminal illness and having severe pain due to various conditions. Patients affected with

HIV/AIDs are also provided with ARVs, Bactrim and treatment of opportunistic Infections to

alleviate their conditions.

Provision of morphine is limited due to stock out observed in several occasion during the FY.

Clinical Condition No. Clinical Condition No.

Cancer Cervix 16 Sickle cells Crisis 38

Liver cancer 2 Chronic osteomyelitis 13

Leukaemia/Lymphoma 3 Herpes Zoster in ISS 2

Cancer Ovary 4 Liver disease in ISS 1

Oral Cancer 4 Liver Cirrhosis 40

Cancer Breast 4 Congested cardiac failure 1

Cancer Prostate 1 Pancreatitis 1

Despite a substantial increment of the number of patients assisted by this service, it is still to be

recognised that many patients once started on the programme of palliative care, are lost to

follow-up due to logistic problems that limit their access to the services in the Hospital (distance

and costs of transport).


43

8. OPHTHALMOLOGY

The ophthalmology Clinic in the Hospital is not fully operational due to lack of qualified staff.

The services are offered periodically by visiting ophthalmology specialist supported by AMREF

through its outreach program. The AMREF program may hopefully be re-introduced as this had

been a big support over the last few years.

C. INPATIENTS DEPARTMENT

1. Summary of beds and qualified health personnel

In FY 2014-2015 Dr. Memorial Hospital Kalongo maintained total of 271 beds after the reduction

from 302 in the previous FY. This was done to give more room for efficient utilization of beds and

to allow a better spacing among beds in some of the congested wards. On the other hand it is because

of the opening of new wing in Medical Ward and the assessment carried out on admission trends in

recent years.

Table 6.17 Summary of beds and qualified health personnel per ward

Ward No. of Beds Medical Personnel No. of No. of beds

Medical Ward 41 1 Medical officer 8 10.3

TB Ward 18

Surgical Ward 76 1 volunteer Surgeon, 1

9 8.4

Maternity Ward 75 2 Medical officer 15 7.5

Paediatric Ward 61 1 Medical officer 9 6.8

Total 271 1 Specialist doctor, 5 MOs 41 7.4

2. Inpatient utilization indicators

In 2014-2015 Dr. Ambrosoli Memorial Hospital admitted a total of 12,891 patients in the wards

with a decreased of -8.5% of admissions from 2013-2014 This could be because of the functional

government lower health units with improved drugs supply where some minor illness can be

managed

A reduction of admissions was observed in the following wards; Paediatric ward decreased by

18.8%, Medical ward decreased by 10.1% and Surgical by 2.7%. It is only Maternity ward which

continued to experience more increment of admissions over the last two FY (5.6% and 5.7%).

This is because the majority of mothers who receive services during the ANC visits in the

hospital prefer to return for delivery.


44

Patient Days and Average Length of Stay

The number of patient days has decreased by 13.5% compared to increment of 19.3% in the

previous FY. This is somewhat proportional with the reduction in the number of Patients

admitted. The Average Length of Stay has remained almost constant. This is to be considered as

a good sign of improved efficiency in the management of patients that allows a shorter period of

hospitalisation to attain the same level of cure rate.

Throughput per Bed and BOR

The Hospital BOR has decreased from 70.7% to 68.0% in the last FY. This result is related to

the decreased number of patients admitted. The throughput per bed has increased from 47.0% to

47.9% indicating a slight improvement in the utilisation of the available beds. The current

condition is not yet quite ideal as the Hospital targets to achieve a BOR of at least 85%.

No. of deaths, death rates, Recovery Rates, and self-discharged

Number of deaths among admitted patients decreased from 225 to 179 in 2014-2015 FY and the

hospital mortality rate is at 1.4%. This indicates the efficient improvement in the management of

patients’ general conditions by carrying out proper procedures necessary from the time of

admission until the final day of discharge from the hospital. The Recovery Rate remained stable

ranging between 98.3% and 98.5% in the last 5 FYs, while the number of admitted patients that

runaway or self-discharge has been on a decrease from 34 to 11 compared to the previous FY.

Overall, these data expressed a positive image of the utilisation of curative inpatient services.

Table 6.18 - Utilization indicators in the last 5 FYs for the entire hospital

Indicator FY

FY

FY

FY

FY

No. of beds 349 302 302 302 271 Total Admissions discharged 10,793 11,374 13,221 14,186 12,981

Patient days 72,233 62,340 74,355 77,880 67,292 Average length of stay 6.7 5.5 5.6 5.1 5.2

Turn over interval 5.1 4.2 2.7 2.3 2.4 Throughput per bed 30.9 37.7 43.8 46.9 47.9

BOR 56.7 56.6 67.5 70.7 68.0

No. Deaths 233 172 204 225 179

Mortality rate 2.2 1.5 1.5 1.6 1.4

Recovery Rate 97.6% 98.3% 98.3% 98.2% 98.5%

Self-discharges 28 16 15 34 11


45

Table 6.19: Utilization indicators per ward in the last 4 FYs

MEDICAL WARD SURGICAL WARD

FY

11-12

FY

12-13

FY

13-14

FY

14-15

FY

11-12

FY

12-13

FY

13-14

FY

14-15

No of beds 58 58 58 41 No of beds 76 76 76 75

Total Admissions

discharged

1,575 1,888 2,284 2,053 Total Admissions

discharged

1,648 1,778 2,028 1974

Patients days 8,703 10,148 10,743 8,045 Patients days 16,799 17,093 16,394 15,685

Ave. length of stay 5.5 5.4 4.7 3.9 Ave. length of stay 10.2 9.6 8.1

Through put per bed 27.2 32.6 39.4 50.1 Through put per bed 21.7 23.4 26.7 25.9

BOR 41.1 47.9 50.7 53.8 BOR 60.6 61.6 59.1 56.5

No of Deaths 87 89 105 93 No of Deaths 16 24 18 22

Mortality rate 5.5 4.7 4.6 4.5% Mortality rate 1.0 1.3 0.9 1.1%

Recovery rate 94.3% 95.1% 95.1% 95.4% Recovery rate 98.5% 98.1% 97.9% 98.4%

Self-discharges 3 3 8 2 Self-discharges 9 10 25 10

PAEDIATRIC WARD MATERNITY WARD

FY

11-12

FY

12-13

FY

13-14

FY

14-15

FY

11-12

FY

12-13

FY

13-14

FY

14-15

No of beds 61 61 61 61 No of beds 75 75 75 76

Total Admissions

discharged

3,542 4,573 4,607 3,741 Total Admissions

discharged

4,198 4,502 4,756 5,027

Patients days 12,555 18,165 22,325 17,498 Patients days 19,801 21,994 21,987 22,173

Ave. length of stay 3.5 4.0 4.8 4.7 Ave. length of stay 4.7 4.9 4.6 4.4

Through put per bed 58.1 75.0 75.5 61.3 Through put per bed 56.0 60.0 63.4 67.0

BOR 56.4 81.6 100.3 78.6 BOR 72.3 80.3 80.3 81

No of Deaths 43 74 78 48 No of Deaths 9 6 8 8

Mortality rate 1.2 1.6 1.7 0.7% Mortality rate 0.21 0.13 0.17 0.2%

Recovery rate 98.7% 98.4% 98.3% 99.3% Recovery rate 99.7% 99.8% 99.8% 99.8%

Self-discharges 2 1 1 0 Self-discharges 2 1 0 1

PRIVATE WARD TUBERCULOSIS WARD [TB]

FY

11-12

FY

12-13

FY

13-14

FY

14-15

FY

11-12

FY

12-13

FY

13-14

FY

14-15

No of beds 8 8 8 No of beds 24 24 24 18

Total Admissions

discharged

153 240 244 NA Total Admissions

discharged

258 240 267 186

Patients days 728 10,24 1,010 NA Patients days 3,754 5,931 5,421 3,891

Ave. length of stay 4.8 4.3 4.1 NA Ave. length of stay 14.6 24.7 20.3 20.9

Through put per bed 19.1 30.0 39.5 NA Through put per bed 10.8 10.0 11.1 10.3

BOR 24.9 35.1 34.6 NA BOR 42.9 67.7 61.9 59.2

No of Deaths 2 1 3 NA No of Deaths 15 10 13 8

Mortality rate 1.3 0.4 1.2 NA Mortality rate 5.8 4.2 4.9 4.3

Recovery rate 98.7% 99.6% 98.8% NA Recovery rate 94.2% 95.8% 95.1% 95.7

Self-discharges 0 0 0 NA Self-discharges 0 0 0 0


46

3. Inpatient Referrals

Table 6.20.Pattern of referrals to and from the Hospital in the last two FYs

FY 2013-2014 FY 2014-2015

Category 0-4 years 5 and over 0-4 years 5 and over

Male Female Male Female Male Female Male Female

Referrals to hospital 2 1 3 21 29 26 99 317

Referrals from hospital 0 0 7 6 1 2 34 12

Total 2 1 10 27 30 28 133 329

In reference to the above table, the need for strengthening the referral system is quite evident.

The hospital currently does not have any support earmarked to cover the costs of referral

especially for the vulnerable.

4. The top ten cause of Morbidity in all the wards

Table 6.21 Ten top causes of admission in all the wards in FY 2013-2014 and 2014-2015

2013-2014 2014-2015

Causes of Morbidity No. of cases % on all No. of cases % on all

1 Malaria 1,818 12.8 1665 18.8

2 Pneumonia 1,209 8.5 563 6.3

3 Injuries due to other causes 1,021 7.2 936 10.5

4 Gastro-Intestinal disorder (non-

infective)

1,002 7.1 707 8.0

5 Respiratory Infections (others) 902 6.4 518 5.8

6 Septicaemia 837 5.9 660 7.4

7 Diarrhoea Diseases 499 3.5 340 3.8

8 Abortions 436 3.1 347 3.9

9 Skin Diseases 324 2.3 580 6.5

10 Urinary tract Infection 273 1.9 108 1.2

All others 5,865 41.3 2,453 27.6

Total 14,186 100.0 8,877 100.0

Malaria still the leading cause of admission in the Hospital as presented in the table 6.22 below.

Although the number of malaria cases admitted during 2014/2015 has reduced from 1,818 cases

in 2013-2014 to 1,665 (representing a decrease of 8.4%), it is still ranked first among the top 10

causes of admission (constituting 18.8% of total diagnosis) in the wards during the financial

year. Pneumonia incidences dropped in number from 1,209 cases in 2013/2014 to 563 in

2014/2015 and in ranking among top 10 causes of admission from 2nd to 6th respectively. There

has been a rise in the number of injuries due to other causes, gastro intestinal disorder and

septicaemia each contributing to 10.5%, 8% and 7.4% respectively of all diagnosis in the2014-

2015.


47

The trend of the first cause of admission in last five previous years

In 2014-2015 FY trends of malaria cases admitted in the hospital still remained the highest with

19% in the proportion of all diagnosis although it has dropped to 13% in 2013-2014 FY

Table 6.22.Trend in malaria admissions in Kalongo Hospital over the last 5 FYs

FY

010-011

FY

011-12

FY

012-013

FY

013-014

FY

014-015

Malaria cases 9,229 3,543 2,454 2,875 1,818

Proportion of all 71% 52% 22% 22% 13%

5. The Top ten causes of death among inpatients

The main causes of death in the Hospital during 2014/2015 FY were pneumonia, cardiovascular

disease, anaemia, injuries and malaria accounting for 44.6% of total mortality. It’s worth noting

that cardiovascular diseases which had been the third leading cause of death among inpatients in FY

2013-2014; has become the second leading cause of death in FY 2014/2015. The fact that they do not

represent a major diagnosis (only 81 cases, but with high case fatality rate of 20.9%) should not lead

to underestimate their actual role as a cause of morbidity.

Table6.23. Top ten causes of death among inpatients of all wards in 2013-2014 and 2014-2015 FYs

2013-2014 2014-2015

Causes of Mortality

No of No of Case No of No of Case Fatality

1 Pneumonia 29 1,209 2.4 22 563 3.9

2 Malaria 21 1,818 1.2 13 1665 0.8

3 Cardiovascular

20 122 16.4 17 81 20.9

4 Septicaemia 14 837 1.7 7 660 1.1

5 Anaemia 13 209 6.2 16 306 5.2

6 Tuberculosis 13 267 4.9 8 186 4.3

7 Injuries (all types) 9 1,021 0.9 12 936 1.3

8 Meningitis 6 46 13.0 4 40 10

9 Diarrhoeal diseases 5 499 1.0 3 340 0.9

10 Liver cirrhosis 5 21 23.8 7 60 11.6

The fatality rate of Liver cirrhosis remained high in the hospital though it does not represent a

major diagnosis (only 60 cases, but with high case fatality rate of 11.6%). It’s observed on many

occasions that patients with these cases report to hospital late when their conditions have become

more severe. There is also low “detection rate” of these diseases and the Hospital strives to improve

and gradually equip itself to better handle these disease (both in terms of prevention and treatment).


48

1. PAEDIATRIC WARD

The Paediatric Ward complex is accommodated in two buildings with 61 beds: one main block

where most cases are admitted, and one smaller block designed as an isolation block with

separated rooms. With the closure integration of Nutrition Unit in early 2012, the block is used

as an extension of Paediatric ward to provide additional space for excess admission and to host a

few children admitted with malnutrition. The entire complex requires major renovation works

1.1. Staff Composition

The personnel assigned to this ward included 1 MO, 9 Nurses and 3 Nursing Assistants, 1

Nursing Aide. Some few students of the Midwifery School are also assigned for short period to

the Ward.

Table 6.24 Tabulated personnel assign to this ward

Cadre/ Discipline Qualification No Present

Medical officers Bachelor degree in Medicine and surgery 1

Enrolled Midwife Certificate of Enrolment 1

Enrolled Nurse Certificate of Enrolment 5

Enrolled Comprehensive Nurse Certificate of Enrolment 3

Nursing Assistant Certificate 3

Nursing Aide Trained on Job 1

Pediatric ward indicators over the last 5 FYs

The performance indicators of Paediatric ward show significant improvement in the performance of the

ward during the financial year. The ALOS drop from 4.8 to 4.6 during the year and the recovery rate

remained high.

Table 6.25 Paediatric Ward indicators over the last 5 FYs

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

No. of beds 108 61 61 61 61

Total Admissions 4,041 3,542 4,573 4,607 3,741

Bed days 19,862 12,555 18,165 22,325 17,498

ALoS 4.9 3.5 4.0 4.8 4.6

BOR 50.4% 56.4% 81.6% 100.3 79%

Throughput 37.4 58.1 75.0 75.5 61.3

Turnover interval 4.8 2.7 1.7 -0.0 1.3

No. Deaths 79 43 74 78 48

Death Rate 2.0% 1.2% 1.6% 1.7 0.7%

Recovery Rate 98.0% 98.8% 98.4% 98.3& 99.3%



49

1.2. Admissions

During FY 2014/2015, a total of 3,741 patients were admitted in Paediatric ward representing

18.8% decline in admission in the ward (a drop from 4,607 in FY 2013/2014 to 3741 in FY

2014/2015). This is a reverse of the incremental trend in admission witnessed in the last two

FYs. The admission in Paediatric ward alone contributes 28.8% of the Hospital total Admission.

The seasonal pattern of admissions remained similar with the previous financial year,

characterised by sudden increments of admissions at the beginning of the rain season, with high

peaks around June-July as shown in the diagram below.

Fig. 6.8: A line graph presenting the trend of monthly admission to paediatric ward in the

last three FYs

Malaria still remains the leading cause of admission in paediatric ward accounting for 27.0% of

diagnosis in the ward. During the 4th quarter of FY 2014/2015 (April-June 2015), the incidence

of malaria cases increased in paediatric ward accounting for 53.2% of total malaria diagnosis.

The sudden increase in malaria cases was equally observed in the Lower health facility in Agago.


50

Table 6.26 Top ten causes of admission in Paediatric Ward in FY 2013-2014 and 2014-2015

2013-2014 2014-2015

Causes of Morbidity No. of

cases

% on all

diagnoses

No. of

cases

% on all

diagnoses

1 Malaria 1,281 27.8 797 27.0

2 Pneumonia 854 18.5 410 13.9

3 Gastroenteritis / diarrhoeal diseases 764 16.6 627 21.3

4 Respiratory Tract Infection-(not Pneumonia) 712 15.5 350 13.9

5 Septicaemia 539 11.7 415 14.1

6 Anaemia 124 2.7 170 27.0

7 Severe Malnutrition 89 1.9 101 3.4

8 Sickle Cell Disease 85 1.8 38 1.3

9 Neonatal sepsis 50 1.1 25 0.8

10 Urinary Tract Infection 50 1.1 17 0.6

Table 6.27 Top five causes of death in Paediatric Ward in FY 2014-2015

Causes of Mortality among Inpatients No of Disease No of cases of Case

1 Perinatal conditions in new born (0-7 days) 12 58 20.7

2 Neonatal Septicemia 8 25 32.0

3 Anemia 8 170 4.7

4 Malaria 6 797 0.8

5 Pneumonia 6 410 1.5


51

2. MATERNITY WARD IN 2014-2015 FY.

The Maternity Ward is one of the largest wards in the Hospital with 75 bed capacity. The ward is

subdivided into various sections which include the Labour Room, and admission rooms divided

in Post Natal Room, Caesarean Room, Gynaecology Room, Drs’ office, Sr. In-charge office,

duty room, Private Rooms and the Premature Nursery. Maternity ward is run by 1 Medical

officer, and 20 Midwives who are directly responsible for management of patient admitted in the

ward. It is also a practical training ward for students of Midwifery at the Midwifery training

school in the Hospital; and on allows an average of 8 students for practical every day under the

supervision of a qualified midwife/mentor.

2.1. Staff Composition

Table 6.28 Personnel assign to maternity ward


Medical officers Bachelor degree in Medicine

/Surgery

1

Registered Midwife Diploma in Midwifery 2

Double Trained Nurse/Midwife Diploma in Nursing /Midwife 1

Enrolled Midwife Certificate of Enrolment 17

Maternity ward has a registered Nurse/midwife who is the ward in-charge and a core leader of all

the staff working in difference parts of the ward to manage the general activities needed for the

patients. The midwives in maternity works in shifts i.e. Morning shift from 8.00am- 3.00pm,

Afternoon shift from 2.00pm- 8.00pm and Night shifts from 8.00pm-8.00am.

2.2. Maternity ward indicators

Maternal Death Rate has decreased, Infection rate of caesarean sections also increased to 10%.

On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still Birth

Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.


particularly the senior midwives with many years of experience that affected the quality of work

in the hospital.

Table 6.29 Maternity Ward indicators over the last six FYs

2009-010 2010-011 2011-012 2012-013 2013-014 2014-015

No. of beds 76 76 75 75 75 75

Total Admissions 3,793 3,497 4,198 4,502 4,756 5,027

Bed days 23,499 18,014 19,801 21,994 21,987 22,173

ALoS 6.2 5.2 4.7 4.9 4.6 4.4

BOR 84.7% 64.9% 72.3% 80.3% 80.3% 81%


52

Throughput per bed 49.9 46.0 56.0 60.0 63.4 67.0

Turnover interval 1.1 2.8 1.8 1.2 1.1 1.03

No. Deaths 7 8 9 6 8 8

Death Rate 0.18% 0.22% 0.21% 0.13% 0.17% 0.2%

Recovery Rate 99.7% 99.4% 99.7% 99.8% 99.8% 99.8

Self-discharges 6 13 2 1 0 0

2.3. Admissions

During FY 2014/2015, a total of 5,027 patients were admitted in maternity (an increment of

5.6% in admission). Maternity ward admits the highest number of patients in the hospital and

contributed 38.7% of total Hospital admission during FY 2014/2015.

Fig.6.9: A line graph showing the trend of total admissions and delivery in Maternity ward in the

last 6 FY

The admission trends in maternity ward continued to increase every financial year. In

FY2014/2015 a total of 5,027 mothers were admitted in maternity (an increment of 5.7%)

compared to 4,756 admission in FY 2013/2014. The number of deliveries equally increased from


53

2,981 in FY 2013/2014 to 3,247 in FY 2014/2015 (an increment of 8.9%). This is still attributed

to the better services offered to the mothers from ANC and maternity ward which includes; good

health education, good hygiene, and better management in case of any complication during

delivery.

Table 6.30 Maternity Ward admissions – (Deliveries & Births indicators) in the last 6 FYs

FINANCIAL YEARS 2009/010 2010/11 2011/12 2012-13 2013-14 2014-15

Deliveries & Births Indicators Total deliveries 2,439 2,464 2,805 2,727 2,981 3,247

Normal deliveries in unit 2,042 1,970 2,289 2,178 2,532 2,816 Abnormal deliveries (incl. C/S) 397 391 516 549 449 431

Live birth in units 2373 2,304 2793 2,737 2,940 3,238

Babies born with low birth weight «2,5Kgs) 345 307 292 289 261 378

Fresh Still births in unit 16 17 11 19 18 32

Macerated still births in unit 23 14 16 18 18 30

Newborn deaths (0-7days) 0 41 23 55 31 28

FSB died in hosp. (FHS Heard before del.) 2 6 0 19 18 32

Maternal Deaths 7 7 7 3 5 3

For Live Births Full term Normal weight 2,306 2,427 2,466 2,448 2,598 2,860

Full term Low birth weight 212 177 292 289 261 378

Premature cases 111 80 35 23* 95 Info Not

available

For Caesarean Sections Elective C/S 7 35 21 48 46 42

Emergency C/S 238 302 384 431 403 327

Caesarean sections total 245 337 405 479 449 369

C/S as % of total deliveries 10.0% 13.8% 14.4% 17.6% 15.1% 11.4 Emergency C/S as % of all C/S 97.1% 89.6% 94.8% 90.0% 89.8% 88.6%

All deliveries in maternity are conducted / assisted by qualified personnel. Being a teaching

hospital, student for enrolment in midwifery are given a chance to participate in the follow up

and monitoring of labour progress and learn how to conduct deliveries under the supervision of a

qualified Midwife or Medical Doctor. Of the total 3,247 deliveries conducted in Maternity ward

during FY 2014/2015, 13.2% were by caesarean sections.

The 10 top reasons for Caesarean Sections:

1. Foetal distress.

2. Previous scars.

3. Obstructed labour with or without distress.

4. Abnormal presentation – breech, persistent occipital, posterior etc.

5. Cord/arm prolapsed.

6. Prolonged labour and post term.

7. Ruptured Uterus.


54

8. [CPD] constricted pelvis in young primigravida.

9. Big baby.

10. Delays in 2nd stage.

The number of caesarean section conducted in Dr. Ambrosoli Memorial Hospital has decreased

from 6.3% in 2013-2014 FY to 17.8% in 2014-2015. A total of 311 mothers who had Caesarean

section were from Agago District and 58 cases from the neighbouring districts. The Hospital,

being the only health facility with a functional theatre and Qualified Medical personnel, is the

main referral facility for pregnant women with complication and risk related to delivery that may

require C/S. However, due to the poor referral means (mostly Bodaboda motorcycle) and

conditions of roads, many of pregnant mothers often arrive in the hospital in advance stage of

labour or in critical conditions which requires emergency C/S. It’s apparent the region does not

have good transport means and roads; and even the available ones are unreliable. This limits the

pregnant women from accessing the Hospital at the right time. This situation has persisted and

affected the referral and response to obstetric emergencies in Agago District.

Table 6.31 Provenance of mothers delivered through C/S in the last 4 FYs

Within the Catchment Area of Agago District

Outside the Catchment Area of Agago District

Sub-

011-

012-

013-

014-

Sub-County 011-

012-13 013-

014-

Adilang 26 27 34 28 Pader 26 29 30 26

Kotomor

54

23 12 14 Pajule 6 4 2 3

Patongo 42 38

32 Namokora 3 2 1 1

Patongo

Omiya

3 7 4 5

Lukole 52 38 39

45 Awere 0 5 1 1

Lukole T.C. Orom 8 4 2 2

Kalongo

55 50 49 21 Abim 4 14 6 11

Paimol 27 23 17 25 Corner Kilak 1 3 2 0

Parabongo 23 38 30 14 Other

9 12 3 9

Omot 21

19 30 14 Acolpii 8 15 11 Lamiyo 11 7 5 Lapono 25 36 49 36 Lira Palwo 23 25 28 17 Omiya

16 24 26 19 Wol 23 35 24 30 Total 345 399 398 311 Total 60 80 51 58

Note: Data for Patongo town council and Patongo Sub county is not disaggregated, the same applies to Lukole Town Council

and Lukole Sub county (source: Kalongo Hospital theatre operation book FY 2011-2012 to FY 2014-2015)

2.4. Other Services/Departments in Maternity

Other than Pregnancy related conditions, maternity ward also admits and provides

gynaecological and Neonatal services.


55

a) Gynaecological ward

In FY 2014-2015 a total of 147 women were admitted in maternity ward with Gynaecological

conditions other than pregnancy (5.1% of all Maternity Ward admissions) as provided in the

table below.

Table 6.27: Admissions in Maternity Ward not related to maternity conditions

Diagnosis of admission 2010-

2011-012 2012-013 2013-014 2014-015

Pelvic Infection Diseases [P.I.D] 59 38 95 106 37

Urinary Tract Infection [U.T.I] 12 16 58 91 57

Cancer of cervix 22 30 30 25 10

Uterine Fibroid 25 8 15 16 7

Ovarian Cyst 25 20 9 12 23

Vaginal candidiasis 8 5 7 6 5

Bartolini’s cyst n.a. n.a. 5 6 7

Peritonitis 4 8 2 2 1

Total 158 130 221 243 147

b) The Nursery

The Nursery is where neonatal and perinatal conditions in new-born babies are managed. The

department is run by Maternity staffs. The ward doctor of maternity and paediatric ward provides

the clinical management of the new-born babies in the nursery.

The commonest causes of admission in new-born babies during 2014/2015 were severe

asphyxia, Neonatal sepsis, jaundice, prematurity and congenital conditions. The nursery is

equipped with an incubator, a phototherapy machine, an oxygen concentrator and a warming

light (dysfunctional).

3. MEDICAL WARD IN 2014-2015 FY

Medical Ward is located in one main block divided into two sections for female and male

patients. It also has an adjacent wing which has four 2-bed rooms and three self-contained

private rooms built with support from Ambrosoli Foundation and some equipment and beds

provided by Italian cooperation.

3.1. Staff Composition The Ward is run by a Medical Officer, Nurses/Midwives, Nursing Assistants and Nursing Aide. In an

effort to enhance learning and clinical practices, a few students of the Midwifery School are also

assigned for short periods to the Ward. The same staff covers also the TB Ward and support the

functionality of OPD especially during Weekends, public holidays and after 5.00pm when the main

OPD is closed.


56

Table 6.33 Personnel assign to this ward


Medical officers Bachelor degree in Medicine/surgery 1

Enrolled Nurse Certificate of Enrolment 1




3.2. Key indicators in the Medical Ward

Table 6.34 Key indicators in the Medical Ward during the last five FYs

Ward: MEDICAL 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

No. of beds 65 58 58 58 41


Bed days 11,644 8,703 10,148 10,743 8,045

ALoS 6.9 5.5 5.4 4.7 3.9

BOR 49.1% 41.1% 47.9% 50.7% 53.8%

Throughput per bed 26.0 27.2 32.6 39.4 50.1

Turnover interval 7.1 7.8 5.8 5.1 3.4

No. Deaths 118 87 89 105 93

Death Rate 6.0% 5.5% 4.7% 4.6 4.5

Recovery Rate 92.8% 94.3% 95.1% 95.1% 95.4


3.3. Admission in Medical Ward

In FY 2014/2015, the admission in Medical ward dropped by 10% altering the ever incremental

trend in admission observed in the last three FYs. The drop in admission in Medical ward was

not peculiar to Medical ward only since all other wards except maternity, experienced a decline

in admission.

Malaria is still the leading cause of morbidity in Medical Ward and accounting for 13.8% of total

admission during FY 2014/2015.

Table 6.35 Top 10 causes of admissions in Medical ward in FY 2013-2014 and 2014-2015 FYs

2013-2014 2014-2015

Causes of Morbidity No. of cases

admitted

% on all

diagnoses

No. of cases

admitted

% on all

diagnoses

1 Malaria 272 11.9 686 13.8

2 Gastrointestinal disorders

not infective 246 10.8 376 7.6

3 Pneumonia 223 9.8 153 3.1


57

4 Typhoid Fever 91 4.0 74 1.5

5 Respiratory Tract

Infections-(not Pneumonia) 85

3.7 168 3.4

6 Urinary Tract Infection 71 3.1 97 1.9

7 Cardio vascular Disease 78 3.4 76 1.5

8 Septicaemia 69 3.0 245 4.9

9 Hypertension 59 2.6 68 1.4

10 Asthma 32 1.4 62 1.2

Table 6.36 Top 5 common causes of death in Medical ward in FY 2013-2014 and 2014-2015

2013-2014 2014-2015

Causes of No of No of Case No of No of Case

1 Pneumonia 8 223 3.6 % 16 153 3.9

2 Cardiovascular

5 78 6.4 % 17 76 2.0

3 Septicaemia 5 69 7.2 % 3 245 6.3

4 Liver Cirrhosis 4 30 13.3 % 2 38 1.0

5 Suicide attempt 4 18 22.2 % 2 108 2.8

4. SURGICAL WARD

Surgical Ward is accommodated in a large building divided in two sessions for female and male

patients. One room is also available for children. The building is one oldest building in the

hospital, it needs substantial renovation works.

4.1. Staffing composition of surgical ward

Table 6.37 Staff composition in surgical ward in 2014-2015 FY


Medical officer Bachelor degree in Medicine/surgery 1

1 volunteer surgeon from JRCs Surgeon 1

Double Trained Nurse/Midwife DNM 1

Registered Nurse Diploma in Nursing 1

Enrolled Comprehensive Nurse Certificate Comprehensive Nurse 6

Enrolled Nurses Certificate of Midwifery 3


Orthopaedic Officer Diploma in orthopaedics 1


58

4.2. Key indicators in the surgical ward

The performance of Surgical Ward slightly decreased from in 2,028 FY 2013-2014 to 1,974 in

FY 2014-2015. The ALoS was further reduced to 7.9, and the Throughput per bed increased to

25.9 The BOR has decreased however to 56.5%, despite the increment of admissions. The

Hospital needs to evaluate the option of reducing the number of beds and allow better space

management in the Ward in relation to the expected number of admissions. Nevertheless, if the

current trend experienced in the last couple of years is maintained then it may be justified

keeping the number of beds as they are at present.

Table 6.38 Key indicators in the Surgical Ward during the last five FYs

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

No. of beds 76 76 76 76 76


Bed days 17,386 16,799 17,093 16,394 15.685

Ave. length of stay 13.2 10.2 9.6 8.1 7.9

BOR 62.7% 60.6% 62.4% 59.1% 56.5%

Throughput 17.4 21.7 23.4 26.7 25.9


No. Deaths 19 16 24 18 22

Recovery Rate 97.8% 98.5% 98.1% 97.9% 98.4


4.3. Admissions in Surgical Ward

The overall performance of the Surgical Department has remained definitely improved over the

last 3 years and this has been largely possible thanks to the constant presence of specialist

surgeons provided on a rotation basis by the Japanese Red Cross Society. Their presence, in fact,

has not only helped the hospital to secure competent management of surgical cases both for

elective and emergency surgery, but also has allowed constant on the job training for the Medical

Officers and Nurses assigned to the Ward.

Table 6.39 Top 10 causes of admissions in Surgical Ward in FY 2013-2014 & 2014-2015

2013-2014 2014-2015

Causes of Morbidity No. of % on all

No. of % on all

1 Injuries due to other causes 804 39.6 1,328 26.7

2 Hernias 151 7.4 86 1.7

3 Injuries due to domestic violence 127 6.3 475 9.5

4 Abscess 181 8.9 223 4.5

5 Injuries due to Road Traffic Accident 191 9.4 119 2.4

6 Hydrocele 65 3.2 68 1.4

7 Snake bites 61 3.0 54 1.1


59

8 Osteomyelitis 49 2.4 44 0.9

9 Urinary Tract Infections 38 1.9 23 0.5

10 Intestinal Obstruction 36 1.8 44 0.9

Table 6.40 Top 5 common causes of death in Surgical Ward in 2013-2014 & 2014-2015 FYs.

2013-2014 2014-2015

Top Ten Causes No of Total No of Case No of Total No Case Fatality

1 Injuries due to

5 804 0.6 7 650 16.7

2 Complications of

2 151 1.3 0 113 2.9

3 Injuries due to 2 191 1.0 6 218 5.6

4 Intestinal

1 36 2.8 3 43 1.1

5 Injuries due to

1 127 0.8 1 134 3.4

5. THEATRE SERVICES

The new Theatre Block constructed with the support from the government of Japan and Dr.

Ambrosoli Memorial Hospital was commissioned in the month of March 2015. This new theatre

block hosts 3 operating rooms with 2 appropriate changing rooms for the staff which is separated

into male and female sections. It also has one recovery room, one duty room, one In-charge

office, one store, one sluice room and one sterilization room.

Table 6.41 Number of staff assign to theatre department


Registered Nurse Diploma in Nursing 1

ECN/Anaesthetist Diploma in Nursing 1

Enrolled Midwife Certificate of Enrolment Enrolled Nurse Certificate of Enrolment 2




Table 6.42: Top major surgical procedures carried out in theatre during the previous year

Top major surgical procedures done Number of

Proportion

1 Caesarean section 369 65.3

2 Laparatomy: 79 14.0

3 Evacuation 6 1.1

4 Orif (Open reduction and internal

6 1.1

5 Thoracotomy 1 0.2

6 Other major procedures 104 18.4

Total 565 100.0


60

Table 6.43 Pattern of anaesthesia used during the last 5FYs

Type of Anaesthesia 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Local Anaesthesia 145 316 321 1,287 569

General Anaesthesia with IV

Ketamine

1,613 1,877 1,705 1,039 1030

Spinal Anaesthesia 141 265 527 518 290

General Anaesthesia with ETT 11 10 52 42 24

Total 1,910 2,468 2,605 2,886 1,913

Currently the hospital does not have a qualified Anaesthetist; a Nurse who has been trained by a

specialist and has over seven years of experience is at the moment providing some limited

support in this department. The hospital has sent one clinical officer for a diploma course in

anaesthesia due to complete in July 2016.

Table6.44 Top minor surgical procedures done in FY 2014-2015

No Top ten surgical procedures done Number of Patients Proportion (%)

1 Safe Male Circumcision 468 34.7

2 Debridement and wound care 226 16.8

3 Incision and drainage of abscesses 273 20.3

4 Herniorrhaphy 213 15.8

5 Minor ENT Surgery 127 9.4

6 Other Minor Procedures 41 3.0

Total 1,348 100.0

Table6.45: Trend of surgical activities in last 5 FYs

Financial Years 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Total Operations 1,910 2,468 3,017 2,886 1,913

Major operations

(including C/S) 640 730 803 663

565

Minor operations 1,270 1,738 2,219 2,223 1,348

Emergencies 331 352 445 416 327

Emergencies as % of

total major operations 51.7% 48.2% 55.4% 62.7%

57.9%


61

6. TB WARD

The TB Ward is located in a single old building. It is divided into two sessions (Male and Female

Rooms) and is managed by the same medical and nursing personnel of the Medical Ward. The

TB Control Programme (and the follow-up of patients on treatment) is also managed directly in

this Ward by the same staff.

While most activity data regarding the TB programme has been presented in the Specialist Clinic

- OPD section of this report, in table 6.38 only the data concerning the admissions to the Ward

are presented.

6.1. Key indicators in TB ward

Table 6.45 Key indicators in the TB Ward during the last five FYs

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

No. of beds 24 24 24 24 18

Total Admissions 244 258 240 267 186

Bed days 5,327 3,754 5,931 5,421 3891

Ave. length of stay 21.8 14,6 24.7 20.3 21

BOR 60.8% 42.9% 67.7 61.9 59.2%

Throughput 10.2 10.8 10 11.1 10.3


No. Deaths 9 15 10 13 8

Recovery Rate 96.3% 94.2% 95.8% 95.1 95.7%

Self-discharge n.a. n.a. 0 0 0

The performance indicators for TB ward show that at present; the ward is not used in a very

efficient way. The management of TB patients needs to be re-addressed and streamlined by

minimising hospitalisation and, on the other hand improving on the quality of care so as to attain

a higher level of cure rate. The number of beds in the Ward has been reduced to 18 at the

beginning of the new FY 2014/2015.

7. PRIVATE WARD

In FY 2014-2015 the data from private ward was integrated into the report from inpatients

services in different wards. There is need to strengthen the private ward as a stand-alone

department in order to make health care services accessible and effective to the customer who

can afford to pay health care services.


62

D. DIAGNOSTIC SERVICES–LABORATORY AND BLOOD TRANSFUSIONS

1. Laboratory Services

Dr. Ambrosoli Memorial Kalongo hospital laboratory has initiated a hub with support with MoH

and UCMB. It serves sixteen lower health unit laboratories in Agago and Pader health District.

The hub renders a complete ART care package for HIV infected patients in terms of laboratory

tests amongst which are CD4 testing, chemistry haematology analysis and collecting Dry Blood

Spot for DNA-PCR and other samples that cannot be analysed at the hub are referred to the

central laboratories, Viral load, all this processes are interlinked through the hub rider who picks

the specimen samples from and distribute results to facilities. Posta Uganda is the means through

which referred samples are dispatched and results sent to and from the Central laboratories. The

hub has now existed for one and half years. The Laboratory and Blood Transfusion services have

been conducted by: 1 Laboratory Technologist, 2 Technicians and 5 Laboratory Assistants.

Table 6.46: Trend of Laboratory testing workload in the last 5 FYs

Type of Tests FY

2010-11

FY

2011-12

FY

2012-13

FY

2013-14

FY

2014-15

Parasitology

Malaria Microscopy, Malaria RDTs,

Other Haemoparasites, Stool

Microscopy.

16,705

11,379

12,163

15,351

16,178

Haematology

HB, WBC Total, WBC Differential,

Film Comment, ESR, RBC, Bleeding

time, Prothrombing time, clotting time,

blood transfusion tests, & Others

4,249

6,861

8,160

13,707

26,829

Biochemistry

Urea, Calcium, Potassium, Sodium,

Creatinine, ALT, AST, Albumin, Total

protein, Triglycerides, Cholesterol,

CK,LDH, IkalinePhos, Amylase,

Glucose, Uric Acid, Lactate, Others

4,634

1,872

3,404

2,688

5,936

Bacteriology

ZN for AFBs, Cultures and

Sensitivities, Gram, Indian Ink, Wet

Preps, Urine Microscopy

2,495

2,431

2,419

6,407

11,141

Serology

VDRL lRPR, TPHA, Shigella

Dysentery, Syphilis Screening,

Hepatitis B, Brucella, Pregnancy Test,

Widal Test, Rheumatoid Factor

15,252

5,629

8,908

12,934

21,184

Immunology CD4 tests & others 1,223 1,647 2,515 4,432

Pathology n.a.

HIV tests by

purpose

HCT, PMTCT, Quality control and

clinical diagnosis 10,841 11,142 9,869

12,623

Total tests (crude ) 43,335 40,236 47,843 63,471 98,323

Total lab staffs 6 7 7 8 8

Average tests per Lab staff 7,223 5,748 6,835 7,934 12,290


63

There has been relatively greater increment in the number of tests performed in 2014-2015 FY at

54.9% compared to 32.7% in 2013-2014 FY. It appears that the demand for laboratory testing by

the clinicians has increased, as well as the compliance with protocols requested by project and

health programmes. The productivity of the laboratory staff has increased from 7,934 (16.1%) in

2013-2014 to 12,290 (54.9%) in 2014-2015 tests per staff.

Table 6.47 Percentage of positive findings per selected examinations in the two FY

2013-2014 FY 2014-2015 FY

Type of Test Total

Total % Total Total %

Malaria (both slide and RDT) 13,557 1,733 12.8 14,999 2,331 15.5

Tuberculosis 1,341 151 11.3 1,199 182 15.2

Widal 4,729 908 19.2 5,947 672 11.3

Hepatitis B 1,046 123 11.8 2,585 260 10.1

Stool microscopy 831 244 29.4 1,179 197 16.7

Table 6.48 the proportionate distribution of blood groups and Rhesus factor D

2013-2014 FY 2014-2015 FY

Group

A

Group

B

Group

AB

Group

0

Rhesus

Factor D

positive

Group

A

Group

B

Group

AB

Group

0

Rhesus Factor

D positive

29% 17% 3% 51% 98% 29.8% 18.3% 4.8% 46.1% 98%

E. DIAGNOSTIC SERVICES - X-RAY, ULTRASOUND

1. X-Rays Department

The X-Ray department is staffed with three X-Ray attendants trained on the job. This situation is

not ideal and despite many years of working experience, the lack of professional qualification

and supervision occasionally affects the quality of the films produced.

Table 6.49: X-Ray examinations done over the last 5 FYs in the hospital

2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Chest 1,846 2,206 2,246 3,176 2974 Upper extremities 722 897 854 1,118 1,172

Lower extremities 557 789 846 1,067 959 Vertebral Column 149 143 283 336 314

Skull and Mandible 137 184 166 330 269

Shoulder and clavicle 113 163 156 221 234


64

Pelvis and hip 167 184 154 142 276

Abdominal – Plain 107 160 169 142 226

Abdominal Contrast 0 16 8 4 1

Screening(chest & other)

4 26 0 0 0

Total 3,802 4,768 4,882 6,536 6,423

2. Ultrasound investigations

Currently the hospital has two Ultrasound machines and one sonographer with a diploma

qualification. The major challenge is the lack of probes for vaginal examination and for system

cardiovascular (Doppler).

Table 6.50: Ultrasound examinations conducted in the last 2 FYs

2013-2014 2014-2015

Obstetrics 434 1,470

Gynaecology 518 1,463

Abdomen 348

1,715 Liver

Soft tissues (Small Parts) 20 141

Heart 0 0

Total 1,320 4,789

Fig. 6.10: A bar graph illustrating the trend of X-ray and Ultra Sound done during the last two FY

Ultrasound was not done in 2012-2013 because of no trained personnel to perform the operation

of the machine and therefore only the two years are reflected.


65

ECG

The Hospital has also an ECG machine but the Medical Officers are not yet sufficiently

experienced in this examination to allow an effective routine utilisation.

The Hospital has conducted training for all the Medical Officers and Clinicians in order to use

and interpret ECG results. In addition the hospital is working closely with a cardiologist from

Italy for the quality of care in this department.

Endoscopy examination

The endoscopy machine exists but it is only used currently by Japanese surgeon according to the

need, the hospital is committed to ensure that the resident surgeon/ senior medical doctor and

other doctors are trained to use this tool effectively.

F. PHARMACY ACTIVITIES

The transfer of the Pharmacy to the new location took place in the first months of FY 2014-2015

and allowed also the transfer of other items (laboratory reagents, gloves, and water for injections)

that had been kept in the General Store. Some items (bulky sundries) are still kept in the General

Store.

In the second half of the year the Hospital has received the technical support of one qualified

Pharmacist from the Japanese Red Cross Society. The objective of this collaboration is to assist

the hospital pharmacy staff to adopt new and more effective procedures to manage and control

the drugs stock and to improve on the drug management both in the pharmacy and the wards.

Under this technical assistance the Hospital Management accepted the introduction of the Unit

Dose System (UDS) for distribution and dispensing of therapies to admitted patients. The new

system which is currently introduced in Surgical and Maternity wards will be extended during

the FY 2015-2016 to the other wards and departments.

1. Staffing level in Pharmacy and General Store

Pharmacy:

One Pharmacy Technician

Three Pharmacy Assistants

One Enrolled Midwife

One Nursing Aide

General Store:

One Store Assistant

Two support staff


66

2. Pharmaceutical supplies

The supplies are mainly ordered from Joint Medical Store (JMS). Items not available at JMS are

bought from other providers like Abacus and Gitteos. JMS and Medical Access – Maul are main

suppliers for most of the Government or other projects).

3. Procurement system

Drugs and sundries are procured in most cases on a quarterly basis. The items to be purchased

are selected basing on the needs of the hospital in line with the Essential Drugs List of Uganda

and the treatment policies. The quantity to be purchased is determined based on the quantity at

hand, average monthly consumption and the available finances.

4. Inventory management

There is a manual and computerized inventory system that helps to manage purchase and stock

movements. Stock taking is done on a quarterly basis and physical count monthly to ensure the

system works well and agrees with what is present physically in the store at that moment.

5. Storage

The arrangement within the store is based on the dosage form where tablets and capsules are kept

on the same shelf while separate shelves are used for parenteral, oral liquids and topical creams

and liquids. The concept of FEFO (first expiry first out) is also employed in order to minimize

losses due to expiry.

The drugs are stored on shelves and the heavy ones are placed on floor pallets. Cold storage

items are kept in the fridge and the temperature is monitored every day to ensure it is within the

desired range of 2°C to 8°C.

The condition of the entire store is also monitored. The readings are taken 3 times a day because

of the variations during the day. An average value is obtained at the end of the month. The

hospital plans to procure additional temperature monitoring equipment to be availed to all the

rooms in the pharmacy were drugs and any such supplies are kept.

Table 6.5: Average temperature and humidity recorded in Pharmacy Department during the

last two FY.

2013-2014 FY 2014-2015 FY

Reading

Temperature Humidity Reading

Temperature Humidity

8.00am 24.6°C 69.7% 8:15 am 10.8°C 71.5%

12.00pm 28.5°C 55.9% 12.00pm 11.1°C 55.1%

5.00pm 30.4°C 55.4% 5.00pm 11.0°C 56.9%

Stocks are checked regularly when issuing and during the monthly counts for near expiry and

expired drugs. The near expiry drugs are consumed or donated before they expire. The expired

drugs are removed from the store and prepared for destruction by National Drug Authority

through the Health Sub District.


67

6. Distribution and use

The pharmacy issue drugs to the different ward and departments basing on their consumption

and average patient number. The departments make request from the pharmacy using ward order

books and requisitions. The Hospital is planning to introduce the Unit Dose System for the

administration of therapies in all wards.

Table 6.52 Twenty most used drugs in FY 2013-2014 in all Hospital departments (excluded

HIV/AIDS clinic)

Drug description Quantity

issued

in FY

2012-2013

tablet/vials

Quantity

issued

in FY

2013-014

tablets/vial

Quantity

issued

in FY

2014-2015

tablets/vial

Monetary

value

for FY

2013-2014

(UGX)

Monetary value

for FY

2014-2015

(UGX)

Paracetamol 500mg 321,635 325,364 305,442 5,681,796 4,920,670.62

Metronidazole 200mg 245,974 267,189 202,387 6,054,999 6,201,137.68

Amoxicillin 250mg 272,800 244,900 237,131 13,785,972 13,094,373.82

Folic acid 77,100 179,955 104,164 714,032 505,195.40

Multivitamins 131,108 114,975 151,761 2,637,527 3,481,397.34

Erythromycin 250mg 127,174 93,990 114,337 8,970,406 10,525,864.22

Diclofenac 50mg 86,270 91,495 53,387 1,462,090 826,430.76

Prednisolone 5mg 103,180 88,540 82,592 3,673,525 3,406,094.08

Ferrous sulphate +folic acid 124,401 85,980 103,574 918,266 1,697,577.86

Ciprofloxacin 500mg 72,810 85,632 79,023 6,730,675 6,037,357.20

Carbamazepine 200mg 66,450 80,970 94,278 3,959,433 4,551,741.84

Ampi-/Cloxacillin 500mg 18,460 76,980 87,311 8,590,198 9,842,569.03

Ibuprofen 200mg 73,431 74,030 104,149 1,918,117 2,698,500.59

Vitamin B complex 84,900 73,564 84,228 1,103460 1,132,866.60

Cloxacillin 250mg 95,060 70,570 36,400 4,799,466 2,475,564.00

Ampicillin 500mg injection 42,729 69,985 60,415 33,643,889 23,363,688.80

Chloramphenicol 250mg 18,800 43,580 35,776 3,467,661 2,846,696.32

Magnesium trisilicate 250mg 51,741 43,471 39,228 516,870 496,626.48

Pyridoxine 25mg 35,911 41,300 27,355 425,390 301,452.10

Mebendazole 27,000 40,807 30,608 679,845 470,751.04

Total 109,733,617 98,876,555.78

a) The unit dose system of drugs management is playing a big role in reducing drugs wastage,

i.e. why the monetary value for financial year 2013-2014 is more compared to monetary

value for financial year 2014/2015.

1. Integration of private ward into other wards e.g. Medical ward.

2. Improvement in Lower health facilities leading to decongestion of patient in the hospital.

3. Pharmacy improvement in stock management.


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7. Challenges

The adoption of the Unit Dose System for dispensing therapies and its gradual extension to all

the wards is demanding a greater workforce in the Pharmacy than the one currently available.

Also the physical space of the Pharmacy, although greatly increased and improved from the

previous location, needs further expansion in order to attain the necessary standard.

The Drug and Therapeutic Committee was established with Terms of Reference and a clear

mandate to address the various aspects of drug management. Its activity has been quite

fluctuating and management is committed to support its activities.

G. INTRAVENOUS FLUID CONSUMPTION

The consumption of intravenous fluids in FY 2013-2014 is presented in Table 6.45.

Table 6.53 Consumption of IV Fluids in FY 2012-2013 to 2014-2015 FYs.

Fluid Description Quantity

FY 012-013

Quantity

FY 013-014

Quantity

FY 014-015

Value (UGX)

for

Value (UGX)

for Water for Injection 10ml 36,107 50,420 51,924 3,831,920 4,284,768

Sodium Chloride 0.9% IV 500ml 16,348 17,148 16,541 21,335,885 19,742,511

Dextrose 5% IV 500ml 7,082 4,500 5,496 5,481,045 6,694,183

Dextrose 5% IV 250ml 5,881 4,380 1,236 5,070,332 1,432,833

Sodium Lactate Compound IV 500 ml 3,931 3,197 1,922 4,194,400 2,367,558

Dextrose 50% IV 100ml 1,532 1,295 651 2,396,553 1,208,432

Gelatine/polygeline Solution 3.5% IV 500ml 182 156 71 2,507,232 1,720,654

Darrow’s Half Strength 500 Ml 129 57 95 326,701 234,546


69

CHAPTER SEVEN

SUPPORT SERVICES

1. Pastoral care

Pastoral care is provided in the Hospital to all patients by a Social Worker, a Catechist and a

Priest. All these persons are volunteers who are not on the payroll of the hospital.

Table7.1: Activities trend in Clinical Pastoral Care of the Sick during the last 5 FYs

Activity / Indicator 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

No. patients visited or counselled 136 394 55 120 228

No. patients baptized 69 198 39 43 0

No. patients confirmed 37 149 0 0 0

No. patients given Sacrament of

marriage

11 45 0 0 0

No. patients anointed 19 2 25 11 4

2. Ambulance service

Referral of patients is from LLUs to the hospital or from the hospital to the Regional Referral

Hospital, and the Lacor Hospital of Gulu and the National Referral Hospital of Mulago and

Butabika as well as other specialised hospitals for further management.

The Hospital uses two Land Cruisers for the provision of Ambulance service. One is fairly new,

but the second is quite old and can be used only for short distances. Currently patients are

required to contribute to the cost of fuel but in case of life-threatening emergencies the transport

is provided. In circumstances the patient is unable to afford, the hospital takes on, however, this

is not sustainable since there is no funding earmarked for this activity.

3. Technical services

The Technical and Maintenance Department of the Hospital is mandated to ensure the ordinary

and extraordinary maintenance of all structures and equipment (including vehicles) for both the

Hospital and the Midwifery Training School. It provides technical assistance and supervision any

time extraordinary renovations and bigger scale constructions are contracted out. The Technical

Department also develops and carries out income generating activities that is meant to

contribute, without additional costs, the sustainability of the Hospital.


70

Table 7.2: Consumption of fuel by destination in the last 5 FYs

FY

2010-2011

FY

2011-2012

FY

2012-2013

FY

2013-2014

FY

2014-2015 DIESEL TOTAL 34,155 34,917 38,413 40,509 33,128

(Board of Governor) Fuel Refund to

members

142 40 0 140 417

Generators 10,946 12,646 13,656 18,618 11,890

Vehicles 14,857 15,984 21,586 20944 19,769

Workshop 22 20 18 47 26

Incinerator 230 265 260 255 260

Others 7,959 5,962 2,893 505 766

PETROL TOTAL 1,717 1,692 1,523 2,020 2,709

Donation 200 160 0 59 0

Generators 0 0 0 0 0

Vehicles 170 583.5 247 184 15

Motorcycles 203 331 556 1,340 2,275

Workshop 30 13.5 65 64 0

Others (Sales) 1,101 604 655 373 419

KEROSENE TOTAL 158 171 196 171 105

Workshop 54 67 49 7 78

Pharmacy 0 0 0 0 3

Main store 27 0 21 1 0

Others 77 104 126 164 24

4. Domestic services

4.1. Water Supply

The Hospital has access to a substantial water supply provided by four wells that serve also the

School, the Mission of the Comboni Fathers and the Convent of the Little Sisters of Mary

Immaculate. The wells are located at approximately 1,300 metres from the Hospital. The water is

pumped to two main tanks with a total capacity of 90.000 litres. The distribution and storage of

water is provided by a network of pipelines that were installed many years ago and currently

show signs of wearing (with leakages that increase the costs of the supply). All buildings are

provided with small tanks (average capacity of 150 litres). Overall the reserve capacity in the

tanks is very small and allows no more than 2-3 days autonomy. A complete analysis of the

yielding capacity of the wells and on the quality of the water pumped was conducted as a basis

for further planning and interventions.

Actions Required:

• Install new pipelines to link the wells to the main tanks.

• Improve/increase the storage capacity of water to a total reserve of at least 240,000 litres.

• Repair/renovate the entire distribution system to eliminate leakages and secure regular

supply.

• These actions are expected to be executed gradually during the next 2-3 FYs.


71

The government has already planned in provision of piped water for the town council and

activities are already underway. The hospital shall also connect to the systems but shall continue

to maintain the private wells.

4.2. Power Supply

The Hospital has been receiving power from the national electricity network since March 2010.

However the supply is not constant and the Hospital has still to rely on generators to provide

sufficient power. In some Hospital Departments and in the Doctors’ quarter small solar systems

provide additional power for lighting. Due to insufficient funding no major activities have been

done to improve the system. The generators of the Hospital are also under-dimensioned in

relation to the requirements that are expected in the near future

Action Required:

• Re-organise the electricity distribution system, replace cables and install new electric

boxes as required to avoid dispersion and losses and ensure safety for all users.

• Procure a new or refurbished generator with substantial higher capacity.

4.3. Sewage System

The sewage system of the hospital serves the entire Hospital, with the doctor’s quarters, plus the

Midwifery School and also the nearby Parish and Convent. All sewage is disposed through a

lagoon at about 600 m from the Hospital.

The hospital got funding from Wamba Anthena Onlus-Cariparo Project through Ambrosoli

Foundation for the rehabilitation of the lagoon. Work started in April 2014 and this involved

constructing a new pre-treatment unit (PTU), Treatment wetland Plant (TWP) and a Sludge

Drying Reed Bed (SDRB). This project shall be completed next financial year. We expect to

have a fully functional and efficient sewage system that is environmentally friendly. There is still

insufficient number of Toilets and bathroom to equate the number of users in the hospital. There

is still a lot of work required to improve these facilities. Actions Required:

• Completion of the major renovation of the sewage system Construct/renovate toilets and

bathroom of the Hospital including that of the staffs residence.

4.4. Waste Disposal

Due to the big population of both the Hospital and the School of about 800 people (staff,

students, patients and attendants) a lot of waste is generated and yet the capacity to manage the

waste is very minimal. The hospital in the same project of the sewage system, has also procured

a new incinerator that has been dimensioned to the appropriate capacity and the building will be

constructed near the lagoon at a distance that does not cause pollution to the population.


72

Much as a new incinerator shall be installed, a lot of effort has to be made in building capacity

and creating awareness on how to properly manage waste. This is still a big challenge that needs

changing the mind-set of the people.

Action Required:

• Install the new incinerator with the capacity to manage the amount of hospital solid

waste.

• Train and build capacity of staffs in the management of waste

• Develop means for the collection and removal of waste to be transported to a final

location of permanent disposal agreed upon with the local Authorities.

5. Internet and Intercom Telecommunication

5.1. The hospital Internet system

The effectiveness of the internet connectivity in the hospital has become quite insufficient and

unreliable. The Internet connection speed has never been faster than 30 KB/s measured by a

direct connection to the satellite receiver. This is very poor taking into account the number of

users and volume of data involved.

Action Required:

• Install a complete WI-FI system for deploying internet connection to cover the entire

hospital complex

• Contact a service provider like MTN or Airtel and procure a bandwidth of 21.6mb/s 3G+

technology

5.2. Intercom Telecommunication

The hospital intercom telecom system with over 80 lines which used to serve the entire Hospital,

with the doctor’s quarters, plus the Midwifery School and also the nearby Parish and Convent

has become old and worse still, was struck by lightning thus destroying the motherboard. Less

than 20 lines are available and this is quite insufficient to serve well the entire hospital.

Action Required

• Adopt and procure a new or refurbished wireless voice communication system with

cordless telephones e.g. a DECT System. This is to avoid copper wired phone lines which

quite costly


73

CHAPTER EIGHT

8.1. Quality and patient safety improvement

The Quality improvement initiatives was harmonized and institutionalized at HCFs within the

national quality improvement framework through technical support from the team of nurses from

Japanese Red Cross society and UCMB.

8.1.1 Quality indicators

1. Availability of clinically qualified staff in the hospital

In the last five years the number of qualified staff has increased, the Hospital is gradually

phasing out both Nursing Aides and Nursing Assistants or transferring them to other non-clinical

responsibilities. Moreover efforts have been made to recruit more qualified staff in a few

departments (Laboratory, Theatre, Maternal related services).

It is to be noted that the Nursing Aides and Nursing Assistants have been counted as Unqualified

Staff.

Table 8.1 - Proportion of clinically qualified staff in the hospital in the last 4 FYs

2. Quality of care

Maternal Death Rate has decreased, however the Infection rate for caesarean section increased to

10%. On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still

Birth Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.



Indicators 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015

Total No. of employees 219 213 220 212 239

Qualified staff 102 113 120 138 194

Clinically qualified staff 86 100 88 97 108

Proportion of clinically qualified

staff over all qualified staff

84.3% 88.5% 73.3% 70.3% 55.67%


staff over all clinical staff

71.1% 84.0% 83.0% 87.4% 85.71%


staff over the total hospital staff

39.3% 46.9% 40.0% 45.8% 45.19%


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Maternity Ward. The stability and adequate qualification of human resources is a prerequisite to

have an effective improvement measures for quality attainment.

Table 8.2: Indicators for the quality and safety measures Indicators 2010-

2011

2011-

2012

2012-

2013

2013-

2014

2014-

2015

Explanation

Recovery rates

on discharge 97.6% 98.3% 96.5% 97% 99%

Recovery rates on discharge:

patients in one year discharged as

clinically recovered from that episode

of disease (from all wards) following

treatment.

Maternal

death rates

after

admission in

maternity

0.20% 0.17% 0.07% 0.11 0.0%

Maternal death rates: is not a

population based maternal mortality

rate or ratio that you may often come

across.

Fresh still

birth rate 0.77% 0.39% 0.7% 0.6% 1.1%

Fresh still birth rate: Fresh Still

births have intact smooth skin not

macerated.

Infection rate

of caesarean

sections.

7.4% 7.2% 1.0% 4.0% 10%

Infection rate of caesarean sections:

if mothers are discharged much earlier

than the 8 days, information is also

collected also from the post-natal

clinic where the mothers will show up

if they got infected.

Early neo-

natal deaths

rate

0.89% 0.80% 1.0% 1.4% 1%

Early neo-natal deaths rate. Number

of babies who died within the 7th day

from birth divided by the total number

of deliveries in the hospital in that year

expressed in percentage terms.

Table8.3: Quality rates per indicator

Years FSB rate MDR

rate

RR rate IRCS rate STAFF

rate

SATIS

rate

DRUGS

rate

2010/2011 0.77 0.20 97.6 7.4 84.3 82.6 88

2011/2012 0.39 0.17 98.0 7.2 88.5 85.6 87

2012/2013 0.70 0.07 96.5 1.0 73.3 65.7 78

2013/2014 0.60 0.11 98.2 4.0 70.3 77.6 90

2014/2015 1% 0.1% 98.5% 0 79.3 79.3% 0 FSB - Fresh still birth rate; MDR - Maternal death rate; RR - Recovery rate on discharge; IRCS - infection rate for caesarean section;

STAFF- Qualified staff percentage; SATIS -Patient Satisfaction score; Drugs - Appropriate drug prescription score.


75

8.2. Health surveys

8.2.1. Patient satisfaction survey

Attempts have been made and continuously so to improve the level of satisfaction of patients

who visit the hospital. Overall, the patient satisfaction score has increased to 79.3% in 2014/2015

compared to 77.6% in 2013-2014 However, some significant variation in patient satisfaction was

realized across the various departments, OPD scored 72.8 percent; In-patient scored 79.4 percent

whereas ACT Section obtained 90.1 percent.

Table 8.3: Satisfaction levels per core area for the last 4years

Satisfaction rate

FINANCIAL YEAR FY11-12 FY12-13 FY13-14 FY14-15

Clinical outcomes 90% 96% 95% 94%

Humanity of care 96% 80% 100% 85%

Organization of the care / waiting time (OPD) 72% 42% 78% 56%

The healthcare environment 98% 62% 100% 99%

General opinion n.a. 73% 96% 97%

Overall score 85.6% 66% 77.6 79.3%

8.2.2. Drugs prescription and dispensing survey

In the survey conducted to gauge the drugs prescription in the hospital, the score was 15/20

Points for Poly Pharmacy which is the 16th level towards achieving the highest score. For use of

Antibiotics, the Hospital scored 16/20 Points four levels below the highest score.

The best clinical practice in this Hospital is seen in the use of injectable drugs in Out Patient

department which was found to be 0.03 per total number of drugs prescribed.

The Survey finding also shows that 97% of drugs prescribed were actually dispensed meaning

that 3% were not dispensed due to stock out.

Out of 80 medical Forms examined, 83 percent contained record of Objective Medical

Examination. All the medical Forms examined contain record of both History and Diagnoses.

Overall, the Hospital scored 82 percent for quality of drugs prescription.


76

8.3. Perspectives and Work plan for Quality Improvement

Quality improvement initiatives proposed for the FY 2015-2016

Table 8.4: Work plan for quality improvement activities for FY 2014-2015

Activity/

Intervention

Key Action Steps Deadline for

implementation

Person(s) Responsible

1. Reduce

infection rate of

C/S.

Strengthen the central

sterilization department

(CSSD)

End of FY (June

2016)

Medical Director ,SNO and

I/C of infection control

committee

2 Reduce early

neonatal deaths.

Ensure the availability of

Emergency bag in all the

wards

End of FY (June

2016)

MO and I/C of Maternity

Wards

3.To reduce

under/over as

well as late

reporting of data

Involve quality assurance

committee in monitoring

the quality, Mgt. to ensure

computerization, Reliable

internet connectivity and

capacity building

End of FY (June

2016)

CEO/Administrator

Medical Director

M&E

I/C of quality improvement

Committee

4.Strengtern

waste

management

Continuous awareness

creation and Education on

waste management

End of FY (June

2016)

Infection control committee

5.Reduce waiting

time in accessing

care

Create a customer care

desk in OPD

Extend the working hours

in OPD from 8:00 am to

9:00pm

End of FY (June

2016)

I/C of OPD.

SNO

Medical Director


77

CHAPTER NINE

HEALTH TRAINING INSTITUTION

St. Mary’s Midwifery started in 1956 as a Midwifery Assistant school. In 1959 it was upgraded

to a Midwifery Training School. The Principal continued to report to HMT all the school issues

including those that needed decision making. Major decisions on the school were taken by the

BOG.

The school offers two courses namely Diploma in midwifery (D/M) and Certificate in Midwifery

(C/M). It is no longer training Enrolled Comprehensive Nurses.

Since its beginning the School has qualified a total of one thousand two hundred and forty nine

(1,249) qualified staffs who are serving in various parts of the country as well as outside Uganda.

• Nine Hundred ninety eight (998) Enrolled/Certificate Midwives (EM/CM),

• Two Hundred and eleven (211) Registered/Diploma Midwives (RM/DM),

• Forty (40) Enrolled Comprehensive Nurses/Certificate Comprehensive Nurse

(ECN/CCN)

9.1. Human Resource Management and Development

Tutors and Clinical Instructors

The school does not have yet sufficient teaching staff and sometimes has to hire part time experts

in the different disciplines to ensure that the syllabus is covered and students get all the necessary

knowledge and skills necessary for the practice.

Table 9.1: School staff and support staff establishment 2014/2015

No Cadre (Qualified) Established

target

Actual Shortage

1 Tutors 6 5 1

2 Trained clinical mentor 5 3 2

3 Untrained clinical instructors 0 0 0

4 Account Assistant 2 2 0

5 Cashier 1 1 0

6 Record Assistant 1 1 0

Total 15 12 3

No Cadre (Support Staff) Established

target

Actual Shortage

7 Store Assistant/Library Attendant 1 1 0

8 Office Attendant 1 1 0

9 Cooks 6 6 0

10 Driver 1 1 0

11 Watchmen 2 2 0

Total 26 21


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Staff attrition

This financial year had seen quite a high attrition of up to 5 Clinical Instructors leaving the

school between March and May 2015. Four of the staff left as they were sponsored by the

UNFPA for another districts and were waiting for their recruitment while working with the

school. Currently we have only five tutors, and two clinical mentors who have obtained diploma

in mentoring and attached to the hospital. One clinical mentor will be recruited in December

2015 after her nursing course. The plan is to recruit more staff to bridge the current gap.

Staff development

The tutor who went for degree course in Nursing finished in December 2014 and is now waiting

for internship next year in February 2016. One staff that went for a degree in accounting has also

finished successfully and is back on duty. Other staffs continuously had rotation in professional

refresher courses in different fields. The staff had always used the information received from

these seminars or workshop for teaching or Continuous Medical Education (CME)/Continuous

Professional Development (CPD).

Other workshops or meetings organized by the following organizations: UNMEB, MOH, MOES

UCMB, Jphiago and UNFPA were attended by the staff as indicated in table 5.

Table 9.2: Workshops/courses attended by the teaching staff

S/N Workshop Organized by Number of staff Duration

1 Update of midwifery records UNMEB 3 1 week

2 Update of Nursing and midwifery records UNFPA 1 1 week

3 Review of Midwifery Curriculum UNFPA 1 1 week

4 Review of teaching methods UNFPA 4 1 week

9.2. School Performance

Table 9.3 Student Enrolment by year in year 1st, 2

nd, 3

rd and success rate 2014/2015

Course In The

Year

1st Year 2

nd

Year

3rd

Year

Current

No.

Sat Final

Exams

Pass

Final

Exams

Success

Rate

C/M 40 in May Now 38 41 54 133 47 46 98%

D/M 9 in Feb Now 8 7 15 11 10 91%

Total 51 46 41 38 148 58 56 97%

The total objective capacity has been increased from 120 to 150 and approved by the BoG. It had

been noted that the number of candidates applying for Diploma in Midwifery is dwindling each


79

year. For this reason, the places for certificate course had been increased. There is need to

consider direct courses as well.

The success rates for both Certificate and Diploma Midwifery have dropped due to two students

who were known to be weak failing a paper each. The School shall not consider students who

fail consecutive examination to sit for state final examination.

In 2014/2015 two students were dismissed due to pregnancy. These students reported when they

were already pregnant and never declared their condition.

In conclusion, the enrollment of students has been controlled to the objective capacity of the

school. However, it had been noted that the students’ performance is dropping therefore, the

school administration together with the school staff need to help the students not only

academically but also in other aspects of their lives that can affect their performance.

Achievement

• The school is finalising the processing of release by the MoES of the bus that has been

donated by DANIDA. This is a big boost in facilitating activities of the School.

• The plan and bill of quantity for the Computer Lab is being is in the final stages of being

developed. This will be submitted to the Town council for approval in the beginning of

2015-2016.The biggest task of insufficient funding still looms.

• UNFPA has procured an assortment of books that will enable students’ access

information to help them improve on their knowledge in the field of Nursing and

Midwifery as well as other values required of such professionals.

Forth Coming Events

The School has planned to organise the 5th Graduation ceremony for both Certificate Midwives

and Diploma midwives scheduled to take place on the 15th of January 2016.

9.3. School Finances

St. Mary’s Midwifery training school is a cost centre in Dr. Ambrosoli Memorial Hospital-

Kalongo. It has its own approved budget but still supported by the hospital for some

administrative procedures. The hospital engages an external auditor that audits both the hospital

and school account and provides two distinct financial reports.

Income

Table 9.4 Planned, actual and unrealized income in 2014/2015

Planned income Actual realization Unrealized income

751,564,026/= 592,108,794/= (159,455,232/=)


80

The actual income was significantly lower than expected as a major project that was planned for

opening up an income generating activity did not materialize. Also the PHC-CGs budget was not

realized according to the budget estimate.

Source of income

The greatest percentage of school’s income comes from school fees from Donors which

includes; UNFPA, MOH-DP & Dr. Ambrosoli Foundation, Copeland Foundation.

Expenditure

Table 9.5 Planned, actual expenditure and unspent balance in 2014/2015

Planned expenditure Actual expenditure unspent balance

751,564,026/= 467,673,625/= 283,890,401/=

The expenditures projected for capital infrastructural development did not materialize as no such

activity took place. The activities have all been shifted to the next FY 2015-2016.

Support from the Hospital

• The Hospital and School is under the same management team.

• Supervision of students in the wards is done together by ward In charges, as other

qualified staffs, Tutors and Clinical Instructors.

• Rotation of staff is done centrally by the Human resource manager in consultation with

key line managers; redeployment is at the discretion of management.

• Hospital’s administrator approves all financial transaction in both the school and the

hospital.

• Management is responsible for lobbying for funds from donors.

9.4. Relations with external partners

The school also enjoyed the support of the local community, the parents and guardians of the

students and external partners like UCMB, UNMEB, UNMC, MoH/DPMoESOther individual

donors such as Dr. Ambrosoli Foundation, UNFPA, Baylor-Uganda, Gretta Foundation,

Copeland Foundation, Light ray, Intra-Health Uganda and HTI in the PNFP.

These external partners continued to play vital roles in the running of the school in terms of

financial support, technical assistance, mentoring in the clinical areas and training. The external

partners provide opportunity that exposed staff to attend various courses and in turn disseminate

the knowledge and skills attained.

In conclusion, the relationship and contributions of external partners are very vital in the life and

continuity of the school.


81

9.5. PHC Activities

The school participates in carrying out PHC activities with the HSD. Some of these activities are

immunization and health education. Tutors, Clinical Instructors and students are always

involved.

9.6. Faithfulness to the Mission

The school progress in Faithfulness to the Mission is monitored through 4 key indicators:

o access = percentage of total capacity used;

o equity = average student fee;

o efficiency = average recurrent cost per student;

o Quality = average rate of students passing their final exams (success rate) and tutor/student

ratio).

The key financial indicators in the year 2014 - 2015

NB: Note that these figures calculated based on the audited accounts for the year ending 30th June 2015

ACCESS

The Total number of students present F/Y = 153 x 100% = 102%

Total Capacity of the School 150

Comparing the past financial year 2013/2014 and this year 2014/2015, there was slight reduction

of 6%, in the number. However, due to some referrals, the number is still beyond the objective

capacity. But at the end of the financial year the physical count of the students present was 148.

This was due to students who left due pregnancy as indicated previously.

After Audit

Total fees Collected F/Y 397,565,454/= 2,598,467/=

Total number of students 153

The school fees income comes from the following sources: fees for students sponsored by Dr.

Ambrosoli foundation, UNFPA, MOH-DP Bursary scheme, MOH IntraHealth strengthening

project, Copeland foundation, and privately sponsored students.

Efficiency

After Audit

Total Recurrent Costs 467,673,625 /= 3,056,691/=

Total number of students 153


82

Quality: success rate

Total number of students who passed = 56 x 100% = 96.5%

Total Number of Students who sat 58

Figure 9.1: EVOLUTION IN STUDENTS’ PASS RATE WITHIN FIVE YEARS

Compared to the previous years as already explained, this year 2014 – 2015 the students success

slightly increased to 96.5% compared to 96.2% last year.


83

CHAPTER TEN

SUMMARY, CONCLUSION AND RECOMMENDATIONS

Conclusion

Dr Ambrosoli Memorial Hospital is a biggest health institution in Agago District that serves

most of the neighbouring Districts. In FY 2014/2015 a number of activity indicators showed a

negative trend but this should not be interpreted as a decline in itself as generally the trend both

at district and national levels show the numbers going down in many facilities. The fact that the

services offered at LLU are becoming better, improved staffing levels, availability of drugs and

community participation and involvement in the affairs of the health facility makes patients to

feel more confident to attend services nearer to their homes and at no or little cost moreover.

At national level, the hospital has once again performed quite well in terms of activity output as

noted in the Annual health sector performance report 2014-2015 league table released by the

Ministry of Health. The hospital ranked 18thout of 132 general hospitals in the country, Among

PNFP hospitals it ranked at position 2 which is quite commendable.

The hospital received a Certificate of Accreditation from UEC/UCMB (Scoring 95%) for the

calendar year ending 31st December 2016.

The hospital on the 28th /10/2014 earned the “Best Employer Awards” certificate of recognition

for being the Most Compliant Employer in Lira area of jurisdiction.

The issue of sustainability is still at the centre of all activities and initiatives that the Hospital

will implement or introduce. In order to meet all these challenges the Hospital strives to

strengthen its governance bodies and its managerial capacity and embark in substantial

reorganizational efforts.

There is still need to invest in building the human resource capacity as well as in other resources

of financial management, infrastructural development in order to attain the required level of

service delivery. Some essential positions in the hospital still lack qualified personnel,

management is making efforts to ensure that qualified personnel are recruited or opportunities

for further studies accorded depending on need and merit.

The hospital after 59years of its existence the hospital needs urgently a facelift in many of its

structures, some of which are old, dilapidating and needs major renovation.

About half the numbers of staffs are accommodated within the hospital premises but the housing

condition needs to be improved and new and better housing units but this needs concerted efforts

to raise funds.


84

Faithfulness to the Mission Report (performance indicators)

The Hospital has maintained its faithfulness to the Mission and has continued monitoring a few

indicators to help assessing its performance in the four key areas of Access, Equity, Efficiency,

and Quality.

ACCESS The OPD attendance has decreased by 12.6 % compared to the previous year (from 29,206 in FY

2013/14 to 25, 526 in FY 2014/15). The there is a decline in absolute number of OPD cases, the

per capita OPD utilisation of 1.2 is consistently achieved looking at the catchment population of

Kalongo Town.

The Major cause of morbidity in OPD in the last FY 2014/2015 has been Malaria, respiratory

tract infection, acute diarrhoea. The same pattern is in the lower level health facilities therefore

likely to be the cause of decline in OPD attendance, however the community still has access

though there is need to improve strengthen more the referral system in order to make sure that

patients are accessing service near their village according to their condition as well as reducing

on waiting time and community sensitization.

The above shows that the number of female attending OPD is still higher for the last five years

compared to the number of male. This may be naturally attributed to health seeking behaviour

among the female and the demographic aspect within our catchment area.

The OPD attendance among children under five has decreased by 4.6 % (from 30.8% in FY

2013/14 to 26.2% in 2014-2015) whereas for Five years and above it decreased by 11.2% (from

95.6% to 84.4%). The hospital was able to be accessible to 9.0% of total OPD attendance

accessing services in Agago district.

ANC Attendances

The total ANC visit has also declined by 11.3 %( from 6,664 in 2013/2014 to 5,909 in 2014-

2015. Although ANC total visit declined, ANC 4th visit increased in proportion by 2.0%. The

hospital has contributed 18% of ANC total visit and 18.2% of ANC 4th visit in Agago district.

This is a good indicator which shows that the mother and baby stand a better chance to minimise

the risk of maternal and neonatal death.

The reduction of utilisation of the Hospital ANC services should not necessarily be looked at as a

problem of accessibility, considering that the LLUs services are offering equivalent and effective

ANC services nearer to the residence of the mothers.


85

Immunisation

In FY 2014-2015 the total number of doses of immunisation antigens administered increased by

46.3%. The Hospital contributed 9.9% of the total number of immunisation in Agago District.

The hospital carries out daily routine immunization services. The outreach services during

Family Health Days and Child Health Days has also contributed to higher number of beneficiary

being immunized because of much effort from the VHT attached to hospital who works

tirelessly to mobilize the community so that they benefits from these services.

Admissions

The total admission has decreased by 8.5 %( form 14,186 in FY 2013/14 to 12,981 in 2014/15).

The hospital contributed 67.8% of total admission in the district. This can be attributed to the

functional lower health units especially HC III who are able to admit and treat minor illness as

well as admit mothers for delivery.

Deliveries increased by 9.0% in 2014-2015 compared to the last financial year. 36.1% of total

professionally assisted deliveries in Agago district were done in Kalongo Hospital. This can be

attributed to the good services being offered to pregnant mothers. Caesarean Sections rate is at

8.8% which still below WHO redline due to Health education and waiting shelter provided on at

risk pregnant mother on regular basis.

The trends observed last FY 14/15 showed that:

� OP contacts decreased by 12.6%

� IP admission decreased by 8.5%

� ANC clients decreased by 11.3%

� Deliveries increased by 9%

� Immunization increased by 46.3%

There is a slight decrease in access to services by the community (6.4%) in FY 2014/2015 as

noted by decrease in the SUO from 258,014 to 241,573.

Equity

The indicator Fee/SUO-OP has increased by 14.6%. For the last 4 years this indicator has been

increasing however the user fees in Kalongo Hospital is still one of the lowest among the PNFP

health facilities in the UCMB network even in the Country.

EFFICIENCY


one SUO has decreased from UGX 15,571 to 15,506


86

Quality of care

Maternal Death Rate has decreased, however the Infection rate for caesarean section increased to

10%. On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still

Birth Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.



Maternity Ward. The Stability and adequate qualification of human resources is a prerequisite to

introduce effective improvement measures and for more focused effort in quality improvement.

SUSTAINABILITY OF THE HOSPITAL

The user fee in Kalongo Hospital is the lowest among PNFP hospital and hospital in Uganda at

large.

The data on sustainability ratios need to be carefully interpreted. In FY 2014-2015 the Hospital

has slightly improved the sustainability ratio depending on its own revenues (from 14.5% to

14.6%) but when also Government support is added, the sustainability ratio increased from

27.2% to 28.1%. For last 10 years the Government financial support (PHC-CGs) has been

maintained practically constant, almost three quarters of the budget depends on foreign support

(donations and projects) making the Hospital extremely vulnerable to financial crisis if any of the

supporters withdraws and is not timely replaced. There is need to organize a stakeholders

meeting in order to address the issues of user fees for the patients.

.

Critical issues

The turnover of the employee is still quite high affecting the quality of care and increasing the

cost of staff employment and development.

Some buildings of the hospital still have asbestos roofs, lack of space for the service delivery

(e.g. Children wards and Laboratory) and inadequate accommodation for the staff.

Lack of internal auditor, radiographer and anaesthetist in the hospital,

For the last 5 years the health care service is facing a transition in morbidity patterns and

utilisation of health services; there is need to re-define the role of the health services and in

particular of the Hospital Vis-à-vis these changes. The existence of a network of 32 LLUS (24

HCII and 8 HCIII) with growing capacity to offer health services as per their level of care, the

primary health care that are provided at lower level, such as those offered in Outpatient

Department and in Antenatal clinics, have reduced but the demand for surgical, comprehensive


87

EMOC, and other specialised care are increasing. There is need to focus and strengthen the

services which are not offered at lower level units such as:

1) Endoscopy examination

2) Dental care

3) Mental Health care

4) Sickle cell clinic

5) Diabetes clinic

6) Cervical cancer screening

7) Ophthalmic care


88

CHAPTER ELEVEN

PLANNING FOR THE FUTURE

Health care service delivery and Primary Health care

To deliver health services with special preference to the poor and most vulnerable and

disadvantaged as well as foster social and spiritual services to the population within the locality.

Management will strive to ensure that all patients are properly assessed, diagnosed, admitted,

treated, discharged and receive preventative care to achieve the best possible health outcome.

Management will also ensure that care is based on the best available evidence; the recognition

that value for money is high on the agenda of healthcare nationally and internationally, thus

necessitating the need to be more committed to delivering health services in a cost effective

manner with clear accountability.


89

Sustainability of the hospital, career development and safety of the staffs

• Sustainability ratio of the hospital still very low, therefore the hospital management is planning to organize a stakeholder meeting by the end of Jun the next financial year.

• We recognize that staffs are the greatest asset of the hospital and the services we provide. We commit to providing a working environment that values and supports staff, and offers unparalleled opportunities for personal and career development for Infrastructure.

Strategies planned for Health care service delivery

Table 11.1: Current status and planned activities for the major department of the Hospital

Service

Current status Strategies Planned Time

Frame Responsible person

Source of

Funding

OPD • OPD services available

from 8:00 am to 5:00 pm

• Long waiting time

• Inaccuracy in data recording and late reporting

• Extend working time in OPD from 8:00 am to 9: 00pm in order to minimise congestion of patients in the wards

• Recruit one clinical officer

• Organising specialised clinics; Diabetes, Dental, Cardiovascular, Sickle cell, and Cervical cancer screening.

• Computerising data recording and to minimise the cost attached to the registers

End of FY 2015/2016

• HMT

• Medical Director

• CEO/Administrator

Hospital Ambrosoli foundation and other partners

Surgical � Trauma & Emergency care

� OPD Surgical Clinic,

burns general surgical operations & Physiotherapy

� Orthopedics limited

services and high # of referrals

� Maintain current service offered � Secondment of One medical officer

by MoH � Conduct quarterly Specialized

Surgical Camps under support of partners and other

� Renovation of surgical building

End of FY 2015/2016

� Medical Director $ Ward Surgeon

� Medical Director

$ Ward Surgeon � CEO/Administrat

or

Dr.Ambrosoli foundation, MoH and other international partners


91

Service



Source of

Funding

� Old building with

asbestos roof

Internal Medicine

• General Adult and Children Outpatient Clinic

• Medical Admissions & care

• Strengthen potential partnerships that could improve quality and efficiency of the services

• Maintain current service offered

End of FY 2015/2016

IDEA Cardiologist from Italy and

Paediatric & Neonatology

� YCC � Therapeutic feeding. � Neonatal intensive care � Paediatric admission &

care � Immunization and

health promotion. � Old building

� Maintain current service offered � Initiate Sickle cell clinic � Renovation of children ward building

End of FY 2015/2016

Ward medical officer

HMT and international partners

Obstetrics & Gynaecology

• Antenatal and Post-natal care PMTCT

• Natural family planning

• General obstetrics & gynaecology Care

• Waiting shelter for pregnant mother at risk

• Maintain current service offered

• Secondment of one medical from MoH.

• Reinforce gynaecological and obstetrical services by recruiting a gynaecologist sponsoring one MO for specialisation

• Initiate cervical cancer screening

End of FY 2015/2016

MoH Patologioltre frontier(project against cancer), Ambrosoli foundation


92

Service



Source of

Funding

• Renovation of waiting shelter building for pregnant mother

Medical imaging

� General radiology

� Ultrasonography

� Electrocardiogram

� Recruitment of qualified

� staff in radiology department

� Strengthen collaboration with

Cardiologist from Italy

� Create one medical

� imaging unit

� Train an addition sonographer for the

sustainability of the service

End of FY 2015/2016

HMT and international partners


93

Service



Source of

Funding

Laboratory service

• General laboratory services for the hospital

• Centre laboratory hub in Pader and Agago district for sample collection, testing and results networking

• Inadequate space to accommodate all laboratory equipment for a wide range of test profiles available in the lab.

• Ensure functionality of laboratory activities and Hub program on 24/7 basis

• Promote, implement and sustain MOH/WHO SLMTA (Strengthening Lab Management towards Accreditation) programme.

• Relocating the lab to the old theatre and renovating it to suite a national laboratory hub.

• Establish a cytology laboratory

• Train lab personnel to ensure quality and reliable cytological diagnostic slides

SDS Hospital Ambrosoli Foundation

Pharmacy � General pharmacy

� Distributing services

� Strengthening internal procurement

committee

� Ensure availability of drugs and

sundries

� Ensure availability of an accurate

procurement plan

� Strengthen drugs therapeutic

committee

Hospital Management and international partners

HIV/AIDS and GBV

• HIV/TB Care & Treatment

• Strengthen the service and comply to the requirement of the donors

Hospital Management and international


94

Service



Source of

Funding

partners

Anaesthesia and resuscitation

� General anaesthetics

� Pre- anaesthetic care

� Inadequate human

resource

� Recruit at least 2 anaesthetists to

reduce work load

� Strengthen collaboration with IDEA

for capacity building

Hospital Management IDEA


95

Strategies planned for Health sub district

Table 3.Activities/supervision to be implemented by the Health Sub-district

Program

Area

Activities Ref.

Person

Timing Indicator Annual

Target

Means of

Verification

Inputs

Support

Supervision

Visit to lower level

Health Units

HSD

Team

Quarterly No. of visits 4 visits Reports Vehicles, Check

list, Allowance,

fuel

Planning

Support to micro-

planning at HC II/III

level

HSD

Team

members

During

routine

visits

No. of planning

meeting conducted

4 meetings Reports /list of

attendance

Stationery,

Allowance

Sub-county planning

sessions

HSD

Team

members

According

to necessity

No. of planning

meeting conducted

9 meetings Reports /list of

attendance

Stationery,

Allowance

Annual Planning

Meeting

HSD

Team

Once per

year

Planning meeting

conducted and

Number of

Participants

1 meeting Approved work plan

in place

Stationery,

Allowance

Monitoring

and

evaluation

HMIS data

collection,

compilation or

reports and analysis

Record

Assistant

Monthly Number of reports

timely produced.

Level of

completeness and

accuracy.

12 Reports Stationery, HMIS

reports transport,

allowances

Weekly surveillance Record

Assistant

Weekly Reports timely

forwarded

52 times a

year

Reports Stationery, HMIS

reports transport,

airtime,

Allowances

Coordination HSD Every 6 Number of meetings 2 meetings Minutes from the Stationery,


96

Program

Area

Activities Ref.

Person

Timing Indicator Annual

Target

Means of

Verification

Inputs

meetings Team months meetings /list of

attendants

Allowances,

transport

Continuing

Medical

Education and

in-service

training

CME Sessions HSD Associated

to

Supervisory

Visits and

Coordinatio

n Meetings

Number of staff

identified and

trained

48 Reports from

supervision visits

and coordination

meetings

Teaching and

learning material,

manpower.

Stationery,

Logistical

Support

Cold Chain and

Distribution of

Vaccines

HSD Cold

Chain

Officer

Monthly No. of visits

conducted

12 Reports and

availability of

Vaccines in the

LLUs

Funds,

allowances, fuel,

transports

Distribution of

essential drugs

HSD

Team

Every two

months

Number of drug kits

supplied

6 Delivery notes and

availability of drugs

at LLUs

Funds,

allowances, fuel,

transports

ANNEXES

Annex 1. - Health Unit Population Report (HMIS 109) FY 2014-2015 Estimation of the target populations in the service area (District Hospital).

Total population in the service area: 330,435 (A)

Women in childbearing age in the service area: (A) x 0.202= 66,748 (B)

No. of pregnancies in the service area (A) x 0.05 = 16,522 (C)

No. of births in the service area (A) x 0.0485 = 16,026 (D)

No. o children under one year in the service area (A) x 0.043= 14,209 (E)

No. of children under five years in the service (A) x 0.202= 66,748 (F)

Suspected tuberculosis in the service area (A) x 0.003 = 991 (G)

People under 15 years of age (A) x 0.46 = 152,000 (H)


98

Annex 2. - Members of board of governors & designation as per 30th June 2015

Name Designation Title

1 H.G. John Baptist Odama Chairperson Archbishop of Gulu

2 Sr. LiberataAmito Member Diocesan Health Coordinator Gulu

3 Msgr Mathew Odong Member Vicar General Gulu

4 Ms. Giovanna Ambrosoli Member Representative Ambrosoli Foundation

5 Fr Hategek'Imana Sylvester Member Provincial Superior Comboni Missionaries

6 Fr Guido Miotti Member Parish Priest Kalongo

7 Mr Louis Odongo Member Lawyer - P.O. Box 800, Gulu

9 Anywar John Kennedy Member District Local Councillor 5 - Kalongo T.C

10 Rose Ogaba Member Representative of the Local Community

11 Dr Emmanuel Otto Member DHO Agago District

12 Sr Susan Dezu Clare Member Superior General LSMIG

13 Mr. Nicholas Gregory Okello Member P.O.Box 166 Gulu

14 Dr Pamela Atim Member Medical Sup’dnt St Joseph Hosp. Kitgum

15 Obonyo Alex Secretary Ag. Chief Executive Officer/Administrator


99

Annex 3. Members of the Management Team and designation as per 30th June 2015

Name Designation Title

1 Mr Alex Obonyo Member Ag. CEO/Administrator

2 Mr Alex Ojera Member Acting Senior Nursing Officer

3 Dr Myango Patient Member I/C Public Health Department

4 Sr Carmel Abwot Member Principal Tutor

5 Ms. Molly Akello Member Human Resource Manager


100

Annex 4 - Hospital Staffing Level as per 30 June 2015 Cadre No. Cadre No.

District Health Officer (DHO) 0 Physiotherapist 0

Medical Officer Principal 0 Occupational Therapist 0

Assistant DHO Environmental Health 0 Orthopedic Officer 1

Assistant DHO Maternity/ Child Health/ Nursing 0 Health Educator Assistant 0

Medical Officer Special Grade (Community) 0 Anaesthetic Officer 1

Medical Officer Special Grade (Obs $ Gynes) 0 Laboratory Technologist 1

Medical Officer Special Grade (Internal Medicine) 0 Laboratory Technician 2

Medical Officer Special Grade (Surgery) 1 Clinical Officer 5

Medical Officer Special Grade (Paeditrics) 0 Steno-Secretary 1

Medical Officer Senior 0 Accounts Assistant Senior 1

Nursing Officer Principal 0 Theatre Assistant 0

Environmental Health Officer Senior 0 Cold Chain Technician 0

Health Educator Senior 0 Stores Assistant G1 1

Hospital Administrator Senior 0 Enrolled Comp. Nurse 18

Medical Officer 5 Anaesthetic Assistant 0

Dental Surgeon 0 Enrolled Nurse 15

Pharmacist 0 Enrolled Nurse Psychiatry 1

Nursing Officer Senior 1 Enrolled Midwife 38

Clinical Officer Senior 0 Laboratory Assistant 6

Health Educator /Counselors 3 Health Assistant 0

Laboratory Technologist Senior 0 Stores Assistant 3

Biostatistician 0 Records Assistant 4

Hospital Administrator 1 Accounts Assistant 5

Personnel Officer /Human Resource Manager 1 Cold Chain Assistant 0

Medical Social Worker 0 Office Typist 1

Nutritionist 0 Nursing Assistants / Aides 20

Supplies Officer 1 Dental Attendant 0

Reg. Comp. Nurse 0 Theatre Attendant/ Assistant 0

Public Health Dental Officer 0 Office Attendant 1

Dispenser 0 Driver 4

Nursing Officer (Nursing) 1 Darkroom Attendant 3

Nursing Officer (Midwifery) 6 Mortuary Attendant 1

Public Health Nurse 0 Cooks 10

Nursing Officer (Psychiatry) 1 Guards 16

Psychiatric Clinical Officer 0 Artisan 11

Ophthalmic Clinical Officer 0 Support 0

Medical Entomology Officer 0 Data Clerks 2

Principal Tutor 1 Other support staffs 39

Tutors 4

M & E Officer 2

Health Inspector 0

Radiographer 0

Clinical Instructors 0 Total number of staff 239


101

Annex 5 - Hospital Staff Detail as at 30 June 2015

S/No. Name Gender Age Qualification Designation

1 Okema Joseph M 39 Dip. Business Studies (Accounting) Account Assistant

2 Okwir Denish M 29 Dip. Business Studies (Accounting) Account Assistant

3 Okello James F 31 Dip. Business Administration/ (Accounting) Account Assistant

4 Ocan Denis M 35 Dip. In Business Admin./Comp. Studies Account Assistant

5 Ayoo Christine Rose F 44 Bachelor in Accounting Account Assistant

6 Owor George Geozee M 44 BBA/Dip in Business Studies Accountant

7 Alex Obonyo M 47 Masters of Science HSM Administrator

8 Okema Alfred M 36 Dip. In Anesthesia Anesthetist Officer

9 Ocero David M 41 Dip. In Pharmacy

Apprentice Pharmacy

Technician

10 Okidi Bruno M 36 Dip. In Business Studies Cashier

11 Olanya Francis M 31 Dip. Business Studies (Accounting) Cashier

12 Auma Florsy F 26 Dip in Business Administration Cashier

13 Ayat Margaret Ann F 36 Dip. In Education. Cashier

14 Akello Christine F 40 Primary Leaving Examination (PLE) Cleaner

15 Abalo Jennifer F 38 Primary Leaving Examination (PLE) Cleaner

16 Adoch Monica F 43 Primary Leaving Examination (PLE) Cleaner

17 Adong Alba F 37 Primary Leaving Examination (PLE) Cleaner

18 Alimocan Beatrice F 33 Primary Leaving Examination (PLE) Cleaner

19 Angut Agnes F 30 Primary Leaving Examination (PLE) Cleaner

20 Atto Mary F 58 Primary Leaving Examination (PLE) Cleaner

21 Oyella Betty F 29 Primary Leaving Examination (PLE) Cleaner

22 Ocan Joseph Cox M 31 Dip. In Clinical Med & Community Health Clinical Officer

23 Taabu Geoffrey M 26 Cert. In Clinical Med & Community Health Clinical Officer

24 Oryem Denis M 26 Dip. In Clinical Med & Community Health Clinical Officer

25 Anying Janet F 25 Dip. In Clinical Med & Community Health Clinical Officer

26 Ongom Innocent M 25 Dip. In Clinical Med & Community Health Clinical Officer

27 Anena Gloria F 24 Cert. In Clinical Med & Community Health Clinical Officer

28 Okot Simon Peter M 33 BA (Hons) Adult& Comm. Educa. Community Coordinator

29 Akecho Bosco Olanza M 40 Dip. In Human Resource Management Community Coordinator

30 Amony Susan F 49 Cert. in Bakery & Jelly Making/UCE) Cook

31 Akot Christine F 29 Uganda Certificate of Education (UCE) Cook

32 Lalam Lilly Grace F 41 Senior Two Leaver Cook

33 Awili Christine F 29 Priimary Six Leaver Cook

34 Lawino Margaret F 60 Nil Cook

35 CecilliaOryema F 60 Nil Cook

36 Labol Susan F 55 Primay Leaving Examination (PLE) Cook

37 AkidiSantina F 59 Nil Cook


102


38 Aciro Florence F 48 Nil Cook

39 Lapura Emma F Primay Leaving Examination (PLE) Cook

40 LamwakaRoselineOkidi F 31 Cert. In Counseling &Guidiance Counselor

41 Aneno Christine F 30

Dip. In HIV/AIDS Social Care & Comm.

Health. Counselor

42 Akidi Beatrice F 28 Dip. In Social Wok Counselor

43 Akot Polly F 51 Dip. In Midwifery/Tutorship Deputy Principle Tutor

44 Ochen Luigi M 65 Driving Permit. Driver

45 Opwa Anthony M 55 PLE/ Driving Permit Driver

46 Otto Boniface M 31 Cert. in Driving. Driver

47 Ochan Simon M 39 Driving Permit. Driver

48 Olua Josef M 29 Cert. in Mechanical Eng.Craft Practice Part II Driver/Mechanic

49 Oling Francis M 29 Cert. in Electrical Installation & Regulation Electrician

50 Olweny Paul M 39 Cert. in Electrical Installation & Regulation Electrician

51 Sagal John Bosco M 27 Cert. In Nursing Enrolled Nurse

52 Sr. Draleru Lilian F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

53 Komakech Alfred M 30 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse

54 Atimango Sarah F 25 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse

55 Sr. Hellen Ayaka F 25 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse

56 Odong Alfonse M 27 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse

57 Ojok Joseph M 26 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse

58 Opito James M 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

59 Ikwap Grace Aketch F 31 Dip. In Clinical Mentoring/ Enrolled Comprehensive Nurse

60 Mwa Daniel M 26 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

61 Echel Jimmy M 28 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

62 Ayege Hellen Rebecca F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

63 Okech Geoffrey M 33 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

64 Apili Judith F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

65 Ojakol David M 31 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

66 Lemo Charles M 30 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

67 AkelloCindrella F 24 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

68 Apio Evelyn F 26 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

69 Ocan Peter Okumu M 30 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse

70 Hellen Kalongo F 68 Cert. In Midwifery Enrolled Midwife

71

Abonyo Eveline

Ajenika F 23 Cert. In Midwifery Enrolled Midwife

72 Ojara Gladys F 20 Cert. In Midwifery Enrolled Midwife

73 Adong Agnes F 22 Cert. In Midwifery Enrolled Midwife

74 Lalam Florence F 21 Cert. In Midwifery Enrolled Midwife


103


75 Acayo Gloria F Cert. in Midwifery Enrolled Midwife

76 Lamwaka Charity F 20 Cert. in Midwifery Enrolled Midwife

77 Oting Betty F Cert. in Midwifery Enrolled Midwife

78 Akello Rose Kevin F Cert. in Midwifery Enrolled Midwife

79 Arach Beatrice F 24 Cert. in Midwifery Enrolled Midwife

80 Akello Josephine F 27 Cert. in Midwifery Enrolled Midwife

81 ArachPancy F 27 Cert. in Midwifery Enrolled Midwife

82 Aparo Caroline F 25 Cert. in Midwifery Enrolled Midwife

83 Lalam Hellen F 35 Cert. in Midwifery Enrolled Midwife

84 Assumpta Kia F 22 Cert. In Midwifery Enrolled Midwife

85 Acan Christine Oroma F 29 Cert. in Midwifery Enrolled Midwife

86 Akello Sarah F 22 Cert. in Midwifery Enrolled Midwife

87 Amony Agnes F 30 Cert. in Midwifery Enrolled Midwife

88 Lajara Molly F 33 Cert. in Midwifery Enrolled Midwife

89 Auma Caroline F 26 Cert. in Midwifery Enrolled Midwife

90 Acan Christine F 28 Cert. in Midwifery Enrolled Midwife

91 Apoo Lillian Flora F 25 Cert. in Midwifery Enrolled Midwife

92 Adyero Harriet Grace F 23 Cert. in Midwifery Enrolled Midwife

93 AnyekoJopsephine F 28 Cert. In Midwifery Enrolled Midwife

94 Anying Jane F 23 Cert. In Midwifery Enrolled Midwife

95 Ayaa Catherine F 28 Cert. In Midwifery Enrolled Midwife

96 Abalo Janet Oburu F 29 Cert. In Midwifery Enrolled Midwife

97 Candiru Gloria F 27 Cert. In Midwifery Enrolled Midwife

98 Layet Nighty Okot F 28 Cert. In Midwifery Enrolled Midwife

99 Akech Jennifer Lopez F 29 Cert. In Midwifery Enrolled Midwife

100 AlimoScovia F 25 Cert. In Midwifery Enrolled Midwife

101 Aketo Janet F 25 Cert. In Midwifery Enrolled Midwife

102

Lalam Pamela

Adokorach F 29 Cert. In Midwifery Enrolled Midwife

103 AbonyoEnrica F 58 Cert. In Midwifery Enrolled Midwife

104 Apiyo Innocent F 25 Cert. In Midwifery Enrolled Midwife

105 Omara Josephine F 29 Cert. In Midwifery Enrolled Midwife

106 Okello David M 23 Cert. in Nursing Enrolled Nurse

107 OkotGaldhino M 24 Cert. in Nursing Enrolled Nurse

108 Iyou Florence F 24 Cert. in Nursing Enrolled Nurse

109 Kongayi Beatrice F 23 Cert. in Nursing Enrolled Nurse

110 Acanit Hellen Beatrice F 23 Cert. in Nursing Enrolled Nurse

111 Acheing Sarah F 25 Cert. n Nursing Enrolled Nurse

112 Adyango Agnes F 29 Cert. In Nursing Enrolled Nurse


104


113 Amollo Anna Grace F 27 Cert. In Nursing Enrolled Nurse

114 Munyes Rosaria F 27 Cert. In Nursing Enrolled Nurse

115 AchiroProscovia F 27 Cert. In Nursing Enrolled Nurse

116 AchiroScovia F 27 Cert. In Nursing Enrolled Nurse

117 Acana Bonny M 28 Cert. In Nursing Enrolled Nurse

118 NdetioZainah F 29 Cert. In Nursing Enrolled Nurse

119 Nawal Sunday M 27 Cert. In Nursing Enrolled Nurse

120 Olaka Joseph Kwotek M 26 Cert. in Psychiatric Nursing Enrolled Psychiatry Nurse

121 Akello Molly F 32 Bach. Devpt. Studies, Post GrsdDipl HRM Human Resource Manager

122 Ogwang Charles M 31 Primary Leaving Examination (PLE) Incenerator Attendant

123 KilamaPuis M 39 Primary Leaving Examination (PLE) Incenerator Attendant

124 OjikAnjelo M 41 Cert. Pharmaceutical Asst. Laboratory Assistant

125 Omoro Luciano M 34 Cert. In Lab. Technology Laboratory Assistant

126 AkanyoCavine F 26 Cert. In Lab. Technology Laboratory Assistant

127 Nyeko Paul F 26 Cert. In Lab. Technology Laboratory Assistant

128 Okidi Ray Ongom M 26 Cert. In Lab. Technology Laboratory Assistant

129 Ocen Godfrey M 32 Cert. In Lab. Technology Laboratory Assistant

130 Okot Godfrey M 26 Dip. In Medical Lab Technology Laboratory Technician

131 Odokonyero James M 27 Dip. In Medical Lab Technology Laboratory Technician

132 EtwopTonny M 31 Bachelor in Biomedical Lab Technology Laboratory Technologyst

133 Olanya Robert M 33 BA (Hons) Public And. & Mgt. LHF Manger NFP Project

134 Opoka Richard M 32 Dip in Business Administration

LHFS

Assistant(Finance&Admin)

135 Opira Daniel M 26 Dip. In Library Library Assistant

136 Olaa Job Joe M 35 Cert. in Strategic Procurement & Logistics Mechanic

137 Abonga Daniel M 33 Bachelor in Medicine & Surgery Medical Doctor

138 OpiyoDenishOdoki M 26 Bachelor in Medicine & Surgery Medical Doctor

139 Okot Godfrey Smart M 31 Master of Medicine in general Surgery Medical Doctor

140 Dr. Ajok Jennifer F 29 Bachelor in Medicine & Surgery Medical Doctor

141 AtwineKahigwa Edison M 30 Bachelor in Medicine & Surgery Medical Doctor

142

MyangoKamundala

Patient M 41 Master in Public Health. Medical Doctor/P.H.Coordinator

143 Ouma Jacob M 23

Cert.in Pharmaceutical & Health Supplies

Mgt Medical Pharmacy Assistant

144 Otto Willy M 39 Cert. In Nursing Assistant Microscopist Assistant

145 OwekaSisto M 44 Cert. In Nursing Assistant Microscopist Assistant

146 Okidi Franco M 43 Primary Leaving Examination (PLE) Microscopist Assistant

147 Komalceh Jimmy M 26 Bachelor of Science in Computer Science

Monitoring & Evaluation

Officer

148 Oringa John francis M 34 Bach. in Business Administration

Monitoring & Evaluation

Officer


105


149 OdongoJovine M 39 Primary Leaving Examination (PLE) Mortuary Attendant

150 Aguma Jimmy M 35 Primary Leaving Examination (PLE) Nursing Aide

151 AtimangoDorine F 31 Primary Leaving Examination (PLE) Nursing Aide

152 Lamunu Hellen F 54 Primary Leaving Examination (PLE) Nursing Aide

153 Olanya Richard M 32 Primary Leaving Examination (PLE) Nursing Aide

154 Oloya Davidson M 31 Primary Leaving Examination (PLE) Nursing Aide

155 Omona Kenneth M 56 Primary Leaving Examination (PLE) Nursing Aide

156 Opira Charles M 37 Primary Leaving Examination (PLE) Nursing Aide

157 Oyella Christine F 38 Primary Leaving Examination (PLE) Nursing Aide

158 Acan Florence F 45 Cert. In Nursing Assistant Nursing Assistant

159 Alanyo Christine Okot F 39 Cert. In Nursing Assistant Nursing Assistant

160 Alimocan Joyce F 39 Cert. In Nursing Assistant Nursing Assistant

161 AlwochPaska F 38 Cert. In Nursing Assistant Nursing Assistant

162 Aryemo Florence F 51 Cert. In Nursing Assistant Nursing Assistant

163 Ayoo Mary Okot F 43 Cert. In Nursing Assistant Nursing Assistant

164 ObwonaGoretty F 54 Cert. In Nursing Assistant Nursing Assistant

165 Ocan Michael M 34 Cert. In Nursing Assistant Nursing Assistant

166 OjokLakareber Thomas M 40 Cert. In Nursing Assistant Nursing Assistant

167 Okello Alfred M 45 Cert. In Nursing Assistant Nursing Assistant

168 OkidiEgidio M 36 Cert. In Nursing Assistant Nursing Assistant

169 Okot Joseph Otyang M 36 Cert. In Nursing Assistant Nursing Assistant

170 Akello Francesca F 36 Uganda Certificate of Education (UCE) Office Attendant

171 Aloyo Stella Oketta F 33 Dip. In Orthopaedics Orthopaedic Officer

172 Akwero Agnes F 26 Cert. In Medical Pharmacy Assistant Pharmacy Assistant

173 Oyugi James M 41 Cert. In Medical Pharmacy Pharmacy Assistant

174 Otim Jimmy M 30 Cert. in Medical Pharmacy Pharmacy Assistant

175 Okello Paul M 32 Cert. in Medical Pharmacy Pharmacy Assistant

176 Lakot Sabina F 55 Experience in the Field of Pharmacy Pharmacy Attendant

177 Ayella V Louis M 39 Dip. In Physiotherapy Assistant. Physiotherapist Assistant

178 Cal Jimmy M 25 Cert. in Plumbing & Borehole repair Plumber

179 Odongkara Willy M 38 Primay Leaving Examination (PLE) Plumber Apprentice

180 Komakech Paul M 40 Primay Leaving Examination (PLE) Porter

181 Ocaya Martin M 46 Primay Leaving Examination (PLE) Porter

182 Okello Bosco M 41 Primay Leaving Examination (PLE) Porter

183 OlwenyPhiliph M 49 Primay Leaving Examination (PLE) Porter

184 Olwora John Bosco M 36 Primay Leaving Examination (PLE) Porter

185 Sr. Carmel Abwot F 57 Masters in Rep.Health/Dip. mid/Tutorship Principle Tutor

186 Watum Geoffrey M 31 BSc. Population Studies. Record Assistant


106


187 Lia Oliver Racheal F 26 Bachelor of Records &ArchievesMgt Record Assistant

188 Lamaro Gloria F 21

Cert. Medical information and health

management Record Assistant

189 Omara Marino M 54

Dip. In Records & Information

Managemnt/HEO Record Assistant/HEO

190 Obol Sisto M 30 Cert. In Nutrition Training. Record Clerk

191 OdongBismark M 37 Uganda Certificate of Education (UCE) Record Clerk

192 TookwaroRobina F 30 Dip. In Midwifery Registered Midwife

193 Amony Dorothy F 33 Dip. In Midwifery Registered Midwife

194 AdeePaska F 43 Dip. In Midwifery Registered Midwife

195 Aneno Irene Jacqueline F 34 Dip. In Midwifery Registered Midwife

196 Lakot Grace F 33 Dip. In Midwifery Registered Midwife

197 Lango Berna F 35 Dip. In Midwifery Registered Midwife

198 Awor Ruth F 31 Dip. In Midwifery Registered Midwife

199 LalamPaska F 44 Dip. In Midwifery/Nursing Registered Midwife/Nurse

200 Sr. AcanSantina F 44

Dip. In Clinical Mentoring/Cert.in Registered

Gen.Nursing Registered Midwife/Nurse

201 Sr. Hellen Alobo F 41 Dip. In Midwifery/Nursing Registered Midwife/Nurse

202 Ajwang Caroline F 38 Dip. In Midwifery/Ultrasound Registered Midwife/Ultrasound

203 Achan Christine Achilla F 29 Dip. in Nursing Registered Nurse

204 Ogwang Sally F 53 Dip. In Nursing/Psychiatry Registered Psychiatric Nurse

205 Ochibo John Paul M 39 Bachelor in Social &Phyosophical Studies. Sample Transporter

206 Inzikuru Diana F 31 Dip. In Entrepreneurship Dev't (DED) Secretay

207 Olanya Simon M 46 Primary Leaving Examination (PLE) Security Guard

208 Onek Charles Celsio M 35 Primary Leaving Examination (PLE) Security Guard

209 Nyero Jimmy M 35 Uganda Certificate of Education (UCE) Security Guard

210 Labeja Alfred M 51 Uganda Certificate of Education (UCE) Security Guard

211 Opio Anthony M 41 Uganda Certificate of Education (UCE) Security Guard

212 Latyet James M 44 Uganda Certificate of Education (UCE) Security Guard

213 Olum Matthew M 41 Primary Leaving Examination (PLE) Security Guard

214 OmaraTooyero Joseph M 28 Uganda Certificate of Education (UCE) Security Guard

215 Otim Andrew M 41 Uganda Certificate of Education (UCE) Security Guard

216 OryemKamillo M 26

Uganda Advanced Certificate of Education

(UCE) Security Guard

217

Odongkara Bosco

Louise M 32 Primary Leaving Examination (PLE) Security Guard

218

Onok Ben

Lutukunyonyo M 55 Uganda Certificate of Education (UCE) Security Guard

219 Olweny Albino M 29 Uganda Certificate of Education (UCE) Security Guard

220 Oryema Bosco M 35 Uganda Certificate of Education (UCE) Security Guard

221 OcenAltimo M 51 Uganda Certificate of Education (UCE) Security Guard


107


222 OkelloMarceliano M 55 Uganda Certificate of Education (UCE) Security Guard

223 Moi Geoffrey M 39 Dip. Business Studies (Accounting) Senior Account Assistant

224 Ojera Alex Latim M 44 Dip. In Nursing/PCN Senior Nursing Officer

225 Laloyo John Paul F 37 Dip. Store Mgt. Store Assistant

226 Okwera David M 41 Primary Five Leaver Store Attendant

227 Okech Charles M 35 Uganda Certificate of Education (UCE) Store Attendant

228 Too-Okema Mathew M 31 Uganda Certificate of Education (UCE) Store Keeper

229 Adong Christine F 35 Cert. In Tailoring. Tailor

230 Abor Teddy Terry F 57

Dip. In Health Personnel Education &

Tutorship Tutor

231 Oyella Florence N F 39 Dip. In Midwifery/Tutorship Tutor

232 Abalo Lucy Joan F 42 Dip. In Midwifery/Tutorship Tutor

233 OpittiGomatox M 61 Primary Leaving Examination (PLE) Washroom Attendant

234 Nokrac Charles M 41 Uganda Certificate of Education (UCE)

X-Ray Operator/Darkroom

Attendant

235 Odongtoo Denis M 38 Uganda Certificate of Education (UCE)


Attendant

236 Ojok David M 35 Uganda Certificate of Education (UCE)


Attendant

237 Fr. Ensio Phillippi M Ordained Priest Priest

238 Okidi Kwenytino M Certificate in Catechist Catechist

239 Regina latigi F Grade II Teacher Pastoral Social Worker


108

ANNEX 6: AUDITED FINANCIAL REPORT ABSTRACT 2014-2015

DR. AMBROSOLI MEMORIAL HOSPITAL STATEMENT OF FINANCIAL POSITION

FOR THE YEAR ENDED 30TH

JUNE 2015

NON - CURRENT LIABILITIES 2015 2014

ASSETS NOTES USHS. USHS.

Non - Current Assets

Property, Plant and equipment 24 1,340,829,195 264,547,966

Work in progress(WIP) sewage system 2 136,300,719 175,226,841

Share Investments 3 1,110,000 1,110,000

1,478,239,914 440,884,807

Current Assets

Treasury Bills 168,491,922 168,491,922

Receivables 4 93,836,701 90,554,788

Prepayments 4 42,399,636

Imprest/Activity advances 5 22,935,779 15,692,054

Inventory 6 803,000,226 928,072,430

Bank and Cash Balances 7 1,209,800,243 1,583,015,299

2,340,464,507 2,785,826,493

TOTAL ASSETS 3,818,704,421 3,226,711,300

EQUITY AND LIABILITIES

CAPITAL AND RESERVES

Capital Fund 26 1,340,829,195 264,550,984

General Fund 26 960,367,023 1,101,300,658

Restricted Fund 26 1,240,913,091 808,169,015

TOTAL FUND BALANCE 3,542,109,308 2,174,020,657

NON - CURRENT LIABILITIES

Current liabilities

Payables and Accruals 8 41,063,250 212,570,493

Deferred Income 235,531,863 840,120,150

276,595,113 1,052,690,643

TOTAL FUND BALANCE AND

LIABILITIES 3,818,704,421 3,226,711,300


109

DR. AMBROSOLI MEMORIAL HOSPITAL

STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 30TH

JUNE

2015.

2015 2014

Appendix USHS. USHS.

INCOME.

User fees 9 429,341,811 399,799,594

Governments grants 10 506,731,434 507,620,471

Donation in cash 11 1,976,532,864 2,261,661,058

Donation in kind 12 1,091,058,978 1,019,614,218

Other income 13 82,600,220 119,265,960

Income Technical department 14 56,945,511 64,191,141

TOTAL REVENUE 4,143,210,818 4,372,152,442

Employment Costs 15 1,454,269,387 1,481,676,063

Administration Costs 16 71,011,973 125,290,190

Governance Costs 17 15,709,344 12,019,000

Medical Goods and services 18 1,436,533,515 1,629,096,034

Supplies and Services 19 75,574,313 48,845,794

Building & Electrical materials 20 61,816,690 87,511,142

Property Costs 21 232,835,274 232,462,749

Transport and Plant Costs 22 147,434,856 157,759,179

Primary Health care 23 250,856,300 242,976,850

Capital development 25 42,812,692 112,542,651

TOTAL EXPENDITURE 3,788,854,344 4,130,179,652

Net Operating Results 354,356,474 241,972,790


110

ST. MARY’S MIDWIFERY TRAINING SCHOOL AUDITED FINANCIAL REPORT ABSTRACT

2014-2015

ANNEX 7: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF

FINANCIAL POSITION AS AT 30THJUNE 2015

2015 2014

Notes USHS. USHS.

FIXED ASSETS

Property, Plant and Equipment 10 78,944,586 81,727,284

Share Investment 60,000 60,000

79,004,586 81,787,284

CURRENT ASSETS

Inventory 11 149,746,760 71,330,397

Treasury bills 12 450,000,000 450,000,000

Cash and Bank 13 366,959,938 341,207,567

Receivables ,advance & Prepayment 14 129,215,674 46,427,415

1,095,922,372 908,965,379

CURRENT LIABILITIES

Creditors and Accruals 15 430,209,320 418,616,111

Total current Liabilities 430,209,320 418,616,111

NET CURRENT ASSETS 665,713,052 490,349,268

TOTAL ASSETS 744,717,638 583,028,747

FUND EQUITY & RESERVES

Capital Fund 2 78,944,586 0

General Fund 2 763,679,345 583,028,747

Restricted Donor Fund 2 -97,906,293 0

TOTAL EQUITY AND LIABILITIES 744,717,638 583,028,747


111

Annex 8: ST. MARY’S MIDWIFERY TRAINING SCHOOL Statement of Comprehensive

Income for the year ended 30th June 2015.

2015 2014

INCOME Notes USHS. USHS.

School fees 397,565,454 308,360,091

Grants 60,124,813 57,798,241

Other incomes 134,418,527 110,866,956

Total Income 3 592,108,794 477,025,288

EXPENDITURE

Employment Costs 4 204,361,178 204,087,584

Students Costs 5 138,916,472 112,017,152

Administration Costs 6 77,132,419 78,545,960

Transport and Plant cost 7 34,442,227 41,110,050

Property cost 8 11,658,229 3,209,863

Supplies and services 9 1,163,100 3,851,356

Total expenditure 467,673,625 442,821,965

Surplus/(deficit) for the year 124,435,169 34,203,323


112

Annex 9: Admissions and deaths by diagnosis in FY 2014-2015 (HMIS 107)

Diagnosis

under five years Five years and above

Cases Deaths Cases Deaths

M F M F M F M F

Notifiable Diseases

01 Acute flaccid paralysis 0 0 0 0 0 0 0 0

02 Cholera 0 0 0 0 0 0 0 0

03 Dysentery 15 17 0 0 11 15 1 0

04 Guinea worm 0 0 0 0 0 0 0 0

05 Bacterial Meningitis 0 1 0 0 0 1 0 0

06 Measles 0 0 0 0 0 0 0 0

07 Tetanus (neonatal) (0 to 28 days age) 0 0 0 0 0

08 Plague 0 0 0 0 0 0 0 0

09 Rabies 0 0 0 0 0 0 0 0

10 Yellow Fever 0 0 0 0 0 0 0 0

11 Viral Haemorrhagic fever 0 0 0 0 0 0 0 0

121nfluenzae Like Illness 0 0 0 0 0 0 0 0

13 Adverse Events Following Immunization

(AEFI) 0 0 0 0 0 0 0 0

14 Other Emerging

infectious Diseases,

specify( e,g, small pox,

ILI, SARS

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0 0

0 0 0 0 0 0 0 0

0

Other Infectious {communicable diseases

15 Diarrhoea - Acute 162 101 0 0 20 18 2 1

16 Diarrhoea- Persistent 25 8 0 0 2 4 0 0

17 Genital Infections 0 2 0 0 4 10 0 0

18 Hepatitis 0 0 0 0 12 3 0 0

19 Leprosy 0 0 0 0 0 0 0 0

20 Malaria 412 385 2 4 322 382 3 4

21 Osteomyelitis 1 2 0 0 13 32 0 0

22 Pelvic Inflammatory Disease (PID) 51 0

23 Peritonitis 48 38 0 1 19 19 2 1

24 Pneumonia 221 189 2 4 73 80 7 9

25 Pyrexia of unknown origin (PUO) 30 25 0 0 7 14 0 0

26 Respiratory infections (other) 188 162 0 0 73 95 2 1

27 Septicaemia 207 208 1 3 118 127 2 1

28 Tuberculosis (new smear positive cases) 0 1 0 0 87 27 5 1


113

29 Other Tuberculosis 2 0 0 0 41 32 2 0

30 Typhoid Fever 3 3 0 0 22 52 0 1

31 Urinary Tract Infections (UTI) 9 2 0 0 31 66 1 0

32 Tetanus (over 28 days age) 1 0 1 0 0 0 0 0

33 Sleeping sickness 0 0 0 0 0 0 0 0

34 Other types of meningitis 7 5 1 1 10 18 0 2

Maternal and Perinatal Diseases

35 Abortions 347 0

36 Malaria In pregnancy 164 0

37 High blood pressure in pregnancy 4 0

38 Obstructed labour 44 2

39 Puerperal sepsis 24 0

40 Haemorrhage related to pregnancy (APH or

PPH)

23 0

41 Sepsis related to pregnancy 25 0

42 Other Complications of pregnancy 127 0

43 Neonatal Septicaemia 12 13 4 4

44 Perinatal conditions in new born (0 - 7 days) 35 23 5 7

45 Perinatal conditions in new born (8 - 28 days) 2 2 1 0

Non communicable diseases 103 67 4 4 62 74 6 2

46 Anaemia 1 2 0 0 12 50 0 0

47 Asthma 0 0 0 0 3 1 0 1

48 Oral cancers 2 0 0 0 2 0 0 0

49 Jaw injuries 9 10 0 1 13 15 0 1

50 Other oral diseases and conditions 2 0 0 0 1 2 0 0

51 Periodontal conditions 0 1 0 0 2 0 0 0

52 Diabetes mellitus (newly diagnosed cases) 0 0 0 0 15 15 3 2

53 Diabetes mellitus (re-attendances) 11 10 0 0 10 23 0 0

54 Endocrine and metabolic disorders (other) 195 136 2 1 153 223 4 0

55 Gastro-Intestinal disorders (non Infective) 0 0 0 0 5 2 0 1

56 Hypertension (newly diagnosed cases) 0 0 0 0 22 39 0 2

57 Hypertension (old cases) 0 0 0 0 6 7 0 1

58 Stroke 2 3 0 0 32 44 6 11

59 Cardiovascular diseases (other) 0 0 0 0 0 0 0 0

60 Anxiety disorders 103 67 4 4 62 74 6 2

61 Bipolar disorders

62 Depression 0 0 0 0 4 2 0 0

63 Schizophrenia 0 0 0 0 1 0 0 0

64 Alcohol abuse 1 0 0 0 45 29 1 1

65 Drug Abuse 3 0 0 0 12 22 0 0

66 Dementia 0 0 0 0 1 0 0 0


114

67 Childhood Mental Disorders 3 1 0 0

68 Epilepsy 5 7 0 0 34 14 1 0

69 HIV related Psychosis 0 1 0 0 11 12 1 1

70 Other forms of Mental illness 1 0 0 0 2 1 0 0

71 Nervous system disorders 3 1 0 0 4 3 0 0

72 Severe Malnutrition (Kwashiorkor) 25 25 1 1 2 1 0 0

73 Severe Malnutrition (Marasmus) 22 14 0 0 4 2 1 0

74 Severe Malnutrition (Marasmic-kwash) 7 8 0 0 13 2 0 0

751niuries - Road traffic Accidents 19 8 0 0 132 59 5 1

761niuries - (Trauma due to other causes\ 37 43 2 1 344 226 1 1

77 Animal bites 0 0 0 0 10 4 0 0

78 Snakes bites 3 3 0 0 28 20 0 1

79 Poisoning 6 4 0 0 26 13 1 0

80 Liver Cirrhosis 23 17 1 1

81 Liver diseases (other) 0 1 0 0 31 29 4 3

82 Hepatocellular carcinoma 1 0 0 0 7 6 0 0

83 Hernias 16 3 0 0 77 36 0 0

84 Diseases of the appendix 23 19 0 0 36 54 0 0

85 Diseases of the skin 131 94 0 0 155 200 0 0

86 Muscular skeletal and connective tissue

diseases 4 9 0 0 7 6 0 0

87 Genitor urinary sys. diseases (non- infective) 0 0 0 0 0 3 0 0

88 Congenital malformations and chromosome

abnormalities 0 0 0 0 0 0 0 0

89 Complications of medical and surgical care 0 0 0 0 1 0 0 0

90 Benign neoplasm's (all types) 0 0 0 0 1 0 0 0

91 Cancer of the cervix(newly diagnosed cases) 2 1

92 Cancer of the cervix (re-attendance) 16 2

93 Cancer of the breast 2 2 0 0

94 Cancer of the prostate 1 0

95 Malignant neoplasm of the digestive organs 0 0 0 0 2 0 2 0

96 Malignant neoplasm of the lungs 0 0 0 0 0 0 0 0

97 Kaposis and other skin cancers 0 0 0 0 2 0 0 0

98 Malignant neoplasm of Haemopoetic tissue 0 0 0 0 0 0 0 0

99 Other malignant neoplasm 0 0 0 0 0 0 0 0

100 Cutaneous ulcers 0 0 0 0 0 0 0 0

Neglected Tropical Diseases (NTDs)

101 Leishmaniasis 0 0 0 0 0 0 0 0

102 Lymphatic Filanasis (hydrocele) 0 0 0 0 0 0 0 0

103 Lymphatic Filanasis (Lympoedema) 0 0 0 0 0 0 0 0

104 Urinary Schistosomiasis 0 0 0 0 0 0 0 0


115

1 05 Intestinal Schistosomiasis 0 0 0 0 0 0 0 0

106 Onchocerciasis 0 0 0 0 0 0 0 0

Medical Emergencies 0 0 0 0 0 0 0 0

107 Cerebro-vascular events 0 0 0 0 0 0 0 0

108 Cardiac arrest 0 0 0 0 0 0 0 0

109' Gastro-intestinal bleeding 0 0 0 0 0 0 0 0

110 Respiratory distress 0 0 0 0 0 0 0 0

111 Acute renal failure 0 0 0 0 1 0 0 0

112 Acute sepsis 16 13 0 0 2 5 0 0

113 Other diagnoses

(specify Priority

diseases for health

unit)

Sickle Cell Dis'e. 23 15 0 0 11 11 1 1

0 0 0 0 3 2 0 0

0 0 0 0 0 0 0 0

114 All others 88 74 0 0 172 239 0 0

Total Diagnoses 2139 1758 26 32 2401 2579 65 55

report 2014/2015 - dr. ambrosoli memorial hospital

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