HOIMA FIELD REPORT May 2013 Medicines and Health Service Delivery Monitoring Unit (MHSDMU)

1. HOIMA FIELD REPORT May 2013 Medicines and Health Service Delivery Monitoring Unit (MHSDMU) Plot 21 Naguru Hill Drive P.O Box 25497 Kampala Tel: 0414-288442, 0414-288445, 0800100447 (Toll free)

2. WHAT IS MHSDMU • MHSDMU is a department set up by a presidential instrument to monitor health service delivery • Is apolitical • It does not overide the function of MOH which has the constitution mandate to oversee the health sector

3. OBJECTIVES • The main objective is to raise the bar in health service delivery • Other specific objectives include to assess health service delivery in health facilities • To identify and rectify any forms of healthcare malpractice, poor administration and mismanagement. • To find out possible immediate and long term solutions together with partners (stakeholders)

4. INFORMATION HARNESSING • MTraC • Public complaints • MOH • Toll free line • Partners e.g ISO,Police • Politicians e.g LCs • Whistle blowers e.g healthworkers

5. METHODOLOGY • PHYSICAL VISIT AND OBSERVATION • DATA COLLECTION TOOL • CLIENT/COMMUNITY SURVEY/INFORMERS • HEAD COUNT FORM • AUDIT • ENGAGE STAKEHOLDERS: LGs,POLICE,HWs • RADIO TALK SHOW • PRELIMINARY AND FINAL REPORTS

6. WHAT DO WE LOOK AT? • INFRASTRUCTURE • STAFFING LEVELS • ATTENDANCE/ABSENTEESM • DRUG AND STORES MANAGEMENT • SANITATION • CLIENT SATISFACTION

7. WHAT DO WE LOOK AT? • STAFF ACCOMODATION • STAFF COMPLAINTS • PHC AND OTHER ACCOUNTABILITIES/Funds • ILLEGAL NURSING SCHOOLS

8. PERIOD OF MONITORING • The monitoring exercise in Hoima district was carried out between 13th – 24th of May 2013.The visit was prompted by a number of complaints generated through M-trac anonymous SMS and calls through the MHSDMU toll free line.

9. FACILITIES VISITED • KYANGWARI HCIII NSOZI HCII • BUHUKA HCIII KASONGA HCII • KASEETA HCIII SEBIGORO HCIII • KYEHORO HCII KIKUBE HCIV • MUKABARA HCIII WAMBABYA HCII • BUGAMBE HCIII LUCY BISEREKO HCII • BUHIMBA HCIII KYAKAPEYA HCII • BUSERUKA HCIII TONYA HCII • BACAYAYA HCII KIHUUKYA HCII • DHO'S CLINIC HCII KAPAPI HCII

10. FACILITIES VISITED • KIBIRO HCII BUJUGU HCIII • KISABAGWA HCII KASOMORO HCII • MPARANGASI HCIII BURARU HCIII • KIBAIRE HCII KYABASENGYA HCII • DWOOLI HCIII KARONGO HCIII • MBARARA HCII KISEKE HCII • KIGOROBYA HCIV KABWOYA HCIII • KITOLE HCII BUJALYA HCIII • KISIHA HCII

11. GENERAL FINDINGS Human resource • Abscondment from duty e.g the in-charge of Bujugu HCIII absconded from duty and works for a private hospital in Hoima town called EDPA. He was arrested and charged for neglect of duty. • Absenteeism was high in all the health facilities visited. E.g at Kabaale HCIII, 2 staff out of 11 were found on duty and this was common in other facilities. • Late coming of staff was high. By 10:12am, only three staff had reported on duty at Kigolobya HCIV.

12. Human resource cont… Heavy patient load at Kigolobya HCIV

13. Human resource cont… • Lack of support staff like Askaris and porters in most facilities, this has led to theft of government assets and filthy facilities. • Lack of staff uniform in all HCs visited. • Newly recruited staff have not yet accessed payroll and this has demoralized them. • Lack of accommodation for health workers. e.g The doctor of Kigolobya HCIV does not reside at the facility; the newly constructed house has no yet been handed over by the district.

14. Human resource cont… • Lack of staff attendance registers in most of the facilities in Hoima district, and this has led to increased absenteeism. • Drunk on duty, in-charge Kiseke HCII had closed the facility by 4:24pm. She later came back to meet the monitoring team when she was very drunk. • Health management committees were none functional in most of the facilities, and had spent close to a year without meeting to plan for their facilities.

15. Infrastructure • Nonfunctional water tanks and lack of water e.g at Kigolobya HCIV, Dwoli HCIII, Buhimba HCIII. • Existence of non-engraved equipment in most facilities, which puts government equipment at risk. • Lack of sign posts in most facilities, and the few present were not clear. • Filthy and dirty facilities like Bujugu HCIII, Bugambe HCIII, Kabwoya HCIII, Kigolobya HCIV.

16. Infrastructure cont…. Maternity floor at Bujugu HCIII with chicken droppings

17. Infrastructure cont…. Maternity sink at Bujugu HCIII covered with chicken droppings

18. Infrastructure cont…. • Maternity sink at Bujugu HCIII covered with chicken droppings

19. Infrastructure cont…. • Lack of power in most of the facilities, partly caused by theft of solar panels and existence nonfunctional batteries. Effect of using candle in maternity at Kabaale HCIII

20. Infrastructure cont…. • Old and dilapidated structures e.gBuseruka HCIII, Kabwoya HCIII, Buhimba HCIII and Kitole HCII staff quarter. Staff quarter at Kabwoya HCIII

21. Infrastructure cont…. • Non functional ambulances at Kigorobya HCIV, Buseruka HCIII, Kabwoya HCIII and Kyangwali HCIII. Grounded ambulance for Buseruka HCIII

22. Infrastructure cont…. Grounded ambulance of Kigolobya HCIV

23. Infrastructure cont…. • Lack of placenta pits most HCiiis and HCiis and yet they deliver mothers. • Lack of fences e.g Kaseta HCIII, Buhimba HCIII, Bujalya HCIII, Mparangasi HCIII, Buraru HCIII, Butema HCIII, Kisabagwa HCII, Mbarara HCII etc. • Lack of transport • Stalled structures e.g at Wambabya HCII

24. Infrastructure cont…. Stalled structure at Wambabya HCII

25. Infrastructure cont…. • Poor workmanship, e.g latrine built in 2008 at Kikuube HCIV has major cracks.

26. Infrastructure cont…. • Bats and vermin infestation was very high in almost all health facilities.

27. Infrastructure cont…. Bats infestation at Buseruka HCIII

28. Infrastructure cont…. Bats infestation in Kabaale HCIII

29. Infrastructure cont…. Bats infestation at Kabalale HCIII

30. Infrastructure cont…. • Charcoal found stored at the facility’s reception in Wambabya HCII

31. Infrastructure cont…. Charcoal stored at reception of Wambabya HCII

32. Infrastructure cont… • Missing motorcycle at Kikuube HCIV, this was taken by Byaruhanga Sereverius. • Most of the health facilities lacked inventory books e.g Kikuube HCIV, Kabwoya HCIII etc. • Disconnected power due to non-payment at Kikuube HCIV.

33. Medical services • Lack of vaccine fridges e.g Kibiro where they cannot keep vaccines yet the facility is hard to reach. • High patients influx e.g Kaseta HCIII, Kyangwali HCIII, Kisabagwa HCII, • Lack of immunization cards at Kaseta HCIII • Lack of HIV testing kits in all facilities visited. • Lack of gas for the vaccine fridge at Mbarara HCII, Muhuiju HCIII

34. Medical services cont… • Closed facilities, e.g Kiseke HCII was found closed by 4:24pm and staff travelled back on the motorcycles after the monitoring team made phone calls. • Lack of equipment / existence of old equipment used in maternity.

35. Medical services cont… Delivery bed for Bugambe HCIII

36. Medical services cont… • Granting study leave to crucial staff without finding replacement. E.g at Bujugu HCIII, the two mid wives went for study leave at the same time and no replacement has been made. The maternity ward has now been turned into a chicken house. • All the facilities in the district lacked inpatient departments apart from Kigorobya HCIV and Kyangwali HCIII.

37. Medical supplies • The facilities were stocked with excess anti-malarials, some of which were expired, or about to expire. • There was poor drug management in most of the facilities. i.e lack of drug requisition and issue vouchers, and most of the drugs could not be accounted for e.g Lucy Bisereko, Kiseke etc

38. Finances • Lack of financial accountability in most HCs apart from Mbarara HCII, ………. • At Kiseke HCII, the facility has not received PHC for the last one and a half years.

39. Support supervision • Lack of support supervision by DHO and DHT especially in hard to reach areas like Kibiro HCII, Kyangwali HCIII

40. Waste management • Lack of rubbish pits at some facilities, and waste was dumped in toilets e.g Dwoli HCIII.

41. APPRECIATION • Health partners like stop malaria, SURE , IDI for the support offered to the district e.g renovation of facilities, supply of kits like RDTs and Determine kits, male circumcision, supply of drug storage shelves.

42. Th Theatre at Kikuube HCIV renovated by IDI

43. Shelves provided by SURE at Kigorobya HCIV for storing drugs

44. Appreciation continued…… • AAH/UNCHR for the support given to Kyangwali HCIII and this has helped ease service delivery in the area. • Hoima district for endeavoring to fence most of the health facilities.

45. Appreciation continued…… Lucy Bisereko HCII is an example of fenced facilities in Hoima

46. Appreciation continued…… • Staff for serving the communities despite difficulties like not being on payroll, and working in hard to reach areas. • Appreciate the following staff for being exemplary i.e: i. in-charge of Kitole HCII, nursing Assistant at Kibiro HCII, Birungiof MuhuijuHCIII. ii. The staff of Bujalya HCIII who were found on duty on a Friday evening at 6:00pm iii. Staff of Kibaire HCII who were all found on duty and smart in uniform.

47. Appreciation cont……. Smartly dressed staff of Kibaire HCIII

48. Appreciation cont… • All health centers including HCIIs for carrying out malaria and HIV tests with support from health development partners. • Appreciation to Kyangwali HCIII and Kigolobya HCIV for being the only facilities with the functioning inpatients department. This means the regional referral hospital is overloaded.

49. Acknowledgement • Health workers that are committed • Health partners in the district: IDI,SURE, Malaria consortium • RDC & DISO Hoima • Police (DPC, CLO, OC CID) • Tullow • Hoima LG • NMS

50. THANK YOU