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KALANGALA FIELD REPORT April 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). Introduction.
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KALANGALA FIELD REPORT April 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)
Introduction • The monitoring exercise in Kalangala district was carried out between 8th – 12th of April 2013. • The visit was prompted by a number of complaints generated through M-trac anonymous SMS and calls through the MHSDMU toll free line. • The facilities visited were: • Kalangala HCIV • MugoyeHCIII • SiaapHCII
Introduction continuation • Lulamba HCIII • Jaana HCII • Bubeke HCIII • Bufumira HCIII • Bukasa HCIV • Mazinga HCIII • Bwendero HCIII • Mulabana HCII
Appreciation • MHSDMU appreciatesall the health staff, for coming to work in this hard to reach area. • Special thanks go to the in-charges and staff of Mazinga HCIII and Jaana HCIII for being exemplary. • We also thank the entire leadership of all the health centers for ensuring that drugs do not expire in their stores.
Major Findings • Human resource • There is total lack of orientation of workers by DHO. • Supervision is lacking. DHO does not do monitoring. • Despite Kalangala being a hard to reach place, the staff are not getting hard to reach allowance. • Many recruited staffs have not reported. • The daily staff reporting registers lack in most health centers, and where they are, they are not adhered to. • Mogoye HCIII staff were found with forged staff attendance register.
Human resource cont…. • There is general late coming and absenteeism; Staffs come late and leave early. Especially the I/C of Mugoye- Bogere, I/C of Kalangala HCIV, the staff of Bwendero HCIII etc. • The newly recruited staff are not yet on payroll, which makes their survival difficult. • Lack of staff uniforms was noted in all the health centers visited. • Shortage of staff accommodation in all health centers. • Misconduct: the team witnessed a health worker who was seeing patients while watching a movie and listening to music on his laptop.
Finance and Administration • The team noted missing financial accountability / poor financial accountability in the lower health centers visited. • Accountability for HCIVs was fair, though they receive little PHC of 1,800,000/= per quarter, which is not enough to run a HCIV.
Infrastructure and Equipment • Existence of dilapidated structures in some of the health centers. E.g staff quarters of BwenderoHCIII and Kalangala HCIV. At BwenderoHCIII, a Lab Assistant was hit by debris in her house.
Infrastructure and Equipment cont….. • The team discovered that the bicycle and motorcycle given to Mulabana HCII were missing. • The monitoring team found very unkempt and dirty facilities in the district e.gMugoye HCIII and Bwendero HCIII. • No inventory management in the whole district, and this risks government property. • All the equipment in the district is not engraved, and the district might end up losing its property.
Infrastructure and Equipment cont….. • All Health centers in the district are not fenced and lack land titles, andsome have been encroached on.
Infrastructure and Equipment cont….. • Most health centers are infested by bats, Vermins etc.
Medical services • Bukasa HCIV is under performing. The services offered at the health center are similar to those of a health center two, despite the infrastructure and equipment in place. • Few or no deliveries done in some of the HCIIIs. E.g in Bwendero HCIII there were no deliveries in February, in Lulamba HCIII, the mid-wife refused to attend to mothers, and no delivers are done. • Lack of placenta pits was noted in most health centers. E.gBukasa HCIV, Mazinga, Bafumira, Lulamba. • There is generally poor record keeping in all the facilities in the district.
Medical supplies • A lot of anti-malarial is yet to expire in health centers. E.gBwendero HCIII, Mulabana HCII, Bafumira HCIII, Bukasa HCIV. • There are excessive medicines in Health facilities, especially anti-malarials, paracetamol, IV fluids and eardrops of gentamycin and Chloramphenicol. • Medicines management is very poor in all health centers. i.e. • There is still poor compliance to HMIS tools most especially those used in medicines management. • Lack of records, and therefore drug d audit could not be done to establish the gaps.
Medical supplies cont… • Expired drugs found at Kalangala HCIV
MHSDMU staff, helping in arranging the drug store of Kalangala HCIV
Theatre • Though doctors were recruited at Kalangala HCIV, the theatre still does only minor surgeries. • At Bukasa HCIV, the theatre was abandoned, all the doors and windows were eaten up by termites, and the structure now provides shelter to chicken and goats.
