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St Kizito Hospital Matany
Moroto Diocese-Karamoja
P.O. Box 46, Moroto - UGANDA-
Annual Analytical Report
Financial Year 2011/12
St Kizito Hospital Matany
31st December 2012


Endorsement of Report
This annual analytical report for St. Kizito Hospital Matany covering the period from 1st July 2011 to 30th June 2012 has been prepared by the management of St. Kizito Hospital Matany. I endorse that it represents management's views on the position of the Hospital in the period under report. Br. Günther NÄHRICH Chief Executive Officer of St. Kizito Hospital Matany Date: 31st December 2012 This is to acknowledge that I have received this annual analytical report for St. Kizito Hospital Matany covering the period from 1st July 2011 to 30th June 2012. I have read it and endorse its authenticity and representativeness of the position of the Hospital in the year Chairperson of the Board of Governors Date: 31st December 2012 Table of contents
Table of content …………………………………………….….… List of Abbreviations and Acronyms ………………………….… ACKNOWLEDGMENT / APPRECIATIONS …….…………. IMPORTANT INDICATORS AND DEFINITIONS ….………. EXECUTIVE SUMMARY ………….………….………….… The Hospital and its environment ……………….…….….… The community and health status …………………….……. HEALTH POLICY AND DISTRICT HEALTH SERVICES …. Page 17 GOVERNANCE AND MANAGEMENT ……………………… Page 25 HOSPITAL HUMAN RESOURCE …………….………………. Page 30 HOSPITAL FINANCES ……………….….…………………… Page 35 HOSPITAL SERVICES ………………….……….…….………. Page 44 A. Curative – OPD ……….……………….………………….  Dental / Orthopaedic and Physiotherapy Unit ……. Page 47  HIV and AIDS Services ……………………………. Page 48  Mental Health ………………………………………. Page 52  Ophthalmology ……………………………………. Page 53  Palliative Care ………………………………………. Page 53 B. Inpatients – Wards ………………….………….…………. Page 54  Utilisation Indicators  Maternal Health / Maternity Ward C. Operating Theatre …………………….….…….………. D. Diagnostic Services – Laboratory ………………….….… Page 62 E. Imaging Services …………………………………………. F. Pharmacy …………………………………………………… Page 65 HOSPITAL SUPPORT SERVICES …………………………. QUALITY AND PATIENT SAFETY IMPROVEMENT ….…… Page 70 HEALTH TRAINING INSTITUTION ……………………….…. Page 78 SUMMARY, CONCLUSION AND RECOMMENDATION …. Annex 1 - Napak District with Health Units Annex 2 - Members of BoG, HMT and HTI Statutory Committee Page 94 Annex 3 - Fin Report LIST OF ABBREVIATIONS AND ACRONYMS Acquired Immunodeficiency Syndrome Average Length of Stay Anti Retro Viral Therapy Board of Governor Bed Occupancy rate Community Based Organisations District Health Committee District Health Officer District Health Management Team District Health Team Directly Observed Therapy Emergency Obstetric care Ear Nose and Throat Expanded Programme on Immunization Field Health Worker Financial Year (July of previous year to June of the current year) Government of Uganda General Staff Meeting HIV Counselling and Testing Human Immunodeficiency Virus Health Management Information System Information and Communication Technology Income Generating Activities Integrated Management of Childhood Illnesses Maternal and Child Health Care/ Family Planning Millennium Development Goal Memorandum of understanding Non-Governmental Organisation Nursing / Midwifery Training School National Social Security Fund Out Patient Department Poverty Eradication Action Plan Primary Health Care People Living with HIV and AIDS Prevention of Mother to Child Transmission Standard Unit of Output Strengthen Weakness Opportunities and Threats The AIDS Support Organization Uganda Catholic Medical Bureau Uganda Demographic Health Survey Uganda Health Sector Support Programme United Nation Children Education Fund Uganda National Minimum Health Care Package Voluntary Counselling and Testing Village Health Team ACKNOWLEDGMENT / APPRECIATIONS
The Hospital Management Team on behalf of the Board of Governors of Matany Hospital wishes first of all to thank all the Hospital employees for the demanding and often unrewarding work without which all what was achieved and described in this report would have not been possible. Br. Günther Nährich Administrator/CEO Internal Auditor Ogwango Samuelle Atim Grace Olanya Lorot J. B. Kapel Accounts Assistant Acc. Assistant/Cashier Records Assistant Ijula Immaculate Sr. Mwendwa Fredah K. NTS Secr. / Librarian Secretary / Gen. Office Mugena Everline Dorothy Pastoral Care Giver MEDICAL OFFICERS
Ongole Peter Owen Dr Lemukol James Dr Balsemin Franco Senor Medical Officer Enrolled Midwife Dr Kiyimba Daniel Enrolled Midwife Dr Luwemba Mathias Senior Medical Officer Anyait Christine Enrolled Midwife Dr Borghi Emanuela Senior Medical Officer Apolot Harriet Faith Enrolled Midwife Dr. Arwinyo Baifa Enrolled Midwife Dr. Mukasa Wilson Enrolled Midwife Dental Attendant Oryema Simon Peter Clinical Officer Nursing Assistant Oyaya Samuel Oryema Clinical Officer Nursing Assistant Clinical Officer Nursing Assistant Toolit Given Raymond Clinical Officer Nursing Assistant Pharmac. Assitant Nursing Assistant Orthopaedic Officer Locham Augustine Ophthalmic Assistant Nursing Assistant Anaesthetic Attendant Nursing Assistant Laboratory Technician Laboratory Assistant Awas Mary Goretti Nursing Assistant Laboratory Assistant Nursing Assistant Laboratory Assistant Nursing Assistant Laboratory Assistant Karane Josephine Nursing Assistant Laboratory Assistant NURSING STAFF
Liakori Rose Mary Nursing Assistant Sr Rosario Marinho Nursing Assistant Nursing Assistant Sr Gladys Licoru Anguasia Ag. Principal Tutor Reg. Nurse/Midwife Reg. Midwife / Tutor Nursing Assistant Otyang Charles Nangiro Registered Nurse Nursing Assistant Dipl. Nurse / Sonographer Senior Nursing Aid Dipl. Comp. Nurse Lomonyang Victor Registered Nurse Registered Psy. Nurse Registered Nurse Dipl. Comp. Nurse Iiko Simon Peter Ajwang Clementina Achan Christine Achilla Akello Josephine Amodoi Josephine Theatre Assistant Theatre Assistant Theatre Assistant SUPPORT STAFF
Sr. Ruaro Giovanna Domestic Officer Longok Valentina Assist Store Keeper Assist Store Keeper Angella Magdalen Assist Store Keeper Mortury Attendant Mortury Attendant incinerator Att. Laundry Attendant Laundry Attendant Koryang Angellina Longole Theresia PUBLIC HEALTH DEPARTMENT
Lopwanya Veronica Incharge PHD / SNO Lotukei Agnes Angole Health Inspector Information Assistant Field Health Worker Lomongin Clementina Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Senior Electrician Field Health Worker Field Health Worker Longoli Simon Peter Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker S. Mechanic / Driver Field Health Worker Field Health Worker Field Health Worker Field Health Worker Field Health Worker TECHINICAL DEPARTMENT
Achilla Matthias Maraka Simon Peter Mubakye Patrick W Onyait Christopher We would also like to remember all those who support us from near and far (our benefactors) with spiritual and material resources. In particular we thank the two Italian Matany support groups: Gruppo di Appoggio dell'Ospedale di Matany-ONLUS, Milano and Associazione Toyai – Onlus, Pavia. We further thank CUAMM for the support towards our NMTS, The Italian Cooperation, Insieme Si Puo, ‘IDEA Onlus' Torino; PMK Aachen, Dreikönigsaktion Wien, MIVA/BBM Austria, Horizont 3000, STACC Scotland, Africa Directo Spain, Dr. Keith's Eye Team, GIZ and so many not mentioned but surely valuable supporters, who have helped Matany a lot in different ways. We thank those involved in making policy decisions in favour of the smooth running of our Institution. A special thanks to the Uganda Catholic Medical Bureau, for all its support and encouragement over the past years. And once again a special vote of gratitude to the numerous patients who have availed us with an opportunity to follow in the footsteps of Christ, to bring healing to the sick and suffering. We thank all our staff, our students, our expatriates and all the Ugandans who continue to make St. Kizito Hospital a model for others to follow. IMPORTANT INDICATORS AND DEFINITIONS

1. Inpatient Day / Nursing Day / Bed days = days spent by patients admitted to the health
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 mercerated.
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 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 table 9. 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.
EXECUTIVE SUMMARY

Description of the Hospital and its environment

St. Kizito Hospital Matany is located within Napak District in North-Eastern Uganda,
bordering Moroto District the east side, Katakwi and Amuria, districts to the west side,
Nakapiripirit to the south side; Kotido and Abim Districts to the north side.
Due to the periodic drought the entire Karamoja Region is always at risk of famine. The
major challenges for health care delivery are: very poor health seeking behaviour, the poor
road network, hard to reach settlements and the irregular telephone network coverage
Functionally the Hospital is a de facto regional referral health facility for the entire
Karamoja Region including the neighbouring Districts of Teso (Amuria, Katakwi, Soroti),
and deals with an average annual admissions of more than 12,000 inpatients and 44,000
outpatient consultations.
The Hospital holds a significant public health influence in the catchment's population and
is linked to nine peripheral Health Units in Bokora Health Sub-District; serves as an
administrative headquarters where planning, implementation, monitoring and evaluation of
all PHC activities are done. The socio-economic impact of the Hospital to the immediate
surrounding community is quite evident by a fast growing and busy Matany Trading Centre
which has now been declared a town board by the District Local Council.
The Hospital entirely depends on the inhabitants of this Trading Centre for its support staff
and a few skilled labourers, thus not only providing employment opportunity to the
community but also creates a symbiotic co-existence between the Hospital and its
neighbourhood as well as a sense of ownership of the Hospital facility and its services by
the community.
The functionality of Matany Hospital is in accordance with the National Hospital policy of
the Republic of Uganda with technical guidance from the Uganda Catholic Medical Bureau
(UCMB) as well as Napak District Health Office, local authorities, and other partners in the
Health sector (including the service beneficiaries).
The Hospital capacity constitutes 284 beds distributed through Obstetrics/Gynaecology,
Internal Medicine, Tuberculosis, Paediatrics and Surgery Departments. Other services
provided by the Hospital include: Diagnostic Laboratory, diagnostic imaging, General
surgery, Orthopaedic and Physiotherapy, Counselling, HIV/AIDS Clinic, Antenatal Clinic
and Prevention of Mother to Child Transmission, human resource development to meet the
Hospital needs. Annexed to the Hospital are a Nursing Training Institution, a Human
Resource Development Centre and an Airstrip.
The Nursing and Midwifery Training School has an annual intake of 25 UCN students and
up to 2009, 15 UDN-student every two years. Since May 2010 the School began to recruit
15 UCM-students annually.
A well established Technical Department with construction department for general repairs
and maintenance of the Hospital's equipments, plants and infrastructures is another
important element of the Hospital, generating also income through service to the public.
The Hospital for its effectiveness in administration and daily operation developed key
documents to guide the management in the day to day running of the institution. Human
resource and finance manuals were developed and are currently in use.
Other aspects in the health professional development involves nursing students, midwives,
clinical officers, paramedical students, pharmacist, medical technologists and others, are
conducted within the hospital. The hospital is contributing to the health manpower
development in Uganda.
Achievements / improvements that have been made in FY 2011/12
Key planned activities
Status of achievement
Supported by CUAMM and officially opened Extension of Maternity Ward and blessed by Bp. Filippi, on the day of the sick, 11th February 2012 Training of departmental heads on importance of To be started in FY 2012/13 Data Management (annually) Brochure for the Hospital Will be achieved in FY 2012/13 Provision of baby care package Restructuring of PHC building to provide storage The building was completed with the help of facilities for PHC GIZ and is utilised This was completed in the first months of Fencing of the NTS Compound FY 2012/13 (financed by CUAMM) Building of two class rooms in order to create This was completed in the first months of space for practical rooms in existing class rooms FY 2012/13 (financed by CUAMM) Rehabilitation of patients/attendants kitchen Not yet achieved due to lack of funds Health education videos in the OPD To be started soon
Challenges encountered are limited financial resources and manpower (interlinked with the
first) which did not allow to achieve all the planned activities. The Hospital Administration
is very slim and functions like for Personnel Officer, Procurement Officer,
Communications Officer, etc. have to be met by other cadres as to keep the employment
costs as low as possible.
Important recommendations/plans for the coming year

 Training of departmental heads on importance of Data Management (annually)  Publish Brochure for the Hospital  Develop a Hospital website  Employ human resource manager (if funds are available)  Develop information and communication guidelines  Continue provision of baby care package  Renovate old Children's Ward and join the roofs of old and new Children's Ward  Rehabilitation of patients/attendants kitchen  Restructure Surgical Ward: create space for the Physiotherapy Unit and for some storage  Search for and employ a general surgeon with experience in Obstetrics and Gynaecology  Health education videos to be shown in the OPD CHAPTER ONE

The Hospital and its environment
St Kizito Hospital Matany is a Private Not-For-Profit (PNFP) institution with social and spiritual objectives, belonging to the Catholic Diocese of Moroto (North-Eastern Uganda). It was built at the beginning of the 70's with the help of MISEREOR (a German Church Organisation) on request of the Comboni Missionaries in Uganda, and has since then provided a very essential comprehensive package of health services to the population of the Karamoja region, an extremely remote and underdeveloped region of the Country characterized by very poor health indicators. By its functional profile, Matany is a General Hospital with a bed capacity of 284 distributed through Obstetrics/Gynaecology, Internal Medicine, Tuberculosis, Paediatrics and general Surgery Departments. In February 2012, additional 15 beds were added in Maternity Ward and reduced in Paediatric Ward in order to keep the same Bed capacity of the Hospital. Other services provided by the Hospital include: Diagnostic Laboratory, diagnostic imaging, General surgery, Orthopaedic and Physiotherapy, Counselling, HIV/AIDS Clinic, Antenatal Clinic, Prevention of Mother to Child Transmission (PMTCT) and human resource development to meet the Hospital needs. Annexed to the Hospital is a Nursing and Midwifery Training Institution, a Human Resource Development Centre and an Air Strip. Although Ministry of Health has upgraded Moroto Hospital into a regional referral hospital, Matany Hospital still shoulders the burden of heavy workload due to patients' preference to seek its services. Also, due to its relatively well developed and maintained infrastructure and above average quality and affordable services provided by committed staff, Matany Hospital still serves as a referral health facility for the entire Karamoja Region including the neighbouring Districts of Teso (Amuria, Katakwi, Soroti). The total number of admissions for the year under review was 11,620 Inpatients with a decrease of 7.8% from the previous year, and the total outpatient consultations during the FY were 45,290, showing a decrease of 7.1% as compared to the previous year. As in the previous years there were continuous increases in out and inpatients it was foreseeable that this trend could not continue. The Public Health demands on the Hospital are becoming more challenging and costly. Although the government gives subsidy to the Hospital in form of delegated PHC funding, less attention has been taken on population growth and the sky-rocketing market prices of medicines and supplies! The number of peripheral health units for support supervision has increased to 11 and the District Local Government has recommended the establishment of six (6) other lower level health units. As much as Matany Hospital would wish to play a significant public health role in the catchment's population, the cost implications of this task need to be taken into consideration. The PHC department serves as an administrative headquarters for Bokora Health Sub-District (HSD) where planning, implementation, monitoring and evaluation of all PHC activities are done. The socio-economic impact of the Hospital to the immediate surrounding community is quite evident by a fast growing and busy Matany Trading Centre which has now been declared a town board by the District Local Council. This lively economic focus in our Health Sub District is a daily convergence point of the community with great influence on the economic and social aspects in Bokora. It caters for all needs of the residents, patients, attendants and visitors. The Hospital entirely depends on the inhabitants of this Trading Centre for its support staff and a good number of skilled labourers, thus not only providing employment opportunity to the community but also creates a symbiotic co-existence between the Hospital and its
neighbourhood as well as a sense of ownership of the Hospital facility and its services by
the community. The role played by the Hospital in the socio-economic transformation of
the surrounding residents cannot be under-estimated. This contribution is done through
salary payments to the staff, vocational training to the youth and scholarship/bursary
support to students.
The functionality of Matany Hospital is in accordance with the National Health policy of
the Republic of Uganda with technical guidance from the Uganda Catholic Medical Bureau
(UCMB) as well as Napak District Health Office, Board of Governors, and other partners in
the Health Sector (including the service beneficiaries). The current Board of Governors
underwent an induction exercise in 2011 by UCMB on the statutory role of overseeing
functionality of the Hospital.
The geographical location of Napak District with Health Units is found in the Annex 1.

The community and health status

Napak District was curved out of Moroto District in July 2010. It is inhabited by the
Bokora sub ethnic group of the Karimojong tribe. The other groups i.e; Matheniko, Jie,
Dodoth, Pokot, Pian, Ik and Kadam comprise the inhabitants of the rest of the other six
Districts of Karamoja Region.
The socio-economic organisation of the community has significant influence on the health
status and indicators. The people live in homestead clusters called "ere" (Karimojong-
homestead), comprising of relatives, friends and kinsmen. For security reasons each ere has
a thorn fence with residential family clusters living all around. A central place right in the
centre of every homestead is the kraal. This is the most protected part of the homestead
where cows, goats, sheep and donkeys live. A village may have up to 400 inhabitants.
People live in small and short round huts with mud walls and grass thatched roofs. The huts
are used mainly for sleeping and during the night up to 10 people can fill it. The average
sleeping arrangement for each family is in three groups (i.e. adults/parents, adolescents and
children) sharing a small hut. Such practices coupled with poor ventilation, lack of
sanitation facilities, limited access to clean and safe water, living in close proximity to
livestock and general poor health seeking behaviour of the community makes it easier for
the spread of communicable and hygiene related diseases like scabies, diarrhoeas, eye
infections, TB, other RTIs, and zoonotic diseases etc.
The Karimojong socio-economic organization is mainly agro-pastoralists. There exist some
agricultural potentialities, especially around Iriri, Apeitolim, Nakapiripirit and Abim where
the land is fertile and the rainfall pattern fairly reliable. The main crop cultivated is
sorghum and few other cereals. The Karimojong population lives in both static and
nomadic communities, the elderly stay in the villages while the youth roam the plains in
search of pasture and water for the livestock, both communities reunite in the rainy season
lasting March to September, the rain pattern in the region is significantly changing and
becoming more unpredictable, with prolonged draught spells subjecting the community to
chronic famine and high levels of malnutrition among the under 5. This nomadic lifestyle
makes health services and other social services delivery quite difficult especially for the
mobile proportion of the population.
Although polygamous lifestyle is not a cultural norm among the Karimojong tribe, this
practice is quite common and has its importance rooted onto the prestige associated with
large family size. Rural-urban migration has overwhelmingly contributed to the rising
HIV/AIDS prevalence in the region though relatively low compared to other regions in the
country. Participation of men in socio economic welfare of their families still leaves a lot to
be desired. Women play a very significant role in family up-keep and welfare; moreover
men control family resources and are the decision makers! This makes women and children
more vulnerable to domestic violence and neglect.
Small arms proliferation with associated insecurity in the region over the last three decades
has had a negative impact on the peace and development programmes in Karamoja.
However; the disarmament programme initiated by government over the last five years has
restored peace and rule of law in the region. It is now possible to travel for medical
outreaches to distant places without carrying military escorts.
Napak District has one Health Sub District: Bokora HSD, which is designated under the
Hospital support supervision. Matany Hospital is heading Bokora Heath Sub District which
has seven Sub-Counties and a total of 42 parishes with 250 villages.
Table 1.1: Demographic data for the catchment area compared to HSD, District and Uganda
Catchment Area
Population Group
Formulae
Matany Sub-
HSD District
Total population (projected for the year under report) Total expected deliveries (4.85% of population) Total Assisted deliveries in Health Facilities Tot. Assisted deliveries as % of expected deliveries Children <1 year (4.3%) Children < 5 years (20.2%) Women in child - bearing age (20.2%) Children under 15 years Suspected tuberculosis in the service area Table 1.2 TOP TEN CAUSES OF OPD ATTENDANCES IN BOKORA HSD
FY 2009/10
FY 2010/11
FY 2011/12
Diarrheal D'ses 10,531 Intestinal Worms Oral D'ses & conditions Graph 1.1: Top 10 diseases in Bokora Health Sub District during FY 2011/12

Top ten causes for OPD attendances in Bokora HSD
during FY 2011/12
Intestinal

Public health surveillance is the mechanism that Matany Hospital PHC department uses to
monitor the health status of the catchment communities. Its purpose is to provide a factual
basis from which the Hospital can appropriately set priorities, plan programs, and take
actions to promote and protect the public's health.

Given the public health role played by Matany Hospital in management of health services
at the HSD, disease surveillance is a routine exercise both at the community and health
facility level. The Ministry of Health Case definitions for each of the epidemic prone
diseases are strictly observed for disease detection. Also the procedures for notification of
such diseases to the district and ministry of health are followed in case of any notifiable
event. Weekly surveillance reports are submitted to the District Health Office, MoH and
WHO field office in Moroto, using the HMIS form 033b. Common diseases epidemic
events reported in the weekly surveillance reports include; malaria and dysentery.
Occasionally there are challenges in timeliness and completeness of the surveillance reports
from lower level health facilities and efforts are being made to ensure that this problem is
overcome by frequent submission reminder to the Health Unit incharges.
The last cholera epidemic was reported in 2009, and Matany Hospital was a treatment
centre. The outbreak was investigated and found out to be propagated by poor sanitation,
low latrine coverage and open defecation practices in the community. The epidemic
response made with technical support from MoH and WHO was quite effective in
controlling the epidemic. Since then, no other outbreak has occurred again. WASH
interventions and community led total sanitation initiative, supported by partners have since
been ongoing.
Severe acute malnutrition is still a big challenge in the community and malnutrition is
among the top five causes of death in the under five age bracket. Nutrition assessments
carried out in Bokora Health Sub District, in May 2012, using VHTs revealed alarming
levels of malnutrition among children in most of the resettlements areas of Nabwal,
Lomaratoit, Nakicumet, Kotipe, Alekilek, Apeitolim and Lomaratoit.


Graph 1.2: Nutrition Assessment in May 2012
Nutrition Assessment in May 2012
m ode rate
m alnouris he d
m alnutrition
m alnutrition

The above figure shows the MUAC Mass screening results according to the color code.
78% of the children were in the green code (Not malnourished), 18% (yellow code) had
moderate malnutrition while 4% (red color code) had severe malnutrition and required
hospitalization. Total no of the under five screened was 30,639 (below 5 yr is 39,935),
76.7% of the under 5 age bracket in the population was screened.

Graph 1.3:
Distribution of malnourished children admitted in Matany Hospital ITFC (Jan – Jul 2012)
Distribution of Cases admitted to Matany Hosp.
ITFC per Sub-County in Napak District (Jan to
Jul 2012)
Lopeei S/C,
Ngoleriet
Iriiri S/C, 22%
Lokopo S/C,
Lotome S/C,
Matany S/C,
The discovered rates were of great concern because the numbers of children hospitalized in during the first half of 2012 were over 60% of the numbers hospitalized in the whole of 2011. The specific monthly figures were also higher as compared to the previous year experience. It was projected that the situation could possibly worsen given the fact that harvest season for 2012 was delayed as a result of delayed rains. The considerable deterioration of food reserves in the community has resulted into most people migrating to neighboring districts of Teso and other towns, as a coping mechanism for survival, which is quite unusual for this period of the year. Several factors appear to play a role: low harvest during the previous year, increasing levels of poverty, most resettlement camps are newly created and still had their first crop in gardens. Also the rainy seasons are characterized by a number of epidemics and disease burden is higher in the community around this time of the year. The overall population strata are affected but the under five age bracket is most affected. Anthropometric Indicators from previous nutrition surveys carried out in November 2011 revealed the following findings. GAM in Karamoja was 9.1% (7.9-10.4 95% CI) and SAM 1.9% (1.4-2.5 95% CI) based on weigh for height Z-scores (WHO Growth Standards). Moroto/Napak districts showed a higher prevalence of GAM 12.5% (9.4-16.6, 95% CI) and SAM 4.3% (2.4%- 7.6, 95% CI).Chronic stunting was 49.7% (42.9-56.4 95% CI) and underweight 33.3% (28.0-38.9, 95 CI). Other factors influencing the health status of the community include, high levels of illiteracy, poverty and poor health seeking behavior of the community. Over time, there has been some observed improvement in the general health status of the community, including the immunization coverage. Reproductive Health indicators are still quite poor in Karamoja and are characterized by; low 4th ANC attendance, low supervised deliveries and low TT coverage for WCBA. There are continued efforts through community dialogue and health education to improve RH indicators in the HSD. CHAPTER TWO
HEALTH POLICY AND DISTRICT HEALTH SERVICES
PRIMARY HEALTH CARE DEPARTMENT (PHC)

A) Catchment area
The community health department of Matany Hospital doubles as Bokora Health Sub-District office as well and is implementing health activities in accordance to the health sector strategic plan set by the Ministry of Health with a purpose of achieving improved health for all in the HSD. Bokora Health Sub-District comprises of 7 Sub-Counties (i.e. Matany, Iriri, Lokopo, Lopei, Ngoleriet, Lotome, and Lorengecora including one town council. It was in July 2010 that Napak District was curved out of Moroto District which covers the area of Bokora HSD. There are 12 Health Units: eleven Peripheral Health Units and the Hospital. These include; Iriri HC III, Kangole HC III, Lokopo HC III, Lopeei HC III, Lorengechora HC III, Lotome HC III, Nawaikorot HC II, Morulinga HC II Amedek HC II, Nabwal HC 11, Apeitolim HC11 and Matany Hospital OPD. The population is accessing health care services from the above mentioned nine government peripheral health centers, one faith based health centre and Matany a private not for profit hospital that renders services at highly subsided costs compared to other PNFPs in the country. There is evident presence of good health care but other factors such as high illiteracy rate,
lack of business and working opportunities, poor climate conditions and the effects of long
standing insecurity that prevailed in the area in the last years continue to grossly impact in
the quality of life, the ability of the population productivity making it more difficult to meet
the target of the millennium development goals.
Table 2.1: Health Centres for support supervision by Matany Hospital in Bokora HSD.

Distance from
Catchment
Health Units
Counties
Matany Hospital
Population
1. Matany Hospital 2. Morulinga HC II 10 km ( 21 Km during the rainy season) 1. Nawaikorot HC II Ngoleriet
2. Kangole HC III 17 Km (50 km during the rainy season) Lorengecora 1.Lorengecora
Total Bokora HSD
Table 2.2: Population figures for year 2011/2012: (Bokora HSD population projected from Census
2002, growth rate annually = 3, 4 %, total population =
182,635):

Age group
Target Population
population
For DPT-HEP B + Hib, Infants < 1 Yr.
measles, polio coverage Children < 5 Yrs
For Polio campaign (NIDs) Women 15 to 49 Yrs
Pregnant Women
>6 months to <5 years
1 – 15 years

B) Personnel/Staffing
Matany Hospital Primary Health Care Department

The Primary Health Care Department (PHC) comprises a team of nine established staff at the HSD office (1 Senior Nursing Officer, 1 Health Educator, 1 Health Inspector, 1 Health Information Assistant, 1 Ophthalmic Assistant, 1 Nursing Assistant and 2 Counsellors (two registered nurses), and a Medical Officer ( In charge of the HSD). At the community level there are 33 Field Health Workers (FHWs) and 1 Leprosy Assistant who are supervised by the PHC team. Their activities include; health education on common diseases, immunization, guinea worm eradication activities, TB case finding, contact tracing, screening children for malnutrition, referral and follow up, identification of people with disabilities, surveillance of epidemic out breaks, case finding and follow up of chronically ill patients. The Field Health Workers (FHWs) carry out PHC activities at community level. The national health policy developed operational responsibility for delivery of the minimum health package to the HSD and it is expected to provide overall day to day management of the health units and community level health activities under its jurisdiction. Its specific functions include: 1. Leadership in planning and management of health services within the HSD including supervision and quality assurance. 2. Provision of technical, logistical and capacity development support to the lower health units and communities. This HSD is relevant in contributing to progress in service delivery and the below narrative report is evidence of the activities carried out however some of its functions were constricted by the DHOs office that continues to under mine the responsibility of the HSD in planning and implementation of the activities. For example funds from UNICEF for various activities do not trickle down to the HSD. This is the major challenge faced at the HSD. 3. Coordinating community health department with other departments in the hospital; Follow up patients at the community level with help of community/field health workers, collection of data and analysis, making reports, health promotion, and integrating other hospital staff such as laboratory in integrated outreaches to hard to reach areas. Peripheral Health Units and staffing levels
Table 2.3:
Personnel by qualification in Bokora HSD Peripheral Health Units as 15/12/2012

(Govt) KANGOLE HC III 0 1 0 2 2 0 0 1
0 0 0 2 0 0 0 1
TOTAL
(current

5 10 5 22 10 7 0 22
staff)
Qualified
Staffing

7 7 1 6 8 4 1 6
Gap
Total (ideal

12 17 6 28 22 11 1 28
staffing)
The health unit that scored over 100% was being graded as health centre III.

C) Activities/Achievements

The PHC Department conducted regular supervision for the eleven peripheral health units
of Bokora Health Sub District and offers a package of services to the community.
Community activities offered are in line with the concept of PHC: MCH/FP/, UNEPI,
TBLCP, GWEP, CBR, EDMP, school health, dental care and primary eye care activities.
Integration, community participation and multidisciplinary approach are the basis of PHC
team activities.
Activity areas include the following:

Support supervision to peripheral health units (Govt. & Non Govt.) and supply of logistics
The PHC Supervisor and team in FY 2011/2012 visited each of the eleven units once a month on integrated programme including supervision. Support supervision was conducted with the aim of ensuring correct patient management and continuous quality assurance improvement. The activities supervised include clinical assessments and prescription habits to ensure rational drug use (EDMP), HMIS monitoring, UNEPI cold chain maintenance, supervision of Maternal and Child health related activities and generally quality of services offered at the health units. Problems identified by the unit staffs or the supervisor were discussed at the end of the working day and possible solutions (which form the basis for subsequent supervision) were suggested and agreed upon for implementation. A report is compiled and annually submitted to the District Health Officer (DHO). Table 2.4: Support supervision visits to peripheral health units in Bokora Health Sub-District
(including
Matany Hospital OPD)

Health Units'

Supervision
No. of visits to Government units No. of visits to Diocesan units
Total visits to all
Total no. of the units Average visits per Provision of Health Care in Hard to Reach Areas
Bokora Health Sub District continues to experience exodus of the local population to other places outside the HSD including to Kampala streets. Some have shifted from their original catchment areas to new settlements along the boarder border with Nakapiripirit, Katakwi and Amuria districts stretching the increased demand for more health care and other social services yet the budget for responding to this unique challenges is not catered for. More settlements have cropped up even in the plain areas of Matany and Lokopo sub counties; Namoruakwangan, Lomongakwangan, Natirae An estimate of over 20,000 people are in Nabwal, Apeitolim, Nakayot, Lomaratoit Alekilek, Kotipe and Nakicumet. The HSD with support of GIZ has been able to carry out integrated activities to some of these settlements from January 2011 to November 2012. A total of 24 out reaches have been conducted. The Services offered include, treatment of patients, ANC services, immunization, health education, screening of children for malnutrition, eye care, counselling, hygiene and sanitation services. However there are new settlements between Iriiri and Apeitolim namely; Komuturunyo, Kaeselem, and Okulonyo which are not yet supported. The HSD too had support of the Italian Cooperation project for immunisation and antenatal but the services were hampered during rainy season due to impassable roads and the programme is ending in December 2012. Health Sector Strategic Plan 2005/06-2009/2010 spelt out the need for special programmes for areas with special needs including Karamoja which could have helped in scaling up interventions highly needed in Bokora HSD which is most hit with this scenario of exodus but there is nothing in place at the moment leaving Matany Hospital with up hill task of reaching the population with services. Maternal and Child Health

A double trained registered nurse (URM/URN/TBA trainer), supervised by a Medical
Officer, is responsible for the "training and supervision" of TBAs and the delivery of ANC
activities in the zone. All the sub-counties have trained TBAs (total 204) and they are
supervised once every month at Sub-County level. ANC services are conducted in all HC
IIIs daily and in the Hospital from Monday to Friday.

Uganda National Expanded Programme on Immunizations (UNEPI)

Bokora County has eleven static units (corresponding to the number of health units
supervised by the Primary Health Care Department) and 84 outreach posts distributed all
over the county. The four hard to reach areas are also reached monthly giving a total of 88
outreaches. Each sub-county has an average 8 outreach posts run by the field health workers
and health unit staff attached to Matany Hospital and Peripheral Health Units respectively.
Table 2.5: Immunisation coverage by antigen for the six killer diseases in Bokora Health
Sub- District over the last six years Coverage Coverage Coverage
Coverage
Coverage
Coverage
National
2011/2012
101% 83% 104% 115% 95% Generally immunizations output targets have been met and surpassed except for TT to non pregnant women. The high coverage is attributed to migrants from Nakapiripirit District who have settled in Nabwal and Nakayot settlements and also other settlements like Apeitolim which has attracted people from other districts. The presence of Italian Cooperation project supporting immunisation and antenatal services in the HSD including hard to reach areas boosted the immunisatioin.most important to note is the mobilisation by the Field Health Workers, TBAs attached to the community health department and VHTs who did a good job in mobilisation and educating the community on the importance of child immunization and there has always been positive response which was reinforced with food supply to children under two years and pregnant women. The contribution of the community health department to the Poverty eradication action plan and Millennium development goals of reducing maternal and infant mortality, tuberculosis and malaria show significant improvements compared to where we were before but disparities still exist compared to other HSDs outside Karamoja Region. Ambulance service from Matany hospital to reach every mother in need of hospital services is readily available 24 hours and maternal audit with support of front line workers is being conducted in the HSD. The Maternal mortality rate for Bokora could be lower than that indicted for Karamoja region if the survey could be carried out in the HSD. Expanded programme on immunization is steadily making progress, routine immunisation, and national immunisation. The HSD achieved out put targets in immunization but surprisingly the UNEPI didn't capture much of our data which was usually sent to the Ministry of Health. Their analysis showed the HSD to have performed poorly in immunization yet a good performance was registered in this area. The establishment of Village health teams was done in 2010 with support from UNICEF as strategy to reach communities and house holds in the HSD. We have a total of 440 village health team members, male and female per village and they are well coordinated through IRC currently implementing intermittent management of fever, diarrhoea and pneumonia for under five children (ICCM) with very good results as indicated by the reduced load of OPD attendance of children in all health facilities. The department has front line workers inform of 440 village team members implementing intermittent management of fever, diarrhoea and pneumonia for under five children, 33 field workers participating in immunization, health education, follow up of patients and mobilization for health services, and 204 traditional birth attendants whose role has been shifted to mobilisation of pregnant women for antenatal care, health education, sending women to deliver in heath facilities and conduct delivery only in unavoidable circumstances. The community health department is making little progress in reducing fertility, malnutrition, and the burden of HIV/AIDs is not effective controlled since the prevalence is rising in stead of declining as per the national prevalence.  PELF (Programme of Eradication of Lymphatic Filariasis)
Lymphatic Filariasis is a disease caused by a filarial worm called Wuchereria Bancrofti. These worms are widely distributed in Moroto District (prevalence: 2-9%, survey done in 2002). Only two species of mosquitoes, known as Anopheles Gambia and Funestura, can spread the disease to human beings. The inoculated worms develop in the lymphatic vessels of a human being and once the above mentioned mosquitoes pick them from the blood of the affected person, the worms become adults and ready to infect others human beings. A mass distribution campaign of ivermectin/albendazole to all people older than 5 years was carried out in December 2007 in order to start the eradication programme which is going to last at least 5 years. The campaign was planned and conducted in 2011/2012, but poorly done due to poor motivation of VHTs and lack of transparency in the implementation of the activity by the responsible focal person.  PRIMARY EYE CARE

The PHC Department has a Primary Ophthalmic Assistant who conducts health education
on primary prevention of eye problems and carries out treatment and simple surgery of
simple eye problems on daily basis. Complicated eye cases are referred or booked for the
eye surgeon team coming from Kampala.
In September - October 2011 a team from Ruharo Eye Hospital had a surgical camp in
Matany Hospital from 26th September to 7th October 2011. Number of operated patients was
137 (78 cataracts with intraocular lens, 29 lids surgery, 30 miscellaneous). One hundred
thirty five out reach services integrated with other activities have been carried out in Bokora
Health Sub-District on scheduled basis. A total of 1,563 patients were visited either in static
or outreach clinics (see overleaf table 2.7).
Table 2.7: Primary Eye Care
No. of uncomplicated cases treated 970 630 1,005 1,399 1,833 1,563 No. of cases operated No. of cases referred Eye care services had improvement in the number of uncomplicated cases treated in the HSD compared to the previous financial year. The number of out reaches reduced due to muddy roads especially in hard to reach and there were no mobile outreaches. Table 2.8: PHC Department: Ophthalmic Assistant Workload during last Financial Year 2011/2012

Ophthalmic Assistant Workload during FY 2011/2012 including
static clinic and outreaches
Eye disease
No.
Eye Surgery
No.
Foreign body removal Other intraocular Non active trachoma Other extraocular Refractive errors Carcinoma/pterygum Dacryyotystorhinostomy Total eye surgery
Total eye diseases
GWEP
Bokora was the most highly endemic county for guinea worm disease in Moroto District. With the establishment of active surveillance, Bokora has achieved a high case containment (meaning cases identified, treated, prevented from contaminating water and verified by Sub-county/District supervisor within 24 hrs of worm emerging from the blister). This was maintained throughout the reporting year to interrupt the transmission cycle. During the Financial Year 2011/2012 no suspect was notified to the local and national authorities. The programme is in the process of being concluded as soon as our Region will be declared guinea worm free. SURVEILLANCE of Epidemic Prone Diseases
Surveillance reports have been collected on weekly basis from all the Peripheral Health
Units of Bokora Health Sub-District throughout the Financial Year 2011/12.
The table overleaf shows a summary of cases reported since 2009/10 to 2011/12

Table 2.9:
Notifiable Diseases since FY 2009/2010 to 2011/2012

FY 2009/10
FY 2010/11
2011/2012
reported
reported
reported
Bacillary Dysentery (suspects) 0
(suspects) 0
meningitis 0 0 0 0 37 7 Meningococcal Meningitis
Yellow fever( suspects) Animal bites/ Susp. rabies
Malaria is still the leading notifiable disease, while no polio, plague, VHF, meningococcal
meningitis and Guinea Worm reported. Seven suspects of measles and two of polio whose
samples were taken to Entebee with negative results received.

HEALTH EDUCATION

Health education, a public health intervention cutting across all areas, was conducted at
individual, family, community, institutions (schools) and Health Units level. The Health
Educator, Hospital staffs, students, and Field Health Workers carry out the activity using
various methods and tools to facilitate learning through voluntary adaptation of knowledge,
attitude, behaviour, and practices for disease prevention, control and health promotion.
It is quite evident that people's attitudes are changing, though gradually towards western
medicine practices. It is still a common finding that most people have been to the traditional
healer before coming to the Hospital but on a general note the health seeking behaviour of
the community is gradually changing. A number of health education sessions on health
related issues were conducted in 2011/2012 by various cadres in the hospital and the
community.
Problems/Constraints


New settlements and nomadic lifestyle. Traditional and cultural beliefs, conservative tendencies. Limited funds to carry all the health education services expected. The HSD functions constricted by DHOs office
Plan for next Financial Year 2011/12


Continue with support supervision to peripheral health units. Continue delivering an integrated health care package, comprising of MCH/FP/TBA, UNEPI, TBLCP, EDMP, school health, dental care and primary eye care activities. Ophthalmic Assistant should be supported to extend the services to village level to reach people who are usually unable to reach to the health units particularly the elderly, disabled and other neglected people in the community. An additional Ophthalmic Assistant to be trained. Eye-Surgeon to be contacted to carry out surgical camps twice a year Continue with epidemiological surveillance of epidemic potential diseases (Cholera, AFP, Measles, Meningitis, …) Lobby funds to support the population in the new settlements and to carry out HIV/AIDS activities especially family support groups. Continue TBAs' facilitation and supervision at Sub-County level, considering the unique situation of Karamoja Region. Strengthen and supervise TB control activities. Strengthen the epidemic preparedness and response activities. Strengthen village health teams in the whole health sub district The in-charge of HSD and other hospital managers to advocate from UNICEF to ensure that the support given to Napak District should also trickle down to the HSD not to remain centralised at the District as it is currently done with no information. It is hoped that the new DHO will communicate more regularly. CHAPTER THREE
GOVERNANCE AND MANAGEMENT
The Hospital operates under the direction of the Board of Governors (BoG), which takes its mandate from the Board of Trustees of Moroto Catholic Diocese through its Chairman, the Bishop. The Hospital constitution indicates that BoG meetings be held four times during a financial year. The flow chart below shows the Management Structure coordinating with the Hospital Management Team. Board of Trustees of Moroto Diocese Board of Governors St. Kizito Hospital Coordinator (DHC) Management Team: Headed by Chief Executive Officer, and consisting of the heads of the main departments Nursing Training Legend: - Hierarchical Authority and communication line = - Advisory Authority and communication line = St. Kizito Hospital Matany Constitution - 11
As seen above the Hospital is owned by Moroto Catholic Diocese with its legal entity the
Board of Trustees.
The congregations working in the Hospital have signed Agreements with the Ordinary
defining the number of personnel of the congregations to the Hospital.
Governance:

Moroto Diocese has a Diocesan Health Commission (DHC) that oversees policy
implementation and statutory undertakings for the Diocesan Health Institutions. The
Hospital is represented in the DHC by the Medical Director and the Nursing Director who
is its chairperson.
The Board of Governors:

St. Kizito Hospital Matany Board of Governors is the supreme governing body of the Hospital and Nursing
and Midwifery Training School. As such it is custodian of – and shall ensure compliance to the Constitution
of the Hospital. The list of BoG members is in Annex 2.
During FY 2011/12 there were only two BoG meetings. One reason was the three months
home leave of the Hospital Administrator from April 2012 onwards. For FY 2012/13 four
BoG meetings are planned as required by the Constitution.
Dates of Board
No of Members
meetings
Reports presented / Key issues handled / decision taken
Activity Report and Faithfulness to the Mission 16
Update from recent HMTW II from UCMB Budget and Audit Report Ministry of Karamoja Affairs Proposal to expand NMTS NMTS – brief report PHC – brief report 1. NMTS Extension – Concept paper discussed and approved 11
2. Budget 2011/12, half year performance analysis 3. NMTS – brief report and formation of a Statutory Committee 4. PHC – brief report 5. - Planning of a Diocesan Health Assembly - 11/02 – Day of the Sick, Blessing of Maternity Extension During the BoG meeting of 20th October 2011 the board received and discussed the Hospital report on the trend of the 4 indices of faithfulness to the mission. Most indicators were still in an upwards trend in spite of the difficult economic trend. The BOR remained still high! The Average length of stay has gone down which is commendable, yet beyond the recommended figure of WHO. The Caesarean Section (CS) Rate with 35% is higher than the WHO recommended 15%. However 46% of CS performed were mothers from outside Napak District. Looking at Napak District alone and evaluating risk deliveries whose rate indicating for CS is 5% of deliveries, it is noted that currently only about 3% are taken care of. The Hospital has also established a Disciplinary and Welfare Committee with the main function of ensuring proper conduct by the staff. The disciplinary committee meets whenever a disciplinary evaluation is urgently needed. The role of the Hospital Communication Officer is performed by the Administrator. An Ad Hoc job description and a first draft of communication policy within and outside the hospital are in place. The position of Personnel Officer has never been created; this responsibility is currently held by the PNO. Job descriptions are available for all cadres and clearly spelt out in their appointments. The human resource issue is of paramount importance in Matany Hospital and there is need to find funds and a personnel officer dedicated specifically to this task of human resource management. General Staff assemblies are regularly held. The Hospital recognised the need for the internal system management /process Auditor and has recruited one. In the year 2011/12 the areas audited were:  The Internal stock management processes,  The internal control procedures.  Follow up on prior years external audit recommendations for implementation, i.e.  Follow up on record keeping of all supporting documents for all transactions in the There was improvement in the stock records following the stock management checks, more
adherences to the internal control procedures in relation to cash movement and vouching
was observed. A proper documentation of transactions and implementation of prior year
external audit recommendations was observed, this can be traced to the External auditors
report for the year 2011/12.

Management

The Hospital is managed by the Hospital Management Team (HMT) with its executive
body, (the daily board), formed jointly by the Chief Executive Officer (CEO), the Medical
Director (MD) and Nursing Director (ND). This executive body meets daily (in the
morning) with the main task of discussing issues arising during the day to day running of
the Institution. Issues concerning finance, personnel, clinical care and project
implementation are the commonest topics discussed.
The Chief Executive Officer has direct access to the Bishop in the event of need and
ensures the function of liaison with the Uganda Catholic Medical Bureau, the Diocesan,
District and National Health Authorities.
 The Hospital Management Team (HMT) is composed of the executive board together
with the PHC Director and Nursing Training Director. The HMT meets regularly and the chairperson is the Medical Director. See the composition of this committee is in Annex 2.  The School Management Team (SMT) was substituted with the formation of a Statutory Committee which was required by the Health Commission of Uganda Episcopal Conference through UCMB. This Committee is specifically responsible for providing oversight on the Health Training Institution and reports to the Board of Governors. The composition of this committee is in Annex 2.
Overleaf in table 3.2 is a summary on the compliance with statutory commitments (with
UCMB, Government and Ministry of Health, etc,). Management is following all these
commitments seriously. However there is an open issue with NSSF concerning arrears of
contributions for expatriate staff, mostly religious. To the understanding of management
there is no obligation to pay contributions to NSSF of this category of employees as
especially the international congregations do have their own social security schemes and
will by all means not claim any assistance from government in case of sickness, disability
or retirement.


Table 3.2 Statutory Requirements

No REQUIREMENT achieve it?
Yes, Partly, No
Government / MoH Requirements
Open issue concerning Yes expatriate staff and young people in industrial training Annual operational licence Practicing licence for staff UCMB statutory requirement
Analytical Report end of FY year External Audit end of FY year Charter (still valid)* Contribution to UCMB for the year HMIS 107 PLUS financial report / quality indicators ending FY Report Status of staffing as of end of Manual of Employment (still valid) Manual of Financial Management (still Report on Undertakings and Actions of
Accreditation status with UCMB

Matany Hospital fully accomplished the 10 statutory requirements and hospital
undertakings set by the Uganda Catholic Medical Bureau and was awarded a certificate of accreditation for FY 2011/12 with score attained 30/33 and valid until 31st December 2012. It is the aspiration of the Hospital Management Team that we shall always strive to achieve this status year after year. Hospital Guidelines and Manuals

The Hospital Charter was revised on the 23rd June 2011 and approved by the BOG, the
Employment Manual, revised and approved by the BOG on the 10th March 2011 and the
Financial and Materials Management Manual are in place and used daily.
A Hospital Strategic Plan covering the period of July 2011 to June 2016 was made with
technical guidance from UCMB. It is a guiding tool for the operation and management of
Matany Hospital. This Strategic Plan was approved by the BoG during its meeting held on
23rd June 2011 with its Theme: "Pursuing the Health and Well Being of the person and
community through a holistic and integrated approach." Copies of these documents are in
the Hospital Library available to whoever wants to consult them. A copy of the
Employment Manual is given to all the employees.
Up to now the Hospital has no approved Information, Communication, and Data
Management Guidelines which will have to be formulated and approved in FY 2012/13 and
then implemented.


Advocacy, Lobby and Negotiation

In the year under report, the policy issues that required advocacy or negotiation with -
government / district included; the proposed salary increase of government employed health
workers. This is likely to result in the demotivation or exodus of health workers from the
PNFP facilities to the government units, thus depriving the Catholic Health net work and
other bureaus of human resource for health. The possible ideas to be fronted for negotiation
should include secondment of more government paid health workers to PNFP facilities or
the government should besides the delegated funds also support a wage bill for the PNFP.
Also the other policy issue is related to the Public Private Partnership for Health, given the
current high operational costs encountered by Matany Hospital in providing services to the
district population, the government contribution into the partnership is barely 1/3 (one
third) of the annual operational costs. Since resource mobilisation is becoming more
challenging for the Hospital, then there is urgent need to bargain for an increase of
government support/contribution into the partnership. There is need for the Catholic Health
Net work to decisively tackle these two issues with the government of Uganda, after all the
PNFP facilities under the respective umbrella bodies greatly complement the Public Health
Care System in this country. These two issues are of concern to the BoG of Matany
Hospital. We do hope that some advocacy agenda be agreed on as a network to pave a road
map to address these issues.
A Diocesan Health Assembly is planned for the same purpose of creating awareness of the
current situation among the district leaders in Karamoja region and also advocate for
improved partnership with local governments, development partners and Ministry of
Health.

CHAPTER FOUR
HOSPITAL HUMAN RESOURCES
Introduction

The Staff shortage and retention of previous years has been overcome. During FY 2011/12
an average of 7-8 Doctors were present in the station.
Napak District has seconded four staff to the Public Health Department to the Hospital and
fully takes care of their salaries. These cadres currently include; The PHC Supervisor,
Health Educator, one Health Inspector for Bokora HSD and a Health Information Assistant.
There is need to strengthen this collaboration to sustain and improve on the contribution of
Matany Hospital to the health services delivery in Napak District and Karamoja Region.
The Health Training Institution has presently two qualified Tutors: The Ag Principal Tutor
and a Midwifery Tutor. A trained Clinical Mentor was also part of the Staff. During this
reporting period however two Clinical Instructors were selected from the Hospital Staff and
two Diploma Nurses were also chosen for part time teaching. Two staff are currently on
training at the tutors' college and a DCN has started the training also as a Tutor sponsored
by MoH/Development Partners.
STAFFING

The total number of employees has been 255 as of 30th June 2012. Matany Hospital is one of the main employers in Karamoja Region. Table 4.1 shows the distribution between Karimojong and Non Karamojong Personnel. Matany Hospital Personnel since FY 2005/06
Graphic 4.1: Levels of Employment at Matany Hospital since 2004/05
The search for missing cadres is on going but the challenge remains above all for the allied medical professionals and by capable indigenous technical cadres. However at the end of FY 2011/12 most of the positions were filled. The output from the NTS significantly provides the only source of qualified nursing staff to Matany Hospital. The Technical Department relies on the supervision of two expatriate staff. The Hospital efforts in training Karimojong is gradually bearing fruit (see Table 7.3). Over the years the academic standard of schools in Karamoja has improved but it is still difficult to get enough candidates for professional training. The high cost of quality education is responsible for many school drop outs. Present situation (June 2012)

The expatriate staff includes the Administrator, the Senior Nursing Officer, two Technical
Supervisors (Lay Missionaries), the Domestic Officer, a Senior Medical Officer sent by
CUAMM and a Senior Medical Officer as a volunteer.
Trends

There has been a progressive increase in the availability of qualified health workers in the hospital over the last years. The hospital management team made it a priority to improve the staffing norms in various departments in the hospital. The other major contributor to this achievement has been a significant reduction of staff attrition. Even though a MoU was signed between the Diocese and the District regarding recruitment of personnel from the Hospital, this year the District has recruited about 10 Support Staff, one Dispenser, one Midwife (still under bonding Agreement with Matany Hospital), and all these were Karimojong Staff. Percentage of qualified staff in Matany Hospital
since FY 2005/06.
FY 2005/06 FY 2006/07 FY 2007/08 FY 2008/09
Graphic 4.2: Percentage Trend of Qualified Staff since 2004/05
During 2011/12 there was an observed increase in the percentage of qualified staff. Some staffs were given opportunity for career development guided by the perceived institutional needs. (see table 4.3) Table 4.1: Total No of staff at Matany Hospital compared to FY 2007/08 – FY 2011/12
MEDICAL OFFICERS
ALLIED MEDICAL PROFESSIONS
NURSING STAFF
ADMINISTRA-TIVE STAFF
PHC STAFF
TECHNICAL STAFF
SUPPORT STAFF
SCHOOL STAFF
KHRDCH STAFF
224 254 250 236 255
( .) = Karimojong Personnel 167 182 183 184 196 Non Karimojong Personnel Turnover of Staff

The remoteness of the place and the hardships of living and working in an environment like
Karamoja make the turnover rate of key health personnel inevitably high. However, last FY
2011-2012 we register the lowest turnover rate of the last three years as seen in table below.
We believe the hiring of more qualified Staff cover the turnover gap we faced the previous
year.
(all combined) Enrolled staff lost Turnover rate for each year is calculated as in the following example for enrolled cadres in 2007/08: Total enrolled staffs lost (1st July 2007 to June 30th 2008) (Total enrolled cadres available at June 30th 2007 + Total no. of enrolled cadres available at
June 30th 2008) / 2
Turnover Rate of trained staff in the last 3
FY 2009/10
FY 2010/11
FY 2011/12

MANAGEMENT
Human Resources' Management is one of the most challenging tasks within an Institution
operating in this region where leisure activities and social programmes are inexistent
combined with poor road access and irregular transport services. Staff have to content
themselves with the simple commodities available in the Trading Centre and sometimes at
high price.
The PNO has been assigned with the task of Human Resources Officer considering
financial constraints to fill this post. Nurses, Doctors, Allied Medical professionals, and
other qualified cadres, work 45 hours per week while some support Staff work only 30
hours per week as stipulated by the Employment Manual (revised in March 2011). This
Manual provides the guidelines utilized in Human Resource Management in the Hospital
and is made available to every employee at the time of induction.
During FY 2011/12 there was an increase in the percentage of qualified staff and, according
to perceived Institutional needs, some were given opportunity for career development.
As mentioned before, the Hospital administration strived to pay salaries to the employees in
line with those of public sector in order to compete favourably for the job market in spite of
the salary increase registered at the end of 2011.
All employees are covered by NSSF (National Social Security Fund) and are paid on a
salary basis. The salary is composed of a basic salary to which some incentives
(responsibility allowance etc.) are added. This constitutes the basis of calculation for
insurance purposes. Other payments (overtime, calls, stand-by allowance and specific task
related allowances) are added for the purpose of calculation of PAYE. The average salaries
paid at the end of the year for the stated categories of staff are indicated in Table 7.2.

HUMAN RESOURCE DEVELOPMENT AND CAREER

The HMT has put a considerable effort in designing a career development scheme and
different Staff are presently benefiting from it, particularly Karimojong candidates. We
have observed though that, in some cases, the sponsorship of natives is not a guarantee for
retention since many prefer to work far from their relatives. Though still limited, a good
number of staffs have chosen to renew their contracts and apply for further training through
this scheme.
The Hospital has sustained an effort for the general well being of the staff in terms of a
relatively attractive remuneration package and recreational programs; senior hospital staffs
live in fully furnished houses with running water, intercom and electricity. All these are
provided as fringe benefits excluded in salaries of senior staff. There is a provision for
internet access for the general staff in the board-room. The above provisions with
availability of mobile telephone net work have significantly softened the typically rural
surroundings.
Decent housing for nurses and other staff is provided, with installation of solar lighting into
each apartment. An effort to increase the number of experienced / senior staff is being
looked into seriously; the justification for this is due to the fact that the experienced Staff
are more productive and efficient. It is from such personnel that other scarce cadres, e.g.
Tutors, clinical instructors, counsellors, etc. are identified and developed.

A Human Resource Development Plan is annually made in order to guarantee that key
health cadres are available. The Management advertises the needs identified within the
institution and sets the criteria for application for sponsorship. Once applications are
received a committee is set up and selects the best candidates for the sponsorship and
training sites are chosen by the candidate. Up to the present most of the candidates have
kept their Bonding Agreement with the Hospital after their training. Developing Staff to
ensure essential services is in any case an ongoing effort of the management considering
that most of those ending Bonding Agreement join civil service or NGO's.
CME's and CNE's are regularly carried out. Topics are assigned to different Wards and
doctors together with other cadres discuss the topic at their level of expertise. Visiting
Doctors/Specialists are asked to offer CME's and they broaden the type of topics and issues
addressed. Topics discussed during this year include: Resuscitation of the newborn,
Endometriosis, Yellow Fever, Meningitis and many others. Staff are also informed about
quarterly review data on Hospital performance.


Table 4.3: Personnel currently on training : (* Karimojong)

Source of funding Enrolled Psychiatric Nurse Health Tutor 1* + 2 CUAMM/MoH/Hospital Diploma Nursing 6 (2*) Bachelor Business Administration 2* Information Technology 1* Physiotherapy Officer 1* Theatre Assistant Nurse 1 Laboratory Assistant 2* Laboratory Technician 1*  The main sources of funding for Staff Development have been external donations and through CUAMM support. Recently, MOH has included one of our candidates for Tutor within its sponsorship scheme aiming at supporting the Nursing and Midwifery Training School considering that it is the only School in the region providing quality training of health professionals especially Nurses and Midwives.  We have observed recently that some cadres, like Laboratory Assistants and Clinical Officers, are easily available and therefore we do not have to make provisions for sponsorship. The Hospital must make continuous provision for Diploma Nurses/ Midwives and technical personnel (mechanics, drivers…) since these are the more movable cadres. The Training of Tutors for the NMTS is a continuous concern of Management in order to ensure proper Staffing of the School and quality training. Therefore, in the Staff Development Plan for the coming year we have included the most pressing gaps at present (NMTS and Diploma Nurses/Midwives) considering also that CUAMM support is reducing and Hospital Financial resources are already strained.
Conclusion
The HMT has been investing a lot of resources both in developing and nurturing the Staff
by providing dignified housing and other fringe benefits and we believe that the
commitment and dedication of our Staff in the provision of care to the patients, speaks for
itself. The number of Staff renewing their contracts is still small and in the exit interviews
done with them we perceive that the reasons for turnover are related with personal reasons
rather than dissatisfaction with work environment or salary package.

CHAPTER FIVE
HOSPITAL FINANCES

Once more the Hospital managed to balance also in this financial year, income and
expenditure. It remains a big challenge for the Hospital Administration to make sure that
the running costs are covered. Up to now it was possible to maintain the high subsidy of
treatment costs. The income from user fees decreased in this financial year as the number of
outpatient attendance and admissions decreased. The previous financial years there were
ever more patients seen and this trend could not continue. It appears that the neighbouring
Lower level Units and the VHTs had this year a better impact on the population. The PHC
Conditional Grant decreased with 34 million UGX, while external donations increased.
Government support in terms of Essential Drugs has increased by 38 million UGX during
this financial year.
The Hospital continues to use the financial program, FIPRO which was initiated by UCMB.
It is a program for Accounting, Budget control and Cost analysis. Since many years the
Hospital tracks costs per cost-centre/department, for better efficiency and timely decision
making. - See the table below concerning various sources of income.

Table 5.1: Trend of Income by sources over the last 5 years, FY2007/08 to FY 2011/12

109,290,500 127,933,900 167,812,400 175,402,500 PHC CG Hospital ¹ 396,913,453 494,495,696 496,157,171 521,426,150 PHC CG School ¹ 17,640,598 21,977,587 22,051,430 22,009,492 21,673,318 29,653,256 38,454,744 44,777,144 46,504,440 Other School Income 86,969,207 283,669,880 152,147,540 External Donations Funds 0 166,431,000 263,308,549 255,119,208 171,757,658 External Donations of Funds ² 1,073,260,145 716,626,498 695,719,874 689,499,203 External Donations 76,971,211 100,139,934 112,116,976 163,909,564 Value of EDP Drugs received 142,803,979 175,607,069 81,578,756 30,421,888 79,791,928 Received in kind for HIV/AIDS Value of Lab Reagents & 211,423,122 212,139,354 184,908,216 275,919,414 203,072,940 TOTAL 2,304,612,264 2,140,794,989 2,352,100,396 2,332,359,399 2,876,299,719
The trend details of the various income sources are compared over the last five financial years in Graph 5.1: User Fees collected decreased by 4.8 % The workload, both in the Outpatient Department as well as Inpatients decreased. The PHC CG to the Hospital decreased by 6.5 % as compared to the previous year. The support towards the Nursing & Midwifery Training School increased as compared to last year. A three year programme of CUAMM with the emphasis on sponsoring a good number of our nursing and midwifery training students, some salaries and teaching aids as well as bursaries from Government and Development Partners are the main support. External donations for recurrent costs have increased, an important component in enabling the Hospital to keep up the highly subsidised services. The value of essential drugs allocated from Government increased as compared to the previous year. Graph 5.1 – INCOME SOURCES AND TRENDS
INCOME DETAILS & TRENDS FY 2007/08 - 2011/12
Donations Donations of 1,073,260,145 76,971,211 166,431,000 716,626,498 263,308,549 695,719,874 255,119,208 689,499,203 171,757,658 943,674,606 384,625,986 203,072,940 Graph 5.2 – Total User Fee / SUO (Indicates Equity or Affordability for patients to the Health
Services)
User fee / SUO
FY 2007/08
FY 2008/09
FY 2009/10
FY 2010/11
FY 2011/12

Comment:
Equity (affordability) refers to user fees per SUO. It refers to the amount that a
patient has to pay per hospital standard unit of output. If services are equitable, then the fee
per SUO must remain low, so that even the poorest of the poor can afford. Equity for
Matany Hospital had a slight increase of 10 from the previous year although the recurrent
cost/SUO increased by 18.2%. The services provided by Matany Hospital however remain
equitable as the services are highly subsidised and the increase of fees by just 1.5% as
compared to the previous year.
Expenditure

Table 5.2: Trend of Expenditure over the last 5 years, FY2007/08 to FY 2011/12

Employment Cost 768,708,973
804,443,383
953,198,281 941,716,096 1,070,688,081
Administration Cost 66,417,854
53,901,533
60,138,224
86,484,091
70,828,920
15,346,686
22,225,481
18,633,876
25,815,857 49,077,983
Transport and Plant Cost 280,784,005
130,033,152
143,850,929
188,136,209 249,939,842
Supplies and services 5,056,000
2,624,500
2,766,800 2,160,000
Medical goods and medical 223,862,515 308,845,295 530,987,655 429,695,863
605,227,717
Non-medical goods/supplies 44,234,708 44,617,781 31,228,605 40,754,387
101,980,959
102,262,853
103,700,032
118,484,223
159,072,384 188,570,409
Major maintenance and 285,751,528 191,857,998
243,321,924 225,688,179
192,998,410
upkeep of buildings Staff Development Cost 5,399,950
25.025,500
48,834,400
74,970,899 81,931,000
Training School Cost 95,677,908
160,978,553
120,372,639
148,307,922 190,972,052
TOTAL 1,889,336,980 1,810,070,795 2,312,281,170 2,323,408,687 2,804,375,373
Comment: Employment Costs have gone up due to a salary increase during FY 2011/12.
Administrative Costs were reduced as less printing of forms was needed. In the Property
Cost the small repairs were included in FY 2011/12 but in previous years they were
captured in Major maintenance. Transport and Plant Costs have risen due to increase of fuel
prices. Medical goods and supplies increased as even for this overhead prices have risen.
Non-medical goods/supplies were mainly food items which the Hospital provided through
the help of ISP in form of dry food ratios to the patients. PHC activities have also gone up
as more support supervisions and outreaches needed to be conducted. GIZ assisted with
some of these activities to the communities. Staff Development has continuously been
rising over the years and this is a clear sign that Management puts lots of resources into
capacity building. This programme was partly supported by CUAMM. As there were more
students in the Nursing and Midwifery Training School consequently the costs have risen.
Graph 5.3 – Expenditure Details and Trends over the last five years
Expenditure Details and Trends over the last five FY's
Employment Administratio Activities Development FY2007/08 UGX 768,708,973 66,417,854 15,346,686 280,784,005 223,862,515 45,124,708 102,262,853 291,151,478 95,677,908 FY 2008/09 UGX 804,443,383 53,901,533 22,225,481 130,033,152 308,845,295 49,290,708 103,700,032 216,883,498 160,978,553 FY 2009/10 UGX 953,198,281 60,138,224 18,633,876 143,850,929 530,987,655 46,859,208 118,484,223 292,156,324 120,372,639 FY 2010/11 UGX 941,716,096 86,484,091 25,815,857 188,136,209 429,695,863 47,001,508 159,072,384 300,659,078 148,307,922 FY 2011/12 UGX 1,070,688,081 70,828,920 49,077,983 249,939,842 605,227,717 104,140,959 188,570,409 274,929,410 190,972,052 Graph 5.4 – Trend of Efficiency over the last five years

Trend of Efficiency over 5 years
Comment: Efficiency is a measure of cost per unit output (SUO). In 2011/12, the cost per
SUO increased to 8,431 as compared to the previous year of 6,893. This is a sharp increase
of 1,538 or 18.2 % cost per output. It is obvious that recurrent costs have increased
tremendously which can be attributed to inflation and general rising of prices. Another
factor for this increase is that with fewer patients the overhead costs had to be covered.
Management has no influence in inflation rates or rising costs. However the staff
establishment will have to be evaluated in order to find out if personnel can be reduced.
UCMB organised a workshop in order to understand the software WISN (Workload
Indicators of Staffing Needs). With the help of this tool we shall be able to find our staffing
needs.
Find in Annex 3 the Financial Report Table which is annually presented to UCMB.
Financial Year Result

FY 2011/12 ended with a little surplus of 60 million UGX which is not of monitory value
but a book value. The big supply of ARV drugs in the early months of FY 2011/12 which
constituted in all the supply of requests previously raised, and little shelf life of these drugs,
resulted in having to return expired drugs to the District to be destroyed. Although the
Hospital Management has become aware that one way forward is the containment of costs,
it remains a challenge to keep costs low. Clinicians are continuously reminded to avoid
Polypharmacy in order to reduce costs for drugs. Management is further confronted with
the increased costs of goods and services. A salary increase for the Financial Year 2011/12
had to be effected as a matter of justice and concern for the staff. There is fear of another
salary increase by Government also during FY 2012/13 and as one measure of staff
retention the Hospital may have to apply this increase as well.
Management strives to increase income through regular reports and by keeping in touch
with faithful donors. However this has not been always possible due to a slim
administration and other commitments.
Government Intervention
As it is shown by the graphs above, Government's support to the Hospital in the form of
PHC CG has decreased by 33 million UGX, comparing FY 2010/11 with FY 2010/11. Its
support to the Hospital in the form of Essential Drugs has however increased during FY
2010/11 by 49 million UGX. The budget figures for PHC CG had been the same figures for
a couple of years now. How can the Hospital make up for inflation and higher costs? In
future the allocation of funds from Government will be based on output rather than on bed
capacity and other parameters.
Appreciation is given to the Government not only for the financial support itself, but also
for the level of co-operation that continued to be good. The release of funds by the District
Authorities, once received from the Centre, has been for the most part very punctual.
However, delays of the release of the PHC CG from the Central Government to the District
were noticed throughout FY 2011/12.
In the entire Karamoja Region there are, apart from Local Government, NGO's, Schools,
Health Units and a few building companies, no major employers. Therefore the vast
majority of people living in this area are not able to afford hospital charges if asked for a
cost recovery.
Table 5.3: Trend of Average user fees by department in the last 5 years
Average Fees
OPD Adult & children 580 827 855 960 959 21,496 22,022 33,305 27,346 32,538
From the data in the table above and the earlier trend of user fee / SUO, it can be seen that
the Hospital is trying to keep user fees extremely low in spite of rising costs and inflation.
However in FY 2009/10 there was a slight fees adjustment, which was mainly felt for adult.
The increase of FY 2011/12 recurrent cost/SUO by 18.2% was not downloaded on the fees,
which increased by only 1.5% gives evidence that services are becoming more equitable i.e
more affordable for the population.
Looking at table 5.4 below the cost recovery from the patients over the past five years in
relation to recurrent cost varied from 7.27 to 9.36. In FY 2011/12 however, it dropped to
7.77% which indicates that Matany Hospital services are not sustainable.
Table 5.4: Cost Recovery Trend in the period FY 2007/08 to 2011/12
2008/09 FY 2009/10 UGX UGX UGX UGX UGX Total User fees (a) 109,290,500 127,933,900 167,812,400 175,402,500 167,002,700 1,502,507,594 1,472,814,660 1,859,146,293 1,874,441,687 2,149,903,502 Expenditure (b) Cost Recovery Rate = 7.27 8.69 9.03 9.36 7.77 (a/b)x100 As Cost-recovery is low and even dropped compared to the previous financial year the effort of management to solicit funds through programmes and donations is evident. - User Fees are captured from the various cost centres and evaluated monthly. Another factor is that often poor patients receive treatment free and the fees downloaded on the Samaritan Fund account. As there have been no major fees adjustments over the past two years the utilization remained high. However in FY 2011/12 there was a drop of out patients and admissions which was attributed to a better utilisation of Lover level Health Units in the District as they were better stocked with drugs and the early treatment of simple illnesses by the Village Health Teams. Table 5.5: Trend of indicators of efficiency in use of financial resources
FY2007/08
FY 2008/09
FY 2009/10
FY 2010/11
FY 2011/12
Maternity Ward
Cost per inpatient /day 240,830 238,060 259,901 271,948 255,011 Paediatric Ward
Cost per inpatient /day 52.9 240,830 238,060 259,901 271,948 255,011 Surgical Ward
Cost per inpatient /day 295.9 240,830 238,060 259,901 271,948 255,011 Medical Ward
Cost per inpatient /day 122.6 240,830 238,060 259,901 271,948 255,011 Cost per inpatient /day 218.2 240,830 238,060 259,901 271,948 255,011 Cost per OPD activity

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

Above table shows in general a trend of rising costs. It is not possible with the inflation and
rising costs to be more efficient in saving funds for activities and services. The cost per bed
reduces when more beds are provided as seen in Paediatric Ward for FY 2009/10 and
2010/11. The cost per inpatient day shows a steady rise, e.g. in Maternity Ward. Also the
cost per OPD activities shows the same trend. How can the continuous rising costs be
covered if public funds are not equally increased year after year (see graph 5.5). The
funding gap increases and is difficult to be overcome with additional donations from
outside as the financial crisis has also hit countries outside Uganda.
Graph 5.5 – PHC CG contribution towards total expenditure
% -ige of PHC Conditional Grant over the last five
FY's vs. expenditure
FY 2008/09
FY 2009/10
FY 2010/11
FY 2011/12

In table 5.6 the average cost of treating three of commonest disease conditions are
compared to what is charged to patients:
Table 5.6: Cost and User fees for three common diseases seen in Outpatient Department

Amount charged as
Estimated cost
to hospital
(B/A)x100
Malaria in children < 5 years Pneumonia in children < 5 years Acute diarrhoea in children < 5 years
In the following two tables (5.7 & 5.8) and graphs (5.5 & 5.6) the possibility of sustaining
the current level of services in the absence of PHC CG and donor funding and in the
absence of donor funds but if PHC CG continues at the current level is assessed. (NB: This
is the extent to which the hospital is able to meet recurrent expenditures from locally raised
revenues- user fees plus any other local sources of income)

Table 5.7: Trend of sustainability ratio of the hospital in absence of both donors and PHC CG
funding in the last 5 years
(Local Revenue being only user fees and other locally raised
funds e.g. IGA, excluding government funds)

Table 5.7
277,417,843 297,645,383 345,002,638 442,567,195 370,075,640 Revenues (a) Total Recurrent Expenditures (b) 1,502,507,594 1,593,187,297 1,859,146,293 1,874,441,687 2,149,903,502 Ratio = a/b)x100 Graph 5.6
Trend of sustainability ratio in absence of both
donors and PHC CG funding in the last 5 years

Table 5.8: Trend of sustainability ratio of the hospital in absence of donors funding but with
PHC CG funding in the last 5 years
(Local Revenue refers to "in-country funding" and
therefore includes user fees, PHC CG, Local Government contributions, IGAs, etc.)

Table 5.8
785,274,155 1,054,271,241 1,018,781,767 1,102,113,393 Revenues (c) Total Recurrent 1,502,507,594 1,593,187,297 1,859,146,293 1,874,441,687 Expenditures (b) Sustainability 52.26 66.17 54.80 58.80 55.73 Ratio = (c/b)x100 Graph 5.7
Trend of sustainability ratio in absence of donors funding but with
PHC CG funding in the last 5 years

The previous tables 5.7 and 5.8 and Graphs 5.6 and 5.7 show clearly the vulnerability of the
financial situation of the Hospital. In FY 2007/08 the PHC CG was far less received than
expected, while in FY 2008/09 it was received fully. In FY 2009/10 EDP drugs were less
that 100 million UGX as compared to the year before and also in FY 2010/11 EDP drugs
were even less, hence the drop of the sustainability ratio.

Internal Audit

The Internal Audit Department was created in June 2011 and was functioning throughout FY 2011/12. However the Internal auditor left the Hospital in August 2012 in order to advance in his career by attending a two year professional course in Kampala. External Audit

Every year the Hospital carries out an external audit. Key observations and recommendations were:  Introduce fuel records in the Technical Department  Engraving all Hospital Assets  Hold regular BoG meetings as stipulated in the Constitution  Improve on the status of personal files by following a Staff File Completion Form  Internal Audit Department should be maintained. The previous audit recommendations were mostly complied with which was stated in the
Management Letter for FY ended June 2012 and others were recommended as a way
forward.
Procurement

The Hospital has currently no procurement manual but is in the process of writing one. The
procurement officer is the Hospital Administrator who co-opts various officers in special
procurements. The needs of the various departments are listed and brought for verification
to the Administrator.
Conclusion

It remains a challenge to contain costs with a proper utilization of resources. Resources are
becoming evermore limited or rather the costs increase and income does not necessarily rise
the same level. With the world economic crisis there is little hope that the emergency fund
of the Hospital can be invested. Taking these factors into account, the action plan for the
next financial year(s) will focus on the following areas:
 Continue the dialogue with the Government at District and at National levels through
the strengthening of co-operation, resource mobilisation and mutual trust. Secondment of more personnel through the District Service Commission would help cutting down on Employment Costs. In the event of salary increase UCMB may have to lobby for additional funds to be used to subsidise the wage bill of the Hospital. Continue monitoring the usage of financial and material resources at departmental levels with more involvement of the staff especially the departmental heads.  Ensure that Internal Audit of all Cost Centres is carried out annually and budget controls done quarterly.  Continue to make use of the accounting program (FiPro) with proper planning and monitoring of departmental costs.  Follow the five year Strategic Plan.  Continue keeping structures well maintained.  Get prepared for the National Health Insurance Scheme and its financial implications to the staff and the Hospital. CHAPTER SIX
HOSPITAL SERVICES

This chapter describes the activities of St Kizito Hospital Matany, with regard to
comprehensive care of the patients and health of the community. The service package
provided by the Hospital is sub divided into 3 sections: Preventive, Curative, and
Supportive/rehabilitative services.
CURATIVE:
A. OUT PATIENT DEPARTMENT (OPD)
OPD serves as an entry point for patients seeking services from Matany Hospital. According to its established function in the District Health System, the Hospital should offer to the public outpatient consultations of first contact exclusively for the immediate catchment's area of the hospital (Matany Sub County), outpatient consultations of referral level (for referred patients only), inpatient and emergency (medical and surgical) services and a package of preventive and promotive services (for the immediate catchment area i.e Bokora Health Sub District). This functional role has been commendable over the last year. Working schedule is from 0800HRS to 1800HRS from Monday to Friday and from 0800HRS to 1300HRS on Saturday. At the peak of the rain season, ranging from March to July, the population is susceptible to multiple epidemics that include; malaria, diarrhoea, dysentery and respiratory tract infections. The patient turn up to the OPD sporadically increases and as a result, the usual designated schedule of OPD cannot match the service demand. During such fluctuations in patient workload, the HMT adopts to some measures that minimise the work burden in the department; this includes readjustment of staffing and opening hours of the OPD. If this management decision is not implemented, the out patients would otherwise seek for services in the busy wards, thus compromising the quality of care given to the inpatients. OPD Staffing level during the financial year remained quite stable and adequate: the clinical team comprised one medical officer and three clinical officers fully responsible for seeing the out patients. The nursing staff level in the department has improved as compared to previous years. Since OPD is the main access point to service care provided by Matany Hospital, a well staffed and efficiently running OPD is a necessity. Laboratory and radiology departments complement the functioning of OPD; in order to ensure diagnostic services, and guarantee quality of care provided to the out patients, these departments are kept functional throughout the readjustments in the OPD work schedule. During Financial Year 2011/12 the total number of OPD attendances was 45,290, reduction of about 3000 visits as compared to the previous year. Although Matany Hospital is not a referral hospital in the region, it was observed that up to 30% of the patients were from out side the catchment's area. The monthly patients' turn up in OPD showed some variation throughout the course of the year: the period from July to December was characterised by high patient turn up, while the period from January to May had a relatively low turn up of the patients. This seasonal variation in the number of patients was associated with the climatic and migratory patterns of the community. The period of January to May corresponds to the dry season during which the mobile proportion of the population is more as compared to the static. During this time, access to health services is a great challenge as most nomadic communities move far away from established health facilities. The other factor responsible
for reduction of OPD attendance is due to the fact that, as a coping mechanism for the
draught and famine, there is an increase in rural-urban migration. Usually the period May-
September (in some years up to November) includes the rainy season and is associated with
an increase in disease prevalence in the community.
Graph 6.1: Illustration of OPD attendance during financial year 2011/2012
Matany Hospital OPD Attendances during FY 2011/12


Table 6.1:
Trend of Out-patient Attendance in the period 2003/04 to 2010/11

OPD Department
19,792 23,685 25,875 25,960 30,193 36,264 40,905 46,429 43,458 9,197 12,444 12,012 13,366 13,895 20,766 20,964 23,215 21,726 10,595 11,241 13,863 12,594 16,298 15,498 19,941 23,214 21,732 3,294 3,853 3,544 3,337 2,008 3,102 3,146 23,086 27,538 29,419 29,297 32,201 39,366 44,051 48,768 45,290

The number of outpatients over the last nine years has almost doubled. The possible
explanation for this is the progressive increase in population size and provision of
affordable, quality services by Matany Hospital, thus attracting patients from outside the
catchment area.


Graph 6.2: OPD attendance Trends over the last five years
OPD attendance trends over the last five years

Table 6.2:
List of Top ten OPD diagnoses in Financial Year 2011/12
Gastro Intestinal Disorders
In spite the various interventions to control malaria in the community, distribution of ITNs,
Home Based Management through the ICCM, IPT in ANC, malaria still remains the
leading cause of patients seeking medical care. This is followed by Respiratory Tract
Infections and Gastrointestinal Diseases.

Graph 6.3:
Top ten causes for OPD Attendance in Matany Hospital during FY 2011/12
Top ten causes for OPD Attendance in Matany Hospital
during FY 2011/12
Skin D'ses
Graph 6.4: Top ten causes for OPD Attendance in Bokora HSD during FY 2011/12
Top ten causes for OPD attendances in Bokora HSD
during FY 2011/12
Intestinal
Diarrheal

The observed morbidity pattern in Matany Hospital OPD is comparable to the disease
pattern in the entire HSD. The above graphic gives an overview of the top ten causes for
seeking medical care in all the twelve health facilities in the HSD. Malaria, RTI and
diarrhoeal disease respectively, have the highest burden in the community.

SPECIALIST OPD CLINICS

Matany Hospital offers specialised outpatient clinics in Dental Care, Eye care,
Comprehensive HIV/AIDS, Antenatal/Postnatal Care, Infant and Young Child care and
Surgical OPD. With exception of HIV/AIDS Clinic which runs twice a week (Tuesdays and
Fridays), the rest of the clinics are functional from Monday to Saturday.
Dental Clinic

The Hospital provides a limited number of dental services as seen below. Although Dental
Care is one of the components of Primary Health Care, its service demand is still low from
the catchment population. For this reason, employment of a dentist/oral surgeon is one of
the least priorities of Matany Hospital. The senior human resource in this department is a
Dental Assistant, with a certificate in dental care.

Table 6.3:
The top three procedures done in the course of the year
No of patients
Ten Dental Procedure
5 yrs and above
Scaling and polishing
Orthopaedic and Physiotherapy

This department is annexed to general surgery. The patient flow to the orthopaedic department is either through the Orthopaedic clinic for the outpatients, or from the surgical department, thus it catering for both in and out patients. For its proper functioning, the expected staffing norm is supposed to comprise two Orthopaedic Officers and a physiotherapist. Currently the Hospital has only a single Orthopaedic Officer and a
Physiotherapist. For quality assurance and proper follow up of patients, these team works
under the supervision of the Medical Officer in charge of the Surgical department. The
workload in this department has significantly reduced over the last four years following a
decline of the gunshot cases hospitalised. The majority of Orthopaedic cases are road traffic
accident victims or due to assault. Occasionally, sporadic cases of congenital abnormalities
(club foot) are treated. Clients for Physiotherapy are identified from all departments, and
daily follow up is done for those that are in patients. Tables 6.3 and 6.4 below show the
orthopaedic and physiotherapy rehabilitative work load during the year 2011/12.

Table 6.4:
Orthopaedic procedures done in FY 2011/12

Orthopaedic procedures done
No of patients
Open reduction and internal fixation
Table 6.5:
Physiotherapeutic services in the Hospital in FY 2011/12

Condition handled
No of patients
Infectious problems
HIV AND AIDS SERVICES
HIV Counselling and Testing/HCT

Since May 2005, Matany Hospital has been running a clinic providing care to people living with HIV/AIDS. The client response to seek treatment and care was initially very low due to stigma in the community. However, following continuous counselling and health education, the cumulative number has since increased progressively with more clients adapting to positive living. There have been a few challenges in provision of treatment and care; termination of IRC and WFP food for Health projects that were providing home care kits and food rations to clients. Other challenges include limited human resource to cope with the increasing clinic work load, short time of contact with clients, frequent stock out of supplies including ARVs. The hospital has tried to address the above challenges by having two medical officers, two clinical officer and two counsellors involved in the comprehensive care of clients, up from one medical and one clinical officer during the previous financial year. Also some partners (Baylor Uganda, MJAP, KIDEP) have been supporting the ART clinic with buffer stocks of ARVs, laboratory supplies and support to PLHA groups, the clinical team has been conducting outreaches to resettlement areas to serve clients in the hard to reach areas and trace clients that got lost from care. Table 6.6: HIV Counselling and Testing (by gender and age group) and Relationship to
Co-trimoxazole Prophylaxis and TB Detection individuals individuals Individuals individuals Individuals Total
0- <2 yrs 2 - <5 yrs 5- <15 yrs 15 – 49 yrs
>49 yrs
Category
Number of Individuals counselled 205 1,402 1,728
Number of Individuals tested 205 1,402 1,728
Number of Individuals who received HIV test results 206 1,402 1,728
Number of Individuals who tested HIV + HIV positive individuals with susp. TB HIV positive cases started on Cotrimo- xazole preventive therapy (CPT) 1 0 4 1 2 4 109
Number of Individuals tested twice or more in the last 12 months (re- testers) 0 0 0 0 0 0 21 46 83
Counselled and tested together as Counselled and received results together as couple Concordant positive couple Discordant couples Individuals counselled & tested for PEP Safe male Circumcision
Table 6.7, below shows the trend of people counselled and tested for HIV since 2008/09.
The number of persons who have undergone HCT has more than doubled during this
interval of time. Note that the percentages of the positive results shown do not depict the
prevalence of HIV in the catchment population. The proportion of people who access
services in the catchment area is quite limited by the poor health seeking behaviour and also
by the fact that up to 40 % of the population in the HSD does live beyond 10 km from the
nearest Health facility. To further boost the utilization of counselling and testing services,
some staff have had capacity building in service provider initiated counselling and testing
initiative. In line with the National policy of routine counselling and testing (RCT), it is
expected that in future, all patients turning up to the hospital for any health services will be
subjected to HIV/AIDS counselling and testing. The primary objective of this is to increase
the number of people who are aware of their HIV status and enhance early initiation of
treatment and care for those found to be positive.

Table 6.7:
Trend of HCT in the four Years (2008/09 to 2011/12)

Positive
Negative
Positive
Negative
Positive
Negative
Total 1,494
Total 2,095
Total 2,140
Total 3,868
(24.6%+ve)
(14.8%+ve, 85.2% -ve)
Graph 6.5: Data of table 6.7. - Trend of HCT in the four Years (2008/09 to 2011/12)
FY 2008/09
FY 2009/10
FY 2010/11
FY 2011/12
PMTCT
Prevention of Mother to Child Transmission (PMTCT) is a compulsory component of
ANC. It is national policy that all mothers who turn up for ANC are subjected to
HIV/AIDS test so as to protect exposed infants for those mothers found to be positive. The
strategy is good, but ANC attendance in the HSD is quite low. Out of the expected 9,618
pregnancies from the HSD population, the number of ANC visits was about 2000, out of
which only 1,572 pregnant women were counseled, tested and received their HIV test
results. Most of the mothers do not know their HIV status prior to getting pregnant and
couple testing is very low as male involvement in family health and social welfare in
Karamoja is very much limited. All mothers who tested positive in ANC were enrolled in
PMTCT and ART Clinic. Continuous follow up is effected through postnatal clinic,
however, the mothers' compliance to return for postnatal visits is lacking greatly, in spite of
medical advice. Table 6.7 below shows a summary of PMTCT indicators. Out of 68 HIV
positive mothers, 48 (70.6%) received antiretroviral drugs for prophylaxis and only 33 (just
below 50%) were followed up in the post natal clinic. This means that the risk is very high
for most mothers who don't even get tested and enrolled in the PMTCT clinic. 15% of the
exposed infants tested HIV positive. Most of the mothers choose exclusive breast feeding
as the feeding option for their infants as all of them cannot afford other artificial infant
feeding options. Since there is a relative risk of passing the infection through breast
feeding, it is not yet established how many of the above infants could have possibly
acquired the infection. As a measure to improve on the early infant diagnosis, the Hospital
has put in place an EID (Exposed Infant Diagnosis) focal person whose role is to ensure
enrolment of HIV positive mothers and their infants into the continuum of HIV/AIDS care.

Table 6.7:
Performance of the PMTCT Program over the last three years
PMTCT INDICATORS
A12-pregnant women counseled, test and received 1,351 1,301 1,572 HIV test results A 13-HIV positive pregnant women given co- trimoxazole for prophylaxis A15 HIV Positive Pregnant women assessed for ART A16-pregnant women who knew their HIV(+) status before the 1st ANC visit A 17-pregnant women given ARVs for prophylaxis PMTCT INDICATORS (cont.)
A 18-0thers Specify for regimens covered A 19-Prenant women on ART for their own health A 20-Male partners tested and received HIV results in PMTCT
6.2.3 POSTNATAL
P2-Number of HIV + mothers followed in PNC 6.2.4 EXPOSED INFANT DIAGNOSIS (EID) SERVICES
E1-Exposed infants tested for HIV below 18 months (by 1st PCR) E2-Exposed infants testing HIV positive below E3-Exposed infants given Septrin for prophylaxis within 2 months after birth
ANTIRETROVIRAL THERAPY

There is a progressive increase in the cumulative number of clients enrolled in the ART
clinic. It is difficult to tell as to whether this is due to an increase in the number of persons
opening up to seek for treatment and support or due to an increase in the prevalence of HIV
in the community. A combination of the above hypotheses could be the reality. Since 2005
the total clients that have enrolled in care is about 1,500. Out of these, 783 were actively in
care by the end of the period under review. The ART Clinic runs twice a week, on Tuesday
and Friday afternoons. The clinic runs only for 3 hours each of the above days with an
average attendance of sixty clients. The workload is progressively becoming more stressful
to the assigned human resource as all of them have got other job obligations other than
work in the ART clinic. Under the TB/HIV/AIDS collaborative activities, all patients
enrolled in the HIV clinic are screened for Tuberculosis and vice versa. It was observed that
22% of TB patients are co—infected with HIV.

Table 6.8:
Number of PHAs started on ARV by age group and gender in the last year (2011 - 2013)
individuals <
individuals
individuals
individuals
Category
2 < 5years
15years and
(24 months)
5 -14years
Male Female Male Female Male Female Male Female
Number of new patients enrolled in HIV care at this facility during the year Number of pregnant women enrolled into care during the year. Cumulative Number of individuals on ART ever enrolled in HIV care at this facility Number of HIV positive patients active on pre-ART Care Number of HIV positive cases who received CPT at last visit in the year Number eligible patients not started on Number of new patients started on ART at this facility during the year Number of pregnant women started on ART at this facility during the year Number of HIV positive patients assessed for TB at last visit in the year Number of HIV positive patients started on TB treatment during the year individuals <
individuals
individuals
individuals
Category
2 < 5years
5 -14years
15years and
(24 months)
Male Female Male Female Male Female Male Female
Net current cohort of people on ART in the cohort completing, 12 months during the year Number of clients surviving on ART in the cohort completing, 12 months on ART during the year Number of people accessing ARVs for PEP Number of individual on ART FIRST LINE Number of individual on ART SECOND LINE
Mental Health

Mental health is one of the components of Primary Health Care, and Matany Hospital being
a general health facility is mandated to provide mental health services among its service
profile. There is no specialised psychiatric clinic run by the hospital but the patients are
taken care of in the routine OPD and in patient service delivery. Through an initiative by
UCMB to improve mental health services in all hospitals in the Catholic Health Services
network, all hospitals under the umbrella were expected to develop human resource
capacity in mental health care. Matany Hospital has a Psychiatric Nursing Officer trained
and bonded through this initiative. Measures were also adopted by the hospital to include
psychiatric/mental health services in the routine PHC outreaches to the community. This
was aimed at addressing the fact that most of the psychiatric patients are neglected in the
community and therefore miss out the necessary care.
Table 6.9 below, shows the disease burden of the top five psychiatric conditions in the
community. Epilepsy is the commonest condition seen in the catchment population. Its high
prevalence is attributed to post cerebral phenomena due to febrile illnesses during
childhood. A few cases may be related to cerebral trauma and intrauterine infections. Most
depression cases are likely due to psyco–social stress factors (substance abuse, gender
based violence, child abuse, extreme poverty, post traumatic stress disorder after the war,
loss of loved ones etc) in the community. Through continued community sensitization and
mental health promotion, we hope to gradually improve community attitude and
perceptions towards mental health. Given the low utilization of mental health service, and
also due to the fact that psychiatry is a highly specialised area in medicine, it is not a
hospital priority to employ a psychiatrist. Patients who require more specialised care are
referred to well developed centres for psychiatric care.

Table 6.9:
Top five mental health diagnoses
Top five mental health diagnoses
Number of Patients
Alcohol and Drug abuse Anxiety Disorders Ophthalmology

Eye care is also one of the components of primary health care. Most disability due to eye
conditions can be avoided through timely and appropriate treatment. Matany hospital
provides a wide spectrum of eye care services that includes medical treatment and eye
surgery. The Eye care clinic in the hospital is run by an Ophthalmic Assistant whose basic
training/qualification is a certificate in eye care. He is able to diagnose and treat most eye
conditions, screen for refractive errors and dispense spectacles with the overall supervision
of the clinical team. The more specialised surgical treatment is provided through
ophthalmology camps carried out by ophthalmologists. During the year, one surgical camp
was done with a total of 137 Patients treated.
The pathology mix for the eye conditions includes the following; allergic and bacterial conjunctivitis, cataract, eye trauma, entropion, active trachoma infection with some cases of trachomatous trichiasis, corneal ulcers and scarring. Cases of glaucoma are not common among the catchment population. Table 6.10: Trend in numbers of Ophthalmology services over the last 5 years

No. of uncomplicated cases 630 1,005 1,399 1,833 1,563 No. of cases operated No. of cases referred
Generally, Ophthalmology services have improved over the financial years. The number of
out reaches reduced due to muddy roads especially in hard to reach and there were no
mobile outreaches.
Palliative care
Care for the terminally ill is one of the challenging tasks that Matany Hospital has to
undertake. There is no Community Based Organisation or Civil Society Organisation
providing support to the terminally ill patients in the district. Home based care for the
chronically ill patients is also nonexistent, leaving the entire burden of palliative care to the
Hospital. Over the last ten years, there has been a gradual increase in numbers of
chronically ill patients. This trend is associated to high levels of poverty, poor health
seeking behaviour, increasing prevalence of HIV/AIDS and Tuberculosis. In the recent
past, there has been a rise of non infectious diseases/diseases of lifestyle like; Liver
Cirrhosis due to alcohol abuse, hypertension, chronic renal failure, congestive cardiac
failure and malignant conditions. The emergence of this wide strata of chronic ill health sets
a new dimension of high cost implications to the operational costs of Matany Hospital.
Most of the affected patients are very poor, neglected and prefer to spend their last weeks–
months in the hospital. Besides providing treatment and nursing care to these patients, the
Hospital has to provide them with food as well. A Samaritan fund was set aside by the
Hospital to provide support to this category of patients. Contributions to this fund have
been sourced from friends and benefactors of Comboni Missionaries. However, resource
mobilisation for such essential humanitarian undertakings is progressively becoming more
challenging for the PNFP hospitals. The proposed National Health Insurance scheme that
should have lifted this corporate responsibility mantle from the Hospital has never come to
existence, and will probably never get into reality. It is high time other options are explored
to write palliative care projects in order to solicit for the necessary support in palliating our
terminally ill patients.
As a measure to improve on the palliative care services in the Hospitals, UCMB came up with a hospital undertaking to have a health worker trained in palliative care and also created the innovation of pastoral care in all Hospital under the Catholic Health Network. A nursing officer from our hospital underwent a nine month training on palliative care, with Hospice Uganda. This officer is also a trained counsellor and is currently serving an open contract with Matany Hospital. There is need to identify and have another health worker undergo the same training. A combination of palliative and pastoral care are very essential to the care of terminally ill as they provide for both medical and spiritual needs to terminally ill patients, thus embracing a holistic approach. B. INPATIENTS WARDS

Organization and management

Matany Hospital has got five in patient care departments which are sub divided into
Obstetric and Gynaecology, General surgery, Internal Medicine, Paediatrics and T.B wards.
The management and organization of each ward is under the care of a Diploma Nurse and
Medical Officer. They are charged with the responsibility of quality assurance in patient
care and treatment, duty allocation and supervision of junior staff. The criterion for
admission includes critically ill patients and those who cannot take oral treatment. During
the triage process, the categories of patients who are moderately ill are kept under
observation while on treatment for at least 24 hours. They are then reassessed and either
allowed home on treatment or admitted for continued inpatient care. Discharge is on
clinical improvement and a patient should be able to feed and take oral treatment at home.
Some patients are discharged on request with full consent of the patient and care taker. This
scenario is common with terminally ill patients or those for whom the caretakers feel they
can find better treatment elsewhere. Under both circumstances, the patient's charter is
strictly observed for medico–legal purposes.
Ward rounds are done twice daily by the clinical team, nurses and paramedics in each
respective department. A general ward round is done in the morning to review all patients
who spent a night in the ward. In the evening round, critically patients are reviewed, newly
admitted patients from OPD are re assessed and patient review with laboratory results is
also done.
Treatment schedules used strictly follow the National Clinical Guidelines for the dosage,
route and frequency of specific drugs. The Hospital also has in place some treatment
protocols adopted from World Health Organization. The annual expected in patient turn up
ranges between 12,000 to 14,000. These are irregularly distributed through all months of
the year with busy months corresponding to the rainy season (as for OPD above).
From the UBOS population projection of 2012, the expected number of T.B cases in the
catchment population was about 593 patients and during 2011/12, Matany Hospital treated
309 patients, a case detection rate of 52.1%. This is far below the expected National Case
detection rate of 70%. This can be attributed to poor health seeking behaviour, with many
T.B cases acting as a reservoir in the community.
Implementation of the CB DOTS strategy was associated with high defaulter rate. For this
reason, Matany Hospital resorted to implementation of DOT strategy which has proved
quite reliable with reduced defaulter rate and increase in treatment success.
With an increase in the prevalence of HIV, the cases of Extra pulmonary T.B are also on the rise and are associated with HIV co–infection. The common extra pulmonary diagnoses include; T.B adenitis, pericarditis, meningitis and tuberculous epididymo orchitis. The diagnosis of T.B is done through sputum smears and a logarithm of other investigations like chest radiograph, tuberculin test, erythrocyte sedimentation rate, non explained generalised lymphadenopathy and history of contact with a known case. T.B ward has the highest mortality rate and average length of stay. This is due to the fact
that most patients in this department are critically ill. The National T.B control program
protocols are used for the respective patient categories. The T.B patients who get lost to
follow up during the continuation phase of treatment are traced with the help of VHTs and
Field Health Workers.
Table 6.11below shows the various in patient indicators for the respective departments.
Table 6.11: Utilization indicators per ward and for the Hospital for 2008/09 – 2011/12)
Surgical
08/09 09/10 10/11 11/12 WARD
08/09 09/10 10/11
(41 Beds)
(41 Beds)
1183 1,309 1,117 1,117 1,497 1,522 1,302 Duration of stay Duration of stay 16,479 15,877 13,006 Avg. duration of 161% 199% 81% 62% 110% 141% 87% 72% Interval (No. of -7.8 -5.6 2.5 5.1 Interval (No. of 28.9 31.9 32 29 Bed (No. of Bed (No. of pts) Paediatric
Maternity
08/09 09/10 (119
08/09 09/10 10/11 (32
(55 beds)
(25 Beds)
6,426 6,661 6,278 5,739 1292 1,644 1,419 15,937 20,264 13,413 180% 224% 103% 90% Occupancy 175% 296% 147% 89% Interval (No. of -2.5 -2.8 -0.2 1.3 Interval (No. of T.B Adults
08/09 09/10 10/11 11/12
Indicators
(58 Beds)
136% 188%
Turnover
-2.7 -3.1
interval
Throughput
47.4 47.5 44.4 40.9
98.0% 83.7% Length
10 10.8 8 7
5.9 7.5 1.9 11.2 Inpatient
112,018 123,936
Throughput per Bed (No.
Table 6.12: Top 10 causes of admission
Admission
Injuries (all types) 10 Genito-urinary
Table 6.12 above and the graphic below show the top ten causes of admission in Matany
Hospital. Malaria is still the leading cause of admission attributing to 44% of inpatients.
This is followed by RTI, deliveries, Pneumonia, anaemia and diarrhoeal diseases. Injuries
constitute 4% of the admissions and the gunshot wound component of this percentage has
significantly gone down after the disarmament exercise.
Graph 6.6: Ten top causes of admission during FY 2011/13
Ten top causes of admission during the FY 2011/12
Injuries(all types) Skin Diseases
Diarrhaeral
Graphic 6.7 below shows the top five causes of mortality in Matany Hospital. Malaria is
still the leading cause of mortality, followed by Pneumonia, AIDS, Anaemia and T.B. The
mortality due to AIDS and Pneumonia are almost equal, this is quite alarming. There is
need to increase the number of people who know their HIV status so as to enhance early
access to treatment and care.

Graph 6.7:
Top 5 causes of death during FY 2011/12
Top five causes of death during FY 2011/12
Malaria, 19%
Anaemia,
AIDS, 12%
Pneumonia,

Table 6.13:
Trends of the top causes of death in the Hospital
TOP 10 CASE FATALITY RATES
A
B
Case
Rate
List Causes of
No of Disease
Total No of cases
(A/B) x 100
Mortality during the
specific deaths
of the disease
Financial Year
admitted
Comment: Morbidity and mortality causes are closely related. Malaria, Pneumonia,
Anaemia and Tuberculosis are among the top 10 causes of morbidity and have also been
implicated in the top 5 causes of mortality.

Maternity Ward


Maternal child health is one of the quality indicators in Matany Hospital. Unfortunately the reproductive health indicators are among the worst in Karamoja region. This is attributed to the fact that quite few mothers seek medical attention and most of the society is still conservative to traditional medicine and birth attendants. The number of ANC first visits only increased slightly by 200 from the previous year while there was a slight reduction in ANC 4th visits. Most mothers come for the first ANC visit when the pregnancy is much advanced. Even for those who come for ANC early, the dropout rate is very high with only 20% mothers able to turn up for the 4th ANC visit. Post natal attendance is gradually increasing, though at a very slow pace. Most mothers do
not come for post natal care making it quite challenging to health workers to provide new
born care. Continuous sensitization of mothers is ongoing in an attempt to improve ANC
attendance, supervised deliveries and postnatal care. There is also an effort to use the TBAs
as change agents to encourage mothers who go to them to seek better services at the health
facilities. Table 6.13 below shows some ANC and post natal indicators during the FY
2011/12
Table 6.14: Antenatal and Postnatal indicators
Indicators
ANTENATAL
A1-ANC 1st Visit A2-ANC 4th Visit A3- Total ANC visits new clients + Re-attendances M-ANC Referrals to unit A5-ANC Referrals from unit P1-Post Natal Attendances P2-Number of HIV + mothers followed in PNC P3-Vitamin A supplementation P4-Clients with pre-malignant conditions for breast
Maternity Admissions:
The In patient – Maternity Ward indicators are seen in the comprehensive table 6.11 above.
During the Financial Year, the number of deliveries in the hospital was 967, with a very
insignificant increase of 47 deliveries from the previous FY. 684 of the deliveries were by
spontaneous vaginal delivery, while 283 were by caesarean section. 135 babies had low
birth weight. The macerated still births were 11, while Fresh Still Births were 14. The
explanation for the FSB was due to delay to report to the Hospital with the consequential
birth asphyxia and not attributed to errors in monitoring progress of labour.
Upon admission of a mother into labour ward, labour is managed according to the
recommended guidelines by the Ministry of Health, and closely monitored by the midwife
using a partograph, which is plotted for each mother who comes into labour. The doctor
attached to Maternity ward periodically reviews mothers in labour, and makes necessary
interventions where need arises. All caesarean sections are sanctioned and performed by the
doctor on duty in maternity ward or the doctor on call where the need arises.
The table below gives a summary of deliveries conducted in the hospital during the period
under review.
Table 6.15: Maternity ward admission – (Deliveries and Births indicators)
Deliveries and Births indicators
Total Admissions for delivery Deliveries in unit Abnormal delivery (incl C/S) Live birth in units Babies born with low birth weight (<2.5Kgs) Fresh Still births in unit Macerated still births in unit Newborn deaths (0-7days) FSB died in hospital (FHS heard before del) For Live Births
Full term Normal wt Full term Low birth wt For Caeserean Sections
C/S as % of Total deliveries Emergency C/S as % of all C/S
Graph 6.8: Trend of deliveries over the last three years
Trend of deliveries over the last three years
FY 2009/10
FY 2010/11
FY 2011/12
Total adm .
Caeserean
for delivery
A Fresh Still Birth is a baby delivered with the skin intact and not macerated, indicating
that the death occurred within 24 hours before delivery. It is a quality indicator of obstetric
services. Total Still Birth Rate takes into account all the foetal deaths while the Fresh Still
Birth rate takes into account foetal demise in the hospital after admission (or shortly before
admission and is delivered within less than 24 hours of admission). For FY 2011/12 the
Total Still Birth Rate was 2.6%, an improvement from 3.2% of the previous year. Fresh
Still Birth Rate however remained constant at 1.4%.
Caesarean Sections

During FY 2011/12 the caesarean section rate as a percentage of total deliveries was 27.9%,
remaining fairly constant compared to last year's 28%. By and large, caesarean section
accounts for the greatest percentage of operative procedures done in the hospital. The main
indications for C/S were:
1. Obstructed labour
2. Foetal Distress
3. Ante partum haemorrhage
4. Cephalopelvic disproportion
5. Previous C/S section (2 or more)
6. Severe oligohydromnios
7. Poor progress of labour
8. Cord prolapse
9. Malpresentation and lie
10. Maternal distress
Maternal deaths
Pregnancy and child birth are expected to be a pleasant experience for the mother, the baby
and the community. It is not expected that any mother should die during pregnancy and
child birth. However, a number of unfortunate circumstances have led to the occurrences of
the unacceptable phenomena. Three delays are likely responsible for the cause of a
maternal death, whenever it occurs; The delay by the mother to make a decision to seek
medical attention, the delay to get the health facility; and the delay to initiate the correct
management/procedure once at the health facility.
During FY 2011/12, eight maternal deaths occurred in the Hospital. Maternal death audits
were done as per the Ministry of Health recommendation using the standard guideline.
Each of the events was reported to the District Health Office, Ministry of Health HMIS data
bank and to the director general of Health services. The death audits showed that the first
two delays (to seek medical care and to get to the hospital) were the determinant factors in
all these events. None of the audit findings pointed to errors in the management and care
given at the Hospital.
Two of the mothers were referred from Health Centres outside Napak District and they
were high risk mothers that presented late with severe obstetric/pathological complications.
Treatment and care of Gynaecological cases:
A section in the maternity ward is designated for the treatment and care of gynaecological
cases. The common gynaecology causes for admission include; abortions, ectopic
pregnancies, tubo–ovarian masses, severe menstrual disorders, hyperemesis gravidarum and
malignancies.
Cases of birth related injuries are occasionally hospitalised with most of them being
mothers who delivered in the village or referred from lower level health units in the
neighbouring districts.
To employ an obstetrician/gynaecologist is a priority among the Hospital plans with the
primary objective to guarantee specialised care for mothers so as to minimise maternal
deaths. This specialist is also expected to play a role in bed side teaching and mentorship of
the midwifery trainees, midwives and junior doctors.
The high caesarean section rate in the Hospital is due to referrals from the neighbouring
districts (45%). Graphic 6.9 overleaf shows a comparative analysis of the provenance of
mothers who underwent caesarean section over the previous two years. 55% of the mothers
who underwent C/S were from Bokora HSD/Napak district while the remaining proportion
was from Moroto, Kotido, Katakwi, Nakapiripirit and others. Mothers referred from
Moroto Hospital increased from 14% to 19% while those from Kotido reduced from 14% to
10 %. It is crucial to note that all the above districts have operational theatres, but for one
reason or another, mothers were referred to Matany Hospital for caesarean section.


Graphic 6.9: Provenance of women who underwent CS in Matany Hospital in the past three years

Provenance of women who underwent CS
From this analysis, it is quite evident that a significant amount of workload is imposed on Matany Hospital by the limited performance of the health care system in the neighbouring districts. The cost implications of this factor is a burden that Matany Hospital should struggle to contain, against all odds of resource mobilisation. From the catchment population of 197,700 (UBOS projection, 2012),the expected number of pregnancies was 9,618 with 9,329 births. The total number of supervised deliveries in the HSD was 1,850. Out of which 967 were in Matany Hospital while the remaining 883 were in the six HC IIIs located within the HSD. Therefore Matany Hospital contributed 52.3% of the supervised deliveries. The overall percentage of supervised deliveries in the HSD was 19.8 %. From the above populations projections the entire District only had 2,731 ANC visits out of which only 1,578 were fist visits,while 263 were fourth visits. The rest were re attendances. 26 mothers were referred for ANC to the Hospital while 10 were referred from Matany to other facilities. Reasons for referrals were due to patients preference. C. OPERATING THEATRE

One of the busiest and most expensive departments in the hospital is the operating theatre.
Due to its efficiency and reliability, workload of Matany's operating theatre is increasing.
We perform both elective and emergency surgeries. Elective surgery is one which is
planned and done at the convenience of the patient and surgical team while Emergency
surgery is that which if not performed urgently, the patient's health would be severely
compromised and may lead to fatality. Operating theatre works 24hrs due to the ever
constant availability of water and electricity. - A wide range of major and minor surgical
procedures are carried out in the theatre as depicted in the data provided below.

Table 6.16:
Top ten surgical procedures done in the course of the year
Top ten surgical procedures
Number of
Proportion %
Patients
Removal of Tubo ovarian mass Hysterectomy for fibroid The key indicators in Surgical Ward over the last three years are seen in table 6.11 above.

Table 6.17:
Trend of surgical activities in the period from 2009/10 to 2011/12
2010/11 2011/12
Major operations (incl C/S) Emergency Op as % of total major operations 1,143 1,237 1,128
As there was no surgeon in the Hospital throughout the year the number of elective major
operations were less than the previous years.
D: DIAGNOSTIC SERVICES
Laboratory
By the end of June 2011, the human resource in our Laboratory included one Laboratory
Technician and five Laboratory Assistants. The Laboratory is a very busy department in the
Hospital with a diagnostic role to both the outpatients and inpatients. The staffs were able
to cope with the increased workload. They maintained a 24-hour on call service throughout
the year. The capacity of the laboratory to carry out some tests like histopathology, culture
and sensitivity is still lacking, thus samples for these tests have to be sent to Kampala.
Table 6.18: Trend of Laboratory testing workload in the period 2007/08 to 2011/12
Type of laboratory test Blood smear for Malaria parasites Blood smear for other purposes WBC Count (total and differential) 1,411 Sputum smears (specific MT/a Urethra, vaginal smears & pus smears Haemoglobin estimations Blood grouping and X-Matching Urine examination Other body fluid examinations Stool examinations Serum Creatinine TOTAL 36,585
As standard it is recommended that each patient should at least have one investigation done
in the laboratory as to guide the clinicians in correct diagnosis. This limits the tendency by
Clinicians to treat patients by giving the best guess treatment. Graph 6.10 shows that over
the last three years this standard was achieved and has even risen to two investigations per
patient in the year under report.
Graph 6.10: Average Laboratory Investigations requested per patient
Average Laboratory Investigations requested per patient since FY 05/06
No. of Lab. Investigations
No. of Patients

Blood transfusions

Most blood supply to the Hospital was from Nakasero Blood Bank and of Mbale Regional
Blood Bank (MRBB), supplied on request. The blood from Nakasero is most times
delivered by air, thanks to Mission Aviation Fellowship (MAF). The Quality Assurance
Team from MoH strongly advised the Hospital to stop local blood collection and screening
as the Hospital has not got the capacity to test for HIV window period. Few blood drives
were undertaken and samples for screening sent to MRBB. In view of the cost implications
of transporting blood from Nakasero and Mbale, there is urgent need to establish as a short
term intervention a blood collection centre and eventually a regional blood bank in
Karamoja to cater for the needs of blood transfusion services in the Regional Referral
Hospital Moroto and the four general hospitals and health centre IVs in the region. During
FY 2011/12 the total number of Blood Transfusion was 2,105. Compared to the previous
year there was a decrease of 402 administered blood transfusions.

Graph 6.11:
Blood Transfusion Services
Blood Transfusion in Matany Hospital during FY 2011/12
NBB - 97.9% = 2,062 Matany - 2.0% = 43 The main indications for transfusions were anaemia due to severe malaria and haemolytic
anaemia due to septicaemia especially in children while in adults the main reasons for
transfusions were gynaecological and obstetric emergencies and surgical interventions.
IMAGING SERVICES

X-Ray Investigations

By the end of June 2011, the human resource in our X-Ray Department included one
Sonographer (trained by and bonded to the Hospital) and two Dark Room Assistants, who
were trained on the job and have gained a lot of experience over the years. - The number of
X-rays taken are classified in the table below.

Table 6.19:
X-ray examinations done over the last eight years in the Hospital
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12
2,620 2,430 2,405 3,214 2,848 3,296 71 87 84 131 141 141 106 1,234 1524 1,404 1,370 2,000 1,739 1,321 669 675 773 937 780 854 3,823 4936 4,631 4,744 6,337 5,521 5,590
4,789 4,218 4,615 6,077 5,327 5,546
It remains a challenge to get trained personnel and at the same time to keep personnel cost
low. Over the years a higher demand for x-rays and ultrasound was observed as clients are
referred from different Health Units in Karamoja for these investigations. This proves that
the staff in the department who were trained in the past by visiting radiologists have gained
great experience. However there is need to identify someone to be trained or eventually find
someone direct from the training school who is also reasonable with his expectations
concerning the salary.
Graph 6.12: Trend of x-ray examinations over the past five years
Trend of x-ray exam inations over the
past five years
Ultrasound
Table 6.20: Ultrasound examinations done over the last six years in the Hospital
2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 736 42 41 116 985 339 30 212 516 1,219 1,186 1,707 388 850 1,398 1,974 2,730 2,240 2,517 Organs 128 33 58 171 454 481 376 88 20 136 309 450 262 206 89 48 27 44 109 259 348 2,103 1191 1,992 3,644 7,250 6,557 7,537
Patients 1,700 1062 1,719 2,559 4,635 4,282 5,235

Graph 6.13: Trend of ultrasound examinations over the past five years

Pharmacy

The Hospital has a cool and dry, burglar proof, and well organized storage space for drugs
in the General Store while stock for regular consumption in the various departments is kept
in the hospital/Dispensing Pharmacy. Pharmacy Staff is comprised of a Pharmaceutical
Assistant and a Certificate Nurse while the Main Drug Store is assigned to a member of
management. These Staff compile JMS ordering forms whenever the minimum levels of
stock are reached and stock out of essential drugs are rare. Credit line orders were made and
most of the orders were completed both for Lab and drugs and money used.
Stock Taking exercise is done half yearly and expired drugs discarded and incinerated in
the hospital incinerator. We have not registered any other loss of drugs apart from expired
drugs. Drugs are ordered from the various departments and are kept in the department drugs
store managed by the department in-charge. Treatments to patients are administered by
qualified Staff and are carried out within the department itself. Regular treatment schedules
are kept as per doctors' orders and patients are very compliant with this regiment of
administration.
The majority of the drugs can be ordered by the Ward In-charge for the routine treatments.
Special/expensive treatments (Ceftriaxone IV etc.) need to be authorized by the MS and a
special order form has been designed for it.
Drug resistance cases were registered especially for TB but no alternatives were available
and patients were referred to Mulago.
The ten most used drugs in our Hospital are: 1 Amoxicillin capsules 6 Paracetamol Tabs 2 Ampicillin inj. 7 Diclofenac Tabs/inj 3 Ibuprofen Tabs 5 Metronidazole IV
The total expenditure on drugs during this FY was of about 284,050,000/= UGX plus
donated ARV drugs. The percentage of the ten top most used drugs on the total amount for
drugs used has not been established. This indicator will be established and reported next
year.
Drug expenditure is significant and the possibilities of economizing are related with drug
prescription practices by the clinicians. We frequently observe polypharmacy and the need
to perfect diagnosis in order to treat patients in a more effective and efficient way. The
availability of drugs in JMS is another factor which may increase hospital expenditure since
out of stock in JMS means to look for important/essential drugs in the pharmacies always at
a higher cost.
The above mentioned drugs are regularly monitored along with Quinine Tabs and
injectables, syrups and creams, ophthalmic drugs, insulin and reagents for the laboratory.
The monitoring tools used are the stock keeping cards and physical count done by the
Dispenser and this has been effective in preventing serious stock outs of essential drugs.



CHAPTER SEVEN
HOSPITAL SUPPORT SERVICES

The services supporting the Hospital running are: Administration and medical records,
domestic services, General Store and food distribution to extremely vulnerable individuals
and chronically ill patients, and ambulance service.
The technical services are provided by the Technical Department which carries out all the
necessary maintenance and renovation and raising new structures that take place in the
Hospital. The mortuary and burial service is another supportive assistance to the
community.
The Hospital considers if resources are made available to create a department of palliative
care to provide support to the terminally ill patients and also implement home based care
for the terminally ill patients.

A) Administration and Medical Records

The Administration Department is staffed with nine employees. The Administrator/CEO
supervises the accounts department with one senior accountant, two accounts assistants and
three cashiers (two in OPD and one for the various wards), the General Office with one
secretary and one assistant being trained on the job. The technical personnel are under his
supervision. The responsibility for procurement and logistics in the absence of specific
personnel are his responsibility. He is also exercising the function of the communication
officer and is responsible for the ICT until the sponsored candidate under training will take
up his position in FY 2012/13. The stores of the Hospital are under supervision of the
various officers of the Departments.
The Stores and basic accounting procedures are clearly described in the Financial and
Material Resource Manual.
HMIS Data are compiled by the HMIS Focal Person who is assisted by the Health
Information Assistant who is a staff in the Public Health Department. The data is
computerised following the HMIS formats as required by the MoH. Reports are regularly
produced and are verified by the Medical Director. Then they are sent to the DHO and
copied to the MoH.
B) Domestic Services
The domestic service comprises catering and domestic store keeping, food preparation and
supply, laundry, tailoring, compound and ward cleaning, waste disposal and waste water
treatment.
The domestic services of the Guest House and the Teaching Centre are as well available for
workshops and seminars. They generate some income so much needed to cover the
running costs of the Hospital.

C) General Store and distribution of food
The General Store is under supervision of a missionary sister and three support staff
members. Throughout the FY 2011/12, in collaboration with Insieme Si Può (ISP) the
Hospital has been providing nutritional support to extremely vulnerable patients. The types
of food supplied and quantities are tabulated below. The Hospital provides dry ratio food
for all the patients admitted. Special feeding programmes are in place for malnourished
children in the Inpatient Therapeutic Centre (supported by UNICEF, through supply of
formula feeds) and TB inpatients (supported by IDEA, Turin).
Table 7.1: Food distributed in FY 2008/09 - FY 2011/12
Food specification
distributed during
distributed during
distributed during
distributed during
FY 2008/09 (kg)
FY 2009/10 (kg)
FY 2010/11 (kg)
FY 2011/12 (kg)
25,500 18,139 26,200 19,834 1,850 660 9,195 2,220 23,550 44,383 37,500 33,222 Oil 13,404 2,278 4,357 3,046 1,350 1,143 4,850 4,820 Dry Skimmed Milk
D) Ambulance Service
The Hospital offers ambulance services within the catchment area and occasionally
referrals to Mbale or Kampala. There is a call line for this service. The road situation to
reach the Health Centres in the catchment area (Bokora Health Sub-District) in the rainy
season is causing delays and high cost of maintenance to the vehicles.
Three Toyota Landcruiser Ambulances (produced 1997, 2003 and 2010) are regularly
serviced by the mechanic section of the Technical Department and are kept at all times in
working condition. The cost of each trip varies. As a baseline 1,400/= UGX per km are
calculated for fuel, wear and tear and driver's allowance. However this rate has to be
corrected for inflation, and pay rises.
The Hospital has maintained extremely subsidised charges for ambulance calls to the
community, especially for children and obstetric emergencies as an affirmative action to
promote maternal and child health. Also a subsidised ambulance service is provided to
transport the deceased from the Hospital to their homes within the catchment area.
Other hospital vehicles are one Toyota Landcruiser for the PHC Department to carry out
support supervision and integrated programmes, another well maintained vehicle for long
distances mainly for Kampala attending meetings, etc. A four wheel drive Hospital lorry
(Benz 911) to ferry Hospital supplies, drugs, surgical sundries, building materials, food, etc.
mainly from Kampala (470 km one way). Another Benz 911 with a crane and a tractor with
two trailers are available for the Technical Department.
E) Technical services – The Technical Department

The Technical Department with a total of 42 established employees is a guarantee that
maintenance, renovation is carried out daily in the Hospital. New building projects within
the Hospital are carried out by and only by this workforce as quality work is guaranteed. It
is supervised by a Comboni Lay Missionary. Following cadres are present: mechanics and
drivers, electricians, plumbers, metal workers, builders, carpenters, and store keeper. There
are also some workers in the tree nursery for the tree plantation project of the Hospital.
Besides the ordinary routine maintenance and repair of equipment and buildings, the works
carried out in 2011/12 were: Completion of the extension of Maternity Ward as a
requirement to address the overcrowding in this Department. This intervention was
supported by CUAMM as another component of their maternal child health initiative. Also
the wall fencing of the NMTS was supported under this project as to improve security at the
HTI. Various services to the public as income generating activity by this department to
supplement onto the running costs of the Hospital prove the importance of this department.
The water supply to the Hospital has been constant during the course of the FY. Water is
provided by two bore-holes (one about 1,500 m West of the Hospital), with one
submersible pump linked to the Hospital mains by an underground cable, another within the
Hospital compound, with a solar panel operated submersible pump.
A biological waste water treatment plant provides clean water for watering plants in the compound and a fruit tree plantation. An underground water reservoir for rain-water collected from the entire hospital roofs, supplies water to the laundry, thus reducing the water consumption from the boreholes. Electricity is produced by generators and an extensive photovoltaic plant. A new solar hot water system, supplied by DKA Austria has been installed for the laundry, reducing the need of firewood and electricity to heat up water.  Recommendations The weather condition in Uganda due to global warming has greatly changed in the passed few years. The quality of the roads has deteriorated which resulted in higher fuel and maintenance cost of vehicles. Demand of oil products in the world have risen sharply as well which has direct impact on the cost of service delivery of the transport division (ambulance and transport of goods). Therefore the cost per km should be reviewed and reserves have to be put aside on a separate account for replacement of equipment. F) PASTORAL CARE

The spiritual support of the patients is of paramount importance to give a holistic approach
to healing. Pastoral care of sick people is one of the essential care provided to our patients.
A pastoral care giver trained by UCMB, the Priests of the Parish and a missionary sister
(until March 2012) readily avail themselves in the Hospital for this service whenever
necessary. However their services were only on call or part time.
Since January 2012 the Hospítal has received a missionary sister fully dedicated for
pastoral care of the patients and her impact is felt (see below table 7.2). The Sister follows a
weekly plan in order to cover all the wards of the Hospital, organises three times a week
prayer moments in the afternoon, alternating in the various wards.
Holy Mass is celebrated in the Hospital Chapel with participation of staff, attendants and
patients every Thursday and on special occasions, like the World Day of the Sick, etc.
The premises of the Hospital are made available to other Christian denominations for their
worship as a gesture of ecumenism.
Table 7.2: Trend of activities in Clinical Pastoral Care of the Sick

Activity / Indicator
FY 2009/10
FY 2010/11
FY 2011/12
No. of patients visited or No. of patients baptized No. of patients confirmed No. of patients given Sacrament No. of patients anointed CHAPTER EIGHT
QUALITY AND PATIENT SAFETY IMPROVEMENT

During FY2011/12, Matany Hospital, in a bid to continue offering care of quality to
patients, carried out several quality improvement activities. Among these were quality
checks including, but not limited to patient satisfaction and drug prescription surveys. In
this chapter we have expounded on quality improvement activities undertaken by the
hospital, basing on already set quality indicators. At the end of the day we endeavor to
achieve a status where the Hospital offers care of better quality.
1. QUALITY IMPROVEMENT ACTIVITIES UNDERTAKEN
The following are the quality improvement activities which were carried out and subsequently their effects felt. a) Incident registration and error reporting where any errors committed or omitted by any health worker which maybe of detriment to the patient, health worker or working environment is unanimously registered in the incident report book. These recordings are periodically analyzed by the department concerned, suggestions discussed and measures taken to avert future occurrences of such. b) Use of Surgical Safety checklist: The surgical safety checklist is a tool used to evaluate a patient's preparedness for an operation. The tool summarizes the systematic preparation of a patient, anticipated intra- and post-operative events. Since it's use in Matany Hospital, there has been improvement in surgical outcome of our patients. c) Clinical audits: These are carried out daily by the clinicians every morning as part of the review of patients over the preceding 24hours. d) The Quality Assurance Committee which was revitalized has been able and is continuing to evaluate and oversee among others, issues to do with Injection safety and infection control, waste management and segregation, maintenance of a clean and safe work environment. e) We have been having, and are continuing to have daily reporting by Department In-Charges. Here issues pertaining their departments are also raised and handled accordingly. This has improved problem solving such that we do not have to wait for a general meeting at the end of the month to solve some key issues. f) We have also had Support supervision by the District. g) Laboratory Quality checks have been ongoing and have been supported by collaborative partners like Baylor-Uganda and MJAP to mention. This has also improved quality of results received and ultimately patient care outcome. h) Accreditation: UCMB annually accredits health facilities under its umbrella basing on set standards and quality of service delivery. Matany Hospital fully accomplished the 10 statutory requirements and hospital undertakings set by UCMB and was awarded a certificate of accreditation, valid until 31st December 2013. i) Continuing Professional Education sessions have been, and are still conducted every fortnight throughout the year where staff members have been continually updated of the previous, current and future advances in various topics with the ultimate aim of holistic management of patients. 2. QUALITY INDICATORS

A. Technical competence and effectiveness of care
Table 8.1:
Proxy Indicators measuring the effectiveness of care in the Hospital
2009/2010 2010/2011 2011/2012
Explanation
Recovery rates on discharge: patients
Recovery
in one year discharged as clinically recovered from that episode of disease (from all wards) following treatment. Maternal
Maternal death rates: is not a
population based maternal mortality rate
death rate
or ratio that you may often comes across. Fresh still
Fresh still birth rate: Fresh Still births
have intact smooth skin not macerated. Early neo-natal deaths rate. Number of
babies who died within the 7th day from Neonatal
birth divided by the total number of death rate
deliveries in the hospital in that year expressed in percentage terms.
Recovery Rate

Our recovery rate has generally been increasing over the previous years. This is attributed
to increase in the numbers of qualified staff, reduced staff attrition rates leading to
improved quality of care.
Maternal deaths
During FY 2011/12, eight maternal deaths occurred in the Hospital, giving maternal death
rate of 0.46, compared to 0.31 for the previous year. Maternal death audits were done as per
the Ministry of Health recommendation and none of the findings pointed to errors in the
management and care given. Two were referred from other Health Centres outside Napak
District. They were high risk mothers that presented late with severe pathological
complications.
Fresh still births
Total still births were 25 out of 967 total births during financial year 2011/2012. This is
equivalent to a still birth rate of 2.6%. Fresh Still births were 14 which is 1.45% of total
deliveries. Macerated still births were 11 which is 1.1% of total deliveries.
In spite the fact that most mothers have poor health seeking behaviour, arrive late for
delivery and some do not attend ANC the still births rate is declining. Efforts have to be
made to keep the fresh still birth rate as low as possible. Up to 65% of deliveries in the
District are unsupervised.
B. Safety of Intervention
The chosen indicator for measuring safety of intervention is Caesarean section infection rate.
Table 8.2 shows trend of C/S Infection rates over the last 3 years
2009/2010 2010/2011 2011/2012 Explanation
Early neo-natal deaths rate. Number
C/S infection
of babies who died within the 7th day from birth divided by the total number of The total number of caesarean sections that got infected was 1 out of 270 operative deliveries that were performed, giving us a caesarean section infection rate of 0.37%. The World Health Organization stipulates that this parameter of quality should be less than 10% in any health facility that provides emergency obstetric care services. Based on this yard stick, Matany Hospital performance has been remarkable. C. Availability of Qualified Staff
Table 8.3:
Proportion of clinically qualified staff in the Hospital
Indicators
1 Qualified
Clinically qualified staff
Proportions of clinically
qualified staff
There has been a progressive increase in the availability of qualified health workers in the
Hospital over the last years. The Hospital Management Team made it a priority to improve
the staffing norms in various departments in the Hospital. The other major contributor to
this achievement has been a significant reduction of staff attrition. The majority of our staff
faithfully served their contracts or bonding agreements to completion, and many of them
even opted to renew / extend their contracts. The proportion of qualified staff is now
48.6%, therefore the aim to have at least 45% of qualified staff in the Hospital has been
achieved.

Graph 8.1

Percentage of qualified staff in Matany Hospital
since FY 2003/04
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12

D. Patient Satisfaction
Clinical outcome as perceived by the patient with regard to Clinical effectiveness of
outcomes e.g. improvement, loss of pain; Humanity of care i.e. staff attitude and patient
involvement in care; Organization of care in terms of flow of clients and waiting time
before seeing clinician; Healthcare environment e.g. toilet facilities, beddings and
bathrooms. Also assessed is overall impression, whether patient is satisfied and willing to
come back.
Based on the above indicators, for Matany Hospital, overall satisfaction rate (In & Out
patients) declined from 100% (2011) to 86% (2012). Humanity of care remained stable at
100%, as all interviewed said the staffs were very kind. 92% of the patients were involved
in decision making, 72% informed about their illness while 74% were informed about their
treatment, for which our overall score was 79.3% below the median rate of 85% across the
UCMB network of health facilities.
Time management declined from 100% (2011) to 50% (2012), thus giving room for
improvement in the next financial year.
Environment of Matany Hospital was rated as definitely clean, along with 13 other
hospitals out of 30 units in the UCMB network.
Regarding the Total Patient Satisfaction Score, whose maximum is 24, Matany Hospital
scored 16 in 2012, a decline from 20 in 2011.
There is thus still room for improvement and this will be done through Continuing
Professional Education, both at department and Hospital level.
Table 8.4: Patient satisfaction levels per core areas
Satisfaction rate Satisfaction rate
Criteria commented
Clinical outcomes
Patients need to be continuously
(Improvement after care)
counselled as to avoid such a decline
Humanity of care
Thanks to the ever committed and
(Kindness)
kind staff
Improved, though still need to

Patient involvement in
perform better to reach at least the
median of 85 (UCMB)
The healthcare
Patients appreciate the general
environment
cleanliness in the Hospital
Waiting time
There was a drastic decline

E. Medication safety

Drug prescription is one of the quality indicators of clinical care provided by the Hospital. Consideration is given to appropriate prescription (poly pharmacy, antibiotic rate, injection rate), dispensed drugs in relation to prescribed drugs (added up to the scores for appropriate prescription). According to WHO standards, average number of drugs prescribed < 2.6, antibiotics as a percentage of total drugs prescribed < 20% (Uganda <40%), Injections should be <15% of drugs prescribed. All (100%) prescriptions should have history and objective examination recorded, and all prescribed drugs actually dispensed. Since FY 2003/04 a regular monitoring system was re-vitalized in order to get information on prescription practises in OPD among Medical Officers and Clinical Officers. This has served a great purpose to regulate poly-pharmacy, in order not to deviate from the WHO/MoH standard recommendations. The average number of drugs prescribed was 2.1 (2.7 during FY 2010/11) and the average of diagnosis was 1.15 per patient (graph 9.6). The percentage of injectable drugs prescribed was respectively 0.8% for children and 1.8% for adults (compared to 0.5 and 2.4 respectively during the previous year), while UCMB average was 6%, for which Matany Hospital was remarkable. The percentage of outpatients getting an antibiotic in the prescription was ranging between 10.5 – 30.9.1 % throughout the FY, with annual average of 21.4% (19.6% during 2010/11). The above observation conforms to both WHO and Ministry of Health recommendations. There is need to remind our Clinicians regularly to take note and regulate their prescription practices in order to minimise poly-pharmacy. Monthly prescription trend for antibiotics and Non Steroid Anti Inflammatory Drugs (NSAIDS) are indicated in graphics 8.1 and 8.2, respectively. Graphic 8.2 Prescription of Antibiotic in OPD during FY 2011/12
Matany Hospital OPD:
% of Prescription with antibiotics during FY 2011/12
WHO recommends <20%
( MoH-Ug recommends <40%)

Graphic 8.3 Prescription of NSAID in OPD during FY 2011/12
% of antinflammatory drugs prescribed to OPD patients
during FY 2011/12
Jul-11 Aug

All the drugs prescribed were available in OPD pharmacy and there was no drugs stock
out during the year under review. The EDP line was completely utilised, thanks to the
regular information from JMS on availability of EDP funds. The greatest challenge has
been irregular supply of ARVs, leading to disruption of medication at times. Efforts to
restore a constant supply and availability of these drugs from NMS have been successful.
Graphic 8.4 Average numbers of Diagnoses made for a patient in OPD during FY 2011/12
Average number of diagnoses per OPD patient
during the FY 2011/12
National Standard
Figure < 1.5%
Table 8.5: Summary of Quality rates per indicator
STAFF SATIS
2009/10 1.84 0.07 95.6 1.49 2010/11 1.08 0.31 95.7 1.55 2011/12 1.46 0.46 96.9 0.37
Performance Indicators

Matany Hospital is a major contributor to the health care outputs in Karamoja region and
neighbouring Teso. Annually, the Hospital performance is assessed on core hospital
functions; quality of care and efficiency of resource utilization. Hospital performance can
be measured through some indicators developed by Uganda Catholic Medical Bureau
(UCMB). These indicators can be used to rank different hospitals on basis of their out puts;
and to monitor the performance of the same hospital over subsequent years.
Matany Hospital provides several health services to the people and these services can be
seen as outputs. The main outputs of a hospital include; the number of patients seen in
OPD, admitted in the wards, the number of mothers who attended Antenatal Care,
Immunizations done and Deliveries conducted throughout the period under review.
Giving a weight to each of the above outputs, five outputs are measured against a term of reference (Op = 1 outpatient contact), UCMB has produced an aggregated indicator of outputs called Standard Unit of Output (SUO-OP). SUO-OP is calculated using the following formula: SUO-OP = ( 15 x no. IP) + ( no. OP) + (5 x no. deliveries) + (0,2 x no. of immunizations given) + ( 0,5 x ANC visits)
In a similar way SUO-IP Standard Unit of Output per Inpatient) can be calculated.
Starting from SUO-OP/IP and knowing the total expenditure of the Hospital, the income
from patients user fees, the number of qualified staff, the bed capacity, the workload of
OPD, PHC Department and wards, it is then possible to calculate other indicators called
SUO-OP per staff (productivity of staff), cost per SUO-OP, cost per SUO-IP, median user
fees per SUO-OP, median user fees per SUO-IP. These indicators can be used to measure
the accessibility, the equity, the efficiency and the quality of Matany Hospital.
Hospital accessibility is measured looking at its utilization and therefore SUO-OP is the
best indicator. During 2011/12 the SUO-OP showed a decline as compared to the previous
FY (see Graph 8.4). This is explained by the fact that there was a decrease in the number of
patients.
Graph 8.4: SUO-OP as measure of accessibility.

Matany Hospital SUO-OP from FY 2005/06
Another useful indicator of accessibility is the Cost Recovery rate from fees (CRR) that is
the percentage of expenditures (recurrent cost) covered with money coming from user fees:
in Matany Hospital for the FY 2011/12 this was 7.7%. According to UCMB the
accessibility is good when this value ranges between 25-30%. Our CRR is far below
average for the UCMB Health Network, this is an indicator of good service access and
equity to the rural poor. This task of providing one of the most subsidised health services is
becoming more difficult in the present circumstances where resource mobilisation is an up-
hill task for the Hospital Management Team.
To measure equity (a hospital is equitable when people who are really in need, i.e.
vulnerable groups: children, pregnant women, are served more and more), three indicators
are used: median user fees per SUO-OP, utilization of services by pregnant women and
immunizations given to the population. Graph 8.6 indicates median user fee per SUO-OP
and SUO-IP in the previous seven years while no. of immunizations given and Ante Natal
Care Clinic workload are discussed in Chapter 6. The graphic indicates that the Hospital
remained equitable although there was a slight increase both in the Median User fee per
SUO-OP and SUO-IP. The rise however was still lower than the overall cost increase
during FY 2011/12 which was 18.2%. It is important to note that no patient is turned away
from accessing services; the Hospital has got a Samaritan Fund, which is used to care for
those patients who are identified as not being in position to meet the cost of user fees.
Graph 8.6: Median user fee per SUO-OP over the last 5 years

Matany Hospital Median User Fee per SUO-OP and SUO-IP
since FY 2005/06
FY 2005/06
FY 2006/07 FY 2007/08 FY 2008/09
FY 2009/10 FY 2010/11
FY 2011/12
Median User fee per SUO-OP Median User fee per SUO-IP
Considering no. of qualified staff and total cost of the Hospital, two other indicators,
measuring the efficiency, SUO-OP per staff (productivity or technical efficiency) and Cost
per SUO-OP (economic efficiency) can be calculated.
Graph 8.7 indicates the SUO-OP per staff and cost per SUO-IP since FY 2006/07. The
graphic reveals that the SUO-OP per staff (productivity) has decreased from 2.428 (for the
previous) year to 2,075 (this year). This is another indicator that fewer patients in OPD and
in the Hospital were cared for thus the productivity of our staff decreased.
Cost per SUO-IP increased due to the high quality of services provided (mainly surgical
and gynaecological procedures). In conclusion, our staff was less productive as compared
to the previous year because we saw less patients as compared to the previous year and the
overall cost has risen.


Graph 8.7: SUO-op per staff, Cost per SUO-OP and SUO-IP (technical efficiency indicators)
Matany Hospital Cost per SUO-op and SUO-ip since
FY 2006/07
FY 2006/07
FY 2007/08
FY 2008/09
FY 2009/10
FY 2010/11
FY 2011/12
SUO-op per staff
Cost per SUO-op
Cost per SUO-ip
CHAPTER NINE
HEALTH TRAINING INSTITUTION

St. Kizito Hospital - Matany School of Nursing and Midwifery is situated in North-Eastern
Uganda located in Matany sub-county, Napak District, Karamoja Region. It is 40 km from
Moroto Municipality and 14 km from the proposed Napak District Headquarter. It begun in
October 1984 with Certificate in Nursing which extended its services in May 1993 when it
started Diploma in Nursing course, this was suspended with the introduction of Certificate
in Midwifery Training course in May 2010.
The school capacity was determined at 90 students due to the available space both for
accommodation and classroom, and availability of qualified tutors as guiding indicators.
Due to demand for midwives in the region, the capacity has increased to 112 students.
However, the school with other development partners including Government strive to
increase gradually the schools capacity from 90 to 120, thus aiming at an increase of 30%.
This depends on the staff development over the years, and other capital development plans
to be realised.
The types of courses at the school:
Table 9.1: Types of courses
students
students
students
enrolled in
students
students
students
(new intake)
35 00 37 40 25 24 96%

This FY 2011/2012 the Students Population was: 112

The following Students were admitted to the HTI:
15 (Female = 08, Male = 07) 21 (Female = 15, Male = 6) 26 (Female = 22, Male = 4)

Currently there are two groups in third year of the training. CN/CM 2010 May Intake in
final semester of the year training. This trend will be on going.
Table 9.2: Number of lost and referred students in the last three financial years
Course CN & CM
2011/2012
Lost during the year Referred during the year This was attributed to gross breaches of HTI rules and regulations many of which involved ethical, professional, and moral issues. This resulted in a number of HTI Welfare/Disciplinary meetings and decisions that were painful for the students, their families and the School management. It was this that prompted the School Management Team to continue prioritizing professional ethics and moral discipline for this fiscal year 2011/2012. To achieve the above the tutors continue to do the following:  Detailed teaching of Nursing Ethics and moral standards of the profession to the incoming students and revision with the continuing students.  Use collective effort by the HTI and Clinical Teams to remind about and strengthen students on professional standards both in class and clinical area.  Introduction of teacher referees for each class, promotion and strengthening of guild leadership has helped a lot in guidance and counselling.  Involvement of family members/guardians in solving their problems
However, 3 students got discontinued due to breaching rules regulations, one due to forged
documents.

ACADEMIC PERFORMANCE

Student success rates according to grades
Graph 9.1: Showing certificate in nursing students' performance in grades


Looking at the above grading pattern according to the various intakes, there is improvement
in the academic performance and practical skills as the grading changes from pass now to
credits and few distinctions and there is need to maintain and improve for better
performance.

25 students of 2009 November Intake finished their state final examinations in May 2012,
although one failed paper II surgical aspects, and she will have chance to re-sit this
November.


The success rate in the last four years:

Table 9.3: showing the success rate in the last four years
2008/2009
2009/ 2010
2011/2012
Lost during the year Referred during the year Fail at 1st attempt Fail 2nd attempt The pioneer Certificate in Midwifery students will sit for their state finals examinations in November 2012. This FY 2011/2012, the HTI management identified the following key priority areas as vital, and therefore all activities within the year were geared towards fulfilment of these priorities. 1. Improvement and maintenance of quality training
2. Promotion of academic performance and improving practical skills of our
3. Development of the spirit of professionalism and moral discipline in students.
1.1 Improvement and maintenance of quality training:
Despite the high tutor-student ratio (1:56), the hospital management has reinforced the teaching staff with part-time teachers. The Hospital Management Team and HTI Team planned to carry out the following activities: 1.2 Training tutors and clinical instructors. The three tutor students who were sent to
Mulago Health Tutors' College for degree program in Medical Education are still on the program.  However, recently in August one identified candidate for tutoring has also joined the program. There is still need to identify and continue training more tutors (both Nursing and Midwifery). 1.3 Acquisition of more training materials. The HTI thank the donors for their
generosity of availing us with teaching materials. Despite the presence of some reference books, Paediatric Books and Mental Health textbooks, new editions of Margaret Myles and Anatomy and Physiology, Surgery, and Medicine text books which fit Certificate Nursing and Midwifery Course level are still needed. 2.1 Promotion of academic performance and improvement of practical skills:
In order for the students to perform better and have their practical skills improved for the
quality and safe care of the patients, coupled with the need to produce future Nurses and
Midwives with highly professional and technical training, to meet the present health
demands of our region and nation respectively, the HTI Management sought the need to
achieve the above priority area by undertaking the following actions:
 Involving actively the departmental leadership at the practicum site in training and supervising students when in the clinical area is ongoing.  Involvement of community leaders, members and neighbouring health facilities in specialized skills. On going.  Active participation in both external and internal academic seminars. Internal academic seminars are held in NMTS premises monthly at the end. Although we get challenged in external seminars due to delay in sending the questions and transport.  Attendance of professional medical education sessions where relevant to the level of training of the students involved. On going.  Promotion of student evidence-based learning where they are sent to the Library to research on certain topics and present in class followed by teacher's inputs is ongoing.  Guidance and counselling of students who are academically performing poorly, psychologically, emotionally, physically, and spiritually affected. 3.1 Development of spirit of professionalism and moral discipline in students:
Reflecting on the numbers of referred students and those who left the training in the last
three financial years as seen below.
Table 9.4: Number of lost and referred students in the last three financial years
Course CN & CM
Lost during the year Referred during the yr This was attributed to gross breaches of HTI rules and regulations many of which involved ethical, professional, and moral issues. This resulted in a number of HTI Welfare/Disciplinary meetings and decisions that were painful for the students, their families and the School management. It was this that prompted the School Management Team to continue prioritizing professional ethics and moral discipline for this fiscal year 2011/2012. To achieve the above the teachers continue to do the following:  Detailed teaching of Nursing Ethics and moral standards of the profession to the incoming students and revision with the continuing students.  Use collective effort by the HTI and Clinical Teams to remind about and strengthen students on professional standards both in class and clinical area.  Introduction of teacher referees for each class, promotion and strengthening of guild leadership has helped a lot in guidance and counselling.  Involvement of family members/guardians in solving their problems
However, 3 students got discontinued due to breaching rules regulations, one due to forged
documents.

Table 9.5: Indicators of faithfulness to the mission:
Below table shows the HTI's faithfulness to the mission in relation to the four key
indicators compared to last financial year. It is noted that efficiency has gone remarkably up
due to inflation and general rising of prices.
Faithfulness to Mission Indicator
2010 - 2011
2011/2012
ACCESS (utilization rate)
EQUITY (fee per student)
EFFICIENCY (expenditure per student)
QUALITY (success rate)
QUALITY (Tutor/Student ratio)


Access: An indicator that looks at the students' capacity of the school and determines its
usage. The number of students has increased because of two programs run at the same time such that the number has gone beyond the targeted 90 students up to 112.
Equity: This looks at the average fee per student.

Efficiency: This looks at the average recurrent cost per student. The Hospital continuous
to support the school in feeding, supplies and maintenance, through bulk purchase and storage of food stuff and other items which are usually bigger component in student cost. This shows a sharp decrease in efficiency due to the current economic condition in the country.
Quality (students' success rate): This has slightly dropped down to 96%

Quality (Qualified Tutor-Student ratio): this ratio has gone up from 1:50 to 1:56 due
to increase in number of students' population. This is expected to improve when one tutor student who is in her third year will complete in the next financial year. The evolution of the staff establishment of the HTI:
Table 9.6:
Staff establishment
Staff Establishment
Qualified Tutors Qualified Clinical Instructors / Mentor Unqualified Clinical Instructors N° qualified teaching Staff lost in the year Attrition rate qualified teaching Staff N° qualified teaching Staff recruited N° unqualified teaching Staff employed during the year N° unqualified teaching Staff lost during the year Attrition rate unqualified teaching Staff N° of Hospital. Staff Members providing lectures in HTI Ratio part-time vs. full-time qualified Governance and Management of the School

St. Kizito Hospital-Matany School of Nursing and Midwifery is governed and managed as
one of the main departments and cost centre of the main Hospital. The title of the school
management has been changed to Statutory standing HTI committee.
In regards to the continuous management of the HTI, the Acting Principal Tutor and the
entire teaching staff are involved in the following:
 Formulation and implementation of monthly clinical and class room teaching time
tables. This entails class room teaching, progressive clinical and academic assessments, examinations, organising/attending internal and external academic seminars.  Discussing briefly main issues of the school on daily basis. Having meetings scheduled fortnightly with teaching staff, supportive or administrative staff and quarterly meetings with In-charges of the wards and relevant departments of the Hospital to discuss professional, ethical training and moral issues. Keeping minutes of these meetings that are revised every beginning of the next one for better decision making, implementation and evaluation.  Conducting meetings with Guild executive and the entire student body on regular basis to strengthen guild constitutional policies, remind students of HTI rules and regulations and to encourage leadership qualities among the student guild and generally to solve any arising problem in the school. Teaching staff participate in staff development programs such as attending seminars, technical workshops, and conferences. Coordinating with the different stakeholders like Hospital Management Team, M.o.E.S-
UNMEB, M.o.H-UNMC, Diocese, District as far as the school issues are concerned.
School finances:
The budget of the school is approved together with the Hospital budget through the BoG. In
below table the different types of source for the school income during FY 2011/12 is
shown.
Table 9.7: Source of income for the Health Training School
Source of income for the
Amount / income
Health Training School
for the year
Student Fees' Collection MOH-DP Bursary Account Bursaries from Donors Student Payments for other costs (regi- stration / exams / specialised training …) PHC Conditional grants to School Other School Income (for services) External Donations of funds for recurrent 221,743,853
The school being one of the departments of the Mother Hospital gets management support
for its finances from the Hospital finance department; this is done through timely update of
the school management of its financial situation. The school accounts are audited as part of
the Hospital account.
Income and Expenditure

The sources of income of the HTI are mainly external donation and bursaries which take
almost three quarters of the total income. Sustainability is still a challenge to the Institution
so heavily supported by Donors.
Income

Graph 9.1:
Sources of income for the HTI in the FY 2011/2012

Bursaries - Donors
for Third parties
(exam fees, etc)

PHC Cond. Grant
other Income
Ext. Donations

Expenditure
Graph 9.2:
showing HTI expenditure in the FY 2011/2012
Admin. cost
Utility & Property
Internally, the School receives unconditional administrative, financial support, in-kind services from the mother Hospital. Much of its supplies are obtained from the Hospital main store besides purchases, transport and storage processes and all repairs and building done by the Hospital Technical Department. The Hospital takes care of 50% of students' medical treatment bill and treats the NMTS staff free. The management of Matany Hospital takes care of staff career development and sponsors a good number of students. The school receives support from the Local Governments of Napak and Moroto Districts through involvement in interviews, community activities and Family Planning Clinical Practice for our students. The HTI is continuously benefiting from spiritual formation of the students from the faith-based organisations within and without Moroto Diocese. It has also enjoyed a lot of support from the Diocesan Health Office both administrative and training. Externally, the HTI is supported by the following partners:  CUAMM: sponsoring both nursing and midwifery students, buildings, major renovations, donated text books  MOH/DP: Bursaries - sponsoring some students.  UNFPA: sponsoring some midwifery students of May 2011 intake  CUAMM-UNICEF: sponsoring some students (both nurses and midwives) in each  FAWE: sponsoring some midwifery students  Saints Project Baylor-Uganda: sponsoring some midwifery students  Government of Uganda: gives PHC-CG  UCMB: sponsors one Tutors' training, Clinical Mentors' Training. It offers administrative support to the HTI by organising workshops, trainings, meetings, support supervision.  M.o.E.S-UNMEB: this supports the HTI, through organisation of workshops, training, meetings, support supervision and examinations  M.o.H-UNMC: supports the HTI through workshops, meetings, support supervision and quality assurance  Other partners and friends: give in-kind services and goods and donations
The HTI is fortunate to have the above partners who have faithfully continued to support it.
It hopes to train quality and highly competent professional Nurses and Midwives to serve
this most underprivileged region of Karamoja, neighbour districts and the entire country.

b)Other training activities of the Health Training Institutions(s):


Despite our limitation in staff the HTI was able to carry out the following:
Participation in some continuous professional medical education sessions organised by the Hospital HTI team decided that each class is exposed to community activities for a period of four weeks in the whole period of training Family Planning Clinical Practice: in Moroto Regional Referral Hospital. Involvement in both internal and external academic seminars. Admission ceremony and swearing in of the student guild committee members. Participation in extracurricular activities. Participation in the UNMEB examinations. Point of Action for FY 2012/2013

The achievements as compared to the annual plan are as follows:
In summary, the HTI was able to register great strides in the area of academic performance
as was seen in the recent state final examinations results except one failed paper II. It was
able to send one teaching staff to Health Tutors College Mulago.
However, the following could still place the HTI at a better position in future:
Maintaining quality training through Tutor and Clinical Instructors training and recruitment Obtaining some more textbooks in specific subjects like Mental Health, Midwifery, Surgery, Medicine, and Paediatric which fit the certificate level. Putting in place more strategies for resource mobilisation for sustainability of the HTI activities Frequent self assessment exercise for the HTI team to improve in the management of the school Training more than one HTI team member in preparation of various HTI reports Strengthening clinical supervision of students CHAPTER TEN
SUMMARY, CONCLUSION AND RECOMMENDATION

Conclusion

Matany Hospital is the only Hospital in Napak District and it is well integrated in the
community. The Public Health Department functions as Head of the HSD Bokora and
collaborated with the District Health System.
The Organisation and management of the Hospital is clearly described in Chapter three
with the organisational structure.
The Hospital relies heavily on external donations and its sustainability is therefore
compromised. The infrastructure of the Hospital is well maintained facilitating quality care.
It is noted that the staff are well motivated and committed to the care of the patients which
is serving as a model for future generation of nurses being trained in the annexed HTI.
1) Achievements and Failures

The Hospital achievements are spelt out in the Faithfulness to the mission report based on
performance indicators. In general the objectives and target were met in spite of inflation
and the decline of government support vis a vis rising costs.
The extension of Maternity Ward, new class rooms at the NMTS were an effort to answer
especially maternal health needs and quality training both of midwives and nurses.
2) Faithfulness to the Mission report ( performance indicators)

Each year management prepares a report with performance indicators, demonstrating faithfulness to the Mission for which the Hospital was set as a health institution of the Roman Catholic Church. The four indicators are: Accessibility, Equity, Efficiency and Quality.  Is the Hospital more accessible especially to the vulnerable groups? While OPD attendance and admissions have reduced compared to the previous year
it has to be noted that the trend continuously increased the previous years.
Apparently the Health Units within the District and the VHTs had a better impact as
patients where treated there. However deliveries, antenatal visits and
immunisations were higher than the year before. Hence the accessibility was
guaranteed.

Table 10.1: Accessibility trend indicators over the past five years
OPD plus special clinics OPD Attendance (new) TOTAL SUO
Table 10.1 overleaf gives a comparative analysis of service utilization over a period of five years; OPD attendance (new) has decreased by 2,971, and admissions by 986. This decrease was expected as the previous year the attendance was extremely high. The good screening in OPD reduced the number of admissions and the presence of VHTs working in the community is felt. Deliveries increased by 45 as well as antenatal attendance by 209. Total immunisations increased by 11,753 which is attributed to the special immunisation days.  Is the Hospital more equitable? The trend of the user fee / SUO over the last 3-5 years as evidenced by the data in
the report and shown in below graph 10.1, refers to the amount that a patient has to
pay per hospital standard unit of output. If services are equitable, then the fee per
SUO must remain low, so that even the poorest of the poor can afford. Equity for
Matany Hospital had a slight increase of 10 from the previous year although the
recurrent cost/SUO increased by 18.2%. The services provided by Matany Hospital
remain equitable as the services are highly subsidised and the increase of fee/SUO
by just 1.5% as compared to the 18.2% of recurrent cost/SUO increase. Hence the
Hospital had to shoulder the extra costs thus subsidising even more its services.

Graph 10.1: Equity/Accessibility trend over the past five years
Trend of Equity over 5 years
 Is the Hospital more efficient? The SUO/staff (Staff productivity and the Cost (hospital expenditure)/SUO as evidenced by the data in the report show that Staff's Productivity has decreased by 9.5 % (230) that is from 2,428 (for the previous year) to 2,198 (this year). (see graph 10.2 overleaf). This is another indicator that fewer outpatients and admissions to the Hospital were registered with a slightly higher number of staff. The seasonal intake of admissions did not occur due to early treatment in the community by LLU and VHTs. This indicator has also to consider as above, that the recurrent cost/SUO increased by 18.2%, due to inflation and rising costs which are factors not being controlled by the Hospital. Graph 10.2: Trend of efficiency over the past five years
Trend of Efficiency over 5 years
 Is the Hospital offering care of better quality? Quality care is measured by the trend of indicators like FSB rate, Recovery rate,
Post C/S infection rate, MMR in the Hospital, % of staff who are qualified. These
indicators were evidenced by the data in the report. The table overleaf on the
quality indexes is self explanatory.

Graph 10.3: Trend of quality indicators over the past five years
Quality indicators over the past 5 years
Re covery Rate
M ate rnal de aths
Fre s h s till births
C-S inf. rate
%age of qual. s taff
2010/11 2011/12
97.6 95.4 94.8 95.7 96.9 Fresh still births %age of qual. staff
3) Contribution to the HSSP and MDG
The contribution of Matany Hospital to the national progress in achieving the MDGs is so
challenging but possible. The success of this contribution depends on the fulfillment of
MDG-8; building partnerships for sustainability. The current economic crises besetting
much of the developed world must not be allowed to decelerate or reverse the progress that
has been made so far. Let us build on the successes we have achieved, and let us not relent
until all the MDGs have been attained.
In relation to the eradication of hunger (MDG 1), Matany hospital has had a long standing
corporate responsibility every other year in providing food hand outs to extremely
vulnerable persons in the community and to the patients. This initiative was initially partly
supported by WFF, but the hospital must now find other partners to support this cause. ISP
has been a leading partner in providing food support to the hospital. GIZ has also been in
position to provide this support in times of crisis.
Millennium Development Goals 4,5 and 6 (reduce child mortality, improve maternal health
and combat HIV/AIDS, malaria and other diseases respectively), form the core function of
Matany Hospital. The role played by Matany Hospital in ensuring environmental
sustainability (MDG 7) is quite outstanding through the artificial forest growing around the
hospital and other technologies like rain water harvesting and recycling of waste water with
a record recovery of about 70% of the water.

4) Sustainability
Matany Hospital sustainability is a very critical and urgent issue. The main threats to
sustainability come from the place where we are situated, from National and Global health
and economic policies, lack of proper financing of health services, and human resource
situation.
Sustainability is threatened locally by the harshness of the region and its isolation mainly
because of the distances (almost 500km from main suppliers of medical goods and
extremely poor access due to dilapidated road network), lack of available trained personnel
in the region and therefore the Hospital has to sponsor almost all needed cadres in order to
guarantee the services. In a region where the Hospital is the main employer and the rest of
the population survives on a extremely low income making it unadvisable (because it
would compromise our mission of making services accessible to the poor) to increase user
fees for service which this year registered the lowest local recovery/cost of only 5.8%.
National and Global Policies regarding the creation of non functional districts and not fully
operational Regional Referral Hospital makes service delivery difficult and more
cumbersome financially for our hospital. The PHC Conditional Grant and all other support
from government has not matched the increased of demand for service added to this
component of the HSD which Matany Hospital heads and must cover financially. The
global economic crisis is having a strong impact on the progressive decline of external
donations and considering the high dependence of this hospital on external donations this
becomes of high concern in near future.
The widespread corruption is known to external donors and the withdrawal of support is
already a reality which surely will affect health services especially to the most vulnerable
people.
The isolation of a region like Karamoja is not attractive to Staff. Retention of Staff is a
challenge and the continuous effort in training personnel is financially draining.
Recruitment of trained and skilled Staff working in our Institutions by government is a very
serious threat and causing a lot of strain on human and financial resources. This well
motivated and skilled Staff who are an asset in a PNFP hospital when posted in a remote
government Health Centre or Hospital becomes redundant and very fast assumes a
undisciplined behaviour and consequently patients will continue to choose PNFP facilities
and thus increasing PNFP expenditure. The expansion of health services is creating new
posts of employment in government and recruitment is being done more frequently. PNFP
Staff are the pool for this recruitment which has not benefited PNFP Units yet. Therefore,
the trend as far as human resources are concerned is one of ongoing training and
sponsorship in order to guarantee essential cadres.
Critical Issues:

Requiring local and internal policy  Full cost recovery of services provided especially for patients seeking private services, those referred or self referred from other districts. Requiring managerial intervention from HSD and District:  Outreaches to hard to reach settlements not availed with basic services Role of NGO's in the region involved in health Secondment of Staff Requiring lobby and advocacy and partnership at district level:  Increase financial support in form of grants based on performance Improvement of access to Hospital by advocating for better and well maintained roads facilitating access of ambulances to health units thus saving lives Requiring attention/intervention of UCMB  More involvement of PNFP in planning and decision regarding health Tax exemption issues for medical goods NSSF deductions issues regarding expatriates Secondment or salary payment of Tutors for NMTS and Medical Doctors to hard to reach areas. Summary of Recommendations:

To Hospital Management:  Need to finalise full cost recovery of services' fees structure and apply to patients asking for private services.  Continue effort of identifying and develop essential cadres  Improve departmental supervision in order to guarantee efficient utilisation of resources in the respective departments.  Mentorship of staffs to ensure quality service delivery at all points of health services To HSD/District:  Strive for better cooperation and sharing in planning and resource allocation  Follow referral system and maintain vehicles at H/C's for transport of emergencies  More participation at Board meetings and Hospital activities on the side of District  District Health Department must recognise the role played by Matany Hospital in health delivery in the District and ensure that the challenges faced by Matany Hospital are a priority in its problem list, all possible effort must be made to advocate and lobby for Matany Hospital at the district level.  The PHC Department in the Hospital must guarantee continued support supervision to the lower level health units in the HSD for which support from the District is expected. To UCMB:  Liaise with Government on issues of financial constraints and sustainability Liaise with national insurance agencies on behalf of Expatriates serving in PNFP's Build capacity of the Hospitals in the net work to enable them do resource mobilisation. The catholic medical bureau should also inform the various health facilities of the available opportunities at the national and international level, besides policy guidance. To MOH:  More support of PNFP institutions, especially those upcountry with the lowest recovery fee offering highly subsidised services Sharing of resources on basis of outputs and performance Conclusion

St. Kizito Hospital operates with one goal: that of making the loving tender touch of Christ
for the sick and the poor perceivable here and now, so that they may see, and believe, in
Him, their Origin and Destiny.
We rejoice with and for all those who have encountered the Lord within the walls of the
Hospital; we know that often we have made this encounter more difficult with our
shortcomings and fragility: we ask forgiveness for it. Above everything else, we desire to
remain faithful to the task, entrusted to us by the Church, of serving the sick: we are
grateful to all those who made and who will make this task possible.
We thank God our Almighty Father for having brought us safely to the end of this Financial
Year. A lot more has been achieved and is not documented in this report.
We hope that the contents of this report will help to inform those who worked with us
during the year towards the achievement of our mission.
They are:
 the Board of Governors of St. Kizito Hospital - Matany  the Health Authorities of the District and the Country  the Local Government  the Diocesan Authorities We thank them for having entrusted us with the task of serving the people of Karamoja and of Bokora Health Sub District in particular. ANNEX 1 - Napak District with Health Units

Ngoleriet
Lokopo
HC III

Hospital
Morulinga
HC II

Apeitolim
Lorengechora
HC III

Iriiri
HC III

Amedek
HC II

Nabwal
HC II

ANNEX 2
Members of the Board of Governors:
(Following the Constitution of the Hospital) Voting Members 1. Mr. Paul Abul, Chairman 2. Fr. Marco Canovi, Parish Priest, Matany Catholic Church 4. Fr. Sylvester Hategekimana, Provincial of the Comboni Missionaries 5. Sr. Alzira Neres, Provincial of the Comboni Missionary Sisters 6. Sr. Dinavence Tushabomwe, DHC Moroto Diocese 7. Dr. Pierluigi Rossanigo, Med. Tec. Advisor Moroto Diocese 8. DHO Napak District 9. Mr. Joseph Lomonyang, LC V Napak District 10. Mr. Dominic Lochoro, LC III Chairman, Matany Sub County 11. Mr. John Bosco Teko, Sub County Chief Matany 12. Ms. Oyela Alice – Representing HSD, In charge of Kangole HC III 13. Dr. Vincentina (Sr.), Medical Superintendent of Kalongo Hospital (Sister Hospital) 14. Dr. Peter Lochoro, Country Representative of CUAMM Members, holding offices in the Hospital 15. Br. Günther Nährich, Administrator/CEO (Secretary of the BoG) 16. Dr. James Lemukol, Medical Superintendent 17. Sr. Rosario Marinho, Senior Nursing Officer 18. Sr. Gladys Licoru, Principal Tutor of the NTS 19. Ms. Deborah Achia, Head of the Public Health Department Members of the Hospital Management Team
1. Dr. James Lemukol, Medical Superintendent (Chairman HMT) 2. Br. Günther Nährich, Administrator/CEO (Secretary of the HMT) 3. Sr. Rosario Marinho, Senior Nursing Officer 4. Sr. Gladys Licoru, Principal Tutor NTS 5. Ms. Deborah Achia, Head of Public Health Department Members on the NMTS Statutory Committee:
1) The SNO, PHD Matany Hospital, Sr. Deborah Achia (Board Member) 2) LC III Chairman, Mr. Dominic Lochoro (Board Member) 3) The CEO, Br. Günther Nährich (Ex-officio) 4) The PNO, Sr. Rosario Marinho (Ex-officio) 5) The PT, Sr. Gladys Licoru (Ex-officio) 6) The Diocesan Education Secretary 7) CUAMM Representative 8) The Assistant DHO Napak District, MCH/Nursing, Sr. Regina Narus (co-opted) 9) The DEO Napak, Mrs. Joyce Nakoya (co-opted) ANNEX 3

MATANY HOSPITAL ANNUAL FINANCIAL REPORT
Cumulative
Difference
Description of financial Item
cumulative of
last year
the year 2011/12
with last year
1XXXX INCOME
User Fees' Collection 175,402,500 (8,399,800) PHC Conditional grants to Hospitals 520,592,077 (32,942,410) PHC Conditional grants to School 17,102,530 4,570,788 Other School Income (incl. Sch. fees) PHC Conditional grant for HSD ( Non- 52,245,476 (5,701,938) Donations of funds/goods for capital 255,119,208 (83,361,550) Donations of funds for recurrent cost Donations of goods and services 163,909,564 6,527,279 Value of Drugs received through EDP Value of Lab. Reagents & Consumables received (in kind) Income for projects(HIV/Aids, Malaria, Tuberculosis etc) Value of antiretroviral drugs, testing kits, antimalarial equipment received in (unexpected high due kind for operation of projects to supply of arrears) (HIV/Aids, Malaria, Tuberculosis) 267,164,695 (64,091,756) TOTAL INCOME
2,876,299,719
2,327,359,400
548,940,319
EXPENDITURES:
21 EMPLOYMENT COST
211101 Staff Salaries and wages 211102 Contact Staff Salaries & Wages 211103 Hous/bic/overtime&other 12,119,881 2,465,205 211103 Night/safari 8,750,700 (1,263,900) 211103 Duty/Resp./Acting 11,716,218 4,316,148 52,558,000 (167,800) 211103 Cost for interns 211103 Cost for student field trips 48,866,590 9,824,416 Staff health/ Social Health Insurance 409,000 3,783,200 213001 (Medical expenses) Incapacity, death benefits & funeral Retrenchment cost / Licence and Staff 6,699,731 (807,007) 213003 Insurance Sub Total
1,070,688,081
941,716,096
128,971,985
2XXX HOSPITAL BOARD COSTS Sub Total
ADMINISTRATION COSTS 221001 Advertising and Public Relations 221002 Workshop/seminars - 606,000 (606,000) 221003 Staff training 221004 Recruitment cost 221005 Hire of venue 221009 Welfare & Entertainment 4,580,500 3,166,000 221011 Printing and stationery Other office expenses ( small office 221012 equipment ) 2,300,008 (2,100,008) 221013 Bad debts 221014 Bank charges 2,417,380 (1,244,780) 221015 Financial & related costs Information Financial Management 221016 System Recurrent cost 221017 Subscription 1,885,000 965,000 221018 Exchange loses / ( gains) 222001 Tel./fax./postage/courier Information and communication 222003 technology (ICT) 223004 Guard and security services 224002 Uniforms & protection clothing 1,339,324 6,251,048 225001 Consultancy charges 4,042,000 (444,500) 227001 Transport all. Sub Total
70,828,920
86,484,091
(15,655,171)
223001 Cleaning of ward/dormitories 223001 Cleaning/slashing of compound 223005 Electricity 228001 Repairs and upkeep of buildings 223xxx Rents and rates Sub Total
49,077,983
25,815,857
23,262,126
TRANSPORT AND PLANT COST 226001 Insurance for vehicles 995,000 640,458 License for property, vehicles , 226002 equipment etc 227002 Air travel Carriage, Haulage, Freight & Transport 228002 Maintenance and repairs 228002 Tyres and spares 3,286,397 18,176,096 228003 Operation/maintenance Sub Total
249,939,842
188,136,209
61,803,633
SUPPLIES AND SERVICES 221007 Newspapers and publications - 261,800 (261,800) 221008 Computer Supplies 228004 Maintenance of equip. and supplies 2,505,000 (345,000) 22xxxx Equipment and supplies Sub Total
2,160,000
2,766,800 (606,800)
MEDICAL GOODS AND SERVICES 223007 Foodstuff and firewood 224001 Medical drugs 224001 Drugs received through EDP (in kind) Value of Lab. Reagents & 224001 Consumables received (in kind) 224002 Beds and beddings 1,339,324 6,251,048 Maintenance of medical tools and Donations of goods and services ( by 282101 hospital ) 22400X Medical supplies 224xxx Medical tools and equipment 5,409,745 27,519,655 Sub Total
707,208,676
470,450,250
236,758,427
PRIMARY HEALTH CARE Support supervision (together with xxxx outreaches) xxxx Outreach services xxxx Drugs & sundries for LLUs xxxx Planning and meetings 535,000 135,000 xxxx Training of TBAs xxxx Hospital Based PHC Sub Total
188,570,409
159,072,384
29,498,025
CAPITAL DEVELOPMENT Major maintenance and upkeep of 312101 buildings 312102 Residential building Transport Equipment ( motor vehicles, 312201 motorcycles ) Machinery & Equipment (non- medical Medical Equipment (eg Precision & 312202X optical equip etc) 312203 Furniture & Fittings Cultivated Assets (Breeding stock -fish 312301 & poultry, diary cattle etc) Depreciation (all categories) ( this can 231XXX placed under expenses category ) Other capital expenditure / 231007 Depreciation cost Staff Development costs (see page 4 221003 for definition) Sub Total
274,929,410
300,659,078
(25,729,668)
TRAINING SCHOOL TOTAL ANNUAL COST (see explanations) Sub Total
190,972,052
148,307,922
42,664,130
TOTAL EXPENDITURE 2,804,375,373
2,323,408,687
480,966,686
Balance (Income less Expenditures)
71,924,346
3,950,713
67,973,633

Source: http://www.gruppomatany.it/cms/wp-content/uploads/2015/07/St_Kizito_Hospital_Matany_Annual_Report_2011-12.pdf

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