Kiryandongo District REPORTJune 2013

Medicines and Health Service Delivery Monitoring Unit (MHSDMU)Plot 21 Naguru Hill DriveP.O Box 25497 KampalaTel: 0414-288442, 0414-288445, 0800100447 (Toll free)

WHAT IS MHSDMU? MHSDMU is a department set up by a

presidential instrument to monitor health service

delivery in Uganda

The department is apolitical

Does not override the functions of MoH, which

has the constitution mandate to oversee health

activities in the country

MHSDMU OBJECTIVES• The main objective is to raise the bar in health

service delivery

• Other specific objectives include to assess health

service delivery in health facilities

• To identify and rectify any forms of healthcare

malpractice, poor administration and

mismanagement.

• To find out possible immediate and long term

solutions together with partners (stakeholders)

INFORMATION HARNESSING

MTraC – free sms to 8200

Public complaints

MOH

Toll free line - 0800100447

Partners e.g ISO, Police

Politicians e.g LCs

Whistle blowers e.g health workers

The Kiryandongo District Visit

Motivation: Prompted by the several

mTrac reports of negligence, absenteeism,

extortion especially at the district hospital

Timing: Performed between 4th – 14th Jun

2013

The Kiryandongo District Visit - Approach

On-spot unannounced visits to all public

health facilities in the district

The Kiryandongo District Visit – What did we look at?

Human resource

Infrastructure and equipment

Finance and administration

Medical supplies

Medical services delivery

Laboratory, infection and vector control

The Kiryandongo District Visit – Facilities Visited

Kiryandongo

district Hospital

Kigumba HCIII

Panyadol HCIII

Mutunda HCIII

Masindi port HCIII

Diima HCIII,

Nyakadoti HCII Yabweng HCII Kiroko HCII Karuma HCII Kaduku HCII Diika HCII Kitwara HCII Teecwa HCII Kicwabugingo HCII Apodorwa HCII Mpumwe HCII

Our Findings

Human Resources

All facilities found to have less than the recommended number of staff.

Hospital most adversely affected

Facility Staff found on

duty

Positions filled

Recommended by MoH

Kiryandongo Hosptial

79 93 190

Kigumba HCIII 07 13 19

Diima HCIII 11 15 19

Mutunda HCIII 06 12 19

Panyadoli HCIII 05 09 19

Masindi Port HCIII 04 08 19

Kaduku HCII 04 04 09

Kitwara HCII 03 04 09

Tecwaa HCII 03 04 09

Nyankadoti HCII 05 05 09

Diika HCII 04 05 09

Kicwabugingo HCII

01 04 09

Karuma HCII 04 04 09

Yabwengi HCII 04 04 09

Mpumwe HCII 03 04 09

Finance and administration

Lower health centres

better managed

compared to facilities

of a higher level. No financial audit queries found at Kaduku HCII

Particularly, the district hospital

found to have queries

amounting to UgX 16,136,258.Symptoms of mismanagement at the district hospital

Infrastructure and equipment

Lower level health facilities were observed to have better maintained infrastructure when compared to higher level faclities

Unkept - Kigumba HCIII Dilapidated -

District Hospital

Well maintained - Diima HCIII

Shoddy work – Nyakadoti HCII

Rather Stalled

Medical supplies Lower level facilities

assessed to have better accountability for drugs and other supplies.

Expired drugs were evident in almost all visited facilities

Particularly, wide gaps found within the drug audits at the district hospital, no dispensing logs in certain wards

Poor house-keeping at district hospital main store

Good records keeping at Diima HCIII

Well-shelved drugs at Kitwara HCIII

Medical Service Delivery Patients appeared to have more

confidence with the services of lower facilities, especially HCII’s & HCIII’s

In the district hospital however, doctors were not honoring the duty roster, which led to loss of lives, especially on the male, female, maternity and peadiatric wards.

Health workers at Kitwaara, Masindi Port and Nyakadoti smartly clad in uniforms. Good performance starts with being smart at work

Her story – found with convulsing child at Kiroko HCII at 11.40am, no health worker, incharge went with the facility’s keys to Gulu. She was carried to the district hospital for admission.

Vector and Infection Control

Generally infection control measures were in place

Vermine

Acknowledgement

• Health workers that are committed• Health partners in the district: IDI,SURE,

Malaria consortium• RDC & DISO Hoima• Police (DPC, CLO, OC CID)• Tullow• Hoima LG• NMS