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REPUBLIC OF RWANDA

MINISTRY OF HEALTH

June 2013

KIBUNGO DISTRICT HOSPITAL

HOSPITAL STRATEGIC PLAN JULY 2012- JUNE 2018

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TABLE OF CONTENTS

LIST OF FIGURES ...................................................................................................................... 5 LIST OF TABLES ........................................................................................................................ 5 FOREWORD................................................................................................................................. 7 GLOSSARY................................................................................................................................... 8

I. PRELIMINARIES .................................................................................................................. 9 EXECUTIVE SUMMARY .......................................................................................................... 9 1. Hospital Vision, Mission, goals and objectives ................................................................... 11

II. HOSPITAL SITUATION ANALYSIS ............................................................................... 14 2. EXTERNAL AND INTERNAL ANALYSIS ..................................................................... 14

2.1. KIBUNGO DISTRICT HOSPITAL PROFILE ................................................................................ 14 2.1.1. Institutional history .............................................................................................................................. 14 2.1.2. Hospital ground plan ............................................................................................................................ 15

2.2. EXTERNAL ANALYSIS ...................................................................................................................... 16 2.2.1. District description ............................................................................................................................... 16 2.2.2. Catchment area population................................................................................................................ 16 2.2.3. District health map ................................................................................................................................ 18 2.2.4. Demography (5-years projections) ................................................................................................ 18 2.2.5. District health problem priorities ................................................................................................... 19

2.3. INTERNAL ANALYSIS ...................................................................................................................... 19 2.3.1. Structures of active services at Kibungo district hospital ..................................................... 19 2.3.2. Working conditions ............................................................................................................................... 20 2.3.3. District hospitals package and gap of health services ............................................................ 20 2.3.4. Hospital personnel and human resource gap ............................................................................ 24 2.3.5. Equipment gap assessment ............................................................................................................... 25 2.3.6. Infrastructure and gaps assessment .............................................................................................. 27

2.4. HOSPITAL PERFORMANCE ANALYSIS ....................................................................................... 29 2.4.1. Clinical efficacy ....................................................................................................................................... 29 2.4.2. Hygiene and patient safety ................................................................................................................. 29 2.4.3. Attention given to the patient ........................................................................................................... 29 2.4.4. Human Resource Management ........................................................................................................ 29 2.4.5. Patient flow analysis ............................................................................................................................. 29 2.4.6. Management and Governance .......................................................................................................... 30

2.5. ANALYSIS OF MAJOR ISSUES ........................................................................................................ 30 2.5.1. Causes of mortality and morbidity in the district hospital ................................................... 30 2.5.2. Hospital SWOT analysis ...................................................................................................................... 32 2.5.3. Analysis of Leadership and Governance Status ......................................................................... 34 2.5.4. Analysis of Maternal child health .................................................................................................... 34 2.5.5. Analysis of Health promotion and environmental health ..................................................... 35 2.5.6. Analysis of disease prevention and control service ................................................................ 35 2.5.7. Analysis of pharmacy services.......................................................................................................... 37 2.5.8. Analysis of Human Resources Services......................................................................................... 37 2.5.9. Analysis of Financial Management Services ............................................................................... 37 2.5.10. Analysis of Logistic and Administrative support services .................................................... 38 2.5.11. Analysis of ICT Services ....................................................................................................................... 39 2.5.12. Analysis of Quality and Safety Services ........................................................................................ 40

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III. STRATEGIC PLAN ............................................................................................................. 41 3. KIBUNGO DISTRICT HOSPITAL KEY PRIORITIES ................................................. 41

3.1. MEDICAL PRIORITIES ..................................................................................................................... 41 3.1.1. Maternal and child health ................................................................................................................... 42 3.1.2. Clinical service ........................................................................................................................................ 42 3.1.3. Disease prevention and control ....................................................................................................... 42 3.1.4. Health promotion and environmental health ............................................................................ 42

3.2. SUPPORTING SYSTEM PRIORITIES ............................................................................................ 42 3.2.1. Leadership and governance .............................................................................................................. 42 3.2.2. Human resources ................................................................................................................................... 42 3.2.3. Financial management ......................................................................................................................... 43 3.2.4. Drugs and consumables ...................................................................................................................... 43 3.2.5. Administrative support services ..................................................................................................... 43 3.2.6. Data management and ICT ................................................................................................................. 43 3.2.7. Quality and safety management ...................................................................................................... 43

4. LOGICAL FRAMEWORK OF KIBUNGO DISTRICT HOSPITAL ............................ 44 4.1. HEALTH PROGRAM ......................................................................................................................... 44

4.1.1. Maternal and child health ................................................................................................................... 44 4.1.2. Nutrition service .................................................................................................................................... 47 4.1.3. Family planning ...................................................................................................................................... 48 4.1.4. Environmental health .......................................................................................................................... 49 4.1.5. Integrated disease Surveillance and Response ......................................................................... 50 4.1.6. HIV ................................................................................................................................................................ 51 4.1.7. Tuberculosis (TB) .................................................................................................................................. 53 4.1.8. Integrated Management of Childhood Hilliness ........................................................................ 54 4.1.9. Malaria ........................................................................................................................................................ 55 4.1.10. Non-communicable disease ............................................................................................................... 56 4.1.11. Neglected tropical disease.................................................................................................................. 56 4.1.12. Immunization .......................................................................................................................................... 57 4.1.13. Adolescent sexual health and reproductive health .................................................................. 57 4.1.14. Gender Based Violence ........................................................................................................................ 59 4.1.15. Mental Health .......................................................................................................................................... 59 4.1.16. Traditional Medicine ............................................................................................................................ 60

4.2. SUPPORT SYSTEM STRENGTHENING ........................................................................................ 61 4.2.1. Leadership and Governance Status ................................................................................................ 61 4.2.2. Clinical service ........................................................................................................................................ 62 4.2.3. Pharmacy service ................................................................................................................................... 64 4.2.4. Human resource management ......................................................................................................... 66 4.2.5. Financial management ......................................................................................................................... 67 4.2.6. Logistic and Administrative support service ............................................................................. 69 4.2.7. Information and communication technology ............................................................................. 70 4.2.8. Quality care and safety ........................................................................................................................ 72

5. COSTING AND BUDGETING OF THE STRATEGIC PLAN ...................................... 74 5.1. COSTING APPROACH ...................................................................................................................... 74 5.2. STRATEGIC PLAN RESOURCE MOBILIZATION ....................................................................... 77

6. MONITORING AND EVALUATION FRAMEWORK .................................................. 78

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LIST OF FIGURES

Figure 1: Kibungo district hospital ground plan ........................................................................... 15

Figure 2: District health map ........................................................................................................ 18 Figure 3: Causes of disease in the hospital ................................................................................... 30 Figure 4: Top 10 Causes of under-five morbidity in district hospital ........................................... 31 Figure 5: Top 10 causes of morbidity in district (5 years and plus) ............................................. 31 Figure 6: Top ten leading causes of death in Ngoma district hospital .......................................... 32

LIST OF TABLES

Table 1: Description of the population distribution of Ngoma District by sector ........................ 16

Table 2: Description of population distribution by health center ................................................ 17 Table 3: Disaggregation by age group and projection .................................................................. 18

Table 4: Description of District hospitals package and utilization of health services .................. 20 Table 5: Table Gaps in internal medicine Services ...................................................................... 21 Table 6: Gaps in hospital clinical services .................................................................................... 23

Table 7: Kibungo District Hospital Personnel .............................................................................. 24

Table 8: Gaps in non medical equipments .................................................................................... 25 Table 9: Gaps in medical equipments ........................................................................................... 26 Table 10: Gaps in infrastructure ................................................................................................... 27

Table 11: SWOT analysis ............................................................................................................. 32 Table 12: Analysis of leadership and governance ........................................................................ 34

Table 13: Analysis of Maternal Child Health ............................................................................... 34 Table 14: Analysis of environmental health ................................................................................. 35 Table 15: Analysis of disease prevention ..................................................................................... 36

Table 16: Analysis of hospital pharmacy service ......................................................................... 37 Table 17: Analysis of human resource service ............................................................................. 37

Table 18: Analysis of financial management services .................................................................. 37

Table 19: Analysis of logistics and administrative support services ............................................ 38 Table 20: Analysis of ITC service ................................................................................................ 39 Table 21: Analysis of quality and safety service .......................................................................... 40

Table 22: Logical framework MCH ............................................................................................. 44 Table 23: Logical framework nutrition ......................................................................................... 47 Table 24: Logical framework family planning ............................................................................. 48 Table 25: Logical framework environmental health ..................................................................... 49 Table 26: Logical framework integrated disease Surveillance and Response .............................. 50

Table 27: Logical framework HIV ............................................................................................... 51 Table 28: Logical framework TB ................................................................................................. 53 Table 29: Logical framework Integrated Management of Childhood Hillness ............................ 54

Table 30: Logical framework malaria ........................................................................................... 55 Table 31: Logical framework NCD .............................................................................................. 56 Table 32: Logical framework NTD .............................................................................................. 56

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Table 33: Logical framework vaccination .................................................................................... 57 Table 34: Logical framework Adolescent sexual health and reproductive health ........................ 57 Table 35: Logical framework GBV .............................................................................................. 59 Table 36: Logical framework Mental health ................................................................................ 59

Table 37: Logical framework traditional medicine ...................................................................... 60 Table 38: Logical framework leadership and governance ............................................................ 61 Table 39: Logical framework clinical service .............................................................................. 62 Table 40: Logical framework pharmacy ....................................................................................... 64 Table 41: Logical framework human resources management ...................................................... 66

Table 42: Logical framework financial management ................................................................... 67 Table 43: Logical framework logistic and administrative support service ................................... 69

Table 44: Logical framework information and communication technology ................................ 70 Table 45: Logical framework quality care and safety .................................................................. 72 Table 46: Costing summarized table per year ............................................................................... 75

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GLOSSARY

Term Definition

ANC Antenatal care

DHIS District Health Information System

EICV Integrated Household Living Conditions Survey -EICV3 (Enquête

Intégrale sur les Conditions de Vie des Ménages)

FP Family planning

GBV Gender-based violence

HMIS Health Management Information System

HSSP III Health Sector Strategic Plan, version III

IMCI Integrated Management Childhood Illness

LLIN Long-lasting impregnated net

MCH Maternal Child Health

MoH Ministry of health

MDR Multi-Drug resistance

Mutuelle Community Health Insurance

M&E Monitoring and evaluation

NCD Non-communicable diseases

OPD Outpatient department

TB Tuberculosis

TracNet Internet based ART monitoring system

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I. PRELIMINARIES

EXECUTIVE SUMMARY

Kibungo district hospital strategic plan will provide strategic guidance to the health system in the

six years starting July 2012 to June 2018.

Kibungo district hospital strategic plan was elaborated after completion and evaluation of

Kibungo hospital strategic plan 2009-2012. It has been inspired and guided by VISION 2020 that

will make Rwanda a lower Middle income county by 2020; Economic Development and Poverty

Reduction Strategy (EDPRS 2008 -2012); Demographic Health Survey ( DHS, 2010); and

Millennium Development Goals. It is also in alignment with Health Sector Strategic Plan III

(HSSP III) and Ngoma District Development Plan

The objective of Kibungo district health strategic plan is to set strategy that will enhance health

systems, promoting continuous quality improvement, informing decision-making and ensuring

accountability to national health policies.

The strategic plan process started in May 2012, thereafter different meeting and workshop with

staff and hospital stakeholders were conducted. Qualitative and quantitative approach was used

in order to develop the hospital strategic plan. Data from different hospital department were

collected, analyzed and interpreted then based on findings strategies, indicators and targets have

been set. The baseline was set using data from HMIS (2012), DHS (2010), EICV3 report

(Integrated Household Living Conditions Survey). The targets were set as per HSSP III targets,

EDPRS priorities and MDGs, Ngoma District Development plan and Ngoma district health

strategic plan .

The development of the strategic plan was involved by all stakeholders and a consensus was

reached on 11 key strategic areas to examine. Goal, strategic, indicator, baseline and targets have

been developed to address the following areas: Leadership and governance, Curative care,

Maternal and child health , Disease prevention and control , Health promotion and environmental

health, Community case management, Human resources, Financial management, Drugs and

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consumables, Administrative support services, Information and communication technology,

Quality and safety management

The conceptual framework was developed in according to HSSP III and is adapted to the

situation of Ngoma district in four components: Leadership and governance, health program,

system strengthening and service delivery

The implementation framework was developed and with the developed monitoring and

evaluation plan, Kibungo district hospital plan will be monitored at the end of each quarter by

the hospital M&E officer and evaluation of outcomes will conducted every year at the end of

financial year.

The achievement of targets will require resources. The costs of Kibungo district hospital

strategic plan have been aligned according to program or pillar, supporting service strengthening

and service delivery, it has the cost of 13,572,285,841 RWF. The main source of fund is

government subsidiaries, the second source is from hospital partner, and finally the hospital own

revenue. The mobilization plan will be developed in order to overcome the problem of gap in

budge

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1. HOSPITAL VISION, MISSION, GOALS AND OBJECTIVES

Hospital vision

The vision for Kibungo District Hospital is to provide “leadership in quality health care.” And

“to be self reliant in all activities that we perform”

Hospital mission

Kibungo District Hospital is committed to providing the highest quality of healthcare and

collaborates with others in our community to improve the health status of population in Ngoma

district thereby enhancing the general well-being of the population

Hospital goals

To employ competent, caring, and well-trained individuals who are responsive to the needs of

our clients, their families, and the communities we serve.

Hospital objectives

The general objective of the hospital is to enhance health systems, promoting continuous quality

improvement, informing decision-makers and ensuring accountability to national health policies.

The specific objectives of the hospital are:

Enhanced health systems by integrating and involving hospitals as an active component

of the health care network.

Continuous quality improvement in using the accreditation process to bring about

changes in practice that will improve the quality of care for patients.

Informed decision-makers in providing data on the quality of health care that various

stakeholders, policy-makers, managers, clinicians and the public can use to guide

their decisions.

Improved accountability and regulation in making healthcare organizations accountable

to statutory or other agencies, such as professional bodies, government, patient groups

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and society at large, and regulating their behaviors to protect the interests of patients

and other stakeholders.

Improved monitoring and evaluation of health centers and the hospital

Improved technical support and supervision of health centers

Value

Kibungo District Hospital strives to offer excellent and affordable health care and community-

based social services to individuals, families, and the communities.

Business philosophy

As a district hospital, we at Kibungo District Hospital provide professional quality of services.

Key to success

Our key to success are:

Reliability by adequate staffing, availability of drugs, supplies and equipment

Effective collaboration with the community and other health-related agencies (NGOs,

government institutions, private sector, health insurance companies, and other health

facilities)

Cost recovery to ensure that money spent on services offered is recovered

Key Success Factors

Effective leadership

Prevention activities

Availability of adequate and sustainable resources

Shared vision and values

Commitment and support of stakeholders

Effective communication

High level security for all patients, including VIPs

Sustainable partnerships and institutional collaboration

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Quality systems that promote best practices in everything it does Optimal utilization of

available resources. Harmonization

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II. HOSPITAL SITUATION ANALYSIS

2. EXTERNAL AND INTERNAL ANALYSIS

2.1. KIBUNGO DISTRICT HOSPITAL PROFILE

2.1.1. Institutional history

Kibungo District Hospital is approximately 100 km from Kigali in the Eastern Province, Ngoma

District, Kibungo sector, Karenge cell. It is a district hospital with a catchment area of 310,955

inhabitants. Ngoma district has 737.92 square kilometer. The density is approximately 421

people per square kilometer. Kibungo district hospital supervises 12 health centers and five

health posts and receives referral cases from Kirehe and Kayonza districts due to additional

expertise of the Chinese specialists and even some patients from neighboring countries like

Uganda, Tanzania and Burundi. We also receive patients with MDR TB from other Districts and

the countries mentioned above.

KIBUNGO district hospital established as a dispensary in 1932, Kibungo Hospital became a

rural hospital in 1935. Its first extension came in 1984 and it’s second in 1992. Its inauguration

occurred in 1997. It offers all complementary packets of activities.

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2.1.2. Hospital ground plan

Figure 1: Kibungo district hospital ground plan

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2.2. EXTERNAL ANALYSIS

2.2.1. District description

Ngoma District is one of seven districts located in the Eastern Province. The District is divided

into 14 sectors made of 64 cells and 473 villages. It is bordered by Rwamagana District to the

northwest, Kayonza District to the northeast, Kirehe District to the southeast, Bugesera District

to the west, and Burundi to the south. In year 2012, the population of Ngoma district is 310,955

inhabitants (Source: ubudehe, 2012), of which 52% are women. The most populated sectors are

Mugesera and Kazo, which have 25,110 and 25,115 inhabitants, respectively. The least

populated sectors are Karembo and Gashanda, with 14,653 and 15,815 inhabitants, respectively.

The economy of the district is mainly based on agriculture and livestock. The most cultivated

crops are bananas, beans, maize, rice, pineapple, and coffee. The district is planning to increase

fish production by introducing improved species of fish in the lakes.

The 18 health facilities in the catchment area of Ngoma district are experiencing a shortage of

health personnel, both in quality and quantity. The hospital has 12 doctors and 234 nurses, which

means only 1 doctor for every 25916 inhabitants and 1 nurse for every 1329 inhabitants. In

addition, there is a problem of insufficient and incomplete health infrastructure and insufficient

medical equipment

2.2.2. Catchment area population

Table 1: Description of the population distribution of Ngoma District by sector

Sector

Number

of Cells

Number

of village Population

% of District

population

Gashanda 4 26 15815 5.09%

Jarama 5 40 23640 7.60%

Karembo 3 26 14653 4.71%

Kazo 5 22 25115 8.08%

Kibungo 5 31 20865 6.71%

Mugesera 5 35 25110 8.07%

Murama 5 44 20865 6.71%

Mutenderi 5 22 19773 6.36%

Remera 4 33 24911 8.01%

Rukira 4 42 24806 7.98%

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Sector Number

of Cells

Number

of village Population % of District

population Rukumberi 5 26 24969 8.03%

Rurenge 6 37 25536 8.21%

Sake 4 34 22724 7.31%

Zaza 4 55 22213 7.14%

Total district 64 473 310995 100.00%

Table 2: Description of population distribution by health center

HEALTH CENTER Population

1 GITUKU 24806

2 JARAMA 23640

3 KIBUNGO 43208

4 KIRWA 25536

5 RUKIRA 20865

6 RUKOMA SAKE 22724

7 RUKUMBERI 24969

8 NYANGE 25110

9 MUTENDELI 31427

10 REMERA 24911

11 SANGAZA 12786

12 ZAZA 31013

TOTAL 310995

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2.2.3. District health map

Figure 2: District health map

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2.2.4. Demography (5-years projections)

Table 3: Disaggregation by age group and projection

Age group

District

(year 2012)

Projection

(2017)

< 1 year

12,751

14,497

1-4 years

37,630

42,783

5-14 years

85,524

97,235

Population >= 15 years

175,090

199,067

Children under 5 years

50,381

57,280

Expected Pregnancies

12,751

14,497

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Age group

District

(year 2012)

Projection

(2017)

Women of reproductive age (15-49)

73,395

83,445

Total Population

310,995

353,582

Source: primary data

2.2.5. District health problem priorities

As part of the planning process, Ngoma district identified specific priorities within the district

health strategic plan. These priorities are a reflection of the greatest need in the district and the

interventions that would make the largest contribution in strengthening the health sector in the

district.

The overall district priorities are as follows: (i) uninterruptible water and electricity supply, (ii)

expansion and rehabilitation of existing health facilities and construction of new facilities where

needed, (iii) reducing the rates of under-five mortality and teenage pregnancy, (iv) reducing

malaria prevalence in district, (v) recruiting staff, capacity building, and providing staff

incentive, and (vi) CHWs training.

2.3. INTERNAL ANALYSIS

2.3.1. Structures of active services at Kibungo district hospital

Outpatient department: Consultation

Internal medicine: General internal medicine

Pediatrics: General pediatrics

Nutrition rehabilitation

Obstetrics and Gynecology: General obstetrics, Gynecological services, PMTCT

Traumatology and orthopedics

Medical Emergencies

General surgery

Medical imaging: General radiography, ultrasound

Laboratory

Psychiatry nursing care

Ophthalmology: General ophthalmology

Clinical psychology: Counseling, Psychotherapy

Pharmacy

Physiotherapy and acupuncture

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Dental services

Anaesthesia and resuscitation

Social services: Internal social services

Reproductive Health: Family planning

2.3.2. Working conditions

In general Kibungo District Hospital is offering PMA and CPA (acupuncture, MDR TB). Its

laboratory become satellite laboratory. The working environmental is very favorable for staff

because the pay regularly salaries and FBP. It collaborates with its partners and stakeholders

through the CA and quarterly review meeting.

2.3.3. District hospitals package and gap of health services

The table below shows the various services offered at the district hospital as per complementary

package of activities

Table 4: Description of District hospitals package and utilization of health services

District Hospital

Check

Availability

Prevention

activities

Preventive consultations for referred cases Yes

Antenatal care consultations for at risk pregnancies Yes

Family

planning

Provision of all methods for referred cases Yes

Including female and male sterilization Yes

Curative

care

Management of referred cases Yes

Referrals for tertiary-level care Yes

Management of difficult labor Yes

Medical and surgical emergencies Yes

Minor and major surgical interventions Yes

Inpatient care Yes

Laboratory testing Yes

Medical imaging such as ultrasounds Yes

Management

The training of paramedical personnel in district schools Yes

Collaboration with the district work group for continuing

education and supervision activities

Yes

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2.3.3.1. Gaps in internal medicine Services

Table 5: Table Gaps in internal medicine Services

CLINICAL SERVICE CURRENT SITUATION IN

SERVICES

PLANNED AS PER EXISTING GAPS

Surgery (admission

ward) General Surgery

Orthopedics/Traumatolo

gy

Minor surgery

IEC,

Nursing care &

treatment,

PIT,

Post-operative care

Maxillofacial surgery

Burns Unit

Stomatology

Digestive surgery

Surgery(Operating

room)

Nursing care &

treatment,

Anaesthesia,

Surgery

Utilization of the recovery room

OPD

General consultation

IEC

Outreach programs at Health

centers

Internal Medicine General internal

medicine

IEC,

Nursing care &

treatment,

PIT

Infectious disease

management

One stop service

Clinical hematology

Endocrinology

Chronic care clinic

Pediatrics&

neonatology General Pediatrics care

Neonatology care

IEC,

Nursing care &

treatment,

PIT,

Kangaroo mother care

Emergency Unit

Infectious diseases management

Initiating Kangaroo mother care at

all HCs

Obstetrics and

Gynecology General Obstetrics and

Gynecological services

EMTCT

Ultrasonography

Family planning

services

IEC, Nursing care &

Antenatal care

Reproductive health service


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SERVICES


treatment,

PIT,

Post Operative care,

EMTCT,

Delivery services,

Cesarean section

Gynecological surgery

Traumatology and

Emergency Consultation,

Nursing care and

treatment

Minor surgery

Resuscitation

Care of burned patients

Medical emergency

Medical imaging General radiography

Ultrasonography

Thoraco-abdominal

radiology

Osteo-arthroradiology

Fluoroscopy

Interventional radiology

Dental panoramic X-ray

Laboratory General laboratory tests

Hematology

Parasitology

Immunoserology

Bacteriology

Biochemistry

Mycobacteriology

(microscopy)

Molecular biology

Immunohematology

virology

Endocrinology

Mycology

Ophthalmology General ophthalmology

Treatment,

Optometry

Admission

Minor surgery

Outreach service

ENT (ORL) None Otology

Audiology unit

Mental Health

Consultation,

Treatment,

Psychotherapy,

Health center

supervision

Outreach sessions

Intensive Care Unit None Set up ICU (intensive care unit)

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SERVICES


GBV Counseling and care

Health center

.supervision

One stop centre

Clinical Psychology Counseling

Palliative care

HIV/AIDS and terminal

care illnesses

PTSD management

Childhood disorders

Disaster and crisis intervention

Addiction (Alcohol and drug

abuse) management

2.3.3.2. Gaps in Clinical services

Table 6: Gaps in hospital clinical services

SUPPORT SERVICE CURRENT SITUATION IN

SERVICES


Physiotherapy Consultation

Physiotherapy treatment for

outpatients and inpatients

Admission unit

Orthopedic workshop (orthotics

and prosthetics )

Outreach programs,

Dentistry Consultation services

Conservative treatment

Periodontal treatment

Dental care & treatment

Dental prosthesis

Maxillofacial surgery

Dental radiology

Admission

Outreach programs

Anesthesia and

resuscitation General anesthesia

Pre anesthetic care

Nursing care & treatment

Surgery


Nutrition Consultation,

Nursing care & treatment

Admission

Supervision of Health centers

Dietary service

Health center

supervision Integrated supervision

PBF evaluation of health

centers activities

Data quality audit

Integrated monitoring

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SUPPORT SERVICE CURRENT SITUATION IN

SERVICES


Social services Internal social services External social services

Sterilization Sterilization services Enhance sterilization services

2.3.4. Hospital personnel and human resource gap

The following table summarizes the staffing at Kibungo District Hospital.

Table 7: Kibungo District Hospital Personnel

Title Quality Current

staff

Needed

Staff

General Practitioner A0 11 24

A0 Pharmacist A0 2 3

Nurses A1 11 48

Midwives A1 6 30

Nurses A2 59 35

Nurses A3 A3 3 0

Paramedical staff Radiology A1 2 4

Ophthalmology A1 1 3

Dentists A1 2 4

Physiotherapists A1 0 3

Laboratory technicians A1 4 4

Laboratory technicians A2

Laboratory technicians A0

6

2

4

10

Anesthetists 3 5

Support Personnel A0 9 14

A1 2 2

A2 11 11

A3 5 5

Auxiliaries de santé 2 0

Sans qualification 5 0

Chauffeur 6 7

Supervisor Supervisor A0 3 10

Supervisor A1 2 3

Supervisor A2 1 0

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Title Quality Current

staff

Needed

Staff

Total 158 229

2.3.5. Equipment gap assessment

2.3.5.1. Gap in Non medical equipments

Table 8: Gaps in non medical equipments

Needed Non Medical equipment Quantity

1

Arm band machine/patient identification

machines 4

2 Bedpans 50

3 bedside commodes 50

4 blankets for bed 200

5 chairs 50

6 curtains for windows for pt privacy 50

7 drug guides 20

8 hospital beds 200

9 hospital linen for bed 400

10 IV Stands 100

11 Laptops 10

12 medical dictionaries 20

13 Movable Multpurpose Cupboard 5

14 pillows for hospital beds 200

15 portable transportation monitor 2

16 portable ultrasound machine 2

17 PROJECTOR 2

18 Scanners 2

19 Small hand towels for drying hands 800

20 TENS 1

21 WASHING MACHINES 2

22 wheel chairs 30

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2.3.5.2. Gaps in Medical equipment

Table 9: Gaps in medical equipments

Needed Medical equipments Quantity Needed Medical equipments Quantity

1 AMALGAMATORS 2 46 Multiparameter Monitor 40

2 ANESTHESIA MACHINE 3 47 NASAL GURGGLES 10

3 Applination Tonometer 1 48 nebulizer machines 30

4

arm band machine/patient

identification machines 4 49 NEGATOSCOPE 10

5 AUTOREFRACTOR 2 50

OPERATING LAMP

(SCIALITIC LAMPS) 3

6 BLOOD WARMER 7 51 OPERATING TABLE 3

7

C.T.G MACHINE (FETAL

MONITOR) 5 52 Operating Table 2

8 CESAREAN KIT 15 53 OPERATING TROLEY 300

9 CURETAGE KIT 15 54 OPHTALMOSCOPE 4

10 DEFIBRILATOR 10 55 ORTHOPEDIC KIT 10

11 DELIVERY KIT 20 56 ORTHOPEDIC TOURQUET 4

12 DENTAL CHAIR 4 57 OTOSCOPES 25

13 DENTAL PROBS 2 58 OXYGEN MACHINE 20

14 DENTAL SERINGUES 10 59 partitions for patient privacy 30

15 Digital Cardiotocography 10 60 PHOTOTHERAPY GRASSES 2

16 Digital Cardiotocography machine 1 61

PHOTOTHERAPY

MACHINE 1

17 Digital thermometers 100 62 Physio Ball 2

18 DOPLER ULTRASOUND MACHINE 3 63 portable oxygen tanks 40

19 DRUMS 3 64 portable suction machines 15

20 ELECTRIC ASPIRATORS 10 65

POUPINEL FOR

STERILISATION 1

21 EMERGENCY TROLEY 4 66 RADIANT WARMER 3

22

ENDOTRACHEAL TUBES (No 3-

8.5) 10 67 Reflex hammer 1

23 EPISIOTOMY KIT 20 68 RESPIRATORY MASKS 5000

24

EYE CHART(DISTANT AND

NEAR) 5 69 RESUSCITATION TABLE 3

25

FILLING MATERIALS

(COMPOSITES,AMALGAMES,ZINC

OXYDE EUGENOL, GRASS

IONOMER, 2 70 RETINOSCOPE 1

26 glucometer machine 15 71 ROTATING CHAIR 10

27 Goneometer 2 72 SATUROMETORS 10

28 HEMOGLOBINOMETOR 2 73 SCHIOTZ TONOMETOR 1

29 HERNIORRAPHY KIT 15 74

SCIALITIC LAMP

AMPOULE 10

30 HYSTERECTOMY KIT 10 75 SLIT LAMP+APPLANATION 10

27

Needed Medical equipments Quantity Needed Medical equipments Quantity

TONOMETOR

31 INCUBATORS 4 76 Standing clutches 2

32 INFANT SCALES 10 77 Standing scale for adults 10

33 INFRA RED 2 78 standing scale for children 10

34 INFUSION WAMER 20 79 sthethoscopes(Littmans type) 50

35 IRRIGATOR 5 80 Stretchers 40

36 LAPAROTOMY KIT 10 81 STRETCHER (BRANCARD) 4

37 LARYNGEAL MASK 25 82 SUPPORT DRUMS 4

38 LARYNGOSCOPES 25 83 TENS 1

39 LENS METER 1 84 Traction bed 1

40 MAGNIFYING LAMP 3 85 Traction cable 3

41 MAYOR’S TABLE IN THEATRE 5 86 TRANSPORT INCUBATOR 3

42 METALIC DENTAL MIRRORS 20 87

TRIAL LENSSETAND

FLAME 1

43

MINOR SURGERY SET IN

OPHTALMOLOGY 1 88

VIBROMASSOR OF

PHYSIOTHERAPY 2

44 modern trolley carts for unit 30 89

WARD SCREEN

(PARAVENT) 20

45 MONOR SURGERY KIT 20

2.3.6. Infrastructure and gaps assessment

Table 10: Gaps in infrastructure

SERVICE CURRENT SITUATION IN

SERVICES


Infrastructure

(Housing)

Inadequate Pharmacy stock

Insufficient Patients’ toilettes

Extension of pharmacy stock

Construction of new patients’

toilettes

Construction of patients’ waiting

room

Construction of new laboratory

Construction of the fence

Construction of public latrines at

the Hospital

Well organized hospital rooms to

ensure optimal use

Well functioning air-conditioning

in hospital server rooms and

admission rooms

Appropriate maintenance plan for

hospital buildings

28

SERVICE CURRENT SITUATION IN

SERVICES


Electricity Availability of electricity

connection in all rooms

Presence of generator but it is

old

Presence of some fire

extinguishers.

Installation of automatic generator

Purchasing of power backup

Reviewing all electrical

connections in the hospital and

mapping according to new master

plan

Make electrical connection master

plan

Water Presence of water in hospital

Presence of Storage water

system

Maintenance of water

Increase of water storage system

Lavatory and

Sanitation Presence of lavatory

Extension of lavatory to meet

required standards.

Incinerator Presence of usual incinerator Construction of modern

incinerator unit.

Laundry unit Presence of usual laundry

Construction of a modern laundry

unit

Purchasing a drying machine.

Kitchen Presence kitchen services Construction of modern Kitchen

Canteen Presence canteen services Construction of modern canteen

Mortuary Presence of mortuary Construction of new modern

mortuary

Wastes Waste management system in

place.

Establish a waste disposal

management plan

Putting in place a standard waste

disposal system

General

Administration Presence of Security office

Presence of administration

bloc

Installation of EMR (electronic

Medical records)

Rehabilitation of administration

bloc

29

2.4. HOSPITAL PERFORMANCE ANALYSIS

2.4.1. Clinical efficacy

Kibungo clinical efficacy is based on providing the highest quality of healthcare based on MOH

norms and protocols. Their health providers are gaining skills through ongoing training and

Continuous Professional Development (CPD). Every department planed the activities and

submitted to the hospital director for approbation. The clinical departments are equipped with

minimum material and equipments.

2.4.2. Hygiene and patient safety

Hygiene and patient safety at KH are well controlled in different departments. The

Environmental Health Officer assumes the hospital hygiene supervision and gives the advice to

the company in charge of hygiene at hospital for improvement or change. The Kibungo District

Hospital goal is to promote the hospital hygiene and safety standards and ensure compliance with

regulatory requirements. Kibungo District Hospital conducts the training in the use, control and

disposal of hazardous chemicals.

2.4.3. Attention given to the patient

In Kibungo District Hospital, patient has the right to medical attention given by adequately

trained staff according to his or her state of health and circumstance that requires attention as

well as be informed when refer to other physician or other health unity. Attention given to the

medical emergency (patient arrival and triage) and to the non-contaminated patients are admitted

the usual treatment area. Contaminated patients are admitted to a specially prepared area.

2.4.4. Human Resource Management

The HR department provides expert advice and support to management and staff on all aspects

of HR management and plays a key role in strategic planning in Kibungo District Hospital.

Human Resource department is currently being reorganized and strengthened to meet the needs

of a dynamic and constantly changing Human Resource and health care environment.

2.4.5. Patient flow analysis

Patient flow used to identify problem in flow, identify personnel needs, space needs and track

personnel costs. Hospital use patient flow for deep analysis to better understanding of roles and

needs of different departments.

30

2.4.6. Management and Governance

2.4.6.1. Administrative management

Kibungo District Hospital is governed by the board of Directors. The board has power to govern,

control, manage and regulate the affairs of the hospital. Funding from the central level to support

hospital is funneled through the health management services fund. Hospital management

committee was set up as an oversight mechanism to unsure sound management of this funding

by the hospital management team. The committee consists of civil society and community

members as well as medical personnel and district government officials. The hospital has other

subcommittees such as quality assurance committee, hygiene committee, pharmacovigilance

committee, etc

2.4.6.2. Financial management

Kibungo District Hospital has a financial management system and it is well organized. It uses

financial software such as “QuickBooks” to manage all hospital fund inclusive fund from Global

fund but it also uses “Tompro” software for managing only money from Global fund. They have

an effective of hospital reimbursement systems on the financial in department. The department is

headed by hospital administrator.

2.5. ANALYSIS OF MAJOR ISSUES

2.5.1. Causes of mortality and morbidity in the district hospital

2.5.1.1. Causes of disease in the hospital

The pie chart below shows the breakdown of causes of disease in the hospital: Teeth and gum

infections, eye problem and respiratory infections take up more than 40%.

Figure 3: Causes of disease in the hospital

31

2.5.1.2. Top 10 Causes of under five morbidity in district hospital

The pie chart below visually shows the breakdown of causes of morbidity in health centers and

hospitals. Child Pneumonia and no dehydration diarrhea take up the largest percentage of causes

of morbidity.

Figure 4: Top 10 Causes of under-five morbidity in district hospital

2.5.1.3. Top 10 causes of morbidity in district (5 years and plus)

The pie chart below visually shows the breakdown of causes of morbidity in health centers and

hospitals. Respiratory infections and intestinal parasites take up the largest percentage of causes

of morbidity.

Figure 5: Top 10 causes of morbidity in district (5 years and plus)

32

2.5.1.4. Top ten leading causes of death in Ngoma district

The pie chart below describes the breakdown of leading top ten causes of death in Ngoma health

facilities, HIV opportunistic infections, severe confirmed malaria and cardiomyopathy cause

more than 50% of all causes of death.

Figure 6: Top ten leading causes of death in Ngoma district hospital

2.5.2. Hospital SWOT analysis

This is the analysis of major issues (specifics, gap assessment, strengths and weaknesses,

problems and solutions, measured to the extent possible through delivery Units (Services) and

Management Units) .

Table 11: SWOT analysis

STRENGTHS

Strongly committed leadership

Clear vision, mission and values for the

hospital and other health facilities in our

catchment area

Ambulance are in 10 out of 13 public health

facilities

Existence of community outreach programs

Existence of Community health workers in all

villages

Chinese specialists

Existence of partner organizations

Hygiene committees in all health facilities and

the community

WEAKNESSES

Inadequate infrastructure

53% of patients are travelling more than 1 hour

to reach heath facility

Low level of sensitization in health promotion

activities

Population is not insured at 100%

Insufficient public toilette and public dust bins

in the community

Lack of proper waste management

Inadequate environmental health awareness

Lack of effective planning

Insufficient funds to support all health activities

Insufficient medical and non medical staff

33

Timely and standard of payments of PBF across

health sector

TB screening in all health facilities

Households have at least 1 Bed net

Existence of policy of protecting the lives of

women and children

Close follow up of women and children by

CHWs

Usage of computers and internet in health

facilities

Drugs distributed by district pharmacy van

Disciplined employees

Availability of land for extension

Insufficient specialized and trained staff

Unsatisfactory customer care

Inadequate remuneration

Insufficient LLN and even no place to buy

them

Insufficient equipment and some of the used

equipment are in poor condition

Lack of spare parts and accessories of medical

equipment.

Unskilled medical equipment users.

Inadequate outreach program in community

Insufficient information system tools

None integrated mental health in community

Stock out of drugs and consumables

Lack of pharmacist(A1) and midwives in health

centers

Ineffective management of suggestion boxes

Inadequate nutrition education outreach

program

None validated organizational structure

No proper safety procedures, emergency

protocols and preparedness

High over due by Mutuelle de santé

Inability to pay by clients

Inadequate management systems (financial,

biomedical & maintenance). Need for

electronic systems

OPPORTUNITIES

Kibungo district hospital to become a

provincial hospital.

Availability of ambulances in health centers

lacking them.

Training on environmental health

Capacity building programs

Follow up programs of teenage girls and

women between 15-19 years old.

Promote income generating activities

Adequate procedure for external procurement

of drugs

Strong development partners commitment to

improve Kibungo District Hospital’s quality of

service delivery

Better public image in terms of service delivery

Strong will for public and private partnership

for collaboration.

Solvency of the hospital clients due to

enrolment in insurance schemes (MMI, RAMA

& Mutuelles, etc…)

THREATS

Financial crisis

Dependence on government financial support

and NGO’s

Ignorance in the community

Malnutrition

High under five mortality rate

Talking about sex and reproductive health in

community is a taboo.

Staff overtime

High rate of teenager (15-19)pregnancies

Insufficient health institutions/schools

Drugs distributed by traditional healers

Language barrier

34

SWOT analysis have been conducted and possible solution has been done in order to improve

clinical efficacy, patient safety, attention to be given to patient , human resources , leadership

and governance patient flow analysis , services (quality and quantity), logistics, administration

and management .

These issues were evaluated at the organization and departmental levels and comprehensive

tables that identify the current and planned status of each area as follow:

2.5.3. Analysis of Leadership and Governance Status

Table 12: Analysis of leadership and governance

SERVICE CURRENT STATUS PLANNED

Leadership and

Governance Functions as a DH

Meetings on good

governance and

leadership

Existence of COGE and

Board of Directors

Regular meetings of existing committees in

the hospital

Joint partnership forum of hospital

stakeholders

Strengthening the hospital monitoring

system

Hospital open day

2.5.4. Analysis of Maternal child health

Maternal Child health has challenges such as insufficient of trained health providers; lack of

standardized supervision tools, insufficient health staff deployed in MCH program, stock out

(delay) of MCH product for example RPR reagents, partograph (for maternal and neonatal to

monitor, document, manager and assess labor) , ANC files. According to DHS, 2010 the under

five mortality rate still high (156/1000 live birth),the teenage women between 15-19 years old

who have had a live birth still high(8.3%) . Malnutrition is still a problem in the district as there

is malnourished children with weigh for age <-3SD is at 4.8.

The MCH performance indicators will be assessing through the monthly supervision and HMIS

report. The training report will be used to assess the trained staff on MCH performance.

Table 13: Analysis of Maternal Child Health

SERVICE CURRENT ACTIVITIES PLANNED

Maternity Emergency

Obstetric and

Antenatal care


35

SERVICE CURRENT ACTIVITIES PLANNED

neonatal care

(EMONC)

Reproductive

health

Family Planning:

provision of FP

methods

Outreach programs in all Health

facilities (Supervision)

Advocacy for training of health care

providers

IMCI/ PCIME Training of

healthcare

providers

Supervision of

IMCI activities at

the HCs

Advocacy for training of trainers

Advocacy for provision of IMCI

logistics

Nutrition Consultation,

Nursing care &

treatment,

Admission

Supervision

Dietary service

2.5.5. Analysis of Health promotion and environmental health

Table 14: Analysis of environmental health

SERVICE CURRENT SITUATION PLANNED ACTIVITIES

Environmental

Health office

Hygiene and Sanitation

Waste management

Waste water management in health

facilities

Training on Hospital waste management

2.5.6. Analysis of disease prevention and control service

The vaccination performance indicators are assessed through the monthly supervision and HMIS

report. The challenges in vaccination programs are the low rate of children with all immunization

(86%) which is under the national average (90%). The training report will be used to assess the

trained staff on vaccination performance.

The HIV full package is available in all HFs. The HIV performance indicators will be assessing

through the monthly supervision and trac net plus HMIS report. The challenges are the lack of

36

standardized supervision tools, delay of HIV data collection tools especially registers, patients’

files and guidelines. The inappropriate infrastructure is big issue to offer HIV services in good

condition. Insufficient health providers trained in HIV management services. The training report

will be used to assess the trained staff on HIV performance.

The TB protocol, guidelines and policies are available. The TB performance indicators will be

assessing through the monthly supervision and quarterly HMIS report. The challenges are low

rate of TB screening and infection control. The training report will be used to assess the trained

staff on TB performance

The malaria protocol, guidelines and policies are available .The malaria performance indicators

will be assessing through the monthly supervision and SIS com plus HMIS report. The

challenges are delay of some medicine at community level, HC and district level .Unavailability

of posters and flyers. The training report will be used to assess the trained staff on Malaria

performance

The NCDs performance indicators will be assessing through the monthly supervision and HMIS

report. The challenges are the lack of standardized supervision tools; an unavailable data

collection tool especially registers patients’ files and guidelines, unavailable of posters and

flyers. The training report will be used to assess the trained staff on NCDs performance

Table 15: Analysis of disease prevention

SERVICE CURRENT SERVICE PLANNED ACTIVITIES

Vaccination Trained staff

Availability of vaccines

Supervision in health centers

Strengthening outreach programs

Quarterly monitoring

Vaccination of staff against disease

TB Trained staff

TB screening, testing and

treatment

MDR –TB unit

Supervision in health centers

Increase TB detection rate

HIV

HIV testing

PMTCT

PIT

VCT

HIV follow-up programs

Training of health providers

EMTCT

PMTCT in health post

Reproductive program of PLWHIV

37

2.5.7. Analysis of pharmacy services

Table 16: Analysis of hospital pharmacy service

SERVICE CURRENT SERVICE PLANNED SERVICES

Pharmacy General pharmacy

Dispensing service

Drugs information

service

Pharmacovigilance

services

Pharmacy Management Information

system

Magistral preparation plant

Outreach sessions

Enhancing clinical pharmacy

2.5.8. Analysis of Human Resources Services

Table 17: Analysis of human resource service


Human

Resources Recruitment

Payroll Management

Performance

Management

Staff Planning

Training and

Development Leave

Management

Contract and filing

Management

Integrated Human Resource Management plan

Develop a human resources capacity building

plan

Review of Internal rules and regulations

Develop a staff retention strategy

Recruit qualified medical and none medical

personnel as per hospital structure

Public relations

Re-enforce all hospital departments

2.5.9. Analysis of Financial Management Services

Table 18: Analysis of financial management services


NTD Diagnosis Availability of laboratory diagnosis tools

NTD unit

NCD Diagnosis Sensitization

NCD unit

Malaria Testing

Distribution of LLTN

Malaria treatment

Outreach programs

Trainings of health providers and CHWs

Enhance distribution of LLTN

38


Finance Annual financial reports

Store management

Internal control

Billing and recovery

Banking and cash flow

management

Finance and accounting

procedures manual

Upgrade management accounting software

(QuickBooks)

Strengthening management of receivables

and payables

Store management reporting system

Putting in place an asset management plan (

codification, etc)

Strengthen the billing system to avoid loss of

income

Strengthen the recording system of in-

coming and out-going patients

reinforce a culture of budget tracking

Develop a treasury management plan for

proper management of debt and receivables

Credit

recovery Invoice preparation Enhance Outreach recovery

Procurement

Annual procurement plan

Internal tender committee

RPPA manual of

procurement procedures

Effective planning and reporting

Installation of Database of suppliers

Logistics

Medical and non medical

equipment

Ambulance maintenance

Electricity management

Maintenance of

infrastructure

Strengthening Maintenance plan

Contracts of maintenance

Qualified staff recruitment

2.5.10. Analysis of Logistic and Administrative support services

Table 19: Analysis of logistics and administrative support services


Ambulances 2 ambulances in place Purchasing of new ambulances

Beds, blankets, bed

sheets and

mattresses

312 beds Continued overhauling

Electricity Availability of electricity

connection in all rooms

Presence of generator

Installation of automatic generator

Purchasing of power backup

Reviewing all electrical

39


Presence of some fire

extinguishers.

connections in the hospital and

mapping according to new master

plan

Make electrical connection master

plan

Water Presence of water in hospital

Presence of Storage water

system

Maintenance of water

Increase of water storage system

Lavatory and

Sanitation Presence of lavatory

Extension of lavatory to meet

required standards.

Wastes Waste management system in

place.

Establish a waste disposal

management plan

Putting in place a standard waste

disposal system

Inspection of district and health

centers on waste management

Medical

equipments

Only a few biomedical

equipment are available in

different departments

Purchasing missing biomedical

equipment

Installation and supply of oxygen

cylinder in services

Rules and

regulations Validated internal rules and

regulations

Reviewing internal rules and

regulation.

A validated maintenance policy

and plan for infrastructure and

equipment

General

Administration Presence of Security office

Presence of Filing system

Presence of Central secretariat

Reception

Presence of Medical legal

service

Installation of EMR (electronic

Medical records)

Strengthening Public relations

services

To introduce some referral

services at the hospital.

2.5.11. Analysis of ICT Services

Table 20: Analysis of ITC service


Equipment/software Internet/optic Fiber Digitalize all the information

40

Small LAN and wireless,

maintenance of computers and

its accessories in DH and HCs

systems; ranging from biomedical

to administrative

Develop a maintenance policy

and plan for hard and software

under the hospital administration

Improvement of local area

network

Equip the server room and

maintenance workshop

Advocacy for installation of

telemedicine conference room

Purchase of new IT equipment

Upgrading existing software

Establish the information security

management system(ISMS)

To create Hospital website

Cabling and provide wireless

connectivity in the entire hospital

2.5.12. Analysis of Quality and Safety Services

Table 21: Analysis of quality and safety service


Quality

Assurance Presence of quality assurance

committee

Data quality analysis

Presence of few Policies and

procedures manual

Presence of PBF

Clinical review of medical

records

Training for quality assurance

Quality assurance committees in all

departments

Strengthening analysis of quality data

Elaborate standard clinical procedures

Monitoring and evaluating of district

hospital and health centers quality

indicators

Strengthening Internal quality awards

and motivation system

Reinforce Clinical review of medical

records

Patient and

Employee

Safety

Presence of some validated

safety policy and procedures

Establish risk management policy and

plan that covers patient safety;

occupational health; emergency plan;

continuous training on employee and

patient safety

Put up a functional safety committee

Put up a validated plan for Clinical

audits

41

Establish a plan for Clinical

effectiveness including pharmaco-

vigilance

Infection

Control Validated infection control

policy in Internal Medicine

Introduce this validated infection

control policy across all departments

with a corresponding monitoring and

evaluation plan

Clients’

Rights Presence of validated policy

and a plan of these rights

Strengthen implementation of these

rights

Customer

care Presence of customer care Reinforce a proper and well functioning

customer care service

III. STRATEGIC PLAN

3. KIBUNGO DISTRICT HOSPITAL KEY PRIORITIES

A consensus was reached on 11 key strategic priorities to examine goal, strategic, indicator,

baseline and targets have been developed to address the following areas:

1. Leadership and governance

2. Clinical service

3. Maternal child health

4. Disease prevention and control

5. Health promotion and environmental health

6. Human resources

7. Financial management

8. Drugs and consumables

9. Administrative support services

10. Information and communication technology

11. Quality and safety management

3.1. MEDICAL PRIORITIES

The top medical priorities are as follows:

42

3.1.1. Maternal and child health

To reduce maternal and child mortality rate

To promote reproductive health

To eliminate malnutrition

3.1.2. Clinical service

To avail needed biomedical and non-medical equipment

To reinforce outreach programs

Capacity-building plan

Develop disease norms and protocols

Put in place an archive system

3.1.3. Disease prevention and control

Malaria prevalence and control

Disease screening and surveillance ( TB, Malnutrition)

Management of Community case

Strengthening IDSR in hospital

3.1.4. Health promotion and environmental health

Construction of public latrines at the Hospital

Waste and water treatment/management in the hospital

Training of Hospital staff on waste management

3.2. SUPPORTING SYSTEM PRIORITIES

The top priorities in the supporting system are as follows:

3.2.1. Leadership and governance

Establish an operational framework (implementation, M&E, etc)

Regular meetings of existing committees in the hospital

To strengthen the hospital monitoring system

3.2.2. Human resources

Increase number of clinical and support staff

Develop a human resource capacity-building plan

Strengthen performance management system (Continuous Program Development)

43

3.2.3. Financial management

Upgrade management accounting software (QuickBooks)

Strengthen the billing system to avoid loss of income

Budget and procurement plan tracking and effective reporting

Strengthen the recording system of incoming and outgoing patients

3.2.4. Drugs and consumables

Annual procurement plan

Usage of Pharmacy Management Information System

DTC training and well functioning

3.2.5. Administrative support services

Well organized hospital rooms to ensure optimal use

Appropriate maintenance plan of hospital buildings

Construction of mortuary, laboratory, and waiting room

Extension of pharmacy stock

3.2.6. Data management and ICT

Purchasing of ICT equipment

Construction of server room and maintenance workshop

Hospital website

Cabling and providing wireless connectivity in the entire hospital

Harmonize data collection tools and provide electronic data management system

Assure data quality system (training, monitoring and evaluation)

3.2.7. Quality and safety management

Provide quality services and customer care

Put in place mechanisms to implement the customer care norms and standards guidelines

in health facilities

Establish strategies for managing complaints

Conduct customer care satisfaction surveys

44

4. LOGICAL FRAMEWORK OF KIBUNGO DISTRICT HOSPITAL

4.1. HEALTH PROGRAM

4.1.1. Maternal and child health

Table 22: Logical framework MCH

Goal: To improve maternal health and reduce child mortality

Strategy /

interventio

n

Activities Output/outcomes Indicator Baseline Target Tim

e

fram

e

To

strengthen

antenatal

care

Training of

health care

providers on

ANC

Reduction of

mother and child

mortality

% of

Health

care

providers

trained

0% 70% 2018

To integrate

focused

antenatal care

in all health

facilities

Increased safe

facility-based

deliveries

% of

facilities

providing

focused

ANC

0% 100% 2018

Provision of

emergency

obstetric

service

Increased safe

facility-based

deliveries

Maternal

mortality

rate

117/1000

00

47/1000

00

2018

Supervision

of ANC

services in the

health centers

Increased safe

facility-based

deliveries

% of

supervisio

n done

50% 100% 2018

45


Strategy /

interventio

n


e

fram

e

Ensure that

all

deliveries

are attended

by skilled

birth

attendants

and done at

the health

facility

Advocacy for

training and

Trainings of

Health

facilities

clinical staff

on MCH

Improved health of

mothers and

children

% of

clinical

staff

trained

30% 60% 2018

Trainings of

CHWs on

MCH

Reduction of

mother and child

Mortality

% of

CHWs

trained

0% 70% 2018

Supervision

of MCH

activities in

health

facilities

Reduction of

mother and child

Mortality

% of

supervisio

ns done

80% 100% 2018

Monitoring of

Rapidsms in

community

Reduction of

maternal and child

death

% of

active

CHWs in

district per

month

65% 100% 2018

Provision of

emergency

obstetric ,

neo-natal

Reduction of

mother and child

Mortality

Under five

mortality

ratio

15.8/1000 7.9/1000 2018

Maternal

death audit

Reduction of

mother and child

Mortality

% of

maternal

death audit

80% 100% 2018

Child death

audit

Reduction of

mother and child

Mortality

% of child

death audit

80% 100% 2018

46


Strategy /

interventio

n


e

fram

e

Strengtheni

ng

surveillance

system of

measles,

neonatal

tetanus,

flask

paralysis

-Availing

reporting

tools to all

health

facilities. To

ensure

effective and

proper

communicatio

n

system/reporti

ng system

Strong surveillance

system and timely

reporting

% of

reports

submitted

on time

N/A 100% 201

3

Strengthen

Integrated

managemen

t of

neonatal

and

childhood

illnesses in

all health

facilities

Strengthenin

g supervision

at the HCs

Reduction of child

morbidity and

mortality

% of

supervisio

ns done

80% 100% 2018

Training

CHWs and

Clinical staff

at HCs on

neonatal and

child illness

Reduction of child

morbidity and

mortality

% of

CHWs and

clinical

staff

trained

33% 100% 2014

47

4.1.2. Nutrition service

Table 23: Logical framework nutrition

Goal: To improve reduce malnutrition in community

Strategy /

intervention

Activities Output/outco

mes

Indicator Baseline Target Time

frame

Promote

good

nutrition and

practices,

especially for

children

under five

Strengthening

sensitization

on balanced

diet in

nutrition

Population

sensitized on

balance diet

% of children

with chronic

malnutrition

20.70% 2% 2018

Promotion

of exclusive

breast-

feeding for

0-6 months

Education of

mothers on

breastfeeding

Increased

awareness of

breastfeeding

support

% of mothers

educated

70% 100% 2015

Promote

good

nutrition and

practices,

especially for

children

under five,

pregnant

women, and

PLWHIV

Screening of

malnutrition

among adult

and children.

Admission of

malnourished

children

Reduction of

child morbidity

% of children

with Chronic

malnutrition/st

unting

25% 12% 2018

Supervision

of outreach

programs

Existence of

follow up on

household

gardens,

communtiy

kitchen for

preparing

balanced diet

Number of

outreach

progaram per

quarter

3 12 2014

48

Goal: To improve reduce malnutrition in community

Strategy /

intervention

Activities Output/outco

mes


frame

Reinforceme

nt of IEC

Information

Education

and

Communicati

on (IEC)

Awareness of

malnutrition

Number of

IEC on

malnutrition

per month

1 4

4.1.3. Family planning

Table 24: Logical framework family planning

Goal: To promote family planning

Strategy /

intervention

Activities Output/outcomes Indicator Baseline Target Time

frame

To improve

accessibilityof

quality of

family

planning and

secondary

health posts

of PF and

outreach

programs

Availing

long term

FP methods:

DIU,

Surgical

intervention

Reduction of high

rate of population

growth/ fertility

rate

Family

Planning

prevalence

rate

45.50% 76% 2018

Outreach

programs in

all Health

facilities (

Supervision)

Increased uptake

of FP services

Family

Planning

prevalence

rate

45.50% 76% 2018

Community

based

Family

planning

Reduction of high

rate of population

growth/ fertility

rate

Family

Planning

prevalence

rate

45.50% 76% 2018

49

4.1.4. Environmental health

Table 25: Logical framework environmental health

Goal: To improve environmental health in district

Strategy /

intervention

Activities Output/

outcomes


frame

To improve

environmental

health by

promoting

personal and

community

practices that

enhance waste

and

resource manage

ment

Installation

of waste

water

pipeline

Reduction of

environment

contamination

Functional

waste

water

pipeline

and waste

water

treatment

plant/site

50% 100% 2015

Training on

environmental

health and

hospital waste

management

Training of

health staff ,

environment

health and

hospital on

waste

management

Awareness on

hospital waste

management

% of

health staff

trained

50% 100% 2014

To improve

hygiene,

sanitation and a

healthy lifestyle

Hygiene

sensitization

Reduced faeco-

oral disease

prevalence

Faeco oral

diseases

prevalence

rate

16% 8% 2014

Promoting

personal and

community

practices that

enhance good

health and prevent

disease

Training of

CHWs in

PHAST (Par

ticipatory

Hygiene and

Sanitation

Transformati

on)

Reduced faeco-

oral disease

prevalence

number of

CHWS

trained

2% 45% 2014

50

Goal: To improve environmental health in district

Strategy /

intervention

Activities Output/

outcomes


frame

Sensitization

on waste

management

Awareness of

waste

management

Number of

sensitizatio

n report per

quarter

0 1 2018

Water testing Safe drinking

water

% of water

source

tested

64% 90% 2018

4.1.5. Integrated disease Surveillance and Response

Table 26: Logical framework integrated disease Surveillance and Response

Goal: To improve the integrated disease Surveillance and Response

Strategy /

intervention


frame

Promote the

Integrated

disease

Surveillance

and

response

Training on

outbreak

investigation

and IDSR

reporting

Timely reporting % of IDSR

team

trained

20% 100% 2014

To elect

IDSR

committee in

sectors,

hospital and

district level

Timely

investigation and

response

Number of

IDRS

committee

0 16 2014

51

Goal: To improve the integrated disease Surveillance and Response

Strategy /

intervention


frame

Strengthen

the link

between

CHWs and

health

facilities

Strengthening

the

collaboration

between the

health

facilities and

CHWs

Population is

knowledgeable

about disease

prevention and

control

% of

patients

which

received

drugs

under

direct

observation

of CHWs

50% 100% 2018

Radio spot

programs on

diseases

prevalence

Population is

knowledgeable

about disease

prevention and

control

Number of

Radio sport

program

per year

0 1 2018

4.1.6. HIV

Table 27: Logical framework HIV

Goal: To prevent the spread of infection and reduce disease incidence

Strategy /

intervention


frame

Prevention

of HIV

incidence in

community

To

strengthen

VCT and

PIT services

Reduced by 50%

HIV incidence.

% HIV

incidence

among men

and women

0.6% 0.3% 2018

Radio spot

programs on

HIV

prevalence

The general

population is

knowledgeable

about HIV and

PMTCT programs

Number of

Radio sport

per year

0 2 2018

52


Strategy /

intervention


frame

To sensitize

community

on HIV

prevention

measure.

Sensitization on

awareness of HIV

in community

Number of

sensitization

report per

quarter

0 1 2018

To train

health

providers

The general

population is

knowledgeable

about HIV and

PMTCT programs

Number of

health

provider

trained in

PMTCT

25 80 2018

To increase

proportion of

women

accompanied

by partners

in PMTCT

programs

Degree of

awareness of men

and women

% of couples tested in PMTCT

87% 100% 2018

To sensitize

men on

circumcision

Reduction of HIV

transmission and

STI (sexual

transmission

infection)

Number of

sensitization

per quarter

0 1 2018

To introduce

of EMTCT

program

Eradication of

mother to child

transmission

Number of

health

service with

EMTCT

0 12 2018

To

strengthen

family

planning of

PLWHIV

Strengthened

family planning

program for

PLWHIV

% of

PLWHIV in

family

planning

N/A 90% 2018

To avail

uninterrupted

stock of

ARV

Quality of

services improved

% of reports

on HIV

M/E

70% 100% 2018

53


Strategy /

intervention


frame

Supervision,

mentorship,

monitoring

and

evaluation of

HIV services

Quality of

services improved

% of reports

on HIV

M/E

70% 100% 2018

4.1.7. Tuberculosis (TB)

Table 28: Logical framework TB

Goal: To prevent the spread of TB and reduce disease incidence

Strategy /

intervention


frame

To promote

TB

screening in

community

and

effective

treatment of

infected

individuals

TB

Screening

Maintained TB

treatment success

rate for TB cases

registered under

Directly Observed

Treatment Short

Course (DOTS)

% TB

(DOTS)

96% 98% 2018

Training in

TB DOTS

Com

Maintained TB

treatment success

rate for TB cases

registered under

Directly Observed

Treatment Short

Course (DOTS)

Treatment

success

rate

95% 100% 2018

Training of

health

providers in

TB

Improved quality

of service

Number

of health

provider

trained at

hospital

3 10 2018

54

Goal: To prevent the spread of TB and reduce disease incidence

Strategy /

intervention


frame

Increase the

number of

CDT

Improved quality

of service

Number

on new

CDT

5 7 2018

Supervision,

monitoring

and

evaluation

of health

centers

Improved quality

of service

Detection

rate

41% 85% 2018

4.1.8. Integrated Management of Childhood Hilliness

Table 29: Logical framework Integrated Management of Childhood Hillness

Goal: To improve the Integrated Management of Childhood Hillness

Strategy /

intervention


frame

To

strengthen

IMCH

service in

health

facilities and

in

community

Provision

IMCH

service

Reduction of

mother and child

Mortality

Under five

mortality

ratio

15.8/1000 7.9/1000 2018

Training on

IMCH

clinic

Reduction of

mother and child

Mortality

% of health

provider

trained

10% 50% 2018

Training on

IMCH to

CHWs

Reduction of

mother and child

Mortality

% of

CHWs

trained

0 100% 2018

Supervision

of IMCI

activities in

health

facilities

Reduction of

mother and child

Mortality

Number of

supervision

per month

1 2 2018

55

4.1.9. Malaria

Table 30: Logical framework malaria

Goal: To improve management of malaria

Strategy /

intervention


frame

Malaria

diagnosis

and curative

Interventions

reinforced

To

strengthen

outreach

programs

Decreased

malaria

prevalence

% of malaria

case

5.30% 1% 2018

Trainings of

health

providers in

malaria case

management

Improved the

quality of service

% of health

provider

trained in

Malaria

(hospital and

health center)

27% 100% 2018

Trainings

and

refresher

training of

CHWs on

RDT

Improved the

quality of service

% of CHWs

trained in

malaria

97% 100% 2018

Distribution

of LLTN

Usage of LLTN

in the community

for malaria

prevention

Number of

household with

2 LLTN

20% 100% 2018

Follow up

health center

activities in

malaria

prevention

Supervision,

monitoring

and

evaluation

of health

centers

Increased

proportion of

malaria case

treatment

(pediatric and

adult)

% of children

under five with

malaria that

receive

appropriate and

affordable

treatment

within 24 hours

95% 100% 2018

56

4.1.10. Non-communicable disease

Table 31: Logical framework NCD

Goal: To improve the prevention of Non-communicable disease

Strategy /

intervention


frame

Non-

communicable

disease

prevention,

diagnosis and

treatment

Training

of health

providers

Integration of care

and treatment for

chronic diseases

into the packages

for all levels of

the health system

% of Public

facilities

providing

integrated

management

of chronic

disease

10% 100% 2018

4.1.11. Neglected tropical disease

Table 32: Logical framework NTD

Goal: To improve control NTDs

Strategy /

intervention


frame

Adequate

management

of cases of

NTDs

including

parasitic

diseases

Training

of health

providers

Diagnosis of

NTDs and

reduced

prevalence of soil

transmitted

helminthes in

school aged

children and

under five

children

Percentage

of health

providers

trained on

management

of NTDs at

district level

5% 50% 2018

Purchasing

of

laboratory

tools

Availability of

laboratory

diagnostic tools

% of

diagnostic

tools

purchased

60% 100% 2012

Promote

outreach

programs

Improved quality

of service

Number of

outreach

done

monthly

0 12 2015

57

4.1.12. Immunization

Table 33: Logical framework vaccination

Goal: To improve immunization of children

Strategy /

intervention


frame

Continued

expansion of

immunization

service

To train

health care

providers in

immunization

Increased full

immunization

coverage in

children <1 year

% of fully

immunized

infants

84.7%

(HMIS

2012)

95% 2018

To strengthen

outreach

programs in

health centers

Increased full

immunization

coverage in

children <1 year

Number of

immunization

outreach

program per

health center

per month

4 12 2018

Supervision

of

immunization

activities in

health

facilities

Increased full

immunization

coverage in

children <1 year

Number of

supervision

per health

center per

quarter

1 3 2018

4.1.13. Adolescent sexual health and reproductive health

Goal: To improve

Table 34: Logical framework Adolescent sexual health and reproductive health

Adolescent sexual health and reproductive health

Strategy /

intervention


frame

58

Goal: To improve

Table 34: Logical framework Adolescent sexual health and reproductive health

Adolescent sexual health and reproductive health

Strategy /

intervention


frame

Continued

expansion of

adolescent

SRH

service

To train

health care

providers in

adolescent

SRH

Increased full

package of

adolescent SRH

coverage in all

HCs

Number of

health care

providers

trained

0 76 2018

To train

adolescent

in RH and

adolescent

sexual

health

Increased full

package of

adolescent SRH

coverage in all

HCs

Number of

adolescent

trained per

quarter per

HC

0 200

000

2018

Sensitization

and

mobilization

on RH

Increased full

package of

adolescent SRH

coverage in all

HCs

Number of

sensitization

and

mobilization

done per

quarter per

HC

0 12 2018

To organize

the training

on school

health

program

Increased full

package of

adolescent SRH

coverage in all

HCs

Number of

school

trained

0 120 2018

Supervision

of

adolescent

SRH

activities in

health

facilities

Increased full

package of

adolescent SRH

coverage in all

HCs

Number of

supervision

per health

center per

quarter

0 12 2018

59

4.1.14. Gender Based Violence

Table 35: Logical framework GBV

Goal: To reinforce GBV programs

Strategy /

intervention


frame

Continued

expansion of

GBV

service

To train

health care

providers

in GBV

High quality of

health care

achieved in all

HCs

Number of

health care

providers

trained on

GBV

39 120 2018

To train the

CHWs on

SGBV

High quality of

health care

achieved in all

HCs

Number of

CHWs

trained on

GBV

0 12 2018

Supervision

of GBV

activities in

health

facilities

High quality of

health care

achieved in all

HCs

Number of

supervision

per health

center per

quarter

1 12 2018

4.1.15. Mental Health

Table 36: Logical framework Mental health

Goal: To reinforce mental health programs

Strategy /

intervention


frame

60

Goal: To reinforce mental health programs

Strategy /

intervention


frame

Continued

expansion of

mental

health

service

To train

health care

providers

in mental

health

High quality of

health care

achieved in all

HCs

Number of

health care

providers

trained on

mental health

24 72 2018

To

strengthen

outreach

programs

in health

centers

High quality of

health care

achieved in all

HCs

Number of

mental health

outreach

program per

health center

per month

0 12 2018

Supervision

of mental

health

activities in

health

facilities

High quality of

health care

achieved in all

HCs

Number of

supervision per

health center

per quarter

1 12 2018

4.1.16. Traditional Medicine

Table 37: Logical framework traditional medicine

Goal: To improve traditional medicine programs

Strategy /

intervention


frame

Continued

expansion of

traditional

medicine

service

To train the

traditional

healers

cooperative

High quality of

health care

achieved in all

HCs

Number of

traditional

healers

cooperative

trained

0 12 2018

61

Goal: To improve traditional medicine programs

Strategy /

intervention


frame

Supervision

of

traditional

healers

activities in

health

facilities

High quality of

health care

achieved in all

HCs

Number of

supervision

per health

center per

quarter

0 12 2018

4.2. SUPPORT SYSTEM STRENGTHENING

4.2.1. Leadership and Governance Status

Table 38: Logical framework leadership and governance

Goal: To guarantee effective leadership that promotes teamwork, and accountability

Strategy /

intervention Activities Output/outcomes Indicator Baseline Target Time frame

Providing

leadership/guidance

on policy

development,

coordination, quality

control, and

monitoring of

implementation

Meetings of

committees

and sub

committees

Organize Joint

partnership

forum of

hospital and its

stakeholders

High quality

service delivery

and timely

decision making

Strengthened

leadership in the

hospital

Number

of

minutes

and

reports

62%

100%

2013-2018

Hospital open

day

Existence of

transparency and

accountability

Number

of open

days per

year

None

1/year

2018

62

Goal: To guarantee effective leadership that promotes teamwork, and accountability

Strategy /


To strengthen the

hospital monitoring

system

Performance-

based

management

Availability of a

high quality

service and

customer care

% of

satisfied

clients

80%

95%

2018

Performance-

based planning

and mentorship

Existence of

mentorship

programs and

plans in all

departments

% of

plans

reviewed

& tracked

50%

100%

2018

4.2.2. Clinical service

Table 39: Logical framework clinical service

Goal: To strengthen existing and develop new clinical services to address the needs of KH’s

patients and communities

Strategy

/intervent

ion Activities Output/outcomes Indicator

Baseline

(Lux

dev,

2010)

Tar

get

Time

frame

To

promote

health care

service in

all health

facilities

Screening of

patients with

infectious

diseases, Triage

of patients

Burden of

infectious diseases

will be reduced

% of patients

screened 16% 80% 2018

To avail

medical and

non- medical

equipment

High quality of

health care

achieved

% of

equipment

purchased 73% 95% 2018

63



Strategy

/intervent


Baseline

(Lux

dev,

2010)

Tar

get

Time

frame

To avail health

care providers

High quality of

health care

achieved

% of health

care providers

available 90% 98% 2018

To train health

care providers

Good service

delivery

% of health

care providers

trained 70% 95% 2018

To strengthen

outreach

programs in

health centers

Good service

delivery close to

the community

% of outreach

programs

done 66% 90% 2018

Increasing the

number of

ophthalmology

technicians

Good service

delivery

Number of

ophthalmolo-

gy technicians

recruited 1 2 2015

To avail

ophthalmology

equipment

High quality in eye

care

% of

ophthalmolog

y equipment 40% 70% 2018

64



Strategy

/intervent


Baseline

(Lux

dev,

2010)

Tar

get

Time

frame To

integrate

new

clinical

services

(specialized

)and

subservices

to address

the needs

of

community

To avail the

needed

equipment and

specialized staff

High quality

service delivery

will be achieved

Number of

additional

new services

N/A

20

2018

4.2.3. Pharmacy service

Table 40: Logical framework pharmacy

Goal: To ensure efficient and effective management of the pharmacy

Strategy /

intervention Activities

Output/outc

omes Indicator Baseline Target

Time

frame

To improve

supply chain

management

To prepare

annual

procurement

plan

Avoidance of

expired drugs

and stock

outs (drugs,

consumables

and

laboratory

reagents)

% of stock

out of

essential

drugs 6% 0% 2018

To make a

weekly, monthly,

quarterly and

annually reports

as per required

Completion

of all

required

reports

% of

required

reports 85% 100% 2018

65


Strategy /


Output/outc


Time

frame

To Strengthen

Pharmacovigil

ance services

Training of

DTC members

on

pharmacovigilan

ce

Effective

rational use

of drugs

% of DTC

members

trained 25% 100% 2013

Distribution of

reporting form

on adverse drug

reactions

Effective

drugs

reaction

management

Number of

reports

distributed

per month

1 per

Quarter

1 per

month 2013

Promote monthly

meetings of DTC

Knowledge

on side

effects of

current used

drugs

% of

monthly

reports 60% 100% 2014

To improve

the storage of

drugs and

consumables

according to

norms and

standards

Extension and

rehabilitation of

pharmacy stock

Existence of

standardized

pharmacy

stock

Pharmacy

stock

rehabilitated N/A 1 2018

Construction of

cold storage

room

Existence of

standardized

cold storage

room

Constructed

cold storage

room

available N/A 1 2018

Purchasing of

equipment for

storage purposes

Effective

storage of

drugs and

consumables

% of drugs

&

consumable

s in

standardized

stock 60% 90% 2018

To implement

pharmacy

management

information

system

Training of

personnel on the

use of PMIS

Effective

and efficient

management

of drugs and

consumables

% of

pharmacy

staff trained

in PMIS 0% 100% 2013

66


Strategy /


Output/outc


Time

frame

Make use of the

software in both

distribution and

stock (PMIS)

Effective

and efficient

management

of drugs and

consumables

% of report

generated in

PMIS 0% 100% 2013

4.2.4. Human resource management

Table 41: Logical framework human resources management

Goal: improvement of human resources management and capacity building

Strategy /

intervention Activities Output/outcomes Indicator Baseline Target

Time

frame

Strengthening

and follow up

of policies,

relationship

between

managers/non-

managers,

customer and

capacity

building

Establish

Human

Resource

Management

plan

Quantity/quality

of human

resource for

health respond to

needs

Doctor/

population

ratio

Nurse /

population

ratio

Midwife/

population

ratio

1/38869

1/1303

1/51675

1/15,000

1/1,100

1/40,000

2018

Establish

capacity

building

plan

Existence of

capacity building

plan

Number of

capacity

building

plan per

department 1 21 2013

Review of

Internal

rules and

regulations

Hospital internal

rules and

regulation

reviewed

Number of

rules and

regulation

reviewed 0 1 2015

67

Goal: improvement of human resources management and capacity building

Strategy /


Time

frame

Increase the

staff as per

hospital

structure

Existence of staff

as per norms and

standards

Employee

turnover

rate

68%

30%

2018

Public

relations

Existence of

functioning public

relation in the

hospital

Number of

staff in

charge of

public

relation 0 1 2015

4.2.5. Financial management

Table 42: Logical framework financial management

Goal: To strengthen financial department for self-sustainability and provide effective and

efficient services

Strategy /


Time

frame

To strengthen a

finance

department able

to manage and

report on the

financial

position and

performance of

the hospital

Upgrade

management

accounting

software

(QuickBooks)

Effective and

efficient financial

performance and

reporting through

financial software

Existence

of

functional

financial

software None One 2013

Establish an

asset-

management

plan (

codification,

etc)

Effective and

efficient financial

management

% of

hospital

assets in

good

condition 80% 100% 2018

68


efficient services

Strategy /


Time

frame

Strengthen

the recording

system of in-

coming and

out-going

patients

Effective and

efficient financial

management

% of Cash

flow from

operations

excluding

government

subsidiaries

(salaries ) 40% 70% 2018

To establish

and maintain a

strong billing

and recovery

system that

makes sure all

services

rendered and

goods delivered

are billed and

payment is

cashed promptly

Strengthening

management

of receivables

and payables

Income recovered

timely and

effective

% of

income

over

expenditure 102% 130% 2018

Strengthen

the billing

system to

avoid loss of

income

Income recovered

timely and

effective

Creditors

payment

period

(Average

collection

period)

129 day

30

days 2018

To put in place

sound internal

control

measures to

make sure that

KH’s assets are

safeguarded

against theft

and

mismanagement

Putting in

place a store

management

reporting

system

Effective inventory

management

% of

monthly

report of

all asset 50% 100% 2018

69


efficient services

Strategy /


Time

frame

To strengthen

the inventory

system

Monthly stock

taking

Effective inventory

management

%

Monthly

inventory

value 50% 100% 2018

To put in place

a budget

preparation and

monitoring

system to make

sure the budget

is closely

monitored

Reinforce a

culture of

monthly

budget

tracking

Integrated financial

accounting

solution; and

monitoring progress

of

budgeted(planned)

outcome measures

against actual

results via reporting

and dash boards

% of

monthly

Budget

execution

(burn

rate) 30% 100% 2018

To reduce

government

dependency by

increasing KH

revenue every

year

Develop a

treasury

management

plan for

proper

management

of debt and

receivables

Reduced

dependency and

increased internal

revenue

Rate of

external

funding

60%

40%

2018

4.2.6. Logistic and Administrative support service

Table 43: Logical framework logistic and administrative support service

Goal: To achieve optimal administrative support services

Strategy /


70

4.2.7. Information and communication technology

Table 44: Logical framework information and communication technology

Goal: To implement integrated information and communication technology systems to support

quality service delivery and training

Strategy /

intervention Activities Output/outcome Indicator Baseline Target

Time

frame

To improve

the

electronic

collection,

analysis and

reporting of

data and use

of evidence

based to aid

in decision

making

Cabling and

connecting the

entire hospital

Decisions

system reports

% of hospital

services with

internet

connection 50% 100% 2015

Conducting

data quality

audit each

month in

hospital (all

departments )

and health

centers

Existence of data

quality

validation team

in hospital

Number of

data quality

audit reports

per month 1 reports

13

reports 2018

Data back up

Existence of

strong data

backup.

% of

computers

backed on the

server or 50% 100% 2018

To strengthen the

effective and

efficiency condition

of administrative

support system

Construction

and

rehabilitation

of needed

buildings

Availability of

appropriate

working

environment

Number of

new

buildings

constructed/

renovated

N/A

5

constructed

and 1

renovated

2018

Purchasing of

biomedical

equipment and

installation of

needed systems

Availability of

appropriate

working

environment

% of

biomedical

equipment

50%

90%

2018

71



Strategy /


Time

frame

external

driver

Maintenance of

ICT based

equipment

High quality of

service delivered

% of ICT

equipment in

good

condition 50% 90% 2015

Training of

system

administrator

and users

Trained system

administrator

and users

% of trained

administrators

and users 50% 90% 2018

Promote

health

information

system and

software

Implementation

of MoH health

information

system

software

Reporting

system improved

% of hospital

services

which use

MoH system 50% 100% 2018

Maintenance of

existing

systems in the

hospital

Well functioning

software

% of well

functioned

software in

the hospital 50% 90% 2018

Promote of

ICT in

health

facilities

Design,

develop and

implement

hospital

website

Published and

marketed

hospital

activities

Number of

websites

hosted None one 2018

Technical

supervision of

health facilities

in ICT

Effective usage

and maintenance

of ICT

equipment in

health facilities.

% of health

facility

supervised in

ICT per

quarter 50% 95% 2018

72



Strategy /


Time

frame

Training on

data collection,

analysis and

interpretation Trained data

managers and

health providers

% of data

managers and

health

providers

trained 30% 90% 2018

Purchasing of

ICT equipment Availability of

ICT equipment

and usage of

internet in health

facilities

% ICT

equipment in

health

facilities 20% 90% 2018

4.2.8. Quality care and safety

Table 45: Logical framework quality care and safety

Goal: To provide a high standard of quality care in a safe environment that ensures patient-centered

service delivery and achieves accreditation status as a district hospital.

Strategy /


Time

frame

To improve the

patients’ care

experience by

providing

methods giving

feedback and

quality audit

recommendations.

Establishing

a system of

First come

first served

client

Existence of

equity in service

delivery

% of clients

satisfied

80%

100%

2018

Distribution

of token in

concerned

service

Waiting time

reduction

% of token

given

34%

100% of

concerned

services

2013

73

Goal: To provide a high standard of quality care in a safe environment that ensures patient-centered

service delivery and achieves accreditation status as a district hospital.

Strategy /


Time

frame

0rganization

of trainings

for quality

assurance

Quality service

delivery

% of trained

personnel 1% 50% 2018

Establishing

standards

and

operating

procedures

Uniformity of

service delivery

% hospital

services with

SOPs 12% 100% 2018

Monitoring

and

evaluation

of SOPs

utilization.

Existence of M&

E, SOPs

Number of M&

E reports N A 12 reports 2018

Establishing

a modern

record

tracking

system

(archive).

Timely access of

hospital data and

information

Existence of

modern record

tracking system

NA

100% of

hospital

services

using the

system 2018

Improving

usage and

analysis of

suggestion

boxes

Promoted time

saving and

anonymous input.

Number of

reports from

suggestion

boxes

50%

100% of

reports

per month

2018

74

5. COSTING AND BUDGETING OF THE STRATEGIC PLAN

The Kibungo District Hospital strategic plan has been carried out in line with the MoH

guidelines, in respect to the format and approach. Program Based Budgeting is the preferred

method of costing the district Hospital strategic plan. Since the Hospital is not able to generate

the necessary funding from its internal revenues, financing will be based on the commitments

made by the Government and its cooperating partners, as well as projected inflows from the

Global Fund and various other donors, health insurance, Ngoma district, and income-generating

activities.

5.1. COSTING APPROACH

A marginal and activity-based costing approach was employed. The costs have been aligned

according to program or pillar, supporting service strengthening and service delivery as follows:

The costing and financing plan covers a period of 6 years starting with 2012 to 2018, which is in

line with the HSSP III.

75

Table 46: Costing summarized table per year

Data in RWF

Component 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 Total Cost

Funding expected

GAP

A. Health Programs 730,995,500 843,908,500

830,178,500 831,123,500

827,178,500 824,123,500 4,887,508,000 (4,887,508,000)

MCH - Maternal and Neonatal Health

45,544,000

45,544,000

45,544,000

45,544,000

45,544,000

45,544,000 273,264,000

(273,264,000)

MCH - Integrated Management of Childhood illness

24,582,000

24,582,000

24,582,000

24,582,000

24,582,000

24,582,000 147,492,000

(147,492,000)

MCH - Sexual and Gender Based Violence

31,285,000

116,453,000

116,453,000 116,453,000

116,453,000 116,453,000 613,550,000

(613,550,000)

MCH - Expanded Programme on Immunization

26,911,000

26,911,000

26,911,000

26,911,000

26,911,000

26,911,000 161,466,000

(161,466,000)

MCH - Adolescent sexual health, reproductive health and rights

39,880,000

39,880,000

39,880,000

39,880,000

39,880,000

39,880,000 239,280,000

(239,280,000)

MCH - Family Planning 50,584,000

50,584,000

50,584,000

50,584,000

50,584,000

50,584,000 303,504,000

(303,504,000)

MCH - Nutrition 9,744,000

9,744,000

9,744,000

9,744,000

9,744,000

9,744,000

58,464,000

(58,464,000)

DPC - HIV/AIDS 213,015,333 213,015,333

213,015,333 213,015,333

213,015,333 213,015,333 1,278,092,000 (1,278,092,000)

DPC - Malaria 36,353,000

36,353,000

36,353,000

36,353,000

36,353,000

36,353,000 218,118,000

(218,118,000)

DPC - Tuberculosis 64,599,000

57,864,000

67,599,000

60,864,000

64,599,000

57,864,000 373,389,000

(373,389,000)

DPC - Mental Health 14,416,000

14,416,000

14,416,000

14,416,000

14,416,000

14,416,000

86,496,000

(86,496,000)

DPC - Non Communicable Diseases

-

6,960,000

6,960,000

-

6,960,000

-

20,880,000

(20,880,000)

DPC - Neglected Tropical Diseases

600,000

7,240,000

600,000

7,240,000

600,000

7,240,000

23,520,000

(23,520,000)

DPC - Integrated Disease Surveillance and Response

48,074,000

48,074,000

48,074,000

48,074,000

48,074,000

48,074,000 288,444,000

(288,444,000)

DPC - Disabilities 12,784,000

12,784,000

12,784,000

12,784,000

12,784,000

12,784,000

76,704,000

(76,704,000)

HP - Health promotion ( bahavior communication change)

9,704,167

9,704,167

9,704,167

9,704,167

9,704,167

9,704,167

58,225,000

(58,225,000)

76

EH - Environmental Health and medical waste management

90,188,000

111,068,000

94,243,000 102,243,000

94,243,000

98,243,000 590,228,000

(590,228,000)

TM -Traditional medicine 12,732,000

12,732,000

12,732,000

12,732,000

12,732,000

12,732,000

76,392,000

(76,392,000)

B. Systems Strengthening 390,089,917 367,886,513

369,752,079 412,365,249

376,684,701 383,418,538 2,300,196,997

- (2,300,196,997)

Planning. Budgeting and monitoring

5,402,000

5,402,000

5,402,000

5,402,000

5,402,000

5,402,000

32,412,000

(32,412,000)

Medical product management ands regulation(including ambulance) 192,081,667

192,081,667

192,081,667 230,431,667

192,081,667 192,081,667 1,190,840,002 (1,190,840,002)

Diagnostic services -

-

Health financing (PBF) 92,400,000

94,866,596

97,399,037

99,999,082

102,668,534 105,409,246 592,742,495

(592,742,495)

Quality assurance and standards

61,676,000

64,006,000

61,676,000

61,676,000

61,676,000

64,006,000 374,716,000

(374,716,000)

Health Information management

35,204,000

8,204,000

8,204,000

8,204,000

8,204,000

8,204,000

76,224,000

(76,224,000)

Knowledge management / research

3,326,250

3,326,250

4,989,375

6,652,500

6,652,500

8,315,625

33,262,500

(33,262,500)

C. Service delivery 1,036,186,348 1,039,910,120

1,026,085,778 1,044,282,411

1,074,736,976 1,163,379,210 6,384,580,844

- (6,384,580,844)

Recurring costs (Including also HRH) 835,986,348

898,410,120

947,085,778 1,009,282,411

1,049,736,976 1,103,379,210 5,843,880,844 (5,843,880,844)

Investments 200,200,000 141,500,000

79,000,000

35,000,000

25,000,000

60,000,000 540,700,000

(540,700,000)

Total costs 2,157,271,765 2,251,705,134

2,226,016,358 2,287,771,160

2,278,600,176 2,370,921,248 13,572,285,841

- (13,572,285,841)

77

5.2. STRATEGIC PLAN RESOURCE MOBILIZATION

The Kibungo district hospital doesn’t have means of financing all activities in strategic plan but

it will use the own revenue and other revenues from MoH and its partners.

The first source of implementing the strategic plan are own revenue generated by hospital though

different services offered by the hospital and other income generating activity such as staff

canteen, etc The second source of funding the strategic plan is government subsidiaries through

Ministry of Health and Ngoma district. The third source of fund is money from different partners

who support the district hospital

As there is a gap between the expected revenue and required revenue to achieve target set in

strategic plan, Kibungo district hospital is recognizing a need to mobilize fund. In order to

mobilize fund, budget proposal will be submitted to different stakeholders. Kibungo district

hospital is planning to avail business plan, action plan and budget every year.

78

6. MONITORING AND EVALUATION FRAMEWORK

The district hospital strategic plan will be monitored at the end of each quarter by the hospital

M&E officer and evaluation of outcomes will conducted every year at the end of financial year.

The following are main data elements and data sources:

1) Main data sources

a. Community

Data Elements

a. Community

Data elements:

- New cases in OPD, New cases in HIV/AIDS/STI/TB and NCD; New cases of childhood

illness; New cases of gender-based violence; Deliveries; Nutrition screening; LLIN

distributed

Data source

- Patient cards; Registers; Rapid SMS; Community Health Report

b. Health Post

Data Elements

- New cases in OPD; New cases in HIV/AIDS/STI/TB and NCD; New cases of childhood

illness; New cases of gender-based violence; Deliveries; Nutrition screening; LLIN

distributed; Stock of tracer drugs

Data Source

- Patient cards; Registers; HMIS Monthly Report

c. Health Center

79

Data Elements


illness; New cases of gender-based violence; Antenatal consultations; Postnatal care;

Deliveries; Nutrition screening; LLIN distributed; Family planning; Vaccinations; Male

circumcision ; Laboratory; Stock of tracer drugs; Finances; Mutuelle enrollment

Data Source

- Patient cards; Registers; HMIS Monthly Report; TracNet; DHIS 2; OpenMRS;

QuickBooks

d. Hospital

Data elements


illness; New cases of gender-based violence; Antenatal consultations; Postnatal care;

Deliveries; Nutrition screening; LLIN distributed; Family planning; Vaccinations; Male

circumcision ; Laboratory; Stock of tracer drugs; Finances; Mutuelle enrollment

Data source

- Patient cards; Registers; HMIS Monthly Report; TracNet; DHIS 2; OpenMRS; PMIS;

QuickBooks; Tompro; HRMS

-

2) Information flow from the community to District level

a. Information is collected through a bottom-up approach via manual and electronic

methods.

80

3) Mechanisms and timeline for monitoring

a. Data will be reviewed on a quarterly basis at each level and feedback will be provided

from top-down.

4) Roles and responsibilities of each actor in data management

Roles Responsibilities

Hospital Data Manager Compile monthly HMIS report, record

data in DHIS 2 and conduct data

analysis.

Review, analyze and report consolidated

health metrics from system ( DHIS 2)

Hospital M&E Manager Review and assess outcomes and outputs

from hospital strategic plan, collaborate

with District M&E manager when

necessary, and distribute reports to the

Hospital Director

Hospital Community Health Workers

supervisor

Collect and report community health

data and collaborate with hospital data

manager to streamline gaps in data

reporting

Hospital Director / Administrator Review quarterly M&E and data

management reports and distribute the

report to the hospital and district

management

81

Management committee and Board of

Directors

Review quarterly hospital reports and

make decisions

5) Expected evaluations during the life of the plan

a. Outputs and outcomes will be reviewed quarterly and annually against expected

results at the District level, hospital level and then health center level.

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