This message is meant to communicate the works, achievements, key challenges and future plans with regards to Mbarara city’s Public Health services. The end goal is to give information and the public health status to the policy makers, health professionals, the general public, implementing partners and all stakeholders. I am excited to share with you here some information focusing on Mbarara city’s health, including: Medical services, Private health sector, general hygiene and sanitation, waste management, and other related issues.
Overview
The Mbarara Municipal Health Sector continues to advocate for Health Service Systems that are used and owned by the people and therefore, with the central line ministry, the department focuses on Health Promotion, Health Education, Environmental Health and sanitation, Community Health Initiatives, Reproductive Health and Child survival. The department is mandated to supervise and technically support all these health programmes, to ensure a healthy and productive population of about 250,000people.
Health financing/PHC-conditional grants
The department received all the allocated PHC funds regularly (Wage & Non-wage) and this money enabled the health sector carry out the basic health care services delivery at all public health facilities, including administrative health unit management and maintenance, integrated health monitoring and supervision, and management of health information and reporting system (HMIS) All the staff salaries were paid by the 28th day of every month. Staff allowances were paid timely to casual laborers and contract staff, fuel for solid waste management at Kenkombe paid, mortuary operations facilitated. The table below summarizes the allocated and released PHC Wage and nonwage for the report period;
| Item | Budgeted/allocated | Amount released | Amount released | Performance |
|---|---|---|---|---|
| PHC Wage | 1,326,768,180/= | 1,326,768,180/= | 1,326,768,180/= | 100% |
| PHC Dev't | 53,563,626/= | 53,563,626/= | 53,563,626/= | 100% |
| PHC Non-wage | 159,284,999/= | 159,284,999/= | 159,277,945/= | 99.9% |
| Mbarara Muslim HC II | 6,373,388/= | 6,373,388/= | 6,373,388/= | 100% |
| Kamukuzi HC II | 7,796,712/= | 7,796,712/= | 7,796,712/= | 100% |
| Kamukuzi DMO HC II | 7,796,712/= | 7,796,712/= | 7,796,712/= | 100% |
| Nyamityobora HC | 7,796,712/= | 7,796,712/= | 7,796,712/= | 100% |
| Ruti HC II | 7,796,712/= | 7,796,712/= | 7,796,712/= | 100% |
| Kakoba HC III | 19,718,940/= | 19,718,940/= | 19,718,940/= | 100% |
| Kyarwabuganda HC III | 19,718,940/= | 19,718,940/= | 19,718,940/= | 100% |
| Nyamitanga HC III | 19,718,940/= | 19,718,940/= | 19,718,940/= | 100% |
| Mbarara MMC IV | 36,621,652/= | 36,621,652/= | 36,621,652/= | 100% |
| PMOs Office | 23,910,248/= | 23,910,248/= | 23,671,248/= | 99% |
The Ministry of Health in order to improve the Health Financing Strategy, introduced the Result Based Financing (RBF) strategy. During the month of December 2019, health facility performance Assessment was done and all the Health Centre IIIs and IV passed with above 85% and therefore qualified for the funding. A start up grant/fund was released in February 2020 to all these facilities aimed improving the reproductive, Maternal Neonatal, Adult and Child Health (RMNACH) services as follows;
| S/N | Facility | Level | Amount received |
|---|---|---|---|
| 1 | MMC | IV | 16,187,050/= |
| 2 | Biharwe | III | 5,090,000/= |
| 3 | Kakoba | III | Kakoba |
| 4 | Nyakayojo | III | 3,662,150/= |
| 5 | Nyamitanga | III | 2,202,600/= |
| 6 | Kyarwabuganda | III | 460,600/= |
| Total | 32,530,450/= | ||
Staffing level
The department is composed of the Principal Medical Officer of Health as the head of department, Health Inspectorate Services/Public Health staff and the general Clinical care staff. The staffing levels for the department stands at about 54% approved posts filled (Totals positions filled is 110 members out of the 212 approved). Note that the national target is at least 75% of the approved staff should be filled. This therefore seeks for massive staff recruitment to fill up most of the critical vacant positions.
Medicine and Essential Health Supplies
The National Medical Stores continue to supply the medicines and essential Health Supplies frequently and regularly. All the health facilities have had no drug stock outs of the six tracer medicines, except for only ARVs, TB drugs and some vaccines especially Measles. The drugs received for all facilities total amount to Ugx.202,316470 for all the facilities for the FY 2019/2020.
Health infrastructure
| S/N | Facility name | Level | Owner | Location/Division |
|---|---|---|---|---|
| 1 | Mbarara Municipal council | HC IV | Public/Government | Kamukuzi |
| 2 | Biharwe Health centre | HC III | Public/Government | Biharwe |
| 3 | Kakoba Health centre | HC III | Public/Goverment | Kakoba |
| 4 | Kyarwabuganda | HC III | Public/Goverment | Kakiika |
| 5 | Nyakayojo Health centre | HC III | Public/Goverment | Nyakayojo |
| 6 | Nyamitanga Health centre | HC III | Public/Goverment | Nyamitanga |
| 7 | Nyamityobora | HC II | Public/Goverment | Kakoba |
| 8 | Rwemigina | HC II | Public/Goverment | Kakiika |
| 9 | Kamukuzi division | HC II | Public/Goverment | Kamukuzi |
| 10 | Kamukuzi DMO | HC II | Public/Goverment | Kamukuzi |
| 11 | Ruti | HC II | Public/Goverment | Nyamitanga |
| 12 | Rwakishakizi | HC II | Public/Government | Nyakayojo |
| 13 | Kicwamba | HC II | Public/Goverment | Nyakayojo |
| 14 | Mbarara Muslim | HC II | PNFP/UMSCMB | Kakoba |
| 15 | Nyamitanga | HC II | PNFP/UCMB | Nyamitanga |
| 16 | St.Johns Community | HC II | PNFP/UPMB | Biharwe |
| 17 | Ruharo Mission | Hospital | PNFP/UPMB | Kamukuzi |
| 18 | Divine Mercy | Hospital | Private | Kamukuzi |
| 19 | Holy Innocents | Hospital | PNFP/UCMB | Nyamitanga |
| 20 | Mayanja Memorial | Hospital | Private | Kakoba |
| 21 | Mbarara Community | Hospital | Private | Kakoba |
Functionality of health facility and general General clinical performance
All health facilities have been monitored and supervised regularly. We have done all the routine quarterly supportive supervision for all the quarters the facilities are fully functional with the HUMCs in place holding regular quarterly meetings, with minutes available. However I hereby report that all these committees their tenure of office has ended and should be renewed or else other new members be appointed. It has been noted that a tremendous increase in outpatients and inpatients utilization at respective public health facilities within the Municipality. It has been noted that the number of clients have increased especially seeking for the Maternal Child Health (MCH) services and other related health indicators, thus improved health facility utilization by the public. The table below summarizes the general clinical performance on the health performance indicators (source; HMIS reports)
| S/N | Indicator | Actual Performance | Targeted For The FY | %age Performance |
|---|---|---|---|---|
| 1 | OPD attendance | 117,250 | 48,648 | 241% |
| 2 | Malaria confirmed cases | 5,784 | ------ | ------ |
| 3 | Number of Inpatients | 11,022 | ------ | ------ |
| 4 | ANC 1st visit | 9,952 | 9,732 | 102% |
| 5 | ANC 1st trimester | 3,077 | 9,732 | 17% |
| 6 | ANC 4th visit | 5,311 | 9,732 | 55% |
| 7 | Total ANC | 29,473 | 9,732 | 303% |
| 8 | IPT2 | 5,120 | 9,732 | 53% |
| 9 | PMTCT | 7,774 | 9,732 | 80% |
| 10 | Facility based Deliveries | 6,440 | 9,732 | 66% |
| 11 | Ceasarian section | 491 | 2,433 | 20% |
| 12 | FSB(Fresh Still Birth) | 4 | 0 | ----- |
| 13 | MSB(Macerated Still Birth) | 6 | 0 | ----- |
| 14 | Maternal Deaths | 0 | 0 | ----- |
| 15 | Immunization(BCG/OPV0) | 7,119 | 8,376 | 85% |
| 16 | Immunization(Polio3) | 7,283 | 8,376 | 79% |
| 17 | DPT1-Hep b-Hib 1 | 7,634 | 8,376 | 91% |
| 18 | DPT3/PCV1 | 7,432 | 8,376 | 89% |
| 19 | Immunization PCV3 | 7,496 | 8,376 | 90% |
| 20 | Measles | 6,253 | 8,376 | 75% |
| 21 | HCT(HIV testing) | 20,272 | ----- | |
| 22 | HIV+ Cases | 992 | ----- | |
| 23 | HIV+ Cases initiated on ART | 966 | ----- | |
| 24 | Number of outreaches | 264 | 368 | 72% |
Environmental Health, Sanitation and hygiene
• The routine solid waste/garbage collection from households/public, transportation and disposal at Kenkombe dump site still ongoing by the use of private service providers using the generator pays principle. With this strategy, engagement of private waste service providers in collection of waste at house hold level and also from the communities, we are now ably collecting more than 200tonnes per day of solid waste and our dumping composting site was constructed to accommodate and process only 70tonnes per day. We intend to resume the composting process to produce organic manure and re-cycle the plastics out of the dumped solid waste.
• We have had a master plan to revamp and restore the Kenkombe garbage dumping site and resume the sorting and composting process of organic solid waste;
• It has been noted with great concern that there is no updated baseline information on the general hygiene and sanitation within the city, it is therefore my prayer that we conduct a baseline survey to establish the number of households, pit latrine/toilet coverage, households without hand washing facilities, bath shelters and drying racks for utensils.in this regard we would like to conduct a comprehensive inspection, monitoring and supervision of premises eating houses and water quality surveillance.
Challenges
a. Lack of staff accommodation from a few health facilities, though some facilities with accommodation staff have remained adamant without a will to stay at the respective facilities hence not able to give adequate services to communities they serve.
b. Inadequate patient’s furniture like beds and benches at all the Health facilities in addition to inadequate working spacing and land for expansion in most of our facilities.
c. Lack of transport to outreach posts/stations most especially for integrated health outreach programmes.
d. Inadequate essential medical equipment especially Microscopes and shortage of medical supplies like drugs, sundries, vaccines, HIV testing kits etc.
e. Most facilities have not been fenced thus very porous borders. This has created a serious insecurity threat to most public facilities.
f. Lack of garbage/solid waste management equipment like a heavy tractor/wheel loader for Kenkombe Dumping site, to manage the garbage at composting plant.
g. Lack of a public incinerator for disposal of some medical/Hazardous wastes within the municipality.
Infrastructure/capital development;
Completed development projects in the last FY 19/20;
• Renovation of the doctors staff house at Muti-drive.
• Renovation of Maternity ward at Kakoba HC III, for Ugx.
• Construction of sanitary/toilet facility at Nyamityobora HC II.
• Installation of water harvesting tank at Nyamitanga HCIII.
• Through the Ministry of Health/GAVI procurement and supply of the motor cycles in support to the immunization outreach programmes. The motorcycles were allocated to the following Health centres; Biharwe, Kakoba, Nyakayojo and Kyarwabuganda
0n-going projects for the next FY 2020/2021;
• The upgrading of Kyarwabuganda HCII to HCIII, the construction works and the upgrading process is towards completion, funded by the World Bank through UGIFT-MOH at a cost of Ugx 540,000,000/=.
• Fencing off of Nyamitanga HC III with installation of a gate for the security personnel to address the security challenges at the facility.
• Upgrading of Kicwamba HC II to HC III, funded by the World Bank through UGIFT-MOH at a cost of 400,000,000/= in the initial stages
• Construction of staff house at Kyarwabuganda HC III, funded by the World Bank through UGIFT-MOH at 269,523,000/=
• Renovation of doctors house with fence on MUTI-Drive using Local Revenue at Ugx.30,000,000/=.
Planned projects/Activities for the next FY 21/22
Recruitment of more Health staff most especially theatre staff, and in accordance to the Workload Indicators for Staffing Needs(WISN), to ensure adequate/improved staffing to at-least 75% staffing level, and capacity building through Continuous Medical Education(CMEs/CPDs).
- Elevation / upgrading of health facilities, Rwemigina and Rwakishakizi to HC IIIs, Nyakayojo, Namitanga, and Biharwe be upgraded to HC IVs, MMC IV to General Hospital aimed at decongesting the MRRH.
- Purchase of coloured printer/photocopier for the department for effective health services and administrative management.
- Improve planning, coordination, resources (financial) management for health management services and infrastructure development especially on staff accommodation facilities at most facilities at MMC IV.
- Implement sustainable waste management system, using the generator pays principle (generator pays to private service providers) at a cost of about 100/= per kg of waste generated, waste minimization/reduction (lessening waste generation),waste segregation/separation at source, Reuse (further use of the waste in its existing form for its original or similar purpose), Recycling (reprocessing waste materials to produce new products), Recovery (extraction of materials or energy from waste for further use or processing e.g. compost manure), Treatment (processing the waste to change its volume, character and cater for adverse environmental impact.) Disposal (final deposit of waste.)
- Medical and other Hazardous waste to be disposed off by incineration using the identified private service provider who will be linked to the generators of this type of waste.
- Revive and emphasize the routine activities as implemented at village level with the involvement of health assistants, inspectors, VHTs.
I. Routine village/community mobilization and sensitization meetings at least one village meeting per village per month.
II. Keep Mbarara city clean activities be conducted and implemented by each village on every last Thursday of the month as organized by the divisions and wards.
III. Routine monitoring and supervision of all health services, including water quality surveillance.
IV. Inspection of premises and factories, home visiting programmes to ensure hygiene and sanitation and update the hygiene and sanitation facilities latrine/ toilet coverage Bath shelters, hand washing facilities and drying racks for food utensils.
V. Food quality monitoring food handlers inspection of food eating premises, places hotels and supermarkets and shelf off of expired food staffs not fit for human consumption.
VI. Revive school health and community health programmes both facility based and outreaches including immunization, Health Education, child health days and formation of school healthy clubs.
Construction of public toilets/sanitary facilities at selected areas around town eg Rwebikoona market, Kakoba road aroud the Kakoba BSU Market, along Kabale road.
Renovation of all the washrooms and construction of a guest/public sanitary facilities at the administration block the mighty white house.
Fencing off of Kenkombe, Installation of Two main entrances into the site Creation of an alternative road in front of the abboitre, with a gate and close off the old road.
Construction of staff house MMC IV, OPD/General ward, and have a physical development plan for all the facilities.
Renovation of the OPD Building at Biharwe HC III, Compound levelling, landscaping and beatification at Biharwe HC III.
Fencing off of Kyarwabuganda and Rwemigina Health centres fronm the Local revenue by the division.
Construction of the general ward for the general in-patients at Nyamitanga HC III.
Construction of patients bathrooms/ bathing shelters at Kakoba HC III, installation of water harvesting tank at Kakoba HC III, Costruction of the general ward at Kakoba HC III.
- Email health@mbararacity.go.ug