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2rl?2 I IVE I] 717 r1 PARLIAMLNT OI' UGANDA PARLIAMENT OF THE REPUBLIC OF UGANDA REPORT OF THE COMMITTEE ON HEALTH TO SELECTED HEALTII FACILITIES IN BUSOGA, ELGON, BUKEDI, ANKOLE & BUGANDA SUB-REGIONS TO ASSESS THE STATE OF HEALTH SERVICE DELTVERY "@/- s Ofllce ofthe Clerk to Parliarnent, Jnly,2022 +& I \O?
t-\ \\6 t:; 0lPagP TABLE OF CONTENTS 1.O INTRODUCTION,, , , , , ,, ,, ,, , 2-O BACXGROI I{D 3.O OBJECTIVES OF THE FIELD VISIT,,, 4.O METHODOLOGY 4.1 BR]EFING SESSIONS 4.2 CUIDED TOURS 4.3 DOCUMENT REVtEW............................................ 4-4 QUESTIONNAIRE 5.O SCOPE 5.1 GEOGRAPHICAL SCOPE 6.
() FI}IDI}IGS, OBSERVATIOI{S A.IID RICOMMENDATIOIIS 6,1 PERFORMANCE OF KEY HEALTI.I INDICATORS AT THF] HDALTIJ FACILITIES 6,2 STAFFING LEVELS IN THE HEALTH FACILITIES 6.3 AVAILABILITY OF ACCOMMODATION FOR STAFF-..,-.-.......,.....,... 6.4 AVAII.ABILITY OF PHARMACEUTICAI^S & MEDICAL SUPPLTES 6.5 STATE OF MATERNITY SERVICES 6.6 STATE OF THEATERS IN THE HEALTH FACILITIES 6.7 STATE OF LABORATOR] ES,,,.,,.,,,.
,... 6.8 AVAILABILITY OF IMAClNG S8RVtCES................................. 6-8.1 GENERAL OBSERVATION ON EQUIPMENT.

6.9 AVAILAB|LITY AND ADEQUACY OF UTILITIES....................... 6.IO PROGRESS OF ONGOINC CONSTRUCTION WORKS 6,I I STATI' OI'AMBULANCES , 7.O CONCLUSION.
# $k .dh \'' 14 ........1s t5 ..........16 ..........2L 26 28 32 33 35 38 40 42 43 45 54 1LP ace LIST OF AAEREVIATIOI{S ART - Anti-letrovirals BP machine - Blood pressure machine CAO - Chief Administrative officer CBC- Complete Blood Count Ceonoc - Comprehensive Emergency Obstetric arld Newborn Cafe CF - Consolidated Fund C-section - caesarean section CT 6call - Computed Tomoglaphy scan DHO - District Health officer FY- Finalcia.l Year CKMA - Greater Kampala Metropolitalr Alea HC - Health Centre IPD - In Patient Department MARPS - Most at Risk Populations NCDS - Non-communicable diseaees NMS - Nationa.l Medical Stores AITR - Non-tax revenue OPD - Out Patient Department PCR - PolFner Chain Reaction PHC - Prima-rjr Health Care PNFPS - Private not for Profit PPE - Personal Protective Equipment RBF - Results Based Financing SDGS - Ssustainable Development Goa-ls TASO- The Aids Suppo Organisation TB - T\rberculosis TC - Tosm Council UGX - Uga-ndar Shillhgs U-S-Sscan - ulba sound scan # 2 Page $& ( N, [^ +r VHTS- Village Health Teams WHO - World Health Organisation I 3lPase d s& $o EXECUTIVE SUMMARY The Cornmittee undertook a Iield vi6it in the last week of May and Iiist week o!
JurLe, 2022 to assess health serice delivery arld assess progress of colrstruction works in selected health facilities in Busoga, Bukedi, Elgon, Ankole and Buganda sub-legions.

The Com&.ittee visited 3 general hospitals, 15 HC IVs, 13 HC llls and 1 HC ll.

In order to get the required information, the CorEnittee held meetings, conducted guided tours of the health facilities, reviewed documents alrd administered a questionnaiie at each health facility.
Key flldiugs and recomfiendatlons fron the Iield vlslt PcrforEance ln regard to tey he.ltL lndlcators Key health iadicators include: caesarea,I sections, evacuations, total number oi deuveries, materna-l deaths, perinatal deaths, ,resh still bi hs, macerated still births, early neonatal deaths, obstetric referrals in and obstetiic referrals out.

The number of normal detveries in health facilities greatly surpasses c' sections.

There are many still births and many evacuations.


However, maternal deaths have greatly reduced to ligures below 10. ln order to Lnprove perforimance on the above indicators, theatres at HC IVs should be well-equipped and adequately stalfed to handle matemal issues.

The HC IVs should be provided wit}r ambulances to tacilitate referrals to higher level units.
St ftrng leveb h tbc health facllltle3 The Committee found out tiat no health facility has lully ftled its structule; many facilities lack anaesthetic oficers and specialists; midqdves and nurses are key in the operations of the facilities; the health facilities have been waiting for a new staJfrng strlrcture for a long time and some stalf are e=( by donors.
( T; lPage C^ $\\ The stall shortage and lac& of molale can be addressed by effecting the salarJr increment for medical workers elfective this FY, finalising the new stalfmB norms and fiIing of vacant positions by the distr:ict service commissions.

Accolrtrodltlor for atatr The need to handle health matters can crop up at any time of the day or night; hence necessitating health workers to stay at the health facilities.
However, many health workers do rrot reside within the preciDcts of the hea.lth facility due to arl acute shortage of housiog units; some accommodation facilities pose a risk to tie occupants because they are very old and dilapidated and ttrere were no plans to address the housing che-llenge.
The scope of some infrastmcture projects by donors includes const uction of staif houses but that was at very few facilities, The Committee recommeirds that Government should continue with its efforts of building the stock of houses for health workers' accommodation and the dilapidated buildings should be urgently renovated.

Avatlatt[ty of phartEr.Gutlc.L anal Eedlcel suppllo.

All health facilities visited have a perennial problem of stock-outs of pharmaceuticals and medical supplies.
The issue is not lirljted to the facilities assessed, but is a national problem.

The stock of critica-l drugs like anti-malarials, antibiotics a.rld NCD drugs is used up fast, leaving tie patients with lro option but to buy the medicines.
There is no ploper stock- taking of t.I.e drugs and the storage space is very small Development paitaers support some healti facilities to purchase more medicines and supplies, The Committee reiterates its earlier recommendations that the budget for National Medical Stores should be increased to match the increasing number of health facil.ities aad growing catchment population se ed by the health units.
ZZP/\ -w At d tr- slPace .u(lY' Avallabill$r of iu'gl'tg serelces X-ray machines which are only for hospitals, were found in Tororo and Busolwe hospitals but were not functioning.

A few HC IVs had US scans provided by well-wishers and NGOs.

These helped in reducing referrals of pregnant mothers in need of imaging senices.

It is important to note that HC IVs do not have sonograghers in their structures.
Those that had US scan services improvised by hiring & training midwives, T?re above challenges can be mitigated by adopting committee proposals on equipment management and maintenance and human resources for health.

Adequacy and rellability of utllitles The Committee confirmed that aI health facilities are grappling with inadequate, unreliable and unstable provision of water and electricity.

The facilities are mitigating the challenges above by harvesting rain water and acquiring generators.
The generators, however, are expensive to use given the meagre PHC funds at the disposal of the medical units.

The Committee encourages health facilities which do not haye enough water to consider the option of rain water harvesting and those experiencing power problems to adopt solar power solutions.
An inter-ministerial committee should be set up comprising the Ministry of Health, Midstry of Enerry and Mineral Development, Ministry of Local Government and Ministry of Water and Environment to develop a Easterplan to address the issue of persistent power black-outs, inadequate supply of water and high utility bills at the health facilities.
Progrea8 of oEgoing colatructlon projects Gombe Hospital The Committee conducted an assessment of construction arld renovation works at Gombe Hospital in Butambala district.

The works are supposed to last four years and started in the FY 2Ol9l2O2O.
During the second FY (2O2O/211, progress was hampered by insufficient capacity of the contractor and sub- standard works- ln the last FY, implementation of the Presidential d d)' \ vre_ x)-jsj-J; M lPage state of EeterElty wards It was evident to the Committee that maternity wards which are usually congested, are the busiest units in the health facilities after the outpatient departments.

However, the majority lack incubators and only have two (2) beds.
The wards are well-stocked with thermometers and BP machines.

The major reason for referrals from t}le maternity wards is lack of blood translusion senrices and semi-functional theatres.

The Committee therefore recommends that the Ministry of Health should develop an expaision plan for maternity wards countqrwide beginning with the most under-served areas.

The plan should be implemented in the medium and long term.

This will go a long way in reducing congestion.


State of theatteE An assessment of the state of tieatres revealed that some were functioning and others were not.

Non-functiona.lity of the theatres was due to shortage of supplies, breal<down of key equipment like anaesthetic machines and autoclaves and lack of critica-l cadres like anaesthetic officers.

It is only Nagongera HC IV without a functional theatre.

A.u tie theatres have a sufficient number of orygen cylinders and C-section kits.
The Committee strongly recommends that the Ministry of Health should carry out a study about functionality of theatres in health centre IVs and immediately undertake the necessary action.

tr'uEctlonality of laboratories The Committee found out that laboratories under the national hub system are more functional compared to those which are not, The most common tests which the laboratories are unable to conduct include CBC, chemistry analysis, PCR ard blood grouping.
There is a shortage of reagen ts due to insufficient supplies.

The servicing of saJety cabinets is long overdue.

Ir order to improve functionality of the laboratories; the budget for NMS should be increased to enable it supply sullicient reagents and the laboratory equipment should be lixed or replaced.

t- g"^-*'$2 6lPage Z?.L ek Jl.-- x>-r5-M i constmction paojects slowed down cornmencement of works since there was no official mode of engagement with the Army.
The Committee observed that the unsatislactory works were pa.dy due to weak supervision by the responsible officers.

The Committee recommends that supervision efforts should be intensilied and the in-charge of Gombe Hospital should play a key role in the entire process.

Subsequent payments should be based on completion ot works.
Busolwe Hospital The Committee visited Busolwe hospital which is being renovated in two phases, i.e the staff quarters by UPDF and then t}te main hospital structure An unidentilied contractor was procured for renovation oI the main but couunencement oI works is awaiting clearance from the PS/ST to approve reflection of the contract sum i!

US dollars not Ugandan shillings.

Thele were complaints by the loca.l comEunity who were employed as casual labourers about their daily payment rates being reduced.
There was also lack of proper coordination between the UPDF, MOH, the local potitical and technical stall arrd the hospital management.

The corn nlttee gulded thdt thete should.

be monthlg Jolnt supervlslo and cootdl^atlon ,neetir.gs oJ key std.kehold.ers lnchtdl^g the cornfiunltg rep"ese tdthE llke d, hospltd,l bodrd ,nentber, Ambulalce services An assessDent of the availability of ambulances in health centre IVs reveals that 46010 (6) have arnbulances and 5470 lack anbulances (7).
Eight (8) of the 13 HC IVs assessed by the Comraittee had twe B a$bulances and only 4 b-ad type C which ar:e old and are duo-purpose vehicles for tra.nsportation of patients and health workers.

This reveals a loophole in provision of services to tie people by the Ministry of Health v # 8 Page +t The Commlttee reiterate6 lts earller recommendation that Govemmeit should l^cted.se the bud.get Jor the Natloa'ql Ambtldnce systern sernlce.
CONCLUSION Health Centre IVs and HC IIIS 6erve the majority of Ugandans who aie Iocated in the rural areas.

Investment in tho6e facilities will go a long way irl improving hea.lth service delivery countiywide.

The investaent can be frnarrcial and non-financia.l and the arrrounts and effort required vary, However, collabolation of the different stakeholders is key in the transformation.

ffi TC +,if;:* D 9lPa '.atiP +\ I.O INTRODUCTION Rt.

Hon.

Speaker and Hon.


Members, In accorda.nce with Rule 159(c),159(d),189(al, t89(bl, 189 (e) and 189 (f) of the Rules of Procedure of Parliarnent; the Committee on Health undertook a field visit to selected health facilities in Busoga, Elgon, Bukedi, Ankole and Buganda sub-regions regio4 in the last week of May and first week of June, 2022 a,rd now begs to report as stipulated in Rule I59 {e) and 34(f) and s4l2l.
2.O BACKGROUND According to the Uganda National Service Delivery Survey, 2018, over g0olo of health facilities (public, private, PNFPS) in t.l.e country are located in the Greater Ka-Elpala Metiopolitan Area (GKMAli an inequality which threatens the countryt efforts towa-rds achieving SDG 3 - which aims at ensu ng healtiy lives and promoting well-being for all at all ages.

The uneven distribution ol health facilities where majority are found in GKMA puts a strain on health service delivery in rural areas.
The current health system is organised ulder four Ievels of health care: primary, secondary, tertiary a,rd quaternar-y.

About 27ol.

of the population of the country are within Skms of the nearest health lacility while about 57% are within lokms.

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€C .w.-,*;@ l0 lPage .,+G \^' The table below shows the health service delivery standalds by level of health facility T8ble I - Heslth rervlce dellvery structure by lcvcl Level Target populatloD Number of Stafitng Services provlded beds HC III Sub-county 19 Community-based level 20,ooo 8-maternity 6-children 4-female 2-male preventive and promotive health services, outpatient, curative, matemity, in patient, laboratory HC TV Constituency 50 49 Comrxrunity-based level 1 6-eaternity 100,000 12-female 12-children lo-male preveDtive and promotive health services, outpatient, curative, daternity, in patient, laboratory, Obstet cs, US scan, emergency, sirople surgery (C-section & life-saving operations) , blood transfu sion, IIlOIIUa4r General Hospltel 500,000 100-200 r85 Comr[unity-based 25-obstetircs & Smaecolosr 25- Peediatricians .d preventive and promotive health services, outpatient, curative, &atemity, in patient, 11 lPage +& Lrl G 25-medical 25-surgery 50-others Iaboratory, Obstetrics, us sound scalr, emergency, simple surgery (C- section & life-saving operations), blood transfusion, aortuary Specialist services in medicine, surgery, paediatricians, community medicine, obstetiics & s/naecolos/, in- service training & basic resea.rch Soutce: Ml^lstry oJ Hed.lth Uganda's doctor to patient and nurse to patient ratio is approximately 1:25,000 alrd 1:1l,0OO respectively.
This is way below the WHO recommended doctor to patient rafio of 1:1000, Though there is no official WHO recotnmended nurse to patient ratio, l:1l,0OO is still iiappropriatc considering that most developed health care systems have a doctor to nurse ratio of 1:2-5- According to the Annual Health Sector Budget Periormance W 2O2O 21, many Healtl Centre IVs have remained non-functlonal due to various reasons.
Out of a total of 2I8 HC IVs that reported, only I87 (86010) were able to carry out caesarean sections.

However, 87 oi them do not have bloo tlanslusion services.

In addition, almost all new HC IVs do not provide Comprehensive Emergency Obstetiic and Newborn Care (CeMNoc)services due to lack ol staff and equipment.
&.rrr.^A 12 Page +\\G '@ It is against ttre background above thal lle Committee on Health conducted a held visit to selected health facilities in Busoga, Bukedi, Elgon, A.kole and Buganda sub-regions.

3.O OBJECTIVES OF TIIE PIELD VISIT The field visit was guided by the following Terms of Reference: .

'To assesa performance of the hea.lth facility in relation to key health indicators; .

?o establish the levels of stafling in the health facilities; .
To ascertain availability and state of accomEodation facilities for medical personnel; .

To ascertain availability of pharmaceuticals and medical supptes; .

To analyse provision ol matemity services; .

To establish the current state of theatres; .

To assess funetionality oflaboratories; .

To ascertain the level of provision of imaging sereices; .

To establish availability and reliability ofutilities; .

To assess ongoing construction projects in the health facilities; .
To establish availability oi ambulances.
6 ,A)' Bz"*-+- ,=.-._---- .q-^ 13 lPage (J ?$ 4.O METHODOLOGY During the fleld visit, the Committee utiiised the foilowing methods: 4.I BRIEFII{G SESSIOI{S The Cornr1ittee paid courtesy calls to the district headquaitels and had face to face interactions at the health facilities u,ith the following stakeholders: District officials like the LCV Chairpersons, Chief AdErinistrative officers (CAO), Deputy CAOS, Resident District Commissioners, Deputy Resident District Commissioners, contractors, Miraistry of Health officials, District secletaries for Health & Education, District Health Officers, Hospital Administiators, In-cha.rge of the health facilities, District Communication Officels, Medical Workels like heads of the respective units like theatre, matemity ward, laboratory and members of the Hea.lth Management Tea.ms of the health facilities.
4.2 GI'IDED TOURS The Co@inittee conducted guided tours of the fouowing facilities at the va.rious health centers and hospitals: maternity wards, laboratories, theaters, general wards, outpatient departments, constuction sites, records rooms, pharmacies, dispensaries, places of convenience, health facility compounds & staff houses.

4,3 DOCITMET{T REVTEW The CorEmittee reviewed and made reference to the following: .

Documeflts submitted by the hospital administratora a-nd DHOS .
Uganda National Service Delivery Survey,2018 .

Annual Health Secto!

Budget Performance Report FY 2020/21 o World Health Organisation 4.4 QUESTIONNNRE The Committee developed a detailed questionnaire which was uscd to gather more detailed information about each health facility.

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,r.4 *lt',^"'*-9= 14 lPaCe +aG The collated data collection tool for all the health facilities is attached as Aaocr l. 5.O SCOPE 5.1 GEOGRAPHICAI SCOPE The Committee visited the following HC U, HC IUs, HC IVs and genera.l hospitals.

Table 2- Health facilttles vt.ltcd by the Coaaittcc s/No 1 2 3 ,+ 6 7 8 9 t0 t1 12 13. t4.

L5 16. t7.
I8 Health Facility Buwama HC III Gombe Hospital Kifampa HC III Butenga HC lV Kiruhura HC IV Kazo HC IV Bwizibwera HC IV Rwekubo HC IV Kinoni HC IV Kikyenkye HC III Bugembe HC IV Wakitaka HC III Buyende HC lll Irundu HC III Kaliro Town Council HC Il Busesa HC IV Busembatia HC III Nsinze HC IV Magada HC Ill Kibuku HC IV Busasira HC lll Budaka HC IV IKiiKi HC III District Mpigi Butambala Gomba Bukomansimbi Kiruhura Kazo Mbarara Isingiro RwamData Ibanda Jinja Jinja Buyende Buyende Kaliro Bugweri Bugweri Namutumba Namutumba Kibuku Kibuku Budaka Budaka k{ffi:4.ea^==r 15 lPaBe [- G +$ 24 25 26.
27 2A 29 30 3i 32 Muyembe HC W Camatimbei HC III Busolwe General Hospita.l Busabi HC III Tororo General Hospital Mularda Hc lV Nagongera HC IVs Busia HC IV Lumino HC III Kaliro Town Council Hc II Bularnbuli Bularnbuli Butaleja Butaleja Tororo Tororo Tororo Busia Busia Kaliro 5.2 CO TEICT SCOPE The content scope is laid down in the Terms of Reference as li6ted above.
6.0 f,'INDINGS, OBSERVATIONA AND RTCOMMENDATIONS 6.1 PERI.OR.IUAI{CE OF XEY HEAITH INDICATORS AT THE HEA'TH TACILITIES The table below shows how some of the health facilities periormed in terms oi key indicators.
Table 3 - Key ilellvcry lndicatorr at .elcctcd hcalth facllltlcs Facillty Maternal Deaths stil births Early Neonatal Deaths Period in months 6 3 3 2 I 1 I Tororo Hospital Budaka HC lV Muyembe HC lv Rwekubo HC IV Busolwe GH Bugembe HC IV Kaz o HC lV # r\& S 5 3 I 16 lPase 20 20 20 25 63 23 28 h 0 0 0 6 a 0 1 u \\,\..V' Irundu HC III Kiruhura HC IV I 0 Bwizibwera HC ry o Kikoni HC IV Buyende HC ItI Kasasira HC Ill Nagongera HC [V 0 0 0 0 63 6 9 8 IO 5 I 0 0 0 0 0 0 5 3 3 3 5 Soutce: F'l.eld tdslt findlngs Chqtt 1 - Numbcr of deaths bcfore & dudnS delivery at selected health faclllties A CHART SHOWING THE NUMBER OF DEATHS BEFORE OR DURING DELIVERY Iorqo I-- Muyembe lrl- 20 20 E xa,o Busmb.
rrI- 2l -2s .

l(ey lidrotos .

a.ny N€onaral Oear hs .

Still births r (€y hdi@lo.!
- Mare,n:l De.thr NI]MB[R OF EITHTR 8]RIH5 Ofl DIAtHS Ftom the table and graph above, Bu3olwe Hospital erd Irundu HC III h8d thc highest aunrber of.tlll bilths at 63 i,r 5 lrorths; followed by Nazo HC fV wtth 28 and Rwekubo HC fV wtth 25. lTlPage \$ur' \ Table 4- KGy chtld d€livery lndlcators by health facility Facility Tororo GH BudaLa HC IV IKiKi HC III Rwekubo HC IV Nagongera HC lV Busolwe GH Irundu HC III Muyembe HC IV Nsinze HC IV Bwizibwera HC IV Buyende HC III Lumino HC III Busesa HC lV Butenga HC IV Kazo HC lV Magada HC III Kiruhura HC IV Wakital<a HC III Bugembe HC IV Klyenkye HC UI Buwama HC III Kinoni HC lV Busembatia HC III Kasasira HC III Kifampa HC Ill Tot.l No DcUvedes of Caesatean Sectlorta Noreal Delivery Perlod ln tnonths 2,000 1,250 948 89r 750 738 738 650 650 476 450 450 400 362 359 320 257 175 850 95 90 66 64 50 500 225 0 45rl 6 233 125 150 110 0 o 150 61 78 o 35 100 0 0 2?
0 0 1500 1025 948 437 744 505 505 525 500 366 ,150 450 250 294 2al 320 175 0 95 90 4a 66 64 50 3 5 5 3 5 5 3 3 5 3 5 5 3 3 3 3 Source: Fleld.

t isit JTndlngs @ (/' G< ..*G \" ,ailr Llt lSlPaBe 1,50O Chart 2" Key chtld dellvery lnallcato.s by health faculty A CHART sHOWING THE NUMBER OF DELIVERIES wskraka 175 - Muyo,D.. EF LLrinifo kundu 5rt r0r -t!

!- -{50 Buda[i-r,025 E K,kdri i21Ir glwdma I90 a*.ainwera flP xi,hu,i EF222 ret --r3r (ukytnky.
- (ta rD; I 95 50 suqe ,ru,€.sa !l- -l!ll Buembc I tuJ B!$rwe Mr8ada 2so 2s3 '1Ia so5 NUMSEN OF NORMAL OEL VERIEs AN D CAESAREAN 5EC1ONs rK€9lndicro6- Nofral Deli!.rv -l- -l?0 s& -+- rKev r,rdiGto6 - C.€erpans..rioE 19 lPase l-t\, \G +\ Flom the illuBtrations above, acloss all the health facilities, there are more noimal deliveries compaJed to caesarean sections with Tororo Genetal Hospital having a total of I,5OO normal deliveries arld 50o cae8arean sections in 5 months- Tororo Hospital topped the list with the highest numter of detvers and c- sections in 5 months followed by Budaka HC IV and Rwekubo HC Mn 3 months.
The contributing factors are human resources for health and intastructure.

Rwekubo HC IV has additiona.l support from partners in the refugee settlements The highest nuEber of matemal deaths reported was 3 at Budaka HC Iv and Muyembe HC IV ald this was largely due to delayed referrals.

Muyembe HC [V recorded the highest number of perinatal deaths at 20 with other facilities like Kazo HC IV, Buye4de HC lll, Budaka HC Iv, Irundu Hc m reporting a minimal number oI 10, 10, 12 and 9 respectively.
HCrys a.rld some HC IIts acted as referral points for some lower units.

Rwekubo HC [V received 696 refeEa]s out of 891 delivedes conducted.

The facility sent out 49 patients for further medica.l attention.

Irundu HC Ill received 163 patients as referrals a'ld sent out 7, Budaka HC IV received 2OO patients alrd sent out 50 while Muyembe HC IV got 215 from lower level urfts and referred 70.
The Committee recomme^d.s that: ln HC Ns uot@ heUt ln strengthe^t^g the rcIerral path@ay I^t€st7,[g d.s show^ by good Jrl'1ctlo^d.Utg of sorfle HC IVs.

throtgh t E lrl^lsttg oI Hed.lth should conplle d The Gorl€tnfieftt repota on the fatnctiondlltg of thedttes l^ dll IIC llls cotntrywlde so as to detElop a,rt tn,cr.tory of equlprne t, stdil and supplles, d,rnoa.g @ t.!te=lS€ -0, T;F 20 lPage Gr$ Y othets.

Afi.et detEloplng the 7^18^tory, d pldft oJ functlondltst^g the thedtres shoilld.
be dro.fted drtd uTgentlg l/?!.plemented.

Slln.ce hd.crno,.rhage ls one ol the leadlng c.r'u'ses ol matendl ded'ths; t tc btdget lor Ugd dd Blood Trd sl\.slon Serulces should be l^credsed to lc.cllttdte coalecnlo^ oI nore u lts oI brood.

fhe mdndgernent of the health u lts should.

e'4sute th.,,t blood ls ptotided to potle't.ts lree o!
chdrge, GotJ€firne'trt should l^cre.Ise t e budget Jo" the Natlor!al A,,,.bulo.^ce System Ser.uace so thdt more drnbuldnces dre duoila}le at the cdll dnd d.lspatch centres to meet the lncted.sln.g dernq d bg hed.lth "eglonol Jdcllltles.

5.2 STIIFFIITG LEVELS IIY THE HEATTH FACILITIES The staffing levels varied across health facilities.

This is due to various reasons like a low wage bill, failure by the district seruice commissions to conduct the recruitrnent exercises and failure to attract candidates fo!
vafious positions.

It's important to note that t]le staffmg bvels can be misleading because the non-critical 6taff are usually more than the critical or essenual stalf who are needed to ensure crilical and maximum service delivery.

The ciitical staff include midwives, medical oflicers arrd anaesthetic oll ers.

The table below shows the percentage level of the stalf at some of the health facilities the Committee visited.
Table 5- Stamng of selected health faclllttes HR Standard Facility Nagongera HC Iv No.

48 Magada HCIU Buwama HCIII 19 l9 HR Total No.
%age Iilled 41 I9 19 85.4 100.o 100.o -bk #l i+ tQ^:*:.s - f;2!lPaEe qG \ Budaka HCIV Busolwe CH 4a 190 Bugembe HCIV Kiruhura HCIV Tororo CH Nsinze HCIII Busesa HCIV Buyende HCIII Lumino HCIII Busembatia HCIII wakitaka HCIII Irundu HCIII .18 48 19 48 19 19 19 19 19 45 118 44 170 15 40 14 t4 )3 t6 t2 1l 93.8 93.5 92.3 9t.7 88,5 8 5.4 83.3 7 3.7 68.4 66.7 63.2 57 .9 Kifampa HCIII I9 Source: lTeld ulslt fi.^d.l^gs Tdble 6- st(tlflng bg keg medlcdl person el dt the hedlth ldcillttes Facility Rwekubu IICIV Tororo GH Kiruhura HCIV Bugembe HCIV Butenea HCIV Busesa HCIV Bwaibwera HC IV Kikoni HVIV Budaka HC lV Kibuku HC IV Lumino HC lll Muyembe HC IV NasonseraHC lV WakilNkallC III Nsinze HC lll Kazo l{C lV Medical Omcet6 Midwives 24 l8 45 ,l l0 3 ii 4 2 a) 3 10 6 5 3 2 2 2 2 2 2 2 2 2 '2 2 I s\ effi 1)-4 GR Anaesthe tic Ofllcet Atraesthetic Assistants 2 3 o 2 I I o o l l l 0 '2 0 0 l l 22lPaEe R, z%L 5 3 2 1 l I o i t 0 0 I (l 0 I I +-t ( HCIN lkiki HcIt Kifampa HC IV Kikyenkve HC IV Buwama IIC lll Busembatia HCIII Buvende HC lll Camatimbei HCIII lrundLr HCItI Kaliro HC I1 Kasasira HCUI Number of heelth factlittes wlth thcae etaff Petcentage Nutnber of h€alth wlthout th€se staff Percent facilitles 0 N/A 0 0 N/A N/A N/A N/A N/A I 6 2 'I 2 3 ) 5 I 3 L7 6t"/" 2A loo./" t1 390/o o oo/o 0 N/A 0 0 N/A N/A 0 N/A N/A N/A N/A t2 430/o 16 570/" o 0 0 N/A N/A N/A N/A N/A N/A N/A 11 39% t7 6lvo A CHART SHOWING THE NUMBER OF H EALTH FACILITIES WITH THESE ESSE NTIAT 5TAFF.
t lMut,3 I NOMBER Of AULTH FAOLIIIT' :'r From Chart 3 above, fifteen (15) HC lvs had oedical officers which represents 1o0o/o although sorne had I a]1d others had the required 2.

L@,F 2SlPage ffikj N .ru V $& te^:s-S - Twelve (12) of the lifteen (15) HCIVg had an Anaesthetic Officer which represents 8ool.

while eleven (11) of the HC tVs had Anaestietic Assistants and this represeits 7370.
Further ana-lysis oI the stalfing Ievels shows that many of the hea.lth facilities a.re laJgely suppolted by midwives and nurses, At Kifampa HC t[, there is one midwife in charge of the matemity unit.

Camati8bei HC III is run by 2 Eidwives, 4 nurses arld 1 laboratory assistant with no clinical offlcer.

Kibuku HC III arrd Busembatia HC IV have no nurses.

Nsinze HC lV has 11 nurses; Budala HC IV has 15 nurses and 4 midwives.

Bugembe HC Mas l0 lddwives aJrd 5 llurses.


The low sta-ffing levels are made worse by the fact that some employees go on study leave, matemity leave and others are in acling capacity beyond 6 months.

Stafi who retire are not replaced.

At Bwizibwera HC IV, a medical olficer left 3 years ago and the position has never beeo [11ed.

Having few employees in a pa-rticular department has led to fatigue amongst the staff and affected service delivery.
Kibuku HC IV is the or y facility visited which has an orthopaedic officer.

In Muyembe HC IV, a clinical offrcer who had gone for a five-year study leave completed school and repoded back as a medical doctor but she is being paid as a clinical oflicer.

The staff shortage in some facilities has been reduced by emplolng persolnel who are paid by donors; for insta-nce, the anaesthetic officer at Rwekubo HC Ms not paid by Govemmellt.
In addition, ttrere is a tendency of making staff act in their jobs for a long time without assuming full responsibility- Some stall have been in the sartre position for a long time and have not promoted, hence they are not motivated.

At the time of the field visit, there was a nationwide strike of Allied Health Plofessional workers over salary increment.
However, fiajority of the staJf in the facilities visited did not participate in the strike, 24 lPaEe < \*GY In some facilities, ttrere was no duty rota for stalf in the OPD.

At Kasasra HC III, only 3 staff were available at the time of the visit, a trend which shows lack of commitment to work.

'Itre health facilities a-re stuck $rith very old staffing structures which have not been revised for over two (2) decades.
C o tumitt e e o b s e r u dti o I s A lot of tuoneA for rudge is rctumed to the Consolidated Fund because District Serrice Commissions haue failed to reouit staJf.

Sotue positions fdil to <.ttrad applico.nts due to lotu remuneration of the hedllh aorkers and lack of other f@cilities like accomfiadation.

There uas ranpant dbse^teeism of health workers did a laissez fdire attitude touard.s uork.

The monitoitug oJ these heq.lth fa.ilities W the MOH and DHOS is not adequate.
The DHO of Bugweri snubbed calls bA district officials and the Parlidmentary Committee.

Health cefttres fouftd in disticts that had health projects or were relugee hosttng e-g Rwelobo HC N had oddition<1l stalJ li}"e doctors and midwiues and this translated into higher output conpared to other HC IVs.

The Commlttec rccomfiwnds th(rt proposed.


sq.l4ry ln.c,.ernf t ol , .dtcal workerg d,esplte the prev@lllng cltcurngtdn.ceS, Attrq.4lo (t,{d Tetc tlort fo.c,tors oj stdll ftc,,rrtt ^ent ,ra'tJ€ to be dddressed.
l^ otder to lTll the uo,cdnt poslf,lons, Mintstry of Publlc Setar,ce ar.d, UOE shoa.ld fr^.lllse the long-drodltzd new stdll sttltcAte to cdter jor the er4.rglng Dlsffca seruace Corzmlssrons s,trou'd ext editioitsly frU vaaa'lt positlons d d confrn std.II uho hirtlc been l^ .lctl'tg c.Ipdctty lor a. lo'rg tl',re, ^eeds, /F (\ EN 25 lPage \\& ^_E; -.c The Mlnlstry ol Publtc servlce should dlso mo^ltor and d.pprd.Tse d,lsttlct servlce commlsslons l,t reldtton to stdlJl^g gaps ln cll s€cto.s.
Esthei N.,,r,nbl, a enrolled mdar{e in uruyernbe fiC Iv, who ts 6 mo t .s pteg^a^t .Ind ll,.,s on a 24 hor4t shtfi due to a colleagte bcl^g at drtg of the natlondl erEnts to ofi ara u4l LdtE should be ,rtoLlve stqlf, "ecognlsed 6.3 AVAILA"BILITY OF ACCOMIUODATION FOR STAFF The committee observed that no health facility has sufficient accommodation for staff.

The chart below shows the number ot housing units in each health facility, Chart 4.
Houllng unita In .electe.l hcslth facllltie6 NUMBER OF ACCOMODATION UNITS IN EACH HEALTH FACILITY 121 ,",,1,", ; ; :: .,i, 5E€'EEE; g;: si g gE; E3+3igi3 : E f i- 120 8,. ieo : Y.o 2zo =- From the chait above, general hospitals have more housing units for staff compared to the health centres because they have more staff.

Some health not offer accommodation to their staff like Kaliro HC II and 25 lPage faciiities w Busembatia HC III.
This might alfect the availability and effectiveness of t]e staff considering the current high standards oI living.

Most of the Doctors have accommodation at the health facilities apalt from Nagongera HC lV, Bugembe HC IV, Kibuku HC IV, Busesa HC lV alrd Muyembe HC IV.

The mqjority of midwives and nurses stay at t}!e health facilities apart from a few who commute.

Not all laboratory staff a,ld theatre stafi stay at the health facilities.

At Busembatia HC IV, staff rent at tlle nearby trading cenke.
Some nursing staff in Nagongera Health Center IV were being accommodated in dilapidated houses near the health centre; that is undignified.

ln Buyende HC tV, an old kitchen had been repurposed to accommodate 2 stsff- Some of the houses are dilapidated and in urgent need of renovations.

At Kinoni HC IV, RBF funds have been used to repair some staff houses.

Despite the housing shortage, there are no plans to provide accommodation for the rest of the staff who do not stay within the hcalti facilities.
C o mflitt e e o b s e r u qti o tLs Ldck of onsite accomtuod.qtion for staf,J negatiuelA inpacts on their Wrfonnaftce siftce a lol of time and.

funds are spent on comtrutting to aftd Jrotu the health locility.

Recorrame'td.ttlo'rs GotErnfi.nt shorJld contlnue utlth its elforts oJ bulldtng the stock ol irtch.dlng q.c.omrnod.dlort lor q,€cd,llsed cddtcs.

fhete should.

be renooatlon oJ accotnmod.atlon jacillties urhich dre very old so ds to endble fiote hed.lth perso^nel reslde at utork.
ffi $& qi- (- )n6-ffit4 ${ 27 lP aEe ZA\/ ..t\Gt' 6.4 AVAILIATLITY OF PHARffACEUTICAIS & MEDICAL SUPPLIES The Committee noted that NMS delivered pharmaceutical supplies on a bimonthly basis as evidenced by the delivery notes and stock cards but some items were few while others like anti-malarials in some facilities had not been delivered for 2 cycles.

Facility in-charges reported frequent stock- outs of pharmaceuticals altd medica.l supplies especially towards the end oI the delivery cycle.
The table below shows the supply of pharmaceuticals and medical supplies per hea.lth facility.

These represent some of the tracer medicines.

Table 7- Avatlab ity of phainaceutlcals and medlcal suppues llr health facllitles FACILITY Rwekubo HCIV Kazo HCIV Bwizibwera HCIV Kinoni HCIV Lumino HCIII Muyembe HCIV Nsinze HCIV Busolv,/e GH Buleng.t HCIV Busesa HCIV Kiruhura HCIV Nagongera HCIV Budaka HCIV Busembatia $& NUMBER COMMODITTES AVAILABLE AT EACH HEALTH FACILITY.
IXl20) STOCK UNDERSTOCKING OT 20 20 20 2A 20 20 19 19 I9 19 19 I8 1a w 100% loo.k 0.00% 0.00% 10070 0.00,7.

100tvo O.OOo/o tooo/o 100o/o r00% 95V" 9501' 950/o 95"1, 9S'.vo 900/o 9Ao/" 0.00% o.oo"/.
0.00% 5.OOv" 5.00% 5.O00l" 5.00% 5.00,x, 10.00% 10.00% -1yfu, 28 lPase +r\b HCIII Ribuk'u HCIV IKiKi HCII] Kifampa HCUI Buyende HCIII Kaliro HCII Wakitaka HCIII Gamatirnbe HCIII Bugembe HCIV Kasasira HCIII Magada HCIII Buwarl1a HCUI Tororo GH Kikyenkye HCll lrundu HC lll % AVERAGE 18 17 t7 17 t7 17 16 15 15 13 13 I3 t2 l0 900k a5"l' 850/, 8s?i, 45./^ 85,X, 80% 7 1ah 75.k 65o/o 65o/o 65% 600k 50% a6.k 1o.00% 15.00,2, 15.00%, 15.00'7o 15.00% 15.00% 20.OO"/o 25.OOo/a 2s.oovo 3s.00% 35.00% 3s.00% 40.00% 50.00,2, t4-tto/" Solttca.
Corn rrlttae neld, t tslt JE,,idlngs The chart below shows the percentage of stocking of pharmaceuticats aod medical supplies in health iacitities.

-# \L 43', --- - ;- I ,dr-r.^[.

*.\ t.rr \ 29 lPage \)& tu, +sc chart 5- Stock of pharmaceuticals and nedical supplles ln health faclllties PERCENTAGE STOCKING LEVEI.5 OF PHARMACEUTICATS AND SUPPTIES IN THE HEALTH CENTRES.
t4.tt% % Sto.k,86% From tlre table above, on average, the health facilities were well stocked with pharmaceuticals and supplies with most of t}le facilities having stocking levels higher than 657.. Generally, the stock lasts 4 weeks after delivery due to high consumption levels arld delay of delivery by NMS- The storage spaces for drugs and supplies is not adequate and the stores are smal1.
There was a genera.l insufficiert delivery of anti-malarials in all facilities visited in cycle 6 with Coaitem 6, which is for children, being tlle only anti- malaiia.l delivered.

Some facilities reported being unable to receive arti- malarials in the last 2 delivery cycles.

This meant adults have to go and buy arti-malarials flom private facilities, thus increasing their out of pocket expenditure.
Areas like Bukedi and Busoga sub-regions ar:e endemic to Balaria hence these shortages present a huge cost to households.

Facilities ffi q 3oI .\\bt like Busesa HC IV, Budaka HC IV, lrundu Hc III and Tororo Hospital had shortages for antibiotics, mama kits, gloves and NCD drugs {anti-diabetes, anti-hj4rertensives).

Some facilities like BuwaEra HC tI and Muyembe HC IV reported that the mama kits they receive do not tally with the number of deliveries meaning mothers have to buy mama kits.
Buwaria receives 30 marna kits yet their need is 80-90kits while Muyembe HC lV has not received mama kits for the 3 cycles.

ARVS were available in facilities that were running ART clinics, A nursing officer at Kiruhura HC IV reported t].at patients were developing coartem resistance although this could not be verified.

Development pa ners have contributed to increased availability of medicines in health facilities.

At Bwiribwela HC ry, more than 95% of Eedicines are available courtesy of RBF support.
C o tunTittee o b s eru at i o ns Rehabilitdtion at nufiber of health centres has led to tle increq.sed patienl load and gel the budget fot nedicines ho.s remdined.

slatic despite increasing pices of medicines due to the depreciqtioa of the shilling dgainst the US Dolla"t, lrhich implies lhat feuer suplies are purchased uith the samc budget.
Stock-ouls oJ crucidl medicines like anti malaials negatiuelA impacts keg heaLth indicators since malaia rs stili the highest cause of motbiditA arLd moftalitg amoftgst children below the age offiue (5)in Uganda.

The committee fuiher obserued.

that the issue of stock-outs has become a national challenge.

Commlttee recomme d.atio,,.s The hrdget Jof Ndtio^al Medlcal Sto,.es should be l^creased.

ln the med,lur'tr tenn to cate" lot the ,,lcredslng demdnd Jor pharrna.ceutlcals and medlco,l suppales.
/&*[^ ffi 31 lPage \\ta AS\s:-9 I \ /l ?

:,re !tri,^lstry oj ,lcd.lth dt d. Nd.tlond.l Medlcdl Stores should ddopt d bottorn up c,pproo'ch dnd get the speclflc requlremcnts o.f heclth Jaci,l'ttes r.rhlch shor.ld be propotalona.l to the catchrne t populdtlon @ d dlsee.se bulden ln the dred.

A^tl-md.laria.ls should.


be prlortt"lsed ln hedlth lo.cllltles slnce mdldri.. o'I.e ccruse oj morbldltg and mortalltg across dll dge ls the gfoups in Agdnd.a MOH sholrld sttbstaftttdte cldlrrrs ol coattern reslsta ce cnd.

the wdg fortodrd, ^unber 6.5 STATE OF MATERMTY EERVICES The Committee observed that all facilities visited were conducting maternity services- This included a$tenata.l care and delivery services arld these were tt.e busiest sections in health facilities aiter the outpatieit departments.
The output aJld scope vaiied based on number of personlel, equipment, infrastructure and medicines.

Details of output deliveries and maternal deaths can be got in Tables 3 and 4 in the pleceding pages.

Tbe quality of emergency obstetric and neonatal care varied across the facllities.

lrltrasound machines which are important in ANC are not part of the macb.ines aEchored at HC IIIS and HC IVs atxd this affects quality of ANC.
The Committee noted that most of the facilities lack incubators for pre-term care and those that had were sometimes non-functional like the one at Busembatia HC lU.

The iacubatora 1,vere iunctiolal at Kiruhura HC lV, Irundu HC lll, Muyemte HC tV and Busia HC IV which had 4 and a phototherapy light machine for jaundiced babies.

Lack of incubators is a major reason for referrals.

Ple-eclampsia, which is an obstetric emergency, was not managed in most of tie facilities and was a major cause of referra.l.
Health Centre IVs aclmowledged receiving the medicines {Hydralazine and MgSO4) for its management while HC IIIS repolted tlat it's beyond tieir level of rnanagement and thererore, refer patients to HC IVs.

This presents a referral $k ffi 32 lPege tut problem especially in hard-to-reach areas Like Camatimbe HC III located in the hils of Butambuli district.

The Committee found out that space for antenatal care, delivery units and postnatal wards was 6mall in some facilities.
This has led to congestion in the maternity waids with some motlers sleeping on the floors.

The post- natal ward at Rwekubo HC lV is old, At Bwizibwera HC IV, thele is only 1 post-nata.l bed.

Wtten maternity walds get full, the patients aJe transferred to the general wards.

Some beds are kept in the stores due to space lil1ritations as is the case of Iki Iki HC lII which has a donation oI beds stock piled irl the stores.

Lumino HC III and Wakita.La HC III have 6 and 2 beds respectively in the wards.
Consumables like sutures, ltlama kits, Bloves, cottons, biood giving sets occasionally run out and the costs were borne by the patients or tley had to be referred to higher facilities.

C o mmitt e e o b s e r 0 atti o n s The distance from louer letet health facilities to higher level facilities is long d.nd that renders the referrals risltg especiallg for fitthers ifl to,bour.

This is made worse bg lack of atubula ces and ill-eqlipped q.mbulances uith no rcsu scitation equ+rment.
CornfiTttee re corn ne nddtions The Cor,tr nlttee t vrelo"e recorrvnends that Jdctots that dddtess the access to d.nd qualtl!

of ,,raternltg se/rtlces should be addrcssed.

Thls lncludes nrjdl4,l7./€s, medlc'lnes dnd.

consl4r'1d.bles, lnftd.stflrcAre atd.

equiprrta^t, Hdrd-to-tedch and, lloe areds shozld be prloritlsed urhe^ pad fi.i^g tot servlce d.eltttery, 6.6 STATE OF THEATERS IN THE HPAITH FACILITIES As shown in Tabte 4 above, the Comrdttee observed that output of theatres varied across facilities.
Ttlis was due to huma!

resoulces challenges, ity of the theaters is further infrasEucture and power and water 33 lPaBe E" <,r,*.-----.Q w G tj->.

:is=r - -tr $a' I alfected by ability a.rld inabiiity to cairy out blood transfusion services, Out of the 15 HC IVs visited, l1 have blood tlansfusion services aId four do not have.

The four arei Mulanda HC IV, Nagoagera IV, Kiiullura HC IV and Butenga HC lV.

The paladox is that most theatres had equipment to conduct surgeries.
These included theatre lights, theatre beds, surgical instruments (laparotomy sets, caeseran section sets, hemioraphy sets), autoclaves, theatre beds, suction machines, anaesthesia machines, oxygen cylinders and concentrators.

Some of the anaesthesia machines were new and had not been used due to lack of the technical staff or required gases.

Although still in use, some of the theatre beds are old and faulty.

Iack of cylinder heads for some of the or<ygen cylindels affects theii functionality.
Anaesthetic officers are key t].eatle staff and their absence arfects the output of theatres.

In Nagongera HC IV, they don't have an anaesthetic oficer and have to call in one from Tororo town whenever there is a surgery to be conducted.

Theatres at Budaka HC IV al1d Rwekubo HC IVs which were non-functional in the past are now fully functional.

The Budaka theatre was constructed under the Ugarda Hea.lth Systems Strengthening Project (UHSSP) by the World Bark.
Kazo HC IV has 3 theatre beds, but only one (l) is in use.

The anaesthetic machine at Muyembe HC lV is dot operationa.l.

The Mulanda HC Mheatre i6 under renovation.

The Committee noted that the main theatre in Busolwe Hospital is otd aj.rd requires a complete ove.haul.

It is curently being utilised but irr a bad state which increases ttre chances of other infections arising out of poor hygiene.
The Corn nittee telterates lts edtller recofirrc^datio thot the GotErnment through the Mt^tstry ol lled.lth should cor pile d report on the fit^ctto'rdltt!

oJ theatres 1^ oll HC IVs cott tryulde so ds to dettelop an l^ve tory ol equipr e^t, stalI and suppltes, .Irnong ot tets, Aftet derElopt^g the i^tEntory, d pld'n oJ Jt ^ctlo .lltstr.g the should be dfdfted @ d urgentl lmplerr'€^ted.

h. ,a/- w l^ a, phased r,l.an^et.


34 lPage ''..\6 Y' 6.7 ATATE OF UIBORATORIEA The Committee observed that laboratories under the national hub system are well-sta1fed, well equipped and have sufficient supply of reagents.

At Rwekubo HC IV, there are 4laboratory technicians on the Govemment payroll arld the laboratory conducts tests for sickle cell, tuberculosis, HIV, COVID and mala-ria, among others.

They have Gen-xpert Bachines.


Other facilities under the national hub system aJe Kazo HC IV, Bwizibwera HC IV aIld Butenga HC IV.

Bwizibwera HC Mas a microbiolory laboratory as well.

The table below shows functionality of the laboratories.

Tablc E- FunctoEeltty of Lboratorlc!

h hc.lth iac ltles NIMBER OF TUNCTIONAI LABORATORY SERVICES (x/1r) o/o Non.
Functlorral functlonal Factltty Bugembe HCIV Busesa HCIV Rwekubo HCIV Budaka HCtV l1 11 1l t1 l1 Tororo CH Busolwe GH l0 Butenga HCIV Kazo HCIV Bwizibwera HCIV IO 10 IO rao,v.

100"1, 100% looo/" t00% 9lo/o 9lvo 9'Lt'/o 9lYo or/a oa o.t oo/o o"k 90/o 90/o 941) a& 1"" 876"*--a _a\ l-==P ,?
)J'- w.. \(4e* 35 lP.ge lrundu HCIII Nsinze HCIII IKiKi HCIII Kifaiopa HCIII Kikyenkye HCIII Buwama HCIII Muyembe HCIV Nagongera HCIV Kiruhura HCIV 10 t0 I 9 I I 9 8 Kikoni HCIV 8 Buyende HCIN Gamatimbei HCIII Kibuku HCIV Magada HCIII Lulrrino HCIII Wakitaka HCIN Busembatia HCtrI B a 7 7 6 9.k 9nt, t 80/o ta.

ta,ri, 14"/.

la% 18% 27./" 270/o 91"/.

9 ro/o 82"/" a2v.

a2Yo 82','; a2v.

a2% 73r/" 73'/a 730/" 73vo 270/" 7 3v" 64V" 27"/.

36./.

64tvo 36ott 640/o 3601, 55% 454/.


sk 36 lPa8e u:zzt-ffi $\\G l.5^{-S -t\ Kasasira HCIII Kaliro HC Il 6 4 7o Average 55% 364/.

aoo/.
aoo/.

45.4 64% 20"/" SorJrce: Codtmlttce lleld ttslt f7^d.t^gs Che.rt 5- Furctionality of lsboratories tr the health f.ctlities vlslted A PIECHART SHOWING PERCENTAGE OF FUNCTIONAL AND NON-FUNCTIONAL LAB SERVICES IN THE HEALTH FACILITIES --@ t:,; From the diagram above, on average most of the iaboratories in the health facilities can ofier and caary out most of the laboratoiy tests such as testing for Bala.ria, urine, blood levels [Hb) and HIV with a percentage average above 6070.
Further findilgs reveal that laboratories in other health facilities like Nagongera HC IV, Muyembe HC IV, Kibuku HC w, Irundu HC tll and Kasasira HC III do not conduct all the tests.

The major tests which are 3TlPage M ( $$a lo^tJ lackirg in the laboratories visited include: CBC, cherdstry analyser arld blood group tests, The Committee further observed a shortage of laboratory reagents in the facilities used arrd low statling levels amidst huge numbers of patients.
The Committee was informed that Busembe HC lll coaducts all the necessary laboratory tests.

lt caEe to the attention of the Committee that servicing of biosafety cabinets was overdue.

At Bwizibwera HC tV, the scheduled servicing for the biosafety cabiaet was due on 2Od April, 2022 add the set date for Butenga HC IV's bio safety cabinet was l6th March, 2022.

No servicing has been done by the tiine of the committee visit.

The Commlttee teit4rdtea lt-, edrller recofirnendatlo oa the need.
to lnc/c(t.se the budget lor Ndtlon4l edical Stores, The Cornmltt e futthet recornr^e ds that the .eglondl ,n4l^tendnce workshops shottld.

se'?, lce thc sa,fetg cabl't.ets on tlrne so d.s to e,.d.hle the ldbordtofies Jttnctlon optlmallg, The hospltal dd.filnlst,,.ttots should protld,e perTodlc reports to the IIHO dbout the sta,tc oJ equlpme t in the ldbotdtories so that the injormatlon ls pdssed o^ to hlgher lelEl oiathorltles, fhere ls need.

to ensirre th.It CBC q.^d.


Chemlstry (LilEt and kldney I,l'trctton) trf,,q.chines whlch dre tEry lfipottd.nt dldg^ostlc and treatnEnt tmonlto,.ing tests, should.

be l^stdlled dt oll HC IVs to reduce reJend,ls .tnd out oJ pocket exl>endltute bg pdtients, 5.8 AVAILABILITY OF IMAGING SERVICES The Committee observed that a newly installed X-ray machirle in Tororo Hospital was non-operational for 2 yeals.
This followed a technical malfunction due to power fluctuations because of lack of a power regulator which protects the machine.

The machine was repaired but MOH is yet to L^q 38 lPage H $r\G lS-$"--F- a^" plocule and install a power regulator.

In the meantime, patients are reterred to private facilities and pay Shs 20,000.

An on-spot call was made to the MoH Commissioner hr{raskucture who acknowledged being aware of t}Ie problem and reported tiat the Ministry is i!
t}le process of procuring and insta.Iling the regulator.

Some health centre IVs had ulbasound machines that had been donated by well-wishers to help in maternal and fetal care.
The Committee observed that that most of the in-chaiges of matelnity units reported the importance of ultrasound scans and fetal doppler machines in helping them to detect complications and a.lso manage them in time.At Nagongera Health Center lV, Rotary Intemational donated an Us-scarr machine but patients pay between 10,000 ugx and 15,oo0ugx at every visit to utilise the machine.
This money is not captured in the Government's booka of accounts a.nd the in-charge repoits that it is used to pay for a sonographer, mailtain the machine and buy the sonograph paper/films.

Imaging services are done by sonographers; but a look at the stalling levels leveals that many of them lack tiis critical cadre of stalf.

Therefore some facilities have iinp.ovised by sending midwives, clinical of[cers and doctors on short courses ir!

ultiasound sonography.


fhe Corn nlttee tecornmeids thot &E to the erne/gittg cll^lcal a d publlc health lssues dnd lnc"ease l^ the populdtlon lft rrttdl dteds, IIC ms should have fetal d.opplers, ultrosou d. scdns @hile HC IVs should The Cor mlltee furthet rccofilJ4,.ends thdt th.

pre.equlsite swf sholald.

dlso be l'tcluded l^ the hiJra4'l tesource stfitcare dld ,ccrltltad.

ln the splrit of task shirting, modtlar .xturses Jor soiographg can d.bo be mdde reddllg dt dllo.ble, lntro.sound, sef1.
lces l^ d hedlth lacllttg should be Jree (rnd il lt's u det pr-rtate @1^g serulces llke tn d hospltdl, lt s,rould be decldred.

ds ion-tax retEnue €ffi 39 lPage L,;f;-,.

/';, E E-_* G\ _______:==-.- -#rs{-!^' N\A Y' Wtro.soi4 d. ald bd.slc sefirlces should catscade doutnu)ard.s to HC IVs ds d mdtter of t ollc!.

6.4.1 GEIiIERAL OBSERVATION ON EQUIPMENT The Committee noted that many of the facilities visited had issues qrith disuse of medical equipment.
This was due to an airay of issues rallging from incompalibilities with power, lack of spare parts, missing parts, maluals il foreign languages such as Chinese and Spanish, among other reasons.

The Comraittee observed gross negligence vrith regard to storage and utilisation of medical equiplxent.

While some equipment was not utilised because it was faulty, in some cases, it broke down due to the poor condidons of its storage and set up.
The Committee further noted that in the health facilities visited, whenever equipment broke down, it took a long period of time for action to be taken to either repair, decomnission or replace the equipment despite inJorInil1g ttre regional workshops.

There were flo reguiar:ly updated inventory records oI equipment and most of the equipment was not ergraved.

The Cotutnlttee tecorn nends thdt fhe Mi^istry ol Hed.lth td.kes keen intetest in c.r,ses uhere equlpme^t btedks dotoft dnd no repo/t ts J7led.
F\lrthe1 the Itnlstry should engage rrut,nJ,gers oJ the differe^t facilities uhere these cases hdtE d,rise'l and, o'sk them to shott cause a.s to ttthg no steps hatE beet ta,ken to a.ddress tlt.e breakd.oto o.f medical equipment.

Hedlth ldciltttes shotrld regwldrlg estdbllsh dn intontory oJ equiprrEn cledrlg stating the lTrnctional and d.^d actio^ required, The report should be dlssemindted to the DHO, regiond.l mdintenance uorkshops a,,I'd Ml^tstry ol lted.lthJor lmmedidte dction.
^on-.functional la=*tr=; tu, %=q- ffi --z:< N%:{s-S, \\\t' 40 lPage \\e The budget Jor teglondl mdlrdtea.d,'?,ce oorkshops shoruld be i^creased Jrom UCX 2.7 bllllo^ d.inudllg to dt least UCX 10 blllto^ d nuallg to e dble mo"e equlp'rl.e^t be r?ral7-talrted on d. regtldr bd.sls, The ltnlstry oJ Hedlth should tecrult more Blo-Med.lca.l englneers sl^ce the neu medlcal equlprnent is becornlng more sophlstTcdted.
MOH should 4lso explote the option, of hdvl^g sedtlce contrdcts urlth supplTers ot d{lete t ptoc-t t?r,'ent optlo^t llke equlprne t placerle^t Ii t acse cases, the e$tlpmc t ls outned aid.

ot tedgc^t m.rlntaT^ed bg the suppller dt dJee.

Dlsposal oJf assets shorzld be ha,nd.led.

ro tlnelg ds per the PPDA guldellflee to decongest hcolth Jdcilltles from old, obsolete d d lTt ctlo'raa equlprnent.
^o^- The Cortu nittze tecotnmends that The Mi^istry oJ Heo.lth takes kee anterest ln catses where eqtipment report ls Jiled, Fwrther, the rinlstry should.

breaks doun dftd engdge maflagers of the dlfJercnt Jdcllltles uthete these c(Ises hdtE dtlse,tr d.td o.sk thefi to show ca'use ds to uhg steps hatE bee^ ^o Cd.ke'n to ad.dress t v bred.kdotlti ol riedlcdl equlpmelt.
^o The llfirttstry oJ gcdlth shollu teciult more Blo-Medlcal engT^eers utho cdn prorryttlg tespond to eqtlprnent brEd.kdol, slnce sorne breakd.ourns q.r'e oJ q.

.

?rlrror notl4,.e.

Governme^t should dlspose oJ dll nor.-fu'].ctlondl medlcdl equlpfient llke X-rag ,,/rdchlnes d d. replacedEnt be pt'ocured os soon ds posslDle to ptovlde servlces.
# 9r*=e s\ ) L/ 41 lPage d fS----rt'-S .=# .V\U\ t' '1 6.9 AVAILABILITY AND AI'EQUACY OF U?ILITIES The Committee discovered that water and power are still a challenge i!!

all the facilities visited.

Different facilities have access to different sources of power but the functiona.lity vanes, Power outages aJlect smooth runrrirlg of services like theatre, matelnity, ultrasound, x-ray and laboratory.

Some facilitres have solai panels which ar:e orlly limited to key structures like theatr:e and maternity.
Maintenance of these solar systems is a challenge if they break down.

HC IVs like Kinoni HC IV, Nagongera HC IV, Bulambuli Hc IV and Busembatia HC tv lack power back-up equipment like generators.

Water supply varies especially due to location of the facility.
i.e urban, peri-urban ard rural, Gamatirnbei HC lll in the hills of Bulambuli uses the gravity flow water scheme, Busembatia HC III uses a borehole, Kifampa HC III in Comba harvests rainwater, Kiruhura HCIV has piped water though inadequate (Ilows at dght) while Butenga HC ]:as piped water but lol, pressure.

Bwizibwera has a piped water system which is fu nctional altd adequate.
The Committee observed that most of the rlew health infrastr:ucture being constructed by Oovernment has component of water harvestrng and solar installation while others have sinking of boreholes that have a submersible motorised pump to a still tank which supplies to the entiie facility.

The unstable power supply has led to a breakdown of equipment hence allecting service delivery.

Recozunc datlons All ncut lnftal'td.cfl.ft sho.rlli, ha'lre ll,rtL,.
hdftEstin,g sgsterns lnstolled, Sol,ar systems should be prlorll:lsad lor Ugh,lng l,^ hed,lth J.rclltttes to reduce huge cos&.

Ah& should lnchtde stqff qua,rtcrs to boost theb mo'ale.

Tt erc should be d majrtteno'n.ce plo oJ soldt systent.s d.fier lnstallatio^ to endble ther^ to h(rt€ d longer l$e spa a'rd to be qulcklg repaired uthe^ theg dre spollt.

E N 42 lPase ,o^.1*le' \.^t ficdlth ldctllttes shou,d dlso be gllE conslderdtlo ol i^dustr'ldl rqte electrtc'lt!
slnce theg operdte 24 hours qnd ca dccnte huge bilk, This qrlll sdrl€ o^ rl'se ol the medgre PIIC resources to pdg bllls.

tlospltals shorlld not be loadshedded to pretE^t interfiiptlon in thelr sefirlces but to e^s1tre d longer llte spa,r o:f tery se'rslthr€ equlpme t. 6.10 PROCRTSS OF OITOOING CONBTRUCTTON WORXS The Committee visited Gombe General Hospital in Butarnbala district and Busolwe Hospital in Butaleja distiict where construction works are taking place.
(X)MBE HOSPITAL The table below provides details about Combe Hospital.

Tablc 9 .

Progrcs6 relrort on con tructior worl.s ct GoDbe Hosplt l Proposed rrrltigatlo n mea6utes completed FY Funds disburse d Scopc of works Progress Challenges 2Ot9/2O2 0 There was delayed contracting due to the administrativ e teviews raised during the procuremeot.
UGX 3bn Renovation Work complete d of administratio n ald service blocks Hospital lagoon Water system Procuring digital x-ray Construction of guard's house 2O2O /2O2 I UGX 3bn Construction of staff block Renovation Work was comPlete Noo structural defects were Delects shall be made lPase A,A" =brt;e w \G +t d of nu!ses' houses (2) Renovatioo of doctors' boys quar"tels (3) Buying equipment good in the defects liability period (6 months).
identfied and the snag list presented to the contractor to make good durinB the defects liability period.

2O2r /202 2 UGX 3bn Construction of staff block ANd MCH block Currently work is progressin g well.

on going The directive Actua] work progress al2Oa/o to use the UPDF Engineering Brigade calDe late (0l.July, 2021).

Being a new Policy, time was 1o6t in developing and il:nplementatio n modalities with the Army.

So!r..r Aeld ,l!
So!r..r Aeld ,l!

{t llnd{n!,s The Comraittee noted that there was shoddy work done in some of the renovation sites like ceiliags and the medical superintendent of the hospital does not sigE certilicates oI coEpletion of t}te works.

Commlttae recornt @a.ddtlons Tre ,ncdlcal stperi^tende^t, as the e^d llser o.f the |acilitg, should stg.tr cett{lcatcs oJ con rletlo^ oJ latorks after tl€rifrcdtlon.

The lfil^istry ol Heo.lth, dtstrict oillcials and.

hospltal stdlJ shollld tntz^s|t!


snJpet?.rlslon etlotts to ellrnl^dte ln'clde't.ces oJ shoddy wotks.

44lPase h w ,t\Gt' so-1a:-9- u&" BUSOLWE HOSPITAL The Comrlittee visited Busolwe Hospital which is being renovated in two phases, i.e t]le stalf quarters by UPDF and then the main hospital structure by a contractor yet 10 be identified.
Commencement of works on the mairr hospital is awaitirg clearance from the PS/ST to applove rellection ol the contract sum iI1 US dollar:s not Ugandan shillings since the main funder is an externa.l donor.

The Government will plovide counterpart fundirrg totalling Shs 9 billion.

Some of the old iron sheets that had been removed from the stalf quarters and piled somewhere had been stolen but were lecovered and culprits arrested.
Ttrere were complaints by the loca.l community who were employed as casual labourers about their daily payment rates being reduced.

The committee also observed tlle lack of proper coordination between the UPDF, MOH, the local political and technical staff and the hospital manageElent.
?he Cornrnlttee gwlded that there shotld be monthlg joint superelslon did cootdlndtlon ,rEetl^gs oJ key stdkeholders lncludl,l.g the fhe meetings communltg representdtive llke a hosplt4l board should be chdired hg the med.lcql superlnte'!.de'rt oj the hospttd.l, ,t wlll lmproue coordi,ra'tio'1 d.nd.

prevent ccctts4tlons si^ce there ls consensus and outnership oJ d,ctions, '7rer'lber.

6.
6.

1 I AllBUt .ltIlCE SYSTEM The Comrnittee assessed availability and effectiveness of arnbulance services in the health facilities.

Ttre cominon causes of referrals are: shortage of blood for transfusion, obstructed labour, prolonged labour, severe malaria, PPH and APH, multi presentation, pre-eclampsia and eclampsia and shortage of personnel to conduct the delivery aslPase w 9.6.&qa s f5^^-; --:k G \\\ The table below shows the number of health centre IVs which have ambulances.
T.blc lO- He.lth cGrtre fva wlth .frbulanccr TABLE SHOWING NIIMBER OF HEALTH CENTRE IVS THAT HAVE AMBULANCES.

Faclllty Butenga HC IV Busesa HCIV Rwekubo HCIv Kazo HCIV Kiruhura HCIV Bwizibwera HCIV Kikoni HClv Budaka HCIV Kibuku HCIV Muyembe HCIV Nagonqera HCIV With/Without Anbulance No No Yes No Yes No No Yes Yes Nsinze Hclv Nuhber of Hcalth Facllitles elth aabuLnces.

(YES) Numbet of health facillties without ambulances.

INO) PERCENTAGES 7 7 50% 500/.
From the table above, seven (7) of the fourteen (14) HC IVs the Committee assessed lacked ambulances, The table b€low shows t]le tjpes of ambulances available in tl.e health facilities, Tabl€ 13- fypeB of ambulaEcei avallable in the health faclllties h4 w 46 lPage Facillty Butenga HCIV Rwekubo HCIV Kiruhura HCIV Bwizibwera HCIV Kikoni HCIV Budaka HCIV Tororo G H Nsinze HCIII Magada HClll Busolwe CH tkiki llcIt Bugembe HCIV Busesa HCIV Icfampa HClll Kikyenkye HClll Kazo HCIV Buwama HCIII Busembatia HClll Buvende HCIII Camatimbei HClll Irundu HCIII Kaliro HCll Kasasira HCill Kibuku HCIV Lumino HCIII Muyembe HCIV Nagongera HCIV Wakitaka l'lClll laumbc" of fectlttles stth MOII Ambulalc.a (?ea) TypeB-Landcruiser Type C -Doublc Cabln No No No No No No No No No No No No No No No No No No NC, No No No No 1 No No No No No No No No No No No No No N.) No No No No ['n 47 lPage w .z# \\\\q -^,=-B ' From Table 10 above, eight {81 of the 13 HCIVs assessed by the CoEmittee had q?e B ambula.nces and only 4 had type C which are old and are duo- purpose vehicles for transportation of patients and health workers.
This reveals a loophole in provision of services to the people by the Ministry of Health.

The photos below show evolution of ambulances from Suzuki to a THE PHOTOS SHOW THE EVOLUTION OF THE AMBULANCE FROM THE THREE WHEELED MOTORCYCLE TO THE CURRENT LAND CRUISERS \ .I 14 '1 T\ :- \ Thls was the Ltltd of Anbulance found at Kasasira Hcalth Center III ir Blbuku dlstrict aEd lt ls used to tsaisport patlents from the wlllages to the Facility.
La-a $& 4slPaEe w \C t] c.-a^ u-- N l l I T ; I Z t-dl This pa'rtlc..lar three urheelcd Arrtbuld.^ce uds used.

@dg b.I.ck l^ the colo4lc.l d.Lys , ( {;- 49 lPase +\\G q- -* S^-- il u lt - - t I L!

;q r The Nissan hard body Plck-up was dlstrlbuted by the Ministry of Health in the eatly 2OOOS and some ar€ still in use in some Health Facilities like this one in Busia district.
w t; s0 lPage ffi =J/4 \\'\q (1*4-L B + CE t \ I I I Atil + I I O-1= .\,] ) The Giovcrnm€nt of Uganda moved to the landlover Just Uke thc one ln the Photo above lra.

capturcd ltr MuycEbc Hcalth CGnter M.n Bulabbult dbtrlct aad thcre a fep Dotable ores that are stlll lD Use lD 8om€ of other dlstrlcta, 'A* 51 lPage r4;-n w .-+z gtC rC-=sJ- u( )1 I @/ The!
there came the Nlssan Pattol6 SUVS whtch were trrajoilly a donated by the Govcrttment ofJapatr through JICA and tlerc a fer, that at€ stlll runalng,thla partlcular one wes caputered ln Busolwe Hospltal h Butaleja Dlstrict.

q 52 lPage =J- rn , r\L, p^.s:o- "i' ,.\) -) t * t!

@ !

r '/ I :, *t: 6 f-",' Thesc are the latest ambulancer to be distributed by the Mintstry Of Hcelth and dost health Facilitle.

have this type and these pa*icular otles w€te captuted at Totoro GGnerel llospltal ln Tororo Distrlct.
( s{ ffi,A M -z+ \\{^- h-=,.ti- s- 53 lPa s€ 'a/: The Coramittee ,eiterates lts earller recommeadatlott that Gor,er,rment should l.lcte(rse the btdget Jor the Ndttonal Arnbuldnce Sgste.n serolce so thdt fiote dfi,buldnces dre dt dLd.ble dt the teglondl cdll d^d.

dlsp(rtch ce^ttes to ,neet the lBcreaslng der a d, bg heo.lth Jaclllt"les.

7.O CONCLUSION Al1 health facilities visited have performed beyond their optimal levels despite the challenges faced- lt!
order to improve the health care service delivery, all stakeholders must be involved: stakeholders at the local/como.unity level; district authorities; and at the national arrd global levels.

These should include both the political as well as technical/professioral stakeholders.

With more vigilance, rnore funding, aore accountability and paitnerships, health sector challenges can tte addressed.
If the above recommendations aie adopted, the health facil.ities will further enhance their pedormalca and the number of referrals to highe!

levei health facilities like general hospitals and national hospitals will reduce.

This will enable the nationa-l hospitals conceDtrate on their specialised mandates.

Rt.

Hon.

Speaker and Hon- Members, I beg to move that this repolt be adopted by the House.
54 Page D)- ffi $\\G N --4+4= ENDORSEMENT OF THE REPORT OF THE COMMITTEE ON HEALTH ON A FIELD VISIT TO SELECTED HEALAH FACILITIES IN BUSOGA, ELGON, BUXEDI, ANKOLE AND BUGANDA SUB.REGIOI{S s/No NAME I Hon.

Dr Charles AJrume - Chelrperson SIGNATURD 2.

3 6 7 8 Hon.

Ssebikaali Yoweri - vlc.- chaLperson Hon.

Ninkusiima John Paul Hon.

Nemukuta Brende Hon.

Nakazibwe Hope Grarfa Hon- Lematia Ruth Molly falcrr.r Hon.

Laker Sharon Balmoyi Hon.

Bebona Babungi Josephine 9.

Hon.

Chelain Betty l-ouke l0 tt.


Hon.

Dr Bhoka Didi George Hon, Atwijukire Dan Kiriosho 12.

Hon.

Otimgiw Isaac Ismail 13 Hon- Ayebare Margaret 1_4.

Hon.

Rutahigwa Elisa kk!- \ 55iPage ?J- q$G t,-/ p.-::3- a (, 15.

Hon.

Dr Ruyonga Joseph i6 \7 l8 19 Hon.

Sekyanzi Benard Kilya Hon.

Eng.

Irene Muloni Nafuna Hon.

Mbayo Esther Hon.

Dr Nandagire Christine Ndiwalana 20 Hon.

Dr Kagabo Twaha Mzee 21.

Hon.

Zaake Francis 22 Hon.

Nanyondo Veronicah 23 24 25 Hon.

Nsibambi Yusuf Hon.
Nsibambi Yusuf Hon.

Dr Kamara Nicholas Hon.

Dr Lulume Bayiga Michael Hon.

Col. Dr Victoria Nekesa 27.

Hon.

Auma Kenny 2A Hon.

Makokha Maigaret 29 30 Hon.

Nakato Mary Annet Hon.

Dr Opio Samuel Acuti fi fln, (,, 1 ffi 56 lPa ) wk t\G Y' N:^-S- .

[* I 31.

Hon.

Bahireira Tumwekwatse B Sylvia Hon.

Zawedde Victorious 33.

Hon.


Nebanda Florence Andiru Ah a8e \tuG r-:^=:S' ANI{EX 2 - Report about individual health facilities BI'trIAMA TIC IlI IN MPIGI DISTRICT Buwama HC III is located in Mpigi district is along the Kampala-Masaka highway and Kampala-Mityana highway.

Mpigi district has a population of about 294,9O9 people.

Surrounded by Kalangala district in the souttr and located on the shores of Lake Victoria, there are Most at Risk Populations (MARPS) in the district.
River Katonga passes through the district as well- There are hsher folks found in Cgolo, Bunjako, Buyiga, Kamaliba landing sites.

There are commercial sex workers in the sub urban area of Buwama, Kayabwe, Nabyewanga and Kamengo.

The district has no general hospital, one HC IV, 11 HC llls and 7 HC lls.

Mpigi HC IV is to be upgraded to a hospital level but the process is rather too slow.

The catchment area lor the health facility is Nkozi, Kayabwe, Kituntu, Kamengo & Kyelima.
The population is about 20,O0O people, including travellers and island residents.

ComtBittee lindiuge The laboratory has laboratory assistants but with no lab technician.

o Staff are not motivated because ttrere are no opportunides for promotion.

The Committe€ was informed about alleged cases of corruption where pregnant women who do not have money take an entire day to receive medical attention.

Another reported case was extortion of money from accident victims by a nurse.

.
.

The facility refers mothers in labour to higher level health facilities.

About 30 mama kits are provided to the facility, against a need of 80-9O per month, .

The facility receives Shs 3 million per quarter for PHC.

I{IFAMPA HC III II{ GOMBA DISTRICT Kifampa HC lll is located in Gomba district in Kabulasoke sub-county.

The district has seasonal casual labourers, sex workers and fishing communities, The number of children under 5 years is 34,943.

The district HIV prevalence is 10.2olo.


The district has a population of 185,518.

There are 11 HC IIs, 7 HC IIIS and I HC IV.

There is no district hospital.

About 40% of sub-counties have functional VHTS.

The district stafflng levels stand at 75.804 and have cadres which are being phased out.

Kabulasoke sub-county has 54,000 people afld there are regular movements ol people in and out of the locality, 1 committce lladlaga: to enable roofing of the facility under construction, .
Due to renovations, the outpatients department was relocated to a tent outside the health facility.

About 80-90 patients are handled, and when it rains, there is no service.

.

The pharmacy is located on the verandah.

The laboratory is also outside .

Out of 19 staff required, there are 9 frued positons.

Staff who retire are not replaced.

The Committee found out tlat a nursing assistant was administering anti-malaria.ls and amoryl for malaria cases.

.
.

Bilharzia is common in the a.rea and the Ministry of Health has sent a .

The facility is water-stressed and relies on rainfall.

There is only 1 post- surveillance team.

natal bed.

RWEKUBO HC IV IN ISINGIRO DISTRICT Rwekubo HC IV is located in Isingiro district.

The district has a projected population of 692,562 of which 540,170 are nationals aJl.d 152,392 are refugees.

The district has 4 HC IVs, 25 HC IIIs and 44 HC IIs; of these 60 are Government-owned, 7 are PNFPS and 6 PFPS.
Theie is no general hospital, the referrals to Rwekubo are many.

Most of the health iacilities are h€nce water-stressed.

The district staffing structure stands at 56%.

There is a high influx of refugees in the area.

Commlttcc Iladi,lga conducts 3OO deliveries per month.

.

The staffing levels at the healti facility stand at 61%.

.

Rwekubo operates the hub system for laboratory services.

The laboratory is well-stocked and all tests, including sickle ceu and COVID-19 are done there.

.
.

The post-natal ward is old and rugged.

There is an incubator.

The facility .

Partners play a crucial role in providing pharmaceuticals and medical supplies.

It was conspicuous to the Committee tl.at tirere were medicines which were about to expire.

There is no inventory management.

.

There is an old-design tieatre with aging equipment and no water but basic supplies are available.

The anaestletic officers are paid by partners.


KINOI{I HC IV IlT RWAMPARA DISTRICT Kinoni HC IV is located in Rwampara district.

Rwampara is a new hard-to- reach district.

The health facility has a large catchment area of Ruganda sub- county, Mbarara, Ntungamo ard Sheema.

The catchment population is about 30,O0O.

The district has 19 health facilities with only 2 HC IVs.

Kinoni HC IV is located on the highway.

The staffing levels stand at 617o.

CouEittee thtdlnga .


The ambulance was provided i.rl 2007 and is currently dilapidated.

It has no resuscitation equipment.

[n order to utilise the ambulance, a modest 2 fee is paid by the users.

For those going to Mbarara, they pay Shs 3O,OO0 while those going to Buganda region pay between Shs 50,000 to 60,000.

Only 5-10 units are available for blood trarsfusion.

When there is a shortage, blood is got from Mbarara RRH.

The facility lacks arr anaesthetic officer.


There is no consistent, adequate water supply.

In the maternity wards, mothers sleep on the floor due to space alld bed inadequacy.

There are LO beds in the mate.nity ward, so when they are full, the mothers are transferred to the general ward.

There is no incubator for prematures.

The pharmacy is very well-organised.

In the outpatient department, there are inventory records.
The Committee noted that there were mary cases of patients with hlper tension yet the drugs are aot suflicient.

There is no duty rota in the OPD.

The laboratory is in a small area and lacks haematolory equipment arld chemistry analyser, among others.

The IPD has very clean wards, clean beds and is organised.

Referrals are done because there are only 2 blood giving sets.

There is an active NCD clinic.

Most of the c-sections done are referrals from tie community.

There is no accommodation for staff.


Very few staff are accomrnodated at the facility.

KASASIIRA HEALTII CENTRE IU I IIIBI'XU DISTRICT Kasasira Health Center III is located south of Lale Lemwa in Kibuku district and serves a catchment population of more 15,OO0 people.

CoDDittee Firdtrgg The Committee made the following findings; There is ongoing constrqction of a new block to house the maternity ward and other wards.
There is also ongoing construction of a new structure to be used as a nursery for premature babies and also house incubators.

The facility lacks adequate and proper housing for staff only 2 staff are housed at the facility.

At the time of the visit essential medicines such as anti-malarial medicine (Artesunate) and laboratory commodities were out of stock.

Low staffing levels at the time of the visit only 3 health workers were available at the facility.
Lack of adequate working space, the labour suite has 2beds in a tight room to the extent that two hea.lth workers caryiot fit in at the sarare time.

There are drug stock outs experienced at the facility resulting from tlle large patient load.

The facility has only one structure which is used as a multipurpose ward.

3 The facility is clean and the compound is well slashed and despite it not being fenced it's not littered with garbage.
INIIXI HEALTH CENTER III IN BI'I'ANA DISTRICT fiadiags The Committee made the following findings; There is ongoing construction of a new block to house t}Ie maternity ward and other words.

The facility lacks adequate and proper housing for stafl only 2 staff are housed at the facility.

At the time of the visit essential medicines such as anti-malarial medicine (Artesunate) and laboratory comeodities were out of stock.
Low staffing levels at the time of the visit only 7 health workers were available at the facility.

Lack of adequate working space, the labour suite has 2beds in a tight room to the extent that two health workers cannot fit in at the same time.

There are drug stock outs experienced at the facility resulting from the large patient load.

The facility has only one structure which is used as a mtrltipurpose ward.

The facility is clean and the compound is well slashed.
BUDAI(A HEALTH CENTR.E IV IN BUDAXA DISTRICT ComEittee Firdtngs .

The Committee applauded the health center management for operating in a clean and meticulously kept environment with .eat scrubbed floors, a well-kept compound, urell-lit wards and an atmosphere conducive for recovery.

.

lt was built in 1968.

Over the years, the underfunded, understaffed hospital's infrastructure has deteriorated and the health center equipment has aged and become antiquated.

.
.

There are drug stock outs experienced at the facility resulting from .

The facility lacks some critical staff such as tie dentist and opitican.

.

The facility has a small mortuary given that it's the only Healt} center .

The staff quarters are too dilapidated and actually accommodate a few .

At the time of the visit essential medicines such as anti-malarial medicine (Artesunate) and laboratory commodities were out of stock.

IV irr the district there is new to construct a big and new one.
the large patient load.

staff- 4 XIKYENI(YE HC III IN IBAI{DA DISTRICT Kikyenkye HC ltl is located in lbanda district.

CotrBittee Ihdfurgs .

The health lacility has very old buildings which pose a risk to the healtl of patients and workers.

This includes staff houses.

.

The Committee found out that construction was going on for a modern maternity ward, toilets, placenta pit and 2 unit blocks of staff houses, borehole and rain water harvesting tank.

.
.

The facility is not fenced and this attracts cattle from the neighbouring residents which come a:,l^d, graze on the facility land.

This is dangerous and can escalate the spread of zoonotic diseases.

.

At the time of the Committee visit, there were few patients in the OPD department.

This is because t}le visit was done in the evening and at such a time, most of the patients have received medical attention.

.
.

There is a shortage of essential drugs like anti-malarials and anti biotics, yet the catchment population is high.

Coartem tablets are available but the injectables are always inadequate.

There is regular & suJficient supply of HIV/AIDS and TB drugs.

.

Availability of matemity supplies like Mama kits, gloves, cotton wool, has been boosted by RBF which provides additional funds.

.

The labour suite is in aI improvised room.

The room is small, poorlyJit ertd in bad condition.

.
.

Kikyenkye HC IV experiences loadshedding on a regular basis .

The facility has accommodation for 2 nurses and 3 midwives.

The rest do not reside at the facility.

Ongoing const.ruction works will add on to .

The Committee was impressed to find out that HIV positive ladies have formed a self-help club.

The club encourages members to live positively and counsels them.

The group is engaged in music, dance arld drama activities among others.
BU'IZTBWERA HC IV IN MBARARA DISTRICT Bwizibwera HC IV is located in Mbarara district.

It is 2lkm from Mbarara Regional Referral Hospital.

Mbarara district has a population of 25O,OOO people.

There are 6 HC nls and one HC IV in the district.

Committee lirdtngs .

The facility has 1 1 I staff out of the 48 required to run a HC lV.

There is a medical officer who left 3 years ago but has not been replaced.

Another MO is on study leave.


o The facility has a micro biolosr laboratory- This was donated after a study done by Makerere University on anti-microbial resistance in the cattle corridor.

.

The laboratory has 5 staff, I lab technician is paid by Government and his colleague is paid by TASO, It is a semi-hub.

It covers 2 small rooms.

5 The safety cabinet was supposed to be serviced on 20, April, but that has not happened.

.

The facility has no US scan and no x-ray.

.


Bwizibwera has the largest medicine store.

More thajl 9O% of the medicines are available.

One pack of every drug is set aside as reserve.

.

It is the only health facility with a children's ward.

There is no neonatal care unit.

About 600 individuals attend tlle NCD clinic.

They formed a club and meet regularly to discuss their challenges.

It is hard to change the attitude of the club members yet it is key ii managing their illnesses.

.
.

The outpatient department is in a small structure with one examination bed in the Doctor' room.

.

The theatre has all the stalf.

.

The facility has a challenge of equipment maintenance.

Kabale Regional Equipment workshop is charged with maintaining the equipment but they take long to respond to requests.

.

A new OPD structure is under construction.

The old one will be used for special clinics.


XAZO BC IV IN KAZO DISTRICT Kazo HC IV is located in Kazo district and is the only HC IV in the district.

Kazo is a new district which was created 3 years ago.

The District Service Commission has been constituted this year.

The facility is located on the highway arrd receives patients from Kyegeglva, Ibalda, Mbarara and Kazo.

CotrDittee flndirgs .

The OPD has no duty rota.

It is a small building.

.

The laboratory has 5 staif.


It is part of the national hub system, is well- equipped and housed in 6 rooms.

There is a Gen-Xpert room.

It is connected to the main grid.

The stock cards are unfilled.

.

There is no x-ray and ultra sound machine.

.

The medicine store is spacious, but poorly-tit.

There is no record of drugs given out.

Some medicines are collected from lower health facilities.

.

The IPD is clean and organised.

The wards are small.


Children and female patients share the same ward.

The NCD clinic is operational.

The expired drugs were ARVS which were no longer administered due to change of regimen.

The facility collects expired drugs from lower level health units.

.

The theatre equipment is old like operating table, there is running water .

The maternity delivery forms were out of stock.

Mama kits are very few.

.


All dead bodies are kept at the health facility, leading to a huge challenge of many unclaimed bodies.

Mbarara which has a big mortuary is 120km away.

and the stall are available.

.

The facility has no vehicle to facilitate transportation of staff.

6 I(RUHURA ITC IV IN KIRIIHI'RA DISTRICT Kiruhura HC IV is located in Kiruhura district.

The district has 29 health facilities of which 11 are PNFPS and 18 are Government facilities.
The Govemment heaith facilities include Rushere Community Hospital, one HC IV, 12 HC IIIS and 5 HC Ils.

The district staffing levels stand at 69.9%.

Kiruhura HC IV operates as a district hospital.

coEElttee fiadlngs: shortage.

.

The average monthly attendance is 1,204.

There are specialist clinics for deDtal, ophthalmolos/, orthopaedic, NCDs, psychiatry and HIV/AIDS.

.

UMEME power supply is on and off.

The facility uses a generator when there is no power.

The prower is pre-paid on a Yaka meter.


The TB Machine consumes a lot of power.

Construction of 6 power centre back- ups is ongoing.

are no stock cards in the laboratory.

.

On a daily basis, the facility admits about 10 patients.

.

Patients are developing coartem resistance.

.

The filing system is a challenge.

There is no equipment inventory.

There .

Blood is sourced irom Rushere Community Hospital when there is a .

The laboratory has 2 sta-ff who handle between 50-60 patients per day.
The laboratory area has an automation room, working area and results dispatch area.

Two laboratory assistants are going to be employed and they will be paid by the partners.

.

The pharmacy is in a small, well-organised space with up todate stock .

The OPD is functional but lacks basic equipment like BP machine.

.

The IPD has separate wards for children, males and females.

There is one incubator.

Antenatal, post-natal and all gmaecolo$/ issues are handled in one place.

.
.

The theatre is well-equipped, well-staffed with a medical officer, nurses .

The nearest hospital, Rushere Community Hospital, does not offer free and 2 anaesthetic staff, an assistant and officer.

They have PPE.

cards.

services yet it receives money from the Consolidated Fund.

BUTENGA HC IV IN BUKOMANSIMBI DISTRICT Butenga HC IV is located irl Butenga sub-county, Kawoko parish, 2km off Ssembabule Road in Butenga Town Council, Bukomansimbi district.
The facility was started in 1954 as a domiciliary clinic and was later upgraded to a HC IV in 2OO4.

The catchment population is about 18,161 km from tl.e districts of Kalungu, Ssembabule and Lwengo.

ComEittee fradlage: .

The facility has 46 beds of which 15 are for maternity, 6 are for emergency and 25 beds are in the general ward and surgical ward.

The theatre has one anaesthetic assistant and 3 theatre assistants.

l not steady.

.
l not steady.

.

There is a functional ambulance with the requisite resuscitation equipment.

The ambulance is managed under a call and dispatch centre.

.

The facility lacks a mortuary.

.

There is no accommodation for staff.

.

Drugs and medical supplies from NMS are not suflicient.

.

The lacility provides advanced medical services like 24 hour emergency services, compiete triage, complete radiolory unit with digital x-ray artd US scan, fully functional laboratory.

.
.

The sources of power are UMEME and the sun (solar).

Power supply is .

There is no inventory management for drugs.

The Committee found out that multi-vitamins expired in March 2022 b:ul were being dispensed.

Aspirin was due to expire in JtsJy,2022- .

The maternity building is old; it was wired in 1960 hence posing a risk.

.

The laboratory staff are professional and motivated and all laboratory services are offered like blood grouping and cross-matching.
lon case of shortages, blood is got from Kitovu Hospital not Masaka Regional Referral Hospital.

The laboratory is part of the national hub system.

Stock-out cards are not fiUed.

The date for servicing the safety cabinet was 16" March, 2021 but nothing has been done, todate.

.

Butenga HC IV boasts of 2 theatres, the old and new.

Supplies are enough apart frorn a few sundries.

The water flow has low pressure.

.

The facility meets 6oolo of the requirements of a general hospital.

The .
The .

The district leadership conducts weekly visits to the facility.

.

There is a high prevalence of NCDs among tlle patients who flock the stafling levels stand at 80%.

facility.

BUGEMBE IIEALTH CEITTR.E IV III JINJA DISTRICT Bugembe Health Center IV is found east of Jinja City West Constituency and is situated along the Jinjajganga Highway, CoE.Eittee ttrdtngs suitable for housing the x-ray.

.
.

The patient load at Bugembe health center continues to be very heavy which alfects the quality of services given that the location of the facility acts as a holding ground to handle the spill over/over flow of patients thronging Jinja main hospital.

.

The facility has an x-ray machine but the structure it's housed in is not .

The health center doesnt have a sonographer.

It has resorted to hiring one who comes in once a week as stop-gap measure.

He is paid using RBF funds.

.


The theatre is too old aid the equipment in it is also too old.

The facility only offers one kind of operation and that is caesarean birth operadons only.

8 Due to the patient load, the budgetary allocation for funds for medicine doesn't match the client ratio and thus experiencing regular drug stocks of essential medicines.

The facility's outside environment is too dusty and this in effect makes the surroundings dirty and muddy on a rainy day.
There is no operational ambulance at the health facili{ and the facility depends on means provided by the clients to convey patients to the point of referral.

WABITAKA HEALTII CEI{TRE III Ir{ JINJA DISTRICT Wakitaka HC III is found in Northem Division Jinja City with a catchment population of over 21246 people.

ColrElttee flndlnge housed at the facility.

.

The Health center has failed to complete the construction of one oI the buildings tiat would house other services.
Thla is due to unclear source of fulds for colstructloD.

.

The facility lacks adequate and proper housing for staff; only 2 stalf are .

There are low staffing levels.

.

There are regular stocks of HIV testing kits.

.

Lack of adequate working space.

The labour suite has 2 beds in a tight room to the extent that two health workers cannot fit in at the same time .

.

There are drug stock outs experienced at the facility resulting from the .
The facility is clean and ttre compound is well slashed and despite it not large patient load.

being fenced it's not littered with garbage.

BIIYENDE HEALTH CEI{TRE IU IIT BI'YEI{DE DIS?RICT Buyende HC III is located in Kiseege village, Buyende Town Council along Kamuli- Nabirumba Road.

It serves a catchment population of 26,735 people.

ColrEittee frudiaga .


Ttre house that is used as the OPD is too old and small, it was constructed during the colonial times to serve as a first room and it lacks the requite amenities to match the current times.

.

The Committee noted the issue of stock outs of essential medicines and sundries.

Management blamed this issue on the monopoly by National Medical Stores.

.

The Committee was informed about the issue of shortage of blood.
Most patients that require blood transfusion are referred either to Kamuli or Jinja because Kidera Health Center Mhe only one in the district is located at the extreme end of the district which is too far.

.

The staff quarters are insufficient to house even the 5 critical staff; instead staff have resorted to sleeping in shifts and this is dangerous since its affects the staff productivity.
9 IRI'IIDU HEALTH CENTR.E III IIT BI'YE DE DI TRICT lrundu Health Center III is located in lrundu sub county Budiope East Constituency in Buyende district.

It offers a number of health related services and serves a catchment population of more than 2O,OOO people.

ComEittee flndilgs .

The stafhng levels of the facility stand at 84o/a ol t}:e established structure.

The in charge however informed the Committee that engagements with ihe DHO are ongoing to ensure that the structure is completely fi1led.

.
.

The facility is in need of accommodation for critical staff near the facility Premises.

.

The facility has one general ward which is shared arnong patients.

.

Electricity has been connected to the facility using RBF funds.

.

The Committee noted t}le issue of stock outs of essential medicines and sundries.

Management blamed ttris issue on the monopoly by National Medical Stores.

.
.

The hospital reported drug stock outs resulting from a mismatch between the quantities delivered and the requirements by t}le large number of patients received at the hospital daily.

.
.

The Committee !i/as impressed that the facility has a teenage center tiat has resulted in significalt improvements in uptake of youth friendly services KALIRO TOWN COUNCIL IIEALTH CEIITR.E II IN KALIRO DISTRICT Established 20 years ago, Kaliro Town Council Health center is located within the town council along the lganga -Kaliro road.

It serves a catchment population of more than 15,000 people.

CoEEittec fi-Edtags .

The facility is occupying rented lock up shops where it is located.

.
.

The location of the facility is not suitable for housing of health center.

lt is located in the central business areas and there many inconveniences.

.

The facility has acquired land and construction of the new structure is ongoing and nearing completion.

.

The hospital reported drug stock outs resulting irom a mismatch between tie quantities delivered and the requirements by the large number of patients received at the hospital daily.

.
.

The Committee was impressed that the facility has a teenage center that has resulted in significant improvements in uptake of youth friendly services.

BUSESA HEALTH CEITTRI tV IN BUGWERI DISTRICT Busesa Health Center [V is located in Busoga sub region in Bugweri district along t}le Iganga- Malaba highway and seryes a total poPulation of more 30,OOo patients.

Its catchment areas are Namutumba, Bugiri, Mayuge and tganga.

It has a bed capacity of 26.

Cotnmittee firdlEgs 10 .


The Committee noted gross negligence in the management and maintenance of Busesa Health Center IV where the disposal pit is filled with s].ringes, glass bottles, microscope slides; machines remain r.mused for a long period of time.

.

The facility conducts an average of 100 deliveries per month.

.

The theatre operating lamp is not operational and management has improvised a torch which is used during operation of caesarean mothers.

.
.

The Committee noted that the facility lacks an ambttlance despite being located along the highway which is prone to accidents.

.

At the time of the visit, only 2 personnel were on site.

The Committee noted wit]l concern the issue of absenteeism and late reporting.

of the equipment in the theatre is non-functional.

.

The operating theatre is dilapidated, dirty and not well maintained.

Most .

The faci[ty shares a borehole which is a source of water with the .
Out of tl.e 40 staff situated at the health center, or y 3 stalf are housed community.

at the facility while tie rest of the staff commute , .

The faeility lacks a mortuary and the preservation/ storage of bodies is referred to tganga Hospital.

.

While the facility is well equipped with mattresses and beds, it still lacks paediatric beds and paediatric mattresses.

.
.

The Committee was informed that the funding to the facility has remained static for the last five years despite increasing population and inflation.

.

The facility sometimes experiences drug stock outs attributed to the small budget for medicines and an increasing population.

The most commonly affected items are anti-malarial medicine (Artesunate) and laboratory commodities.
BUSEMBATIA HEAITH CENTRE III IN BUGU'ERI DISTRICT Busembatia Health Center III is found in Busembatia Town Council in Bugweri disrict along the Tirinyi road.

It is a public facility that receives funding from the Government of Uganda through the Ministry of Health and general care is free.

CoEElttee fiadlrgg littered with garbage.

.

The first impression oI the facility is that it lacked cleaning stalf as it was .
The health center has no staf houses for stalf accommodation and instead staff rent in the nearby trading center.

.

Both male and female patients share a ward.

.

The building housing the general ward outpatient department and reproductive cases had cracks and windows and doors were all shattered and the committee was informed that this very building has been condeirned.
1t Being the only building with no alternative, the health center management has continued using it arrd this puts the lives of patients and health workers at a risk.

There are drug stock outs experienced at the facility resulting from the large patient load.

NSINZE HEALTH CEITTRE IV IIT NAMUTTIMBA DISTRICT Nsinze Health Center Ms found in Busiki County Namutumba district.
lt is the only Healtl Center w in the district and serves patients from neighbouring districts oflganga, Luuka, Mayuge, Bugiri, Narnutumba and Kaliro.

Committee llnding8r .

There is an acute lack of equipment in most depadments such as a slit lamp for eye department, dental chair for dental unit, incubators for neonatal unit ald examination couches for OPD, fridges for matemity and operation sets in theatre among others.

.
.

The Committee applauded the health center management for operating in a cleal and meticulously kept environment with neat scrubbed floors, a well-kept compound, well-lit wards and an atmosphere conducive for recovery.

.

lt was built in 1968.

Over the years, the underfunded, understaffed hospital's infrastructure has deteriorated ard the health center equipment has aged and become antiquated.

.

There are drug stock outs experienced at the facility resulting from the .
The facility has a small mortuary given that it's the only Health center IV large patient load.

in the district there is new to construct a big and new one.

MAGADA HEALTH CENTRE III IN NAMUTI'MBA DISTRICT Magada HC III is found in Busiki North Constituency in Magada Sub County along the Tirinyi-Mbale highway ard serves a population of more thar 25,00O people.

The Committee made the following findings.

.

The building that is used as the OPD is too old and small.
It was constructed during the colonial times to serve as a first room.

Despite being frequently remodelled, the building lacks the requisite arnenities to match the current times.

.

There were atock outs of essential medicines and sundries.

Management blamed this challenge on the monopoly by National Medical Stores.

.
.

The Committee was informed about the constraint of shortage of blood and how most patients that require blood transfusion are referred either to Iganga or Mbale for blood transfusion in case of an emergency yet the facility is located along the highway.

.

The staff quarters are insufficient to house even the 5 critical staff; instead staff have resorted to renting houses in the nearby trading center.
12 KIBUKI' EC IV IN KJBIJI(U DISTRICT Kibuku Health Center IV is located in Kibuku County in Kibuku Town Council and offers a number of health related services.

It is the only health center tV in the district and has a catchment population of more than 25,O0O people.

t'irdhgs by the CotaraittGe: .

The theatre doesn't have a functional anaesthetic machine.

It broke down a year ago and t}le regional maintenance workshop has failed to fix it todate, accommodate about 5 bodies using RBP funds.

.
.

The facility has constmcted a mortuary which is sizeable to .

The facility also has repaired the pick ambulance using RBF funds.

.

The space for the general ward is too small to accommodate 5 patients at a time.

large padent load.

.

There are drug stock outs experienced at the facility resulting from the .

At the time of the visit, essential medicines such as anti-malarial medicine (Artesunate) and laboratory commodities were out of stock.
BI'DAXA IIEALTH CE.r{TR.E IV IN BUDAKA DISTRICT Findtagr by the CoEEittee: large patient load.

deteriorated and the health center equipment has aged.

r The health center operates in a clean and meticulously kept environment with neat scrubbed floors, a well-kept compound, well-lit wards and an atmosphere conducive for recovery.

.

It was built in 1968.

Over the years, the underfunded infrastructure has .

There are drug stock outs experienced at the facility resulting from the .
The facility lacks some critical stalf such as the dentist and optician.

.

The facility has a small mortuary given that it's the only health center IV .

The staff qua-rters are too dilapidated and can only accommodate a few .

At the time of tl.e visit, essential medicines such as arlti-malarial medicine (Artesunate) and laboratory commodities were out of stock.

in the district.

There is need to construct a big and new mortuary.

staff.
staff.

MIIYEMBE HE,AITII CENTER W IN BI'LAIIBI'II DISTRICT Muyembe health center IV is located all the Sironko Amudat highway in Bulambuli district and serves a catchment population of more 7O,OOO clients and is the only Health Center Mn the district with a population size estimated at 300,00O people.

1l Fladiags The Committee made t}le following findings; .
The facility has no functional x-Ray machine not even an ultra sound scan machine aid patients are referred to private facilities for these services and Kapchorwa or Mbale.

.

The Health center conducts an average of 130 deliveries per month and these aJe normal deliveries and conducts between 20 to 25 cesarean births monthly.

.

The facility has a small mortuarl that accommodates 4 bodies.

.
.

The theatre is too old and equipment in it is also too old and the facility only offers one kind of operation and that is cesarean birth operations only.

.

Due to tie patient load the budgetary auocation for funds for medicine doesnt match the client ratio and thus experiencing regular drug stocks of essential medicines.

.

The facility outside environment is too dusty and this in effect has makes .

At the time of the visit essential medicines such as anti-malarial medicine .
There is no operational ambulance at the health facility and the facility depends on means provided by the clients to convey patients to the point of referral.

.

The staff quarters are limited in number to the extent that it accommodates (Artesunate) and laboratory commodities were out of stock.

the surrounding dirty and muddy on a rainy day.

only a handful of staff.


GAIIIATIMBEI HEALTH CENTER III IIt BI'IIIMBI'LI DISTRICT Gamatimbe Health Center IIt is located in Elgon Constituency off r(apchorwa road at Kaserem in Bularnbuli district and seryes more than 15,000 people.

personnel only 14 were filled.

(Artesunate) and laboratory commodities were out of stock.

Fiadiugs .

At the time of the visit essential medicines such as anti-malarial medicine .

Low stafling levels at the time of the visit out of the staff structure of 19 .
Lack of adequate working space, the labour suite has 2beds in a tight room o There are drug stock outs experienced at the facility resulting from the large .

The facility has only one structure which is used as a multipurpose ward.

.

The facility is cleai and the compound is well slashed and despite it not .

The Laboratory conducts a number of investigations ranging from blood to the extent that two health workers cannot lit in at tlle same time.

being fenced it's not littered with garbage.


patient load.

grouping, urinalysis, RBS, RDT etc.

BUSOLWE GENERAL HOSPITAL BUTALEJA DISTRICT 14 Busolwe General Hospital, also Busolwe Hospital, is a hospital in Busolwe Town, Butaleja District, in the Eastern Region of Uganda.

It is a pubLic hospital, owned by the Ugandan Government and is administered by Butaleja Distdct Local Govemrnent and serves a popr:lation of close to 350,OO0 people and is a 170 bed capacity facility.

Ftrdtrgs .
Ftrdtrgs .

The Committee noted that the theatres in the hospital were not fully functional.

This results in the faiture to handle critical cases which should not be the case with a Health Facility like Busolwe General Hospital especially since it is handling cases of matemal and neonatal healti.

r The UPDF construction brigade had taken over the site arrd construction of the staff quarters was on course as planned.

.
.

The Hospital is in need of accommodation for critical staff like doctors near the hospital premises, The Hospital requests Government to include the construction of houses for the doctors with other construction works in regard to renovation of the hospital.

r The hospital reported drug stock outs resulting from a mismatch between the quantities delivered and the requirements by the large number of patients received at the hospital daily, .
The Committee was informed that the Health Faci.lity lacks piped water and the nearest source is lskms away and this mal<es it had to run the operations of the health facility without water.

.

The Committee wondered how it was possible for a water shortage to last so long without any corrective action for a facility as important as a health center.

The Committee was inlormed that the facility had resorted to using harvested water for its operations.

.
.

The Committee noted that the X-ray Machine and the Ultra sound Scan had been delivered to the Hospital but had remained non-Iunctional ever since.

T?re machines have been in the hospital occupying space and yet to date, no patient has benefited from their presence.

The Committee was informed ttrat the machines could not be used because they were defective, had rro technicians to repair them and the power fluctuations also caused t].e malfunctioning, .
The Hospital has transport challenges with only one ambulance for transporting refe[ed patients.

The ambulance was received in 2010 and is now old and keeps on breaking down.

.

The hospital has issues of Iand encroachment by squatters.
The Committee noted tllat some people have grabbed the hospital land and the land is not fenced and this has continued to attract encroachers, BUSABI HEALTH CENTER III IN BUTALA'A DISTRICT 15 Busabi Health Center III is found in Bunyole West Constituency in Busabi Sub County in Butaleja district alfd serves a population of more 20,000 people and conducts an average of 12O deliveries per month.
Filldilgs The Comrnittee made the following findings; o The facility lacks adequate and proper housing for stalf only 6staff are housed at the facility.

.

At the time of the visit essential medicines such as anti-malarial medicine (Artssunate) and laboratory commodities were out of stock.

.

Low staffing levels at t}Ie time of the visit only 3 health workers were available at the facility.

.
.

At the time of the visit the two midwives were all on leave one was on annual leave and the other on matemity leave and this meant that the medical assistalt and other health workers were the ones conducting deliveries.

.

Lack of adequate working space, the labour suite has 2beds in a tight room to the extent that two health workers cannot lit in at the sarDe time.

o There are drug stock outs experienced at the facility resuiting from tl.e large patient load.

.
.

The facility is clean and the compound is well slashed and despite it not being fenced it's not littered with garbage.

NAGOIYGERA IIEALTH CENTER TV IN I1ORORO DISTRICT Nagongera Health Center Ms one of the Health Centers ivs in the district Fltrditrgg .

The Committee noted gross negligence in the management and maintenance of Nagongera Health Center IV where the disposal pit is filled with syringes, glass bottles, microscope slides; machines remain unused for a Iong period of time.

.
.

The facility conducts an average of 10O deliveries per month.

.

The theatre operating lamp is not operational and management has improvised a torch which is used during operation of cesarean mothers.

.

The Committee noted that the facility lacks an ambulance.

.

At the time of the visit onty 3 medical Officers were on site and note with concern the issue of absenteeism and late reporting.

.
.

The operating theatre is dilapidated, dirty and not well maintained most of the equipment in the theatre is nonfunctional.

.

The theatre at the facility is not fully functional for the last 2 years.

.

Out of the 40 staffed situated at the health center only 3 staif are housed at the facility the rest oI ths staff commute.

.

The facility lacks a Mortuary and the preservation/ storage of bodies is rererred to lganga Hospital.
While the facility is well equipped with mattresses and beds, it still lacks pediatric beds and pediatric mattresses.

The Committee was informed that tie funding to the facililr has remained static for the last five years despite increasing population and inflation.

The facility sometimes experiences drug stock outs attributed to the small budget for medicines and an increasing population, The most commonly affected items are; arrti malarial medicine (Artesunate) and laboratory commodities.
MULANDA HEALTH CENTER IV IN TORORO DISTRICT Located South West of Tororo district and offers a number of heallh related services.

Fhdirg!

The Committee noted th-at the tieatre at the facility was not fully functional.

This results in the failure to handle critical cases which should not be the case with a Health Facility like Mulanda especially since it is handling cases of maternal and neonatal healti.
At the time of the visit there were some renovation works ongoing on some of the buildings at the facility.

The facility is in need of accommodation for critical staff like doctors near the facitity premises.

The facility sometimes experiences drug stock outs attributed to tie small budget for medicines ald aI increasing population, The most commonly affected items are; alti-malarial medicine (Artesunate) and laboratory commodities.
The health facility reported drug stock outs resulting from a mismatch between the quantities delivered and the requiremeflts by the large number of patients received at the hospital daily.

The facility has transport challenges with onty one ambulance for transporting referred patients.

And this a donation by the area Member of Parliament.

The health facility has issues of land encroachment by neighbors.
The Committee noted that some people have grabbed the facility land and the land is not fenced aid this has continued to attract encroachers.

BUSIA HEALTH CENTER TV IN BUSIA DISTRICT Located in the Eastern border district of Busia, near the produce market the facility is popularly referred to as Red Cross and offers a variety of services ranging from reproductive health to maternity among others, it serves a population of more than 50,O0O people.

1'l the hospital premises.


functional the other was faulty.

and this is one of the biBgest cause for referrals.

it is meant to house the theatre and also the maternity ward.

Fltrdlngs .

The Committee noted that operating lamps in the theatre, only one was o The facility was faced with a challenge of acute lack of blood for transfusion o There was newly constructed storied building donated by World Vision and .

The faciliry is in need of accommodation for critical staff like doctors near .
The hospital reported drug stock outs resulting from a mismatch between t}le quantities delivered and the requirements by the large number of patients received at the hospital daily.

.

The Committee wondered how it was possible for a water shortage to last so long without any corrective action for a facility as irnportant as a health centre.

The Committee was informed that the facility had resorted to using harvested water for its operations.

.
.

The Committee noted that the facility has no X-ray Machine and Ultra .

The facility has transport challenges with only one ambularlce (Nissan Pick- up) for transporting referred patients.

The ambulance was received in 2010 and is now old and keeps on breaking down.

sound Scan machine.

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There was construction of one block to house staff using RBF funds.

LIIMINO HEALTH CENTER trI IIY BUSTA DISTRICT Located along the Busia -Namiyingo-Musitwa high way it serves a population of about 15,O0O people.
Firdiigs .

The facility [acks adequate and proper housing tor staff only 6staff are housed at the facitity.

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At the time of the visit essential medicines such as anti-malarial medicine (Artesunate) and laboratory commoditics were out of stock.

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Low stafling levels at the time of the visit only 3 health workers were available at the faci[ty.

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Lack of adequate working space, the labour suite has 2beds in a tight room to the extent that two health $/orkers cannot fit in at the same time, .
There are drug stock outs experienced at the facitity resulting from the large patient load.

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Regular stock outs of laboratory reagents .

The labour suite has two delivery beds which have become mal functional and yet these were a donation about 7 years ago.

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The facility is clean and the compound is well slashed and despite it being allocated in the town council.

18 TORORO OENERAL HOSPITAL IN TORORO DISTRICT Fladlags .
The Hospital is in need of accommodation for crilical staJf like doctors near the hospital premises.

The Hospital iequests Government to include the construction of houses for t].e doctors with other construction works in regard to renovation of the hospital.

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the Committee noted that the X-ray Machine and the Ultra sound Scan had been delivered to the Hospital but had remained non-functional ever since.
The machines have been in the hospital occupying space and yet to date, no pati€nt has benefited from thet presence.

The Committee was informed tllat the machines could not be used because t]ley were defective, had no technicians to repair them and the power fluctuations also caused the malfunctioning.

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The Hospital has transport challenges with only one ambulance for transporting referred patients.

The ambulance was received in 2010 and is now old and keeps on breaking down.
o The budget for NCDS is limited 2.5m per quarter yet NCDS are on the raise, .

PHC funds are still little.

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The hospital reported drug stock outs resulting from a mismatch between the quartities delivered and tl.e requirements by the large number of patients received at the hospital daily.

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