KALANGALA FIELD REPORT April 2013 Medicines and Health Service Delivery Monitoring Unit (MHSDMU)

1. KALANGALA FIELD REPORT April 2013 Medicines and Health Service Delivery Monitoring Unit (MHSDMU) Plot 21 Naguru Hill Drive P.O Box 25497 Kampala Tel: 0414-288442, 0414-288445, 0800100447 (Toll free)

2. Introduction • The monitoring exercise in Kalangala district was carried out between 8th – 12th of April 2013. • The visit was prompted by a number of complaints generated through M-trac anonymous SMS and calls through the MHSDMU toll free line. • The facilities visited were: • Kalangala HCIV • MugoyeHCIII • SiaapHCII

3. Introduction continuation • Lulamba HCIII • Jaana HCII • Bubeke HCIII • Bufumira HCIII • Bukasa HCIV • Mazinga HCIII • Bwendero HCIII • Mulabana HCII

4. Appreciation • MHSDMU appreciatesall the health staff, for coming to work in this hard to reach area. • Special thanks go to the in-charges and staff of Mazinga HCIII and Jaana HCIII for being exemplary. • We also thank the entire leadership of all the health centers for ensuring that drugs do not expire in their stores.

5. Major Findings • Human resource • There is total lack of orientation of workers by DHO. • Supervision is lacking. DHO does not do monitoring. • Despite Kalangala being a hard to reach place, the staff are not getting hard to reach allowance. • Many recruited staffs have not reported. • The daily staff reporting registers lack in most health centers, and where they are, they are not adhered to. • Mogoye HCIII staff were found with forged staff attendance register.

6. Human resource cont…. • There is general late coming and absenteeism; Staffs come late and leave early. Especially the I/C of Mugoye- Bogere, I/C of Kalangala HCIV, the staff of Bwendero HCIII etc. • The newly recruited staff are not yet on payroll, which makes their survival difficult. • Lack of staff uniforms was noted in all the health centers visited. • Shortage of staff accommodation in all health centers. • Misconduct: the team witnessed a health worker who was seeing patients while watching a movie and listening to music on his laptop.

7. Finance and Administration • The team noted missing financial accountability / poor financial accountability in the lower health centers visited. • Accountability for HCIVs was fair, though they receive little PHC of 1,800,000/= per quarter, which is not enough to run a HCIV.

8. Infrastructure and Equipment • Existence of dilapidated structures in some of the health centers. E.g staff quarters of BwenderoHCIII and Kalangala HCIV. At BwenderoHCIII, a Lab Assistant was hit by debris in her house.

9. photo of dilapidated staff quarters at Kalangala HCIV

10. Infrastructure and Equipment cont….. • The team discovered that the bicycle and motorcycle given to Mulabana HCII were missing. • The monitoring team found very unkempt and dirty facilities in the district e.gMugoye HCIII and Bwendero HCIII. • No inventory management in the whole district, and this risks government property. • All the equipment in the district is not engraved, and the district might end up losing its property.

11. Un-engraved equipment found at Kalangala HCIV

12. Infrastructure and Equipment cont….. • All Health centers in the district are not fenced and lack land titles, andsome have been encroached on.

13. Wamala supermarket built on Kalangala HCIV land

14. Infrastructure and Equipment cont….. • Most health centers are infested by bats, Vermins etc.

15. Medical services • Bukasa HCIV is under performing. The services offered at the health center are similar to those of a health center two, despite the infrastructure and equipment in place. • Few or no deliveries done in some of the HCIIIs. E.g in Bwendero HCIII there were no deliveries in February, in Lulamba HCIII, the mid-wife refused to attend to mothers, and no delivers are done. • Lack of placenta pits was noted in most health centers. E.gBukasa HCIV, Mazinga, Bafumira, Lulamba. • There is generally poor record keeping in all the facilities in the district.

16. Medical supplies • A lot of anti-malarial is yet to expire in health centers. E.gBwendero HCIII, Mulabana HCII, Bafumira HCIII, Bukasa HCIV. • There are excessive medicines in Health facilities, especially anti-malarials, paracetamol, IV fluids and eardrops of gentamycin and Chloramphenicol. • Medicines management is very poor in all health centers. i.e. • There is still poor compliance to HMIS tools most especially those used in medicines management. • Lack of records, and therefore drug d audit could not be done to establish the gaps.

17. Medical supplies cont… • Expired drugs found at Kalangala HCIV

18. Expired drugs found at Kalangala HCIV

19. MHSDMU staff, helping in arranging the drug store of Kalangala HCIV

20. Theatre • Though doctors were recruited at Kalangala HCIV, the theatre still does only minor surgeries. • At Bukasa HCIV, the theatre was abandoned, all the doors and windows were eaten up by termites, and the structure now provides shelter to chicken and goats.

21. Photos of Bukasa HCIV theatre

26. THANK YOU