Dr.Ambrosoli Memorial Hospital ,Kalongo
P.BOX.47, Kalongo
Agago
ANNUAL ANALYTICAL REPORT
2014-2015
By
Chief Executive Officer
Endorsement of Report
This annual analytical report for Dr Ambrosoli Memorial Hospital – Kalongo covering the
period of Financial Year 2014-2015 has been prepared by the management of Dr Ambrosoli
Memorial Hospital. I endorse that it represents management’s views on the position of the
hospital in the period under report.
Name: --------------------------------------------
: --------------------------------------------
Dr Ambrosoli Memorial Hospital
Date: -------------------------------------------------------
This is to acknowledge that I have received this annual analytical report for Dr Ambrosoli
Memorial Hospital – Kalongo covering the period of the Financial Year 2014-2015, I have read
it and endorse its authenticity and representativeness of the position of the hospital in the year
under report.
Name JOHN BAPTIST ODAMA
Chairperson of the Board of Governors
Date19th
December 2015
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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FOREWORD
This Annual Analytical Report covers the period between July 2014 and June 2015 and portrays
the performance of Dr Ambrosoli Hospital in the various activities. The Hospital runs a wide
range of activities that include curative, preventive and rehabilitative services, training,
administrative, logistics and technical support services. Data presented are directly derived from
the Hospital’s activity and financial database.
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TABLE OF CONTENTS
ENDORSEMENT OF REPORT ............................................................................................................. I
FOREWORD ..................................................................................................................................... II
ACRONYMS ................................................................................................................................... VII
IMPORTANT INDICATORS AND DEFINITIONS .............................................................................. VIII
ACKNOWLEDGEMENT / APPRECIATIONS ....................................................................................... X
EXECUTIVE SUMMARY ................................................................................................................... XI
CHAPTER ONE ................................................................................................................................. 1
THE HOSPITAL AND ITS ENVIRONMENT ......................................................................................... 1
SOCIAL AND ECONOMIC ORGANIZATION .................................................................................................. 1
COMMUNITY AND HEALTH STATUS .......................................................................................................... 4
MORTALITY AND MORBIDITY .................................................................................................................. 5
NOTIFIABLE DISEASES AND EPIDEMICS .................................................................................................... 5
HEALTH POLICY AND DISTRICT HEALTH SERVICES .......................................................................... 6
HEALTH POLICY ...................................................................................................................................... 6
DISTRICT HEALTH SERVICES ................................................................................................................... 6
HUMAN RESOURCES ................................................................................................................................ 7
FUNDING ................................................................................................................................................. 8
HEALTH INFRASTRUCTURE ...................................................................................................................... 8
ESSENTIAL MEDICINES AND SUPPLIES PROVISION ................................................................................... 9
EQUIPMENT AND OTHER LOGISTICS .......................................................................................................... 9
TRANSPORT MEANS................................................................................................................................. 9
PREVENTION AND HEALTH PROMOTION SERVICES ................................................................................... 9
THE HC II FUNCTION OF THE HOSPITAL ................................................................................................... 9
CHAPTER THREE ............................................................................................................................ 12
GOVERNANCE ............................................................................................................................... 12
THE BOARD OF GOVERNORS .................................................................................................................. 12
MANAGEMENT ...................................................................................................................................... 13
STATUTORY COMMITMENTS COMPLIANCE ............................................................................................ 13
INTERNAL REGULATORY DOCUMENTS ................................................................................................... 13
ADVOCACY, LOBBY AND NEGOTIATION ................................................................................................. 14
CHAPTER FOUR ............................................................................................................................. 15
HUMAN RESOURCE ...................................................................................................................... 15
STAFF ESTABLISHMENT ......................................................................................................................... 15
TURN-OVER AMONG STAFF .................................................................................................................... 15
MANAGEMENT ...................................................................................................................................... 16
HUMAN RESOURCE DEVELOPMENT AND CAREER PROGRESSION ............................................................. 16
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CHAPTER FIVE ............................................................................................................................... 17
FINANCES ...................................................................................................................................... 17
INTERNAL AUDIT ................................................................................................................................... 21
EXTERNAL AUDIT .................................................................................................................................. 22
PROCUREMENT ...................................................................................................................................... 22
CHAPTER SIX .................................................................................................................................. 23
SERVICES ....................................................................................................................................... 23
A GENERAL OUT PATIENT DEPARTMENT ..................................................................................... 24
OPD STAFFING LEVEL ........................................................................................................................... 24
OPD ACTIVITIES .................................................................................................................................... 25
B.SPECIALIST OPD CLINICS ............................................................................................................ 30
1. ANTE NATAL CLINIC ................................................................................................................ 30
2. HIV / AIDS CLINIC ................................................................................................................... 32
ACTIVITIES WHICH ARE OFFERED UNDER HIV/AIDS PROGRAM INCLUDES: ............................................ 33
A) HCT / VCT ............................................................................................................................... 33
B) PMTCT SERVICES .................................................................................................................... 35
C) ANTIRETROVIRAL THERAPY ...................................................................................................... 36
3. ORTHOPAEDIC SERVICES ................................................................................................... 38
4. TUBERCULOSIS CLINIC ....................................................................................................... 38
5. MENTAL HEALTH CLINIC.................................................................................................... 41
6. DENTAL CLINIC .................................................................................................................... 42
7. PALLIATIVE CARE ................................................................................................................ 42
8. OPHTHALMOLOGY .............................................................................................................. 43
C. INPATIENTS DEPARTMENT................................................................................................. 43
1. SUMMARY OF BEDS AND QUALIFIED HEALTH PERSONNEL .......................................................... 43
2. INPATIENT UTILIZATION INDICATORS ........................................................................................ 43
3. INPATIENT REFERRALS.............................................................................................................. 46
4. THE TOP TEN CAUSE OF MORBIDITY IN ALL THE WARDS ............................................................ 46
5. THE TOP TEN CAUSES OF DEATH AMONG INPATIENTS ................................................................ 47
1.PAEDIATRIC WARD ..................................................................................................................... 48
1.1. STAFF COMPOSITION ................................................................................................................. 48
1.2. ADMISSIONS ............................................................................................................................. 49
2.MATERNITY WARD . ................................................................................................................... 51
2.1. STAFF COMPOSITION ................................................................................................................. 51
2.2. MATERNITY WARD INDICATORS ................................................................................................ 51
2.3. ADMISSIONS ............................................................................................................................. 52
2.4. OTHER SERVICES/DEPARTMENTS IN MATERNITY ...................................................................... 54
3.MEDICAL WARD ........................................................................................................................ 55
3.1. STAFF COMPOSITION ................................................................................................................. 55
3.2. KEY INDICATORS IN THE MEDICAL WARD ................................................................................. 56
3.3. ADMISSION IN MEDICAL WARD ................................................................................................ 56
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4.SURGICAL WARD ........................................................................................................................ 57
4.1. STAFFING COMPOSITION OF SURGICAL WARD ............................................................................ 57
4.2. KEY INDICATORS IN THE SURGICAL WARD ................................................................................. 58
4.3. ADMISSIONS IN SURGICAL WARD .............................................................................................. 58
5.THEATRE SERVICES ..................................................................................................................... 59
6.TB WARD .................................................................................................................................... 61
7. PRIVATE WARD .................................................................................................................... 61
D.DIAGNOSTIC SERVICES–LABORATORY AND BLOOD TRANSFUSIONS ........................................ 62
1.LABORATORY SERVICES ............................................................................................................. 62
E.DIAGNOSTIC SERVICES - X-RAY, ULTRASOUND .......................................................................... 63
1. X-RAYS DEPARTMENT .............................................................................................................. 63
2. ULTRASOUND INVESTIGATIONS ................................................................................................. 64
F.PHARMACY ACTIVITIES .............................................................................................................. 65
1. STAFFING LEVEL IN PHARMACY AND GENERAL STORE .............................................................. 65
2. PHARMACEUTICAL SUPPLIES ..................................................................................................... 66
3. PROCUREMENT SYSTEM ............................................................................................................ 66
G. INTRAVENOUS FLUID CONSUMPTION ............................................................................. 68
CHAPTER SEVEN ............................................................................................................................ 69
SUPPORT SERVICES ....................................................................................................................... 69
1.PASTORAL CARE ......................................................................................................................... 69
2.AMBULANCE SERVICE ................................................................................................................ 69
3.TECHNICAL SERVICES ................................................................................................................. 69
4.DOMESTIC SERVICES .................................................................................................................. 70
5.INTERNET AND INTERCOM TELECOMMUNICATION .............................................................................. 72
CHAPTER EIGHT ............................................................................................................................. 73
8.1.QUALITY AND PATIENT SAFETY IMPROVEMENT .................................................................... 73
1. AVAILABILITY OF CLINICALLY QUALIFIED STAFF IN THE HOSPITAL ............................................ 73
2. QUALITY OF CARE ..................................................................................................................... 73
8.2. HEALTH SURVEYS ..................................................................................................................... 75
8.3. PERSPECTIVES AND WORK PLAN FOR QUALITY IMPROVEMENT ................................................. 76
CHAPTER NINE .............................................................................................................................. 77
HEALTH TRAINING INSTITUTION ................................................................................................... 77
9.1. HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT ........................................................... 77
9.2. SCHOOL PERFORMANCE ............................................................................................................ 78
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9.3. SCHOOL FINANCES .................................................................................................................... 79
9.4. RELATIONS WITH EXTERNAL PARTNERS .................................................................................... 80
9.5. PHC ACTIVITIES ....................................................................................................................... 81
9.6. FAITHFULNESS TO THE MISSION ................................................................................................ 81
CHAPTER TEN .................................................................................................................................... 83
SUMMARY, CONCLUSION AND RECOMMENDATIONS ................................................................. 83
CONCLUSION ................................................................................................................................. 83
FAITHFULNESS TO THE MISSION REPORT (PERFORMANCE INDICATORS) ................................... 84
ACCESS ............................................................................................................................................... 84
EQUITY 85
EFFICIENCY ....................................................................................................................................... 85
QUALITY OF CARE ................................................................................................................................. 86
SUSTAINABILITY OF THE HOSPITAL ............................................................................................. 86
CRITICAL ISSUES ................................................................................................................................... 86
CHAPTER ELEVEN .......................................................................................................................... 88
PLANNING FOR THE FUTURE ........................................................................................................ 88
ANNEXES ....................................................................................................................................... 97
ANNEX 1. - HEALTH UNIT POPULATION REPORT (HMIS 109) FY 2014-2015 ......................................... 97
ANNEX 2. - MEMBERS OF BOARD OF GOVERNORS & DESIGNATION AS PER 30TH JUNE 2015 .................... 98
ANNEX 3. MEMBERS OF THE MANAGEMENT TEAM AND DESIGNATION AS PER 30TH JUNE 2015 ............. 99
ANNEX 4 - HOSPITAL STAFFING LEVEL AS PER 30 JUNE 2015 ............................................................... 100
ANNEX 5 - HOSPITAL STAFF DETAIL AS AT 30 JUNE 2015 .................................................................... 101
ANNEX 7: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF FINANCIAL
POSITION AS AT 30THJUNE 2015 ................................................................................................... 110
ANNEX 8: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF COMPREHENSIVE INCOME
FOR THE YEAR ENDED 30TH JUNE 2015. ............................................................................................... 111
ANNEX 9: ADMISSIONS AND DEATHS BY DIAGNOSIS IN FY 2014-2015 (HMIS 107) .............................. 112
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ACRONYMS
ACT Aids Care & Treatment
AIDS Acquired Immuno-Deficiency Syndrome
ALoS Average Length of Stay
ART Anti-Retroviral Therapy
BCG BacilleCalmette-Guerin
BOG Board of Governors
BOR Bed Occupancy rate
CEO Chief Executive Officer
DPT Diphtheria-Pertussis-Tetanus
FSB Fresh Still Birth
FY Financial Year
CHD Child Health Day
CO Clinical Officer
CRS Catholic Relief Services
C/S Caesarean Section
CH Health Centre
FY Financial Year
HIV Human Immunodeficiency Virus
HMIS Health Management Information System
HMT Hospital Management Team
HRM Human Resources Manager
HSD Health Sub-District
HSSP Health Sector Strategic Plan
IDP Internally Displaced People
ITN Insecticide Treated Nets
LLU Lower Level Unit
MO Medical Officer
MoH Ministry of Health
NSSF National Social Security Fund
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NTLP National Tuberculosis Leprosy Programme
NUHEALTH Northern Uganda Health Programme
OPD Out-Patient Department
PCH Primary Health Care
PHC-CG Primary Health Care Conditional Grants
PMTCT Prevention Mother To Child Transmission
PNFP Private Not For Profit
SNO Senior Nursing Officer
SUO Standard Unit of Output
TT Tetanus Toxoid
UCMB Uganda Catholic Medical Bureau
UEC Uganda Episcopal Conference
UNMEB Uganda Nurses Midwives Educational Board
IMPORTANT INDICATORS AND DEFINITIONS
1. Inpatient Day / Nursing Day / Bed days = days spent by patients admitted to the health
facility wards.
2. Average Length of stay (ALOS)
= Sum of days spent by all patients/number of patients
= Average length of days each in-patient during each admission. The actual individual
days vary.
3. Bed Occupancy Rate expressed as %
= used bed days/available bed days
= Sum of days spent by all patients/365 x No. of beds
=ALOS x No. of patients/365 x No. of Beds
4. Throughput
=Average number of patients utilising one bed in a year
=Number of patients/no. of beds
5. Turn over interval
=Number of days between patients
= (365 x no. of beds)-Occupied bed days/no. of patients
6. FSB (Fresh Still Birth): This is a baby born with the skin not pealing / not macerated. The
foetal death is thought to have occurred within the 24 hrs before delivery. However it is
important for us to know the trend of deaths of foetuses actually occurring in mothers who
have arrived already in the hospital (Foetal heart sound heard on arrival). For this purpose we
shall monitor FSB in total as well as FSB of fetuses who died in hospital. They have been
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separated in the table. The hospital should try to provide space to collect this information
from the maternity ward / delivery room.
7. Post C/S Infection Rate:
= (No. mothers with C/S wounds infected / Total No. of mother who had C/S operations
in the hospital) x 100.
= The rate if caesarean section wounds getting infected. It is an indicator of the quality of
post-op wound care as well as pre-op preparations.
8. Recovery Rate:
= % of patients admitted who are discharged while classified as “Recovered” on the
discharge form or register.
= (No. of patients discharged as “Recovered” / Total patients who passed through the
hospital) x 100
9. Maternal Mortality Rate (for the hospital):
= Rate of mothers admitted for delivery and die due to causes related to the delivery
= (Total deaths of mothers related to delivery / Total number of live deliveries) x 100
10. SUO = Standard Unit of Output. This is where all outputs are expressed into a given
equivalent so that there is a standard for measurement of the hospital output. It combines
Outpatients, Inpatients, Immunisations, deliveries, etc which have different weights in terms
of cost to produce each of the individual categories. They are then expressed into one
equivalent. As the formula is improved in future it may be possible to include Out-patients
equivalence of other activities that may not clearly fall in any of the currently included output
categories.
11. SUOop = SUO calculated with inpatients, immunizations, deliveries, antenatal attendance,
and outpatients all expressed into their outpatient equivalents. In other words, what would be
the equivalent in terms of managing one outpatient when you manage e.g. one inpatient from
admission to discharge? Please see the detail formula below or at the foot of Fig. 5.6.
12. TB case notification rate = total cases of TB notified compared with the expected number
for the population in one year =Total cases of TB Notified / Total population x 0.003.
13. OPD Utilisation = Total OPD New attendance in the year / Total population of the area.
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ACKNOWLEDGEMENT / APPRECIATIONS
We intend to thank all those who, in different capacities and forms, have supported the Hospital
during the Financial Year 2014-2015 and contributed to its sustainability. Notable among them
but not limited to are; the Government of Uganda, Dr Ambrosoli Foundation, Comboni
Missionaries, IDS- UEC/UCMB, the Japanese and the Uganda Red Cross Societies, the NU-
Health Programme, Wamba Athena Onlus ,IDEA Onlus, the Italian Cooperation, and Agata
Smeralda Onlus.
We have a special debt of gratefulness to UCMB for the continuous and valuable technical
support and guidance.
We would like to thank H.G. Archbishop John Baptist Odama and all the members of the Board
of Governors for the guidance and encouraging supervision given to the Hospital.
One special thanks is for all the employees of the Hospital and of the School who, at all levels
and with different qualifications and responsibilities, have been the makers of all achievements
that are presented in this report. This acknowledgement is certainly due but intends to be also an
encouragement to maintain and possibly enhance the same spirit for the future.
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EXECUTIVE SUMMARY
Dr. Ambrosoli Memorial Hospital is a 271 bed capacity serving a 27,121population of Agago
District. It is the referral facility of Kalongo HSD-Agago District, coordinating 33 lower level
health facilities.
The hospital provides both curative and preventive services.
Hospital Activity Performance
Table I – Summary of activity output in Dr Ambrosoli Memorial Hospital FY 2013-2014 and 2014-
2015
Activity Output for
FY 11-12
Output for
FY 12-13
Output for
FY 13-14
Output for
FY 14-2015
Variation (%) I:I
FY 13-14 & 14-15
Admissions Medical Ward 1,575 1,888 2,284 2,053 -10.1%
Admissions Surgical Ward 1,648 1,778 2,028 1,974 -2.7%
Admissions Maternity Ward 4,198 4,502 4,756 5,027 5.7%
Admissions Paediatric Ward 3,542 4,573 4,607 3,741 -18.8%
Admissions TB Ward 258 240 267 186 -30.3%
Admissions Private Ward 153 240 244 NA NA
TOTAL ADMISSIONS 11,374 13,221 14,186 12,981 -8.5%
Total Deliveries 2,805 2,727 2,981 3,247 8.9%
Caesarean sections 405 479 449 369 -17.8%
Minor operations / procedures 1,738 2,219 2,223 1,081 -51.4%
Major operations 730 798 663 565 -14.8%
OPD 1st visits 16,769 21,338 25,322 21,761 -14.1%
OPD total visits 23,714 31,225 29,306 25,526 -12.9%
Ante Natal Clinic 1st visits 2,958 2,290 2,033 1,817 -10.6%
Ante Natal Clinic 4th visits 1,235 1,199 1,249 1,217 -2.6%
Ante Natal Clinic total visits 7,936 5,312 6,664 5,909 -11.3%
Total HIV patients under care 1,996 2,219 2,087 2,285 9.5%
Immunization doses 20,807 19,294 16,654 26,632 46.3%
The OPD attendance has decreased by 12.6 % (total OPD attendances has decreased from 29,206
in FY 2013/14 to 25,526 in FY 2014/15). The Major cause of morbidity in OPD in the last FY
2014/2015 are also provided to the lower level unit such as Malaria, respiratory tract infection ,
acute diarrhoea etc.; this is most likely the cause of decline in OPD attendance, however The
community still have access to the facility however there is need to improve access through
strengthening referral system in order to make sure that patients are accessing services near their
village according to the condition; this can be achieved through reducing of waiting time,
accurate data recording and community sensitization.
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The OPD attendance among children under five has decreased by 4.6 % (from 30.8% in FY
2013/14 to 26.2% in 2014-2015) and Five years and above decreased by 11. 2% (from 95.6% to
84.4%).The hospital has contributed 9.0% of OPD attendance to the Agago district in FY 2014-
2015. Generally there is a fluctuation on number of patients who accessed care in the Hospital N
the last five years in different services.
In the area of antenatal care, the total ANC visit has declined by 11.3 % (form 6,664 in
2013/2014 to 5,909 in 2014-2015.Whereas ANC 4th visit increased in proportion by 2.0%,the
contribution to the district was 18% of ANC total visits and 18.2% of ANC 4th visit in the Agago
district.
This is a good indicator which shows that the mother and baby are most likely to minimise the
risk of maternal and neonatal death. The reduction of utilisation of the Hospital ANC services
should not necessarily be looked at as a problem of accessibility, considering that the LLUs can
offer equivalent and effective ANC services nearer to the residence of the mothers.
In FY 2014-2015 the total number of doses of immunisation antigens administered increased by
46.3%. The Hospital contributed 9.9% to the District immunisation coverage in FY 2014-2015.
The hospital is carrying out daily routine immunization services. The outreach services during
Family Health Days and Child Health Days has also contributed to higher number of
beneficiaries being immunized because of much effort from the VHT attached to hospital who
work tirelessly to mobilize the community so that they benefit from these services.
The total admission has decreased by 8.5% (from 14,186 to 12,981) in FY 2013/14 to FY
2014/15. The hospital contributed 67.8% of admission to the district. This is attributed to the
functional lower health units who are able to treat minor illness.
Deliveries increased by 8.9% in 2014-2015 compared to the last financial year. The hospital has
contributed 36.1% of the total deliveries in the district. This can be attributed to the good
services being offered to pregnant mothers. Caesarean Sections rate is at 8.8% which still below
WHO redline. This is due to Health education and waiting shelter provided to at- risk pregnant
mother on regular basis.
The year 2014-2015 compared to the previous year presents a slight decrease in access of
services by community (6.4%) in FY 2014/2015 as noted by decrease in the SUO from 258,014
to 241,573.
In FY 2014/2015, the OPD contacts decreased by 12.6%; In patient admission decreased by
8.5%; ANC total attendance decreased by 11.3%;however the deliveries increased by 9.0% and
Immunisation increased by 46.3%.
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The indicator Fee/SUO-OP increased by 14.6%. For the last 4 years this indicator has been
increasing however the user fees in Kalongo Hospital still remains very low among the PNFP in
UCMB network even in private hospital in the Country.
The staff productivity as a measure of efficiency has decreased by 19% in 2014/15(2,367 in
2013/14 to 1,917 in 2014/15).
The hospital economic efficiency has improved slightly by 1.5% because the cost of producing
one SUO has decreased from UGX 15,571 to 15,333
Maternal Death Rate has decreased. Infection rate for caesarean section also increased to 10%.
On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still Birth
Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.
Some of these negative trends may be explained by the high attrition rate of qualified staff
particularly the medical personnel that affected the quality of work in the hospital, especially in
Maternity Ward. The Stability and adequate qualification of human resources is a prerequisite to
introduce effective improvement measures and for more focused effort in quality improvement.
In FY 2014-2015 the hospital been ranked among the best for its performance and compliance to
requirement for accreditation under UCMB network .In addition, at national level following the
Health sector performance report the hospital has been ranked at number 18 among the 137
general hospitals in Uganda. The Hospital received “Golden Award” for “Outstanding
Performance in Logistics Management of HIV drugs and supply” for two consecutive years. In
addition the hospital has also been ranked as one of the best - most compliant institution in
remittance of NSSF in Northern Uganda for the year.
Dr. Ambrosoli Memorial Kalongo hospital laboratory has initiated a hub with support with MOH
and UCMB. It serves sixteen lower health unit laboratories in Agago and Pader health District.
The hub renders a complete ART care package for HIV infected patients in terms of laboratory
tests amongst which are CD4 testing, chemistry, haematology analysis and collecting Dry Blood
Spot for DNA-PCR, Viral load, and other samples that cannot be analysed at the hub hence the
need for referral to the central laboratory, All this processes are interlinked through the hub rider
who reaches all these facilities collects samples to the hub, Posta Uganda for despatch to the
central laboratory. He also collects results from Posta Uganda and the hub and subsequently
distributes to the respective health facilities. The hub has now existed for one and half years.
The strategies initiated for the quality of health care service were partially or fully implemented.
In particular, formation of quality assurance committee, drug therapeutic committee, Unit Dose
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System for dispensing treatments in the wards, infection control team, Maternal and neonatal
death audit, recruitment of qualified human resource, completion of the construction of the new
Theatre, the new Guest House Complex and three apartments for accommodation of staff.
Challenges
Human resources
The hospital has experienced high staff turnover leading to inadequate qualified staff. This is still
a big challenge in implementation of quality of health care services. In addition, many key
departments are still lacking qualified staffs notably; Radiographer, Anaesthetist, Dentist,
Orthopaedist, and Gynaecologist.
Financial resources
The cost of running the hospital has continued on the increase with Employment cost and
Drugs/medical sundries accounting for about 77% of total recurrent expenditure. The hospital is
able only to recover about 11.5% of its recurrent expenditure from user fees collection,
meanwhile Government provides subsidy which accounts to about 15% of the recurrent budget
and donors contribute about 68%, unfortunately donor funding has continued to decrease due to
the current global economic crises. In addition the user fees still low and is affecting the
sustainability of the hospital.
Infrastructure and Equipment
Renovation and/or repairs of hospital building and staff house has become a key priority focus
area. Some of the urgent works required are; Renovation of surgical and children ward to secure
the regular functionality of the hospital.
There is need for more spacious laboratory to accommodate all laboratory equipment for a wide
range of test profiles available in the laboratory.
Plans for the coming year
The Hospital intends to continue improving on the following key areas:
• Extending the working time in OPD from 8:00am to 9:00pm to improve accessibility.
• Recruiting key cadres like Anaesthetist and radiographer and other essential cadres
essential for enhancing clinical services.
• Develop a new Strategic plan 2016/2020 Recruiting essential cadres like Internal auditor
to help improvement in the implementation and compliance of best accounting practises
by also adopting a good finance management with the ultimate goal to secure the best
sustainability of the hospital and accountability to the major donors.
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• Ensure approval of the draft staff training and development plan and ensure its
subsequent implementation;
• Review and update the Employment manual and Financial and Material Resource
Manual
• Developing a website for the hospital through which the hospital can showcase itself.
• Infrastructural renovation especially the Old theatre to be converted into a new laboratory
• Quality and safety health care initiatives.
CHAPTER ONE
THE HOSPITAL AND ITS ENVIRONMENT
Dr Ambrosoli Memorial Hospital was founded in 1957 and its annex the Midwifery school was
established in 1959 by Fr Dr Giuseppe Ambrosoli of the Comboni Missionaries. The Legal and
Registered Owner of the Hospital is the Roman Catholic Diocese of Gulu. The Hospital is a
Private Not For Profit institution that is part of the network of Catholic health facilities under the
coordination of the UCMB.
Dr Ambrosoli Memorial Hospital is a general rural hospital with 271 bed capacity. It provides
curative services for outpatients and inpatients, preventive/promotive/ rehabilitative services with
special focus on maternal and child care. It also runs a comprehensive HIV/AIDS programme. It
is head of the Agago Health Sub-District and, in this capacity, supervises a total of 33 LLUs (25
HC2 and 8 HC3).
The Hospital is located in Kalongo Town Council (Oret Parish) within Agago County. Agago
county is the only County of the District which incidentally entails the entire District of Agago.
It is bordered by 6 Districts: Pader to the West, Kitgum to the North, Kotido and Abim to the
East, Otuke and Alebtong to the South. These neighbouring Districts do not have functional
Hospitals and, therefore, Dr Ambrosoli Memorial Hospital serves also their population for all
conditions requiring hospitalisation.
The District is still lacking good road network. All roads are murram and in poor maintenance
conditions, that occasionally disrupt routine field activities (transfer of patients for emergency
care, immunisation campaigns, supervision of LLUs, home visiting) and adds extra costs to all
transport activities.
Telephone and internet communication is available but quite poor, erratic and not fully reliable.
Availability of power supply, although not constant and regular, has been nevertheless quite
improving in the last year, at least in the major urban centres.
Social and economic organization
The level of literacy in the District population is still quite low and quite a large proportion of the
population, especially among women, do not speak or write English. Acholi is the main ethnic
group and the language spoken is Acholi with Langi being the other minority ethnic group
mainly to the southern extremities of the district borderingOtuke andAleptong.
Main economic activities of the population is mainly agriculture, predominantly practised is
subsistence farming. It absorbs about 85% of available labour force. The main crops grown in
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the region are millet, sorghum, maize, beans, groundnut, simsim, cassava, and sweet potatoes
produced mainly for local consumption. Other crops include cotton, rice, soya beans and
sunflower produced mainly as cash crops. Most homesteads in the area rear cattle, goats, sheep,
poultry and pigs as additional source of income. There are no known industries in the district as a
whole and commercial activities are very limited.
This situation maintains large proportion of the population in a condition of poverty.
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Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Demographic data for the Hospital catchment area
The population of Agago District for the FY 2014-2015 amounts to 227,486 according to the
Annual Health Sector report 2014-2015.
Table 1.1: Demographic data for the Hospital catchment area (Kalongo Town Council and
Parabongo Sub County) compared to HSD and District for the FY 2014-2015
Population Group Formulae Catchment
Area
HSD District
(A) Tot. Population (Projected for the year
under report)
27,121 227,486 227,486
(B) Tot. expected deliveries (4.85% of
population) (4.85/100) x A
1,315 11,033 11,033
(C) Tot. Assisted Deliveries in Health
Facilities (A)*0.05
1,356 11,374 11,374
(D) Tot. Assisted Deliveries as % of
expected deliveries (C/B) x100
103 103.1% 103.1%
(E) Children <1 year (4.3%) (4.3/100) x A 1,166 9,782 9,782
(F) Children < 5 years (20.2%) (20.2/100) x A 5,478 45,952 45,952
(G) Women in Child-bearing age (20.2%) (20.2/100) x A 5,478 45,952 45,952
(H) Children under 15 years (46%) (46/100) x A 12,476 104,644 104,644
(I) Orphans (≈ 10%) = (10/100) x A 2,712 22,749 22,749
(J) SUSPECTED T.B IN THE SERVICE
AREA: (A) X 0.003 81 682 682
Community and health status
Table 1.2: Relative percentage of the top 10 causes of morbidity recorded in the HSD OPDs
in the last 5 FYs (HMIS – Form 105)
Diagnosis 2011-2012 2012-2013 2013-2014 2014-2015
1. RTI not Pneumonia 25.5 28.6 29.2 33.0
2. Malaria (included cases in pregnancy) 26.9 29.7 22.9 20.0
3. Intestinal worms 7.4 7.1 5.1 5.5
4. Acute Diarrhoea 4.8 4.8 4.5 6.2
5. Gastrointestinal disorders 2.6 3.3 3.2 3.9
6. Eye condition 2.8 2.9 2.5 2.1
7. Skin diseases 3.4 3.5 2.3 2.3
8. Trauma-injuries, wounds, burns 2.0 1.8 1.6 1.7
9. UTI 1.5 1.6 1.6 2.1
10. ENT conditions 2.3 2.3 1.6 1.7
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Table 1.3: Relative percentage of the top 10 causes of mortality during the last four years in
the HSD (HMIS 108)
Diagnosis 2011-2012 2012-
2013
2013-
2014
2014-2015
1. Malaria 6.6 21.6 18.3 18.5
2. Pneumonia 9.5 15.6 12.9 17.8
3. Perinatal conditions n.a. n.a. 11.2 16.1
4. Cardiovascular Disease 5.8 13.1 7.5 8.6
5. Septicaemia n.a. n.a. 7.5 5.8
6. Anaemia 1.7 6.0 5.4 11.2
7. Typhoid fever n.a. n.a. 5.0 0.8
8. Gastrointestinal disorder not infection. n.a. n.a. 3.3 4.1
9. Severe Malnutrition 5.0 2.5 2.1 2.4
10. Road Traffic Accident 2.1 2.0 2.1 4.0
All others 60.2 12.1 24.9 10.7
Total Diagnoses 100.0 100.0 100.0 100.0
Mortality and Morbidity
Morbidity and mortality data are summarised in above Tables 1.2 and 1.3, presenting in
percentage the ten top causes of morbidity and mortality respectively.
In relation to morbidity in FY 2014-2015; RTI is still the major cause of morbidity at 33%
followed by Malaria at 20.3% in the pattern of diagnosis made in OPDs in the HSD.
In FY 2014-2015 about 52.4% of death recorded were attributable to only three diseases
(Malaria, Pneumonia and Perinatal conditions). It may be disputable the correctness of diagnosis,
especially when made at Health Centre level, but it is all the same significant that Cardiovascular
diseases are the 4th cause of death registered in this FY.
We are probably facing an epidemiological transition in the District that is not yet fully captured
by the HMIS data. Greater attention should be given to data collection to improve the quality
(completeness and accuracy) of our recording system. Non-communicable diseases are most
likely grossly under-reported and, therefore, the dimension of their role and impact may be
largely underestimated.
Notifiable diseases and epidemics
Weekly surveillance was regularly maintained throughout the year; in 2014-2015 the HSD did
not register any notifiable disease or an epidemic situation.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER TWO
HEALTH POLICY AND DISTRICT HEALTH SERVICES
Health Policy
Dr Ambrosoli Memorial Hospital is guided by the framework set by the National Health Policy
and the Health Sector Strategic Plan (HSSP), to provide the major components of the Uganda
Minimum Health Care Package. It also adheres to the guidelines set by the Uganda Episcopal
Conference through the UCMB.
District Health Services
The District of Agago was established in July 2010 by separating Agago County from Pader District.
It comprises only the HSD of Agago. Dr Ambrosoli Memorial Hospital acts as District Referral
Hospital and as the Head of Agago HSD. Since its inception no review has been made despite the
new dynamics where the district and the HSD are one and the same area of jurisdiction.
Table 2.1: Distribution of Health Service points by Sub-county
Sub-Counties Total
Population
No of
Hospitals
No of
HC IV
No of
HC III
No of
HC II
Total
Immunizations
Static Stations
Kalongo Town Council 11,062 1 0 0 0 1
Omiya Pacwa sub-county 11,860 0 2 2
Paimol sub-county 13,905 1 1 2
Lapono sub-county 17,310 1 4 5
Adilang sub-county 22,973 1 3 4
Patongo sub-county 22,272 0 0 0
Patongo Town council 1 0 1
Kotomor sub-county 14,661 0 1 1
Omot sub-county 11,587 0 2 2
Arum sub-county 9,798 1 0 1
Lamiyo sub-county 11,530 0 2 2
Lira Palwo sub-county 21,235 1 3 4
Wol sub-county 24,648 1 2 3
Parabongo sub-county 16,059 0 3 3
Lukole sub-county 18,586 0 2 2
Agago Town council 1 0 1
Total for HSD 227,486 1 0 8 25 34
Total for the District 227,486 1 0 8 25 34
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Dr Ambrosoli Memorial Hospital acts as District Referral Hospital and as the head of Agago
HSD. The Hospital participates in the planning process and Disaster Preparedness Taskforce at
the District level. As the head of the HSD, it coordinates with the District Health Office to
elaborate the HSD Annual Work plan and ensure its implementation.
The functionality of LLUs has significantly improved in the last years although has not yet
attained the ideal standard. Currently there are 8 HCIII and 25 HCII. They are all Government
Units except one HCII belonging to the Church of Uganda.
The limited resources available represent a major obstacle to successfully implement the required
activities and gradually expand their scope to meet affectively the growing needs of the
population.
The main factors that affected the performance in FY 2014-2015 include:
Human Resources
The inadequate and right qualified staff mix in most of the health facilities is a major constraint
and tends to affect the quality of services provided.
Table 2.2: Summary profile of population, health unit and staffing level in Agago District
for FY 2014-2015 by Sub-county
Sub-Counties Populations
2014-2015
FY
Health units (Level &
ownership)
Staffing levels Staffing
gap Staffing
Norm
No.
available
1. Lira Palwo 21,235
Lira Palwo HC III-Govt. 19 14 5
Acuru H/C II-Govt 9 5 4
Obolokome H/C II-Govt 9 6 3
St Janani H/C II CoU 0 0 0
2. Omot 11,587 Omot HC II-Gov 9 4 5
Geregere HC II-Gov 9 6 3
3. Adilang 22,973
Adilang HC III-Govt. 19 15 4
Ligiligi HC II-Govt. 9 6 3
Alop HC II-Govt 9 6 3
Orina H/C II-Govt 9 5 4
4. Lamiyo 11,530 Kwonkic H/C II-Govt 9 7 2
Lamiyo H/ II-Govt 9 6 3
5. Arum 9,798 Acholpii H/C III. 19 15 4
6. Kotomor 14,661 Odokomit H/C II-Govt 9 7 2
7. Omiya Pacwa 11,860 Omiya Pacwa H/ II-Govt 9 7 2
Layita H/C II 9 4 5
8. Lapono 17,310 Lira Kato HC III-Govt. 19 14 5
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Lira Kaket HC II-Govt. 9 5 4
Ongalo H/C II-Govt 9 6 3
Amyel H/C II-Govt 9 6 3
Ogwangkamolo H/CII 9 5 4
Abilinino H/C II-Govt 0 0 0
9. Wol 24,648 Wol HC III-Govt. 19 10 9
Kuywee H/C II-Govt 9 7 2
Toroma H/C II 9 5 4
10. Paimol 13,905 Paimol HC III-Govt. 19 14 5
Kokil H/C II-Govt 9 6 3
11. Parabongo 16,059 Pakor HC II-Govt. 9 6 3
Pacer H/C II-Govt 9 6 3
Kabala H/C II-Govt 9 7 2
12. Lukole Sub-
County & Town
Council
18,586 Lapirin HC II-Govt. 9 6 3
Olung HC II-Govt. 9 6 3
Lukole HC III-Govt. 19 13 6
13. Patongo Sub- 22,272 16. Kalongo Town
11,062 Kalongo Hospital NGO
375 260 115
Table 2.3: Structure of the Health Sub District team at referral facility
Human resource Staffing norm Current No.
Nursing Officer
1
Sub Total 3
Administrative and Support Staff Office Typist
1
Sub Total 3
Grand Total 6
Funding
Funding for health services is quite inadequate compared to the needs and this inevitably affects
the performance. PHC Conditional Grant in the last financial year was fully realised according to
the expectation for every quarter.
Funds apportioned for the function of the HSD is hardly sufficient to secure even the very
minimum activities like supervision to the LLUs, the distribution of drugs and vaccines, and the
effective implementation of the HMIS. Therefore many essential and much needed activities
cannot be implemented and support supervision remains quite unsatisfactory.
Health Infrastructure
The major problem faced are; insufficient staff accommodation; lack of space for maternity and
lighting for some units in spite of the electricity lines passing near or through these units.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Essential Medicines and Supplies Provision
There has been a fairly good supply of essential medicines, but there is need to improve on the
management of the drugs and monitoring of the average monthly consumption to avoid the
issues of drug stock outs.
Equipment and other logistics
The units are still not well-equipped as they lack the basics for effective service delivery. The
available funds can hardly provide the resources needed to bridge the gap.
Transport Means
The HSD lacks transport means for its activities (supervision, outreaches, HMIS monitoring,
Cold Chain, TB Control Programme, referral of patients, etc.) and therefore rely on a limited
number of motorcycles and vehicles provided by the hospital, projects or other donors. The
government has never provided any Vehicle for the HSD activities. The Fund allocated is often
insufficient for the running cost (fuel and maintenance). Some of the vehicles that the hospital
supports the HSD in facilitating the implementation for its activities are in need of major repairs
and are in fact grounded. This affects the possibility to provide regular and meaningful
supervision to the LLUs.
Prevention and Health Promotion services
The Hospital carries out a variety of prevention and health promotion activities. They include the
activities connected with the HIV/AIDS projects, the immunisation programmes, health
education, and support supervision to the LLUs of the HSD.
In terms of organisational set-up of a public health department; the hospital is still in need of
dedicated personnel. This however is not fully operational.
The HC II Function of the hospital
The assigned catchment area of the Hospital for the HC II functions covers the Sub-County of
Parabongo and the Town Council of Kalongo, with a total population estimated for FY 2014-
2015 of 27,121 people.
The overall performance of the Hospital, in relation to Immunisation, ANC, and Family Planning
activities as proportion of the district coverage is summarised in the Tables 2.2 and 2.3.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Table2.4: Contribution of the Hospital as a HC II to the prevention and health promotion
services of the HSD/District in FY 2014-2015
Activity : TT to child bearing ages In the Hospital and
its catchment area
In the HSD
(=District)
Hosp. output as %
of HSD (=District)
Pregnant women
TT 1 1,992 7,281 27.4
TT 2 1,420 5,497 25.8
TT 3 78 2,625 3.0
TT 4 42 2,046 2.1
TT 5 27 1,795 1.5
Non Pregnant women
TT 1 640 7,293 8.8
TT 2 363 5,680 6.4
TT 3 203 4,647 4.4
TT 4 165 3,812 4.3
TT 5 74 3,296 2.2
Immunization in school
TT 1 765 3,378 22.6
TT 2 497 2,729 18.2
TT 3 313 2,136 14.7
TT 4 205 1833 11.2
TT 5 114 2130 5.4
Total TT 2 in all categories 2,192 13,906 22.6
Immunization in Children
BCG 3,385 10,325 32.8
Protection at Birth for TT (PAB) 2,795 48,160 5.8
Polio 0 3,385 10,325 32.8
Polio 1 1069 12,409 8.6
Polio 2 718 11,854 6.1
Polio 3 726 13,121 5.5
PCV 1 957 11,989 8.0
PCV 2 751 11,183 6.7
PCV 3 716 11,438 6.3
DPT-HepB+Hib 1 858 12,357 6.9
DPT-HepB+Hib 2 725 12,158 6.0
DPT-HepB+Hib 3 729 13,450 5.4
Measles 650 12,987 5.0
Total Immunisation doses in Children 17,464 191,756 9.1
Total Family Planning attendances 1,846 16,265 11.3
Total ANC attendance 5.909 33,180 17.8
Deworming 12,165 151,797 8.0
Vitamin A Supplementation 1,928 56,059 3.4
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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For the immunisation programme the Hospital clearly has played a major role in the
HSD/District of Agago accounting for 32.8% of BCG, 18.2% of all TT2, 5.5% of Polio3, 5.4%
of DPT3, 5% of the Measles, and 6.3% of PCV3 doses administered in the HSD/District. In the
new FY 2014-2015 the Hospital has contributed in promotion of natural FP method attendances
by 11.3%.
HSD Function –Role of the Hospital as Headquarter of the HSD
Kalongo Hospital has the responsibility of heading Agago HSD. This responsibility implies,
among other, the following main tasks:
1. Coordination of the planning process for the yearly HSD Work plan.
2. Ensure proper utilisation of PHC-Conditional Grant allocated to the HSD
3. Coordination with all stakeholders in the health sector actively involved in the HSD.
4. Coordination of main health programme in support to the LLUs (EPI, TB control
Programme, Essential Drug Programme, etc).
5. Support supervision of LLUs.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER THREE
GOVERNANCE
The Board of Governors
The BoG is the supreme policy maker and controlling body of the Hospital and school, while the
Hospital Management is fully responsible for all operational aspects of the hospital and school.
The minimum number of Ordinary BoG meetings to be held in a year is two as enshrined in the
hospital Statute. In FY 2014-2015 the hospital held two ordinary and one extraordinary BoG
meeting.
The Statute enumerates key thematic committees that have to be in place and functioning
namely: Human Resources/Disciplinary Committee, Finance Committee, and School Committee.
The Board can appoint additional committees if need arises. Their role is to examine reports and
proposals from the Management in advance and to present comments and suggestions to the
Board during the plenary meetings. Although it is requested that each Committee meets at least
twice a year, it has been observed that this practice has not been followed regularly.
Table 3.1: Summary of BoG meeting held in FY 2014-2015
Dates of Board
meetings
Reports presented / Key issues handled / decision taken No of Members
present
25 April,2015 Extraordinary Meeting (Performance review &Forth coming
changes in key management of the hospital)
08/15
29 Jun,2015 Ordinary Meeting (Presentation of Budget Performance Report
2014-2015 and Annual Budget 2015-2016
10/15
23 Nov,2015 Ordinary Meeting (Presentation Faithfulness to the mission and
financial report 2014/2015)
11/15
The Board received and discussed the hospital management report that highlighted key issues
pertaining to the activities and challenges affecting the hospital and school. Furthermore the
report also highlighted successes and work in progress. Organisational and financial constraints
did not allow the Hospital Stakeholder Assembly for external accountability to be held.
Table 3.2: Functionality of the Board committees
Name of committee Required No. of No. of meetings Percent of required
Finance Committee 2 2 100%
School Committee 2 0 0%
Human Resources/ 2 0 0%
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Management
The Hospital Management Team headed by the Chief Executive Officer (CEO) is the body
responsible for decision making on all matters regarding the Hospital and the Training School.
The Hospital Management Team collectively shares the task of achieving the strategic objectives
and the specific targets decided by the Board of Governor. It is granted operational autonomy
within the scope of the Hospital strategic plans, approved policies, manuals and procedures. The
Hospital Management Team meets at least once every month.
The core members of the Hospital Management Team are:
1. The Chief Executive Officer
2. The Medical Director
3. The Administrator
4. The Senior Nursing Officer
5. The Principal Tutor of the School
6. The Human Resources Manager
7. The Coordinator of Public Health Department
Table 3.3: Frequency of HMT meetings 2014/2015
No of planned
Management
meeting
No. of Management
meeting held
Average No. of
members present
Reports / key issues handled
12 (one per
each month) 8 100
Minutes of each meeting were
prepared and circulated by the CEO.
The Hospital Management Meetings formally held were only 8, but less formal meetings have
been held with higher frequency throughout the year.
Statutory Commitments Compliance
The Hospital has been regularly complying with all statutory commitments set by Government,
MoH and UCMB as displayed in details in Table 3.4.
The Hospital satisfied the accreditation requirement established in the accreditation programme
2014-2015 for Hospitals of the Catholic Health Network. This accreditation entitles the Hospital
to the full range of services provided by UCMB for the period ending on 31st December 2016.
Internal regulatory documents
The Hospital has in place some important manuals/guidelines (Employment Manual and the
Financial & Material resources manual). Some of these documents though need to be reviewed.
However, there is need for improving the respect of norms and procedures set in these
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
14
documents even in their current forms. Management intends to at least start these revisions of the
aforementioned policy documents in the new FY 2015-2016.
Table 3.4: Statutory Commitments Compliance
No REQUIREMENT Did you achieve it?
Yes, Partly, No
Comment
Government / MOH Requirements
1 PAYE YES Regularly observed
2 NSSF YES Regularly observed
3 Local service tax YES Regularly observed
4 Annual operational licence YES Regularly observed
5 Practicing licence for staff YES Regularly observed
7 Monthly HMIS YES Regularly observed
UCMB statutory requirement
1 Analytical Report end of FY year YES Regularly observed
2 External Audit end of FY year YES Regularly observed
3 Charter (still valid) YES Finalised revised version
5 Contribution to UCMB for the year YES Regularly observed
6 HMIS 107 PLUS financial report / quality
indicators ending FY
YES Regularly observed
7 Report Status of staffing as of end of FY YES Regularly observed
8 Manual of Employment (still valid) YES Planned for next FY
9 Manual Financial Management (still valid) YES Needs a revision
10 Report on Undertakings & Actions of FY YES Regularly observed
Advocacy, lobby and negotiation
The Hospital has not yet developed a formal advocacy agenda; however, it has maintained
constant contacts with local leaders, international NGOs, and major donors according to the
need. It plans to set up a website in the next financial year 2015-2016.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER FOUR
HUMAN RESOURCE (STAFF)
Staff Establishment
During FY 2014-2015, there was a slight increment in the total number of employees especially
for the qualified staffs both clinical and not clinical staff.
Table 4.1: Total number of employees in the Hospital in the last 5 FYs
Category 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Clinical Qualified 86 100 88 97 108 Unqualified 35 19 28 26 18 Total Clinical 121 119 116 123 126
Not
Clinical
Qualified 16 13 32 41 86 Unqualified 82 81 72 48 27 Total Non-Clinical 98 95 104 89 113
Total Qualified 102 113 120 138 194 Total Unqualified 117 100 100 74 45 Grand Total 219 213 220 212 239
% of qualified clinical staff/ total staff 39.3% 46.9% 40.0% 45.8% 45%
N.B. Additional details on the staff composition are presented in Annex 4.
Most recruitment have been for nursing and clinical personnel (Nurses, Midwives, Clinical
Officers and Medical Officers) mainly replacement of those staffs that left the Hospital.
Turn-over among staff
The turn-over among enrolled cadres has been lower than the previous FY. The Hospital salary
scale and benefit packages are still not competitive with the ones offered by the Government and
this has contributed to the high attrition rate among employees. Other “internal” factors may also
have played a role (end of contract and personal interest for capacity building).
Table 4.2: Turn-over trends of key health personnel in the last 3 FYs
Cadres FY 2012-2013 FY 2013-2014 FY 2014-2015
Total staff 222 212 239 Enrolled cadres (all combined) 57 66 68 Turn-over for Enrolled cadres 98.3% 29.3% 19%
Table 4.3: Turn-over trends of key health personnel in the last 3 FYs
Cadres FY 2012-2013 FY2013-2014 FY2014-2015
Total staff 222 212 239
Total arrivals of key health personnel 64 40 48
Total departures of key health personnel 70 25 27
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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The turn-over in FY 2014-2015 was high compared to the previous FY, but it still denotes a
major difficulty the hospital faces in retaining its staff. Management has developed a new staff
training and development plan that is awaiting approval of the BoG to guide in retention of staff.
Management
The working hours for Administration and Technical Department employees are 40 per week.
Doctors, Nurses, Midwives and Nursing Assistants/Aides have 42 working hours per week. The
Hospital provides accommodation for a large proportion of its employees (56%) in houses
located in staff quarters within the Hospital premises. This housing facilitation includes also
availability of water and power supply (the latter when provided by PACMEC or by the Hospital
generator from 6.30 p.m. to 9.00 p.m.).
Salaries have been regularly paid before the end of every month. Statutory obligations are
regularly remitted (PAYE and NSSF) according to the current legislation.
Staffs are expected to elect their representative who coordinates with management through the
HRM office and facilitates the communication of requests, grievances, or other matters amongst
staff and to the Hospital Management.
Human resource development and career progression
The initiatives in the staff training and development plan include: provision of scholarship for
further studies, participation in workshops and short courses, organisation of CME sessions
within the Hospital.
The areas of main focus cover Maternal and Child Health, surgical services, administration,
Pharmacy, and the Midwifery School.
It is the intention of the Hospital to incorporate it within the 5-year Strategic Development Plan.
A programme for weekly sessions of CME is prepared by various departments of the Hospital
are encouraged to organise on rotation each session, with topics of relevance.
Table 4.4: List of Hospital Staff that attended courses in FY 2013-2014
Course attended Duration Institution
1 Master in General Surgery 3 yrs Completing in couple of mths Makerere University
2 Bachelor in Procurement and
Logistic Management
3 years Completing in the next
couple of months
Uganda Christian University
3 Bachelor in Nursing 3 years, on going Uganda Christian University
4 Diploma in Laboratory
Technology
2 years Completing in the next
couple of months
Nsambya School of Laboratory
5 Diploma in midwifery 2 years on going Kalongo Midwifery School
6 Diploma in Nursing 2 years - completed Lubaga School of Nursing & midwifery
7 Diploma in Midwifery 2 years completed Kalongo Midwifery School
8 Diploma in Clinical Mentoring 1 year completed Uganda Martyrs University
10 Diploma in Anaesthesia 2 years Lacor
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER FIVE
FINANCES
Dr Ambrosoli Memorial Hospital manages distinctly the finances of the School from the
finances of the Hospital and the financial statements are audited separately.
Table 5.1: Trend of Income by source over the last 5 years
Income over the Last 5 Years
FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
HOSPITAL
User Fees 199,655,029 277,428,212 320,211,091 399,799,594 429,341,811
PHC CG cash 495,182,241 455,045,373 494,261,142 494,379,756 506,731,434
Gov. donations
in kind
(Drug/Lab)
37,386,622 73,525,612 29,690,056 13,240,715 0
Other donations
in kind 126,226,392 323,937,510 852,245,261 1,019,614,218 1,091,058,978
Donations in
cash (including
project funding)
1,034,331,095 1,218,257,145 1,561,261,600 2,261,661,058 1,076,532,863
Others Financial
sources ( Deposit
Interests &
others)
60,164,680 100,706,070 56,767,272 119,265,960 82,600,220
Technical
Department 54,139,181 54,331,333 51,596,750 64,191,141 56,945,510
Sub-Total
Hospital 2,007,085,240 2,503,231,255 3,366,033,172 4,372,152,441 4,143,210,818
SCHOOL
Fees (private) 104,494,500 77,995,546 44,697,128 65,177,382 397,565,454
PHC CG School 56,843,759 49,083,184 58,935,060 56,468,241 55,634,813
Donations and
other income 244,933,341 303,496,320 341,583,977 355,379,665 138,908,527
Sub-Total
School 406,271,600 430,575,050 445,216,165 477,025,287 592,108,794
HSD
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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Income over the Last 5 Years
FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
HOSPITAL
Sub-Total HSD 98,343,106 90,772,200 98,669,600 98,668,800 12,356,576
Grand-Total 2,511,699,946 3,024,578,505 3,909,918,937 4,947,846,528 4,747,676,188
Table 5.2: Trend of Expenditure over the last 5 FYs
Expenditures over the Last 5 Years
Expenditure Item FY
2010-2011
FY
2011-2012
FY
2012-2013
FY
2013-2014
FY
2014-2015
HOSPITAL
Human Resource
cost 1,140,654,092 1,207,759,814 1,272,027,988 1,481,676,063
1,454,269,386
Administration 58,284,911 71,362,652 165,565,943 125,290,190 86,721,317
Medical goods and
supplies (included
drugs)
497,009,686 592,602,710 1,231,903,798 1,629,096,034
1,436,533,515
Non-medical goods
/ supplies 22,853,000 55,028,424 125,000,750 136,356,936
137,391,002
Property Costs 74,114,973 137,868,459 168,121,102 232,462,749 232,835,273
PHC 179,441,100 136,480,468 194,306,705 242,976,850 250,856,300
Transport & Plant
Costs 157,566,761 195,149,382 178,580,518 157,759,179
147,500,245
Capital
Development 0 0 0 112,542,651 42,812,692
Hospital Total
Expenditure 2,129,924,523 2,396,251,909 3,335,506,804 4,130,179,651 3,788,754,342
SCHOOL
Employment 124,229,697 170,609,669 180,326,141 204,087,584 204,361,178
Administration 59,141,420 48,646,463 78,195,938 78,545,960 77,132,419
Students costs 95,855,847 145,231,270 133,043,554 112,017,153 138,916472
Transport &
Travelling
23,147,484 34,161,377 59,511,250 41,110,050 34,442,227
Property, Supplies,
Services
8,414,198 28,405,798 17,737,723 7,061,219 12,821,329
Capital
Development
School Total 310,788,646 427,054,577 468,814,606 442,821,965 467,673,625
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
19
Expenditure
HSD
HSD Total
Expenditures 98,343,106 90,772,200 98,669,600 98,668,800 12,456,576
Grand Total 2,539,056,275 2,914,078,686 3,902,991,010 4,671,670,416 4,241,686,664
• The expected income for the hospital for the year was 4,244,039,944/=, the hospital was
though able to realise 4,143,210,818 (2.4% above expected amount).This was mainly
attributed to some additional donation received and an extension from NU Health funds.
• Major donors like NU-Health have come to an end. Attracting new donors has become
increasingly challenging.
• Government PHC Conditional Grants has been received promptly and consistently in full
for all the quarters.
• The fact that PHCCG has been disbursed every year for more than a dozen years, nothing
has been done towards incrementing.
• Income from user fees has increased from about 399,799,594 million to expectedly
429,341,811million (+7.4%). Fees are still very low; there is consideration for review and
possible adjustment next financial year.
• The no cost extension of the ACT project significantly affected service delivery
Table 5.3: Trend of Average user fees by department in the last 5 years (2010-2011to 2014-2015)
Average Fees
FY 2010-
2011
FY 2011-2012 FY 2012-
2013
FY 2013-2014 FY 2014-2015
OPD Adult Male 5,000 6,854 7,783 9,400 11,317
OPD Adult Female 5,000 6,854 7,783 9,400 11,317
OPD Children < 5yrs 1,000 1,583 1,885 3,300 3,499
OPD Children 5-13
yrs 1,000 1,583 3,750 4,800
6,507
IP Medical Male 24,400 23,611 20,860 18,868 25,149
IP Medical Female 23,400 22,511 20,860 18,868 24,276
IP Maternity 10,400 11,925 15,113 17,368 18,351
IP Paediatric < 5 yrs 3,500 4,212 4,821 6,343 8,300
IP Paediatric 5-13 yrs 3,500 4,212 4,821 6,343 8,300
IP Surgical Ward 30,400 25,350 25,832 27,689 19,306
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
20
Fig. 5.1: Average user fee applied per SUO-OP in the last 5 FYs
977
1,282 1,283
1,550
1,757
-
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
The indicator Fee/SUO-OP has increased by 13.4%. For last 4 years this indicator has been
increasing however the user fees in Kalongo Hospital still very low among the PNFP in UCMB
network.
Table 5.4: Trend of Cost Recovery from Fees in the last 5FYs
FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
Total User fees (a) 199,655,029 277,428,212 320,211,091 399,799,594 429,341,811
Total Recurrent
Expenditure (b) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,367,000 3,788,754,342
Cost Recovery Rate
= (a/b)x100 9.4% 11.6% 9.9% 10.0%
11.3%
The current cost recovery from fees collection has increased by 1.5% of all recurrent
expenditures. The recovery rate of 11.3% is still very low the target is to attain 30% in the next 3
to 5 years. There is need to revise the user fees in order to meet that target but this will be done
cautiously so us not to marginalised the vulnerable groups. The hospital will in the nest year
organise a stake holders meeting to highlight among other issues of sustainability and costs of
services.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
21
Table 5.5: Trend of indicators of efficiency in use of financial resources
Indicator FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
Cost per bed 5,999,787 7,934,609 10,670,321 13,303,434 13,823,032
Cost per IP/day 29,318 38,438 43,339 51,588 55,668
Cost/SUOop 10,426 11,069 12,912 15,571 15,333
(NB: Total SUOop = Total OP + 15*IP + 5*Deliveries + 0.5*Total ANC + 0.2*Total Immunisation) Source:
UCMB
The hospital economic efficiency has improved slightly by 1.5% because the cost of producing
one SUO has decreased from UGX 15,571 to 15,333 but the cost of treating one in- patient per
day has increased by 0.2%.
Table 5.6: Trend of sustainability ratio of the hospital in absence of both donors and PHC
CG funding in the last 5 years
Without PHC CG FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
Total Local
Revenues (a) 313,958,880 432,465,615 428,575,113 583,256,695
568,878,543
Total Recurrent
Expenditures (b) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,637,000 3,745,941,650
Sustainability
Ratio = (a/b)x100 14.7% 18.1% 13.3% 14.5% 15.1%
Table 5.7: Trend of sustainability ratio of the hospital in absence of donor funding but with
PHC CG in the last 5 FYs
(Local Revenues refers to “in-country funding” and therefore includes user fees, PHC CG,
Local Govt contributions, IGAs, etc)
FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
Total Local
Revenues (c) 846,527,743 961,036,600 952,526,311 1,090,877,166
1,075,609,977
Total Recurrent
Expenditures (d) 2,129,924,523 2,396,251,909 3,222,436,875 4,017,637,000 3,745,941,650
Sustainability
Ratio = (c/d)x100 39.7% 40.1% 29.6% 27.2% 28.7%
Internal Audit Since May 2012 the position of Internal Auditor in the Hospital has remained vacant. The
hospital has sent out an advert in one of Uganda Newspaper- the Daily Monitor for position of
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
22
Internal Auditor. We have received some applications which shall be shortlisted with the help of
a qualified technical person and interviews will be held in the within the shortest possible time.
External Audit Every FY the Hospital has an external audit conducted and the resulting Financial Statement and
Management Letter are presented for final approval to the Board of Governors (after in depth
analysis by the BoG Finance Committee). The hospital financial statement for the year 2014-
2015 has been audited by Thonna Associates Certified Accountants based in Kampala.
Procurement Currently the staff who was sponsored for bachelor course in procurement and logistics has
finished his study and he is working in the hospital there is need to make a procurement policy
and form a committee for procurement in order to strengthen this department by the beginning of
FY 2015-2016.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
23
CHAPTER SIX
SERVICES
Currently the hospital offers the following
services:
Obstetrics & Gynecology Services
• Antenatal, Delivery & Postnatal care
• Prevention of Mother to Child
Transmission of HIV
• Emergency Obstetric and Neonatal care
• General and Specialized Obstetric and
Gynecologic Surgery
General Surgical Services
• Trauma and Emergency care
• Surgical Clinic
• Minor Orthopedics services
• Burns care
• Specialized Surgical Camps
• Anesthesia
• General surgical operations
Internal Medical Care
• HIV Care and Treatment
• General Adult Out-patient Clinic
• Private Out-patient Clinic
• Emergency medical care
• Electro Cardiogram(ECG)
• Medical Admissions and care
• TB Detection and treatment
• Communicable and Non-communicable
disease care and prevention.
Pediatrics & Child Health
• Young child clinic
• Malnutrition Therapeutic feeding.
• Neonatal intensive care
• Pediatric admissions and care.
• Immunization and health promotion
Community Health
• Health promotion out reaches.
• Immunization
• Health education
• Primary Health Care.
Health Training
• Midwifery training
• Internship for Medical Officers is
currently suspended but shall be
reintroduced soon. However, medical
students are given opportunity to learn
and practice under supervision of senior
medical officers and specialist.
• Opportunities also provided to other
cadres like Clinical Officers, Pharmacy,
Nurses, Midwives and laboratory
students for attachment during holidays;
guidance is usually under a senior staff
in the area of discipline.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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A. GENERAL OUT PATIENT DEPARTMENT (OPD)
The Hospital runs a General Outpatient Department which is also the main entrance. The OPD
operates six days a week from Monday to Saturday from 8.00 am to 5.00pm excluding Sundays
and Public Holidays.
OPD Staffing Level The staffing composition of OPD consists of Clinical Staff; Nurse Staff and Non-medical staff.
The Nursing staffs works in shift i.e. morning hours from 8:00 am to 3:00 PM. Those coming
for evening starts at Midday to 5: 00 pm but some time they extend up to 6:00pm depending on
the number of patients in OPD on that day. However, the hospital is planning to expand the
working hours in OPD because in several occasion patients who delay to receive their result
from laboratory end up returning home without receiving treatment. The clinical officers are
available in OPD from 9.00 am to 5.00pm every working day. There is need to employ an
additional clinical officer who will be covering the evening duty to reduce delay in accessing
care and work load. The clinical Officers are still the main Medical personnel who review
patients in the OPD.
The presence and support of Medical Officer in OPD is limited due to few numbers of Medical
Doctors at the Hospital to cover the wards and OPD. The OPD has not yet attained the optimal
staffing level as required by the MOH due to lack of personnel in departments such as Dental,
Psychiatric, Ophthalmic and ENT Officers. The hospital still faces difficulty in finding and
attracting such cadres.
For next financial year the hospital is planning to introduce the Diabetes, Cardiovascular, Sickle
cell, mental health and cervical cancer clinics at least two times a week.
Table 6.1: The staff composition in OPD in the FY 2013/14 and FY 2014/2015
Cadre/ Discipline Qualification 2013/2014 2014/2015
Clinical officers Diploma in clinical medicine 4 4
Double Trained Nurse/Midwife Diploma in Nursing / Midwifery 2 1
Enrolled Midwife Certificate of Enrolment 1 2
Enrolled Nurse Certificate of Enrolment 3 2
Enrolled Comprehensive Nurse Certificate of Enrolment 6 1
Nursing Assistant Certificate 2 3
Cashier On job training 2 3
Nursing Aide Trained on Job 1 1
The staffing level in OPD dropped from 21 in FY 2013/2014 to 17 in FY 2014/2015 due to
increased staff attrition especially among qualified Health workers.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
25
The clinical officers in OPD run Minor theatre for minor surgical under local anaesthesia,
including safe male circumcision. The investigation from OPD is done in collaboration with
other support service departments like X-ray, Ultrasound, Laboratory and others during the
investigation and diagnosis of patients’ complaints. The OPD has a functional Ultrasound
machine which operates from 8.00am to 5.00pm from Monday to Friday; while on Weekends
and Public holidays, the ultrasound in Maternity can be accessed on request by clinicians for
emergency cases only. The Laboratory is open 24 hours a day and on weekends and Public
holidays, while the X-ray is open from 8.00am - 5.00pm from Monday to Saturday excluding
Sundays and Public holidays.
OPD activities
During the FY 2014/2015, the Hospital registered a drop in OPD utilization with new OPD
attendance falling from 25,322 in FY 2013/2014 to 21, 761 (decrease of 14 % compared to the
previous FY). The Re-attendances also dropped from 3,884 in FY 2013/2014 to 3,765 (decrease of
3% compared to the previous FY). The downward trend in OPD Utilization in the Hospital is similar
to that experienced by the Lower health facilities in Health Sub District (decrease of 8% from
previous FY).
The spontaneous drop in OPD utilization in the Hospital and in the Lower Health facilities in the
HSD cannot be pointed out to a single factor. This requires a careful study to justify the decline.
Table 6.2 Trend Out-patient Attendance by gender & age group -FYs 2010/2011 to 2014/2015
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
FEMALE New
Attendance
0-4 yrs 2,744 2,321 3,068 3,217 2,642
5 yrs and Over 8,165 7,385 8,751 12,134 10,690
Re-attendance 0-4 yrs 470 346 375 212 122
5 yrs and Over 1,528 3,612 5,365 1,646 1,511
MALE New
Attendance
0-4 yrs 3,030 2,495 3,606 3,492 3,188
5 yrs and Over 5,486 4,568 5,913 6,479 5,311
Re-attendance 0-4 yrs 541 350 348 203 161
5 yrs and Over 1,132 2,637 3,799 1,823 1.971
All New Attendances 19,425 16,769
21,338 25,322 21,761
All Re-attendances 3,671 6,945
9,887 3,884 3,765
All attendances (new + re-attendances) 23,096 23,714
31,225 29,206 25,526
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
26
Fig 6.1: Trend of OPD attendance for the last 5 FYs
Fig. 6.2: Total OPD Attendances by Age Group
The disaggregated data of OPD attendance during FY 2014/2015 by gender shows that females
registered higher number of new OPD attendance (60% of New OPD attendance). The
dominance of new OPD attendance by female has been a continuous trend over the past years.
There is no significant dominance of re-attendance by either gender during the FY 2014/2015.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
27
Fig. 6.3: proportion of OPD new visits to total OPD attendance
In the last two FYs, the total OPD attendances showed a progressive drop from 31,225 in FY
2012/2013 to 29,206 in FY 2013/2014 to 25,526 in FY 2014/2015(a decrement of 6.4 % in FY
2013/2014 and 12 % in FY 2014/2015 respectively). This drop may be interpreted as the
consequence of the reduction of malaria incidence that was one of the main causes for the seasonal
increment of attendances in the OPD and the strengthening of the Lower health units in the District
where Patients can now access a considerable proportion of primary health services care nearer to
them.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
28
Fig. 6.4 (a): Trend of OPD 1st Visits in the last
FY
Fig. 6.4 (b): Trend of OPD 1
st Visits in the last 2 FYs
During FY 2014/2015 the OPD monthly attendances showed a more stable trend with irregular
fluctuations, except for the last quarter of the Financial Year when the District started experiencing
Malaria Outbreak. In past three FYs, OPD monthly attendances showed a characteristic of seasonal
variation with a sharp increase in the months of May to July and slower decrement from August to
October and a kind of plateau in the remaining months.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
29
Table 6.3 Top ten diagnoses in OPD in the last three FYs (Source: HMIS 105)
Top 10 lists of OPD diagnoses FY 2012/2013 FY2013/2014 FY 2014/2015
No. % No. % No. %
01 RTI (excluded pneumonia) 4,355 13.5 4,316 14.3 3,562 14.3
02 Gastro-Intestinal Disorders (non-Infective) 3,081 9.6 2,354 7.8 2,255 9.0
03 All Injuries (any cause) 1,215 3.8 2,698 8.9 2,304 9.2
04 Malaria 3,609 11.2 1,908 6.3 957 3.8
05 Urinary Tract Infections (UTI) 1,063 3.3 1,286 4.3 993 3.9
06 Skin Diseases 1,234 3.8 1,020 3.4 869 3.5
07 Acute diarrhoea 264 0.8 992 3.3 1,020 4.1
08 Pneumonia 725 2.3 907 3.0 798 3.2
09 Typhoid fever 83 0.3 893 3.0 352 1.4
10 Eye conditions 741 2.3 688 2.3 399 1.6
11 All other diagnoses 15,778 49.1 13,167 43.6 11,450 45.9
Total diagnoses 32,158 100.0 30,229 100.0 24,959 100.0
Fig. 6.5: Top ten Diagnosis in OPD in the last 3 FYs
NOTE:
1. Top 10 Diagnosis contributed 54.8 % of Total OPD Diagnosis in 2012 – 2013
2. Top 10 Diagnosis contributed 56.4 % of Total OPD Diagnosis in 2013 – 2014
3. Top 10 Diagnosis contributed 54.1 % of Total OPD Diagnosis in 2014 – 2015
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
30
Major constraints observed in OPD
• Working hours, availability of staff and organizational set-up do not always allow provision
of quick service. Too often the waiting time is excessive (see further detail in Chapter 8).
• Due to the heavy workload in the Wards, Medical Officers seldom appear in the OPD except
in emergency situations. This inhibits the possibility to provide clinical guidance and support
to the Clinical Officers.
• Medical equipment for clinical examination is not enough or, at times, not in working
conditions.
B. SPECIALIST OPD CLINICS
1. Ante Natal Clinic (ANC)
Ante Natal Clinic (ANC) is an Outpatient Clinic which provides specialized services to pregnant
women and their unborn children and Non-pregnant women of child bearing age. ANC is open and
operational 5 days a week from Monday to Friday from 8.00 am – 5.00pm. The Clinic is closed on
Saturdays, Sundays and all Public holidays. ANC is autonomous from the General OPD and is hosted
in the same building with eMTCT Care point, Natural family Planning Clinic, HCT clinic and a
minor laboratory. These Clinics provide wide range of services to clients yet the rooms available are
clearly not sufficient for all these activities and, as a norm, are quite congested.
The structure was remodeled by breaking rooms to create space for additional services like
counseling, Cervical Cancer Screening, Baby-mother Care point and Natural Family Planning Clinic.
This endeavor provided a temporary space for offering quality care to the patients. With availability
of funding, the entire area needs to be re-designed and improved to provide adequate working space
and waiting shelter for the pregnant mothers attending the clinic.
ANC staffing level
The staff working in the ANC includes 8 Midwives who are also responsible for the running of the
Young Child Clinic and PMTCT programme. The Clinic lost 2 midwives who joined local
government. This gap is not filled considering the fact there are other departments like Maternity
which was hit more by staff attrition during the FY. Considering the ever high numbers of ANC
attendances in the Hospital, the available midwives in ANC are certainly not enough to cover the
current number of attendances hence the need for future plans for further expansion of these services.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
31
Table 6.4 Antenatal and Postnatal indicators during the last three FYs
Indicators 2011-2012 2012-2013 2013-2014 2014-2015
ANTENATAL
A1-ANC 1st Visit 2,958 2,290 2,033 1,817
A2-ANC 4th Visit 1,235 1,199 1,249 1,217
A3- Total ANC visits new clients + Re-attendances 7,936 5,312 6,664 5,909
A4-ANC Referrals to unit n.a. 11 2 0
A5-ANC Referrals from unit n.a. 1 0 0
POSTNATAL P1-Post Natal Attendances 2,805 2,473 1,890 847
P2-Number of HIV + mothers followed in PNC 190 19 77 25
P3-Vitamin A supplementation 2,805 2,351 1,367 847
P4-Clients with premalignant conditions for breast n.a. 0 0 0
P5 Clients with premalignant conditions for cervix n.a. 0 0 0
Fig.6.6: ANC visits in last 3 FYs from FY 2011/2013 to 2014/2015
The decreasing trend in the number of ANC 1stvisit and subsequently ANC total Visit (New ANC +
Re-attendance) in the Hospital has progressively continued over the last 3 FYs. In FY 2014/2015, the
number of ANC 1st Visit dropped by 10.6%, while the Total ANC attendance also dropped by 11.3%.
This can possibly be explained by the fact that LLUs are also providing ANC services and may
represent a more convenient location for many mothers. However, the re-attendances have
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
32
substantially remained stable. This reaffirms the fact that some pregnant women who begin ANC
visit in the LLUs usually complete their ANC visit at the Hospital. This can be attributed to the good
response and other additional service provided by the Hospital such as Ultrasound scans, Waiting
Shelters for pregnant mothers amongst others.
2. HIV / AIDS Clinic
HIV/AIDS services in Kalongo Hospital are managed under the umbrella of the ACT Programme
(Aids Care & Treatment) funded by CDC through Uganda Episcopal Conference and UCMB. These
services were initiated in November 2005 and are substantially integrated into the Hospital services.
The Programme provides comprehensive HIV/AIDS care which includes Antiretroviral Therapy,
Prophylaxis for and Treatment of Opportunistic Infections, HIV Counseling and Testing, VCT,
eMTCT, and a Community Programme.
All these activities are located in two nearby but distinct areas: HIV Counseling and Testing and
PMTCT services are run within the ANC building, while all the other activities (ART and
Community and Outreaches Programme) are managed in a separate nearby building.
The HIV/AIDS program is headed by a Medical Doctor who coordinates the activities of the Clinic.
The personnel involved in the project activities in FY 2014-2015 included; 1 Medical Doctor, 1
Clinical Officer, 4 Support staffs, 4 counselors, 1 driver, 3 Information system staffs, 5
Nurses/Midwives, 1 community coordinator, 2 laboratory staffs, 3 Pharmacy staffs and 40
community health volunteers.
The Clinic registers an ever expanding number of HIV Clients every year. This is due to high
number of new HIV/AIDS infection and the increasing number of patients transferred from other
facilities. The new additions into HIV/AIDS care program of the Hospital imply an increased
demand for HIV/AIDS service which is not commensurate with the resources available.
The Clinic is located in a temporary structure used for dispensing drugs, nursing care,
counselling, clinical consultation, storage of files; and Data entry & Information Management.
The eMTCT component of HIV/AIDS services is provided in a distinct area adjacent to the
clinic. The Clients hardly have waiting space since the movable tent provided cannot provide
safe cover against rain and sunshine during clinic days.
During the first half of FY 2014/2015, the activities of the HIV/AIDS clinic was greatly affected
by the No-Cost extension instituted by CDC in late 2013/2014 FY due to change in the financial
year. This limited the capacity of the project to finance and run crucial programs such as PMTCT
follow up, HCT, EID sample collection and salaries of some staffs.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
33
Activities which are offered under HIV/AIDS program includes:
a) HCT / VCT HCT/VCT is one of the strategies to fight HIV/AIDS. It seek to provide free access to HIV
Counseling & testing. It is also referred to as voluntary Counseling & testing. HCT/VCT services are
hosted in a structure adjacent to ART Clinic and under one roof with ANC and eMTCT programme.
Table 6.5 HIV/AIDS COUNSELING AND TESTING (HCT) DURING FY 2014/2015
Category
No of
individuals
No of
individual
No of
Individual
No of
individual
No of
Individuals
Total
0- <2 yrs 2 - <5 yrs 5- <15 yrs 15 – 49 yrs >49 yrs
M F M F M F M F M F
Number of Individuals counseled
16 30 854 1,427 17 42 2,386
Number of Individuals tested 16 14 18 22 18 30 858 1,435 17 43 2,471
Number of Individuals who received
HIV test results 15 14 18 22 18 30 854 1,427 17 43 2,458
Number of Individuals who tested
HIV positive - 1 1 1 3 - 40 84 3 1 134
H IV positive individuals with
suspected TB - - - - - - 7 9 - 1 17
HIV positive cases started on
Cotrimoxazole preventive therapy
(CPT)
- 2 1 1 2 - 46 85 2 - 139
Number of Individuals tested twice
or more in the last 12 months (re-
testers)
9 5 10 13 9 12 551 928 4 27 1,568
Counseled and tested together as
couple 722
Counseled and received results
together as couple 668
Concordant positive couple
26
Discordant couples
8
Individuals counseled and tested for
PEP -
2
2 1 10 3 1
19
Safe male Circumcision -
-
205
62
-
267
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
34
Table 6.6 Trend of HCT/VCT results in the last 5 FYs
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Number Tested
Male 3,323 1,031 1,095 1,632
927
Female 4,098 1,484 1,679 1,886
1544
TOTAL (Tested) 7,421 2,515 2,774 3,518
2,471
Tested +ve for HIV
Male 273 123 78 118
47
Female 298 166 117 138
87
TOTAL (+ve Tests) 571 289 195 256
134
Positivity Rates of HCT
Male 8.2% 12.0% 7.1% 7.2%
5.1%
Female 7.3% 11.2% 7.0% 7.3%
5.6%
Both sexes 7.7% 11.5% 7.0% 7.3%
5.4%
Fig.6.7: Trend of HIV positivity in HCT/VCT Clinic by gender
The trend of HIV positivity among HCT/VCT clients has continued to decline. The
disaggregation of the HIV Positive test results by gender shows that Females have the higher
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
35
number of positive test results than their male counterparts. This can be explained to the fact that
more females access HCT/VCT services than the males.
However, with the emergence of new strategies like Provider Initiated Testing & Counselling
(PITC), Rapid Testing & Counselling (RCT), Mandatory HIV testing in ANC and Maternity for
elimination of Mothers to Child Transmission (eMTCT), pre-operative HIV counselling &
testing during Safe Male circumcision (SMC), at total of 11,882 clients accessed HIV
Counselling & testing services during FY 2014/2014.
Table 6.7 HIV test by purpose during FY 2014/2015
Types of test HCT SMC PITC PMTC
T
Clinical Diagnosis
(RCT) Total
Number of clients tested for HIV 2,471 267 3,088 3,945 2,111 11,882
No. of HIV +ve tests 134 6 175 232 230 777
Positivity Rate (%) 5.4% 2.2% 5.7% 5.9% 10.8% 6.5% NB: The above figure are for total test done purely for HIV screening & excludes quality control tests done during the FY
2014/2015.
The general HIV positivity rate in FY 2014/2015 in the hospital stands at 6.5 % and at 5.4% in
HCT/VCT clinic alone. This represents a 47.6 % drop in the number of HIV positive test (from
256 in FY 2013/2014 to 134 in 2014/2015) in HCT/VCT clinic alone. The SMC program that
also helped to beef up the numbers of tests has been is not funded due to unavailability of funds.
b) PMTCT services in 2014-2015 FY
Table 6.8 Performance Indicators of the PMTCT Programme in FY 2014-2015
A. Antenatal No.
A1. Mothers re-tested later in pregnancy, labour or postpartum 716
A2. Mothers testing positive on a retest 9
A3. New pregnant and lactating mothers newly enrolled into psychosocial support groups. 59
A4. HIV positive pregnant women already on HAART before 1st ANC visit /Current
pregnancy 57
A5. Pregnant women who received services at the health facility after referral from the
community 0
A6. HIV (+) lactating mothers followed up in community for infant feeding, early infant
diagnosis, or linkage into chronic care 361
A7. HIV positive Pregnant women initiated on Cotrimoxazole 79
A8a. Mothers assessed using CD4 0
A8b. Mothers assessed using WHO clinical staging only 74
A9a. HIV + pregnant women initiated on HART (Option B+) for EMTCT - CD4 >350 or
Stage I and 1I (ART-T) 49
A9b. HIV + pregnant women initiated on HART (Option B+) for EMTCT - CD4 <350 or
Stage III and IV(ART-T) 0
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
36
B. Maternity No.
B1. HIV positive deliveries initiating ARVs in Labour 0
C. Postnatal No.
C1. Postnatal mothers newly tested for HIV 135
C2. Postnatal mothers testing HIV positive 32
C3. Postnatal mothers initiating ARVs in PNC period 1
D. Early Infant Diagnosis (EID) No.
D1. HIV-exposed infants (<18 months) getting a 2nd DNA PCR 185
D2. HIV-exposed infants initiated on Cotrimoxazole prophylaxis 178
D3a. 1st DNA PCR results returned from lab within 2 weeks of dispatch 131
D3b. 2nd DNA PCR results returned from lab within 2 weeks of dispatch 219
D4a. Total HIV-exposed infants who had a serological/rapid HIV test at 18 months or older. 189
D4b. Positive Number of HIV-exposed infants who had a serological/rapid HIV test at 18
months or older 0
D5. DNA PCR results returned from the lab that are positive 10
D6. HIV-exposed infants whose DNA PCR results were given to caregiver 211
D7. Number of referred HIV positive-infants who enrolled in care at an ART clinic 10
c) Antiretroviral therapy Table 6.9 PHAs eligible for ART and started on ART by age group and gender in the last 5 FYs
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
ELIGIBLE FOR ART
Male <5 yrs 1 2 0 2 0
5-<18 yrs 5 4 1 5 0
18 and above 87 20 24 102 20
Female <5 yrs 1 1 0 0 0
5-<18 yrs 7 3 0 1 0
18 and above 96 26 21 71 15
TOTAL ELIGIBLE FOR ART 197 56 46 181 35
STARTED ON ART
Male <5 yrs 7 11 7 18 4
5-<18 yrs 2 9 5 15 7
18 and above 76 112 117 142 108
Female <5 yrs 8 7 9 15 5
5<18 yrs 7 3 7 25 4
18 and above 105 140 268 282 169
TOTAL STARTED ON ART 205 282 413 497 297
ART Clinic operates as an outpatient clinic from Monday – Friday, 8.00am to 5.00pm excluding
weekends and all public holidays. ART (including ARVs, Counselling, HAART, Clinical care)
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
37
services are offered in the clinic. The number of patients started on ART dropped by 40% from
497 in FY 2013/2014 to 297 in FY 2014/2105. This is due to opening of ART sites in all the
eight HC IIIs in the District. The opening of the ART sites in the HC IIIs provided convenience
to patients in and around the areas served by these Health units.
The number of patients eligible for ART significantly reduced from 181 in FY 2013/2014 to only
35 in FY 2014/2015 due to improvement in timeliness in ART enrolment for all clients due for
ART.
Besides ART services, ACT project also runs community programs which includes:
a) Training of youths on life skills where abstinence is advocated for;
b) Training of married couples on being faithful in their marriages;
c) Adherence monitoring through home visits;
d) Community meetings for health talks;
e) Support to the orphans and vulnerable children (OVCs) which includes Educational support,
economic empowerment through IGA and apprentice trainings amongst others.
f) Gender Based Violence (GBV) support services to victims of GBV
g) Food security & livelihood support to PLWHA, especially to infected & affected Children.
Table 6.10 Number of PLHAs started on ARV by age group and gender in FY 2014/2015
CATEGORY NO. OF
INDIVIDUA
LS <
2YEARS
NO. OF
INDIVIDU
ALS
NO. OF
INDIVIDU
ALS 5-14
YEARS
NO. OF
INDIVIDUAL
S
TOTA
L
M F M F M F M F
NUMBER OF NEW PATIENTS
ENROLLED IN HIV CARE AT THIS
1 3 3 2 6 2 78 122 217
NUMBER OF PREGNANT WOMEN
ENROLLED INTO CARE DURING
0 49 49
CUMULATIVE NUMBER OF
INDIVIDUALS ON ART EVER
ENROLLED IN HIV CARE AT THIS
2 5 29 25 83 81 833 1,530 2,688
NUMBER OF HIV POSITIVE
PATIENTS ACTIVE ON PRE-ART
0 0 0 0 0 0 57 86 143
NUMBER OF HIV POSITIVE CASES
WHO RECEIVED CPT/DAPSON AT
LAST VISIT IN THE YEAR
3 5 24 18 68 71 713 1,305 2,236
NUMBER ELIGIBLE PATIENTS NOT
STARTED ON ART
0 0 0 0 0 0 20 15 35
NUMBER OF NEW PATIENTS
STARTED ON ART AT THIS FACILITY
1 3 3 2 6 4 109 169 297
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
38
3. ORTHOPAEDIC SERVICES
Currently the hospital is offering limited orthopaedic services due to lack of orthopaedic surgeon,
however the minor orthopaedic services is done by the orthopaedic officer, the main procedure
is the reduction of closed fracture and Physiotherapy, in several occasion the open fracture are
always referred to the specialised hospital.
Table 6.11 Main procedures in orthopaedics and physiotherapy done in the last 4 FYs
Procedures FY2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
1 Plaster (POP) 497 565 582 622
2 Physiotherapy 43 83 106 72
4. TUBERCULOSIS CLINIC
The Hospital runs a TB Clinic where TB patients are registered and given their treatment and
followed up. The management and running of TB Clinic is merged into Medical ward, though
the ward is located in a separate structure next to Medical ward. The staffs of Medical ward are
responsible for the treatment, management, follow up and reporting of Patients admitted in TB
ward.
All TB patients, once diagnosed, are admitted in the Hospital TB Ward for at least the first phase
of intense treatment or as long as general conditions allow them to go back home and come to
NUMBER OF PREGNANT WOMEN
STARTED ON ART AT THIS FACILITY
0 49 49
NUMBER OF HIV POSITIVE
PATIENTS ASSESSED FOR TB AT
4 2 11 9 31 37 312 657 1,063
NUMBER OF HIV POSITIVE
PATIENTS STARTED ON TB
2 0 0 0 1 1 38 13 55
NET CURRENT COHORT OF PEOPLE
ON ART IN THE COHORT
0 0 3 0 1 0 24 36 64
NUMBER OF CLIENTS SURVIVING
ON ART IN THE COHORT
COMPLETING, 12 MONTHS ON
0 0 2 0 0 1 8 10 21
NUMBER OF PEOPLE ACCESSING
ARVS FOR PEP
0 0 0 1 4 4 1 0 10
NUMBER OF INDIVIDUAL ON ART
FIRST LINE
3 5 24 18 66 69 627 1,193 2,005
NUMBER OF INDIVIDUAL ON ART
SECOND LINE
0 0 0 0 2 2 29 55 88
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
39
receive their treatment for the continuation phase. But for patients whose conditions allow and
who live at a short distance from the Hospital shorter period of admission is requested.
In a bid to enforce TB/HIV co-infection management policies, all TB patients were tested for
HIV. A total of 35 TB patients tested HIV positive and; 47 came with known HIV positive
results during FY 2014/2015. This put HIV positivity rate in TB clinic at 44% during FY
2014/2015.
The detection rate of new smear positive pulmonary cases diagnosed and/or referred to the
Hospital (the hospital catchment area, entire district of in Agago & neighboring district) was at
120% for FY 2014-2015. However, if this analysis is restricted to cases whose provenance is
Parabongo Sub County and Kalongo Town (the hospital catchment area), and then the actual
detection rate falls very low to 30% and far below the target of 70%.
Table 6.12 TB patients registered for treatment in the FYs 2011/12 to 2014/15
2011-12 2012-13 2013-14 2014-2015
No. of patients registered (all) 258 260 252 186
Children (< 5 yr.) 10 1 0 0
Disaggregation by Disease classification
New Pulmonary Positive 73 123 89 97
Relapses Pulmonary Positive 4 5 6 4
Failure Pulmonary Positive 7 2 7 8
Default Pulmonary Positive 9 21 17 9
New pulmonary Negative 141 53 91 26
Relapses Pulmonary Negative 4 7 3 4
Default Pulmonary Negative 3 15 6 4
Pulmonary no smear done n.a. 6 0 0
Extra Pulmonary 17 28 33 0
Disaggregation by Treatment Category
New Patients 231 208 213 161
Re-treatment 27 52 39 25
Other Patients
Transferred in 5 6 2 0
During FY 2014/2015, a total of 27 samples for Gene-expert were collected from the LHUs and
the hospital for MDR screening. Of these, 9 samples tested positive for TB with no Resistance;
and 4 tested Positive for resistance to Rifampicin and referred to Kit gum Referral Hospital for
Management. The Hospital does not have the facility to provide treatment to MDR patient; and
as required by the National TB control program.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
40
Table 6.13 MDR/MTB Diagnosis during 2014/2015
Age group Samples
Collected
Samples
Tested
MTB
positive
Cases
MDR positive
(Rifumpicin
Resistant TB)
MDR cases
referred
< 15 years 04 04 0 0 0
15 yrs& above 23 23 9 4 4
Total 27 27 9 4 4
TB Treatment Outcome
Following the National TB Leprosy Program reporting system, the table below show treatment
outcome of TB patient registered and enrolled for TB treatment 12 months back. The success
rate of treatment (No. of cured and completed treatment over the total of diagnoses) calculated
for all the patients registered for treatment in FY 2013-2014 and reported in FY 2014-2015 was
only 36% (against 48.1% of the previous FY).
The success rate among new smear positive pulmonary cases diagnosed in the same period is
40% (against 45.5% in previous FY). This is less than target success rate of 85% required
attaining a meaningful control of the disease.
Table 6.14 Results of TB treatment of all TB patients reported in the last 4 FYs
Outcome of treatment 2011-12 2012-13 2013-14 2014-2015
No. No. No. No. %
Cured 17 22 52 32 12.7
Treatment Completed 88 67 73 59 23.4
Died 5 15 11 15 5.9
Failure 0 2 4 2 0.8
Defaulted 165 123 66 100 39.7
Transfer out 7 29 54 44 17.5
Total 282 258 260 252 100
Table 6.15 Results of TB treatment of cohorts of Smear positive Pulmonary TB patients reported in the last 4
FYs (diagnosed and registered for treatment in the 4 previous respective FYs)
Outcome of treatment 2011-2012 2012-2013 2013-2014 2014-2015
Cured 17 18 39 28
Treatment Completed 41 13 17 17
Died 2 6 5 8
Failure 0 2 4 2
Defaulted 48 27 32 42
Transfer out 1 7 26 22
Total 109 73 123 119
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
41
The number of treatment defaulters has remained high at 39.7% among TB patients registered in
FY 2013/2014 (against 25 % in the previous FY 2012/2013). The Hospital adopted a stringent
criterion for assessing outcome of treatment based on completeness of documentation in the TB
register. This explains why we report a high number of defaulters.
5. MENTAL HEALTH CLINIC
Mental Health Clinic in Dr. Ambrosoli Memorial Hospital -Kalongo is established and the
services run within the OPD where one room is allocated and the services run by a Registered
Psychiatric Nurse. Owing to the fact that mental health is a fundamental component of the health
service delivery system, the hospital provides mental health services in an integral part of
primary health care.
During FY 2014/2015, a total of 364 attendances have been registered against 676 attendances in
FY 2013/2014. The most common cases registered were epilepsy followed by depression and
post-traumatic stress disorder. The decline in the number of cases can be attributed to the
temporary interruption of AMREF support for specialised clinic.
Table 6.16 Mental health cases reviewed in OPD in the last 4 FYs
S/n Diagnosis FY 2011-2012 FY 2012-2013 FY 2013-2014 FY 2014-2015
No. % No. % No. % No. %
1 Epilepsy 1,093 89.7 907 90.9 455 69.0 194 53.3
2 Depression & post-traumatic stress disorder 49 4.0 33 3.3 15 2.3 38
10.4
3 Bipolar affective disorder 21 1.7 8 0.8 4 0.6 2 0.5
4 Attempted suicide 19 1.6 14 1.4 21 3.2 36 9.9
5 Learning disability & attention deficit,
hyperactivity disorder 12 1.0 1 0.1 1 0.2 1 0.3
6 Drug/alcohol abuse 16 1.3 32 3.2 57 8.6 12 3.3
7 Psychosis (schizophrenia) 09 0.7 3 0.3 3 0.5 3 0.8
8 HIV related Psychosis 30 4.6 18 4.9
9 Other mental illnesses 73 11.1 60 16.5
Total 1,219 100 998 100 659 100. 364 100
Challenges in mental health services
While the Hospital ensured continuity of mental health services, faced with the following
challenges that need to be taken into account to improve the effectiveness of the services:
• Admissions of mental patients in Medical Ward leads to the risk of violence to other
patients admitted.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
42
• There is still some inadequacy in the availability of some essential drugs, such as
fluoxetine and second generation antipsychotics.
• Ignorance and inadequate awareness in the general population.
• Poor community sensitization on mental health services causing drastic increase of other
preventable conditions like alcohol abuse.
• Interruption of specialized clinic for mental health by AMREF
Recommendations
1. Increase public awareness on mental health issues to facilitate access to the service.
2. Improve financial support for mental health services and improve on availability of drugs.
3. Recruit additional mental health personnel for effective care of mentally ill patients.
6. DENTAL CLINIC
The dental Clinic in the Hospital is not fully operational due to lack of dental personnel and
sufficient equipment for dental care. Though there is a designated room in OPD for dental Clinic
with basic dental equipment, dental services in the Hospital are offered periodically by visiting
dental surgeons supported by AMREF through its outreach program.
7. PALLIATIVE CARE
The palliative care within hospital is covers a number of conditions where patients are suffering
from terminal illness and having severe pain due to various conditions. Patients affected with
HIV/AIDs are also provided with ARVs, Bactrim and treatment of opportunistic Infections to
alleviate their conditions.
Provision of morphine is limited due to stock out observed in several occasion during the FY.
Clinical Condition No. Clinical Condition No.
Cancer Cervix 16 Sickle cells Crisis 38
Liver cancer 2 Chronic osteomyelitis 13
Leukaemia/Lymphoma 3 Herpes Zoster in ISS 2
Cancer Ovary 4 Liver disease in ISS 1
Oral Cancer 4 Liver Cirrhosis 40
Cancer Breast 4 Congested cardiac failure 1
Cancer Prostate 1 Pancreatitis 1
Despite a substantial increment of the number of patients assisted by this service, it is still to be
recognised that many patients once started on the programme of palliative care, are lost to
follow-up due to logistic problems that limit their access to the services in the Hospital (distance
and costs of transport).
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
43
8. OPHTHALMOLOGY
The ophthalmology Clinic in the Hospital is not fully operational due to lack of qualified staff.
The services are offered periodically by visiting ophthalmology specialist supported by AMREF
through its outreach program. The AMREF program may hopefully be re-introduced as this had
been a big support over the last few years.
C. INPATIENTS DEPARTMENT
1. Summary of beds and qualified health personnel
In FY 2014-2015 Dr. Memorial Hospital Kalongo maintained total of 271 beds after the reduction
from 302 in the previous FY. This was done to give more room for efficient utilization of beds and
to allow a better spacing among beds in some of the congested wards. On the other hand it is because
of the opening of new wing in Medical Ward and the assessment carried out on admission trends in
recent years.
Table 6.17 Summary of beds and qualified health personnel per ward
Ward No. of Beds Medical Personnel No. of No. of beds
Medical Ward 41 1 Medical officer 8 10.3
TB Ward 18
Surgical Ward 76 1 volunteer Surgeon, 1
9 8.4
Maternity Ward 75 2 Medical officer 15 7.5
Paediatric Ward 61 1 Medical officer 9 6.8
Total 271 1 Specialist doctor, 5 MOs 41 7.4
2. Inpatient utilization indicators
In 2014-2015 Dr. Ambrosoli Memorial Hospital admitted a total of 12,891 patients in the wards
with a decreased of -8.5% of admissions from 2013-2014 This could be because of the functional
government lower health units with improved drugs supply where some minor illness can be
managed
A reduction of admissions was observed in the following wards; Paediatric ward decreased by
18.8%, Medical ward decreased by 10.1% and Surgical by 2.7%. It is only Maternity ward which
continued to experience more increment of admissions over the last two FY (5.6% and 5.7%).
This is because the majority of mothers who receive services during the ANC visits in the
hospital prefer to return for delivery.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
44
Patient Days and Average Length of Stay
The number of patient days has decreased by 13.5% compared to increment of 19.3% in the
previous FY. This is somewhat proportional with the reduction in the number of Patients
admitted. The Average Length of Stay has remained almost constant. This is to be considered as
a good sign of improved efficiency in the management of patients that allows a shorter period of
hospitalisation to attain the same level of cure rate.
Throughput per Bed and BOR
The Hospital BOR has decreased from 70.7% to 68.0% in the last FY. This result is related to
the decreased number of patients admitted. The throughput per bed has increased from 47.0% to
47.9% indicating a slight improvement in the utilisation of the available beds. The current
condition is not yet quite ideal as the Hospital targets to achieve a BOR of at least 85%.
No. of deaths, death rates, Recovery Rates, and self-discharged
Number of deaths among admitted patients decreased from 225 to 179 in 2014-2015 FY and the
hospital mortality rate is at 1.4%. This indicates the efficient improvement in the management of
patients’ general conditions by carrying out proper procedures necessary from the time of
admission until the final day of discharge from the hospital. The Recovery Rate remained stable
ranging between 98.3% and 98.5% in the last 5 FYs, while the number of admitted patients that
runaway or self-discharge has been on a decrease from 34 to 11 compared to the previous FY.
Overall, these data expressed a positive image of the utilisation of curative inpatient services.
Table 6.18 - Utilization indicators in the last 5 FYs for the entire hospital
Indicator FY
FY
FY
FY
FY
No. of beds 349 302 302 302 271 Total Admissions discharged 10,793 11,374 13,221 14,186 12,981
Patient days 72,233 62,340 74,355 77,880 67,292 Average length of stay 6.7 5.5 5.6 5.1 5.2
Turn over interval 5.1 4.2 2.7 2.3 2.4 Throughput per bed 30.9 37.7 43.8 46.9 47.9
BOR 56.7 56.6 67.5 70.7 68.0
No. Deaths 233 172 204 225 179
Mortality rate 2.2 1.5 1.5 1.6 1.4
Recovery Rate 97.6% 98.3% 98.3% 98.2% 98.5%
Self-discharges 28 16 15 34 11
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
45
Table 6.19: Utilization indicators per ward in the last 4 FYs
MEDICAL WARD SURGICAL WARD
FY
11-12
FY
12-13
FY
13-14
FY
14-15
FY
11-12
FY
12-13
FY
13-14
FY
14-15
No of beds 58 58 58 41 No of beds 76 76 76 75
Total Admissions
discharged
1,575 1,888 2,284 2,053 Total Admissions
discharged
1,648 1,778 2,028 1974
Patients days 8,703 10,148 10,743 8,045 Patients days 16,799 17,093 16,394 15,685
Ave. length of stay 5.5 5.4 4.7 3.9 Ave. length of stay 10.2 9.6 8.1
Through put per bed 27.2 32.6 39.4 50.1 Through put per bed 21.7 23.4 26.7 25.9
BOR 41.1 47.9 50.7 53.8 BOR 60.6 61.6 59.1 56.5
No of Deaths 87 89 105 93 No of Deaths 16 24 18 22
Mortality rate 5.5 4.7 4.6 4.5% Mortality rate 1.0 1.3 0.9 1.1%
Recovery rate 94.3% 95.1% 95.1% 95.4% Recovery rate 98.5% 98.1% 97.9% 98.4%
Self-discharges 3 3 8 2 Self-discharges 9 10 25 10
PAEDIATRIC WARD MATERNITY WARD
FY
11-12
FY
12-13
FY
13-14
FY
14-15
FY
11-12
FY
12-13
FY
13-14
FY
14-15
No of beds 61 61 61 61 No of beds 75 75 75 76
Total Admissions
discharged
3,542 4,573 4,607 3,741 Total Admissions
discharged
4,198 4,502 4,756 5,027
Patients days 12,555 18,165 22,325 17,498 Patients days 19,801 21,994 21,987 22,173
Ave. length of stay 3.5 4.0 4.8 4.7 Ave. length of stay 4.7 4.9 4.6 4.4
Through put per bed 58.1 75.0 75.5 61.3 Through put per bed 56.0 60.0 63.4 67.0
BOR 56.4 81.6 100.3 78.6 BOR 72.3 80.3 80.3 81
No of Deaths 43 74 78 48 No of Deaths 9 6 8 8
Mortality rate 1.2 1.6 1.7 0.7% Mortality rate 0.21 0.13 0.17 0.2%
Recovery rate 98.7% 98.4% 98.3% 99.3% Recovery rate 99.7% 99.8% 99.8% 99.8%
Self-discharges 2 1 1 0 Self-discharges 2 1 0 1
PRIVATE WARD TUBERCULOSIS WARD [TB]
FY
11-12
FY
12-13
FY
13-14
FY
14-15
FY
11-12
FY
12-13
FY
13-14
FY
14-15
No of beds 8 8 8 No of beds 24 24 24 18
Total Admissions
discharged
153 240 244 NA Total Admissions
discharged
258 240 267 186
Patients days 728 10,24 1,010 NA Patients days 3,754 5,931 5,421 3,891
Ave. length of stay 4.8 4.3 4.1 NA Ave. length of stay 14.6 24.7 20.3 20.9
Through put per bed 19.1 30.0 39.5 NA Through put per bed 10.8 10.0 11.1 10.3
BOR 24.9 35.1 34.6 NA BOR 42.9 67.7 61.9 59.2
No of Deaths 2 1 3 NA No of Deaths 15 10 13 8
Mortality rate 1.3 0.4 1.2 NA Mortality rate 5.8 4.2 4.9 4.3
Recovery rate 98.7% 99.6% 98.8% NA Recovery rate 94.2% 95.8% 95.1% 95.7
Self-discharges 0 0 0 NA Self-discharges 0 0 0 0
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
46
3. Inpatient Referrals
Table 6.20.Pattern of referrals to and from the Hospital in the last two FYs
FY 2013-2014 FY 2014-2015
Category 0-4 years 5 and over 0-4 years 5 and over
Male Female Male Female Male Female Male Female
Referrals to hospital 2 1 3 21 29 26 99 317
Referrals from hospital 0 0 7 6 1 2 34 12
Total 2 1 10 27 30 28 133 329
In reference to the above table, the need for strengthening the referral system is quite evident.
The hospital currently does not have any support earmarked to cover the costs of referral
especially for the vulnerable.
4. The top ten cause of Morbidity in all the wards
Table 6.21 Ten top causes of admission in all the wards in FY 2013-2014 and 2014-2015
2013-2014 2014-2015
Causes of Morbidity No. of cases % on all No. of cases % on all
1 Malaria 1,818 12.8 1665 18.8
2 Pneumonia 1,209 8.5 563 6.3
3 Injuries due to other causes 1,021 7.2 936 10.5
4 Gastro-Intestinal disorder (non-
infective)
1,002 7.1 707 8.0
5 Respiratory Infections (others) 902 6.4 518 5.8
6 Septicaemia 837 5.9 660 7.4
7 Diarrhoea Diseases 499 3.5 340 3.8
8 Abortions 436 3.1 347 3.9
9 Skin Diseases 324 2.3 580 6.5
10 Urinary tract Infection 273 1.9 108 1.2
All others 5,865 41.3 2,453 27.6
Total 14,186 100.0 8,877 100.0
Malaria still the leading cause of admission in the Hospital as presented in the table 6.22 below.
Although the number of malaria cases admitted during 2014/2015 has reduced from 1,818 cases
in 2013-2014 to 1,665 (representing a decrease of 8.4%), it is still ranked first among the top 10
causes of admission (constituting 18.8% of total diagnosis) in the wards during the financial
year. Pneumonia incidences dropped in number from 1,209 cases in 2013/2014 to 563 in
2014/2015 and in ranking among top 10 causes of admission from 2nd to 6th respectively. There
has been a rise in the number of injuries due to other causes, gastro intestinal disorder and
septicaemia each contributing to 10.5%, 8% and 7.4% respectively of all diagnosis in the2014-
2015.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
47
The trend of the first cause of admission in last five previous years
In 2014-2015 FY trends of malaria cases admitted in the hospital still remained the highest with
19% in the proportion of all diagnosis although it has dropped to 13% in 2013-2014 FY
Table 6.22.Trend in malaria admissions in Kalongo Hospital over the last 5 FYs
FY
010-011
FY
011-12
FY
012-013
FY
013-014
FY
014-015
Malaria cases 9,229 3,543 2,454 2,875 1,818
Proportion of all 71% 52% 22% 22% 13%
5. The Top ten causes of death among inpatients
The main causes of death in the Hospital during 2014/2015 FY were pneumonia, cardiovascular
disease, anaemia, injuries and malaria accounting for 44.6% of total mortality. It’s worth noting
that cardiovascular diseases which had been the third leading cause of death among inpatients in FY
2013-2014; has become the second leading cause of death in FY 2014/2015. The fact that they do not
represent a major diagnosis (only 81 cases, but with high case fatality rate of 20.9%) should not lead
to underestimate their actual role as a cause of morbidity.
Table6.23. Top ten causes of death among inpatients of all wards in 2013-2014 and 2014-2015 FYs
2013-2014 2014-2015
Causes of Mortality
No of No of Case No of No of Case Fatality
1 Pneumonia 29 1,209 2.4 22 563 3.9
2 Malaria 21 1,818 1.2 13 1665 0.8
3 Cardiovascular
20 122 16.4 17 81 20.9
4 Septicaemia 14 837 1.7 7 660 1.1
5 Anaemia 13 209 6.2 16 306 5.2
6 Tuberculosis 13 267 4.9 8 186 4.3
7 Injuries (all types) 9 1,021 0.9 12 936 1.3
8 Meningitis 6 46 13.0 4 40 10
9 Diarrhoeal diseases 5 499 1.0 3 340 0.9
10 Liver cirrhosis 5 21 23.8 7 60 11.6
The fatality rate of Liver cirrhosis remained high in the hospital though it does not represent a
major diagnosis (only 60 cases, but with high case fatality rate of 11.6%). It’s observed on many
occasions that patients with these cases report to hospital late when their conditions have become
more severe. There is also low “detection rate” of these diseases and the Hospital strives to improve
and gradually equip itself to better handle these disease (both in terms of prevention and treatment).
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
48
1. PAEDIATRIC WARD
The Paediatric Ward complex is accommodated in two buildings with 61 beds: one main block
where most cases are admitted, and one smaller block designed as an isolation block with
separated rooms. With the closure integration of Nutrition Unit in early 2012, the block is used
as an extension of Paediatric ward to provide additional space for excess admission and to host a
few children admitted with malnutrition. The entire complex requires major renovation works
1.1. Staff Composition
The personnel assigned to this ward included 1 MO, 9 Nurses and 3 Nursing Assistants, 1
Nursing Aide. Some few students of the Midwifery School are also assigned for short period to
the Ward.
Table 6.24 Tabulated personnel assign to this ward
Cadre/ Discipline Qualification No Present
Medical officers Bachelor degree in Medicine and surgery 1
Enrolled Midwife Certificate of Enrolment 1
Enrolled Nurse Certificate of Enrolment 5
Enrolled Comprehensive Nurse Certificate of Enrolment 3
Nursing Assistant Certificate 3
Nursing Aide Trained on Job 1
Pediatric ward indicators over the last 5 FYs
The performance indicators of Paediatric ward show significant improvement in the performance of the
ward during the financial year. The ALOS drop from 4.8 to 4.6 during the year and the recovery rate
remained high.
Table 6.25 Paediatric Ward indicators over the last 5 FYs
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
No. of beds 108 61 61 61 61
Total Admissions 4,041 3,542 4,573 4,607 3,741
Bed days 19,862 12,555 18,165 22,325 17,498
ALoS 4.9 3.5 4.0 4.8 4.6
BOR 50.4% 56.4% 81.6% 100.3 79%
Throughput 37.4 58.1 75.0 75.5 61.3
Turnover interval 4.8 2.7 1.7 -0.0 1.3
No. Deaths 79 43 74 78 48
Death Rate 2.0% 1.2% 1.6% 1.7 0.7%
Recovery Rate 98.0% 98.8% 98.4% 98.3& 99.3%
Self-discharges 2 2 1 1 1
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
49
1.2. Admissions
During FY 2014/2015, a total of 3,741 patients were admitted in Paediatric ward representing
18.8% decline in admission in the ward (a drop from 4,607 in FY 2013/2014 to 3741 in FY
2014/2015). This is a reverse of the incremental trend in admission witnessed in the last two
FYs. The admission in Paediatric ward alone contributes 28.8% of the Hospital total Admission.
The seasonal pattern of admissions remained similar with the previous financial year,
characterised by sudden increments of admissions at the beginning of the rain season, with high
peaks around June-July as shown in the diagram below.
Fig. 6.8: A line graph presenting the trend of monthly admission to paediatric ward in the
last three FYs
Malaria still remains the leading cause of admission in paediatric ward accounting for 27.0% of
diagnosis in the ward. During the 4th quarter of FY 2014/2015 (April-June 2015), the incidence
of malaria cases increased in paediatric ward accounting for 53.2% of total malaria diagnosis.
The sudden increase in malaria cases was equally observed in the Lower health facility in Agago.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
50
Table 6.26 Top ten causes of admission in Paediatric Ward in FY 2013-2014 and 2014-2015
2013-2014 2014-2015
Causes of Morbidity No. of
cases
% on all
diagnoses
No. of
cases
% on all
diagnoses
1 Malaria 1,281 27.8 797 27.0
2 Pneumonia 854 18.5 410 13.9
3 Gastroenteritis / diarrhoeal diseases 764 16.6 627 21.3
4 Respiratory Tract Infection-(not Pneumonia) 712 15.5 350 13.9
5 Septicaemia 539 11.7 415 14.1
6 Anaemia 124 2.7 170 27.0
7 Severe Malnutrition 89 1.9 101 3.4
8 Sickle Cell Disease 85 1.8 38 1.3
9 Neonatal sepsis 50 1.1 25 0.8
10 Urinary Tract Infection 50 1.1 17 0.6
Table 6.27 Top five causes of death in Paediatric Ward in FY 2014-2015
Causes of Mortality among Inpatients No of Disease No of cases of Case
1 Perinatal conditions in new born (0-7 days) 12 58 20.7
2 Neonatal Septicemia 8 25 32.0
3 Anemia 8 170 4.7
4 Malaria 6 797 0.8
5 Pneumonia 6 410 1.5
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
51
2. MATERNITY WARD IN 2014-2015 FY.
The Maternity Ward is one of the largest wards in the Hospital with 75 bed capacity. The ward is
subdivided into various sections which include the Labour Room, and admission rooms divided
in Post Natal Room, Caesarean Room, Gynaecology Room, Drs’ office, Sr. In-charge office,
duty room, Private Rooms and the Premature Nursery. Maternity ward is run by 1 Medical
officer, and 20 Midwives who are directly responsible for management of patient admitted in the
ward. It is also a practical training ward for students of Midwifery at the Midwifery training
school in the Hospital; and on allows an average of 8 students for practical every day under the
supervision of a qualified midwife/mentor.
2.1. Staff Composition
Table 6.28 Personnel assign to maternity ward
Cadre/ Discipline Qualification No Present
Medical officers Bachelor degree in Medicine
/Surgery
1
Registered Midwife Diploma in Midwifery 2
Double Trained Nurse/Midwife Diploma in Nursing /Midwife 1
Enrolled Midwife Certificate of Enrolment 17
Maternity ward has a registered Nurse/midwife who is the ward in-charge and a core leader of all
the staff working in difference parts of the ward to manage the general activities needed for the
patients. The midwives in maternity works in shifts i.e. Morning shift from 8.00am- 3.00pm,
Afternoon shift from 2.00pm- 8.00pm and Night shifts from 8.00pm-8.00am.
2.2. Maternity ward indicators
Maternal Death Rate has decreased, Infection rate of caesarean sections also increased to 10%.
On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still Birth
Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.
Some of these negative trends may be explained by the high attrition rate of qualified staff
particularly the senior midwives with many years of experience that affected the quality of work
in the hospital.
Table 6.29 Maternity Ward indicators over the last six FYs
2009-010 2010-011 2011-012 2012-013 2013-014 2014-015
No. of beds 76 76 75 75 75 75
Total Admissions 3,793 3,497 4,198 4,502 4,756 5,027
Bed days 23,499 18,014 19,801 21,994 21,987 22,173
ALoS 6.2 5.2 4.7 4.9 4.6 4.4
BOR 84.7% 64.9% 72.3% 80.3% 80.3% 81%
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
52
Throughput per bed 49.9 46.0 56.0 60.0 63.4 67.0
Turnover interval 1.1 2.8 1.8 1.2 1.1 1.03
No. Deaths 7 8 9 6 8 8
Death Rate 0.18% 0.22% 0.21% 0.13% 0.17% 0.2%
Recovery Rate 99.7% 99.4% 99.7% 99.8% 99.8% 99.8
Self-discharges 6 13 2 1 0 0
2.3. Admissions
During FY 2014/2015, a total of 5,027 patients were admitted in maternity (an increment of
5.6% in admission). Maternity ward admits the highest number of patients in the hospital and
contributed 38.7% of total Hospital admission during FY 2014/2015.
Fig.6.9: A line graph showing the trend of total admissions and delivery in Maternity ward in the
last 6 FY
The admission trends in maternity ward continued to increase every financial year. In
FY2014/2015 a total of 5,027 mothers were admitted in maternity (an increment of 5.7%)
compared to 4,756 admission in FY 2013/2014. The number of deliveries equally increased from
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
53
2,981 in FY 2013/2014 to 3,247 in FY 2014/2015 (an increment of 8.9%). This is still attributed
to the better services offered to the mothers from ANC and maternity ward which includes; good
health education, good hygiene, and better management in case of any complication during
delivery.
Table 6.30 Maternity Ward admissions – (Deliveries & Births indicators) in the last 6 FYs
FINANCIAL YEARS 2009/010 2010/11 2011/12 2012-13 2013-14 2014-15
Deliveries & Births Indicators Total deliveries 2,439 2,464 2,805 2,727 2,981 3,247
Normal deliveries in unit 2,042 1,970 2,289 2,178 2,532 2,816 Abnormal deliveries (incl. C/S) 397 391 516 549 449 431
Live birth in units 2373 2,304 2793 2,737 2,940 3,238
Babies born with low birth weight «2,5Kgs) 345 307 292 289 261 378
Fresh Still births in unit 16 17 11 19 18 32
Macerated still births in unit 23 14 16 18 18 30
Newborn deaths (0-7days) 0 41 23 55 31 28
FSB died in hosp. (FHS Heard before del.) 2 6 0 19 18 32
Maternal Deaths 7 7 7 3 5 3
For Live Births Full term Normal weight 2,306 2,427 2,466 2,448 2,598 2,860
Full term Low birth weight 212 177 292 289 261 378
Premature cases 111 80 35 23* 95 Info Not
available
For Caesarean Sections Elective C/S 7 35 21 48 46 42
Emergency C/S 238 302 384 431 403 327
Caesarean sections total 245 337 405 479 449 369
C/S as % of total deliveries 10.0% 13.8% 14.4% 17.6% 15.1% 11.4 Emergency C/S as % of all C/S 97.1% 89.6% 94.8% 90.0% 89.8% 88.6%
All deliveries in maternity are conducted / assisted by qualified personnel. Being a teaching
hospital, student for enrolment in midwifery are given a chance to participate in the follow up
and monitoring of labour progress and learn how to conduct deliveries under the supervision of a
qualified Midwife or Medical Doctor. Of the total 3,247 deliveries conducted in Maternity ward
during FY 2014/2015, 13.2% were by caesarean sections.
The 10 top reasons for Caesarean Sections:
1. Foetal distress.
2. Previous scars.
3. Obstructed labour with or without distress.
4. Abnormal presentation – breech, persistent occipital, posterior etc.
5. Cord/arm prolapsed.
6. Prolonged labour and post term.
7. Ruptured Uterus.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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8. [CPD] constricted pelvis in young primigravida.
9. Big baby.
10. Delays in 2nd stage.
The number of caesarean section conducted in Dr. Ambrosoli Memorial Hospital has decreased
from 6.3% in 2013-2014 FY to 17.8% in 2014-2015. A total of 311 mothers who had Caesarean
section were from Agago District and 58 cases from the neighbouring districts. The Hospital,
being the only health facility with a functional theatre and Qualified Medical personnel, is the
main referral facility for pregnant women with complication and risk related to delivery that may
require C/S. However, due to the poor referral means (mostly Bodaboda motorcycle) and
conditions of roads, many of pregnant mothers often arrive in the hospital in advance stage of
labour or in critical conditions which requires emergency C/S. It’s apparent the region does not
have good transport means and roads; and even the available ones are unreliable. This limits the
pregnant women from accessing the Hospital at the right time. This situation has persisted and
affected the referral and response to obstetric emergencies in Agago District.
Table 6.31 Provenance of mothers delivered through C/S in the last 4 FYs
Within the Catchment Area of Agago District
Outside the Catchment Area of Agago District
Sub-
011-
012-
013-
014-
Sub-County 011-
012-13 013-
014-
Adilang 26 27 34 28 Pader 26 29 30 26
Kotomor
54
23 12 14 Pajule 6 4 2 3
Patongo 42 38
32 Namokora 3 2 1 1
Patongo
Omiya
3 7 4 5
Lukole 52 38 39
45 Awere 0 5 1 1
Lukole T.C. Orom 8 4 2 2
Kalongo
55 50 49 21 Abim 4 14 6 11
Paimol 27 23 17 25 Corner Kilak 1 3 2 0
Parabongo 23 38 30 14 Other
9 12 3 9
Omot 21
19 30 14 Acolpii 8 15 11 Lamiyo 11 7 5 Lapono 25 36 49 36 Lira Palwo 23 25 28 17 Omiya
16 24 26 19 Wol 23 35 24 30 Total 345 399 398 311 Total 60 80 51 58
Note: Data for Patongo town council and Patongo Sub county is not disaggregated, the same applies to Lukole Town Council
and Lukole Sub county (source: Kalongo Hospital theatre operation book FY 2011-2012 to FY 2014-2015)
2.4. Other Services/Departments in Maternity
Other than Pregnancy related conditions, maternity ward also admits and provides
gynaecological and Neonatal services.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
55
a) Gynaecological ward
In FY 2014-2015 a total of 147 women were admitted in maternity ward with Gynaecological
conditions other than pregnancy (5.1% of all Maternity Ward admissions) as provided in the
table below.
Table 6.27: Admissions in Maternity Ward not related to maternity conditions
Diagnosis of admission 2010-
2011-012 2012-013 2013-014 2014-015
Pelvic Infection Diseases [P.I.D] 59 38 95 106 37
Urinary Tract Infection [U.T.I] 12 16 58 91 57
Cancer of cervix 22 30 30 25 10
Uterine Fibroid 25 8 15 16 7
Ovarian Cyst 25 20 9 12 23
Vaginal candidiasis 8 5 7 6 5
Bartolini’s cyst n.a. n.a. 5 6 7
Peritonitis 4 8 2 2 1
Total 158 130 221 243 147
b) The Nursery
The Nursery is where neonatal and perinatal conditions in new-born babies are managed. The
department is run by Maternity staffs. The ward doctor of maternity and paediatric ward provides
the clinical management of the new-born babies in the nursery.
The commonest causes of admission in new-born babies during 2014/2015 were severe
asphyxia, Neonatal sepsis, jaundice, prematurity and congenital conditions. The nursery is
equipped with an incubator, a phototherapy machine, an oxygen concentrator and a warming
light (dysfunctional).
3. MEDICAL WARD IN 2014-2015 FY
Medical Ward is located in one main block divided into two sections for female and male
patients. It also has an adjacent wing which has four 2-bed rooms and three self-contained
private rooms built with support from Ambrosoli Foundation and some equipment and beds
provided by Italian cooperation.
3.1. Staff Composition The Ward is run by a Medical Officer, Nurses/Midwives, Nursing Assistants and Nursing Aide. In an
effort to enhance learning and clinical practices, a few students of the Midwifery School are also
assigned for short periods to the Ward. The same staff covers also the TB Ward and support the
functionality of OPD especially during Weekends, public holidays and after 5.00pm when the main
OPD is closed.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
56
Table 6.33 Personnel assign to this ward
Cadre/ Discipline Qualification No Present
Medical officers Bachelor degree in Medicine/surgery 1
Enrolled Nurse Certificate of Enrolment 1
Enrolled Comprehensive Nurse Certificate of Enrolment 3
Nursing Assistant Certificate 2
Nursing Aide Trained on Job 1
3.2. Key indicators in the Medical Ward
Table 6.34 Key indicators in the Medical Ward during the last five FYs
Ward: MEDICAL 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
No. of beds 65 58 58 58 41
Total Admissions 1,691 1,575 1,888 2,284 2,053
Bed days 11,644 8,703 10,148 10,743 8,045
ALoS 6.9 5.5 5.4 4.7 3.9
BOR 49.1% 41.1% 47.9% 50.7% 53.8%
Throughput per bed 26.0 27.2 32.6 39.4 50.1
Turnover interval 7.1 7.8 5.8 5.1 3.4
No. Deaths 118 87 89 105 93
Death Rate 6.0% 5.5% 4.7% 4.6 4.5
Recovery Rate 92.8% 94.3% 95.1% 95.1% 95.4
Self-discharges 3 3 3 8 2
3.3. Admission in Medical Ward
In FY 2014/2015, the admission in Medical ward dropped by 10% altering the ever incremental
trend in admission observed in the last three FYs. The drop in admission in Medical ward was
not peculiar to Medical ward only since all other wards except maternity, experienced a decline
in admission.
Malaria is still the leading cause of morbidity in Medical Ward and accounting for 13.8% of total
admission during FY 2014/2015.
Table 6.35 Top 10 causes of admissions in Medical ward in FY 2013-2014 and 2014-2015 FYs
2013-2014 2014-2015
Causes of Morbidity No. of cases
admitted
% on all
diagnoses
No. of cases
admitted
% on all
diagnoses
1 Malaria 272 11.9 686 13.8
2 Gastrointestinal disorders
not infective 246 10.8 376 7.6
3 Pneumonia 223 9.8 153 3.1
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
57
4 Typhoid Fever 91 4.0 74 1.5
5 Respiratory Tract
Infections-(not Pneumonia) 85
3.7 168 3.4
6 Urinary Tract Infection 71 3.1 97 1.9
7 Cardio vascular Disease 78 3.4 76 1.5
8 Septicaemia 69 3.0 245 4.9
9 Hypertension 59 2.6 68 1.4
10 Asthma 32 1.4 62 1.2
Table 6.36 Top 5 common causes of death in Medical ward in FY 2013-2014 and 2014-2015
2013-2014 2014-2015
Causes of No of No of Case No of No of Case
1 Pneumonia 8 223 3.6 % 16 153 3.9
2 Cardiovascular
5 78 6.4 % 17 76 2.0
3 Septicaemia 5 69 7.2 % 3 245 6.3
4 Liver Cirrhosis 4 30 13.3 % 2 38 1.0
5 Suicide attempt 4 18 22.2 % 2 108 2.8
4. SURGICAL WARD
Surgical Ward is accommodated in a large building divided in two sessions for female and male
patients. One room is also available for children. The building is one oldest building in the
hospital, it needs substantial renovation works.
4.1. Staffing composition of surgical ward
Table 6.37 Staff composition in surgical ward in 2014-2015 FY
Cadre/ Discipline Qualification No Present
Medical officer Bachelor degree in Medicine/surgery 1
1 volunteer surgeon from JRCs Surgeon 1
Double Trained Nurse/Midwife DNM 1
Registered Nurse Diploma in Nursing 1
Enrolled Comprehensive Nurse Certificate Comprehensive Nurse 6
Enrolled Nurses Certificate of Midwifery 3
Nursing Aide Trained on Job 1
Orthopaedic Officer Diploma in orthopaedics 1
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
58
4.2. Key indicators in the surgical ward
The performance of Surgical Ward slightly decreased from in 2,028 FY 2013-2014 to 1,974 in
FY 2014-2015. The ALoS was further reduced to 7.9, and the Throughput per bed increased to
25.9 The BOR has decreased however to 56.5%, despite the increment of admissions. The
Hospital needs to evaluate the option of reducing the number of beds and allow better space
management in the Ward in relation to the expected number of admissions. Nevertheless, if the
current trend experienced in the last couple of years is maintained then it may be justified
keeping the number of beds as they are at present.
Table 6.38 Key indicators in the Surgical Ward during the last five FYs
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
No. of beds 76 76 76 76 76
Total Admissions 1,320 1,648 1,778 2,028 1,974
Bed days 17,386 16,799 17,093 16,394 15.685
Ave. length of stay 13.2 10.2 9.6 8.1 7.9
BOR 62.7% 60.6% 62.4% 59.1% 56.5%
Throughput 17.4 21.7 23.4 26.7 25.9
Turnover interval 7.8 6.6 6.0 5.6 6.1
No. Deaths 19 16 24 18 22
Recovery Rate 97.8% 98.5% 98.1% 97.9% 98.4
Self-discharges 10 9 10 25 10
4.3. Admissions in Surgical Ward
The overall performance of the Surgical Department has remained definitely improved over the
last 3 years and this has been largely possible thanks to the constant presence of specialist
surgeons provided on a rotation basis by the Japanese Red Cross Society. Their presence, in fact,
has not only helped the hospital to secure competent management of surgical cases both for
elective and emergency surgery, but also has allowed constant on the job training for the Medical
Officers and Nurses assigned to the Ward.
Table 6.39 Top 10 causes of admissions in Surgical Ward in FY 2013-2014 & 2014-2015
2013-2014 2014-2015
Causes of Morbidity No. of % on all
No. of % on all
1 Injuries due to other causes 804 39.6 1,328 26.7
2 Hernias 151 7.4 86 1.7
3 Injuries due to domestic violence 127 6.3 475 9.5
4 Abscess 181 8.9 223 4.5
5 Injuries due to Road Traffic Accident 191 9.4 119 2.4
6 Hydrocele 65 3.2 68 1.4
7 Snake bites 61 3.0 54 1.1
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
59
8 Osteomyelitis 49 2.4 44 0.9
9 Urinary Tract Infections 38 1.9 23 0.5
10 Intestinal Obstruction 36 1.8 44 0.9
Table 6.40 Top 5 common causes of death in Surgical Ward in 2013-2014 & 2014-2015 FYs.
2013-2014 2014-2015
Top Ten Causes No of Total No of Case No of Total No Case Fatality
1 Injuries due to
5 804 0.6 7 650 16.7
2 Complications of
2 151 1.3 0 113 2.9
3 Injuries due to 2 191 1.0 6 218 5.6
4 Intestinal
1 36 2.8 3 43 1.1
5 Injuries due to
1 127 0.8 1 134 3.4
5. THEATRE SERVICES
The new Theatre Block constructed with the support from the government of Japan and Dr.
Ambrosoli Memorial Hospital was commissioned in the month of March 2015. This new theatre
block hosts 3 operating rooms with 2 appropriate changing rooms for the staff which is separated
into male and female sections. It also has one recovery room, one duty room, one In-charge
office, one store, one sluice room and one sterilization room.
Table 6.41 Number of staff assign to theatre department
Cadre/ Discipline Qualification No Present
Registered Nurse Diploma in Nursing 1
ECN/Anaesthetist Diploma in Nursing 1
Enrolled Midwife Certificate of Enrolment Enrolled Nurse Certificate of Enrolment 2
Enrolled Comprehensive Nurse Certificate of Enrolment 4
Nursing Assistant Certificate 4
Nursing Aide Trained on Job 2
Table 6.42: Top major surgical procedures carried out in theatre during the previous year
Top major surgical procedures done Number of
Proportion
1 Caesarean section 369 65.3
2 Laparatomy: 79 14.0
3 Evacuation 6 1.1
4 Orif (Open reduction and internal
6 1.1
5 Thoracotomy 1 0.2
6 Other major procedures 104 18.4
Total 565 100.0
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
60
Table 6.43 Pattern of anaesthesia used during the last 5FYs
Type of Anaesthesia 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Local Anaesthesia 145 316 321 1,287 569
General Anaesthesia with IV
Ketamine
1,613 1,877 1,705 1,039 1030
Spinal Anaesthesia 141 265 527 518 290
General Anaesthesia with ETT 11 10 52 42 24
Total 1,910 2,468 2,605 2,886 1,913
Currently the hospital does not have a qualified Anaesthetist; a Nurse who has been trained by a
specialist and has over seven years of experience is at the moment providing some limited
support in this department. The hospital has sent one clinical officer for a diploma course in
anaesthesia due to complete in July 2016.
Table6.44 Top minor surgical procedures done in FY 2014-2015
No Top ten surgical procedures done Number of Patients Proportion (%)
1 Safe Male Circumcision 468 34.7
2 Debridement and wound care 226 16.8
3 Incision and drainage of abscesses 273 20.3
4 Herniorrhaphy 213 15.8
5 Minor ENT Surgery 127 9.4
6 Other Minor Procedures 41 3.0
Total 1,348 100.0
Table6.45: Trend of surgical activities in last 5 FYs
Financial Years 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Total Operations 1,910 2,468 3,017 2,886 1,913
Major operations
(including C/S) 640 730 803 663
565
Minor operations 1,270 1,738 2,219 2,223 1,348
Emergencies 331 352 445 416 327
Emergencies as % of
total major operations 51.7% 48.2% 55.4% 62.7%
57.9%
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
61
6. TB WARD
The TB Ward is located in a single old building. It is divided into two sessions (Male and Female
Rooms) and is managed by the same medical and nursing personnel of the Medical Ward. The
TB Control Programme (and the follow-up of patients on treatment) is also managed directly in
this Ward by the same staff.
While most activity data regarding the TB programme has been presented in the Specialist Clinic
- OPD section of this report, in table 6.38 only the data concerning the admissions to the Ward
are presented.
6.1. Key indicators in TB ward
Table 6.45 Key indicators in the TB Ward during the last five FYs
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
No. of beds 24 24 24 24 18
Total Admissions 244 258 240 267 186
Bed days 5,327 3,754 5,931 5,421 3891
Ave. length of stay 21.8 14,6 24.7 20.3 21
BOR 60.8% 42.9% 67.7 61.9 59.2%
Throughput 10.2 10.8 10 11.1 10.3
Turnover interval 14.1 19.4 11.8 12.5 14.4
No. Deaths 9 15 10 13 8
Recovery Rate 96.3% 94.2% 95.8% 95.1 95.7%
Self-discharge n.a. n.a. 0 0 0
The performance indicators for TB ward show that at present; the ward is not used in a very
efficient way. The management of TB patients needs to be re-addressed and streamlined by
minimising hospitalisation and, on the other hand improving on the quality of care so as to attain
a higher level of cure rate. The number of beds in the Ward has been reduced to 18 at the
beginning of the new FY 2014/2015.
7. PRIVATE WARD
In FY 2014-2015 the data from private ward was integrated into the report from inpatients
services in different wards. There is need to strengthen the private ward as a stand-alone
department in order to make health care services accessible and effective to the customer who
can afford to pay health care services.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
62
D. DIAGNOSTIC SERVICES–LABORATORY AND BLOOD TRANSFUSIONS
1. Laboratory Services
Dr. Ambrosoli Memorial Kalongo hospital laboratory has initiated a hub with support with MoH
and UCMB. It serves sixteen lower health unit laboratories in Agago and Pader health District.
The hub renders a complete ART care package for HIV infected patients in terms of laboratory
tests amongst which are CD4 testing, chemistry haematology analysis and collecting Dry Blood
Spot for DNA-PCR and other samples that cannot be analysed at the hub are referred to the
central laboratories, Viral load, all this processes are interlinked through the hub rider who picks
the specimen samples from and distribute results to facilities. Posta Uganda is the means through
which referred samples are dispatched and results sent to and from the Central laboratories. The
hub has now existed for one and half years. The Laboratory and Blood Transfusion services have
been conducted by: 1 Laboratory Technologist, 2 Technicians and 5 Laboratory Assistants.
Table 6.46: Trend of Laboratory testing workload in the last 5 FYs
Type of Tests FY
2010-11
FY
2011-12
FY
2012-13
FY
2013-14
FY
2014-15
Parasitology
Malaria Microscopy, Malaria RDTs,
Other Haemoparasites, Stool
Microscopy.
16,705
11,379
12,163
15,351
16,178
Haematology
HB, WBC Total, WBC Differential,
Film Comment, ESR, RBC, Bleeding
time, Prothrombing time, clotting time,
blood transfusion tests, & Others
4,249
6,861
8,160
13,707
26,829
Biochemistry
Urea, Calcium, Potassium, Sodium,
Creatinine, ALT, AST, Albumin, Total
protein, Triglycerides, Cholesterol,
CK,LDH, IkalinePhos, Amylase,
Glucose, Uric Acid, Lactate, Others
4,634
1,872
3,404
2,688
5,936
Bacteriology
ZN for AFBs, Cultures and
Sensitivities, Gram, Indian Ink, Wet
Preps, Urine Microscopy
2,495
2,431
2,419
6,407
11,141
Serology
VDRL lRPR, TPHA, Shigella
Dysentery, Syphilis Screening,
Hepatitis B, Brucella, Pregnancy Test,
Widal Test, Rheumatoid Factor
15,252
5,629
8,908
12,934
21,184
Immunology CD4 tests & others 1,223 1,647 2,515 4,432
Pathology n.a.
HIV tests by
purpose
HCT, PMTCT, Quality control and
clinical diagnosis 10,841 11,142 9,869
12,623
Total tests (crude ) 43,335 40,236 47,843 63,471 98,323
Total lab staffs 6 7 7 8 8
Average tests per Lab staff 7,223 5,748 6,835 7,934 12,290
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
63
There has been relatively greater increment in the number of tests performed in 2014-2015 FY at
54.9% compared to 32.7% in 2013-2014 FY. It appears that the demand for laboratory testing by
the clinicians has increased, as well as the compliance with protocols requested by project and
health programmes. The productivity of the laboratory staff has increased from 7,934 (16.1%) in
2013-2014 to 12,290 (54.9%) in 2014-2015 tests per staff.
Table 6.47 Percentage of positive findings per selected examinations in the two FY
2013-2014 FY 2014-2015 FY
Type of Test Total
Total % Total Total %
Malaria (both slide and RDT) 13,557 1,733 12.8 14,999 2,331 15.5
Tuberculosis 1,341 151 11.3 1,199 182 15.2
Widal 4,729 908 19.2 5,947 672 11.3
Hepatitis B 1,046 123 11.8 2,585 260 10.1
Stool microscopy 831 244 29.4 1,179 197 16.7
Table 6.48 the proportionate distribution of blood groups and Rhesus factor D
2013-2014 FY 2014-2015 FY
Group
A
Group
B
Group
AB
Group
0
Rhesus
Factor D
positive
Group
A
Group
B
Group
AB
Group
0
Rhesus Factor
D positive
29% 17% 3% 51% 98% 29.8% 18.3% 4.8% 46.1% 98%
E. DIAGNOSTIC SERVICES - X-RAY, ULTRASOUND
1. X-Rays Department
The X-Ray department is staffed with three X-Ray attendants trained on the job. This situation is
not ideal and despite many years of working experience, the lack of professional qualification
and supervision occasionally affects the quality of the films produced.
Table 6.49: X-Ray examinations done over the last 5 FYs in the hospital
2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Chest 1,846 2,206 2,246 3,176 2974 Upper extremities 722 897 854 1,118 1,172
Lower extremities 557 789 846 1,067 959 Vertebral Column 149 143 283 336 314
Skull and Mandible 137 184 166 330 269
Shoulder and clavicle 113 163 156 221 234
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
64
Pelvis and hip 167 184 154 142 276
Abdominal – Plain 107 160 169 142 226
Abdominal Contrast 0 16 8 4 1
Screening(chest & other)
4 26 0 0 0
Total 3,802 4,768 4,882 6,536 6,423
2. Ultrasound investigations
Currently the hospital has two Ultrasound machines and one sonographer with a diploma
qualification. The major challenge is the lack of probes for vaginal examination and for system
cardiovascular (Doppler).
Table 6.50: Ultrasound examinations conducted in the last 2 FYs
2013-2014 2014-2015
Obstetrics 434 1,470
Gynaecology 518 1,463
Abdomen 348
1,715 Liver
Soft tissues (Small Parts) 20 141
Heart 0 0
Total 1,320 4,789
Fig. 6.10: A bar graph illustrating the trend of X-ray and Ultra Sound done during the last two FY
Ultrasound was not done in 2012-2013 because of no trained personnel to perform the operation
of the machine and therefore only the two years are reflected.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
65
ECG
The Hospital has also an ECG machine but the Medical Officers are not yet sufficiently
experienced in this examination to allow an effective routine utilisation.
The Hospital has conducted training for all the Medical Officers and Clinicians in order to use
and interpret ECG results. In addition the hospital is working closely with a cardiologist from
Italy for the quality of care in this department.
Endoscopy examination
The endoscopy machine exists but it is only used currently by Japanese surgeon according to the
need, the hospital is committed to ensure that the resident surgeon/ senior medical doctor and
other doctors are trained to use this tool effectively.
F. PHARMACY ACTIVITIES
The transfer of the Pharmacy to the new location took place in the first months of FY 2014-2015
and allowed also the transfer of other items (laboratory reagents, gloves, and water for injections)
that had been kept in the General Store. Some items (bulky sundries) are still kept in the General
Store.
In the second half of the year the Hospital has received the technical support of one qualified
Pharmacist from the Japanese Red Cross Society. The objective of this collaboration is to assist
the hospital pharmacy staff to adopt new and more effective procedures to manage and control
the drugs stock and to improve on the drug management both in the pharmacy and the wards.
Under this technical assistance the Hospital Management accepted the introduction of the Unit
Dose System (UDS) for distribution and dispensing of therapies to admitted patients. The new
system which is currently introduced in Surgical and Maternity wards will be extended during
the FY 2015-2016 to the other wards and departments.
1. Staffing level in Pharmacy and General Store
Pharmacy:
One Pharmacy Technician
Three Pharmacy Assistants
One Enrolled Midwife
One Nursing Aide
General Store:
One Store Assistant
Two support staff
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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2. Pharmaceutical supplies
The supplies are mainly ordered from Joint Medical Store (JMS). Items not available at JMS are
bought from other providers like Abacus and Gitteos. JMS and Medical Access – Maul are main
suppliers for most of the Government or other projects).
3. Procurement system
Drugs and sundries are procured in most cases on a quarterly basis. The items to be purchased
are selected basing on the needs of the hospital in line with the Essential Drugs List of Uganda
and the treatment policies. The quantity to be purchased is determined based on the quantity at
hand, average monthly consumption and the available finances.
4. Inventory management
There is a manual and computerized inventory system that helps to manage purchase and stock
movements. Stock taking is done on a quarterly basis and physical count monthly to ensure the
system works well and agrees with what is present physically in the store at that moment.
5. Storage
The arrangement within the store is based on the dosage form where tablets and capsules are kept
on the same shelf while separate shelves are used for parenteral, oral liquids and topical creams
and liquids. The concept of FEFO (first expiry first out) is also employed in order to minimize
losses due to expiry.
The drugs are stored on shelves and the heavy ones are placed on floor pallets. Cold storage
items are kept in the fridge and the temperature is monitored every day to ensure it is within the
desired range of 2°C to 8°C.
The condition of the entire store is also monitored. The readings are taken 3 times a day because
of the variations during the day. An average value is obtained at the end of the month. The
hospital plans to procure additional temperature monitoring equipment to be availed to all the
rooms in the pharmacy were drugs and any such supplies are kept.
Table 6.5: Average temperature and humidity recorded in Pharmacy Department during the
last two FY.
2013-2014 FY 2014-2015 FY
Reading
Temperature Humidity Reading
Temperature Humidity
8.00am 24.6°C 69.7% 8:15 am 10.8°C 71.5%
12.00pm 28.5°C 55.9% 12.00pm 11.1°C 55.1%
5.00pm 30.4°C 55.4% 5.00pm 11.0°C 56.9%
Stocks are checked regularly when issuing and during the monthly counts for near expiry and
expired drugs. The near expiry drugs are consumed or donated before they expire. The expired
drugs are removed from the store and prepared for destruction by National Drug Authority
through the Health Sub District.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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6. Distribution and use
The pharmacy issue drugs to the different ward and departments basing on their consumption
and average patient number. The departments make request from the pharmacy using ward order
books and requisitions. The Hospital is planning to introduce the Unit Dose System for the
administration of therapies in all wards.
Table 6.52 Twenty most used drugs in FY 2013-2014 in all Hospital departments (excluded
HIV/AIDS clinic)
Drug description Quantity
issued
in FY
2012-2013
tablet/vials
Quantity
issued
in FY
2013-014
tablets/vial
Quantity
issued
in FY
2014-2015
tablets/vial
Monetary
value
for FY
2013-2014
(UGX)
Monetary value
for FY
2014-2015
(UGX)
Paracetamol 500mg 321,635 325,364 305,442 5,681,796 4,920,670.62
Metronidazole 200mg 245,974 267,189 202,387 6,054,999 6,201,137.68
Amoxicillin 250mg 272,800 244,900 237,131 13,785,972 13,094,373.82
Folic acid 77,100 179,955 104,164 714,032 505,195.40
Multivitamins 131,108 114,975 151,761 2,637,527 3,481,397.34
Erythromycin 250mg 127,174 93,990 114,337 8,970,406 10,525,864.22
Diclofenac 50mg 86,270 91,495 53,387 1,462,090 826,430.76
Prednisolone 5mg 103,180 88,540 82,592 3,673,525 3,406,094.08
Ferrous sulphate +folic acid 124,401 85,980 103,574 918,266 1,697,577.86
Ciprofloxacin 500mg 72,810 85,632 79,023 6,730,675 6,037,357.20
Carbamazepine 200mg 66,450 80,970 94,278 3,959,433 4,551,741.84
Ampi-/Cloxacillin 500mg 18,460 76,980 87,311 8,590,198 9,842,569.03
Ibuprofen 200mg 73,431 74,030 104,149 1,918,117 2,698,500.59
Vitamin B complex 84,900 73,564 84,228 1,103460 1,132,866.60
Cloxacillin 250mg 95,060 70,570 36,400 4,799,466 2,475,564.00
Ampicillin 500mg injection 42,729 69,985 60,415 33,643,889 23,363,688.80
Chloramphenicol 250mg 18,800 43,580 35,776 3,467,661 2,846,696.32
Magnesium trisilicate 250mg 51,741 43,471 39,228 516,870 496,626.48
Pyridoxine 25mg 35,911 41,300 27,355 425,390 301,452.10
Mebendazole 27,000 40,807 30,608 679,845 470,751.04
Total 109,733,617 98,876,555.78
a) The unit dose system of drugs management is playing a big role in reducing drugs wastage,
i.e. why the monetary value for financial year 2013-2014 is more compared to monetary
value for financial year 2014/2015.
1. Integration of private ward into other wards e.g. Medical ward.
2. Improvement in Lower health facilities leading to decongestion of patient in the hospital.
3. Pharmacy improvement in stock management.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
68
7. Challenges
The adoption of the Unit Dose System for dispensing therapies and its gradual extension to all
the wards is demanding a greater workforce in the Pharmacy than the one currently available.
Also the physical space of the Pharmacy, although greatly increased and improved from the
previous location, needs further expansion in order to attain the necessary standard.
The Drug and Therapeutic Committee was established with Terms of Reference and a clear
mandate to address the various aspects of drug management. Its activity has been quite
fluctuating and management is committed to support its activities.
G. INTRAVENOUS FLUID CONSUMPTION
The consumption of intravenous fluids in FY 2013-2014 is presented in Table 6.45.
Table 6.53 Consumption of IV Fluids in FY 2012-2013 to 2014-2015 FYs.
Fluid Description Quantity
FY 012-013
Quantity
FY 013-014
Quantity
FY 014-015
Value (UGX)
for
Value (UGX)
for Water for Injection 10ml 36,107 50,420 51,924 3,831,920 4,284,768
Sodium Chloride 0.9% IV 500ml 16,348 17,148 16,541 21,335,885 19,742,511
Dextrose 5% IV 500ml 7,082 4,500 5,496 5,481,045 6,694,183
Dextrose 5% IV 250ml 5,881 4,380 1,236 5,070,332 1,432,833
Sodium Lactate Compound IV 500 ml 3,931 3,197 1,922 4,194,400 2,367,558
Dextrose 50% IV 100ml 1,532 1,295 651 2,396,553 1,208,432
Gelatine/polygeline Solution 3.5% IV 500ml 182 156 71 2,507,232 1,720,654
Darrow’s Half Strength 500 Ml 129 57 95 326,701 234,546
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER SEVEN
SUPPORT SERVICES
1. Pastoral care
Pastoral care is provided in the Hospital to all patients by a Social Worker, a Catechist and a
Priest. All these persons are volunteers who are not on the payroll of the hospital.
Table7.1: Activities trend in Clinical Pastoral Care of the Sick during the last 5 FYs
Activity / Indicator 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
No. patients visited or counselled 136 394 55 120 228
No. patients baptized 69 198 39 43 0
No. patients confirmed 37 149 0 0 0
No. patients given Sacrament of
marriage
11 45 0 0 0
No. patients anointed 19 2 25 11 4
2. Ambulance service
Referral of patients is from LLUs to the hospital or from the hospital to the Regional Referral
Hospital, and the Lacor Hospital of Gulu and the National Referral Hospital of Mulago and
Butabika as well as other specialised hospitals for further management.
The Hospital uses two Land Cruisers for the provision of Ambulance service. One is fairly new,
but the second is quite old and can be used only for short distances. Currently patients are
required to contribute to the cost of fuel but in case of life-threatening emergencies the transport
is provided. In circumstances the patient is unable to afford, the hospital takes on, however, this
is not sustainable since there is no funding earmarked for this activity.
3. Technical services
The Technical and Maintenance Department of the Hospital is mandated to ensure the ordinary
and extraordinary maintenance of all structures and equipment (including vehicles) for both the
Hospital and the Midwifery Training School. It provides technical assistance and supervision any
time extraordinary renovations and bigger scale constructions are contracted out. The Technical
Department also develops and carries out income generating activities that is meant to
contribute, without additional costs, the sustainability of the Hospital.
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Table 7.2: Consumption of fuel by destination in the last 5 FYs
FY
2010-2011
FY
2011-2012
FY
2012-2013
FY
2013-2014
FY
2014-2015 DIESEL TOTAL 34,155 34,917 38,413 40,509 33,128
(Board of Governor) Fuel Refund to
members
142 40 0 140 417
Generators 10,946 12,646 13,656 18,618 11,890
Vehicles 14,857 15,984 21,586 20944 19,769
Workshop 22 20 18 47 26
Incinerator 230 265 260 255 260
Others 7,959 5,962 2,893 505 766
PETROL TOTAL 1,717 1,692 1,523 2,020 2,709
Donation 200 160 0 59 0
Generators 0 0 0 0 0
Vehicles 170 583.5 247 184 15
Motorcycles 203 331 556 1,340 2,275
Workshop 30 13.5 65 64 0
Others (Sales) 1,101 604 655 373 419
KEROSENE TOTAL 158 171 196 171 105
Workshop 54 67 49 7 78
Pharmacy 0 0 0 0 3
Main store 27 0 21 1 0
Others 77 104 126 164 24
4. Domestic services
4.1. Water Supply
The Hospital has access to a substantial water supply provided by four wells that serve also the
School, the Mission of the Comboni Fathers and the Convent of the Little Sisters of Mary
Immaculate. The wells are located at approximately 1,300 metres from the Hospital. The water is
pumped to two main tanks with a total capacity of 90.000 litres. The distribution and storage of
water is provided by a network of pipelines that were installed many years ago and currently
show signs of wearing (with leakages that increase the costs of the supply). All buildings are
provided with small tanks (average capacity of 150 litres). Overall the reserve capacity in the
tanks is very small and allows no more than 2-3 days autonomy. A complete analysis of the
yielding capacity of the wells and on the quality of the water pumped was conducted as a basis
for further planning and interventions.
Actions Required:
• Install new pipelines to link the wells to the main tanks.
• Improve/increase the storage capacity of water to a total reserve of at least 240,000 litres.
• Repair/renovate the entire distribution system to eliminate leakages and secure regular
supply.
• These actions are expected to be executed gradually during the next 2-3 FYs.
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71
The government has already planned in provision of piped water for the town council and
activities are already underway. The hospital shall also connect to the systems but shall continue
to maintain the private wells.
4.2. Power Supply
The Hospital has been receiving power from the national electricity network since March 2010.
However the supply is not constant and the Hospital has still to rely on generators to provide
sufficient power. In some Hospital Departments and in the Doctors’ quarter small solar systems
provide additional power for lighting. Due to insufficient funding no major activities have been
done to improve the system. The generators of the Hospital are also under-dimensioned in
relation to the requirements that are expected in the near future
Action Required:
• Re-organise the electricity distribution system, replace cables and install new electric
boxes as required to avoid dispersion and losses and ensure safety for all users.
• Procure a new or refurbished generator with substantial higher capacity.
4.3. Sewage System
The sewage system of the hospital serves the entire Hospital, with the doctor’s quarters, plus the
Midwifery School and also the nearby Parish and Convent. All sewage is disposed through a
lagoon at about 600 m from the Hospital.
The hospital got funding from Wamba Anthena Onlus-Cariparo Project through Ambrosoli
Foundation for the rehabilitation of the lagoon. Work started in April 2014 and this involved
constructing a new pre-treatment unit (PTU), Treatment wetland Plant (TWP) and a Sludge
Drying Reed Bed (SDRB). This project shall be completed next financial year. We expect to
have a fully functional and efficient sewage system that is environmentally friendly. There is still
insufficient number of Toilets and bathroom to equate the number of users in the hospital. There
is still a lot of work required to improve these facilities. Actions Required:
• Completion of the major renovation of the sewage system Construct/renovate toilets and
bathroom of the Hospital including that of the staffs residence.
4.4. Waste Disposal
Due to the big population of both the Hospital and the School of about 800 people (staff,
students, patients and attendants) a lot of waste is generated and yet the capacity to manage the
waste is very minimal. The hospital in the same project of the sewage system, has also procured
a new incinerator that has been dimensioned to the appropriate capacity and the building will be
constructed near the lagoon at a distance that does not cause pollution to the population.
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Much as a new incinerator shall be installed, a lot of effort has to be made in building capacity
and creating awareness on how to properly manage waste. This is still a big challenge that needs
changing the mind-set of the people.
Action Required:
• Install the new incinerator with the capacity to manage the amount of hospital solid
waste.
• Train and build capacity of staffs in the management of waste
• Develop means for the collection and removal of waste to be transported to a final
location of permanent disposal agreed upon with the local Authorities.
5. Internet and Intercom Telecommunication
5.1. The hospital Internet system
The effectiveness of the internet connectivity in the hospital has become quite insufficient and
unreliable. The Internet connection speed has never been faster than 30 KB/s measured by a
direct connection to the satellite receiver. This is very poor taking into account the number of
users and volume of data involved.
Action Required:
• Install a complete WI-FI system for deploying internet connection to cover the entire
hospital complex
• Contact a service provider like MTN or Airtel and procure a bandwidth of 21.6mb/s 3G+
technology
5.2. Intercom Telecommunication
The hospital intercom telecom system with over 80 lines which used to serve the entire Hospital,
with the doctor’s quarters, plus the Midwifery School and also the nearby Parish and Convent
has become old and worse still, was struck by lightning thus destroying the motherboard. Less
than 20 lines are available and this is quite insufficient to serve well the entire hospital.
Action Required
• Adopt and procure a new or refurbished wireless voice communication system with
cordless telephones e.g. a DECT System. This is to avoid copper wired phone lines which
quite costly
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CHAPTER EIGHT
8.1. Quality and patient safety improvement
The Quality improvement initiatives was harmonized and institutionalized at HCFs within the
national quality improvement framework through technical support from the team of nurses from
Japanese Red Cross society and UCMB.
8.1.1 Quality indicators
1. Availability of clinically qualified staff in the hospital
In the last five years the number of qualified staff has increased, the Hospital is gradually
phasing out both Nursing Aides and Nursing Assistants or transferring them to other non-clinical
responsibilities. Moreover efforts have been made to recruit more qualified staff in a few
departments (Laboratory, Theatre, Maternal related services).
It is to be noted that the Nursing Aides and Nursing Assistants have been counted as Unqualified
Staff.
Table 8.1 - Proportion of clinically qualified staff in the hospital in the last 4 FYs
2. Quality of care
Maternal Death Rate has decreased, however the Infection rate for caesarean section increased to
10%. On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still
Birth Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.
Some of these negative trends may be explained by the high attrition rate of qualified staff
particularly the medical personnel that affected the quality of work in the hospital, especially in
Indicators 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015
Total No. of employees 219 213 220 212 239
Qualified staff 102 113 120 138 194
Clinically qualified staff 86 100 88 97 108
Proportion of clinically qualified
staff over all qualified staff
84.3% 88.5% 73.3% 70.3% 55.67%
Proportion of clinically qualified
staff over all clinical staff
71.1% 84.0% 83.0% 87.4% 85.71%
Proportion of clinically qualified
staff over the total hospital staff
39.3% 46.9% 40.0% 45.8% 45.19%
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
74
Maternity Ward. The stability and adequate qualification of human resources is a prerequisite to
have an effective improvement measures for quality attainment.
Table 8.2: Indicators for the quality and safety measures Indicators 2010-
2011
2011-
2012
2012-
2013
2013-
2014
2014-
2015
Explanation
Recovery rates
on discharge 97.6% 98.3% 96.5% 97% 99%
Recovery rates on discharge:
patients in one year discharged as
clinically recovered from that episode
of disease (from all wards) following
treatment.
Maternal
death rates
after
admission in
maternity
0.20% 0.17% 0.07% 0.11 0.0%
Maternal death rates: is not a
population based maternal mortality
rate or ratio that you may often come
across.
Fresh still
birth rate 0.77% 0.39% 0.7% 0.6% 1.1%
Fresh still birth rate: Fresh Still
births have intact smooth skin not
macerated.
Infection rate
of caesarean
sections.
7.4% 7.2% 1.0% 4.0% 10%
Infection rate of caesarean sections:
if mothers are discharged much earlier
than the 8 days, information is also
collected also from the post-natal
clinic where the mothers will show up
if they got infected.
Early neo-
natal deaths
rate
0.89% 0.80% 1.0% 1.4% 1%
Early neo-natal deaths rate. Number
of babies who died within the 7th day
from birth divided by the total number
of deliveries in the hospital in that year
expressed in percentage terms.
Table8.3: Quality rates per indicator
Years FSB rate MDR
rate
RR rate IRCS rate STAFF
rate
SATIS
rate
DRUGS
rate
2010/2011 0.77 0.20 97.6 7.4 84.3 82.6 88
2011/2012 0.39 0.17 98.0 7.2 88.5 85.6 87
2012/2013 0.70 0.07 96.5 1.0 73.3 65.7 78
2013/2014 0.60 0.11 98.2 4.0 70.3 77.6 90
2014/2015 1% 0.1% 98.5% 0 79.3 79.3% 0 FSB - Fresh still birth rate; MDR - Maternal death rate; RR - Recovery rate on discharge; IRCS - infection rate for caesarean section;
STAFF- Qualified staff percentage; SATIS -Patient Satisfaction score; Drugs - Appropriate drug prescription score.
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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8.2. Health surveys
8.2.1. Patient satisfaction survey
Attempts have been made and continuously so to improve the level of satisfaction of patients
who visit the hospital. Overall, the patient satisfaction score has increased to 79.3% in 2014/2015
compared to 77.6% in 2013-2014 However, some significant variation in patient satisfaction was
realized across the various departments, OPD scored 72.8 percent; In-patient scored 79.4 percent
whereas ACT Section obtained 90.1 percent.
Table 8.3: Satisfaction levels per core area for the last 4years
Satisfaction rate
FINANCIAL YEAR FY11-12 FY12-13 FY13-14 FY14-15
Clinical outcomes 90% 96% 95% 94%
Humanity of care 96% 80% 100% 85%
Organization of the care / waiting time (OPD) 72% 42% 78% 56%
The healthcare environment 98% 62% 100% 99%
General opinion n.a. 73% 96% 97%
Overall score 85.6% 66% 77.6 79.3%
8.2.2. Drugs prescription and dispensing survey
In the survey conducted to gauge the drugs prescription in the hospital, the score was 15/20
Points for Poly Pharmacy which is the 16th level towards achieving the highest score. For use of
Antibiotics, the Hospital scored 16/20 Points four levels below the highest score.
The best clinical practice in this Hospital is seen in the use of injectable drugs in Out Patient
department which was found to be 0.03 per total number of drugs prescribed.
The Survey finding also shows that 97% of drugs prescribed were actually dispensed meaning
that 3% were not dispensed due to stock out.
Out of 80 medical Forms examined, 83 percent contained record of Objective Medical
Examination. All the medical Forms examined contain record of both History and Diagnoses.
Overall, the Hospital scored 82 percent for quality of drugs prescription.
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76
8.3. Perspectives and Work plan for Quality Improvement
Quality improvement initiatives proposed for the FY 2015-2016
Table 8.4: Work plan for quality improvement activities for FY 2014-2015
Activity/
Intervention
Key Action Steps Deadline for
implementation
Person(s) Responsible
1. Reduce
infection rate of
C/S.
Strengthen the central
sterilization department
(CSSD)
End of FY (June
2016)
Medical Director ,SNO and
I/C of infection control
committee
2 Reduce early
neonatal deaths.
Ensure the availability of
Emergency bag in all the
wards
End of FY (June
2016)
MO and I/C of Maternity
Wards
3.To reduce
under/over as
well as late
reporting of data
Involve quality assurance
committee in monitoring
the quality, Mgt. to ensure
computerization, Reliable
internet connectivity and
capacity building
End of FY (June
2016)
CEO/Administrator
Medical Director
M&E
I/C of quality improvement
Committee
4.Strengtern
waste
management
Continuous awareness
creation and Education on
waste management
End of FY (June
2016)
Infection control committee
5.Reduce waiting
time in accessing
care
Create a customer care
desk in OPD
Extend the working hours
in OPD from 8:00 am to
9:00pm
End of FY (June
2016)
I/C of OPD.
SNO
Medical Director
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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CHAPTER NINE
HEALTH TRAINING INSTITUTION
St. Mary’s Midwifery started in 1956 as a Midwifery Assistant school. In 1959 it was upgraded
to a Midwifery Training School. The Principal continued to report to HMT all the school issues
including those that needed decision making. Major decisions on the school were taken by the
BOG.
The school offers two courses namely Diploma in midwifery (D/M) and Certificate in Midwifery
(C/M). It is no longer training Enrolled Comprehensive Nurses.
Since its beginning the School has qualified a total of one thousand two hundred and forty nine
(1,249) qualified staffs who are serving in various parts of the country as well as outside Uganda.
• Nine Hundred ninety eight (998) Enrolled/Certificate Midwives (EM/CM),
• Two Hundred and eleven (211) Registered/Diploma Midwives (RM/DM),
• Forty (40) Enrolled Comprehensive Nurses/Certificate Comprehensive Nurse
(ECN/CCN)
9.1. Human Resource Management and Development
Tutors and Clinical Instructors
The school does not have yet sufficient teaching staff and sometimes has to hire part time experts
in the different disciplines to ensure that the syllabus is covered and students get all the necessary
knowledge and skills necessary for the practice.
Table 9.1: School staff and support staff establishment 2014/2015
No Cadre (Qualified) Established
target
Actual Shortage
1 Tutors 6 5 1
2 Trained clinical mentor 5 3 2
3 Untrained clinical instructors 0 0 0
4 Account Assistant 2 2 0
5 Cashier 1 1 0
6 Record Assistant 1 1 0
Total 15 12 3
No Cadre (Support Staff) Established
target
Actual Shortage
7 Store Assistant/Library Attendant 1 1 0
8 Office Attendant 1 1 0
9 Cooks 6 6 0
10 Driver 1 1 0
11 Watchmen 2 2 0
Total 26 21
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
78
Staff attrition
This financial year had seen quite a high attrition of up to 5 Clinical Instructors leaving the
school between March and May 2015. Four of the staff left as they were sponsored by the
UNFPA for another districts and were waiting for their recruitment while working with the
school. Currently we have only five tutors, and two clinical mentors who have obtained diploma
in mentoring and attached to the hospital. One clinical mentor will be recruited in December
2015 after her nursing course. The plan is to recruit more staff to bridge the current gap.
Staff development
The tutor who went for degree course in Nursing finished in December 2014 and is now waiting
for internship next year in February 2016. One staff that went for a degree in accounting has also
finished successfully and is back on duty. Other staffs continuously had rotation in professional
refresher courses in different fields. The staff had always used the information received from
these seminars or workshop for teaching or Continuous Medical Education (CME)/Continuous
Professional Development (CPD).
Other workshops or meetings organized by the following organizations: UNMEB, MOH, MOES
UCMB, Jphiago and UNFPA were attended by the staff as indicated in table 5.
Table 9.2: Workshops/courses attended by the teaching staff
S/N Workshop Organized by Number of staff Duration
1 Update of midwifery records UNMEB 3 1 week
2 Update of Nursing and midwifery records UNFPA 1 1 week
3 Review of Midwifery Curriculum UNFPA 1 1 week
4 Review of teaching methods UNFPA 4 1 week
9.2. School Performance
Table 9.3 Student Enrolment by year in year 1st, 2
nd, 3
rd and success rate 2014/2015
Course In The
Year
1st Year 2
nd
Year
3rd
Year
Current
No.
Sat Final
Exams
Pass
Final
Exams
Success
Rate
C/M 40 in May Now 38 41 54 133 47 46 98%
D/M 9 in Feb Now 8 7 15 11 10 91%
Total 51 46 41 38 148 58 56 97%
The total objective capacity has been increased from 120 to 150 and approved by the BoG. It had
been noted that the number of candidates applying for Diploma in Midwifery is dwindling each
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
79
year. For this reason, the places for certificate course had been increased. There is need to
consider direct courses as well.
The success rates for both Certificate and Diploma Midwifery have dropped due to two students
who were known to be weak failing a paper each. The School shall not consider students who
fail consecutive examination to sit for state final examination.
In 2014/2015 two students were dismissed due to pregnancy. These students reported when they
were already pregnant and never declared their condition.
In conclusion, the enrollment of students has been controlled to the objective capacity of the
school. However, it had been noted that the students’ performance is dropping therefore, the
school administration together with the school staff need to help the students not only
academically but also in other aspects of their lives that can affect their performance.
Achievement
• The school is finalising the processing of release by the MoES of the bus that has been
donated by DANIDA. This is a big boost in facilitating activities of the School.
• The plan and bill of quantity for the Computer Lab is being is in the final stages of being
developed. This will be submitted to the Town council for approval in the beginning of
2015-2016.The biggest task of insufficient funding still looms.
• UNFPA has procured an assortment of books that will enable students’ access
information to help them improve on their knowledge in the field of Nursing and
Midwifery as well as other values required of such professionals.
Forth Coming Events
The School has planned to organise the 5th Graduation ceremony for both Certificate Midwives
and Diploma midwives scheduled to take place on the 15th of January 2016.
9.3. School Finances
St. Mary’s Midwifery training school is a cost centre in Dr. Ambrosoli Memorial Hospital-
Kalongo. It has its own approved budget but still supported by the hospital for some
administrative procedures. The hospital engages an external auditor that audits both the hospital
and school account and provides two distinct financial reports.
Income
Table 9.4 Planned, actual and unrealized income in 2014/2015
Planned income Actual realization Unrealized income
751,564,026/= 592,108,794/= (159,455,232/=)
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The actual income was significantly lower than expected as a major project that was planned for
opening up an income generating activity did not materialize. Also the PHC-CGs budget was not
realized according to the budget estimate.
Source of income
The greatest percentage of school’s income comes from school fees from Donors which
includes; UNFPA, MOH-DP & Dr. Ambrosoli Foundation, Copeland Foundation.
Expenditure
Table 9.5 Planned, actual expenditure and unspent balance in 2014/2015
Planned expenditure Actual expenditure unspent balance
751,564,026/= 467,673,625/= 283,890,401/=
The expenditures projected for capital infrastructural development did not materialize as no such
activity took place. The activities have all been shifted to the next FY 2015-2016.
Support from the Hospital
• The Hospital and School is under the same management team.
• Supervision of students in the wards is done together by ward In charges, as other
qualified staffs, Tutors and Clinical Instructors.
• Rotation of staff is done centrally by the Human resource manager in consultation with
key line managers; redeployment is at the discretion of management.
• Hospital’s administrator approves all financial transaction in both the school and the
hospital.
• Management is responsible for lobbying for funds from donors.
9.4. Relations with external partners
The school also enjoyed the support of the local community, the parents and guardians of the
students and external partners like UCMB, UNMEB, UNMC, MoH/DPMoESOther individual
donors such as Dr. Ambrosoli Foundation, UNFPA, Baylor-Uganda, Gretta Foundation,
Copeland Foundation, Light ray, Intra-Health Uganda and HTI in the PNFP.
These external partners continued to play vital roles in the running of the school in terms of
financial support, technical assistance, mentoring in the clinical areas and training. The external
partners provide opportunity that exposed staff to attend various courses and in turn disseminate
the knowledge and skills attained.
In conclusion, the relationship and contributions of external partners are very vital in the life and
continuity of the school.
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9.5. PHC Activities
The school participates in carrying out PHC activities with the HSD. Some of these activities are
immunization and health education. Tutors, Clinical Instructors and students are always
involved.
9.6. Faithfulness to the Mission
The school progress in Faithfulness to the Mission is monitored through 4 key indicators:
o access = percentage of total capacity used;
o equity = average student fee;
o efficiency = average recurrent cost per student;
o Quality = average rate of students passing their final exams (success rate) and tutor/student
ratio).
The key financial indicators in the year 2014 - 2015
NB: Note that these figures calculated based on the audited accounts for the year ending 30th June 2015
ACCESS
The Total number of students present F/Y = 153 x 100% = 102%
Total Capacity of the School 150
Comparing the past financial year 2013/2014 and this year 2014/2015, there was slight reduction
of 6%, in the number. However, due to some referrals, the number is still beyond the objective
capacity. But at the end of the financial year the physical count of the students present was 148.
This was due to students who left due pregnancy as indicated previously.
After Audit
Total fees Collected F/Y 397,565,454/= 2,598,467/=
Total number of students 153
The school fees income comes from the following sources: fees for students sponsored by Dr.
Ambrosoli foundation, UNFPA, MOH-DP Bursary scheme, MOH IntraHealth strengthening
project, Copeland foundation, and privately sponsored students.
Efficiency
After Audit
Total Recurrent Costs 467,673,625 /= 3,056,691/=
Total number of students 153
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Quality: success rate
Total number of students who passed = 56 x 100% = 96.5%
Total Number of Students who sat 58
Figure 9.1: EVOLUTION IN STUDENTS’ PASS RATE WITHIN FIVE YEARS
Compared to the previous years as already explained, this year 2014 – 2015 the students success
slightly increased to 96.5% compared to 96.2% last year.
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CHAPTER TEN
SUMMARY, CONCLUSION AND RECOMMENDATIONS
Conclusion
Dr Ambrosoli Memorial Hospital is a biggest health institution in Agago District that serves
most of the neighbouring Districts. In FY 2014/2015 a number of activity indicators showed a
negative trend but this should not be interpreted as a decline in itself as generally the trend both
at district and national levels show the numbers going down in many facilities. The fact that the
services offered at LLU are becoming better, improved staffing levels, availability of drugs and
community participation and involvement in the affairs of the health facility makes patients to
feel more confident to attend services nearer to their homes and at no or little cost moreover.
At national level, the hospital has once again performed quite well in terms of activity output as
noted in the Annual health sector performance report 2014-2015 league table released by the
Ministry of Health. The hospital ranked 18thout of 132 general hospitals in the country, Among
PNFP hospitals it ranked at position 2 which is quite commendable.
The hospital received a Certificate of Accreditation from UEC/UCMB (Scoring 95%) for the
calendar year ending 31st December 2016.
The hospital on the 28th /10/2014 earned the “Best Employer Awards” certificate of recognition
for being the Most Compliant Employer in Lira area of jurisdiction.
The issue of sustainability is still at the centre of all activities and initiatives that the Hospital
will implement or introduce. In order to meet all these challenges the Hospital strives to
strengthen its governance bodies and its managerial capacity and embark in substantial
reorganizational efforts.
There is still need to invest in building the human resource capacity as well as in other resources
of financial management, infrastructural development in order to attain the required level of
service delivery. Some essential positions in the hospital still lack qualified personnel,
management is making efforts to ensure that qualified personnel are recruited or opportunities
for further studies accorded depending on need and merit.
The hospital after 59years of its existence the hospital needs urgently a facelift in many of its
structures, some of which are old, dilapidating and needs major renovation.
About half the numbers of staffs are accommodated within the hospital premises but the housing
condition needs to be improved and new and better housing units but this needs concerted efforts
to raise funds.
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Faithfulness to the Mission Report (performance indicators)
The Hospital has maintained its faithfulness to the Mission and has continued monitoring a few
indicators to help assessing its performance in the four key areas of Access, Equity, Efficiency,
and Quality.
ACCESS The OPD attendance has decreased by 12.6 % compared to the previous year (from 29,206 in FY
2013/14 to 25, 526 in FY 2014/15). The there is a decline in absolute number of OPD cases, the
per capita OPD utilisation of 1.2 is consistently achieved looking at the catchment population of
Kalongo Town.
The Major cause of morbidity in OPD in the last FY 2014/2015 has been Malaria, respiratory
tract infection, acute diarrhoea. The same pattern is in the lower level health facilities therefore
likely to be the cause of decline in OPD attendance, however the community still has access
though there is need to improve strengthen more the referral system in order to make sure that
patients are accessing service near their village according to their condition as well as reducing
on waiting time and community sensitization.
The above shows that the number of female attending OPD is still higher for the last five years
compared to the number of male. This may be naturally attributed to health seeking behaviour
among the female and the demographic aspect within our catchment area.
The OPD attendance among children under five has decreased by 4.6 % (from 30.8% in FY
2013/14 to 26.2% in 2014-2015) whereas for Five years and above it decreased by 11.2% (from
95.6% to 84.4%). The hospital was able to be accessible to 9.0% of total OPD attendance
accessing services in Agago district.
ANC Attendances
The total ANC visit has also declined by 11.3 %( from 6,664 in 2013/2014 to 5,909 in 2014-
2015. Although ANC total visit declined, ANC 4th visit increased in proportion by 2.0%. The
hospital has contributed 18% of ANC total visit and 18.2% of ANC 4th visit in Agago district.
This is a good indicator which shows that the mother and baby stand a better chance to minimise
the risk of maternal and neonatal death.
The reduction of utilisation of the Hospital ANC services should not necessarily be looked at as a
problem of accessibility, considering that the LLUs services are offering equivalent and effective
ANC services nearer to the residence of the mothers.
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Immunisation
In FY 2014-2015 the total number of doses of immunisation antigens administered increased by
46.3%. The Hospital contributed 9.9% of the total number of immunisation in Agago District.
The hospital carries out daily routine immunization services. The outreach services during
Family Health Days and Child Health Days has also contributed to higher number of beneficiary
being immunized because of much effort from the VHT attached to hospital who works
tirelessly to mobilize the community so that they benefits from these services.
Admissions
The total admission has decreased by 8.5 %( form 14,186 in FY 2013/14 to 12,981 in 2014/15).
The hospital contributed 67.8% of total admission in the district. This can be attributed to the
functional lower health units especially HC III who are able to admit and treat minor illness as
well as admit mothers for delivery.
Deliveries increased by 9.0% in 2014-2015 compared to the last financial year. 36.1% of total
professionally assisted deliveries in Agago district were done in Kalongo Hospital. This can be
attributed to the good services being offered to pregnant mothers. Caesarean Sections rate is at
8.8% which still below WHO redline due to Health education and waiting shelter provided on at
risk pregnant mother on regular basis.
The trends observed last FY 14/15 showed that:
� OP contacts decreased by 12.6%
� IP admission decreased by 8.5%
� ANC clients decreased by 11.3%
� Deliveries increased by 9%
� Immunization increased by 46.3%
There is a slight decrease in access to services by the community (6.4%) in FY 2014/2015 as
noted by decrease in the SUO from 258,014 to 241,573.
Equity
The indicator Fee/SUO-OP has increased by 14.6%. For the last 4 years this indicator has been
increasing however the user fees in Kalongo Hospital is still one of the lowest among the PNFP
health facilities in the UCMB network even in the Country.
EFFICIENCY
The hospital economic efficiency has improved slightly by 0.4% because the cost of producing
one SUO has decreased from UGX 15,571 to 15,506
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Quality of care
Maternal Death Rate has decreased, however the Infection rate for caesarean section increased to
10%. On the other hand, Recovery Rate on discharge improved from 97% to 99% and Fresh Still
Birth Rate increased from 0.60% to 1.1%. Early neonatal death rate decreased from1.4% to 1%.
Some of these negative trends may be explained by the high attrition rate of qualified staff
particularly the medical personnel that affected the quality of work in the hospital, especially in
Maternity Ward. The Stability and adequate qualification of human resources is a prerequisite to
introduce effective improvement measures and for more focused effort in quality improvement.
SUSTAINABILITY OF THE HOSPITAL
The user fee in Kalongo Hospital is the lowest among PNFP hospital and hospital in Uganda at
large.
The data on sustainability ratios need to be carefully interpreted. In FY 2014-2015 the Hospital
has slightly improved the sustainability ratio depending on its own revenues (from 14.5% to
14.6%) but when also Government support is added, the sustainability ratio increased from
27.2% to 28.1%. For last 10 years the Government financial support (PHC-CGs) has been
maintained practically constant, almost three quarters of the budget depends on foreign support
(donations and projects) making the Hospital extremely vulnerable to financial crisis if any of the
supporters withdraws and is not timely replaced. There is need to organize a stakeholders
meeting in order to address the issues of user fees for the patients.
.
Critical issues
The turnover of the employee is still quite high affecting the quality of care and increasing the
cost of staff employment and development.
Some buildings of the hospital still have asbestos roofs, lack of space for the service delivery
(e.g. Children wards and Laboratory) and inadequate accommodation for the staff.
Lack of internal auditor, radiographer and anaesthetist in the hospital,
For the last 5 years the health care service is facing a transition in morbidity patterns and
utilisation of health services; there is need to re-define the role of the health services and in
particular of the Hospital Vis-à-vis these changes. The existence of a network of 32 LLUS (24
HCII and 8 HCIII) with growing capacity to offer health services as per their level of care, the
primary health care that are provided at lower level, such as those offered in Outpatient
Department and in Antenatal clinics, have reduced but the demand for surgical, comprehensive
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EMOC, and other specialised care are increasing. There is need to focus and strengthen the
services which are not offered at lower level units such as:
1) Endoscopy examination
2) Dental care
3) Mental Health care
4) Sickle cell clinic
5) Diabetes clinic
6) Cervical cancer screening
7) Ophthalmic care
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CHAPTER ELEVEN
PLANNING FOR THE FUTURE
Health care service delivery and Primary Health care
To deliver health services with special preference to the poor and most vulnerable and
disadvantaged as well as foster social and spiritual services to the population within the locality.
Management will strive to ensure that all patients are properly assessed, diagnosed, admitted,
treated, discharged and receive preventative care to achieve the best possible health outcome.
Management will also ensure that care is based on the best available evidence; the recognition
that value for money is high on the agenda of healthcare nationally and internationally, thus
necessitating the need to be more committed to delivering health services in a cost effective
manner with clear accountability.
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Sustainability of the hospital, career development and safety of the staffs
• Sustainability ratio of the hospital still very low, therefore the hospital management is planning to organize a stakeholder meeting by the end of Jun the next financial year.
• We recognize that staffs are the greatest asset of the hospital and the services we provide. We commit to providing a working environment that values and supports staff, and offers unparalleled opportunities for personal and career development for Infrastructure.
Strategies planned for Health care service delivery
Table 11.1: Current status and planned activities for the major department of the Hospital
Service
Current status Strategies Planned Time
Frame Responsible person
Source of
Funding
OPD • OPD services available
from 8:00 am to 5:00 pm
• Long waiting time
• Inaccuracy in data recording and late reporting
• Extend working time in OPD from 8:00 am to 9: 00pm in order to minimise congestion of patients in the wards
• Recruit one clinical officer
• Organising specialised clinics; Diabetes, Dental, Cardiovascular, Sickle cell, and Cervical cancer screening.
• Computerising data recording and to minimise the cost attached to the registers
End of FY 2015/2016
• HMT
• Medical Director
• CEO/Administrator
Hospital Ambrosoli foundation and other partners
Surgical � Trauma & Emergency care
� OPD Surgical Clinic,
burns general surgical operations & Physiotherapy
� Orthopedics limited
services and high # of referrals
� Maintain current service offered � Secondment of One medical officer
by MoH � Conduct quarterly Specialized
Surgical Camps under support of partners and other
� Renovation of surgical building
End of FY 2015/2016
� Medical Director $ Ward Surgeon
� Medical Director
$ Ward Surgeon � CEO/Administrat
or
Dr.Ambrosoli foundation, MoH and other international partners
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Service
Current status Strategies Planned Time
Frame Responsible person
Source of
Funding
� Old building with
asbestos roof
Internal Medicine
• General Adult and Children Outpatient Clinic
• Medical Admissions & care
• Strengthen potential partnerships that could improve quality and efficiency of the services
• Maintain current service offered
End of FY 2015/2016
IDEA Cardiologist from Italy and
Paediatric & Neonatology
� YCC � Therapeutic feeding. � Neonatal intensive care � Paediatric admission &
care � Immunization and
health promotion. � Old building
� Maintain current service offered � Initiate Sickle cell clinic � Renovation of children ward building
End of FY 2015/2016
Ward medical officer
HMT and international partners
Obstetrics & Gynaecology
• Antenatal and Post-natal care PMTCT
• Natural family planning
• General obstetrics & gynaecology Care
• Waiting shelter for pregnant mother at risk
• Maintain current service offered
• Secondment of one medical from MoH.
• Reinforce gynaecological and obstetrical services by recruiting a gynaecologist sponsoring one MO for specialisation
• Initiate cervical cancer screening
End of FY 2015/2016
MoH Patologioltre frontier(project against cancer), Ambrosoli foundation
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Service
Current status Strategies Planned Time
Frame Responsible person
Source of
Funding
• Renovation of waiting shelter building for pregnant mother
Medical imaging
� General radiology
� Ultrasonography
� Electrocardiogram
� Recruitment of qualified
� staff in radiology department
� Strengthen collaboration with
Cardiologist from Italy
� Create one medical
� imaging unit
� Train an addition sonographer for the
sustainability of the service
End of FY 2015/2016
HMT and international partners
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Service
Current status Strategies Planned Time
Frame Responsible person
Source of
Funding
Laboratory service
• General laboratory services for the hospital
• Centre laboratory hub in Pader and Agago district for sample collection, testing and results networking
• Inadequate space to accommodate all laboratory equipment for a wide range of test profiles available in the lab.
• Ensure functionality of laboratory activities and Hub program on 24/7 basis
• Promote, implement and sustain MOH/WHO SLMTA (Strengthening Lab Management towards Accreditation) programme.
• Relocating the lab to the old theatre and renovating it to suite a national laboratory hub.
• Establish a cytology laboratory
• Train lab personnel to ensure quality and reliable cytological diagnostic slides
SDS Hospital Ambrosoli Foundation
Pharmacy � General pharmacy
� Distributing services
� Strengthening internal procurement
committee
� Ensure availability of drugs and
sundries
� Ensure availability of an accurate
procurement plan
� Strengthen drugs therapeutic
committee
Hospital Management and international partners
HIV/AIDS and GBV
• HIV/TB Care & Treatment
• Strengthen the service and comply to the requirement of the donors
Hospital Management and international
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Service
Current status Strategies Planned Time
Frame Responsible person
Source of
Funding
partners
Anaesthesia and resuscitation
� General anaesthetics
� Pre- anaesthetic care
� Inadequate human
resource
� Recruit at least 2 anaesthetists to
reduce work load
� Strengthen collaboration with IDEA
for capacity building
Hospital Management IDEA
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Strategies planned for Health sub district
Table 3.Activities/supervision to be implemented by the Health Sub-district
Program
Area
Activities Ref.
Person
Timing Indicator Annual
Target
Means of
Verification
Inputs
Support
Supervision
Visit to lower level
Health Units
HSD
Team
Quarterly No. of visits 4 visits Reports Vehicles, Check
list, Allowance,
fuel
Planning
Support to micro-
planning at HC II/III
level
HSD
Team
members
During
routine
visits
No. of planning
meeting conducted
4 meetings Reports /list of
attendance
Stationery,
Allowance
Sub-county planning
sessions
HSD
Team
members
According
to necessity
No. of planning
meeting conducted
9 meetings Reports /list of
attendance
Stationery,
Allowance
Annual Planning
Meeting
HSD
Team
Once per
year
Planning meeting
conducted and
Number of
Participants
1 meeting Approved work plan
in place
Stationery,
Allowance
Monitoring
and
evaluation
HMIS data
collection,
compilation or
reports and analysis
Record
Assistant
Monthly Number of reports
timely produced.
Level of
completeness and
accuracy.
12 Reports Stationery, HMIS
reports transport,
allowances
Weekly surveillance Record
Assistant
Weekly Reports timely
forwarded
52 times a
year
Reports Stationery, HMIS
reports transport,
airtime,
Allowances
Coordination HSD Every 6 Number of meetings 2 meetings Minutes from the Stationery,
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Program
Area
Activities Ref.
Person
Timing Indicator Annual
Target
Means of
Verification
Inputs
meetings Team months meetings /list of
attendants
Allowances,
transport
Continuing
Medical
Education and
in-service
training
CME Sessions HSD Associated
to
Supervisory
Visits and
Coordinatio
n Meetings
Number of staff
identified and
trained
48 Reports from
supervision visits
and coordination
meetings
Teaching and
learning material,
manpower.
Stationery,
Logistical
Support
Cold Chain and
Distribution of
Vaccines
HSD Cold
Chain
Officer
Monthly No. of visits
conducted
12 Reports and
availability of
Vaccines in the
LLUs
Funds,
allowances, fuel,
transports
Distribution of
essential drugs
HSD
Team
Every two
months
Number of drug kits
supplied
6 Delivery notes and
availability of drugs
at LLUs
Funds,
allowances, fuel,
transports
ANNEXES
Annex 1. - Health Unit Population Report (HMIS 109) FY 2014-2015 Estimation of the target populations in the service area (District Hospital).
Total population in the service area: 330,435 (A)
Women in childbearing age in the service area: (A) x 0.202= 66,748 (B)
No. of pregnancies in the service area (A) x 0.05 = 16,522 (C)
No. of births in the service area (A) x 0.0485 = 16,026 (D)
No. o children under one year in the service area (A) x 0.043= 14,209 (E)
No. of children under five years in the service (A) x 0.202= 66,748 (F)
Suspected tuberculosis in the service area (A) x 0.003 = 991 (G)
People under 15 years of age (A) x 0.46 = 152,000 (H)
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Annex 2. - Members of board of governors & designation as per 30th June 2015
Name Designation Title
1 H.G. John Baptist Odama Chairperson Archbishop of Gulu
2 Sr. LiberataAmito Member Diocesan Health Coordinator Gulu
3 Msgr Mathew Odong Member Vicar General Gulu
4 Ms. Giovanna Ambrosoli Member Representative Ambrosoli Foundation
5 Fr Hategek'Imana Sylvester Member Provincial Superior Comboni Missionaries
6 Fr Guido Miotti Member Parish Priest Kalongo
7 Mr Louis Odongo Member Lawyer - P.O. Box 800, Gulu
9 Anywar John Kennedy Member District Local Councillor 5 - Kalongo T.C
10 Rose Ogaba Member Representative of the Local Community
11 Dr Emmanuel Otto Member DHO Agago District
12 Sr Susan Dezu Clare Member Superior General LSMIG
13 Mr. Nicholas Gregory Okello Member P.O.Box 166 Gulu
14 Dr Pamela Atim Member Medical Sup’dnt St Joseph Hosp. Kitgum
15 Obonyo Alex Secretary Ag. Chief Executive Officer/Administrator
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Annex 3. Members of the Management Team and designation as per 30th June 2015
Name Designation Title
1 Mr Alex Obonyo Member Ag. CEO/Administrator
2 Mr Alex Ojera Member Acting Senior Nursing Officer
3 Dr Myango Patient Member I/C Public Health Department
4 Sr Carmel Abwot Member Principal Tutor
5 Ms. Molly Akello Member Human Resource Manager
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Annex 4 - Hospital Staffing Level as per 30 June 2015 Cadre No. Cadre No.
District Health Officer (DHO) 0 Physiotherapist 0
Medical Officer Principal 0 Occupational Therapist 0
Assistant DHO Environmental Health 0 Orthopedic Officer 1
Assistant DHO Maternity/ Child Health/ Nursing 0 Health Educator Assistant 0
Medical Officer Special Grade (Community) 0 Anaesthetic Officer 1
Medical Officer Special Grade (Obs $ Gynes) 0 Laboratory Technologist 1
Medical Officer Special Grade (Internal Medicine) 0 Laboratory Technician 2
Medical Officer Special Grade (Surgery) 1 Clinical Officer 5
Medical Officer Special Grade (Paeditrics) 0 Steno-Secretary 1
Medical Officer Senior 0 Accounts Assistant Senior 1
Nursing Officer Principal 0 Theatre Assistant 0
Environmental Health Officer Senior 0 Cold Chain Technician 0
Health Educator Senior 0 Stores Assistant G1 1
Hospital Administrator Senior 0 Enrolled Comp. Nurse 18
Medical Officer 5 Anaesthetic Assistant 0
Dental Surgeon 0 Enrolled Nurse 15
Pharmacist 0 Enrolled Nurse Psychiatry 1
Nursing Officer Senior 1 Enrolled Midwife 38
Clinical Officer Senior 0 Laboratory Assistant 6
Health Educator /Counselors 3 Health Assistant 0
Laboratory Technologist Senior 0 Stores Assistant 3
Biostatistician 0 Records Assistant 4
Hospital Administrator 1 Accounts Assistant 5
Personnel Officer /Human Resource Manager 1 Cold Chain Assistant 0
Medical Social Worker 0 Office Typist 1
Nutritionist 0 Nursing Assistants / Aides 20
Supplies Officer 1 Dental Attendant 0
Reg. Comp. Nurse 0 Theatre Attendant/ Assistant 0
Public Health Dental Officer 0 Office Attendant 1
Dispenser 0 Driver 4
Nursing Officer (Nursing) 1 Darkroom Attendant 3
Nursing Officer (Midwifery) 6 Mortuary Attendant 1
Public Health Nurse 0 Cooks 10
Nursing Officer (Psychiatry) 1 Guards 16
Psychiatric Clinical Officer 0 Artisan 11
Ophthalmic Clinical Officer 0 Support 0
Medical Entomology Officer 0 Data Clerks 2
Principal Tutor 1 Other support staffs 39
Tutors 4
M & E Officer 2
Health Inspector 0
Radiographer 0
Clinical Instructors 0 Total number of staff 239
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Annex 5 - Hospital Staff Detail as at 30 June 2015
S/No. Name Gender Age Qualification Designation
1 Okema Joseph M 39 Dip. Business Studies (Accounting) Account Assistant
2 Okwir Denish M 29 Dip. Business Studies (Accounting) Account Assistant
3 Okello James F 31 Dip. Business Administration/ (Accounting) Account Assistant
4 Ocan Denis M 35 Dip. In Business Admin./Comp. Studies Account Assistant
5 Ayoo Christine Rose F 44 Bachelor in Accounting Account Assistant
6 Owor George Geozee M 44 BBA/Dip in Business Studies Accountant
7 Alex Obonyo M 47 Masters of Science HSM Administrator
8 Okema Alfred M 36 Dip. In Anesthesia Anesthetist Officer
9 Ocero David M 41 Dip. In Pharmacy
Apprentice Pharmacy
Technician
10 Okidi Bruno M 36 Dip. In Business Studies Cashier
11 Olanya Francis M 31 Dip. Business Studies (Accounting) Cashier
12 Auma Florsy F 26 Dip in Business Administration Cashier
13 Ayat Margaret Ann F 36 Dip. In Education. Cashier
14 Akello Christine F 40 Primary Leaving Examination (PLE) Cleaner
15 Abalo Jennifer F 38 Primary Leaving Examination (PLE) Cleaner
16 Adoch Monica F 43 Primary Leaving Examination (PLE) Cleaner
17 Adong Alba F 37 Primary Leaving Examination (PLE) Cleaner
18 Alimocan Beatrice F 33 Primary Leaving Examination (PLE) Cleaner
19 Angut Agnes F 30 Primary Leaving Examination (PLE) Cleaner
20 Atto Mary F 58 Primary Leaving Examination (PLE) Cleaner
21 Oyella Betty F 29 Primary Leaving Examination (PLE) Cleaner
22 Ocan Joseph Cox M 31 Dip. In Clinical Med & Community Health Clinical Officer
23 Taabu Geoffrey M 26 Cert. In Clinical Med & Community Health Clinical Officer
24 Oryem Denis M 26 Dip. In Clinical Med & Community Health Clinical Officer
25 Anying Janet F 25 Dip. In Clinical Med & Community Health Clinical Officer
26 Ongom Innocent M 25 Dip. In Clinical Med & Community Health Clinical Officer
27 Anena Gloria F 24 Cert. In Clinical Med & Community Health Clinical Officer
28 Okot Simon Peter M 33 BA (Hons) Adult& Comm. Educa. Community Coordinator
29 Akecho Bosco Olanza M 40 Dip. In Human Resource Management Community Coordinator
30 Amony Susan F 49 Cert. in Bakery & Jelly Making/UCE) Cook
31 Akot Christine F 29 Uganda Certificate of Education (UCE) Cook
32 Lalam Lilly Grace F 41 Senior Two Leaver Cook
33 Awili Christine F 29 Priimary Six Leaver Cook
34 Lawino Margaret F 60 Nil Cook
35 CecilliaOryema F 60 Nil Cook
36 Labol Susan F 55 Primay Leaving Examination (PLE) Cook
37 AkidiSantina F 59 Nil Cook
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S/No. Name Gender Age Qualification Designation
38 Aciro Florence F 48 Nil Cook
39 Lapura Emma F Primay Leaving Examination (PLE) Cook
40 LamwakaRoselineOkidi F 31 Cert. In Counseling &Guidiance Counselor
41 Aneno Christine F 30
Dip. In HIV/AIDS Social Care & Comm.
Health. Counselor
42 Akidi Beatrice F 28 Dip. In Social Wok Counselor
43 Akot Polly F 51 Dip. In Midwifery/Tutorship Deputy Principle Tutor
44 Ochen Luigi M 65 Driving Permit. Driver
45 Opwa Anthony M 55 PLE/ Driving Permit Driver
46 Otto Boniface M 31 Cert. in Driving. Driver
47 Ochan Simon M 39 Driving Permit. Driver
48 Olua Josef M 29 Cert. in Mechanical Eng.Craft Practice Part II Driver/Mechanic
49 Oling Francis M 29 Cert. in Electrical Installation & Regulation Electrician
50 Olweny Paul M 39 Cert. in Electrical Installation & Regulation Electrician
51 Sagal John Bosco M 27 Cert. In Nursing Enrolled Nurse
52 Sr. Draleru Lilian F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
53 Komakech Alfred M 30 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse
54 Atimango Sarah F 25 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse
55 Sr. Hellen Ayaka F 25 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse
56 Odong Alfonse M 27 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse
57 Ojok Joseph M 26 Cert. in Comprehensive Nursing Enrolled Comprehensive Nurse
58 Opito James M 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
59 Ikwap Grace Aketch F 31 Dip. In Clinical Mentoring/ Enrolled Comprehensive Nurse
60 Mwa Daniel M 26 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
61 Echel Jimmy M 28 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
62 Ayege Hellen Rebecca F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
63 Okech Geoffrey M 33 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
64 Apili Judith F 27 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
65 Ojakol David M 31 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
66 Lemo Charles M 30 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
67 AkelloCindrella F 24 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
68 Apio Evelyn F 26 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
69 Ocan Peter Okumu M 30 Cert.In Comprehensive Nursing Enrolled Comprehensive Nurse
70 Hellen Kalongo F 68 Cert. In Midwifery Enrolled Midwife
71
Abonyo Eveline
Ajenika F 23 Cert. In Midwifery Enrolled Midwife
72 Ojara Gladys F 20 Cert. In Midwifery Enrolled Midwife
73 Adong Agnes F 22 Cert. In Midwifery Enrolled Midwife
74 Lalam Florence F 21 Cert. In Midwifery Enrolled Midwife
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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S/No. Name Gender Age Qualification Designation
75 Acayo Gloria F Cert. in Midwifery Enrolled Midwife
76 Lamwaka Charity F 20 Cert. in Midwifery Enrolled Midwife
77 Oting Betty F Cert. in Midwifery Enrolled Midwife
78 Akello Rose Kevin F Cert. in Midwifery Enrolled Midwife
79 Arach Beatrice F 24 Cert. in Midwifery Enrolled Midwife
80 Akello Josephine F 27 Cert. in Midwifery Enrolled Midwife
81 ArachPancy F 27 Cert. in Midwifery Enrolled Midwife
82 Aparo Caroline F 25 Cert. in Midwifery Enrolled Midwife
83 Lalam Hellen F 35 Cert. in Midwifery Enrolled Midwife
84 Assumpta Kia F 22 Cert. In Midwifery Enrolled Midwife
85 Acan Christine Oroma F 29 Cert. in Midwifery Enrolled Midwife
86 Akello Sarah F 22 Cert. in Midwifery Enrolled Midwife
87 Amony Agnes F 30 Cert. in Midwifery Enrolled Midwife
88 Lajara Molly F 33 Cert. in Midwifery Enrolled Midwife
89 Auma Caroline F 26 Cert. in Midwifery Enrolled Midwife
90 Acan Christine F 28 Cert. in Midwifery Enrolled Midwife
91 Apoo Lillian Flora F 25 Cert. in Midwifery Enrolled Midwife
92 Adyero Harriet Grace F 23 Cert. in Midwifery Enrolled Midwife
93 AnyekoJopsephine F 28 Cert. In Midwifery Enrolled Midwife
94 Anying Jane F 23 Cert. In Midwifery Enrolled Midwife
95 Ayaa Catherine F 28 Cert. In Midwifery Enrolled Midwife
96 Abalo Janet Oburu F 29 Cert. In Midwifery Enrolled Midwife
97 Candiru Gloria F 27 Cert. In Midwifery Enrolled Midwife
98 Layet Nighty Okot F 28 Cert. In Midwifery Enrolled Midwife
99 Akech Jennifer Lopez F 29 Cert. In Midwifery Enrolled Midwife
100 AlimoScovia F 25 Cert. In Midwifery Enrolled Midwife
101 Aketo Janet F 25 Cert. In Midwifery Enrolled Midwife
102
Lalam Pamela
Adokorach F 29 Cert. In Midwifery Enrolled Midwife
103 AbonyoEnrica F 58 Cert. In Midwifery Enrolled Midwife
104 Apiyo Innocent F 25 Cert. In Midwifery Enrolled Midwife
105 Omara Josephine F 29 Cert. In Midwifery Enrolled Midwife
106 Okello David M 23 Cert. in Nursing Enrolled Nurse
107 OkotGaldhino M 24 Cert. in Nursing Enrolled Nurse
108 Iyou Florence F 24 Cert. in Nursing Enrolled Nurse
109 Kongayi Beatrice F 23 Cert. in Nursing Enrolled Nurse
110 Acanit Hellen Beatrice F 23 Cert. in Nursing Enrolled Nurse
111 Acheing Sarah F 25 Cert. n Nursing Enrolled Nurse
112 Adyango Agnes F 29 Cert. In Nursing Enrolled Nurse
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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S/No. Name Gender Age Qualification Designation
113 Amollo Anna Grace F 27 Cert. In Nursing Enrolled Nurse
114 Munyes Rosaria F 27 Cert. In Nursing Enrolled Nurse
115 AchiroProscovia F 27 Cert. In Nursing Enrolled Nurse
116 AchiroScovia F 27 Cert. In Nursing Enrolled Nurse
117 Acana Bonny M 28 Cert. In Nursing Enrolled Nurse
118 NdetioZainah F 29 Cert. In Nursing Enrolled Nurse
119 Nawal Sunday M 27 Cert. In Nursing Enrolled Nurse
120 Olaka Joseph Kwotek M 26 Cert. in Psychiatric Nursing Enrolled Psychiatry Nurse
121 Akello Molly F 32 Bach. Devpt. Studies, Post GrsdDipl HRM Human Resource Manager
122 Ogwang Charles M 31 Primary Leaving Examination (PLE) Incenerator Attendant
123 KilamaPuis M 39 Primary Leaving Examination (PLE) Incenerator Attendant
124 OjikAnjelo M 41 Cert. Pharmaceutical Asst. Laboratory Assistant
125 Omoro Luciano M 34 Cert. In Lab. Technology Laboratory Assistant
126 AkanyoCavine F 26 Cert. In Lab. Technology Laboratory Assistant
127 Nyeko Paul F 26 Cert. In Lab. Technology Laboratory Assistant
128 Okidi Ray Ongom M 26 Cert. In Lab. Technology Laboratory Assistant
129 Ocen Godfrey M 32 Cert. In Lab. Technology Laboratory Assistant
130 Okot Godfrey M 26 Dip. In Medical Lab Technology Laboratory Technician
131 Odokonyero James M 27 Dip. In Medical Lab Technology Laboratory Technician
132 EtwopTonny M 31 Bachelor in Biomedical Lab Technology Laboratory Technologyst
133 Olanya Robert M 33 BA (Hons) Public And. & Mgt. LHF Manger NFP Project
134 Opoka Richard M 32 Dip in Business Administration
LHFS
Assistant(Finance&Admin)
135 Opira Daniel M 26 Dip. In Library Library Assistant
136 Olaa Job Joe M 35 Cert. in Strategic Procurement & Logistics Mechanic
137 Abonga Daniel M 33 Bachelor in Medicine & Surgery Medical Doctor
138 OpiyoDenishOdoki M 26 Bachelor in Medicine & Surgery Medical Doctor
139 Okot Godfrey Smart M 31 Master of Medicine in general Surgery Medical Doctor
140 Dr. Ajok Jennifer F 29 Bachelor in Medicine & Surgery Medical Doctor
141 AtwineKahigwa Edison M 30 Bachelor in Medicine & Surgery Medical Doctor
142
MyangoKamundala
Patient M 41 Master in Public Health. Medical Doctor/P.H.Coordinator
143 Ouma Jacob M 23
Cert.in Pharmaceutical & Health Supplies
Mgt Medical Pharmacy Assistant
144 Otto Willy M 39 Cert. In Nursing Assistant Microscopist Assistant
145 OwekaSisto M 44 Cert. In Nursing Assistant Microscopist Assistant
146 Okidi Franco M 43 Primary Leaving Examination (PLE) Microscopist Assistant
147 Komalceh Jimmy M 26 Bachelor of Science in Computer Science
Monitoring & Evaluation
Officer
148 Oringa John francis M 34 Bach. in Business Administration
Monitoring & Evaluation
Officer
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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S/No. Name Gender Age Qualification Designation
149 OdongoJovine M 39 Primary Leaving Examination (PLE) Mortuary Attendant
150 Aguma Jimmy M 35 Primary Leaving Examination (PLE) Nursing Aide
151 AtimangoDorine F 31 Primary Leaving Examination (PLE) Nursing Aide
152 Lamunu Hellen F 54 Primary Leaving Examination (PLE) Nursing Aide
153 Olanya Richard M 32 Primary Leaving Examination (PLE) Nursing Aide
154 Oloya Davidson M 31 Primary Leaving Examination (PLE) Nursing Aide
155 Omona Kenneth M 56 Primary Leaving Examination (PLE) Nursing Aide
156 Opira Charles M 37 Primary Leaving Examination (PLE) Nursing Aide
157 Oyella Christine F 38 Primary Leaving Examination (PLE) Nursing Aide
158 Acan Florence F 45 Cert. In Nursing Assistant Nursing Assistant
159 Alanyo Christine Okot F 39 Cert. In Nursing Assistant Nursing Assistant
160 Alimocan Joyce F 39 Cert. In Nursing Assistant Nursing Assistant
161 AlwochPaska F 38 Cert. In Nursing Assistant Nursing Assistant
162 Aryemo Florence F 51 Cert. In Nursing Assistant Nursing Assistant
163 Ayoo Mary Okot F 43 Cert. In Nursing Assistant Nursing Assistant
164 ObwonaGoretty F 54 Cert. In Nursing Assistant Nursing Assistant
165 Ocan Michael M 34 Cert. In Nursing Assistant Nursing Assistant
166 OjokLakareber Thomas M 40 Cert. In Nursing Assistant Nursing Assistant
167 Okello Alfred M 45 Cert. In Nursing Assistant Nursing Assistant
168 OkidiEgidio M 36 Cert. In Nursing Assistant Nursing Assistant
169 Okot Joseph Otyang M 36 Cert. In Nursing Assistant Nursing Assistant
170 Akello Francesca F 36 Uganda Certificate of Education (UCE) Office Attendant
171 Aloyo Stella Oketta F 33 Dip. In Orthopaedics Orthopaedic Officer
172 Akwero Agnes F 26 Cert. In Medical Pharmacy Assistant Pharmacy Assistant
173 Oyugi James M 41 Cert. In Medical Pharmacy Pharmacy Assistant
174 Otim Jimmy M 30 Cert. in Medical Pharmacy Pharmacy Assistant
175 Okello Paul M 32 Cert. in Medical Pharmacy Pharmacy Assistant
176 Lakot Sabina F 55 Experience in the Field of Pharmacy Pharmacy Attendant
177 Ayella V Louis M 39 Dip. In Physiotherapy Assistant. Physiotherapist Assistant
178 Cal Jimmy M 25 Cert. in Plumbing & Borehole repair Plumber
179 Odongkara Willy M 38 Primay Leaving Examination (PLE) Plumber Apprentice
180 Komakech Paul M 40 Primay Leaving Examination (PLE) Porter
181 Ocaya Martin M 46 Primay Leaving Examination (PLE) Porter
182 Okello Bosco M 41 Primay Leaving Examination (PLE) Porter
183 OlwenyPhiliph M 49 Primay Leaving Examination (PLE) Porter
184 Olwora John Bosco M 36 Primay Leaving Examination (PLE) Porter
185 Sr. Carmel Abwot F 57 Masters in Rep.Health/Dip. mid/Tutorship Principle Tutor
186 Watum Geoffrey M 31 BSc. Population Studies. Record Assistant
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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S/No. Name Gender Age Qualification Designation
187 Lia Oliver Racheal F 26 Bachelor of Records &ArchievesMgt Record Assistant
188 Lamaro Gloria F 21
Cert. Medical information and health
management Record Assistant
189 Omara Marino M 54
Dip. In Records & Information
Managemnt/HEO Record Assistant/HEO
190 Obol Sisto M 30 Cert. In Nutrition Training. Record Clerk
191 OdongBismark M 37 Uganda Certificate of Education (UCE) Record Clerk
192 TookwaroRobina F 30 Dip. In Midwifery Registered Midwife
193 Amony Dorothy F 33 Dip. In Midwifery Registered Midwife
194 AdeePaska F 43 Dip. In Midwifery Registered Midwife
195 Aneno Irene Jacqueline F 34 Dip. In Midwifery Registered Midwife
196 Lakot Grace F 33 Dip. In Midwifery Registered Midwife
197 Lango Berna F 35 Dip. In Midwifery Registered Midwife
198 Awor Ruth F 31 Dip. In Midwifery Registered Midwife
199 LalamPaska F 44 Dip. In Midwifery/Nursing Registered Midwife/Nurse
200 Sr. AcanSantina F 44
Dip. In Clinical Mentoring/Cert.in Registered
Gen.Nursing Registered Midwife/Nurse
201 Sr. Hellen Alobo F 41 Dip. In Midwifery/Nursing Registered Midwife/Nurse
202 Ajwang Caroline F 38 Dip. In Midwifery/Ultrasound Registered Midwife/Ultrasound
203 Achan Christine Achilla F 29 Dip. in Nursing Registered Nurse
204 Ogwang Sally F 53 Dip. In Nursing/Psychiatry Registered Psychiatric Nurse
205 Ochibo John Paul M 39 Bachelor in Social &Phyosophical Studies. Sample Transporter
206 Inzikuru Diana F 31 Dip. In Entrepreneurship Dev't (DED) Secretay
207 Olanya Simon M 46 Primary Leaving Examination (PLE) Security Guard
208 Onek Charles Celsio M 35 Primary Leaving Examination (PLE) Security Guard
209 Nyero Jimmy M 35 Uganda Certificate of Education (UCE) Security Guard
210 Labeja Alfred M 51 Uganda Certificate of Education (UCE) Security Guard
211 Opio Anthony M 41 Uganda Certificate of Education (UCE) Security Guard
212 Latyet James M 44 Uganda Certificate of Education (UCE) Security Guard
213 Olum Matthew M 41 Primary Leaving Examination (PLE) Security Guard
214 OmaraTooyero Joseph M 28 Uganda Certificate of Education (UCE) Security Guard
215 Otim Andrew M 41 Uganda Certificate of Education (UCE) Security Guard
216 OryemKamillo M 26
Uganda Advanced Certificate of Education
(UCE) Security Guard
217
Odongkara Bosco
Louise M 32 Primary Leaving Examination (PLE) Security Guard
218
Onok Ben
Lutukunyonyo M 55 Uganda Certificate of Education (UCE) Security Guard
219 Olweny Albino M 29 Uganda Certificate of Education (UCE) Security Guard
220 Oryema Bosco M 35 Uganda Certificate of Education (UCE) Security Guard
221 OcenAltimo M 51 Uganda Certificate of Education (UCE) Security Guard
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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S/No. Name Gender Age Qualification Designation
222 OkelloMarceliano M 55 Uganda Certificate of Education (UCE) Security Guard
223 Moi Geoffrey M 39 Dip. Business Studies (Accounting) Senior Account Assistant
224 Ojera Alex Latim M 44 Dip. In Nursing/PCN Senior Nursing Officer
225 Laloyo John Paul F 37 Dip. Store Mgt. Store Assistant
226 Okwera David M 41 Primary Five Leaver Store Attendant
227 Okech Charles M 35 Uganda Certificate of Education (UCE) Store Attendant
228 Too-Okema Mathew M 31 Uganda Certificate of Education (UCE) Store Keeper
229 Adong Christine F 35 Cert. In Tailoring. Tailor
230 Abor Teddy Terry F 57
Dip. In Health Personnel Education &
Tutorship Tutor
231 Oyella Florence N F 39 Dip. In Midwifery/Tutorship Tutor
232 Abalo Lucy Joan F 42 Dip. In Midwifery/Tutorship Tutor
233 OpittiGomatox M 61 Primary Leaving Examination (PLE) Washroom Attendant
234 Nokrac Charles M 41 Uganda Certificate of Education (UCE)
X-Ray Operator/Darkroom
Attendant
235 Odongtoo Denis M 38 Uganda Certificate of Education (UCE)
X-Ray Operator/Darkroom
Attendant
236 Ojok David M 35 Uganda Certificate of Education (UCE)
X-Ray Operator/Darkroom
Attendant
237 Fr. Ensio Phillippi M Ordained Priest Priest
238 Okidi Kwenytino M Certificate in Catechist Catechist
239 Regina latigi F Grade II Teacher Pastoral Social Worker
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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ANNEX 6: AUDITED FINANCIAL REPORT ABSTRACT 2014-2015
DR. AMBROSOLI MEMORIAL HOSPITAL STATEMENT OF FINANCIAL POSITION
FOR THE YEAR ENDED 30TH
JUNE 2015
NON - CURRENT LIABILITIES 2015 2014
ASSETS NOTES USHS. USHS.
Non - Current Assets
Property, Plant and equipment 24 1,340,829,195 264,547,966
Work in progress(WIP) sewage system 2 136,300,719 175,226,841
Share Investments 3 1,110,000 1,110,000
1,478,239,914 440,884,807
Current Assets
Treasury Bills 168,491,922 168,491,922
Receivables 4 93,836,701 90,554,788
Prepayments 4 42,399,636
Imprest/Activity advances 5 22,935,779 15,692,054
Inventory 6 803,000,226 928,072,430
Bank and Cash Balances 7 1,209,800,243 1,583,015,299
2,340,464,507 2,785,826,493
TOTAL ASSETS 3,818,704,421 3,226,711,300
EQUITY AND LIABILITIES
CAPITAL AND RESERVES
Capital Fund 26 1,340,829,195 264,550,984
General Fund 26 960,367,023 1,101,300,658
Restricted Fund 26 1,240,913,091 808,169,015
TOTAL FUND BALANCE 3,542,109,308 2,174,020,657
NON - CURRENT LIABILITIES
Current liabilities
Payables and Accruals 8 41,063,250 212,570,493
Deferred Income 235,531,863 840,120,150
276,595,113 1,052,690,643
TOTAL FUND BALANCE AND
LIABILITIES 3,818,704,421 3,226,711,300
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
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DR. AMBROSOLI MEMORIAL HOSPITAL
STATEMENT OF COMPREHENSIVE INCOME FOR THE YEAR ENDED 30TH
JUNE
2015.
2015 2014
Appendix USHS. USHS.
INCOME.
User fees 9 429,341,811 399,799,594
Governments grants 10 506,731,434 507,620,471
Donation in cash 11 1,976,532,864 2,261,661,058
Donation in kind 12 1,091,058,978 1,019,614,218
Other income 13 82,600,220 119,265,960
Income Technical department 14 56,945,511 64,191,141
TOTAL REVENUE 4,143,210,818 4,372,152,442
Employment Costs 15 1,454,269,387 1,481,676,063
Administration Costs 16 71,011,973 125,290,190
Governance Costs 17 15,709,344 12,019,000
Medical Goods and services 18 1,436,533,515 1,629,096,034
Supplies and Services 19 75,574,313 48,845,794
Building & Electrical materials 20 61,816,690 87,511,142
Property Costs 21 232,835,274 232,462,749
Transport and Plant Costs 22 147,434,856 157,759,179
Primary Health care 23 250,856,300 242,976,850
Capital development 25 42,812,692 112,542,651
TOTAL EXPENDITURE 3,788,854,344 4,130,179,652
Net Operating Results 354,356,474 241,972,790
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
110
ST. MARY’S MIDWIFERY TRAINING SCHOOL AUDITED FINANCIAL REPORT ABSTRACT
2014-2015
ANNEX 7: ST. MARY’S MIDWIFERY TRAINING SCHOOL STATEMENT OF
FINANCIAL POSITION AS AT 30THJUNE 2015
2015 2014
Notes USHS. USHS.
FIXED ASSETS
Property, Plant and Equipment 10 78,944,586 81,727,284
Share Investment 60,000 60,000
79,004,586 81,787,284
CURRENT ASSETS
Inventory 11 149,746,760 71,330,397
Treasury bills 12 450,000,000 450,000,000
Cash and Bank 13 366,959,938 341,207,567
Receivables ,advance & Prepayment 14 129,215,674 46,427,415
1,095,922,372 908,965,379
CURRENT LIABILITIES
Creditors and Accruals 15 430,209,320 418,616,111
Total current Liabilities 430,209,320 418,616,111
NET CURRENT ASSETS 665,713,052 490,349,268
TOTAL ASSETS 744,717,638 583,028,747
FUND EQUITY & RESERVES
Capital Fund 2 78,944,586 0
General Fund 2 763,679,345 583,028,747
Restricted Donor Fund 2 -97,906,293 0
TOTAL EQUITY AND LIABILITIES 744,717,638 583,028,747
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
111
Annex 8: ST. MARY’S MIDWIFERY TRAINING SCHOOL Statement of Comprehensive
Income for the year ended 30th June 2015.
2015 2014
INCOME Notes USHS. USHS.
School fees 397,565,454 308,360,091
Grants 60,124,813 57,798,241
Other incomes 134,418,527 110,866,956
Total Income 3 592,108,794 477,025,288
EXPENDITURE
Employment Costs 4 204,361,178 204,087,584
Students Costs 5 138,916,472 112,017,152
Administration Costs 6 77,132,419 78,545,960
Transport and Plant cost 7 34,442,227 41,110,050
Property cost 8 11,658,229 3,209,863
Supplies and services 9 1,163,100 3,851,356
Total expenditure 467,673,625 442,821,965
Surplus/(deficit) for the year 124,435,169 34,203,323
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
112
Annex 9: Admissions and deaths by diagnosis in FY 2014-2015 (HMIS 107)
Diagnosis
under five years Five years and above
Cases Deaths Cases Deaths
M F M F M F M F
Notifiable Diseases
01 Acute flaccid paralysis 0 0 0 0 0 0 0 0
02 Cholera 0 0 0 0 0 0 0 0
03 Dysentery 15 17 0 0 11 15 1 0
04 Guinea worm 0 0 0 0 0 0 0 0
05 Bacterial Meningitis 0 1 0 0 0 1 0 0
06 Measles 0 0 0 0 0 0 0 0
07 Tetanus (neonatal) (0 to 28 days age) 0 0 0 0 0
08 Plague 0 0 0 0 0 0 0 0
09 Rabies 0 0 0 0 0 0 0 0
10 Yellow Fever 0 0 0 0 0 0 0 0
11 Viral Haemorrhagic fever 0 0 0 0 0 0 0 0
121nfluenzae Like Illness 0 0 0 0 0 0 0 0
13 Adverse Events Following Immunization
(AEFI) 0 0 0 0 0 0 0 0
14 Other Emerging
infectious Diseases,
specify( e,g, small pox,
ILI, SARS
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0
0
Other Infectious {communicable diseases
15 Diarrhoea - Acute 162 101 0 0 20 18 2 1
16 Diarrhoea- Persistent 25 8 0 0 2 4 0 0
17 Genital Infections 0 2 0 0 4 10 0 0
18 Hepatitis 0 0 0 0 12 3 0 0
19 Leprosy 0 0 0 0 0 0 0 0
20 Malaria 412 385 2 4 322 382 3 4
21 Osteomyelitis 1 2 0 0 13 32 0 0
22 Pelvic Inflammatory Disease (PID) 51 0
23 Peritonitis 48 38 0 1 19 19 2 1
24 Pneumonia 221 189 2 4 73 80 7 9
25 Pyrexia of unknown origin (PUO) 30 25 0 0 7 14 0 0
26 Respiratory infections (other) 188 162 0 0 73 95 2 1
27 Septicaemia 207 208 1 3 118 127 2 1
28 Tuberculosis (new smear positive cases) 0 1 0 0 87 27 5 1
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113
29 Other Tuberculosis 2 0 0 0 41 32 2 0
30 Typhoid Fever 3 3 0 0 22 52 0 1
31 Urinary Tract Infections (UTI) 9 2 0 0 31 66 1 0
32 Tetanus (over 28 days age) 1 0 1 0 0 0 0 0
33 Sleeping sickness 0 0 0 0 0 0 0 0
34 Other types of meningitis 7 5 1 1 10 18 0 2
Maternal and Perinatal Diseases
35 Abortions 347 0
36 Malaria In pregnancy 164 0
37 High blood pressure in pregnancy 4 0
38 Obstructed labour 44 2
39 Puerperal sepsis 24 0
40 Haemorrhage related to pregnancy (APH or
PPH)
23 0
41 Sepsis related to pregnancy 25 0
42 Other Complications of pregnancy 127 0
43 Neonatal Septicaemia 12 13 4 4
44 Perinatal conditions in new born (0 - 7 days) 35 23 5 7
45 Perinatal conditions in new born (8 - 28 days) 2 2 1 0
Non communicable diseases 103 67 4 4 62 74 6 2
46 Anaemia 1 2 0 0 12 50 0 0
47 Asthma 0 0 0 0 3 1 0 1
48 Oral cancers 2 0 0 0 2 0 0 0
49 Jaw injuries 9 10 0 1 13 15 0 1
50 Other oral diseases and conditions 2 0 0 0 1 2 0 0
51 Periodontal conditions 0 1 0 0 2 0 0 0
52 Diabetes mellitus (newly diagnosed cases) 0 0 0 0 15 15 3 2
53 Diabetes mellitus (re-attendances) 11 10 0 0 10 23 0 0
54 Endocrine and metabolic disorders (other) 195 136 2 1 153 223 4 0
55 Gastro-Intestinal disorders (non Infective) 0 0 0 0 5 2 0 1
56 Hypertension (newly diagnosed cases) 0 0 0 0 22 39 0 2
57 Hypertension (old cases) 0 0 0 0 6 7 0 1
58 Stroke 2 3 0 0 32 44 6 11
59 Cardiovascular diseases (other) 0 0 0 0 0 0 0 0
60 Anxiety disorders 103 67 4 4 62 74 6 2
61 Bipolar disorders
62 Depression 0 0 0 0 4 2 0 0
63 Schizophrenia 0 0 0 0 1 0 0 0
64 Alcohol abuse 1 0 0 0 45 29 1 1
65 Drug Abuse 3 0 0 0 12 22 0 0
66 Dementia 0 0 0 0 1 0 0 0
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
114
67 Childhood Mental Disorders 3 1 0 0
68 Epilepsy 5 7 0 0 34 14 1 0
69 HIV related Psychosis 0 1 0 0 11 12 1 1
70 Other forms of Mental illness 1 0 0 0 2 1 0 0
71 Nervous system disorders 3 1 0 0 4 3 0 0
72 Severe Malnutrition (Kwashiorkor) 25 25 1 1 2 1 0 0
73 Severe Malnutrition (Marasmus) 22 14 0 0 4 2 1 0
74 Severe Malnutrition (Marasmic-kwash) 7 8 0 0 13 2 0 0
751niuries - Road traffic Accidents 19 8 0 0 132 59 5 1
761niuries - (Trauma due to other causes\ 37 43 2 1 344 226 1 1
77 Animal bites 0 0 0 0 10 4 0 0
78 Snakes bites 3 3 0 0 28 20 0 1
79 Poisoning 6 4 0 0 26 13 1 0
80 Liver Cirrhosis 23 17 1 1
81 Liver diseases (other) 0 1 0 0 31 29 4 3
82 Hepatocellular carcinoma 1 0 0 0 7 6 0 0
83 Hernias 16 3 0 0 77 36 0 0
84 Diseases of the appendix 23 19 0 0 36 54 0 0
85 Diseases of the skin 131 94 0 0 155 200 0 0
86 Muscular skeletal and connective tissue
diseases 4 9 0 0 7 6 0 0
87 Genitor urinary sys. diseases (non- infective) 0 0 0 0 0 3 0 0
88 Congenital malformations and chromosome
abnormalities 0 0 0 0 0 0 0 0
89 Complications of medical and surgical care 0 0 0 0 1 0 0 0
90 Benign neoplasm's (all types) 0 0 0 0 1 0 0 0
91 Cancer of the cervix(newly diagnosed cases) 2 1
92 Cancer of the cervix (re-attendance) 16 2
93 Cancer of the breast 2 2 0 0
94 Cancer of the prostate 1 0
95 Malignant neoplasm of the digestive organs 0 0 0 0 2 0 2 0
96 Malignant neoplasm of the lungs 0 0 0 0 0 0 0 0
97 Kaposis and other skin cancers 0 0 0 0 2 0 0 0
98 Malignant neoplasm of Haemopoetic tissue 0 0 0 0 0 0 0 0
99 Other malignant neoplasm 0 0 0 0 0 0 0 0
100 Cutaneous ulcers 0 0 0 0 0 0 0 0
Neglected Tropical Diseases (NTDs)
101 Leishmaniasis 0 0 0 0 0 0 0 0
102 Lymphatic Filanasis (hydrocele) 0 0 0 0 0 0 0 0
103 Lymphatic Filanasis (Lympoedema) 0 0 0 0 0 0 0 0
104 Urinary Schistosomiasis 0 0 0 0 0 0 0 0
Dr Ambrosoli Memorial Hospital – Annual Analytical Report – FY 2014-2015
115
1 05 Intestinal Schistosomiasis 0 0 0 0 0 0 0 0
106 Onchocerciasis 0 0 0 0 0 0 0 0
Medical Emergencies 0 0 0 0 0 0 0 0
107 Cerebro-vascular events 0 0 0 0 0 0 0 0
108 Cardiac arrest 0 0 0 0 0 0 0 0
109' Gastro-intestinal bleeding 0 0 0 0 0 0 0 0
110 Respiratory distress 0 0 0 0 0 0 0 0
111 Acute renal failure 0 0 0 0 1 0 0 0
112 Acute sepsis 16 13 0 0 2 5 0 0
113 Other diagnoses
(specify Priority
diseases for health
unit)
Sickle Cell Dis'e. 23 15 0 0 11 11 1 1
0 0 0 0 3 2 0 0
0 0 0 0 0 0 0 0
114 All others 88 74 0 0 172 239 0 0
Total Diagnoses 2139 1758 26 32 2401 2579 65 55