ELCT KARAGWE DIOCESE

NYAKAHANGA DESIGNATED DISTRICT HOSPITAL

KARAGWE

2013 ANNUAL REPORT

E-mail: PO BOX 110

KARAGWE

Web: KAGERA, TANZANIA

TABLE OF CONTENTS:

  1. HOSPITAL OVERVIEW…………………………….1
  2. SERVICES RENDERED IN THE YEAR 2013…....3
  3. FINANCIAL SUMMARY REPORT………………....9
  4. DRUGS AND MEDICAL SUPPLIES……………..10
  5. STAFF REPORT…………………………………...10
  6. DEVELOPMENT PROJECT DONE IN 2013……11
  7. CHALLENGES……………………………………..12
  8. PRIORITIES FOR 2014…………………………....13
  9. TOKEN OF THANKS………………………………14

This report doesn’t entail everything in detail, it is just to give the insight of what transpired in the year 2013.

Should anyone need detailed information please don’t hesitate to contact the Doctor Incharge through the addresses below.

DOCTOR INCHARGE

NYAKAHANGA DESIGNATED DISTRICT HOSPITAL

PO BOX 110, KARAGWE via BUKOBA, KAGERA

EMAIL:

Web:

1

HOSPITAL OVERVIEW

1.1.History and development

Located in Karagwe District, Kagera Region, Northwestern corner of Tanzania.

Owned by Evangelical Lutheran Church-Karagwe Diocese

Found in 1912, as a small dispensary by Germany Missionaries

1963 was expanded and elevated to the status of a Hospital

1972 started to serve as a district Hospital

1992 A formal contract with Tanzania Government to become Designated District Hospital (DDH) was signed

The contract stipulates:

The Government is responsible for staff salaries, drugs cost and other operational costs.

The Church – Retains the ownership and is responsible for capital development.

1.2.Capacity and functions/services

The hospital capacity is 224 patients’ beds

Has 254 permanent staffs

Serves the population of over 500 000 people in Karagwe and neighboring areas.

Provides – Curative services (Medical, Surgical, Psychiatry, Obstetrical, Dental, Eye etc.)

-Preventive services (through public health program)

-Supportive services: Laboratory, Diagnostic radiology, pharmacy, Physiotherapy

-Outreach (mobile) services/clinics

The hospital directly supervises three Dispensaries belonging to the Diocese

The average annual patients turnover:

-Outpatient 60 000 – 62 000

-Inpatients 11 000 – 15 000

-Deliveries 3 500 – 4 000

1.3.VISION

Nyakahanga DDH is a reputable institution providing sustainable and affordable healthcare services to individuals and communities comprehending the spiritual needs resulting in peaceful and joyful life.

1.4.MISSION

Build a community that witnesses and glorifies the spirit of Christ through provision of holistic, affordable and accessible quality health care services through collaboration with other stakeholders

1.5.DECISION MAKING LEVELS

NYAKAHANGA DDH - DECISION MAKING /ADMINISTRATIVE LEVELS

Owner of the Facility

  1. SERVICES RENDERED IN THE YEAR 2013
  2. Various Services were offered in the year 2013 by our doctors, nurses and other staff and some specialist doctors from AMREF and Germany (Ategris group)

Two special services were introduced

  1. Cervical Cancer Prevention Program. Screening and Cryotherapy

This service started in July 2013 in collaboration with ICAP with the main objective of reducing morbidity and mortality from the cervical cancer among women by provision of early detection and management.

There are trained clinician and nurse for the purpose of this service. The targeted groups are:

HIV negative women between the age of 20 and 50 years

All HIV positive women above 20 years of age

Performance: July to December 2013

HIV status
Cancer status / Positive / Negative / Total
Positive / 12 / 9 / 21
Negative / 224 / 138 / 362
Total / 236 / 147 / 383

Among 383 clients screened 5.48% ad positive findings for ca. cervix

5.08% of all HIV positive clients were fund to have positive findings for Cancer of cerivix

6.12% of all HIV negative clients had problem.

Among 21 clients who were found to have problem, 19 received Cryotherapy where as the other two were referred to Bugando medical Centre as they had frank/advanced cancer of cervix.

  1. Endoscopy

38 patients were investigated by endoscopy in the year 2013. The following were the results;

Condition / Number of patients
1 / Peptic Ulcer Disease / 14
Oesophageal carcinoma / 7
Peptic Ulcer Disease / 3
Oesophageal Candydiasis / 10
Hiatus Hernia / 1
No conclusion (NAD) / 2
TOTAL / 38

Biopsies taken were sent to Bugando Laboratories for histology and cancer patients are referred to Ocean road cancer Institute for further management.

2.2.ADMISSIONS (Inpatients)

The hospital has 8 inpatient departments for various conditions and categories of patients.

Compared to the previous year (2012) the total number of patients admitted during the year 2013 was 14,392 being 9% higher than 2012.

Wards which had more patients were Private rooms (328%), ICU (46%), Surgical (17%).

Maternity/Obstetrics ward admitted 4,380 in 2013 compared to 4,215 in 2012 being increment of 4%.

Of all the patients admitted, special groups which were exempted in accordance to the National policy were children under five years (4008, 28%), Obs/Gyn (4981, 34.6) these group account for 62.6% of all inpatients.

Patients admitted on diagnosis of clinical AIDS and Tuberculosis were 394 equivalent to 2.7% of all admissions.

More details on admissions see table 2.1

Table 2.1: 2013 admissions per department
Ward / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / 2012 / Variance
Children / 289 / 284 / 301 / 364 / 426 / 522 / 445 / 305 / 243 / 276 / 269 / 284 / 4008 / 3678 / 9%
Gyn. / 79 / 70 / 61 / 59 / 78 / 68 / 61 / 68 / 49 / 8 / 0 / 0 / 601 / 613 / -2%
Surgical / 110 / 117 / 116 / 94 / 97 / 108 / 113 / 128 / 105 / 123 / 114 / 137 / 1362 / 1163 / 17%
Obst. / 319 / 321 / 361 / 349 / 393 / 366 / 405 / 447 / 391 / 359 / 327 / 342 / 4380 / 4215 / 4%
Medical / 295 / 276 / 306 / 271 / 346 / 414 / 368 / 271 / 227 / 273 / 258 / 293 / 3598 / 3275 / 10%
Isolation / 27 / 17 / 23 / 11 / 27 / 27 / 25 / 19 / 16 / 22 / 18 / 23 / 255 / 244 / 5%
ICU / 4 / 1 / 6 / 7 / 5 / 10 / 2 / 3 / 5 / 6 / 2 / 0 / 51 / 35 / 46%
Private / 5 / 16 / 21 / 12 / 17 / 7 / 14 / 11 / 10 / 8 / 8 / 8 / 137 / 32 / 328%
Total / 1128 / 1102 / 1195 / 1167 / 1389 / 1522 / 1433 / 1252 / 1046 / 1075 / 996 / 1087 / 14392 / 13255 / 9%

2.3.TOP DIAGNOSES (Inpatients)

Children under five years of age.

Although Uncomplicated malaria cases dropped by 27% as compared to 2012, it still topped the inpatient diagnoses for the year 2012 with 717 children. And so are the cases of Pneumonia and acute diarrhoea diseases which were second and third respectively.

Cases of severe malaria dropped by 45%. Fall in malaria cases is attributed to a number of factors such as use of Insecticide Treated Nets, Indoor Residual spray, education on early health care seeking behaviour.

Of much concern is the raise of Severe Malnutrition which rose by 47% as compared to previous year (19 cases to 28 cases) and that of anaemia which went up by 4%.

Table 2.2.i. Top conditions for inpatients below 5 years of age
2013 Jan-Dec < 5 yrs / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / 2012 / Variance
Uncomplicated Malaria / 0 / 106 / 90 / 80 / 70 / 60 / 58 / 53 / 40 / 60 / 60 / 40 / 717 / 979 / -27%
Pneumonia / 76 / 80 / 77 / 66 / 70 / 80 / 75 / 68 / 50 / 45 / 48 / 44 / 779 / 894 / -13%
Acute Diarrhoeal Disease / 20 / 24 / 20 / 15 / 20 / 18 / 16 / 76 / 20 / 18 / 24 / 7 / 278 / 475 / -41%
Anaemia / 0 / 20 / 18 / 23 / 20 / 25 / 15 / 38 / 20 / 14 / 41 / 46 / 280 / 270 / 4%
Urinary Tract Infection / 25 / 27 / 20 / 18 / 22 / 35 / 20 / 30 / 20 / 30 / 28 / 17 / 292 / 407 / -28%
Severe Malaria / 1 / 12 / 10 / 7 / 8 / 12 / 7 / 9 / 8 / 6 / 4 / 1 / 85 / 155 / -45%
Acute Respiratory Infection / 0 / 4 / 6 / 4 / 5 / 10 / 12 / 4 / 7 / 4 / 3 / 3 / 62 / 126 / -51%
Severe Protein Energy Malnutrition / 0 / 3 / 2 / 1 / 1 / 2 / 1 / 7 / 5 / 2 / 4 / 0 / 28 / 19 / 47%
Burns / 0 / 1 / 1 / 3 / 1 / 2 / 3 / 3 / 4 / 0 / 3 / 1 / 22 / 23 / -4%
TOTAL / 193 / 301 / 304 / 366 / 397 / 339 / 319 / 418 / 272 / 239 / 283 / 205 / 2543 / 3779 / -33%
Table 2.2.ii. top ten conditions for inpatients above 5 years of age
2013 Jan-Dec > 5 yrs / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / Total / Variance
* Urinary Tract Infection / 83 / 71 / 60 / 40 / 30 / 40 / 73 / 112 / 80 / 49 / 56 / 68 / 762 / 659 / 16%
Uncomplicated Malaria / 67 / 89 / 90 / 70 / 60 / 80 / 70 / 35 / 55 / 13 / 40 / 54 / 723 / 619 / 17%
Tuberculosis / 27 / 26 / 20 / 16 / 12 / 8 / 20 / 22 / 20 / 14 / 24 / 24 / 233 / 298 / -22%
Severe Malaria / 14 / 8 / 10 / 8 / 12 / 10 / 12 / 7 / 14 / 2 / 18 / 28 / 143 / 136 / 5%
Anaemia – other / 21 / 31 / 30 / 18 / 20 / 32 / 28 / 56 / 40 / 22 / 23 / 24 / 345 / 226 / 53%
Hypertension / 31 / 26 / 30 / 25 / 20 / 18 / 22 / 11 / 31 / 16 / 18 / 24 / 272 / 314 / -13%
Clinical AIDS / 23 / 21 / 20 / 16 / 12 / 10 / 8 / 6 / 20 / 13 / 8 / 4 / 161 / 155 / 4%
Gastro-Intestinal Diseases / 1 / 1 / 0 / 0 / 1 / 1 / 0 / 2 / 1 / 3 / 3 / 4 / 17 / 96 / -82%
Fractures / 9 / 10 / 12 / 10 / 18 / 20 / 12 / 7 / 9 / 10 / 7 / 7 / 131 / 102 / 28%
Pneumonia / 10 / 13 / 14 / 8 / 6 / 8 / 12 / 13 / 10 / 5 / 6 / 14 / 119 / 142 / -16%
Other diagnoses / 496 / 413 / 450 / 444 / 390 / 388 / 290 / 390 / 340 / 412 / 348 / 284 / 4645 / 4944 / -6%
TOTAL / 782 / 709 / 736 / 655 / 581 / 615 / 547 / 661 / 620 / 559 / 551 / 535 / 7551 / 7691 / -2%

2.4.OTHER PERFORMANCE STATSTICS

2008 / 2009 / 2010 / 2011 / 2012 / 2013
Bed Occupancy rate / 102% / 88% / 88% / 88% / 77% / 74%
Average Hospital Stay / 7DAYS / 6DAYS / 5DAYS / 5DAYS / 4DAYS / 4 days
Number of Hospital Deaths / 454 / 417 / 450 / 435 / 448 / 481
Maternal Deaths / 14 / 15 / 15 / 16 / 11 / 15
Total Deliveries / 3791 / 3054 / 3484 / 3625 / 3507 / 3,768
Total Caesarian Sections / 755 / 651 / 756 / 875 / 851 / 786
Caesarian Rate / 19.9% / 21.3% / 22.0% / 24% / 24.% / 21%
Major Surgeries / 1171 / 911 / 1123 / 1117 / 1162 / 1,154
Minor Surgeries / 460 / 487 / 645 / 536 / 751 / 769
Total x-rays taken / 2,667 / 2,668 / 4,031 / 1987 / 2,667 / 2,776
Total Laboratory Tests / 72,871 / 83,281 / 106,885 / 95,685 / 98,073 / 109,000
Blood Donors HIV Seropositive / 13.7% / 9.8% / 1.5% / 3.0% / 4.2% / 3.8%

The above table shows other important hospital performance indicators:

Down is explanation of some indicators

  1. Bed accupancy rate on average was 74%. This indicator shows how much one bed is used by patients. However Maternity and children wards have far worse score od 103% and 99%, which indicate that these wards are heavily congested. The acceptable range is between 80% to 85%
  2. Average length of stay has been maintained at 4 days. This is the average number of days spent in hospital by all patients. The acceptable range is between 4 and 6 days. Longer days indicate that the patients management is not effective and thus spend longer time admitted in the wards
  3. The number of pregnant related deaths was 15 out of 3,768 women who were delivered at the this hospital. The martenal mortality audit done by the regional health management team (RHMT) revealed that only one death was directly linked to hospital, where by the patient got anaesthetic complication after being delivered by c-section. The rest of deaths were linked to either the paitient herself being very late in seeking help of being delayed at the dispensary or heath centre before being referred to us.

The c-section rate was 21% accounting for 786 operations.

TotalAttendances / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / 2012 / Variance
Antenatal Clinic / 829 / 612 / 654 / 687 / 846 / 791 / 778 / 486 / 650 / 500 / 600 / 605 / 8038 / 8642 / -7%
Postnatal Clinic / 289 / 297 / 292 / 303 / 375 / 357 / 364 / 362 / 314 / 287 / 270 / 144 / 3654 / 2764 / 32%
Family Planning / 312 / 248 / 242 / 267 / 406 / 298 / 406 / 245 / 312 / 319 / 300 / 338 / 3693 / 2877 / 28%
Palliative Care / 11 / 13 / 7 / 11 / 13 / 9 / 8 / 12 / 11 / 10 / 12 / 16 / 133 / 235 / -43%
VCT / 66 / 95 / 130 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 291 / 3698 / -92%
TB clinic / 29 / 18 / 22 / 25 / 30 / 22 / 19 / 32 / 25 / 33 / 22 / 33 / 310 / 294 / 5%
Physiotherapy / 4 / 134 / 100 / 109 / 150 / 99 / 116 / 125 / 122 / 115 / 105 / 150 / 1329 / 1236 / 8%
Diabetic Clinic / 128 / 106 / 81 / 80 / 127 / 115 / 239 / 95 / 78 / 124 / 67 / 72 / 1312 / 929 / 41%
Ophthalmology / 192 / 136 / 156 / 99 / 186 / 140 / 176 / 186 / 174 / 180 / 199 / 152 / 1976 / 2360 / -16%
Dental Clinic / 415 / 376 / 318 / 330 / 359 / 337 / 383 / 331 / 314 / 283 / 232 / 251 / 3929 / 4573 / -14%
Mental Health / 130 / 110 / 115 / 140 / 125 / 148 / 41 / 27 / 32 / 45 / 55 / 75 / 1043 / 1446 / -28%
Main OPD / 3251 / 2760 / 2766 / 2906 / 3341 / 3371 / 3373 / 3027 / 2468 / 2702 / 4245 / 5132 / 39342 / 31083 / 27%
TOTAL / 5579 / 4797 / 4746 / 4946 / 5945 / 5678 / 5895 / 4916 / 4489 / 4588 / 6095 / 6952 / 64626 / 62272 / 4%

2.5.OUT-PATIENT DEPARTMENT SERVICE ATTENDANCE 2013

The table above shows attendances of patients in our various outpatient clinics. Generally, the year 2013 has seen more patients than 2012 (64,626 vs. 62,272) being an increase by 4%

Main out patient department (OPD) has seen more patients being 27% higher than the previous year.

We have been witnessing the increase of newly diagnosed cases of Diabetes Mellitus. This is really raising an alarm and concrete action has to be taken. Diabetes is one of the fast raising none infectious condition in our area and country at large. School/community health education programmes have to be re-started.

The newly opened health facilities (dispensaries) around the catchment area has helped to decongest the hospital on various services e.g. Antenatal clinic visits, which has seen a drop o visits by 7% and palliative care by 43%.

Voluntary Counselling and Testing dropped by 92% owing to the demolition of our centre which was providing these service to pave the way for road expansion. Not operating since April 2013.

Drop in other services e.g. Eye, Dental and mental health were mainly attributed by few out reach activities done in 2013 as compared to 2012. This was due to low budget for the year 2013 led to cancellation of some visits.

Care and Treatment Centre (CTC)

This clinic is specialised for patients who are HIV positive. After being diagnosed to have contracted HIV, patients are referred to this centre for further management in accordance to national guidelines for HIV treatment.

By the end of December 2013 this clinic has registered 4,294 people with HIV.

gender
age group / male / female / Total
<1 yr / 21 / 42 / 63
1 to 4 / 71 / 51 / 122
5 to 14 / 55 / 77 / 132
>=15 / 1415 / 2562 / 3977
1562 / 2732 / 4294

Of these patients 2893 have been started on Anti retroviral (ARV) drugs according to standard guidelines.

  1. FINANCIAL

Table 3.i. summary of income and expenditure
ELCT KARAGWE DIOCESE: NYAKAHANGA DDH
INCOME AND EXPENDITURE FOR THE FINANCIAL YEARS: 2011/2012 AND 2012/2013
2011/2012 / 2012/2013
BUDGET / ACTUAL / %GE / BUDGET / ACTUAL / %GE
INCOME / TSHS. / TSHS.
Government Grant / 2,503,185,568.30 / 1,362,362,273.00 / 54.43 / 3,224,885,505.48 / 1,583,307,629.47 / 49.10
Cost Sharing / 258,104,000.00 / 312,949,496.00 / 121.25 / 341,602,180.00 / 577,878,872.00 / 169.17
Other Sources / 196,417,045.16 / 205,461,855.00 / 104.60 / 258,116,950.00 / 232,534,168.70 / 90.09
Total Income / 2,957,706,613.46 / 1,880,773,624.00 / 63.59 / 3,824,604,635.48 / 2,393,720,670.17 / 62.59
EXPENDITURE
Salaries and Allowances: / 1,442,795,761.00 / 1,096,822,807.00 / 76.02 / 2,228,806,354.20 / 1,394,988,892.74 / 62.59
Drugs and Supplies: / 854,760,548.96 / 334,786,698.00 / 39.17 / 858,177,570.78 / 516,628,488.40 / 60.20
Other Expenses: / 660,150,303.50 / 359,727,999.00 / 54.49 / 737,620,710.50 / 499,403,746.86 / 67.70
Total Expenditure / 2,957,706,613.46 / 1,791,337,504.00 / 60.57 / 3,824,604,635.48 / 2,411,021,128.00 / 63.04

The major funder of the hospital is the Government of Tanzania through Ministry of Health.

The government is responsible for the Staff Salaries, Drugs and medical equipments as well as fund for running costs (other charges)

The year 2013 has experience a drop of funding from the government vs. requirement as compared to the year 2012.

In the year 2012 we received 54.43% of the total budget expected from the government wheres as this amount dropped to 49.1% in the year 2013.

The hospital management has been working hard to close the financial gap by improvising various ways to raise internal collections.

In the year 2012 we managed to exceed the collection target in cost sharing and other sources by 121% and 104% respectively. Whereas in the year 2013 we managed to reach 169% and 905 respectively.

However these efforts took us to just a total of 63% of the expected funds to run the hospital. The gap of 37% is still huge and the buden of it is seen on frequent stock out of drugs and equipment as well as debts (internal<staff allowances> and external<suppliers>)

  1. DRUGS AND MEDICAL SUPPLIES.

In the year 2013 the hospital tried to increase spending on drugs and medical supplies as compared to 2012 (60% vs. 39%)

Insufficiency of funds for drugs and Medical supplies received from the Government posed a major stumbling block in the delivery of service .

The General Budget for drugs and medical supplies was TShs. 858,177,570.78, amount spent on drug was TSh. 516,628,488.40equivalent to 60% of the requirement. In addition, frequent missed items from the state authorised supplier had made the situation

  1. STAFF REPORT
  2. Present key Staff by end of the year
  1. Medical Doctors/Officers 2 needed number is 5, deficit is 60%
  2. Dental Surgeon 1, needed 1
  3. Assistant Medical Officer 8, needed 15, deficit is 47%
  4. Assistant dental surgeon 1, needed 1.
  5. Clinical Officers 7, needed 15, deficit 54%
  6. Registered Nurses 62, need is 104 deficit is 40%
  7. Nurse Assistant 43, need is 62, equivalent to 30.6%
  8. Other staff report

a)New Employment
Cadre / No.
Clinical Assistants / 4
Assistant Nursing Officer / 5
Nurse Midwife / 4
Medical Attendants / 3
Technologist Officer / 1
Records Management Assistants / 4
Total / 21
b)Staffon training / COLLEGE
Medical Doctor / 1 / IMTU
Bachelor of Pharmacy / 1 / BUGANDO
MBA – hospital management / 1 / ULM UNIVERSITY – Germany
Degree in Nursing / 2 / ST. ANTHONY
Diploma in Nursing / 5 / TANGA, BUGANDO, MIREMBE
Assistant Technologist (Lab.) / 1 / SINGIDA
Total / 11
c)Staff completed training
AMO / 1 / BUGANDO
Hospital management (CORAT) / 2 / NAIROBI
Anaesthesia (Nurse) / 1 / BUGANDO
Diploma in Accountance / 1 / SAUT
Total / 5
d)Left employees / Remarks/reason
Medical attendants / 2 / Age retirement
Medical attendants / 3 / Termination due to misconduct
Clinical Assistant / 1 / Government employment
Clinical officers / 5 / Government employment
Assistant Nursing officers / 4 / Government employment
Nurses / 3 / Government employment
Technologist officer / 1 / Government employment
Accountant / 1 / Transferred out
Pharmacist / 1 / Resignation
  1. DEVELOPMENT PROJECTS DONE IN 2013
  1. Construction of obstetric theatre
  2. Installation and launch of Afya Pro system (computerised information system)
  3. Completion of new infusion unit
  4. Renovation of Maternity ward – construction of post operation room
  5. Completion of the drawings for the college of health studies
  1. CHALLENGES

1.Shortage of skilled staff. One of the major challenges facing the hospital is the enormous shortage of medical personnel. Cadres mostly affected are Clinicians, nurses, pharmacists and technicians. The deficit gap is 60%.

At this juncture, in addressing the shortage of skilled/trained staff, the Karagwe Diocese has come with the proposal to establish a college for health studies in Karagwe. The college will train Clinical Officers, Nurses, lab techinicians and Environmental Health workers.

2.Big shortage of drugs and other medical equipments due to fund insufficiency

3.Infrastructure.Most of the infrastructures are old and give no more enough space for the staff and patients. Luck of minor repair and maintenance subjected these structures in even bad condition.

  1. Inadequate patients’ rooms/wards/consultation – leading to overcrowding and cross infections
  2. No doctors offices - this makes it difficult to find doctors in the premises just after ward rounds
  3. Staff houses - are old and inadequate
  4. Clean water and sewage system
  5. Electrical system – frequent power problems due to old circuits and installation
  6. Communication. Frequent breakdown of intercom systems

Major maintenance which is estimated to cost TSh. 800 million is needed to face lift the structure in the hospital.

4.Gross delays in fund disbursement from the government. Salary delays of up to two weeks demoralize the staff and this contributes to departure of the staff from our hospital.

5.Low budget. Funds received from the government is by far not enough to meet the hospital demand on drugs, medical equipments, costs for utilities and other needs.

6.Extreme poverty of the communities we serve. Most of the patients we serve are poor and cannot afford the cost for treatment though our hospital has lowered the costs. Of all patients admitted 85% were treated without paying. This reduces the purchase power of the hospital especially drugs and other important equipment.

7.Service – disease burden/patterns, economic status of the people.Nyakahanga is one of the hospitals serving in areas with low socio-economic status the population of which is burdened with poverty, ignorance and diseases.

Changing disease pattern. With time we are witnessing increased cases of none communicable conditions such as diabetes, cardiovascular, renal and mental health cases. The problem with these conditions among many is the cost to deal with as well as they are mostly life long conditions and affected several systems in the body.

At different times outbreaks of diseases are observed, this poses some challenges in healthcare delivery by our hospital.

8.Ever changing government/partners’/donors’ policies. For the past ten years Tanzania has engaged in several reforms, some of which have direct impact to Nyakahanga and other hospitals alike . Local government reforms, Health sector reforms in one hand and global economy dynamics on the other hand, all have caused changes in policies, both internal and external which in one way or the other brought impact in healthcare services in our area.

  1. PRIORITIES FOR THE YEAR 2014

With limited resources available, the hospital will continue to work hard to improve the quality of services it provides by working on the following:

8.1.Institutional Development

  1. Continue with processes to establishment of College of health studies which will encompass schools for Nurses, Clinical Officers, Laboratory technicians and Health Officers.

The objectives for this college are:

  1. To produce trained personnel in the field of health care services and therefore to abolish the deficit within and outside Karagwe district.
  2. To provide accessible and affordable opportunity for lower cadre staff in Karagwe and Kagera as a whole to go for upgrading.
  3. To provide accessible and affordable opportunity for secondary school leavers to go for professional courses and hence deal with the issue of unemployment for the youth.
  4. To increase employment coverage and contribute to the district economy
  1. Capacity building in the areas of;
  2. Development of the existing staff
  3. Recruitment of the new staff, preferably with specialities
  4. Installation of technological advancement for diagnostics and

Treatment

  1. To continue with preventive maintenance of our buildings and other infrastructure.
  2. Continuing with Environmental cleanliness and plantation of trees and flowers in and around the hospital
  1. In cooperation with ICAP, we plan to build a new CTC block which will enhance the performance and quality of care for HIV clients.

8.2.Management Area

  1. To continue with Quality Improvement Initiatives
  2. Roll out Afya Pro system for HMIS to other departments
  3. Continuous Performance Management System
  4. To conduct Managerial and staff meetings
  5. Staff development and capacity building
  6. Five year strategic planning

8.3.Financial capacity building.