2012 SUMMARY REPORT

1.  HOSPITAL OVERVIEW

1.1. History and development

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

Ø  Owned by Evangelical Lutheran Church-Karagwe Diocese

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

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

Ø  1972 started to serve as a district Hospital

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

The contract stipulates:

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

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

1.2.  Capacity and functions/services

Ø  The hospital capacity is 224 patients’ beds

Ø  Has 254 permanent staffs

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

Ø  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

Ø  The hospital directly supervises three Dispensaries belonging to the Diocese

Ø  The average annual patients turnover:

-  Outpatient 60 000 – 62 000

-  Inpatients 11 000 – 13 000

-  Deliveries 3 500 – 4 000

2.  SERVICES RENDERED IN THE YEAR 2012

2.1. ADMISSIONS (Inpatients)

Ward / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total
2012 / 2011
Children / 335 / 326 / 261 / 179 / 338 / 439 / 518 / 341 / 212 / 225 / 209 / 295 / 3678 / 3455
Gyn / 0 / 28 / 48 / 30 / 47 / 61 / 73 / 63 / 68 / 72 / 57 / 66 / 613 / 1631
Surgical / 113 / 66 / 84 / 73 / 64 / 118 / 98 / 135 / 118 / 95 / 87 / 112 / 1163 / 1026
Martenity / 393 / 401 / 369 / 350 / 375 / 303 / 352 / 379 / 348 / 316 / 313 / 316 / 4215 / 4592
Medical / 291 / 291 / 240 / 218 / 221 / 235 / 325 / 297 / 275 / 302 / 308 / 272 / 3275 / 1846
Isolation / 31 / 18 / 7 / 19 / 21 / 18 / 26 / 21 / 26 / 21 / 18 / 18 / 244 / 207
ICU / 2 / 4 / 0 / 1 / 9 / 5 / 0 / 1 / 2 / 3 / 4 / 4 / 35 / 0
Private / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 8 / 3 / 6 / 7 / 8 / 32 / 0
Total / 1165 / 1134 / 1009 / 870 / 1075 / 1179 / 1392 / 1245 / 1052 / 1040 / 1003 / 1091 / 13255 / 12757

2.2. TOP TEN DIAGNOSES

2012 Jan-Dec < 5 yrs / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / 2011 / Variance
Uncomplicated Malaria / 142 / 138 / 68 / 29 / 42 / 59 / 157 / 66 / 48 / 51 / 63 / 116 / 979 / 1308 / -25%
Pneumonia / 43 / 56 / 60 / 41 / 164 / 129 / 100 / 90 / 47 / 63 / 40 / 61 / 894 / 827 / 8%
Acute Diarrhoeal Disease / 28 / 44 / 28 / 28 / 38 / 47 / 107 / 79 / 26 / 14 / 16 / 20 / 475 / 359 / 32%
Anaemia / 35 / 35 / 23 / 15 / 9 / 6 / 33 / 35 / 24 / 13 / 13 / 29 / 270 / 331 / -18%
Urinary Tract Infection / 34 / 36 / 32 / 40 / 38 / 40 / 45 / 35 / 24 / 33 / 19 / 31 / 407 / 321 / 27%
Severe Malaria / 40 / 17 / 10 / 6 / 10 / 5 / 19 / 12 / 6 / 9 / 9 / 12 / 155 / 230 / -33%
Acute Respiratory Infection / 13 / 20 / 11 / 6 / 25 / 15 / 17 / 6 / 3 / 3 / 2 / 5 / 126 / 137 / -8%
Severe Protein Energy Malnutrition / 2 / 1 / 0 / 0 / 6 / 3 / 1 / 5 / 0 / 0 / 1 / 0 / 19 / 31 / -39%
Peri and Neonatal Conditions / 15 / 0 / 4 / 10 / 9 / 0 / 0 / 0 / 0 / 0 / 0 / 0 / 38 / 26 / 46%
Burns / 0 / 2 / 5 / 1 / 0 / 0 / 4 / 3 / 1 / 0 / 3 / 4 / 23 / 22 / 5%
Other diagnoses / 34 / 20 / 16 / 47 / 38 / 40 / 31 / 42 / 34 / 35 / 33 / 23 / 393 / 464 / -15%
TOTAL / 386 / 369 / 257 / 223 / 379 / 344 / 518 / 373 / 213 / 221 / 199 / 301 / 3779 / 4056 / -7%
2012 Jan-Dec > 5 yrs / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / Total / 2011 / Variance
Urinary Tract Infection / 49 / 66 / 48 / 39 / 29 / 51 / 90 / 67 / 46 / 45 / 70 / 59 / 659 / 728 / -9%
Uncomplicated Malaria / 61 / 16 / 45 / 36 / 54 / 41 / 91 / 68 / 56 / 49 / 50 / 52 / 619 / 682 / -9%
Tuberculosis / 28 / 20 / 13 / 27 / 21 / 20 / 33 / 34 / 32 / 24 / 30 / 16 / 298 / 280 / 6%
Severe Malaria / 2 / 39 / 18 / 4 / 0 / 6 / 18 / 6 / 8 / 11 / 13 / 11 / 136 / 270 / -50%
Anaemia – other / 23 / 27 / 14 / 16 / 13 / 16 / 20 / 16 / 18 / 28 / 24 / 11 / 226 / 256 / -12%
Hypertension / 22 / 27 / 32 / 27 / 19 / 20 / 22 / 30 / 24 / 26 / 32 / 33 / 314 / 232 / 35%
Clinical AIDS / 14 / 11 / 16 / 14 / 10 / 7 / 11 / 14 / 20 / 16 / 11 / 11 / 155 / 213 / -27%
Gastro-Intestinal Diseases - others / 12 / 5 / 3 / 23 / 10 / 6 / 8 / 6 / 13 / 3 / 5 / 2 / 96 / 191 / -50%
Fractures / 14 / 0 / 12 / 7 / 9 / 12 / 9 / 15 / 10 / 2 / 8 / 4 / 102 / 176 / -42%
Pneumonia / 9 / 15 / 18 / 8 / 16 / 11 / 6 / 13 / 11 / 11 / 18 / 6 / 142 / 151 / -6%
Other diagnoses / 149 / 474 / 404 / 487 / 187 / 497 / 482 / 414 / 517 / 469 / 436 / 428 / 4944 / 4219 / 17%
TOTAL / 383 / 700 / 623 / 688 / 368 / 687 / 790 / 683 / 755 / 684 / 697 / 633 / 7691 / 7398 / 4%

2.3. OTHER STATSTICS

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

2.4. OUT-PATIENT DEPARTMENT SERVICE ATTENDANCE 2012

Total Attendances / Jan / Feb / Mar / Apr / May / Jun / Jul / Aug / Sep / Oct / Nov / Dec / TOTAL
Antenatal Clinic / 743 / 792 / 858 / 793 / 653 / 704 / 748 / 718 / 753 / 776 / 514 / 590 / 8642
Postnatal Clinic / 134 / 139 / 285 / 137 / 297 / 164 / 299 / 326 / 300 / 267 / 130 / 286 / 2764
Family Planning / 322 / 368 / 254 / 252 / 249 / 134 / 244 / 156 / 197 / 270 / 208 / 223 / 2877
CTC / 711 / 643 / 633 / 629 / 677 / 724 / 705 / 700 / 646 / 655 / 666 / 678 / 8067
OPD (TOTAL) / 4022 / 3672 / 3242 / 2974 / 3400 / 3493 / 4093 / 4041 / 3065 / 3316 / 3059 / 3250 / 41627
Palliative Care / 31 / 35 / 25 / 11 / 16 / 14 / 7 / 4 / 10 / 40 / 25 / 17 / 235
VCT / 376 / 384 / 402 / 454 / 508 / 397 / 407 / 92 / 368 / 310 / 0 / 0 / 3698
VCT POSITIVE / 16 / 22 / 20 / 29 / 19 / 16 / 20 / 14 / 16 / 19 / 0 / 0 / 191
TB clinic / 11 / 10 / 29 / 10 / 38 / 28 / 24 / 38 / 27 / 32 / 25 / 22 / 294
Physiotherapy / 153 / 148 / 127 / 97 / 147 / 104 / 91 / 100 / 94 / 111 / 64 / 98 / 1334
Diabetic Clinic / 53 / 90 / 58 / 54 / 57 / 104 / 99 / 60 / 72 / 109 / 91 / 82 / 929
Ophthalmology / 241 / 138 / 132 / 144 / 126 / 191 / 252 / 299 / 225 / 199 / 197 / 216 / 2360
Dental Clinic / 481 / 464 / 351 / 342 / 346 / 367 / 443 / 458 / 329 / 323 / 312 / 357 / 4573
Mental Health / 148 / 160 / 138 / 138 / 102 / 97 / 86 / 106 / 83 / 137 / 134 / 117 / 1446
Main OPD / 2946 / 2672 / 2436 / 2199 / 2622 / 2630 / 3122 / 3018 / 2262 / 2437 / 2261 / 2380 / 30985
TOTAL / 5943 / 5624 / 5301 / 4795 / 5314 / 5247 / 6113 / 5979 / 4988 / 5316 / 4602 / 5049 / 64271

3.  FINANCIAL

In the financial year 2011/2012, the total budget was Tshs. 2,409,535,414.00 while actual income was Tshs. 1,735,384,663.00 which is 72% of the budgeted amount. Due to that gap, the hospital facing difficulties in paying bills as they fall due ( TANESCO,Water Authorities, communication, structural and machinery maintenance costs) which hindered in provides quality services as planned.

TABLE SHOWING SOURCES OF FUNDS FOR THE YEAR JULY 2011/JUNE 2012

Income Source / % of total
Government grants / 65%
Health Service fund (cost sharing) / 15%
Donation from Abroad / 1%
Others Sources / 5%
Basket Fund / 14%

TABLE SHOWING THE EXPENDITURE FOR THE YEAR JULY 2011/JUNE 2012

Expenditure / % of total
Personal Emoluments / 54%
Drugs Supplies / 17%
All others / 29%

4.  Drugs and medical supplies.

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. 694,594,831.90, amount spent on drug was TSh. 291,053,889.00 equivalent to only 42% of the requirement. In addition, frequent missed items from the state authorised supplier had made the situation

5.  DEVELOPMENT PROJECTS DONE IN 2012

I.  Construction of 160,000 litres water reservoir

II.  Completion of new infusion unit

III.  Renovation of Main Block, ward B, 4 Private rooms

IV.  Construction of corridors to mortuary and pharmacy

V.  Instalment of endoscopy machines

6.  CHALLENGES

1.  Shortage of skilled staff – Gap deficit of 60%

2.  Big shortage of drugs and other medical equipments

3.  Old infrastructure

4.  Delayed fund disbursement from the government

5.  Low budget

6.  Extreme poverty of the communities we serve

7.  Changing disease pattern

8.  Changing policies

7.  PRIORITIES FOR THE YEAR 2013

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

7.1.  Institutional Development

1.  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:

i.  To produce trained personnel in the field of health care services and therefore to abolish the deficit within and outside Karagwe district.

ii.  To provide accessible and affordable opportunity for lower cadre staff in Karagwe and Kagera as a whole to go for upgrading.

iii.  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.

iv.  To increase employment coverage and contribute to the district economy

2.  Capacity building in the areas of;

i.  Development of the existing staff

ii. Recruitment of the new staff, preferably with specialities

iii.  Installation of technological advancement for diagnostics and

Treatment

v.  To continue with preventive maintenance of our buildings and other infrastructure.

vi.  Continuing with Environmental cleanliness and plantation of trees and flowers in and around the hospital

7.2.  Management Area

vii.  To continue with Quality Improvement Initiatives

viii.  Installation of Afya Pro system for HMIS

ix.  Continuous Performance Management System

x.  To conduct Managerial and staff meetings

xi.  Staff development and capacity building

7.3.  Financial capacity building.

·  To put strategies in improving revenue collection

·  Cuts on unnecessary expenditures

·  Initiation of new income generating projects

·  To continue with efforts to improve financial management and reporting

May Lord be with us,

DR. ANDREW CHARLES. CESARI, MD. PgD. Hosp. Mgt, MBA

MEDICAL OFFICER INCHARGE.