Health

Health Services

4.1 Introduction to health services

Kasese district health sector is composed of 105 health unities of these 3 are hospitals, 5 are health Center IV, 42 are Health Center III, and 69 are health Center II. Each health sub district has got a health unit implying a well distributed health services related maternal, infant and child feeding services. In addition, these health units have been used as referral centers by VHTs, and relevant stakeholders, however there is need to build the capacity of the different stakeholders, the VHTs, Health workers to respond to nutrition related issues.

Population Demographics for FY year 2016/2017

The population for the period under review has been projected from UBOS National Population and Housing census 2014 using a growth rate of 2.45%. The projected figures are shown below

Population projections for FY 2016/2017

Demographic Variable Proportion Projected population(2016/2017)
Total population 100% 737274
Males 48.6% 358315
Females 51.4% 378959
children under 1 years 4.3% 31703
children under 5 years 17.7% 130497
children below 18 years 55.1% 406238
Adolescents & youth 10-24 yrs. 34.80% 256571
Expected Pregnancies 5% 36864
Women of reproductive age 15-49yrs 20.20% 148929

Source UBOS mid-year projections 2016

3.1   Health Infrastructure

 Table 22:  Health facilities

Constituency Sub County Gov’t H.U Private-Not-Profit Private-for-Profit
Bukonzo West Lhubiriha-Mpondwe Town Council Bwera Hospital  
 
Bwera Kasanga PHC
Bukonzo East Kisinga Kagando Hospital
Munkunyu Kinyamaseke HC III
Busongora South Kasese Town Council Kasese Town Council HC III St. Pauls HC IV

Bishop Masereka Medical Centre

 Kasese Cobalt Company Clinic
Kilembe Kilembe Mines Hospital
Busongora North Kyabarunigra Rwesande HC IV Hima Cement Clinic

District Health Office

Table 23: Health facilities per Sub County

Table 23: Health facilities per Sub County

Sub-County Health Unit Name Level Ownership Owner Category Status Functionality
Mpondwe-Lhubiriha Tc  Nyabugando III PNEP PNFP IP & OPD Functional
Karambi Nursing Home II Private PFP OPD Functional
Kasanga PHC III PNEP
Kyambogho SDA Clinic II Private PFP OPD Functional
Kyambogho Clinic III Private PFP IP & OPD Functional
Bwera Hospital Public Government IP & OPD Functional
Mpondwe Moslem II UMSC PNFP OPD Functional
Nyakiyumbu Mushenene III PNEP PNFP IP& OPD Functional
Kayanzi II Public Government OPD Functional
Katholhu II Public Government OPD Functional
Muhindi II Public Government OPD Functional
Bukangara HC II Public Government OPD Functional
Munkunyu Kinyamaseke III COU PNFP IP & OPD Functional
Kabingo II Public Government OPD Functional
Kisinga Kagando hospital public Government OPD Functional
Nyabirongo III Public Government OPD Functional
Kiburara II Public Government OPD Functional
Give a goat II Public Government OPD Functional
Krusandara Kanamba III Public Government OPD Functional
Karusandara III Public Government OPD Functional
Rukooki Buhaghura II Public Government OPD Functional
Bughalitsa II Public Government OPD Functional
Nyakabingo II Public Government OPD Functional
Maliba Maliba III public
Isule III public
s Bikone II public
Kisojo II Public
Mukathi II Public
Kihyo II Public
Nyangorongo II Public
Kyanya SDA II Public
Mubuku prisons II Public
Kyabarungira Rwesande Govt
Bugoye Nyangonge II Public Govt
 Mt. Rwenzori II Public Govt
Bugoye III Public
kibirizi II Public
Kisamba II Public
Nyangorongo II Public
Maghoma II Public
Katoke II Public
Ibanda II Public
Kitswamba Kitswamba III Public
Kinyabwamba II Public
Ibuga Refugees II Public
Ibuga Parisons II Public
Nkoko II Public
Nyakatonzi Nyakatonzi II Public Govt
Kyarumba Kyarumba PHC III Public
Kyarumba III Public
Kitabu III Public
Kabirizi upper II Public
Hima Hima HC III Public Govt
Hima micro care IV Public Govt
Nyamwamba Saluti public Govt
Kasese Mun.C Public
Rukoki Public
Mubuku Irrig. Public
Kitholhu Kitholhu III Public Govt
Kanyatsi II Public
Kiraro II Public
Ihandiro Ihandiro III Public Govt
Kikyo

 

 II Public
Bubothyo II Public
Buhungamuyagha II Public
Karambi Karambi III Public Govt

Private
Kisolholho II Public
Bikunya II Public
Kamasasa II Public
Bwera Nyakimasa II Public NGO

Govt
Isango Kyempara II Public Govt
Kamukumbi II Public
Lake Katwe Hamukungu II Public Govt
Kabirizi II Public
Kahokya III Public
Kasenyi II Public
Katunguru II Public
Mweya II Public
Kyondo Kyondo III Public Govt
Bwethe II Public
Mahango Mahango III Public Govt
Buthale II Public
Bwesumbu Bwesumbu II Public
Kasangali II Public
Buhuhira Buhuhira II Public
Busongora north Rwesande IV Public
Kabatunda III Public
KASESE MUNICIPALITY
Central division Kirembe II Public
Railway public
St.pauls
BMCF
Katodoba
Bulembia division Kilembe hosiptal
Kilembe Disp.

Source: District Health Office

 Table 24:    Accessibility of Health Services 2015

Name of health Unit Population served
Kilembe Hospital 150,000
Kagando Hospital 400,000
St. Pauls HC IV 53,000
Rwesande HC IV 150,000
Bwera Hospital 300,000

Source: District Planning Unit

Accessibility to Health Services 2016/2017 FY

Health services in the district are delivered at 106 health facilities covering all sub counties. However 17% (5) sub counties of Bwesumbu, Buhuhira, Bwera, Nyakatonzi and Isango have centres only at level II. This hinders the delivery of a full package of MCH and HIV/AIDS services in the District.

Therefore there is need for remodelling these HCIIs in the underserved sub counties to enable provision of MCH services.

The District also faces challenges of blood shortage and there is no blood bank in the district that can supply blood for transfusion to the patients in the District

SUMMARY OF HEALTH FACILITIES WITH THEIR OWNERSHIP.

Level Govt NGO Private Total
Hospital 1 2 0 3
HC IV 1 3 0 4
HC III 20 13 5 38
HC II 56 1 4 61
Clinic 0 0 0 0
Laboratory 0 0 0 0
Blood Bank/Distribution centre 0 0 0 0
Total 78 19 9 106

 Table 25: Services Delivered

Health Centres i)                    Curative-OPD

ii)                  Preventive-school health, environmental health and sanitation, childhood immunization, growth monitoring, TB treatment, care for injuries, dental/oral care, &STI treatment

iii)                Promotive- Health education, Nutrition, counseling, condom distribution, disease surveillance, F.P/ANC
Hospitals i)                    Surgical operations

ii)                  Curative-OPD & in-patient services

iii)                Preventive-school health, environmental health and sanitation, childhood immunization, growth monitoring, TB treatment, care for injuries, dental/oral care, &STI treatment

iv)                 Promotive- Health education, Nutrition, counseling, condom distribution, disease surveillance, Family planning/ANC

Source: District Health Office

 Table 26:  Private clinics, Pharmacies, and Drug shops

County Clinics Pharmacies Drug shops
Bukonzo 2 0 2
Busongora 10 3 12
Total 12 3 14

Source: District Health Office

 4.3 Accessibility to health services

Accessibility to health services in Kasese district currently stands at 78%.

Table 27:  Distance to nearest social Facility

Facility  Up to 5 kms  Over 5kms On premises Up to 1 km Over 1 km
Health facility 80,994 17,845
 Water source 7,583 65,197 26,059
Primary school 92,291 6,548
 Average %age 81.9 18.1 7.7 66 26.3

Source: 2002 Housing and population census

4.4 Maternal mortality Ratio (MMR)

The MMR has reduced to 122 per 1,000 live births (DHIS2 August 20. 2017) from 164 per 100,000 (DHIS 2016). The reduction is attributed to Governments efforts in recruiting critical skilled staff especially midwives to improve MCH services and equipping health facilities with equipment and trainings of staff by implementing partners.

The majority of the maternal deaths occurred in Kagando Hospital accounting 458/100,000 live birth compared to 104/100,000 in Bwera Hospital and 169/100,000 lives in Kilembe Hospital Respectively. And a mong the HCIVs Rwesande had the highest MMR at 394/100,000 higher than St. Pauls at 234/100,000 live births.

Maternal death review committees were oriented at all HCIVs and Hospitals leaving behind the volume HCIIIs. And yet some of the mothers are delayed at these lower level facilities. Delay in seeking care was still perceived as the common reason. Health system factors especially lack of blood was a major avoidable factor.

Common factors underlying maternal deaths

  • Delay of the women seeking help
  • Lack of partner support
  • Herbal medicate on
  • Refusal of treatment or admission
  • Refused transfer to higher facility
  • Lack of transport from home to health facilities
  • Lack of transport between health facilities
  • Lack of Blood products, supplies & consumables
  • Staff lack of expertise
  • Inadequate numbers of staff

4.5 Health Manpower

Table 28: District Health Office manpower

NO Job Title Approved Filled vacant/excess
1 Laboratory Microscopist 0 0 0
2 District health officer 1 1 0
3 Asst. DHO environment health 1 0 1
4 Asst. DHO(MCH/Nursing) 1 0 1
5 Principal medical officer 2 0 2
6 MOSG-internal medicine 2 0 2
7 MOSG-general surgery 2 0 2
8 MOSG-obstetrics and gynaecology 2 0 2
9 MOSG-Paediatrics 2 0 2
10 MOSD-Public health 2 0 2
11 principal nursing officer 2 1 1
12 principal human resource officer 0 0 0
13 senior medical officer 4 4 0
14 senior midwifery officer 0 0 0
15 senior ophthalmic clinical officer 0 0 0
16 senior orthopaedic clinical officer 0 0 0
17 principal radio pharmacist 0 0 0
18 principal environment health  officer 0 0 0
19 senior public health dental officer 0 0 0
20 senior health educator 1 0 1
21 principal health visitor 0 0 0
22 senior human resource officer 0 0 0
23 senior hospital administrator 2 0 2
24 bio-statistician 1 0 1
25 medical officer 10 6 4
26 senior nursing officer 12 0 12
27 public health nurse 4 0 4
28 nursing officer paediatrics 0 0 0
29 nursing officer orthopaedic 0 0 0
30 nursing officer ophthalmic nursing 0 0 0
31 senior Anaesthetic officer 0 1 1
32 senior medical clinical officer _ _ _
33 dental surgeon 2 1 1
34 pharmacist 2 0 2
35 senior dispenser 0 0 0
36 senior environment health officer 1 0 1
37 nutritionist 2 0 2
38 senior clinical officer(speech therapy) 0 0 0
39 senior medical lab technologist 2 0 2
40 senior medical lab technician      
41 public health dental asst. 0 0 0
42 health educator 2 0 2
43 senior Asst. health educator 0 0 0
44 senior health visitor 0 0 0
45 senior health inspector 0 0 0
46 entomologist 0 0 0
47 vector control officer 0 0 0
48 Laboratory technologists 0 0 0
49 Accountant 0 0 0
50 principal accounts asst. 2 0 2
51 hospital administrator 2 1 1
52 medical social worker 2 1 1
53 medical records officer 0 0 0
54 supplies officer 2 0 2
55 human resource officer 2 0 2
56 nursing officer 64 64 0
57 nursing officer psychiatry 4 4 0
58 ophthalmic clinical officer 4 0 4
59 anaesthetic  officer 2 0 2
60 medical clinical officer 42 45 3
61 orthopaedic clinical officer 4 1 3
62 dispenser 6 3 3
63 Environmental health officer 0 0 0
64 physiotherapist 2 1 1
65 occupational therapist 2 1 1
66 radiographer 4 1 3
67 medical lab technologist 2 2 0
68 medical lab technician 34 18 16
69 senior enrolled nurse 0 0 0
70 public health dental officer 6 5 1
71 Asst health educator 4 0 4
72 Health inspector 6 10 -4
73 Asst entomological officer 4 4 0
74 nursing officer midwifery 8 31 -23
75 Asst. nursing officer midwifery 0 0 0
76 senior Accounts Asst 4 2 2
77 stenographer secretary 3 1 2
78 Administrative Asst. 0 0 0
79 Assistant Records Officer 0 0 0
80 Assistant supplies officer 0 0 0
81 TB/Leprosy supervisor 1 1 0
82 Senior Health Asst 0 0 0
83 Senior stores Asst. 0 1 -1
84 Theatre Asst. 4 2 2
85 Cold chain Technician 1 0 1
86 stenographer 0 0 0
87 Anaesthetic Asst. 4 0 4
88 TB/leprosy Asst 0 0 0
89 medical laboratory Asst. 32 45 -13
90 enrolled nurse 232 205 27
91 enrolled psychiatric  nurse 6 1 5
92 enrolled midwife 162 78 84
93 medical records Asst. 0 0 0
94 health information Asst. 30 4 26
95 Records Asst 4 18 -14
96 Health Asst 80 24 56
97 Accountants Asst. 6 4 2
98 Telephone operator 0 0 0
99 stores Asst. 7 2 5
100 Entomological Asst 0 0 0
101 enrolled comprehensive nurse 0 0 0
102 office typist 4 1 3
103 copy typist 0 0 0
104 Cold chain Asst. 2 0 2
105 Incinerator Attendant 0 0 0
106 Nursing Asst. 224 92 132
107 mental Health Attendant 0 0 0
108 Anaesthetic attendant 4 0 4
109 dental attendant 2 0 2
110 X-Ray attendant 0 0 0
111 Artisan mate plumber 0 0 0
112 Artisan mate 6 1 5
113 car driver 7 3 4
114 cook 6 2 4
115 pharmacy attendant 0 0 0
116 mortuary Attendant 4 1 3
117 orthopaedic attendant 0 0 0
118 Asakari (security guard) 166 19 147
119 Darkroom attendant 2 0 2
120 seamster/seamstress 0 0 0
121 office attendant 1 1 0
122 theatre attendant 0 1 -1
123 kitchen Attendant 0 0 0
124 porter 162 6 156

Source: Kasese District Health Department work plan 2017/18

 Table 29: Bwera Hospital

s/n Service provider category Approved Filled Gap
1 Principal Medical Officer 1 0 1
2 Medical officer Special Grade (Community) 1 0 1
3 Senior Medical Officer 1 1 0
4 Medical Officer 4 4 0
  Dental  
5 Dental Surgeon 1 1 0
6 Public Health Dental Offocer 2 1 1
7 Dental Attendant 1 1 0
  Pharmacy  
8 Pharmacist 1 0 1
9 Dispenser 2 1 1
  Nursing  
10 Principal Nursing Officer 1 0 1
11 Senior Nursing Officer 5 2 3
12 Nursing Officer (Nursing) 17 7 10
13 Nursing Officer (Midwifery) 3 2 1
14 Nursing Officer (Psychiatry) 1 1 0
15 Public Health Nurse 1 0 1
16 Enrolled Psychiatry Nurse 2 0 2
17 Enrolled nurse 46 18 28
18 Enrolled midwife 25 9 16
19 Nursing Assistant 15 23 0
  Allied Health Professionals  
20 Senior Clinical Officer 1 0 1
21 Health Educator 1 0 1
22 Senior Laboratory Technologist 1 0 1
23 Psychiatric Clinical Officer 1 0 1
24 Ophthalmic Clinical Officer 1 1 0
25 Clinical Officer 5 5 0
26 Health Inspector 1 1 0
27 Assist. Entomological Officer (Medical) 1 0 1
28 Radiographer 2 1 1
29 Physiotherapist 1 0 1
30 Occupation Therapist 1 0 1
31 Orthopaedic Officer 2 0 2
32 Assist. Health Educator 1 0 1
33 Anaesthetic Officer 2 1 1
34 Laboratory Technologist 1 0 1
35 Laboratory Technician 2 2 0
36 Laboratory Assistant 1 2 0
37 Anaesthetic Attendant 1 0 1
  Administrative & Other Staff  
38 Senior Hospital Administrator 1 0 1
39 Hospital Administrator 1 1 0
40 Personnel Officer 1 0 1
41 Social Medical Worker 1 1 0
42 Nutritionist 1 0 1
43 Supplies Officer 1 0 1
44 Senior Accounts Assistant 1 1 0
45 Stenographer Secretary 1 1 0
46 Office typist 1 0 1
47 Stores Assistant 2 1 1
48 Records Assistant 2 2 0
49 Accounts Assistant 2 1 1
  Support Staff  
50 Darkroom Attendant 1 1 0
51 Mortuary Attendant 1 2 0
52 Driver 2 2 0
53 Cook 3 3 0
54 Askari 3 6 0
55 Artisans Mate 2 2 0

Source: Kasese District Capacity Building Plan 2008/9

Table 30:  Health Center IV (Rwesande HC IV and St. Pauls HC IV)

s/n Service provider category Approved Filled Gap
1 Senior Medical Officer 2 0 2
2 Medical officer 2 2 0
3 Senior Nursing Officer 2 0 2
4 Public Health Nurse 2 0 2
5 Clinical Officer 4 2 2
6 Ophthalmic Clinical Officer 2 0 2
7 Health Inspector 2 1 1
8 Dispenser 2 0 2
9 Public Health Dental Officer 2 0 2
10 Laboratory Technician 2 0 2
11 Assistant Entomological Officer (Medical) 2 0 2
12 Nursing Officer (Nursing) 2 0 2
13 Nursing Officer (Midwifery) 2 2 0
14 Nursing Officer (Psychiatry) 2 0 2
15 Assistant Health Educator 2 1 1
16 Anaesthetic Phychaiatic 2 0 2
17 Account Assistant 1 1 0
18 Enrolled Phyciatric Nurse 2 0 2
19 Enrolled nurse 6 4 2
20 Enrolled midwife 6 3 3
21 Cold chain assistant 2 0 2
22 Office typist 2 0 2
23 Laboratory assistant 2 2 0
24 Stores assistant 2 0 2
25 Health assistant 2 0 2
26 Health information assistant 2 2 0
27 Nursing assistant 10 7 3
28 Driver 2 1 1
29 Askari 6 3 0
30 Porter 6 3 3

Source: Kasese District Capacity Building Plan 2008/9

Table 31:    Health Center III

s/n Service provider category Approved Filled Gap
1 Senior Clinical officer 22 2 20
2 Clinical Officers 22 20 2
3 Nursing Officer (Nursing) 22 3 19
4 Laboratory Technician 22 0 22
5 Enrolled Midwife 44 0 22
6 Enrolled Nurse 66 20 46
7 Laboratory Assistant 22 4 18
8 Health assistant 22 21 1
9 Health Information Assistant 22 20 2
10 Nursing assistant 66 66 0
11 Askari 44 2 42
12 Porter 44 0 44

Source: Kasese District Capacity Building Plan 2008/9

Table 32:  Health Center II

Service provider category Approved Filled Gap
1 Enrolled Nurse 60 30 30
2 Nursing Assistant 60 30 30
3 Askari 60 28 32
4 Porter 60 0 60

Source: Kasese District Capacity Building Plan 2008/9

Table 33:     Inspection of private Health Units

Health unit No. of visits
Kagando Hospital 12
Kilembe Mines Hospital 12
Bishop Masereka Medical Centre 12
Kasanga PHC 12

Source: District Health Office

4.7 Sanitation Coverage

Table 35: District Sanitation Coverage

Year Pit latrines Hand washing facilities Pupil stance ratio Bathrooms Safe water coverage
2008 80% 1:109 83%
2009 81%   1:74   84%

Source: District Water Office

4.8 Immunization

Table 36: Kasese District Immunization Coverage (proxy indicators)

Immunization

centres

 Antigen 2008 2009
All health centre IIIs, hospitals and health centres IVs are immunization centers BCG
DPT3 84%
Polio 117%
Measles 69% 101%
TT (preg.)
TT(Non. preg)
Vitamin A supplementation 72% 97.2%
Deworming children 67% 96%
Under weight 15% 15%

Source: District Health Office

4.9 Maternal and Child health

  • The number of deliveries by skilled personnel (proportion of supervised deliveries to those who attend antenatal) is 32%.
  • The number of pregnant mothers receiving antenatal and postnatal care is 34%
  • The contraceptive prevalence rate/number of mothers practicing family planning is 50%
  • The infant mortality rate is at 76/1000.
  • The less than 5 mortality rate is 145/1000.
  • The maternal mortality rate stands at 505/100000.
  • The district has a very high fertility rate which accounts for one of the highest population growth rates of 3.6% above the national average of 3.2%.

4.10 AIDS Control (prevalence, control and treatment)

Table 37: The status of HIV/AIDS and condom use in Kasese

Indicator 2004 (%) 2006 (%) 2009
HIV sero-prevalence 15.2 11.2 11.2
15-24 year olds prevalence (South west) F=4.2, M= 0.6 4.6 4.6
Prevalence in pregnant mothers 6.5 (national) 3.5 6.9
Condom use rate 21.8 21.8
Condom use at first sex 15-24 years (western) M=11.9, F=6.6 25
Persons on ARVs 20.4

Source: UDHS 2006

 4.10.1 HIV Counselling and Testing

There are 14 HIV voluntary testing and counselling centres in the district at Rwesande, Kagando, Bwera, Kasanga, Karambi, Kinyamaseke, Nyabirongo, Kyarumba, Katwe, St. Paul’s, Katadoba, Kasese T/C, Kilembe, Bugoye, Mukathi and Kinyabwamba, Bwera Hospital, Kilembe Hospital and Kagando hospital. PMTCT services are also offered at these centres.

4.10.2 Drivers of HIV/AIDS

The factors affecting HIV prevalence include: the ADF war of 1996 when a large portion of the population was displaced and also that fact that Kasese is a mining and border district, which is a major destination of all sorts of people including sex workers, casual labourers, expatriates, foreigners etc. Others include Poverty, Culture, urbanization, Drug and substance abuse, prostitution and sex working and others.

4.10.3 Treatment and drug administration

Table 38: People on ARVs three of the four major health facilities in Kasese

  Health facility
Sex and age Kilembe Kagando St Paul
Adult males (18 and above) 149 2,480 379
Adult females (18 and above) 323 6,998 677
Pregnant adult females (18 and above) 26  – 62
Children males (17 and  below) 51 392 124
Children females (17 and below) 47 1,664 87
Pregnant female children (17 and below) 0 – 1
TOTALS 596 11,534 1,330

Sources: Kilembe, Kagando and St Paul HCIV 2008

  • The number of people counselled in 2008 was 29,945.
  • Number of people tested for HIV is 29,945.
  • The number of people tested positive is 1,568.
  • The number of people receiving VCT is 29,945.
  • AIDs control structures are at all levels and this is true for the whole district.

 4.10.4 Prevention of Mother to child Transmission of HIV (PMTCT)

PMTCT services are offered at all the functional HC IIIs, HC IVs and hospitals in the district.