2ARUA DISTRICT MONITORING REPORT I wish to thank all of you who have been involved in treating this large population from within and without. I want to thank especially those health workers who have sacrificed to go and work in remotest places and have done what is expected of them with difficulties notwithstanding. Facilities like in Vurra HC III, Pajulu HG III were clean. Opia HC III had greatly improved in cleanliness and performance despite overwhelming number of patients from Congo and long distances staff travel to work .In a special way I wish to upload outstanding commitment, integrity, and professionalism exhibited by Lazebu HC II in charge. This center performs far beyond expectations. Its output has by far exceeded the performance of some HCIVs. To us he is a hero.
3General findings cont’d However, allow me to spend more time on issues found in some health centers that require our collective responsibility to tackle if health service delivery is to be improved.AbsentismOut of ….health centers visited ,…incharges were present. Most in charges are reported to have their private clinics where they spend most of their time.ExtortionExtortion was at its peak; e.g. in-charge Abaru Asia, and Onzima Charles of Omugo HCIV sell diabetes drugs at 15,000/= and 5000/= for diabetes testing. In Okollo HCIII, patients pay 5000/= for servicesIn Omugo HCIV, Patients are charged 50,000/= for ambulance yet the facility has a budget for fuel.
4Lack of meaningful supervision by the district There were no staff attendance registers found in most of the facilities visited.Almost all the facilities lacked updated inventory.The DHO had never visited most of the facilities for more than 3 years, e.g Okollo HCIIIMost of the facilities had expired drugs. i.e. condoms, folic acid, contraceptives, ARVs.There was also lack of patients’ registers in most departments in the facilities E.g. Wadi HCIIIMost health centers did not have proper record managementWadi HCIII was downgraded to HCII. Maternity at Wadi HCIII lacks a roof; the top was brown off by the wind two years ago. Lack of priority settingStaffs in all the facilities were not in uniform, this has been accepted.A new ambulance that was donated by UNHCR to Okollo HCIII for referral broke down due to poor servicing and lack of tyres.Senior staff have abdicated their duties to lower cadre staff e.g. at Ofaka HCIII, a Nursing Assistant was found delivering mothers; and patients informed the team that mid-wives abandoned their duties to the nursing Assistant.
5Shoddy workSolar in most of the facilities was nonfunctional due to batteries, and deliveries in maternity were done using lamps at night. Some have never worked at all since installationAll the solar powered phones have never worked since they were delivered. There was no value for money.New constructions handed over in Ajia and Arivu with very poor workmanship. The floor is all cracked and peeling in the new buildings. Magtech built one of themInfrastructure mismanagementSome facilities have grossly mismanaged equipment, beds, mattresses and buildings e.g Silipi,Bondo
6Poor medicines management and accountability All health centers visited in Adumi health sub-district had poor medicine accountability and nearly all medicine s stock out. There was a strong correlation between poor accountability and stock outs.Funds accountability:most units did not have accountability claiming they were at the HSDs yet at some health sub-districts the documents were missing.
7SPECIFIC FINDINGS CILIO HCIII Abscondment of the in-charge, who works for only one day a week.The facility lacked an updated inventory.The DHO has never visited the facility for over 3 years.The solar at the facility is non functional due to batteries, and deliveries in maternity are done using lamps at night.The facility has no water, since the bore hole at the facility broke down.There was no financial accountability at the facility.
8OGUA HCII The in-charge was not present at the facility. The health Centre had expired drugs. i.e. condoms, folic acid, contraceptives, ARVs.The facilities is disturbed by late delivery of drugs by companies contracted by NMS.The facility has only two staff.The facility endeavors to account for the drugs supplied to it.The facility lacked a staff register.
9WADI HCIIIThe facility was downgraded to HCII, and this has led to shortage of drugs since the population is big.The staff lacked uniform, and could not be differentiated from the patients.There was no financial accountability due to the absence of the in-charge.Maternity lacks a roof; the top was blown off by the wind two years ago.The in-charge was not present at the facility.The facility’s inpatient department and maternity are none functional due to collapsed roof.Medicines management at the facility was still very poor.Extortion at the facility, i.e. selling of drugs and paying for services.The facility lacked patients’ registers in most departments.There was no daily reporting register.
10OKOLLO HCIII Lack of accountability for finances and drugs. Extortion; The facility charges 5000/= to access treatment.The DHO has never visited the facility for over 3 years.A brandy new ambulance that was donated by UNHCR for referral broke down due to poor servicing and lack of tyres.Vaccines are supplied by the health sub district due to lack of refrigeration services caused by break down of solar.
11OMUGO HCIVAbsenteeism; seven staff out of twenty one were found at the facility.The facility is severely understaffed with only twenty one staff, both clinical and support staff.Extortion was at its peak; in-charge Abaru Asia, and Onzima Charles sell diabetes drugs at 15,000/= and 5000/= for diabetes testing.The facility is almost none functional, it rarely admits, and staffs generally do not work.There was no accountability for drugs; and the store was completely empty yet patients rarely come to the facility.The facility has a lot of dilapidated structures that needed urgent renovation.Patients are charged 50,000/= for ambulance yet the facility has a budget for fuel.Maternity and children’s ward lack power due to break down of solar batteries; deliveries are done with a lamp.The facility lacked a duty roster.There was no staff attendance register found at the facility.The facility lacks a medical doctor and has not had any operations for more than two years.There was financial accountability due to the sub-accountant’s absence.
12OLI HC IV The facility had a clean compound and well maintained. The facility was very clean both inside and outside.All received funds were properly accounted for and displayed for public viewing.Lack of reagents in the lab and not fully equipped.In adequate space in the lab.The generator is non functional simply because battery got spoilt.No security at the health facility there was no any Askari at the facility.The in charge was absent however out of 22 staffs only 13 were present.The inventory book was not seen but generally they seem to be in order.The store was locked during working hours.The accountabilities were not seen and financial audit was not done by the Unit.
13PRISONS HCIIThe prisons health center was closed since in charge had gone with the keys.MILITARY HC IIOnly one nursing assistant was found on the sight.The health center was infested with bats.VURRA HC III.All staffs were present and in uniform.Compound was clean.The health centre is fully functionalThe medicines were well accounted for and the store was very organized.Accountabilities were not displayed for public viewing and lacked activity reports.They did not have gas in the Fridges for Vaccines.The solar is not working because of batteries
14OPIA HCIII The In charge was present and busy working. It had been upgraded and well organized.They don’t have an operational OPD.Medicines were well accounted for although they don’t have a store.No staff accommodation.Accountabilities were seen although it lacked activity reports.GIBO contractor did not rectify the problem of solar from the time of installmentThey did not have BCG syringes.The vaccine fridges is non functional.They are fewer and overwhelmed by the numbers received per day.In general, the health center is understaffed
15LOGIIRI HC III.The in charge was present and all staffs were in uniform.There is a building that staledThey have poor record keeping and the store was not clean.They turned maternity into a timber and broken beds store.The facility is not well utilized especially maternity and the existing wards.Funds received not displayed for public viewing and lacked activity reports.No Syringes for BCGNo functional Fridges for vaccines due to lack of Gas.3 out of 5 expected staff were present.
16LAZEBU HCII The place was so busy and functional The in charge was present although not in uniform.He had worked for 24hours and had had four deliveries.The output is well above the expected.New maternity was well constructed.Despite understaffing they go out for outreachesThe few selected medicines were well balanced with stock cards.Accountabilities were seen and well organized
17BONDOBondo is a housing estate for health workers with micro structures scattered all over.We found only one worker out of 9health workers.We found an abandoned very sick patientDespite its strategic position and structures available Bondo is underperforming.There is gross abuse of infrastructure and equipments e.g. the wards.A number of medicines were missing. They were not matching with the stock cards.A few things listed in the inventory book were not seen.They abandoned the ward and the beds were empty yet the mattresses were scattered outsideThe lab person was not there yet he stays in the health facility.The Fridge was not working.Waste management was poor. They use open burning yet they have an incinerator.The health center is not fenced.The solar is not working.Bondo is underutilized and patients have resorted to go to Bondo Military for treatment
18AJIA HCIII. We found only four out of nine workers on spot. They were not in uniform.They have a very old and depilated OPD.The new structure is of a health center two with tiny maternity and OPD wards.They don’t have a lab yet they go ahead to receive microscope.Funds were properly accounted for.Drugs were properly managed.Out of three fridges only one was functional.
19Non functional Fridge and Dilapidated OPD of Ajia HCIII
20ADUMI HC IVThe wards were dilapidated all papers scattered in the compoundWe did not find any health worker until they called them except the people that they were doing circumcision.There is no meaningful inventory at the health centerThe health center is grossly underutilizedIt was also noticed that in charge is always busy with other activities not at the health facility.There is no proper circular showing how each health center PHC fund is supposed to get per quarter.Funds were poorly accounted for and not displayed for public viewing.Many beds lacked mattressesMost departments don’t use dispensing logs.Their stock cards were not well updated.The community is complaining about the in charge of not being at the health facility.They had no vaccines for immunization.
21AROI HC III We found only one midwife on spot. No staff register book was seen.There was nothing like accountability for PHC at health facility. There is no circular showing how much money a health center is supposed to getStaffs were not in uniform.Drugs were grossly mismanaged and stolen.They abandoned using issue and requisition vouchers instead they use papers.The store was dirty infested with bees.There were stocks yet on stock cards were showing many drugs in store.Their record keeping was very poor, all papers scattered everywhere, stock cards not updated.
22ADUMI HC IVThe wards were dilapidated all papers scattered in the compoundWe did not find any health worker until they called them except the people that they were doing circumcision.There is no meaningful inventory at the health centerThe health center is grossly underutilizedIt was also noticed that in charge is always busy with other activities not at the health facility.There is no proper circular showing how each health center PHC fund is supposed to get per quarter.Funds were poorly accounted for and not displayed for public viewing.Many beds lacked mattressesMost departments don’t use dispensing logs.Their stock cards were not well updated.The community is complaining about the in charge of not being at the health facility.They had no vaccines for immunization.
23PAJURU HC IIIThe compound was clean and it was actively engaged in treating patientsInventory book was not seen.Accountability was displayedOnly one staff was in uniform.The in charge was found on sight.They get medicine for health center II yet it is a health center III and hence constant stock outs.They don’t admit and it’s a health center III.Solar energy was installed about three years ago but has not functional for about a year, a lamp is used.The vaccines were in stock and the fridge was in good condition.
24AYIVUNI HC III. In charge was not at the facility. There no dispensing records kept on the facility.There was under supply of Drugs.No placenta pit at the facility.The maternity ward is very small with one bed.They send all their accountabilities to the HSD.We found many patients not attended to waiting at the health facility.They have beds but no space.Their solar went off 3 year ago they now use a lamp.DPT vaccines are out of stock.The toilets were surrounded by bush.No inventory book.Staffs were not in Uniform
25OMBIDRIONDREA HC III No placenta pit at health center. Only 5 staffs were present.No inventory book was seen.No solar system at facility.The compound was bushy.The solar penal in the OPD is reportedly to have been stolen.Fridges were in good condition and had all the vaccines.Stock cards were poorly recorded; most of the drugs were out of stock.The lab functions twice a month and lab attendant is employed by Baylor and charges patient.The junior staffs stay at the health facility and senior ones stay in Arua town.
26RIKI HC IIIStock cards were not updated and some medicines were found missing like parecetamol.There were little medicines at the facility.The lab was closed because lab attendant goes with the keys.No accountability was seen at health facility because the in charge was absent.ORIVU HC III.The health center has no medicine that indicates underperformance of the health facility.There was no activity at health centre.No patients were found at the facility.Poor workmanship of maternity floor, full of cracksThe maternity was not properly handed over.Staffs work for only 2 weeks in a month.No accountability was seen at health facility.The health center does not admit, yet a health center III.
27SILIPI HC III.No accountability for PHC was seen at the facility and the in charge did not know about accounting for the same.Some staffs were in uniform.There was total collapse of administrative roles of the health unit.The beds were abandoned in the compound despite being new and of good quality.The maternity building collapsed 5 years after construction.Most of the drugs were found missing from the drug store.The building that was supposed to house the general ward is condemned as unfit for inhabitation by patients.All the drug stock cards are not updated.No inventory book/record was seen at the health facility.It was voted the worst performing health centre visited so far by the unit.
28RHINO CAMPIt is one of the remotest health centre IV in the District and it has not had a doctor in the last 4 years.The health centre has a well equipped theatre but no surgeries take place and the equipment is covered with dust because they don’t have a Doctor and a theatre nurse.One functional fridge cannot be utilised due to lack of a socket.The medicines are stored in a fridge meant for blood.All the health workers were not in uniform.The stock cards for drugs were not updated.They have enough drugs however stock cards were not reflecting what is in stock including the donation from UPDF.All the buildings except the few staff houses are in a dilapidated state.Patients are still being asked to buy exercise books despite having the medical form 5 booklets in the store.A brand new ultra sound machine has never been used and instead kept in theatre covered with dust as a room is being prepared.