1. Welcome to Mifumi Health Centre

2. Mifumi Health Centre Modern type IV clinic Nursing Sister, Clinical Officer, Midwife, nursing aids and support staff Provides comprehensive clinical and immunization services Outpatients, lab, antenatal services Mini theatre for minor/cold surgery Exchange programmes with overseas students

3. Mifumi Advice Centre

4. Sr Goretti - Incharge

5. The Lab

6. Outpatients

8. Mifumi Health Centre Facilities 8 flats for staff accommodation Has electricity and water Integration with the school, loans and domestic violence programmes Computers

9. Situational Health Analysis : To assess the reproductive and sexual health needs of the population of Mifumi and to design and implement a reproductive health program in Mifumi. Conducted: 2002

10. Health Indicators Tororo District Population growth rate4.5% Fertility rate6.9% Dependency ratio94.1 per 100 Infant mortality (per 1000 live births)98.1 Child mortality (per 1000 pop)86.0 Maternal mortality (per 100,000 births)506 Life expectancy at birth in yrs47

11. Situation Analysis - Findings Lack of essential prenatal and delivery care and of referral facilities particularly obstetric and paediatric.

12. Situation Analysis - Findings Lack of a health information source. Helplessness towards the morbidity and mortality from AIDS and the related consequences, orphans and the of inheritance widows. Unsafe and unwanted pregnancies among adolescents and the related abortions.

13. Situation Analysis - Findings Poor access to family planning information and services. Lack of access to information and care for cases of infertility and cancer.

14. Situation Analysis - Findings Age Eighty percent (80%) of this population is aged from 21 to 50 years. 1.5% are Adolescents aged nineteen and less. 8% are aged 60 years and above.

15. Situation Analysis - Findings Education 70% of the population has received some formal education ranging from Primary 1 to Primary 4, but only 5% of women and 25% of men can read. National literacy rates are:- Male 47%; Female28% Occupation: 70% peasant farmers

16. Situation Analysis - Findings Contraceptives & family planning Contraceptive prevalence: 14%. 53% think contraceptives are essential 57% respondents can access the services within 10km distance 94% access family planning services 50% respondents with `Nil education` think contraception is dangerous. 5.5% of respondents with Secondary School Education or more think contraception is dangerous.

17. Situation Analysis - Findings Marital union: 78% monogamous, 17% bigamous, 5% above. Antenatal: 96% of women, 5-times per pregnancy Maternity: Only 30% have access to labour and delivery care by qualified staff

18. Situation Analysis - Findings Impact of formal education on Frequency of ANC attendance: 60% mothers educated to secondary school and above attended ANC at least 5 times compared to 42.5% of mothers with nil education. Only 42% of mothers attending ANC had received education about Breast feeding. This “Tip of the iceberg” reflects a serious gap in Health Education quality during antenatal care.

19. Situation Analysis - Findings Access to Emergency Obstetric Care 77% of respondents reported absence of access to emergency obstetric care which obviously has a direct impact on Maternal and Neonatal mortality and morbidity (Fig 13). For this unfortunate majority therefore an obstetric emergency cannot be treated in safe time. These mothers must travel at least 15Km in order to access emergency obstetric care.

20. Situation Analysis - Findings Causes of Maternal / Neonatal and Infant Morbidity & Mortality: Late reporting for medical attention is a common cause. Access to Essential Care for the new-born 68% of respondents felt they had no access to essential care for the new born and a majority 34.6% of those who could access had to travel at least 11-15 km to the health unit. Thus, delay- related complications set in again as with the mothers in labour.

21. Situation Analysis - Findings Breastfeeding 59% of female spouses had never been educated on breastfeeding or encouraged to practice it. It is notable that 60.8% of mothers have no easy access to postnatal care mainly owing to the distance from the source of service. The majority 81.5% of mothers must travel 11km or more in order to access it and 20% have to travel further (16-20Km) as they come from the other side of the village.

22. Way forward Poverty eradication to improve access to health services Mifumi Health Center for training and research Thus: COBES is welcome.