2 Final Annual Report 06-07 - Lacor Hospital

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St Mary’s Hospital Lacor, Annual Report F/Y 2006/2007

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Table of Contents

FOREWORD .................................................................................................................................................................... 3 MAP OF GULU AND AMURU DISTRICTS................................................................................................................. 5 EXECUTIVE SUMMARY ................................................................................................................................................ 6

THE HOSPITAL ............................................................................................................................................................... 6 MAJOR ACHIEVEMENTS IN FY 2006/07 ........................................................................................................................ 7 SERVICE UTILISATION .................................................................................................................................................... 7 FINANCES....................................................................................................................................................................... 8 LOGISTICS AND TECHNICAL WORKSHOP ...................................................................................................................... 8

1. INTRODUCTION .................................................................................................................................................... 9 2. THE HOSPITAL AND ITS ENVIRONMENT .................................................................................................... 10 3. HEALTH POLICY AND DISTRICT HEALTH SERVICES ............................................................................. 11 4. MANAGEMENT.................................................................................................................................................... 12 5. LACOR HOSPITAL STAFF ............................................................................................................................... 12

5.1. NUMBER OF STAFF AND ATTRITION RATE .................................................................................................... 12 5.2. COMPREHENSIVE PACKAGES OFFERED TO LACOR HOSPITAL STAFF......................................................... 13 5.3. STAFF SALARIES ........................................................................................................................................... 13

6. DOMESTIC SERVICES ...................................................................................................................................... 13 7. AMBULANCE SERVICES.................................................................................................................................. 14 8. TECHNICAL SERVICES .................................................................................................................................... 14 9. FINANCES ............................................................................................................................................................ 14

9.1. EXPENDITURES.............................................................................................................................................. 14 9.1.1. Recurrent Costs....................................................................................................................................... 14 9.1.2. Capital Development Costs .................................................................................................................. 15 9.1.3. Revenue and Coverage of Recurrent Costs..................................................................................... 15

10. LACOR HOSPITAL ACTIVITIES.................................................................................................................. 17 10.1. OUTPATIENT SERVICES ................................................................................................................................. 17

10.1.1. Trends of Outpatient Attendance (Hospital and Health Centres) ............................................. 17 10.1.2. Outpatient attendance in the Health Centres................................................................................. 18 10.1.3. Morbidity pattern ................................................................................................................................... 19

10.1.3.1. Adult OPD in the Hospital..........................................................................................................................19 10.1.3.2. Young Child Clinic in the Hospital ..........................................................................................................20

10.2. INPATIENTS SERVICES .................................................................................................................................. 21 10.2.1. Bed Capacity .......................................................................................................................................... 21 10.2.2. Admissions in the Hospital and in the Health Centres ............................................................... 21 10.2.3. Trends of Admissions.......................................................................................................................... 21 10.2.4. Daily Rate of Admissions.................................................................................................................... 22 10.2.5. Admissions in the Health Centres .................................................................................................... 22 10.2.6. Leading Causes of Admission in the Hospital .............................................................................. 23 10.2.7. Inpatient Mortality in the Hospital..................................................................................................... 24 10.2.8. Leading Causes of Death in the Hospital ....................................................................................... 25 10.2.9. Case Fatality Rate in the Hospital..................................................................................................... 27 10.2.10. Hospital Average Length of Stay (ALOS) and Bed Occupancy Rate (BOR)........................ 29

10.3. OPERATION THEATRE ................................................................................................................................... 29 10.4. MATERNITY SERVICES .................................................................................................................................. 30 10.5. HIV/AIDS CARE SERVICES .......................................................................................................................... 31 10.6. DENTAL TREATMENTS .................................................................................................................................. 31 10.7. LABORATORY SERVICES............................................................................................................................... 32 10.8. BLOOD TRANSFUSION SERVICES ................................................................................................................. 32 10.9. RADIOLOGICAL EXAMINATIONS .................................................................................................................... 33


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10.10. COMMUNITY HEALTH CARE SERVICES.................................................................................................... 33 10.10.1. Health Centres ..................................................................................................................................... 33 10.10.2. Outreach Activities ............................................................................................................................. 34 10.10.3. Ambulance Services .......................................................................................................................... 34 10.10.4. Epidemic Preparedness & Response ............................................................................................ 34 10.10.5. Primary Health Care Activities ........................................................................................................ 34 10.10.5.1. Immunisation activities ............................................................................................................. 34 10.10.5.2. Community Based Health Care (CBHC) ............................................................................... 35

11. TRAINING......................................................................................................................................................... 35 11.1. GULU UNIVERSITY TEACHING SITE .............................................................................................................. 35 11.2. LACOR NURSE TRAINING SCHOOL AND SCHOOL OF LABORATORY ASSISTANTS ...................................... 36 11.3. INTERNSHIP OF MEDICAL DOCTORS ............................................................................................................. 37 11.4. IN HOUSE TRAINING (CONTINUING PROFESSIONAL DEVELOPMENT) .......................................................... 37

12. HUMAN RESOURCES DEVELOPMENT ................................................................................................... 37 13. STRATEGIC PLAN......................................................................................................................................... 38 ANNEXE 1 – THE VISION........................................................................................................................................... 39 ANNEXE 2 – THE MISSION ........................................................................................................................................ 40 ANNEXE 3 - STRATEGIC PLAN 2007-2012............................................................................................................ 41 ANNEXE 4 - MEMBERS OF THE BOARD OF DIRECTORS, THE EXECUTIVE COMMITTEE AND THE HOSPITAL MANAGEMENT TEAM............................................................................................................................ 42 ANNEXE 5: FINANCIAL STATEMENT FOR THE YEAR ENDED 30/06/2007 .................................................. 44 ANNEXE 6 – LACOR HOSPITAL ORGANOGRAM ............................................................................................... 46


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Foreword

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This is the fifth consecutive year in which the hospital is producing its annual activity report. Service provision was the core activity of the hospital as evidenced by the statistics, however two major events needs special mention. The production of the hospital five year strategic plan (2007—2012) and the final phase of the hand over process scheduled to end in February 2008. These two events reinforce one another in that future management will benefit from the experience gathered in the past but now consolidated into a working document, the strategic plan, which will be used to run the hospital in a transparent and efficient way. Broad consultation of all the stake holders was done in production of this plan. Namely hospital staffs, the community, district officials and ministry of health to mention but a few. In the area of service provision the plan envisages consolidation of current services with flexibility, decentralization of services to the health centres and in the capacity building to have qualified ,adequate human resource and sustainable hospital funding in order to deliver quality service in humane way The hand over process has seen the rotation of the deputy directors in all the key areas of responsibilities thus ensuring pool of manpower that can work as a team and interchangeably. Job mobility, which has become a fact of life, continues to be a big challenge to the hospital in terms of direct service delivery and also transmission of core hospital values. The effect of the current peace prevailing in the northern Uganda is unpredictable on the workload of the hospital. Whereas other health units are opening up, the ease of movement could widened our catchment area a lot .On behalf of the board of directors we wish to the thank staffs who have contributed in a big to the successes of this financial year. Special thanks also go to all our donors, ministry of health and well wishers. Finally we would say that together we can improve on the performance of Lacor hospital

Dr Opira Cyprian

Deputy Director Operations

NOTE

St. Mary’s Hospital Lacor is a complex including 1. Lacor Hospital itself 2. The health centres III of Opit, Pabo and Amuru 3. Lacor Nurse Training School and other training programmes In this report “Lacor Hospital” refers to the complex ”The Hospital” refers to the hospital only The “health centres” refers to Opit, Pabo and Amuru health centres “LNTS” to Lacor Nurse Training School


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LIST OF ABBREVIATION AND ACRONYMS ALOS Average Length of Stay

ARI Acute Respiratory tract Infection

BOR Bed Occupancy Rate

CBHC Community Based Health Care

CHW Community Heath Worker

CPD Continuing Professional Development

CRSC Catholic Relief Services Consortium

DHC District Health Committee

DHMT District Health Management Team

DHT District Health Team

DOTS Directly Observed Therapy short-course

ECN Enrolled Comprehensive Nursing

EPI Expanded Programme of Immunisation

GDHSSP Gulu District Health Sector Strategic Plan

HMIS Health Management Information System

HSD Health Sub-district

HUMC Heath Unit Management Committee

ICU Intensive Care Unit

NSSF National Social Security Fund

OPD Out-Patients Department

PEPFAR The President’s Emergency Plan For AIDS Relief

PHC Primary Health Care

PMTCT Prevention of Mother to Child Transmission

PNFP Private Not For Profit

PTC Pharmacy and Therapeutic Committee

TB Tuberculosis

TBA Traditional Birth Attendant

UBOS Uganda Bureau of Statistics

UCMB Uganda Catholic Medical Bureau

UDHS Uganda Demographic Heath Survey

UHSSP Uganda Health Sector Support Programme

UNICEF United Nations Children’s Fund

URN Uganda Registered Nursing

VCT Voluntary Counselling and Testing

VHC Village Health Committee

YCC Young Child Clinic

St. Mary’s Hospital Lacor, Annual Report FY 2006/07

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Map of Gulu and Amuru districts


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Executive Summary

The Hospital St. Mary’s Hospital Lacor is a private non-profit catholic based institution founded in 1959 the Comboni Missionaries and the Diocese of Gulu. The mission of the Hospital is to provide quality health care to the needy and to fight diseases and poverty for every sick person regardless of ethnic origin, social status, religious or political affiliation. To promote access to health care of the weakest social groups, like women, children, people in destitute financial conditions, and people affected by chronic diseases. Through a comprehensive, integrated and sustainable action on health, including treatment, prevention and training of health workers.

Lacor Hospital is registered with the National Board for Non-Governmental Organisations and is accredited to Uganda Catholic Medical Bureau. Lacor Hospital activities are in line with Uganda Ministry of Health policies of health care provision. Lacor Hospital is fully integrated into the Uganda national health system in line with national health reform, which was implemented from 1996/1997.

From a small 30-bed hospital started in 1959, Lacor Hospital is now a complex with 476-bed capacity, 3 peripheral health centres III located at Opit, Amuru and Pabbo, a Nurse Training School and other training programmes. Lacor Hospital is also a Gulu University teaching site for medical school.

The Hospital is located in Gulu Municipality, about 6 km west of Gulu town along Highway to Sudan. It has been built on land owned by Gulu Catholic Archdiocese and is situated close to several other Catholic institutions including a teacher training centre, Alokolum and Lacor seminaries, primary and secondary schools. The Christian doctrine of dedication and providing care to the sick is the strong pillar on which Lacor Hospital’s identity and performance rests.

Gulu municipality has 115,000 inhabitants and Gulu district 468,407 (UBOS, 2002). Gulu Government Hospital, about 6 km from Lacor, has 250 beds and is the regional referral hospital. There are other small private clinics and drug shops for commercial purposes in Gulu town and the suburbs. The approach of Lacor Hospital is to supplement the government’s efforts in health service provision.

Lacor Hospital has operated for many years in a very difficult social and economic environment. Insecurity has since 1986 devastated the economy of northern Uganda leaving the population in dire need, suffering and despair. Now the situation has improved significantly, protected camps are being gradually dismantled and there are no more “night commuters” coming to the Hospital for the night. Most of the patients getting services in Lacor Hospital are nevertheless still among the poorest of the poor who live well below the poverty line.

The Hospital accommodates every day on average 600 inpatients plus their attendants and receives on average 500 outpatients (totaling about 2000 people each day). There are about 1000 family members of employees living within the Hospital.

The health centres of Amuru and Pabo are located in the new Amuru district, while the health centre of Opit is in Gulu district. All the health centres of Lacor Hospital are similar in size and design, with 24 beds, a delivery room and outpatient facilities.


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Major achievements in FY 2006/07 Highlighted below are some of the major achievements made in the FY 2006/07 in the different departments or service areas according to the Hospital plan.

• Completion of the development of the Hospital five year Strategic Plan 2007-2012.

• Completion of reconstruction and refurbishment of the Operation theatre, Central Sterilisation unit, Endoscopy room, Plaster of Paris room, Intensive Care Unit, and the Administration block.

• Construction of 18 apartments for the senior staff residence as well as the construction of an 8 flats for Doctors residence.

• Construction in progress of five additional apartments for staff accommodation at the three health centres and accommodation for students at Pabo and Opit.

• Acquisition of new equipment for the sterilisation unit and the clinical laboratory.

• General increase in service output across the board, with OPD attendance increasing by 11% from last year, Admission increasing by 6.5%, Deliveries increasing by 19%, while major surgical operations increased by up to 24% from last year.

• Hospital mortality rate remained low at 5%, with Maternal Mortality Ratio reducing by 37% from 534 to 334 per 100,000 Live Births.

• More patients (1,802) were able access Anti-Retroviral Therapy including 173 children through AIDSRelief programme. In 2006/07 309 women have received prophylaxis against vertical transmission of HIV infection.

• Renewal of another 3 year Memorandum of Understanding with Gulu University.

• Reduction in staff attrition rate from 13% last year to 7.9% this year.

• Implementing payment of employee salaries through the Bank after the opening of Post Bank in the Hospital.

• Staff development programme continued, 30 employees are for further studies on hospital sponsorship

Service utilisation The demand for Lacor Hospital services remained high in the FY 2006/07 as shown in the following table:

Table 1: Selected service output FY 2006/07 Selected service Output FY 2005/06 Output FY 2006/07 Difference OPD attendance 240,525 267,253 11% Admissions 34,947 37,371 7% Deliveries 2,913 3,591 23% Major Surgical operations 3,972 5,212 31% Caesarean sections 283 382 35% Dental treatments 6,248 7,705 23% Laboratory Examinations 217,197 226,129 4% Radiological Examination 41,991 42,034 0.1% Immunisations 50,864 43,390 -15%


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Finances In FY 2006/2007 the income of Lacor Hospital increased to 8,825 million shilling from the 6,790 of the previous year, with the proportion of support from donors rising to 78.8% from the previous 75.6%. The expenditure for recurrent costs amounted to 5,722 million against 4,676 of the previous year (+22%) and 2,453 million were spent on capital development against 1,774 of the previous year (+38%). The five top contributors to Lacor Hospital in the last FY were in descending order the Corti Foundation Italy, the Italian Episcopal Conference, AVSI with projects funded by EU, ECHO, UNICEF, Royal Dutch Embassy, the Government of Uganda (complete list of donors in Annex 5)

Table 2: Finances FY 2006/07

Income (Revenue) Amount (Shs ‘000) % contribution

1. Receipt from donors 6,956,349 78.8% 2. Uganda Gov’t contribution1 762,472 8.7% 3. User fees from patients 1,034,454 11.7% 4. Locally generated revenue 71,646 0.8%

Total income 8,824,921 100.00% Expenditure % of total revenue

1. Capital expenditure 2,453,492 27.80% 2. Recurrent expenditure2 5,721,974 64.8%

Total expenditure 8,175,466 92.60% Surplus brought forward to start FY 2007/08 649,455 7.4%

Logistics and Technical workshop All the activities of the hospital require materials some of which have to be transported from Kampala – the capital city about 350 km away. Lacor hospital has well-organized system for handling logistics. Special logistics office is established in Kampala and, goods and supplies are transported at least twice every week from Kampala to Lacor. This inevitable demand accounts for significant proportion of recurrent expenditure.

The technical workshop built within the hospital compound constitutes a very vital component of Lacor hospital. All activities of construction, maintenance of buildings and some equipment, renovations, waste management, water supply and maintaining constant electricity supply, are performed by the workshop.

1 The receipt from Uganda Government excludes salaries for the doctors seconded to Lacor by the government 2 56% of the total running cost is accounted for by the personnel cost alone


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1. Introduction This comprehensive annual report covers the period between July 2006 and June 2007. The report depicts Lacor hospital’s performance in the various activities. The activities provided by Lacor hospital include integrated curative and rehabilitative services, community health services, training, administrative, logistics and technical support services. Trends of outputs for the last five years have been used to allow comparison of selected core services. The report also describes the demanding environment Lacor hospital operates in and, the critical roles the hospital plays in the local community.

The bulk of data for this report was directly derived from the hospital’s data archives i.e. both activity and financial databases. Some relevant reports and publications from Gulu district and Uganda Ministry of health have been quoted in order to explain how Lacor Hospital’s activities fit into the Uganda national health care delivery system.

The key information the report tries to bring out is the high and increasing demand for health services especially by the most vulnerable sector of our population (women and children). The report highlights how the hospital is responding to this challenge of increasing demand for services, with specific emphasis on equity and increasing accessibility to the most vulnerable, within the limitations of the available resources.

The increasing demand for health care services is a clear indication of high disease burden in our catchments area, and can be attributable to the insecurity which has affected the region until very recently. Very little socio-economic activities were possible in the area due to the war. With up to 90% of the population displaced at times and living in internally displaced people’s camps, the socio-economic conditions of the people have been for long time and are still very poor.

The population has been reduced to relying heavily on food relief from World Food Programme (WFP), and non-food items from relief agencies. Moving around was dangerous and the vast fertile land for cultivation remained un-utilized except those very close to the camps.

Lacor has been operating in a context of war, poverty and disease for a very long period of time. In order to keep to its mission of providing quality health care to the most vulnerable sector of the society indiscriminately, Lacor hospital has adjusted to fit into the changing environment by developing a five year strategic plan. The Hospital shall take advantage of the local capacity and the flexibility that it has developed in order to respond to emergencies. With limited resources Lacor has to make hard choices and use available resources prudently.

Although there has been relative peace in the region for about two years now, majority of the population still have not managed to return to their home villages, they still live in the IDP Camps.

After the end of the war there is likely to be a period of 5 – 10 years in which the population has to pick up before any meaningful economy is put in place. Therefore, the region will still continue to depend on donors to supplement its economy in order to run essential services.

Feedback and critical comments from readers and reviewers of this annual report will allow us gain more insight into our activities and adjust accordingly. Feel free to contact us.


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2. The Hospital and its environment The Hospital, found 6 kilometers west of Gulu town, the regional capital and 340 km north of the national capital, Kampala, started as a small Hospital in 1959, founded by the Comboni missionaries. Starting July 2006, it is a 476-bed hospital offering referral services, primarily serving the population of Gulu district but also receiving patients from other parts of Uganda. It offers services ranging from promotive and preventive, through curative and rehabilitative health care services including specialist services and is a training centre for different cadres of medical personnel. In order to further improve accessibility of health services to the community, Lacor Hospital constructed three satellite health centres in Amuru, Opit and Pabbo with additional 24 beds each. The health centres are located about 30 km away from the Hospital. Some years ago the operation of Amuru was temporarily handed over to the District because Lacor Hospital was unable to deploy staffs in Amuru due to insecurity. On the 1st of July 2006, Lacor Hospital fully resumed its activities in Amuru health centre.

Lacor Hospital gets funding from three main sources: the government of Uganda (delegated funds), user fees and donations (mostly from external sources). A small proportion of revenue (about 2%) is locally generated.

Gulu district, where Lacor Hospital is found, is bordered by seven districts: Amuru, Adjumani, Arua and Nebbi to the West; Apac and Masindi to the South; Kitgum and Pader to the East and has a total population of 468,407 with an annual population growth rate of 3.0 % per annum (UBOS 2002). For about 20 years, the district has had insecurity, which has led to many deaths and disruption of life, with massive displacement of people, most of whom have ended up either in urban areas or in protected camps for the Internally Displaced. Normal life, food production, education, health and other social services have all been disrupted by the insecurity for all this time and the district has some of the worst health indicators in the country. Infant Mortality Rate is at 172/1,000 live births (national average is 88/1,000), Maternal Mortality Rate at 700/100,000 live births (national average is 506/100,000) and Life Expectancy at Birth being 39 years (males) and 41 years (females). The crude birth rate is 53.7 per 1,000 and crude death rate 21.7 per 1,000 (DDHS Gulu 2003). It has 60 health units (5 hospitals, 3 Health Centres of level IV, 17 of level III and 35 of level II) but only 30% of the population live within 5 km from a health facility and 33% of the lower level units were until recently not operational due to the insecurity (Gulu DDHS, 2005). Less than 10% of the adult population is formally employed and 75% of households survive on subsistence farming.

In spite of this situation Gulu District in the last years has positioned itself consistently among the top performing districts in the District League Table of the Annual Health Sector Performance Report.

Lacor Hospital operates in a very difficult social, political and economic environment. The two-decade civil war and the activities of the rebels have devastated the economy of northern Uganda leaving the population in dire need, suffering and despair. Majority of the patients getting services in Lacor Hospital are among the poorest of the poor who live well below the poverty line. Many of the patients still come from IDP camps.

The Hospital accommodates every day on average 600 inpatients plus their attendants and receives on average 500 outpatients (totalling about 2,000 people each day). About 1,000 family members of employees live within the Hospital. In the past the Hospital had to provide also for the thousands of night commuters that would come to the Hospital every night. Their number declined sharply in the first part of the last financial year and Lacor shelters for night commuters could be closed at the end of December 2006.


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In addition to insecurity, poverty undermines the development of the health sector in the district. The average household income is about $ 0.5 per day, which cannot sustain the basic health requirements. About 66% of the population in Gulu cannot meet their basic needs due to insecurity and displacement caused by the war (GDHSSP). As shown by Table 2, most of the diseases in Gulu are associated with poverty and are preventable.

Table 3: The Burden of disease in Gulu District and corresponding life years lost

Number DISEASE % Contribution to Life years lost

1 Malaria 18.8 2 Diarrhoeal Diseases 11.8 3 Malnutrition 10.5 4 Tuberculosis 7.0 5 HIV/AIDS 6.6 6 Acute Respiratory Tract Infection 6.0 7 Trauma 4.8 8 Peri-natal & Maternal complications 3.3 9 Others 31.3

Source: Gulu District Health Sector Strategic Plan (HSSP) 2000/01 – 2005/06

3. Health policy and District health services Lacor Hospital implements the Uganda National Health Policy and the Health Sector Strategic Plan. Lacor Hospital provides the major components of the Uganda Minimum Health Care Package offering inpatient, outpatient and community-based services. The Hospital receives patients referred from all the districts of northern Uganda and beyond. The range of services offered includes diagnostic, therapeutic and preventive services.

With creation of the new Amuru district, Lacor’s two of the three health centres (Amuru and Pabbo) are now located in the new district. The operational plan of each of the health units is incorporated into the overall activity plan of the respective districts.

Each of Lacor Hospital’s peripheral health centres is designated health centre III and offers a range of services including VCT for HIV/AIDS, PHC activities, and clinical services with maternity component. The health centres provide support supervision to the local lower level units within their catchments areas, including the lower level government health units. The health centres also serve as points of screening of patients for referral to the Hospital. Ambulance services are available free of charge for referral of patients from the health centres to the Hospital.

Lacor Hospital community health department conducts PHC activities in Layibi and Bardege sub-counties and offers CBHC services3 in 30 parishes within Gulu district. Lacor Hospital participates in the DHMT and DHC meetings and the operational plans for the common activities are incorporated in the district health plan. Lacor Hospital provides technical membership to the generic Gulu District Epidemic Response Team – headed by Gulu DDHS; e.g. in the fiscal year 2004/05, the Cholera Task Force, in FY 2000/01, Ebola Task Force, in FY 2005/06, the Meningitis Task Force, e.t.c.

3 CBHC activities include training and supervision of Community Resource Persons (CORPs) like TBAs and CHWs and VHCs.


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4. Management The major policy decisions for running Lacor Hospital are made by the Board of Directors headed by the Archbishop of Gulu RCC Archdiocese. The Executive Committee, with the Hospital Management Team having an advisory role, makes the day-to-day operational decisions.

In the FY 2004/05, Lacor Hospital further strengthened the management structure aimed at building a strong sustainable senior management (organogram in Annex 6). Lacor Hospital Director is the Chief Executive Officer. Two Deputy Directors i.e. Deputy Director Institutional Affairs and Deputy Director Operations assist the director. The deputy directors have clearly defined responsibilities.

The Hospital Director heads the Executive Committee4 that is responsible for the operations of Lacor Hospital. The Executive Committee meets every two weeks, but may convene meetings as and when situation demands for a meeting. The Hospital Management Team (comprising all heads of departments and clinical/administrative services) is the main link between the top management and hospital staffs, and meets once in a month.

The Medical Superintendent is the overseer of all the clinical services and is assisted by the Deputy Medical Superintendent and the Hospital Matron. The non-medical and administrative issues are the responsibilities of the Hospital Administrator. All the Departments are headed by team leaders/in charges who are responsible for planning and supervising the departmental services/activities. The departments hold routine meetings where performance review and subsequent remedial plans are devised. Key decisions made at departmental level are fed back to the management through the hospital management team.

Besides the Executive and Management committees, there are other specialised committees e.g. the Disciplinary Committee, the Pharmacy and Therapeutic Committee (PTC), ARV Committee, Promotion and Training Committee, and Staff Welfare Committee.

5. Lacor Hospital Staff 5.1. Number of Staff and attrition rate The total number of permanent staff as of 30/06/2007 was 574 (including the ones on study leave), medical and non-medical staff inclusive. At the same date the temporary workers for constructions were 176.

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4 The Executive Committee is constituted by the Director, Deputy Directors, Medical Superintendent, Matron, Hospital Administrator and Hospital Secretary.


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Table 4: Lacor Hospital Staff turnover in FY 2006/07 �

Category Total by 30/6/06

Total left Recruited Total by

30/6/07 Variance

Clinical Officers 13 1 5 17 4 Enrolled midwives 15 1 4 18 3 Enrolled nurses 108 21 18 105 -3 Laboratory Staff 18 3 6 21 3 Medical Officers 23 3 4 24 1 Intern Doctors 10 7 12 15 5 Nursing Assistants 36 1 1 36 0 Nursing aides 97 2 5 100 3 Registered Nurses/midwives 13 2 0 11 -2 Others - support staff 223 7 10 226 3 Public dental officer 1 1 1 1 0 Physiotherapist 0 1 1 0 0 Total 557 50 67 574 17 �

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5.2. Comprehensive packages offered to Lacor Hospital Staff

Staff retention strategies in Lacor Hospital, among others, include sharing of Lacor hospital’s vision with all the categories of staff, prompt and commensurate monthly salaries with access to salary advances, training opportunities including CME, provision of loans, free medical care to all the staffs and their immediate relatives. For all its staffs, Lacor Hospital either provides free housing within the hospital quarters (i.e. for staff who work on night shifts or need to be available 24 hours a day), or pays housing-subsidy for those who are not accommodated. All hospital employees are enrolled with NSSF.

5.3. Staff salaries Salaries of all Hospital are paid promptly. For the second year running, the salaries of staff are at least the same level with those in government, when not higher. Staff in the health centres are paid an hardship allowance.

All salaries are now paid through the bank, which is located within the hospital compound, but serves the entire community of Lacor and its surrounding.

6. Domestic services The Hospital laundry is in good condition and has been re-equipped recently but already utilised to its full capacity. Food provision and catering services are mainly in the Nutrition Unit, Nursing school for the students, the interns and for Lacor Hospital guests at Lacor guest-houses. Also World Food Programme supplies food in form of dry rations to TB patients on the wards and those under TB community DOTs, and for the mothers in Nutrition Unit. UNICEF provides the milk for malnourished children on therapeutic feeding.


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7. Ambulance services The Hospital has ambulance services from the Health Centres of Amuru, Pabbo and Opit. Ambulance services are provided for emergency cases and are free of charge. While for ambulance services within the Municipality, a token of charge is allowed.

8. Technical Services The Hospital has a functional technical workshop which gives a big technical support to the Hospital in the maintenance and repair of vehicles, equipments, generators, provision and regulation of electricity, water, actual construction (buildings), repair and maintenance. At the moment the workshop basically provides the technical support services to the Hospital only and not for external service provision or as an income-generating project.

9. Finances The total recurrent costs for the FY 2006/07 reached Shs. 5,721,974,000. Compared to the previous year, there was an increase of recurrent expenditure by Shs. 1,046,130,000 accounting for 22.4% increase. 9.1. Expenditures

Table 5: Costs FY 2005/06 – 2006/07

Costs 2005-2006 Shs ‘000

2006-2007 Shs ‘000

Personnel 62,755,249 3,195,889

Supplies and services 1,239,332 1,637,195

Transport, plant and PHC 238,785 282,512

Administrative expenditure 227,789 228,052

Property expenditure 144,369 247,988

Primary Health Care 70,312 130,338

Total recurrent costs 4,675,836 5,721,974

Capital expenditure 1,773,993 2,453,492

Total 6,449,829 8,175,466 9.1.1. Recurrent Costs As shown in the next graph personnel cost accounts for more than half (55.85%) of the recurrent cost followed by purchase of supplies and services from third parties. Personnel cost increased by Shs 440,640,000 (16% in one year) reflecting the continuous effort of the Hospital to improve the welfare of the staff.


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Fig. 1: Breakdown of Recurrent Costs

2.28%

2.28%

4.33%

4.94%

28.61%

55.85%

PHC

Administrativeexpenditure

Property expenditure

Transport and plant

Supplies and services

Personnel

9.1.2. Capital Development Costs The total capital development cost for the year was 2,453 million with an increase of 679,499 million (38.30%) compared to the previous year. Capital developments in FY 2006-07 were the renovation administrative block, the building of new doctors’ and nurses’ quarters funded by the Italian Episcopal Conference. The construction of new houses in health centres of Amuru, Pabbo and Opit were funded under AVSI/UNICEF project. New equipment has been installed in the clinical laboratory and in the sterilisation unit thanks to the support respectively of the Italian Institute of Health (ISS) - Italian Cooperation of the and of the Province of Bolzano, whose project together with ROTARACT Italy contributed also to the renovation of the operation theatre, while the new intensive care unit was constructed with the contribution of the Italian organisation Byelo.

9.1.3. Revenue and Coverage of Recurrent Costs �

Table 6: Income FY 2005/06 – 2006/07

Income 2005/06 Shs ‘000

2006/07 Shs ‘000

Difference Shs ‘000

% difference

Fees 881,366 1,034,454 153,088 17.37%

Other local revenues 98,186 71,646 -26,540 -27.03%

Uganda Government 5 678,103 762,472 84,369 12.44%

Receipts from donors 5,132,770 6,956,349 1,823,579 35.12%

Total 6,790,425 8,824,921 2,034,496 29.65%

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Against a total expenditure of Shs.8,175 million there was an income of Shs. 8,824 million with a surplus of Shs. 649,455 million, which was brought forward to start FY 2007/08.

While most of the expenditures for buildings and equipment can be usually postponed until a donor that is willing to finance them is found, the running costs must be met without delay in order to avoid any disruption in the service delivery; ideally there should be continuity in most of the sources of finance for recurrent costs.

As shown in the next figure, this is not yet the case for Lacor Hospital, which still covers 67.34% of its running costs with donations from abroad. This is a direct consequence of the poor economic environment in which it operates and which does not allow higher revenue from user fees. In Lacor Hospital there was no general increase of fees since 2001, rather reduction or waiving of fees for vulnerable groups, in spite of the increment of costs (especially personnel and supplies). Last financial year fees for antenatal clinic, admission of children and pregnant women were scrapped off reflecting this policy. The increase in the fee revenue reflects the higher service output in the services where a token fees is still maintained. Patients with chronic diseases pay reduced fees and patients in destitute financial position can enrol in a free-treatment scheme.

Actually, compared to the previous FY the proportional contribution to the sources of income by the user fees decreased from 18.85% to 18.08 % as a consequence of abolition of fees in antenatal clinic and admission of pregnant mothers and children, in association with Increase of recurrent costs, and globally the fees paid by the patients are now subsidised by 82%.

Fig. 2: Financing Recurrent Costs FY 2006/07

Uganda Government,

13.33%

From donors, 67.34%

Other local revenues, 1.25%

User fees, 18.08%

The contribution of Uganda Government has been considered according to the funds received in the FY, independently for which year they had been apportioned and this explains the wide fluctuations from year to year.


17

10. Lacor Hospital Activities 10.1. Outpatient services The outpatient department is the reception point for most patients receiving services in the hospital. Services are delivered through the adult OPD for patient more than six years old and through the Young Child Clinic for patients less than six years of age.

The OPD is opened from Monday to Saturday during working hours with Young Child Clinic also opened on Sundays and public holidays to handle emergency cases. Emergencies which come after hours are served in the respective inpatient wards and or in the casualty department which remain opened twenty four hours a day.

The OPD includes specialised clinics like ANC, Gynaecology, AIDS, Surgical, Dental and private clinics. An average of more than 500 patients are seen in the Outpatient department of the Hospital daily. The three health centres see patients in the adult OPD, in the Young Child Clinic and in the ANC. The average attendance of the three health centres is above 250 patients a day.

Children below 6 years and pregnant mothers are more than 50% of the whole outpatient attendance.

10.1.1. Trends of Outpatient Attendance (Hospital and Health Centres)

Fig. 3: Trends of Outpatient Attendance

0

50,000

100,000

150,000

200,000

250,000

300,000

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

The Out patient attendance over the years have continued to show up wards trends, reaching the highest peak this year with 264,000 attendances. The relative peace experienced in the last one year opened up roads links with Southern Sudan and other regions of the country, patients who used to fear travelling to Gulu are now coming without any fear. Patient receiving HIV care including ART continued to increase in numbers, too. The abolition of user fees for pregnant mothers and children below six years at the health


18

centres has continued to allow more and more of these groups to access our services at the hospital as well at the health centres.

10.1.2. Outpatient attendance in the Health Centres A total of 80,934 patients were treated in the three health centres this year.

This accounted for 30% of the total OPD Attendance in the hospital and health centres combined. This is very significant particularly as the hospital plans to decentralize it services to the health centres in line with the policy of taking services nearer to the rural population. As the health services are strengthened at the health centres, we expect more and more patients to access services at the health centres.

Fig.4: Proportion of Outpatient attendance�

Amuru, 10%Opit, 8%

Pabo, 12%

Lacor Hospital, 70%

Fig. 5: Monthly Outpatient attendance

0

2000

4000

6000

8000

10000

12000

YCC 6485 5994 5178 6485 6029 5381 5567 4493 5882 4666 6799 6822

ADULT OPD 8129 8634 8431 8278 8610 7289 9556 8858 11276 8411 8814 9873

ANC 742 776 624 848 874 705 884 927 955 1002 986 1056

July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June


19

10.1.3. Morbidity pattern 10.1.3.1. Adult OPD in the Hospital Malaria, Respiratory tract infections and helminthiasis are the leading causes of illness seen in the adult OPD, accounting for up to 56.5% of all the major diseases treated as out patients.

Malaria alone accounted for 27% of OPD attendance. HIV/AIDS and Hypertension combined accounted for 10% of all OPD attendance; both these conditions are chronic in nature and require patients to be followed up frequently for life. ��

Table 7: Leading causes of morbidity in adults attending OPD, FY 2006/07

Number Disease Total number Percentage

1 Malaria 27,600 24.5% 2 Helminthiasis 13,530 12.0% 3 Upper Respiratory Tract Infections 11,388 10.1% 4 Pneumonia 11,145 9.9% 5 Injuries 11,055 9.8% 6 AIDS 7,038 6.2% 7 Diarrhoea 6,597 5.8% 8 Complications of Pregnancies 6,390 5.6% 9 Urinary Tract Infections 6,045 5.4%

10 Skin Infections 4,557 4.0% 11 Hypertension 3,255 2.9% 12 Tuberculosis 2,457 2.2% 13 Dysentery 1,464 1.3%

TOTAL 112,521 100% �

Fig. 6: Leading causes of morbidity among patients in Adult OPD, FY 2006/07

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Mal

aria

Hel

min

tiasi

s

ARI

Pneu

mon

ia

Inju

ries

AID

SC

omp.

pre

gn

Dia

rrhoe

a

UTI

Skin

Inf

Hyp

erte

nsio

n

TB

Dys

entry

Num

ber o

f cas

es

�


20

10.1.3.2. Young Child Clinic in the Hospital Malaria and Respiratory Tract Infections including Pneumonia accounted for 75.4% of the major causes of illness treated in the YCC. Malaria alone accounted for 44.9% of all the cases. Diarrhoeal diseases, skin diseases, intestinal worms as well as anaemia combined accounted for 15% of all the major conditions treated in YCC. Malnutrition accounted for 1.4% of the major cases seen, while HIV/AIDS contributed to 0.4% of children seen in YCC. The major causes of morbidity in children as seen in the YCC are largely preventable through improvement of general living conditions of the populace in the community. Community based health care services would probably go a long way in reducing the incidences of these conditions.

Table 8: Morbidity Pattern YCC.

Order Diagnosis Number Percentages

1 Malaria 30,930 45.0 2 Upper Respiratory infections 13,015 18.9 3 Pneumonia 7,988 11.7 4 Diarrhoea 4,211 6.2 5 Skin diseases 2,699 3.9 6 Intestinal worms 1,810 2.6 7 Anaemia 1,626 2.3 8 Injuries 1,597 2.3 9 Ear infections 1,124 1.6

10 Malnutrition 957 1.5 11 Dysentery 881 1.3 12 Eye infections 745 1.0 13 UTI 527 0.7 14 TB 324 0.5 15 AIDS 314 0.4 16 Meningitis 75 0.1

TOTAL 68,823 100

Fig. 7: Leading causes of morbidity among children under Five years seen in YCC, FY 2006/07

0

5000

10000

15000

20000

25000

30000

35000

40000

Mal

aria

ARI

Pnue

mon

iaD

iarrh

oea

Skin

dis

ease

Hel

min

tiasi

sAn

aem

iaIn

jurie

sEa

r dis

ease

Mal

nutri

tion

Dys

entry

Eye

dise

ase

UTI TB

AID

SM

enin

gitis

Num

ber o

f cas

es


21

10.2. Inpatients Services 10.2.1. Bed Capacity The hospital bed capacity remains at 476 in the main hospital and 24 beds in each of the three health centres. The total bed capacity of the hospital complex is therefore 548.

Patients with severe medical and surgical conditions are admitted and treated as inpatient both in the three peripheral health centres and in the Hospital. Patients that require specialist treatment are referred to the hospital from the health centres through the hospital ambulance services.

10.2.2. Admissions in the Hospital and in the Health Centres The total number of admissions in the hospital and the health centres this year was 37,371, compared to 34,947 FY 2005/06, making an increase of 6.5% this year.

About 72% of all these admissions are children less than 6 years and mothers with reproductive health problems, children alone accounting for over 55% of the admissions. This means that over 70% of all the patients treated as in patients are children and mothers who are the most vulnerable group in the community.

It is therefore in compliance with the mission of the hospital which targets the most vulnerable people in the society.

Fig. 8; Admissions by group of patients.

Children < 6 yrs, 55%

Others, 28%

Maternity, 17%

10.2.3. Trends of Admissions The number of patients treated as inpatients continue to increase over the years reaching the highest number of 37,371 this year. More and more complicated disease conditions are being seen at the hospital, many of them coming as referral from other hospitals and units. This increase was dramatic after the Ebola out break of 2000/2001��


22

The reputation gained during the fight against the Ebola has made the hospital a ray of hope for all patients with life threatening conditions in the region and beyond.

The quality measure established in the hospital after the Ebola outbreak has also improved the overall hospital quality performance thus attracting more and more patients.

Fig. 9: Trends of Admissions (Hospital and Health Centres)

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

10.2.4. Daily Rate of Admissions A total of at least 100 patients are admitted to the hospital every day on average. Majority of these admissions are children below six years of age.

10.2.5. Admissions in the Health Centres A total of 10,178 patients were admitted to the three health centres of Opit, Pabbo and Amuru. This accounted for about 27.3% of all the admissions.

As more and more of the population in the region return to their rural home villages, the health centres will be best placed to handle more and more conditions that can be treated at that level.

Strengthening the health centres would possibly decongest the hospital as services will be taken nearer to the rural population therefore improving access to the services.

��

��


23

Fig. 10: Proportion of Admissions in Health Centres

Lacor Hospital, 73%

Pabo, 8%

Opit, 10%

Amuru, 9%

Fig. 11: Hospital Inpatient monthly admissions in the FY 2006/07

0

200

400

600

800

1000

1200

1400

1600

1800

2000

Num

ber o

f Cas

es

PAEDIATRICS 1645 1215 1085 1270 1285 1339 1404 1001 1026 1245 1743 1464

MATERNITY 288 265 312 321 281 277 311 292 330 292 308 304

MEDICINE 446 470 400 424 449 447 387 344 353 365 380 353

SURGERY 285 287 289 234 235 208 309 311 289 243 300 257

July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June

�

10.2.6. Leading Causes of Admission in the Hospital

As shown in the figure below, malaria is the commonest cause of admission among patients less than 6 years; followed by pneumonia, diarrhoea, anaemia, malnutrition and Septicaemia.

Deliveries, Malaria, AIDS and Injuries are the commonest causes of admissions in patients more then six years of age.

�


24

Fig. 12: Leading causes of admission of children < 5 yrs in the Hospital, FY 2006/07

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

Malaria

Pneumonia

Diarrhoea RTI

Anaemia

Malnutrition

SepticaemiaInjuries

AIDS

Skin sepsis

Dysentery

Meningitis

Num

ber o

f adm

issi

ons

Fig. 13: Leading causes of admission of patients > 5 yrs in the Hospital: FY 2006/07

0

200

400

600

800

1000

1200

1400

1600

1800

2000

DeliveriesMalaria

AIDSInjuries

Comp. pregn TB

Pneumonia

Anaemia

Hypertension

Diarrhoea

Liver dise

Cardiac dise

Diabetes

Num

ber

of c

ases

10.2.7. Inpatient Mortality in the Hospital Mortality rates in the hospital have remained fairly stable in the hospital for the last five years ranging between 4% and 5%. This is in spite of the increasing numbers of patients being treated in the wards.

The increasing complexity of the disease conditions and the bigger number of referral of critical cases from other hospitals might have contributed to the slight increase of mortality rates particularly in the Medical and the surgical wards.


25

Table 9: Summary of Hospital mortality by ward FY 2002/03 –2006/07

2002/03 2003/04 2004/05 2005/06 2006/07 Last 5 years Medicine ward (General Med and TB) Admissions 4,960 5,018 4,818 4,358 4,041 23,195 Total deaths 367 472 586 556 537 2,518 Mortality rate 7.40% 9.41% 12.16% 12.76% 13.28% 10.85% Paediatric ward (Children ward, Nutrition & Isolation) Admissions 18,371 18,361 17,226 16,215 14,437 84,610 Total deaths 773 609 688 665 664 3,399 Mortality rate 4.21% 3.32% 3.99% 4.10% 4.59% 4.00% Surgical ward (Surgery I & II plus ICU) Admissions 2,935 3,208 3,247 3,413 4,232 17,035 Total deaths 119 110 98 117 172 616 Mortality rate 4.05% 3.43% 3.02% 3.43% 4.06% 3.6% Maternity ward (Obstetric and Gynaecology) Admissions 2,659 3,231 3,581 3,963 4,483 17,917 Total deaths 19 24 16 25 12 86 Mortality rate 0.71% 0.74% 0.45% 0.63% 0.26% 0.47% All wards Admissions 28,925 29,818 28,872 27,949 27,193 142,757 Total deaths 1,278 1,215 1,388 1,363 1,384 6,628 Mortality rate 4.42% 4.07% 4.81% 4.88% 5.08% 4.64%

10.2.8. Leading Causes of Death in the Hospital �

As seen from the table below Malaria, Pneumonia, Malnutrition and Anaemia are the most common cause of death in the children ward. They are also the leading causes of admission in the children ward. Septicaemia, Diarrhoea, AIDS, Meningitis, and Tuberculosis as well as Acute Respiratory Tract Infection are the other leading causes of deaths. While HIV/AIDS, Pneumonia, and Tuberculosis as well as Meningitis is the leading causes of deaths in the medical wards.

Table 10: Leading causes of deaths in children ward FY 2006/07

Disease condition No of Deaths

%

1- Malaria 219 22.0% 2- Pneumonia 200 20.1% 3- Malnutrition 169 17.0% 4- Anaemia 138 13.8% 5- Septicaemia 81 8.1% 6- Diarrhoea 63 6.3%

Disease condition No of Deaths

%

7- AIDS 52 5.2% 8- Meningitis 34 3.4% 9- Tuberculosis 25 2.5% 10-Respiratory Tract Infections

13 1.3%

TOTAL 994 100

�


26

Fig. 14: Leading causes of deaths in children ward

Leading causes of Deaths in children ward

0

50

100

150

200

250

Malaria Pneumonia Malnutrition Anaemia Septicaemia Diarrhoea AIDS Meningitis TB RTI

Disease condition

No.

of D

eath

s

� Fig. 15: Leading causes of Deaths in Medical ward �

Leading causes of Deaths in Medical ward

0

50

100

150

200

250

AIDS Pneumonia TB Menigitis Anaemia Diarrhoea CVD Malaria Liver dise RTI

Disease conditions

No.

of D

eath

s

��4)��


27

Table 11: Leading causes of deaths in Medical ward.

Disease condition No of Deaths % AIDS 202 38.0% Pneumonia 83 15.6% Tuberculosis 57 10.7% Meningitis 40 7.5% Anaemia 35 6.6% Diarrhoea 30 5.6% Cardiovascular diseases 30 5.6% Malaria 29 5.4% Liver diseases 14 2.6% Hepatitis 11 2.0% TOTAL 531 100% 10.2.9. Case Fatality Rate in the Hospital In Children wards disease/conditions with highest Case Fatality Rates are Pyogenic Meningitis, 41.9%, HIV/AIDS, 21.4%, Malnutrition, 15.7%. While those with moderate case fatality rates are Anaemia, 9.6%, Septicaemia, 8.1%, and TB, 7.8%.

Malaria, Diarrhoea and Acute Respiratory Tract Infections have the lowest Case Fatalities of 2.9%, 2.2% and 0.5% respectively.

The main reason for the high case fatality rates for Meningitis, HIV/AIDS and Malnutrition is due to late presentation to the hospital, often in moribund states or with advanced complications.

Disease conditions with the highest case fatality rates in Adults are Cardiac disease, 17.1%, HIV/AIDS, 16.8%, Pneumonia, 15.6%, Diarrhoea 12.3% and TB, 10.3%.

Conditions with low case fatality rates are Hypertension, 0.2%, Malaria, 4.9% and Diabetes, 6.2%. Those dying from Pneumonia, Diarrhoea as well as TB may have underlying HIV infections though not all of them are usually tested for HIV.

� �

Table 11: Case Fatality Rates of leading causes of admission in the children wards, FY 2006/07

Disease condition No. of Admissions No. of Deaths Fatality Rates Malaria 7,479 219 2.9% Pneumonia 3,258 200 6.1% Malnutrition 1,073 169 15.7% Anaemia 1,432 138 9.6% Septicaemia 995 81 8.1% Diarrhoea 2,804 63 2.2% AIDS 242 52 21.4% Meningitis 81 34 41.9% Tuberculosis 320 25 7.8% Respiratory Tract Infections 2,258 13 0.5% �


28

Table 12: Case Fatality Rates for leading causes of admissions to Medical ward

Disease condition

No. of Admiss

ions

No of Deaths

Fatality Rate

AIDS 1,196 202 16.8% Malaria 586 29 4.9% TB 556 57 10.2% Pneumonia 528 83 15.7% Anaemia 360 35 9.7%

Disease condition

No. of Admiss

ions

No of Deaths

Fatality Rate

Hypertension 278 7 0.2% Liver disease 260 25 9.6% Diarrhoea 242 30 12.3% Cardiac disease 175 30 17.1% Diabetes 113 7 6.2%

Fig. 16: Recovery Rates among children (<5 yrs) associated with the 12 leading causes of

admission in the Hospital Paediatric wards, FY 2006/07

Fig. 17: Recovery Rates associated with the leading causes of adult admissions in the Hospital, FY 2006/007

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Sur

viva

l Rat

e pe

r 100

cas

es a

dmitt

ed

Survival rates 99.97 98.40 91.40 93.70 82.40 97.90 95.70 98.90 97.10 91.80 99.60 95.70 96.10 94.50 71.60

Deliveries

Malaria

TBPneumonia

AIDSInjurie

sDiarrhoea

Hypertension

Anaemia

BSISkin

sepsisAnaemia

Cardiac d'se

Diabetes

Bact. Meningitis

Data analysed is for 7660 diagnosis, which were indicated on patients’ charts.

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Rec

over

y R

ate

per 1

00 c

ases

Survival rate 97.60% 93.20% 95.20% 91.60% 92.00% 89.90% 99.70% 95.40% 98.80% 89.90% 73.10% 84.70%

MalariaPneumo

niaDiarrhoe

aAnaemia BSI

Malnutrition

Skin sepsis

Dysentery

UTI TBMeningiti

sAIDS


29

10.2.10. Hospital Average Length of Stay (ALOS) and Bed Occupancy Rate (BOR) The Average Length of Stay in the hospital (without health centres) in FY 2006/07 was 8.09 days, with a Bed occupancy rate of 125.63%. The average length of stay varies by ward, with maternity having the lowest ALSO of 5.27 days and surgery with the highest ALSO of 13.0 days. This is because of the different case mixes treated in the various wards. War trauma and other trauma related conditions treated in the surgical wards tend to take longer to recuperate in the hospital. While most of the cases treated in the maternity ward tend to recover more quickly.

Table 13: Hospital Average Length of stay and Bed Occupancy Rates FY 2006/07

Ward Bed Capacity Admissions Bed State ALOS BOR Paediatrics 166 14,437 104,057 7.21 170.34% Medicine 115 4,041 37,527 9.29 88.67% Surgery 134 4,232 54,884 12.97 111.30% Maternity 61 4,483 23,603 5.27 195.15% Total 476 27,193 220,071 8.09 125.63% ��

10.3. Operation Theatre There are currently six operation rooms which remain open 24 hours for emergency operations. Elective planned operations are carried out from Mondays to Fridays from 8:30 am to 5:00 pm. Major kind of surgery carried out are general surgery, obstetrics and gynaecology surgery, orthopaedic surgery, urology surgery, oral/dental surgery, reconstructive surgery including VVF surgery and plastic surgery. The number of major surgery has continued to increase yearly for the last years as seen in the graph below. In FY 2006/07 there was a 31% increase in the number of major operations FY 2006/07 from 3,972 last year to 5,212 this year.

Fig.18: Trends of major surgical operations

0

1,000

2,000

3,000

4,000

5,000

6,000

2000-2001 2001-2002 2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

��


30

10.4. Maternity Services The total number of deliveries in the hospital and the heath centres increased from 2,913 last year to 3,591 this year, up by 578 (19.8%) from last year. It has more than doubled in the last five years. This is due partly to the abolition of user fees for all delivery services, and due to improvement in the maternity services both in the hospital as well as in the health centres. Maternal Mortality Ratio dropped from 530 last year to 334 this year, a 36% reduction. Delays in reaching the hospital are still a major factor in the high Maternal Mortality Ratio. Caesarean section rates have remained stable at 10% for the last four years. Still Birth Rates have also dropped from 38.4 last year to 22.0 this year, a 44% reduction.

Table 14: Maternity services FY 2006/07 Type of service 02/03 03/04 04/05 05/06 06/07 No. of deliveries (Hospital & HC) 1,625 2,150 2,534 2,913 3,591 Deliveries HC 323 401 626 730 1,063 No. of Caesarean Sections 249 221 280 283 382 Caesarean Section Rates 15% 10% 11% 10% 10% No. of Maternal Deaths 12 13 12 21 12 Maternal Mortality Ratio/100,000 Live births 813 618 513 530 334 No. of Live births 1,598 2,104 2,536 2,854 3,538 No. of Still births 66 89 56 112 78 Still Birth Ratio/1000 Live births 41.4 42.3 22.0 38.4 22.0

Fig. 19: Trends in Maternal Mortality Ratio and Still Birth Ratio

0

100

200

300

400

500

600

700

800

900

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

Maternal Mortality Ratio Still Birth Ratio

The hospital Maternal Mortality Rates has continued to decline in the last five years from 813/100,000 Live Births in 2002/03 to 334/100,000 Live Births this year. The improvement is attributed to the general improvement in the obstetric care in the district as well as the improvement in the referral system, both by Government heath units and NGO-run heath units making patients to reach the hospital more timely to receive more timely interventions.


31

10.5. HIV/AIDS Care Services The Hospital has a very busy AIDS clinic, which operates daily from Monday to Saturday. Started in 1993, the clinic now offers comprehensive care to HIV infected patients who seek care from Lacor hospital. The package of care includes Voluntary Counselling and Testing (VCT) for HIV; treatment of opportunistic infections; provision of ART with routine clinical, laboratory and community follow up. Community follow up is done by Comboni Samaritans – another faith based NGO with vast experience in home-based AIDS care. Lacor-Comboni partnership ensures good adherence to antiretroviral therapy.

To date, over 10,000 patients have ever enrolled in Lacor AIDS clinic and about 6,000 are still being actively attended to in the clinic with 1802 patients on antiretroviral therapy, of which 173 are children below six years. Most of the patients receiving ARVs from Lacor are provided free services under AIDS Relief programme funded by PEPFAR. Lacor also offers PMTCT services (in 2006/07 to 309 mothers). The number of patients being treated in the AIDS clinic has continued to increase since the introduction of ARV under the AIDS Relief programme. On average a total of 80 patients are treated in the AIDS clinic on a daily basis.

Lacor Hospital is one of the government-designated 21 national sentinel surveillance sites for monitoring trends of HIV/AIDS epidemic in Uganda. HIV prevalence trends are monitored based on testing all pregnant mothers attending ANC for the first time. The prevalence at Lacor Hospital sentinel for the year is 10.99%

10.6. Dental Treatments There were 7705 dental treatments FY 2006/07. These included conservative dentistry as well as other emergency dental treatment. This figure is up by 23% from a total of 6248 dental treatment of FY 2005/06.

Fig. 21: Trends in Dental Treatments

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007


32

10.7. Laboratory Services The number of laboratory examinations continued to increase with the general increase in the number of patients treated in the hospital. There was a 4% increase of laboratory examinations from 217,197 in FY 2005/06 to 226,129 FY 2006/07.

The general increase in the case mix and referral requires more laboratory tests. The increasing number of patients receiving treatment for HIV/AIDS also demands more laboratory examinations.

Fig. 22; Trends of laboratory examinations.

170,000

180,000

190,000

200,000

210,000

220,000

230,000

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

10.8. Blood Transfusion Services A total of 4,957 units of blood were consumed in the hospital FY 2006/07 compared to 5,591 units consumed FY 2005/06. About 400 units of blood are consumed monthly in the hospital, about 15 blood transfusions daily. The month of May continues to be the month requiring the highest number of blood transfusions. This is also the season with the highest number of malaria cases especially in children in the region.

Fig. 23; Monthly blood consumption

3,000

4,000

5,000

6,000

7,000

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007


33

10.9. Radiological Examinations A total of 42,034 radiological examinations were carried out in FY 2006/07 compared to 41,991 in FY 2005/06.

There has been a general increase in the numbers of radiological examinations in the last five years the highest numbers of examinations was in 2004/05.

Fig. 24: Trends of Radiological Examinations

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

2002-2003 2003-2004 2004-2005 2005-2006 2006-2007

�

10.10. Community Health Care Services 10.10.1. Health Centres These services are delivered through the three health centres III located at Pabo, Opit and Amuru.

They are located near the major Internally Displaced Peoples Camps of Gulu and Amuru districts, and have contributed enormously to the health of the people in these camps over these years, sometimes being the only functional units in these areas.

About 30% of Lacor Hospital services delivery in FY 2006/07 was through these health centres.

This is due to increase further with the hospital strategy to decentralize services closer to the community through strengthening the services at the health centres.

With the spirit of increasing access to service to the most vulnerable, Lacor Hospital has since year 2004, scrapped off in the health centres all user fees for pregnant mothers and children below 6 years.

This has led to increase utilisation of services by this group of patients since then.


34

10.10.2. Outreach Activities The hospital also delivers its community health care services through out reach activities in the designated service delivery areas of Bardege and Layibi divisions in Gulu Municipality.

These activities include immunisation, heath education, school heath programmes and participation in mass vaccination campaigns among others.

10.10.3. Ambulance Services The hospital offers free ambulance services in the three health centres for transfer of critically ill and patients who require emergency treatments at the hospital. Ambulance service is also given to government health centres (like Keyo and Parabongo) along the routes serving Lacor Hospital’s health centres

Ambulance services are also provided for emergency situations to bring patients from the community around the Gulu town to the hospital.

There were a total of 188 Ambulance trips for referral from the three health centres to the hospital FY 2006/07.

10.10.4. Epidemic Preparedness & Response Lacor Hospital continues to play crucial roles in detection and control of disease epidemics. Lacor Hospital has functional and active epidemic detection and rapid response systems. Because of Lacor Hospital’s large service area covering most parts of northern Uganda, with over 500 outpatient contacts daily, the Hospital is in ideal position to detect disease epidemics promptly.

The hospital’s epidemic preparedness plan involves daily routine surveillance for epidemic-prone and ‘strange’ diseases in all the departments, including the laboratories. Suspicious cases are immediately isolated in a special Isolation ward for further investigation.

Note that in October 2000, Lacor Hospital detected the outbreak of a ‘strange’ disease that turned out to be the largest Ebola epidemic in the world. Although the Hospital paid a high price in controlling the Ebola outbreak by loosing 12 of its experienced staff members, the epidemic prevention, detection and response mechanisms have been greatly strengthened after the outbreak. Special isolation facilities have been established in the hospital.

10.10.5. Primary Health Care Activities Lacor Hospital offers PHC activities within the Hospital, in the Health Centres and in the two designated sub-counties of Layibi and Bardege. The services provided include routine immunisation under UNEPI, follow-up of TB patients on therapy, school health and health education to the community.

10.10.5.1. Immunisation activities During FY 2006/07 Lacor Hospital continued to carry out immunisation in its static and mobile centres. The table below is a summary of output in terms of vaccines administered.


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Table 15: Immunisation activities ��

ANTIGEN 2002/03 2003/04 2004/05 2005/06 2006/07 BCG 6,129 3,571 4,413 5,919 3,916 POLIO 17,238 10,479 13,415 17,055 17,968 DPT 14,403 8,182 10,005 13,030 6,799 MEASLES 7,942 3,532 3,323 3,875 9,364 TETANUS TOXOID 9,000 5,956 7,389 10,985 5,343

TOTAL 54,712 31,720 38,545 50,864 43,390

The above data includes the routine UNEPI vaccination outputs, the NIDS and the child days vaccination campaigns.

10.10.5.2. Community Based Health Care (CBHC) Lacor CBHC project provides services in 30 parishes covering various areas of Gulu district. The services offered include TBA training and supervision, health education to the communities, training of village health workers, provision of delivery kits, facilitation of village health workers and TBAs (provision of bicycles, and free medical care to the workers and mothers they refer to the Hospital). In total Lacor CBHC project has trained 719 TBAs,. 568 of the trained TBAs are still active and being supported by Lacor. Due to the large area covered by the project, close monitoring of CBHC activities is a challenge. In the next financial year, CBHC activities may have to be restricted to fewer parishes for proper follow up.

11. Training

The Hospital has continued with training programmes for Intern doctors, Nurses, and Lab. Assistants. Some post-graduate students, mainly from Italian Universities, have done their electives/research projects in the Hospital during the year.

11.1. Gulu University Teaching Site Lacor Hospital in FY 2003/4 became an official University Teaching Site for Gulu University Faculty of Medicine. A Memorandum of Understanding was then signed with Gulu University and renewed this year spelling areas of cooperation in terms of infrastructure, services and technical needs. Specialist doctors from Lacor Hospital are absorbed into the teaching staff and are given the status of honorary lecturers in their various specialisations. They are also members of Gulu University Medical Faculty Board, which plans the operations of the faculty. Lacor medical superintendent is designated as the Honorary Faculty Dean and is responsible for coordinating the university activities within Lacor Hospital.

From the 3rd year medical students get most of their training at bedside. The students are organised in two shifts for about 30 students and all of them rotate through Gulu Regional Referral Hospital and Lacor Hospital were they are divided in smaller groups for coaching in the in the various departments.


36

11.2. Lacor Nurse Training School and School of Laboratory Assistants In 2003, Lacor Nurse Training School adopted the National Policy of training Enrolled Comprehensive Nurses (ECN) instead of the traditional Enrolled Nurses. The last set of traditional Enrolled Nurses completed their course in November 2004. The current programmes in LNTS are ECN and Uganda Registered Nursing Extension programmes.

Table 16: Students population as of 30th June 2007

Training Courses Male students Female students Total ECN 50 79 129 URN 15 55 70 Lab. Assistants 35 4 39 TOTAL 100 138 238 There has been a progressive increase in the number of students admitted yearly to the two training schools as shown in the table below. The total students population as of 30/06/2007 was 229. This increase in number of students has been due to the high demand for the training in the region and due to the infrastructural improvement leading to increased capacity in the schools.

Table 17: Trends of students intake population 2003 – 2007

Years/Course 2002/03 2003/04 2004/05 2005/06 2007 Total ECN 0 24 35 46 49 154 URN 28 7 28 32 38 133 Lab. Asst 14 0 15 14 20 63 TOTAL 42 31 78 92 107 350

Fig. 25: Yearly students’ intake years 2003 – 2007

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The laboratory assistants’ school in the FY 2005/06 has become residential following construction of more students’ dormitories. This has made it possible for students from districts far away from Lacor to study in the school. Support is needed to construct more classrooms and teaching laboratory for the school of laboratory.

11.3. Internship of Medical Doctors A total of 17 intern doctors did their internship in different disciplines in Lacor Hospital in FY 2006/07. By 30/06/2007, 11 of the intern doctors had completed their 6 or 12 months internship and 6 were still present. More interns have joined in the first quarter of the new fiscal year 2007/08.

11.4. In House Training (Continuing Professional Development) Continuing Professional Development activities have been incorporated into the Hospital routines. Doctors and other clinicians meet for one hour every Saturday from 8.30 - 9.30 a.m. for clinical presentations and to discuss administrative issues as well. The nursing staffs conduct clinical presentations every two weeks. Joint discussions are conducted for some crosscutting issues like epidemic control, drug utilisation etc. Copies of all presentations are kept in CME files for record and reference.

12. Human Resources Development

A number of doctors, nurses and other support staffs of Lacor Hospital have completed or are currently studying in various institutions under Lacor Hospital sponsorship scheme. On the 30/06/07 there were 30 of them sponsored by the Hospital, and 7 on leave without pay.

Table 18: Lacor sponsored staffs and the courses offered as per 30/06/07

Category Institution Course offered

Medical Officer Makerere University Master in Radiology

Medical Officer Dar Es Salaam Univ. Master in Orthopaedic Surgery

Medical Officer Makerere University Master in Obstetrics/Gynaecology

Medical Officer Makerere University Master in Surgery

Medical Officer Makerere University Master in Paediatrics

Medical Officer Makerere University Master in Medicine

15 Enrolled nurses / 1 Midwife

Lacor Nurse training school, Nsambya(1) Uganda Registered Nursing / Midwifery

4 Admin. Staff Gulu University Bachelor in business administration, 1 Master in Business administration.

2 Lab. Assistants Jinja School of Lab. Tech. Lab technicians course (certificate)

Registered Midwife Lacor nursing School Uganda Registered Nurse

Laboratory Technician Kenya Laboratory Technologist

Total 30 on Hospital sponsorship


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The hospital continues to be mindful of career development and continuing professional development of its employees and will continue to sponsor more staff in the different priority areas in the next financial year in order to maintain quality services.

13. Strategic Plan

Lacor Hospital has recognised the achievements and the challenges of the previous years and has used this experience to develop a strategy for the long term planning and sustainability.

Routine analysis of trends of inputs, processes and outputs/outcomes will continue to provide the basis for projections on which strategic planning is based.

The Lacor Hospital’s strategic plan runs from this year, 2007 to the year 2012. The need to invest on the Human resource development is certainly still high on the agenda. This is meant to develop competence so as to maintain and promote the culture/identity of Lacor Hospital so far responsible for the existence of Lacor amidst all odds.

There is deliberate intent and effort towards sustainability, decentralisation of services nearer to the community through strengthening of services at the three health centres, capacity utilisation and quality control and less on expansionism. At the same time more participation and coordination from key stakeholders are considered an important factor (note the role of Lacor Hospital on research and educational services with the other universities including now Gulu University having a teaching site in the Hospital).


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Annexe 1 – The Vision��

St. Mary’s hospital Lacor has the vision of being a general hospital serving the population of northern Uganda. It will offer: • the highest standards of affordable and quality in-patient and out-patient care,

provided with humanity, in the field of medicine, general surgery, paediatrics and maternity that respond to the health needs of the population and which complement the services of other health care providers in northern Uganda

• a limited number of specialised services for which it will strive to become a centre of

excellence, that correspond to the priority needs of the population and that build on existing competency and comparative advantage

• primary health care and outreach services through its existing network of health

centres as well, as the work of the hospital in Layibi and Bardege, in line with the minimum health care package recommended by MoH in the HSSP II

• training and teaching facilities for student doctors, nurses and laboratory assistants

that contribute to the implementation of the Government’s (forthcoming) national strategy for human resources development for health, and to the development of Gulu University’s medical faculty

• opportunities for research that can contribute to more effective functioning of the

hospital, to new knowledge on tropical disease and health care provision, and to the further advancement of staff knowledge and expertise.

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Annexe 2 – The Mission

The Mission of the Hospital is to provide health care to the needy and to fight diseases and poverty, thus witnessing the maternal concern of the Church for every sick person regardless of ethnic origin, social status, religious or political affiliation. The Hospital wants to promote the access to health care of the weakest social groups, like women, children, people in destitute financial conditions, and people affected by chronic diseases who are unable to provide for themselves offering to all of them a quality medical service. The Hospital advocates a comprehensive, integrated and sustainable action on health, which includes treatment, prevention and training of health workers. In fulfilling its mandate, the Hospital shall always follow the medical ethics and the moral teaching of the Roman Catholic Church and shall follow the Mission Statement and Policy of the Catholic Health Services in Uganda, as approved by the Bishops’ Conference in June 1999. The Hospital will deliver its services in accordance with the stated Policies and directives of the Ministry of Health. The Hospital management and all employees shall adhere to the principles of the Mission Statement of the Hospital and, since the person is at the centre of all activities of Lacor Hospital, a basic attitude of respect for human dignity and of compassion for the sick and needy shall be the guideline for all.

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Annexe 3 - Strategic Plan 2007-2012 �

Overall Objective

To improve the health and welfare of the population of northern Uganda by being the driver of quality health care provision and socio-economic development in the region

Strategic Objectives The strategic objective is divided into two main groups i.e. Service delivery and capacity building objectives:

Service Delivery Objectives SD 1: Consolidate core areas of in-patient, out-patient and PHC service delivery

SD 2: Bring hospital services closer to the community by decentralizing service

delivery to the health centres

SD 3: Consolidate, expand or introduce a select number of specialized services

SD 4: Reinforce the hospital’s learning and teaching role

Capacity Building Objectives CB 1: Re-orient hospital activities across-the board towards quality of service

and humanity of care

CB 2: Secure and retain a sufficient numbers of qualified, satisfied and committed personnel

CB 3: Enhance the hospital’s knowledge management and communications capacity

CB 4: Secure hospital funding at a sustainable level


42

Annexe 4 - Members of the Board of Directors, the Executive Committee and the Hospital Management Team

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Annexe 6 – Lacor Hospital Organogram

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Documents

2 Final Annual Report 06-07 - Lacor Hospital