Mission Statement

As a Catholic Organisation, the Saint John of God Catholic Health Services springs from the Christian values and the holistic approach practiced by its founder Saint John of God. Its mis- sion is to evangelise through the provision of accessible, affordable, efficient, and acceptable quality health-related services to all people in Sierra Leone irrespective of race, tribe, religion, or nationality

Vision

St. John of God Catholic Health Services wants to be recognised as leader in the provision and main- tenance of excellent and quality health-related services that are acceptable, affordable and efficient to all our clients. Core Values

Hospitality As a hospital we believe that the life of the patient is the immediate consideration in care delivery and that no patient’s life should be lost as a result of any fringe considerations.

Quality Our aim is to ensure that the hospital will deliver quality patient care by balancing patient expecta- tions, patient needs, and resources that are available to the hospital.

Respect Respect for human dignity, the sick, and the aged is highly valued by the hospital. We believe the pa- tient has the right to expect that his human person shall be respected and high sense of professionalism will be displayed by care givers.V

Justice Every patient shall be treated in a fair manner with equal rights and responsibilities. No patient shall be denied medical care on the basis of race, colour, religious beliefs, ethnicity, and/or sexual orienta- tion

Excellence Being a center of excellence in hospitality, professionalism, care delivery and general attitude of staff is a core value of the hospital.

Spirituality We value spiritual healing as much as clinical healing. We believe that types of care are important for healing of every patient and it is our aim to deliver quality spiritual and emotional care to patients

I Table Of Contents

Introduction 1

Organizational Stracture 1 Board Members & Officers 2017 2 Management Team 2017 2 Legal & Banking 2017 3 Donors & Partners 4

Chief Executive’s Review 5

Governance & Administration 7 Centers & Services 8 The Golden Jubilee Anniversary: Fifty Years of Hospitality Services 10

Department Reports 13 Human Resource 13 Financial Administration 16 Internal Audit 18 Medical Administration 19 Nursing Administration 27 Information & Communication 29 Pastoral Care & Bioethics 30 General Services 32 Capital Projects and Developments 34

Activity Report 36

Lungi Health Center Report 38

Nursing School Report 40

Appendix 43 Hospital Activity Data - 2017 43

II //// Annual Report 2017

Introduction

Organizational Structure

Chistian Health Provincial Superior Distric Medical Officer Association of Sierra leone St. Augustine Province Of Africa

CEO/MAB Chairman Partners Brothers Community Sierra Leone

Communication Project Manager Procurement & Information Stores

Executive Secretary Health Service Administrator

SJOG Hospital SJOG Comm. Health mabesseneh Center Lungi

Internal Financial Medical Nursing Auditor Administrator Director Director Financial Officer Doctors OPD Account clerk Clinicl officers Pediatrc ward Cashiers Pharmacy Adult ward Estate & Records X-Ray Martenity ward Transport Store keeper Laboratory Anesthetists Dentistry Triage Emergency Theater Statistic Dressing Officer IPC PHC

St. John of God Catholic Health Services 1 /// Annual Report 2017

Board Members & Officers 2017 Br. Michael Musa Koroma, Chairman/Chief Exec- Health center utive Officer • Bro. Ignace Aloula, Clinic Supervisor Br. Nestor Bamboye, Local Superior • Ms.Kadiatu Mansary, Nursing Supervisor Br. Augustine K. Mansaray, Estate, Transport & • Mr. Alfred A. Lahai, Medical Supervisor Maintenance Officer

• Br. Patrick Njungbung, Medical Coordinator Nursing school • Br. Francis Kabia, Nursing School Administra- • Br. Michael M. Koroma, Principal tor • Br. Francis Kabia, Administrator • Br. Thomas Antwi, Member • Ms. Beatrice Bangalie, SECHN Programme • Lawyer Stephen Y. Mansaray, Legal Consultant Coordinator • Mr.Abdul Deen, Labour Consultant • Mr. Gibril S. Conteh, SRN Programme Coor- • Madam Isha Daramy Kabia, Midwife Consul- dinator tant • Mr. Joshua Sandy, Communication Officer • Mr.UsmanThoronka, Project Officer • Ms.Fatmata Mansaray, Procurement Officer

Management Team 2017

Hospital • Bro. Michael Musa Koroma, Chief Executive Officer • Mr. Eugene Osei-Wusu, Health Service Ad- ministrator • Bro. Patrick Njungbung, Medical Coordinator • Ms.Fatmata Mansaray, Executive Secretary • Ms.Aminata Bobor Bangura, Financial Ad- ministrator • Ms.Jerikatu Bangura, Acting Nursing Admin- istrator • Bro. Nestor Banboye, Local Superior of Broth- ers’ Community

St. John of God Catholic Health Services 2 //// Annual Report 2017

Legal and Banking 2017 Bankers Standard Charted Bank lightfoot-Boston Street Freetown, Sierra Leone

Marampa Masimira Community Bank Siaka Stevens Street Lunsar, Sierra Leone

Eco Bank Sierra Leone Lightfoot-Boston Street Freetown, Sierra Leone

Union Trust Bank, Ltd Lunsar Branch

Peter Kamaray & Co. Auditors Chartered Accountants Free Town, Sierra Leone

Legal Advisors Lawyer Stephen Y. Mansaray Legal Practioner Freetown, Sierra Leon

Mr. Abdul Deen labour Advisors Labour Consultant Makeni, Sierra Leone

St. John of God Catholic Health Services 3 /// Annual Report 2017

Donors and Patners • Grupo Solidaridad con el Tercer We are grateful to our donor community, and partners • Mundo (Tavernes de la Valdigna) whose endless contributions form a great part of our • Italian Episcopal Conference health service delivery. • Ayuntamiento de Tavernes de la Valdigna • Asociación Zer07 – Fondo de Trabajadores • General Curia Rome, (Italy). del Gobierno Vasco • Provincial Curia Accra, (Ghana) St. John of • Obra Social “laCaixa” God Development Company, Western Euro- • Ministry of Health and Sanitation, Sierra pean Province (Ireland) Leone • Aragón Province (Spain) • HospitaalBroeders, Netherlands • Betica Province (Spain) • GLOBAL LAB, (Germany) • Juan Ciudad, ONGD (Spain) • Fundación PROBITAS, (Spain) • International Cooperation Office of the Hos- • Apostolic Administrator, Diocese of Make- pitaller Order, Rome (Italy) ni, Sierra Leone. • Twinning programme-Hospital Sant Joan de • Christian Health Association, Sierra Leone Déu (Barcelona, Spain) • Port Loko District Health Management • St. Joseph Fathers (Murialdo), Lunsar Team • Orthopaedic –fur-die-dritte-Welt (ODW) • Caritas Makeni Diocese Germany • Caritas Freetown Diocese • Obra Social Sant Joan de Déu Barcelona • Doctors with Africa (CUAMM) (Spain) • MANOS UNIDAS, Spain • Africa Viva Fundacion • CNMO, Mrs. Hossinatu M. Koroma, • Fundacion Ordesa MoHS • Fundacion Roviralta • Br. Joseph Zacharia Fundation, USA • Villa Reyes (Spain) • Rev. Brother Joseph & Benjamin Charities • Fundacion Española de Pediatria • Ayuntamiento de Murcia • Ayuntamiento de Pamplona

St. John of God Catholic Health Services 4 //// Annual Report 2017

Chief Executive’s Review Br. Michael M. Koroma - CEO

2017 was another year of continuous change and challenge for St. John of God Health Services. Throughout the year, I have been enormously impressed but not surprised by the level of commitment St. John of God Health Services have to providing the best possible care to our students, patients and their families.

Since my appointment as Chairman of the St. John of God Health Services Board in June 2014, I have begun to appreciate the scale and complexity of what it takes to run the largest acute rural services in the Province. I have been particularly impressed by the ‘can do’ attitude of staff coupled with their commitment to delivering the best possible service to patients and students. I would like to highlight certain developments in 2017 which perhaps best represent this attitude and commitment.

SERVICE PRESSURES During the course of 2017, the hospital made significant progress improving bed utilisation. In par- ticular, the reduction in the number of patients who were delayed discharge and the reduction in the number patients on trollies awaiting admission in our Emergency Department has enabled a signifi- cant improvement in elective admissions. The improvement in 2017 can be attributed to a combina- tion of factors: • The improved availability of medical officers • The medically-led initiatives regarding specialty visits by doctors from abroad • The improved replacement of medical equipment • The rigorous internal controls and severe expenditure cuts down All of these improvements have been achieved in the context of both increased attendance to, and a corresponding increase in admissions from our Emergency Department. In 2017, we also celebrated the golden jubilee anniversary of the arrival of the first missionaries of the Hospitaller Order of the Brothers of St. John of God. This celebration was very colourful with great remembrance and recognition of remarkable personalities who had contributed immensely to the growth of the mission in Sierra Leone. The celebration did provide the hospital doors to obtain gifts and donations. This included very significant building and refurbishment activities, replacement St. John of God Catholic Health Services 5 /// Annual Report 2017 of much obsolete equipment like the Radiology machine, Operation bed, Anesthetic machine, etc. The ‘can do’ attitude and commitment of staff made this possible whilst minimizing the impact on patient services.

CHALLENGES AND OPPORTUNITIES AHEAD While we have made progress on patients’ activities, we continue to have challenges around staffing, and reducing the operational cost deficit. One area of particular concern to me, the Board and Exec- utive management team, is the ongoing clinical equipment needs of the services and quality teaching and supervisory methods for the students. It is essential that staff and students have adequate and safe equipment to learn, diagnose, treat and care for our patients.

CONCLUSION I would like to thank my colleagues Brothers and staff on the Board and the Executive Management team and all the dedicated staff of St. John of God Catholic Hospital, St. John of God Catholic Com- munity Clinic and St. John of God Catholic School of Nursing and our beloved friends and generous benefactors for their support and advice, inspiring team spirit, their hard work over the year, and their continued efforts to deliver the best possible service to our patients and students.

I have no doubt that the years ahead will remain challenging as we continue to deal with a demand for quality services with high out of pocket expenditure by our clients which significantly outweighs our capacity to supply those services at a free cost. We will continue to focus on using the resources we do have to the best benefit of our clients and to advocating clearly for the resources required to meet the needs of clients who are not receiving timely access to our health and educational services.

On a personal note, I am grateful to have gained the opportunity to lead this remarkable and complex organisation. My 4 years has been a stimulating learning experience that has greatly increased my respect for the quality and commitment of those who work in the hospital, and education sector and relating with diverse partners both home and abroad.

Br. Michael M. Koroma Chairman/CEO

St. John of God Catholic Health Services 6 //// Annual Report 2017

Governance & Administration

In 2014, we developed a five year strategic plan aimed at achieving a number of strategic objectives for our services. The strategic plan which comes to an end in 2019 has been an extremely important gov- erning document in the past four years, with most of the strategic targets already attained. Mr. Eugene Osei-Wusu Health Service Administrator Stince 2014, we have piloted the Management Advisory Board (MAB) governance system initiated by St. Augustine’s Province, by establishing a functioning board, whose membership were carefully drawn to suit the needs of the mission in Sierra Leone. Members of the board and officers as listed above, include professionals of varied backgrounds.

Recognizing the important role of the Brothers in running the affairs of the institutions, the present MAB also relies heavily on their advice and counsel in seeking the interest of the services.

Under our new organizational structure, the Board through the Chief Executive exercises supervi- sory role over all the facilities, which are directly managed by Administrators on operational basis. However, each center has its own management team which is the decision making body of the cen- ter.

Through the Board, we have developed new operational policies and also reviewed existing ones in line with our strategic plan to guide the running of the centers. These include the Human Resource Policy (HRP), Surgical Operational Protocols, Media and Communication Policy, Accounting and Administrative Policy Manual as well as Training and Further Education Policy.

The MAB system enabled the establishment of a central procurement, project and development office to oversee procurement and development in all the centers. In line with our strategic plan, a number of projects have been implemented in all the centers. Few examples include the fully funded SRN program for the Nursing school, fully resourced and reinvigorated Public Health Unit in the hospital, and the construction of a commercial water production factory in Lungi.

St. John of God Catholic Health Services 7 /// Annual Report 2017

Centers & Services Center Locations

We are located in two major towns (Lunsar and Lungi), within the Port Loko district. The district has a population of about 614,000 (9.5% of the entire population of Sierra Leone). It borders the Western Area to the west, Kambia district to the north, Bombali District to the east and Tonkolili District to the south. The district is made up of eleven (11) chiefdoms as the third level of adminis- trative subdivision (Bureh Kaseh, Buya Romende, Debia, Kaffu Bullom, Lokomassama, Maforki, Marampa, Masimera, Koya, Sanda Magbolontor, and T.M Safroko). The Port Loko district is the second most populous district in Sierra Leone and Lunsar is the largest city within the district. The Marampa Chiefdom, where the Hospital is located has a catchment population of about 55,934 The city of Lungi is host to the Freetown International Airport, and it is only separated from Free- town (which is the capital city of Sierra Leone) by approximately, 20km stretch of the Atlantic Ocean.

Health facilities in the District There are a total of 112 health facilities within the Port Loko district. These consist of 108 public facilities and 4 private facilities. Presently, only 6 out of the 112 health facilities are hospitals. 15 are Community health centers and the rest are health posts.

St. John of God Catholic Health Services 8 //// Annual Report 2017

Services The following services are currently on offer in all three centers. Hospital • General Medicine • General Surgery • Orthopedic and Traumatology • Obstetrics & Gynecology • Pediatric services • Dentistry • Diagnostics (Laboratory, X-ray, Ultrasonography and Electrocardiogram) • Primary Health Care Services (HIV/TB clinic, Medical outreach, under five clinic and safe motherhood promotion center) • Antenatal clinic • Emergency services (on 24 hours basis) Health Center • General medicine • Diagnostic services (X-ray, Ultrasonography, and Laboratory services), • Primary Health Care clinic (HIV/AIDS and under five clinic) Nursing School • Certificate programme in State Enrolled Community Health Nurses, ends in 2018 • Certificate programme in Nurse Midwife Technician, starts in 2018 • Diploma programme in State Registered Nursing.

St. John of God Catholic Health Services 9 /// Annual Report 2017 The Golden Jubilee Anniversary: Fifty Years of Hospitality Services

Historical Background Fifty years on, the hospital is now known for its unique and quality services it provides to the wid- 2017 marked the 50th anniversary of the open- er population. Additionally, its establishment is ing of the St. John of God Catholic Hospital in considered a strong support to the government of Sierra Leone. Sierra Leone through curative medicine, preven- tion of communicable diseases, health promotion, Fifty years ago, the pioneering Brothers of Saint health education and community support. John of God under the leadership of late Bishop Augustus Azzolini of blessed memory in the The Anniversary Makeni diocese, founded Saint John of God Catholic Hospital. On this historical background, the Brothers of St. John of God in Sierra Leone, together with The initial plan of the early Brothers was to the staff and students of the services welcomed establish a clinic and address the health needs several visitors, religious leaders, Chiefdom and of the people in the Marampa chiefdom through traditional rulers, government delegations and preventive health awareness and the control many dignitaries from different parts of the world of minor disease conditions. However, people to climax the celebration of the Golden Jubilee from different regions in the country became Anniversary on 8th March 2017 under the Theme attracted to the then clinic through the provision “Celebrating Fifty Years of Hospitality with Qual- of accessible, efficient and affordable services ity and Passion”. rendered by the Brothers and the staff. There was an increase demand for the services pro- The yearlong celebration was actually launched vided by the clinic so much so that expansion on January 72016, with a Thanksgiving Mass led became inevitable. by Fr. Emmanuel Sesay, the Parish Priest of the

St. John of God Catholic Health Services 10 //// Annual Report 2017

St. Peter Claver Parish in Lunsar. The fiftieth anniversary of the hospital was a great event in the history of the Brothers of St. John of God in Sierra Leone hence the decision to allocate a whole year to enable the planning of activities.

Throughout 2016, several social events were held to create awareness and also raise funds towards the celebration. These activities included a Football gala competition, a Beauty Pageant show, A Marathon, a Bazaar, Radio talk shows, as well as one day free medical treatment in the hospital. Special anniversary T-shirts, Face caps and Clothes, as well as various stationeries were all print- ed and sold to raise funds. A special shop, named the “Jubilee shop” was also opened to enable the display and sale of these wares. The hospital also taught it wise to come up with a legacy project which will be a symbol of remem- brance of our fiftieth anniversary celebration. Acquisition of a digital Radiology machine was ap- proved for this purpose. Thankfully, this proposal was warmly accepted by our donor partners. The day of the anniversary was truly a remarkable one with several dignitaries and visitors left in awe of the tremendous work done by the Brothers of St. John of God in Sierra Leone over the past fifty years. Several past Brothers of the Lunsar community were present at the occasion. Some of the key speakers during the event included:

• Bro. Jesus Etayo – Superior General of the Brothers of St. John of God Order, who was the key note speaker during the event. • Bro. Barthelomew Kamara – Provincial Superior of St. Augustine Province of Africa • Fr. Natalio – Bishop of the Makeni Diocese, who led the Thanksgiving Mass during the event • Dr. Abubakarr Fofanah – Minister of Health and Sanitation • Chief Koblo Queen II – Paramount Chief of Lunsar • Hon. Osman Karanke Conteh – Member of Parliament, Constituency 50 • Mr. Ahmid M. Fofanah – Chairman, Port Loko District Council, who was also chairman for the occasion.

St. John of God Catholic Health Services 11 /// Annual Report 2017

The occasion was also used to recognize the hard work of several Brothers and co-workers who have played key roles for the hospital in the past. Notably, was Bro. Fernando Aguilo Martinez whose dedication and love for his patients was again remembered by the Traditional leaders of Marampa Chiefdom, and was honoured with the Title of a Sub Chief for development within the Marampa Chiefdom, and awarded the Order of Rokel by His Excellency the President of the Repub- lic of Sierra Leone. A special plague to commemorate the occasion was unveiled by the Superior General of the Broth- ers of Saint John of God Order - Brother Jesus Etayo.

St. John of God Catholic Health Services 12 //// Annual Report 2017 Department Reports Human Resource Work Force As at December 2017, there were a total of 122 employees of the hospital, con- sisting of 73 health staff and 49 non-health staff. Employees are also categorised according to the type of engagement. This is significant for payroll, end-of-service liability, as well as human resource management of peak and off-peak patient flow. As at December, there were 105 permanent staff and 17 casual/short-term staff Ms. Fatmata Mansaray Executive Secretary Table 1: Workforce Workforce Number Nurses (SECHN) 46 Nurses (SRN) 1 Aide Nurses 5 Laboratory Scientist 1 Laboratory Technicians 3 Laboratory Administrative officer 1 Doctors 2 Anesthetists 3 Pharmacist 1 X-ray Tech 1 X-ray Assistant 1 Midwives 5 MCHA 1 SACHO 2 Other Support Staff 49 Recruitment From a recruitment and retention perspective, challenges continued to present themselves particularly in the area of nursing and medical workforce staffing. These will remain key areas of focus for the HR Depart- ment as we approach 2018 and endeavour to motivate and maintain our committed staff.

General recruitment activities increased significantly at the nursing department as a result of increase in patient load, and filling of vacancies.

In summary, the Hospital Management Team approved about 13 applications to fill various vacancies. These include a Surgical Assistant Community Health Officer (SACHO), an Assistant Store Keeper, a Midwife, a Security officer and 9 Nurses. A few volunteers and student interns were also engaged in the nursing, medical and laboratory units throughout the year. Additionally, two midwives were assigned to the Maternity ward by the Ministry of Health and Sanitation (MoHS) during the year.

The department ensured that all recruitment processes strictly adhered to protocols stipulated in the new Human Resource Policy, and this was immensely beneficial. Notwithstanding, nursing recruitment and sourcing of appropriate skilled and experienced candidates continue to be a challenge.

St. John of God Catholic Health Services 13 /// Annual Report 2017

Employee Relations Once again this year the hospital can be justifiably proud of the progress made in building a solid and re- sponsible worker-friendly environment. During the past four years we have pursued a change agenda aimed at encouraging a sense of responsibility, leadership, and communication among the staff as well as between the staff and management. In 2016, we supported the process electing a staff representative for all three cen- ters, instituting a single staff association to oversee the welfare of the staff.

During 2017 we worked closely with the staff association president in communicating key change decisions, managing grievances and complaints and a range of individual and group claims.

A proposal to provide marginal increment on the allowances of all staff in the low salary bracket has already been approved for 2018.

Learning and Development In meeting the diverse learning and development needs of staff, a number of education and training pro- grammes, seminars, and workshops were provided during the year to various categories of our staff.These include topics on:

▪ Malnutrition facilitated - by Dr. Martha ▪ Cardiopulmonary resuscitations- by Dr. Maeteh ▪ Sepsis :surgeon’s point of view - by Dr. Carlo (CUAMM) ▪ Physiotherapy - by Dr. Sabina and team ▪ Gut comfort- by Ms. Gbessay and Ms. Jerikatu Bangura ▪ IPC refresher training - by Ms. Jennifer Suarez and Mr. Lamin Kamara ▪ The Global lab team led by Nils also provided training to the laboratory technicians ▪ Visiting surgeons from Germany also conducted trainings sessions for the nurses.

Training sessions were conducted as follows: ▪ Management of external Fixators ▪ Management of Fracture ▪ Sterility and Disinfection ▪ Malnutrition facilitated - by Dr. Martha

Sessions organized for staff in the pharmacy unit covered the following areas: ▪ Basic idea on management of drugs. ▪ Drug storage ▪ The dispensary (organization) ▪ Contents of a prescription and its interpretation ▪ Dispensing drugs to patients ▪ Packaging and labeling of drugs ▪ Dosage calculations

Further Education In 2017, we continued to pursue our objective of upgrading the skill and knowledge of key staff through further education and training. Two staff that were sponsored to pursue further studies in 2015 successfully graduated this year and have returned to take up their duties. They were:

▪ Mr. Hassan E. Fofanah – diploma in Electrical Engineering ▪ Ms. Hajaratu Bah – diploma in Laboratory Science.

St. John of God Catholic Health Services 14 //// Annual Report 2017

The following staffs were granted scholarship for further studies in 2017 ▪ Mr. Mustapha Kamara – Bachelor of Science programme in Nursing ▪ Ms. Rashidatu K. Sheriff – Diploma programme in State Registered Nursing (SRN)

Overall, educational and training activity has increased substantially year on year since 2014. Funding for further education has also increased significantly, in view of our goal to improve staff capacity and ensure competencies in key positions.

During the year, funding was received from Campus Doscent San Joan de Deu, Barcelona, in Spain to regis- ter and provide classes to eight Nurses to take their WAESCE, with the aim of obtaining the required grades that would enable their admission into the State Registered Nursing (SRN) programme offered at the St. John of God Catholic School of Nursing.

St. John of God Catholic Health Services 15 /// Annual Report 2017

Financial Administration Income and Expenditure Overview The year 2017 recorded one of the most successful years post Ebola in terms of internal income generation and patient activity. Income from patient fees in 2017 increased by 10% compared with 2016, while total recurrent expenditure decreased by 20% when compared with the previous year. The principle contributions to patient fees related to increase in major surgical procedures and increase in income from bed fees as a result of improvement in inpatient utilization.

In terms of expenditure Payroll expense continued to contribute more Ms. Aminata B. Bangura than half of total recurrent expenditure. In general, running cost of (Financial Administrator) the hospital was considerably lower in 2017 compared to 2016 due to reduction in workforce and improvement in internal controls.

Accounts Receivables & Payables As at December 2017, our account receivable balance was about $40,544 whereas, account payables balance stood at $40,127.

Stores & Procurement The procurement and store units control a vital part of our health service delivery system. Under our new procurement policy, we have established a procurement committee involving the Procure- ment officer, the CEO, the Administrator, the Pharmacist, the Medical Coordinator, the Financial Adminis- trator, the head of Laboratory and the Store Managers. All major procurements are approved by the procure- ment committee.

Procurement for both the hospital and the clinic is done monthly. The proposed procurement list is prepared by the head of procurement after collating all the requisitions from the various departments and the central store. The final list indicating cost for each item, proposed supplier, etc., is approved by the procurement committee if found satisfactory.

The procurement unit is faced with a number of challenges, including the availability of some essential sup- plies in the country, persistent increases in prices of goods by suppliers vis-a-vis the ability of our patients to afford them, and prevalent rate of stock dry-out as a result of the time lag between requisition, approval and delivery of stocks by suppliers. In this year, supply of drugs and other non-consumables accounted for about 21% of total recurrent expenditure.

We have improved management of our stores by instituting various systems of accountability in the manage- ment of stocks. These include the formation of an inventory team, formation of goods delivery inspection team, and tally system to monitor stock movement. In order to achieve this objective, we have created a central pharmacy unit which serves both inpatient and outpatient departments and is run twenty four hours each day. With these new systems in place, we have seen tremendous improvement in the management of the stores.

St. John of God Catholic Health Services 16 //// Annual Report 2017

Table 5: Income Statement as at 31stDecember, 2017 (Unaudited) Description Leones (000) Income

Patient Fees 3,008,302 Other Income 0 Donor funds 1,014,735 Total Income 4,023,037 Less: Cost of Sales (272,731) Gross Profit 3,750,306

Operational Cost

Payroll & Related Expenses (2,150,004) Utilities (134,985) Hospital Running Cost (1,305,122)

Travel & Transport (241,608) Repairs & Maintenance (132,028)

Training, Seminars &Conferences (42,767) Project Expenses (2,432,592) Total Expenditure (6,439,106)

St. John of God Catholic Health Services 17 /// Annual Report 2017

Internal Audit he Internal Audit unit is an independent function that assesses and evaluates the systems of control that Toperate within the hospital. The unit was established in 2014 as part of our strategic goal to strengthen internal controls and systems of accountability.

The unit monitors purchases, daily revenue collections, repairs and maintenance, fixed assets, inventory and store requisitions. The office also controls purchase of fuel for generators and vehicles which are key areas of expenditure in the hospital.

The Internal Auditor reports to the Health Service Administrator (HSA) and is responsible to the CEO on all operational matters. Annually, the hospital engages external audit firm to carry out general audit work.

St. John of God Catholic Health Services 18 //// Annual Report 2017

Medical Administration Introduction he year under review was a busy year for the clinical department of the Thospital as the hospital continues to gain grounds on the post-Ebola recovery process as well as continue efforts to improve the quality of the services deliv- ered to the clients. The Medical department includes the Medical Officers, Para- medics, Laboratory staff, and Pharmacy staff and consulting rooms.There were improvements in all the units of the Medical department. Br. Patrick Bung (Medical Coordinator)

The Medical Unit

The medical team experienced several significant changes in its composition, which made the team to be more effective in responding to clinical needs of the hospital. Two clinicians (without surgi- cal skills) left the team and were replaced by two Surgical Assistant Clinical Officers (SACHOs) in the course of the year. This means all the members of the clinical team are capable of responding both to the medical and surgical needs of the hospital; mak- ing the team more efficient. The medical team is made up of the following clinicians: • Bro (Dr) Patrick Njungfiyini Bung, Medical Coordinator and Brother from the Province ▪ Dr. Munguiko P. D. Baziha, General Practitioner from Congo DR ▪ SACHO Suilaiman Pizaro Kamara, A Sierra Leonean Surgical Assistant Community Health Officer ▪ SACHO Ibrahim Fortune, A Sierra Leonean Surgical Assistant Community Health Officer ▪ Three CUAMM doctors worked at the maternity during 2017: Dr Arne Beguin (A General Praction- er), Dr. Natalia Russo (Gynaecologist) and Dr. Elizabeth (Gynaecologist)

Volunteers and Surgical Missions The following volunteers and surgical missions visited the hospital in 2017: ▪ Dr. Fernando Aguilo Martinez who attended the Golden Jubilee celebrations and carried out a few surgical operations in the hospital in March ▪ ODW German Orthopaedic Teams from November, 2017 through to February 2018. Led by Dr. Wofgang Heller, Dr. Frijof Schmidt-HoensdorfDr. Michael Zellneh, Dr. Artur R. Klaiber ▪ Spanish Surgical team from Madrid made up of an Orthopaedic Surgeon – Dr. Maximino Vellena Gozalvo, and three Plastic Surgeons – Dr. Elena Lorda Barraguer, Dr. Maria Teresa Fernandez Diez, and Dr. Maria Teresa Ibanez Marti A Spanish Maxillofacial Surgeon from Barcelona who spent two weeks at the hospital ▪ Italian Surgeons through CUAMM in the following specialties: Dr. Paulo - Gynaecologist, Dr. Paulo - General Surgeons and Dr. Bruno - Urologist In other to meet up with the needs of the hospital, there is a need for a permanent gynecologist, a regular urologist and a regular or permanent general surgeon to be added to the team.

Medical Records Management Our Records department holds volumes of records of patients more than ten years ago. Currently, the depart- ment is facing a huge challenge in managing these records. The challenges include finding space to accom- modate new records, filing and retrieval of records, and prevalent cases of missing records.

St. John of God Catholic Health Services 19 /// Annual Report 2017

Laboratory Unit

The laboratory unit underwent some innovations in 2017 which improved the quality delivery of the depart- ment as well as information management. Some of these innovations included:

• Setting up of a data base for the results of the tests carried out in the lab and the employment of a data clerk to manage the information. This improved on the quality of the results produced by the lab since they are printed out and the records saved in the data base and can be reproduced when needed. The in- formation of the database also helped in the tracing of patients’ folders when the reference cards are not available. This innovation was done with the support of Fundacion Probitas. • Still in the area of information management, the confidentiality of patients’ information has been im- proved. There was the introduction of an informed consent form for blood donation. • he blood donation service of the lab was boasted with the acquisition of a blood bank through the help of Fundacion Probitas. This has reduced the stress involved in blood transfusion in the hospital, especially for obstetric emergencies. • A safety cabinet was also introduced in the lab in 2017 with the aid of Fundacion Probitas.

The Radiology Unit

The radiology unit currently has two permanent staff. The old X-ray machine was replaced in 2017 with a brand new digital x-ray machine and a new generator to stabilize the power supply to the unit. This has im- proved remarkably the quality of the X-rays done by the unit and has also made the service more affordable. Towards the end of 2017, we introduced the Hysterosalpingography (HSG) test which has been extremely helpful both in income generation and improved evaluation of female fertility.

The Pharmacy Unit

Introduction The pharmacy is the major powerhouse of the hospital - the final point of a pa- tients visit to a health facility. Its activities are well structured and well-coordinat- ed so as to improve on the healthcare delivery system of the hospital.

The main reason, among others, patients may visit a health facility is because of the increased confidence and trust they have on the type and quality of medicines they will receive in that facility which they hope will effectively solve their pre- senting health condition. Having drugs of the required quality and standard had been our target throughout 2017 and no fake, counterfeited or substandard drugs were delivered and/or received in our facility.

The availability of basic drugs at the hospital has improved. One of the significant improvements in the pharmacy unit was the reduction in the amount of drugs that get to expire in the unit. A lot still needs to be done to improve and stabilize the supply of basic drugs in the hospital. In Conclusion the year was a positive one for the hospital and the medical department contributed its share in the improvement of the services delivered by the hospital.

Staff Strength The pharmacy department had the following caliber of staff in 2017:

▪ Pharmacist (head) ▪ Two (2) SECH Nurses ▪ Two (2) Auxiliary nurses

St. John of God Catholic Health Services 20 //// Annual Report 2017

Shifting/Duty The pharmacy was operated on a 24hour basis.

▪ Morning shift: Two staff + Pharmacist ▪ Afternoon shift: One staff + Pharmacist ( where clarification was required) ▪ Night shift: Cashier assisted by the Pharmacist (when called upon)

Training The pharmacy staff, storekeeper and cashiers had the opportunity to acquire knowledge and skills on phar- macy operations through a workshop organized by the pharmacist. There were also a series of ‘on the spot’ trainings.

Drug/Non-drug Requisitions Requisitions for drugs and other items were prepared on a daily basis by the pharmacist who submitted these requisitions to the hospital Administrator for approval before the said items were supplied by the storekeep- er.

One of the pharmacy staff received the supplies from the store and entered the quantities of each item re- ceived on the ‘activities at the dispensary form’ under the supervision of the pharmacist.

Dispensing of drugs Quantities of items dispensed are entered on the ‘activities at the dispensary form’ by the staff on duty and later verified by the pharmacist.

Monitoring and Supervision The pharmacist monitored and supervised the department on the following areas:

▪ Attendance of staff which was excellent ▪ Interpretation of prescriptions ▪ Drug combinations ▪ Correlation between the prescribed drug regimen and the diagnosis. ▪ Polypharmacy ▪ Dispensing of drugs ▪ Dosage calculation ▪ Receipt of supplies from the store. ▪ Entry of items received from the store together with one of the pharmacy staff. ▪ Physical checks of the stock at the dispensary on a daily basis. ▪ Calling on the prescribers’ attention if there is any prescription-related problem. ▪ Monitoring stock movement in each of the ward’s emergency cupboards.

Successes ▪ No theft case ▪ More improved recording system ▪ Internal problems were settled without the involvement of external personnel (s). ▪ The staff willingness to accept new ideas implemented by the pharmacist was very encouraging. ▪ No major shortage of drugs and other items for long periods ▪ Staff were punctual and regular

St. John of God Catholic Health Services 21 /// Annual Report 2017

Challenges ▪ Frequent transfer of staff who have gone through pharmacy experience to other departments. ▪ Lack of staff who have not acquired experience on pharmacy operations before.

Objectives for 2018 To further improve on the level of care given to our clients, the unit has set up the following objectives for the coming year 2018.

▪ Continuation of in-service training for pharmacy staff and cashiers. ▪ Continuation of in-patient post-marketing surveillance of drugs. ▪ Review of current drug list. ▪ Development of drug use protocols (especially on antibiotic use). ▪ Introduction of the ‘adverse drug reaction form’ to nurses whenever the revised edition is made avail- able by the Pharmacy Board of Sierra Leone. ▪ More improvement on proper reporting on drug use in the facility. ▪ Shall curtail and/or control drug expiration especially those we receive from donors. ▪ Shall continue to put more measures in place on how drugs are dispensed and accounted for in other to prevent losses due to theft/pilferage or expiration. ▪ Stock out for a very long time within the facility (especially of essential drugs) shall be handled with utmost priority. ▪ The pharmacy department shall continue to collaborate with other members of the healthcare deliv- ery system. ▪ Organize presentations on drug administration and use for nurses. ▪ Shall continue to supervise all pharmaceutical products delivered to the facility by various suppliers and donors in other to avoid stocking of fake, counterfeit, and substandard products. ▪ The dynamics involved in the frequent transfer of staffs who have gone through pharmacy experi- ence to other departments shall be looked into. ▪ Shall continue to ensure that prescribers follow the approved drug list of the hospital. ▪ Shall support the administration to solicit for donors to help with drug procurement to subsidize the cost of providing services to the patients with quality drugs.

Primary Health Care

The Medical Outreach The Outreach program was started in 2014 during the peak of the Ebola crisis to provide food and other household materials to the immediate communities of the hospital and to provide medical care to the quarantined homes.

Today, the program is focused on a small community within the Marampa chiefdom called Mange Acre with about twenty (20) villages and a total pop- ulation of over 3,600 people. Poverty in the community has a big influence on the health of the people. The people are mainly peasant farmers who have literally no household income reserved for their health needs. Children suffer most in this condition with most of them being malnour- ished and stranded growth conditions are common among children.

The hospital outreach team works hand in hand with some influential people in the villages as volunteers to support their daily works. These volunteers serve as motivators, and also provide security for the team’s

St. John of God Catholic Health Services 22 //// Annual Report 2017

items. We are very grateful to Africa Viva Fundacion which has supported the implementation of the out- reach programmes successfully.

The outreach program is multi-faceted in nature – mainly providing Health Education, Immunization, treatment of minor ailments, surveillance, maternal and child health care activities, water and sanitation, as well as a nutritional program. During the year a total of 796 patients were seen by the outreach as de- picted by Figure 1 below. Figure: Attendance by Age group 209 209 187

92

52 47

0-11 months 1-5 years 6-15 years 16-35 years 36-45 years 50 yrs & above HIV/AIDS &Tuberculosis Units One of the priorities of the Ministry of Health and Sanitation is the control of TB and HIV/AIDS. Our TB and HIV/AIDS units work to support the MoHS to achieve this objective. During the year, activities in both units saw significant increases as compared to the previous year partly due to increase incidences of these diseases in the country.

In the case of TB for example, reasons such as poor compliance of TB patients on treatment, frequent short- age of drugs for treating TB, prevalent cases of drug resistance, etc. are possible reasons for the increases.

Presently, the hospital is collaborating with ICAP on a piloted project funded by CDC to implement inpa- tient voluntary counseling and testing as a way of building effective HIV prevention program by improving HIV testing.

Table 2: HIV activity Description 2016 2017 VCT Counseled 1,289 2,003 VCT - Tested 1,289 2,003 VCT - Positive Cases 144 174 PMTCT Counseled 807 1,190 PMTCT - Tested 807 1,190 PMTCT - Positive Cases 14 17 All Other HIV Tested 0 336 All Other HIV Positive Cases 0 9 No. on ART Treatment 32 27 ART Treatment Referred 8 5

St. John of God Catholic Health Services 23 /// Annual Report 2017

Table 3: Tuberculosis Data No Description 2016 2017 1 Registered cases 31 535 2 Still on Treatment 8 80 3 Defaulted cases 0 9 4 Cases cured 0 0 5 Deaths 0 1 6 Re-Infections 1 3 7 TB + HIV Infection 1 4

Safe Motherhood Promotion Center The Safe motherhood Promotion Centre was established post Ebola to address various maternal health chal- lenges that resulted after the Ebola crisis. After the Ebola crisis, patients, including pregnant women contin- ued to shy away from hospitals for fear of hospital triage procedures and Ebola related diagnosis and stigma. This mentality affected pregnant women so much so that they could not access antenatal clinical services and many a times this resulted in pregnancy complications leading to maternal and infant mortality.

In order to address this gap, instill hospital attendance confidence to pregnant women and also women, who require child bearing related services, were the main factors leading to the establishment of the center. The “Safe motherhood Promotion Centre” and now often called by its participants as the “Pregnancy School” is a friendly call-in centre for pregnant women and women of child bearing age. It is a friendly, confidence building environment established for pregnancy related services. The aim of this intervention is to make pro- vision for all women who are pregnant or may/may not want to become pregnant to gain relevant informa- tion about pregnancy, childbirth, and childcare and fertility health and also birth control in order to reduce women and child mortality to the minimum.

St. John of God Catholic Health Services 24 //// Annual Report 2017

The “Pregnancy School” has no clinical facilities, but merely talking to the clients on pregnancy related ser- vices whilst also allowing feedbacks from these clients on their individual experiences. There is also provision for confidential discussions with those who opt for it on issues bothering clients that require private hearing in one of the rooms in the Centre. The center is run by a Mid Wife Consultant with rural experience in mid- wifery and assisted by two Nursing aides.

On the 30thNovember, 2016, the Centre celebrated its one year of existence with all the clients it has served. Among several of its achievements, the center has been able to yield positive statistical trends in the areas of antenatal attendance, reduced maternal and infant mortality, and increased normal deliveries in the hospital. On the occasion of its one year anniversary, the center launched a Pregnancy Savings and Loans scheme with a Maternal and General Healthcare Insurance Provision to help support pregnant women accessibility to health services.

Safe motherhood calendar of activities Week 1 Monday (1) Thursday (2) 1. First attendance for new participants: introduc- Session for pregnant women between week 16-28 tion to SafeMotherhood program, aim and activities, (distinguishing the beneficiaries into groups accord- patient’s registration. ing to gestational age would make the session more focused and effective). 2. Health insurance presentation and registration Contents: 3. Cooking demonstration 1. personal and medical history of each woman 2. early pregnancy 3. avoiding physical exercise 4. nutritional advice 5. signs and symptoms of pregnancy related ill- nesses 6. hospital visit 7. immunization 8. hygiene

At this point of pregnancy, women should come to attend the program ONCE PER MONTH

St. John of God Catholic Health Services 25 /// Annual Report 2017

Week 2 Monday (3) Thursday (4) Session for pregnant women between week 28-37 Session for pregnant women between week 37-40

Contents: Contents: 1. physical exercise 2. nutritional advice 1. preparation for delivery 3. preparation for delivery 2. late pregnancy related illnesses 4. danger signs 3. advice about packing things before going to 5. breastfeeding the hospital for delivery 6. newborn’s care 4. breastfeeding 7. proper home care for newborn 5. breast care 6. hygiene after delivery At this point of pregnancy, women should come to attend the program TWICE PER MONTH At this point of pregnancy, women should come to attend the program ONCE PER WEEK Week 3 Monday (5)

Week 3 Monday (5) Thursday (6) Postnatal care Birth to 6 months

Contents: Contents: 1. postnatal care package 1. exclusive breastfeeding 2. breastfeeding immediately after delivery 2. preparation for other food 3. breast care 3. baby’s care 4. hygiene after delivery 4. family planning 5. wound care in case of CS 6. newborn’s care 7. moving from the hospital to the house 8. immunization 9. exclusive breastfeeding

Week 3 Monday (7) Thursday (8) From 6 months to 2 years 1. Health insurance 2. Cooking demonstration (benny mix) Contents: 1. introduction of diversified diet 2. weaning advice 3. baby’s care 4. family planning

St. John of God Catholic Health Services 26 //// Annual Report 2017

Nursing Administration During this reporting period, the nursing department has been operational with the normal daily activities of the nurses; providing competent and compassion- ate and nursing care including symptom control and pain relief of patients that access this facility without discrimination or favour. The emergency and all in-patient units were covered twenty-four (24) hours in three shifts. However, staffing was an issue for some units but we were able to overcome this chal- lenge and succeed. Ms. Sylvia Jabbie (Nursing Administrator) Staffing Nurse staffing continue to be a challenge in the department. However, this challenge was lessen by the avail- ability of some contract nurses and volunteers throughout the year.

Table 4: Unit breakdown of staff capacity No Unit/Ward Permanent Govt. Staff Contract Volunteer Total staff Supported serving Staff staff staff bond term 1 General Ward 7 0 2 0 0 9 2 Maternity/ ANC 7 4 1 0 0 12 3 Emergency/Triage 7 0 2 1 0 10 4 Pediatric Ward 7 0 0 0 1 8 5 OPD 5 0 1 0 0 6 6 Operating Theatre 6 0 1 0 0 7 7 Pharmacy 2 0 0 0 0 2

Staff Meetings 3 general nurses, 2 in- charges and 2 unit meetings were held. In these meetings, unit In-charges give up- dates about their units including challenges and some of the challenges were promptly addressed, whilst others were action points.

Capacity Building Nurses are doing well, but in order to ensure that they are updated and thus scale up their service provision, there is need for Continuous Nursing Education (CNE) to be conducted for the nurses. Some of these can be sessions on new topics and some can be refresher sessions thus ensuring that they always provide quality care.

Clinical Placement During this year, Student nurses from the nursing school were sent to the hospital on clinical placement. There are a total number of seventy nine (79) State Registered Nurses in two different sets; 1& 2.These nurses were sent to the hospital on four (4) different placements for clinical learning sessions.

Also, a total number of 137 State Enrolled Community Health Nurses in training belonging to two different sets were sent to the hospital for clinical training. They were all attached to the different units of the hospi- tal, allocated in all three shifts supervised by their clinical instructors and preceptors respectively.

St. John of God Catholic Health Services 27 /// Annual Report 2017

Challenges • In adequate number of staff for some units • Inadequate resources for effective service provision; i.e. equipment and instruments e.g. glucometer with strips, stretchers etc. • Patient folders have no provision for recording of nurses’ notes. • There are no porters to help with transportation of patients from one unit to the other • Long waiting time for patients at the cashier point that interferes with the timing of drug administra- tion to patients.

Recommendations • Recruit more staff to enable efficient service provision. • Prompt repairs or replacement of damaged equipment. • Management to plan and conduct Continuous Nursing Education (CNE) sessions for all nurses em- ployed in the hospital (at least 1 per month). • Provide sheets for nurses’ patient notes. • Need to employ porters • Management to differentiate the cash point for purchase of folders/ payment for consultation from the cashier point for purchase of drugs in order to reduce the waiting time of patients and ensure accurate timing of drug administration by nurses.

Improvement in Quality A key objective of our strategic plan was to improve quality of care to 100% by 2018. Since 2014, measures such as relocation of the Emergency department to a much bigger and easily accessible space, construction of Isolation unit, sustainability of IPC structures through regular refresher trainings and supply of PPEs, as well as improvement in major equipment and supplies have all made significant contributions towards attaining our quality improvement target.

In 2017, a gift from the General Curia, in Rome donated and replaced major equipment including: Digital X-ray machine, Anaesthetist machine, Operation bed. Africa Viva fundacion through the safemotherhood project procured new Autoclave sterilising machine and other paediatric equipment like the CPAP, Blood pressure machines, and drug support, the Local community of Las Palmas of the Brothers of St. John of God also procure a micro digital autoclave for the hospital. We are grateful to all these donors.

St. John of God Catholic Health Services 28 //// Annual Report 2017

Information & Communication nder our present governance structure, we have set up a functioning Information and Communication Uunit which is represented on the Management Advisory Board due to the significant role the unit plays. Its main functions include communication and education, research as well as community engagement. Since 2014, the unit has built close ties with the community meeting with stakeholders and opinion leaders involv- ing them in shaping our services.

Tremendous strides were made towards our strategic goal of encouraging communication and proper dis- semination of internal and external communication. An effective way of achieving this target was to encour- age staff meetings, especially at unit and departmental levels. We continued to motivate and empower heads at all levels so as to ensure that issues are handled in a competent manner.

Another important milestone for the Information and communication department so far has been the formu- lation of a media and communication policy manual for the services. This policy document guides informa- tion content management and sharing within and outside of the services.

Writing, and design of publications continue to be a challenge and a new initiative to set up a Media and Publication Committee involving the Statistics, IT, and Communication departments will be implemented in 2018. In 2018, our goal is to constantly update our stakeholders and key partners about what we do through periodic release of publications.

Accurate recording and management of data is key for the information and communication department. The hospital continues to support the Statistics with logistics and by booting the capacity of the Statistics officer through his participation in key workshops and seminars usually organized by the Ministry of Health and Sanitation.

St. John of God Catholic Health Services 29 /// Annual Report 2017

Pastoral Care & Bioethics The pastoral care team is a body that sees into the pastoral or spiritual aspect of the patients and workers. The team has four members:

▪ Bro. Nestor Bamboye(Leader) ▪ Mr. Joshua sandy (Member) ▪ Mr. Kizitokamara (Member) ▪ Mr. Hajaratu Bah (Member)

The pastoral care is very active in the hospital. Morning Prayer is organized by the unit every morning in the outpatient department except on OPD off days. The members visit patients in the wards especially those who need spiritual as- Br. Nestor Banboye sistance and those with other challenges such as paying hospital bills, acquir- Superior Brothers’ ing blood for transfusions and sometimes counsel patients with complications Community ,or those with sickness that have social implications such as Tuberculosis, HIV, mental or psychological problems.

Pastoral Activities, 2017 • The newly employed workers are orientated by the pastoral team. The new workers are brief on the history of St. John of God, the values of the order, etc. In 2017, over 21 newly employed workers were orientated.The pastoral care team members visited over 348 patients in the wards.

• These were patients facing different challenges while in the wards. 128 patients were referred to the pastoral by either the clinicians, doctors, nurses, midwifes etc for counseling. Over 301 patients re- quested to see the pastoral care team for different reason.

• The pastoral care team met 91 patient relatives to thoroughly explain surgical interventions such as amputation, hysterectomy and other complicated operations. The pastoral care team makes sure that the relatives or families understand the process and the aftermath of the whole procedure before it is per- formed on their relatives.

• Over 11 staff from the hospital, clinic or school also approached the pastoral team for different issues. Most of them came to discuss and find solution on family or workplace challenges.

• Some of the patients who are discharged from hospital are followed up in their homes by the team members. 102 patients were visited in their homes to see the progress after being discharged from the hospital.

• Most of the children or pregnant women who cannot afford the transfusion cost are referred to the pas- toral care. In 2017, the pastoral team through the hospital management made blood available over 200 children and 40 pregnant women.

• During the year, the feast of our patron was celebrated in the hospital. A Novena to St. John of God was organized in the hospital. Two masses were said in the hospital in 2017 even though no spiritual retreat or recollection was organized. The world day of the sick was observed in the services. It is difficult to organize spiritual exercises in the services because there is no resident chaplain in the hospital.

St. John of God Catholic Health Services 30 //// Annual Report 2017

St. John of God Catholic Health Services 31 /// Annual Report 2017

General Services Estate, Maintenance & Transport

The Estate, Maintenance & Transport units are all together headed by a Brother of the Mission under the MAB due to the important role these units play for our services. The Estate unit is placed under the Projects office to oversee developments and manage the estates of the hospital.

The Transport unit plays a dual role of facilitating transportation of staff members if necessary, and also runs the ambulance referral service for patients. The unit has one permanent Driver and two supporting Drivers employed under the CUAMM project.

The Maintenance department continue to serve as a direct resource to the hospital in providing a safe, functional, supportive and effective environment for patients, staff members, and individuals who use our facilities. The unit currently has 6 staff including two Labourers, a Plumber, two Electricians and a Masonry technician. During 2017, the Maintenance unit was adjudged the best performing unit due to the commit- ment, dedication and response rate of the staff in keeping all major equipment of the hospital in good state of repair throughout the year.

Catering, Cleaning, &Laundry Catering service is provid- ed daily to all inpatients and meals are served once a day during lunch as part of the inpatient day fee. The depart- ment has two trained cooks with several years of expe- rience. Additionally, food is available on sale at the hospi- tal’s canteen and also by vari- ous food vendors outside of the hospital compound. However, most patient relatives prefer to bring food from their homes to their patients. This is very challenging in terms of con- trolling movement of visitors in the ward and also costly for the patients. To solve this problem, the hospital plans to build patients’ relatives kitchen purposely to be used by patient relatives to prepare meals for their patients.

The Sanitary unit is responsible for housekeeping. The unit has a distinctive role, as regards with its func- tions of cleaning the entire hospital, infection control and sanitation. Currently, the department has 10 staff including 6 females and 4 males.

The Laundry unit is of utmost importance to the hospital. The main purpose of this unit is to provide clean materials to the patients and ensure that hygienic conditions are maintained in the process. Currently the department has two functioning laundry machines with two staff. Bed linens from the various wards are washed and replaced daily. However, the department has no Dryer machine and linens are dried by means of drying ropes. This poses a big challenge especially during the raining season.

St. John of God Catholic Health Services 32 //// Annual Report 2017

Security

The Security Department endeavours to provide a safe and secure environment for all patients, relatives and staff.

Currently, the hospital has ten security officers, about one third reduction over the past four years. This is mainly attributable to various cost reduction strategies implemented post Ebola. However, the reduction in personnel has not impacted negatively on security of the center as it has rather had positive impact on the level of professionalism of the remaining security personnel. Additionally, we continue to instil a sense of security consciousness among the staff through regular meetings and creation of security awareness at all times.

We have installed fire safety equipment at various points of the hospital since 2016. These installations in- clude fire extinguishers and anti-smoke detectors. All our Security officers have been trained in handling and operating fire safety equipment. We are also grateful to our donor partners for financing the construction of a perimeter wall around the hos- pital during 2017. This has been a major boost to security on the compound. Most significantly, it has helped to reduce unauthorized access to the compound and has also ensured that there is only a one way route in and out compound.

St. John of God Catholic Health Services 33 /// Annual Report 2017

Capital Projects and Developments The Capital Projects office oversees several Capital development and programme for the MAB. Our donor partners and benefactors have been very supportive in ensuring that this key department continues to deliv- er on its core mandate. In 2017, a number of projects and developments were undertaken in all of the three centers through the support of various partners, and our donor community as shown in Table 2 Table 2: Projects and Programme, 2017 No. Project/Programme Financed by Value 1 MedShare Container Project-assorted medical sup- HospitaalBroeders, $25,000 plies Netherlands 2 Shortening the distance in Port Loko: Reactivate Italian Episcopal Confer- €489,438 the Maternal and Child health services in St John of ence God Catholic hospital and in the referral chiefdoms after Ebola 3 Safemotherhood Promotion Centre Fundacion Africa Viva €20,250 4 Strengthening Mother and Child Health Services in Manos Unidas €65,619 Port Loko, Sierra Leone 5 Emergency Support to Mudslide Victims Ayuntamiento de Murcia €15,000 6 Water production and packaging Project for the Fondo Zer0,7, Spain € 46.245 provision and sale of pure and safe drinking water

7 Support the Health System through SRN training in La Caixa Bank, Spain € 27,900 Lunsar, Sierra Leone 8 Minibus Project for the Nursing school HospitaalBroeders, €23,700 Netherlands 10 Construction of two classrooms at St. John of God Roviralta Foundation, €9,000 Catholic School of Nursing in Lunsar, Sierra Leone.” Spain 11 Scholarship for Student Nurses HospitaalBroeders, €29,459 Netherlands 12 Scholarship for Student Nurses Campus Docent San Joan €6,000 de Deu, BCN Spain

St. John of God Catholic Health Services 34 //// Annual Report 2017 Future Projects & Programmes Hospital • Establishing a physiotherapy and rehabilitation unit project. • To renew all the electrical wiring of the hospital • To construct a kitchen for the patients relatives • To replace the hospital solar batteries. • To construct a Central Sterilisation supply Department (CSSD) • To engage a general surgeon and Gynaecologist for the hospital • To develop a long term and comprehensive PHC programme • Improving the Dental programme. • To construct a kitchen for the patients relatives in Lunsar and Lungi • To Support the safemotherhood & malnutrition programme • To embark on training staff on the use of the ultrasound, ECG, X-ray • To support the hospital with sutures, drugs and Personal protective equipment (PPEs) • To support the Apadrina Programme for under five children

Nursing School • To provide a 24 hours electricity to the students hostel and administration through the Installation of a 40 solar panel energy supply unit. • Further Academic Training Programme for Br. Francis Kabia, The Nursing School Administrator to specialize in academic curricula development for the benefit of the Nursing School. • To construct a 135 bed student hostel. • To construct an administrative Building with staff offices for the school. • To support the capacity building of the nurse lecturers and the implementation of the SRN and NMT programme. • To provide scholarships to poor, but brilliant and needy students • To gain accreditation from the Tertiary Education Commission (TEC). • To gain accreditation and affiliation with the University of Makeni (UNIMAK)

Clinic • To construct 8 room apartment for volunteers visiting the clinic • To renovate the staff and Brothers quarters

St. John of God Catholic Health Services 35 /// Annual Report 2017

Activity Report

Performance Highlights

The post Ebola recovery has been steady during the past four years, and the year 2017 recorded one of the highest outputs. Both Outpatient and inpatient attendance were at least 20% higher than the previous year. These increases were the result of various factors including increase in confidence of the community in the services we offer, presence of visiting specialist doctors, and improvement in facilities and major equipment such as the new digital x-ray machine.

The number of surgical interventions was significantly higher during the year mainly due to the presence of different specialist volunteers especially in general surgery, orthopaedic and gynaecology who spent inter- mittent periods with the hospital throughout the year.

The free delivery and antenatal for major obstetric emergencies and high risk pregnancies in partnership with CUAMM and funded by Manos Unidas, Spain and Italian Episcopal Conference, has contributed largely to the output at both the Antenatal and Maternity unit. Total number of deliveries in 2017 was nearly 40% higher than 2016 and An- tenatal visits were about 38% higher compared to 2016.

Utilization of our diagnostic services was also positive. Reduction in cost of x-ray tests and the presence of orthopaedic teams during the year contributed to the increase in the number of x-ray test. Stand out result was recorded from the number of ultrasound scans largely due to the presence of Gynaecologist at various times during the year and the increase in Ante- natal attendance.

Detailed activity reports are shown on the Appendix

St. John of God Catholic Health Services 36 //// Annual Report 2017

Table 3: Activity Highlights 2013 - 2017 Indicators 2013 2014 2015 2016 2017 Outpatient visits 32,445 10,522 12,641 14,950 18,525 Admissions 8,534 3,230 2,194 3,935 4,689 Antenatal visits - - 840 2,037 2,806 Emergency visits - - 3,044 4,181 7,117 Surgical interven- 888 602 426 644 856 tions Laboratory 44,841 4,373 15,287 54,248 52,744 X-ray 4,658 2,373 986 1,628 2,082 USG 4,091 568 1,204 1,513 2,238 ECG 73 - 24 155 26 Deliveries 316 46 158 509 710 Fresh SB 41 5 10 41 32 Macerated SB 25 4 11 16 42 Maternal deaths 5 5 2 13 10 Number of beds 151 146 74 100 80 Inpatient days 33,626 13,722 7,165 17,675 20,248 Discharges 8,081 2,987 1,698 3,725 4,499 Deaths 182 87 115 187 202 ALOS (days) 4 4 4 5 4 Occupancy (%) 61% 52% 27% 48% 69% Turnover per bed 55 21 25 39 59

St. John of God Catholic Health Services 37 /// Annual Report 2017

Lungi Health Center Report Brief Background Located in Malokoh, Lungi, in the Port Loko district, the St. John of God Community Health Center was established two decades ago with the aim of providing basic health interventions to the Malokoh communi- ty and beyond. Before the Ebola crisis, the clinic operated both outpatient and inpatient services. However, after a temporary closure during the Ebola crisis in 2014, the clinic was opened again in March 2015. As at December, 2017, the clinic’s total workforce was 18 comprising of; Ten (10) clinical staff and seven (8) non clinical staff.

Activity During the year, activity at the center improved markedly due to a grand agreement reached with Reliance Insurance Trust Corporation (RITCORP) to provide medical services for their clients. Clients from the RITCORP constituted more than 50% in all activity areas. The number of beds was increased to 20 due to increase in utilization.

Table 4: Activity Highlights Service 2016 2017 Outpatient visits 2,189 3,421 Scan 548 678 Laboratory 3,422 6,344 X-ray 54 79 Deliveries 5 28 Admission 16 323

St. John of God Catholic Health Services 38 //// Annual Report 2017

Major Capital Improvement

2017 was a successful year in terms of capital development. Two major capital projects were successfully implemented including: A solar energy system which was constructed by the Ministry of Health and Sanita- tion through the Port Loko District Health Office. Currently electricity is available in the center on 24 hours. The second project was the construction of a water production factory for the commercial production of treated bundle water.

Financial Statement Due to activity increase, income generation from patient fees also improved significantly during the year. Increase in activity resulted in slight increase in purchases – mainly drugs and consumables. Payroll expens- es increased slightly due to employment of three nurses to lessen the workload on the few nurses in center. Notwithstanding these increases, total expenditure for the period was significantly lower than total income for the year.

Table 5: Income Statement as at 31stDecember, 2017

Description Leones (000) Income Patient Fees 362,189 Other Income 0 Donor funds 31,660 Total Income 393,849

Operational cost Payroll & Related Expenses 174,610 Utilities 8,422 Clinic Running Cost 90,233 Travel & Transport 5,686 Repairs & Maintenance 1,450 Training, Seminars &Conferences 0 Total Operational Cost 280,402 St. John of God Catholic Health Services 39 /// Annual Report 2017

Nursing School Report Background. The St. John of God Catholic School of Nursing was established in 2007 to address the skilled gab of nurses in the hospital and the entire country. The school’s main goal is “to contribute to the improvement of quality health services by producing trained and professionally competent nurses and midwives for all health care facilities”. The State Enrolled Community Health Nurses (SECHN) programme was the only programme offered by the school. However, today, the State Registered Nurses Programme has been added with the first batch of students due to begin classes in January 2017.

Enrolment The training center has the capacity to accommodate 300 students. Below is the record of enrolment and graduates since 2007. Recruitment for the SECHN programme was put on hold in 2017.

Table 5: State Enrolled Community Health Nurse (SECHN) Year of Enrolment Set Number Enrolled Number Graduated

2007-- 2010 1 43 21 2008-- 2011 2 94 63 2009-- 2012 3 102 93 2010-- 2013 4 90 78 2011-- 2014 5 108 94 2012-- 2015 6 72 57 2013 --2016 7 87 71 2014 --2017 8 61 54 2015 --2018 9 76 - 2016 --2019 10 76 - 809 531

St. John of God Catholic Health Services 40 //// Annual Report 2017

Table 6: State Registered Nursing (SRN)

Year of Enrolment Set Number Number Enrolled Graduated 2016-- 2019 1 20 0 2017 -- 2020 2 49 0 69 0

Academic Activities • During the year, 56 pupil nurses were presented to the State Board Exams and we obtained a 100% pass rate. • 49 new student nurses were enrolled • 62 pupil nurses are currently on their midwifery affiliation in SOM in Makeni for 20 weeks • 69 student nurses are also on their vacation practicum for 6 weeks after their end of 1st and 3rd semes- ter examinations respectively. • The school administration continues to foster a very conducive learning environment for all.

Staffing As at December, 2017, a total of 23 staff were in the school of which 17 are permanent staff and 6 are tem- porary staff. Out of this number, three staff are on secondment post by the MoHS.

Projects Completed • The following projects were successfully completed during the year. • Construction of two classroom block (50 space capacity each) for the SRN programme. • Procurement of 15 seater Toyota Hiace Mini Bus for clinical placement and supervision • Refurbishment of toilet facility of one of the hostels • Procuring and equipping the computer library • Receipt of funding extension for the SRN programme financed by La Caixa Bank of Spain, through Africa Viva Foundation. • Approved funding for 63 students and pupil nurses for 3 years training.

St. John of God Catholic Health Services 41 /// Annual Report 2017

Academic Achievement • The school obtained 100% pass rate during the 2017 State Final Licensure Examination for the SECHN programme • We have made some improvements regarding the students’ clinical placement coordination and super- vision.

Challenges • Collection of school fees • Placement of students at the clinical sites • Recruitment of Lecturers • Increase consumption of water • High cost of providing electricity.

St. John of God Catholic Health Services 42 //// Annual Report 2017

Appendix Hospital Activity Data - 2017

Table 4: Emergency & Trauma Unit Activity, 2017 Gender Age group Treated & Treated & Observation Referral Death Admitted Discharged

Male < 5years 1,238 748 200 2 25 > 5years 769 523 128 12 15 Female <5years 969 640 169 2 17 < 5years 909 607 127 7 10 3,885 2,518 624 23 67

Table 5: Outpatient Statement, 2017 Age Group Male Female

< 1 604 580 1-4 965 859 5-9 268 309 10-14 224 239 15-17 145 599 18-19 124 869 20-34 1,444 5,401 35-49 1,120 2,045 50-59 529 577 60-69 446 447 70 & above 402 329 6,271 12,254

Table 6: Inpatient Statement, 2017 Age Group Admissions Discharges Deaths < 1 738 682 52 1-4 1,036 1,018 47 5-9 203 189 9 10-14 96 93 2 15-17 166 169 2 18-19 180 155 1 20-34 1,151 1,111 28 35-49 592 570 33 50-59 184 189 8 60-69 166 159 7 70 & above 180 164 14 4,692 4,499 203

St. John of God Catholic Health Services 43 /// Annual Report 2017

Table 7: Outpatient Morbidity, 2017 No Disease Conditions Percentage of Total Visits 1 General Medical conditions 80% 4 Reproductive Tract Infections 9% 3 Obstetrics &Gynaecological conditions 7% 2 Other Specialized conditions 3% 5 Accidents & Injuries 1%

Table 8: Inpatient Morbidity, 2017 No Disease Conditions Percentage of Total A dmissions 1 General Medical conditions 96% 2 Other Specialized conditions 3% 3 Accidents & Injuries 1%

St. John of God Catholic Health Services 44 //// Annual Report 2017

Table 9: Laboratory Activity, 2017

LAB AREA TYPE OF TEST NUMBER OF TESTS Biochemistry Albumin 22 Amylase Test 11 Calcium Ca2+ 0 Chloride Cl- 39 Cholesterol 20 Creatinine 109 D. Bill 31 Potassium K+ 40 SGOT/AST 105 SGPT/Alt 93 Sodium Na+ 39 T. Bill 31 Total Protein 31 Triglyceride 11 Urea 109 Uric Acid 24 Biochemistry Total 715 Hematology Blood transfusion (Adult) 553 Blood transfusion (Children) 1,312 B. Time 36 Blood Type 4,612 C. Time 28 ESR 17 FBC 2,647 Glucose 2,483 HCT (Hb) 6,926 Sickle Cell 245 Hematology Total 18,859 Microbiology Antibiogram 73 CSF 0 Culture& Sensitivity 73 Gram Stain 135 Other 0 Siemen Analyses 54 Sputum For AFB 690 Utheral Smear 4 Virginal Smear 135 Microbiology Total 1,164

St. John of God Catholic Health Services 45 /// Annual Report 2017

Other tests Malaria Smear 4,872 RDT 3,698 Others tests Total 8,570 Parasitology HCG/PT 505 Skin Scrapping 16 Skin Snip 98 Stool R/E 399 Urine R/E 2,216 Parasitology Total 3,234 Serology/Immunology H-Pylori 1,089 Hepatitis B 4,280 Hepatitis C 2,817 HIV Test 4,064 Others 12 PSA 17 VDRL/RPR 3,756 WIDAL 4,167 Serology/Immunology Total 20,202 Grand Total 52,744

Table 10: Scan Activity, 2017

No. Category Number of Scans 1 Obstetrics 791 2 Gynaecology 797 3 Abdominal 650 4 ECG 26 2,264

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Table 11: X-ray Activity, 2017

No of Tests Type of X-ray Number

1 Chest/Ribs 932 2 Lumber/Sacral 218 3 Pelvis 197 4 Knee 142 5 Femur 86 6 Shoulder 77 7 Leg 73 8 Skull 60 9 Ankle 52 10 Elbow 45 11 Foot 45 12 Wrist 33 13 Hip 19 14 Cervical 16 15 Sinuses 14 16 Humurus 13 17 Forearm 12 18 Hand 12 19 Hysteronosalpingography 11 20 Abdomen 8 21 T/Spine 8 22 Clavicle 2 23 Jaw 2 24 Arm 2 25 Limb 1 26 Lumber 1 27 Mandible 1

Table 12: Maternal Health Data 2017 No Category Number 1 Antenatal (New pregnancy) 1,315 2 Antenatal (Old Pregnancy) 1,491 3 Post Natal Clinic 268 4 Fresh Still Birth 19 5 Macerated Still Birth 44 6 Normal Deliveries 425 7 C/S Deliveries 278 8 Maternal Death 10 9 Maternal Death Audited 10 10 Abortion Complication/EOU 39 11 Twin Delivery 42 12 Promotion Centre 1,315

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Table 13: Surgical Procedures, 2017 No. Specialty Number of Cases 1 General Surgery 242 2 Orthopaedic 155 3 Obstetrics and Gynaecol- 378 ogy 4 Other Major surgeries 8 5 Minor surgeries 73 856

Table 14: Immunization Returns Vaccine Description Number BCG 698 Measles 255 1st– 322 2nd– 457 3rd– 294 OPV At birth – 697 1st– 430 2nd– 286 3rd– 183 Yellow Fever 301 Pregnant Woman 143 1st– 331 2nd– 133 3rd– 90 4th– 0 5th– 0 Tetanus toxoid 1st– 31 2nd – 1 3rd – 0 4th– 183 5th– 157 P.C.V 1st– 430 2nd – 396 3rd – 333 ROTA 1st– 279 2nd – 332 3rd – 38 Vitamin A blue 121 Vitamin A Red 43

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Theater Bed (Funded by General Curia, Rome)

Anaesthetic Machine Funded by HospitaalBroeders, (Funded by General Curia, Rome) Netherlands

Digital X-ray Machine Blood bank - Biosafety Cabinet - Funded (Funded by General Curia, Rome) Funded by Probita by Probitas St. John of God Catholic Health Services 49 /// Annual Report 2017

St. John of God Catholic Health Services 50