Kumi Hospital - Ongino

KUMI HOSPITAL - ONGINO

“WE TREAT, GOD HEALS”

ANNUAL REPORT 2011 TABLE OF CONTENTS PAGE

TABLE OF CONTENTS : 2 ACRONYMS AND ABBREVIATIONS : 3 EXECUTIVE SUMMARY : 4 GOVERANCE : 5 ADMINISTRATION DEPARTMENT : 6 NURSING : 8 OPD : 9 ANC & PHARMACY : 10 ART CLINIC : 11 LABORATORY : 12 ORTHOPAEDIC : 14 PHYSIOTHERAPY : 15 NUTRITION UNIT : 16 MEDICAL SOCIAL DEPARTMENT / LEPROSY CARE : 17 FARM : 19 FINANCIAL REPORT : 22 HOSPITAL STATISTICS : 27 GRAPHS : 29

Kumi Hospital Annual Report 2011 Page 2 Acronyms and Abbreviations ART : Anti-Retrieval Therapy CBM : Christoffel Blinden Mission CP : Cerebral Palsy CTEV : Congenital Talipes Equino varus DTLS : District Tuberculosis and Leprosy Supervisor EDP : Essential Drug Programme FOAG : Farmers Overseas Action Group GLRA : German Leprosy Relief Association HIV : Human Immune Virus HMC : Hospital Management Committee HOD : Heads of Department I & D : Incision and drainage IOL : Intra ocular lens JMS : Joint Medical stores MSD : Medical Social Department NGO : Non-Government Organization NSSF : National Social Security Fund OPD : Out Patient Department PAF : Poverty Alleviation Fund PAYE : Pay as you earn PMTCT : Prevention of Mother to child Transmission. PPP : Post-Polio Paralysis PRS : Preventative and Rehabilitation surgery. TLMI : The Leprosy Mission International UPMB : Uganda Protestant Medical Bureau VCT : Voluntary counseling and testing. VVF : Vesico Vaginal Fistula.

Kumi Hospital Annual Report 2011 Page 3 EXECUTIVE SUMMARY

The year under review saw many huddles overcome and many challenges met and we thank the almighty God for his unfailing mercy and faithfulness.

We are forever grateful to our partners who have much faith in us and have taken great courage to continue supporting us despite our fragile situation at that time- indeed a friend in need is a friend indeed. All appreciation goes to  FOAG  CBM  Kumi Hospital Dutch foundation  Kyoga foundation

We also thank the visiting surgeons through the Kumi Hospital Dutch foundation (Dr. Ton, Bass and Carole), AMREF (Dr. Kirya, Wachira and Dr Davis) and Dr. Charles Viva for providing highly specialized services that our people would have not otherwise accessed.

The year was full of new beginnings. With open minds the Board of Governors and management team worked hard to begin the process of making a five year strategic plan. This plan will serve to help the hospital remain focused on progress in certain key areas. The support from CBM and UPMB was of a great help to the development of this document.

The key strategies in the next five years include; 1) KH Institutional Strengthening (Governance and Management) and motivating our human resources to depict a well governed/managed health facility with adequate resources and quality healthcare 2) Improved KH Clinical performance and service delivery to contribute to having a healthy population in a healthy environment by targeting the most vulnerable, stigmatized and disabled persons 3) KH improved relations and image within the local communities - “the community identifies with KH as their health facility” 4) KH institutional Resource Mobilization for sustainability; and improving the hospital financial management/ accounting/ procurement and records management systems 5) Develop new/ refurbish existing hospital infrastructure for improved quality of healthcare 6) Develop financial plan to meet the hospital medical, administrative and personnel needs

We are hopeful for a bright future in the event that these strategies are adopted over the next five years.

I therefore welcome you to look into the data, activities, achievements and challenges of the year under review.

Kumi Hospital Annual Report 2011 Page 4 Dr. Ruth Obaikol Medical Director Kumi Hospital

GOVERNANCE

Members of Board of Trustees

His Grace The Archbishop of CoU - Chairman AGM Mrs. Okiria Gladys Canon Thomas Mugoya Canon Pauline Magomu

Members of Board of Governors

Rt. Rev. Dr. Nicodemus Okille : Bishop of Bukedi Diocese : Chairman Rt. Rev. Patrick Gidudu : Bishop of Mbale Diocese Rt. Rev. Thomas Edison Irigei : Bishop of Kumi Diocese Mr. Sylivanue E. Isiagi : Nominee CoU Mrs. Wakumire Edith : Nominee Mbale Diocese Mrs. Emoit Salome : Nominee Bukedi Diocese Ms. Rose Ochom : Female Representative : District Health Officer Kumi Mr. Bataringaya Willy : CAO – Kumi Dr. Okia David : Medical Superintendent Ngora Dr. Ruth Obaikol : Medical Superintendent: Secretary.

Members of Appointments Board

Rt. Rev. Dr. Nicodemus Okille : Chairman Personnel Officer – Kumi Sr. Jane Edyegu (PNO) Kumi Dr. Ruth Obaikol : Medical Superintendent/Secretary Mr. Edmond Emokol Mr. Okula Charles

Finance Committee:

Mr. Sylivanus E. Isiagi : Chairman Dr. Ruth Obaikol Mr. Okula Charles Mr. Etiang D. : Secretary

Kumi Hospital Annual Report 2011 Page 5 Hospital Management

Dr. Obaikol Ruth : Chairman Mr. Okula Charles Mr. Etiang D. Mr. Emokol Edmond Obuku Sr. Odikor Margaret Ms. Isangu Rose ADMINISTRATION

Many of the difficulties we experienced in the previous year followed us into the year 2011 The normal functioning at the hospital continued though with difficulty. A lot of strain was still realized in the areas of Human Resource, Financing and Medical supplies. However, the later part of the year showed signs of positive recovery.

Routine meetings were held during the year as follows:- 1. Board of Governors Meetings - 2( with one board retreat)

2. Hospital Management meetings - 8

3. Heads of department meetings - 2

4. General Staff meetings - 3

5. Interested stake holders meetings - 2

Achievements  Energy Project was launched with the arrival of the Project Manager Mr. Ouke Dijkstra with his wife Hanneke Dijkstra as shown in picture below during the ground breaking ceremony of the ESCo office at Kumi Hospital.

Kumi Hospital Annual Report 2011 Page 6  Umeme bill of Shs. 71Million was paid with the help of the Government of Uganda and the Kyoga Foundation of Holland.

 Power was reconnected to the hospital.

 Renovation of stone/children’s ward was accomplished as shown in picture below.

Kumi Hospital Annual Report 2011 Page 7  15 Salaries (including 3 arrears of 2010) were paid.

 Donors continued to support the Hospitals namely

- The Dutch Foundation

- The Kyoga Dutch Fund

- FOAG

- Elspeth Robinson

- Rev. Benwell

 We managed to continue funding the training of the Orthopaedic surgeon and 3 Nurses.

 Our Gynaecologist Dr. Ntege completed training and resumed work.

 Auditing was carried out successfully for both 20009 and 2010.

 The Five year strategic plan was initiated.

Challenges  Staff attrition continued though at a reduced rate.

 Tightening in internal controls led to abrupt departure of Accountant, Cashier and Accounts Assistant leaving only one Senior accounts Assistant to manage the department.

 Reduced funding was received from our major donors CBM and none from TLMI creating difficulty in management of resources.

 Salary payments were irregular and unpredictable.

 The hospital continued running without the services of a Human Resource Manager and a Farm Manager because of failure to identify a competent farm manager and lack of resources to pay for a human resource manager.

 Though now reduced, the hospital still has a challenge of meeting 2 Months’ Salary arrears and backlog of NSSF and PAYE remittances.

 Staff houses are getting dilapidated and require urgent repair.

 Reduced support from Government, increased poverty levels among our Clients leading to inability to pay hospital bills.

Kumi Hospital Annual Report 2011 Page 8 Staffing During the year staffing levels reduced with the total staff at 170 broken down as follows:-  Doctors : 06 (one at School)

 Clinical Officers : 04

 Registered Midwife Nurse : 10

 Enrolled Nurse : 13

 Enrolled Midwife : 03

 Nursing Assistants/Aids : 23

 Laboratory staff : 05

 Ortho. Technicians : 06

 Orthopaedic Officer : 01

 Physio/Social Workers : 06

 Administrative Staff : 08

 Support Staff : 85

TOTAL : 170

Recommendations  Intensify public awareness on services offered by the hospital to improve utilization.

 Continue to lobby for increase in Government support both in funding and staffing.

 Enhance collaboration with other Agencies/Organizations both internal and external.

 Continue lobbying for funds to revamp the Farm.

 Increase utilization of Farm land by tree planting.

NURSING The department improved in the handling and management of patients and other clients. The Staff turnover reduced due to encouragement from the Management and payment of salaries. The department did perform to its full capacity as recent better health information and promotion messages dissemination. Out reaches services were regularly performed because of the assurance of the availability of PHC funding.

Kumi Hospital Annual Report 2011 Page 9 Staffing

Management has done a lot in improving the staffing levels in the department. This includes:- - Increase in number of Nurses and training and it continues to train and give professional development Continuing Medical Education Workshops and Seminars for Special service delivery points. - The friends of Kumi, UPMB and other Partners are hereby thanked for this immense contribution towards staff development.

Staffing levels

Table 1 Out Training PNO - 01 SNO (RCN) - 01 RN/MW - 03 RN - 08 RMW - 01 E/N - 08 E.M - 02 ECN - 16 04 02 N/Assistants/Aids - 25 02 Opth/Assistants - 03 Vaccinators - 02 TOTAL 70 05 02

The Vaccinators are not nurses but Community volunteers who were working with us. They have made a tremendous improvement to the PHC Component of the hospital work and improved more on relationship with the village health Teams and Community.

Support supervisors/visitors to the department The Department received a number of mentors from the Hospital, District and Ministry of Health and other Partners who contributed towards the improvement of health Care Delivery. The department also received a number of nursing students/Medical students from various Institutions who equally helped a lot in its activities as they also gained experience.

Achievements - Staff development through short courses and Workshops and others got Sponsorships for their Children through Kumi Hospital. - Staff motivation and a spirit of togetherness was achieved during the end of year Party. - Team work was also achieved.

Kumi Hospital Annual Report 2011 Page 10 - Some Nurses were recruited to lessen work load. Challenges - Inadequate number of nurses in the Ward to meet the demand. - There were some gaps in the Nursing skills and documentation of data. OPD The Out-Patient Department is a starting point for all Hospital departments. It is an area where patients are received and handled according to the severity of their sickness/conditions (triage). Deciding who to be managed as an Emergency (triage), who to be admitted to which ward and who to be managed as an Out-Patient. Activities  Receiving and recording patients  Health education  Diagnosis, Treatment and Monitoring  Referral to appropriate units for definitive care Achievements  Many staff attended workshops that helped in improving the way patients are handled  Two members of staff were deployed to OPD improving the staffing and efficiency Challenges  There is lack of equipment for examination; Bp machines, books  There is difficulty in transferring patients to the wards and to the sites of investigation because of lack of a mobile wheel chair.  Delays within the different functional units increasing waiting time  Challenges in storage as the cupboards cannot be kept under key and lock Recommendations  Avail equipment and books to aid diagnosis.  Improve on storage  Improve on staff efficiency at OPD

ANC  Health education talks to all the clients every morning  Pre test counseling and post test counseling for all pregnant women  HIV testing  History taking and examination  Providing mothers with ITN  Provision of drugs for PMTCT  Identification of complication of pregnancy and referring mothers appropriately  Attending to mothers post natally  Preparing patients and providing family planning

Achievements  There is an improvement in male involvement from 20% to 90 %  Provision of ITN has reduced the prevalence of malaria in women  Provision of ART services in the ANC has provided for an opportunity for holistic care for HIV patients hence instilling confidence in the health service

Kumi Hospital Annual Report 2011 Page 11 Challenges  Occasional Stock out of test kits Recommendations  There is need to develop a means of sustaining test kits.

PHARMACY Activities  Organizing the department  Placing orders early enough to prevent stock outs  To scrutinize the prescriptions in order to prevent stock outs  Dispensing in well labeled envelopes  Control drug flow right to the actual consumer who is the patients  Prevent irrational drug use  Prevent drug theft

Achievements  There has been improvement of rational drug prescription  Issue forms were designed and in use to monitor drug flow  Envelopes for dispensing were designed and now in use  The drug store was arranged and all the leakages were sealed Challenges  Adhering to pharmacy policy remains a challenge to many staff especially the procedures of ordering drugs  A few new leakages are starting to show with need of re sealing the roof  The student bills are not met this need to be clarified  There is delay in other OPD procedures making patients exit late. Recommendations  Discharge forms should be filled before the billing is finalized  The leakages should be sealed  The dispensing with envelopes should be sustained as it is presentable.

ART CLINIC

Activities  HIV counseling and testing  Comprehensive palliative care services +  Provision of anti- retroviral service  HIV AIDS prevention Achievements  More clients were tested compared to the previous year  Availability of ARVs for eligible clients  Improved and prolonged life of People living with HIV AIDS  Easier follow-up of clients due to availability of motor-cycles.

Kumi Hospital Annual Report 2011 Page 12  Assistance to the poorest of the poor in management of OIs and the transport facilitation. Challenges  High expectation by clients  Inability to fully investigate patients because they cannot pay.  Occasional stock outs of test kits and septrine  Lack of nutritional support for clients especially children

ART Clinic Output Activity 2009 2010 2011 No Counseled & Tested 4766 6051 2895 No +ve 302 241 128 Enrolled for HIV/AIDS Care 295 287 196 On ART (ARVs) 142 197 106 TB/HIV 42 49 35 TB/HCT 61 128 77 HBC/Home Visiting 177 177 134 CD4 Count 824 1109 633 PCR/DNA 166 180 145 ITNs-IRCU 12 388 228 PACE 0 0 406

LABORATORY Activities Clinical laboratory helping with diagnosis has six sections:  Hematology  Blood transfusion  Parasitology  Microbiology/ virology  Clinical chemistry  Serology Specimens for histology are sent to Mulago National Referral Hospital. Other specimens as for CD4 P.S.A. etc. are still on referral.

Laboratory Statistics for the year 2011 in comparison to 2010

Section 2010 2011 HB Est 9811 5663 ESR Est 2809 626 CBC Total 3810 597 Differential 3810 597 Haematology Film Comment 3810 597 Sickling Test Total +ve Total +ve 504 162 137 03 Bleeding & Clotting Time Est: 16 Bleeding & Clotting Kumi Hospital Annual Report 2011 Page 13 time Est:12 2010 2011 Grouped Total : 4846 2050 Blood Transfusion: 2844 1050 Transfusion Children 2610 605 Male Adults 97 156 Female Adults 137 289 B/S – mps Total +ve Total +ve 19710 9412 12916 4998 Microfiliria 16 00 23 00 Trypanosomes 19710 00 12916 00 Parasitology Stool Microscopy 873 58 1334 27 Modified ZN-stain 12 00 16 00 Concentration 443 21 349 06 Method

Celebral spinal Total Abnormal Total Abnormal fluid (CSF) 106 06 112 08

Urinalysis Total: 4956 Total: 2455 Clinical chemistry Protein: 639 Protein: -1335 Sugar: 1 Sugar: -04 Deposit: 388 Deposit: 750

Blood Sugar Total Abnormal Total Abnormal (RBS) 1778 34 2003 154 HCG (Preg. Test) 398 +ve: 34 402 +ve: 36 LFTS/RFTS 258 63 19 09 Sputum: ZN-stain Total +ve Total +ve 337 48 355 36 Skin scrape (F1) 2350 787 2650 802 Skin smear (Lep) 132 08 121 04 (BI & MI) Bacteriology H.V.S. Swabs 14 14 26 26 (Gram stain) Wound Swabs 123 63 19 17 (G/Stain) Culture/Sensitivity 04 04 00 00 RPR/VDRL 1796 13 1011 20 HEP.B 397 25 515 22 Serology WIDAL TEST 4180 120 2078 483 Brucella B.A.T 287 10 898 111 Rhematoid Factor 49 1 48 02

Kumi Hospital Annual Report 2011 Page 14 HIV TEST 4180 209 8822 370 Virology PCR/DNA 162 12 108 03 CD4 Samples 00 771 Male: 294 Referred Female: 477

ORTHOPEDIC WORK SHOP Activities  Fabrication and fitting of Orthopedics appliances  Repair of Hospital equipment. Achievements  Department received a new Orthopedics Technologist Challenges  Need for one carpenter to meet rising demands for Crutches and C.P. Chairs.

Output of Orthopedic Work shop

Section Appliances 2010 2011 Foot wear  Open Sandals 75 Pairs 84 Pairs  18 Pairs 03 Pairs  Plastazote 14 Pairs 19 Pairs  Orthopedic 252Pairs 268 Pairs Boots 21 Pairs 34  Shoe repairs  Shoe raise 71 66  Hospital equipment repairs S/TOTAL 451 474 Orthotics  AF0 Splints 334 283  KAFOS Splints 55 41  A.K Calipers 13 12 Kumi Hospital Annual Report 2011 Page 15  Knee Caps 14 28  T. Straps 05 04  Arch Supports 08 27  S.FABS 102 119  Lumber Corsets 11 22  Wooden 35 Pairs 59 Crutches 04 30 19 20  Wooden cane 13 27  Cervical collars 37 19  Hand Splints 11 19  C.P. Chairs 09 06  Head support 37 11  Corner seat 12 12  Wooden walker 126 31  Standing Frame 17 26  Splints Repairs 19 12  S.FABS Repair  Caliper Repair 130 135  Wheel Chair repairs S/TOTAL 988 1009 Prosthetics  Symes 11 06  Transtibial 55 29  Knee Disarticulation 28 20  Transfemoral 83 14  Prostheses repair 40 35 S/TOTAL 217 104 Grand Total 1677 1566

PHYSIOTHERAPHY

Activities  Outreach clinics  Managing surgical camps  Performing physiotherapy for patients  Offering social support for patients with disability Challenges  lack of adequate funding reduced the bulk of the much needed help  staffing was low Recommendations  There is need to re-establish support for the disadvantaged disabled children

Kumi Hospital Annual Report 2011 Page 16  As the new orthopedic surgeon comes the next year it is advisable to recruit a physiotherapist and an occupational therapist.

Summary of Patients seen in the Disability Outreach Clinic from January to December 2011

Adults Children

Male Female Total Boys Girls Total Grand Total Hearing 45 47 92 92 Impaired Cerebral Palsy 10 11 21 166 120 286 307 Epilepsy 61 53 114 200 224 424 538 No. of 144 185 329 1040 1067 2107 2436 individuals screened No. of 1040 107 2107 2107 individuals screened entering CBR services No. of 116 142 258 105 128 233 491 individuals screened referred to other services Leprosy 3 3 5974

Summary of Patients seen in the Rehabilitation department from January – December 2011

Adults Children

Male Female Total Boys Girls Total Grand Total Physiotherapy 8 3 11 114 104 218 229 Club foot 160 70 230 230 manipulation P.I.P & Gluteal 10 30 40 327 328 655 695 fibrosis Epilepsy 106 89 195 382 346 728 923 Fractures 42 32 74 74 Others 26 33 59 25 20 45 104 Cerebral Palsy 22 27 49 49 Cleft Lip and 14 12 26 26

Kumi Hospital Annual Report 2011 Page 17 Palates V.V.F 63 45 108 108 TOTAL 2438

Nutrition Unit This has been a most challenging year for the department but nevertheless, with the little/limited resources realized the department was able to provide initial feeds to malnourished children/patients. The department was rim by one staff (Social worker).

Activities - Feeding - Daily weighing (growth monitoring) - Health and Nutritional education/counseling - Playing therapy Recommendation - There is a need to extend nutritional education and counseling to the community for early diagnosis and referral of malnourished children to reduce on the complication of malnutrition.

Output of the Nutrition Unit

Type of PEM S T A T U S A T D I S C H A R G E Improved Died Escaped Transferred Total Number

Kwashiorkor 18 3 - - 21 Marasmus 53 1 - - 34 Marasmus 33 4 1 - 38 Kwashiorkor Total number of 94 8 1 - 93 Patients

Medical Social Department: Persons challenged by Leprosy M F TOTAL 1. At the beginning of the year 14 13 27 2. Total Counseled with Social problems 77 71 148

3. Run away 2 0 2 4. Discharges 46 44 90 5. Referrals to other facilities 0 3 3 6. Soaking of ulcer/ dry skin daily 29 7. Pending for resettlement 4 4 8 8. Those who died 2 3 5

HIV/Other Clients 1. PHA with Social Economic problems 1 21 22 (with 50 orphans)

Kumi Hospital Annual Report 2011 Page 18 2. Health Education talks Daily on microphone 3. Teaching sessions Once weekly to ART Clients

4. Meetings with Patients/attendants 31 (978 people attended)

NON MEDICAL/SUPPORT SERVICE DEPARTMENTS Activities Achievements Challenges Remarks Building and  Water Completion of the  Maintenance of Need to develop a maintenance distribution and renovation of stone the water maintenance -plan maintenance. ward system as  Electrical moving islands Maintenance keep blocking  Building the inlet to the maintenance pump in the  Compound rainy season Maintenance  The staff houses remain dilapidated in need of renovation Security  Guarding the Theft is reduced  Law staffing hospital  Lack of co- premises and operation with property the Police  Solving disputes Catering  Cooking Bakery is in use  Not all staff get section refreshments at work Main Store  Receiving (a) Weighing scale  Verifying and needs distributing rectification stock. (b) Leaking roof of  Carrying out the stores external stock (c) Lack of count with protective gears stock taking for the staff Committee Garage  Proving  Transport  Not having  This year transport Officer enough working has been  Maintenance of  Water in the tools better than the Air strip Garage.  Need to put the 2009 and using the  Putting right Compressor, 2010 Mower Tractor our vehicles. tyre aligning  We are  Our old Machine right going to

Kumi Hospital Annual Report 2011 Page 19 tractor  Fitting light in use all old working the depart is metal  Trailer needed works for working  Boots and income  Enough staff Uniforms are generation  Welding Solar needed stands for the Hospital  Covering up transport part without many break downs Pastoral  Devotions  Received  Office for the Ministry  Church services donation from Chaplain  Administering Rev. John  Transport sacraments Barnwell of  Expectations of  Ministering to 100 Plastic Clients during the sick Chairs Home visits  Home visits  Mother of Mr. Ouke gave 20 Come & Worship Books and 20 UYP Books  Mission Team came to evangelize within the Hospital

THE FARM

Resources: Ongino Farm is yet a small diary business project with a vision to operate for self sustainance and to raise supplement for Kumi Hospital support; both of which are not successful yet.

1. LAND RESOURCE: 1061 HA = 7 miles perimeter

2. STAFF: by December 2011 the Farm employed seven (7) staff on contract. Because of the financial problems the other four workers were retired off by October 2011. The post of Farm Manager has not yet been recruited.

3. CATTLE RECORD 31/12/11:

Kumi Hospital Annual Report 2011 Page 20 Mature cows: 20 Hc Jouner calves: 23 Hc Breeding bulls: 02 Hc Kenyan cows: 03 Hc Heifers: 01 Hc Calves born in: 05 Hc Steers: - Weaners: 11 Hc Total: 65 Hc

4. CATTLE HEALTH: Diseases experienced were: i) Foot and Mouth Disease (FMD) June-July 2011 ii) Cantagious Bovin Pleuro Phneumonia (CBPP): September-October 2011 iii) Ctall Sickness: mainly September-October 2011 iv) Anaplasmosis: experienced all the year through, but mostly when the Dip was under repair. v) East Coast Fever (ECF): experienced all the year through, but mostly when the Dip was under repair.

5. BIRTHS: 25 calves were born in the year out of which 7 males and 18 females.

6. DEATHS: 32 deaths were realized.

Herd Category of No. Of Causes of death cattle deaths Original + herds Calves 11 1 kicked by another cow 1 Persistent Respiratory Problem 3 Foot and Mouth Disease (FMD) 4 East Coast Fever (ECF) 2 Diarrhea - Weaners 6 Tick Bone Diseases (Gall Sickness + ECF) - Cows 2 Tick Bone Diseases (Gall Sickness) Kenyans herd Cows 13 1 cow: drowned in water trough 4 cows: Foreign Bodies/ plastic bags/ cloth pieces 3 cows: Contagious Bovine Pleura Pneumonia (CBPP) 4 cows: Tick Bone Diseases (Gall Sickness + ECF) 1 cow: Liver Problem (long suffered since arrival TOTAL 32 Hc

7. FREE OFFERS: 2 Heifers were given as free offers.

Date Category of cattle Client Kumi Hospital Annual Report 2011 Page 21 27.01.11 Weaner Heifer No. 108 To the son of BP. Ilukor for marriage 14.11.11 Weaner Heifer Pledge to the wedding of nurse Eunice Odeke

8. END OF YEAR PARTY 2011: one cow (no. 46) was slaughtered (sorted out from original herd)

9. SALES: The Hospital Management authorized the sale of five (5) cows of poor breed to raise money for Dip repair and payment of accumulated Farm staff salaries, unpaid by then.

10. ARTIFICIAL INSEMINATION: This was carried out on the 16.02.11 on eight (8) Kenyan Heifers with hope to boost the milk production; but unfortunately all these cows died.

11. TICK CONTROL: The full plunge Dip which was charged on the 15.03.11, with SYPERTIX Acaricude, developed failure by midyear after noted cracks. Attempts to repair was hindered and delayed when torrents of Oozing water rushed in and filled the Dip tank form underground. Tick control in the El Nino rains was done merely by spraying using foot pump, which was not effective. This resulted in high mortality rate for the year 2011. After eruption of Tick Bone Diseases and other complications especially in the Kenyan herd (Ayrshire Breed), very susceptive to Tick Bone Diseases.

12. VACCINES ACQUIRED: only two (2) categories of vaccines were received for the year 2011.

Date Vaccine No. Of livestock Remarks 20.01.11 FMD 80 Hc Later realized to be dead vaccine hence eruption of the epidemic June-July 2011 12.10.11 CBPP 90 Hc Successfully offered

13. MILK PRODUCTION: average 1360 liters per month

Month 2011 Milk in liters Cows milked January 1437.5 20 February 1685 25 March 1674.5 26 April 2316 26 May 2133 27 June 1405.5 27 July 910.5 21 August 1166.5 21 September 881 19 October 667.5 16 November 937.5 17 December 1104.5 13 TOTAL 16319

Kumi Hospital Annual Report 2011 Page 22 14. SOME OF THE PROBLEMS AND CHALLENGES EXPERIENCED:

i) Foreign cattle encroachers within the Farm pasture hence increasing Tick multiplication and chances of Tick Bone Diseases. ii) Irregular, unreliable sources and or none obtained cattle vaccines like FMD, CBPP (received), LSD, Brucellosis and ANTHRAX (non-received) gives chances to eruption of cattle epidemics within Farm stock. We need to observe routine mass vaccinations. iii) Absence of supplementary feeding – cattle stimulated to pick foreign bodies. iv) Paddocking (erection of fences) and maintenance not yet possible. v) Sometimes Farm suffers accumulated unpaid salary debts; and demoralized staff. Also the apparent salary scale is quite low. vi) Lack of skilled labour. Training opportunities lacking but necessary for developing the Farm. vii) Lack of enough financial support.

FINANCIAL REPORT 1ST JANUARY TO 31ST DECEMBER 2011

Brief highlights: In 2011 the accounts department carried out its activities well, despite reduced financing and reduced number of staff in the department. Financing of many hospital activities was a challenge with exception of programs funded by designated funds. We are grateful to our partners for supporting these programs. Fruitful discussions were held with CBM on the possibility of getting more finance support from the regional office.

Kumi Hospital Annual Report 2011 Page 23 During the year the department saw the departure of 2 staff resigning their appointments with the Hospital for better alternatives. This left the department with thin staff of 3 members: 2 senior officers and 1 volunteer. Computerized accounting did not take off as expected. The sage accounting package installed in 2010 could not be up graded to accommodate 2011 programs (data), consequently the department continued preparing its financial statements manually.

Source of income: During the year 2011 the major sources of funds included: CBMI (Christoffel Blind Mission International), PEPFAR (IRCU), Dutch Foundation, Kyoga Project, GLRA, Presidents’ office, FOAG, TDT, UPMB, user fees, own activities and other general donations. The total income realized in 2011amended UGX 2,106,758,215/= with grants/ donor support accounting for 71% (UGX 1,503,759,804/=) of the total revenue. Locally generated income realized UGX 602,998,411/= (29%). This shows that during the period financing of the activities heavily relied on donor & grants support. Thank you for the response of our partners to our plight for support to finance salary arrears 2010.

Expenditure: The major expenditure arrears in 2011 involved: salaries & wages, procurement of medical drugs and supplies, investment, fuel & oils and maintenance costs. The expenditure for the year is summarized as follows:

Details: UGX % (i) Salaries & wages 907,107,723 44 (ii) Investment 232,587,752 11 (iii) Maintenance 292,015,478 14 (iv) Medical drugs & supplies 226,322,660 11 (v) Transport (fuel & oils) 171,283,954 8 (vi) Administration 234,437,691 12 2,063,755,258 100

 Salaries & wages accounted for 44 percent of the expenditure during the period  Investment accounted for 11 percent of the expenditure - ESCo office was constructed - Stone Ward renovation done  The electricity line within the Hospital duly maintained and construction of new powerhouse  Settlement of electricity bill and maintenance of water pumps  Procurement of drugs and supplies

INCOME AND EXPENDITURE STATEMENT Note: This financial statement is not an audited report for financial year 2011 but a fair representation of the Hospital transactions throughout 2011.

INCOME UGX A DONATIONS/ GRANTS Kumi Hospital Annual Report 2011 Page 24 Christoffel Blind Mission(CBM) 157,379,612 PAF 313,176,358 PEPFAR (IRCU) 180,718,000 Dutch Foundation 181,893,000 Kyoga Project 472,150,150 Presidents’ office 50,000,000 FOAG 45,640,326 Global fund 27,481,584 Teso Development Trust(TDT) 6,868,251 General donations 36,135,023 UPMB 6,000,000 Lilian Fund 11,500,000 JOCS 4,584,000 GLRA 8,591,000 Nutrition Unit 1,642,500 Sub Total 1,503,759,804

B LOCAL SOURCES 1 User fees 568,366511 2 Orthopaedic sales 9,336,400 3 Bicycle park 1,008,700 4 Hire of vehicles 6,528,300 5 Patients bills recovery 1,138,000 6 Disposal of old assets 1,117,000 7 Rent 13,337,500 8 Training Hall Hire 2,166,000 Sub Total 602,998,411

GRAND TOTAL (A+B) 2,106,758,215

EXPENDITURE DETAILS UGX 1 Salaries & Wages 647,651,407 2 Retirement benefits 8,132,800 3 Drugs & medical supplies 197,864,920 4 Fuel & oils 78,731,700 5 Operation & Travel expanses 68,729,000 6 Telephone, fax & email 3,908,200 7 Publicity 3,220,000 8 Audit fees 22,318,600 9 Ledger fees 4,206,823 10 BOG and other meetings 21,034,050

Kumi Hospital Annual Report 2011 Page 25 11 Cleaning mat. 14,460,496 12 Staff uniform (medical & non medical) 2,381,000 13 Theatre supplies 2,513,000 14 Laboratory material 14,836,500 15 Patients welfare 2,653,100 16 Leprosy patients food 26,580,200 17 Nutrition Unit food 2,356,150 18 Orthopaedic materials 11,108,240 19 PHC support supervision 3,380,000 20 Theatre meals 9,879,000 21 Lilian fees 34,077,500 22 Renovation of Stone Ward/ Bathrooms 119,569,600 23 Construction of ESCo 109,900,152 24 Forestry 3,118,000 25 Staff training 15,730,500 26 Building repairs 20,001,400 27 Piped water system 19,365,550 28 House rent 900,000 29 Electricity 87,296,278 30 Electricity-maintenance line 163,952,250 31 Entertainment 13,519,972 32 Sports & Games 1,544,500 33 Salary Arrears - 2010 166,131,771 34 Staff party 4,822,500 35 Staff medication 12,802,000 36 Burial assistance 2,531,000 37 NSSF Arrears - 2009 15,255,241 38 Consultancy-Strategic Plan 7,717,500 39 NSSF Penalty 2,613,740 40 Stationary, postage & office 40,145,100 41 Plumbing materials 1,400,000 42 Insurance 257,000 43 Repairs vehicles 23,566,254 44 NSSF - 10% contribution PEPFAR 12,083,000 45 NSSF- 0% General Hospital 39,509,264 TOTAL 2,063,755,258

The summary of Income and Expenditure for the year ended 31st December 2011 is as follows:

A INCOME: UGX

Kumi Hospital Annual Report 2011 Page 26 CBM 157,379,612 PAF (Uganda Government) 313,176,358 PEPFAR (IRCU) 180,718,000 Dutch Foundation 181,893,000 Kyoga Project 472,150,150 President’s Office 50,000,000 FOAG 45,640,326 Global fund 27,481,584 Teso Development Trust TDT) 6,868,251 General donations 36,135,023 UPMB 6,000,000 Lilian Fund 11,500,000 JOCS 4,584,000 GLRA 8,591,000 Nutrition Unit 1,642,500 User fees 569,504,511 Own sources - others 33,493,900 TOTAL 2,106,758,215

B EXPENDITURE UGX 1 Salaries & Wages/ Training (Personnel costs) 907,107,723 Drugs & other medical 2 supplies 226,322,660 3 Administration costs 234,437,691 4 Capital/ Investment 232,587,752 5 Maintenance costs 292,015,478 6 Transport/ Travel costs 171,283,954 TOTAL 2,063,755,258

BALANCE C/F (Surplus) 43,002,957

Achievements In 2011 the department recorded the following achievements:

Fully settled the outstanding electricity bill of UGX 71, 272, 678/=. - Audit fees of UGX 22,318,600/= outstanding was fully settled. - Sky Pharmacy - medical drugs supplier was cleared the outstanding amount of UGX 8,956,250/=. - Significant reduction of salary arrears for 2010 from 257,940,957/= to UGX 91,809,186/=. - Regular procurement of drugs, stationary, food staff and cleaning materials was adequately facilitated. Kumi Hospital Annual Report 2011 Page 27 - Successfully carried out Audit exercise for 2009 and 2010.

Challenges - Financing for Orthopaedic activities remained a challenge as funds had not yet been approved by CBM. - Salary arrears for August - October 2010 and December 2011 could not be covered. - Computerized accounting package had not yet been installed for quick, timely and accurate processing of financial statements. - Departure of 2 senior accounts staff at the end of 2011 left the department with a small number of staff to cover the activities. - Settlement of the outstanding obligations UGX 483,831,875/= of the Hospital as on 31/12/2011 as below:

Name UGX JMS 17,175,337 Abacus Pharmacy - Mbale 19,531,900 NSSF Arrears 2009 & 2010 145,477,040 PAYE 115,009,363 JEFKKE Cleaners 18,379,600 M/s Aromait& Sons 450,000 Staff SACCO 8,789,000 Retirement benefits 21,538,780 Salary arrears (December 2011 inclusive) 136,183,855 Cyber webs 1,297,000 TOTAL 483,831,875

Kumi Hospital Annual Report 2011 Page 28 Appendix

Kumi Hospital Statistics

Table 2: In-Patient Admissions and Deaths

WARD YEARS 2009 2010 2011 Admissions Death Admissions Death Admissions Deaths STONE (Paediatric) 4313 69 5667 60 4088 46 OJIKAN (Surgical) 1983 34 5667 28 227 01 LAING (Female) 990 47 1717 17 792 14 BUSIMO (Male) 614 55 985 52 744 55 PRIVATE (Ndahura) 473 08 875 05 320 04 NUTRITION 185 16 542 06 154 11 MATERNITY 1839 06 185 11 1091 06 EYE 823 00 1723 00 447 00 REHABILITATION 532 00 879 00 1091 00 Total 11,652 235 13026 179 8073 137

Table 3: Maternity Year 2009 2010 2011 Admissions 1839 1723 1380 Referrals: In 441 141 346 Out 02 04 04 Deliveries 942 775 561 Normal Live Births 892 750 503 Caesarian section 216 309 216 Neonatal Deaths 02 03 18 Maternal Deaths 06 11 06 Lower Birth Weights N/A N/A 96

Table 4: ANC

Activity 2009 2010 2011 New Attendance 703 668 568 4th Attendance 96 110 101 IPT 2 783 452 00 PMTCT 477 288 00 +ve Mothers N/A 788 484

Table 5: Family Planning Method 2009 2010 2011 Oral 03 02 00

Kumi Hospital Annual Report 2011 Page 29 In Plant 00 00 22 Injectable BT Ligation 42 87 68 IUD 01 03 00 Vasectomy 00 00 01 Condoms Table 6: Immunization

Antigen 2009 2010 2011 BCG 1130 480 663 DPT-HepB+Hib3 523 560 456 Polio 3 523 560 513 Measles 515 400 462

Table 7: Immunization Pregnant Women Tetanus Toxoid 2009 2010 2011 TTI N/A N/A 340 TT2 N/A N/A 93

Kumi Hospital Annual Report 2011 Page 30 Kumi Hospital ANC attendance 2008 - 2011

800 771

703 700 668

600 568

0 2008 2009 2010 2011 years

Kumi Hospital Annual Report 2011 Page 31 Kumi Hospital in-patient Admission 2009 - 2011

14,000 13,026

12,000 11,652

10,000

s 8,000 t P

In-patients . o

N 6,000

0 2009 2010 2011 YEARS

Kumi Hospital Annual Report 2011 Page 32 KUMI HOSPITAL OPD ATTENDANCE 2007 -2011

30000 YEAR NO. OF PTS.

0 1 2 3 4 5 YEAR 2007 2008 2009 2010 2011 NO. OF PTS. 28,063 29,580 57,535 39,795 28,086

Kumi Hospital Annual Report 2011 Page 33 KUMI HOSPITAL MATERNITY DELIVERIES 2006 - 2011

1200 1,117

1000 978 952 942 912

800 775

600 DELIVERIES

0 2006 2007 2008 2009 2010 2011

Kumi Hospital Annual Report 2011 Page 34 HCT services kumi Hospital

5,000 2010 2011 4,000

0 Clients counseled Tested clients HIV + clients Confirmed with TB Started on CTX 2010 4,933 4,933 196 47 161 2011 7,802 7,824 247 19 206

Kumi Hospital Annual Report 2011 Page 35 Kumi Hospital Bed Occupancy 2008 - 2011

80% 76% 75%

50% 45% 44%

40% Bed Occupancy

0% 2008 2009 2010 2011

Kumi Hospital Annual Report 2011 Page 36 In-Patient death registered from year 2007 - 2011

299 300

250 235 h

a 183 e D

f I/P deaths o

N 150 138 124

0 2007 2008 2009 2010 2011 Year

Kumi Hospital Annual Report 2011 Page 37