Masaka Regional Referral Hospital Having started in 1927 as a treatment centre for World War I veterans, Masaka Regional Referral Hospital was elevated to regional referral status in 1996. Mugisha Ereazer, the principal Hospital Administrator says the hospital has a 330 bed capacity with an annual admission of 23,456 patients giving a bed occupancy rate of 90.6%. With the completion of a new mega hospital facility, the bed capacity is expected to increase to about 540 beds. The hospital's catchment is spread across eight districts ± Masaka, Rakai, Lyantonde, Lwengo, Ssembabule, Bukomamnsimbi, Kalungu and Kalagala, taking care of over two million people. The infrastructural capacity of Masaka regional referral hospital has been limited too. Masaka Regional Referral hospital offers all services expected of a regional referral health facility but also offers nutritional support for both children and adults. It also handles complicated paediatric and gynaecological cases including carrying out fistula repairs. It has also teamed up with MIFUMI ± a national NGO project ± to offer support to victims of gender-based violence from Burundi, Rwanda, the DR Congo and Tanzania. Being along the busy Mombasa - Kampala - Mbarara - Kigali Highway makes it the first point of call for patients mainly accident victims from Burundi, Rwanda, the DR Congo and Tanzania. Consequently , the hospital©s average daily contact with patients is about 2,000. At Masaka Hospital, the patients are very excited about how they are treated and now refer to the hospital as `Mulago'. The staff members are overstretched especially in the maternity ward. Up to 40 babies can be born in one night with 3 midwives on duty. Of the 40 babies born, 5 may be by caesarean. Patient feeding is one of the services highly appreciated by the patients. One of the patients said: ªI was taken to Mulago hospital in Kampala and for two days there was no one attending to me. My sisters removed me and we came to Masaka hospital. As soon as I arrived, they took me to theatre and when I woke up I was in the ward. I have been here for three weeks being fed by the hospital and am very happy. I even feel much better now. I will never, never recommend any one to go to Mulago in Kampala. I stay in Kampala and I will always come to Masaka hospitalº. This patient, according to the doctors, had an abdominal pregnancy and needed immediate attention they did. Consequently, the hospital's average daily contact with patients is about 2,000. But Mugisha says the hospital's staffing levels are still too low. According to the Ministry of Health's 1996 staffing norms for regional referral facilities, Masaka Hospital is supposed to have 303 medical personnel yet it has about 260 ± short by more than 40. However, the hospital has benefited from a recent wave of funding from the government that has facilitated a number of developments at the hospital. A number of facilities have been revamped. In the 2012/13 financial year, the hospital finalized the design of its 30-year Master Plan, which will help guide infrastructural development at the hospital. Support from donors such as USAID, JICA, Uganda Cares, TASO and UVRI has also been instrumental. Through JICA for instance, the hospital has acquired a new OPD unit, complete with modern theaters, fully equipped with the latest medical equipment. Additionally, the hospital has an electronic-medical records data base. Besides capturing the medical personnel's vital data of the hospital, it is now able to register every birth and death that occurs at the facility. Dr Florence Tugumisirize the hospital director says they have adopted the Rx Solutions for stores management system which is able to monitor drug stock puts electronically in all wards around the hospital. ªPaper-based records will soon be completely phased out at the hospitalº, she says. The hospital recently benefited from a donation of solar heaters by the Energy Ministry and management intends to procure more solar equipment for lighting so that it can reduce on electricity bills. In the 2013/14 financial year, they embarked on building a new maternity and children complex ± a four level structure to accommodate both mothers and children. Additionally, the hospital recently completed construction of a 54-unit housing complex and these are now fully occupied. Dr. Tugumisirize says negotiations are also underway with the University of Labore in Pakistan to start an imaging centre to provide Ct-Scan, MRI, Ultra-sound, among other services. Insert pictures of the records Store, Inside the hospital threater, OPD Deptmt & Accident Unit built with support from JICA, Staff accommodation Masaka Hospital©s New Complex Building Currently, Masaka hospital lacks a mortuary and uses one shared among the hospital, the police and the municipality. This has gotten the hospital into wrangles with especially the municipality when it comes to maintenance and equipping it. The mortuary officially belongs to the municipality and most often they dump dead bodies in it for days resulting into emission of foul smell that affects the hospital. Ironically, the mortuary attendant is employed by the hospital. The mortuary is also located a stone throw away from the mental health unit facility which often times force the mental health patients to escape from their unit. A hospital-based mortuary for Masaka Hospital is all that is desired. The mortuary that is being shared by Masaka Regional Referral Hospital, Masaka Municipality and the Police who bring especially accident victims Staff Accommodation Masaka regional referral hospital is not any different from the other regional referral hos pitals when it comes to staff accommodation concerns. Only 86 out of 296 staff members are accommodated in the hospital's poor structures as seen in the pictures below. Twelve of the accommodated staff members live in unipots. The rest of the staff members are in dilapidated single-room houses. The bigger number of the staff (229) rent houses in places far off from the hospital (up to 7km distance) due to high cost of house rent in the town. Owing to these circumstances, the hospital has embarked on an ambitious staff housing project to put up 45 housing units for staff. It is hoped that once this is completed it will be a good start towards solving accommodation problems for staff. The members of staff are optimistic about the new project and only hope that the hospital administration will complete the project soon to ensure some decent accommodation for them. According to one nurse ªonce I have a good house, I do not mind about salary increase because right now am spending a lot on rent and transport every day. It is too much to bear.º A proposed 45-Units staff estate for Masaka regional referral hospital. Source: Report of the hospital to Parliament of Uganda Channel of communication in the hospital Masaka Hospital is not very different from other referral hospitals. It too has unit committees and committee heads report to the Hospital management. The Hospital administration also has a good relationship with the District leaders who often communicate to them on any issue of interest. They work very closely with the media especially the radio stations in the areas. Outside every Hospital unit, one easily notices telephone numbers of the Hospital Director and Administrator for anyone who has an issue to call and get attended to. Suggestion boxes are also easily noticed outside every unit. Access to Essential Medicine Masaka regional referral hospital is well stocked and never waits for stocks to run out. They follow NMS quarterly delivery schedules promptly, and when releasing drugs from the store, they follow the ªfirst expiry, first outº and if expiry dates are the same, they use the ªfirst in, first outº system. The Hospital management is very particular when receiving drugs from NMS. They tend to send back what has been sent to them when not request for. Drugs are ordered electronically but the Hospital Director calls to make follow up after a request form has been electronically sent. The drug store at Masaka is well-built and spacious. Health Financing The inadequacy in health resources has made referral hospitals become creative by seeking health partners to assist them fund some unmet needs. This has enabled them to channel government allocations to necessary activities and services that cannot be funded by the health partners. For example Masaka hospital has partnered with many health providers to manage areas like eye defects, HIV/AIDS, support for safe motherhood, infrastructure and equipment, mwana mugumu malnutrition, open record electronic monitoring and training among other areas. As a result, Masaka hospital has been able to offer so much with so little to the extent that it is equated by the communities to Mulago National referral hospital because of the readiness of the hospital administrators and staff to provide services amidst the challenges of limited government funding. Furthermore, in Masaka, patient services take more share of the money for utilities. The Hospital has three generators serving the administration, maternity, accident and emergency wards. Five million of the hospital budget is spent on feeding patients monthly; drugs take 1.2 billion. Patient care takes 60 million annually. Part of the 2010/2011 budget was also spent on the staff hostel which is being co-funded by JICA. The hospital budget also caters for activities such as Admissions, Feeding inpatients, carrying out surgical and medical procedures, conducting ANC sessions and deliveries, health education sessions, immunization sessions, post mortem and Histo-pathological examinations of biopsies, ultrasound and x-ray examinations, taking and examining patient samples in the laboratory, referring and transporting referred patients, formulation of orthopaedic appliances, record keeping, data management and utilization, meetings, sensitization seminars including CPDs, advertising, procurement and payment for goods and services, payroll management, payment of staff allowances, maintenance of hospital assets and ensuring a clean conducive work environment.