District Council Health Profile

MKALAMA DISTRICT COUNCIL

DISTRICT COUNCIL HEALTH PROFILE

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FOREWORD The District Health Profile (DHP) offers insight into district health conditions by assessing priority health indicators that reflect the district health status of the population, status of health systems, and status of health service delivery. The DHP also tracks the progress in the district and highlights some of the challenges and successes the district has encountered.

The DHP offers information through a reliable and transparent platform. It allows district health officials to monitor priority disease trends and adequately target relevant interventions. It helps the Ministry of Health, Community Development, Gender, Elderly and Children to determine what policies are needed to support work in the district, and in turn how to allocate resources to district efforts. It educates and empowers district health workers and in turn the community they serve.

The District Health Profile (DHP) is a like mirror that enables the District to know what is prevailing in the area, its causes and what measures can be taken to grab the problems. The profile also allows the District to budget and allocate the resources based on the magnitude of the problem or disease.

DHP is an essential tool for monitoring and evaluating the implementation of programs and knowing the impact of health interventions. Through observing the trend of diseases covered in this DHP document, it will be easy to note the success and failure of the efforts ever tried to alleviate or control the problems prevailing in the entire community.

It is our expectation that planning of health related interventions for the control of diseases as well as health problems other than diseases in Mkalama DC this tool will be used at all levels starting with the community up to Council level. We are also expecting to see more attention in relation to resource allocation be given to health problems seem to have more effects or impact to community health as noted in this document.

Since this is a continuous process, this document will act as a base for the next year planning and assessment of various interventions implemented in the district.

DHP document will also give room for the researchers to look for the causes of the rise and fall of disease trends and recommend on measures to be taken by various levels basing on the findings. The District is therefore expecting to see Development partners to use this DHP document as a guide for their interventions on various health issues found in Mkalama District Council.

ACKNOWLEDGEMENT Mkalama District Council Health Management Team (CHMT) acknowledges that the preparation of this DHP document could have not been successful, without the technical and moral support from different stakeholders. It is impossible to list all of them here. However, we should like to convey our special gratitude to the District Executive Director (DED) Mkalama, whose consent enabled our team to spare time for successful preparation of the document. We, should like to pass special thanks to Singida Regional Health Management Team(RHMT) for their great role of passing through the whole DHP document, giving relevant comments and adding significant inputs to enrich our profile.

We, also recognize and appreciate the contribution from different heads of departments including health facility in charges who spared time to provide Health Facility Reports required for compilation of this document. We recognize the solid commitment from multi-sectoral collaborators both at district and national level for their support in provision of health services.

Last, but not least in importance, we would like to express the concern of the Ministry of Health,Community Development,Gender,Elderly and Children (MoHCDGEC) and Presidents office, Regional Administration and Local Governments (PO-RALG) for their critical and constructive guidelines and policies which played a key role during development of the profile. The financial and material support from the government, council and different partners offered all necessary support during all exciting time of this work.

I would also like to extend my sincere gratitude to all stakeholders and partners in Mkalama Council who are involved in provision and promotion of Health Services. These include EGPAF, AMREF, SIGHT SAVERS, PSI, and HAPA, Marie Stopes and TASAF.

We believe that strength and team work in collaboration with different partners are important tools to improve the better health services provision in our community.

So thankful, we remain!

DR. DEOGRATIAS B. MASINI DISTRICT MEDICAL OFFICER MKALAMA DISTRICT COUNCIL

EXECUTIVE SUMMARY This District Health profile covers the introductory information of Mkalama i.e. geographical location of the area, size, population, health status and education status. The DHP deeply explains the common health problems dominating the community and the efforts done by the government to alleviate that conditions and diseases. It also covers the data collection and analysis methods and achievements observed in various aspects in meeting the health indicators covered in this DHP. The Health Indicators included in this DHP fall under the following areas:  Health Status of the Population: The health status of the population has shown improvement in terms of vaccination coverage, utilization of health services and improvement of health delivery services in health facilities.  Health Service Delivery OPD attendance rate in the facilities in the council. This is an indication of improved health service delivery  Progress in the Health Sector Progress in health financing, increased skilled health workers, progress in health facility coverage, improved referral services and progress in ANC attendance In this DHP outcomes in relation to control and management of diseases is noted covering: 1. Morbidity 2. Mortality 3. Reproductive health services 4. Immunization 5. Causes of deaths, 6. Causes of Inpatients 7. Human Resources for Health 8. Health Financing and Availability of Medicine 9. Progress in Health Sector 10. Best Practices

ACRONYMS AND KEY TERMS AIDS Acquired Immune Deficiency Syndrome AMO Assistant Medical Officer ANC Antenatal Care ANO Assistant Nursing Officer ARI Acute Respiratory Infection BCG Bacillus Calmette Guerin CHBG Council Health Basket Grant CHF Community Health Fund CHMT Council Health Management Team CHSB Council Health Service Board CO Clinical officer CSWO Council Social Welfare Officer DACC District Aids Control Coordinator DCCO District Cold Chain Operator DEHO District Environmental Health Officer DHS District Health Secretary DLT District Laboratory Technician DMO District Medical officer DNO District Nursing officer NTDs District Neglected Diseases DPLO District Planning Officer DPT-HB Diphtheria Peruses Tetanus- Hepatitis B DTLC District Tuberculosis/Leprosy Coordinator HBC Home Based Care HFGC Health Facility Governing Committee HIV Human Immune Deficiency Virus HMIS Health Management Information System ITNs Insecticide Treated Nets LGCDG Local Government Capital Development Grant MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children MSD Medical Stores Department NGOs Non-Governmental Organizations NHIF National Health Insurance Fund NTDs Neglected Tropical Diseases OPD Out-Patient Department 4

PLHIV People Living with HIV/AIDS PMTCT Prevention of Mother to Child Transmission PPM Planned Preventive Maintenance RCH Reproductive Child Health MDC Mkalama District Council STIs Sexually Transmitted Infections TB Tuberculosis UTI Urinary Tract Infection VCT Voluntary Counseling and Testing MMAM Mpango wa Maendeleo ya Afya ya Msingi FBO Faith Based Organization HRH Human Resource for Health

CHAPTER ONE

INTRODCUTION

Mkalama District Council is one among seven district forming Singida Region. Others are Singida District Council, Manyoni District Council, Itigi district council and Singida Municipal Council, Iramba District Council and Ikungi District Council. Location of the District Council The council is situated in the North of the region between latitudes 4° and 4.30° South of the Equator and Longitudes 34° and 35° East of Greenwich Meridian. The district is divided into three major zones, the eastern low land and the central – lowlands. The central zone is covered with hills and plateau with an altitude of 1,000m to 1,500m above sea level, with sandy loam soils. The eastern zone comprises at lowlands along the Great Rift Valley with scattered hills with red, black and sandy loam soils. It mounts an altitude of 1,000m to 1,500m above sea level.

Mkalama is bordered by Singida District Council in the South and South East, Hanang District Council in the East, Mbulu and Karatu District councils in the North and North – East, Meatu and Shinyanga district Councils in the North West and Iramba district Council in the West. There are 3 existing divisions, 17 wards and 70 registered villages.

Council Vision and Mission Statement

Vision: An educated, healthy and accountable society committed to sustainable socio–economic development by 2020.

Mission Statement: Participation of the community and all other stakeholders in quality services delivery through good governance and efficient utilization of available natural resources.

District Background Mkalama District Council was established in July 2013 having divided from the former Iramba district council into two independent district councils namely Mkalama and Iramba.

Mkalama District Council has a total area of 3365.9 square kilometers out of which 29,408 Ha(297.08 km2) are covered by water bodies leaving a land area of 3068.82 Square kilometers, of these 1480.99 square kilometers are arable land and 30,356 Ha(303.56 km2) are forest reserves.

The District aims at alleviating poverty and improving the quality of life of the people in the District. Its Mission is to promote and facilitate investment that will harness the rich and diverse unexploited resources found in the District in order to bring about economic and social development. Optimum utilization of the available resources in Mkalama District for wealth creation and raising the standard of living other people in Mkalama District, Singida region and Tanzania as a whole by the year 2025’.

Administration: Mkalama District Council is within Singida Region and Nduguti is the district headquarters located 75 kilometers away from Singida Municipality. It is has one administrative Parliamentary constituency zone known as Iramba Mashariki, 3 divisions, 17 wards 70 registered villages.

Geography:( nature, climate and season). Mkalama is situated in the North of the region between Latitudes 4o and 4.30o south of the Equator and Longitudes 34o and 35o East of GM. It covers an area of 3,328.65 square Kilometers of which 44.3% is arable land. It is bordered by Singida District Council in the South and South East, Hanang District Council in the East, Mbulu and Karatu District councils in the North and North – East, Meatu and Shinyanga district Councils in the North West and Iramba district Council in the West.

Mkalama District has only one rainy season which starts from November and ends in April next year. The Annual Rainfall ranges between 500-800mm. Transport: The district has a road network of total length 579.23 kilometers, 402.11 kilometers (69.43%) is accessible throughout the year that includes dry and rain season. The road network helps in transportation services which include transport of crops, the main source of income in the district and passengers. The road network is very important in the transportation of patients especially pregnant mothers who need referrals from remote areas to the health facilities. During rainy season about 47% of roads are not passable and vehicles have to divert to the longest route, which maximizes fuel consumption, contributing to tear and wear of vehicles and finally delay of referral services.

Telecommunication: There are telecommunication services provided by the TTCL, Vodacom, Halotel, Airtel, Halotel and TIGO companies. The coverage of the telephone network provides opportunity for the health department to strengthen the health management information system. The telecommunication network has a positive effect on consultation, reporting and referral system. There is also police communication by radio calls in all 3 divisions. Finally, the district is connected with one airstrip at Iambi Hospital. This airstrip is mainly used for medical emergencies, routine flying Doctors as well as political routes. However, there are currently no planes landing on the strip as major rehabilitation is required and improvement of security is essential for the safe landing of the planes. Availability of telecommunication network creates an opportunity to improve communication between lower and higher health facilities. Meanwhile health providers spent their own funds to communicate with the headquarters which is one among the factors contributing to delay of referral services. Although there are telecommunication services stated above, other important telecommunication Companies such as TTCL which provides FAX services and ZANTEL which provide cheap communication services. Water supply: The major sources of water in the district include unsafe and safe sources. The unsafe sources belong to rivers, lakes, swamps and damps. Only 40% of the population enjoys clean water from taps, springs and improved wells. The estimated distance from households to the sources of safe water is shown in the table below. Distance from the households to the sources of safe water Distance (meter) No of households % <400 2,941 39% 400-1000 26,991 36% >1000 18,744 25%

21.5% of the households access safe water above 1km. Long distance to the sources of safe water leads majority to find their own sources that are in most cases not safe. Unsafe sources of water are risky to the epidemics eruption and contribute to many incidence of water borne diseases. However, the CHMT has allocated some fund to ensure preparedness to medical emergencies including infection epidemics is maintained.

On other side only 52.2% of health facilities enjoy safe water from harvesting tanks and water tapes. Therefore, efforts to ensure availability of safe water by water harvesting tanks and improved wells are required so that to safeguard the population from epidemics. Electricity: There are two electricity networks (National grid) mainly along National highway from Singida to Mwanza region.The electricity for Mkalama District council has been distributed in district as it runs from Singida through Iguguno to Nduguti all the way to Ibaga and finally to the villages. This will provide an additional opportunity to access electricity power to especially for the population and health facilities alongside the highways. Out of 34 councils health facilities, 11(32.4%) enjoy the availability of National Grid whereby 23(67.6%) health facilities are installed with solar power. The electrical supply ensures availability of quality health services as most of laboratory equipmentm need electrical power for investigation, facilitating delivery and other emergence services especially during the night and also minimizes cost for frequent refilling cylinders with natural gases for storage of vaccines.

Road Infrastructure

The district has a road network of total length 579.23 kilometers, 402.11 kilometers (69.43%) is accessible throughout the year that includes dry and rain season The road network is very important in the transportation of patient’s especially pregnant mothers who need referrals from remote areas to the health facilities. During rainy season about 47% of roads are not passable and vehicles have to divert to the longest route, which maximizes fuel consumption, contributing to tear and wear of vehicles and finally delay of referral services. There are telecommunication services provided by the TTCL, Vodacom, Halotel, Airtel, Halotel and TIGO companies. The coverage of the telephone network provides opportunity for the health department to strengthen the health management information system. The telecommunication network has a positive effect on consultation, reporting and referral system. There is also police communication by radio calls in all 3 divisions. Finally, the district is connected with one airstrip at Iambi Hospital. This airstrip is mainly used for medical emergencies, routine flying Doctors as well as political routes. However, there are currently no planes landing on the strip as major rehabilitation is required and improvement of security is essential for the safe landing of the planes. There are two electricity networks (National grid) mainly along National highway from Singida to Mwanza region.The electricity for Mkalama District council has been runs from Singida through Iguguno to Nduguti 9

all the way to Ibaga and finally to the other villages. This provides an additional opportunity to access electric power to especially for the population and health facilities alongside the highways. Out of 34 council’s health facilities, 11(32.4%) enjoy the availability of National Grid, whereby 19(55.8%) health facilities are installed with solar power whereby 4(11.7%) health facilities are disadvantageous with neither national Grid no Solar power. The electrical supply ensures availability of quality health services as most of laboratory equipment’s need electrical power for investigation, facilitating delivery and other emergence services especially during the night and it also minimizes costs for frequent refilling cylinders with natural gases for storage of vaccines Socio-economical situation with gender perspective: among major ethnic groups includes Agro- pastoralists, Nomads and Hadzabe. The largest ethnic group is Agro-pastoralists (The Nyiramba, Nyisanzu and Nyaturu) followed by Nomads (The Sukuma and Barbaigs) and Hadzabe who practices primitive hunting. The life style for Nomads and Hadzabe is a challenge to the health system, since it involves mobility from one place to another; therefore it is hard to reach this kind of communities. Nomadic life maximizes costs for maternal and child health especially maintenance of mobiles and outreach immunization services. Main economic activities: The national income depends mainly on agricultural and farming activities. A low rain season affects productivity of both cash crops and food crops, therefore contributing to poverty which on the other side affects health financing.

CHF coverage: The coverage of CHF in 2017 was 52%. The CCHP aims at raising the coverage from 52% -61 % by June 2018. Adequate coverage of CHF is vital as it enables vulnerable community to access and afford health services at less cost.

Among major economic activities includes Agriculture, animal husbandry, Mining and Quarry, Fishing and Lumbering. Mining and Quarry which are mainly small scale activities. The mining sites attracts many mobile groups from different regions. Mixed mobile groups deserve attention in order to access health services especially health information on HIV/AIDS and STIs. This plan will allocate funds to facilitate provision of health education by the regional cinema vehicle, counseling and testing for HIV, distribution of condoms and STI medicines.

Education (literacy rate): According to the information available at the district planning office the literacy rate in 2012 was 75%. Low literacy rate is a challenge to the health systems since it affects the uptake of health information and interventions. Population: According to the population projection from the National Census, the population by 2012 at Mkalama stands at 208,772 and the growth rate is 2.7%. The council has birth rate of 6.5% and TFR of 6. The population is challenged by infant mortality rate which remained at 1/1000. During every financial year plan CHMT allocate funds in order to facilitate family planning mobile services and immunization coverage. Community Involvement: There are two structures available to ensure community involvement in provision of health services. These structures are the community health service board (CHSB) and health facility governing committees (HFGCs). Mkalama has full coverage of CHSB and HFGCs.

Mkalama District Council Divisions, Wards and Villages Distribution There are 3 divisions in Mkalama District Council namely Nduguti, Kirumi and Kinyangiri. Nduguti is the most populated division which contains 1/3 of the total population. Generally, Kirumi is an isolated division compared to other divisions. Therefore, it needs more attention in respect to the allocation and distribution of health resources.

Table: 2 Wards and Villages: Ward names number of villages/streets 1. Kinyangiri 4 2. Kikhonda 3 3. Msingi 5 4. Iguguno 3 5. Tumuli 3 6. Nduguti 4 7. Miganga 4 8. Ilunda 4 9. Kinampundu 3 10. Mwanga 6 11. Nkalakala 3 12. Gumanga 5 13. Ibaga 5 14. Nkinto 5 15. Mpambala 4 16. Mwangeza 6 17. Matongo 3 Total number of wards 17 Total no. of villages 70

CHAPTER TWO

PROVISION OF HEALTH SERVICES IN MKALAMA DISTRICT COUNCIL

Health Facility Distribution

Mkalama District Council has 34 Health Facilities of which 1 is a Hospital owned by Faith Based Organisation, 4 Health Centres where by 3 are owned by the Government and 1 owned is owned by Faith Based Organization(FBO). There are 29 Dispensaries among which 24 are owned by the Government while 4 are owned by a Faith Based Organization and 1 in under private ownership.

Table 1: Health Facility Distribution by type and ownership

Type of facility Number of facilities Ownership Hospital 1 FBO Health center 4 3 Government 1 FBO Dispensary 29 24 Government 4 FBO 1 Private Clinics 0 -

Total 34 -

Tabla 3. Names, type, ward, location and ownership of Health Facilities SN NAME TYPE WARD OWNERSHIP 1. Iambi Lutheran Hospital Hospital Ilunda FBO 2. Mkalama Health Centre Ibaga Public 3. Kinyangiri Health Centre Kinyangiri Public 4. Kinyambuli Health Centre Nkinto Public 5. St. Agnes Mwanga Health Centre Mwanga Public 6. Nduguti Dispensary Nduguti Public 7. Iguguno Dispensary Iguguno Public 8. Nkalakala Dispensary Nkalakala Public 9. Ishinsi Dispensary Msingi Public 10. Ishenga Dispensary Kinyangiri Public 11. Ilongo Dispensary Ibaga Public 12. Ndala Dispensary Kinyangiri Public 13. Iambi Dispensary Ilunda Public 14. Ikolo Dispensary Mwangeza Public 15. Marera Dispensary Mwanga Public 16. Malaja Dispensary Nkalakala Public 17. Singa Dispensary Kinampudu Public 18. Munguli Dispensary Mwangeza Public 19. Mpambala Dispensary Mpambala Public 13

20. Mwangeza Dispensary Mwangeza Public 21. Nkinto Dispensary Nkinto Public 22. Chem Chem Dispensary Matongo FBO 23. Iguguno RC Dispensary Iguguno FBO 24. Kinampundu Dispensary Kinampundu Public 25. Isanzu Dispensary Matongo FBO 26. Dominiki Dispensary Mwangeza Public 27. Lyelembo Dispensary Kinyangiri Public 28. Mgimba Dispensary Gumanga Public 29. Gumanga Dispensary Gumanga Public 30. Miganga Dispensary Miganga Public 31. Ishenga Shia Dispensary Kinyangiri Private 32. Kikhonda Dispensary Kikhonda Public 33. Msingi Dispensary Msingi Public 34. Kirumi Dispensary Matongo Public

Fig.1 District map showing divisions, wards, roads and distribution of health distributions of health facilities.

Source: CCHP 2017/2018

CHAPTER THREE DATA SOURCES AND THEIR DATA COLLECTION AND ANALYSIS METHODS. Introduction Data used in the preparation and final development of this DHP was collected using HMIS whereby the main source was Health facilities and some data are from the community. The data are of health issues (diseases and services) i.e. Curative and Preventive from each facility and community. The data are analyzed by the aid of DHIS 2 software at district level. Also there some data which are collected through vertical programs, surveys and census. These data are used in preparation of various reports and interventions plans such as CCHP and Council Strategic Plan. Also these data have been used in preparation of this DHP.

Human Resource for Health (HRH) and Social Welfare: The Council has 197 skill mix Health Staffs which is 29.7% of the required 666 staffs. The shortage is in all cadres. There are 6(15.3%) clinicians out of 39, No pharmacist (0%) out of 1, 2(50%) health laboratory technologists out of 4 required. Assistant laboratory technologists are 14(51.8%) out of 27 required and Enrolled nurses are 50 (54.9%) out of 91. The shortage of these cadres is threatening the health service delivery especially at the community level, thus making difficulties in meeting sustainable development goals. During 2017/2018 financial year, the council expected to recruit 84 new health staff out of which 12 new health staffs were recruited by December 2017 as reflected in the table below; SN Cadre Number 1 Medical Officer II 1 2 Clinical Assistant 3 3 Assistant Nursing Officer 1 4 Clinical Assistant 3 5 Nurse II 2 6 Assistant Laboratory Technologist 1 . Also the planned activities make sure the health staffs appointed in the district are retained and attracted. These plans include, P4P, extra duty allowance in every month, transport like motorcycles, bicycles, availability of staff houses with solar systems or national grid electricity, promotions and upgrading courses e.t.c.

Health Financing

Health activities in the districts are funded by the following main sources of funds, these includes, Local Government block grants, Health sector Own sources (council funds) through CHF, NHIF and User Fee, Health Sector Basket Fund, community funds (Cost Sharing/CHF), NHIF, Health sector development Grants and donor funding. Donor provide fund for activities of interest but no activity is funded by more than one donor at a time. Currently, the main donor supporting health services is EGPAF which supports all activities related to HIV/AIDS transmission prevention in five health facilities.

CHAPTER FOUR

HEALTH SITUATIONAL ANALYSIS Table 1 Important Primary Indicators of Health Status DHS 2016 Indicator No of death No of death in Total No of deaths Rate in health the facilities community National District Maternal 0 0 0 556 0 mortality Infant 18 2 20 43 4.59 Mortality rate Neonatal 9 1 10 26 2.30 deaths rate Under five 40 3 43 67 9.88 mortality rate Total 67 6 73 Important health indicators in table 1 above reflect that there is a decrease in maternal mortality rate. This achieve is the result of improved health facility delivery. However, there is neonatal, infant mortality rates due to birth asphyxia, pre maturity complication, pneumonia and congenital malformation, malaria and diarrhea. CCHP always allocate resources that will help to reduce the deaths through providing health worker with proper management by using IMCI guideline.

Table 2: Vital Health Indicators Indicators National Region Council Total Population 51,557,365 1,551,766 209,958 Growth rate Birth Rate(%) 5.2 2.3 3 Children < 1 year 0.03 52,817 7,356 Children < 5 years 16.2 270,183 17.2% Women: 15-49 years 21 341,023 45,426 Young People(10-24) 32 30.6 31.4 Maternal Mortality ratio 556 109.6/100,000 0/100,000 Perinatal Mortality rate 39 13.6/1000 3/1000 Neonatal mortality rate 25 6/1000 2/1000 Infant mortality rate 43 7/1000 5/1000 Under Five Mortality 67 13/1000 1/1000 Number of elderly aged 1,657,206 54,854 7,356 60+(0.4%) MVC(10-125 of < 18 years 655,597 39,327 4,100 Permanent Toilet 2,339,476 47.1% 24% Table…..2 above reflects that the number of young people is relatively high. The group needs special attention which includes proper health care among other necessary interventions. More resources will be located in this plan so as to get adequate information from the community in order to address this special groups sucg as elderly, pregnant mothers and under five children as per government health policy.

Table 4: Inpatient admission and Deaths per Diagnosis (list the top 10 diseases depending on the prevailing situation in the district) S/N < 5 5+ years Total CFR in % Admissions Deaths Admission Deaths Admission Deaths M F M F M F M F M F M F Normal 0 0 0 0 0 5,326 0 0 0 5,326 0 2 0.04 Deliveries Malaria severe 194 160 3 6 227 364 2 2 421 524 5 8 1.38 Other 55 48 0 0 335 393 6 2 390 441 6 2 0.96 diagnosis Pneumonia 133 112 4 8 114 274 2 2 247 386 6 10 2.53 Emergence 0 0 0 0 0 246 0 0 0 246 0 0 0.00 surgical conditions ARI 26 20 1 1 20 52 1 0 46 72 2 1 2.54 Anemia 18 20 1 0 15 27 0 1 33 47 1 1 2.50 Cardiovascular 0 0 0 0 26 46 4 4 26 46 4 4 11.11 Diseases PID 0 0 0 0 0 42 0 0 0 42 0 0 0.00 624 520 11 17 851 7,044 19 17 1,475 7,564 30 34 0.04

Table 4 above reflects that pneumonis is a threat to the community for underfive where 245 were admitted. The table also shows that there are cases as the district does not have a council hospital. There is on FBO Hosptial in the district and most of the patients cannot afford high costs of treatment. The council is working in collaboration with FBOs to ensure affordable and good health service care is provided.

Table 5: Notifiable Diseases Diagnosis < 5 years Total 5+ Years Total M F Death CFR M F Death CFR Malaria 885 888 9 0.51 1,773 1,650 1,650 4 0.12 3,330 Typhoid 49 19 8 11.75 68 445 630 17 1.58 1,075 Dysentry 38 40 0 0.00 78 56 75 0 0.00 131 Rabid 2 3 0 0.00 5 11 13 0 0.00 24 animal bite Acute 0 0 0 0.00 0 0 0 0 0.00 0 flaccid paralysis Cholera 0 0 0 0.00 0 0 0 0 0.00 0 Relapsing 0 0 0 0.00 0 0 0 0 0.00 0 fever Measles 0 0 0 0.00 0 0 0 0 0.00 0 Neonatal 0 0 0 0.00 0 0 0 0 0.00 0 tetanus 974 950 17 0.88 1,924 2,192 2,368 21 0.46 4,560 Table 5 shows that Community data is a challenge as not all cases are reported to the district by the community health workers. Also some health facilities are managed by nurses who sometimes fail to make proper diagnosis and fail to conduct proper treatment. However, the council has been allocating more resources in its annual plan to equip health facilities with skilled health personnel and medical equipment and supplies for proper diagnosis and management of notifiable diseases.

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Table 6: Summary of Important HMIS Indicators showing the trend S/N Indicator 2015 2015 2016 1. OPD attendance(persons attending) 182,009 124,903 2. Outpatient attendance per health worker ratio 544 3,903 3. ANC new attendance rate(in %) 35 100 4. ANC clients receiving TT2+(in %) 87 87 5. IPT2(in %) 75 6. OPV 0(in %) 60 69 7. DPT-HB-HIB3 immunization < 1 year(in %)- 100 100 Pentavalent 3 8. BCG(%) 100 100 9. Measles (%) 100 100 10. Vitamin A Supplementation(in %) 40 38 11. Family Planning New Acceptance Rate(in %) 49 38 12. Percentage Births attended at health facility (%) 87 79 13. Percentage community delivery(%) 2 1 14. Percentage of health centres that provide basic EMoc 3 3 % 15. Percentage of FSB among reported births (in %) 0 0 16. Caesarian Sections per expected births (in %) 3 4 17. Number of maternal death per year of general 4 2 surgeries recorded 18. Number of TB cases diagnosed in the last 12 months 132 101 19. Percentage of TB cases treated successfully (%) 100 92 20. Percentage of TB cases cure rate(%) 100 58 21. Percentage of TB patients offered HIV testing(%) 100 97 22. Percentage of PLHIV screened for TB(%) 100 23. Percentage of under 5 deaths due to malaria(%) 1 0 24. Severe malnutrition rate(in %) 1 0 25. Moderate malnutrition rate(in %) 0 26. Percentage of low birth weight(in %) 2 1 27. No. of PLHIV cases recorded 1,500 28. No. of PLHIV patients on ARVs 1,006 29. HIV prevalence among pregnant women(PMTCT) 1 1 30. Prevalence of HIV among people tested through VCT 2 0 31. Prevalence of HIV among people tested through PITC 4 0 32. Prevalence of HIV among blood donors 1 0 Total 186,370 129,879

Table 6 above shows low coverage of OPV0 by 69% low coverage of family planning acceptance rate by 39%. In order to improve reproductive and child health care the council has allocated funds to develop intervention in order to address these problems.

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Table 7: Health and Social welfare training institutions, other institutions, initiatives and programs Health and Social welfare Other Initiatives Programmes training institutions institutions Iambi Nursing School Msingi NHIF CEDHA FDC CHF SIGHT SAVERS User Fee EGPAF TACOSODE for social development TB program supported by global fund Malaria CTC PMTCT Home Based Care Marie Stopes The council benefits from health training institution of Iambi nursing school by increasing the number of trained staff who perform their field and clinical practices at different health facilities resulting in reducing in the gap of human resources for health. Health care financing contributions through NHIF, CHF and USER FEE will improve quality of health care services in the district. Moreover support from different programmes will also contribute to equipment and supplies and staff update in knowledge and skills.

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Table :8 Community Based Initiatives(CBI) available in the Council Priority area CBI No of No of HFs No of Remarks CORPS covered villages available covered Medicine, medical equipment, medical and cIMCI diagnostic supplies management system VHDs(VHWs) 140 34 70 CBDAs of FP CBPM Maternal, Newborn and Child Health CBGM,Community Based Iodated 140 0 12 salt monitoring Community Based Malaria Control(CBMC) Community Based HBC 26 10 23 CBDOTS Community Health Agency(CHA) Communicable disease control CBHMIS/DSS Non-communicable disease control Mass medicine administration 0 Treatment and care of diseases of local PHAST,WASH 8 4 4 priority with the council Environmental health and sanitation Community Based ECD centres 140 34 70 Strengthening and Social Welfare and Social CHSB & HFGCs Participatroy 27 27 70 Protection Service Planning(O&OD) Health promotion TBAs & THs Total 481 109 249

Table 8 shows availability of CBI in the council. Proper management, coordination, monitoring and evaluation of health implemented activities will keep these initiatives active and strong thus improving health delivery in the council.

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Resource availability Human Resource for Health and Social Welfare requirement Personnel Type(Cadre) Staff establishment Gap identified Number of staff Number of staff required Surplus Deficit available

M F Medical Officer 2 1 5 - 2 Assistant Medical Officer 4 0 7 - 3 Nursing Officer 1 1 3 - 1 Assistant Nursing Officer Nurse 9 41 91 - 41 Medical attendant 6 55 51 10 - Clinical officer 6 1 14 - 7 Clinical assistant 5 3 14 - 6 Health laboratory 2 0 4 - 2 technologist Health laboratory assistant 8 6 30 - 16 IT Technician 0 0 3 - 3 Health Secretary 2 1 2 1 - Dhobi 0 0 9 - 9 Dental Therapist 0 0 3 - 3 Dental officer 0 0 3 3 Data Entry Operator 0 0 3 3 Assistant accountant 0 0 3 3 Biomedical Technologist 0 0 3 3 Assistant Social Welfare 0 0 3 3 Officer Assistant supplies officer 0 0 3 3 Assistant radiographer 0 0 3 3

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Assistant pharmaceutical 0 0 3 3 technologist Assistant Nursing Officer 7 19 8 11 - Assistant Medical Officer- 0 0 1 1 Psychiatrist Assistant medical officer- 0 0 1 1 Opthalomologist Assistant Medical Officer- 0 0 1 1 Anesthetist Cook 0 0 6 6 Environmental Health 0 0 1 1 Officer Health Laboratory 0 0 1 1 scientist Plumber 0 0 1 1 Electrical Technician 0 0 1 1 Accountant assistant 3 0 3 - - Accountant 0 0 1 1 Computer operator 0 0 1 1 Computer System Analyst 0 0 1 1 Medical Record 0 0 1 1 Technician Bio Medical Technologist 0 0 1 1 Economist 0 0 1 1 Opthalmologist 0 0 1 1 Radiographer 0 0 1 1 Technologist Radiology scientist 0 0 1 1 Medical Recorder 0 0 1 1 Pharmaceutical 0 0 1 1 Technologist Social welfare assistant 0 0 1 1

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Nursing officer 0 0 1 1 Nutritionist 0 1 1 1 Occupation Therapist 0 0 1 1 Optometrist 0 0 1 1 Assistant medical officer 0 0 1 1 dematologist Pharmaceutical assistant 1 0 27 26 Orthopaedic Technologist 0 0 1 1 Pharmacist 0 0 1 1 Physiotherapist 0 0 1 1 Radiographer 0 0 1 1 Security guard 0 0 1 1 Social Welfare Officer 0 0 1 1 Mortuary Attendant 0 0 1 1 Personal Secretary 0 0 1 1

3 MKALAMA DISTRICT HEALTH PROFILE

Category Type of vehicle Registration Date of station Used Condition number acquisition for(purpose) Vehicle Land Rover Tdi SM 4263 19/01/2013 Nduguti Ambulance Needs major repair Nissan Double DFPA 1445 11/09/2015 Nduguti Supervision and Needs major repair Cabin distribution Toyota Hard Top STK 83 20/10/2005 Nduguti Supervision and Needs major repair distribution Toyota Hard Top DFP 6097 02/06/2008 Nduguti Supervision and Needs major repair distribution Motor Cycle HON -DA DFP 2000 02/10/2016 Nduguti Supervision and Needs major repair distribution HONDA DFP 12562 10/10/2016 Nduguti Supervision and Needs major repair distribution HONDA XL DFP 4849 08/10/2004 Nduguti Supervision Needs major repair RANGER STK 3333 23/05/2012 Kinyambuli Supervision Needs major repair SUZUKI STK 3374 09/11/2001 Gumanga Supervision Needs major repair SUZUKI STK 3372 20/08/2003 Nduguti Supervision Needs major repair Vehicles/motor cycle and their uses

Item Available Good/Functioning Needs Repair Not Functioning Required Microscope 9 3 5 1 3 CD4 Machine 2 2 0 0 3 Blood Lancets 100 0 0 0 800 Biochemistry Machine 0 0 0 0 1 Hemotology Machine 0 0 0 0 1 Urinalysis strips(multi 1 1 0 0 2,400 Glucose in urine strips 0 0 0 0 1,200 Fridge 0 0 0 0 3

4 MKALAMA DISTRICT HEALTH PROFILE

Autoclave 0 0 0 0 3 Kidney dishes 5 0 0 0 92 Venous Blood collection 0 0 0 0 12 Application stick wood 0 0 0 0 16 Sterilizer 0 0 0 0 3 Table…above reflects the number of medical equipment available in health facilities. These medical equipment are very useful and facilitate provision of health services in the facilities. The council has been allocating enough funds as per guideline in it annual financial plans to help in the purchase of more medical equipment and distribute to all health facilities.

Council Best/Good Practices in the council

The council has maternal death to 0/100,000 maternal death during the financial year 2016/2017. The reason for this great achievement was due to the fact that all deliveries are conducted by skill health personnel. Moreover, in case of emergences referral services are enhanced where an ambulance carry those with emergence especially women who fail to conduct normal deliveries to higher health facilities.