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Working on Malaria Without Csos – an Experience of a DHO. Kiruhura

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Working on Malaria Without Csos – an Experience of a DHO. Kiruhura Working on Malaria without CSOs – an experience of a DHO. Kiruhura Dr. Zirabamuzaale Franco Caretaker DHO-Kiruhura DLG [email protected] 31st March to 2nd April 2009 Working on Malaria Without CSOs 1 at Hotel Africana, Kampala Presentation outline • Background • Administrative and Health structures • Demographics and Malaria burden • CSOs and NGO Activities 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Kiruhura District Map BUREMBA BURUNGA RWEMIKOMA KANONI KAZO KINONI KENSHUNGA KASHONGI ¯ KIKATSI NYAKASHASHARA Population Density Persons per Sq Km 16 - 21 KANYARYERU 22 - 35 KANYARYERU 36 - 43 SANGA 44 - 88 89 - 126 Water Body 0 5 10KM 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Background • Kiruhura District is one of the newly created Districts in Southwestern Uganda which was curved out of the former Greater Mbarara. Its now 31/2 years old still in its infancy and has a projected population of 260,794 people. It is a rural district with virtually no power and water. It is located about 240km from the capital city of Uganda, Kampala. • It has the biggest surface area of 4103.5 sq. km bigger than the 3 current Districts of Mbarara, Ibanda and Isingiro. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Climate and Vegetation • Average annual rainfall ………………………1000mm • Temperature : Range …………17deg C to 30 deg C • Bi-modal pattern of rain seasons…………Mid-August to November and March to May Vegetation • The District has Savannah Woodlands type of Vegetation with a wide cover of thorny shrubs. The district has little water bodies (Lakes; Kacheera and Mburo respectively with no natural forests. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Location • Kiruhura District lies in the cattle corridor in South Western Uganda. It borders with Ibanda and Kamwenge in the North West, Mbarara District in the West, Isingiro District in the South, Rakai District in the South East, Lyantonde District in the East, Kyenjojo and Sembabule Districts in the North and North East respectively. • The District headquarters are located in Kiruhura Town Council. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Administrative structures • Counties (HSDs)…………………………….2 • Sub counties ………………………………..12 • Town council………………………………..1 • Parishes……………………………………….59 • Wards …………………………………………3 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Health structures UNIT Number Name of Hospital 01 Rushere Community Hospital (PNFP) Health Centre 01 Kazo (Non IV functional) Health Centre 13 IIIs31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Health Structures • 2 HSDs- Kazo and Nyabushozi • 1 Hospital- Rushere Community Hospital • 1 Health Centre IV -Kazo HC IV (Not Functional) • 13 Health Centre IIIs-(2PNFPs, 11 Public) • 19 Health Centre IIs (F) and 4 Non- functional ones 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Demographics Category Population Total Population (A) 260,794 Women in child bearing age (B) 0.202 52,680 # of pregnant women (C ) 0.05 13,040 # of Deliveries (D) 0.0485 12,649 Children < 1yr (E) 0.043 11,214 Children > 5yrs (F) 0.202 52,680 Suspected TB cases (G) 0.003 782 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Morbidity due to Malaria - FY 06/07 70% 63% 59% 60% 60% 60% 58% 53% 52% 52% 53% 49% 50% 48% 47% 40% 30% Percentage 20% 10% 0% jul aug sep oct nov dec jan feb mar apr may jun Month 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Morbidity due to Malaria - FY 07/08 70% 59% 60% 58% 59% 57% 56% 53% 52% 53% 51% 49% 50% 48% 48% 40% 30% Percentage 20% 10% 0% jul aug sep oct nov dec jan feb mar apr may jun Month 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Morbidity due to Malaria - FY 08/09 70% 59% 60% 58% 56% 51% 51% 50% 46% 47% 44% 40% 30% Percentage 20% 10% 0% jul aug sep oct nov dec jan feb Month 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala IPT1 & IPT2 Coverages for FY 06-07 70% 60% 59% 60% 58% 58% 55% 55% 55% 54% 52% 52% 50% IPT1 50% coverage 46% (%) 40% 32% 32% 30% IPT2 30% 28% 27% 29% 28% coverage 25% IPT %age Coverage (%) 23% 21% 21% 19% 20% 10% 0% Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala IPT1 & IPT2 Coverages for FY 07-08 70% 67% 63% 61% 59% 60% 59% 59% 50% 51% 49% 49% IPT1 50% 48% coverage 46% (%) 40% 34% 33% 33% 30% 30% 29% IPT2 30% 27% 26% 26% coverage 24% 24% IPT %age Coverage (%) 21% 20% 10% 0% Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Month 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Summary of Basic Malaria Data • OPDs->59% are Malaria cases • IN-PTS: 06-07 FY……71% were Malaria cases of all admissions • IN PTS DEATHS: 06-07 FY….67% were due to Malaria of all Admissions • IN-PTS: 07-08 FY….50% Malaria cases of all admissions • IN PTS DEATHS: 07-08 FY….46% were due to Malaria of all Admissions 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala CSOs/NGOs ACTIVITIES • To date none is really active in the control of malaria. • Previously it was UPHOLD , PSI, AFFORD, EGPAF-for pregnant Mothers and a local NGO-Kaaro Rural Development Agency (Distributed LLINs to Buremba S/C) • UPHOLD was supporting the HBMF program in which about 1,000 (1,014) CMDs were involved. These active ones were able to treat 56% of U5s 05/06 FY and 52% of U5s in 06-07FY before project ended in 2007. • UPHOLD was also supporting Data collection and compilation; quarterly meets of CMDs with the Health workers and supervision of CMDs work. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Malaria Control Measures • Preventive/Promotive – Health Education – LLINs (CSOs) – IPT in pregnant women and HIV (MoH) Curative: Co-artem (MoH)-NMS We mainly depend on MoH for our support`for the essential medicines. We grateful but support is inadequate. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Critical challenges and Questions • Critical challenges and questions – Staffing levels vs disease burden – Staffing training (basic + CME) – Diagnosis both clinical and Laboratory – CMDs no longer active- no “HOMAPAK Coartem”. Think about the now jobless Community Doctor’s-CMDs – Drugs – insufficient supplies -> frequent stock-outs and high cost on open market 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala cont’d • Critical challenges and questions – LLINs (pregnant women, U5s, HIV, rest of population) • No. distributed(12,000) + current need. • Health education – Funding - Solely (only) from govt and not sufficient 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala cont’d • Critical challenges and questions – District covers a vast area -> difficulties in co- ordination – Sparse population -> difficult to reach with services – Homapak removed but no replacement provided yet (Expired Homapak still in stores awaiting disposal) 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala cont’d • Critical challenges and questions - continued – Low coverage (40%) for IPT II – VHTs are not well established – No or Inadequate research + minimal utilization of existing HMIS data 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Cont’d • Questions to challenge participants on their role – MOH • Policy supports establishment of HC III vs HC II but HC II more practical in vast area /sparse population (E.g Rurambira HC II manned by a N/Asst is about 40km from Nyakashashara HC III) • Funding – drugs/sundries, personnel, LLINs • DDT/IRS-when is the action? 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Cont’d • Questions to challenge participants on their role – UN agencies –WHO/UNICEF • Support data utilization and operations research • DDT/IRS • Human resource attraction and retention 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Cont’d • Questions to challenge participants on their role – NGOs/CSOs • LLINs • IRS 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Appreciation • The fight against Malaria is no simple one, however we wish to sincerely thank the Ministry of Health and our other development partners for the support rendered and continuing to accord us in the fight against this epidemic. “Akatono okayana kali munkwawa”- you argue while keeping under the arm pit that little you have already got. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala KIRUHURA TOO NEEDS YOUR SERVICES AND MUCH SUPPORT LIKE GULU!!! THANKS AND GOD BLESS YOU ALL. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala Service Need • These badly need your support. • After an Outreach for IMMUNISATION late in the evening in a place called Kitongore in Kanoni Sub county, Kiruhura District. 31st March to 2nd April 2009 Working on Malaria Without CSOs at Hotel Africana, Kampala.
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