ST. FRANCIS HOSPITAL MUTOLERE ANNUAL ANALYTICAL REPORT FOR THE FY 1st July 2014-30th June 2015. KEEP THE CANDLE BURNING AND PASS ON THE LIGHT Written by: Dr. Mugisha Jerome Medical Director/CEO. i ENDORSEMENT OF REPORT This annual analytical report for St. Francis Hospital - Mutolere covering the FY 1st July 2014-30th June 2015 has been prepared by the management of the Hospital. I endorse that it represents management’s views on the position of the hospital in the period under report. …………………………………………………. Dr. Mugisha Jerome Chief Executive Officer St. Francis Hospital - Mutolere Date………………………………….. This is to acknowledge that I have received this annual analytical report for St. Francis Hospital - Mutolere covering the FY 2014/2015. I have read it and endorse its authenticity and the representativeness of the position of the hospital in the year under report …………………………………………………….. Rev. Fr. Zeno Mbishinzimana Chairperson of the Board of Governors St. Francis Hospital –Mutolere Date………………………………………… ii LIST OF ACRONYMS 1. ALOS: Average length of stay 2. BOR: Bed occupancy rate 3. C/S: Caesarean section 4. CORDAID: Catholic organization for relief and development 5. EDP: Essential drugs program 6. FSB: Fresh still birth 7. HBMF: Home based management of fever 8. HC: Health center 9. ITNs: Insecticide treated nets 10. OPD: Outpatient department 11. PHP: Public health program 12. PNFP: Private-Not-For-Profit 13. SUOop: Standard unit of output, outpatient equivalents 14. UDHS: Uganda demographic and health survey iii ACKNOWLEDGEMENT I would like to acknowledge and recognize the contributions of the following individuals for the support rendered in the compilation of this 2014/2015 Annual Analytic Report. Mr. Pontius Mayunga (the Hospital Administrator), Mrs. Immaculate Asiimwe (The Human Resource Officer), Sr. Inviolate Baganizi (The Principal, Nurses’ &Midwifery Training School), Sr. Beatrice Kefuruka (The Senior Nursing Officer), Ms. Katto Justine (Co-ordinator Public Health Program), Mr. Tuyikunde Peter (Hospital accountant), Mr. Paschal Nsekuye (head OPD) and Ms. Winnie Nyiramugisha (responsible for palliative care services) and all ward/departmental in-charges for the various technical and moral support provided during and in the process of compiling this report. I wish to further appreciate the support the Board of Governors and its committees provide to the hospital management and staff which also enables us to continue service provision while fulfilling the mission of Christ’s healing ministry. I thank you very much. The immeasurable contributions of every member of staff, from cleaner, receptionist, student, up to the most senior members of staff are appreciated for it is because of all the individual efforts, aggregated together, that we see this institution’s efforts all focus on bettering the wellbeing of the common man. May you forever find pleasure in bringing smiles to all those persons that are afflicted by bad health. To our development partners, (including but not limited to Together for Uganda, Friends of Mutolere in Holland, Ministry of Health/GOU, UCMB, Kisoro district local government, Sustain for life (The Eurochange Charity), Humedica/Germany) and all others not mentioned here, many thanks for your generosity and big hearts. We sincerely thank you for your continued support for the poor and less privileged people. I pray we continue strengthening the existing cooperation so as to assure good quality health care, all in fulfillment of the mission of the Hospital. To our clients the patients, may you continue finding and experiencing healing whenever you utilize this facility. ………………………………….. Dr. Jerome Mugisha iv TABLE OF CONTENTS 1. Endorsement of report…………………………………………………………………………...................ii 2. List of acronyms……………………………………………………………………………………...................iii 3. Acknowledgement…………………………………………………………………………………………………. iv 4. List of tables………………………………………………………………………………………………………….. vi 5. List of figures……………………………………………………………………………………………………………viii 6. Important indicators and definitions…………………………………………………………………….. ix 7. Executive summary………………………………………………………………………………………………….xi 8. Chapter 1: Introduction…………………………………………………………………………………………..1 9. Chapter 2: The health policy and district health services………………………………………..5 10. Chapter 3: Governance and management……………………………………………………………….18 11. Chapter 4: Human resources for health…………………………………………………………………..23 12. Chapter 5: Finances…………………………………………………………………………………………………27 13. Chapter 6: Hospital activities……………………………………………………………………………………41 14. Chapter 7: Hospital support services……………………………………………………………………….65 15. Chapter 8: Quality and patient safety improvement……………………………………………...70 16. Chapter 9: Mutolere vegetable gardens project………………………………………………………73 17. Chapter 10: The nurse training school……………………………………………………………………..78 18. Chapter 11: Hospital projects…………………………………………………………………………………..82 v List of Tables Table 1: Demographic data for the catchment area compared to HSD, District and Uganda (Source: UDHS). Table 2: MCHC activity indicators at Mutolere hospital compared to HSD, district and country FY 2014/15. Table 3: Data of HCT coverage for the year 2014-2015 Table 4: Detailed MC H activities for the FY 2014/15: Table 5: Table indicating Number of OVC supported. Table 6: Table indicating performance in CCMB activities for the year 2014- 2015. Table 7: Hospital compliance with statutory requirements Table 8: Disaggregated staff data FY 2014/15 Table 9: Hospital Budget against actual income for FY 2014-2015 Table 10: Trend of hospital Income over the last 5 years Table 11: Hospital expenditure for FY 2014/15 compared with the previous year. Table 12: Hospital expenditure categories over 5 years Table 13: Average User Fee per SUO Op Comparisons from 20109/10 FY through to 2014/15 FY Table 14: Average Expenditure per SUO Op Comparison from 2010/11 through to 2014/15 Table 15: Hospital liquidity Table 16: Utilization of the OPD for the last 5 years. Table 17: Mutolere hospital OPD diagnoses FY 2014/15 Table 18: Current palliative care staffing Mutolere hospital Table 19: Palliative care cases attended to in FY 2014/15 Table 20: Ophthalmology cases for the year Table 21: HIV/AIDS counseling and testing activities FY 2014/15. Table 22: IPD utilization for the year 2014/15 Table 23: Morbidity patterns 2014/15 Table 24: Mortality patterns for FY 2014/15. vi Table 25: Admissions and deaths per cause FY 2014/15 Table 26: Fast moving items at Mutolere hospital FY 2014/15 Table 27: Expiries for FY 2014/15 Table 28: X-ray report 1st July 2014 – 30th June 2015 Table 29: Laboratory activity report in table form (FY 2014/15). Table 30: Quality indicators for the period for 2014/15 with comparisons for two previous years and projections for 2015/16. Table 31: Hospital gardens project results by objectives for FY 2014/15 Table 32: Enrollment and Performance of Mutolere school of Nursing and Midwifery vii List of Figures Fig 1: Graph showing the trend of attrition of Clinical Staff for the last five years. Fig 2: Reasons for attrition of clinical staff Fig 3: Graph showing an analysis of the employment cost of the total recurrent costs for the past five years. Fig 4: Proportionate contribution of income sources to the hospital in FY 2014-2015 Fig 5: Proportionate contribution of User fees to total income in 5 years Fig 6: Proportionate contribution of PHC conditional grant to total hospital income in 5 years Fig 7: User fees plus PHC CG per SUOop and total recurrent costs per SUOop compared over a 5 yr period Fig 8: Contribution of different expenditure lines to total hospital expenditure Fig 9: Employment costs and costs of medical goods and services as % of total hospital costs Fig 10: OPD trends in the last 5 years viii IMPORTANT INDICATORS AND DEFINITIONS 1. Inpatient Day / Nursing Day / Bed days = days spent by patients admitted to the health facility wards. 2. Average Length of stay (ALOS) = Sum of days spent by all patients/number of patients = Average length of days each in-patient during each admission. The actual individual days vary. 3. Bed Occupancy Rate expressed as % = used bed days/available bed days = Sum of days spent by all patients/365 x No. of beds =ALOS x No. of patients/365 x No. of Beds 4. Throughput =Average number of patients utilizing one bed in a year =Number of patients/no. of beds 5. Turn over interval =Number of days between patients = (365 x no. of beds)-Occupied bed days/no. of patients 6. FSB (Fresh Still Birth): This is a baby born with the skin not peeling / not macerated. The fetal death is thought to have occurred within the 24 hrs before delivery. However it is important for us to know the trend of deaths of fetuses actually occurring in mothers who have arrived already in the hospital (Fetal heart sound heard on arrival). For this purpose we shall monitor FSB in total as well as FSB of fetuses who died in hospital. They have been separated in the table. The hospital should try to provide space to collect this information from the maternity ward/ delivery room. 7. Post C/S Infection Rate: = (No. mothers with C/S wounds infected / Total No. of mother who had C/S operations in the hospital) x 100. = The rate if caesarean section wounds getting infected. It is an indicator of the quality of post-op wound care as well as pre-op preparations. 8. Recovery Rate: = % of patients admitted who are discharged while classified as “Recovered” on the discharge form or register. ix = (No. of patients discharged as “Recovered” / Total patients