The hospital faces a struggle every day to serve its community; dilapidated buildings, inadequate equipment and lack of funding for staff and drugs makes the achievements of the hospital in providing the care it does nothing short of miraculous. The building in the photograph accommodates five nurses and their families, at least 30 people in total. The roof leaks and it has no water supply. Much of the hospital infrastructure is similarly in need of repair and replacement

A medical team from Nottingham UK visited the Hospital in July 2010, specifically to audit the hospital’s maternity provision but their report highlights many of the problems that the hospital faces.

A pdf of the report is available here

The following list of challenges was provided by the hospital management team

1. Inadequate funding, which affect the hospital budgets. There are two main sources of income:

– PAF (Poverty Alleviation Fund) Delegated Funds – there have been unpredicted government budgets cuts as well as irregular releases of funds

– User Fee – this is the revenue generated from patient treatment.

Due to high levels of poverty, low levels of income are realized from fees charged by the hospital yet it is one of the major sources of income to the hospital. The low rates are charged at outpatients for children Ushs.2,000= an equivalent of about $1 irrespective of the treatment given. This is to cater for the majority of the catchment community living in severe poverty

2. High attrition rate of the staff. More staff prefer to be in Urban areas and to be employed by government for better pay and pension on retirement. Two specialist doctors left the Hospital for probably better pay in the last one and half years. The hospital is not in position to pay staff salaries on time. This has led to inadequate numbers of qualified staff to deal with patient numbers both in the Hospital and for community outreach programmes.

3. Staff Accommodation and wards need rehabilitation. At the same time the space in these wards is not adequate to accommodate all the clients. The chapel has collapsed.

4. The operating theatre still lacks most of the instruments / equipment for carrying out specialized services like Eye care, Dental, Obstetrics and Gynecology services. The operating table is also broken down.

5. Inadequate laboratory facilities such as for CD4 Count, Renal function test, Liver function tests, Blood Cell Counts, Culture & Sensitivity.

6. Inadequate communication facilities – Fax, transport, analytical and storage facilities of data for Epidemiological resource.

7. Irregular power supply which makes the hospital unable to maintain Cold Chain, carry out laboratory investigations, regular operations and emergencies in theatre. This has also affected regular supply of piped water; the old pump engine at Adwoka has broken down and needs replacement.

8. Lack of waste disposal facilities such as incinerator

9. Drugs stock outs. Drugs and medical supplies are purchased from Joint Medical Store Kampala using PAF funds and User Fee. Due to delay in releases, budget cuts and low income from User Fee the hospital at times runs short of supplies

10. Despite lower staff salaries far below what is stipulated by government we are still unable to pay the staff salaries on time. The hospital faces major strains in paying NSSF arrears, terminal benefits to former and current staff, auditors, utilities like electricity and water.

11. Lack of tutors and accommodation for them