The Commissioner for infrastructure in the Ministry of Health has described the equipment and infrastructure in Kisoro Health Units as substandard and congested.
Eng. George Otim concluded his two-day visit to Health Units in Bufumbira South Constituency and Kisoro District General Hospital this Friday.
He pledged to deliver beds and mattresses to the Maternity Ward at Muramba Health Centre III and other facilities, after finding old-wooden beds in use.
The Commissioner arrived in Kisoro on Thursday June 15 on invitation by Bufumbira South MP Alex Niyonsaba Seruganda, and was accompanied by two other staff from the Health Ministry, Eng. Emmanuel Kiburi and Eng. Jeniifer Kiiza Turyomurugyendo.
He was shocked to see mothers sleeping on the ground in the Maternity ward, and the old wooden beds with torn mattresses at Muramba HC III.
“I want to go back to my ministry and check the store. Whatever I get, I will deliver within two weeks. They need at least 20 beds and mattresses. Then the rest we shall deliver later,” Said Eng. Otim.
“I have seen patients sleeping on ground, patients sleeping on beds I have never seen. I don’t know where they are collecting them from,” exclaimed the Commissioner.
He was stunned that Muramba HCIII delivers a monthly average of 70 mothers, has an average of 200 admissions and handles between 1500-2000 outpatients, but remains a Health Centre III.
“The policy is that every Constituency must have a Health Centre IV. Muramba has the required staff and a sufficient 6-acres of titled land. That’s a plus for us. I will recommend for an upgrade,” Said Otim.
The In-Charge, Mr Mbaga Evary says the numbers received at Muramba are overwhelming, in face of inadequate human and financial resource, drug shortages and accommodation for the staff.
According to Mbaga, an average of 20 mothers are referred to Kisoro and Mutolere Hospitals for C-section every month. He says a Health Centre IV would have a theater and a medical doctor to address this problem.
The Commissioner and his team, who were accompanied by Hon Niyonsaba, the District Health Officer Dr Stephen Nsabiyumva and his assistant Nick Muneza also visited Bunagana Health Centre II and Kisoro District General Hospital.
Bunagana was recommended for an upgrade to a Health Centre III due to the DRC refugee influx, which renders quarterly medical supply a drop in the ocean. At the peak, medical supplies are used up in the first three weeks.
The upgrade is already in the process with the Office of the Prime Minister (OPM) constructing a structure to house a maternity and general ward at a tune of 700 million Shillings.
Eng. Otim however says that operationalizing Bunagana Health Centre III will commence in the next financial year since the FY 2023/24 budget has already been passed.
Under construction is a structure to house a Maternity and a General ward once Bunagana is elevated to Health Centre III
With funding from the World Bank, Kisoro Hospital will benefit a standard theater and isolation ward, while the Radiology section will be equipped and given a facelift by the Ministry. The Commissioner commended the sanitation at the District Hospital, despite having old buildings.
“Before the year ends, the contractor will be on ground to kick off the work. This isolation unit can as well serve as a ward in case there are no epidemics.” He explained.
The Commissioner at the team visited Kisoro District General Hospital. He praised its sanitation despite having old buildings.
Kisoro Hospital Medical Superintendent, Dr Benon Rukunda Karekezi says the Hospital theater is outdated, the maternity ward is congested, while the x-ray machine has not worked for the last 4 years.
The Commissioner however reasoned that congestion at Kisoro Hospital wards will be addressed by both disease prevention and equipping lower Health Units with efficiency for service delivery.
Old-wooden beds, congested wards
On Friday, the Commissioner and his team inspected Muganza Health Centre II, Nyabihuniko HC III, Cyanika Border Post Health facility that is under construction, Claire Nsenga Health Centre and Nyarusiza Health Centre III.
He observed that most HCs lack inadequate ward space, with male and female patients mixed up at Nyabihuniko.
“Most wards were developed as a result of communities pooling up resources. These are no longer on standard and my recommendation is to have good wards that can accommodate at least 30 beds.” He noted.
He was also concerned that old wooden beds are being used in all Health Units.
“Wooden beds are not recommended for health care services because they are very difficult to disinfect. I will see if I can mobilise some beds for these Units.” Said Otim.
Construction of Cyanika Border Post Health Facility is 70% complete. Local authorities want this to serve as a Health Centre III
The Health Ministry is establishing a Border Post Health Facility at Cyanika, about half a kilometer from the Rwanda border. The facility, meant for testing services is over 70% complete.
Eng. Otim noted that upgrading the facility into a Health Centre III to serve the communities around. Cyanika Town Council authorities, who claim to have over 15 acres of free land for the project, have already passed a resolution which was forwarded to Kisoro District Council for consideration.
Meanwhile, Clare Nsenga Health Centre, a Private-not-for-Profit facility established by the Judiciary Permanent Secretary Pius Bigirimana would be considered for support in terms of medical supplies.
According Hon Seruganda, he had spent two years writing and physically engaging the Health Ministry officials to upgrade Muramba to a Health Centre IV.
“Bufumbira South is the only Constituency in Kisoro without a Health Centre IV!” He said.
He says that once elevated, Muramba would reduce overwhelming numbers at Kisoro Hospital, and address other shortages in the healthcare system in his constituency.
During the inspection, the team was led by the Kisoro District Health Officer, Dr Stephen Nsabiyumva and his Assistant Nick Muneza, and Martin Hakizimana, the Muramba LC5 Councillor, also the District Secretary for Health and Social Services.
The Referral System
The Commissioner noted that for a proper referral system, there should be a Health Centre III at the Sub County, that referrers to a Health Centre IV at the level of a Constituency then to a District General Hospital, and to a Regional Referral Hospital.
According to the Health Ministry, a Health Centre IV is a mini hospital. It should have the kind of services found at Health Centre III, but it should have wards for men, women, and children and should be able to admit patients. It should have a senior medical officer and another doctor as well as a theatre for carrying out emergency operations.
A circular from the Ministry of Public Service dated 5th April 2023 states that the new approved structure for a Health Centre IV has 130 staff, including 3 Medical Doctors. These will have a combined annual salary of Shs 3.6 billion.
On the other hand, a Health Centre III shall have 55 staff up from 21, with 2 Medical Doctors and a combined annual salary of Shs 1.18 billion.
The ministry plans to phase out Health Centre IIs. The structures will be used by Community Health Extension Workers (CHEs) to supply drugs for chronic diseases and treat simple illnesses.
The ministry plans to train these extension workers who include the already practicing Village Health Teams (VHTs) and equip them with relevant knowledge.
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