Health

4.1 Introduction to health services

Health Services
4.1 Introduction to health services

Kasese district health sector is composed of 105 health unities of these 3 are hospitals, 5 are health Center IV, 42 are Health Center III, and 69 are health Center II. Each health sub district has got a health unit implying a well distributed health services related maternal, infant and child feeding services. In addition, these health units have been used as referral centers by VHTs, and relevant stakeholders, however there is need to build the capacity of the different stakeholders, the VHTs, Health workers to respond to nutrition related issues.

Population Demographics for FY year 2016/2017

The population for the period under review has been projected from UBOS National Population and Housing census 2014 using a growth rate of 2.45%. The projected figures are shown below

Population projections for FY 2016/2017
Demographic VariableProportionProjected population(2016/2017)
Total population100%737274
Males48.6%358315
Females51.4%378959
children under 1 years4.3%31703
children under 5 years17.7%130497
children below 18 years55.1%406238
Adolescents & youth 10-24 yrs.34.80%256571
Expected Pregnancies5%36864
Women of reproductive age 15-49yrs20.20%148929

Source UBOS mid-year projections 2016

3.1   Health Infrastructure
 Table 22:  Health facilities
ConstituencySub CountyGov’t H.UPrivate-Not-ProfitPrivate-for-Profit
Bukonzo WestLhubiriha-Mpondwe Town CouncilBwera Hospital
BweraKasanga PHC
Bukonzo EastKisingaKagando Hospital
MunkunyuKinyamaseke HC III
Busongora SouthKasese Town CouncilKasese Town Council HC IIISt. Pauls HC IVBishop
Masereka Medical Centre
Kasese Cobalt Company Clinic
KilembeKilembe Mines Hospital
Busongora NorthKyabarunigraRwesande HC IVHima Cement Clinic

District Health Office

Table 23: Health facilities per Sub County
Table 23: Health facilities per Sub County
Sub-CountyHealth Unit NameLevelOwnershipOwner CategoryStatusFunctionality
Mpondwe-Lhubiriha Tc NyabugandoIIIPNEPPNFPIP & OPDFunctional
Karambi Nursing HomeIIPrivatePFPOPDFunctional
Kasanga PHCIIIPNEP
Kyambogho SDA ClinicIIPrivatePFPOPDFunctional
Kyambogho ClinicIIIPrivatePFPIP & OPDFunctional
BweraHospitalPublicGovernmentIP & OPDFunctional
Mpondwe MoslemIIUMSCPNFPOPDFunctional
NyakiyumbuMusheneneIIIPNEPPNFPIP& OPDFunctional
KayanziIIPublicGovernmentOPDFunctional
KatholhuIIPublicGovernmentOPDFunctional
MuhindiIIPublicGovernmentOPDFunctional
Bukangara HCIIPublicGovernmentOPDFunctional
MunkunyuKinyamasekeIIICOUPNFPIP & OPDFunctional
KabingoIIPublicGovernmentOPDFunctional
KisingaKagandohospitalpublicGovernmentOPDFunctional
NyabirongoIIIPublicGovernmentOPDFunctional
KiburaraIIPublicGovernmentOPDFunctional
Give a goatIIPublicGovernmentOPDFunctional
KrusandaraKanambaIIIPublicGovernmentOPDFunctional
KarusandaraIIIPublicGovernmentOPDFunctional
RukookiBuhaghuraIIPublicGovernmentOPDFunctional
BughalitsaIIPublicGovernmentOPDFunctional
NyakabingoIIPublicGovernmentOPDFunctional
MalibaMalibaIIIpublic
IsuleIIIpublic
sBikoneIIpublic
KisojoIIPublic
MukathiIIPublic
KihyoIIPublic
NyangorongoIIPublic
Kyanya SDAIIPublic
Mubuku prisonsIIPublic
KyabarungiraRwesandeGovt
BugoyeNyangongeIIPublicGovt
 Mt. RwenzoriIIPublicGovt
BugoyeIIIPublic
kibiriziIIPublic
KisambaIIPublic
NyangorongoIIPublic
MaghomaIIPublic
KatokeIIPublic
IbandaIIPublic
KitswambaKitswambaIIIPublic
KinyabwambaIIPublic
Ibuga RefugeesIIPublic
Ibuga ParisonsIIPublic
NkokoIIPublic
NyakatonziNyakatonziIIPublicGovt
KyarumbaKyarumba PHCIIIPublic
KyarumbaIIIPublic
KitabuIIIPublic
Kabirizi upperIIPublic
HimaHima HCIIIPublicGovt
Hima micro careIVPublicGovt
NyamwambaSalutipublicGovt
Kasese Mun.CPublic
RukokiPublic
Mubuku Irrig.Public
KitholhuKitholhuIIIPublicGovt
KanyatsiIIPublic
KiraroIIPublic
IhandiroIhandiroIIIPublicGovt
Kikyo IIPublic
BubothyoIIPublic
BuhungamuyaghaIIPublic
KarambiKarambiIIIPublicGovtPrivate
KisolholhoIIPublic
BikunyaIIPublic
KamasasaIIPublic
BweraNyakimasaIIPublicNGOGovt
IsangoKyemparaIIPublicGovt
KamukumbiIIPublic
Lake KatweHamukunguIIPublicGovt
KabiriziIIPublic
KahokyaIIIPublic
KasenyiIIPublic
KatunguruIIPublic
MweyaIIPublic
KyondoKyondoIIIPublicGovt
BwetheIIPublic
MahangoMahangoIIIPublicGovt
ButhaleIIPublic
BwesumbuBwesumbuIIPublic
KasangaliIIPublic
BuhuhiraBuhuhiraIIPublic
Busongora northRwesandeIVPublic
KabatundaIIIPublic
KASESE MUNICIPALITY
Central divisionKirembeIIPublic
Railwaypublic
St.pauls
BMCF
Katodoba
Bulembia divisionKilembehosiptal
Kilembe Disp.

Source: District Health Office

 Table 24:    Accessibility of Health Services 2015

Name of health UnitPopulation served
Kilembe Hospital150,000
Kagando Hospital400,000
St. Pauls HC IV53,000
Rwesande HC IV150,000
Bwera Hospital300,000

Source: District Planning Unit

Accessibility to Health Services 2016/2017 FY

Health services in the district are delivered at 106 health facilities covering all sub counties. However 17% (5) sub counties of Bwesumbu, Buhuhira, Bwera, Nyakatonzi and Isango have centres only at level II. This hinders the delivery of a full package of MCH and HIV/AIDS services in the District.

Therefore there is need for remodelling these HCIIs in the underserved sub counties to enable provision of MCH services.

The District also faces challenges of blood shortage and there is no blood bank in the district that can supply blood for transfusion to the patients in the District

SUMMARY OF HEALTH FACILITIES WITH THEIR OWNERSHIP.
LevelGovtNGOPrivateTotal
Hospital1203
HC IV1304
HC III2013538
HC II561461
Clinic0000
Laboratory0000
Blood Bank/Distribution centre0000
Total78199106
Table 25: Services Delivered
Health Centresi)Curative-OPD.
ii)Preventive-school health, environmental health and sanitation, childhood immunization, growth monitoring, TB treatment, care for injuries, dental/oral care, &STI treatment.
iii)Promotive- Health education, Nutrition, counseling, condom distribution, disease surveillance, F.P/ANC.
Hospitalsi)Surgical operations.
ii)Curative-OPD & in-patient services.
iii)Preventive-school health, environmental health and sanitation, childhood immunization, growth monitoring, TB treatment, care for injuries, dental/oral care, &STI treatment.
iv)Promotive- Health education, Nutrition, counseling, condom distribution, disease surveillance, Family planning/ANC.

Source: District Health Office

 Table 26:  Private clinics, Pharmacies, and Drug shops
CountyClinicsPharmaciesDrug shops
Bukonzo202
Busongora10312
Total12314

Source: District Health Office

 4.3 Accessibility to health services

Accessibility to health services in Kasese district currently stands at 78%.

Table 27:  Distance to nearest social Facility
Facility Up to 5 kms Over 5kmsOn premisesUp to 1 kmOver 1 km
Health facility80,99417,845
 Water source7,58365,19726,059
Primary school92,2916,548
 Average %age81.918.17.76626.3

Source: 2002 Housing and population census

4.4 Maternal mortality Ratio (MMR)

The MMR has reduced to 122 per 1,000 live births (DHIS2 August 20. 2017) from 164 per 100,000 (DHIS 2016). The reduction is attributed to Governments efforts in recruiting critical skilled staff especially midwives to improve MCH services and equipping health facilities with equipment and trainings of staff by implementing partners.

The majority of the maternal deaths occurred in Kagando Hospital accounting 458/100,000 live birth compared to 104/100,000 in Bwera Hospital and 169/100,000 lives in Kilembe Hospital Respectively. And a mong the HCIVs Rwesande had the highest MMR at 394/100,000 higher than St. Pauls at 234/100,000 live births.

Maternal death review committees were oriented at all HCIVs and Hospitals leaving behind the volume HCIIIs. And yet some of the mothers are delayed at these lower level facilities. Delay in seeking care was still perceived as the common reason. Health system factors especially lack of blood was a major avoidable factor.

Common factors underlying maternal deaths

  • Delay of the women seeking help
  • Lack of partner support
  • Herbal medicate on
  • Refusal of treatment or admission
  • Refused transfer to higher facility
  • Lack of transport from home to health facilities
  • Lack of transport between health facilities
  • Lack of Blood products, supplies & consumables
  • Staff lack of expertise
  • Inadequate numbers of staff
4.5 Health Manpower
Table 28: District Health Office manpower
NOJob TitleApprovedFilledvacant/excess
1Laboratory Microscopist000
2District health officer110
3Asst. DHO environment health101
4Asst. DHO(MCH/Nursing)101
5Principal medical officer202
6MOSG-internal medicine202
7MOSG-general surgery202
8MOSG-obstetrics and gynaecology202
9MOSG-Paediatrics202
10MOSD-Public health202
11principal nursing officer211
12principal human resource officer000
13senior medical officer440
14senior midwifery officer000
15senior ophthalmic clinical officer000
16senior orthopaedic clinical officer000
17principal radio pharmacist000
18principal environment health  officer000
19senior public health dental officer000
20senior health educator101
21principal health visitor000
22senior human resource officer000
23senior hospital administrator202
24bio-statistician101
25medical officer1064
26senior nursing officer12012
27public health nurse404
28nursing officer paediatrics000
29nursing officer orthopaedic000
30nursing officer ophthalmic nursing000
31senior Anaesthetic officer011
32senior medical clinical officer___
33dental surgeon211
34pharmacist202
35senior dispenser000
36senior environment health officer101
37nutritionist202
38senior clinical officer(speech therapy)000
39senior medical lab technologist202
40senior medical lab technician
41public health dental asst.000
42health educator202
43senior Asst. health educator000
44senior health visitor000
45senior health inspector000
46entomologist000
47vector control officer000
48Laboratory technologists000
49Accountant000
50principal accounts asst.202
51hospital administrator211
52medical social worker211
53medical records officer000
54supplies officer202
55human resource officer202
56nursing officer64640
57nursing officer psychiatry440
58ophthalmic clinical officer404
59anaesthetic  officer202
60medical clinical officer42453
61orthopaedic clinical officer413
62dispenser633
63Environmental health officer000
64physiotherapist211
65occupational therapist211
66radiographer413
67medical lab technologist220
68medical lab technician341816
69senior enrolled nurse000
70public health dental officer651
71Asst health educator404
72Health inspector610-4
73Asst entomological officer440
74nursing officer midwifery831-23
75Asst. nursing officer midwifery000
76senior Accounts Asst422
77stenographer secretary312
78Administrative Asst.000
79Assistant Records Officer000
80Assistant supplies officer000
81TB/Leprosy supervisor110
82Senior Health Asst000
83Senior stores Asst.01-1
84Theatre Asst.422
85Cold chain Technician101
86stenographer000
87Anaesthetic Asst.404
88TB/leprosy Asst000
89medical laboratory Asst.3245-13
90enrolled nurse23220527
91enrolled psychiatric  nurse615
92enrolled midwife1627884
93medical records Asst.000
94health information Asst.30426
95Records Asst418-14
96Health Asst802456
97Accountants Asst.642
98Telephone operator000
99stores Asst.725
100Entomological Asst000
101enrolled comprehensive nurse000
102office typist413
103copy typist000
104Cold chain Asst.202
105Incinerator Attendant000
106Nursing Asst.22492132
107mental Health Attendant000
108Anaesthetic attendant404
109dental attendant202
110X-Ray attendant000
111Artisan mate plumber000
112Artisan mate615
113car driver734
114cook624
115pharmacy attendant000
116mortuary Attendant413
117orthopaedic attendant000
118Asakari (security guard)16619147
119Darkroom attendant202
120seamster/seamstress000
121office attendant110
122theatre attendant01-1
123kitchen Attendant000
124porter1626156

Source: Kasese District Health Department work plan 2017/18

Table 29: Bwera Hospital
s/nService provider categoryApprovedFilledGap
1Principal Medical Officer101
2Medical officer Special Grade (Community)101
3Senior Medical Officer110
4Medical Officer440
Dental
5Dental Surgeon110
6Public Health Dental Offocer211
7Dental Attendant110
Pharmacy
8Pharmacist101
9Dispenser211
Nursing
10Principal Nursing Officer101
11Senior Nursing Officer523
12Nursing Officer (Nursing)17710
13Nursing Officer (Midwifery)321
14Nursing Officer (Psychiatry)110
15Public Health Nurse101
16Enrolled Psychiatry Nurse202
17Enrolled nurse461828
18Enrolled midwife25916
19Nursing Assistant15230
Allied Health Professionals
20Senior Clinical Officer101
21Health Educator101
22Senior Laboratory Technologist101
23Psychiatric Clinical Officer101
24Ophthalmic Clinical Officer110
25Clinical Officer550
26Health Inspector110
27Assist. Entomological Officer (Medical)101
28Radiographer211
29Physiotherapist101
30Occupation Therapist101
31Orthopaedic Officer202
32Assist. Health Educator101
33Anaesthetic Officer211
34Laboratory Technologist101
35Laboratory Technician220
36Laboratory Assistant120
37Anaesthetic Attendant101
Administrative & Other Staff
38Senior Hospital Administrator101
39Hospital Administrator110
40Personnel Officer101
41Social Medical Worker110
42Nutritionist101
43Supplies Officer101
44Senior Accounts Assistant110
45Stenographer Secretary110
46Office typist101
47Stores Assistant211
48Records Assistant220
49Accounts Assistant211
Support Staff
50Darkroom Attendant110
51Mortuary Attendant120
52Driver220
53Cook330
54Askari360
55Artisans Mate220

Source: Kasese District Capacity Building Plan 2008/9

Table 30:  Health Center IV (Rwesande HC IV and St. Pauls HC IV)
s/nService provider categoryApprovedFilledGap
1Senior Medical Officer202
2Medical officer220
3Senior Nursing Officer202
4Public Health Nurse202
5Clinical Officer422
6Ophthalmic Clinical Officer202
7Health Inspector211
8Dispenser202
9Public Health Dental Officer202
10Laboratory Technician202
11Assistant Entomological Officer (Medical)202
12Nursing Officer (Nursing)202
13Nursing Officer (Midwifery)220
14Nursing Officer (Psychiatry)202
15Assistant Health Educator211
16Anaesthetic Phychaiatic202
17Account Assistant110
18Enrolled Phyciatric Nurse202
19Enrolled nurse642
20Enrolled midwife633
21Cold chain assistant202
22Office typist202
23Laboratory assistant220
24Stores assistant202
25Health assistant202
26Health information assistant220
27Nursing assistant1073
28Driver211
29Askari630
30Porter633

Source: Kasese District Capacity Building Plan 2008/9

Table 31:    Health Center III
s/nService provider categoryApprovedFilledGap
1Senior Clinical officer22220
2Clinical Officers22202
3Nursing Officer (Nursing)22319
4Laboratory Technician22022
5Enrolled Midwife44022
6Enrolled Nurse662046
7Laboratory Assistant22418
8Health assistant22211
9Health Information Assistant22202
10Nursing assistant66660
11Askari44242
12Porter44044

Source: Kasese District Capacity Building Plan 2008/9

Table 32:  Health Center II
Service provider categoryApprovedFilledGap
1Enrolled Nurse603030
2Nursing Assistant603030
3Askari602832
4Porter60060

Source: Kasese District Capacity Building Plan 2008/9

Table 33:     Inspection of private Health Units
Health unitNo. of visits
Kagando Hospital12
Kilembe Mines Hospital12
Bishop Masereka Medical Centre12
Kasanga PHC12

Source: District Health Office

4.7 Sanitation Coverage

Table 35: District Sanitation Coverage

YearPit latrinesHand washing facilitiesPupil stance ratioBathroomsSafe water coverage
200880%1:10983%
200981%1:7484%

Source: District Water Office

4.8 Immunization
Table 36: Kasese District Immunization Coverage (proxy indicators)
ImmunizationcentresAntigen20082009
All health centre IIIs, hospitals and health centres IVs are immunization centersBCG
DPT384%
Polio117%
Measles69%101%
TT (preg.)
TT(Non. preg)
Vitamin A supplementation72%97.2%
Deworming children67%96%
Under weight15%15%

Source: District Health Office

4.9 Maternal and Child health
  • The number of deliveries by skilled personnel (proportion of supervised deliveries to those who attend antenatal) is 32%.
  • The number of pregnant mothers receiving antenatal and postnatal care is 34%
  • The contraceptive prevalence rate/number of mothers practicing family planning is 50%
  • The infant mortality rate is at 76/1000.
  • The less than 5 mortality rate is 145/1000.
  • The maternal mortality rate stands at 505/100000.
  • The district has a very high fertility rate which accounts for one of the highest population growth rates of 3.6% above the national average of 3.2%.
4.10 AIDS Control (prevalence, control and treatment)
Table 37: The status of HIV/AIDS and condom use in Kasese
Indicator2004 (%)2006 (%)2009
HIV sero-prevalence15.211.211.2
15-24 year olds prevalence (South west)F=4.2, M= 0.64.64.6
Prevalence in pregnant mothers6.5 (national)3.56.9
Condom use rate21.821.8
Condom use at first sex 15-24 years (western)M=11.9, F=6.625
Persons on ARVs20.4

Source: UDHS 2006

4.10.1 HIV Counselling and Testing

There are 14 HIV voluntary testing and counselling centres in the district at Rwesande, Kagando, Bwera, Kasanga, Karambi, Kinyamaseke, Nyabirongo, Kyarumba, Katwe, St. Paul’s, Katadoba, Kasese T/C, Kilembe, Bugoye, Mukathi and Kinyabwamba, Bwera Hospital, Kilembe Hospital and Kagando hospital. PMTCT services are also offered at these centres.

4.10.2 Drivers of HIV/AIDS

The factors affecting HIV prevalence include: the ADF war of 1996 when a large portion of the population was displaced and also that fact that Kasese is a mining and border district, which is a major destination of all sorts of people including sex workers, casual labourers, expatriates, foreigners etc. Others include Poverty, Culture, urbanization, Drug and substance abuse, prostitution and sex working and others.

4.10.3 Treatment and drug administration
Table 38: People on ARVs three of the four major health facilities in Kasese
Health facility
Sex and ageKilembeKagandoSt Paul
Adult males (18 and above)1492,480379
Adult females (18 and above)3236,998677
Pregnant adult females (18 and above)26 –62
Children males (17 and  below)51392124
Children females (17 and below)471,66487
Pregnant female children (17 and below)01
TOTALS59611,5341,330

Sources: Kilembe, Kagando and St Paul HCIV 2008

  • The number of people counselled in 2008 was 29,945.
  • Number of people tested for HIV is 29,945.
  • The number of people tested positive is 1,568.
  • The number of people receiving VCT is 29,945.
  • AIDs control structures are at all levels and this is true for the whole district.
4.10.4 Prevention of Mother to child Transmission of HIV (PMTCT)

PMTCT services are offered at all the functional HC IIIs, HC IVs and hospitals in the district.