By Irene Lamunu
St. Joseph’s hospital is the only hospital in Maracha district. It has served the population since 1952. A year later, the facility was upgraded to a dispensary and then a maternity home run by the Comboni Missionaries. In 1972, the health unit became a fully-fledged hospital and it was handed over to the catholic diocese of Arua in 1985.
St. Joseph’s Hospital Maracha provides curative, preventive, promotive and rehabilitative health care services to the population of Maracha, Koboko, Terego and Arua. The hospital has a 200 bed capacity. The Medical Director of the hospital, Dr. Taban Alphonse said it had a catchment population of 20,237-20,300 in the financial year 2018/2019, and last year, it served a total of 13,000 people. Dr. Taban attributed last year’s low turn up at the hospital to poverty in the district; revealing that 74% of the people cannot afford treatment or the adult consultation fee of Ug shs 10,000. He also said that utilization of services at the hospital has greatly decreased from 2016/2017 due to the increase in user fees. Dr. Taban noted that the hospital has flat rates for consultation, investigation and treatment.
The Medical Director said the OPD fees for children under 5 years is at Ug shs 4,816 ($1.30) and adults is Shs Ug 9,633 ($2.60) as compared to the Ministry of Health’s recommended fee of Ug shs 34,086 ($9.20) and Ug shs 43,719 ($11.80) respectively for children and adults. The Caesarean section costs Ug shs 43,000 ($ 11.80) and Ug shs 77, 000 ($21) for referrals compared to the MOH estimates of Ug shs 281,580 ($76) for a quality caesarean section. He added that the human resource wage bill is at $157,894 per annum and medicine at the hospital costs $84,210 per annum. He noted that the hospital cannot raise this without assistance from stakeholders. In fact, they had delayed paying salaries for their employees because of financial constraints.
The hospital monthly wage bill is $13,158 per month yet the hospital collects only $7,895 every month. The hospital employs four doctors, five medical officers and 105 qualified nurses. The Belgian Technical Corporation (BTC) has been the partner for result based financing under MOH project and they have been providing 48% of the annual budget and income required to provide services at the hospital since 2015. Dr. Taban said at the end of December 2019, BTC will wind up their project at the hospital. “We have a threat that if we don’t find a way of running the hospital, in June next year, the hospital will close and be handed over to government,” said Dr. Taban. He noted that their partners; the government and Maracha district local government support human resource with 12% of the staff, primary healthcare medicines and primary healthcare non-wage funds with 24% of the annual budget. Doctor fears that the future of this support too is skeptical because of pressure on government to open health center IV for which funds currently delegated to Maracha hospital will be directed.
According to Dr. Taban, management is working hard to begin projects that will generate money to help run the hospital at the exit of BTC. The hospital will soon open up a cafeteria and also revive the carpentry workshop. He said they have a strategic plan to open a nursing school at the hospital as well. He added that the Bishop of Arua Diocese has been very helpful in trying to fundraise for the hospital by suggesting to get volunteers and fundraisers for the hospital. Besides, Dr. Taban says, the refugee influx is a very heavy weight on the hospital; as they have received 188 refugees with TB cases within a short time.
The hospital is not only facing financial challenges. Dr. Taban said all the facilities at the hospital are in a sorry state. The kitchen is close to the mortuary which does not have a refrigerator. Besides, Dr. Taban said the labour suit is very small and under-staffed to accommodate four mothers during delivery, yet the ideal labor suit for Maracha hospital should be holding 6 delivery beds with 14 midwives and not the seven who are currently managing the ward. He noted that the delivery beds at the hospital are dilapidated, rusty and potentially spreading infections to babies and mothers during delivery and the hospital also has an old operating table with a nonfunctional head-lamp.
Despite the insufficiency, they manage to have procedures in the theater. However, if a patient needs a CT scan and MRI, it may not be possible at Maracha hospital because of lack of personnel and equipment. He said the hospital receives close to 3 patients with head injuries per month considering that the hospital is along the high way.
The hospital has only two resuscitation kits being used and reused against infection control guidelines which are potential for spreading infections diseases. This, he said, has affected the neonatal care which mandates a Warmer in the resuscitation area in the surgical theater and in the special care unit. Currently, they have no Warmers for the neonatal care and resuscitation.
According to the Medical Director, the hospital’s previous line graph shows the trend of neonatal mortality over four years. Note-worthy is the increasing numbers of babies which were dying during or within seven days of birth from 2014 to 2017. He added that the high mortality rate made Maracha district the fourth worst district to deliver a child among 116 districts in 2017.
Dr. Taban said finding in 2017 revealed that the biggest factor was the lack of a special care unit/neonatal intensive care unit, poor monitoring of labour, and delay in referral of mothers into Maracha hospital from the lower units. He noted that the hospital management started a special care unit in 2018, reducing neonatal death to 29 per 100. Above all, St. Joseph’s hospital Maracha has no ambulance, as it borrows one from Maracha District if there is need of it. His worry is that once the district builds its own health centre IV, it will be difficult for the hospital to use it. The Medical Director said the hospital lacks specialists like gynecologists/obstetrians, internal medicine specialist, pediatrician and a surgeon because the budget is not enough to sustain them in terms of salaries and allowances. He also said the hospital needs oxygen back up.
The hospital also has a problem of power shortage not because they lack a generator but because they cannot afford fuel for the modern generator which needs 100ltrs of fuel per week. “The hospital is in anguish. Over time, we found ourselves in this situation, we are going to fight for the hospital,” added Dr. Taban.
He said he is ready to receive medical Camps at the hospital to keep it going.
Apr 11, 2019 0By Venasio Ahabwe Mr. Naperi, a company chief executive,...
Jul 15, 2019 0In the wake of terrible conditions of negligence and abuse reported at some U.S. hospice facilities, several Catholic doctors are emphasizing the need for Christians to embrace a ministry of aiding hospice patients and...
Jul 15, 2019 0On an island in Rome’s Tiber River, there is a basilica devoted to the Christian martyrs of the 20th century, the bloodiest century in the history of the Catholic Church. Flanked on either side by relics of Christians...
Jul 15, 2019 0Helping a person in need requires compassion toward their situation, Pope Francis said Sunday, encouraging Catholics to think first about their own hardness of heart, not the sins of others. “If you go down the street...