Following a complaint from one of my friend’s mothers, I visited Kamonkoli Health Centre III a few weeks ago (21 September 2011). This health centre is located in Nyanza village about one kilometre from Tirinyi-Mbale highway in Budaka district, Eastern Uganda. It serves an average clientele of 100 people everyday from the villages of Nyanza, Kamonkoli, Sekulo, Kositi, Kapulukucu, Jami, Kadimukoli, Nakyewu and Kakoli among others.
The standard time for health units to open is 8am. I arrived at 8.30am but there was no health worker present until 9.10 am when the lab attendant arrived, followed by the clinical officer at 10.05am. No more health workers arrived until 10.30am.
During this time, a crowd of more than 40 patients had gathered and were seated on a cement waiting desk and on the ground, while others were standing within the shade of the entry place. The place had a funeral service mood with a few shouts from the maternity wards where four unattended women were in labour.
While waiting to interview the clinical officer, I had a chat with the lab attendant (Nakimolo Alex), who told me the health centre has 10 health workers including two clinical officers (health centre head and assistant ), two nurses, one midwife, two lab attendants, three counsellors and two support staff.
Although there were many patients waiting, none were attended to by the lab attendant. In order to respect the correct procedure, patients see the physician (i.e. the clinical officer) first, who either refers them directly to the nurses for treatment or the lab for necessary tests before receiving treatment prescriptions.
Stuart Mary, the clinical officer, was quite calm during the interview amidst the big load that awaited him, which stunned me! My first concern was about the women in labour that were not being attended too. He politely responded that he was yet to create time for them since the midwife, nurses and counsellors were all away from the workstation (one nurse had lost a close relative, a second was on maternity leave, while the midwife and the two counsellors were attending a workshop that was scheduled to last for a week). I was about to ask if clinical officers have a course unit on human resources management to help them appreciate the need for delegation and for correct procedures to be followed when allowing staff to be away from the health unit to ensure minimal gaps in service delivery. In his communication, he seemed sympathetic about the situation but there seemed to be no evidence of any initiatives towards improving it - evidence that the situation is in bad shape.
Another concern was about the comprehensiveness of the health package offered to the pregnant women. Although they are supposed to receive tetanus vaccines three times, one of the pregnant women (Deborah Gosoli Gutaki) had not received any by the eighth month of her pregnancy. She said she remembered being told there were not enough vaccines and she would be vaccinated on the next antenatal visit. This could be an anomaly since I only interacted with one expectant mother. No life is worth discounting though.
I wish to commend the health centre for the HIV tests offered to the pregnant women; however it is important to expand this service to the general population. During my interaction with the patients who were waiting, I realised they had never heard about the presence of free HIV services at the centre. After a short open discussion, some offered to have the test immediately, indicating that many would be willing to be tested but are not aware that they can be free of charge. HIV counseling and testing is a key component in HIV prevention, which should be promoted.
In the area of family planning, a lot is wanting. While interacting with the health workers, I was reliably informed that the health centre only offers condoms as a family planning method to the women. This is a good strategy towards both HIV prevention and family planning. However, it is important to note that condom use is not very popular among married couples, especially those living in rural settings, unless advised for other purposes, for instance in cases where one partner has HIV and the other does not (discordant couples).
There is a need for the health centre management to take note of the issues that affect service delivery such as human resource management, lack of water and electricity and cleanliness, since they all affect the quality of services offered to expectant mothers and other patients.
Thank you Julia, this is a good piece with a picture, you have surprised me. keep writing
Thank you
Sharifah
The government has failed to provide adquate health services to health centres and unless the situation changes, many patients especially in villages will prefer using local herbs.And for pregnant mothers,they will always prefer TBAs.