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Project
Annual Report
Year-V
1 August 2013 to 31 July 2014
Includes
Summary of Achievements of the 5-year Gift
from Inger &Claes
and
Proposed Plans for sustainability
Contact Persons:
Director
Network
Dr Samuel Kalibala
P.O. Box 2598 Kampala, Uganda
Uganda Cellphone 256 772 638 540
Kenya Cellphone 254 722 514 371
Skalibala@hotmail.com
Source of Funding:
Funded by the kindness of Inger and Claes Ortendahl of
Arholma in Sweden plus a number of friends
Table of Contents
Summary of Achievements of the 5-year Gift from Inger & Claes..............................3
Summary of Proposed Plans for Sustainability...........................................................4
Brief background information about Namulaba Health Center...................................5
Achievements of 5-year Gift from Inger & Claes.........................................................6
Detailed Report........................................................................................................ 11
The Maternity Wing: Muzadde Center......................................................................11
Muzadde Center Service Statistics December 2011 to July 2014..........................12
Ante Natal Care (ANC)........................................................................................... 12
Labor and Delivery................................................................................................ 14
Birth Certificates................................................................................................... 16
Photos of Babies.................................................................................................... 17
Service Statistics for the Main Medical Clinic Aug 2013 to July 2014........................20
All Clients Seen in the Main Medical Clinic............................................................20
General Medical Clients......................................................................................... 22
Clients Tested for HIV............................................................................................ 23
Patients Tested for Malaria.................................................................................... 24
Service Statistics of Nurses Clinic............................................................................26
Vote of thanks.......................................................................................................... 29
is
managed
by
the
Namulaba
Network
of
Community
Based
Organizations (CBOs). The money for buying the first stock of medicines was
obtained from a local fundraising event that was organized by the CBO Network and
attended by the area member of parliament. The medicines are sold at almost cost
price and this enables the pharmacy to re-stock its supply. The salary of the nurse is
paid by our project. The nurse also examines and treats patients who come seeking
care. On these Saturdays the clinic is also used as an outreach post for the ministry
of health to provide family planning and child immunization services. In December
2011 we added maternity services to the services we provide.
The project is currently funded out of the kindness of a Swedish couple, Inger and
Claes Ortendahl of Arholma in Sweden since July 2009. At the celebration of Ingers
birthday in 2009 Inger and Claes made a commitment to fund this project for five
years which have just ended in July 2014. They chose to help Namulaba as a way of
thanking God for Ingers happiness. On behalf of the community served by this
project, we are very grateful to Inger and Claes. Inger and Claes have been joined
by a number of friends who contributed to the project especially to the construction
of the maternity building. The contributors are listed in the vote of thanks at the
bottom of this report. They include the 65 residents of Arholma Island, Sweden,
where Inger and Claes live as well as other friends of theirs including those living in
Germany. We are grateful for these kind hearts.
The project was started by the Director (Dr Samuel Kalibala) on his farm land in
February 2005. He was prompted by the number of patients who would come to him
for help whenever he visited the farm. In February 2007 the project got its first
external funding which came from AVERT, a UK based charity. This funding helped
with the purchase of equipment and the clinic became operative from June 2007.
The project provides a full range of primary health care services, HIV/AIDS care and
reproductive health services including maternity.
In the main clinic all clients are offered HIV testing. Some of the clients receive HIV
testing as part of their general medical care while some may come only for HIV
counseling and testing. In figure-b it is shown that over the five years we have
provided HIV testing and counseling to a cumulative total of 1,508 clients of whom
1,025 (68%) were female.
Malaria is endemic in Uganda and many people who do not have access to a health
service that can test malaria end up suffering from the disease without knowing or
just guessing that they have malaria and they seek self-medication. This does not
only results in increased morbidity and mortality especially among children and the
elderly but it also contributes to the emergence of resistant malaria. In figure-c it is
shown that over the five years we tested a cumulative number of 2,145 patients for
malaria of whom 1,409 (65.7%) were female.
Figure-d shows that the cumulative number of clients who tested malaria positive
over the five years was 1,273 representing 59.3% of the 2145 who were tested for
malaria (shown above in figure-c). All these patients were treated with the new
Artemesinin Combination Therapy (ACT) which is highly effective unlike the old antimalarial medicines against which the malaria parasite has become resistant.
431 received HIV counseling and testing at the clinic which is a decrease
from 517 in the previous reporting period.
542 received testing for malaria which is an increase from 469 in the
previous reporting period.
Nurses Clinic (Community Pharmacy): On the three Saturdays of the month when
we are not operating the main medical clinic, a nurse opens the clinic and provides
medical care to patients paying at a subsidized rate. She also sells over-the-counter
medicines to community members and that is why it is called a community
pharmacy. In addition this nurse provides immunization, vitamin-A supplementation
and de-worming tablets to children and family planning to women. The supplies for
these preventive services are provided to us by the government-run Nagojje Health
Center-III and in this aspect we function as an outreach site of Nagojje Health Center
III.
In the period August 2013 to July 2014 the Nurses clinic provided curative
services to 244 clients, immunization to 354 children and family planning to 188
women. In addition 133 children were provided Vitamin-A supplementation and 93
received de-worming tablets.
The Nagojje Sub-county Local Council (LC-3) was very supportive of the idea
of a community health insurance. They also pledged to add a budget line in
the local councils budget to support Namulaba Health Center. Indeed, a
budget of Shs 300,000 (US$ 120) was added for the financial year 20132014. We are pleased to report that in August 2014 Shs 150,000 was paid by
the Local Council to Namulaba Health Center. This is the first cash grant from
the government to Namulaba Health Center and we are grateful for it. The
government is making the following in-kind contributions: immunization
supplies, Vitamin-A supplementation and de-worming tablets for children and
family planning supplies for adults.
The Chairman of the Mukono District2 Council and the District Health Officer
were very supportive of the idea of a community health insurance and were
eager to have Namulaba Health Center as a place to pilot test the idea and
later roll it out to other parts of the district.
Need to register Namulaba Health Center as a legal entity: during this visit it
became apparent to the team that Namulaba has been operating as a
personal private clinic of Dr Sam Kalibala and donor funds were being
provided relying on the good faith of the individual owner. However, in order
for the health center to attract, accept and account for more public funds it
was important that it gets registered as a legal entity that can sue and can be
sued. Indeed, on 25th October 2013 Namulaba Community Health
Services Limited a company limited by guarantee was registered by the
Registrar of Companies in Kampala.
Claes made a follow-up visit in March-April 2014 during which he together with Dr
Kalibala and Mrs. Margaret Kizito held the following meetings:
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a) Insurance Company of East Africa (ISEA): The team met with officials of this
insurance company in Kampala and presented the proposal of a community
based health insurance (CBHI) scheme that could be hosted by ISEA. This
would involve ISEA collecting insurance payments from community members
and paying Namulaba Health Center as the service provider. The company
officials promised to present this idea to their management and get back to
the team. At the time of writing this report there was no response yet.
b) District Health Officer: The Mukono District Health Officer reiterated his
support for the idea of the community based health insurance (CBHI) scheme
and advised the Namulaba team to visit a community health project in Fort
Portal District in Western Uganda which appears to have a successful CBHI
scheme. Indeed, Claes provided Shs 400,000 (US$160) which enabled Mrs.
Margaret Kizito together with Namulaba Program Officer Phoebe Namigadde
to visit the Kitojo Integrated Development Association (KIDA). This visit was
carried out in June 2014 and a separate report is provided about the visit. In
brief, KIDA is a registered not for profit company that provides full hospital
services to the community. The health insurance scheme has a membership
fee for each family and an annual premium paid by each family. The
Namulaba team will study this report to extract lessons that can be applied to
Namulaba. In addition the Mukono District Health Officer advised the
Namulaba team to register the health center into the Uganda Protestant
Medical Bureau where sometimes the member health centers can receive
some outside help as a group. At the time of writing this report this action
was yet to be undertaken because we were waiting for the annual medical
license of Namulaba Health Center which is necessary for the registration into
Uganda Protestant Medical Bureau. This license was obtained in August and
we have started the process of seeking registration into the Uganda
Protestant Medical Bureau.
c) Legal Adviser: The Namulaba team visited a legal adviser in order to
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attract, accept and account for public funds including community contributions to a
community based health insurance scheme to provide these services.
Transition: The financial year 2014-2015 is being considered as a transition year
when we will transition from the five year kind gift from Inger and Claes to a more
sustainable funding mechanism mixing public funding and a community based
health insurance scheme. We are grateful that Inger and Claes have decided to
support this transition period. We cannot thank them enough but we commit
ourselves, with the help of God, to work hard to make this transition a success.
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Detailed Report
The Maternity Wing: Muzadde Center
Muzadde Center is the name we gave to the maternity wing of Namulaba Health
Center because the word Muzadde means parent. We remain grateful to Claes and
Inger for extending beyond their original commitment and making extra personal
contributions to ensure the construction of the maternity unit. In addition to the
personal contributions, they went out of their way to raise money from their 65
neighbors on Arholma Island in Sweden plus other friends in Sweden and Germany.
These contributions started at Ingers birthday party in 2009. When she told her
neighbors about the Gift she and Claes had given to Namulaba, the neighbors
reacted by contributing the equivalent of US $ 2,300. This was the money used to
start the foundation of the building. Part of the building has now been put to use
and we started providing antenatal care (ANC) in December 2011 and had the first
baby delivered on 28th March 2012.
Inger and Claes have continued to work hard and raise funds for Namulaba. Please
see list of donors at the end of this report. One of the methods Inger has used is to
host a tea club and at the end of it, the guests make a small contribution in a cup. In
May 2011, we received Swedish Kronna 1120 from the tea club. We are grateful to
Claes and Inger Ortendhal; Mrs. Kerstin Lindgren and Family; Ingela rtendahl;
Kristina and Torbjorn Paulin; Dr Susanne Richert; the Arholma Syjunta; and
the
Family of Jurgen and Hella Richert plus all friends of Namulaba for enabling us to
provide the services below to the community of Namulaba.
The Tea Club Members, the Arholma Syjunta:
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14
Figure-1b shows that in 2013 on average there were 5.4 new ANC visits per month,
17.3 repeat ANC visits and 22.7 total ANC visits per month. The peak of ANC visits
was in the months of June-September where the total ANC ranged from 30 to 37 per
month.
Figure-1b: ANC visits in 2013
In figure-1c is shown the ANC visits in the first seven months of 2014 (Jan-Jul). The
data indicates that the highest first ANC visits were in March (13) and the highest
repeat ANC visits were in June (36).
Figure-1c: ANC visits in 2014
Figure-2 shows that there was a great increase in the overall ANC attendance from 7
visits in the month of December 2011 to an average of 26.3 visits per month in the
first seven months of 2014. The biggest increase was in repeat visits from 1 per
month in 2011 to 24.4 per month in 2014. The number of new ANC visits started
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with 6 in December 2011 at the opening, it then dropped to only 2.6 per month in
2012 and increased to 5.4 new ANC visits per month in 2013 up to 8.6 new ANC
visits per month in the first seven months of 2014
Figure-2: Average monthly ANC visits in 2012 to 2014 (First seven months)
Figure-3b shows that in the twelve months of January to December 2013 a total of
33 births occurred giving an average of 2.8 births per month.
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Figure-3c shows that in the period Jan-Jul 2014 22 babies were born giving a
monthly average of 3.4 babies per month.
Figure-3c: Number of births Jan-Jul 2014
Comparing the number of births in 2012 to the number in the first seven months of
2014 it can be seen that the number of births per month has increased from an
average of 1.6 per month to 3.4 per month. We believe that this shows that the
community is increasingly gaining confidence in the services provided at Muzadde
Center.
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Figure-4 shows that 56% of the babies were males. Hence, we seem to have more
male babies than female babies. It is an interesting observation although we are
unable to explain it.
Figure-4: Sex of babies born
Birth Certificates
We have started the process of getting birth certificates for babies born at our
maternity. Please see below one of the birth certificates:
In Uganda very few children ever get their birth certificates usually because the
procedure is too cumbersome and rather expensive for the parents since each birth
certificate costs Shs. 15,000 (US $6.52). In the Uganda Demographic Health Survey
of 2006 only 21.0% of children under five years had their births registered of whom
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10.5% did not have a birth certificate, another 6.1% the parents claimed they had
birth certificates but could not show them to the interviewers and interviewers were
only able to see birth certificates for 4.4% of the children. We are thus proud that
we are giving these children this gift.
Photos of Babies
Another gift we proudly give to the babies is a photo taken on the day of their birth.
This again we feel is a rare article to find in impoverished communities. Many
people did not have the opportunity to have a photo taken when they were babies.
Here below are some photos of babies, mothers and midwives taken on the day of
birth including twins in the third photo.
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Figure-4 shows that of the 72 babies born in Muzadde Center so far we have
provided birth certificates to 26 (36%). The rest of the babies have not yet got their
birth certificates because we have slowed down the process based on a review we
carried out in May 2013 which showed that the families needed time to fully
establish the formal names of the babies. Culturally, in Uganda each child is given a
surname different from the fathers name. This name is chosen by the head of the
clan and it may take time for the name to be given. Secondly, the first and middle
names are usually given after some discussion with elders and religious leaders. For
this reason we suspended the process of birth certificate issuance to allow our
community health workers to obtain the final formal names of the infants. When we
resume we will start with the backlog which has accumulated and thereon we will
be issuing to batches of infants aged six months. We were able to take birth photos
for 58 (80%) out of the 72 babies because some babies could not be photographed
due to non-availability of the photographer. The center does not yet have its own
camera so currently the photos are taken by a commercial photographer who is
called whenever a baby is born. Sometimes he is not able to avail himself before the
baby and mother are discharged.
Figure-4: Babies who have received birth certificates or photographs
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Service Statistics for the Main Medical Clinic Aug 2013 to July 2014
All Clients Seen in the Main Medical Clinic
Namulaba Health Center operates a free3 primary health care clinic for all
community members on the last Saturday of every month.
The information
presented here is for 12 months from August 2013 to July 2014. The annual funding
cycle of Namulaba starts in August since this is the month when the five-year gift
from Inger and Claes Ortendhal started in the year 2009. Figure-5a shows that the
lowest total number of clients seen on the last Saturday was 96 in the month of July
2014 of whom 27 were males and 69 were females. The highest total number see
was 148 in the month of December 2013 of whom 40 were males and 108 were
females. These patients received primary health care in the way of diagnosis and
treatment of common illnesses including fevers, diarrheas, worms, skin diseases as
well as malaria. The services also included HIV counseling and testing as well as
provision of Septrin (Cotrimoxazole) to people living with HIV which helps to prevent
opportunistic infections. HIV positive clients needing CD4 testing are sent to Kawolo
Hospital together with a community health worker who directs the patient and
ensures payment for CD4 testing using funds provided from our health center.
Those found eligible for ARVs are put on ARVs which they continue to receive from
Kawolo hospital but they attend our clinic to obtain Septrin and to receive treatment
for any opportunistic infection they may have as well as ongoing counseling and
group support from other people living with HIV.
Figure-5a: All Clients Seen August 2013 to July 2014.
Patients are asked to pay Uganda Shillings 1,000 (US $0.43) for the visit. This represents 10% of the
actual cost of care. Women, children, adolescents and people living with HIV and those seeking HIV
testing are exempted from this fee. Very poor patients who dont belong to these groups are given a
waiver based on assessment by the Sister In-Charge.
22
In figures-5b it is shown that in this reporting period we saw a total of 1,465 clients
of whom 469 (32%) were males and 996 (68%)were females. Thus females form the
majority of our clients.
Figure 5b: All clients by Sex
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As shown in figure-5c the largest group of patients came for general medical care
(1,382) and of these 542 (39.2%) were tested for malaria which means that they
came complaining of a fever. In Uganda the commonest cause of fever is malaria
and hence if a patient is complaining of fever the first disease to test for is malaria.
And as is shown later in figure-8b between 37% and 74% of those tested for malaria
are found positive depending on the season since the occurrence of malaria is
highest in the rainy season.
Figure-5c: Distribution of Clients by Service
24
In figure-6b it is shown that the patients who received medical care in the 12
months of reporting were 1,382 of whom 431 (31%) were males while 951 (69%)
were females.
Figure 6b: General Medical Clients by Sex
25
HIV Positivity
Figure-7b shows that over the reporting period a total of 341 clients of whom 90
were males and 251 were females received HIV testing. Among the males 7 clients
(8%) were HIV positive and among the females 8 clients (3%) were HIV positive.
Thus the overall HIV prevalence among the clients we tested was 4%. The
prevalence among our females is lower than the prevalence of HIV in the general
population which according to a recent sero-survey 4 was 9.4 % among females.
However, the prevalence among our males (8%) is similar the general population
which is 8.2% among males. Given that ours is a self-selected population of patients
seeking medical care mixed with individuals seeking voluntary HIV counseling and
testing we cannot make any conclusions about these differences with the general
population.
Figure-7b: HIV Positivity
The Uganda AIDS Indicator Survey of 2011 showed that in the Central-2 Region where
(Namulaba-Mukono District) belongs the HIV prevalence among women was 9.4% and
among men it was 8.2% and both sexes combined it was 8.9%.
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and the lowest were in the months of September, November and December (35, 20
and 38 respectively).
Figure-8a: Patients Tested for Malaria
Malaria Positivity
In figure-8b it is shown that the months with the highest malaria positivity were
August and October (74% and 73%) respectively and the months with the lowest
positivity were June and July (35% and 37% respectively). The rest of the months
had a positivity of between 40% and 50%. The prevalence of malaria tends to vary
by season since mosquitoes breed in water ponds and other water collection points
which are more abundant during the rainy season.
Figure-8b: Malaria Positivity
Figures 8c shows that the male clients tested for malaria were fewer than females
(150 Vs 392). However, figure 8d shows that the positivity rate of malaria was
similar between males (51%) and females (49%).
Figures 8c Malaria Test clients by sex and 8d Malaria Positive Clients by
Sex
27
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of November 2013 and July 2014. The number of children seen in October is
unusually high because in that month there was a government campaign to
mobilize children to attend immunization services.
Figure-9: All patients served in the Nurses Clinic
29
https://www.unfpa.org/swp/2010/web/en/pdf/EN_SOWP10_ICPD.pdf
30
In figure-13 it is shown that the largest number of clients seen in the Nurses
clinic was children for immunizations (354) followed by clients of curative
services (244) and women receiving family planning (188).
Figure-13: Total number of clients by type of service
Vote of thanks
The Director (Dr Sam Kalibala) and the Chairperson (Mrs. Margaret Kizito), on
behalf of the Namulaba community, would like to express their gratitude to
Inger and Claes for the five year commitment to fund Namulaba activities. In
addition, we are very thankful to the following friends who have made
donations to us through Inger and Claes:
31
We would also like to thank our friends from AVERT UK for the seed funding
that enabled us to function during the first year of our project. We are also
grateful to the local council (LC) members at all levels LC-1, LC-2, LC-3 and
LC-5 who have given us unconditional support since the beginning and the
District Medical Officers office which continues to provide supervisory
support and use of Namulaba as an outreach for childhood immunizations.
We are also grateful to all the friends of Namulaba who have visited us and
encouraged us to push on. Last but not least, we are grateful to the people of
Namulaba as well as the political and religious leaders who have let us join
them to work together to make a difference in peoples lives.
As we go into the period of transition to a more sustainable funding
mechanism we are especially grateful to Inger and Claes for their decision to
stay with us and continue supporting us financially and technically. We thank
God for giving them such kind hearts and we pray that God blesses them and
the work of Namulaba Health Center for many years to come.
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