Chapter 1 Executive Summary
Introduction
St Kizito Hospital of Matany is a private non-profit institution with social aims belonging to the Catholic Diocese of Moroto (Northern Uganda).
It was built at the beginning of the '70 and since then it has provided essential medical and health services to the population of Karamoja Region, the most underdeveloped region of the entire Country.
The Hospital is presently equipped with 220 beds, surgery, laboratory, diagnostic imaging service, physiotherapy service and deals with an average of 5000 admissions per year, 4-500 major surgical operations and 30-40,000 outpatient consultations. It ensures a regular supervision for the Health Units of Bokora Health Sub-District.
The Hospital operates in accordance with the policy guidelines of the Ministry of Health of the Republic of Uganda and in co-operation with the local Health Authorities.
Within this report the activities will be related to the Government financial year introduced in the accounting system of the Hospital in 1996. Where it is possible the activities of previous financial years will be presented for comparison.
Services Offered
and Activities
The health and medical services provided by the Hospital cover a wide spectrum: preventive care (vaccinations, ante-natal clinic, growth monitorage and under 5 clinic, epidemiological surveillance), curative care (diagnosis and treatment of the most common diseases and of referred cases within and beyond the catchment area, emergency and elective surgery), promotive care (health education, training of professional and lay personnel) and rehabilitative care (physiotherapy).
About 80% of the infants of the area covered by the Hospital vaccination service receive a complete course of vaccinations before 1 year of age and the vaccination coverage is above the target for the 6 killer diseases; less than 20% of the numerous TB patients placed under abandon treatment; more than 30% of the surgical operations performed are emergencies.
The Hospital since 1984 has a Nurses Training School, recognised by the MoH: about 15-20 nurses qualify each year as Enrolled Nurse and 5 as Registered Nurse. It is the only recognised professional training offered in the entire Region of Karamoja.
A centre for research on health management and for permanent training of health personnel (Karamoja Human Resources Development Centre for Health) is attached to the Hospital: it is open to all of those who wish to utilise it and started operating in 1994; it is currently being completed. This initiative responds to a double need: that of providing a structure for the much needed ongoing training and health management research and that of generating some income for the Hospital recurrent costs.
Management and
Finance
Since its foundation the Hospital has relied on the presence of expatriate medical and managing personnel linked to the Italian Co-operation for Development (CUAMM) and to the Comboni Missionary Societies (Sisters and Fathers). The dwindling external funding has severely affected the Hospital, depriving it of both skilled personnel and financial support. The employment of local Medical Personnel and the introduction of living wage salary levels by Government in 1996 has remarkably increased the cost of salaries bringing the Hospital to the verge of financial collapse, from which it was rescued by an emergency intervention of the Royal Danish Embassy during FY 96/97 and, in FY 97/98, by the release of Delegated Funds from Government.
Extraordinary expenses (buildings, major equipment, extraordinary maintenance) are exclusively financed by external aid. Ordinary expenditure (recurrent costs) is covered through patients' fees, recoveries and income generating activities (training centre, workshops, hospital guest house); the remaining is covered with donations and aid (from catholic organisations, international aid, NGOs, private benefactors). Since the beginning of 1997 the Hospital has operated without reserve funds.
Due to the extreme poverty of the population, all attempts at increasing the quota of income generated by fees has resulted in a reduction of the demand for service by the weakest sectors of the population (women, children and destitute; women and children represent 80% of the admissions). This reached its apex with the introduction of a new fee structure in August 97, when the impact on utilisation was dramatic. Fees were reduced in November 97, after the release of delegated funds and an extraordinary fund raising mission abroad.
The cost of the services offered has been analysed and will be presented in chapter 3. On average the cost of one IP activity unit is 27,000 Ush against an average fee charge of 6,500 Ush; the cost on one OPD activity unit is of 4,500 Ush against a fee of 2,600 Ush. Both activities are subsidised in view of maintaining the Hospital being accessible to all strata of population and thus faithful to its mission statement. The effect of the increase of fees has closely been monitored and lead to a reversal of policy in November 1997 and in September 98 with another reduction of fee charges. The financial year 98/99 closed with a fair situation of the finances of the Hospital compared to previous years, giving a better outlook for the on-going financial year, even though the financial stability will remain very uncertain for the next few years.
The 1998/99
financial year Annual Report
The 1998/99 financial year annual report is the first in which the activity report will be compared to the financial year to relate better input and output. Therefore the comparison with previous years will be, wherever possible, presented with the activities of the correspondent FY; some of the data will still be presented as activities of calendar year 1998.
The data presented here will be commented on and interpreted. Whenever possible a working hypothesis will be offered to explain data with controversial interpretation. The hypothesis proposed will be, where possible, tested in the course of 1999/00. Policy issues arising from the information presented, will be highlighted. Points requiring action will be identified at the end of each chapter and compared with the points of action identified in the previous edition of the report. Therefore it is hoped that all data presented can be placed and viewed in a dynamic perspective, thus making the reading of this report more attractive and enlightening.