Introduction and general remarks
Preparing an annual report early has the obvious disadvantage that some data (especially financial data) are not complete yet. For example we do not know the definite balance of our account at the MSD (medical stores department) in Dar es Salaam yet, because there was a network failure when we bought a large supply of drugs and dressing materials in December 2003. We will be sent a statement some time in 2004.
On the other hand the advantage of starting to write an annual report on the 1st of January is that figures are still fresh and the writer can still learn something from them. I think this advantage outweighs the disadvantage, because annual reports are mostly written for the benefit of the writer. How many people will really read it?
Following the national census in August 2002 the catchment area of Lugala Lutheran Hospital can be identified more clearly than in the annual report for 2002. The catchment area includes the following wards: Kilosa kwa Mpepo, Ngoheranga, Biro, Malinyi, Sofi, Usangule, Mtimbira, and Itete in Ulanga District. In addition the catchment area includes Utengule and Masagati in Kilombero District. This means that in 2002 about 92 659 people were served by Lugala Lutheran Hospital, 41.5% of the population of Ulanga District and 3.7% of the population Kilombero District. Of course some people from Itete go to the hospital in Ifakara depending on transport facilities, on the other hand patients are regularly referred to us from Mlimba, in particular obstetric patients.
Based on these figures Lugala Hospital should have at least 92 official beds. At present the number of official beds is 57.
An application for a modest increase in the number of official beds from 57 to 72 was sent to the Ministry of Health in 2003 and received. I was told that I may expect a reply in 2004.
Hopefully this report will remind the Ministry of Health to reconsider the number of official beds.
Overall bed occupancy rates could be calculated in relation to the actual number of beds in the hospital (at present 137), in relation to the number of official beds we should have (92) or in relation to the number of official beds we applied for (72) or in relation to the number of beds presently recognized by the Ministry of Health (57). The respective bed occupancy rates are 43.5%, 64.7%, 82.7% and 104.5%.
2003 was not a bad year. Many staff left to join the Government Health Services where they were offered higher salaries and a number of fringe benefits. However, most of the resulting gaps could be filled in time by new staff. In this context my particular thanks go to the Medical Officer i/C of Ilembula Hospital and the Officer i/C of the nursing school who let us have four newly trained midwives in August 2003. Right now we are only short of one clinical officer and a midwife for the MCH clinic. Of course it would be nice to gradually replace our untrained staff (medical attendants) by qualified staff according to the policy of the Ministry of Health. However, it needs to be recognized that at present we do not have the financial means to do so. Also the level of care given to patients in the wards by members of staff frequently depends on their dedication rather than on the amount of formal training they received. Still, in the long run we should have more trained nurses. This will however only be possible if we manage to open our own nurses training school and if the Ministry of Health increases our official number of beds.
Several staff (in particular clinical officers), who applied for jobs, came and left again immediately – Lugala was just to remote for their expectations in life.
Nine members of staff have gone for further training. While this means a considerable financial burden we consider it vital for the hospital to support such training of staff, because they will be obliged to work for Lugala Hospital for several years after completion of their training.
The hospital continues to have the following departments:
Outpatient department, operating theatre including X-ray facilities and dental care unit, laboratory, pharmacy including the infusion unit, male ward, female and children’s ward, maternity unit, MCH department, a workshop and an administration department.
All decisions are taken by the management committee, which meets every Friday afternoon. Members are: J.M. Pönnighaus (Med. Officer i/C), M. Mwemi (AMO), M. Matimbwi (engineer), I. Mollel (assist. accountant), E. Nyemele (matron), L. Chogo (assist. matron), H. Nyangi (representative of the medical assistants) and D. Thindwa (representative of the nurses).
The cafeteria (canteen California), which was closed at the beginning of 2002 because it was a loss making part of the hospital, was rebuilt and let to a businessman for TSH 20 000 per month. This covers the cost of supplying the place with water and electricity. Thus the cafeteria is no longer a burden.
In a similar vein the guest house which was also a financial burden was handed over to Mrs. Nyemele for administrative purposes. She turned it into a profit- making place! The profit of 142,055 TSH will be shared between Mrs. Nyemele and the hospital.
The pre-nursing school has been turned into a Preparatory School for Nursing College Entrance Examinations. It is now also financially independent of Lugala Hospital.
Our PHC activities are funded by the Danish Mission Council Development Department. They receive quarterly reports.
Altogether there were 3940 admissions in 2003 (3715 in 2002). This increase is largely due to an increase in admissions in the maternity unit. The male ward actually experienced a fall in admissions.
Even in Lugala AIDS has now become the leading cause of death in the female and in the male ward.
The number of outpatients declined from 11512 in 2002 to 10124 in 2003. The reasons for this are discussed below.
Lugala Lutheran Hospital joined the National Health Insurance Fund (NHIF) scheme on the 1st of April 2003. This means government employees do not pay directly for the services given to them anymore, instead we are reimbursed by the NHIF. The advantage of this is that the NHIF pays more for most services than we dare to charge patients for (e.g. we charge TSH 4000 for a C-section, the NHIF pays TSH 45 000 for such an operation). On the other hand there is a lot of paper work involved and there is a considerable delay in payments. Thus our actual income in 2003 is approximately one million TSH less than what we have earned. However, we shall eventually get this money in 2004.
The specialist outreach programme of AMREF continued to send doctors to Lugala as requested. In particular, we enjoyed the (one week) visits of a paediatrician (Dr. Msoma), the VVF surgeon (Dr. Rassen), a urologist (Dr. waweru) and a gynaecologist (Dr. Uromi). Unfortunately our airstrip is not fenced and some people have used it when driving to Tumaini rather than using the (bad) road. This will lead to a deterioration of the airstrip in due course but we do not have the means to fence the area.
The eye specialist from Morogoro did not come this year although he promised to do so several times.
The best news of the year is probably that we received a set of new batteries for our solar systems from the Lutheran church in Sachsen-Anhalt / Germany (KPS). This now allows us to operate even at night without having to switch on our generator. So the generator only runs from 7 pm until 10 pm now. All sterilizing is done during this time thanks to the cooperation of the theatre staff.
Financial liabilities mentioned in the last annual report could be solved with a generous donation also from the KPS.
In 2003 we have been able to reduce the gap between income and expenditure (in comparison with 2002). However, this gap will widen again following the increase in salaries on the 1st December 2003. Since that date trained and untrained staff are largely paid according to the latest Government salary scales. In any case it needs to be realized that our ‘expenditure’ does not cover the real costs because the depreciation of equipment and buildings is not mentioned. Also the cost of the expatriate medical officer is not listed. Thus there is no hope whatsoever that Lugala Lutheran Hospital will ever become independent of considerable donations.
The most important visitors in 2003 were Pastor J-H. Witzel from the church in Sachsen-Anhalt (KPS) who came in October 2003 together with Pastor Zipser of the Berliner Missionswerk and Mrs. U. Rhein. They were followed in November by Pastor Heyroth, Dr. Hable, Frau Richter and Frau Künanz from the Lugala Arbeitskreis in Germany. The future of Lugala Hospital was most thoroughly discussed with them. They assured us of their continuing support.