About Hoima

Basingstoke Hoima Partnership For Health

Our Aim "To work with the people of Hoima Uganda to improve the delivery of healthcare"

About Hoima

Hoima is a town in North Western Uganda, smaller than Basingstoke but with a much larger district population. It lies on a good tarmac road about 4hrs from the capital, Kampala, but other roads in the district are very poor and some villages are not accessible by road. Most people there live by subsistence farming.

HOIMA REGIONAL REFERRAL HOSPITAL

Infrastructure and services

Like all Government Hospitals in Uganda, Hoima suffered total neglect during the political upheavals in 1970s and early 1980s. It was constructed in 1910 during the colonial period to serve Bunyoro Kingdom and white settlers. Though a few structures have been added over the years, the old ones have had little renovation. The population is now four times larger than when the hospital was built.

 

According to the Ministry of Health, the hospital has 139 beds. This is the number it is supposed to contain for the space available. In fact it has 246 - Medical (44), Surgical (46), Gynaecology, Ante-natal and Post- natal, (66), Paediatrics (40), Ophthalmic (18), Nutrition (8), TB and mental health (24). These numbers are often exceeded with patients lying on mattresses on the floor. There were 13,263 admissions in 2008/9 = 36 per day.

There are now two operating theatres, one for obstetric and the other for orthopaedic and surgical emergencies. Elective cases are frequently delayed. There is no recovery room. There is no isolation ward, nor the facilities for barrier nursing, which is a serious deficiency.

Accident/Emergency work has now been separated from out-patients. The outpatients department deals with over 200 patients a day.

Hoima Hospital was elevated to Regional Referral status in 1995 but the government never funded it properly. It therefore still serves mainly as a district hospital and none of the referral services actually exists except ophthalmology. Through a BHPH initiative, Dermatology and GU medicine services started in November 2011. The pathology service is very limited. There is no microbiology culture service and histology specimens have to be sent to Kampala. There is a single X-ray machine for plain X-rays only and one ultrasound machine. Blood for transfusion has to be brought from Kampala.

There is no general practice as we understand it. Community services are delivered through health centres staffed by nurses and outreach from the hospitals and include immunisations, antenatal care, child health, family planning and HIV counselling. Although immunisations are being done, we are told that outreach is not working well in Hoima District.

Finance

The hospital is funded entirely by Government grants and budgets are very inadequate for the workload, especially drugs, medical supplies and diesel. Drugs and supplies ordered from the Government store in Kampala are not always sent so essential items often run out.

Staffing

The Auditor General’s report for 2008/9 records ‘Out of the approved staff establishment of 361 posts only 161 are currently filled (44.6%) leaving a shortage of 200 staff.’ This was attributed by the hospital in part to lack of staff accommodation.

Hoima has 1 doctor per 38,917 people. The national average is 1/24,725 while WHO recommends 1/800. Staff are also badly paid. A newly qualified doctor earns £2,277 p.a. and a consultant £5,818. A registered nurse earns £1,720 p.a.

At present the hospital has specialists in obstetrics, paediatrics, medicine and ophthalmology and surgery. There is no consultant anaesthetist or orthopaedic surgeon. However, the doctors serving the surgical ward deal with fractures and burns and they do emergency laparotomies. They do not open the chest and there is no urological surgery. There are two surgical ‘camps’ each year when surgeons visit from Kampala and operate on elective cases now including childbirth injuries (VVF)

In the draft strategic plan, the Medical Superintendent calls for improvements in management capacity at all levels, particularly in human resources.

Utilities

Electricity supply is erratic and power can be off for hours at a time almost every day. There is a diesel generator for theatre but the fuel budget does not allow it to be used for long periods. Some areas have solar power for lighting. There is no lighting between the buildings. Water is on mains supply but is is unreliable. Each ward has just two wash hand basins and there is only one in theatre. Each ward has a toilet block with two ‘long-drop’ latrines. There are no hand-washing facilities for patients.

The challenges

Despite these huge deficits, our volunteers have praised the clinical skill, competence, dedication and hard work of many of those they have worked with. Given the staff shortages, financial constraints and the many difficulties they work under this is highly commendable. The Medical Superintendent writes, ‘The health care system in this region is weak and functioning sub-optimally due to a number of challenges. All health units are understaffed to handle the heavy patient load. However we can do better with the available resources. This partnership is one of the best things happening to the region and can help improve our services. This has already started.’

There are encouraging signs. The hospital is much cleaner than it used to be. New staff houses are being built which will make Hoima a more attractive destination for resident doctors. The new school of nursing means that in time there will be a pool of qualified nurses looking for work locally. A new maternity unit with its own theatre has been built and is functioning. There is a real desire to improve patient safety.

AZUR CHRISTIAN CLINIC

This is a private not-for-profit hospital in Hoima Town run by the ‘Help Hoima’ charity. It has outpatient facilities, a medical and a maternity ward. A maternity theatre was commissioned in July 2010 and a new paediatric ward opened in May 2011. BHPH has close links with ‘Help Hoima’ and there are growing links between HRRH and the Azur Clinic as well.

Hoima

Has a population of 585,000

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