Annual Benchmarking Report for Mbale
Regional Referral Hospital and related
communities Health Centers, May 2011 -
Jennifer June Lamb and Jamille Paschoal Vicente, with assistance of
Esther Nandutu and Fred Chemuko
7. Data gathering
This report is the first in a planned series of Annual Benchmarking Reports
based on the collation and analysis of data on maternal and perinatal mortality
for Mbale Regional Referral Hospital (MRRH). This report has been compiled
on behalf of the Ugandan Maternal Health Partnership Hub, a newly
developed partnership with the objectives of collating Ugandan maternal
services to allow efficient exchange of knowledge, skills and training across
The overall aims of the partnership are:
Improve Maternal and Infant Health
Improve Inter-Project Collaboration to support Sustainability and
Encourage North-South and South-South (within Uganda) Knowledge
Promote Integration and Engagement with Health Systems
Improve Evaluation and Audit
Consolidate and Mobilize Additional Resources
This first report reflects several of these objectives, by:
To establish a against which to evaluate the impact of UMMPH-
Invest in and improve record-keeping and management systems at
MRRH so that:
o Recording processes are improved to reduce the level of
inaccuracy in current reporting and recording, improving the
quality of data.
o Sustainable data recording, management and analysis systems
become part of the routine day-to-day processes.
Funding received from the Tropical Health and Education Trust has allowed
development of the UMHPH across eight Ugandan Healthcare Partnerships,
of which MRRH is one.
Sustainability is key for this project to reduce the vulnerability of dispersed
individual projects. Links will be built to develop a more sustainable
infrastructure, allowing mutual support and collaboration, by adding value to
existing structures and initiatives. By working together in the UMHPH, we can
enhance existing services across Uganda.
Despite its broad objectives, UMHPH has sought to be narrowly targeted,
highly contextualized, and closely responsive to the identification of need and
policy initiatives raised by practitioners and managers in Uganda.
Whilst working for UMHPH we also set about the implementation of Vacuum
Assisted Delivery in the Mbale Region encompassing nine Health Centres.
This Work was implemented for Pontypridd Overseas Networking Trust
(“PONT”) which is a charity which has been successfully delivering Health
Care and Educational projects in the Mbale region of Uganda for 10 years.
Over the course of our visit we met with many different communities to aid in
gathering information for both KIWI and HUB projects. Present were
community health workers such as TBRAs, CHIPs, OPLs and the doctors in
charge. Issues discussed were concerning maternal and child health.
To meet with community members
To collect data pertaining Maternal and child health
To introduce new data collection specifically for KIWI project
To gain knowledge of any specific issues concerning workers
Visited Mbale RRH, Wanale health unit, Magale Health unit, Bugobero Health
unit, Bubutu Health unit, Bududa Health unit, Busiu Health unit, Bushika
Health unit, and Makhonje Health unit to hold meetings with all concerned.
Introduced workers form Liverpool University and gave explanation of new
data to be gathered to aid both KIWI and HUB projects. Health workers raised
issues and challenges they face with a hope for resolution.
The meetings were very successful and much information gathered. Workers
that attended have stated they are willing to aid in new data collection and
realised that without their continued participation help would be limited. Data
specific to Liverpool HUB was collected pertaining maternal heath from
monthly reports submitted to the DHOs office. An Excel spreadsheet was also
distributed for baseline data collection, (Appendix I), concerning the KIWI
study, this was studied by the centres concerned and any challenges raised
and problems resolved.
All Health units have vast areas to cover and find it difficult to reach all
perspective patients. This includes those in labour, children under five
and also the general community when delivering information on health
matters, sanitation and hygiene. This is due to a lack of transport for all
workers (all communities visited)
Not everyone has sufficient stationary to carry out the task of data
collection in all areas (Wanale and Busiu)
Workers could do with more support to aid in their duties as they feel
more information and supplies would give great results.
At this moment in time the ambulance motorcycles donated by PONT
have been well received, it was however stated that the design is not
suitable for the terrain in all areas (Bududu and Wanale) . Also at the
present time not all areas have been equipped with an ambulance
(Bugobero and Busiu). When referring on patients to MRRH the
ambulances are also not fully stocked with all necessary equipment
and this makes referral more challenging.
Problem concerning premature deliveries in Wanale health unit, the
centre has no way of keeping the baby warm, no incubator, and also
no method to administer oxygen resulting in neo-natal death. This
problem is not aided by the lack of electricity supply (all communities
Lack of lighting, of a night when a women is delivering there is no light
to aid the process in many of the health centres (Wanale). If
complications then arise the lack of light is a major risk factor. Also for
workers being contacted to visit with a patient at nighttime they feel it is
putting them at unnecessary risk to have no light source (Bugobero).
Equipment in some units is of poor quality, much of it out of date
(Busiu). Most units need equipment such as delivery kits, and also do
not have enough stitches for the patient numbers.
A full vaccination schedule cannot be followed for all infants, as
supplies are limited (all communities visited).
Workers do not have correct uniform, or none in some cases (Most
communities visited but Busiu in particular). They urgently need
protective work wear such as gum boots, so as to cut down on infection
rates and harm to workers.
Data from all Health Centres in the Mbale region is collected monthly and
delivered to the District Health Office. Here they are imputed into a database
by the records keeping department and they ensure that all Heath Centres
give forward their records that are produced in line with Ministry of Health
requirements. It is these records that allowed for our data collection, they
were however lacking in certain areas and it is this we have corrected with the
implementation of the new data collection spreadsheet.
7) Data Gathering:
In order to implement the the KIWI delivery system, it was distributed to all
communities Health Centers, a data sheet to be filled primarily to the month of
November. This information will make possible to evaluate the how effective
and what is the necessity of a KIWI assisted birth method in each area by
taking into considerarion: total number of births, number of standard vaginal
deliveries, number of ceaserian sections, number of breech babies, number of
vacuum deliveries, number of ruptured uteruses, number of eclamptic
mothers, number of Premature Rupture of Membranes (PROM), number of
Pre-Eclampsia Toxaemia (PET), number of women referred to the Regional
Referral Hospital, number of neonatal deaths/stillbirths, number of babies
born with Apgar <7 at 5 mins, number of maternal deaths, number of first time
mothers and second time mothers (including the information of previous
caesarean sections), number of Postpartum hemorrhage (PPH), and HIV
statuses of mothers and babies.
When ambulances are allocated terrain should be accounted for, when a
better-suited ambulance is available it would be beneficial to change the
model held at a given health unit.
Provisions for both incubators and oxygen supplies should be given to help
avert unnecessary neo-natal deaths.
The issue of electricity supply could be tackled with the installation of solar
Lack of light needs immediate attention; the implementation of torches or
paraffin lamps for example would be of great use.
Delivery kits and other equipment need replacing urgently as the current
supplies are outdated.
Support supervision for workers from both the district and the PONT office.
i) THIS IS WHERE THE SPREADSHEET WITH ALL DATA IN
WILL BE ATTACHED