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1. INTRODUCTION


Mission Statement of Wasso Hospital:

“WASSO HOSPITAL EXISTS TO FULFILL THE CALL OF CHRIST IN THE
HEALING MINISTRY BY IMPROVING AND MAINTAINING THE HEALTH
STATUS FOR ALL, ESPECIALLY FOR THOSE MOST IN NEED”.

History: The catholic priest and physician, the late Dr. Herbert Watschinger founded
Wasso Hospital as a mission hospital in 1964. He founded as well Endulen Hospital in
the south of the district in 1975 and Sonjo Dispensary at Digodigo in 1973. Until his
death in 1991 funds and donations in kind originated mainly from private and church
related sources in Austria.

Since 1991 the Austrian Government provides the major amount of funding for current
expenditure and investment of the hospital within the frame of the bilateral development
co-operation of Tanzania and Austria.

Since 1995 Wasso Hospital has officially functioned as the District Designated Hospital
for the Ngorongoro District with curative, preventive and promotive services. The
designation is based on an agreement between the Catholic Diocese of Arusha as the
legal owner and the Ministry of Health for the Tanzanian Government. The hospital is
since then entitled to receive government grants for staff, drugs and other charges.

Situation and Population: Wasso Hospital is located in the Arusha Region of northern
Tanzania and more specifically in the highlands of the northern half of the Ngorongoro
District (14,036 square km). The District Headquarters are at the little town of Loliondo
(2°03´ south, 35°37´east). Wasso is 9 km south of Loliondo located at an altitude of
2,005 m above sea level. The border to Kenya is 35 km to the north. The area is mostly
semiarid, comprising steppe, acacia shrub with riverine woodland and forests, the latter
especially at the higher altitudes. Depending on the elevation ranging from 610 m at
Lake Natron in the rift valley to 3.290 m in the crater highlands there is a tropical to
subtropical climate. Most of the year is dry with a short and a longer rainy season
providing pasture for the numerous wild animals and livestock. But the low rainfall is in
most of the area insufficient for agriculture.

The district population is estimated to be 129,776 people from national census of 2002 at
a growth rate of 4.0% per year. Total household in the district is 26,722 with an average
size of 4.9. There is a very low population density of about 9.2 per square kilometres
compared to the national of 39 per square km. All people are living in remote rural areas,
Wasso being 400 km distant from the regional town Arusha. It takes a full day travelling
mostly over rough roads or mere tracks to Arusha. About 85 % of the people belong to
the Maasai, a semi-nomadic pastoralist tribe. About 12 % are Batemi, agriculturists with
traditional irrigation systems in the fertile Sonjo Valley and the remaining minority are
of mixed tribal origin living in Loliondo and the few major villages including Wasso.
The per capita income is about USD 112 per year.

Wasso Hospital and its Health Services: Wasso Hospital is the only hospital in the
northern half of Ngorongoro District serving especially the Loliondo and Sale Divisions
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of the district and bordering areas of Kenya. The nearest hospital is Endulen, 213 km
away at the southern border of the district. With the exception of the few villages the
majority of the people are living scattered and far remote in the vast area, without means
of modern communication, roads, schools or health facilities. The Maasai live in their
traditional homesteads (kraals) in family units of 20 to 60 people with distances of
commonly 20 to 50 km apart and up to 150 km from the hospital. There are only a few
dispensaries in the major villages, too far away to serve the majority of the people. The
Maasai live a semi-nomadic life and they are forced and traditionally accustomed to
follow with their livestock the available pasture depending on the rains. This is why
Wasso Hospital runs within the PHC Program a high number of regular scheduled
mobile clinics (total 35 mobile clinic places) by car and small aircraft of the Flying
Medical Service with at least monthly visits by car and in case of the flight clinics visits
every two weeks. It is essential to maintain this component together with the other
curative, preventive and promotive hospital services if the hospital intends also in future
to aim at an adequate coverage of its service area and at fulfilling its referral function as
a district hospital. The services of Wasso Hospital including the bedded Digodigo
Dispensary and the comprehensive Primary Health Care Programme with mobile clinics
continued without serious problems during the reporting period. There were no major
outbreaks of diseases. Malaria remained at the top of the disease statistics for children as
well as for adults in both in and outpatient departments.

Reporting Period: This report covers the period from 1st January to 30th June 2003.

Health Management Information System and Participatory Approach to
Reporting: The contributions of the Department Leaders of the Wasso Integrated Health
Project were integrated into this report. The various departments for recording and
reporting have used the National Health Management Information System (HMIS) of
Tanzania (MTUHA) and is the basis for the regular feed back to the District Health
Authorities.

Organisational Set up: The Archdiocesan Medical Board, the Wasso Hospital Board of
Governors, the Hospital Management Team and the Hospital Management Committee
are the major components of the hierarchical structure. The Board of Governors and the
Archdiocesan Medical Board meet quarterly. The Hospital Management Committee
meets monthly and General Staff Meetings are held quarterly.

Land Title: After a long process, the hospital managed to obtain the Title Deed.

Environment Protection: A better protection of woodland and springs on the hospital
land has been achieved with the support of the Board of Governors, District Officials and
in co-operation with the Representatives of the local community. The hospital has fenced
the area of the major springs and provided a protected site where the community has
access to piped water from the overflow of the hospital tanks.

Funding: The Austrian Government through Austroproject has been the main funding
agency of the hospital over the past decade within the frame of the bilateral development
co-operation of the two countries. It is hoped that sufficient funding for the health
services of the hospital will be available within the support of the Austrian Development
Cooperation for the Ngorongoro District Development Plan (NDDP) and more
specifically, for the Comprehensive Council Health Plan.
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Co-operation with the District Medical Office, Decentralisation, Health Sector
Reform, Budget 2002 / 2003: Increasingly funding will have to come in future from the
local government under consideration of the national decentralisation policy and the
health sector reform to guarantee long term sustainability of the health services of this
District Designated Hospital

A Comprehensive Council Health Plan and Health Budget for the period of five years
from 2002 to 2007 was conducted from 3rd to 9th April 2002. This was prepared on the
basis of community needs assessment. A prototype comprehensive council health plan
format was used under the facilitation of the RMO and RHS. This was followed by two
more workshops conducted at CEDHA by MOH facilitators between the 6th to the 19th of
October and between the 4th to the 15th of November 2002. The plan is under
implementation during this reporting period.

During this first six months of the year 2003, the grants of the central government
covered 43.4% of the total grants to the hospital, 35.8% came from Austria and 20.8 %
were generated by the hospital locally.

The VISION of Wasso Hospital and for the Wasso Integrated Health Project remains
unchanged:

„To undertake all efforts to contribute towards a better health status of the people
in the area by improving the quality of the health services and by making them
easier accessible, acceptable and affordable“.
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2. WASSO HOSPITAL

2.1 VISITORS

The hospital welcomed many visitors on official and private business from Tanzania and
abroad of whom only some can be mentioned in this report.

 See Tables and Statistics: A-1.


2.2 SPECIALIST OUTREACH PROGRAM TO WASSO HOSPITAL:

The visiting specialists from the African Medical Research Foundation (AMREF)
Nairobi, the Regional Mount Meru Hospital Arusha, St. Elizabeth Hospital (Archdiocese
of Arusha) and the Kilimanjaro Christian Medical Centre (KCMC) Moshi work usually
for a period of several days in Wasso Hospital. These visits are very beneficial for
preselected patients and enable the hospital staff to get updates and acquire skills in their
respective fields of work.

18.02.-21.02.2003     Dr. C. K. Muasya, paediatrician, AMREF, Nairobi
                      Mission:Specialist outreach visit in paediatrics.
18.02- 21.02.2003     Sadiki Materu, laboratory technician, AMREF, Nairobi
                      Mission: Supervision and training of laboratory staff.
06.03.-08.03.2003     Dr. Moke Magoma, consultant gynaecologist, St. Elizabeth
                      Hospital, Arusha.
                      Mission: Specialist Outreach Visit Obstetric and Gynaecology
                      conditions.
03.04.-05.04.2003     Dr. Landrada Mutasingwa, Dental Surgeon, Regional Mount Meru
                      Hospital, Arusha.
                      Mission: Specialist outreach visit in Oral diseases.
22.04.-25.04.2003     Dr. Wachira, Urologist, AMREF, Nairobi.
                      Mission: Specialist outreach visit in Urology.
06.05.-08.05.2003     Dr. Brian Savage, Eye Surgeon, KCMC, Moshi.
                      Mission: Screening and operating on eye patients.
06.05.-08.05.2003     Dr. Chibuga, Ophthalmologist in training, KCMC, Moshi.
                      Mission: Screening and operating on eye patients.
24.06.-27.06.2003     Dr. Muli Mutinda, General Surgeon, AMREF, Nairobi
                      Mission: Screening surgical patients and performing surgery.


2.3 ADMINISTRATION

Introduction: The administration of Wasso Hospital consists of various units and
sections including: Registry and records, accounts, communication, staff welfare, public
relations, library, stores, guest tract, guest kitchen, workshop and garage, security guards,
flower and vegetable gardens, energy and water. The department is also responsible for
environmental sanitation of the hospital compound.

Staff: Head of the department is Mr. Aloyce Koillah. The doctor i/c, the matron, the
hospital secretary and the accountant are forming the Management Team of the hospital.
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A secretary trained in computer work and a stores assistant complete the staff of the
administration.

The hospital is at the apex of implementing the specific objectives of acquiring qualified
staff, recruitment, and training of the excisting staff. However recruitment of qualified
personnel has not been achieved.

Communication: A telephone system with direct dialling is in place and is also used for
e-mail and internet facilities. This replaced an old method whereby the hospital used to
have access to e-mail through the high frequency radio call. The hospital received a fax
machine from a private donor. This has started to a operate few days after the end of this
reporting period.

Library: The library has been up-dated during the current and past year and have quite a
number of books, most related to health issues . Also some newspapers and journals are
regularly available. A useful selection of books is now also available at the small new
library of Digodigo Dispensary.

Vegetable Garden: From the hospital garden, established at a new site more than a year
ago, a good harvest of green vegetables, cabbage and tomatoes was obtained for the
patient and the guest kitchen during the reporting period.

2.4 WORKSHOP/ INFRASTRUCTURE/ TRANSPORT / ENERGY / WATER

Manpower: The workshop is a sub-department of the administration. Workshop leader
is Mr. Noeli Chipegwa, motor vehicle mechanic. There are also two electricians, one
plumbing assistant, one plumbing attendant, one carpenter, other two mechanics, and two
drivers.

Repairs and Maintenance: A well functioning system for repairs and continuing
preventive maintenance of structures, infrastructure and equipment has been established.

Transport: The hospital has one Toyota Land Cruiser (1994), one Toyota Land Cruiser
Hard Top (1994), one Toyota Pick Up (1997) and a 5.5 ton Mercedes Benz. The
condition of the Hard Top and the Pick Up requires replacement of these vehicles
(Registration No. ARQ-4 and TZK-8033) as their maintenance is getting increasingly
expensive due to frequent major repairs. Thanks to MIVA Switzerland together with
MIVA Austria for donation of a new car, Toyota Land Cruiser Hard Top. The oldest two
of the four motorbikes require frequent repairs and need to be replaced.

Energy: The solar systems are reliable and effective. The generators remain however
indispensable especially for the x-ray unit, some workshop equipment, the photocopy
machine, the steam pressure autoclave and for stand by in case of a break down of some
vital solar system, e.g. the one for the operating theatre.

Water and Sewage: The new water supply system functions well. The new sewer line
requires a lot of maintenance due to misuse by patients and attendants. However,
considerable improvement of the situation has been achieved by controls, education and
information of the users. The biological sewage plant functions well.
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2.5 STAFF AND TRAINING

Staff development and qualified staff: Wasso Hospital including the Primary Health Care
Team and Digodigo Dispensary had 112 members of staff per 30.06.2003. This number
includes 14 members of staffs who were and still are under training in a health profession
institute during the reporting period. So far 58 qualified and 54 (including 15 Nurse
assistants) non-qualified staff members are under contract.

The hospital had a privilege of employing another volunteer physiotherapist from
Holland after an agreement with Horizon Holland, a Dutch organization that sends
volunteers to work in developing countries. She took over from the first physiotherapist
who finished her six months contract in April this year. We highly recommend for the
continuation of physiotherapy activities.

Arrivals of new recruited qualified staff:
    11.01.2003 Goodluck T. Maiga            Trained nurse/ Anaesthetist
    03.02.2003 Pamela Kereri                Health Attendant
    03.02.2003 Juliana Masago               Health Attendant
    06.02.2003 Florida Justus Subira        Nurse Officer
    01.03.2003 Magreth Loth                 Nurse Assistant
    01.03.2003 Joyce Matiku                 Nurse Assistant
    17.04.2003 Dr. Nyaluke Paul             Medical Officer
    15.05.2003 Loes Ero                     Volunteer Physiotherapist

Departures of staff: The following staff departed in this reporting period:

      30.04.2003     Dorah Mwassa           Senior Nurse Officer
      30.04.2003     Martha Mtui            Nurse Midwife
      30.04.2003     Aneth Megiroo          Nurse Assistant
      30.04.2003     Elizabeth Lorivi       Cleaner
      30.04.2003     Mathilde Hiep          Volunteer Physiotherapist

Death: It was a sad moment on 23rd of June 2003, when one of our staff, Flora Kuba,
passed away following a long illness. She was working as an accountant assistant in the
hospital prior to her illness.

Sponsored formal training and upgrading: Investing in sponsored formal training and
upgrading in health professions for existing and especially indigenous staff will bring
long lasting benefits for Wasso Hospital and its services. This is a better and long term
solution to the problem of shortage of qualified staff in this remote area than merely
recruiting non permanent staff from other areas of Tanzania.

Staff on formal training / upgrading per 30th June 2003: The hospital still has the
plan of training its employees in order to impart them with necessary knowledge and
improve, sharpen their performance skills in the reformed health sector. Several staff sat
for entry examinations before joining different courses organised by the ministry of
Health. There are still a number of staff in different training institutions.

 See Tables and Statistics. A-2.
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External seminars and workshops:

 See Tables and Statistics. A-3.


Social Welfare: Social Fund Account was established specifically to with loan. Any
staff who want to join the fund has to contribute a sum of Tshs 89,000/= to guarantee
membership. This scheme has benefited its members in various ways including the
construction of houses, payment of school fees and other needs.
Other social activities include table tennis and the use of the hospital television for staff.

Trade Union: A branch of the Tanzania Union of Government and Health Employees
(TUGHE) has been established in 1999 at the hospital. The hospital management
appreciates the co-operative approach of the members of the TUGHE branch in the
hospital.

Security: Two security guards undergone local training at a nearby village called
Oloirien to improve their effectiveness at work. The district authority organized their
training.


2.6 CURATIVE SECTOR

 See Tables and Statistics. A-4 to A-44.

Some Key Statistics for the period from 01.01.2003 to 30.06.2003:

   Out Patient Department:
    Total number of attendance 8294 (7269), or 45.8 per day.
    In Patient Department:
    Capacity: 86 beds.
    Total number of admissions 896 (860), or 4.9 per day.
    Total number of in patient days 17,939 (16,238)
    Average length of stay 20 (18.9) days.
    Bed occupancy rate 115% (102%)
    Total number of death: 35 (51)
    Total number of deliveries: 116 (147). Maternal death: 1 (0).

Remarks:
 Figures in brackets are taken from the previous report for comparison.
 The higher number of outpatient attendances is mainly caused by rain season and
  thus increased incidence of malaria cases during the reporting time. A total of 2622
  malaria outpatients attended during the last reporting period. During this reporting
  period the number was 3300. A poor health system in the district also contributes to
  this matter.

Nursing Department:
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Nursing Services: Curative nursing care and daily preventive services including health
education, counselling and family planning are provided. Proper handing over from shift
to shift is obligatory. Up to date equipment is in place. The nursing staffs are working
hard to provide a good quality nursing care despite the shortage of qualified nurses.
Under the nursing department is also the patient kitchen, laundry and sewing room.

Staff of the Nursing Department per 30.06.2003:
Qualified: The acting head of the department is Ms. Cecilia Nkii, an experienced nurse
midwife, she took over from Sr. Dorah Mwassa who finished her contract during this
reporting period. The total number of qualified nursing staff is 35 (including nurse
assistants). This includes however 16 staff members who are working full time or part
time in the medical department (pharmacy, operating theatre), PHC Department,
Digodigo Dispensary or who are attending upgrading courses.

Staff List per 30.06.2003:
4 Nursing Officers.
9 Nurse Midwives, of whom 1 is also anaesthetist and HIV/Aids counsellor, 1 is in
training.
1 Trained Nurse who is also a nurse anaesthetic
20 Nurse Assistants, of whom 2 are in upgrading to become Nurse Midwives
1 Public Health Nurse B.
1 Mother and Child Health Aid undergoing upgrading to become Public Health Nurse B.
10 Health Attendants (Earmarked for Training).

Staff Requirements:
6 Nursing Officers
9 Nurse Midwives
2 Public Health Nurse

Medical Department:
Head of the department is Dr. Paul Nyaluke, MO. There are 14 qualified staff members
per 30.06.2003. Medical department includes: outpatient department, radiology,
pharmacy store, operating theatres, dental unit, and physiotherapy and laboratory
departments.

Staff List per 30.06.2003:
2 Medical Officers (1 in charge of Wasso Hospital)
1 Assistant Medical Officer.
1 Physiotherapist (Volunteering for six months, from May 15th 2003)
5 Clinical Officers (1 is also a qualified radiographic assistant)
1 Dental Therapist
2 Laboratory Assistants
1 Laboratory Attendant
1 Radiographic Assistant
2 Pharmacy Attendants (qualified nurse assistants)
2 Outpatient Department Clerks.

Staff Requirements listed in Order of Priority:
1 Assistant Medical Officer
1 Pharmacy assistant
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1 Medical Recorder
1 Laboratory Technician

In Patient Department: There are five wards, maternity, female ward, paediatric ward,
male ward and tuberculosis ward. We have two nurse stations, a midwifery station and
an ICU (Intensive Care Unit) with 2 beds. There are 3 self-contained private rooms,
which are an important aspect of income generating for the hospital. Up to date ward
equipments are in a good order. Some bed needs replacement in the near future.

Out Patient Department: The laboratory, the dispensing room and the mother child
health clinic are integrated in the out patient department. The examination room of the
medical officer is equipped with an ultrasound apparatus operated by solar electricity and
an electrocardiograph. A basic dental unit with a dental therapist in charge, functions
without any problem.

Operating Theatres: There is a major and a minor theatre. Two experienced anaesthetic
nurse provides safely different types of anaesthesia. Improved asepsis and safety, a
reliable solar system for lights, theatre lamp, suction machine and oxygen concentrator
but also a functional flow pattern of staff, patients and materials are the major
achievements. Of the two new steam autoclaves one is operated by alternating current
from the generator. The second autoclave and distillation apparatus need still to be
connected to an independent solar system. We hope this will be achieved during the next
reporting period.

Laboratory: A qualified laboratory assistant is the acting head until we succeed to
recruit a laboratory technician. Another laboratory assistant and one locally trained
laboratory attendant complete the team. The quality and the range of tests and
investigations are adequate for an up-country district hospital.

X-Ray Unit: A qualified radiographic assistant is in charge, sometimes assisted by a
nurse assistant who receives on job training in the handling of the x-ray machine. The
very well functioning Siemens x-ray apparatus, donated from Austria in 1999 (a second
hand but as new machine) meets all the requirements of up to date radiation protection.
The quality of the x-ray pictures is excellent.

Pharmacy and Drug Management: Two nurse assistants with a long time experience
in the main pharmacy store, do a great job. The stock keeping, drug issuing and ordering
process is properly handled. We are compiling monthly stock and issue lists for the
assessment of the consumption. This enables the timely re-ordering of drugs in sufficient
quantities. Orders are placed to the Zonal Medical Stores Department in Moshi at least a
month in advance with the aim to get most of the drugs from this government subsidized
source. By big orders we try to build up a stock sufficient for at least six to eight months.
Operating with a smaller stock results in shortages. Shortages in consequence result in
urgent drug orders from private pharmacies in Arusha; a situation we try to avoid
because of the high drug costs there.

Study shows that the prices at private pharmacies are between two and five fold higher
than in the Medical Stores Department for virtually all kind of drugs. In this reporting
period the percentage of drugs fund used to pay for private pharmacy is 28.8%. We are
trying hard to reduce further the purchases from private pharmacies. But the problem is
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that the Medical Stores Department has frequently a number of common drugs not in
stock for prolonged periods. We have however made sure that the drug orders and the
drug supplies of the hospital are adequate in quantity and quality and that they follow the
national list of essential drugs.

Another issue is the control of drugs. Drug pilfering seems to cause only minor losses.
We continue to provide education and information in order to reduce poly-pharmacy by
the prescribers. Continuing medical education in meetings and during supervised ward
rounds is a valuable tool. During the daily morning meetings of the doctors, clinical
officers and the senior nursing staff all new admissions are presented and discussed
including the drug prescriptions. Every doctor and clinical officer has got a copy of the
National Treatment Guidelines and is requested to follow it.

Dental Department: This is housed in one of the rooms that was supposed to be a
private room for patients. For the time being the dental therapist is doing many
procedures and treat all common dental problems in the area.

Physiotherapy Department: As for dental department, this new department in the
hospital also occupies one of the rooms in the private unit.

Eye Department: There is no separate eye unit in the hospital, all eye patients are
treated at the outpatient department.

A proposal has been written to try to get funds for the building of a separate dental,
physio and eye unit. This proposal has been send to an organisation in the Netherlands,
but no reply has been received up till this moment.

2.7 PRIMARY HEALTH CARE

 See Tables and Statistics. A-45 to A-58.

Introduction: All activities continued without major problems. The services are mainly
delivered in the Loliondo and Sale Divisions with an estimated population of 69,918
people (2002 Census). The team succeeded in achieving the main objective, to provide
essential preventive, promotive and curative services to the communities with a good
coverage in the service area.

Staff of the Primary Health Care Department per 30/06/2003: Head of the
department is Ms. Suzanna Koillah, a qualified community development officer.
Staff List per 30/06/2003:
1 Community Development Officer
1 Nurse Officer
3 Nurse Assistants
1 Community Based Distributor

Staff Requirements:
1 Nurse Midwife or Nurse Officer.

Primary Health Care Activities:
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Mobile Clinics: Scattered and remote settlements in the service area make such kind of
services indispensable. Many people live 20 up to 50 km away from the next health
facility. The primary health care team visits at present 35 clinic places covering 25
clinics by car once a month. 10 remote clinic places, often not accessible by car, are
visited by small airplane of the Flying Medical Service twice a month. During the
reporting period one new car clinic was started at "Olosho" and one new flight clinic at
"Olchoro". Preventive services including child health and antenatal clinics, vaccinations,
health education, basic treatment and referrals to the hospital are the major tasks.

Child Health Care: All children under the age of five were registered at the clinic
places following the guidelines for the Health Management Information System
(MTUHA) of the government. A total number of 7757 (8,284) children under five have
been weighed. 6020 (5,947) were found in the green zone, 1730 (2,150) in the grey
zone and 7 (190) in the red zone. All of the severely malnourished children were
referred to the hospital. The national targets for the vaccination coverage are as follows:
BCG 95%, DPT3 80% and Measles 70%. The actual vaccination coverage is
documented under Tables and Statistics. A-46 and A-47 for Wasso and B-6 for
Digodigo. (In brackets are figures of the previous reporting period)

Mother Health Care: All pregnant women who attended the clinics have been screened
following the government guidelines including the use of HMIS (MTUHA) for
recording and reporting. Of a total number of 1114 (3724) screened pregnant women
116 (91) were assessed as having at risk pregnancies and referred to the Hospital. A total
number of 291 (402) doses against tetanus (TT) were given to women in the
childbearing age (15 to 49 years). A total number of 800 women were screened for
syphilis, 85 were found to be reactive and treated. (In brackets are figures of the
previous reporting period)

School Health Programme: Twice a year all schools in the catchment area are visited.
A clinical officer or doctor screens all students for health problems. Health education
especially on STD / HIV / AIDS, Trachoma and Dysentery was provided. Students
without a BCG scar were vaccinated against tuberculosis. 35 Female students in the
childbearing age (from 15 years onwards) received tetanus toxoid. BCG was given to 18
students.

11 Primary schools were visited out of 14. A total of 2041 students have been screened.
361 students received treatment. The most common diseases found were pneumonia,
eye-diseases, skin infections and worm infestations.

Dental Health: The dental therapist visited all schools in our catchment area during this
reporting period. He joined the team on school visits and checked all students for dental
problems and provided education on dental care.

Tuberculosis Programme: The tuberculosis programme of the hospital follows the
national guidelines. Case finding, referrals to the hospital for investigations and initial
treatment, the continuation of treatment at the clinic sites and defaulter tracing are
important activities of the PHC team. Due to the neighbourhood of Kenya we receive
many patients from across the border.
                                                                                        12


STD / HIV / AIDS Programme: Sexually transmitted diseases including HIV / AIDS
are a growing problem in our catchment and service area. We have increased the efforts
to provide information through video, seminars and counselling. Treatment of STD’s
follows the syndromic approach in line with the national guidelines. The counselling
services and health education concerning STI’s including HIV / AIDS are provided by a
number of trained counsellors of the hospital.

Eye Health Programme: Lack of water in our area contributes to eye infections
including trachoma. Health education aims at reducing this problem. In collaboration
with the Northern Maasai Land Mobile Unit (NMMU) we identified and provided
transport for the referral of eye patients from remote places to the hospital to be seen by
the visiting ophthalmic surgeon. During his visit 20 cataracts removals with intra-ocular
lens replacement were performed.

Health Education / Information: Health education and information is regularly
provided at the clinic places, during school visits and within the hospital. The topics
during outreach are often depending on a prevalent disease or health problem at a place
visited. Common topics were Malaria, Pneumonia, Diarrhoeas, STI/HIV/AIDS and
Tuberculosis. A total number of 233 teaching sessions were provided. See also under
Tables and Statistics. A-57.

Also during the reporting period the PHC team conducted seminars for village health
workers and headmasters from several schools in the district. The first one was
conducted from to the 12.06.2003 to 14.06.2003 for headmasters. The second seminar
was conducted from 26.06.2003 to 28.06.2003 for the VHW's. The main topics for both
seminars were STI/HIV/AIDS and environmental sanitation.

Basic Treatment and Referrals: Total numbers of 1127 (1140) patients were treated
during outreach clinics 355 (319) patient at car clinics, and 772 (821) patients at flight
clinics, 32 (38) were evacuated to the hospital. (In brackets are figures of the previous
reporting period)

Community Involvement: The community of Olchoro have constructed a small airstrip
and on 17.05.2003 the first flight clinic was done. Since 20.05.2003 a new car clinic in
Olosho was started according to the planning of the period July - December 2002.

Collaboration with others: There was a good co-operation with the district medical
officer and his team. We received a regular and sufficient supply of vaccines, kerosene
for the refrigerator and for sterilization and anti-tuberculosis drugs. There were several
supportive supervision visits by the district medical officers team. Collaboration is
established especially in the fields of the health management information system (HMIS/
MTUHA), Tuberculosis Programme, Expanded Programme of Immunization (EPI), STD
/ HIV / AIDS and Family Planning. The hospital participates in the quarterly District
Primary Health Care meetings represented by the doctor in charge and the PHC
department leader of the hospital.

Collaboration was started with OXFAM concerning STI/HIV/AIDS strategies and we
hope to continue this in the future as well as collaboration with ERETO (NGO working
already in Ngorongoro division).
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3. DIGODIGO DISPENSARY

 See Tables and Statistics. B-1 to B-11.


3.1 INTRODUCTION:

Digodigo Dispensary (12 beds) is a health unit under Wasso Hospital. It is located in the
Sale Division at Digodigo in the more densely populated Sonjo valley, 56 km by road
from Wasso. The Batemi (about 15,000 people) are the main inhabitants of the valley.
They depend mainly on subsistence farming with traditional irrigation systems and to a
lesser extent on livestock. The valley is surrounded by land of the majority tribe, the
pastoralist Maasai.

The curative and preventive activities of the Dispensary continued smoothly during the
reporting period. Malaria remains the leading diagnosis. 3362 (3195) outpatients out of
total attendances of 6447 (6450), and 147 (160) inpatients out of a total admission of
294 (208) patients were treated for malaria from January to June 2003. (In brackets are
figures of the previous reporting period)


3.2 STAFF AND TRAINING

Staff of Digodigo Dispensary: Mr. Frank Lisso, clinical officer, is in charge of the
dispensary. Ms. Mwivei Mtunguja, nurse midwife, is the matron and deputy head of the
dispensary following the transfer of Ms. Cecilia Nkii to Wasso Hospital to be acting
matron. One rural medical aid attends an upgrading course to become a clinical officer.
He is due to finish in July 2003. Two nurse assistants are attending a nurse midwife
training, Three health attendants are in training to become clinical officers and one health
attendant is in training to become a nursing officer. The Mother Child Health Aid went
for upgrading to become a public health nurse grade B. She is due to finish in July 2003.

Exchange Programe: There has been no exchange program during the reporting time.
One nurse assistant went to Digodigo to reinforce the team.

Staff List per 30.06.2003:
    1 Clinical Officer in charge of the dispensary
    1 Nurse Midwife (Matron and Deputy in charge).
    1 Laboratory Assistant
    3 Nurse Assistants
    2 Health Attendants (Community Based Distributors).
    1 Ward Attendants with a temporary contract.
    2 Sanitary Attendants / Night Watchmen (alternating) and one more watchman
       with a temporary contract.

3.3 INFRASTRUCTURE, TRANSPORT, ENERGY, WATER

Buildings: - All buildings are in good order whereby all qualified staffs are
accommodated. Two staff lives in the village near the Dispensary. A contract is signed
                                                                                        14


with the owner so that they can be accommodated till December 2003 whereby the
contract will be renewed.

Transport: The two motorbikes are still working though the Honda 125 / Reg. No. TZJ
9606 needs urgent replacement as it is old and spare parts are difficult to obtain for this
model. Also the Yamaha 225 / Reg. No. ART417 has had several mechanical problems.
The garage department of Wasso Hospital can repair many of these, but also spare parts
for this type are difficult to get. There has been a request from the dispensary to obtain
new motorbikes, which will be more reliable.

Energy: There have been problems with the solar system for light during this reporting
time and the solar technician from Wasso Hospital had to come for reparation and
maintenance.

Water: It is a serious deficiency that the dispensary has no piped water. The existing
rainwater tank does not provide sufficient water around the year. However there has been
assistance from Mr. Claus Derung who built small water tanks and according to the
planning a reliable water source to the dispensary should be established by September
2003.


3.4 CURATIVE SECTOR

 See Tables and Statistics. B-1 to B-5.

Some Key Statistics for the period from 01.01.2003 to 30.06.2003.

Out Patient Department:
Total number of attendance: 6447 (6450), 35.6 (35) patients per day.
In Patient Department:
Capacity: 12 (10) beds.
Total number of admissions: 294 (208), 1.6 (1.1) per day.
Number of death: 14 (6).
Deliveries: 15 (14) Maternal death 0 (2).
Patients referred to Wasso Hospital: 16 (14) inpatients and 16 (13) outpatients

      Figures in brackets are taken from the previous report for comparison.

Out Patient Department: During the reporting period a total number of 6,447
outpatients were treated, among them 3,362 cases of malaria. Malaria remains the top
diagnosis in the out and in patient department.

In Patient Department: During this reporting period 294 patients were admitted,
amongst them 147 with severe malaria, and 59 with pneumonia. There was a little
increase of deliveries from 14 to 15 at present. A total number of 16 inpatients were
referred to Wasso Hospital; most of them complicated obstetric or surgical cases.

Laboratory: A qualified laboratory assistant is in charge of a laboratory. All common
investigations at dispensary level, but also sputum for AFB, blood grouping and cross
matching are performed here.
                                                                                      15


Drugs and Medical Supplies: Drugs and other supplies were supplied by Wasso
Hospital to Digodigo timely and in sufficient quantities. The supplies are dispatched
from Wasso Hospital on a regular monthly basis after receiving the monthly general and
drug reports from the in charge of the dispensary.


3.5 PRIMARY HEALTH CARE

 See Tables and Statistics. B-6 to B-11.

Introduction: The main objective and the range of activities are the same as for the
Wasso PHC team (see 2.7). The Digodigo PHC team visits also individual homes in the
villages. All activities continued without major problems. The services are mainly
delivered in the Sonjo Valley and at Masusu, a Maasai village, 30 km distant from
Digodigo. The team provided successfully essential preventive, promotive and curative
services to the communities with a good coverage in their catchment area. The
environmental sanitation is generally very poor. Strong traditional beliefs of the Batemi
guarded by influential people, usually old men and age group leaders, make behavioural
changes in the community difficult.

Staff of the PHC Team per 30/06/2003: Team leader is Mr. Joseph Saisa Laisser,
community based health distributor. There is a close collaboration with the Matron, a
qualified nurse midwife.

Staff list per 30/06/2003:
    2 Health Attendant (community based distributor)
    1 health attendant went for upgrading to Clinical Officer.
    The Mother Child Health Assistant (MCHA) went for up grading to Public
        Health Nurse B.

Staff Requirements:
    1 Public Health Nurse Grade B or
    1 Nurse Midwife

Primary Health Care Activities:

Mobile clinics: They are mainly done by motorbike, for some clinics by hired car. The
four major villages, Digodigo, Mugholo (3 km), Kisangiro (6 km) and Masusu (30 km)
are monthly visited clinic places. Three other clinic places are visited on market days,
Bwelo Digodigo, Makurehenane and Bwelo Mugholo.

Child Health Care: All children under five years of age are registered, weighed and
vaccinated in line with the national guidelines. Mothers of malnourished or low weight
children are individually counselled with feeding advice.

Mother Health Care: Registration and tetanus immunization of all women in the child
bearing age (15-49 years) and examination and screening of all pregnant women to
detect at risk pregnancies are the major tasks. Out of a total number of 247 pregnant
women 83 were assessed as being at risk. The number of deliveries in the dispensary
increased considerably since a nurse midwife started to work in Digodigo dispensary in
                                                                                        16


December 2000. In the year 1999 the total number of deliveries were 12, in 2000 15
deliveries, in 2001 27 deliveries, in 2002 37 deliveries. In this six months reporting
period the number is 15.

School Health Programme: All five schools in the catchment area are visited twice a
year with a new school at Masusu, Digodigo Primary School, Digodigo Secondary
School, Kisangiro Primary School, Samunge Primary School and Eyasi Mdito Primary
School. In this reporting period 864 primary school pupils were screened, 3 had no BCG
scar and were vaccinated against tuberculosis. 31 girls in the childbearing age were
vaccinated against tetanus. The common health problems were malaria, intestinal worms,
upper respiratory tract infections and fungal infections. 252 secondary school students
were screened. Nobody was vaccinated with BCG, 50 girls in the childbearing age were
vaccinated against tetanus.

Dental Health: The dental health screening and education on dental care during school
visits was done in all schools within our catchment. The dental therapist from Wasso
Hospital joined the PHC team on school visits and checked all students for dental
problems and treated / provided education on dental care.

Tuberculosis Programme: In the catchment area 15 patients with tuberculosis were
registered in Wasso Hospital.

STD / HIV / AIDS Programme: At all clinic places and during school visits this is a
major topic for health information and education. It is needed to intensify the awareness
campaign and involve influential people as traditional, church and school leaders to fight
against this major threat.

Eye Health Programme: In collaboration with the Northern Maasai Land Mobile Unit
(NMMU) patients with eye problems were identified and referred to Wasso Hospital for
management by the visiting ophthalmic surgeon from KCMC in May 2003.

Health Education / Information: Health education and information is regularly
provided at the clinic places, during school visits and every morning in the dispensary for
outpatients and inpatients. Common topics during the reporting period were malaria,
sexually transmitted diseases including HIV / AIDS, personal hygiene and environmental
sanitation, family planning and nutrition. Environmental sanitation remains very poor. Of
620 homesteads at Digodigo only 38 have a pit latrine, of 440 homesteads at Mugholo 26
have a pit latrine, of 273 homesteads at Kisangiro 8 have a pit latrine and among 19
bomas at Masusu only 2 have a pit latrine.

Treated Mosquito Nets: In this reporting period 34 treated nets have been sold at low
cost to the community. We have not been re-treating mosquito nets with Permethrin in
our dispensary, although more people than previous years have been requesting for it.

Vaccine and Kerosene Supply: There was a good collaboration with the District
Medical Officer. Vaccines and kerosene for the refrigerator and for sterilization were
monthly received in sufficient quantities. Also contraceptives for family planning and
some equipment for the mother child health clinic were supplied.
                                                                                        17


4. PLANNING MATRIX 2002-2003.


The planning matrix for the project phase 2002 to 2003 is our guide for the operational
planning. The ranges of activities are required to be achieved, the specific objectives is
wide and requires a lot of effort.

A lot has been achieved already. The implementation of activities is still ongoing but will
depend last but not least on the funds available.

A Planning Matrix for the year 2002 – 2003 which is at the annex was formulated by the
head of departments and will be the continuation of what we have achieved, what has to
be maintained and what has to be implemented.
18
19
                                                                                         20


     A. TABLES AND STATISTICS – 1st JANUARY TILL 30th OF JUNE 2003

     TABLE A-1: VISITORS

  Date     Name                  Position                       From                Mission
  2003
03.01.03   Eamon Brehony         Teacher                 Arusha                PWC evaluation
16.01.03   M. Patricia           Officer NHIF            Dar es Salaam         Training
16.01.03   K.S. Mfangavo         Tutor Mandaka College   Moshi                 Visit
16.01.03   M. Namfua             Principal    “          Moshi                 Visit
17.01.03   Carsten Bendik        Danida Review Team      Denmark               ERETO
17.01.03   Rahab Kenana          Danida Review Team      Kenya                 ERETO
20.01.03   Caroline Heinz        C.S. Heinz Foundation   U.S.A.                Visitor
21.01.03   Mathew Ndomondo       Auditor                 Arusha                Supervision
24.01.03   R.H. Kisanga          Judge                   Dar es Salaam         Visit
24.01.03   Catherine H.M.        Commissioner            Dar es Salaam         Visit
           Kwanda
24.01.03   Jecha Salim Jecha     Commissioner            Dar es Salaam         Visit
27.01.03   Francesca             Teacher                 Cambridge, United     Visitor
           Woodburn                                      Kingdom
29.01.03   Edward Mahenge        NMCP                    Dar es Salaam         Malaria data
                                                                               collection
29.01.03   W.J. Mwafongo         NMCP                    Dar es Salaam         Malaria data
                                                                               collection
02.02.03   Mameso Frederick      Clinical Officer        Endulen               Seminar
02.02.03   Lodwin mshumbe        PHC                     Endulen               Seminar
07.02.03   Ronnie Johnson        Researcher              Chapel Hill, U.S.A.   Research
07.02.03   Trude Bennett         Researcher              Durham, U.S.A.        Research
24.02.03   Dr. Gabriel Shirima   Researcher              NIMR                  Brucellosis
                                                                               research
24.02.03   Dr. John Kunda        Researcher              NIMR                  Brucellosis
                                                                               research
26.02.03   M. Gembe              FANC Data collection    Arusha                Data Collection
26.02.03   Gladness R. Swai      FANC Data collection    Arusha                Data Collection
26.02.03   Regina Darabe         FANC Data collection    Arusha                Data Collection
26.02.03   Hasina Sandewa        FANC Data collection    Karatu                Data Collection
26.02.03   Augusta A. Mziray     FANC Data collection    Loliondo              Data Collection
26.02.03   Lilian Msoffe         FANC Data collection    Arusha                Data Collection
28.02.03   Francisca Walter      Desk Officer            Austrian Foreign      Familiarization
                                                         Ministry              Visit
28.02.03   Samwel Rimbani        Administrator Endulen   Endulen               Visit
05.03.03   Hans H. Solevak       Administrator           Denmark               Visit LADO
05.03.03   Birthe Solevak                                Denmark               Visit LADO
06.03.03   Corina Leegwater      Bookseller              The Netherlands       Visitor
06.03.03   Edwin Bijker          Police Officer          The Netherlands       Visitor
10.03.03   Evarist Bishanga      NSSF                    Karatu                Visit
10.03.03   Chambera Oms          NSSF                    Karatu                Visit
19.03.03   M.W. Matunga          Regional Radiologist    Arusha                Supervision
30.03.03   Alatanga              Accountant              Dar es Salaam         Visit
                                                                                     21


           M.Mwabena
01.04.03   M.A. Babu           RC                    Arusha              Visit
17.04.03   Dr. P. Nyaluke      Medical officer       Moshi               New staff
22.04.03   Bert Hiep           Teacher               The Netherlands     Visit
22.04.03   Gemma Groot         Teacher               The Netherlands     Visit
23.04.03   James Ole Kone      Chairman Entesekera   Entesekera, Kenya   Visit
                               Health Centre
23.04.03   S.E. Kiwoli         Planning Officer      Arusha              Visit
23.04.03   A.P. Mauli          Pharmacist            Arusha              Visit
23.04.03   Rose Lyimo          RCCO                  Arusha              Visit
23.04.03   C.M. Mremi          RACC                  Arusha              Visit
25.04.03   Adam Mtanganyika Driver                   USA river           Visit
25.04.03   David Read          Writer                USA River           Visit
25.04.03   Dick Novak          Businessman           USA River           Visit
26.04.03   Dr. Paul A. Kisanga Surgeon               Selian Hospital,    Visit
                                                     Arusha
26.04.03   Dr. Emil A. Mchaki Medical Officer        Selian Hospital,    Visit
                                                     Arusha
30.04.03   Datius             Consultant OXFAM       Dar es Salaam       Visit
           Rweyememu
30.04.03   Hanus Kisyikari    Oxfam                  Dar es Salaam       Visit
30.04.03   Godfrey Lelya      Oxfam                  Loliondo            Visit
06.05.03   Herman Sterken     Pilot                  Dodoma              Outreach visit
06.05.03   Magdalena Shayo    Nurse                  KCMC, Moshi         Outreach visit
06.05.03   Heide mitsche      Project coordinator    Vienna, Austria     Supervision
06.05.03   Torjon Ockeman     ORGUT coordinator      Dar es Salaam       Supervision
06.05.03   Jan Bargher        ORGUT consultant       Dar es Salaam       Training
06.05.03   Dr. Brian Savage   Eye specialist         KCMC, Moshi         Outreach visit
06.05.03   Dr. Chibuga        Ophthalmologist in     KCMC, Moshi         Outreach visit
                              training
10.05.03   Jack Rejman        Pilot                  Arusha              Outreach clinics
11.05.03   Manuza, S.         Regional Cold chain    Arusha              Supervision
                              Officer
17.05.03   Oliva Kinabo       Caritas Tanzania       Dar es Salaam       Visit
17.05.03   Scott Martin       Caritas Australia      Sydney, Australia   Visit
17.05.03   Joachim Wangabo    AAIDRO                 Arusha              Visit
17.05.03   Geward Aloyce      AAIDRO                 Arusha              Visit
17.05.03   Mrs Helen Nguya    AAIDRO                 Arusha              Visit
26.05.03   Mafipa, S.P.       PCB-Arusha             Arusha              Visit
26.05.03   Gwarisa B.M.       PCB-Arusha             Arusha              Visit
26.05.03   Ojude, M.O.        PCB-Arusha             Arusha              Visit
26.05.03   Nkule, P.L.        PCB-Arusha             Arusha              Visit
27.05.03   Yvonne Huga        Agriculture teacher    Tengeru, Arusha     Training
27.05.03   Mwduga H.S.        Training Officer       Arusha              Training
28.05.03   Changah, E.F.      Ag. Regional Local     Arusha              Visit
                              Goverment Officer
18.06.03   Dr. Sarah          DFID Brucellosis       Edington, United    Research
           Cleaveland         Project                Kingdom
18.06.03   Dr. John Kundi     NIMR                   Dar es Salaam       Research
                                                                                                 22


 18.06.03       Dr. G.M. Shirima       SUA                      Morogoro              Research
 24.06.03       Luella Rowberg                                  U.S.A.                Visit
 24.06.03       Thea Peterson          Student                  Seattle, U.S.A.       Visit
 24.06.03       Sonja Schaeffer        Student                  Valparaiso, U.S.A.    Visit
 24.06.03       Charles Schaeffer      Professor                Valparaiso, U.S.A.    Visit
 24.06.03       Kathryn Rowberg        Professor                Valparaiso, U.S.A.    Visit
 24.06.03       Krista Schaeffer       Student                  Valparaiso, U.S.A.    Visit
 24.06.03       Erik Rowberg           IT                       Arusha, Tanzania      Visit

       The Hospital welcomed many other visitors from Tanzania and abroad not compiled in
       the above list. Amongst the officials and other influential people who visited the hospital
       repeatedly or frequently were the following:

                District Commissioner, Captain Aseri Msangi.
                District Council Chairman, Mr. Simon Soinda.
                District Executive Director, Mr. Tingirawanyuma.
                Acting District Medical Officer, Dr. Loongisho
                Officers of the District Health Management Team.
                Members of the Wasso Hospital Board of Governors.
                Parish Priest and Hospital Chaplain of the Catholic Parish Loliondo, Rev. Fr.
                 Venance Kway and Fr. Gabriel Ole Killel.
                Project Manager of Losadei, Mr. Francis Shomet.
                Clinical Officer Incharge of the Northern Maasai Land Mobile Unit, Mr. Richard
                 Ngambi.
                Pilots of the Flying Medical Service Arusha Fr. Pat Patten, Andries, Jacq and
                 Elizabeth.
                Dr Moke Magoma, as a consultant gynecologist and also for research.


       TABLE A-2: WASSO HOSPITAL STAFF ON TRAINING DURING
       REPORTING PERIOD.

Name                          Current position     Upgrading to                         Training
                                                                                        period
Angela Meipuki                Health Attendant     Clinical Officer, Machame, Moshi     2001 – 2005
Daniel Mshana                 Ass. Clinical        Clinical Officer, Musoma, Mara       2001 – 2003
                              Officer
Elina Gimirei                 Nurse Assistant      Nurse Midwife, Kiomboi, Singida      2000 – 2004
Elinora Lemeu                 Nurse Assistant      Nurse Midwife, Kiomboi, Singida      2000 – 2004
Elizabeth Amma                MCH AIDE             Public Health Nurse, Mbulu           2001 – 2003
Esther Besango                Health Attendant     Clinical Officer, Machame, Moshi     2001 – 2004
Esther Clement                Nurse Midwife        Nursing Officer, Kibosho, Moshi      2002 - 2004
                                                                                          23


Helena Tendeu             Ward attendant        Nursing Officer,Huruma, Rombo      2002 - 2006
Joackim Mbosha            Health Attendant      Clinical Officer, Sengerema        2002 - 2005
Joyce Sinodya             Health Attendant      Nursing Officer, Huruma, Rombo     2000 – 2004
Loturiak Korio            Clinical Officer      Advanced Diploma in PHC, Iringa    2002 - 2004
Namnyaki Parkipunyi       Health Attendant      Nursing Officer, Huruma, Rombo     2001 – 2005
Rohela Simon              Health Attendant      Clinical Officer, Machame, Moshi   2000 – 2003
Upendo Natha              Health Attendant      Nurse Midwife, Mvumi, Dodoma       1999 – 2003


       TABLE A-3: SEMINARS / WORKSHOPS/ SHORT COURSES.

   Dates          Place            Subject           Facilitators              Participants
    2003
 24.03.03 -   Arusha           Breastfeeding     CEDHA                 Mwivei Mtunguja (NM)
 29.03.03                      counselling
 07.04.03 -   Moshi            Quality           Ministry of Health    Agnes Ammi (NM)
 11.04.03                      improvement in
                               Health care
 07.04.03 -   Arusha           Practicals in     Mount Meru            Dr. Simon Megiroo (AMO)
 19.05.03                      Obstetrics and    Regional Hospital
                               Gynaecology
 03.06.03     Karatu           Improving         Ministry of Health    1) Dr. Nyaluke (MO)
                               Family                                  2) Cecilia Nkii (NM)
                               Planning                                3) Teddy Tarimo (NM)
                                                                       4) Restituta Nkwema (NM)
 16.06.03 -   Dar es Salaam    Post abortion     Ministry of Health    1) Frank Liso (CO)
 28.06.03                      care                                    2) Nathihaika Kisaka (NO)
 17.06.03 -   Karatu           Psychiatric       Ministry of Health    George Marwa (CO)
 20.06.03                      disorders
                                                                                24


         WASSO HOSPITAL OUTPATIENT DEPARTMENT

        TABLE A-4: ATTENDANCE.

           Attendance                Jan    Feb    Mar    Apr    May     Jun    Total
Patients under 5 years                264    457    556    380    271     401   2329
Patients above 5 years                707    810    927    708    649     253   4054
Re-attendance                         134    364    388    268    295     462   1911
Total                                1105   1631   1871   1356   1215    1116   8294


        TABLE A-5: NUMBER OF DIAGNOSES.

          Attendance                 Jan    Feb    Mar    Apr    May     Jun    Total
Below 5 years                         475    943    842    551    712     475   3998
Under 5 years                         883   1180    860    711   1076     762   5472
Total                                1358   2123   1702   1262   1788    1237   9470


        TABLE A-6: TOP TEN DISEASES FOR OUTPATIENTS UNDER 5 YEARS.

              Diagnosis               Jan   Feb    Mar    Apr    May     Jun    Total
1.    Malaria                         158   283    414    184    165      117   1321
2.    Acute Respiratory Infections    124   208    117     98    225       81    853
3.    Pneumonia                        38   159    103     90    101      104    595
4.    Diarrhoea diseases               26   142    143     64     45    19       439
5.    Eye infections                   17    45     19     37     13       32    163
6.    Intestinal worms                 25    25     16     27     39        7    139
7.    Skin infections                  23    32     11      9     19       21    115
8.    Minor surgical conditions         8    10      3      5     18       17     61
9.    Ear infections                   10    13      4     17      0        4     48
10.   Urinary Tract Infections          6     3      0      2      8       17     36


        TABLE A-7: TOP TEN DISEASES FOR OUTPATIENTS ABOVE 5 YEARS.

             Diagnosis               Jan    Feb    Mar    Apr    May     Jun    Total
1.    Malaria                        292    387    423    217    379     281    1979
2.    Acute respiratory infections   180    196    127    128    219     113     963
3.    Intestinal worms               106     79     47     65     76      47     420
4.    Pneumonia                       44     48     43     28    108      33     304
5.    Minor surgical conditions       37     47     40     45     55      58     282
6.    Pelvic inflammatory             27     43     20     18     26      18     152
      diseases (PID)
7.    Urinary tract infections        18     33     21     21      3      34     130
8.    Genital discharge syndrome      16     32     13     23     30      15     129
9.    Skin Infections                 12     23     10     20     25      21     111
10.   Eye Infections                  14     25     12     15      2      19      87
                                                                                   25


        TABLE A-8: OUTPATIENT SYNDROMIC DIAGNOSIS FOR SEXUAL
        TRANSMITTED DISEASES EXCLUDING HIV/ AIDS.

           Attendance                 Jan   Feb   Mar   Apr     May      Jun       Total
Pelvic Inflammatory Disease            27    43   20    18       26       18        152
Genital Discharge Syndrome             16    32   13    23       30       15        129
Genital Ulcer Disease                   6     4   13     7       17        4         51
Other sexual transmitted               10     0    2     0        0        0         12
diseases
Total                                 59    79    48    48       73       37        344


        TABLE A-9: TOP TEN EYE DIAGNOSIS FOR OUTPATIENTS

                          Diagnosis                           Number of Patients
1    Allergic Conjuctuvitis                                         31
2    Bacterial Conjuctivitis                                        28
3    Cataracts                                                      23
4    Trachoma                                                       16
5    Trichiasis                                                     12
6    Pterygium                                                       9
7    Glaucoma                                                        8
8    Cornea Scar                                                     7
9    Eye Trauma                                                      4
10   Cornea Ulcer                                                    3


        TABLE A-10: DENTAL OUT PATIENT ATTENDANCE.

Attendance                            Jan   Feb   Mar   Apr     May      Jun       Total
Dental Patients                        20    34   29    38       25       20        166


        TABLE A-11: TOP 8 DIAGNOSES FOR OUTPATIENT DENTAL CLINIC.

Diagnosis                             Jan   Feb   Mar   Apr     May      Jun       Total
1    Pulpitis                          15    20   20    28       15       15        113
2    Shedding                           2     5    2     7        2        1         19
3    Periodonditis                      1     3    3     -        2        2         11
4    Dental abcess                      -     3    2     2        1        2         10
5    Malposition                        1     -    1     1        5        -          8
6    Extra-supernumeral                 1     3    -     -        -        -          4
7    Pericoronitis                      -     -    1     -        -        -          1
8    Gingivitis                         -     -    -     -        -        -          0
Total                                  20    34   29    38       25       20        166
                                                                                                     26


        TABLE A-12: DENTAL PROCEDURES PERFOMED IN DENTAL CLINIC.

Procedure                         Jan       Feb         Mar          Apr         May         Jun     Total
Extraction                         15        20         20           25           15          15      111
Filling                             -         2          -            3            -           -        5
Scalling                            -         2          2            3            2           2       11
Total                              15        24         22           31           17          17      127


        WASSO HOSPITAL INPATIENT DEPARTMENT.

        TABLE A-13 ADMISSIONS

                                           Jan     Feb             Mar     Apr     May        Jun     Total
Male patients under 5                        8       23             39      27      10          9      116
Female patients under 5                     12       23             30      15      19         12      111
Male patients above 5                       45       32             58      50      34         31      250
Female patients above 5                     62       61             75      56      50         72      376
Total                                      132      177            202     148     113        124      896


        TABLE A.14: TOP TEN DISEASES FOR INPATIENTS UNDER 5 YEARS.

                  Diseases                       Jan         Feb     Mar    Apr        May     Jun    Total
1    Malaria                                       7          24     34      9          7       5      87
2    Pneumonia                                     2          17     14     14          7       5      59
3    Gastro-enteritis                              3          10     35      7          3       1      59
4    Anaemia                                       2           8      3      5          -       3      21
5    Acute respiratory infections (ARI)            3           3      6      2          1       -      15
6    Severe protein-energy malnutrition (PEM)      2           4      2      3          1       -      12
7    Burns                                         -           2      1      2          2       2       9
8    Prenatal and neonatal complications           1           2      2      -          -       1       6
9    Ear infections                                1           -      -      1          1       2       5
10   Tuberculosis                                  1           1      -      1          1       -       4


        TABLE A-15: TOP TEN DISEASES FOR INPATIENTS ABOVE 5 YEARS.

               Disease                     Jan         Feb         Mar     Apr     May        Jun     Total
1    Malaria                                24          26         43      18       33         21      165
2    Tuberculosis                            8          13         16      13        9         11       70
3    Pneumonia                               6           2          7       6        5          6       32
4    Anaemia                                 2           7          3       4        3          2       21
5    Complications of pregnancy              2           2          3       2        4          8       21
6    Acute respiratory tract infections      4           4          9       2        1          -       20
7    Urinary tract infections                4           2          2       2        3          -       12
8    Fractures                               4           2          2       2        1          1       12
9    AIDS                                    3           3          1       1        -          3        9
10   Asthma                                  2           -          2       3        1          1        9
                                                                                      27


        TABLE A-16: NEW TUBERCULOSIS PATIENTS FROM TANZANIA.

        Break Down of New Patients         Jan    Feb    Mar    Apr      May    Jun    Total
Adult Male AFB Positive Pulmonary Tb         0     0      1      3        0      2       6
Adult Male AFB Negative Pulmonary Tb         1     0      1      4        1      0       7
Adult Female AFB Positive Pulmonary Tb       1     3      5      2        0      4      15
Adult Female AFB Negative Pulmonary Tb       4     0      0      1        2      2       9
Under 5 Male AFB Positive Pulmonary Tb       0     0      0      0        0      0       0
Under 5 Male AFB Negative Pulmonary Tb       0     0      0      1        1      0       2
Under 5 Female AFB Positive Pulmonary Tb     0     0      0      0        0      0       0
Under 5 Female AFB Negative Pulmonary Tb     1     0      1      1        1      0       4
Adult Male Extra Pulmonary Tb                1     0      2      1        0      0       4
Adult Female Extra Pulmonary Tb              0     0      2      1        1      0       4
Under 5 Male Extra Pulmonary Tb              1     0      1      0        0      0       2
Under 5 Female Extra Pulmonary Tb            0     0      0      0        0      0       0
Total                                        9     3     13     14        6      8      53


        TABLE A-17: NEW TUBERCULOSIS PATIENTS FROM KENYA.

        Break Down of New Patients         Jan    Feb    Mar    Apr      May    Jun    Tota
                                                                                         l
Adult Male AFB Positive Pulmonary Tb        0      4      0         0     2      0       6
Adult Male AFB Negative Pulmonary Tb        2      1      0         2     3      0       8
Adult Female AFB Positive Pulmonary Tb      2      6      3         0     1      0      12
Adult Female AFB Negative Pulmonary Tb      0      0      0         1     0      0       1
Under 5 Male AFB Positive Pulmonary Tb      0      0      0         0     0      0       0
Under 5 Male AFB Negative Pulmonary Tb      0      0      0         0     0      0       0
Under 5 Female AFB Positive Pulmonary Tb    0      0      0         0     0      0       0
Under 5 Female AFB Negative Pulmonary Tb    0      0      0         0     0      0       0
Adult Male Extra Pulmonary Tb               0      0      0         1     0      0       1
Adult Female Extra Pulmonary Tb             0      0      0         0     0      0       0
Under 5 Male Extra Pulmonary Tb             0      0      2         0     0      0       2
Under 5 Female Extra Pulmonary Tb           0      0      0         0     0      0       0
Total                                       4     11      5         4     6      0      30


        TABLE A-18: SUMMARY OF NEW TUBERCULOSIS PATIENTS FROM
        TANZANIA AND KENYA.

                                     Jan    Feb    Mar        Apr       May    Jun    Total
Total number of patients              13     14    18         18        12      8      83
                                                                                28


        TABLE A-19: TREATMENT STATUS OF NEW TUBERCULOSIS PATIENTS
        FROM TANZANIA.

                              Status of patients                    Number
New Patients Diagnosed                                                53
Patients with sputum positive                                         21
Patients Under Re-Treatment                                            1
Patients with sputum negative                                         22
Patients with Extra Pulmonary Tuberculosis                            10
Defaulters                                                             0
Patients Who Died                                                      2


        TABLE A-20: TREATMENT STATUS OF NEW TUBERCULOSIS PATIENTS
        FROM KENYA.

                              Status of patients                    Number
New Patients Diagnosed                                                30
Patients with sputum positive                                         18
Patients Under Re-Treatment                                            0
Patients with sputum negative                                          9
Patients with Extra Pulmonary Tuberculosis                             3
Defaulters                                                             1
Patients Who Died                                                      2


        TABLE A-21: BREAKDOWN OF DEATH (TUBERCULOSIS).

                                      From Tanzania   From Kenya        Total
Adult male                                  1             2              3
Adult female                                1             0              1
Child under five years male                 0             0              0
Child under five years female               0             0              0
Total                                       2             2              4


        TABLE A-22: PATIENTS WITH EXTRA PULMONARY TUBERCULOSIS
        FROM TANZANIA.

TB Arthritis                                                        1
TB Adenitis                                                         5
TB Osteomyelitis                                                    2
TB Spine                                                            1
TB Renal                                                            0
TB Pericarditis                                                     1
Total                                                              10
                                                                                              29


       TABLE A-23: PATIENTS WITH EXTRA PULMONARY TUBERCULOSIS
       FROM KENYA.

TB Arthritis                                                                       0
TB Adenitis                                                                        2
TB Osteomyelitis                                                                   0
TB Spine                                                                           0
TB Renal                                                                           1
TB Pericarditis                                                                    0
Total                                                                              3


       TABLE A-24: TUBERCULOSIS / OVERVIEW OF NEW CASES

New Tuberculosis cases             Jan          Feb         Mar    Apr    May      Jun       Total
Pulmonary / AFB Positive            3            13          9      5      3        6           39
Pulmonary / AFB Negative            8             1          2     10      8        2           31
Extra Pulmonary                     2             0          7      3      1        0           13


       TABLE A-25 TUBERCULOSIS BREAKDOWN INTO SEX AND AGE GROUPS.

New Tuberculosis cases             Jan          Feb         Mar    Apr    May       Jun      Total
Adult male                          4            5           4     11      6         2         32
Adult Female                        7            9          10      5      4         6         41
Below 5 yrs Male                    1            0           3      1      1         0          6
Below 5 yrs Female                  1            0           1      1      1         0          4


       TABLE A-26: TUBERCULOSIS TREATMENT STATUS

New Tuberculosis cases             Jan          Feb         Mar    Apr    May       Jun      Total
Relapse                             0            0           0      1      0         0          1
Defaulter                           0            0           1      0      0         0          1
Death                               0            0           0      0      0         0          0


       TABLE A-27: HIV TEST OF INPATIENTS AND OUTPATIENTS

Patients                                  Jan         Feb    Mar    Apr     May        Jun     Total
Number of Counseled and tested             5           11     4      6       6          9       41
Number of HIV positive                     4            7     2      2       3          6       25

             Out of 25 HIV positive patients, 15 were female, 10 male and 2 under five.
                                                                                  30


        TABLE A-28: BREAK DOWN OF HIV POSITIVE CASES FROM TANZANIA

No.           Sex          Age                  Tribe        Home area
1             M            32 years             Mchagga      Soitsambu
2             M            35 years             Mbulu        Loliondo
3             F            25 years             Mwarusha     Loliondo
4             F            25 years             Kalenyini    Soitsambu
5             M            45 years             Safa         Wasso
6             F            40 years             Mbulu        Wasso
7             M            50 years             Mrangi       Loliondo
8             M            55 years             Mbulu        Wasso
9             M            30 years             Msonjo       Oldonyo Sambu
10            F            26 years             Mwarusha     Loliondo
11            F            25 years             Msonjo       Digodigo
12            M            36 years             Msonjo       Oldonyo Sambu
13            F            28 years             Maasaai      Sukenya
14            F            25 years             Maasai       Olobo
15            F            1 year 5/12          Maasai       Olobo
16            F            33 years             Kikuyu       Soitsambu
17            F            28 years             Msonjo       Samunge
18            F            46 years             Msonjo       Samunge
19            M            28 years             Mbulu        Ololosokwan
20            F            68 years             Kalenyini    Magaiduru
21            M            35 years             Mchagga      Moshi
22            F            13 years             Maasai       Naiyobi

        FROM KENYA

23            F             60 years            Maasai        Transmara
24            F             25 years            Maasai        Maasai-Mara
25            M             1 6/12              Maasai        Maasai-Mara


        TABLE A-29: DEATHS FROM JANUARY - JUNE 2003

                                         Jan   Feb    Mar   Apr   May       Jun   Total
Patients under 5 years                    -     2      3     4     2         1     12
Patients above 5 years                    7     5      4     1     3         3     23
Total                                     7     7      7     5     5         4     35


        TABLE A-30: CAUSES OF DEATHS UNDER 5 YEARS.

1     Prematurity                                                        5
2     Severe pneumonia                                                   4
3     Severe dehydration                                                 1
4     Burn                                                               1
5     Septicaemia                                                        1
      TOTAL                                                             12
                                                                                     31


        TABLE A-31: CAUSES OF DEATHS ABOVE 5 YEARS.

1    AIDS                                                                     5
2    Severe malaria                                                           4
3    Hydatid cysts                                                            2
4    Tuberculosis                                                             2
5    Pneumonia                                                                2
6    Anaemia                                                                  2
7    Peritonitis                                                              1
8    Pyloric stenosis                                                         1
9    Septicaemia                                                              1
10   Borrelia                                                                 1
11   Intestinal obstruction                                                   1
12   Embolism                                                                 1
     TOTAL                                                                   23


        TABLE A-32: OBSTETRICS STATISTICS JANUARY – JUNE 2003

                                          Jan        Feb   Mar   Apr   May    Jun     Total
Spontaneous vaginal deliveries             13         17   20    18     13     16       97
Abnormal/ Assisted deliveries               4          -    -     7      5      3       19
Total                                      17         17   20    25     18     19      116


        TABLE A-33: BREAK DOWN OF DELIVERIES.

                                          Jan        Feb   Mar   Apr   May    Jun     Total
Spontaneous vaginal deliveries             13         17   20    18     13     16       97
Multiple twins                              -          -    1     1      1      -        3
Breech                                      -          -    -     -      2      3        5
Vacuum extraction                           -          -    -     1      -      -        1
Caesarian section                           4          -    -     6      3      -       13
Ante partum haemorrhage (APH)               -          -    -     -      1      -        1
Total                                      17         17   21    26     20     19      116


        TABLE A-34: OTHER ASSISTANCE DURING / AFTER DELIVERY.

Episiotomy                                                                   17
Manual removal of placenta                                                    1
Birth Before Arrival (BBA)                                                    3
Total                                                                        21

        TABLE A-35: INDICATIONS FOR CEASARIAN SECTIONS.

                                       Indications                                  Number
Obstructed labour                                                                     2
Previous scar with contracted pelvis                                                  2
                                                                                     32


 Placenta praevia                                                                       1
 Foetal distress                                                                        5
 Eclampsia                                                                              1
 Cord/ arm prolapse                                                                     1
 Transverse lie                                                                         1
 Total                                                                                 13


         TABLE A-36: MATERNAL DEATHS WITH CAUSES.

 Cause                                                                         No.
 Home delivery with severe PPH (anaemia)                                       1


         TABLE A 37: BABIES.

                              Jan        Feb     Mar   Apr       May     Jun         Total
 Male babies                   11         8      10    14         13       7           63
 Female babies                  6         9      11    12          7      11           56
 Total                         17        17      21    26         20      18          119


         TABLE A-38: PREMATURES AND ADVERSE PERINATAL OUTCOMES.

                              Outcomes                                  Number
Premature                                                                  7
Small for Date                                                             2
Premature Followed by Neonatal Deaths                                      5
Fresh Stillbirth (Full term Pregnancy)                                     1
Macerated Stillbirth (premature)                                           1
Macerated in Full Term Pregnancy                                           3
Total                                                                     19


         TABLE A-39: OBSTETRIC OPERATIONS.

Operation                                      Major         Minor             Total
Ceasarian sections                              13             -                13
Manual removal of placenta                       -             1                 1
Cervical / perineal tear repair                  -             3                 3
Episiotomy                                       -            17                17
Total                                           13            21                34


         TABLE A-40: OPERATING THEATRE.

HEAD/NECK/CHEST                                              MAJOR     MINOR     TOTAL
Cataract Removal With Intraocular Lens Replacement             20        -         20
Entropion Correction                                            -        5          5
                                                                      33


Radical Mastectomy                                          1    -     1
Thyroidectomy                                               4    -     4
Tonsillectomy                                               4    -     4
Under Water Seal Drainage                                   -    6     6
ABDOMEN AND ABDOMINAL WALL
Appendicectomy                                               3   -     3
Exploration Laparotomy                                       9   -     9
Herniorrhaphy                                               11   -    11
Laparotomy, Endocystectomy of Hydatid Liver Cysts            6   -     6
Laparotomy, Trunk Vagotomy and gastrojejunostomy             1   -     1
UROLOGY AND ANAL SURGERY
Anal dilatation                                             -    3     3
Circumcission                                               -    4     4
DVU                                                         -    2     2
Hydrocelectomy                                              2    -     2
Perineal repear                                             1    -     1
Prostatectomy (Freyer)                                      3    -     3
Reduction of paraphimosis                                   -    3     3
Suprapubic Catheterization                                  1    -     1
TURP (trans-urethral prostatectomy)                         3    -     3
Urethral Bouginage                                          -    4     4
GYNECOLOGICAL OPERATION
Cervical cerclage (shirodkar suture)                        -     1    1
Evacuation of Incomplete Abortion/DIC                       -    18   18
Reconstruction of vaginal stenosis                          1     -    1
OBSTETRIC OPERATIONS
Lower Segment Cesarian Section                              13   -    13
Bilateral Tubal Ligation                                     -   4     4
Removal of Retained Placenta (Manual)                        -   2     2
TRAUMATOLOGY AND ORTHOPEDIC SURGERY
Amputation Above Elbow                                      1     -    1
Amputation of End Phalanx of Finger                         0     1    1
Amputation above knee                                       1     -    1
Bone Grafts (Cancellous)                                    -     1    1
Close Reduction of Fractures and Plaster of Paris           -    65   65
(Circular/Slabs)
Extirpation and Suture of Calcified Popliteal Cyst          -    13   13
Open Reduction and Various Osteosynthesis (Screws, Wires,   4     -    4
External Fixator etc).
Redressment of POP for Club Foot Manipulation               -    8     8
Reduction/ Cuff and Color/ Crepe Bandages                   -    1     1
Removal of Fixators (K-wires etc.)                          1    3     4
Sequestrectomy                                              1    -     1
Skeletal Traction                                           4    -     4
Triple release (ETA)                                        3    -     3
PLASTIC SURGERY
Mesh skin graft                                             3    -     3
Pinch skin graft                                            1    -     1
                                                                                                               34


MISCELLANEOUS
Change of catheters/ catheterization in minor theatre                      -                    7                 7
Dressings of wounds                                                        -                  964               964
Excision of ganglion, lipoma, biopsies,cysts etc                           -                   10                10
Incision and drainage of abscesses                                         -                   37                37
Necrestomy/ debridement/ disloughing of wounds                             -                   14                14
POP removal                                                                -                   65                65
Removal of foreign bodies & examination under Anesthesia                   -                    9                 9
Removal of stitches                                                        -                  102               102
Surgical toilet (with or without stitching)                                1                   31                32
Total                                                                     103                1383              1486


        TABLE A-41: PHYSIOTHERAPY NUMBER OF INPATIENT TREATMENTS

                       January       February      March         April          May               June              To-
                       <5 >5         <5 >5         <5 >5         <5 >5          <5       >5       <5      >5        tal
Amputation             -    -        -    -        -   -         -     -        -        5        -       6         11
Arthrodese             -    17       -    9        -   8         -     1        -        -        -       -         35
Burn injury            1    -        -    18       -   11        19    20       5        6        5       -         85
Cerebral palsy (CP)    -    -        -    -        -   12        -     22       1        10       1       18        64
Clubfoot               18   2        -    -        -   -         -     -        -        -        -       -         20
Cox arthritis          -    7        -    -        -   2         -     2        -        -        -       -         11
Down syndrome          -    -        -    -        4   -         -     -        -        -        -       -         4
Fracture femur         1    81       -    61       -   61        -     23       -        2        -       12        241
Fracture others        -    21       -    11       -   22        -     8        -        -        5       9         76
Hemiparese             -    -        -    -        -   -         -     -        -        3        -       1         4
Malnutrition           1    -        -    -        -   -         -     -        -        -        -       -         1
Meningitis             -    -        -    -        -   11        -     -        -        -        -       -         11
Osteomyelitis          -    64       -    20       -   34        -     24       -        7        -       9         158
Pain hip - S1 joint/   -    -        -    -        -   -         -     -        -        3        -       -         3
lumbar spine
Paralysis              23     9      21     25     21     15     4      10      -        1        -       -         129
Post-operative         -      9      -      -      -      6      -      2       -        1        -       3         21
Pulmonary problems     -      1      -      -      -      -      -      -       -        -        -       -         1
Rheumatic diseases     -      -      -      -      -      1      -      -       -        -        -       -         1
Severe malaria/ Tb     -      42     -      21     -      10     -      13      -        -        -       -         86
Tb joint problems      -      -      -      -      -      -      -      -       -        9        -       10        19
Tendonitis             -      -      -      -      -      -      -      -       -        1        -       -         1
Tendon repairs         -      3      -      -      -      -      -      -       -        10       -       -         13
Torticollis            -      -      -      -      -      -      -      -       -        -        -       2         2
Trauma without         -      9      -      17     -      15     -      17      -        -        -       -         58
fracture
                       44      265   21      182   25      208   23      142        6        58     11        70    1055
TOTAL                       309           203           233           165               64               81
                                                                  35


        TABLE A-42: LABORATORY EXAMINATIONS.

        BLOOD SMEARS FOR PARASITES.

               Month          Jan   Feb   Mar   Apr   May   Jun   Total
Total Number of smears        181   163   250   213   222   283   1312
Positive Malaria               63    37    74    34    34    16    258
Positive Borrelia               -     -     -     -     -     -     0
Positive Trypanosoma            -     -     -     -     -     -     0
Positive Filaria                -     -     -     -     -     -     0

        HAEMATOLOGY

                Month         Jan   Feb   Mar   Apr   May   Jun   Total
Total Number of HB tests      135   103   63    124    95   119    639
Hb below 50%                   27    35    5      -    30     -     97
Sickle cell test                -     -    -      2     -     -      2
Positive sickle cell test       -     -    -      1     -     -      1
ESR tests                      75    45   67     53    76    58    374
Total number of WBC tests       6     6    5      8    12     6     43
Differential Tests              6     6    5      8    11     6     42

        SEROLOGY TESTS

            Month             Jan   Feb   Mar   Apr   May   Jun   Total
Number of VDRL tests           26    21   45    31     35    36    194
Number of positive VDRL         -     1    1     1      5     -      8
Number of Widal test           35    76   40    21     35    17    224
Number of positive Widal        1     -    1     -      3     1      6
Number of Brucella tests       47    38   40    41     33     8    207
Number of positive Brucella     7     4    3     2      6     1     23

        BIOCHEMISTRY

              Month           Jan   Feb   Mar   Apr   May   Jun   Total
Number of blood sugar tests    21    33   63    32     22    19    190
Above 10mmol (180mg/dl)         5     4    -     -      -     -     9
Pandy test                      -     -    -     -      -     1     1
Positive Pandy tests            -     -    -     -      -     1     1

        BLOOD GROUPING AND TRANSFUSION

              Month           Jan   Feb   Mar   Apr   May   Jun   Total
Donors grouped                 48    38   39    50     20    31    226
Patients grouped               25    27   55    46     29    40    222
Number of Cross Match Done     21    16   21    15      5     7     85
Blood transfusions             19    12   21    14      5     7     78
                                                                             36


         HIV SCREENING TESTS.

              Month                Jan    Feb   Mar     Apr     May    Jun   Total
Donors tested                       20     16   21      15       5      7     84
Positive donors                      1      2    1       -       -      -      4
Patients tested                      5     11    4       6       6      9     41
Positive patients                    4      7    2       2       3      6     25

         SPUTUM TESTS

             Month                 Jan    Feb   Mar     Apr     May    Jun   Total
Number of sputum tests              34     26   31      37       50     31    209
Number of Positive AFB               3      9    7       6        3      -     28

         URINE EXAMINATIONS

               Month               Jan    Feb   Mar     Apr     May    Jun   Total
Total Number of tests               44     36   95      69       64     68    376
Positive S. Haematobium              -      -    -       -        -      -      0
Positive protein                     7      4    7       4        2      -     24
Positive sugar                       1      2    1       -        -      -      4
Positive pregnancy tests             1      2    1       -        -      2      6
Positive White blood cells           -      -   30       8       10      -     48
Positive red blood cells             -      -   10       8        3      -     21
Positive Trichomonas Vaginalis.      -      -    2       -        1      -      3

         STOOL EXAMINATIONS

Month                               Jan   Feb   Mar     Apr     May    Jun   Total
Total Number of tests                87    76   68      51       35     42    359
Positive Hookworm                     -     -    1       1        -      1     3
Positive Schistosoma Mansoni          -     -    -       -        -      1     1
Positive Ascaris Lumbricoides         2     -    -       3        -      -     5
Positive Trichuris Trichuria          -     1    -       2        1      -     3
Positive Enterobius Vermicularis      -     -    -       -        -      -     0
Positive Taenia Saginata              -     -    -       -        -      2     2
Positive Taenia Solium                -     -    -       -        -      -     0
Positive G. Lamblia                   1     -    2       2        -      2     7
Positive strongyloides                -     -    -       -        -      -     0
Positive E. Histolitica               -     -    -       -        1      -     1

         TABLE A-43: TOTAL NUMBER OF LABORATORY EXAMINATIONS

        Month            Jan       Feb    Mar     Apr         May     Jun     Total
  Stool                   87        76     68      51          35      42      359
  Urine                   44        36     95      69          64      68      376
  Sputum                  34        26     31      37          50      31      209
  HIV                     25        27     25      21          11      16      125
  Blood Grouping &        94        81    115     111          54      78      533
                                                                                                  37


 Crossmatch
 Biochemistry             21        33          63              32          22         20              191
 Serology                108        135        125              93         103         61              625
 (excluding HIV)
 Haematology             222        160        140          195            194         189         1100
 Blood Smears            181        163        250          213            222         283         1312
 Total                   816        737        912          822            755         788         4830

           TABLE A-44: HOME AREA OF HIV POSITIVE DONORS AND PATIENTS.

                                    Jan       Feb         Mar        Apr       May      Jun       Total
Wasso                                -         4           -          -         -        -          4
Muholo                               -         1           -          -         -        -          1
Loliondo                             2         1           1          -         -        1          5
Oldonyo Sambu                        -         -           2          -         -        -          2
Kisangiro                            1         -           -          -         -        -          1
Samunge                              -         -           -          -         1        1          2
Maasai Mara                          -         2           -          -         -        -          2
Digodigo                             -         -           -          2         -        -          2
Nayobi                               -         -           -          -         -        1          1
Olobo                                -         -           -          1         2        -          3
Sukenya                              -         -           -          -         -        -          0
Transmara                            -         1           -          -         -        -          1
Magaiduru                            -         -           -          -         -        1          1
Soitsambu                            2         -           -          -         -        1          3
Moshi                                -         -           -          -         -        1          1
Total                                                                                              29

           TABLE A-45: AGE DISTRIBUTION OF HIV POSITIVE DONORS AND
           PATIENTS.

            0-5y     6 - 18 y   19 - 24 y     25 - 30 y     31 - 35 y      36 - 45 y   45+ yrs         To-
            M   F    M      F   M     F       M     F       M     F        M     F     M    F          tal
January                         1                   2       2                                          5
February    1                                       1       2              1     1     2      1        9
March                                         2     1                                                  3
April                                               2                                                  2
May              1                            1     2                                                  4
June                       1                  1             1        1                        2        6
Total       1    1   0     1    1         0   4     8       5        1     1     1     2      3        29
                                                                                                38


        TABLE A-46: X-RAY/ TYPE OF EXPOSURE

                    Jan           Feb           Mar          Apr          May          Jun           Total
Chest X-rays         51            20            46          40            46           38            241
Bones X-rays         46            26            56          28            33           57            248
Others X- rays        5             5            17           2             1            3             33
Total               102            53           119          70            80           98            522

        TABLE A-47: X-RAY / BREAKDOWN OUTPATIENTS/ INPATIENTS.

                    Jan           Feb           Mar          Apr           May         Jun           Total
OPD                  47            33            69           53            48          61            311
IPD                  55            20            50           17            32          37            211
Total               102            53           119           70            80          98            522

        TABLE A-48: X-RAY BREAK DOWN INTO SEX AND AGE GROUP

                    Jan           Feb           Mar          Apr          May          Jun           Total
Male Adult           33            13            34          18            24           40            162
Male > 5 yrs          4             2             2           2             3            5             18
Male <5 yrs          18             6            15          15            13           14             81
Female Adult         28            26            27          27            30           20            183
Female >5 yrs         1             1             2           2             4            4             16
Female<5 yrs         18             4             6           6             6           13             62
Total               102            53           114          70            80           98            522



                          WASSO HOSPITAL PRIMARY HEALTH CARE

        TABLE A-49: CHILD HEALTH CARE: VACCINATION COVERAGE BY CAR.

No   Village Name           No.     BCG       %      DPT    %      DPT    %     DPT     %     Mea       %
                            of                        1             2            3            sles
                            <5
1    Wasso A+B               426        426   100%    426   100%    425   99%    295    69%    105      25%
2    Lopolun A+B             244        244   100%    244   100%    240   98%    198    81%    103      42%
3    Olobo/ Ilchorweti       135        135   100%    135   100%    130   96%    109    81%     92      68%
4    Loosoito                289        289   100%    289   100%    268   99%    204    71%    102      35%
5    Maaloni/ Ndung’orot     379        379   100%    370   98%     368   99%    280    74%    106      30%
6    Oloiswashi/ Isitet      315        315   100%    313   99%     310   99%    240    76%    112      36%
7    Sukenya                 220        220   100%    220   100%    215   98%    196    89%     97      44%
8    Orongay                 169        169   100%    169   100%    163   97%    104    62%     76      45%
9    Oloirien                198        198   100%    198   100%    192   97%    169    85%     87      44%
10   Olemishiri              245        245   100%    245   100%    243   98%    205    41%    107      44%
11   Magaiduru               145        145   100%    145   100%    143   99%    128    88%     92      63%
12   Oldonyowasso/           278        278   100%    278   100%    275   98%    189    68%    108      39%
     Orbukoi
13   Oloipiri                182        182   100%    182   100%    180   99%    106    58%     93      51%
                                                                                                  39


14   Orkuyaine              196    196 100%        195   99%     190    97%    150   77%         86     44%
15   Enguserosambu          245    245 100%        243   98%     240    98%    185   76%         76     31%
16   Ndulele                190    190 100%        190 100%      187    98%    167   88%         68     36%
17   Olosho                 198    198 100%        198 100%      193    97%    160   81%         72     36%
18   Mgongo/ Endakirowa     245    245 100%        242   98%     238    98%    198   81%         87     36%
19   Mageri                 125    125 100%        125 100%      120    96%    105   84%         50     40%
20   Tinaga                 167    167 100%        167 100%      165    98%    137   82%         65     38%
           These 27 clinic places, 20 villages / sub villages are visited once a month.


                TABLE A-50: CHILD HEALTH CARE: VACCINATION COVERED BY
                                        FLIGHT.

No   Vilage                  No.   BCG     %     DPT      %   DPT      %    DPT     %       Mea        %
                             of                     1            2            3             sles
                             <5
1    Orpirikata            220   220    100% 220       100% 218     99%     202    91%      102        46%
2    Ololosokwan           114   114    100% 114       100% 112     98%     102    89%      72         63%
3    Pinyinyi              254   254    100% 254       100% 250     98%     198    78%      98         39%
4    Njurleen              66    66     100% 66        100% 63      95%     59     92%      43         85%
5    Lorbilin              86    86     100% 86        100% 80      93%     79     91%      59         69%
6    Olaika                235   235    100% 235       100% 230     98%     207    88%      107        46%
7    Mondorosi             383   383    100% 383       100% 327     85%     305    80%      125        33%
8    Empopong’i            215   215    100% 215       100% 210     98%     200    93%      98         46%
9    Ghabere               184   184    100% 184       100% 180     98%     175    95%      93         51%
10   Olchoro               140   140    100% 140       100% 138     96%     103    74%      51         36%
            These 10 far remote places are visited every two weeks.

        TABLE A-51: CHILD HEALTH CARE: NUTRITION STATUS.

Nutrition status      Total        Green       Grey zone Red zone       Referred to         Admission
                      assessed     zone                                 hospital
Number of children    7757         6020    1720           7             7                 7
<5
           All children with severe malnutrition are referred to the hospital but compliance
              by the parents is very low.

        TABLE A-52: MATERNAL HEALTH CARE: ANTENATAL SCREENING.

     Number of Pregnant Women              At Risk Pregnancies       Referred for Hospital Delivery
             Screened
                1114                                116                           116


        TABLE A-53: ANTENATAL SCREENING BY CAR AND FLIGHT CLINICS.

                                    Jan       Feb       Mar      Apr       May        Jun         Total
Car clinic                          398       240       169      174       140        203         1324
Flight clinic                       200       188       164      118       131        126          927
                                                                                                             40


Total                              598       428        333             292        271            229         2251

        TABLE A-54: MATERNAL HEALTH CARE/ TETANUS VACCINATION.

Number Vaccinated With Tetanus               TT 1            TT 2           TT 3           TT 4             TT 5
Toxoid
Women in Child Bearing Age 15 – 49               28           28              19            8                 -
years
Other patients                                   18           18              -             -                 -

        TABLE A-55: SCHOOL HEALTH PROGRAMME OVERVIEW.

Date       Name of the school            Total        With          BCG       TT       TT       TT      TT        TT
                                         screened     health                  1        2        3       4         5
                                         students     problems
06/05/03   Wasso Primary School          315          14            -         -        -        8       2         -
07/05/03   Oldonyowas Primary School     159          46            -         -        -        -       -         -
08/05/03   Oloosoito Primary school      66           42            3         -        -        -       -         -
13/05/03   Mgongo Primary School         244          56            -         15       13       -       -         -
20/05/03   Sukenya Primary school        162          55            -         -        -        -       -         -
23/05/03   Enguserosambu Primary         167          37            -         -        -        -       -         -
24/05/03   Loliondo Secondary school     130          7             -         5        9        7       3         -
26/05/03   Oloipiri Primary School       186          34            -         3        4        -       -         -
28/05/03   Oloirien Primary School       351          14            -         5        4        4       3         -
TOTAL                                    1780         305           3         28       28       19      8         -


        TABLE A-56: DENTAL DIAGNOSES AND TREATMENTS DURING SCHOOL
        EXAMINATION PROGRAMME.

               Total              DIAGNOSIS                              TREATMENT                           Topic
  School       scree-   Carrie    Mal-   Shed-        Gingi-       Extrac Filling Scallin                     H/E
                ning      s      positio  ding         vitis        -tion           g
                                   n
Wasso                                                                                                       Cause of
primary         257      17       14         5           -          20             -              2         caries
school
Oldonyowas                                                                                                   Proper
Primary         159       2        3         7           -              6          3              1           tooth
school                                                                                                      brushing
Loosoito                                                                                                     Proper
primary         66        4        1         2           -              3          -              3           tooth
school                                                                                                      brushing
Loliondo                                                                                                     Proper
Sec. School     130       2        2         -          3               1          -              1           tooth
                                                                                                            brushing
Mgongo                                                                                                       Proper
primary         244       8        5        10           -          15             -                -         tooth
School                                                                                                      brushing
Maaloni                                                                                                      Proper
                                                                                                    41


Primary          258          15          4       20         -      25         -        -            tooth
School                                                                                             brushing
Sukenya                                                                                             Proper
Primary          160          7           1       7          3      12         -        2            tooth
School                                                                                             brushing
E/Sambu                                                                                             Proper
Primary          167          15          -       15         3      25         -        1            tooth
School                                                                                             brushing
Oloirien                                                                                            Proper
Primary          351     15               3       10         -      22         -        2            tooth
School                                                                                             brushing
Oloipiri                                                                                            Proper
Primary          186          3           4       2          -       5         1        1            tooth
School                                                                                             brushing
Total           1978          88         37       78         9     134         4        13



         TABLE A-57: HEALTH EDUCATION/ SESSIONS TAUGHT JANUARY - JUNE
                                    2003.

        Topic                      Wasso          Car Clinics      Flight Clinics    Total
                                   Hospital       (sessions)       (sessions)
                                   (sessions)
        Tuberculosis                  Twice per         16                32                 48
                                        week
        Pneumonia                          8            16                24                  48
        Malaria                           12            18                18                  48
        Diarrhoea                         10            20                18                  48
        STD/HIV/AIDS                       8            25                18                  51
        Total                             38            95               100                 243


        TABLE A-58: PATIENTS TREATED AT MOBILE CLINICS

                                          Jan     Feb        Mar    Apr        May      Jun         Total
Patients treated at car clinic             80      96         33     58         25       63           355
Patients treated at flight clinic         152      76        120    155        104      165           772
Total                                     232     172        153    213        129      228          1127
                                                                                              42


                      DIGODIGO DISPENSARY / CURATIVE SERVICES.


       TABLE B-1: ATTENDANCE 1ST JANUARY TO 30st JUNE 2003 FOR
       OUTPATIENTS.

                                     Male                   Female                    Total
Children: New cases                   331                     339                      670
   “      Repeaters                   790                     745                     1535
Adult:    New cases                   373                     541                      914
   “      Repeaters                   480                     696                     1176
           Total                     1974                    2321                     4295

       Total New Cases and Repeaters:                     4295
       Returns:                                           2152
       Outpatients Referred to Wasso Hospital:            16
       Total Number of Attendance:                        6447
       The Average Number of Outpatients per day is:      36


       TABLE B-2: TOP TEN DISEASES OF ALL OUTPATIENTS

No.       Diseases                               Number of diagnosis from Jan - July 2003
1         Malaria                                                      3362
2         ARI                                                           870
3         Pneumonia                                                     666
4         Diarrhoea                                                     386
5         Worm infestations                                             205
6         Minor surgical condition                                      168
7         Eye infection                                                 149
8         Skin infection                                                130
9         UTI                                                            53
10        Allergic Conditions                                            27


       TABLE B-3: INPATIENT DEPARTMENT/ ADMISSIONS.

Total Number of Patients Admitted                                               294
Number of Inpatient Referred to Wasso Hospital                                   16

       Number of death:       5
       Causes of Death:
          1) Man, 62 years old died due to severe malaria and bronchitis.
          2) Male child of 8 months died due to severe broncho-pneumonia and
              gastroenteritis.
          3) Female child of 3 years died due to severe malaria.
                                                                                            43


          4) Male child of 3 months died due to severe broncho-pneumonia and
             gastroenteritis.
          5) Old man of 87 years died due to severe lobar pneumonia.

       TABLE B-4: TOP TEN DISEASES OF ALL INPATIENTS.

No               Disease                        Number of diagnosis July - December 2002
1    Malaria                                                      147
2    Pneumonia                                                     59
3    Gastro enteritis                                              56
4    Delivery                                                      15
5    Anaemia                                                        8
6    Incomplete abortion                                            5
7    Burns                                                          5
8    Puerperal sepsis                                               2
9    Cut wounds                                                     2
10   Abscesses                                                      2

       NB: Number 4 is not a disease, but inserted in this table to show the rank amongst
       admissions.

       TABLE B-5: LABORATORY EXAMINATIONS.

                                                Total            Positive          Specifications
BLOOD SLIDE
Malaria                                          620               500
Borrelia                                          5                 1
SEROLOGICAL SCREENING
Widal test                                        79               23
Brucella test                                     50               20
VDRL test                                         60               35
HIV test                                          30               12
STOOL EXAMINATION                                250
Hookworm                                                           35
Trichuris Trichuria                                                10
Amoebiasis                                                         44
Giardiasis                                                         40
Schistosoma Mansoni                                                13
URINE EXAMINATION                                94
Pregnancy Test                                   12                 5
Urinalysis                                                         10
Yeast cells                                                         6
Pus cells                                                          60
Trichomonas Vaginalis                                               0
Schistosoma Haematobium                                             0
OTHER EXAMINATION
Haemoglobin (Hb)                                 51                25          Below 50%
Blood group                                      60
Blood Transfusion                                30
                                                                                               44


ESR                                               28                 17           Above 20 mm/hr
Sputum For AFB                                    24                 11
Total Number of Specimen Examined                1393
Total Number of Patients Examined                1274


          DIGODIGO DISPENSARY- PRIMARY HEALTH CARE.

          TABLE B-6: CHILD HEALTH CARE: VACCINATION COVERAGE.

Village        Total number      BC   %       DPT %           DPT %           DPT %         Meas    %
               of registration   G            1               2               3             les
Digodigo              485         485 100      485 100         478 98,5        475 97,9       464   96
Mugholo               376         376 100      373  99         366  97         357 94,9       343   91
Kisangiro             410         410 100      407  99         395  96         388 94,6       385   94
Masusu                187         187 100      185  98         177  95         174  93        164   88
Total                1458        1485 100     1450 99         1416 96         1394 95        1356   92.
                                                                                                    25


          TABLE B-7: CHILD HEALTH CARE: NUTRITION STATUS.

Village                 Total number of registered             Green zone        Grey zone     Red
                        children                                                               zone
Digodigo                               485                     481 (99.2 %)      3 (0.6%)      1 (0.2%)
Mugholo                                376                     372 (98.9 %)      4 (1.1%)      0 (0%)
Kisangiro                              410                     403 (98.3 %)      5 (1.2%)      2 (0.5%)
Masusu                                 187                     186 (99.5 %)      0 (0%)        1 (0.5%)


          TABLE B-8: MATERNAL HEALTH CARE: ANTENATAL SCREENING.

Village                  Number of pregnant   At Risk Pregnant Women           Grand          Primi
                             women                                            Multipara      Gravida
Digodigo                        62                       17                     12              2
Mugholo                         52                       17                     10              5
Kisangirro                      32                       15                     12              1
Masusu                          31                       11                      6              5
Others                          70                       23                     16              4
       Total                   247                       83                     56             17


          TABLE B-9: MATERNAL HEALTH CARE: TETANUS TOXOID
          VACCINATION COVERAGE.

                                              TT 1      TT 2        TT 3          TT 4         TT 5
Pregnant Women                                 98        80          12             6           11
Non-Pregnant Women                             85        48          48            12           13
Total Women in Child Bearing Age              183       128          60            18           24
                                                                                                      45


       TABLE B-10: DENTAL / EYE SERVICES IN SCHOOLS VISITED IN SONJO
       AREA

    School      Number of students         With Dental              With Eye               Number of
                   examined                 Problems                Problems                 visits
Yasi mdito            276                      19                       6                      1
Samunge               236                      25                       7                      1
Digodigo              127                      19                      22                      1
Secondary
Masusu                    87                       15                      18                    1
Digodigo                 218                       21                      13                    1
Primary
     Total               944                       99                      66                    5


       TABLE B-11: DENTAL DIAGNOSES AND TREATMENTS DURING SCHOOL
       EXAMINATION PROGRAMME.

             Total               DIAGNOSIS                              TREATMENT                     Topic
  School     scree-   Carries    Mal-      Shed-        Gingi-   Extrac-        Filling   Scalling     H/E
              ning              position   ding          vitis    tion
Yasimdito                                                                                             Proper
primary       276       10        20        5             2        16              -         3         tooth
school                                                                                               brushing
Samunge                                                                                               Proper
Primary       236       15         6        12            -        25              -         -         tooth
school                                                                                               brushing
Digodigo                                                                                              Proper
secondary     127       18         3         -            2        15             3          1         tooth
school                                                                                               brushing
Masusu                                                                                                Proper
Primary       87        22         2        12            3        15              -         -         tooth
School                                                                                               brushing
Digodigo                                                                                              Proper
Primary       218       16         2        12            -        19             1          1         tooth
School                                                                                               brushing
Total         944       81        33        41            7        90             4          5
                                                                                                      46



              WASSO DISTRICT DESIGNATED HOSPITAL, NGORONGORO DISTRICT.
                              PLANNING MATRIX 2002-2003.


          SUMMARY OF                             INDICATORS                     SOURCES        ASSUMPTIONS
 OBJECTIVES / ACTIVITIES
Overall goal: Health status of
the population in Ngorongoro
district improved
(Project) Purpose: Quality              Immunization coverage for children     Registry       The availability
health services accessible,              under five (DPT3).                                    of funds is
acceptable and affordable for the    Immunization coverage for pregnant                       maintained.
district population provided.            women (TT2).
                                     Bed occupancy rate.
                                     Percentage of clients coming from
                                         outside of our catchment area.
                                     Percentage of first contact from other
                                         areas with health facilities.
Specific Objective 1: Supply of      Availability of 10 most essential drugs   ledger         Availability of all
drugs and other medical                  in days per year.                                     ordered drugs
materials made more adequated        Costs of expired drugs in relation to                    from medical
and efficient.                           total costs of drugs purchased in a                   stores department
                                         year.                                                 (MSD) in time.
Specific objective 2:               Number of available qualified staff in      Staff list     Qualified staff
Availability of qualified staff     relation to the recommended number (see                    will be retained in
increased and maintained.           attached of required staff).                               the hospital
Specific objective 3: Staff         Number of qualified staff leaving the       Administra     Availability of
motivation improved.                hospital in percentage of all qualified     tion office    funds maintained
                                    staff.
Specific objective 4: Buildings     Number of buildings, structures or          Maintenanc     Material will be
and other structures well           equipment repaired as a percentage of       e and repair   available.
maintained.                         total number of broken buildings,           record
                                    structures or equipment.                    book
                                                                                (workshop)
Specific objective 5: Rational      Number of newly broken equipment in         Inventory      Instrument will
use made from existing and new      relation to the number of available         book.          be of good
equipment.                          equipment.                                                 quality.
Specific objective 6: Health         Number of health education sessions       Outreach       Reliable transport
education offered (hygiene,             per outreach point (car/flight) in      clinics        available.
nutrition, utilization of health        relation to the number of visits.       register
services).                           Average number of peoples attending       book
                                        each H/E session.
                                     Nos. of VHW (Village Health               PHC            Funds for training
                                        Workers) trained.                       minutes        will be available.
                                     No. of TBA’s (Traditional Birth
                                        Attendants) trained.
                                     No. of CORPS (Communities Own
                                        Resources Peoples) trained
Specific objective 7: Clear         No. of General staff meetings, Health       Minutes of     Annual timetable
organizational set-up brought       Management Committee meetings, Board        the            will be prepared
into operation.                     of Governors meetings done in relation to   meetings       on time.
                                    the planned meetings of respective          (Administr
                                                                                                        47

                                   governing bodies.                              ation)
Specific objective 8: District      No. of supervision done / no of              DMO’s          Annual timetable
Health Services (including             planned supervision.                       office         of DHMT
supporting supervision) better      No. of DHMT meetings attended by                            arranged on time.
integrated.                            MO I/C / No. of DHMT meetings
                                       conducted.
Specific objective 9: Data         Monthly data prepared before the 7th of        MTUHA          Availability of
collection, compilation and        following month                                books          MTUHA books
utilization (HMIS) improved.                                                                     on time.
Specific objective 10: Health         No. of examination huts build and          Outreach       Community
care activities implemented by         maintained by communities in relation      register       involvement and
communities.                           to the total outreach points.                             participation.
                                      No. of health facilities built by
                                       community initiatives in the
                                       catchment area.
                                      No. of airstrips maintained regularly /
                                       total number of airstrips.



                                                 ACTIVITIES.

      OBJECTIVES                                           ACTIVITIES
Specific objective 1.       1.1. To train or employ two Pharmaceutical Assistants
Supply of drugs and other   1.2. Proper prescription of drugs according to standard treatment
medical materials made           guidelines of Tanzania emphasized.
more adequate and           1.3. To ask for permission to have hospice drugs such as morphine,
efficient.                       codeine etc.
                            1.4. To maintain the use of HMIS for estimating the needs of the use
                                 of drugs
                            1.5. To maintain monthly stocktaking.
                            1.6. To continue to use car and flight clinics in assessing the quantity
                                 of drugs needed.
                            1.7. To optimise the supply from MSD (Medical Stores Department).
                            1.8. To assist Digodigo Dispensary in assessing their needs of drugs.
                            1.9. To ensure a timely delivery of drugs to Digodigo in desired
                            quantities
Specific objective 2.       2.1. To assess the needs of different cadres of personnel.
Availability of qualified   2.2. To determine the possibilities to upgrade existing personnel
staff increased                  (TNA: Training Needs Assessment).
                            2.3. To send selected personnel for training.
                            2.4. To set criteria for recruitment.
                            2.5. To recruit the necessary additional personnel.
                            2.6. To strengthen the in-house- training (On-going training
                                 programme).
                            2.7. To determine strategies on how to bind personnel to the hospital
                                 who received training sponsored by the hospital.
                            2.8. To re-trench some of the unqualified personnel (pruning).
                            2.9. To request the services of curative and preventive specialists.

      OBJECTIVES                                          ACTIVITIES
Specific objective 3.       3.1. To mortgage plots to staff members for gardening, small domestic
Staff motivation                 animals or agriculture.
improved.                   3.2. To offer the participation in seminars, workshops or conference.
                                                                                                      48

                             3.3. To provide loans to the staff.
                             3.4. To provide compensation (for e.g. overtime, responsibility, call
                                  allowances, hardship).
                             3.5. To exploit fully the possibilities of staff promotion.
                             3.6. To ensure that annual salary increments are prompt and regular.
                             3.7. To allow the establishment of a small shop (tea room) on the
                                  hospital compound.
                             3.8. To give access to table tennis, volleyball in Sonjo, internet and
                                  others, also to provide TV access to Sonjo Dispensary and a TV
                                  sender for Wasso hospital staff.
                             3.9. To equip the library with current newspapers and journals.
                             3.10. Provision of solar power equipments to staff on Loan basis.
                             3.11. To build more staff houses in Wasso and Digodigo.
Specific objective 4.        4.1. To acquire the official land title for the hospital compound.
Building and other           4.2. To establish a clear plan of preventive maintenance.
structures well maintained   4.3. To build a permanent and reliable fence around the compound of
                                  Wasso Hospital and Digodigo dispensary.
                             4.4. To establish an internal communication (telephone) system.
                             4.5. To solicit for funds from potential donors.
                             4.6. To construct a reliable water supply to Digodigo dispensary.
                             4.7. Expansion and promotion of Digodigo dispensary to a health
                                  centre.
                             4.8. To build one pit latrine near TB ward.
Specific objective 5.        5.1. To update the existing inventories of the different departments.
Rational use made from       5.2. To identify the essentially needed additional equipment.
existing and new             5.3. To complete the sets of basic medical instruments.
equipment                    5.4. To equip the car of the mobile clinic with radio communication.
                             5.5. To complete the instructions of users on how to use the
                                  equipment properly.
                             5.6. To carefully administer the manuals of the new material (make
                                  copies).
                             5.7. To establish a schedule for regular maintenance and repair.
                             5.8. To assign one responsible for every major equipment (repair and
                                  maintenance).
                             5.9. To keep a stock of the essential and most commonly used spare
                                  parts and consumables.
                             5.10. To establish a scheme of positive and negative sanctions /
                                  reinforcements.
                             5.11. To identify and to clear the hospital from used and worn out
                                  equipment / expired drugs.
                             5.12. To replace the old photocopy machine with a new one.
                             5.13. To provide a Hb calorimeter for Sonjo Dispensary.
                             5.14. To provide one car for Digodigo dispensary.
Specific objective 6.        6.1. To identify communities for health education.
Health education offered     6.2. To assess training needs of the target population.
(hygiene, nutrition,         6.3. To develop a workplan and a budget.
utilisation of health        6.4. To intensify training of the PHC team.
services)                    6.5. To train existing community based staff in providing health
                                  education (training of trainers).
                             6.6. To identify community based people for providing health
                                  education.
                             6.7. To train community resource people.
                             6.8. To plan and to conduct activities for various target groups.
                             6.9. To monitor and to evaluate the training activities in order to
                                                                                                        49

                                 replan.
                            6.10. To provide a portable generator (Honda 750W) for Teaching
                            purposes in Sonjo and Wasso. Also a small TV screen for Sonjo.
Specific objective 7.       7.1. To maintain the collaboration with existing diocesan health
Clear organisational set-        projects.
up brought into operation   7.2. To request more support services from the arch-diocese (e.g
                            Gynaecologist)
Specific objective 8.       8.1. To get clarification on the policies / standing orders of
District health services         Government and Local Council / and other health related NGO’s
(including supporting       8.2. To strengthen collaboration with the DHMT and with health
supervision) better              related NGO’s
integrated                  8.3. To design a common plan (DMO and Dr. I/C Wasso) for
                                 supportive supervision of the peripheral units.
                            8.4. To conduct on the job trainings for District Health Providers.
                            8.5. To co-ordinate the Wasso mobile clinics (car and flight) with the
                                 DHMT.
                            8.6. To continue and to strengthen mobile clinics for the otherwise
                                 inaccessible villages.
                            8.7. To train / motivate existing community health workers for minor
                                 treatment in remote areas.
                            8.8. To request the DMO to provide supplementary drugs for needy
                            peripheral units.
Specific objective 9.       9.1. To recruit or train one medical recorder.
Data collection,            9.2. To provide adequate facilities / equipment for medical recording.
compilation and             9.3. To conduct on-the-job-training for non-qualified / peripheral staff.
utilisation (HIMS)          9.4. To plan regular meetings for data review and analysis.
improved.                   9.5. To extract relevant information for decision-making.
                            9.6. To conduct quarterly meetings (HMIS) with DMO and the
                            DHMT to review the health situation in the district.
Specific objective 10.      10.1. To sensitise communities to contribute to health care.
Health care activities      10.2. To assist the communities in identifying their priority health
implemented by                    needs.
communities                 10.3. To vitalise village health committees.
                            10.4. To assist in identifying and implementing locally adapted
                                  solutions.
                            10.5. To support community based health activities (CBHA).
                            10.6. To conduct a participatory evaluation.