Mangochi-ICEIDA-Partnership-in-Public-Health-2012-2016-Part-II ...

MANGOCHI ICEIDA PARTNERSHIP IN PUBLIC HEALTH – PROGRAMME DOCUMENT 2012-2016
Level C: (secondary/district hospital): A district hospital provides primary level health care to
the surrounding community and secondary health care to the entire district. A district
hospital is a referral facility for both health centres and rural hospitals. Rural or community
hospitals serve as first level of referral for health centres in defined areas and provide
technical supervision to lower units.
In Mangochi there are 25 health centres (12 government-run and 13 CHAM centres), 10 governmentrun
dispensaries (some are being up-graded to the status of health centres) and 8 established health
posts, two in each health zone except Monkey Bay, where one health post is under construction. A
survey conducted in May 2011, recorded 235 outreach clinics connected to health centres. Finally, 14
private clinics are registered in the district. The network of health centres in the district is presented
schematically in Annex 3.
The district hospital is in Mangochi Boma. There are also three rural hospitals in the district, one in
each health zone except in Chilipa zone where there is no hospital. The rural hospitals are: Monkey
Bay Community Hospital (MBCH), Saint Martin’s Hospital in Malindi (Makanjira zone) and Mulibwanji
Hospital in Masuku (Namwera zone).
The MoH provides 57% of the district population with primary health facilities (when looking at
catchment areas). This proportion is lowest in Makanjira zone (35%) and highest in Namwera zone
(72%). In Chilipa the government’s share is 62%, in Mangochi 60% and in Monkey Bay 52%. This
indicator does not reflect the actual utilisation of services however, which varies between MoH- and
CHAM facilities and among different types of services. Furthermore, the division into MoH and CHAM
facilities underestimates the government’s contribution to the provision of health services because
of subsidies and SLAs as discussed in section 1.2 above.
2.1.3. Referral Systems and Ambulance Services
Outreach clinics, health posts and dispensaries refer patients to health centres. Health centres refer
patients to rural hospitals or directly to the district hospital. The district hospital can refer patients to
Zomba Hospital and from there patients may be referred to Blantyre or Lilongwe if needed.
With a vast land area and a high fertility rate the need for good ambulance services in Mangochi is
obvious. Ambulance services in the district are inadequate and need to be strengthened in order to
improve access to referrals. Some of the current ambulances are old and require frequent and costly
maintenance. In addition, they are frequently taken out of service for lengthy periods of time due to
cash shortages at the DHO.
There are ambulances in the four hospitals. A survey conducted in May 2011 listed three ambulances
in good condition in CHAM centres (model 2009 or later). Two of these are in Mangochi zone (Koche
HC, As Salam clinic) and one in Makanjira zone (Lulanga HC). A fourth ambulance is in Nkope HC in
Monkey Bay zone (2002 model in fair condition). The survey listed three ambulances in MoH-run
centres. One (1998 model) is in Namwera zone (Katuli HC) and two in Makanjira zone (Lungwena and
Makanjira HCs) but both were in the DHO garage in November 2011.
2.1.4. District Health Management
Health services are managed by the DHMT. Members of the DHMT include the District Health Officer,
District Environmental Health Officer, District Medical Officer, District Nursing Officer, Human
Resource Management Officer, an administrator and an accountant. The organisational setup at the
DHO is presented in Annex 4.
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