Kitgum District - Journal of Medicine and the Person

Kitgum District
Government
Hospital
Year of Foundation: 1934
Management: Ministry of Health of Uganda
Number of beds: 208
Staff: 148
Medical Officers: 4
Outpatients 2004/05: 102.781
Inpatients 2004/05: 9.848
Inpatient Mortality: 3,3%
Children’s Mortality: 3,2%
Average Length Of hospital Stay: 8 days
Bed Occupancy Rate: 95%
Background
Kitgum District Hospital is the official government
hospital for Kitgum District. It was founded
under the British Protectorate in 1934 as part
of an integrated national health System. It is also
the site of a military ward for the care of soldiers
controlling the district and exposed to
guerrilla actions.
AVSI has a long history of presence in this hospital
since the 1970s, strengthened by the support
given during the last 20 years ravaged by
the war.

Context and Location
Kitgum District Hospital is located within the town council area, 3 km away from Kitgum Mission where St.
Joseph’s Hospital is and constitutes the Health Sub District s of Chua County. It covers an area of about
7.557 square kilometres, with 80% of the land being arable. The vegetation is savannah predominantly flat
fertile land with gentle slopes becoming hilly towards the North to the Sudan border. The district is predominantly
inhabited by the Acholi tribe. The total population by mid 2005 is estimated to be 317.107 with
an annual growth rate of 4,19%. The females constitute 52% of the total population, children under-5 years
the 18% (Uganda Population and Housing Census, 2002). Currently nearly all the rural population, an estimated
310.000 people is displaced in 21 IDP camps (OCHA – Uganda October 2005). The community life
style has been interrupted by the prolonged insecurity in the area and the family structure is broken down.
The disease burden in the community is mainly communicable and therefore preventable diseases. The
five top causes of morbidity are malaria, acute respiratory infections, intestinal worms, skin diseases and
pneumonia. More than half of the morbidity in the OPD in all health facilities is among the under five.
The recent Health and Mortality Survey among Internally Displaced Persons conducted by WHO in collaboration
with other partners shows worse figures than the above. Because of the prolonged period of civil
strife minimum IDP services standards are very far from being met.
Hospital Mission
The attainment of a good standard of health by all the people in Uganda, in order to promote a healthy and
productive life.

Kigtum District Government Hospital 49
HOSPITAL PROFILE
The total number of beds, 208, has remained stable for the past 3 financial years. The medical and surgical
wards are mixed and distributed as male and female ward. There is a paediatric ward, a maternity ward,
a TB ward and a military ward managed directly by military health workers. There is no nutrition unit but
a Supplementary Feeding Centre.
Ward
N. of beds
Medical 58
Surgical 22
Paediatric 42
Maternity 39
TB 25
Military 22
Table 1. Hospital Wards and beds
Figure 1. OPD trend of contacts in the last 3 financial years
Outpatient Services
The Outpatient department is open Monday to Friday until 5 pm and on Saturdays morning. It includes
Dental and Eye services provided by clinical officers. Daily contacts are about 200 per day during dry season,
400 per day during rain season. Clinical Officers recruited through ECHO were posted to OPD
where they screen patients and send referrals directly to wards for medical officers’ review.
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SUPPLEMENT NUMBER 1, JOURNAL OF MEDICINE & THE PERSON. JUNE 2006, VOL. 4
2002-03 2003-04 2004-05
New attendances 0-4years 27.252 24.088 22.995
New attendances 5 years and over 40.420 46.497 51.354
Total new attendances 67.672 70.585 74.349
Re-attendances 0-4 years 8.365 9.157 8.136
Re-attendances 5 years and over 18.202 23.280 20.296
total Re-attendances 26.567 32.437 28.432
TOTAL 94.239 103.022 102.781
Table 2. OPD attendance in the last 3 financial years.
Figure 2. Leading OPD diagnoses among patients > 5 years in the last 3 financial years.
Despite remaining one of the busier OPD’s in the region, Kitgum like Gulu Regional Referral Hospital has
seen a slight decline in OPD attendance in the last year due to the under 5 years old attendance, while it is
slightly increasing the 5 years and older attendance. This is analyzed in relation to St. Joseph’s hospital
(which shows an increase in both younger and older age groups for the same period). Not differently from
Gulu, the drift of children towards St. Joseph’s Hospital is associated with the reduction in user fees. The
opening of some nearby health centres that were previously closed is another possible explanation. Other
reasons difficult to prove because they did not change in the last two years, are a preference for care at St.
Joseph’s, or that there may be drug shortages at Kitgum.

Kigtum District Government Hospital 51
Figure 3. Leading OPD diagnoses among patients < 5 years in the last 3 financial years.
Figure 4. Leading causes of admission in children in the last 3 financial years.
© Punto Effe, 2006

Figure 5. Leading causes of admission in adults in the last 3 financial years.
Inpatients
The total inpatient number considerably diminished as compared to 2003-04 from 11.301 to 9.096, but
Case Fatality Rate (CFR) was also reduced to 3,3% from 5,3% of the previous year when the increase of
workload from 2002-03 (9.466 patients) was probably hard to handle and raised CFR from 4,5% of 2002-
03. Numbers of admissions reduced in particular for children’s ward where the shift was probably towards
St. Joseph’s that increased admissions in the same age group. At the same time quality of care improved
with smaller number of patients, with case fatality rate equalling that of St. Joseph’s at 3,16%. This might
be considered as a good indicator of integration between the two hospitals in the field of management of
children’s illness. Maternity ward was the only one to increase slightly its number of admitted patients
(2.697 with 2.305 deliveries). In other words, one can hardly draw any conclusions about the ward activity
except for maternity/gynaecology and paediatrics. The children’s ward decrease well correlates with the
reduced outpatient activity.
HOSPITAL STAFF
Currently there are 4 Medical Officers employed by Kigtum District Government Hospital including the
Medical Superintendent who contributes to the clinical activity of medical ward. One medical officer is
present in Surgical, Maternity and Children’s ward.
Medical ward is mainly staffed by 2 Clinical Officers. Among qualified personnel there is also 1 or-

Kigtum District Government Hospital 53
thopaedic officer (supported by ECHO funding) and 1 anaesthetic officer, 4 laboratory technicians, 13
Clinical Officers.
ECHO employed further 2 Clinical Officers. There are 12 Nursing Officers, 24 Enrolled Nurses plus 3 additional
under ECHO, 16 Enrolled Midwives and 2 with ECHO, 21 Nursing Aides. Administrative and
support staff is 14 with 4 additional under ECHO: namely Medical Social worker, mortuary attendant,
plumber, and gatekeeper.
AVSI-ECHO Interventions
in KITGUM GOVERNMENT HOSPITAL
ECHO Uganda 4 PROJECT: OCTOBER 2002 TO JANUARY 2003.
BUDGET: 78.200.000 Uganda Shillings (40.600 Euro)
• Supply and transport of drugs, sundries and equipment
• Construction of a shelter for night commuters and water tank
• Construction of pit latrines
• New generator and fuel for the hospital
ECHO Uganda 5 PROJECT: FEBRUARY 2003 TO APRIL 2004.
BUDGET: 267.000.000 Uganda Shillings (120.000 Euro)
• Support to a Medical Officer
• Drugs, disinfectant, supplies
• Theatre light and bed
• Food for patients
• Fuel, servicing and spare parts for Generator.
• Vehicle overhaul, fuel and spare parts
• Procurement of reserve stock of IV Fluids in case of outbreak
• Mosquito proofing and repairs to night commuter shelters
• Emergency preparedness training and production of emergency procedures manual.
• Cesspool emptying of hospital and night commuter latrines with hired machine.
• Repair of old cesspool emptying vehicle
• Construction of a new IV Fluids Production Unit.
• Latrine construction for night commuters.
• Erection of an additional water storage tower.
ECHO Uganda 7 PROJECT: APRIL 2004 TO MARCH 2005
BUDGET: 120.000.000 Uganda Shillings (56.000 Euro)
• Salary support for a national medical doctor
• Foodstuff for vulnerable patients with no support.
• Medical drugs/sundries and disinfectants
• Medical equipment
• Support for the purchase and repair of new medical equipment.
• Fencing of Staff Quarter
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SUPPLEMENT NUMBER 1, JOURNAL OF MEDICINE & THE PERSON. JUNE 2006, VOL. 4
FRONT LINE HEALTH WORKERS
Martin Origa
Dr Martin Origa, 29 years old, completed his studies in 2000. A student from Kitgum, he attended St.
Joseph’s Hospital for training during his holidays since 1998 and served there as a medical officer after completing
internship in Mulago Hospital, Kampala, in 2001. At the end of 2001 he was appointed as Medical
Officer to Kitgum Government Hospital and placed his effort mainly in the medical ward, although his main
field of interest and his aim for post-doctorate training is Gynaecology and Obstetrics. «By May 2002 war
reached t its peak. Maximal displacement of people brought 7.000 night commuters into the hospital ground
every night, putting great pressure on water and sanitation. Thanks to AVSI and ECHO we had shelters for
night commuters built within the hospital ground. AVSI
was one of the few organizations who never left during the
war providing also water tanks, taps and latrines.
The government meanwhile continued with the same
funding, and the hospital built up a huge deficit. Not only
were we spending more money on drugs but also on detergents
and soaps. Plus, due to the war, many health
workers left the area so that staff shortages increased».
Since December 2003, Dr Origa started taking up administrative
responsibilities to become in 2005 Medical Superintendent.
There are currently 4 Medical officers employed
by the hospital, and he still works as a doctor on
call performing emergency surgery and up to 5 caesarian
sections per week. «We are obviously understaffed to face
the emergency of war. We receive patients from a wide area including Sudan but we are no referral hospital.
Not only our staff is not adequate but it also lacks motivation. Insecurity, displacement, a disproportionate
workload affect the working capacity of each of us and we find ourselves often just resisting to
hardships. Of course we benefit of the neighbourhood of St. Joseph’s Hospital for referral of complicated
cases, especially in the field of surgery. And we have to recognize achievements under the AVSI - ECHO
projects. We now have a new IV fluid production unit, a new generator to supply power to the whole hospital
with revised electrical line especially in the theatre where we also got a new operating table. But in
particular we appreciate the possibility to have additional qualified staff under our payroll through ECHO:
a clinical officer, an orthopaedic officer, a radiological attendant, a social worker, one enrolled nurse and
one enrolled midwife».
After the initial support of ECHO Uganda 4 project, ECHO 5 came as a huge relief for the hospital. The
generator provided under ECHO 5 came after four months without power. This support determined a
fundamental change of situation: the generator can now supply the whole hospital.
In the second phase of ECHO support, the focus was more on human resources as the hospital was still

Kigtum District Government Hospital 55
understaffed. Plus, with the war, the Health Centres were only partially functioning. So the hospital became
point of first referral for many simple cases, and was overwhelmed.
Areas in progress are the upgrading of the Intra Venous fluid unit: a distillery machine was ordered from
Europe. Being the access to Kampala insecure, it made sense to localize fluid production.
Problems still identified by Dr. Martin are the water system that is very old, needs repair and produces a very
erratic supply, and improvement on radiology services, because the hospital only has a portable X-ray machine.
OVERVIEW
Kitgum District Hospital is a reasonably functional government hospital, smaller in size and manpower than
Gulu Regional Referral Hospital with similar critical points. In Gulu hospital though, AVSI has a strong presence
in the surgical and paediatric ward that makes a real difference.
Although ECHO through AVSI is already supporting the staff of the hospital, the attempt to employ directly
a national medical officer failed because of the insecurity of the area. AVSI, that has a long and complex history
with expatriate support to Kitgum Government hospital since the 1980s, is still looking for ways for direct
supervision or personnel support to complement its many logistical and structural interventions. A way to handle
this gap would be to favour consultation and education from the expatriate and national staff at St. Joseph’s
Hospital. Eventually either a strong national or expatriate doctor could then be tried again possibly on medical
or children’s ward, with some attempt to complement the services at St. Joseph’s Hospital.
Kitgum Government Hospital has much to gain in quality of care. OPD needs supervision that would be better
carried out by an AVSI supported medical doctor. The children’s ward is underutilized and OPD figures as
demonstrated, show a decline in attendance in favour of St. Joseph’s hospital. However ECHO 7 support and
its readjustments followed well on the ECHO 5 project and gave stability to the hospital.
Another point of weakness, data collection, is slowly improving thanks also to AVSI training and supervision.
© Punto Effe, 2006