Mbale Regional Referral Hospital is one of the 13 regional referral hospitals in Uganda. It is also designated as one of the three public clinical paramedical teaching hospitals in the country.
The hospital started in 1924 as a collection and treatment centre for World War 1 wounded returnees before it was turned into as a small health centre, handling mostly child health services.
Today the hospital, which was designated to serve only 11 districts in the sub region, now caters for patients as far Soroti and Karamoja areas. Although originally meant to handle only complicated referral cases that could not be handled by lower health centre IVs, IIIs, and IIs in Mbale sub-region, today the hospital handles even the most basic of cases.
Reports at the hospital indicate that it handles treatment of respiratory tract infections, tuberculosis, cholera, dysentery, and diarrhoea. Other ailments the hospital handles include obstetrics, cancer, reproductive health services, deliveries, HIV/Aids counselling and guidance and minor and major operations.
According to Mr Louis Muhindo, the principal administrator, the hospital is grappling with an increased number of patients from about 14 districts that make up the catchment area of about 2,500,000 million people.
“This regional referral is also handling cough, cold, diarrhoea and any other infectious conditions which are supposed to be handled at health centre IIs, IIIs and IVs. This is what strains the hospital,” said Mr Muhindo. He said this has compromised the quality of services being offered.
Over stretched resources
Mr Muhindo explained that overtime, people have continued to accuse the hospital administrators and medical workers of providing inadequate services, yet the problem is beyond their jurisdiction. He claims that they have always tried their best to provide better services within the available, often over stretched resources.
The hospital has in recent months been on the spot for abuse of patients and maladministration. Mr Muhindo said although the hospital receives a non-recurrent wage bill of about Shs1.5 billion and development wage of about Shs1 billion for routine maintenance of the hospital and repair of vehicles and infrastructure, the increase in the number of patients makes the bill too little to run the hospital.
The hospital has a 400-bed capacity but that there are more patients sleeping on the floor than beds.
Mr Muhindo said although they have an X-ray unit which is supposed to be manned by three workers, there is only one. The ultra-sound scan department, Radiograph, and CT scan also lack manpower.
“National Medical Stores, which supplies medicines and reagents, at times supplies reagents below what is budgeted for and we have had no choice but to buy directly from the joint medical stores to supplement this shortfall,” said Mr Muhindo.
The hospital board chairperson, Dr Dominic Waburoko, said the hospital is challenged by the high number of patients who turn up at the facility. He said the problem is made worse by patients who make self-referrals. Dr Waburoko said that the attitude of workers is also a challenge as many of them think their salary is too low to work and so they spend most of the time at private clinics and in the gardens to earn a living.
Medical personnel-patient ratio
Dr Benon Wanume, the director of the hospital, says that although the World Health Organisation recommends a medical personnel-patient ratio of 1:4, at Mbale Hospital, the ratio is stands at almost 1:110.
“We have been put at 83 per cent medical staffing levels but this number does not cater for those who retire and those who die every year. We have more nurses [about 183] but few midwives (31). This is very low for a referral hospital,” said Dr Wanume.
Mr Wanume added: “Look at our floors, verandahs of wards they are all occupied with patients. At the paedeatric ward we have had to admit two to three children on one bed to enable them get the required services because we are overwhelmed but even then we work efficiently,”
Records at the hospital indicate that the hospital admits and treats 1,076 mothers in a month, handles 750 deliveries and 130 caesarian cases. It also has an average maternal death of three to four cases every month.
At the maternity ward, a patient, who declined to be named, said there are always two midwives at night catering for about 17 women who give birth at almost the same time. “Here it is normal for us to be overwhelmed with patients because the medical team is inadequate. We are overworked and yet our input is not commensurate to our remuneration from government,” said a midwife at the maternity ward who did not want to be named.
Mr Muhindo consented that there are some challenges that need to be urgently addressed such as shortage of medical workers and lack of supplies.
The Mbale District Service Commission chairperson, Mr Christopher Wetaya, said they usually advertise for health jobs but are restricted by the ceiling. “The hospital, according to the ministry, is filled up to 93 per cent and yet there are other hospitals out there that are below this. So, we are usually restricted to recruit only for lower rural health centres,” said Mr Wetaya.