Global Grant Proposal Form for Project G-72
Section A: Host and International Sponsor Information
1. Host Partner Information
2. International Partner Information
Section B: Community Needs
1. Describe the benefiting community including its location, using any relevant geographic and demographic information (Please be as specific as possible). If the activity is a scholarship, enter "N/A".
St. Stephen’s Hospital serves a population of about 80,000 people in more than 8 parishes including, Komamboga, Kanyanya, Katalemwa, Mpererwe, Kawempe II, Kitagobwa, Kiteezi, Kitetika and Masooli. There are about 16,000 women in child bearing age and over 15,000 children under five years old.
The area is peri-urban with many living below the poverty line. The community has people with a variety of ethnic, cultural and economic backgrounds. The economic activities range from transporting passengers on motorbike (fee of $0.5 - $1 depending on distance, brick making and charcoal vending, petty trading and vending, manual labour, casual work, cultivating of small food gardens, carpentry, metal fabrication, collecting scrap from a nearby dumping site to salary/ wage earners. Housing types range from temporary shacks for the very poor; semi-permanent house for the poor; and permanent houses for the middle income earners.
Many families have several dependants including orphans, school drop outs, unemployed people, especially the youth and the elderly. There is often insufficient food and inadequate knowledge about proper nutrition, diseases causes and prevention.
2. What community needs have been identified? If the activity is a scholarship, enter "N/A".
The health needs identified include:
- Curative services especially for the common illnesses such as: Malaria, acute respiratory infections, diarrhea, hypertension and HIV related complications. Malaria is the major disease burden in the community, leading to absenteeism from work and from school. HIV prevalence is 6.4% (similar to the national prevalence). Other diseases include hypertension especially in the elderly and diabetes mellitus. Mental illnesses are also a challenge in the community.
- Emergency care needs: Emergency obstetric care, resuscitation for adults, children and newborns, care for the critically ill and injured, blood transfusions
- Preventive services: oral health; ante-natal care; immunizations; reproductive health services and education to reduce maternal mortality, spread of HIV/AIDS and other sexually transmitted diseases; limiting the spread of vector borne diseases with emphasis on malaria, health education focusing on childhood diseases prevention, e.g. nutrition rehabilitation and counseling
- Surgical needs: general and specialised surgery; dental surgery.
The core need addressed in this project is creating sustainable access to good medical services addressing these health needs in a poor community.
3. How are these needs currently being addressed with local resources and/or government agencies, NGOs, etc.? If the activity is a scholarship, enter "N/A".
The community's own response to their health care needs was the setting up of St Stephen's Hospital. This community founded hospital (started over 20 years ago initially as a unit with one nurse offering basic services) has its origins in St Stephen's Church (but does not discriminate among religions in offering services). It has grown to a hospital that has a capacity of forty (40) beds, along with a general operating theatre; a maternity wing; and a dental surgery. It is supervised by a formal Board of Directors and headed by a Medical Superintendent (GSE Alumnus and now a Rotarian, Dr Catherine Nakibuule). It is a formally registered organisation with a title to its own land.
The Medical Superintendant leads and manages a staff of four (4) registered midwives, two (2) registered nurses, two (2) enrolled nurses, two (2) Clinical Officers, a Public Health Dental Officer, Laboratory Technician, two (2) counselors, and community health workers. The hospital also calls upon expertise as needed from a team of five consultants: a Surgeon, Psychiatrist, Public Health Officer, Radiologist and Oncologist, Obstetrician and Gynaecologist.
The services offered at the hospital include: outpatient and inpatient services, reproductive health, HIV/AIDS care, minor and major surgery, immunization, health education, counseling, home care, mental health, ambulance, dental, laboratory, school health and family planning. The hospital has a strong linkage to the surrounding community through its network of community health workers: A major component of the work carried out by St Stephen's Hospital involves medical outreach - visiting families in their homes, offering treatment and instructing them in both preventive and primary health care.
St. Stephen’s Hospital is registered with the Uganda Protestant Medical Bureau. The umbrella organization offers support supervision for quality assurance, accredits the hospital, represents the hospital in negotiations with Government and, from time to time, extends financial assistance to the hospital. Worth noting is the community based reproductive Health Project worth approximately 15,000,000 Ugx.
The hospital also partners with the Uganda Ministry of Health to help meet community health needs through delegated funds and PHC conditional grants and also receives support from other partners like the Rope Trust Charitable Fund, the St. Cuthbert Presbyterian Church in Canada and the Rotary Club of Kololo grants.
Government grants and donations cannot sustain the services, even when supplemented by the current user fees (that must be set low to permit access to services). To address the challenge of sustainability, the Board embarked on a strategy of setting up the Hospital as a community based health care training centre. This involved setting up a general operating theatre, inpatient facilities and a dental surgery, along with increasing installation of the kind of equipment required for a good small hospital.
As a result, the College of Health Sciences Makerere University, now routinely sends students (along with supervising experts) to use the Hospital for training in Community Based Health Education, Research and Services (COBERS).
Yale University in the USA also started sending students and staff 5 years ago. The result is that the community can now get access to advanced healthcare through the attachments of students and staff of medical schools. As the facilities of the Hospital are improved, the Hospital will gain increasing recognition as a training center to the stage where the large medical schools would be willing to pay for the training facilities.
Section C: Activity Description
1. Summarize the proposed activity(ies) in 250 words or less, including the need it will address, the intended beneficiary(ies), and the potential benefits to the community.
Principle objective: to provide general and advanced health services to a peri-urban poor community on a sustainable basis.
Srategy: to improve the facilities of the Hospital so that it becomes more attractive as a training center for community based health care, using what has been achieved todate as a foundation. This will attract more specialists and their students to use the hospital as a training base, bringing the benefits of advanced health interventions to a community that would normally never afford the services of a consultant.
Three categories of beneficiaries:
- Primary beneficiaries: members of the local community who will get access to better and more advanced medical services without incurring high costs.
- The medical students who will receive better field based training that will equip them better work;
- The general population of Uganda, which will benefit through better trained doctors.
Facilities to be improved to enable this include:
- Laboratory capacity: chemistry analyzer, hematology analyzer, CD4 count machine (investigations into: liver and renal function tests; CD4 counts
- Diagnostic capacity: X-ray; ECG and Echocardiogram will improve the diagnostic capacity of the hospital thus quality of care.
- Enhancing the capacity to care for critically ill and injured - oxygen concentrators, pulseoximeters for monitoring pulse and oxygen saturation for very ill patients and surgical patients; and a blood bank fridge to store blood and blood products; electric suction machines for suctioning patients with secretions.
- More beds and mattresses to improve inpatient capacity, and sterilization equipment and surgical sets to enhance the operating theater.
- Diagnostic equipment for Maternal and Child Health
2. Please list any cooperating organization(s) or university(ies) involved in the proposed activity(ies).
Makerere University College of health Sciences has Community Based Education and Research (COBERS) as part of its curriculum. Stephen’s Hospital was visited and assessed for suitability and selected as a training site since 2004. They have sent twenty students per year since then. A formal MOU to support St Stephen's Hospital in establishing itself as a training center for Community Based Health Education, Research and Service (COBERS) will soon be concluded.
3. Describe how the benefiting community will be involved in the activity(ies) (Provide specific examples). If the activity is a scholarship, enter "N/A".
- School heads and teachers will continue to be involved in community outreach programmes recognising especially the role of students in the community where they live;
- The Board and staff of the Hospital will continue supervise all local activities. As has been done before, established families in the community will continue to offer home-hosting to visiting students and specialists as the Hospital expands its visiting doctors’ residential facilities. The community will be involved in mobilizing the people in need health of care to utilize the services of the hospital.
- The community is also involved in mobilization for outreaches for example the antenatal care mobile clinics, immunization outreaches, health talks
4. Has the benefiting community(ies) confirmed that it would like the activity(ies) to take place?
Community outreach is already an accepted and appreciated part of the Hospital activities. The Board has been briefed and given formal consent (the Board includes community representatives, specificaly to ensure ownership and participation in all hospital activities.
Community has accepted the activities as evidenced by the increased utilization of the already existing services (see 2010 annual report). This will certainly grow with improved facilities.
5. Proposed Start Date: 1-DEC-
6. Proposed Completion Date: 30-JUN-2012
Section D: Area of Focus
1. With which area(s) of focus is the proposed activity aligned?
2. Please describe how the activity(ies) will address the goal(s) of the area(s) or focus.
Disease prevention and treatment will be addressed through improved diagnosis and care, with the acquisition of appropriate equipment and also through improved training of students and residents from various universities. Data from the various tests done at the hospital will be utilized as basis for health education and research aimed at improving the health of the community
Maternal and Child Health will be greatly improved when the hospital acquires more diagnostic equipment and improved emergency care facilities.
Economic and community development will be addressed when the overall health of the community is improved through disease prevention, quality care, improved training of health workers as a result of improved capacity for diagnosis, treatment and training.
Section E: Project Outcomes
1. What will be the immediate and long-term outcomes of the activity(ies).
- The main objective is to improve the quality of life of the community through better health. St Stephen's Hospital routinely monitors the health of the community through following indicators like incidence of common and preventable diseases and this will be used as a statistical basis for monitoring.
- The supporting outcome is the establishment of St Stephen's hospital as a center for primary and community based health care training. This will be monitored through the number of specialist and students who come to the hospital to teach/learn.
- Collaboration with Yale and other international universities will increase international understanding in line with Rotary objectives
2. Explain how all involved parties will act to ensure the sustainability of the activity(ies) and/or outcomes.
- At the programme level, the Board will seek more linkages with medical schools within and outside Uganda, seeking to build a continuing stream of visiting specialists and students;
- At the community level, modest user fees will be charged to ensure that equipment can be mantained and replaced. The means tested approach to user fees will continue so that the presence of experts yields income for the Hospital through those who can afford to pay more.
- Memoranda of understanding with Makerere College of Health Sciences and with Yale University in order to increase their engagement .This will increase the chances for sustainability
- St.Stephen’s Hospital community based nature, with several established community based programs for example outreaches, dental days, cancer screening days, home visits will enhance sustainability of the activities and outcomes
- Representations were made to the local authority and they have started to upgrade the access roads to the hospital. With access improved, utilization will go up and this will ensure sustainability.
- We applied for accreditation as an ART center and soon we will be offering HIV treatment and we are seeking partnership with organizations like the Mildmay Uganda and the Infectious Diseases Institute for capacity building in provision of HIV care and treatment.
- We have also applied for, and will soon get, a complete dental set and this will improve utilization of the services and this ensure sustainability.
- The community is also lobbying for a students center to house a resource center and accommodation for visiting students and residents
- We are also establishing a program for Continuing Professional Development at the hospital involving staff, students, residents and consultants from Yale and other universities
Section F: Budget
Section G: Financing