introduction.
the rotary club of mbale was chartered in 1964 and since then, it has offered services to the communities singly or in partnership with other service providers. it has worked with the government organs, private organizations, and other rotary clubs – both locally and internationally.
mbale people’s clinic was established and registered under the ministry of health in 1998 as a non-profit medical centre offering health services to people within mbale and the surrounding communities. the clinic handles all the common medical health services, consultancy, minor surgeries, and prescriptions as well as admissions. for the last 11 years that mbale people’s clinic has been in operation, its capacity has grown in facilities and personnel. the clinic is still growing, and the demand for health services keeps increasing beyond the current capacity of the clinic hence requiring the clinic to expand further in its capacity, facilities and personnel.
on this particular project, mbale rotary club will implementing it in conjunction with mbale people’s clinic and it is requesting for support in-kind and cash from rotary club of cataraqui – kingston
background and justification
according to statistics, 1 out of every 5 pregnant women gets medical complications and 345 out of 100,000 mothers die during delivery. for the case of rural and underprivileged mothers, the situation is worse leading to deaths of either babies, or mothers and in some instances both. most of these rural mothers are affected due to several factors like traditional attitudes, ignorance, lack of adequate facilities and personnel, poverty, illiteracy, unprofessional practices by traditional birth attendants, high costs of professional services in modern clinics, these modern clinics are far in urban centers and hence inaccessible because mothers have to travel long distances (sometimes on foot or pick-up trucks) to reach government hospitals/health centers which are very congested and less attention is paid to individual complications.
mothers are also expected to buy all the items that will be used to handle the delivery process. for instance, if a mother goes to the health center without gloves, she will not be attended to, yet due to high poverty, some can not afford these requirements leading to so many deaths that would have been prevented.
according to cia world fact-book, uganda’s infant mortality rate: total: 65.99 deaths/1,000 live births (male: 69.65 deaths/1,000 live births, female: 62.21 deaths/1,000 live births (2008 est). the causes of morbidity and mortality in uganda remain the same i.e. preventable and mainly infective diseases (respiratory tract infections (rti), diarrhoea, malaria, and measles). hiv infected infants have higher morbidity and mortality rates hence the need for pmtct, improvements in vaccinations for childhood diseases and improved general health care services to cause a significant reductions in infant mortality rates – (imrs).
on the millennium development goals, mdg4 - reduce child mortality with a target of reduction by two-thirds, between 1990 and 2015, the under-five mortality rate, infant mortality rate and proportion of 1 year-old children immunized against measles and other immunize-able diseases.
mbale people’s clinic with mbale rotary club will target maternal and neonatal tetanus diseases that kills tens of thousands of newborns each year. the disease is often called the "silent killer" because many newborns affected by it die at home in very remote and poor communities where both the births and the deaths go unreported. a modern maternity home will be accessible and contribute towards solving this among other challenges in realizing the mdg4.
the infant mortality rate, which measures child deaths before the age of one, uganda improved to 76 deaths per 1000 live births in 2007, from 122 deaths per 1000 live births in 1991. on the other hand, the under-five mortality rate, which measures child deaths before the age of five, declined from 167 to 137 deaths per 1000 live births during the same period. given the fact majority of infants die before their first birthday, this target is unlikely to be achievable if it is left to the government alone. since the deaths are still high, there is need for rotary and other service provides to lend a hand in serving humanity.
on mdg5 - improve maternal health – i.e. to reduce by three quarters, between 1990 and 2015, the maternal mortality ratio and proportion of births attended by skilled health personnel. under this, the target is to achieve, by 2015, universal access to reproductive health in fields like; contraceptive prevalence rate; adolescent birth rate; antenatal care coverage; and unmet need for family planning in mbale district and the surrounding districts.
one of the main challenges is called fistula, so the aim is to prevent and treat a terrible childbirth injury called fistula-a rupture in the birth canal that occurs during prolonged, obstructed labour and leaves women incontinent, isolated and ashamed because the birth process is not handled by professionals. mbale people’s clinic with mbale rotary club aims at working towards realizing this goal within its areas of jurisdiction.
the maternal health indicators for uganda have generally remained poor in the last two decades. over the period 1995-2000, maternal mortality stagnated at about 505 deaths per 100,000 live births. the estimated maternal mortality from the uganda demographic and health survey is 435 deaths per 100,000 live births. to meet the mdg target, uganda will need to reduce its mortality rate from 505 to 131 deaths per 100,000 live births by 2015. mbale rotary club and people’s clinic intervention is paramount and it will contribute greatly.
over the last few years, the government has implemented a number of interventions aimed at improving overall maternal and child health. however, data available on a few output indicators shows that although there was a general improvement in health performance over the year 2003/04, all process indicators available have fallen short of targets, thus meeting the goals of maternal mortality by 2015 is unlikely, unless combined efforts are put in by all stakeholders like the rotary clubs and private service providers.
on mdg6 - combat hiv/aids, malaria and other diseases - mbale people’s clinic with mbale rotary club focuses on having these diseases halted through treatment and preventive services that the population will get at the clinic. we also will carry out prevention of mother to child transmission of hiv/aids, encouraging expecting couples to take a test to ascertain their sero status, and through the centre, messages on hiv/aids will be disseminated. this we hope will reverse the spread of hiv/aids. mbale people’s clinic with mbale rotary club desires to have full access to treatment for hiv/aids for all those who need it by 2010, and increased proportion of population with advanced hiv infection with access to antiretroviral drugs
according to the 2004-05 uganda hiv/aids sero behavioral survey (uhsbs), 6.4% (or slightly over 800,000 people) of adult population in uganda are infected with hiv. overall, there has been a declining trend of hiv infection from a peak of 18% in 1992 to the current figure. the international target is to halt, by 2015, and begin to reverse the spread of hiv/aids. uganda, therefore, seems to be well on track on this target. but despite the sustained declining trend of hiv/aids prevalence, it remains a significant threat to human and economic development.
over one million cumulative hiv/aids-related deaths have been reported since hiv/aids was first recognized in the country; and hiv/aids remains one of the major causes of morbidity and mortality in uganda. hiv/aids has orphaned scores of children. uganda has about two million orphans, 45% of whom are the result of hiv/aids – yet the number is rising. hiv/aids has created long-term impacts on the education system, which include mortality of children and teachers. the pandemic has also adversely affected labour productivity and output in all organizations through decimating the workforce, especially skilled personnel.
malaria kills a child in the world every 30 seconds. it infects 350-500 million people each year killing 1 million, mostly children, in africa. ninety percent of malaria deaths occur in africa, where malaria accounts for about one in five of all childhood deaths. we want to join efforts in eradicating this within our areas of operation and create a lasting impression by realizing the dreams of many poor people in the area.
malaria remains the leading cause of morbidity and mortality in uganda. it accounts for 52% of outpatient department attendance, and 30% of in-patient admissions. malaria morbidity remains high and 95% of the country is still classified as endemic to the disease. the disease is responsible for 9-14% of all in-patient deaths.
however, the inpatient deaths for children under-five attributed to the disease are about double at 20-23%. increasing cases of malaria may be attributed to limited medical facilities and few service providers. it’s at this point, that the rotary club of mbale in conjunction with mbale people’s clinic resolved to undertake this project.
problem statement - as shown above, uganda (like other african states), infant and maternal mortality rates are alarming. this can be attributed to a number of problems like;
v lack of maternity care and information during pregnancy
v very few experienced and well trained personnel
v high costs of maternity services which are unaffordable to the rural poor
v poor facilities in small clinics and health centers
v hiv/aids among pregnant mothers leading to mother-to-child transmission
as a result of these above, many mothers and their children die during the birth process.
the overall aim of the project is to offer quality maternal health care to needy women in mbale, uganda.
purpose of the project
this project aims at;
Ø establishing a modern maternity health facility
Ø reducing infant mortality rates and maternal mortality rates and improving women’s health
Ø reduce unprofessional health service deliveries
Ø provide affordable and easily accessible maternity services to the underprivileged women
Ø provide pmtct and hiv/aids related services to the community.
in order to achieve the above targets, the following equipment are required
1. x-ray machine
2. ultra sound machine
3. laboratory reagents and theatre equipment
4. maternity equipment (delivery kit, delivery bed, suction machines & oxygen concentration machine, oxygen cylinder, weighing scale for babies, feta scope, instruments [evacuation set, episiotomyscissors, cord clippers, sponge holding forceps, artery forceps, and incubators], fridge, bulb syringes, drugs [pitocin, lignocaine, anti-malarials, analygesics, pitocycin, engometrine], jik, detergents, buckets, curtains for separating beds, furniture [tables, chairs, benches], gloves, iv fluids)
5. basic diagnostic equipment (bp machine, stethoscope, autoscore, clinical thermometers, patetle hammer, tongue depressors, torches, weight machines)
6. sterilizers and bowls
7. mosquito bed nets
8. pmtct (test kits, drugs)
9. 50 medical beds
activities, outputs, targeted beneficiaries and future prospects
in addition to delivering babies, the facility will offer pre- and postnatal care, treatment of other diseases, immunization, family planning services, antenatal services, post abortion trauma care, pmtct hiv/aids, hiv/aids testing, preventive methods, couselling, and provision of arvs — all at affordable charges in consultation with the government of uganda.
at the clinic, we will achieve; reversed incidence of malaria and other major diseases; declined incidences and death rates associated with malaria; increased proportion of children under 5 sleeping under insecticide-treated bednets; increased proportion of children under 5 with fever who are treated with appropriate anti-malarial drugs; reduced incidence, prevalence and death rates associated with tuberculosis; and more tuberculosis cases detected and cured under directly observed treatment. many mothers shall deliver with full professional care hence reducing the infant and maternal mortality rates.
the center will serve and treat around 90 patients daily with 15 – 20 delivery cases. the centre is strategically located to serve people from the densely populated slums of namatala, malukhu, bugema, nauyo, namakwekwe, nkoma, mutoto, mooni, budaka, busajja-bwankuba, nampanga and the surrounding villages of mbale. residents in the mentioned places earn low incomes or no income at all. these are slums with all the characteristics and challenges faced by slum dwellers. they will be the primary beneficiaries of the project.
after the clinic being fully renovated, improved and equipped (in its three storied building in industrial division – indian quarters), it will open up its services to neighboring districts of kapcorwa, iganga, tirinyi, budaka, pallisa, bukedea, kumi, sironko, tororo, manafwa, bududa, namutumba among others. mbale town is centrally located and it serves all the mentioned districts.
it will be a very rewarding experience for rotarians and the community at large to see thousands of lives handled professionally at the centre.
process and funding
the project will be implemented in a number of phases;
phase one is securing the building to which mbale people’s clinic and well wishers like the church and the corporate world has secured at 200million uganda shillings.
phase two is renovations and repairs, this is ongoing. it has started and it is being supervised by the rotary club of mbale together with the management of the clinic and well wishers. this will cost 20million uganda shillings and mbale people’s clinic is to meet the costs.
phase three involves equipping the building. the building will require a number of equipment such as x-ray machine, ultra sound machine, laboratory reagents, theatre equipment, maternity equipment, drugs, furniture, basic diagnostic equipment and medical beds among others as shown in the itemized budget below. these will cost us $25,000. we are requesting the rotary club of cataraqui – kingston to support us.
phase four will include recruiting and staffing. the rotary club of mbale will work in conjunction with mbale people’s clinic, and the government of uganda – ministry of health to recruit and staff the clinic. we will network with the government and the ministry of health to post the following medical personnel and meet their wages/allowances; 3 doctors 1 full time and 2 part time), 5 midwives, 2 comprehensive nurses, 1 clinical officer, 1 dietician, 1 laboratory technician, 1 accountant, 2 cleaners, and 1 security guard. these shall be professionals qualified in the respective areas of specialization. the ministry of health (government of uganda) will meet these expenses.
phase five is the project take-off stage. this will take off immediately after the above. it will be presided over by officials from the rotary district 9200, rotary clubs, government officials, and community leaders. the clinic will officially be launched and thereafter it will be managed by the management of mbale people’s clinic and closely monitored by the rotary club of mbale and other stake holders. periodic reports and accountabilities will be made and disseminated.
phase six will be for acquiring an ambulance, x-ray machine and ultra sound machine. since most of the women come from far places, there is need for an ambulance to expedite their access to the clinic and other referral places. this ambulance will be on standby and at this time, we will recruit a driver on full time basis. the community leaders will have access to telephone contacts such that the ambulance can be called upon to pick and deliver them at the clinic. the x-ray and ultra sound machines are essential relevant technologies which will improve the services and facilitate the realization of our goals.
the rotary club of mbale will contribute us $500 in cash and offer the following services in-kind – supervise renovations, order the maternity ward’s equipment and supplies, which will include beds, a delivery table, kitchen equipment, and linens. the club will further supervise the operations of the clinic and make periodic reports. district 9200 officials are expected to preside over the official opening of the clinic.
the current management of mbale peoples clinic will handle the statutory/legal requirements, and they, together with well wishers like the church and the corporate organizations have contributed the building at 200 million ugandan shillings, and will meet the costs of; renovation and maintenance (at 20 million uganda shillings), and conduct the management on daily basis reporting to the rotary club of mbale, and the ministry of health. weekly surveillance reports shall be submitted and thorough accountability done.
the intention of this proposal is two-fold;
a. to request for the mentioned medical equipment; and
b. to solicit for funding amounting to us $25,000 (approximately 48,750,000 uganda. shillings.)
the above amount will be used to acquire the following items/equipment for phase three of the project.
medical beds (50) drugs
mosquito bed nets pitocin
laboratory reagents lignocaine
theatre equipment anti-malarials
maternity equipment analygesics
delivery kit pitocycin
delivery bed engometrine
suction machines jik
oxygen concentration machine detergents
oxygen cylinder buckets
weighing scale for babies curtains for separating beds
feta scope furniture
instruments tables
evacuation set chairs
episiotomy benches
sterilizer basic diagnostic equipment
bowls bp machine
scissors stethoscope
cord clippers autoscore
sponge holding forceps torches
artery forceps clinical thermometers
incubators tongue depressors
fridge patetle hammer
bulb syringes gloves
iv fluids pmtct
test kits
drugs (neverapin, arvs)
sustainability plan
the centre will be sustained basing on the four pillars of primary health care and these are;
· goodwill and political commitment, under which the clinic is already granted permission to operate by the government. the government also encourages women to deliver with professional assistance and as discussed above, the government is endeavoring to realize the discussed mdgs. so this project fits into government plans and it’s fully supported. we plan to enter a memorandum of understanding through the private-public partnership program to support the clinic with drugs and other essential requirements. this will enable the clinic to operate beyond the funding period.
· the second pillar that we will strongly utilize to sustain this clinic is intersectoral collaborations. we will network with other service providers in the region like cure children’s hospital that specializes in handling neurological issues, mbale regional referral hospital, the corporate community, churches, local governments, among other service providers. when we network with these other sectors, we will gain through the forward and backward linkages and through the corporate/social responsibility where corporate bodies give back to the community. through our linkages, we will tap from them hence aiding the clinic to survive.
· the third pillar that will enable the clinic to be sustained is use of appropriate technology. this helps to save the resources and offer technical and professional services. the saved resources can then be utilized on other related avenues. it also builds confidence in the recipients of the services, which enables the provision of services to be carried on.
· the final pillar that we will rely on heavily is community participation. we are involving the community in all the phases of the project such that they develop the spirit of ownership and hence become more responsible towards the clinic and all the equipment. the rotary club is a community based club comprising of members from various vocations and backgrounds – culturally and professionally. the clinic will tap from this wealth of experience and support for its survival. the members in the community are also supportive to all the efforts of mbale people’s clinic. this is evidenced by the continuous use of the services being offered through the many years it has existed. they keep demanding for even more services. the neighboring communities mentioned above are too congested / crowded hence expressing a potential need for health services. with this enormous support, the clinic will be sustained.
· the other factor that can enable us survive is the long experience that has been gained by both the rotary club and the clinic coupled with government support. since 1964 the club has been in operation and serving the community and the clinic has also operated since 1998. the two are very experienced and have worked on many similar projects that have survived a test of time. this project too will equally be managed well leading to its survival. |