BUNDA COMMUNITY MEDICINE MD4 2019

GROUP MEMBERS
1.Magreth Clement MD/4001399/T/15
2.Evodia Chatila MD/4001396/T/15
3.Abdalah Ally MD/4001382/T/15
4.Anosisye Godfray MD/4001381/T/15
5.Jackson Fukumbe MD/4001413/T/15
6.Agnes Jackson MD/4001433/T/15
7.Elius Emmanuel MD/4001408/T/15

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APPRECIATION/ACKNOWLEGMENT

We are kindly taking this chance to give our appreciation to all health facilities of Bunda Town
Council, health personnels and the community in general which permitted us to learn our
objectives of Community medicine for all the three weeks we had.
We also thank the TMO of Bunda TC Dr.Richard Majahasi for his support, the Medical officer
incharge of Boma dispensary Dr Beatrice and acting Medical officer incharge of
Manyamanyama Dr Peter for their caring and support.
We thank our lecturers Dr.Basinda,Dr. Kapesa ,Dr Ngallaba ,Dr Mwanga and Dr Elias for their
instructions before the field work and supervision during the field work.
Great thanks to our almighty God for guiding us before, during and after the field work .

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TABLE OF CONTENTS
ACKNOWLEDGEMENT....................................................................................................................................................... i
TABLE OF CONTENTS....................................................................................................................................................... ii
LIST OF ABBREVIATION................................................................................................................................................. iv
INTRODUCTION.................................................................................................................................................................... 1
1.0 DISPENSARY WEEK :BOMA .................................................................................................................................. 2
1.1 CATCHMENT AREA................................................................................................................................................ 2
1.2 HUMAN RESOURCES............................................................................................................................................. 3
1.3 HEALTH LEADERSHIP ......................................................................................................................................... 3
1.4 SUPPLY CHAIN.......................................................................................................................................................... 3
1.5 MEETINGS AND COMMITTEE........................................................................................................................... 3
1.6 LEVELS OF COMMUNITY INVOLVEMENT AND PARTICIPATION IN DECISION
MAKING............................................................................................................................................................................... 3
1.7 PLANNING AND BUDGETING........................................................................................................................... 4
1.8 REFERRAL SYSTEM................................................................................................................................................ 4
1.9 RCH SERVICES........................................................................................................................................................... 4
1.10 EPI AND COLD CHAIN........................................................................................................................................ 4
1.11 COMMUNITY OUTREACH SERVICES, MNCH........................................................................................ 5
1.12 ROLES OF HEALTH FACILITY IN-CHARGE............................................................................................ 5
1.13 COMMUNICABLE DISEASES SURVEILLANCE- INFECTIOUS DISEASES WEEK END
REPORT REVIEW (IDWE)............................................................................................................................................ 5
1.14 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) REVIEW- MTUHA....................6
1.15 GENERAL CHALLENGES FACING BOMA DISPENSARY................................................................6
2.0 HEALTH CENTER-WEEK:MANYAMANYAMA............................................................................................. 7
2.1 CATCHMENT AREA................................................................................................................................................ 7
2.2 HUMAN RESOURCES ............................................................................................................................................ 7
2.3 HEALTH LEADERSHIP ......................................................................................................................................... 7
2.4 SUPPLY CHAIN........................................................................................................................................................ 8
2.5 MEETING AND COMMITTEE............................................................................................................................. 8
2.6 LEVELS COMMUNITY INVOLVEMENT AND PARTICIPATION IN DECISION MAKING.. .8
2.7 PLANNING AND BUDGETING........................................................................................................................... 8
2.8 REFERRAL SYSTEM................................................................................................................................................ 9

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 2.9 RCH SERVICES........................................................................................................................................................... 9
2.10 EPI AND COLD CHAIN........................................................................................................................................ 9
2.11 COMMUNITY OUTREACH SERVICES, MNCH.....................................................................................10
2.12 ROLES OF HEALTH FACILITY IN-CHARGE.......................................................................................... 10
2.13 COMMUNICABLE DISEASES SURVEILLANCE- INFECTIOUS DISEASES WEEK END
REPORT REVIEW (IDWE).......................................................................................................................................... 10
2.14 HEALTH MANAGEMENT INFORMATION SYSTEM REVIEW (HMIS) – MTUHA...............10
2.15 GENERAL CHALLENGES AT MANYAMANYAMA HEALTH CENTER..................................11
3.0 TMO OFFICE WEEK................................................................................................................................................... 11
3.1 LEADERSHIP IN HEALTH CARE IN THE TOWN COUCIL................................................................12
3.2 DUTIES OF TMO..................................................................................................................................................... 12
3.3 TOWN HEALTH FINANCING MECHANISM AND RESPECTIVE CHALLENGES (CHF,
NHIF, USER FEE, COST SHARING)...................................................................................................................... 13
3.4 COMPREHENSIVE COUNCIL HEALTH PLANNING (CCHP)...........................................................13
3.5 TOWN INFECTIOUS DISEASE WEEK ENDING (IDWE) REPORT-SURVEILLANCE............13
3.6 TOWN HEALTH MANAGEMENT INFORMATION SYSTEM-MTUHA.........................................13
3.7 TOP TEN DISEASES AT THE DISTRICT HOSPITAL.............................................................................14
3.8 CHALLENGES AT THE TMO OFFICE………………………………………………………………………………….23
4.0 GENERAL RECOMMENDATIONS…………………………………………………………………………………………..24

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LIST OF ABBREVIATION
ANC- Antenatal care

AMO- Assistant medical officer

CCHP- Comprehensive community health planning

CHF- Community health fund

CHMT- Council health management team

CO- Clinical Officer

TMO- Town medical officer

HIV- Human Immunodeficiency Virus

HMIS- Health management information system
IDWE- Infectious disease week ending
MNCH- Maternal Newborn Child Health
MOI- Medical officer Incharge
MSD- Medical store department
MTUHA- Mfumo wa taarifa za uendeshaji wa huduma za afya
NHIF- National Health Insurance Fund
OPD- Outpatient department
PITC- Provider initiative testing and counseling
PMTCT- Prevention of mother to child transmission
RBF- Results Based Fund
RCH- Reproductive and child health
STI- Sexual transmitted infections
TB- Tuberculosis
WDC- Ward Development Committee.

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 INTRODUCTION
Bunda is the district found in Mara region in the United Republic of Tanzania.Bunda Township
serves as the Bunda district capital.It is located in the Northern direction with the road going to
Musoma in the middle. According to the 2012 Tanzania National Census,the population of
Bunda District was 335,061.
The following map shows the distribution of health facilities in Bunda Township As Far As
Community Medicine is concerned:

FIGURE 1:Showing health facilities distribution at Bunda Township

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1.DISPENSARY WEEK AT BOMA

Figure 2:Showing Boma dispensary

1.1 CATCHMENT AREA
Boma dispensary is located in Bunda township,and it serves three villages which are Bunda
stoo,Bitare and Migungani,the areas has population of 12632.
1.2 HUMAN RESOURCES FOR HEALTH.
The dispensary comprises of the following health services providers, 1 Clinical Officers, 4
Registered Nurses and ,1 data clerk, 1watchman and 3 community health workers.

There are two health committees governing dispensary which are dispensary board which
comprises of dispensary clinical officer in charge, one nurse and seven appointed members from
the community, the chairman of this committee come from the community and dispensary in
charge is the secretary. The second committee comprises of hospital staffs.

The dispensary committee conducts their meetings after every three months in a year and also
they have a meeting for quality improvement at the same interval. They discuss various issues
such as challenges faced in the different departments, environmental hygiene, ways forward and
others.

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1.4 SUPPLY CHAIN
Boma dispensary receives drugs and equipments from Medical store department (MSD) which is
the main supplier and sometimes from private donors and NGOs .

It receives funds to run the facility from BASKET FUND, RESULT BASED FUND (RBF) and
internal resources like CHF, NHIF and user fees from the patients.

1.5 MEETINGS AND COMMITTEE

The meeting and committee are conducted at the end of each month.Though if a great issue has
occurred and need urgent intervention,the committee can conduct a meeting for quick answers.
The meeting contain health staffs and appointed community representatives in the committee.

1.6 LEVELS OF COMMUNITY INVOLVEMENT AND PARTICIPATION IN DECISION

MAKING.
The community is involved in decision making at Boma dispensary through their representatives
who are village executive officer and the village chairman for every meeting that are legally
required.

1.7 PLANNING AND BUDGETING.

Budgeting and planning is done by all health workers in their meetings and they plan about the
whole matters concerning the facility,these are transport services for dispensary works and
refferals, drugs, outreach services and medical equipments.

Planning and budget is usually in every year and is commonly in March,April and May at Boma
dispensary and the overall planner is clinical officer who is the in charge.

1.8 REFERRAL SYSTEM

From Boma dispensary patients are referred to Manyamanyama health center for further
management,and from Manyamanyama to district hospital, the patient is given a referral letter
which explains the suspected diagnosis and the reason for referral and then if it is an emergency
the patient is sent by the district ambulance.

Also a patient has a chance of using his/her personal costs to get reffered directly from the
dispensary to district hospital or regional hospital.

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1.9 RCH SERVICES
RCH clinic at Boma operates from Monday to Friday. The clinic provides services like
vaccination, PMTCT, weighing services with reproductive health and family planning education.
The services starts from morning around 8:00am up to 3:30pm although the working time
depends on the number of clients.

Last year (2017/2018) the clinic served approximately 14523 people. Fortunate enough, at the
RCH there is 1 registered nurse and 2 community health workers.

1.10 COLD CHAIN AND EPI

Boma dispensary provides all the vaccines according to expanded program on
Immunization/vaccination. In the dispensary there is 1 special refrigerator which is used to store
vaccines before they are being used, vaccines are stored under required temperature ranges from
2-5 degree Celsius up to 8 degree Celsius, also there is a chart for monitoring temperature daily,
from the refrigerator to the area of vaccination they use vaccine carriers which contain ice packs.

Then,After vaccination the vaccines are carried to the vaccines carrier back to the
refrigerators for future use. In order to preserve vaccines viability the vaccines should be
returned to the refrigerator not more than 12 hours and should be opened only twice in a day,
when taking out the vaccines and when returning the vaccines for storage.

1.11 OUTREACH SERVICES IN THE COMMUNITY

The facility also offers community outreach services in villages which are located far from the
facility but commonly within the catchment area,Bunda stoo,Bitare and Migungani.

The services provided during outreach are mainly those from RCH department including
vaccination, weighing children, family planning, and VCT.

1.12 ROLES OF HEALTH FACILITY IN-CHARGE.

The roles of health facility in-charge as far Boma dispensary is concerned are monitoring and
supervising all the activities done in the dispensary in all levels every day such as being involved
in all the meetings which are held in the dispensary, community and ward development
committee for dispensary development and improvement.
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1.13 COMMUNICABLE DISEASES SURVEILLANCE- INFECTIOUS DISEASES WEEK
END REPORT REVIEW (IDWE).
The report is done weekly in which every Monday after working hours all the diseases which
have occurred in that particular week are recorded in written copies then filled in online
application and sent direct to the ministry of health and the district.

1.14 HEALTH MANAGEMENT INFORMATION SYSTEM (HMIS) REVIEW- MTUHA

MTUHA means Mfumo wa taarifa za uendeshaji wa huduma za afya
HMIS books have been designed in different forms according to the needs there is book 1 up to
book 18.
The following are MTUHA books found at Boma dispensary,the missing numbers means the
services are not found at Boma dispensary.
HMIS 1: It provides guideline on how to use other books.

HMIS 2: Facility and hospital summary book.

HMIS 3: Community outreach register book

HMIS 4: It is used to record all vaccines and drugs received from MSD and District hospital also
the vaccine and drugs which have dispensed.

HMIS 5: Outpatients department register

HMIS 6: Antenatal care register

HMIS 7: Register for all under-five children

HMIS 8: Family planning register

HMIS 9: Diarrhea treatment corner

HMIS 10: Monthly report book

HMIS 13: Postnatal register

HMIS 15: Human resources register

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1.15 GENERAL CHALLENGES FACING BOMA DISPENSARY.
 Finance; most of the time money come late from the government and other sources of
fund
 Lack of motivation for the health providers especially in doing extra duties without any
payment
 Shortage of staff members especially in RCH
 Lack of Ambulance for refferals
 Absence of reliable water source.
 Community awareness on importance of health services provided by the dispensary
 Shortage of drugs
 Poor latrine for staffs and patients

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2.0 HEALTH CENTER-WEEK:MANYAMANYAMA

Figure 3:Showing Manyamanyama health center

2.1 CATCHMENT AREA

Manyamanyama health Centre is currently serving four villages of ward which are Bitaraguru
village,Kiwasi village and Kung’ombe village.

It serves a population of 13446 in its catchment area though it serves people from other areas
nearby the center.

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 Figure 4: Showing a map of Manyamanyama catchment area

2.2 HUMAN RESOURCES FOR HEALTH

The facility consists of 5 medical officers, 2 Assistant medical officers, 1 Radiographers,12
clinical officers,6 clinical assistants,18 Assistant nurses,39 Nurses,3 Medical recorders,22
Medical attendants,2 Laboratory scientists,2 Pharmaceutical technologists,3 Health insurance
expert and 2 Accountant assistants.

In addition,the center has 2 Ambulances.

2.3 HEALTH LEADERSHIP AT H/CENTER, VILLAGE, WARD AND DIVISION LEVELS

Manyamanyama health center has 3 committees,Health management team(HMT) which
comprises of medical officer incharge as a chairman and health staff members,Therapeutic
committee which has MOI as chairman and pharmacist as a secretary and 4 staff members.

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Then,the third committee, health center committee, comprises of ward councilors,MOI as a
secretary, other health workers, four members from the community, representatives of special
groups and representative from faith based organizations . The other committee comprises of
health center department in charges and also there is a meeting which includes all staffs’ member
in the health center, they all held their meetings quarterly and in case of emergency.

2.4 THE SUPPLY CHAIN

Manyamanyama health center receives drugs and equipment from different sources which are
Medical store department (MSD) which is the main supplier and from private donors like
AGIPAI and USAID.

Other sources which supply the center for funds are BASKET FUND, RESULT BASED FUND
(RBF) and internal sources which are user fees,CHF and NHIF payment.

2.5 MEETING AND COMMITTEE.

Meeting and committee involves the health Centre staff members are usually done at the end of
each month and between health workers and the village health committee meeting is done after
every 3months.

Although sometimes when health issues raised that need emergence discussion they sit
immediately. Important matters discussed are like health quality improvement, hospital
managements plans/teams,common cases occurred and others.

2.6 COMMUNITY INVOLVEMENT AND PARTICIPATION IN DECISION MAKING.

The third committee,health center committee,comprises of ward councilors,MOI as a
secretary,other health workers, four members from the community, representatives of special
groups and representative from faith based organizations.

This committee is responsible for organize and monitor all issues concern the facility and all
matters concerning health among members of the community. Also the communities are highly
involved in the developmental matters concerning the facility like,they are also participating in
building of the health center infrastructures in cooperation with other private sponsors and
contributions from the facility workers.

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2.7 PLANNING AND BUDGETING.
The Planning and budgeting at Manyamanyama is done in health meetings ,which involves
representatives of the department and community committee whereby they plan about the whole
matters concerning the facility like transport services, buying drugs, outreach services and
equipments . Planning and budget is usually done in every year from march to may and submit to
the TMO office in may also, overall planner is Medical officer in charge of the facility.

2.8 REFERRAL SYSTEM

From Manyamanyama health center to Bunda Designated District hospital. This is done when
facility is unable to manage some complicated cases such as major surgeries and complicated
obstrestics cases. The patients are referred with referral latter which will explain the reason for
referral but also made the phone call before referring the patients. Sometimes they refer patient
direct to Musoma regional hospital or Bugando medical center.

2.9 RCH SERVICES

Manyamanyanma RCH clinic operates from Monday to Friday. The clinic provides vaccination,
PMTCT, ANC, STI services, Postnatal Care, weighing services with reproductive health and
family planning education. The services starts from morning around 8:00am up to 3:30pm but
the working time depends on the number of clients. In the RCH clinic registerd nurses are 2 and
1 community health worker only.

2.10 EPI AND COLD CHAIN

Manyamanyama provides all the vaccines according to expanded program on Immunization,
also all the vaccines needed for the program are usually available during the immunization
process. In the facility there is a special refrigerator which is used to store vaccine before they
are being used, vaccines are stored under required temperature ranges from 3-5 degree Celsius
up to 8 degree Celsius, also there is a chart for monitoring temperature daily, from the
refrigerator to the area of vaccination they use vaccine carriers which contain ice packs.

Then, after vaccination all remained vaccines are carried t back to the refrigerators for future use.
In order to preserve vaccines viability the vaccines should be returned to the refrigerator not
more than 12 hours and should be opened only twice in a day, when taking out the vaccines and
when returning the vaccines for storage.

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2.11 COMMUNITY OUTREACH SERVICES
RCH outreach services are conducted across the area of their services, the services offered
includes Health education and promotion on breastfeeding,early ANC visit importance, HIV
Counseling and Testing, Family planning education and methods and also they do vaccination.

It is done after every 2 months around catchment/service areas.

2.12 ROLES OF HEALTH FACILITY IN-CHARGE

The roles of health facility in-charge at Manyamanyama includes monitoring and supervising all
the activities done in the health Centre at all levels such as being involved in all the meetings
which are held in the health Centre and also in the village/ward development committee,ensuring
budgeting is done effectively and monitoring all the implementations of health center plans.

2.13 COMMUNICABLE DISEASES SURVEILLANCE- INFECTIOUS DISEASES WEEK

END REPORT REVIEW (IDWE).
The report is done for every week. In which every Monday after the working hours the report is
sent. All the diseases which have occurred in a respective week are filled in an online application
and sent direct to the district and the ministry of health by using special website.

The report is reviewed and analyzed to see if there is outbreak of any disease that has occured in
order to take early preventive measures and control methods.

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2.14 HEALTH MANAGEMENT INFORMATION SYSTEM REVIEW (HMIS) – MTUHA

Figure 5:Showing MTUHA books

The following are MTUHA books found at Manyamanyama health center

HMIS 1: It provides guideline on how to use other books.

HMIS 2: Facility and hospital summary book.

HMIS 3: Community outreach register book

HMIS 4: It is used to record all vaccines and drugs received from MSD and District hospital also
the vaccine and drugs which have dispensed.

HMIS 5: Outpatients department register

HMIS 6: Antenatal care register, used to record information about pregnant women

.HMIS 7: Register for all under-five children

HMIS 8: Family planning register

HMIS 9: Diarrhea treatment corner

HMIS 10: Monthly report book

HMIS 11: Dental register book

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HMIS 12: Labour and delivery register book

HMIS 13: Postnatal register

HMIS 14: Inpatient department register

HMIS 15: Human resources register

HMIS 16: Eye register

HMIS 17:Death register book

2.15 GENERAL CHALLENGES FACING MANYAMANYAMA HEALTH CENTER.

 Political leaders interference in plans and budget of the center tend to drawback the goals
 Shortage of workers especially registered nurses at the RCH clinic
 Serving more numbers of patients than required.
 Lack of enough motivation among health workers in extra duties
 Poor working conditions.
 Shortage of buildings especially inpatient wards and pharmacies.
 Funds come late to the facility something that hinders early implementations of hospital
plans

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3.0 TMO OFFICE WEEK

Figure 6:Showing Bunda TMO Office

Figure 7:Showing Bunda DDH

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3.1 LEADERSHIP IN HEALTH CARE IN BUNDA TOWN COUCIL

In town council leadership there is Council Health Management Team (CHMT).

The head of CHMT is the Town Medical Officer (TMO).
The team conducts meeting at the end of each month.
The CHMT consists of three teams which are:

 District hospital management team

 Health center management team and
 Dispensary management team.

The health center and dispensary management teams consists of laboratory in charge, RCH in
charge, labour in charge (for health center) and OPD in charge as heads and representatives in
the teams.

3.2 DUTIES&RESPONSIBILITIES OF TMO

The TMO office of Bunda township council has administrative, professional, training, public
health and political roles.The following are those duties and responsibilities of TMO:

 Monitor and Oversee daily health issues in the township council

 Allocation of staffs depending on demand and gaps.
 To monitor funds about health services
 Head of CHMT and the secretary of the DHB.
 In charge of all health facilities in the township council
 To articipate in comprehensive council health planning (CCHP)
 To organize and train activities for the health staffs.
Acts as a link between government and community in health sector
 Conducting and supervision of outreach programs
 Environmental education

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  To Support governmental programs and intervention

3.3 HEALTH FINANCING MECHANISM AND THEIR RESPECTIVE CHALLENGES

(CHF, NHIF, USER FEE, COST SHARING).

The following are the financing mechanisms of the TMO office:

1.Basket Fund
These are money that come directly from Government health budget depending on various
parameters.
2.Office Charges
For different health and administrative services that are being offered by the office.
3.Miscellaneous Accounts
These come from health sponsors like USAID,AGIPAI and JHPIEGO.

Challenges on the financing mechanism:

There is several cost sharing modalities available at this health facility including: NHIF,
CHF, RBF and user fees:

 Basket Fund

Money tend to delay much to arrive at the office

 NHIF

Delay of funds from the government.

Other services and drugs cannot be covered by NHIF

 CHF

It is limited to respective area

It Covers only 6 member of the family hence difficult for large families

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3.4 COMPREHENSIVE COUNCIL HEALTH PLANNING
CCHP deals with identification of problems with in the district ,where by the TMO collects
problem proposal from each dispensary and health center and then submit to CCHP to counter
measures the specific problems. This CCHP implement health promotion and vaccine .

3.5 DISTRICT INFECTIOUS DISEASE WEEK ENDING (IDWE) REPORT-

SURVEILLANCE.
Infectious disease week ending report (IDWE) is usually done weekly ,Where by the report is
analyzed to see if there is any outbreak of disease ,maternal death and complicated cases.

3.6 DISTRICT/TOWNSHIP HEALTH MANAGEMENT INFORMATION SYSTEM.

At district and Township level they use HMIS from number 1 to 17 to collect and store data
which is usually filled in the respective units by MOs, AMOs or Nurses through paper based
system then compiled by DHO office monthly and finally entered data base where it is handled
automatically to provide a properly analyzed and interpretable report. Feedback is provided
inform of report which entails reports on late data submission from the various centers where
data was collected and conclusions on the trend of diseases in the district. This is done quarterly
and supervision done monthly.

3.7 TOP TEN DISEASES AT BUNDA DESIGNATED DISTRICT HOSPITAL

1: Malaria

2: TB

3: Anemia

4:Malnutrion

5:HIV

6:Pneumonia

7:Worms infestation

8:Trauma

9;Heart diesases
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10:Neurosis

3.8 CHALLENGES AT THE TMO OFFICE

The folowing are challenges facing the TMO office

1.Funds come late to the office

2.Shortage of
Staffs
Tools and equipments for facilities work
Drugs and medicines
3.Poor infrastructures: Shortage of Ambulances(Transporting mechanism for refferals).

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4.0 OUR GENERAL GROUP RECOMMENDATIONS
The following are our recommendations regarding our areas of rotations:
1.Govenment should introduce electronic system to store health information instead of current
manual filling system to increase efficancy and minimize time.
2.Government should build more facilities such as ward,laboratories,mortuary and maintain
previous theatre to all health facilities from Boma,Manyamanyama to bunda DDH.
3.Governent should hire more health personel such as medical doctors,pharmacies,assistant
medical officers and etc.
4.Government and other health sponsor should provide enough money and given in right time.
5.Government should rise salaries, incentives and good working condition to her employees.

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