MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED

SCIENCES

SCHOOL OF PUBLIC HEALTH AND SOCIAL SCIENCES

DEPARTMENT OF COMMUNITY MEDICINE

LUGOBA HEALTH CENTRE REPORT

Dec 14th 2015–Jan 8 2016

Supervisor: Dr. Kessy

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GROUP MEMBERS

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TABLE OF CONTENTS page
LISTOFABBREVIATION……………………..…………………………………………………………………3
Objectives……………………………………………………………………………………………………………5
Acknowledgement …………………………………………………………………………………………….6
Introduction ………………………………………………………………………………………………………7
Lugoba health centre buildings………………………………………………………………………….8
Methodology ……………………………………………………………………………………………………..9
Results ……………………………………………………………………………………………………….……..10
Factors related to health of the community……………………………………………………….10
Accessibility and utilization of health centre services…………………………………………11
Staffs………………………………………………………………………………………………………………….11
Equipments ……………………………………………………………………………..………………………..12
Building maintenance…………………………………………………………………………………………13
Health centre activities………………………………………………………………………………………13
OPD TOP TEN……………………………………………………………………………………………………..13
IPD top ten…………………………………………………………………………………………………………14
Admission, discharge and referral…………………………………………..………………………….14
RCH services……………………………………………………………………………………………………....15
TB/Leprosy…………………………………………………………………………………………………………18
Challenges faced by the health centre………………………………………………………….……19
Discussion ………………………………………………………………………………….……………………..19
Conclusion……………………………………………………………….…………………………………………20
Recommendations ……………………………………………………………………………………..……..21
References ……………………………………………………………………….……………………………….21

LIST OF ABBREVIATIONS
AD Assistant dentist
AHO Assistant health officer
AMO Assistant Medical Officer
ANC Antenatal Clinic
ARI Acute Respiratory Infections

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ARV Anti-RetroViral
BCG Baccile Calmette Guerin
BP Blood Pressure
CHF Community Health Fund
CO Clinical Officer
CTC Care and Treatment Center
DMO District Medical Officer
DOT Direct Observed Therapy
Dpt-HB-Hib Diphtheria, Pertussis, Tetanus-Hepatitis B- Haemophilus
Influenza B
FBP Full Blood Picture
FP Family Planning
HIV/AIDS HumanImmunodeficiencyVirus/Acquired
Immunodeficiency syndrome

HMIS Health Management Information System

IPD In-patient Department

IPT Intermittent Presumptive Treatment
IRS Indoor Residual Spraying
ITN Insecticide Treated Nets
IVDP Immunization and Vaccination Development Program
mRDT Malaria Rapid Diagnostic Test
NHIF National Health Insurance Fund
NTLP National Tuberculosis and Leprosy Program
OPD Out-Patient Department
OPV Oral Polio Vaccine
PCV Pneumococcal Conjugate Vaccine
PMTCT Prevention of Mother to Child Transmission
RCH Reproductive and Child Health
RPR Rapid Plasma Reagent
SP Sulphadoxine Pyrimethamine
STI Sexually transmitted Infections
TB Tuberculosis
TBA Traditional Birth Attendant
TT Tetanus Toxoid
UPT Urine Pregnancy Test
UTI Urinary Tract Infections
VCT Voluntary Counselling and Testing
VDRL Venereal Disease Research Laboratory
WEO Ward Executive Officer

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EN Enrolled nurse
MA Medical attendant

OBJECTIVES

A. ENVIRONMENTAL HEALTH

1. To study and evaluate the environmental sanitation status of a village

2. To discuss the health hazards of bad environmental sanitation with villagers
3. To practically demonstrate a measure to improve environmental sanitation

B. STRUCTURE OF MEDICAL SERVICES AT HEALTH CENTER LEVEL

1. To familiarize with the National policy for health center activities

2. To study outpatient activities
3. To study in-patient activities
4. To study MCH activities
5. To study antenatal activity
6. To study child clinic activities
7. To study the administrative and managerial aspects of a Health Centre

C. HEALTH EDUCATION

1. To give health education to STD. VI and VII pupils

2. To give health education to a village community
3. To be able to teach the health center staff

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ACKNOWLEDGEMENT
Our objectives during this Health Centre week could not have been achieved without the aid of
many individuals. Thus we would like to express our gratitude to all those who made this week
fruitful to our cause.

We thank the department of Community Medicine for organizing this field activity and so giving
us a learning opportunity. We would also like to thank our supervisor Dr. Kessy for her
guidance and support.

We also thank the Lugoba Assistant Medical Officer in charge, Dr.Tumain Swai and the Lugoba
village executive officer (VEO) Mr Elias Enzimbali for their warmly welcoming us to their
respective health center and village and for taking time out of their busy schedule.

Our gratitude also goes to all the staff of the Health Centre for extending their courtesy and
assistance to us. We could not have learnt much if it was not for them.

Our hope is that this report will be of backing in shaping the situation of the Health Centre and
will aid in its further improvement in provision of health services.

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INTRODUCTION
The Health Centre is the third lowest health facility in the health system in Tanzania. Ideally, a
health center is supposed to serve 50,000 people.

A Health Centre shall have the following qualified staff:

 Medical assistant/Assistant medical officer

 Rural medical aide
 Senior nurse
 Midwife/nurse
 MCHA or public health nurse
 Health officer
 Assistant health officer
 Assistant lab technician
 Pharmaceutical Assistant

A Health Centre and a dispensary provide similar services but the difference is that the former
has the following additional services:

 In-patient department for patients who require short hospitalization

 Supervision of dispensaries as well as provision of primary health care services in the
division
 The Health Centre practices and follows the guidelines of all the available National
Programs as compared to a dispensary
The District Medical Officer is the personnel in charge of the district medical services, which
includes health centers, dispensaries and other public health services which are always under
his/her supervision.

As future DMOs we need to have knowledge on the whole health system and various health
services provided and the resources available at health centers. This is essential as it will allow
us as future DMOs to be able to deduce community diagnoses related to community health
problems, institute proper interventions to community health problems and to be a better leader
in terms of administrative and managerial duties.

Furthermore, as medical students we have to know how different referral systems link with other
health facilities such as dispensaries, health centers, district hospitals and even traditional

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healers. This will help us to know the flow of patients from one facility to another in the event of
a referral.
As students we should also be able to familiarize with the financial aspect of the Health Centre.
This includes the budget, the equipment at Health Centre facility and their maintenance and also
the implementation of national control programs e.g. National TB and Leprosy Program (NTLP).

LUGOBA HEALTH CENTRE BUILDING

The Health Centre is comprised six buildings, each with a different area of concern, which
includes the following:

 Reception and dispensing room

 Consultation rooms
 Male ward
 Female ward
 Labour ward
 MCH/RCH clinic
 Theatre building
 Laboratory
 Pharmacy and store
 Injection room
 TB and Leprosy room
 Casualty room
 Mortuary
 Post delivery room

In total there are 3 consultation rooms, male and female wards with 4 beds each, a labour ward
with 3 beds and 5 beds in post delivery room. There are a total of 19 beds in the Health Centre.
The beds are less compared to the number of beds required in health center although tne beds
were enough compared to the average number of patients admitted.

The theatre is not equipped for surgeries required to be done at the health center although minor
procedures such as D&C and wound stitching are done.

The laboratory carries out 4 main investigations.

 Hematology – FBP, HB, Biochemistry(RBG/FBG,creatinine)

 UPT
 Parasitology – malaria and stool samples
 Microbiology – TB (AFB), VDRL, leprosy and HIV and Widal tests

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  urinalysis

Every 3 months, a district lab technician is tasked with auditing the lab samples at the Health
Centre. If the district technician’s diagnosis matches the one of the Health Centre technicians, the
used samples and specimens are then incinerated.

The Health Centre is not entirely well equipped to deal with all the patients. This is due to the
fact that there are an overwhelming number of patients that visit the Health Centre while the staff
and the building facilities are not enough to accommodate them all. In addition to this the Health
Centre is lacking in funds. Due to these problems the Health Centre has to cope and compromise
in many aspects pertaining to its functions.

METHODOLOGY
Various methods were approached to get the required information from the daily activities
carried out at the Health Centre as per our objectives. These methods include:

Interviewing

We interviewed the Health Centre staff (AMO, clinical officer, nurses, nurse attendant,
receptionist, drug dispenser, etc.)and mothers/ guardians who brought their family members to
the Health Centre for treatment

Observation

Going through the registry books and admission records (outpatients, inpatients, MCH and
antenatal) at the Health Centre

Generally, we observed all the activities being done at the Health Centre by the staffs i.e.
outpatient, laboratory activities, pharmacy activities and ward activities

Participation

We actively participated in different activities done at the Health Centre. We participated in the
morning reports, vaccinating children in RCH, OPD,CTC, family planning and HIV testing
counseling, TB/Leprosy clinic.

We also had an educational teaching session with LUGOBA Primary School for the STD VI
pupils.We screened pupils on diarrhea diseases and we provided health education concerned
with meaning , causes , ways of transimission , preventive measures and action to be taken
during illness.

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RESULTS

GENERAL DESCRIPTION
Lugoba ward is located in bagamoyo district and it consists of Mtambani, LUGOBA, Mjini,
Mihambe, Ruvu kwa Dosa, Kibwende, Msufini, Kitemvu, Njia Panda JKT, Vikuruti and
LUGOBA Kati. LUGOBA has a total population of 17,318 people, 8546 males and 8772
females. Kilangalanga has a total population of 10,588 people, 4997 males and 5591 females.
Janga has 10,926 people, 5242 males and 5684 females.
The ward is located along the Dar es salaam-Morogoro highway about 62km from Dar es
Salaam. They mainly practice agricultural activities and the crops grown include maize, rice and
cashew nuts. The other community members practice small scale businesses and herd animals.

FACTORS RELATED TO THE HEALTH OF THE COMMUNITY

Social and cultural beliefs
Many food taboosm still exist among the women i.e. goat meat and eggs were forbidden to
consume during pregnancy and also some society in Lugoba like masai do not eat some
nutritious food like fish which render them to have some nutrition related diseases like
kwashiorkor in under fives. Furthermore many people had more faith in traditional medicine and
healers rather than the Health Centre services.
Lugoba located along Arusha road where most of long vehicles are parked, this increase
interaction between people and therefore increase spread of HIV/AIDS. There are traditional
dances like vigodoro which have also been contributing factor for spread of STIs.

Environmental factors
The houses in LUGOBA are made by burnt bricks and mud, with poor ventilation making
people more prone to respiratory diseases. Majority of the households have electricity and good

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water supply. Almost all of the households have traditional pit latrines with poor hand washing
technique leading them to contact fecal oral diseases.
There is scarcity of water which renders most of people to access safe water but inadequate
amount of water for daily use, which has contributed to water washed diseases example skin
fungal infection which is very common in Lugoba
Economic factors.
Majority of people living in Lugoba have low social economic status, mainly depend on
agriculture, as a result most of them fail to join health insurance services or pay user fees. This
rend them to access health services making them to opt for traditional healers. This has
contributed to poor health status of community as majority of people go to health care facility in
late stages of diseases.

ACCESSIBILITY AND UTILIZATION OF THE HEALTH CENTRE

LUGOBA Health Centre not only serves LUGOBA, but also other nearby wards in Bagamoyo
district. The average daily outpatient visits in Lugoba Health Center ranges from 50 to 100
patients more than the ideal number of people attends the Health Centre every day and it is
usually overwhelmed with excessive patients.
However there are many people who still prefer traditional healers and traditional medicine as
compared to the Health Centre and thus this is a major competition for health seeking behavior.

STAFF
S/NO NAME OF STAFF QUALIFICATION
1 Tumaini Swai AMO-I/C
2 Edward Mosha CO
3 Matokeo Sanga ANO
4 Mohamed Zando LT
5 Felister Haule EN
6 Miriam Malecela AMO
7 Elida Gabriel EN
8 Atupakise Solomon EN
9 Mwanaid Msagati CO
10 Hussein Ramadhan AD
11 Flavian Msofe AHO

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 12 Pili Hamis MA
13 Adelina Hussein MA
14 Mwajuma Mlwale MA
15 Senga Aweso MA
16 Selina Lugutwi MA
17 Selina Lucian MA
18 Luth Eliakim MA
19 Zuhura Mustapha EN
20 Joice Ndege MA
21 Ibrahim Dawson RECORD KEEPER
22 Hassan Muyumbe SECURITY
23 Jumanne Milayo SECURITY
24 Aisha Salum MA
25 Aisha Sanga MA
26 Joseph macyaga ALT
27 Daniel Obelo DRIVER

In an ideal Health Centre setting these are the appropriate number of medical personnel who are
meant to be present:

5 Assistant Medical Officers 1 Ophthalmologists

(AMO)
12 Clinical Officers (CO) 1 Health Officer (HO)
14 Medical attendants 2 Dental Therapist
3 Pharmaceutical technician 3 Laboratory Technician

There are a total of 27 staff members at the Health Centre in Lugoba. These include 2 AMOs, 2
clinical officers, 1 Lab technicians, 1 Lab assistants, 4 enrolled nurses, 10 medical attendants, 1
ambulance driver, 1 assistant dentist, 2 security , 2 cleaner, and 1 assistant health officer.
The heath center has scarcity of about 22 staff member , includes 5 CO, 2 EN, 2 NO, 1 AD, 2
SECURITY, 5 HI, 2 PHARMACITY , 1 CLEANER, 1 DRIVER, and 1 RECORD KEEPER

EQUIPMENT
Drugs – are received from MSD via the IRS every quarter in the year .
Once drugs are brought at Health center they are recorded in the issue voucher book, stored in
the pharmacy main store. There is a special card called a BIN card which records input and
output of drugs and other medical equipment to make sure that all drugs are accounted for at all
times

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From the main store room, drugs are kept ready to be issued to the dispensing room (pharmacy).
There is one pharmacy window, where all patients using health insurance services and those for
user fee patients receive their drugs. Drugs can also be taken out directly from the main store if
ordered from the wards, theatre, CTC, RCH, OPD and other special clinics such as dentistry .

There is no shortage of ALu, and ARVs because these drugs are provided free of charge. But for
other drugs there is often shortage due to many patients and lack of funds.
In the event of shortage patients are advised to buy their own drugs if possible, drugs are
requested from neighboring hospitals and often the in charge is responsible for acquiring funds,
both privately and government based, in order to combat this.
Other equipment – items such as surgical blades, gloves and so forth are almost always in
shortage due to lack of funds and many patients. This is usually addressed by requesting patients
to buy their own equipments.

BUILDING MAINTENANCE
LUGOBA Health Center consists of six buildings and since it is government funded
establishment maintenance is through government funds, although private sector funds are often
welcomed and used as well.
The Bagamoyo district council is responsible for maintaining the Health Centre. Most
equipment, especially lab testing machines, is supplied by government.

HEALTH CENTRE ACTIVITIES

OUT-PATIENT DEPARTMENT
The average daily outpatient visits in Lugoba Health Center ranges from 50 to 100 patients. The
number could be much higher on busy days such as Mondays

This health center are provides health care services to Lugoba,Lunga, Mindu tulieni,Saleni,
Kinzagu and Makombe.
The top ten causes of regular outpatient visit include:-

1. Malaria
2. Urinary tract infections (UTI)
3. Acute Upper respiratory tract infections (AURTI)
4. HIV/AIDS
5. Diarrhea
6. STI/RTI
7. Minor surgeries
8. Skin infections

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 9. Eye infections
10. Ear infections

The health center receives referrals cases from various dispensaries that fall under or near the
Lugoba ward. These dispensaries are Lugoba secondary school dispensary,Tahima
dispensary,and Lugoba mission dispensary. Most patients use their own means of transport. The
most popular form is motorcycles, followed by bicycles

Common Cases of referral to this health center include:

 Severe malaria
 Severe anemia
 Obstetric and Gynecological conditions
 Injuries which requires minor surgery.

IN-PATIENT ACTIVITIES
The most common conditions necessitating in patient care include

1. Complicated Malaria
2. UTI
3. severe pneumonia
4. Diarrhea
5. HIV/AIDS.
6. Abortions
7. Pregnancy
8. Septicemia
9. Minor surgeries
10. Hypertension

ADMISSION, DISCHARGE AND REFERRAL

Admission – patients are admitted to the Health Centre from the OPD. Patients are only admitted
based on the severity of their disease.

Discharge– patients are discharged when they are fully treated and cured or if they have the
capability to return home and continue with allocated clinic attendance. Patients are also
discharged if the patient seeks to return home by autonomy. In the case of a sick patient who
requests discharge, a consent form is signed stating that the patient was discharged against the
doctor’s wishes. For critical patients who want discharge, the Health Centre may revoke the
patient’s autonomy to save life, but this must be done as per protocol by seeking permission from
higher administrations.

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Referral – patients are referred from the IPD and OPD, and are referred to Bagamoyo and
Tumbi hospitals. Reasons for referral include:

 The patient needs to be reviewed by a specialist

 For investigations not present in the Health Centre e.g. CT scans,MRI, US, X rays
 Inability of the Health Centre to treat the patient e.g. for major surgeries

Common conditions for referring patients from Lugoba Health center include:

 Severe anemia,
 Obstetric and Gynecological cases
 Severe injuries due to accidents
 Major surgeries

The referral procedure at LUGOBA is as follows:

1. Identify reason for referral, explain to a patient and prepare a referral note.

2. Communicate to the driver.

3. Communicate to where your patient is referred

4. Prepare patient for referral. E.g. Insert IV line, NGT tube, and catheter and stabilize the
patient.

REPRODUCTIVE AND CHILD HEALTH SERVICES

Records in RCH clinic are kept in registers named HMIS(MTUHA).

There are 6 MTUHA registries used in RCH clinic:

 MTUHA 2 and 10 – these are quarterly and year reports which include laboratory
reports, antenatal, postnatal, home visits, school visits.
 MTUHA 6 – antenatal (pregnant women)
 MTUHA 7 - Children Clinic
 MTUHA 8 – Family planning
 MTUHA 13 – postnatal (deliveries)
Information from the registries is transferred to a summary book and eventually HMIS data base.

VISIT TO THE CLINIC

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Common areas from which women come from to attend clinic include
Lunga,Kinzagu,Makombe,Saleni,mindu tulieni, and other areas neighboring Lugoba.

There is no specific gestation age for women to attend their first ANC clinic visit, but most of
them make four visits through their course of pregnancy.

During the first visit they are given maternal health education together with their partners on
necessary pregnancy services, danger signs during pregnancy and after delivery and pre
requisites prior to delivery. Counseling and testing of HIV/AIDS, Syphilis, and malaria. General
assessment of the pregnancy includes physical examination. In subsequent visits, they attended
with their RCH cards and are given services as required per visit such as provision of anti-
malarial prophylaxis, hematenics, anti-helminthes and TT shots.

REASONS FOR FAILURE TO ATTEND CLINIC

The reasons for failure to attend ANC clinic included preference to hospitals with better services,
long distance to the Health Centre, lack of transport to Health Centre, household duties which
interfere with clinic appointments and poor mother’s attitude regarding ANC clinics

IMMUNIZATION AND VACCINE STORAGE

The Health Centre has all recommended vaccines available according to the IVD guidelines.
These vaccines include BCG, Rota, Polio, Measles/Rubella, PCV13, PENTA and TT.

On interviewing and participation with a RCH staff we learnt when, where and how vaccine is
given and stored

Polio 2 drops orally (OPV0 at birth, OPV1 at 6 week, OPV2 at 10 week, and OPV3 at 14 week)

Rota 1.5ml orally (ROTA1 at 6week, ROTA2 at 10 week )

BCG 0.05ml on the right arm intradermal at birth and repeat at 3 month if no scare

Measles 0.5ml right arm at 9months and boost at 18 months

PCV 0.5ml right thigh intramuscular three doses

PENTA 0.5ml left thigh intramuscular three doses

TT 1.5ml intramuscular ( five doses; 1st contact, 2nd dose after 4 weeks, 3rd after 6 month, 4th
after 1yr, and lastly after 1 yr after 4th dose)

The vaccinations are stored in a cold environment i.e. fridges, at positive 2 – 8 degrees C.
Temperature is assessed and regulated daily to maintain the vaccination integrity. In the case of
power shortages, generators are used and also the vaccines are kept with ice packs immediately.

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Ideally there is no shortage of vaccines at the Health Centre and the DMO is in charge of
delivering them every three months. The challenges to this is the delay by many people in
attending the Health Centre for appropriate immunizations, mainly attributed to ignorance and
shortage of health staff compared to the number of clients who attend for immunization at HC

ANTENATAL ACTIVITIES
A. RCH Aids criteria used for identifying “at risk” mothers.
 History of 3 or more previous scars
 Primi gravidae mothers with twins
 Elderly primi gravidae (age more than 35 yr)
 Haemoglobin level below 8.5g/dl
 Multigravidae
 Height less than 150cm
 Pregnancy induced hypertension
 Bad obstetric history eg. recurrent fetal loss, rubella

B) Advices given to mothers about antenatal and postnatal care delivery.

1) Antenatal Care
Pregnant women are advised to return to the Health Centre immediately whenever
they experience the following symptoms.
 Vaginal bleeding
 Severe headache and blurred vision
 Loss of consciousness
 Difficulty in breathing
 Easy fatigability
 Fever
 Reduced fetal movement

2) Post Natal Care and Delivery

Post natal care is essential and all mothers are supposed to attend. During their visits
the following advices are given
 Advice on the type of baby clothes they are supposed to bring with them at
the time of delivery and equipment needed for delivery
 Umbilical cord care
 Hygiene of both mother and the baby
 Education on family planning
 The importance of immunization in children

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  Danger signs which indicate that the child is not well
 Education on breastfeeding practices

C) Delivery by traditional birth attendants.

During our interview with mothers we found out that few women who live far from the
Health Centre usually receive delivery services from traditional birth attendants this is due to
increased health education provided to mother and traditional birth attendant as well.

CLINIC ACTIVITIES
Child clinic mostly involves children between 1 month of age up to 2 years. This clinic provides
services such as Anthropometric measurements and immunization. Mothers carried their cards at
each visit to the clinic. Education on breastfeeding and immunization is given to mothers when
they attend clinic. *children are also given vitamin A and dewormed as per IVD.

TB/LEPROSY PROGRAM
During our interview with the TB/Leprosy focal person, Mr.Hussein Ramadhani, we were told
that the Health Centre is up to date with the 2013 edition of the National Tuberculosis and
Leprosy program manual guidelines.. Patients not only come from LUGOBA but also from other
areas such as lunga,kinzagu,makombe,saleni and mindu tulieni. Patients from other areas are
registered and then sent back to their own area and told to follow up at their local clinics for
treatment, with the Health Centre responsible for sending drugs there for those patients.

The Health Centre deals with both new and old TB cases and is also capable of treating
reinfections with a modified timeline of 6 months, where streptomycin is added for 2 months
along with the usual rifampicin, isoniazid, pyrazinamide and ethambutol for 6 months. The
Health Centre also treats children under 15 differently with a different regime. For the cases of
MRD, patients are referred to Kibong’oto. All the new cases of TB are checked for HIV status
and vice versa.

It was also found from the TB/Leprosy focal person that drugs used to be obtained from the
National TB/Leprosy program, but currently they are received from MSD.

According to the quarterly report of January 2015 – March 2015 concerning TB/Leprosy in
LUGOBA, there were 14 TB cases of which 5 were females and 9 were males and 8 cases of
leprosy of which 1 female and 7 males.

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Challenges faced by the Health Centre concerning this program are mainly three. The first being
ignorance of many people in seeking appropriate medical care. The second being occasional
shortage of drugs. The third being the lack of active TB finding programs to detect TB early
before patients present to the Health Centre with symptoms.

CHALLENGES FACED BY THE HEALTH CENTRE

During our stay at Lugoba health center and interview with some of health staffs we noted many
challenges facing health center the major ones being the following:

 Inadequate health staffs, according to Dr Swai the in charge of the health center there is
scarcity of about 22 health staffs. Furthermore the health centre has no some of the health
staffs like pharmacists and PEP personnel.
 Insufficient medical supplies such as drugs, laboratory reagents, gloves, examination
beds in OPD rooms and gauze.
 Extremely high number of patients in comparison to the available staff and equipment,
especially in RCH department and OPD.
 No constant water supplies in every department which leads to poor hand washing
practices as well as all other water dependant cleaning procedures.
 No ambulance leading to very poor referral system especially in emergency cases.
 Poor buildings infrastructure; no independent CTC building leading to utilization of OPD
room for CTC activities, small laboratory room which is overcrowded with laboratory
equipments,non equipped and not working theatre,small ward which accommodates only
four beds and no kitchen.
 Ignorance among the community members. Most patients only ever come in the late
stages or critical conditions. Others often seek discharge against doctor’s wishes.

DISCUSSION
As per the national health policy guidelines, the health center has no required number of health
staff to provide timely quality health services in comparison with large number of patients
attending this health facility, despite these challenges the Health Centre is still making an effort
to assist its patients. These efforts are mainly due to the hard work of the in charge and all the
staff members.

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Health services provided at the facility includes in patient department , outpatient department,
reproductive child health, also the facility provides the national control programs like national
TB and leprosy program, malaria program, family planning, HIV/AIDS program, neglected
tropical diseases control program and immunization and vaccine development program.

Most of patients attending this facility are user fee patients and few are using health insurance
schemes like CHF and NHIF leading to low contribution hence decreasing facility source of
income making the facility highly dependent to the government which normally brings medical
supplies after every three months. When the facility is out of stock there is no other source of
medical supplies.

The most common cases referred to the health centre from dispensaries include severe malaria,
diarrhea with dehydration, obstetrics complications, severe pneumonia and UTI. For more severe
cases the Health Centre is not well equipped and thus patients are referred to Bagamoyo and
Tumbi hospital. The blame for sub-par service lies on the Health Centre due to inadequate
resources but the community is also at fault as it has poor health seeking behavior which is not
timely.

During screening standard six pupils at Lugoba primary school about diarrhea, we found that
most of the children were not aware on diarrhea and had no enough knowledge on the meaning,
causes, mode of transmission, prevention and control of diarrhea. We provided health education
to the pupils on diarrhea and demonstrated hand washing technique to them.

CONCLUSION:

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Despite of Lugoba health centre providing good quality health services, it has been facing a lot
of challenges such as inadequate medical supplies, poor building infrastructure ,no ambulance,
no constant water supply and inadequate health staffs.

This experience has been a good foundation in preparing us to become better advocates of Health
Care and it has equipped us to familiarize with the situation in the different settings pertaining to
health services provision.

RECOMMENDATIONS
1. The number of health staffs should be increase to reach the required maximum number of
health staffs at the health centre as per nation health policy, so that to ensure provision of quality
health services to the community.

2.The government should also provide adequate funds where needed and should ensure adequate
drugs and medical equipment are available at the health centre all the time.

3. To establish home based care programs which will help encourage the community towards
better health care seeking behavior and early diagnosis of diseases. And should provide
education to fight against bad cultural beliefs which renders people to involved in improper
health seeking behavior.

4. The Health Centre should also organize more fund raisers from private sponsors to receive
more capital to invest in resources and services. Also should advocate people to join in health
insurance schemes.

5. Emergency obstetric care should be established at the health centre to decrease the cost of
referring patients to hospitals. Furthermore the ambulance should be brought so as to ensure
sustainable referral system in case of emergencies.

6. They should ensure constant water supply at the health centre e.g., build borehole

7. Improve building infrasture by building wards which can accommodate many patients, the
theatre building should be equipped to allow surgeries to be conducted as per protocol, they
should separate CTC building so that all services pertaining to CTC are done at the right time,
and reduce inconvenience to the patient attending CTC.

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REFFERENCES

1.MTUHA book 2015

2.TB/Leprosy register book.

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