Professional Documents
Culture Documents
Regional Referral Hospital
Having started in 1927 as a treatment centre for World War I veterans, Masaka Regional Referral
Hospital was elevated to regional referral status in 1996. Mugisha Ereazer, the principal Hospital
Administrator says the hospital has a 330 bed capacity with an annual admission of 23,456 patients
giving a bed occupancy rate of 90.6%. With the completion of a new mega hospital facility, the bed
capacity is expected to increase to about 540 beds.
The hospital’s catchment is spread across eight districts – Masaka, Rakai, Lyantonde, Lwengo,
Ssembabule, Bukomamnsimbi, Kalungu and Kalagala, taking care of over two million people. The
infrastructural capacity of Masaka regional referral hospital has been limited too.
Masaka Regional Referral hospital offers all services expected of a regional referral health facility
but also offers nutritional support for both children and adults. It also handles complicated
paediatric and gynaecological cases including carrying out fistula repairs. It has also teamed up with
MIFUMI – a national NGO project – to offer support to victims of genderbased violence from
Burundi, Rwanda, the DR Congo and Tanzania.
Being along the busy Mombasa Kampala Mbarara Kigali Highway makes it the first point of
call for patients mainly accident victims from Burundi, Rwanda, the DR Congo and Tanzania.
Consequently , the hospital's average daily contact with patients is about 2,000.
At Masaka Hospital, the patients are very excited about how they are treated and now refer to the
hospital as ‘Mulago’. The staff members are overstretched especially in the maternity ward. Up to
40 babies can be born in one night with 3 midwives on duty. Of the 40 babies born, 5 may be by
caesarean. Patient feeding is one of the services highly appreciated by the patients. One of the
patients said:
“I was taken to Mulago hospital in Kampala and for two days there was no one attending to me. My
sisters removed me and we came to Masaka hospital. As soon as I arrived, they took me to theatre
and when I woke up I was in the ward. I have been here for three weeks being fed by the hospital
and am very happy. I even feel much better now. I will never, never recommend any one to go to
Mulago in Kampala. I stay in Kampala and I will always come to Masaka hospital”.
This patient, according to the doctors, had an abdominal pregnancy and needed immediate attention
they did.
Consequently, the hospital’s average daily contact with patients is about 2,000. But Mugisha says
the hospital’s staffing levels are still too low. According to the Ministry of Health’s 1996 staffing
norms for regional referral facilities, Masaka Hospital is supposed to have 303 medical personnel
yet it has about 260 – short by more than 40. However, the hospital has benefited from a recent
wave of funding from the government that has facilitated a number of developments at the hospital.
A number of facilities have been revamped. In the 2012/13 financial year, the hospital finalized the
design of its 30year Master Plan, which will help guide infrastructural development at the hospital.
Support from donors such as USAID, JICA, Uganda Cares, TASO and UVRI has also been
instrumental. Through JICA for instance, the hospital has acquired a new OPD unit, complete with
modern theaters, fully equipped with the latest medical equipment.
Additionally, the hospital has an electronicmedical records data base. Besides capturing the
medical personnel’s vital data of the hospital, it is now able to register every birth and death that
occurs at the facility.
Dr Florence Tugumisirize the hospital director says they have adopted the Rx Solutions for stores
management system which is able to monitor drug stock puts electronically in all wards around the
hospital. “Paperbased records will soon be completely phased out at the hospital”, she says.
The hospital recently benefited from a donation of solar heaters by the Energy Ministry and
management intends to procure more solar equipment for lighting so that it can reduce on electricity
bills.
In the 2013/14 financial year, they embarked on building a new maternity and children complex – a
four level structure to accommodate both mothers and children. Additionally, the hospital recently
completed construction of a 54unit housing complex and these are now fully occupied.
Dr. Tugumisirize says negotiations are also underway with the University of Labore in Pakistan to
start an imaging centre to provide CtScan, MRI, Ultrasound, among other services.
Insert pictures of the records Store, Inside the hospital threater, OPD Deptmt & Accident Unit built
with support from JICA, Staff accommodation
Masaka Hospital's New Complex Building
Currently, Masaka hospital lacks a mortuary and uses one shared among the hospital, the police and
the municipality. This has gotten the hospital into wrangles with especially the municipality when it
comes to maintenance and equipping it. The mortuary officially belongs to the municipality and
most often they dump dead bodies in it for days resulting into emission of foul smell that affects the
hospital. Ironically, the mortuary attendant is employed by the hospital. The mortuary is also
located a stone throw away from the mental health unit facility which often times force the mental
health patients to escape from their unit. A hospitalbased mortuary for Masaka Hospital is all that
is desired.
The mortuary that is being shared by Masaka Regional Referral Hospital, Masaka Municipality
and the Police who bring especially accident victims
Staff Accommodation
Masaka regional referral hospital is not any different from the other regional referral hos pitals
when it comes to staff accommodation concerns. Only 86 out of 296 staff members are
accommodated in the hospital’s poor structures as seen in the pictures below. Twelve of the
accommodated staff members live in unipots. The rest of the staff members are in dilapidated
singleroom houses. The bigger number of the staff (229) rent houses in places far off from the
hospital (up to 7km distance) due to high cost of house rent in the town.
Owing to these circumstances, the hospital has embarked on an ambitious staff housing project to
put up 45 housing units for staff. It is hoped that once this is completed it will be a good start
towards solving accommodation problems for staff.
The members of staff are optimistic about the new project and only hope that the hospital
administration will complete the project soon to ensure some decent accommodation for them.
According to one nurse “once I have a good house, I do not mind about salary increase because
right now am spending a lot on rent and transport every day. It is too much to bear.”
A proposed 45Units staff estate for Masaka regional referral hospital.
Source: Report of the hospital to Parliament of Uganda
Channel of communication in the hospital
Masaka Hospital is not very different from other referral hospitals. It too has unit committees and
committee heads report to the Hospital management. The Hospital administration also has a good
relationship with the District leaders who often communicate to them on any issue of interest. They
work very closely with the media especially the radio stations in the areas. Outside every Hospital
unit, one easily notices telephone numbers of the Hospital Director and Administrator for anyone
who has an issue to call and get attended to. Suggestion boxes are also easily noticed outside every
unit.
Access to Essential Medicine
Masaka regional referral hospital is well stocked and never waits for stocks to run out.
They follow NMS quarterly delivery schedules promptly, and when releasing drugs from the store,
they follow the “first expiry, first out” and if expiry dates are the same, they use the “first in, first
out” system. The Hospital management is very particular when receiving drugs from NMS. They
tend to send back what has been sent to them when not request for. Drugs are ordered electronically
but the Hospital Director calls to make follow up after a request form has been electronically sent.
The drug store at Masaka is wellbuilt and spacious.
Health Financing
The inadequacy in health resources has made referral hospitals become creative by seeking health
partners to assist them fund some unmet needs. This has enabled them to channel government
allocations to necessary activities and services that cannot be funded by the health partners. For
example Masaka hospital has partnered with many health providers to manage areas like eye
defects, HIV/AIDS, support for safe motherhood, infrastructure and equipment, mwana mugumu
malnutrition, open record electronic monitoring and training among other areas. As a result, Masaka
hospital has been able to offer so much with so little to the extent that it is equated by the
communities to Mulago National referral hospital because of the readiness of the hospital
administrators and staff to provide services amidst the challenges of limited government funding.
Furthermore, in Masaka, patient services take more share of the money for utilities. The Hospital
has three generators serving the administration, maternity, accident and emergency wards. Five
million of the hospital budget is spent on feeding patients monthly; drugs take 1.2 billion. Patient
care takes 60 million annually. Part of the 2010/2011 budget was also spent on the staff hostel
which is being cofunded by JICA.
The hospital budget also caters for activities such as Admissions, Feeding inpatients, carrying out
surgical and medical procedures, conducting ANC sessions and deliveries, health education
sessions, immunization sessions, post mortem and Histopathological examinations of biopsies,
ultrasound and xray examinations, taking and examining patient samples in the laboratory,
referring and transporting referred patients, formulation of orthopaedic appliances, record keeping,
data management and utilization, meetings, sensitization seminars including CPDs, advertising,
procurement and payment for goods and services, payroll management, payment of staff
allowances, maintenance of hospital assets and ensuring a clean conducive work environment.
Health Partners
Masaka regional referral hospital partners with Uganda Virus Research Institute (UVRI) in the
HIV/AIDS area, Infectious Disease Control Institute, Protecting Families against AIDS
(this partnership is through the district), Uganda Cares (they provide manpower and the
hospital provides drugs), SUSTAIN (training, laboratory and link to JCRC), ENGER (support safe
motherhood), JICA (infrastructure and equipment), Uganda Society for Disabled
Children (USDC). The Hospital also partners with UNICEF (Mwana mugimumalnutrition),
Helping babies to breath, WHO (Open recordselectronic monitoring), RX SURE and Douglas
College (Training).
The Hospital Director was full of praises for the partners saying without them Masaka regional
referral hospital would not have progressed to the level they are at now.
Hospital Infrastructure
Accessibility to health services by all people is a cardinal principle and key determinant of the
enjoyment of the right to health. Persons with disabilities are among the most vulnerable groups of
people and prune to exclusion.
Masaka regional referral hospital has included toilets for PWDs in their new facility. There are
ramps available for the wheel chairs and rolling chairs and beds are also available for PWDs.
Communication by sign language for the deaf and dumb is available.
Staff welfare and motivation
The health sector like the military is hugely dependent on highly trained and skilled workforce.
However, a critical assessment of the human resources for health in regional hospitals reveals
shortages in both numbers and specialist skills.
The hospital is in need of specialized doctors and nurses. Unlike the other hospitals, Masaka
regional referral hospital has a large number of staff members who have not been confirmed in
service for more than a year, contrary to the medical staff recruitment manual and the health service
commission terms
Despite the short fall in staff numbers, the management in Masaka regional referral hospital ensures
that health workers have breakfast served in their work stations. This has made staffs work tirelessly
until they are replaced by others who come later. At the end of each year, the staffs are treated to an
inhouse party where those found to have excelled in their work are rewarded publicly. Each year
therefore the health workers strive to work even harder in order to be among those to be recognized
for excellent work.
Probes for CT Scan