AUDIT:Renovation Of Kawolo Hospital Raises Hopes Of Addressing Eminent Health Challenges

By PATRICK JARAMOGI

BUIKWE, Uganda|SHIFTMEDIA| Will the renovation of Kawolo General Hospital addresss eminent health challenges in Buikwe, Buvuma, Mukono and Kayunga? Perhaps so, as we report below.

Thanks to the refubishment of the 50-year-old health facility located in Lugazi Town Council in Buikwe District.

With support from the Spanish Government under the Spanish Aid/debt SWAP, the facility was revamped at the tune of US$11.8 (Ugx39b). Ministry of Health contracted Excel Construction Company Limited that undertook the civil works.

The rehabilitation work started in June 2017 and ended in April 2019.  It included the construction of a new OPD, (Out Patients Department), casuality Ward (emergency accident unit), main operating theatre, new antenatal block, maternity block, new drainage system, sewage works, renovation of water and electric systems, as well as the renovation of new office blocks for staff.

Excel Construction also did works on the security fence and the internal parking and roads within the hospital premises. Four new modern latrines were constructed, as well as two solar-powered boreholes with a 144,000 liter capacity reservoir.

The mortuary that handled mainly accident victims, (30 previously per-day) was also refurbished. It now handles lesser numbers, 5 per day due to the new units that have enabled a reduction in fatalities.

Findings

Kawolo Hospital was among the government hospitals that were in poor shape before the refurbishment that started in 2017. Before the revamping, the facility had spent over three years without clean water.

Its’ water bills had accumulated to over 17 million by 2015 prompting National Water and Sewerage Corporation to shut down the supply.

Though under the renovation, a water harvesting and water pumping mechanisms were put in place, the bills are yet to be cleared, according to Haruna Wamala the Hospital Administrator.

Background to these investigations

The findings on ground is a follow up to the CoST Uganda 4^th Assurance Report findings. (The report will be launched on February 10^th 2021)

The report focused on three projects under the Ministry of Health: The refurbishment and equipping of  Kawolo General Hospital in Buikwe, and that of Busolwe Hospital in Butalejja district.

Since 2017, CoST Uganda has been conducting Assurance process on selected public infrastructure projects to assess the level of Transparency of Public Infrastructure undertaken by Government Procuring Entities. Ministry of Health has previously participated in this study under the 3rd Assurance process held in 2019 where it emerged as the most transparent government Procuring Entity (PE).

 

Was there value for money?

Built-in 1968, Kawolo General Hospital that serves over 2 million residents from Buikwe, Mukono, Buvuma, and Kayunga districts was the center point for most accident victims along the Kampala, Jinja highway. John Mwebe, a resident of Lugazi revealed that the renovation has helped reduce on deaths.

“The theatres were non-functional, the accident cases were many yet the emergency units were not fit to handle such cases. Today the place is different, and many accident cases are treated from there without necessarily referring them to Mulago,” said Mwebe.

Julius Sentongo, another  resident of Najja sub-county in Buikwe says the facility used to have issues of theft due to lack of a perimeter fence. “Even during the construction works, army had to be deployed to curb on thefts of construction materials. Now, with the new wall in place, thefts have been managed,” said Sentongo.

The assertions by Sentongo are clear indicators that Ugandans are getting empowered to demand for transparency and accountability in the public infrastructures.

 

Accident Emergency Ward

Kawolo Hospital was a hub for accident victims. According to Haruna Wamala, the Hospital Administrator, the numbers used to be 30+, but this has reduced to 5 per day.

The renovations paved way for a new modern accident emergency unit (above), fully equipped with three modern theaters. It also has a modern mortuary, a trauma center and new Out-Patients Department that according to Wamala has led to an increase in the number of Out patients. The general sanitation has also greatly improved following the construction of placenta and medical waste pits, as well as the construction of an incinerator.

 

 Issues at Hand

Though Dr Diana Atwine, the permanent secretary in the ministry of Health, said the newly built theaters that were created to handle accident emergencies would be equipped with a modern ICU together with computerised tomography (CT) scan, this is not what we found on ground.

What has emerged is that the maintenance costs have shot up despite the renovations. “We can still not handle critical accident emergency cases that need CT scan because we don’t have the equipment,” said Wamala. He said the hospital had notified the Ministry of Health, but no response was forthcoming.

The other aspect is the oxygen in the Intensive Care Unit. Though under the project outline this was to be worked upon, the hospital still uses oxygen cylinders, some which are very old for use.

“The ICU was supposed to be equipped with a modern oxygen line to support those being operated in the theaters. This is not the case,” explained Wamala.

We unearthed that Kawolo gets 14 oxygen cylinders weekly from Roofings in Namanve. Wamala noted that even the 14 cylinders they get weekly isn’t enough given the high number of COVID 19 patients who need oxygen. Roofings opted to provide free oxygen to all hospital after COVID 19 struck, but given the high demand, they limit what is given.

“When we get emergency cases that need CT Scans that we can’t handle, we refer to Kawempe or Kiruddu, “ said Wamala.

But, on a rather positive note, the maternal deaths have drastically reduced, thanks to the new facility. In 2019, Kawolo hospital registered zero deaths due to maternal health.

This according to the hospital administrator was due to the new wards coupled with the coming of a resident surgeon and a gynaecologist.

“We are still understaffed. We have 154 staff out of the needed 190. We mainly need a visiting physician,” he said.

Other issues arising

Despite the construction of two solar powered boreholes, we found out that water wasn’t being pumped into the 144,000 liter tank, reason, the ground is dry.

The drainage system is also already in bad shape due to blockages. The old drainage system that the dilapidated staff houses has wasn’t worked upon.

Though the staff were motivated with a new staff block, they remain unhappy due to the state of housing units where they live.

Worry of power

The hospital was equipped with an 800KVa transformer and a standby generator. The administration, however,

said Umeme, the power distributors had declined to service the transformer due to its capacity.

 

“They (Umeme) can only service 500KVa transformers. Apparently, the contractors didn’t consult Umeme when installing this 800Kva transformer. To us this is a disservice because we shall have to undergo costs to maintain it,” said Haruna Wamala.

Umeme we observed has promised and continues to service the old 500Kva transformer.

Isolation ward

The hospital had the construction of an isolation ward, but the ward isn’t in use due to poor ventilation. “We can’t even accommodate our Covid 19 patients in there due to poor ventilation. We can perhaps put there Marburg patients,” said Wamala.

He said a separate room with proper ventilation had been created to cater for Covid 19 patients.

The Ministry of Health we noted increased the budget of  PHC to Kawolo from Ugx260 million to Ugx400m, but the administration says most of this is now channelled into maintenance costs.

“For instance, since we don’t have water pumped from the ground, we now resorted to National Water again. We pay all our new bills as they come, as we also clear the old accumulated bills,” he said.

Ambulance lacking

The other challenge we observed was that the ambulance that was purchased under the refurbishment project was written off after it had an accident. The ambulance had an accident as it returned to Kawolo after referring a patient to Mulago.

The facility now has its old ambulance that can’t manage quick emergency cases. They now use the Uganda Police ambulance stationed in Lugazi Town Council, but who always “cry” for lack of fuel.

“The police Ambulance is only used for accident victims, so if we have a pregnant mother in Buvuma, or far away we can’t rely on the police ambulance, said Wamala.

This story was published with support from CoST Uganda Chapter Infrastructure Transparency Project