ST JOSEPH COLLEGE OF HEALTH AND ALLIED

SCINCE, BOKO CAMPUS

DEPARTMENT OF COMMUNITY MEDICINE(MC400)

MSOGA DISTRICT HOSPITAL AND DMO WEEK REPORT

i
GROUP MEMBERS

REGISTRATION
SN NAME
NUMBER
1 17671151110 RACHEL MALILA
2 17671151111 REHEMA JUMANNE
3 17671151113 RIDHIWANI USSI
4 17671151114 SALIM KHAMIS SALIM
5 17671151116 SALOME MWALONGO
6 17671151119 SOMOE FAROUK
7 17671151120 SOPHIA MIGIRO
8 17671151121 STELLA SHIRIMA
9 16671151125 SHIMAYO NYAMUBI
10 17671151126 TIMOTH JACKSON
11 17671151127 TRIZA TOWO
12 17671151128 TUMAINI SHAO
13 17671151130 VICTORINE BRUNO
14 17671151134 WINNIE MDACHI
15 17671151136 YVONNE WICHOKA
16 17671151094 MONICA G.MALLOMO
17 17671151138 GERALD MASHIKU
18 17671151139 KAHUNGO MKUMBWA
19 17671151141 DOMINICK RUGAMBWA
20 17671151142 BOAZ MINGA
21 17671151143 YUSUPH KIPUTA
22 17671151144 IBRAHIM KICHUNGO
23 17671151145 PRINCE JEGO
24 17671151146 HAMIS ISONDA
25 17671151147 ALFRED PIUS
26 17671151148 MUSSA BOGWA
27 17671151149 RAPHAEL LWESYA
28 17671151150 DESDELY KATO ILUNGA
29 17671151151 KASSIMU LASENGA
30 17671151154 MOHAMED SHARIF
31 17671151156 VICENT KIBONA
32 17671151157 NDILABIKA NDILABIKA
33 17671151158 MICHAEL MASSAWE

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34 17671151159 NEMES NEMES
35 17671151160 RASHID S HUMOUD
36 15671151255 KELVIN AWANGISYE
37 15671151003 ABDALLA H. KOMBO
38 15671151101 EDWIN MAGADULA THOBIAS
39 15671151194 HILALI RENATUS
40 15671151196 HOSEA MUSSA
41 15671151238 MSIGWA JOSEPHAT
42 15671151281 LUNYUMGU MAGNUS
43 15671151290 NASSOR MARIAM
44 15671151307 ABDALLAH MUGISHA
45 15671151440 TUROLEY YUSUPH
46 15671151448 HILDA A MESULI
47 16671151021 CHARLES JOACHIM MAGANGA
48 16671151023 CHRISOSTOM DOUGLAS SAKIBU
49 16671151024 CHRISTOPHER ANDREW MBENA
50 16671151081 KIVARERI MHANDO MSUYA
51 16671151084 LUCAS ALFRED
52 16671151095 MWAJABU AHAMED KAWAMBWA
53 16671151097 NYANDA KISENHA MWELELE
54 16671151118 SALUMU RAMADHANI
55 16671151119 SAMIATH K SWALEH
56 16671151146 NYENZA EMANUEL
57 16671151151 ANDREW AMAN MAGOMBA

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ACKNOWLEDGEMENT
We all thank almighty GOD for his protection and guidance during our stay at Chalinze district
council. We also extend our sincere gratitude to the Department of Community Health at SJCHS
in a special way to Dr Dominic Tibyampasha, the head of department, Dr Avelino Bangi and all
the members of department for moral and material support which enabled us to accomplish our
field work throughout our community health rotation.

We thank the District Medical Officer (DMO) and his office for having us in his district for the
and ensure that our objective in DMO week were achieved in whole time of our stay at Chalinze
district council

We would also like to thank the Hospital Management Team of Msoga district hospital, the
secretary of Msoga district hospital, Erick Rugemalila and his office and all members of staff for
their cooperation and assistance throughout our stay in their hospital.

We would like also to extend our profound gratitude to all coordinators of different national
programs at Msoga district, in charges of each department and all health workers at Msoga district
hospital.

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TABLE OF CONTENTS

Contents
ACKNOWLEDGEMENT..............................................................................................................................v
LIST OF TABLES:......................................................................................................................................viii
LIST OF FIGURES:......................................................................................................................................ix
LIST OF ABBREVIATION..........................................................................................................................ix
ABSTRACT...................................................................................................................................................x
1:INTRODUCTION.......................................................................................................................................1
2: OBJECTIVES............................................................................................................................................1
4: METHODOLOGY.....................................................................................................................................2
5:GENERAL DESCRIPTION OF THE CHALINZE DISTRICT..................................................................2
5.1 LOCATION.........................................................................................................................................3
5.2 ADMINISTRATIVE SETTING...........................................................................................................3
5.3 AREA AND POPULATION SIZE:.....................................................................................................3
5.4 SERVICES PROVIDED BY THE CHALINZE DISTRICT COUNCIL:...........................................4
5.4.1 WASTE MANAGEMENT................................................................................................................5
5.4.3 WASTE TRANSPORTATION.........................................................................................................7
5.4.4 SAFE AND WATER SERVICES.....................................................................................................9
5.4.5 ROAD NETWORK...........................................................................................................................9
5.4.6 SAFE AND WATER SERVICES...................................................................................................10
5.4.6 EMPLOYMENT AND ECONOMIC ACTIVITIES.......................................................................11
5.4.7 EDUCATIONAL SERVICES.........................................................................................................11
6:DESCRIPTION OF THE HOSPITAL......................................................................................................12
6.1 MSOGA DISTRICT HOSPITAL...........................................................................................................12
6.2 HEALTH STATUS OF MSOGA DISTRICT HOSPITAL....................................................................12
6.2.1 ATTENDANCE AT THE FACILITY............................................................................................12
6.2.2 RANKING OF DISEASES AT MSOGA DISTRICT HOPITAL...................................................13
7: DESCRIPTION OF ORGANIZATION OF HEALTH SERVICES AT CHALINZE DISTRICT
COUNCIL....................................................................................................................................................17
7.1 FUNCTIONS OF THE HOSPITAL MANAGEMENT TEAM:............................................................17
8 FUNCTIONS OF A DMO/ CHMT...........................................................................................................18
9 DISTRICT HEALTH SERVICES STRUCTURE , NUMBER, TYPE AND OWNERSHIP OF HEALTH
FACILITIES , WITH THE EXISTING NUMBER AND STAFF CADRES...............................................24

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9.1 DISTRICT HEALTH SERVICE STRUCTURE,...................................................................................24
9.2 NUMBER, TYPE AND OWNERSHIP OF HEALTH FACILITIES.....................................................25
9.3 ORGANIZATION OF HEALTH SERVICES.......................................................................................26
9.4 HEALTH STAFF CARE IN CHALINZE..............................................................................................28
10 THE EXISTING VERTICAL AND INTEGRATED HEALTH PROGRAMS, THEIR REPORTED
SUCCESS AND CHALLENGES IN THE DISTRICT................................................................................30
10.1 REPRODUCTIVE, MATERNAL, NEONATAL AND CHILD HEALTH (RMNCH).......................30
10.1.1 AT THE ANTENATAL CLINIC..................................................................................................31
10.1.2 IN THE LABOUR WARD............................................................................................................33
10.1.3 POST-NATAL SERVICES...........................................................................................................34
10.1.4 CHILD NUTRITION....................................................................................................................35
10.2 IMMUNIZATION AND VACCINATION DEVELOPMENT PROGRAM (IVD).............................35
10.2.1 THE CARES INVOLVED IN IMMUNIZATION AND VACCINE DEVELOPMENT..............35
10.2.2 FINANCING OF IVD...................................................................................................................37
10.2.3 FORECASTING PROCUREMENT AND DISTRIBUTION OF VACCINES.............................37
10.2.4 STORAGE OF VACCINES..........................................................................................................37
10.2.5 CHALLENGES OF IMMUNIZATION........................................................................................39
10.3 NATIONAL MALARIA CONTROL PROGRAM..............................................................................39
10.4 NATIONAL AIDS CONTROL PROGRAM.......................................................................................40
10.4.1 HTC (HIV TESTING AND COUNSELING)...............................................................................41
10.4.2 CTC (HIV CARE AND TREATMENT CLINIC).........................................................................41
10.4.3 PMTCT;........................................................................................................................................42
10.5 NATIONAL TUBERCULOSIS AND LEPROSY PROGRAM...........................................................44
11 PROBLEM HINDERING THE PROVISION OF HEALTH SERVICES IN THE DISTRICT..............46
12 DISTRICT HOSPITAL WEEKS............................................................................................................48
13 DISCUSSION.........................................................................................................................................55
14 RECOMENDATION..............................................................................................................................57
15 CONCLUSIONS.....................................................................................................................................58
16 REFERENCES........................................................................................................................................59

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LIST OF TABLES:

Table 1:Showing Total population by wards.....................................................................................4

Table 2:The waste generation in all wards of the Municipality is shown below...............................5
Table 3:source of waste......................................................................................................................6
Table 4 :table showing waste collection.............................................................................................7
Table 5:Top ten diseases at Sinza district hospital among patients below five years in OPD........13
Table 6:The top ten diseases from OPD for clients above five Sinza district hospital February 2021
..........................................................................................................................................................14
Table 7: The top ten diseases from IPD for obstetrics and gynecology (OBGY) at Sinza district
hospital February 2021.....................................................................................................................15
Table 8: The top ten diseases from OPD for patients above five years old at Sinza district hospital
in February 2021..............................................................................................................................16
Table 9:nmber,type and ownership of health facilities....................................................................25
Table 10: cadres involved in Ubungo district hospital.....................................................................28
Table 11:Cadres involved in immunization.....................................................................................36
Table 12: routine immunization chart..............................................................................................38
Table 13:timetable to visit at Sinza district hospital and to a DMO office......................................48
Table 14:table showing activities conducted at the DMOs week....................................................52

LIST OF FIGURES:
Figure 1:map of Ubungo district........................................................................................................2
Figure 2 :Solid waste Transportation from the Municipal Market to the Dumping site....................9
Figure 3 :80 m3 and 9m overhead tank and pump house constructed at Mpiji Magohe water
scheme..............................................................................................................................................10
Figure 4: Top ten diseases at Sinza district hospital among patients below five years in OPD......13
Figure 5:Bar graph showing top ten diseases from OPD for clients above five Sinza district
hospital February 2021.....................................................................................................................14
Figure 6: The top ten diseases from IPD for obstetrics and gynecology (OBGY) at Sinza district
hospital February 2021.....................................................................................................................15
Figure 7: Bar graph showing top ten diseases from OPD for patients above five years old at Sinza
district hospital in February 2021.....................................................................................................16
Figure 8:DUTIES OF A DISTRICT MEDICAL OFFICER............................................................23
Figure 9:DISTRICT HEALTH SERVICE STRUCTURE..............................................................24
Figure 10: UBUNGO DISTRICT HOSPITAL ORGANOGRAM..................................................27

vii
LIST OF ABBREVIATION

AIDS/HIV Acquired immunodeficiency syndrome/Human immune virus

AMO Assistant medical officer
CO Clinical officer
DMO District medical officer
SJCHS St. Joseph college of health science
HC Health centre
MCH Maternal and child health
MD Medical doctor
UTI Urinary tract infection
THPS Tanzania Health Promotion Support.
ICAP International Centre for AIDS care and Treatment Programs.
PSI Population Services International.
IMCI Integrated Management of childhood Illness.
CHMT Community health management team.
FEFO First Expiry First Out
MSD Medical Store Department
OBGY obstetrics and gynecology
URTI Upper respiratory tract infection
UTI Urinary tract infection
CDM Chronic diabetes mellitus
STI Sexual transmitted infection
RCH Reproductive and child health

viii
ABSTRACT
INTRODUCTION: District is a type of administrative division that is managed by the local
government, with an average population of 100,000 to 500,000. District Hospital is the third level
of health care delivery system after the health center. CHALINZE DISTRICT HOSPITAL
consists of different departments such as OPD, IPD, pharmacy, laboratory, and RCH clinic,
radiation, care and treatment clinics ( CTC), maternity ward, mortuary and labor ward. The in-
charge of MSOGA DISTRICT HOSPITAL is the Medical Officer.

METHODOLOGY: Methods used to obtain information and various data from the MSOGA
DISTRICT HOSPITAL was through observation of how health services are provided; interview
with medical personnel and with few patients; reviewing of documents and records that were
available at the district hospital and participation during different health activities.

RESULTS: In Msoga district hospital, supervision of health services provision and preparation of
hospital plan is under MOI in collaboration with appointed in charge of each unit and MATRON is
full responsible to maintain and improve delivery of services. The disciplinary health committee,
QIT, HMT and health facility governing committee are also present at Msoga district hospital. The
supervision at the hospital is done mostly by CHMT and RHMT quarterly. Procurement of drugs
and medical supplies is done quarterly on the basis of the national essential drug list. Drugs were
properly stored and dispensing services were good, although the hospital faced challenges like few
numbers of staffs as there are only 56 staff members whereby the minimum number is 200. There
is a suggestion box at the hospital so as to increase effectiveness of the services that are provided
by the hospital. Advices and complains from clients or health practitioners are put in the box and it
is handled by a special team also the hospital is not fenced this hinder the security at the hospital
also delaying of money for central government is a challenge that hinder in provision of service.
Health promotion to the people is done in the hospital by implementing National Health
Interventional Programs like Malaria, TB and LEPROSY, HIV/AIDS, PMTCT, and RMNCH.
Despite challenges the facility faces, it has managed to budget available funds to provide essential
services for its level. Again, the health sector must increase budget to the district level as they

ix
provide service to many people than their capacity. Were budget in year 2022/2023 was 1.4 billion
and has to increase to approximate 3 billion in year 2023/2024

CONCLUSION: Msoga district hospital plays a great role in providing health services to the
members of the community at the district level. The leadership and organization structure of the
hospital is well organized and ensures hard work among staff members to reach all clients with
quality health services. The DMO week has enabled us to integrate the theoretical knowledge with
the practical experience in the community into skills which will enable us as a future DMOs to
perform our duties in health care service

x
1:INTRODUCTION
At district level, the health system comprises of community health services, dispensaries, health
centers and district hospital. District hospital is the center of provision of health services at the
district level and acts as referral center for patients from lower level health facilities of the district
which are dispensaries and health centers and refers patients to the regional hospital. District
hospital should be in position to provide all basic specialty services and aim at super specialty
services. It needs also to be ready for epidemics and disasters management all the times. Also, it
offers teaching and training of middle and operational health cares and research programs in the
district. Also offers supportive supervision and inspection and provides technical skills to lower
health facilities of the district.
In Tanzania, primary curative and preventive services are provided by dispensaries and health
centers. The referral point for these primary health facilities are the district hospitals. The primary
facilities including the district hospital are under the responsibility of District Medical Officer who
in turn reports to the Executive Director of the local council. This has resulted in decentralization
of health services. The DMO plans, coordinates and implements local health services delivery with
the support of the council health management team (CHMT). The DMO and the CHMT prepare
the Comprehensive Council Health Plan (CCHP) that guides the provision of health services.

2: OBJECTIVES
 Describe the district health profile (Including population, Geography, Physical features and
weather condition, Administrative structure, transport and communication network.
 Describe job description of DMO.
 Describe district health service structure, number, type and ownership of health facilities
also the existing number and staff cadres.
 Identify the existing vertical and integrated health programs, their reported success and
challenges in the district.
 Identify one problem hindering provision of health service in the district and use problem
solving approach to suggest possible solutions to it.

1
4: METHODOLOGY
The data was obtained by interview, observing, deliveries, gaining experience on how the district
medical officer works as a unit which includes management, counseling, recording, organization
of documents and planning and review documents and available data. Also, data were collected
through interview with members of CHMT.

5:GENERAL DESCRIPTION OF THE CHALINZE DISTRICT COUNCIL

Chalinze district council is one of nine administrative districts in Pwani region in Tanzania the
district covers an area of 8042 Km2, it was created from bagamoyo district in July 2016. The
district has been inhabited by humans for thousands of years by Bantu peoples. The area is the
ancestral home to three bantu people groups, namely the kwere, Doe people and the zigua. The
zaramo are native to the southern portion of the district. the district is bordered to the northeast by
pangani district, the north by Handeni District and in kilindi district of Tanga region. The district is
bordered to east by the Indian ocean. Chalinze is also borders Bagamoyo district, Kibaha urban
district and southern by Kibaha district. On western part, the district is bordered by Mvumero
District and Morogoro rural district of Morogoro region.
Chalinze climate falls under subtype “Aw” of the Koppen Climate classification (Climate of a
tropical savanna) Chalinze’s yearly average temperature is 78.4℉ ( 28.5℃) in health facilities
Chalinze has 46 health facilities in the following distribution has 26 government dispensaries
where 10 dispensaries are private, 9 health center and 1 district hospital. As shown in table below

Level of health Government Private ownership Total health

facilities ownership
Dispensary 26 10 36
Health center 9 0 9
District hospital 1 0 1
Total 36 10 46
Figure 1: table showing distribution of health facilities

2
Figure 1:map of chalinze district council

5.1 LOCATION
the district is bordered to the northeast by pangani district, the north by Handeni District and in
kilindi district of Tanga region. The district is bordered to east by the Indian ocean. Chalinze is
also borders Bagamoyo district, Kibaha urban district and southern by Kibaha district. On western
part, the district is bordered by Mvumero District and Morogoro rural district of Morogoro region.

5.2 ADMINISTRATIVE SETTING

Chalinze district council has 74 villages, 15 wards and 469 sub wards. The district has one
electoral constituent namely Chalinze. The district governing body is the Full Council which

3
comprises 15 Councilors who are elected Ward representatives, 1 Members of Parliament elected
constituencies representatives (MPs), while Members of Parliament (MPs) (women special seats)
and Presidential Appointees are not yet distributed

5.3 AREA AND POPULATION SIZE:

Chalinze district council has a total area of 8042 Km 2. According to the 2022 population Census,
the district had a population of 214,080 where male was 105,595 and female was 108,485. The
council has 120 primary schools, 30 secondary schools, 36 dispensaries, 9 health center, 1 district
hospital,

POPULATION DISTRIBUTION IN CHALINZE DISTRICT COUNCIL

4
No WARD MAL FEMA TOT AVAREG SEX
E LE AL E RATI
HOUSEH O
OLD

1 kiwangwa 7403 7183 1458 4.4 103

6

2 Miono 8,301 8,708 17,00 4.8 95

9

3 Mkange 5,981 6,045 12,02 4.5 99

5.4 SERVICES
6
PROVIDED BY THE
4 Kibindu 7,098 6,575 13,67 4.9 108 UBUNGO MUNICIPAL
3 COUNCIL:

5 Kimange 4,174 4,359 8,533 4.7 96

The Ubungo Municipal
6 Lugoba 5,624 5,799 11,42 4.1 97 Council provides the
3 following services: Council

7 Mandera 4,676 4,689 9,365 4.3 100 affairs, health, solid waste
management, infrastructure
8 Mbwewe 7,029 7,480 14,50 4.4 94
including roads, natural
9
resources, trade and
9 Msata 6,844 6,896 13,74 4.5 99 informal sector
0 development, urban
development, legal issues,
10 Msoga 4,961 5,183 10,14 4.4 96
education and culture;
4
agriculture and livestock,
11 Pera 6,164 6,537 12,70 4.8 94 water, cooperative
1 development, community
development, and
12 Talawand 4,710 4,519 9,229 4.7 104
information and
a
communication technolog
13 Ubenazo 7,644 7,699 15,34 4.3 99
mozi 3

14 Vigwaza 8,176 8,474 16,65 4.2 96

0

15 Bwilingu 16,81 18,339 35,14 4.25 92

0 9

TOT   1055 10848 2140 4.48 98.133

5.4.1 WASTE MANAGEMENT
The Municipal Council plays an important role in the financing, planning and providing waste
collection and disposal services. Currently the transportation of solid waste is done by both the
Municipal council and the private sectors. The source of waste includes Household waste,
Commercial waste, Institutional waste, Market waste, Street’s waste and Informal sector waste

Ubungo Municipality is estimated to generate about 827.4 tons of waste per day, (which gives
302,001 tons per year) according to the current generation projections based on the other informal
sectors comprise this amount.

Table 1:The waste generation in all wards of the Municipality is shown below

WASTE JICA 1997 ERC 2004

COMPOSITION. TYPE % %
OF WASTE
KITCHEN WASTE 45 39
TEXTILE 17 6
GRASS AND WOOD 24 10
METAL 2 5
CERAMIC AND STONE 1 5
PAPER 4 8
PLASTIC 2 16
LEATHER AND 1 6
RUBBER
GRASS 3 2
OTHER 1 3
WASTE GENERATION. Source of Waste 2016/17 Tons/day
TOTAL 100 100
No
1. Household waste 661
2. Commercial waste 12.4
3. Institutional waste 4.9
4. Market waste 16.5
5. Street’s waste 0.74
6
6. Informal sector waste 131.6
TOTAL 827.4
Table 2:source of waste

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Solid waste collection in Ubungo Municipality is carried out by both the Municipal, some private
companies, community-based organizations and informal sectors.
Apart from collection activities, the Municipality is also responsible for supervising the
franchisees involved in SWM.
SOLID WASTE COLLECTION Amount (tons/day) 2016/17
Name of SW collector
222
Municipality

200
Contractors

Total SW collection 422

Table 3 :table showing waste collection

5.4.3 WASTE TRANSPORTATION

Currently the transportation of solid waste is done by both the Municipal council and the private
sectors. The Municipal council have about three Trucks for transportation of solid waste from
different areas of the Municipal to the current dump site which is situated more than 35 Km from
the Centre of Ubungo which makes the round trip to cover about 80Km. Other trucks are owned
by the private sectors including contractors, Community groups and NGO’s. Other equipment
which are used to collect the waste and transportation is the Trailers owned by Municipal
Council and these are pulled by Municipal Tractors and other private owned tractors which are
hired.

MAJOR Stakeholders and their Roles

The Municipal council; is responsible for managing the general waste, such as ensuring
availability of sufficient services for refuse collection and night-soil removal from households.

The government; provides all necessary guidance (legislation and policy) to Municipal council
and financial aid and other resources when available.
8|Page
Franchisees; are required to promote more efficient wastes collections services to their
respective areas as directed by the Mtaa Executive Officer, Ward Executive Officer and the
Municipal council and as per contracts.

Roles of residents; Cooperate in the waste management programs and pay their refuse collection
charges (RCC). Also, they will be required to keep their surroundings clean wherever they are.

Supporting groups, Community groups (including NGOs, CBOs etc.), Academic institutions
and donors also have their identified rolls to play. This includes financing, moral and
promotional support, technological and marketing.

The following is the list of equipment owned by the Municipal.

 1 Cesspit emptier (Since 1987) - On and Off
 3 Tipper trucks [TATA] - On road
 1 Tipper trucks [TATA] -Grounded
 1 Tractors -Owned by Municipal Council
 8 Compactors -Owned by Contractors Solid

9|Page
Figure 2 :Solid waste Transportation from the Municipal Market to the Dumping site.

5.4.4 SAFE AND WATER SERVICES

The main source of water for Ubungo residents is from Lower and Upper Ruvu which managed
by Dar-es-salaam Water and Sewerage Authority (DAWASA). The water from DAWASA
systems contributes 68% of water being consumed daily and the rest is contributed by shallow
and deep wells which owned by both private and community. The estimated population of
Ubungo Municipality is 1,031349 out of that only 68% have direct access to clean and safe water
while the rest 32% have no smooth access

5.4.5 ROAD NETWORK

Chalinze district council has total of 679.05Km which are maintained by the district council out
of which 169.76Km equivalent to 25% are in good condition and. Also Chalinze is connected
with other region by tarmac road where is connected with Dar es salaam with tarmac road of
116km and is connected with Morogoro with a tarmac road of 85 km. chalinze district Council is
continuing to conduct rehabilitation, maintenance, upgrading and construction of roads and
bridges/box culverts to improve its roads network within district specifically by focusing routes
which are decongesting traffic from main roads and routes accessing to services areas by using
funds from Road Funds Board, own source and from other sources. Also, chalinze district
Council is using its own source funds to upgrade some gravel roads to tarmac roads

5.4.6 SAFE AND WATER SERVICES

The main source of water for Ubungo residents is from Lower and Upper Ruvu which managed
by Dar-es-salaam Water and Sewerage Authority (DAWASA). The water from DAWASA
systems contributes 68% of water being consumed daily and the rest is contributed by shallow
and deep wells which owned by both private and community. The estimated population of
Kinondoni Municipality is 1,031349 out of that only 68% have direct access to clean and safe
water while the rest 32% have no smooth access.

10 | P a g e
This is the population the council is responsible to facilitate it in getting clean and safe water
from other water sources such as deep and shallow wells.
Under WSDP - RWSSP the Council has drill 17 boreholes in which 4 boreholes are dry among
17. Water supply system for two bores of Mpiji Magohe and Kibwegere has been under
constructed

Figure 3 :80 m3 and 9m overhead tank and pump house constructed at Mpiji Magohe water
scheme.

5.4.6 EMPLOYMENT AND ECONOMIC ACTIVITIES

It is estimated that Ubungo municipality has a population of 1,031,349, among of those 701,317
are manpower while the remainders are elders and children who are 20,626 and 309,404
respectively. whereby 61% manpower are engaged in private sector, 35% are self-employed and
4% are employed in public sector. The activities engaged are private companies, institutions,
business, petty traders, fishing, livestock keeping and agricultural activities.

5.4.7 EDUCATIONAL SERVICES

Chalinze district hospital has 113 Pre -Primary Schools out of which 60 belongs to Government
and 53 owned by private sector. Also, District Council has 118 Primary schools, whereby 64 are
owned by Government and 54 primary Schools owned by Private Sector.

11 | P a g e
Currently Ubungo District Council has a total number of 65 secondary schools, out of which 26
are registered community secondary schools and 39 are privately owned. In addition to that, 7
out of 50 private Secondary Schools are at Advanced Level. (SOURCE UBUNGO MUNICIPAL
PROFILE 2016)

Ubungo is also the educational center of Tanzania, with famous Educational Institutions.

The University of Dar es Salaam, Ardhi University, The EASTC and St. Joseph University

6: DESCRIPTION OF THE HOSPITAL

6.1 MSOGA DISTRICT HOSPITAL

Msoga hospital is the district hospital located in Chalinze district. It upgraded from dispensary to
district hospital in 2020, it started with 2 buildings then it added the 2 buildings which previously
used as school classes and currently are used as wards. Recently it has 14 buildings out of 26
building where the rest 12 buildings are in progress.it has complete 14 complete and functioning
department this include outpatient, inpatient, CTC, RCH, physiotherapy, radiology, laboratory,
labor, social welfare, pharmacy, ophthalmology, dental, psychotherapy and environmental
health. The OPD in which there is 2 consultation room hence two patient can be served
simultaneously where it serves 11225 people in zone but 202,005 in district,

12 | P a g e
The hospital has catchment area of 11225 people with bed capacity of 50 beds in total where
previous it had 30 beds.

The hospital use GOTOMIS system to serve patient where a patient is registered in system and
the system act as the data base for all previously registered patient

6.2 HEALTH STATUS OF MSOGA DISTRICT HOSPITAL

6.2.1 ATTENDANCE AT THE FACILITY
The daily attendance rate of the facility is about 250-550 patients per day at OPD and about 25
30 patients per day .

In Chalinze district, there is no traditional birth attendants or traditional practitioners. Since

traditional birth attendants are no longer allowed to provide delivery service to the pregnant
mothers from Ministry of Health regulations that restrict them to aid delivery as it was done
previously. The attendance of patients at the dispensary is average with some covered with
insurance either NHIF or ICHF and mostly pay for their bills. Pregnant women, children under
5 years and aged people above 60 years with permit from their street councils are exempted to
pay their bills as per government guidelines

The patients covered with ICHF cards face a lot of challenges which is currently discouraging
most of the community member joining the insurance. The insurance is not reliable to its clients
as it has limited services especially some of the important drugs are not covered by the
insurance.
6.2.2 RANKING OF DISEASES AT MSOGA DISTRICT HOPITAL
All the patients above five years who attended at Chalinze district hospital in 2022, were as
follows:
Table 4:Top ten diseases at Msoga district hospital among patients below five years in OPD

S/NO DIAGNOSIS TOTAL PERCENTAGE

1 URTI 557 57.48%
2 PNEUMONIA, NON-SEVERE 120 12.38%
3 OTHER DIAGNOSIS 78 8.05%
4 DIARRHOEA WITH SOME DEHYDRATION 67 6.91%
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 5 PNEUMONIA, SEVERE 45 4.64%
6 UTI 26 2.68%
7 SOME INFECTION 26 2.68%
8 OTHER SECONDARY INFECTIOS DESEASES 24 2.48%
9 EYE INFECTION 12 1.24%
10 ACUTE OTITIS MEDIA 14 1.44%
TOTAL 969 100.00%

Source of data: MTUHA

TOP TEN DISEASES AT MSOGA DISTRICT HOSPITAL IN

PATIENT BELOW FIVE, OpD

SOME IN-
FECTION
UTI OTHER3%SECONDARY INFECTIOS EYE INFECTION
3% DESEASES 1%
2% ACUTE OTITIS MEDIA
PNEUMONIA, 1%
SEVERE
5%

DIARRHOEA
WITH SOME
DEHYDRA-
TION
7%

OTHER DI-
AGNOSIS
8%

URTI
57%
PNEUMONIA,
NON-SEVERE
12%

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Figure 4: pie chart showing Top ten diseases at Msoga district hospital among patients below
five years in OPD

Table 5:The top ten diseases from OPD for clients above five Msoga district hospital 2022

S/NO DIAGNOSIS TOTAL PERCENTAGE (out

of all case
diagnosed at the
hospital)
1 MALARIA 202 22.72
2 PNEUMONIA, NON-SEVERE 166 18.67
3 ANEMIA 154 17.32
4 HYPERTENSION 73 8.21
5 URINARY TRACT INFECTION 55 6.19
6 BROCHIAL ASTHMA 39 4.39
7 DIABETES MELLITUS 36 4.05
8 PEPTIC ULCER 25 2.81
9 UPPER RESPIRATORY TRACT 23 2.59
10 ACUTE OTITIS MEDIA 19 2.14
  TOTAL 792 89.09

NOTE; the percentage recorded is out of all diagnosed cases

15 | P a g e
 top ten diseases in patient above 5 year in opd

UPPER RESPIRATORY TRACT

ACUTE OTITIS MEDIA
3% 2%
PEPTIC ULCER
DIABETES MELLITUS
3% MALARIA
5%
BROCHIAL ASTHMA 26%
5%
URINARY TRACT
INFECTION
7%

HYPERTENSION
9%
PNEUMONIA, NON-
SEVERE
ANEMIA 21%
19%

Source of data: MTUHA

Figure 5:pie chart showing top ten diseases from OPD for clients above five Msoga district
hospital 2022

16 | P a g e
Table 6: The top ten diseases from LABOUR

S/NO DIAGNOSIS DIAGNOSIS PERCENTAGE

1 PREVIOUS SCAR 27 31.40%
2 OBSTRACTED LABOUR 11 12.79%
3 PROLONGED LABOUR 9 10.47%
4 PRE-ECLAMPSIA-INDUCED 8 9.30%
HYPERTENSION
5 ANEMIA IN PREGNANCY 8 9.30%
6 MALARIA IN PREGNANCY 7 8.14%
7 PRE-ECLAMPSIA 5 5.81%
8 ECLAMPSIA 5 5.81%
9 POST PARTUM HAERMORRHAGE 4 4.65%
10 HIV 2 2.33%
TOTAL 86 100.00%
Source of data: MTUHA

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 TOP TEN CONDITION IN LABOUR

HIV

POST PARTUM HAERMORRHAGE

ECLAMPSIA

PRE-ECLAMPSIA

MALARIA IN PREGNANCY

ANEMIA IN PREGNANCY

PRE-ECLAMPSIA-INDUCED HYPERTENSION

PROLONGED LABOUR

OBSTRACTED LABOUR

PREVIOUS SCAR

0 5 10 15 20 25 30

Figure 6: The top ten condition in labour dat Msoga district hospital 2022.

7: DESCRIPTION OF ORGANIZATION OF HEALTH SERVICES AT CHALINZE

DISTRICT
HOSPITAL MANAGEMENT TEAM
The hospital management team of Chalinze district hospital comprises of the following
members.
• Medical Officer in-charge
• Health Secretary in-charge
• Heads of Department/section

7.1 FUNCTIONS OF THE HOSPITAL MANAGEMENT TEAM:

• Ensure provision of quality medical/health services in the hospital in line with essential health
packages

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• Prepare (comprehensive) hospital annual plans and budget based on HMIS data analysis, and
submit to relevant authorities
• Control and rational use of resources (funds, drugs, reagents and other supplies)
• Conduct comprehensive need assessment in terms of personnel, finance, equipment arid
supplies
• Procure, store, maintain drugs, supplies and equipment in the hospitals
• Conduct meetings according to their schedules
• Resolve conflicts among hospital workers
• Compile quarterly/annual progress and financial reports, and submit to relevant
• authorities
• Assist CHMT in the control of outbreaks and emergencies
• Ensure adherence of professional ethical codes of conduct by all health workers in the
hospitals.
• Support and strengthen council referral system and give feedback to lower health facilities on
referred cases.

DMO
District Medical Officer (DMO) is the most senior local official in the health sector. The DMO is
appointed by the Ministry of Health, but formally reports to the local council through the
Executive Director. The criteria considered when appointing the DMO is that, he/she should be a
graduate in a Medical University preferably with a postgraduate qualification in public health
and training in leadership and managements, vetting is also done to ensure his/her leadership
skills and ability can accomplish the required tasks. He/she plays an important role in planning,
coordinating and implementing the delivery of local health services at the local level. The DMO
is supported in this role by the Council Health Management Team (CHMT) and guided in this
task by central guidelines and instructions. In order to assure the coordinated delivery of health
services at the local level, the DMO and CHMT are required to prepare a Comprehensive
Council Health Plan (CCHP) that guides the delivery and development of health services.

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8 FUNCTIONS OF A DMO/ CHMT
The success of health care activities in the district depends to a large extent on members of the
CHMT working as an effective team
The most senior local official in the health sector is the District Medical Officer (DMO). The
DMO is supported by the Council Health Management Team (CHMT) which is comprised by
the DMO and senior local healthcare administrators

I. Public Health duties

i) General:
The district Medical Officer is the Medical Officer of health for the urban district of rural
district. The title “District Medical Officer” connects medical responsibility for both a district
hospital. With emphasis on public health and district work. As far as public health is concerned.
The first step is to make a diagnosis of the health situation and work out priorities of health
problems, with a view to promoting health and combating major preventable illness in his
district. The District Medical Officer is also in charge of all
environmental health work in which his supporting staff may include at least Health Officer and
one or more health auxiliaries.
ii) Disease Control:
Specific measures to combat major communicable disease include means treatment schemes.
And vaccination programs either through the general health services by special campaigns.
At present such scheme are usually directed against, tuberculosis, Leprosy, Malaria, bilharzias,
smallpox poliomyelitis, tetanus, whooping cough, measles, HIV and AIDS, NCDs, Neglected
Diseases and may be filariasis and some of the important intestinal helminths. The District
Medical Officer is responsible for organizing and directing or c0-ordinationg all the necessary
action against these and similar diseases of public health importance. At the same time, special
attention and measures are required to combat the widespread incidence of protein-calorie
malnutrition.

iii) Reproductive l and Child Health

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A number of maternal and child health clinics are operated in each district. The District Medical
Officer must ensure that these clinics fulfill all the general functions from which they are
established and that the local maternal and child health problems are adequately catered for in
these clinics. A formal school health services is not feasible in nearly all districts, but the District
Medical Officer must supervise the health of school children as fast as is possible. As part of
Reproductive and Child Health the District Medical Officer should supervise Family Planning
Activities in the district. The role of such activities being geared at child spacing.

II. Supervision of peripheral health units

Regular supervision by DMO/CHMT will improve and sustain the quality of care in the
peripheral health facilities. Supervision: an educational process in which the supervision helps
and guides the health worker to become more competent, to the ultimate benefit of patients and
the community.” Supervision is a way of assisting a health worker, to see if certain pre known
tasks (the job description) are properly performed of not. It gives a base for which action can be
undertaken either by praising if the tasks have been performed well or by criticizing if not so. In
the latter case possible corrective measures should be initiated. By no nears supervision is equal
to negativism. This will only discourage the health worker. Supervision should result in a
stimulation to perform better. Tasks to be performed during supervision
Taking into account the CHMT/DMO’s tight working-schedule it should be feasible that one day
of the week is spend on supervision of peripheral health units. Such a day, depending on distance
and road conditions 3 – 5 dispensaries/health centers can be visited. This leaves in general
around ½ - 1 hour per unit.
Four main topics have to be covered during such visits:
a) Discuss and advice on current problems in administration, organization and implementation of
health unit functions as brought to the DMO by the unit staff.

b) See and advice on “problems patients” with the medical staff of the unit.

21 | P a g e
c) A short educational talk to the unit medical staff on any health topic e.g., treatment schedules:
a certain disease, control aspects: a certain disease, control aspects: health education versus
health information etc.

d) Evaluation of one aspect of the functions of the health unit, going through e.g., the drug
ordering and storage system; environmental cleanliness and maintenance of latrines, building,
garbage pits etc.; the registration and referral system; calculation of top ten common medical
conditions; relationship with the community like village health term meetings, surveillance
activities, self-help programs, relation with traditional practitioners etc.

III. Teaching:
It is very important that each District medical Officer fully appreciated the importance of his
responsibility to teach his staff. It is through such teaching that a team spirit is established in a
place and it is through continued teaching that auxiliaries working in dispensaries, etc. can be
integrated into a district health service or district health projects. There is another important
reason why a doctor must see teaching as one of his essential duties. Tanzania is short.

IV. Hospital:

i) Clinical: In terms of patient care, general medical duty in Tanzania means that a medical
officer must be capable or b potentially capable of practicing medicine pediatrics, surgery and
obstetrics and gynecology. The term ‘Medicine’ as used here must be interpreted fairly liberally.
A general hospital should include psychiatric care and, in that case, a working knowledge and
skill in psychiatry are necessary. At the same time, diseases of local importance such as
tuberculosis, leprosy, malaria, protein calorie malnutrition, etc. necessitate postgraduate reading
or study if a medical officer is to cope competently with the average medical cases of a district
hospital. The term “surgery” is similarly used to include simple ophthalmology. Most district
hospitals have waiting lists of hernia and hydroceles, and at the same time obstetrical
abnormalities, injuries and fractures, strangulated external hernias and intestinal obstructions are
common occurrence necessitating emergency surgery at many district hospitals. The District
Medical Officer must endeavor to be able to cope with all these confidently and competently. If

22 | P a g e
the hospital is equipped with an X-ray machine but has no qualified radiographer to operate the
machine, the medical officer must be prepared to operate the machine himself or supervise the
radiographic auxiliary to whom this work is delegated.

ii) Medical—legal Duties:

A district Medical Officer is expected to perform o number of medico-legal examination and to

give evidence in courts of law as required. Duties commonly undertaken in this respect are
medico-legal postmortem examinations, examinations for alleged sexual assault, assessment of
age mental state and physical fitness of persons for various medico-legal purposes.

iii) Administrative Duties:

A district Medical Office has overall responsibility for staff control and discipline. He is
expected to be able to allocated and delegate duties to other officers having due regard to the
functions and capabilities of each cadres of staff and of each individual staff member within the
various cadres. To do this effectively the District Medical Officer should familiarize himself with
the level of training and capabilities of each cadre of staff in his charge. A district Medical
Officer is expected to compile and to submit objective periodic reports on staff members in his
charge as required. As the supervising officer, a District Medical Officer has to ensure that
finance and stores are properly managed in accordance with standing regulations. District
Medical Officer is expected to compile and submit various periodical returns and reports about
health activities in his district. He is expected to be able to evaluate such reports and decide on
appropriate action as indicated.

iv) Planning:

A District Medical Officer is expected to help plan an integrated health service for his district.
This he will do through consultations with other interested parties such as doctors from voluntary
Agency. Hospitals and other local leaders of the community under the ambit of the District
Development Director.

V. District:
23 | P a g e
i) The District Medical Officer is in medical charge of the district medical services. These
usually consist of health centers, several dispensaries and other units and public health services,
and they all have to be visited and supervised regularly for administrative and professional
purposes.
ii) The District Medical Officer is responsible for visiting and keeping an eye on voluntary
agency (mission) medical services, particularly those that do not employ a doctor of their own.

DUTIES OF A DISTRICT MEDICAL OFFICE

ORGANIZATION OF HEALTH SERVICES

D.M.O.
TRAINING CONTROL HEALTH
HEALTH TEAM MANAGER

ADMINISTRATION

Figure 7:DUTIES OF A DISTRICT MEDICAL OFFICER

24 | P a g e
9 DISTRICT HEALTH SERVICES STRUCTURE, NUMBER, TYPE AND OWNERSHIP OF
HEALTH FACILITIES, WITH THE EXISTING NUMBER AND STAFF CADRES

District health service

Figure 8:DISTRICT HEALTH SERVICE STRUCTURE

25 | P a g e
9.1 DISTRICT HEALTH SERVICE STRUCTURE,
The district health services start at level of council headed by council chairperson, district
executive director as the secretary and all councilors. In the council there is council health
service board consisting of elected members and DMO as the secretary, addressing various
health related issues during council meetings. The district health board consist of 11 members ,5
of them are medical personnel and 6 elected members citizens. The Council health management
team (CHMT) takes charge of health service delivery within the District Council; it consists of 8
core members and 24 co-opted members making a total of 32 members. CHMTs' key functions
include organizing, supervising, monitoring and evaluating health services, and development of
the annual Council Comprehensive Health Plan (CCHP). Also, CHMT integrate with vertical
programs taking place at the level of the district. At district level there is district hospital
supervised by hospital management committee consisting of 8 members and hospital
management team headed by medical officer in charge. District hospital also consists of various
departments and different cadres of staffs. At the division level there is health center, governed
by health center committee in which the clinician in charge is the secretary, health center also
consists of departments and staffs. At ward level there is dispensary, governed by dispensary
committee in which the dispensary in charge is the secretary. At community level there is village
health committee, the committee will comprise members of the community which use the
services of the health facility (Health Centre or dispensary).

9.2 NUMBER, TYPE AND OWNERSHIP OF HEALTH FACILITIES

Chalinze district council is responsible for providing health services to its people in collaboration
with private sector service providers. The Council currently has a total of 46 health facilities of
which 36 are government owned, while the remaining 10 are owned by Private Organizations.
Msoga hospital is the only hospital owned by the government providing health services within
the district. This hospital is called a district hospital which is providing services for 250 to 600 in
and out patients per day. All the health facilities provide cure, preventions of communicable and
non-communicable Diseases. A table below shows a list of health facilities available in Chalinze
District Council

26 | P a g e
Table 7:nmber,type and ownership of health facilities

HEALTH FACILITY GOVERNMEN PRIVATE TOTAL

LEVEL T
HOSPITAL 1 0 1
HEALTH CENTRES 9 0 9
DISPENSARIES 26 10 36
TOTAL 36 10 46

9.3 ORGANIZATION OF HEALTH SERVICES

The hospital has three committees and two teams which are: Health facility governing committee
which is comprised of MOI, Matron, Health secretary and 4 Community representatives,
Therapeutic committee which is comprised of in charges of all departments, MOI, matron,
heathy secretary and pharmacist as the secretary, Health management team that consists of MOI,
Matron, Health secretary and Heads of departments which are Doctors and Nurses in charge and
quality improvement team (QIT).

Medical officer in charge is the overseer of the day-to-day activities at Chalinze district hospital.
MOI has both clinical and administrative roles as described below

Clinical roles

 Attends patients in OPD and participate in major ward rounds at the IPD.

 Preforming surgical procedures.

Administrative roles

 Responsible to various activities assigned by DMO

 Medical officer in charge supervises hospital revenue collection for the facilitation of
hospital activities.

 Provide clinical advice to DMO on health issues in the district hospital.

27 | P a g e
 Responsible for supervision of all hospital staffs, ensuring that each one is responsible for
their duties.

 Ensures that the hospital fund and materials are properly managed in the hospital.

 Involved in solving problems related to medical staffs for disciplinary action

 Supervising the hospital pharmacy and ensuring the availability of drugs and medical
equipment at all times.

 Collaborates with the Matron to ensure the smooth running of the daily hospital activities in
implementing the hospital plans.

 Organizing job training, seminars and exchange programs for staffs.

 Representative of the hospital in various meetings like CHMT.

9.4 HEALTH STAFF CADRE IN CHALINZE.

Msoga district in general consists of Outpatient Department (OPD), Inpatient Department (IPD),
Reproductive and Child Health (RCH), Care and Treatment Clinic (CTC), Psychiatry
department, Department of preventive services, Operating theatre, Laboratory services and
Pharmacy, physiotherapy, radiology department, opthamology department, otorhinolaryngology,
emergency department is on progress

28 | P a g e
Table 8: cadres involved in Msoga district hospital

S/N CADR REQUIR AVAIL DEF

E EMENT ABLE ICIT
MIN NUMB
NUMBER ER

1 Medical 8 6 2
Officer

2 Assistan 16 2 14
t
Medical
Officer

3 Dental 1 0 1
Officer

4 Assistan 1 0 1
t Dental
Officer

5 Dental 1 0 1
Therapis
t

6 Nursing 12 0 12
Officer

7 Assistan 33 14 19
t
Nursing
29 | P a g e
 Officer

8 Nurses 33 12 21

9 Health 1 0 3
Laborat
ory
Technol
ogist

10 Assistan 2 3 0
t Health
Laborat
ory
Technol
ogist

11 Radiolo 1 0 0
gy
Scientist

12 Radiogr 2 1 1
apher
Technol
ogist

13 Nutritio 1 0 1
nist

14 Emerge 1 0 1
ncy
medicin
e
physicia

30 | P a g e
 n

15 Social 2 1 1
welfare
Officer

16 Pharmac 1 0 1
ist

17 Pharmac 1 0 1
eutical
Technol
ogist

18 Assistan 1 0 1
t
Pharmac
eutical
Technol
ogists

19 Assistan 2 0 0
t
Environ
mental
Health
Officer

20 Insuranc 2 0 2
e Expert

21 Bio 1 0 1
Medical
Technol
ogist
31 | P a g e
 22 Medical 3 0 3
Record
Technici
an

23 Health 1 1 0
Secretar
y

24 Medical 44 7 37
attendan
t

25 Mortuar 2 0 2
y
Attenda
nt

26 Comput 1 0 1
er
Operato
r

27 Account 1 0 1
ants

28 Account 1 0 1
assistant

29 Assistan 1 0 1
t
Account
ant

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 30 Assistan 1 0 1
t
Supplies
Officer

31 Personal 1 0 1
Secretar
y

31 Cook 4 0 4

32 Clinical 13 2 11
officer

33 Environ 2 2 0
mental
health
officer

34 Lab 1 0 1
attendan
t

35 physioth 1 1 0
erapist

TO   200 52 148
TA
L

33 | P a g e
10 THE EXISTING VERTICAL AND INTEGRATED HEALTH PROGRAMS, THEIR
REPORTED SUCCESS AND CHALLENGES IN THE DISTRICT.

10.1 REPRODUCTIVE, MATERNAL, NEONATAL AND CHILD HEALTH (RMNCH)

The RMNCH clinic at MSOGA DISTRICT HOSPITAL operates every day. The services
provided by the RCH clinic included antenatal care, labor, immunization and vaccination,
postnatal care, PMTCT and child nutrition.

The clinics official working time begins at 7:30am to 3:30pm from Monday to Friday although
sometimes they go beyond this time due to large number of clients at the hospital and all the staff
members rotate in all sections according to their timetable.

The registers used by the department are as follows; The MTUHA register, vaccines register,
patients register, register showing number of mosquito nets distributed and PITC register.

10.1.1 AT THE ANTENATAL CLINIC

All pregnant women visiting the ANC were offered all basic antenatal services for free.

The following are the services provided during the first visit;

1. Screening for HIV/AIDS, STI’S and counselling were pregnant women are supposed to
come with their partners.

2. Provision of IPT at contact and after every 4weeks after first trimester.

3. Provision of mebendazole and hematinic

4. Provision of tetanus toxoids as per reference schedule which sums up to 5 doses.

5. Measurement of BMI, and blood pressure

6. Lab investigations such as MRDT, urinalysis, Hb level and blood grouping.

7. Counselling on birth preparedness such as EDD, delivery place, transport arrangements and
delivery pack which includes gloves, cotton, 2 cord clamps, surgical blades and maternity
pads and things like bucket and long plastic sheets.

34 | P a g e
8. Counselling on family planning.

9. Counselling on danger signs such as, premature rupture of membranes, abnormal vaginal
discharge, high fever, vomiting, convulsions, decreased fetal movements, DIB, and swelling
of the face and limbs.

10. Provision of insecticide treated nets.

All women attending for the first time are to come with their partners. This was still a problem to
many of the women, and to motivate women coming with their partners, preference was given to
any woman who came with her partner regardless of the time she reported to the clinic.

Services provided during subsequent visits are as follows;

1. Confirmation of services supposed to be provided during the first visit.

2. Lab investigations of Hb level, MRDT, urinalysis

3. Weight and blood pressure monitoring

4. Fetal growth monitoring by confirming fetal heart rate, lie and presentation.

5. Detection and treatment of any complication.

6. IPTp

Services provided during the 4th visit are as follows;

1. Confirmation of services that were supposed to be provided in the subsequent visits

2. Confirmation of fetal lie and looking for malformations if any.

3. Reminding the pregnant woman on birth preparedness and individual birth plan.

Ultrasound services are also provided to all pregnant women whenever necessary and are also
advised to seek medical attention in the nearby health facility in case they encounter any danger
signs.
35 | P a g e
They are also told about danger signs of pregnancy and advised to come immediately if any of
those signs appear such as per vaginal bleeding or discharge, blurry vision, headache,
epigastric/lower abdominal pain, and lower limb swelling. For the past four quarters most signs
observed were facial swelling, high blood pressure, lower abdominal pain, anemia, headache and
preeclampsia.

10.1.2 IN THE LABOUR WARD

In Msoga district hospital medical attendants, 1 clinical officer, 3 medical doctors and 1 assistant
medical officer.

The ward is divided into 4 units which are; antenatal ward, post cesarean section deliveries,
labour room, premature unit, and postnatal room containing only post spontaneous vaginal
deliveries.

It has the following equipment; 6 delivery beds, 1 oxygen concentrator, 2 resuscitation machines,
2 vacuum machines, 1 warmer machine and there is portable ultra sound machine.

The average number of deliveries per day is 15 to 20 and 360 to 400 deliveries per month. Out of
400 deliveries per month 50 to 60 are by cesarean section (mostly due do previous scar and early
pregnancy) and about 340 women deliver by spontaneous vaginal delivery.

Once the patient is admitted in the labour ward the following are done; The nurse quickly and
thoroughly examines the woman in labour and vital signs are taken, a proper obstetric with per
vaginal examinations are done to establish the fetal heart rate, lie, presentation and the cervical
dilatation. The partograph is filled after the onset of true labor pain which is evident when a
bloody mucoid vaginal discharge called "Show" is noticed. Therefore, the quality of filling the
partograph at Sinza district hospital is good as all the necessary information is timely filled.

36 | P a g e
Inadequate number of resting beds and availability of drugs and supplies was also a challenge at
SINZA DISTRICT HOSPITAL.

The average number of deliveries per day is 15 to 20 and 360 to 400 deliveries per month. Out of
400 deliveries per month 50 to 60 are by cesarean section (mostly due to previous scar and early
pregnancy) and about 340 women deliver by spontaneous vaginal delivery.

Once the patient is admitted in the labor ward the following are done; The nurse quickly and
thoroughly examines the woman in labor and vital signs are taken, a proper obstetric with per
vaginal examinations are done to establish the fetal heart rate, lie, presentation and the cervical
dilatation. The partograph is filled after the onset of true labor pain which is evident when a
bloody mucoid vaginal discharge called "Show" is noticed. Therefore, the quality of filling the
partograph at Sinza district hospital is good as all the necessary information is timely filled.

Most of the complications encountered during delivery over the past four quarters included, fetal
distress, obstructed labor, post-partum hemorrhage, eclampsia, and still birth, neonatal sepsis was
a rare complication at SINZA DISTRICT HOSPITAL.

The challenges that the health workers face includes; shortage of number of beds whilst a high
number of women in labor are admitted, late coming of pregnant women sometimes with an
already full dilatation and shortage of emergency drugs and medical equipment.

The outcomes of delivery in terms of maternal death and infant death seem to be low at this ward
whereby only 4 maternal deaths had been reported for the past four quarters and only 3 infant
deaths reported per month.

10.1.3 POST-NATAL SERVICES.

These services were given at 24-48hrs, 2-7days, 8-24days and 25-42days. MSOGA HOSPITAL,
the services were given every day due to large number of deliveries in Chalinze district. Some of
the services that were given in post-natal clinics

Assessment of the mother includes the following:

1. General examination to assess body temperature, and blood pressure
2. Initiation of breastfeeding within 1 hour of delivery and providing education on exclusive
breastfeeding for 6 months.
37 | P a g e
3. Genital examination to make sure there are no tears, if episiotomy was done then the wound
has healed, and if there is any kind of discharge.
4. Counselling on family planning.
5. Discuss the danger signs and postnatal complications with the mother like abnormal vaginal
bleeding and sepsis, then should report to the hospital without any delay if occur of any.

Assessment of the child includes the following:

1. General assessment e.g., temperature, jaundice, skin rashes etc.
2. Cord care (look for any signs of inflammation)
3. Immunization
4. Nutritional status i.e., weight and height monitoring and recording in the RCH-1 card
graphically.

10.1.4 CHILD NUTRITION

At MSOGA DISTRICT HOSPITAL, mothers were advised to breastfeed their babies within the
first hour after delivery and then exclusive breastfeeding their babies for six months without
giving the babies not even water. Complementary feeding was advised to start after six months.

All mothers were required to bring their children to clinic where weights of the children were
measured and recorded on RCH-1 card. This was done every month to check and monitor the
nutritional status of children. Depending on the growth pattern of the babies in the RCH-1 cards,
all mothers were advised on proper ways of feeding to improve the growth of their babies.

10.2 IMMUNIZATION AND VACCINATION DEVELOPMENT PROGRAM (IVD)

10.2.1 THE CADRES INVOLVED IN IMMUNIZATION AND VACCINE
DEVELOPMENT.
At national level, the immunization and vaccination development program Manager was
responsible for immunization.

At regional level, Regional Immunization and Vaccines Officer (RIVO) was the overall in
charge of the immunization services in the region answerable to the Regional Medical Officer
(RMO) through the Regional Health Management Team (RHMT). RHMT works under the close
38 | P a g e
coordination of the Regional Primary Health Committee under chairmanship of the Regional
Commissioner. Members of Regional PHC were Head of Health-Related Departments and
agencies in the region. The RIVOs managed the Regional Vaccine Stores supported by the
Regional and District Vaccine Store Keepers.

At district level, District Immunization and Vaccines Officer (DIVO) was the overall in charge
of the immunization services in the district answerable to the District Medical Officer (DMO)
through the Council Health Management Team (CHMT). CHMT worked under the close
coordination of the District Primary Health Committee under chairmanship of the District
Commissioner. Members of District PHC were Head of Health-Related Departments and
Agencies in the district council. The DIVOs managed the Districts Vaccine Stores supported by
the District Vaccine Store Keepers.

Table 9:Cadres involved in immunization

Levels Cadre Activity done

Community Community health workers organizing outreach sites, informing

families of scheduled outreach and
assist in service delivery such as
weight measuring

Hospital Enrolled nurses, Registered Administering vaccines

nurses and medical attendant

District DIVO Ensure supply of vaccines to lower

levels

Regional RIVO Ensure supply of vaccines to district

levels

National IVD programme manager Enforcing policies, organizing

national programs on vaccination

39 | P a g e
At health facility level, implementation of immunization activities was done by a Public Health
Nurse (PHNB) responsible for immunization, social mobilization, outreach activities and record
keeping. The Public Health Nurse was answerable to the Health Facility in charge.

10.2.2 FINANCING OF IVD.

The Sources of financing for the health sector were: -

On-budget sources: Central Government Funds, General Budget support, Health sector basket
fund and foreign funded projects and programmes

Off-budget sources: Health services fund (user fees), Community Health Fund, Council own-
sources and foreign funded projects and programs.

10.2.3 FORECASTING PROCUREMENT AND DISTRIBUTION OF VACCINES.

The Government procured traditional EPI vaccines (BCG, OPV, Measles and TT) and their
related injection devices and cold chain equipment. New vaccines including DPT-Hep B-Hib,
PCV-13 and Rotavirus vaccine was co-financed by the Government and GAVI. The government
had, over the years met its co-financing commitments to GAVI for procurement of new vaccines.

Procurement of all vaccines, injection materials and cold chain equipment was done through
UNICEF procurement channel. Vaccines, injection materials, and cold chain equipment and
related spare parts and supplies were cleared, stored and distributed by the Medical Stores
Department (MSD) .

MSD delivered the vaccine and related supplies to the Regional Vaccine Stores (RVS). Regions
were required to deliver vaccine and related supplies to the councils. Councils distributed the
bundled vaccines to health facilities.

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10.2.4 STORAGE OF VACCINES

the vaccines are stored in the refrigerator at a temperature of 2 to 8 degree centigrade in order
maintain their potency. Vaccines such as BCG, MR and OPV are stored in the freezer at a
temperature between -15 to -25 degrees centigrade.

At this level monitoring of cold chain was by fridge and freeze tag which were inside the
refrigerator and the automatic generator as a backup system for electricity when it went off.

During the outreach services, they used the cold boxes into which they put the ice packs and
vaccines. The ice packs ensured cold environment for the vaccines during the outreach services.

Table 10: routine immunization chart

S/n Antigen Age

1 OPV0 At birth up to 14 days

2 BCG At birth or first contact

3 OPV1, DTP-HepB-Hib1, PCV 1, Rota 1 6 Weeks of age

4 OPV2, DTP-Hep B-Hib 2, PCV 2, Rota 2 10 Weeks of age

5 OPV3, DTP-Hep B-Hib 3, PCV 3, 14 Weeks of age

6 Measles/ Rubella – 1st dose 9 Months of age

7 Measles/Rubella – 2nd dose 18 Months of age

8 TT 1 First contact

9 TT 2 1 Month after the 1st dose

10 TT 3 6 Months after the 2nd dose

11 TT 4 1 Year after the 3rd dose

12 TT 5 1 Year after the 4th dose

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13 e –1 9 years old female

14 HPV - 2 6 months after 1st dose

10.2.5 CHALLENGES OF IMMUNIZATION
The challenges experienced by workers in trial to rise coverage are remoteness of areas, shortage
of staff and transportation costs. The vaccine which has most challenge is BCG vaccine because
it requires about 20 children in order for single vial to be used and therefore it is not given at the
recommended time and mothers might not come back for vaccinating their children. Another
vaccine that faces challenges is MR vaccine, this is due to the duration at which it is to be
administered such that mothers might forget or they might be pregnant and be lost to follow up.
Also adherence of patients to vaccine some use to skip appropriate time for vaccination

10.3 NATIONAL MALARIA CONTROL PROGRAM.

This is a programme that was meant to prevent malaria transmission, and its aiming at
eliminating malaria in the community. It has the following objectives; All households should
own at least one ITN, Ensuring large part of the general population are sleeping under ITNs,
Increase the number of children under-five and pregnant women sleeping under treated net, All
pregnant women shall be on appropriate Intermittent Preventive Treatment, 90 % of all structures
in targeted districts will be covered through indoor residual spraying, All health facilities will
provide prompt and effective treatment using ACTs, All patients with uncomplicated malaria
will be correctly managed at public and private health facilities using ACTs, All communities
will have access to community-based treatment for uncomplicated malaria, 90% of caretakers
and parents will be able to recognize early symptoms and signs of malaria, and 90% of children
under five years of age with fever will receive an appropriate ACT within 24 hours of onset.

MSOGA DISTRICT HOSPITAL offers diagnostic, treatment, prophylactic and preventive

services to its clients concerning malaria.

Diagnostic services include; consultation followed by laboratory investigation which is rapid

malaria diagnostic test (MRDT) and blood slide for malaria parasites (BS for MPS). Those who
will test positive are put on antimalarial drugs according to the severity of the patient.
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Curative services include;

1.Mild and moderate malaria, the patient is put on Artemether Lumefantrine (ALU)

2. Severe malaria, the patient is initiated with Artesunate three doses at (0,12 and 24) hours and
is put on ALU after finishing the Artesunate injections. Also, paracetamol is given for fever and
diazepam in case of convulsion. Prophylactic services include provision of sulfadoxine-
pyrimethamine (SP) to all pregnant women attending antenatal clinic at MSOGA DISTRICT
HOSPITAL as prophylaxis against malaria.

Malaria prevention; MSOGA DISTRICT HOSPITAL offers health educational services to the
community concerning the importance of using appropriately the insecticide treated nets,
creating awareness on common early symptoms and signs of malaria and environment sanitation
such as bush clearing. Also provides free insecticides treated nets to pregnant women attending
ANC and to women with children under five years after taking the second MR vaccine.

Success of the program: awareness to the community that not every fever was due to malaria,
(“SIO KILA HOMA NI MALARIA”) increased coverage of distribution of ITNs and increased
usage of ITNs among households, decrease in malaria prevalence at CHALINZE DISTRICT

Challenges: insufficient number of qualified and skilled personnel in the diagnosis of malaria in
health facilities in the district, loss of protective immunity since it was a hypo-endemic area and
misuse of interventions like ITNs.

10.4 NATIONAL AIDS CONTROL PROGRAM

At Msoga district hospital the HIV/AIDS control programme is under District AIDS Control
Coordinator (DACC) who monitors the programme at district hospital as well as the lower level
of health services provision such as the dispensaries and health centres in the district. Other
members who work in this programme are CTC In-charge, nurses, clinicians, pharmacists and
community health workers. The DACC receives data regarding all HIV infected patients from
the dispensary level to the hospital level and combines these data giving an overall quarterly
report through the DHIS2 to the required authority.

HIV/AIDS sub programs present at MSOGA DISTRICT HOSPITAL include;

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 10.4.1 HTC (HIV TESTING AND COUNSELING)
This includes PITC (Provider initiated testing and counselling), VCT (voluntary testing and
counseling) and HBC (Home based counseling). The PITC program operates through giving
health education related to HIV testing at the waiting area for OPD patients which is followed by
counselling and testing. Clients are asked questions that might make them eligible for HIV
testing. Questions asked are whether a person has ever tested for HIV since birth, whether a
person has symptoms/Ever been treated for STIs, whether a person has a HIV positive sexual
partner. At the CTC clinic, testing is emphasized on commercial sex workers, biological index
and sexual index.

10.4.2 CTC (HIV CARE AND TREATMENT CLINIC)

Services provided are;

i. Voluntary counselling and testing (VCT)

ii. Provider initiated testing and counselling (PITC): this operates through giving health
education related to HIV testing at the waiting area for OPD patients which is followed by
counselling and testing.

iii. Index testing: this operates as a chain testing aiming at finding all possible HIV positive
patients where by once a person is found positive for HIV all his/ her sexual indices are also
tested and the chain continues.

iv. Medication: At Msoga CTC, ARVs are given where by first line TLD regimen is used,
patients are also given Isoniazid preventive therapy (IPT) as a prophylaxis against TB, this
dose is given for 6 months which provides protection for a 2-year duration. Cotrimoxazole
preventive therapy is also provided.

v. Health education: Adherence to medication, prevention of new HIV infections, family

planning and nutrition counselling.

vi. Laboratory investigations: CD4 counts and viral load, this investigation is done in order to
monitor the condition of the patient and the well-functioning of the medication given. At

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 Sinza DH first viral load and CD4 investigation is done 6 months after initiation of treatment
then followed after other six months after this the investigations are done yearly.

Testing for infections: at Msoga there is a TB screening questionnaire used to screen HIV patient
for tuberculosis in case there is any suspicious symptom

The facility has a pediatric CTC clinic every last Saturday of the month. Through this clinic, HIV
positive children receive child-friendly HIV services. Health education is given through special
posters, children meet, play, eat together and therefore it promotes hope and social attachment
among children living with HIV.

10.4.3 PMTCT;
This program emphasizes on early detection of HIV through integrating HIV testing and
counselling at the RCH clinic. When a woman attends to the antenatal clinic for the first time she
is tested for HIV/AIDS as per the recommendations of MOHCDGEC and WHO, this includes
HIV screening of partners during first ANC visit. For all HIV positive mothers are started on
first line of Antiretroviral therapy at the ANC clinics and HIV positive partners are registered to
CTC. This program also emphasizes on birth by skilled birth attendant. During labor, health
workers avoid performing artificial membrane rupture as well as multiple vaginal examination in
order to minimize chances of HIV transmission to the child. After delivery the child is
administered ARV prophylaxis (nevirapine syrup). ARV prophylaxis is given up to 18 months
where by dry blood sample is taken for confirmation of the child’s HIV status. This goes along
with counselling of the mother on adherence to medication, family planning advice and exclusive
breastfeeding for six months.

The hospital has HIV groups for pregnant women and breastfeeding women living with HIV.
Through these groups, these women are given health education, they create social attachment but
also it is a way to reduce HIV-related stigma.

Follow-up of HIV patients

This health facility conducts routine CTC 3 days in a week of which there is a list of patients
who are supposed to attend according to their respective appointments. If a person misses an
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appointment, he/ she is shifted to the next day within a week where a CTC clinic will be
conducted. If this person doesn’t show up, then he/she is contacted to remind him/her of the
appointment and scheduled for next day, if he/she doesn’t show up, then an HBC (Home based
counsellor) is assigned at their respective area of stay to take medication to the missing client. If
a client is dead then a report is recorded.

CHALLENGES:

Loss to follow up and missed appointments, excessive amount of work due to shortage of health
care staff at the hospital, poor adherence to the drugs that would result to drug resistance

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 10.5 NATIONAL TUBERCULOSIS AND LEPROSY PROGRAM.
At Msoga district hospital the Tuberculosis and Leprosy programme is under District
Tuberculosis and Leprosy Coordinator (DTLC) who monitors the programme at district hospital
as well as the lower level of health services provision such as the dispensaries and health centres
in the district. Other members who work in this programme are clinicians and DOT nurses. They
also work together with the TB/HIV co-infection coordinator.

The DTLC receives data regarding all Tuberculosis and Leprosy patients from the dispensary
level to the hospital level and combines these data giving an overall quarterly report through the
DHIS2 to the required authority. The TB/HIV co-infection coordinator works in ensuring early
detection of TB in HIV infected patients. The DOT nurses are responsible for the patient care,
health education, treatment observation, specimen collection and screening of TB and Leprosy
patients. A TB focal person is present in various departments of the hospital, their key role is to
detect new cases of TB and send them to the programme

The hospital provides both primary and secondary preventive services for tuberculosis and
leprosy. On primary prevention, every newborn receives BCG vaccine for TB soon after birth or
for children who come to the clinic who are < 2 weeks. Patients are diagnosed with TB after
sputum positive results for Acid-fast bacilli. Patients are started on anti-TB regimen as per the
national guideline. For relapse or inconclusive results, tested for GeneXpert this is done in
hospital.

The NTLP aims at controlling the occurrence of Tuberculosis and Leprosy diseases in the
community by working with the following objectives.

i. To diagnose TB and Leprosy patients early.

ii. To reduce the incidence and prevalence of TB and Leprosy

iii. To reduce the source of infection in the community.

iv. To reduce the incidence and prevalence of disability due to Tb and Leprosy.

v. To train health workers on proper case finding and management.

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vi. To ensure the availability of drugs and monitoring of DOT treatment.

vii. Provision of health education on tuberculosis and leprosy to patients, health workers and the
community as well as recording and reporting all the cases.

TB NOTIFICATION TRED IN CHALINZE DISTRICT

Chalinze district had the target of 488 notification in 2022 and 126 from community where the
distribution where as follow

Health facility Target number of Tb patient

Msoga district hospital 96
Chalinze health center 160
Lugoba health center 50
Mlowa health center 40
Mbwewe dispensary 27
Kiwangwa dispensary 20
Msata dispensary 19
Kikombo health center 11
Mboga dispensary 11
Vigwaza dispensary 6
RTS kihangaiko 4
Kibindu health center 2
Matipuli dispensary 2

In every 3 months Chalinze district had target of 122 patient and 32 from community.

123 case were notified from April to June 2022 in which 64 were bacteriological, 16clinical
AFB negative, 43 extrapulmonary TB, 14 with history of TB, 37 community, 25 pediatrics

Hence the goals was archived by 100%

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SUCCESS

The TB / leprosy unit has been able to provide services to a larger number of people due to the
improvement in the awareness of the people brought about by the program. The program has
succeeded to train health officials at lower levels such that they are able to clinically diagnose
patients early and refer them to the district hospital before complications arise. Due to the
distribution of free anti-TB drugs by the vertical programs, patients do not hesitate in acquiring
these drugs.

CHALLENGES:

A number of people do not attend the clinic regularly and hence miss out the dose of the
medications and complications may arise. Another challenge faced is that as soon as people get
relieved from the symptoms, they stop taking the medications i.e., poor adherence to the drugs.
Some people who stay far away from the hospital are unable to attend regularly and this hinders
the efficient provision of these services.

11 PROBLEM HINDERING THE PROVISION OF HEALTH SERVICES IN THE DISTRICT.

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The main problem hindering the provision of health services in Chalinze district is long
inflexible bureaucratic management system. The organizational is too inflexible to affect
necessary changes effectively making it difficult to change rules, regulations, this makes it
difficult to change in progress and development. The structure in hierarchal in nature whereby
authority is assigned in ranks and employees take directions from their superiors.

At Chalinze district there is a Full council responsible for the approval of health budgets and
plans and CHSB which amends district health plans and plans identifying and soliciting financial
resources to run the council health services and CHMT which prepares comprehensive health
plans ensuring the provision of transport ,drugs and modified medical supplies to the health
facilities carrying out supervision to the lower level facilities ensuring there is provision of
quality health services in Chalinze district However for adequate and effective health service
provision every rank has to perform its responsibility authentically taking into consideration the
needs of citizens at the particular time. This bureaucratic organizational structure of management
has been a major setback to provision of health services especially in pharmaceutical department.
Drugs being ordered take a very long time a month or two to get to the hospital as there is a very
long process of approval and signing before the particular list of drugs reaches MSD. Sometimes
there might be shortage of some of the drugs ordered at the MSD so the hospital has to prescribe
drugs to patients and send them to buy outside the hospital.

The other major problem is delay of disbursement of funds from the central government to local
government authority (LGAs) particularly basket funds. Excessive delays over funds from the
central government affect the implementation of health services as per plan.

Limitation on how much councils should budget is another major problem as it appears that the
council may have more health needs that those budgeted for but since the central government has
limited resources, then there must be a limit on how much should be allocated to the council
resulting to shortage of medical personnel, drugs, medical appliances and funds that ensure
effective delivery of health services.

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WHAT SHOULD BE DONE

The government should reform the organizational structure to a flexible one that will ensure
timely and effective provision of health services at MSOGA DISTRICT HOSPITAL

The district council should plan alternative reliable sources of revenue apart from depending
only on the central government that faces shortage in allocation of funds. There should be other
sources of revenue like patient user fee, market fees health facility user fee results base funds’
that will support the council to their social and economic development activities that facilitates
effective delivery of health services

Proper planning and allocation of funds from reliable sources both medical appliances and
medical personnel that will prioritize the enhancement of quality health services in the district
according to particular top diseases affecting the particular district hospital

12 DISTRICT HOSPITAL WEEKS

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In third week, students were divided into two groups each group had 2 day of visiting DMO
Office and 3 days to visit at MSOGA DISTRICT HOSPITAL.

Table 11:timetable to visit at Msoga district hospital and to a DMO office

MONDAY TUESDAY WEDNESD THURSDAY FRIDAY

6/02/2022 7/02/2022 AY 9/02/2022 10/03/2022
8/02/2022
DMO GROUP I GROUP I GROUP II GROUP II GROUP II
MSOGA GROUP II GROUP II GROUP I GROUP I GROUP I
HOSPIT
AL

In the MSOGA DISTRICT HOSPITAL the students we subdivided into six groups of 7 to 8
people who distributed into various department of the Hospital to participate into various
activities performed in the departments as mentioned in the table below.

DAY OF THE ACTIVITY DURATION FACILITATOR

WEEK FROM 6TH PERFORMED
TO 10 TH FEB 2022
MONDAY OPD: Worked with
OPD Clinician to 0800hrs to 1500hrs OPD Clinician

manage the patients.

RCH: Worked with

RCH nurse in
RCH Nurse and her
attending to pregnant
0800hrs to 1500hrs teams
women clinic, family
planning activities
and under five

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 children vaccination.

PHARMACY: The
group in pharmacy 0800hrs to 1500hrs Hospital pharmacy

participated attendants

dispensing drugs.

CTC: The CTC group

participated in CTC clinician and
0800hrs to 1500hrs Nurses
failing, testing and
TO
counselling, learning
about HIV drugs.

LABORATORY:
The laboratory group Laboratory
FRIDAY observed the common technicians.
0800hrs to 1200hrs
test and procedures.
E.g., blood grouping,
MRDT test, HB test,
gene expert test, viral
load test.

GROUP PICTURES FOR MD 4 STUDENTS AT SINZA DISRTICT HOSPITAL

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54 | P a g e
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DMO DAY

Each group had a day to visit at DMO office the main objectives were to learn Job descriptions
of DMO and District Health services structures.

DAY OF 6TH ACTIVITY DURATION FACILITATOR

MARCH- 10TH PERFORMED
MARCH 2022
MONDAY TO Introduction to DMO 0800hrs to 0900hrs
FRIDAY office. District Hospital

Lecture on DMO 1000hrs to 1100hrs health secretary

functions and District

Health Service
Structure.
Facilitator proceeded
with DMO functions 1200hrs to 1230hrs District Hospital

and hierarchy of Director

district hospital.
Facilitator
summarized DMO
District Hospital
functions, then he
1230hrs to 0100hrs Director
mentioned about the
existing vertical and
integrated health
programs, their
success and
challenges in the
District.
Table 12:table showing activities conducted at the DMOs week

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GROUP PICTURES OF STUDENTS ON A DMO WEEK AT DMO OFFICE

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58 | P a g e
13 DISCUSSION
In Msoga district hospital, planning is done in accordance with various national policies and
guidelines such as Tanzania Health policy and CHOP guidelines. As it is to any other institution
or organization, conflicts are inevitable either between service providers or service providers and
customers or clients. As for Msoga district hospital, there is a standard disciplinary committee to
resolve such conflicts if they couldn’t be resolved within their individual departments as
expected.

Supervision is overall done by stake holders to see whether there is a positive change or negative
change as per available resources in order to influence effective planning. For Msoga district
hospital, supportive supervision is done as expected by; CHMT, RHMT, PMORALG, and
MOHCDGEC who are responsible in escalating proper health services provided at the hospital
by always giving feedback when necessary especially when a negative change has been spotted
within the facility. Hence the more the supervisions done, the better the services are being
offered(3). Following the Health Sector Strategic Plan IV for supervision of hospitals, there is
adequate supervision both internally and externally at Msoga district hospital.

Data collected from IPD, Dispensing, and OPD which includes the general OPD, NHIF, CTC,
RCH, dental clinic and TB & LEPROSY buildings, helps in formulating policies and
interventions that directly addresses the problem in the community. for example, data collected
and analysed can help in knowing HIV/AIDS prevalence as well as Malarial outbreaks in an
area, this in turn helps policy makers to enable allocation of enough resources such as ARVS and
ITNS to tackle these problems..

At Msoga district hospital drugs were managed properly. There were lockable shelves as well as
pallets for storage of drugs. Main store had air conditioning for maintaining the required
temperature to ensure drugs safety although there was no a temperature monitor. There were no
expired drugs found during our visit, although in case of drug expiry the pharmacists reported to
record in accordance, that is; expired product name, expire date, quantity of the expired drugs,
batch number and respondent person particulars as recommended to be done by the drug

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authority(5). The most commonly expiring drugs are ARVs which occur as a result of change of
regime.

As stipulated by the ministry of health and social welfare, District hospital should have 7 wards;
medical ward (males and females), surgical ward (male and female), pediatric ward, obstetrics
/gynecology ward and labor ward however at Msoga district hospital there is no male ward and
the number of wards that are present are inadequate as compared to the number of patients
admitted despite having the recommended hospital bed capacity. In some wards i.e., maternity
ward, both obstetrics and gynecology patients are sometimes mixed together. Furthermore,
having the medical and surgical patients admitted in isolated in the same ward is as good as it
aims at management of the condition of the patient came in with although it increases the risk of
nosocomial infection.

The supportive supervision from both internal and external supervisors at Msoga District hospital
is of paramount significance to the development of this health facility as it assesses the major
areas of quality of care like leadership and governance, financial status, human resource for
health ,health commodities and medical supplies ,services provision and quality ,physical assets ,
hospital environment and annual planned activities and it has been done at the frequency and
duration as recommended by MoHCDGEC.

Council Health Management Team (CHMT) deals with management of Health at District level.
This has core and co-opted members. It is responsible for coordinating preventive, curative,
rehabilitative, supervision and promotes health activities. It assists health facilities to develop
comprehensive health plans and to monitor and to evaluate the implementation.

CCHP consist of council health panning team who deals with creating a plan for the whole
district, Chalinze district municipal have all required members of the council planning team who
are eighteen in addition to co-opted members, school health programme coordinator being one
among of the co-opted members of the CCHP. School heath program coordinator is responsible
for creating awareness on the alcohol use, dietary behaviours, drug use, mental health, physical
activities and new arising burning issue in the community concerning health.

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14 RECOMENDATION
We would like to recommend the following to the MSOGA DISTRICT HOSPITAL
management team and DMO office

1. Completion of the building for labor, antenatal and postnatal wards to prevent overcrowding
of patients in the maternity ward as well as the male ward

2. Providing education to patients pertaining the removal of breeding sites for mosquitoes such
as scattered coconut remains that will help reduce the morbidity among under-fives and also
encouraging them on the behaviour of proper use of insecticide treated nets.

3. Increase the number of health personnel, medical equipment and vaccines together with
vaccine provision instruments like syringes, in order to reduce the maternal and infant
mortality rate.

4. Encouraging men to accompany their partners in the first ANC visit this will help on timely
accessing of necessary health services and thereby improving the health status of the woman
and her unborn child.

5. Timely disbursement of funds should be ensured by the government so that there is early
implementation of plans by the hospital hence improving the provision of health services to
patients.

6. Medical officer in charge should have regular training for the staffs to ensure efficiency of
the work done by following the existing guidelines.

7. To install temperature monitoring devices in the hospital main store to ensure optimum
temperature for drug storage.

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15 CONCLUSIONS
Basically hospital management and DMO weeks have been a great time for learning purposes.
This has helped us to get involved and get knowledge on how people handle issues at hospital
and district level. It is important because health services are made for the purpose of the
community in solving people's problems and ill conditions.

Msoga district hospital provides services to the community in both inpatient and outpatient
departments and it also receives the referrals from dispensaries and health centres in the district.
Budget planning is done annually where every staff participates in giving views in their
respective departments and prioritization is made depending on demand and urgency. The
disciplinary committee settles all conflicts and misunderstandings among the staffs, facility
supportive supervision is done quarterly and annually to ensure proper functioning, data obtained
from every department is used to improve health services, rational drug prescription is ensured
and the therapeutic team ensures drugs and medical equipment are ordered or bought on time to
prevent scarcity, various national health intervention programmes such as RMNCH, NHCP,
NMCP and NTLP are effectively implemented. The DMO's office function in organising the
health facilities in plan making and implementation.

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16 REFERENCES.

1. REVIEW_STAFFING_LEVEL_2014-19; Ministry of Health Community Development

Elderly and Children
2. National priorities in disease prevention. McGinnis JM. Issues Sci Technol. 1989-89
Winter.
3. Community Health: Rural health series 12, second edition, African medical and research
foundation.
4. The District Health Profile (DHP) Reports2012
5. The District Health Profile (DHP) Reports 2019
6. Version SD. THE UNITED REPUBLIC OF TANZANIA the National Health Policy
2017.
7. Development C, Authorities LG. The Ministry of Health , Community Development ,
Gender , Elderly and. 2015;21(21):2015–20.
8. For G, Testing HI V, In C, Settings C. UNITED REPUBLIC OF TANZANIA
MINISTRY OF HEALTH AND SOCIAL WELFARE NATIONAL AIDS CONTROL
PROGRAMME GUIDELINES FOR HIV TESTING AND COUNSELLING IN
CLINICAL SETTINGS. 2007;(July)
9. Tuberculosis N. National Guidelines for Tuberculosis Infection Control. 2017
10. Welfare S, Malaria N, Programme C. National Guidelines for Diagnosis and Treatment
of Malaria. 2013;(August)
11. United THE, Of R. Comprehensive Council Health Planning Guideline Fifth Edition.
2019;

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