News: Mbarara finally chases TB
Jossy Muhangi
The Daily Monitor
22 March 2006
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Uganda - Once a very congested place, the TB ward at Mbarara hospital will soon start handling other medical cases, following a new system where patients are diagnosed and referred to local health centres for treatment
It appears strange yet it is true. Mbarara University Teaching Hospital's Tuberculosis (TB) ward which up to recently has been notorious for over congestion with chronic patients is today virtually empty. According to the director of Health Services for Mbarara district, Dr. Amooti Kaguna, they "have decongested, let alone depopulated the TB ward at the main hospital. The ward will soon be transformed to accommodate other medical cases".
Kaguna attributes this situation to the adoption and implementation of a system/strategy known as Directly Observed Treatment Short Course (DOTS), which involves a downward referral of TB patients who are diagnosed and sent to the local health centres for treatment.
The system entails sending patients to their home locations where they are accessed by health workers from health centres with the TB drugs. In turn, a volunteer, not necessarily a health personnel is selected and assigned to monitor the administration of these TB drugs to the patients at the right times and ensure completion of the eight-month dosage.
This development which is also implemented in neighbouring Kenyan diagnostic and treatment facilities, has led to decongestion of the TB wards where affected cases would lie for several months bearing extra costs of feeding and facing the inadequate space hazards.
Kaguna says that last year, 3,550 cases were detected through health centres which examine sputum and X-ray examinations (specimen) to screen for TB in greater Mbarara which entails the four new districts carved out recently. Of these however, about 2,056 were identified for treatment and management while the rest remained untouched in the communities which represents about 40 percent.
Kaguna however said the prevalence rate has gradually been going down due to consistent intervention and support from the donors particularly the German Association of Leprosy and TB Relief Primary health care Funds and the Global fund contributions.
In 2005, the National TB/Leprosy allocated Mbarara district Shs116m for drugs procurement, the German Leprosy Relief Association gave Shs2.5m for allowances and other programme activities, the Global Fund contributed Shs12m and the Primary Health Care gave Shs700,000, thus a total of 132m for the entire programme.
With this support, the programme has not run short of TB drugs in recent times while Leprosy has become history. Kaguna says only two cases of leprosy were detected last year, one from Kyenjojo district and another in the refugee camp located in newly created Isingiro district.
He adds that the policy of screening HIV patients for TB and vice versa has also contributed to management of Tuberculosis which affects the lungs, bones and other parts of the body.
He however laments that there are limited centres which do counselling and testing for HIV/TB. In fact, it is only at the Aids Information centre (AIC) where HIV suspects are also screened for TB.
In all, the greater Mbarara has only eight counselling and testing centres. Of the 150 health centres including five hospitals and several health centres at constituency, sub-county and parish levels, only 62 centres have integrated services to include diagnosing and treating TB components.
He however said the situation has improved as most of the patients get screened at the main hospital and are sent back to the Community-Based Health DOTS (CBH) for management. All the sub-counties have got the CBH-DOTS facilities, according to Kaguna.
He said of the affected cases, 60 percent are men, 38 percent women and about 5 percent children. He attributed the higher rates in men to their level of predisposition, lifestyles including heavy drinking and working in congested communities among other risk factors. He identified some of the most affected areas as Rwampara, Bukanga and Ibanda counties.
Besides the health centres with integrated services, there are 24 diagnostic centres where TB patients can be examined. However, these are not evenly distributed and are located mostly in urban centres.
Although the anti TB programme boasts of adequate drugs and reduced prevalence rates, it is faced with a number of challenges that slow its pace and desired targets. Kaguna said the programme lacks sufficient trained personnel to monitor and implement the activities. He said there is need for enough clinicians especially at lower levels who take the drugs to the communities and identify volunteers to administer the drugs. And where there are staff, they lack adequate means of transport to traverse their areas of operation including reviewing the patients' situations.
There is also lack of enough equipment and reagents for testing the cases though the drugs are sufficient unless the health workers have not ordered in time. The adherence rate is yet another challenge to health workers as many patients rarely complete the doses according to prescription in the right times and amounts over long periods. According to Kaguna, the compliance rate has been at 55 percent and defaulting rate at 45 percent.
Defaulting leads to Drug resistance and an infected patient may have to start the dose all over again with stronger medication. Currently, the anti TB drugs are only provided by the government while private hospitals access it from government departments free of charge. Another challenge has been stigma about the disease which is closely associated
with HIV/Aids.
Estimates show that 60 percent of HIV patients have TB (hidden or obvious) while 48 percent of TB patients have HIV. In spite of the intensive sensitisation of the communities that TB is preventable, manageable and curable, a number of the affected do not show up to utilise available opportunities and services.
Yet another problem is that of migratory populations which makes it difficult to follow them up. However, there are regular collaborative meetings through which those moving within neighbouring districts can be tracked, Kaguna explained.
Health workers here have a vision of having at least 100 diagnostic centres in the near future from the current 24, detecting at least 75 percent of the affected cases and treating about 85 percent of them. He said last year, of the 2,056 identified patients, 55 percent completed treatment. They also wish to intensify the follow up programme, collaboration with neighbouring counterparts and community sensitisation.
Online at: http://www.monitor.co.ug/socpol/socpol03221.php
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Stay connected - Speak your world!
A posting from Stop-TB (stop-tb@eforums.healthdev.org)
Thursday, April 2, 2009
TB is manageable,treatable and preventable
solid waste management
Jossy Muhangi March 13 Mbarara makes headway in solid waste management
Environmental and health hazards currently bedeviling
With Mbarara Municipality population generating over 150 tons of solid waste per day part of which is collected by trucks for dumping at a site in Kenkombe ,Kakoba division thereby degrading the land and polluting the air in the vicinity, the construction of a compositor which turns solid waste into manure is expected to greatly check the hazardous impact on the neighbouring communities . The garbage that has been a menace will also turn into a blessing as its product once its turned into manure will help generate some income when it is sold to the farming community.
While the long time vision for
But the chief township officer Mbarara Municipality David Naluwayiro Kigenyi discloses that with assistance from the environment watchdog the National Environment Management Authority(NEMA),a project worth 400 million
The project site will also benefit from a six kilometer extension of piped water with the help of National water and sewerage corporation from which the neighbouring community will benefit. Kigenyi says the NEMA coordinated project has contributed a refuse collecting truck and 20 collection skips while in the subsequent phase the ministry of local government has promised to provide another truck.
The Mbarara Municipal environment officer Herbert Tumwebaze says the sites at which solid waste is collected and dumped suffers the environment and health hazards through the degrading of land and air pollution. He says the refuse from the unsorted garbage litters and contaminates the neighbouring water sources .
Councilors who represent the area where the dumping site is located cry foul of the nasty smell and pollution of the atmosphere but are optimistic the new project will mitigate the adverse effects .
The township officer Mr. Kigenyi reveals that about 17m shillings is spent per month on collection of the solid waste by the trucks in the municipality. Part of it is collected directly by the council trucks and another part is managed by private contractors .
He attributes the ever rising solid waste problem to an increasing population a big percentage of which is poor which does not appreciate the desire for beauty and standards. All the majority of the town dwellers care about is their survival and it is difficult to change their negative attitude .He wonders why some town dwellers for instance in their own wisdom choose to throw their solid waste on the surface even when the skips are half empty.
On the government policies, Kigenyi feels the implementation of our environment laws is weak compared to neighbouring
Mbarara’s Resident District commissioner Clement Kandole also agrees with Kigenyi on the ambiguity of Ugandan laws on environment. He wonders for instance how an ordinary person is expected to comprehend the difference in gauges of the polythene materials in terms of microns yet it could be more realistic to say impose a ban on all polythene materials.
With proper implementation of the solid waste management project, active involvement of the stake holders including the communities neighbouring the dumping site and continued awareness on sustainability of the project, the environment related hazards in Mbarara and other towns could be history .
End
Wednesday, April 1, 2009
Journalists think tanks
Media Associations Should Promote Local Think Tanking
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Journalists organized in regional press clubs can go beyond playing a fire brigade role. Besides the traditional roles of covering events, crises, disasters and conflicts, practicing journalists in Uganda are playing a more watch dog role of promoting Transparency, Accountability and rule of law as corner stones of good governance.
One major sensitive area is the Public procurement and disposal of public goods, services and works. They are also setting the agenda on topical issues that impact on people’s lives by involving a wider public to participate in the debate, and monitoring the allocation and use of resources.
Members of Ten press regional clubs scattered around the country have realized through research and documentation that procedures in procurement and disposal of public goods and services impact on creation of a sound business environment in the country, promote efficiency and transparency. Before 1994 decentralization reforms, procurement of public goods and services was based on a centralized “system with central tender board" under the Ministry of Finance being in pole position. With de-concentration of powers and increase in government entities, it became inevitable that even the procurement role be decentralized thereby empowering lower entities to plan and execute their own programs.
In the case of Uganda, district tender boards were created but mostly comprised political appointees as members. Elected political bosses took advantage of this to reward their cronies and supporters with such positions to the statutory bodies and commission, contrary to laid down procedures. Such committees were not intent on choosing proven integrity and best practices in terms of the right source, quality, prices, quantity and time. They encouraged air supply, shoddy work and overpricing of goods and services among other evils. Besides, politicians competed with and had an unfair edge over the ordinary business people. Following the outcry over related evils, the government made reforms in 2003 to replace the tender boards made of politicians with contracts committees made of civil servants/technocrats. The committees evaluate bids, procurement methods, documents and amendments to contracts. They are also supposed to ensure compliance with the laid down regulations.
While accounting officers and technical personnel ensure availability of funds and execution of the contracts, press clubs have resolved to closely monitor compliance with terms of reference, right from advertising the tenders and contracts, execution of the contracts/works, the quality and quantity of goods and services supplied and compliance with the specified time of contracts. The common area of suspicion is routine roads maintenance. Some politicians form companies with quasi partners and virtually do no work on the sections allocated to them but the engineers will purport to have inspected the sections and certify as satisfactory work done thereby recommending payments. Alternatively, connivance is made with storekeepers to indicate in the stock books that quantities and qualities recommended in the contracts of goods have been supplied and delivered thus suppliers ready for payments. Legal experts are also paid hefty sums of retainer fees for advisory for contracts that more often than not backfire leading to compensations arising out of breaches. Through organizing and conducting public- media dialogues, the stake holders are brought together with public servants to brainstorm and point out the weaknesses and strengths in adherence to procedures. Radio talk shows are organized to stimulate debate from the public about how they view works executed and services provided in their respective areas. A website for press clubs and their activities is being designed whereby a number of analytical articles pointing out shoddy works and commending best practices highlighting success stories will be accommodated. In playing such a watch dog role, journalists meet a number of challenges especially to do with the ownership of the media houses. While it is true that over 120 FM radio stations have been licensed and newspapers are mushrooming, several journalists, editors and presenters have to tow the line of the owners. Journalists fear to point out failures of the local governments where they are located for fear of being at loggerheads with potential advertisers, let alone losing their jobs. As if this is not limiting enough, business matters or economic news rarely find space or air time on prominent pages or programs. They are relegated to the inside pages or announced at odd times of the day with unpredictable audience.
Press clubs in collaboration with development partners ought to start their own community radio stations (media houses), newsletters and online magazines among others to enable them freely contribute well researched topical issues with a view to influencing policy and decisions that favor a fair business environment.By Jossy Muhangi Journalist - Uganda
article published by the African Executive in September 2007
-
Journalists organized in regional press clubs can go beyond playing a fire brigade role. Besides the traditional roles of covering events, crises, disasters and conflicts, practicing journalists in Uganda are playing a more watch dog role of promoting Transparency, Accountability and rule of law as corner stones of good governance.
One major sensitive area is the Public procurement and disposal of public goods, services and works. They are also setting the agenda on topical issues that impact on people’s lives by involving a wider public to participate in the debate, and monitoring the allocation and use of resources.
Members of Ten press regional clubs scattered around the country have realized through research and documentation that procedures in procurement and disposal of public goods and services impact on creation of a sound business environment in the country, promote efficiency and transparency. Before 1994 decentralization reforms, procurement of public goods and services was based on a centralized “system with central tender board" under the Ministry of Finance being in pole position. With de-concentration of powers and increase in government entities, it became inevitable that even the procurement role be decentralized thereby empowering lower entities to plan and execute their own programs.
In the case of Uganda, district tender boards were created but mostly comprised political appointees as members. Elected political bosses took advantage of this to reward their cronies and supporters with such positions to the statutory bodies and commission, contrary to laid down procedures. Such committees were not intent on choosing proven integrity and best practices in terms of the right source, quality, prices, quantity and time. They encouraged air supply, shoddy work and overpricing of goods and services among other evils. Besides, politicians competed with and had an unfair edge over the ordinary business people. Following the outcry over related evils, the government made reforms in 2003 to replace the tender boards made of politicians with contracts committees made of civil servants/technocrats. The committees evaluate bids, procurement methods, documents and amendments to contracts. They are also supposed to ensure compliance with the laid down regulations.
While accounting officers and technical personnel ensure availability of funds and execution of the contracts, press clubs have resolved to closely monitor compliance with terms of reference, right from advertising the tenders and contracts, execution of the contracts/works, the quality and quantity of goods and services supplied and compliance with the specified time of contracts. The common area of suspicion is routine roads maintenance. Some politicians form companies with quasi partners and virtually do no work on the sections allocated to them but the engineers will purport to have inspected the sections and certify as satisfactory work done thereby recommending payments. Alternatively, connivance is made with storekeepers to indicate in the stock books that quantities and qualities recommended in the contracts of goods have been supplied and delivered thus suppliers ready for payments. Legal experts are also paid hefty sums of retainer fees for advisory for contracts that more often than not backfire leading to compensations arising out of breaches. Through organizing and conducting public- media dialogues, the stake holders are brought together with public servants to brainstorm and point out the weaknesses and strengths in adherence to procedures. Radio talk shows are organized to stimulate debate from the public about how they view works executed and services provided in their respective areas. A website for press clubs and their activities is being designed whereby a number of analytical articles pointing out shoddy works and commending best practices highlighting success stories will be accommodated. In playing such a watch dog role, journalists meet a number of challenges especially to do with the ownership of the media houses. While it is true that over 120 FM radio stations have been licensed and newspapers are mushrooming, several journalists, editors and presenters have to tow the line of the owners. Journalists fear to point out failures of the local governments where they are located for fear of being at loggerheads with potential advertisers, let alone losing their jobs. As if this is not limiting enough, business matters or economic news rarely find space or air time on prominent pages or programs. They are relegated to the inside pages or announced at odd times of the day with unpredictable audience.
Press clubs in collaboration with development partners ought to start their own community radio stations (media houses), newsletters and online magazines among others to enable them freely contribute well researched topical issues with a view to influencing policy and decisions that favor a fair business environment.By Jossy Muhangi Journalist - Uganda
article published by the African Executive in September 2007
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