Introduction

Administratively Iganga District Health sector is divided into 4 Health sub-district (Bugweri, Kigulu North, Kigulu South and Iganga Municipality. It has 58 health centres both public and Private not for Profit. These are almost evenly distributed with a health centre in a parish although about 20 parishes still lack health centres. There is 1 general Hospital, 2 HC IVs, 15 HC IIIs and 40 HC IIs. These HCs form the base from which the population access health services. There is some degree of poverty. Iganga District has made some improvements in delivery of health services in the year. However, there are still many barriers to uptake of health services mainly on demand side (decision making inability of women/low male involvement, Poverty, ignorance, Lack of transport) but also the supply side like the poor attitude of health workers, inadequate staff, inadequate supplies, accommodation, and poor infrastructure amongst others. Health is a right and everybody should have unhindered access to health care. That is why Iganga District has been providing services to community at no cost as much as possible.

The health of people is the greatest ingredient to catalyze economic progression and development. Whenever people are healthy, then they are able to work and stimulate development. The main focus in health sector in Iganga District has been on prevention of diseases and then treating patients. Borrowing from the National Health policy, the Primary Health Care approach has been deployed in order to stimulate community-based efforts for health promotion and disease prevention. Planning hinges on provisions of the National Development Plan, the National Health Policy and the Health Sector Strategic Plan. Attempts have been made towards provision of a Minimum Health Care Package free of charge in public health facilities.

Progress With Addressing The Disease Burden

           (A) Morbidity

Outpatient top 5 causes of morbidity among the under five:

	Disease/condition	(New cases) Contact	%'ge
1	No pneumonia – cough or cold	165,858	46.6
2	Malaria	103,285	29
3	Diarrhoea – acute	13,447	3.8
4	Intestinal worms	9823	2.8
5	Skin conditions	6605	1.9

Outpatient top 10 causes of morbidity among the above five:

	Disease/condition	(New cases) Contact	%'ge
1	Malaria	188,829	38
2	No pneumonia – cough or cold	106,015	21
3	Pelvic Inflammatory Diseases	17,221	3.5
4	Gastro-intestinal disorders (non-infective)	14,227	3.1
5	Tooth Extraction	12,250	2.5

           (B) Mortality

Infant mortality rate (IMR) = 75/1000 live births (source: DSS)
Under 5 year's mortality rate – 91/1000 live births (source: DSS)
Maternal mortality rate 421/100,000 live births (HMIS)

Top 5 causes of mortality for children under 5 years

	Disease/condition	No. new cases	No. of Deaths	Case fatality rate
1	Neonatal Tetanus	3	1	33
2	UTI	7	2	28.6
3	Tetanus over 28 days	4	1	25
4	Perinatal conditions	70	14	20
5	Neonatal septicemia	272	32	11.6

Top 5 causes of mortality for persons 5 years and older

	Disease/condition	No. new cases	No. of Deaths	Case fatality rate
1	Malaria	8	3	37.5
2	HIV / AIDS	32	6	18.8
3	T.B	146	19	13
4	Anaemia	276	24	8.7
5	Peritonitis	89	8	8.4

IMPLEMENTED ACTIVITIES IN THE YEAR UNDER REVIEW

          Sanitation:

The strategy has been mobilization of the population to voluntarily appreciate the requirement to have and use pit-latrines and also have drying racks in homes. Where people have failed to observe these homestead requirements, then we have resorted to enforcement using the law. The latrine coverage has therefore improved from 73% to 75% and hand washing has improved from 25% to 30%. The district has executed Home and Village Improvement Campaigns with good effect in improving latrine coverage. We have reactivated sanitation committees for public latrines wherever they exist in the district to maintain them clean and usable. 

We have done community awareness creation on general sanitation through community sensitization meetings at every parish, and also held sanitation and advocacy meetings for all leaders at district and sub-county levels. The hope has been that all the leaders shall participate in sanitation campaigns and ensure total sanitation in their areas of jurisdiction. As for sanitation in schools, the situation is still wanting because the pupil to stance ratio is 106:1 instead of the ideal 30:1; however concerted effort is being made to have the education sector to do the needful. The Community Self Driven NBS clubs, the Uganda Village Health Project, UNICEF and Water Mission have been handy partners and have greatly assisted in the improvement of sanitation in the District

          Immunization:

There have been tremendous successes scored in improving immunization in the year. The district is now in category one of immunization performance. 90% of eligible children have been able to complete immunization. Leaders at all levels and parents have been instrumental in this success together with partners like AFENET and MCSP, WHO, UNICEF, GAVI, SDS, UNEPI and others. The challenges that remain are difficulties in transporting health workers to implement out-reach activities.

          Key Achievements Include: :

1.   We have made COARTEM universally available free of charge in all public health facilities and some schools
2.   We have continued to educate the masses via radio and community meetings on measures to prevent mosquito bites especially now that we have supplied insect-side treated mosquito nets just a few years ago.

         Nutrition

Nutrition status of the population in Iganga especially children and women is poor resulting into major health problems. Many children are reporting to healthy facilities with severe malnutrition and many are dying. With support from UNICEF in the Child Health Days programme, we have been conducting nutrition assessments in all health centres to screen malnourished children and adults. Advocacy for micronutrient fortified foods like RUTF has been carried out using mass media nationally and at district level with support from UNICEF and SDS/RECO. Bi-annual Vitamin A Supplementation was carried out in the district and has helped to supplement on vitamin A.

         Accessibility To Health Services

Efforts to construct and improve health facilities have been undertaken at district and sub-county levels.

In the financial year 2014/15, funds were provided for completion of ward at Namungalwe, Completion of OPD at Minani. The completed health facilities at Kasozi in Makuutu Sub-County and Nawangisa in Namalemba Sub-county are pending approval of Ministry of Health to supply them with drugs but the district has provided staff and enabled them take off in serving the population. 

At sub-county level, efforts were made to address health services accessibility issues especially in a number of sub-counties and we appreciate those sub-counties that prioritize health of the population.

Works on renovating Iganga Hospital are nearing completion under the Uganda Health Systems Strengthening Project. However the renovation is going to cover some areas while others like the wards will remain un-catered for.

Needless to mention, the demand for health centers, staff housing, wards, and renovations is still high and shall continue to be addressed depending on availability of the necessary resources.

         The District Hospital

The hospital registered improvement in services delivery maintaining high levels of drug stocks and a reduction in under table payments. The hospital also continues to be the leading performer of all the hospitals in Uganda. However, some structures in the hospital have served their life spans, are old and need serious renovations which we regret is not going to be addressed in the on-going project! The hospital was rated the best performing general hospital in the country in the financial year.

         Challenges

i)   A big client load in limited space is a big problem. 
ii)   Lack of accommodation for many staff members hampers efficient provision of night duty services.
iii)   Meagre quarterly provision of funds is inadequate and not sufficient to offset recurrent requirements in addition to servicing the heavy indebtedness for UMEME bills to the tune of shs. 171m and water bills standing at shs.50m currently
iv)   The resources to run the expansion are over stretched

         The HSDs

There are four HSDs
          i)   Kigulu South – Functional through Iganga Hospital 
        ii)  Kigulu North at Bugono HC IV is partially functional due lack of anaesthetist and lack of blood.
      iii) Bugweri at Busesa is equipped and is also partially functional due to lack of anaesthetist.
         iv)   The municipal HSD.

         Lower Level NGOs.

Lower level NGOs are funded by government to participate in the delivery of health services in the district through provision of drugs to the public at subsidized costs in addition to carrying out the out-reach visits and health education. There are 16 NGO health units in Iganga District. The challenges faced by these health units were maintenance and upkeep of their health workers, and difficulties in infrastructure developments. The NGOs also continued to charge some nominal fees which often caused conflicts between them and the communities.

The Iganga/Mayuge/Makerere University Demographic Surveillance Site (DSS)

This project continues to provide the basis for evidence based planning. The routine demographic data continues to be of much significance in the planning for the health services.

         Human Resources For Health

The availability of appropriately trained and well motivated human resource is an important prerequisite for delivery of the National Minimum Health Care package. 

The staffing situation in health facilities has registered marked improvements as we continue to improve on filling the establishment for required health workers. Currently the district staffing level is 85% of available posts filled up however the level for the qualified health workers is 60% filled up.

         Drugs

Drug supply at health facilities has remained inadequate compared to the demand. Funding for drugs has remained constant despite increase in population and disease rates. The drug situation however continues to improve with improvements made in the performance of the National Medical Stores.

         Deliveries In HCs

The need to have deliveries in HCs in order for the deliveries to be conducted by skilled people has been recognized. Few women are delivering under the care of skilled personnel (43%). More women should be mobilized to utilize HCs for deliveries since the government is now providing maama kits to mothers.

         OPD Attendances

This was 100% achievement that all our population was seen in our health centres and served.

         HUMC

The Health Unit Management Committees are available but they seem not to be well versed with the responsibilities on them.

         School Health

Schools have contributed and participated in immunization activities, the management of neglected tropical diseases, management of HIV/AIDS, TB and other common health conditions in communities. Health related challenges in the education sector in the financial year were the imbalances in latrine stances versus UPE enrollments, some schools lacking latrines at all, and the lack of feeding school children in UPE schools.

         Health Education & Promotion

This continues to be a priority area. We maximized the use of available audio and video equipment and use of many other IEC materials.

         Village Health Teams (VHTs)

Five sub-counties now have trained and equipped Village Health Teams doing work in health service delivery at the level of health centre one. The particular sub-counties that are well off in this aspect are: Ibulanku, Nakigo, Nambale, Makuutu and Nawandala. Efforts are on-going courtesy of STAR-EC and the Ministry of Health to have the rest of the sub-counties armed with VHTs.

         HIV / AIDs

The approach to HIV has been maintained as multi-sectoral. The three fronts of the fight against HIV/AIDs have been of; emphasis to prevention programmes, offering care and support for those infected/affected and finally capacity building and recruiting many players in the struggle. The District continued to work with STAR-EC and SDS to increase awareness and distribute the messages of the strategies for prevention of HIV transmission. National Medical Stores maintained the supply of condoms in drug kits and we did not experience any stock-outs of condoms. There however remains a big burden of HIV/AIDS with prevalence standing at 6.7% and unknown incidence rates in the district.

The following NGOs also contributed tremendously to activities towards the control of HIV/AIDS in the district: Integrated Development Activities and Aids Concern (IDAAC), Women Alliance And Children Affairs (WAACHA), Mawagala Aids Care, Reproductive Health-Uganda (Iganga Branch), NACWOLA-Iganga Branch, Red Cross-Iganga Branch, Uganda Women and Youth Development Initiatives (UWYDI), Livelihood Development Initiatives (LIDI)-Uganda, Family Concept, TASO-Jinja

         Key Challenges

i)   Inadiquate funding. 
ii)   Shortage of staff.
iii)   Many incomplete health unit infrastructure initiated by the communities
iv)   Lack of staff uniform (all cadres v)   Lack of transport especially at lower local government health units and the Sub-County health workers

         Priorities For 2016/17

   • To provide quality health services to the people of Iganga District. 
   • To promote health of the people in the district so as to enhance development in the district through health education.
   • Improve management of the health services and units.
   • Get all Health Sub –Districts (HSDs) to full functional capacity.    • Provide drugs and supplies for Kasozi HC II and Nawangisa HC II to make them functional.    • Capacity building through essential trainings    • Completion of health centres and renovation of the existing facilities will be the number one priority under capital development and the following will be considered depending on available funds:
            1.Completion of staff house at Nawandala HC III and general ward at Namungalwe HC III.
            2.Renovation of Iganga Hospital
            3.Construction of pit latrine in Ituba HC II.
            4.Fencing of health centres and survey of health unit land beginning with land at kawete HC II..
            5.Construction of Nawansega HC II
            6.Renovation of Kawete HC II, Busembatya HC III, Nambale HC III and Namungalwe OPD