DIOCESE OF MAHENGE: ST FRANCIS HOSPITAL IFAKARA

Background Information/Situation Analysis

Tanzania with an area of 945,087 square Kilometers assumes its present form in 1964 after a merger between the mainland Tanganyika and the islands of Zanzibar. The population in Tanzania is about 35 million. The economy of the Country depends mainly on the sale of raw products, main exports being Sisal, Clove, Cotton, Tobacco and Minerals. The average annual income is US Dollars 260, per person, the GNP is US Dollars 180. The inflation rate is 40%. Life expectancy is 51 years for men and 53 years for women.

Literacy wise Tanzania though a poor country, provides environment where virtually every child of school age goes to Primary School. Primary education comprises of 1 year in the Kindergarten School and 7 years in basic primary education. Training facilities in the rural areas are primitive less so in urban areas. Generally literacy is high. Instruction is in Swahili, which is the national language, and English, the second language. What happens after Primary School is very much dependent on the family fortunes and high level education is only a distant possibility. This is due to the fact that High learning Institutions are few and often located in urban areas where poor families have less access. The literacy ration (1995 test) is 79.4% for male and 56.8% for female. This indicates that female members are underprivileged compared to male members.

The health care delivery system in Tanzania is such that there are primary health care facilities (Dispensaries and Health Center) which refer patients to District Hospital and District Hospital refer patients to Regional Hospitals or to Referral Hospitals (only 4 in the whole country). The role of District Hospitals as the first referral center is vital. In some districts (currently 19) the government has agreements with mission Hospitals to function as District Hospitals.

a. St. Francis Designated District Hospital.

St. Francis Designated District Hospital is the Diocese of Mahenge owned Hospital that functions as a District Hospital for Kilombero District since 1976. As a District Hospital it serves a population of about 254,000. However, the Hospital serves patients in Kilimbero District and Ulanga District which together from administrative territory of Mahenge Diocese. The two Districts together have a population of nearly 500,000.

Ifakara lies on the latitude 8 degree South. The vicinity of the Equator and its low altitude ( 280mm above sea level) give it an extremely tropical climate. The two Districts are potentially agriculturally productive. During the dry season, humidity is low. During the rainy season, it is high, and large areas of the valley are flooded. Such a damp climate provides an excellent breeding-ground for tropical diseases germs and their carries.

History

The hospital was started in 1927 s a dispensary by Baldegg Sisters. In 1930 a 30 bed hospital was build. The first Medical Officer came to Ifakara in 1951. The main buildings were built in the late fifties. Other buildings were constructed: 1963 – TB ward, 1969 OPD, 1974 operating theatre, 1977 labour ward and 1982 the laboratory.

Currently the hospital has developed into a 371 bedded hospital with well-developed Surgical Department, Obstetric and Gynecology Department, Dental Unit, Ophthalmology, Medical Department, Pediatric Department, TB and Leprosy, community Health Department, Maintenance Unit and Administration Department. The Hospital is involved in training of Medical students and Nurses (upgrading course). There are 2 outreach services conducted weekly by the community Health Department of the Hospital, which aims at imparting promotive and preventive health services to mothers, children and the community at large. The hospital attends an average of 500,000 patients a year.

District Designated Hospital for Kilombero

As a Designated District Hospital for Kilombero, St. Francis Hospital operates according to guidelines of the Ministry of Health. The treatment guidelines and the essential drug list in use at the hospital are those endorsed by the Ministry of Health. However, the hospital with 369 employees falls short of over 250 employees when compared to the establishment (see comparison in appendix 11). The shortage is mainly felt on the Nursing cadre, a cadre that is in close contact with patients.

The Funding The main source of funding for the hospital is the government, which pays for basic salary of employees and contributes 56% of costs for drugs and pharmaceuticals used. Cost sharing collections (user fees) amounts to 125,000 a year, which is about 15% of the budget. Some amount, which has significant impact, comes form donations that the hospital receives from the local community and abroad. The financial accounts of the hospital are audited annually per government and Diocese regulation.

b. Function and importance of St. Francis Designated District Hospital.

Designation of the hospital since 1976 brought in the feature of free treatment to the community which had been the National policy till 1993. More patients came to the hospital than at the time when it was only functioning as a Missionary hospital. Today the main functions of the hospital may be summed up as:

Ø District Hospital: Referral point and resourceful place for Kilombero District and Ulanga with facilities to accommodate patients, children nd expectant mothers. A refuge for disease outbreaks and catastrophes occurring in the area.

Ø Training center: It is a training hospital for Clinical Officers, General Nurses doing upgrading. The hospital also offers environment for Research activities run by the nearby Ifakara Health Research Development Center and other authorized Research.

Ø Supervision: St. Francis Hospital is a supervision unit of the 20 peripheral dispensaries (medical out stations) of the Diocese of Mahenge. a doctor visits these at regular interval in order to give professional advice to clinic personnel, to help overcome inadequacies and to get feedback for improvement of hospital referral services.