Administratively, Lira District is divided into 3 constituencies which are equivalent of 3 health Sub Districts one being Urban(Lira Municipal Council) further sub-divided into lower administrative units namely 13 sub-counties and 83 parishes(22 in Urban) and 717 villages (64 in Urban). Overtime, the numbers of districts and lower level administrative units have increased in number with the aim of making administration and delivery of social services easier and closer to the people. This has however placed increased strain on delivery of health services, as numbers of management and administrative units and functions increase.
As a way of improving the efficiency and effectiveness of service delivery, the GoU decentralized delivery of services guided by the Constitution of the Republic of Uganda (1995) and the Local Government Act CAP 243. Both NHP I and II support the decentralization of services to districts and Health Sub-Districts (HSDs). Each level of the decentralized health delivery system has specific roles and responsibilities. With changing leadership and creation of new districts, the district leadership needs to be periodically oriented in the roles and responsibilities. Supervision both from districts to Health Sub-districts and to lower levels is inadequate; inadequate funding and weak logistics management constrain the delivery of quality health services. Over the period of the HS5DP, the sector shall continue reviewing the strategies and adopt the ones that will give optimum outcomes.
Health services coverage
Geographical access to health care has remained stagnant and is limited to about 31.4% of the population living within 5 km radius of health facility). This can affect the health seeking behaviour of mothers who opt for cheaper and dangerous traditional means or self medication purchasing medicines from grocery shops, market stalls or drug shops operated by untrained personnel. Even among these health facilities, many do not provide full range of essential primary health care services. Only 36.8% of the population in sub-counties in Lira District have access to maternity services. Rural communities are particularly affected mainly because the health facilities are mostly located in sub-county headquarters.
Immunisation coverage (DPT3 – 2008/2009) is at 86 % during the review period of Dec. 2009, DPT3 stand at 73% this has remain stagnant in the first two quarters of this financial year (2009/10). This coverage is significantly lower than the target coverage of 90%. Tetanus Toxoid immunisation coverage in pregnant mothers is at 51% while in non-pregnant mothers is at 24%, safe water coverage at 64.4% and latrine coverage is at 72% IN FY 2009/2010, an improvement from 53% in 2008 indicators which are all below national target.
The operations of health services the district is decentralised as required, that is: The HSDs which are mandated with planning, organization, budgeting and management of the health services at their levels (constituency level) and lower health centre levels. HSDs carries an oversight function of overseeing all curative, preventive, promotive and rehabilitative health activities including those carried out by the PNFPs and PFP service providers in the health sub district. The headquarters of an HSD remains a HC IV in Lira District.
Health Centres III, II and Village Health Teams (HC I)
HC IIIs provide basic preventive, promotive and curative care. They also provide support supervision of the community and HC IIs under their jurisdiction. There are provisions for laboratory services for diagnosis, maternity care and first referral cover for the sub-county. The HC IIs provide the first level of interaction between the formal health sector and the communities. HC IIs only provide out patient care, community outreach services and linkages with the Village Health Teams (VHTs). VHTs have been established to facilitate health promotion, service delivery, community participation and empowerment in access to and utilization of health services. The VHTs are responsible for:
• Identifying the community’s health needs and taking appropriate measures;
• Mobilizing community resources and monitoring utilization of all resources for their health;
• Mobilizing communities for health interventions such as immunization, malaria control, sanitation and promoting health seeking behaviour;
• Maintaining a register of members of households and their health status;
• Maintaining birth and death registration; and
• Serving as the first link between the community and formal health providers.
• Community based management of common childhood illnesses including malaria, diarrhoea and pneumonia; and management and distribution of any health commodities availed from time to time.
While VHTs are playing an important role in health care promotion and provision, attrition is quite high among VHTs mainly because of lack of emoluments.
The delivery of health services in Lira District is by both public and private sectors with GoU being the owner of most facilities. Over the past decade, Government has focused on expanding its health infrastructure through construction of health facilities in an effort to bring services closer to the people. The GoU owns about half of the health facilities in Lira, followed by the PNFPs in 2010 as can be seen below. The number of private facilities is unclear but table 4.6.2 below indicates their existence as of 2008
The top ten causes of mobility
The Burden of Diseases in Lira District (HMIS Database December 2009) is due to preventable causes. Malaria still rank first of the top ten causes of morbidity in the district with average in all age groups 30.8% ( the table below illustrate morbidity by age groups in under 5 and 5 years and above) other causes of morbidity includes cough/cold, acute diarrhoea , Intestinal Worm , Pneumonia, Skin diseases ,Eye conditions, Dysentery , Anaemia, and ENT condition, trauma, oral diseases and condition, pelvic inflammatory diseases, Eye condition, Urinary tract Infection and sexually transmitted infections
Apart from the heavy burden of preventable diseases, Lira District is also simultaneously experiencing marked upsurge in the occurrence of non-communicable disease e.g. mental illnesses; however, there is scanty morbidity data on mental disorders.
The majority of Health Unit Management Committees continue to be non-functional, despite the fact that they were formed. There is need to revitalise and train all HUMC for all the health units.
Funding for health services is largely dependent on donors and primary health care grant, with very little contribution from the district. Moreover some Donor projects are closing or have closed their activities, leaving funding gaps
Gender inequalities in Lango sub-region has resulted in lower uptake of health services. In rural setting in Lira District men are decision makers and many mothers will only take children for immunisation when instructed by their spouses. This has led to low Family planning and PMTCT coverage. This has contributed to both a high infant mortality and maternal mortality. Pregnant mother may get ruptured uterus and die because the husband is not available to sanction movement to hospital. This can be seen from Male involvement in going together with their spouses for ANC and HCT services were less than half of pregnant women are accompany by their spouses. Although this has begun to take shape in the district only 62% of HIV+ mothers access PMTCT with their spouses.
Many health programmes in the district have not responded to gender concerns although it’s mainstreamed in all sectors but implementation remains a challenge. As s results there had been low participation of men in immunization and family planning services. Health problems related to gender violence, early age of first sex for girls and early marriages are increasingly notable. The Health Department has trained some health workers in aspects of Sexual & Gender Based Violence (SGBV) in order to equip them with appropriate level of knowledge and awareness of ways in which gender issues affect health. In addition, the community is also being sensitised on this important aspect of service delivery by other partners. Access to health services is open to all without gender bias.
The Uganda national sero-behavioural survey of 2004/2005 indicate the prevalence rate of 8.3% for the mid-North and this is very high compare to the national average of 6.4%., their is need to increase awareness to mitigate the impact of HIV/AIDS and improved on HIV/AIDS services. The HIV/AIDS prevalence among pregnant women currently stands at 7% according to analysis from the district HMIS data (December 2010)
The district has trained a number of health workers on PMTCT, HCT, and ART however there is still need to train more give the staff attrition rate in the district. The district now have 6 ART sites with medicines and supplies to provide ART services and 16(1 HCII, all HC IIIs, HCIVs and Hospital) are now providing PMTCT services.
The district still needs to train more health workers on ARV management, procure more ARVs for the affected population and expand PMTCT services to all HC IIs.
In Lira District, environment plays a big part in determining the health of people. Over 60% of diseases affecting the community are environmental related, for instance gastrointestinal worms which contribute to (5.3 %), Malaria (30.8 %) and Diarrhoea (6.2 %) are linked to poor management of sanitary wastes in both urban and rural settings. Acute Respiratory infection not pneumonia is due to indoor pollution as a results of using solid carbon fuel (firewood) dust, poor ventilations/housing etc.
Low latrine coverage of 62% implies that most of the population disposes feacal matter indiscriminately, leading to contamination of water sources with feacal matter. Also poor drainage has created suitable breeding sites for mosquitoes, leading to high prevalence of malaria in most parts of the district.
Over 35.6% of water sources used by community are not protected and this has led to increased prevalence of water-borne illnesses. However sampled water quality analysed shows that even the water from protected sources get contaminated before it is used at home.
Also food hygiene practices are still very poor among rural communities in Lira District and public eating places. From the above it can be seen that addressing environmental problems will contribute greatly to improved health situation in Lira
As can be seen from the above table, many partners are supporting the district, especially in addressing the humanitarian crisis. However, some of these partners have short life span, restricted support to specific programme areas and locality of interest, leaving gaps in providing other minimum health care package and equity.
Water department supports sanitation improvement activities, that is, construction of latrines in schools, rural growth centres around new water sources only, soft ware (hygiene education, training water user committees Hand washing campaign) remain weak due to capacity. Community Based Services department carries out mobilisation for health programmes; Population Office coordinates HIV/AIDS activities; Education department supports school health programmes.
Maintenance of infrastructures
A good number of health Units have be rehabilitated by this review period. However some health unit’s structures are in a poor state and need rehabilitation.
Government funding has not been adequate during the current planning period; special attention to construction of staff accommodation, maternity wards and the maintenance of existing structures should be made.
-High morbidity and mortality resulting from diseases like malaria, diarrhea, intestinal worms, Respiratory Tract Infections etc.
-Poor domestic hygiene and sanitation.
-Sporadic outbreaks resulting from other diseases.
-Referral system is weak.
-Inadequate facilities for medical waste management at health centres.
-Low utilisation of some health services.
– Lack of life skills by youth
– Few psychosocial support groups
– Few people trained in HIV/AIDS service delivery
– Inadequate CPD (continuous professional Development)
– Inadequate monitoring of nutrition status
– Weak laboratory services (few HRH and capacity gaps in carrying test due to advancement in technology, reagents and equipments)
-Inadequate trained health workers
-Low utilization of health information