The health facility was in a deplorable state – poor infrastructure, including the sanitation facilities, understaffing, equipment of sub-standard quality equipment. One stark challenge was one toilet being shared by both female and male patients and staff.
But citizens engagement in county governance processes has changed the situation of Mogotio Level Four Hospital, located in Soin Ward, Rongai sub-county, Nakuru County. Uraia Trust, through its Implementing Partner, Centre for Transformational Leadership (CTL), supported citizens to influence service delivery in the county.
A community scorecard was undertaken in November, 2015, which highlighted the challenges the facility faced. At the time of the initial scorecard, the facility had one toilet.
“Patients and staff, both male and female, were using an old single door toilet. It was more difficult for PWDs because the block had no ramp to allow access. When got trained and held the first community meeting, facility users prioritized this issue and emphasized to during the dialogue we had with duty bearers. We are happy that the department of health acted on our feedback,” Julius Sunguli, a member of the scorecard committee says.
By the time the second scorecard process was completed, the county department had constructed a new sanitation block with three toilet blocks, one for male patients, another for female patients and one for staff. The block is fitted with ramps and wide doors to facilitate PWDs access. These changes have enhanced citizen access to sanitation facilities at the hospital as well as health services for PWDs who in the past, had to go back home to access sanitation facilities.
“Kutengezwa kwa hii choo imetusaidia sisi walemavu sana kwa sababu wale ambao wanatumia wheelchairs hawangeweza kutumia ile choo ilikua inatumaka hapa. Wakati mwingi wakija hospitalini na wahitaji kuenda msalani, ilibidi warudi nyumbani na mara nyingi inakua ngumu kurudi hospitali tena. Njambo ambalo lilikuwa linatukera sisi walemavu kiasi kwambo wengi wetu walionelea ni vema kusafiri mbali wanapohitaji matibabu kuliko kuja hapa,” Evelyn Auma, a PWD facility user says.
In 2015, the facility was being served by one medical superintendent, two pharmacists, two clinical officers, one dentist and nine nurses. In a facility that serves about 80 patients on a normal day and up to 150 patients on clinic days, the staff on duty would get overwhelmed and their morale to work would be low.
According to the Medical Superintendent, Dr. Lilian Mureithi, it was a challenge to allow staff, particularly in the pharmacy where one would work during the day and another at night, to go on leave because of the gap that this would create in the Facility.
Since the initial scorecard, there had been notable improvement in staffing levels. Currently, the facility is served by four clinical officers, one administrator and 13 nurses. The medical superintendent who had been posted in the Facility has been transferred but there are plans to deploy someone else.
As a result of these staffing changes, there is increased efficiency in delivery of services at the facility as patients spend less time on the queue waiting to be served. Facility staff are now handling fewer patients and are therefore not straining much during service delivery. This has improved their morale to work in the facility.
Previously, the facility had nine beds and an obsolete dental chair. The facility had an old stretcher and did not have a wheel chair, as such patients who could not walk to the ward would be carried by staff to the wards.
Though the facility had a dentist, it could only refer patients to county referral hospital because the dental chair was obsolete and could not be used for dental services. Due to the few beds in the facility, patients, particularly those in the maternity ward, had to share beds. Presently, the facility has a new dental chair and is offering dental services, citizens are no longer being referred to county referral facilities to access such services.
Further, with the new wheelchair, moving patients who are in critical condition to wards from the admission block has become easier for facility staff. The facility also got four beds added to the maternity and now has 13 beds. This has helped ease the sharing of beds in the maternity ward. The county government’s department of health has undertaken renovation works that included painting and fitting of new ceiling boards in the facility.