Problem Assessment: Crude mortality rate was 0.1/1000/month (Std < 0.75), while Under-five mortality rate was 0.2/1000/month (Std <1.5). 22% of OPD attendants were nationals. Malaria accounts for 38% of the OPD cases and 21% of deaths reported. This is due to low malaria prevention awareness, low mosquito nets coverage and high vector density. Immunization coverage was 90% in SW due to inadequate staffing, vaccine shortages, limited transport for outreaches, and low immunization and high mobility. Infrastructure is a challenge with a gap of 9 temporary health facilities and 1 medical store, 135 housing units, 15 incinerator, 7 pit latrines, 11 fencing. Staff reside in tents or share which contribute high turnover. The patient/clinician/day is higher than recommended (58) due to staff turnover, failure to attract skilled workers due to low pay, poor living and working conditions and remoteness. Some staff have inadequate skills to deliver high quality health services and hence require capacity building. Bed occupancy rate is highest in Rwamwanja and Kyaka II due to inadequate space and beds. The VHTs exists in SW however, community disease prevention activities such as health education, case finding and referrals is inadequate due to low motivation which overwhelm the health facilities. Threat of communicable diseases and outbreaks due to continuous flow of new refugees. Non-communicable disease response is slowed by lack of skills, equipment and medicines. The referral system is functional however, there is need to replace the old ambulances. Referral sites lack of specialized staff, equipment, medicines and supplies that increases referral costs to more distant referral centers including blood. Feedback mechanism is through HUMC, dialogues, participatory assessments, coordination meetings.
Comprehensive response: Quality comprehensive primary health care at facility and community levels. Quality will be emphasized with appropriate infrastructure, essential quality medicines and diagnostic services, adherence to rational prescription strategies for retention of quality trained staff and standard clinical protocols. 9 temporary health facilities and 1 medical store, 135 housing units, 15 incinerator, 7 pit latrines, 11 fencing, 4 isolation wards, 1 post-operative ward, 4 OPD clinics, 7 pit latrines and 8 placenta pits. Expansion of 2 maternity wards and assorted equipment and logistics. Strengthen VHT system through training, performance-based incentives and equipping VHTs to perform their roles. Procure 1000 VHT kits, 1000 stretchers for community referrals, and 22 motor bikes. Procure 10 ambulances and 25 tricycle ambulances and functionalize 4 HC IVs with capacity for blood transfusion and Surgery with support to referral hospitals and 1 regional hostel. Medicines, commodities and medical equipment procurement, training of health workers and VHTs in the relevant areas of their work, focus on EPI, IMCI, implement the Non-communicable diseases strategy, Epidemic Preparedness and Response Plan and Malaria prevention and response implementation. MOH, UNICEF, WHO, UNFPA will support the response.
Prioritized response: Comprehensive Primary health care including mental health, with adequate motivated qualified and trained staff, equipped facilities, and adequate medicines and supplies. Focus on EPI, IMCI and community-based health activities, prevention and promotive health and surveillance with a strengthened VHT network and outreaches. New arrival medical services through screening, vaccinations, first aid. Update and implement EPR for each settlement. For secondary health care, functionalize 4 HC IVs within the settlements with capacity for blood transfusion and Surgical operations and continued support to the district referral hospitals through ReHoPE. Procure 10 Ambulances and 22 motorcycles. Construction of 9 semi-permanent, malaria prevention and response interventions – including SMART malaria initiatives.