Chalabesa

Chalabesa Rural Health Centre

Chalabesa Mission Rural Health Centre
PO Box 450 147
Mpika, Zambia

1. General informations

1.1. Background

The health centre is managed, since its opening in 1983, by the Little Servants of Mary Immaculate, popular known as the “Blue Nuns”.

1.2. Place

The centre is situated at Chalabesa St. Joseph’s Parish, which was opened in 1934 by the White Fathers. It is 100 km from Mpika, in the north-western part of Mpika District: the mission is 31 km from the Mpika-Kasama road (tarmac road). The track to reach the mission has been recently renewed.

1.3. Hospital of reference

Mpika District Hospital (1st level hospital). Chalabesa is a referal centre for other small Rural Health Centres.

1.4. Catchment

around 15 750 people, in 44 villages.

1.5. Posts/Out-centres

9 (in 2001, 6 were visited by Chalabesa, and the 3 others by the District).

In 2002, Chalabesa has to visit 8 centres

• Chapoko
• Chikakala
• John
• Chibeleta
• Kawama
• Washeni
• Andrea
• Munikashi
• Mikuba

1.6. Managment

Meetings

• RHC Board : monthly meetings, with the qualified members of staff
• CDEs’s meetings : monthly meetings
• Health Neighborhood meetings : monthly meetings with the Community Health workers and some members of the RHC staff (Sister-in-charge, CO, EHT and representative of the CDEs)

Administration: Sister Regina Tembo, the sister-in-charge, is responsible for the administration.

2. Buildings

2.1.The centre

Description (cfr plan): 3 separate wings (OPD, In patient wing – including maternity block – and services’s wing)

• 3 male wards with 4 beds
• 1 female ward with 10 beds
• 1 children ward with 10 beds
• isolation block with 6 beds
• maternity & labour room: 2 beds for labour, 1 bed for post natal, 5 beds for ante-natal and 6 beds for post natal.

Total number of beds is 52 of which 35 beds are approved.

Remarks: the RHC is quite big and well maintained. They try not to accept too many patients due to shortage of qualified staff and lack of money for running costs.

2.2. Facilities, equipment…

Electricity: The centre has solar modules (light is available night & day). the system works without problems.

Water: The water supply is good. Two new tanks have been recently installed by the diocese. Old pipes, leaking toilets, cisterns have been replaced with new ones.

Quality of the water : the water needs to be boiled. The centre has no hot water: it would be needed in the kitchen, the laundry and the maternity ward. For the time being they boil water in the kitchen and in the laundry.

Communication: The RHC has radio communication, every day, with the diocese and the others missions.

2.3. Staff Accomodation

There are 5 Staff houses (3 were built in 1983 and 2 in 1993): 2 are for the Clinical Officers, 1 is for the EHT and the 2 others are for nurses (currently only one house is occupied due to the shortage of nurses).

Convent: 3 sisters are living there for the moment.

2.4. Shelters for relatives

There is one shelter (with 2 rooms) for relatives, just outside the RHC’s fence, next to the EHT’s office.

3. Staff

NB : the staff is quite new (Sr. Regina Tembo came only in June 2000)

3.1. In the centre

Current Staffing (2001)

• 1x Sister-in-Charge, she is a ZEM (Zambia Enrolled Midwife)
• No Medical Officer for the time being
• 2x Clinical Officer
• 1x EHT (Environmental Health Technician)
• 2x Nurses, ZEN (Zambia Enrolled Nurses)
• 7x CDEs (Commisioned Daily Employees), i.e. non-professional staff, such as cleaners, cooks etc.
• 3x dressers

That is a total of 16 staff members for 35 approved beds.

3.2. Neighborhgood health committees, CHWs (Community Health Workers) and TBAs (Traditional Birth Attendants)

There are 9 CHWs and 5 TBAs. Some of them are not really active, so the RHC would like to replace some of them and train more, but there is no money for training.

4. Hospital Activities

4.1. Curative Activities

A. Out Patient Department (the responsible is a clinical officer)

Opening hours:

• Morning : 8h00 – 12h00
• Afternoon : 14h00 – 16h00
• Saturday : 8h00 – 12h00
• Closed on Sundays

OPD Attendance in 2001

• Total OPD attendance = 9337
• OPD attendance daily average = 25,6
• Referrals were 27
• Deaths in 2001 = 23

B. In Patient Department (IPD)

IPD Attendance in 2001

• 694 Patients admitted
• In-Patients Days = 3044
• In-Patients daily average = 8,2
• Occupancy rate (on approved beds) = 23 %
• Length of stay per admission = 4,25 days per patient

C. Maternity

Admissions for obstetrical reasons

Deliveries = 145

4.2. Preventive & Promotive Services

Children’s clinics (UCI, growth monitoring, health education, cooking demonstration). The mothers come with their children once a month:

• at the centre : every Friday
• in the out-centres : once a month

Ante natal care	twice a week in the centre (every Monday : booking & first attendance ; every Thursday : for re-attendance)
Post natal care	some are coming after one week, some don’t come (after a delivery, the mother stays at least one day, then she has 7 days to come back and check if everything is all right. After, they should normally come again in the 6 weeks, but they often don’t come). Therefore, post natal care is often provided during the children’s clinics.
Home based care & HIV/AIDS programs	the EHT and Sister Juliet are responsible for these programs.
Scientific natural family planning	the programme has just started with one of the dresser: it will take place once a week (every Monday afternoon : new couples came in the beginning of December 2001 for registration so the new program will start in 2002.

NB: All these activities are free of charges
Contribution of the community:

• TBAs conduct deliveries in villages.
• CHWs give the primary health care in the small centres (every month they receive a drug kit, when they go to the centre to report about their activities)
• Volunteers will be trained for Home Based Care

4.3. Supportive medical services

Laboratory & Blood transfusions
The laboratory had to be closed as the dresser who was trained as laboratory assistant left the RHC. They try to define the disease by analysing the symptoms, otherwise they have to send the patient to Mpika District Hospital.

pharmacy & drugs
From the District : Chalabesa receives 1 drug kit per month, which is not at all enough (only the chloroquine is enough).
From donors: for extra drugs, Chalabesa receives some upplies from one english organisation and from Action-Medeor in Germany.

4.4. Non-medical support activities

Kitchen & catering
The centre provides 2 meals per day. This new measure started a few months ago. When it is possible (financially) they offer 3 meal per day. The RHC has a vegetable garden and a maize field. In 2002, they will extend the vegetable garden, a beans field, a fishpound.

Laundry & domestic
The equipment is sufficiantt (hot water, however, would be needed)

Transport
The centre has 1 car (Toyota Land Cruiser, 7 years old) and bicycles. The car is used for preventive and curative care : each out-centre is visited once a month.

6.1. Income & Expenditure – 2001

6.2. Explanations

Salaries
At the end of the year 2001, the CDEs were still not yet on the governmental payroll.

From the district
Running costs : they were used to receive K 995 000 per month but is has been reduced to K 945 000 since March 2001. In January 2002 the running costs were increased to K 1,039,500. The District doesn’t want to help for the car maintenance.

Patient fees

• OPD (under five & above 65) = free of charge
• OPD (above five) = ZMK 750.00 once
• Admission (above five) = ZMK 2000.00 once
• Maternity= free of charge

NB: These prices will be reduced in 2002, so everybody will be able to pay (they want to discourage people to pay the fees in kind).

Donations in kind
The RHC receives some drugs from England (via ECHO), Drugs (donations from abroad, through the Diocese)

Income generating projects:

• In January 2001 K 775,000 was raised from the sales of finger millet (given by the community)
• In 2001, they harvested 3 bags of beans of 90 kg each
• In January 2002 K 2,457,800 was raised from the sales of the finger millet (given by the community).
• The building of the piggery should be finished in March 2002 : the RHC will have 3 pigs.

7. Planning for the future

• They have some facilities compare to other centres : the centre is big enough, the solar electricity is
• they would like to improve the out-reach activities and the in-patient department but the main problem is the lack of medical staff
• they plan more income generating projects.