St. Joseph’s is considered to be one of the bigger regional hospitals. It is a “private” hospital which means that it levies a charge for all services. Given that the salary costs are fully covered by the government of Malawi and the anti-retroviral medicine is provided free through the government, it means these charges cover other drugs, supplies and operating costs. This still imposes a considerable financial burden on the patient and St. Joseph’s indeed does not collect all that it charges due to thepoverty of the people it serves. Without the charges, however, it could not survive financially. The operating picture of St. Joseph’s is as follows:
Catchment Area
The total population of the hospital’s official catchment area with a size 184 sq km is estimated at 56,275 people (2009 census). This population consists of approx. 10,515 households divided over 119 villages within an average radius of 10 km from the hospital. The population density is one of the highest densities in rural Malawi and has a strong mixture of tribes.
The Community
The lifestyle is based on subsistence farming. Only a minority of the population has a paying job but even they are engaged in agriculture to produce their own food due to low wages. The main crops grown are maize, cassava, groundnuts and rice. Other crops are vegetables like tomatoes and cabbage and fruits like bananas and mangoes.
The area is prone to drought and there is very little water conservation. The water supply from the Blantyre Water Board is very unreliable and pump water from boreholes is limited due to very poor pumping equipment. As a result, there is no readily available source of water. Similarly, the supply of electricity is also unreliable and there are frequent blackouts. The sewage system is by way of septic tanks but the system is very old and in need of rehabilitation.
Malawi’s social indicators and health indicators are amongst the world’s worst. The health burden of the HIV/AIDS pandemic is enormous and is one of the leading causes of death in the most productive age group (20 to 48 years).
St. Joseph’s Operations
· Staffing levels @ 85% of approved 227 positions
· Staff vacancies @ 44% for nurses and 35% for clinicians and other HPs – lab tech, pharm and rad)
· BUT spending is @ 105% budget > budget based on prior actuals vs approved positions
o 2004 9,774
o 2005 11,640
o 2006 15,311
o 2007 16,839
o 2008 17,657
o 2009 18,570
· Diagnoses
o Malaria 24%
o Respiratory 16%
o HIV/AIDS 7%
o Trauma 6%
· Note diarrhoreal and malnutrition have been reduced due to improved water and sanitation and improved food security
· In-Patient admissions
o 2004 3,330
o 2005 5,560
o 2006 6,216
o 2007 6.975
o 2008 7,640
o 2009 8,285
· Diagnoses
o Malaria 42%
o Other non-communicable diseases 29%
§ eg. Asthma, epilepsy, sepsis
o Pneumonia 8%
o Trauma 5%
o TB 3%
· 2009-10 In-Patient Metrics
In-patients | # Beds | # Admission | Nursing Days | % Occ | ALOS | Deaths | Death Rate per 1000 |
Female | 33 | 1,485 | 4,675 | 38.81% | 3.15 | 40 | 26.94 |
Male | 36 | 1,641 | 5,133 | 39.06% | 3.13 | 53 | 32.30 |
Pediatric | 56 | 2,781 | 8,642 | 42.28% | 3.11 | 55 | 19.78 |
TB | 34 | 218 | 2,450 | 19.74% | 11.24 | 9 | 41.28 |
Maternity | 37 | 2,111 | 6,145 | 45.50% | 2.91 | 1 | 0.47 |
Nursery | 4 | 49 | 31 | 2.12% | 0.63 | 2 | 40.82 |
200 | 8,285 | 27,076 | 37.09% | 3.27 | 160 | 19.31 |
· Preventative Health Care Service: Primary Health Care Program
Also of note is the growing Preventative Health Care Service: Primary Health Care Program. The core of the program is the Health Surveillance Assistant and there are 36 of these people. They are trained by the District Health Office but are linked to the St. Joseph’s Primary Health Care Team comprised of 4 community health nurses. The focus is on behavior change, early detection of infectious disease, immunization, pregnancy detection and home based care.
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