Services at Mogotio Sub-County Hospital, in Rongai Sub-County, Nakuru County, three years ago, were poor. The facility was understaffed with only nine nurses and two clinical officers providing medical services to citizens. A borehole at the facility was not functioning because of a failed water pump. In the maternity ward, mothers shared beds, which had torn mosquito nets.
The infrastructure in the facility was deplorable. The facility had one sanitation block shared by staff and patients (both male and female). Ceiling boards were falling apart, and facility users complained of snakes falling into the wards during the hot season. These were among many challenges at the health facility.
Presently, notable changes have been made in the facility, after citizens and service providers dialogued over these challenges using a community scorecard. In 2015 and 2017, Centre for Transformational Leadership (CTL)- an Uraia Trust Implementing Partner – worked with a team of 30 facility users to monitor service delivery. Ten community leaders were taken through a training on the community scorecard methodology. The community leaders went ahead to constitute a 30-member accountability cell that brought together service users from Soin and Visoi Wards. The accountability cell members volunteered their time and prepared a Community Scorecard (that highlighted service delivery gaps in the facility.
Among issues raised was the beds available in the maternity wing are also not Persons With Disability (PWDs)-friendly. It makes it difficult for patients with living with disabilities to access maternity services in the facility. As a result, PWDs were referred to Nakuru Level 5 Hospital. Mosquito nets in the maternity wards are torn and are not treated regularly, a problem that exposes newborns and mothers to mosquito bites and risks contracting malaria.
CTL also worked with the service providers to develop a service provider scorecard, in which service providers raised challenges including lack of power backup and inadequate staffing and clean water supply.
An interface meeting held in February 2018, provided a platform for duty bearers, service providers at the facility level and facility users to interact, share feedback and dialogue about the state of service delivery in the facility based on their respective scorecards. During the interface meeting, duty bearers committed to address an array of issues, including delays in delivery of essential drugs in the facility, supply of water in the facility, security of the facility and equipping and staffing concerns.
As a result of the service monitoring process, the facility has registered notable improvements. Security has been enhanced in the facility through installation of a gate that is manned by security guards and a security grill at the ward entrance. Construction of a perimeter wall is in progress and a new water pump has been installed in the borehole that had not been functioning. Renovation works to fix the falling ceiling boards and roofing of the wards has been done and a new 3-door sanitation block has been constructed in the facility. The facility acquired a new ultra-modern dental chair and four hospital beds have been added to wards in the facility. The worn-out mosquito nets in the wards have been replaced with new ones and the facility has been fitted with new curtains. Mobility of patients has been enhanced with the purchase of a new wheelchair. There have been improvements in staffing as well and currently, the facility is being served by four clinical officers and 14 nurses, up from two clinical officers and nine nurses, when the service monitoring work began.
The facility’s Nurse-in-charge, Mrs. Irene Chirchir says: “Previously, many nurses did not want to be posted to this facility because of its location and the low and poor inputs. No service provider wants to work in a facility that lacks inputs they need to deliver services to citizens because it troubles us when we have to refer patients to other facilities for ailments that we can easily treat. But now, things are changing here to the extent that even nurses want to be posted to this facility.”
Ms. Evelyn Auma, a community member who lives with disability, says: The nurses at this health facility have changed. They treat us with respect unlike before. I remember sometime back when I was expectant they could not attend to me, and directed go to Nakuru Referral hospital. Their attitude has drastically changed for the better.”
A mother and her baby under a mosquito net, with New seats installed at the waiting bay of the maternity a a new bed at the maternity ward