REPORT ON A THREE-MONTH FIELD ATTACHMENT

TIME OF ATTACHMENT: FROM 6TH MAY, 2019 TO 31ST JULY, 2019

MSAMBWENI COUNTY REFERAL HOSPITAL

SCHOOL OF PUBLIC HEALTH AND PURE AND APPLIED

SCIENCES

DEPARTMENT OF HEALTH MANAGEMENT AND INFORMATICS

BACHELOR OF SCIENCE IN HEALTH RECORDS AND

INFORMATION MANAGEMENT

BY

JANET ACHIENG OGUTU

Q124/4902/2015

EMAIL:OGUTU.JANET@YAHOO.COM

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 SUBMITTED ON 13TH, SEPTEMBER, 2019

DECLARATION

I do hereby declare without no doubt that work presented during this attachment report is my
own original and independent work and it has never been presented before to the department of
health management and informatics for the award of Bachelor’s degree in health records and
information management, of Kenyatta University or any other institution of higher learning for
the award of certificate or degree

Student name: JANET OGUTU Reg. no: Q124/4902/2015

Sign……………………………………… Date……………………..

Supervisor

Name ……………………………….

Sign………………………………….date……………………….stamp

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ACKNOWLEDGMENT

Presentation inspiration and motivation have always played a key role in success of any venture
have always undertaken.

The completion of this attachment would not have been successful without the cooperation and
support of so many people of Msambweni hospital and the entire community whose names may
not all be enumerated. Their contributions are sincerely and gratefully acknowledged.

However, the group would I like to express deep appreciation and indebtedness particularly to
the following;

Mr. Mohamed Nzallah the in-charge Records Department Msambweni hospital, and most of all
the entire records department staff and the CCC staff.

Special thanks to Kenyatta University for giving me the time to go out of class and get
experience to tackle work on the outside world Mr. Andrew Yitambe our Chairman department
of Health Management and Informatics and the entire staff of the department, Thank You.

To my parents, siblings relatives, friends and others who in any way or another shared their
support, either financially morally and physically, thank you. Above all, to the Great Almighty,
the author of knowledge and wisdom, for His countless love.

I thank you

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EXECUTIVE SUMMARY

This report has been written and compiled as a requirement for the for partial fulfillment for the
award of Bachelor’s Degree in Health Records and Information Management as a degree course
in Kenyatta University. The report contains and overview of what I have been doing in the
hospital for 12 weeks.

It contains a brief history of the hospital and the services offered according to the hospital service
charter, the organogram of the hospital. Different duties assigned to the student including
understanding of health management information system, role of health records manager in
(CBHIS),health records law and policy planning, child health and reproductive health,

Library services, diagnostics departments e.g. X-Rays, consultant clinics, office organization and
management, outpatient and emergency department, wards (Medical, Surgical, Paeds and Obs
and Gynae),Medical Statistics, Indexing and coding.

I used different types of data collection methods as the source of information in my document
,this include observations, extraction of information from the written sources ,face to face
interviews with patients and the staff of the hospital having obtained the permission from the in-
charge health records, the information also obtained from reading articles on the internet about
the facility. Done evaluation using SWOT analysis, Conclusion and Recommendations for
future.

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LIST OF ACRONYMS

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AOP: Annual Operational Plan
ABD: Allocated Bed Days
ALOS: Average Length of Stay
CBHIS: Community Based Health Information Management
CCC: Comprehensive Care Unit
CD4: Cluster of Differentiation 4
CHW: Community Health Worker
COI: Clinical Officer Interns
DBR: Daily Bed Return
DHIS: District Health Information System
DMOH: District Medical Officer
EMR: Electronic Medical Records
GOPC: Gynecology Outpatient Clinic
HIS: Health Information System
HRIO: Health Records and Information Officer
ICD10: International Classification of Diseases 10
ICPM: International Classification of Procedures in Medicine
KMTC: Kenya Medical Training College
MCH: Mother Child Health
MFL: Master Facility List
MOH: Ministry of Health
MOIs: Medical officer interns
MOPC: Medical Outpatient Clinic
OPD: Outpatient Department
PNC: Post Natal Clinic
POPC: Pediatric Outpatient Clinic
PEPFAR: Presidents
SOPC: Surgical Outpatient Clinic

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TABLE OF CONTENT
DECLARATION…………………………………………………………………………………II
ACKNOWLEDGMENT…………………………………………………………………………III
EXECUTIVE SUMMARY…………………………………………………………………………………………………..IV
LIST OF ACRONYMS…………………………………………………………………………..V
1.0CHAPTER ONE……………………………………………………………………………….1
1.1 INTRODUCTION…………………………………………………………………………….1
1.2 Hospital background ………………………………………………………………………….1
1.2.0 Vision………………………………………………………………………………………..2
1.2.1 Mission ……………………………………………………………………………………...2
1.2.2 Resources……………………………………………………………………………………2
1.2.3 Team Guidelines…………………………………………………………………………….2
1.2.4 Key Performance Indicators………………………………………………………………...2
1.2.5 Communication Plan ……………………………………………………………….…….....2
2.0 CHAPTER TWO………………………………………………………………………...……3
2.1 Work Experience and Specific Tasks ……………………………………………….……..…3
2.2 The purpose of the Attachment………………………………………………………………..3
2.3 The specific areas I tackled …………………………………………………………………...3
2.3.0 Health management information system……………………………………………………4
2.3.1 Role of health records manager in Community Based Health Information System………..6
2.3.2 Health Records Law and Policy Planning…………………………………………………..6
2.3.3 Child Health and Reproductive Health……………………………………………………...8

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2.3.4 Sequence of child vaccinations and immunizations schedules…………………………….11
2.3.5 Coding and Indexing……………………………………………………………………….12
2.3.6 Medical Statistics section………………………………………………………………….14
2.3.7 Wards (Medical, Surgical, Paeds and Obs/Gynae)………………………………………...15
2.3.8 Office organization and management……………………………………………………...17
2.3.9 Consultant clinics…………………………………………………………………………..18
2.3.10 Diagnostics departments (lab, X-ray)……………………………………………….……20
2.3.11 Library services……………………………………………………………………….…..21
2.3 Problems encountered and their solutions…………………………………………………...23
3.0 CHAPTER THREE………………………………………………………………………….25
3.1 Evaluation of Host Institution………………………………………………………………..25
4.0 CHAPTER FOUR……………………………………………………………………………27
4.1 Recommendations and Conclusion…………………………………………………………..28
4.1.1 Recommendations………………………………………………………………………….28
4.1.2CONCLUSION…………………………………………………………………………….28
REFERENCES………………………………………………………………………………….29

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1.0 CHAPTER ONE:
1.1 INTRODUCTION.

1.2 Hospital background

Msambweni County Referral Hospital is situated in Msambweni sub-county, 70km from

Mombasa city and about 8km off Likoni -LungaLunga Highway. Msambweni hospital neighbors
KMTC, the district headquarters and Kwale International Sugar Company. The areas scenery is
characterized by rocky beaches, rocky outcrops and low cliff tops and is relatively unspoiled.

The hospital was established in early 1940s as a dispensary. Since then the institution grew
leading to the present structure that was put up in the 1990s and officially opened on 23rd August
1997.

Msambweni hospital became a referral hospital for the entire Kwale County in August 2013.

It serves a catchment population of 160,905, has a bed capacity of 169 and bed occupancy is
90%.

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1.2.0 Vision

To be the center of excellence in providing quality health care services in Kwale County.

1.2.1 Mission

To support work improvement teams provide quality health service delivery which meets
customer needs.

1.2.2 Resources

The team focuses on utilization of available human resources and infrastructure to achieve
quality health

1.2.3 Team Guidelines

The team meets every second Thursday of the month at 10:00a.m.

Decisions made are based on consensus reached by majority of the members.

1.2.4 Key Performance Indicators

The key performance indicators are determined by the continuous quality improvement
assesments and the annual workplan of the hospital

1.2.5 Communication Plan

Monthly report is normally written and given to the sponsor and the hospital management team.

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 2.0 CHAPTER TWO
2.1 WORK EXPERIENCE AND SPECIFIC TASKS
2.2 The purpose of the Attachment

As a student in Kenyatta University, Department of Health Management and Informatics am

expected to go for my industrial attachment out of class for a period of 12 weeks in order that I
may acquire knowledge and practical skills on the areas listed below, improve my confidence in
problem solving and decision making issues encountered in the outside world, utilizing the
opportunity to relate with different types of people including the patients

2.3 The specific areas I tackled:

Health records and information management department in Msambweni Hospital is a strong

pillar that is responsible for provision data that is quality and which is used as evidenced based
information after this data has been processed, this information is utilized by the hospital in
decision making and problem solving processes, resource allocation, disease outbreak
monitoring and control, used by policy planners.

These areas I was to tackle on my attachment period:

Health Management information system

Role of health records and information managers in community based health

management system.

Health records law and policy planning

Child Health and Reproductive Health.

Coding and Indexing

Medical statistics

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 Wards (Medical, Surgical, Paeds and Obs/Gyn)

Outpatient/Accident and Emergency department

Office organization and management

Consultant clinics

Diagnostics departments(lab, X-ray)

Library Services

2.3.0 Health management information system

HMIS is a data collection system specifically designed to support planning, management and
decision making in health facilities and organizations. Whereas HIS is a system designed to
manage healthcare data by collecting, storing, analyzing and disseminating of patient electronic
medical record to support healthcare policy decisions. In Msambweni hospital they have
incorporated the use of these systems which has been of great impact and successful since they
implemented.

There are various systems put in place as you start from the reception and runs throughout the
departments of the hospital, this include Dormax HIS which contains all the patients records,

IQ care system used in CCC, DHIS2.

Dormax HIS is the main hospital information system, it’s been used in the both the outpatient
and inpatients departments. It’s a comprehensive system which comprises of computerized
provider order entry (CPOE), E-prescribing, lab tests and billing .it’s well designed to suite the
hospital needs

IQ Care System is a system used in the comprehensive care clinic (CCC), its used management
of information for HIV/AIDS patients who are on-care and those enrolled on HAART. Patients’

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information’s such as viral load copies, CD4 count and ARV regimen are well tracked by the
system.

DHIS-2 District Health Information system 2: is a web based system database that connects
all the health levels .The system is updated remotely by the district health records and
information officers (DHRIO’s) and HRIO’s in those facilities authorized.

How the systems work

When the system is logged in using the usernames and passwords data entry is done where the
data is fed into the computer, its processed and stored in the system database. Data in this sense
are the health data that include the Doctors notes about the patient, patient details, audio and tape
recordings, etc. Then validation of the data is done to remove any errors and improve its
accuracy. After checking of errors and prove to be successful then the data is uploaded and
disseminated into the system.

The second stage of this HIS is Analysis of data; Analysis is close examination of this data and
entails investigations, scanning, survey and scrutiny among others. All the analysis is done using
tools available within the DHIS 2.after analysis disseminated using the DHIS system.

IDSR

International Disease Surveillance and Response (IDSR) -Data obtained in these systems are
reported in IDSR weekly epidemic monitoring form MOH 505 for detection and control of
disease outbreaks

Monitoring and Evaluation is done in order to check on the quality of the data in ensuring that
data is accurate, relevant, complete, consistent and reported on time.

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The main ethics governing the management of health records is confidentiality and privacy of
health records, every person have to follow that and be aware of the consequences accompanied

2.3.1 Role of health records manager in Community Based Health Information System.

CBHIS refers to information, required, gathered, analyzed and used by the community as well as
other levels for planning, monitoring and decision making. The system collects this type of
information: demographic, nutrition, immunization, malaria, reproductive and child health,
health status, environmental and sanitation, schools and social economic status. The data is
usually obtained from the following communities; Ramisi ward, Ukunda ward, Kinondo ward,
Gombato Bongwe ward Community based health information and data is useful disease
detection and control in these communities. There are 4 operational Community based HIS in
Msambweni sub-county all of which are linked to Msambweni hospital.

Data collection in CBHIS is done by recording of these data on the following tools MOH 513 the
household register, MOH 514 Service Delivery Logbook, MOH 515 Community Health
Extension Worker summary, MOH 516 Community Chalk Board. CHW visits home regularly to
promote health behaviors, update records, report pregnancies, births, deaths and migrations.

Community based health data is managed by each health facility with CBHIS, the health data is
submitted to Msambweni hospital every month to be entered to the DHIS2. All reports from
health facilities in Msambweni sub –county are entered to the DHIS2 by the district health
records and information officer (DHRIO); each report must be validated for accuracy and
completeness, and then uploaded to the system. Analysis is done to the data using the tools
available in the DHIS2 and presented in form of pie charts and graphs. Ethics arising from theses
collection of information should focus on the privacy, confidentiality and security of the
information.

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Community mapping is essential in order to obtain the number of the total households in the
community, source of information is majorly from the registers. Always done by obtaining
permission from the chief.

2.3.2 Health Records Law and Policy Planning.

Having been taken through this chapter by Mr. Richard Langat the HRIO in-charge. Health
Records are very vital and thus should be considered sensitive and be protected from getting into
the hands of unauthorized persons; this is through protecting its security, confidentiality and
privacy of this information Msambweni hospital has come up with hospital policies on privacy
and confidentiality. This include regulating authorization of people to access records in files and
systems, each medical personnel has password to his/her computer and having lockable filing
cabinets

Conditions under which the information can be released;

 When there is a Court order, regarding a case filed either by the patient or by next of kin
of the patient.

 In cases of disease outbreaks, this is by getting the total number of the victims, the
area/place and time to monitor the trend and control of the disease

 Patient information can be released to another hospital or health facility for the purpose
of diagnosis or treatment of a patient

 The information of the patient can be released when authorized by law or by its charter to
assist in disaster relief efforts, to notify, or assist in the notification of (including
identifying or locating), a family member, a personal representative of the patient, or

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 another person responsible for the care of the patient, the patient’s location, general
condition or death.

Elements for the release of the information;

You obtain the consent from the patient which can either be written or oral, if it is a child, insane
or an elderly person the consent can be obtained from the parent or guardian.

Annual Operating Plan (AOP)

The information stored in these systems are very helpful in developing of the AOPs since data
processed are the evidenced based. In Msambweni they have Annual Work plan (AWP) which
they normally run annually, it is composed of strategic plans, the quarterly plans divided into 1st
quart starting from the month of July, Aug, Sept ,2nd quart Oct,Nov,Dec,3rd quart
Jan,Feb,March,4th quart April ,May, June and the monthly plans. Upon the set targets there is
penalizing in case one fails twice to accomplish the set target. The current completion of the
strategic plans that was running from the year 2013 among the targets that was set is the
successful completion of the New Casualty, upcoming new laboratory and the modern NBU Unit

2.3.3Child Health and Reproductive Health

Maternal child health MCH department in Msambweni hospital deals with antenatal, neonatal
and children under the age of 5years.The department comprises of nutritional clinic, family
planning, records office, antenatal clinic, PITC, counseling, PMTCT,CCC and Consultant clinic
for pediatrics and gynecology/obstetrics .

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This section is separated from the outpatient clinics because of the unique conditions the patients
present with and involves lengthy follow ups.

Antenatal care

This is the care given to pregnant mothers prior the delivery of the baby

The mother should have at least 4 antenatal visit to the MCH clinic

Number of Period What should be done;

visits

1st visit 16 weeks of Obtaining full information from the mother for example the last
pregnancy day having her menstrual period (lmp), number of children born
alive or dead. The mother should undergo lab tests for HB, TB
screening, Bs, MPs, Rhesus group, blood group and the serology
and urinalysis. This information is documented in the MOH 216
Booklet, which is then issued to the mother. The mother is
assigned a unique antenatal care number and details of the mother
written on the MOH 405 register.

2nd visit 28 weeks of Quick assessment and routine checks done on the mother through
pregnancy interviewing so as to obtain the health state of the mother

3rd visit 32 weeks of Preventive measures should be provided at each visit, routine
pregnancy checks and assessment of the mother done, mother should be

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 advised to take up drugs and adhere to it.

4th visit 40 weeks of Continuous routine check is done

pregnancy

The package of evidence-based preventive measures recommended for pregnant women

includes:

 Provision of tetanus toxoid immunization

 Iron and folate supplementation

 Deworming

 Intermittent preventive treatment for malaria

 Sleeping under LLIN.

 Prevention of mother-to-child transmission of HIV (PMTCT).

The most common Danger signs in pregnancy are; any vaginal bleeding,convulsions,severe
abdominal pain, severe headache,paleness,fever,reduced or no fatal movements,breaking of
water, getting tired easily, swelling of the face and hands and breathessness.

Neonatal Care.

These are newborns of up to 28 days from date of birth .Neonates are so sensitive since they are
vulnerable to many conditions. Normally born children are allowed home while premature or
newborns with complications such as low birth weight are placed in the newborn unit (NBU) for

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his/her condition to be closely monitored the mother stays with the newborn at least a week then
discharged others even stay as long as one month depending on the condition of the Neonate. At
birth the newborn is administered the BCG vaccine.

Postnatal care programs

The Post natal building in Msambweni is located on the Maternity wing alongside the labor ward
room and the NBU Unit. After delivery the Mother is usually observed for a day in the Post
Natal ward, then the newborn is immunized with the BCG Vaccine before the mother is
discharged.

Postnatal care is offered to children up to 5years of age, these include immunization, deworming,
feeding and checking of the umbilical cord. Over the period development milestones of the
children are monitored, with both boys and girls differently. Children are registered in the
postnatal care register MOH405 and registers updated such as the Immunization Register
MOH710. Care provided must be recorded, all the time (Mother Baby booklet, registers).
Confidential information should not be recorded on the mother child booklet if the woman does
not want this.HIV Exposed children are identified at the sixth week, and then they are started on
Clotrimaxazole prophylaxis for 12 months to prevent them from getting infected HIV.A system
called HIT System an online system where HIV exposed infants are monitored for 12 months.

2.3.4 Sequence of child vaccinations and immunizations schedules

Infants are brought for immunization with their mothers following the stipulated immunization
schedule. Upon arrival ,infants are registered and go for growth monitoring at nutritional clinic
then proceeds to the immunization rooms .The immunization schedule is as follows;

BCG Vaccine given at birth, injecting through the intra-derminal left forearm, after 6 weeks ,10
weeks, and 14 weeks, the mother comes with the baby as schedule for polio vaccine given 2
drops orally,Diphtheria,Hep ,haemophilis,pneumococcal injection (0.5 Mls) intra muscular right

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outer thigh. Measles vaccine (0.5 Mls) injected subcutaneously right upper arm given at 9
Months.

Family planning.

This is a method aimed at the couples who are married, but now days it has been used by the
youth mostly to prevent pregnancy.

Family planning come in two ways there are those that are hormonal and those that are non-
hormonal methods.

Hormonal methods

Hormonal methods are the birth control methods that have either estrogen or progestin or it can
have progestin only. Prevent a woman ovary from releasing an egg during her cycle, it affects the
level of other hormones produced in the body, it also prevents sperm from making their way to
the egg by making mucus around women’s cervix thick and sticky. Examples of Birth control
pills, implants (small rods implanted beneath the skin, release continuous dose of hormones to
prevent ovulation.

Depo-Provera (progestin injection) given to muscles of the upper arm or buttocks every 3
months. Emergency contraception are medicine that can be bought without the prescription of a
doctor, usually taken immediately after unprotected sexual intercourse.

Non-hormonal methods

Condoms -thin latex sheath placed around erect penis (male) or female condom placed on the
vagina before an intercourse

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Intrauterine device -small plastics or copper device placed inside women’s uterus by the provider
.Release small amount of progestin for 5 to 10 years depending whether they are safe and work
well.the other non-hormonal methods include the vasectomy.

In Msambweni hospital the most preferred FP method is ranked as follows:

intrauterine device

Condoms

Depo Provera injection

implants

2.3.5 Coding and Indexing

Coding and indexing is done at the inpatients health records department, here it’s done using a
computer systems, this are the DHIS-2, the Dormax HIS and indexing form on designed
database, the 3 ICD 10 volumes are used.

There are 3 volumes of ICD 10, each designed for specific function:

Volume 1:with tabular list (confirmatory volume) contains classification of the morphology of
neoplasm, special tabulation lists for mortality and morbidity, definitions and the nomenclature
regulations in three and 4-character levels. This is used for confirmation of codes after being
searched in the volume 3.
Volume 2: Brings together the notes on certification and classification with instructions and
guidance to the ICD users
Volume 3: has the alphabetical index to the classification of conditions, diseases, external
causes of injury, accidents, poisoning and neoplasm. Assist in the location of the specific disease
codes.
Before coding you must open the discharge summary in the Dormax HIS for patients discharged.

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The patient file is opened one by one from maternity to medical files. The final diagnosis will
show what the patient was treated and subsequent notes gives a clear impression. The diagnosis
assist in locating the correct disease code, since it usually has the lead term e.g. When you open
the maternity file most mothers give birth through Normal delivery that is Spontaneous Vertex
Delivery (SVD) the lead term would be is Delivery, on Volume 3 you look on the Delivery then
under delivery, vertex with one dash then spontaneous which is O80.0, on volume 1 there are
chapters arranged Alphabetically (A-Z).
Coding of External causes under chapter (S00-T98) on injury, poisoning and certain
consequences of external causes.
Coding is also done to external causes of injury such as accidents, assault or rape case. The direct
cause of the injury must be specified e.g. road traffic accident with a motorcycle and how the
accident happened. Also to be specified is part of the body injure
Coding is also done for poisoning and adverse effects of therapeutic drugs such as
Organophosphate poisoning (OPP) is coded T60.0, other codes are between T00-T98 then you
specify whether it is intentional for Adults and non-intentional for children below 15 years.
Dagger and Asterisk -these are two codes for diagnostic statement. It contains information about
an underlying generalized disease and manifestation in particular organ or site which is clinical
problem on its own right. The Dagger (+) is the primary code for the underlying disease, must
always be used. Asterisk (*) is an optional code for the manifestation, must not always be used
alone, they appear as three character categories. For example the corresponding Dagger codes
are given for conditions mentioned in Asterisk for example syphilitic parkinsonism is G22* ,the
dagger code is A 52.1 (+).These two codes are important to describe fully a person’s condition.
Procedures in medicine are published in the international classification of procedures in
medicine (ICPM) by WHO. It includes procedures for medical diagnosis, prevention, therapy,
radiology, drugs, and surgical laboratory procedures. Arranged according to chapters.
An indexing form is designed in such a way that it contains the inpatient number, age, disease
code, and residence, date of admission and date of discharge.
The manual way of indexing involves filling of indexing form with specified details and the
disease name, disease code written in the indexing form. Every disease even if from the same

15
inpatient number is recorded in a different indexing for. Thereafter morbidity and mortality
statistics are generated.
In Msambweni hospital disease indexing is done through database system where the disease
codes are entered, the age category, disease category, sex, date of admission and date of
discharge and a report is generated.

2.3.6 Medical Statistics section

This entails the hospital administrative statistics and other forms of statistics in the hospital such
as those from the CCC. Hospital administrative statistics deals with the day to day running of the
hospital. It constitutes calculating the available beds, occupied bed days (OBD), available bed
days (ABD), turnover per bed, vacant bed days, turnover interval, percentage occupancy and
average length of stay (ALOS).

All these have specific formulas for calculation. Data use in hospital administrative statistics is
obtained from the daily bed return form and also the manual collection of data in all registers of
all departments in the hospital. Microsoft Excel with hospital administrative statistics formulas
have been designed to help in entry, analyzes and interpretation of this data.

The data is collected from the health records officer and also data generated from the Dormax
HIS. There is conducting of ward rounds every morning to get the number of patients admitted,
discharged or dead, number of absconders (those who sneak out of the hospital), paroles. There
are different sheets for male ward and paeds ward is divided into medical and surgical section,
female ward sheet is divided into Medical, Surgical and Gyna for maternity it’s divided into
Labor, NBU and Post-Natal

Upon the collection of data, it is checked for reliability and validity basing on the past
information generated. This is important to ensure data quality is upheld and the report generated
to be reasonable.

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Morbidity data is generated from the outpatient and admission department while the mortality
data is generated in the wards. Data is therefore calculated using the above formulas so that it
makes sense for analysis. The correct calculation leads to analysis where the data is made sense
out to generate information. The information generated from analysis is therefore interpreted and
presented in form of graphs and pie charts to aid in quick analysis of the information generated.

All these information generated is therefore disseminated to the hospital administration and other
health stakeholders such as the health management team

The reports assist the hospital management in planning, decision making, budgeting and
allocation of resources to specific departments and workplaces based on the information
received.

2.3.7 Wards (Medical, Surgical, Paeds and Obs/Gynae).

Inpatient Bed State

However, the hospital has the a total of 227 beds for the in-patient services

SNO. WARD BED CAPACITY

1 Male Ward 38

2 Female Ward 37

3 Pediatric Ward 36

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 4 Maternity Ward 45

5 Amenity Ward 12

6 New Born Unit 10Cots & 5 incubators

7 Surgical ward 44

Each ward is head by a matron who is the nursing officer, who are under specific consultants
such as surgeon, pediatrician, physicians and gynecologist. Each nursing station has a computer
which is networked and all the activities in the wards are entered.

When a patient is eligible for admission he/she is directed to admission center to be admitted and
provided with a unique patient number in a receipt and then directed to the respective ward. At
the ward he/ she is received by a nurse then allocated a bed.

Billing is done in the Billing office and the patients’ are provided with a medical bill which
includes all the cost incurred in treatment, he/she then goes to the revenue office to pay. If the
patient has a medical cover such as NHIF, the billing office, also account for all cost to be
claimed. The records department also codes the disease as per ICD10 the patient was treated so
as to help in insurance claims.

In the event a patient dies, he/she is certified dead by a clinician, then wrapped and taken to the
morgue for embalmment and storage. Before a body is released from the morgue, a burial permit
should be written which is used for death certificate issuance, in which a copy remains with
records department for future use in case the family of deceased comes back.

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Every newborn is provided with a birth notification form in the maternity, this later used by the
parent to seek the child’s birth certificate. Dispatch of birth notifications and burial permits forms
to the District Register of Births and Death office is done every Thursday.

Reports are done weekly and monthly basis, the reports are generated using the Dormax HIS and
the registers which include maternity register MOH333, Inpatient register MOH301. Some of the
reports generated include MOH718 Inpatient morbidity and mortality Report. Weekly reports are
the malaria reports and the IDSR reports.

Msambweni hospital has a standard designed outpatient room, divided by large window with
grills, the patient is served while he/she is on the other side of the window. The room has a
computer, a table and drawers, sits for the staff and a CCT-TV camera.

Patients are registered into the Dormax HIS by providing them providing there details such
as full names, age, sex, residence .the patient is selected the exact clinic he/she is visiting
whether clinical officer CO, Eye clinic, MCH or Radiology department. A patient pays
Ksh50 for registration receipt which contains a unique outpatient number which is used in all
departments to get services.

Revisiting patients usually comes with a receipt of the previous visit; the number is revisited
in the system and the patient provided with a new receipt and pays. There are patients who
don’t pay services because they have been credited this include schools such Msambweni
secondary and Kingwede schools and others. Children under 5 years, women coming for
maternity and patients brought by police also don’t pay for registrations they receive free
services.

After a patient sees a clinician and a doctor he/she will be eligible to be admitted to the
wards, he come to the admission center, where he/she is registered and give unique inpatient
number and admitted to the respective ward either male, maternity, female or pediatrics.

19
 Then they are directed to the wards where they are received by the matron who is able to see
in the computer that the patient has been admitted there.

There are daily, weekly and monthly generated in the outpatient section from all the
departments which sum up to the outpatient morbidity report MOH705A under five years and
MOH705B over five years.

2.3.8 Office organization and management

The hospital consists of the following committees in which some are permanent and others are
just formed and dissolved once the activity is over, these committees include

Quality improvement team ,Disciplinary committee, catering, infection prevention committee,

On demand committee(Procurement) and Mortality committee these are permanent committees,
the temporary ones are the End Of Year Party committee.,

Msambweni hospital is privileged to have a number of health and development partners such
ministry of health MOH, Afya Pwani , USAID, AMREF and other government ministries, they
help in funding since the hospital cannot stand alone without their help.

Health management team (HMT) comprise of all head departments in the hospital. They are to
ensure access to quality care, mobilize and distribute resources to all needed areas they supervise
and monitor activities in the hospital, Look for partners, set targets and policy implementation in
the hospital.

District health management team (DHMT) which consist of District Health (MOH), District
Nursing Officer, and District (HRIO) is a team which is mandated to supervise other district
health facilities in Msambweni sub-county such as Kinondo Kwetu hospital and Diani beach
hospital.

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2.3.9 Consultant clinics

These are clinics where the patients undergo specialized treatment by the consultant doctor upon
booking or appointments for a period

Msambweni hospital has 7 outpatient clinics for consultancy services; namely gynecology
outpatient clinic(GOPC) , surgical outpatient clinic(SOPC), ear, nose and throat(ENT)clinic,
medical outpatient clinic(MOPC), pediatrics outpatient clinic(POPC), CCC clinics for
HIV&AIDS patients.

Booking of appointments for patients for clinic is done based on doctor’s recommendation and
availability of opportunity, the doctors notes as TCA 2/52 which is to come after 2 weeks,1/12
after 1 month, the patient is then told in normal language the date to come.

The patients are registered on the day they are scheduled to visit, to the number the consultant is
expected to see those that are new and revisits

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On the clinic day the patient’s presents with their outpatient cards, the cards are checked for the
TCA (to come again) and the clinics the patient is coming for. The files are and the confirmed
and the patients direct to the triage area for the vitals to be captured. These after the patient
proceeds to the doctor managing the day’s clinic

The doctor examines the patient and decides on whether to book another appointment date
according to the condition of the patient. The HAART clinics separated from other general
clinics to avoid stigma that the patients undergo. The clinic operates daily from Monday to

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Friday .The clinic is very sensitive since patients undergo long follow ups therefore any
information is treated with high level of sensitivity.

Patients are also offered nutritional advice and counseling in the clinic in order to live a positive
life.

Reports from these clinics are always generated on every visit day and monthly basis.

2.3.10 Diagnostics departments (lab, X-ray)

The laboratory and imaging departments are the one which help in provision of evidence-based
care and quality healthcare because the assist in diagnosis of conditions. Msambweni hospital
has a large standard new laboratory and small lab in the CCC which performs all sorts of tests
such as virology, bacteriology and serology .The lab is connected to the Dormax HIS in which
the test request and results are entered. Patients are received with lab request form for laboratory
tests and then they are registered in Laboratory Register MOH240. Other systems used in the lab
include the GeneXpert information system for tests done using the Gene eXpert machine.

The radiology department performs X-ray, ultrasounds, ECG and the latest is the acquired state-
of-art Toshiba C.T scan. Patients are received using the X-ray/ultrasound request form and then
registered in the radiology register MOH209.patient are always prepared for the imaging then are
asked some important question like if she is pregnant? So as help radiologist know what to do.
The radiology images of the scanning are stored in the hospital database and server and a copy of
x-ray and ultrasound given to the patient to take to the clinician.

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2.3.11 Library services
Msambweni hospital, uses the straight numerical system as their filing system, the files mostly
found in the store are medical record file, of year 2014 backwards, this is because the automation
of the files began in 2015 and the these medical records found in the system up to date . The only
files that are not stored in the system are the Maternity files pink in color this is because of the
number of mothers giving birth is large and the documentation in writing is much important
during the monitoring of the mother.

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Main activities taking place in the Library

file sorting –process of assembling patient file before physical filling

a) File filling- process of arranging and sorting files based on files number and arranging
them in descending order.

b) file tracing –process of keeping track of patient folder that is tracking and tracing patient
file movement within the hospital

Others activities include:

a) receiving various patients files form users point usually the maternity files

a) weeding of inactive files these are commonly for mothers who gave birth normally(SVD)

b) management of misfiling

c) filling and retrieval of patient records the filling system put in place

d) identifying various equipment’s used in the library

e) filling of sensitive confidential records

the library is always under lock so as to protect the privacy and the security of patient
information.

2.4 Problems encountered and their solutions.

Large number of mothers coming for the birth notifications at lunch hour making hard for the
staff to get out and get lunch, the solution of these problem is asking the nurses to release the
mothers at a stipulated time.

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System and hardware breakdown -The hospital sometime experienced breakdown of its Dorm ax
system hence the delays that resulted inconveniences to the patients’ registration and attendance.
This could take time for concerned IT personnel to solve the problem. Hardware problems such
tablets chargers malfunctions and hard-drives crashing could result in inefficient work. The
solution of this problem is by engaging records department to be well informed on the basic
skills of computer troubleshooting so as to solve a problem which doesn’t require the IT
personnel. There should an alternative system in place to be used when the main one has big
problems.

Most patients do not understand how the hospital operates .When they come for the first visit
they are given a unique patient number which they are to use during the whole year. Most of
them do not even know the importance of the receipt and some even lose it .This will require
them to be registered again .the solution of this problem would be using charts and notices
explaining to them the importance of coming with the receipt.

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 3.0 CHAPTER THREE:
3.1 EVALUATION OF HOST INSTITUTION.

The SWOT Analysis presents an assessment of the Internal Strengths and Weaknesses of the
hospital. These are internal factors that enhance the competitiveness of the hospital and those that
inhibit the competitiveness and healthcare delivery in the hospital. The analysis also looks at the
opportunities that are available for the hospital which, if harnessed can greatly increase its
competitiveness. Threats on the other hand are external factors that may hinder or work against

Strengths: Weaknesses:

Qualified Personnel Inadequate staff

Good and Modern Infrastructure Inadequate Funds

Modern Diagnostic equipment e.g. Shortages in Commodities and Medical

C.T scan Equipment

Government Subsidy Inadequate Maintenance of Equipment &

Infrastructure
Provision of Timely Services
Lack of utility Vehicle
Efficient Governance Structures
Weak Inventory Management
Relatively enlightened and critical
community Infrastructure Constraints

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 Digitized medical records

Threats: Opportunities:

Stiff Competition Supportive Partner, WRP/PEPFAR

Poverty index is High Regulation of Service Providers

Inadequate Security Collaborating Medical Training

Institutions , KMTC
Staff Turnover
Strategically Placed
Poor transport infrastructure
Networking with other organizations
Societal substance
abuse(alcoholism) Devolved government

Exempted services

Power & water supply interruptions

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 4.0 CHAPTER FOUR
4.1 RECOMMENDATIONS AND CONCLUSION.
4.1.1 Recommendations

Hospital

Medical supply-The hospital should make a timely communication with the Kenya Medical
supplies board to avoid shortage of drugs in the hospital

The hospital should look on the issue of the toilets/washrooms since it has become one of the
major concern, inadequate water supply and tissue papers would recommend the hospital to
either look for space to build pit latrines or use the containers to store water for the toilets.

Increase the number of staff to ensure the smooth run of the activities on the hospital. Addition
research unit to curb on the emerging and re-emerging of diseases

Records Department

Increase the number of staff on the IT part and staff working on the records department, since the
number is too low and there is a large workload to tackle

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Conducting of the ward rounds; the statistics of the hospital is of great importance, proper
collection of the statistics of the ALOS, DBR and Patient length of stay statistics is much
wanting.

Systems

Continuous training of the staff to adopt the culture of the technology, this is a concern on the
user and user of the system. These means that the staff should be fully equipped with the
knowledge of computer, how to use and changing trends of the technology.

There should be timely reporting and highlighting of the problems arising from the use of these
systems. Introduction of patient appointment technologically for example use of SMS instead of
doing it manually

4.1.2 CONCLUSION

For me coming to Msambweni has been of great importance to my education life, since I have
acquired experience, skills and knowledge throughout my stay in the hospital.

I thank Almighty God once more for seeing me through the entire period

Choosing Msambweni has been a nice decision since, it is an organized hospital embracing the
new technology of automating its systems so as to improve the healthcare delivery services to its
clients. Integrating the Health Records Section to outpatient and inpatient departments for proper
handling of data, observing the confidentiality, privacy and security of the information. I
honestly will miss Msambweni and I would like to work with you people in future.

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REFERENCES
Msambweni county referral hospital annual strategic plan 2014-2019 a five year plan

Msambweni county referral hospital profile

Annual work plan for Msambweni county referral hospital from from January, February,March
April, May June and July

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