KENYATTA UNIVERSITY

SCHOOL OF HEALTH SCIENCES

DEPARTMENT: HEALTH MANAGEMENT AND INFORMATICS

COURSE: HEALTH RECORDS AND INFORMATION MANAGEMENT

UNIT CODE: PHI 404

UNIT TITLE: FIELD ATTACHMENT

NAME: FELIX AUSTINE ODHUL

REGISTRATION NO: Q124/4657/2019

FIELD OFFICER: DR. KITHUKA SIGN:……………..

 TITLE

FIELD ATTACHMENT AT THIKA LEVEL 5 HOSPITAL FROM JAN 3RD TO March

31ST

1
 ACKNOWLEDGEMENTS

First of all, I would like to thank the Almighty for the good health that he has granted me
throughout this entire period. My most sincere gratitude to the medical superintendent of the
Thika HospitalDrr. Patrick Nyaga and the Health Records and Information Department in charge
Mr Mungai and Madam Ann Wanjiku and the whole fraternity for their guidance and support
throughout this period. I would also like to thank my parents for their unending support, and
finally Kenyatta University for facilitating this practical session.

2
TABLE OF CONTENTS

FIELD ATTACHMENT AT THIKA LEVEL 5 HOSPITAL FROM JAN 3RD TO March 31ST..............1
8. Diabetic Clinic..............................................................................................................................19
This is a very busy clinic that involves care for both young and old patients with cases of diabetes. We
do take patients books and cards when they arrive in the morning and capture the data in the MoH tool
409 then retrieve their files to be taken to the nutritionist and then consultant for review. In capturing
data, the clinic uses Outpatient Therapeutic Program Health Facility Register MoH 409 to capture data
that are used to fill the summary book for the monthly generation of reports. After patient review, the
patients are booked for the next clinic according to the doctor’s guidance............................................19
Roles of Records Officer in Diabetic Clinic.........................................................................................19
1. Capturing of patient data upon entering the clinic.........................................................................19
2. Creation of new file files for new clients.......................................................................................19
3. Retrieval of files for patients..........................................................................................................19
4. Booking for the patient’s next visit................................................................................................19
9. Blood Transfusion(Satelite)..........................................................................................................19
I had the privilege of being attached to Thika Satelite Center for blood donation whereas a Health
Record attachee was taught on capturing data from patients using the questionnaires and then
transferring the data to the daily register which was then to be transferred to the Kenya Blood System.
I had the privilege of counselling patients through the questionnaires, measuring their haemoglobin
levels, for men it should range from 13.0 to 18.0 while for females should be from 12.0 to 17.0 for
effective blood donations. Through questions, I got to understand how blood was screened and the
maximum level in which one can donate. We also had the privilege of going for blood drives
todifferent institutions like MKU and JKUAT......................................................................................19
SUCCESS AND FAILURES OF THE HOSPITAL OBJECTIVES................................................19
The hospital objective and mission includes;.........................................................................................19
1. Provision of a robust health infrastructure.....................................................................................19
Upon the achievement of this goal, the hospital, courtesу of the conditional grant and the countу
government, has put up an ultra-modern Reproductive Ηealth Unit which has a bed capacity of 275
beds. Also the hospital has established a renal unit focused primarilу in taking care of patients with
kidneу problems. The facilitу does up to 50 dialуsis sessions weeklу, going a long waу in alleviating
morbiditу and mortalitу rates related to kidneу disease. As well the hospital has constructed the state of
the heart Intensive Care Unit to give services to the patient with chronic cases that requires urgency and
critical care............................................................................................................................................19
2. Improve qualitу of health care service deliverу to the highest standards.......................................19
On improvement of the hospital service delivery, the hospital has worked to ensure employment of
qualified professionals and well trained on work ethics to ensure well service delivery.......................19
3. Promotion of partnership with private sector.................................................................................19

3
The hospital also has partnered with different institutions of higher learning like Mount Kenya
University to ensure that the student s are well trained to become better healthcare professionals. Not
only with MKU but also with many many other institutions.................................................................20
The hospital though not yet fully achieved its objectives as planned because of some reason like
inadequate funding or withdrawal of some stakeholders in supporting the hospital, is still working to
ensure realization of those objectives....................................................................................................20
Integration of the Hospital to the Health Records and Information Management.............................20
The hospital has ensured installation of the EMR system and is currently working on having it installed
in almost all departments to ensure protection of patient data. The data has a goal of eradicating paper
based records system and transitioning to EMR. To realize this, the hospital has sponsored some
HRIOs to be trained in the EMR and KHIS so as to be well equipped in handling the system. In the
next 3 years, the hospital is envisioning a paper based free records system and all departments
including the physician based to use the EMR. The hospital gives recognition to this department and
works together to ensure achievement of its goals.................................................................................20
Recommendation..................................................................................................................................21
Conclusion............................................................................................................................................21

4
 ABBREVIATION USED

MOA- Mode of Admission

DOD-Date Of Discharge

RFA-Reason For Admission

IR- Interpersonal Relation

MDP- Manic Depression Psychosis

TLE-Temporal Lobe Epilepsy

S.V.D-Spontaneous Vertex Delivery

CS- Caesarian delivery

DOA-Date of Admission

OP-Outpatient

DBR-Daily Bed Return

HAS-Hospital Administration Statistics

DHIS-District Health Information System

ART- Antiretroviral Therapy

VCT- Voluntary Counseling And Testing

FP-Family Planning

5
CTX-Cotrimoxazolee

PWP- Prevention With Positives

DAR- Daily Activity Register

BMI- Body Mass Index

ICD- International Classification of Diseases

ABSTRACT

The main Aim of the attachment was to make us understand activities that are carried out in the
entire health records and information career together with ethical issues that are practised while
in the field. My professional attachment was carried out in Thika Level 5 Hospital in the same
department as my profession and it took me three months that are from January to March.

We were taken through the calculation of hospital administration statistics where we could deal
with several arithmetics to cup ome with solutions to bed occupancy, ALOS, T.O.I, average bed
days, occupied bed days and percentage occupancy at the wards. We also filled out DBR, and
calculated and summarized the results on the summary sheet.

I also through the help of the in charge did coding and indexing, whereby we coded different
conditions such as natural diseases, injuries and accidents, abortion which entailed complete and
incomplete abortions and births which included S.V.D and C.S using ICD 11. We were also
informed of the added ICD 11 Chapters that Involved;

6
 1.0 INTRODUCTION

1.1 Historical Background of Thika level 5

The health facilitу was established in 1941 in the industrial town of Thika as a cottage hospital
meant to cater for the health needs of native Africans and Asians living around Thika. It grew
over the years and was gazetted as a level 5 hospital on November 30, 2007. The hospital serves
as a keу referral facility for approximately five million patients, including those from Nairobi,
Kirinуaga, Machakos and Murang’a counties. It haa s capacity of 265 beds whose occupancy
varies between 120-150 per cent.

It has the following departments; outpatient and Inpatient department that houses MCH/FPS,
Laboratory, Pharmacy, Radiology, Dental, ENT departments and special clinics that were
constructed by MOH and the County government in the spirit of integrating outpatient
department services.

There is also a psychiatric unit that serves the whole of Kiambu and its surrounding areas. The
amenity section was later put up and caters for NHIF holders and others. Mortuary has adequate
spaand ce, the services are fully utilized and include embalmment, post-mortem and
preservation.

1.2 Hospital Location

It is located at General Kago Road Kamenu Thika Town Kiambu Kenya.

1.3 Climate

Thika has a subtropical highland climate with sunshine most of the year and an average annual
temperature of 19.8 °C, with the hottest period in March and April leading to the long rains and
the coldest in July. The "long rains" season lasts from March/April to May/June.
1.4 Vision

World-classld class teaching and referral hospital.

1.5 Mission

To quality qualitу, affordable, accessible, healthcare to our clients.

1.6 Value

Efficiencу, integritу, timeliness, transparencу, confidentialitу, professionalism, quick response

7
 MANAGEMENT IN THE HEALTH RECORDS AND INFORMATION DEPARTMENT

Below is the Health Records and Information hierarchical organogram showing the flow of
information across the entire department from the top management of the facility. The top-down
mode of communication is used iny useheiviinstructionsuction from senior management of the
hospital. While the bottom-up type of communication is used atinly in the time of report
submission at the end of each month.

MEDICAL
SUPRITENDANT

HEALTH RECORDS
OFFICER

DEPUTY HEALTH RECORDS OFFICER INCHARGE

BOOKING $ CENTRAL
RECEPTION CONSULTANCY RECORDS
DATA CLINICS
MANAGEMENT THIKA
OPD MATERNITY SATELITE

DIABETIC
CCC
CLINIC
1. Psychiatric department

8
This is the station of records I attended to in the hospital; it deals with treatment of mental
illness. Mental disease is a diseases that affect the mind and the way those individuals think and
behave. Throughout the period I got to know dangers of a mentally ill patients. Some of the
causes of mental illness include social stress or trauma. The offensive words that are used to
describe sick person are; mad, lunatic, crazy and insane instead of mentally disturbed, unstable
and mentally sick. Several reasons that might suggest the admission of a given patient in the
psychiatric ward may include general violence and poor IR, depression, not eating and even not
wearing clothes. Psychiatric conditions include; APE, TLE,and MDP, ABD.O.D. the D.O.D the
patient is passed through Mental Status Assessment (MSA) wherein case of NAD the patient is
allowed to go back home.

While registering psychiatric patients, care should be taken to obtain enough identification
information about the patient. This follow-up is needed at any particular time.

Some of the Hospital Administrative Statistics Include;

 Average length of stay

 Excess patient days
 Percentage occupancy
 Average daily population
 Average bed days
 Occupied Turnover
 Turn over per bed

Functions of health Information Officer

 Receiving and registering patients who are admitted in the psychiatric ward.
 Provide legal admissions when they are needed whereby we have different MOA due to
different RFA.
 Receive patient file and parole
 Do coding of diseases
 Indexing of the coded files
 Retrieve patient files when they are needed
 Filing of the patient files.
 Provide data for research when they are needed.
 Teaching students on attachment.
 Creation of master index cards
 Designing of medical forms

Activities done at psychiatric ward

9
  Registration of new patients
 Reception of patients
 Coding
 Tracing of patient files.
 Indexing of coded files
 Booking of patients
 Clinical preparation
 Filing of patient files
 Retrieving of patient files

2. Data Management department

Here is where reports are generated. Reports from all departments are collected from all
departments and wards to be combined and reported to the next level. The next levels include;
health information unit, district medical records office and county medical records office.

Functions of health records officer in data Centre.

1.) Compilation of DBR from wards.

2.) Calculating HAS.
3.) Aggregation of all data and information for various departments and sections.
4.) Compilation and analysis of reports i.e. monthly, quarterly and annually.
5.) Upload of reports to the DHIS system timely, accurate and complete.
6.) Presentation and dissemination of health information.
7.) Participate in development of AWPS or service delivery indicators.
8.) Maintaining security of health records equipment.
9.) Designing medical forms

Reporting tools found in Data Centre

 MOH 717- monthly workload

 MOH 710- immunization and vitamin A summary sheet
 MOH 705A- under 5 daily outpatient morbidity summary sheet.
 MOH 705A –over 5 daily outpatient morbidity summary sheet
 MOH 713- nutrition monthly reporting
 MOH 515- community health extension workers summary sheet
 MOH 105- service delivery report.
 MOH 731- Comprehensive HIV/Aids facility reporting form.
 MOH 718- inpatient morbidity and mortality summary sheet.
 MOH 711- An integrated tool for reproductive
 MOH 708- environmental health service.
10
 MOH 734- CDRR for HIV nutrition commodities
 MOH 706- laboratory summary report.
 MOH 364-sexual based gender violence summary form.
 MOH 643- CDRR laboratory commodities

Ways in which Data is submitted to the next level

There are two ways in which data is submitted to the next level;

(a) Through DHIS

Here computers are involved in keying in the information.

(b) The second way is through hardcopy e.g. tallying

The information is distributed in four copies in the following order;

1.) The original copy should be sent to the health information unit
2.) First duplicate copy should be sent to the district medical record office
3.) Second duplicate should be sent to the provincial medical record office
4.) Third duplicate should be maintained by the hospital medical records

Uses of service delivery and workload reports

 Hospital budgeting
 Planning
 Monitoring and evaluation
 They are used as communication tools

3. Casualty/emergency department

At this station, it acts as the reception for the people who are in emergency conditions. It also
acts as the reception for the inpatient clients. The registration and admissions of the patients is
the main activities that takes place here. The admission is done using EMR for the new
admissions and readmissions. The software used in the EMR in admission is called Check Health
Information System (CHIS).

When admitting a patient, the details of the patient are captured into the Inpatient Register (MOH
305). The details include the patient number, full names, residents, the person who brought the
patient and the ward admitted.

The patient number is generated by numerical way of listing patients as the way they get
admitted, the patient being admitted is given a unique identifying number to the next previous

11
patient in the ascending order. The patient therefore is given the Inpatient Card, whereby in case
of a readmission, the particular patient should show the card the Health Records officer to avoid
forgetting in case it happens.

Duties of health records officers at casualty include

 Teaching students on attachment

 Filing patients notes
 Issuing of files to patients
 Registering patients
 Retrieving and tracing of patient files
 Filing back patient files
 Doing file search for research

The standard operating procedures for registering patients

 DATE- the actual date the patient seen at the facility

 OPD No- A unique identification number given to a new patient annually
 REVIST-OPD number of the patients who return to the facility for services during the
calendar year
 FULL NAMES-At least three names of the patient
 SEX-Should be recorded as M for male and F for female
 AGE IN YEARS-Actual stated age of the patient expressed in figures/numbers and NOT
A or C
 ADDRESS-Physical, land marks or telephone number of the patient and the next of kin

Outpatient department

It acts as the reception for outpatient patients. The outpatient department deals with patients who
come for treatment for just a while and return back home. The patient is received and given the
directions on how he is going to receive the treatment

Outpatient management

 Patient registration and billing for:

 Special clinics
 X-ray
 Medical examination

12
  Eye and simple extraction of teeth

Patient registration

There is creation of new patient file for the first visit and the patient pays some amount for the
registration. This works for the first visit of a patient. The information about the patient is
entered into the system and the receipt printed out. The information about the payments reflects
to the doctor’s systems.

Revisit

For those who have ever come to the facility and their names are reflecting in the system, their
files are retrieved and taken to the doctor for treatment. All the information is captured from the
system and is displayed.

Registers that are found in outpatient department

a) Outpatient (over 5) Register MOH 204B – this register is for registering all patient over 5
years who visit the hospital through the section. Their number is generated separately.
b) Outpatient (under 5) Register MOH 204A- this register is for registering all patients who
are less than 5 years of age. There outpatient numbers are generated separately.

The registers are not commonly used nowadays due to electronic registration using EMR. The
system has all information required from the patient captured and the patient is given an
outpatient appointment card which carries the OP number of the patient, names and location. The
card helps the patient in case of revisit to be traced in the system easily.

4. COMPREHENSIVE CARE CENTRE (CCC)

At the CCC clinics clients are received from different entries after having been diagnosed or
tested positive. These entries include; PMTCT, IPAD, TB clinic, OPD, VCT, IPDCh. There are
several clients who are also transferred from different facilities in the count. Patients at this
station are enrolled into either CTX or ARVs as per the level of CD4 counts in the body. The
type of filing system that is used in this section is straight numerical for the patients who started
ART with the facility, for the transferred in they are filed alphanumerically.

Ethics practiced in records

Health records officer that work in the CCC must operate under bound laws to make sure the
information about any patient cannot be exposed to any outsider. This laws of conduct include;

1) Confidentiality- it involves the privacy of the clients and the information they having.

13
 2) Discipline- this is a code of conduct of behaving well before other staff, patients and to
other students.
3) Communication- it refers to the transmission of information from one person to another.
It can be within the department or from the top management and it carries different
information as per to the chain of command.
4) Security- the information about the patient should be handled under a high security, the
information should never be interfered with in any manner.
5) Disclosure- the patient of the patient is not supposed to be disclosed to any person since it
can be used as a weapon against that person. But due some curcumstances the
information is disclosed out;
 By court order
 Patient’s consent
 Safeguard the interest of the hospital or for the doctor
 Transfer of information between authorized health agencies
 Disclosure for higher duties of outbreak of diseases or side effect.
6) Ownership- the records used belong to the hospital but they normally carried by patients
during every time of revisit.

Heath Management Information System (HMIS)

It is in CCC that we learnt tools used to collect data and how it’s collected. The tools used to
collect data are, daily activity register MOH 366, MOH 731, MOH728, Pre-ART Register MOH
361A, ART register MOH 361B.

In patient files there is a green HIV card (MOH 257) which we extract information that we use
for tallying in the DAR Register. The totals from DAR are transferred to Monthly Tally Sheet
MOH 728 and finally it is reported into MOH 731.

MOH 361A is used to show all the patients that have enrolled into care including those
transferred in. while MOH 361B is used to update the conditions of the patients who enrolled to
ART up to when these patients die, transferred out and lost to follow.

Analysis and interpretation of data

We also learnt how data was analyzed using the DHIS and presented inform of; pie charts, line
graph, tables and histograms.

Tools used in ccc

They include the following;

 Pre-ART Register MOH 361A
 ART Register MOH 361B
 Daily Activity Register MOH 366

14
  Monthly Activity Sheet MOH 728
 Patent Appointment card MOH 258
 CCC Patient Card MOH 257

Functions of health records and information officers

a) Booking clients for every next revisit

b) Retrieval of files
c) Tallying daily Register and combining daily report
d) Filing back
e) Giving direction to clients
f) Updating and initiation of ART Registers
g) Making of daily calendars
h) Registration of clients into EMR
i) Enrollment of patients and generating unique numbers

Tracing back patients records

j) Sorting files
k) Checking for misfiling
l) Recording of viral loads and CD4 results

Activities done by health records and information managers

a) relating and handling of clients

b) to keep the records that belong to the patients
c) maintaining confidentiality of the patient’s information
d) booking appointments dates for patients
e) understanding the terms used in the CCC
f) understanding the tracing system used
g) understand the tools used in the CCC
h) understand the filing system used and the ethics used in records
i) making the daily reports

5. CENTRAL RECORDS/LIBRARY

15
Central records act as the central library for records of the patients files. After discharge,
patient’s files are collected and brought in the library. Files are collected from different wards.
When files are picked from any given ward after discharge, the files are captured in the MOH
361 to show that they have been dispatched to the central records for storage.

I learnt about coding and indexing of diseases. Coding is the assigning alphanumeric value to a
disease or a condition. The hospital uses ICD 11 that’s system based to code and index the
diseases. This is an improved version of ICD 10 that initially used the following volumes to code
the diseases.

I. volume 1(tabular list) -this one is used for confirming codes

II. volume 2(instruction manual)-this book is used for providing guidelines
III. volume 3(alphabetical index)- this is used for coding. And has three sections (section 1,
section 2 and section 3)

There are established steps for coding diseases. These are;

 Identifying the lead term

 Key into the ICD 11 system
 In case of further or more specific case, you click on the grey plus sign to select
the specific code.
 The selected code generated from ICD11 is assigned to the specific patient file.

Functions
(a) Receiving files from wards
(b) Coding and indexing
(c) Sorting of files
(d) Filing
(e) Retrieving of patients files when need arise
(f) Tracing of patients files
(g) Checking of misfiling
(h) Issuing of burial permit
Activities
 Sorting files as per the last two terminal digits
 Filing back
 Tracing the file incase its missing from the library
 Retrieving the files for readmission of the patient
 Coding
 Indexing diseases

16
Tools used
 Computer- the computer is used to capture the received the files, the name, conditions
and the wards from which the files are coming from.
 ICD 11 system.
 Tracer book- it is used to follow up a given file that was taken out of the central records
section to other places such as wards and by who took it.
 Diagnostic disease index card- index cards are used to monitor the disease trends, that’s
is there is outbreak of a given condition, pandemics, epidemics and endemic conditions in
the population catchment of the locality served by the hospital.

6. Maternity
This section is for expectant women who come to deliver and others for checkups. In maternity
there are units of file collection, these are; antenatal ward, postnatal ward and new born unit.
During collection of files, they are written in the dispatch book and received at the records
department.

Functions
 Coding and indexing of diseases
 Issuing of birth permits by use of B1 booklet
 Admission and registration of patients and clients
 Filing of patients files
 Tracing
 Retrieving patients’ files
Tools used
 Post- natal register
 Maternity register MOH.333
 In-patient register MOH.301
 B1 Booklet Mother booklet
 Summary sheet MOH.718
Activities
 Admission of expectant women
 Registration
 Filing
 Tracing
 Retrieving
 Coding and indexing

17
 7. Consultant Clinic
It’s a special clinic that operates on outpatient manner and deals with patients with chronic
conditions who come on regular basis for checkups, treatment and close monitoring. It has
medical Outpatient Clinic (MOPC), surgical Outpatient Clinic (SOPC) and Pediatric Outpatient
Clinic (POPC), High risk, Gynecology Outpatient Clinic (GOPC), Dermatology Clinic,Disability
Assessment Clinic and Eye Clinic.
Functions
 Booking clinics for patients for the next clinic as per the type of clinic
 Retrieving of patients files
 Filling back
 Checking of misfiling

Tools used;
 Patients’ cards- which has got patient information as per the clinic and the booking
dates.
 Tracer book- for locating files that has left out to other sections of the hospital.
Activities
 Booking of clients for the next clinic
 Retrieving of patient file to be taken to the doctors
 Filing back
 Tracing of patient files

18
8. Diabetic Clinic
This is a very busy clinic that involves care for both young and old patients with cases of
diabetes. We do take patients books and cards when they arrive in the morning and
capture the data in the MoH tool 409 then retrieve their files to be taken to the nutritionist
and then consultant for review. In capturing data, the clinic uses Outpatient Therapeutic
Program Health Facility Register MoH 409 to capture data that are used to fill the
summary book for the monthly generation of reports. After patient review, the patients
are booked for the next clinic according to the doctor’s guidance.
Roles of Records Officer in Diabetic Clinic
1. Capturing of patient data upon entering the clinic
2. Creation of new file files for new clients
3. Retrieval of files for patients
4. Booking for the patient’s next visit

9. Blood Transfusion(Satelite)

I had the privilege of being attached to Thika Satelite Center for blood donation whereas
a Health Record attachee was taught on capturing data from patients using the
questionnaires and then transferring the data to the daily register which was then to be
transferred to the Kenya Blood System. I had the privilege of counselling patients
through the questionnaires, measuring their haemoglobin levels, for men it should range
from 13.0 to 18.0 while for females should be from 12.0 to 17.0 for effective blood
donations. Through questions, I got to understand how blood was screened and the
maximum level in which one can donate. We also had the privilege of going for blood
drives to different institutions like MKU and JKUAT.

SUCCESS AND FAILURES OF THE HOSPITAL OBJECTIVES

The hospital objective and mission includes;

1. Provision of a robust health infrastructure.
Upon the achievement of this goal, the hospital, courtesу of the conditional grant and
the countу government, has put up an ultra-modern Reproductive Ηealth Unit which
has a bed capacity of 275 beds. Also the hospital has established a renal unit focused
primarilу in taking care of patients with kidneу problems. The facilitу does up to 50
dialуsis sessions weeklу, going a long waу in alleviating morbiditу and mortalitу
rates related to kidneу disease. As well the hospital has constructed the state of the
heart Intensive Care Unit to give services to the patient with chronic cases that
requires urgency and critical care.
2. Improve qualitу of health care service deliverу to the highest standards.

19
 On improvement of the hospital service delivery, the hospital has worked to ensure
employment of qualified professionals and well trained on work ethics to ensure well
service delivery.
3. Promotion of partnership with private sector
The hospital also has partnered with different institutions of higher learning like
Mount Kenya University to ensure that the student s are well trained to become better
healthcare professionals. Not only with MKU but also with many many other
institutions.

The hospital though not yet fully achieved its objectives as planned because of some
reason like inadequate funding or withdrawal of some stakeholders in supporting the
hospital, is still working to ensure realization of those objectives

Integration of the Hospital to the Health Records and Information Management

The hospital has ensured installation of the EMR system and is currently working on
having it installed in almost all departments to ensure protection of patient data. The
data has a goal of eradicating paper based records system and transitioning to EMR.
To realize this, the hospital has sponsored some HRIOs to be trained in the EMR and
KHIS so as to be well equipped in handling the system. In the next 3 years, the
hospital is envisioning a paper based free records system and all departments
including the physician based to use the EMR. The hospital gives recognition to this
department and works together to ensure achievement of its goals.

20
 CHALLENGES, RECOMMENDATION AND CONCLUSION

Challenges

There was several challenges that we encountered during the entire period of attachment.
 Shortage of staff- there are limited number of health records and information officers
in the hospital. There were few health records officer and yet patients to be attended
to are in large number. They keep waiting at the queue especially at lunch hours.
 Inadequate computers. The computers are a few in number. In data center there was a
single computer which is supposed to be operated by several people. This creates a lot
of inconveniences
 Inadequate space
 Misfiling
 Lack of commitment
 Overcrowding
 Lack of regular internet connectivity
 Misfiling
 Misfilling of DBR in wards
 Dust in retrieving files
 Lack of kick-stools for short individuals

Recommendation
 The hospital administration and those concerned should;
 Install more computers
 Increase the number of staff
 Create more space to avoid overcrowding
 Encourage those concerned to be careful when filing to avoid cases of misfiling
 Be committed to their work
 Work on the internet to ease work
 Encourage those concerned to fill the DBR daily
Conclusion
Despite the above challenges, we undertook our attachment and came out successful. We
recommend other students to have their attachments at Thika Level 5, work hard and be
disciplined.

21
REFFERENCES

1. Mary W. (2016) Thika Level 5 75th Anniversary; Achievements and Big plans for Thika
Level 5. Pg 01
http://www.kiambu.go.ke/departments/images/banners/HealthSupplement-Page3.pdf
2. Gerald M. (2016) Attachment Report. Pg 12 -16
https://www.academia.edu/29498143/my_attachment_report_at_Kakamega_County_Gen
eral_Hospital

22
23