2008 Annual Report of Wasso Hospital: Ngorongoro's District Designated Hospital.
In this report you will find some background information of our hospital and a summery of our achievements and challenges in 2008.
2008 Annual Report Wasso Hospital, Ngorongoro, Tanzania
1.
Contributing to a better health status of the people, by improving the quality of the
health care services and making them accessible, acceptable and affordable
Annual Report 2008
Wasso District Designated Hospital
Postal: PO Box 42, Loliondo
Fax: +255 27 253 049
Tel: +255 27 253 190
Email: moic@wassohospital.org
Website: www.wassohospital.org
Prepared by Dr Christian van Rij, accordingly to CSSC template 2009
2.
Contents
EXECUTIVE SUMMERY ........................................................................................................................................ 3
BACKGROUND ................................................................................................................................................... 4
HISTORICAL DATA OF FACILITY ...........................................................................................................................................
4
AREA OF OPERATION .......................................................................................................................................................
5
POPULATION AND DEMOGRAPHY OF THE AREA OF COVERAGE .................................................................................................. 6
SITUATIONAL ANALYSIS ..................................................................................................................................... 7
FINANCIAL ANALYSIS ....................................................................................................................................................... 7
STAFFING .....................................................................................................................................................................
. 7
INFRASTRUCTURE AND ACCESSIBILITY ................................................................................................................................. 8
MAJOR BURDEN OF DISEASES ............................................................................................................................................ 9
INSTITUTIONAL ARRANGEMENT ....................................................................................................................... 1
. 1
STRATEGIES ...................................................................................................................................................... 2
1
ACHIEVEMENTS AND CONSTRAINTS .................................................................................................................................. 3 1
WAY FORWARD ........................................................................................................................................................... 4
1
STAFF ESTABLISHMENT ..................................................................................................................................... 6
1
STAFF ON TRAINING ...................................................................................................................................................... 6
1
SOCIAL WELFARE ......................................................................................................................................................... 7
1
SUMMARY OF SERVICES GIVEN ......................................................................................................................... 8
1
MEDICAL SERVICES ....................................................................................................................................................... 8
1
PARAMEDICAL SERVICES ................................................................................................................................................ 0
2
SUPPORTIVE SERVICES ................................................................................................................................................... 1
2
SATELLITE SITE: DIGODIGO DISPENSARY ............................................................................................................ 4
2
EPILOGUE AND ACKNOWLEDGEMENTS ............................................................................................................. 5
2
ANNEX 1: DISEASE STATISTICS ........................................................................................................................... 7
2
ANNEX 2: MAP NGORONGORO DISTRICT ........................................................................................................... 8
2
ANNEX 3: NGORONGORO DIVISIONS, WARDS AND POPULATION ...................................................................... 9
2
ANNEX 4: INCOMING AND OUTGOING STAFF IN 2008 ....................................................................................... 0
. 3
ANNEX 5: COMMUNITIES SERVED WITH OUTREACHES ...................................................................................... 2
3
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3.
Executive Summery
Wasso Hospital is a District Designated Hospital. The remote location is making our operation quite
difficult as it gives logistic problems. Due to this we also have higher running costs and it makes it
also more difficult to attract good staff. The patients we are serving are among the poorest of the
country, which limits us in making a financial balance with patient fees for the costs not covered by
governmental sources.
Wasso Hospital Key Data 2007 2008
Outpatients 16,589 16,951
Although 2008 was a challenging year
for Wasso Hospital, we feel blessed Admissions 2,316 3,094
that we managed to overcome these Death / Admission Ratio 0.032 0.021
difficulties. In the medical field we Deliveries 523 605
continued with our different projects, Perinatal Mortality / Delivery Ratio 0.048 0.031
like the outreaches and the Care and Treatment Clinic for people living with HIV/Aids. Although we
faced a shortage of medical officers at our site, we are happy to announce that the quality of care
remained good or improved in all major areas. We did not have complaints for malpractice and the
ratio of death per admission dropped with one third. Although we had an increase of 16% of the
amount of deliveries, we did not had any maternal death and our perinatal mortality ratio dropped
with 34%.
As a reflection of good medical practice, we saw the number of patients rise slightly in our
outpatient department and significantly in our inpatient department. The hospital also managed to
gain a good name at Dutch universities making them decide to send student doctors for electives to
our hospital, which boosted an atmosphere of education at our hospital.
Administratively we also made a lot of progress. We managed to fill the gap in our management
team with the arrival of a new administrator in June. The management became more transparent by
clarifying the basis of management decisions, and by proposing an organogram to the staff so that
lines of communication within the hospital became clear. Finally we also managed to improve our
financial transparency to donors and to gain further trust from by undertaking all efforts to make a
cost reductions in our not medically very relevant expenditure. Together with a good medical
performance, this triggered our donors to assist us more, which
enabled us to make large reductions in our debts.
Digodigo Dispensary is run as a satellite of Wasso Hospital. It is
located 68 kilometer from Wasso Hospital. Staff shortages en drugs
shortages remain a difficult issue for this site. We have the ambition
to make several improvements to the site in the coming year to
facilitate its upgrading to a Health Centre with a Service Agreement
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with the Ministry of Health and Social Welfare (MOHSW). But even
though these problems exist, Digodigo Dispensary still remained the dispensary with the highest
utilization in the district.
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6.
Population and demography of the area of coverage
Projected from the 2002 national census, in 2008 Ngorongoro District was populated by 186,464
people divided over roughly 32 thousand households. This means on average 13 people per square
kilometre. The annual growth was estimated at 4.5% (roughly twice as high as country average).
There is no data known about the age distribution and life expectancy of our population. Also key
indicators for the health care are not know on district level. As reference we shall therefore mention
the Tanzanian averages (data from WHO statistics from 2007):
Age structure: <14 years: 43%; 15‐64 years: 54.1%; > 65 years: 2.9%. The median age is 18
years. Total life expectancy at birth is 50.5 years for males and for female 53.3 years.
The total fertility rate is 4.5 children born/woman. An estimated 43% of all births is attended
by skilled personnel. The maternal death rate is reported to be 578 per 100,000 but
estimated by WHO at 950 per 100,000. The under‐5 mortality rate in rural areas is 138 per
1000 live newborns.
We expect that the age distribution is even lower in our district, and likewise also the life
expectancy. The fertility rate is likely higher, the non‐medically supervised deliveries is certainly
higher, and therefore the maternal death rate will also likely be higher. Also the under five mortality
rate is expected to be higher.
The main and indigenous inhabitants of the district are the Maasai (±80%) and the Watemi (also
called Sonjos). The Maasai are mainly pastoralists who depend on cattle herding. The Watemi
sustain themselves mainly with agricultural activities and are living in Sonjo valley (the area around
Digodigo Dispensary). Both groups are therefore extremely vulnerable to periods of long drought. In
more recent times there is a big influx of job looking non‐indigenous ethnic groups to the area
around Wasso and Loliondo. The Maasai and Watemi have quite distinct cultural differences.
Language problems are still a serious problem in our district where especially people with a Maasai
background have often difficulties expressing themselves in Swahili. Also the districts literacy rate is
estimated to be far below the countries average.
On average, the people in our district have little financial means. The Gross National Income (GNI)
per capita in Ngorongoro district was according to the 1998 Arusha Region Socio‐Economic Profile
one third of the countries average.
Extrapolating this ratio to 2008 would
mean an average income in Ngorongoro
of around 317 euro per capita per year.
Financial reserves are within the Maasai
population mainly invested in cattle.
Periods of drought in which many cattle
will die will therefore directly influence
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their means for living.
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17. Faraja Israel Malalika Certificate in Nursing 07‐31‐2008
Frank Lisso Assistant Medical Officer 06‐19‐2008
Jacob Joseph Seyai Nursing Officer 30‐06‐2011
Joseph Saisa Laizer Trained Nurse 31‐07‐2009
Linda Thomas Ndangoya Diploma in Nursing 19‐06‐2008
Lucas Toroya Advanced Diploma Social Worker 01‐08‐2008
Mlejo Ngurumwa Lembyino Diploma in Nursing Psychiatry 14‐06‐2010
Sabina James Kiromo Diploma in Nursing 11‐06‐2009
Theresia Tarimo Aloyce Nursing Officer 10‐09‐2009
Victor Mushi Ndale Dental Technician / Assistant Dental Officer 01‐09‐2009
Rohela Simon Kaseriani Bachelor of Medicine & Surgery 01‐01‐2013
Social Welfare
Staff under contract with the Archdiocese make social welfare contract. In 2008 there has been
some staff unrest as there were worries that not all mandatory payments had been paid in the
preceding years. Although it was not difficult for the management to prove that currently payments
were done properly, the administrator it lacked documents with individual staff NSSF summaries of
previous years. A task force was put on the issue and by the end of the year, serious progress had
been made to clear up this issue. The final NSSF summery will be made in 2009.
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18.
Summary of Services Given
Medical Services
Outpatientdepartment
We can reflect on a good running out patient department (OPD) in 2008. OPD 2008
Although staff shortages were present, the head of the OPD, dr Humphrey under five 7,244
Mshana, managed to run it well. We even saw a small increase in our above five 8,573
patients treated there, reaching almost seventeen thousand patients in retreatment 1,037
2008. 46% of the patients were under five years old and therefore treated referrals 97
for free. Furthermore we saw a decrease in the amount of patients we Total 16,951
had to refer.
The outpatient department consists of a room for the cashier, registration, dental, drug dispensary,
and five doctors rooms. Although this is already a huge improvement compared to the situation in
early 2007, we are still running short in space, especially for the waiting patients.
Inpatientdepartments
As mentioned before we saw an increase of 34% of our admissions. This gave a very significant
increase in the workload for the nursing staff. It would also challenge our budget as we in our flat fee
system can only regain a small portion of the actual admission costs. But fortunately we managed to
keep the quality of care up to a high level and even managed to achieve a reduction in our patient
mortality.
The following wards have been managed as one unit by Joyce Sinodya: Pediatric (36), ICU(6), TB (32)
and the Private Ward (5). The following wards have been managed as one unit by Cecilia Nkii:
Female (24), Male(20), Antenatal (24), and Labor (11) Ward (consisting of a first‐stage room, a labor
room, and a post‐delivery room). In total we have 155 beds plus 3 first stage beds and 3 delivery
beds.
Theatre
Mrs. Esther Clement has been besides assistant matron also the head of major theatre. In the past
year we have received many compliments from visiting specialist for the quality achieved in that
unit. In total 224 operations have been performed in major theatre. Caesarian sections are the
leading major operation performed (47 times in 2008), but abdominal and orthopedic surgeries are
also performed at our hospital.
Mrs. Bertha Stephen is besides our most experienced nurse anesthetist also the head of minor
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theatre. Minor surgeries, incision and drainages, curettages, fracture reductions and wound
dressings are performed on daily basis. In 2008 4474 procedures were done in minor theatre.
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19.
Specialist Outreach Program
During the past year we were happy that multiple specialist have been willing to come to Wasso to
assist us with patients in need of specialist care. We are also grateful to them that they assisted us
with continuing education program by giving lectures during their visits. In total we have received
the following 10 teams.
Date Specialty Via
4‐7 February Pediatrician AMREF
21‐24 April Gynecologist AMREF
19‐22 May Ophthalmologist St. Elizabeth
14‐17 July Surgeon AMREF
11‐14 August Ophthalmologist St. Elizabeth
22‐25 September ENT Surgeon AMREF
27‐30 October Urologist AMREF
3‐6 November Opthalmologist St. Elizabeth
1‐4 December Pediatrician AMREF
13‐17 December Orthopedic Surgeon Selian
Aids Control Program
Since February 2006 we have started to provide services to people living with HIV/aids. We were
grateful for the support we received from the NGO EGPAF who supported this vertical program in
many ways.
In 2008 we managed to test 645 people for HIV of which 95 were positive. At the beginning of 2009
we had 161 patients in total enrolled of which 81 were eligible to ARV, 78 were actually taking the
ARVs (of which 3 were under 14 years). We managed to do follow up on most of our patients,
although it remained a difficult task as often we were lacking a car for this purpose. Fortunately, we
expect to receive an additional car from EGPAF in 2009 so that this problem will be solved in the
near future. We hope that another constraint, the lack of enough staff trained on HIV/ART, will also
be solved in 2009.
Dental Unit
The Dental unit showed a decrease of patients served. In 2008 a 2007 2008
total of 365 patients received dental care; most of them needed Carriers 68 62
extraction as the condition of the teeth was too bad. Unfortunately Other 433 303
our assistant dental officer had to be discharged in December due Total 503 365
to integrity problems. Fortunately we expect a new Assistant Dental Officer to come back from
school in 2009.
Mother and Child Health Services
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In 2008 we continued giving Maternal and Child Health Services at our hospital. This service consist
of performing medical checks on al pregnant mothers and giving them the required vaccinations. In
2008 1335 mothers were checked during their pregnancy. Also the regular checkups were
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performed on newborn children, who also received their necessary vaccinations during their first
20.
years of life. The 2667 BCG vaccines from Wasso outreaches are a good reflection of the high rate of
vaccinations given by this unit. People could also come to this department for advices on family
planning.
Wasso
Pregnant mothers seen 1,335
Mothers seen after delivery 1,281
BCG vaccines given to children <1 year 2,667
Children underweight at 9 months 2,7%
Outreach Services
The above high numbers for our Mother and Child Health Services were not only achieved within the
hospital compound. Due to the fact that many communities have difficulties reaching our facility, we
have been reaching out to them since the early start of our hospital. We started with visiting the
communities by car clinics. But from 1969 with the help of the Flying Doctor Service, later AMREF,
and from 1983 onwards with Father Pat’s Flying Medical Service, we have became able to also serve
the furthest communities by airplane.
During these outreaches a clinical officer treats general illnesses, a nurse officer and a medical
attendant perform an integrated mother and child health care – where preventive measurements
like vaccinations are the key approaches. If seriously sick patient are met during the outreaches, they
are taken back to the hospital for further treatment.
Currently we are visiting on a 4 weekly basis the 18 sites with our car clinics from Wasso and 7 sites
from Digodigo. With the help of Flying Medical Services, we also provide clinics to 11 of the most
remote locations of our district every 2 weeks. Please see annex 5 for an overview of the 36
communities served with our outreaches.
Paramedical Services
Radiology Unit
In 2008 our radiology department has been performing fine. Our radiologist, Mr. Solomon Ombati
has been taking and developing x‐rays of outstanding quality. He has also developed himself into a
very able sonographer. Since early 2008 he also started making ECG on patients. The quality of the x‐
ray machine and developer are good; having enough films in stock has appeared to be a difficult task
due to a shortage of funds. The quality of the ultrasound machine is not adequate anymore due to
problems with the probes. As replacing the probes alone is very costly, we should look for a new
ultrasound machine in 2009. In total 1,494 x‐ray pictures have been made 1,033 patients. 1,560
patients received an ultrasound investigations.
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Laboratory Unit
The laboratory has set a good performance in 2008 though they have been short of staff and
equipment (especially reagents). Although the total number of investigations done is not counted,
in the underneath table reflects their performance on key indicators.
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21.
In early 2008 we were screening our own Investigations Performed Abnormal
blood donors for transfusion blood. But Blood slides 9,528 3,211
as there is a window period of false Stool 2,042 1,243
negative results following a recent TB Sputum 597 63
infection, we started to collaborate with Syphilis 398 39
the Blood Bank in Moshi who can Hemoglobin (<7g/dl) 1,561 740
overcome this window period with CSF Fluid 22 15
Gram Stain 287 216
sophisticated PCR testing on viral
HIV serology 645 95
DNA/RNA. But transport problems are
Units of blood transfusion 121 1
also with this issue an obstacle.
Pharmacy Unit
The pharmacy unit was in 2008 had difficulties keeping proper stocks as the amount of medicines
allocated to our MSD account reflects only 86 beds, while we have 155 beds at Wasso plus an
extensive outreach program. Additional procurements therefore had to be done, also at private
suppliers as MSD also often lacked certain essential items. The total amount spend on medicines and
medical supplies (including our MSD allocation) is roughly estimated on 120 million shilling for 2008.
Under the leadership of Mr. Roche Nyamhanga, the pharmacy underwent several significant
improvements, especially in the area of proper stock keeping and prescriptions. In the coming year
we will continue with these improvements where we will put special emphasis on proper
prescription and on an electronic ordering and stock keeping system.
Spiritual Services
We were happy that in January 2008 the hospital got strengthened by the arrival of Fr Willibrord
Muemans, a Belgian priest who served many years in Congo. It was very unfortunate that his health
started to trouble him and he therefore had to return to Belgium in September that year. The
spiritual service would continue to be given by the parish priest from Loliondo.
Supportive Services
Administration and Accounting
Administratively 2008 has been a very challenging year, especially as we were without an
administrator since October 2007. Fortunately the management team was strengthened from June
onwards by the arrival of Mr. Claude Rieser as the new administrator.
Within the administration we faced quite some difficulties as the organization of documents were
previously organized not properly so it was difficult to find specific documents (as for example
mentioned above with the issue of NSSF documents, but also when it came to the breakdown of the
debts we had with our staff). We therefore started to go through all old documents and organize
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them with a bookkeeping hierarchy. Also new documents were ordered in the same manner. By the
end of 2008 we had also made serious progress in electronizing all current documents by scanning
them, which makes them easily accessible and searchable.
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24.
Satellite Site: Digodigo Dispensary
Our clinical officer Joachim Mbosha served the people of Sonjo Valley 2008
another year as the in‐charge of Digodigo Dispensary. Although the OPD patients 6471
populations served is huge, the constraints on this dispensary are big. Admissions 252
Most significantly these are the staff shortages and the essential drug Deliveries 47
shortages. These problems could be solved to large extend if we could upgrade the Dispensary to
the status of a Health Centre and come into a Service Agreement with the government. Plans have
been undertaken to achieve this in the coming year. In the mean time, the dispensary has to be self
reliant in many areas; medicines for example can only be procured from their revenue made.
Although a CTC is officially already established on paper, we are discussing with EGPAF how we can
turn it into proper action. Plans for this, including the construction of a new building, have already
started to turn into actions by the end of 2008.
Despite of all constraints, Digodigo Dispensary remained among the best visited dispensaries of our
district.
Digodigo Dispensary
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29.
Annex 3: Ngorongoro Divisions, Wards and Population
Division Ward Health Facilities Population
Loliondo Orgosorok Wasso Hospital; Loliondo Health Centre; 51,416
Magaiduru Dispensary;
Soitsambu Soitsambu Dispensary; Oloipiri Dispensary;
Sero Dispensary
Arash Arash Lutheran Dispensary
Sale Digodigo Digodigo Dispensary; Samunge Dispensary; 39,468
Ondonyosambu Oldonyosambu Dispensary
Sale Sale Dispensary
Malambo Malambo Health Centre
Pinyinyi Ngarasero Dispensary
Ngorongoro Ngorongoro NCAA Dispendary 77,580
Olbalbal Olbalbal Dispensary
Nainokanoka Nainokanoka Dispensary
Endulen Endulen Hospital
Kakessio Kakesio Dispensary
Naiyobi
Total 176,045
Wasso Hospital Catchment Area describes the area where we are supposed to provide a health care
to. According to government decision, our catchment area consists of 30,002 people in 2008.
Wasso Hospital Service Area is the area where we are providing medical services to the people. This
is Loliondo Division and Sale Division as the quantity of services by other facilities was minimal in
2008.
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30.
Annex 4: Incoming and outgoing staff in 2008
Outgoing staff
Full Name Designation specific Employment End
Namnyaki Lazaro Parkipuny Nurse Officer III 31‐10‐2008
Onesmo John Kiromo Driver I 31‐10‐2008
Jeremia Msika Kaduga Clinical Officer II 31‐12‐2008
Kennedy Israel Dodo Assistant Medical Officer / Dentist I 31‐12‐2008
Libori Ephrem Tarimo Clinical Officer II 31‐10‐2008
Felix Zelote Lukumay Laboratory Technician II 31‐10‐2008
Solomon Michael Ombati Technician II 31‐10‐2008
Agnes Lucas Ammi Senior Nurse 31‐10‐2008
Ansila Inyasi Silayo Nurse Officer I 31‐10‐2008
Cecilia John Nkii Senior Nurse 31‐10‐2008
Esther Clement Mpondo Nurse Officer II 31‐10‐2008
Loturiaki Ngunyi Korio Senior Health Officer 31‐10‐2008
Febronia Mushi Simbero Nurse Officer III 30‐11‐2008
New Incoming staff
Full Name Designation specific Employment Start
Claude Simon Rieser Senior Health Secretary 1‐5‐2008
Elias Elisha Nkambi Medical Attendant II 1‐8‐2008
James Robert Kiromo Medical Attendant II 1‐8‐2008
Momboshi Lendano Kesike Security Guard 1‐7‐2008
Juliana Melkiory Shirima Medical Attendant II 1‐12‐2008
Amina Adam Ramadhan Medical Attendant II 1‐10‐2008
Dorcas Nyaboke Mokaya Nurse Officer III 14‐2‐2008
Emanuela Castul Anney Nurse II 1‐4‐2008
Flora Charles Eliphadhil Medical Attendant II 1‐5‐2008
Hereswida Myaki Medical Attendant II 1‐11‐2008
Maoi Moriaso Kipakwa Medical Attendant II 1‐8‐2008
Nossim William Mollel Medical Attendant II 1‐7‐2008
Zaina Alfani Shemaghembe Nurse Officer III 1‐3‐2008
Samwel Samwel Mattur Medical Attendant II 1‐8‐2008
Sakara Murkuk Security Guard 1‐7‐2008
Balthazar Seho Bayo Technician II 1‐8‐2008
Peter Emanuel Losiki Medical Attendant II 1‐8‐2008
Sarim Joseph Kashe Medical Attendant II 1‐8‐2008
Kanja Motegha John Nurse Officer III 6‐1‐2008
Joseph Parsambey Principal Office Assistant 1‐12‐2008
Manace Williams Medical Attendant II 1‐8‐2008
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31. Lennard Linus Daserwa Medical Attendant II 1‐8‐2008
Lilian Albert Masawe Nurse Officer III 29‐9‐2008
Zuwena Abdalah Christina Nurse Officer III 29‐9‐2008
Febronia Mushi Simbero Nurse Officer III 29‐9‐2008
Eliatikiswa Festo Pallangyo Medical Attendant II 1‐8‐2008
Moses Tumate Kikonya Nurse Officer III 1‐11‐2008
Jane Robert Kiromo Medical Attendant II 1‐12‐2008
Timizaeli Laanvuni Sumunai Medical Officer / Dentist II 4‐12‐2008
Julius Ole Sitoy Kututu Security Guard 1‐12‐2008
It should be noted that the above two tables only reflect staff under archdiocesan contract and not
seconded staff. Some of the staff who left the Archdiocesan contract, but remained working at
Wasso as seconded staff. The significant turn over in the group of seconded staff is also not
reflected in the above tables.
Wasso Hospital Car Outreach
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32.
Annex 5: Communities Served with outreaches
Currently we are visiting the following 18 sites on a 4 weekly basis with our car clinics from Wasso
• Magaiduru: 40 km from Wasso Hospital
• Esero / Orkuyaine: 28 km from Wasso Hospital
• Oloipiri: 34 km from Wasso Hospital
• Engusero and Sambu: 55 km from Wasso Hospital
• Ndulele: 70 km from Wasso Hospital
• Olosho: 74 km from Wasso Hospital
• Sukenya: 34 km km from Wasso Hospital
• Orongai: 34 km from Wasso Hospital
• Maaloni: 58 km from Wasso Hospital
• Mgongo: 63 km km from Wasso Hospital
• Mageri: 59 km from Wasso Hospital
• Olorien: 30 km from Wasso Hospital
• Olosoito: 60 km from Wasso Hospital
• Oldonyowass: 45 km from Wasso Hospital
• Olobo: 11 km from Wasso Hospital
• Lopolun: 15 km from Wasso Hospital
• Oloswashi: 72 km from Wasso Hospital
• Olemeishiri: 30 km from Wasso Hospital
The following 7 sites are visited by car clinic from Digodigo Dispensary on 4 weekly basis:
• Mugholo: approximate 8km from Digodigo
• Bwelo Mugholo: approximate 10 km from Digodigo
• Kisangiro: approximate 12 km from Digodigo
• Bwele Digodigo: approximate 12 km from Digodigo
• Makurendane: approximate 10 km from Digodigo
• Masusus: approximate 60 km from Digodigo
• Tinaga: approximate 30 km from Digodigo
The following 11 sites are visited by flight clinics from Wasso on 2 weekly basis:
• Olaika • Njurleen
• Mondorosi • Loorbilin
• Empopongi • Oljhoro
• Ololosokwan • Olemnei
• Orpirikata • Moniil
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• Pinyiny
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