Those who have not visited an African Hospital before may be surprised by mattresses on the floor although they also comment on the high standard of cleanliness despite frequent overcrowding.  What many visitors may not realise is that they are looking at one of the better resourced and managed hospitals in rural Africa.  They may not appreciate the enormous problems that have to be overcome to reach and then improve on this standard.

In Uganda as in most of sub-Saharan Africa the financial resources are many orders of magnitude less than in the developed world.  The Ugandan Government Health budget is about £6 GBP (10$ USD) per person per year, compared to around £1,500 GBP (2,900$ USD) spent by Government in the UK.  Although Kagando is the only hospital in Kisinga Sub-District it operates in the private sector with obligations to the Government for some public health functions and for its training and service standards.  Its depends on charging fees for its drugs and services.  These are set at the minimum possible level as the population is mainly rural, poor and largely dependent on subsistence farming.  As a consequence salaries to staff are mostly below those paid in Government service. 

Government hospitals in Uganda charge negligible fees, but the expected services are often not available either.  Patients arriving in a Government hospital, even in an emergency, are often expected to bring basic supplies, including items like sterile gloves and drugs and dressings before they will be treated.  Even then other basic supplies may not be in stock and there may not always be a doctor available.  By contrast Kagando almost always has doctors, well trained and conscientious nurses and supplies.  It functions reliably as a hospital and consequently has a reputation that extends well outside its own natural catchment area with patients often passing other hospitals to reach it.  Emergencies are never turned away, some of which have been referred on by neighbouring hospitals.  Many fees remain unpaid.  Tradable assets are often accepted in lieu of fees.

Kagando is the nearest hospital for about 200,000 people and the approximate equivalent of a medium-sized District Hospital in the UK.  Although 45km from the District capital, Kasese, it is the largest hospital in the District.  It has a long tradition for providing selected specialist services.  In recent years, for example, it has become the second largest provider in Uganda of surgical operations and support services for women with complete incontinence following childbirth (obstetric fistula), a  not uncommon problem in the whole of sub-Saharan Africa while excessively rare in developed nations.  It also acts as a base for many community services and preventative health projects. Its unique combination of reliability and specialist services deserves its claim to be a 'centre of excellence'.  Its high standards despite lower than average salaries is a reflection of its Christian foundations and vocational ethos.

The table below details its various departments and activities.

Overview: History, Current Status and Future Plans
WARDS AND DEPARTMENTS
Maternity	Outpatients
Paediatrics	Operating Theatres
Surgery	Dental Department
Medical	Pathology Laboratory and Blood Bank
Leprosy	Xray and Ultrasound
Fistula Ward	Pharmacy
Visiting Specialist Services	Physiotherapy
Overflow / Contingency
Outreach: HIV/AIDS, TB, Leprosy, Disabilities, Palliative Care	Administration: Logistics, Personnel, Salaries, Fees collection, Estate management, Planning
The School of Nursing and Midwifery	Electro-Mechanical Maintenance
Pastoral Care	Kitchens, Laundry and Sanitation
STAFF and Management Structure
Doctors	Allied Professions
Nurses and Midwifes	Non-Clinical Management
Care Assistants	Technical Assistants
VISITORS
Medical - Specialist/Non-specialist - Surgical/Non-surgical	Non-Medical - Professional/Technical Support and Governance
Specific Project Support - e.g. HIV/AIDS	Medical Students - Elective/Work Experience
Pastoral / Fund-Raisers / Miscellaneous	Other Trainees
WORKLOAD AND OTHER STATISTICS - Reports