Sabatia Eye Hospital 2008 Annual Report

Annual Report 2008 Friends Church Sabatia Eye Hospital

Friends Church Sabatia Eye Hospital P.O.Box 214, Wodanga 50311, Kenya Tel: +254 20 2393883 / +254 733 731013 E-mail:[email protected] Website: www.sabatiaeyehospital.org

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Sabatia Eye Hospital Annual Report 2008

Table of Contents 1.

Executive Summary .............................................................................................................. 3

2.

Eye Care Services .................................................................................................................. 4 2.1 Clinical Services at the Base Hospital ............................................................................... 4 Clinic ...................................................................................................................................... 4 Ward and Theatre .................................................................................................................... 4 Laser Treatments ..................................................................................................................... 4 2.2 Mobile Clinics, Lions Camps and Surgical Outreach Services........................................... 6 Paediatric Eye Care Services / Childhood blindness ................................................................ 6 Low Vision Therapy and Visual Rehabilitation ....................................................................... 7 2.3 Training Programs ............................................................................................................ 8 Registrars from the University of Nairobi (UoN) ..................................................................... 8 Cataract Surgery and Ophthalmic Nurse Trainees from Kenya Medical Training College........ 8 Ophthalmic Skills Upgrading Training in Eye Care ................................................................. 8 2.4 Vision 2020:The Right to Sight” Program in Western Province ........................................ 9

3.

Administration, Human Resource Development and Hospital Security ........................... 10 3.1 Computerization of the Hospital Systems / ICT............................................................... 10 3.2 Security of the Hospital................................................................................................... 11 3.3 Hospital 2006-2008 strategic plan Review ...................................................................... 11 3.4 Human Resource Development ....................................................................................... 12 3.5 Staff Development and Training Opportunities ............................................................... 12 3.6 Performance Appraisals and Evaluation .......................................................................... 13 3.7 Staff Welfare Initiative.................................................................................................... 13 3.8 Transport and Vehicle Management ................................................................................ 13

4.

Finance and Supplies Management .................................................................................... 14 4.1 Cost Containment Measures............................................................................................ 16

5.

Public Relations and Outreach Program Coordination .................................................... 16

6.

Partnership Development ................................................................................................... 16 International Partners ................................................................................................................ 16 National Partners ....................................................................................................................... 16 7. Challenges and Problems encountered ............................................................................... 17 8.

Future Plans ........................................................................................................................ 17

9.

Conclusion ........................................................................................................................... 17

10. The year 2008 in pictures .................................................................................................... 18

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Sabatia Eye Hospital Annual Report 2008

1. Executive Summary The year started with Kenya experiencing a post election violence which seriously affected the country mainly the western part and consequently had a negative impact on the overall hospital services. The number of patients coming to the Hospital significantly decreased due to difficulty of transport access and security. With low turnout of patients, revenue generation declined which was reflected in the reduction of income in all areas of hospital services, while total expenditure and mainly running cost remained very much unaltered or almost constant. The economic situation with raising inflation, higher food and fuel cost contributed in affecting the capacity of patients paying for and accessing services. The cost of medical and other supplies also increased. In 2008 sponsorship for congenital cataract for children by Standard Chartered Bank improved our support to poor needy children and families who are benefiting from the service. The sponsorship support for poor patients for cataract surgery by Oud in Afrika has continued to help a lot of needy poor patients during these economically trying times. We maintained our service quality control through continuous cataract audit. We strengthened the low vision service through training of staff at the unit. The training component of our services has progressed well and even strengthened. We have trained two groups of eight and ten trainees respectively. Three of them were from South Sudan. We continued offering training in collaboration with the University of Nairobi and the Kenya Medical Training College A dreadful and very violent security incidence happened in July when our guests, the parents of Dr. Heiko Philippin were attacked and injured by a gang of thugs in the Hospital guest house at night. It was a shocking and unfortunate incident for all of us, specially the victims and their family. Following this painful incident, the hospital has received significant and encouraging moral and financial support from CBM RO, CBM HQ in Bensheim, the local community, the local administration, board members, the patron DPM Honorable Musalia Mudavadi, partners, friends and others. We are immensely grateful to all of you who directly or indirectly supported us during that difficult time. We have reviewed our security status and put major preventive measures in place within our premises. The hospital supplies management and control system has been computerized. The hospital in partnership with a local software company is about to develop a comprehensive software which will combine the patient database with clinical activities, stores management, human resource information, financial and public relations activities and others. The hospital has continued pursuing its sustainability effort despite serious setbacks & difficulties encountered during the year. We countered the effect of these problems by stepping up our efforts and keeping up with the challenges. I am grateful to all of you who continue supporting us and in particular to all our staff who demonstrated determination and hard work making the hospital end the year with good service output, improved revenue and positive balance despite all the difficulties encountered during the year.

Dr. Demissie Tadesse Hospital Director/CEO

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Sabatia Eye Hospital Annual Report 2008

2. Eye Care Services 1.1 Clinical Services at the Base Hospital Due to the difficulties encountered in 2008 the total number of cataract operations has decreased from 3,335 to 2,728 and the total number of surgeries has decreased from 4,252 to 3,627 a decrease of 15%. There was also a decrease in the total number of patients as it can be seen from the summary table below. A summary of eye care services data is given below. This reduction is mainly because of the difficulties encountered by patients in accessing the hospital during the post election violence and the economic hardship that followed then after.

Clinic This year the hospital experienced a decrease of 19% of outpatients in the base hospital as compared to 2007. This decrease is also attributed to the reasons indicated above.

Ward and Theatre According to our records, we did a total of 2,407 cataract operations and 3,048 total operations at the base hospital. There were a significant num-

Outpatients waiting bay

ber of patients admitted and treated for various medical eye diseases apart from those for surgery. We had a 17% decrease of cataract surgeries at base hospital and a 19% decrease of total surgeries; however the decrease was not as bad as we expected given the situation the country passed through.

Laser Treatments Our laser treatment services comprise of a Diode Laser for cyclophotocoagulation in (secondary) glaucoma, grid, focal, and panretinal photocoagulation for diabetic retinopathy and other ischemic conditions of the retina. We also offer YAG Laser-capsulotomy with the latest Visus III YAG -Laser machine from Zeiss. In 2008 we performed a total of 147 laser treatments, 109 with the YAG- and 38 with the Diode-Laser. We are planning to further increase our laser treatments. Especially the treatment of diabetic retinopathy needs to be extended towards more patients since it is an increasing condition. We plan to network with other general hospitals in the area to enhance the referral of diabetic patients for eye examination and eventual treatment.

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Sabatia Eye Hospital Annual Report 2008

Table I: Patients Statistics Summary from 2005-2008 Base Hospital Services Services Provided

2005

2006

2007

2008

Patients Seen

16,034

17,427

19,868

16,164

Cataract Operations

2,186

2,571

2,907

2,407

Total Operations

2,857

3,216

3,779

3195

Table II: Outreaches /Mobile Services Services Provided

2005

2006

2007

2008

Patients Seen/ Visits

13,546

13,401

15,885

14,049

Cataract Operations

483

489

428

321

Total Operations

562

553

473

579

No. of Outreach Visits

72

76

84

70

Table III: Total Services (Mobile & Base Hospital) Services Provided

2005

2006

2007

2008

Patients Seen/ Visits

29,580

30,828

35,753

30,213

Cataract Operations

2,669

3,060

3,335

2,728

Total Operations

32,249

33,888

39,088

32,941

Table IV: Reduction of Services in 2008 Compared to 2007 Service Provided

2007

2008

Reduction from 2007

Reduction %

Patients seen

35753

30213

- 5540

15%

Cataract Operations

3335

2728

- 607

18%

Total Operations

4252

3627

- 625

15%

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Sabatia Eye Hospital Annual Report 2008

Chart I: Cataract and Total Surgeries done from 2005 to 2008 Catarct and Total Surgeries done from 2005 to 2008 4,500 4,000 3,500 3,000 2,500

Cataract Operations

2,000

Total Operations

1,500 1,000 500 0 2005

2006

2007

2008

Ye a rs

1.2 Mobile Clinics, Lions Camps and Surgical Outreach Services A total of 70 mobile clinics, eye camps, follow up visits and surgical safari services were conducted. Among these, we did 15 Surgical Outreaches where we performed 321 cataract operations. Overall we shifted from surgeries outside the Hospital to more surgeries at base hospital. We are evaluating our working relationship with some partners who have demonstrated less commitment. We Patients during a surgical outreach

plan to terminate partnerships with some of them and initiate new partnership in some underserved areas in the

coming years. We have started these efforts by going to Kerio Valley, Pokot and Marakwet in collaboration with Africa Inland Church (AIC) and World Vision Kenya program in Rift Valley Province.

Paediatric Eye Care Services / Childhood blindness The hospital has continued to strengthen this service in western Kenya. We treat and operate many children who come with various medical and surgical eye problems including significant numbers of eye injuries/Traumas referred from all over western Kenya. We did a total of 245 operations on children under 15 years of age. There was a decrease by 33% in comparison to the previous year. The operations include a wide range of congenital, developmental

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Sabatia Eye Hospital Annual Report 2008

and other pathologies including Cataract, Glaucoma, and Trauma. We also provide free spectacles to children in blind and integrated schools in collaboration with Optica Ltd. Our paediatric surgical service has received a big support of Kshs 1,664,000 in surgical sponsorship for congenital cataract from Standard Chartered Bank with the coordinative effort of CBM Regional Office. The support has continued for the year 2009, we are grateful to the Standard Chartered Bank for their support and commitment for this nobble cause.

Table V: Various Paediatric Operations performed from 2006 – 2008 2006

2007

2008

Cataract

132

155

127

Glaucoma

20

17

18

Traumas/Corneal Perforations

33

37

26

Various Others

134

146

74

Total

319

364

245

Low Vision Therapy and Visual Rehabilitation The Low Vision Unit expanded its services and manpower further in 2008. One additional staff was added and received a one month training in orientation and mobility at CCBRT Tanzania. The department head participated in a two months refraction course for low vision children in Ruharo Eye Centre Uganda. A teacher’s seminar on low vision was held for 14 participants in August 2008. This also included facilitators from Kikuyu Eye Unit who contributed a lot towards the seminar’s success. The trainees of the skills upgrading course in eye care were also given lectures on low vision expecting that they will disseminate the same knowledge to the community and refer as appropriate. In November Dr Ulrika from Sweden visited the low vision department and gave positive recommendations. We highly appreciate her support. This year a total of 2061 patients were seen in the Low Vision Unit as shown below. The hospital is strengthening its Low Vision services. It has at present taken over serving the three blind and integrated schools in western Kenya from Kikuyu Eye Unit. We feel it should further be strengthened both with manpower, supplies and a vehicle if possible.

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Sabatia Eye Hospital Annual Report 2008

Table VI: Patients seen in Low Vision Unit & outside Visual acuity of children below 6 years

1178

Low Vision assessments

382

Rehabilitation of adults with low vision

115

Early intervention

211

Squint and amblyopic therapy

40

Refractive errors

13

Low Vision assessments at outreach programmes

122

Total

2061

1.3 Training Programs Registrars from the University of Nairobi (UoN) This year a total of five registrars from the University of Nairobi (UoN) were attached to the Hospital each staying for a period of eight weeks. They received training in cataract surgery and other procedures. They were exposed to a large variety of pathologies in the clinic and outreach services. We are in a process of developing a memorandum of understanding with the department of Ophthalmology of the University of Nairobi. We hope this will strengthen our working relationship and collaborative effort.

Cataract Surgery and Ophthalmic Nurse Trainees from Kenya Medical Training College The hospital does also host trainees from Kenya Medical Training College (KMTC) regularly for the last many years. There were two cataract surgery trainees who did their training at our institution for eight months each last year which has extended to this year. We also received Ophthalmic Nurse trainees from KMTC. They stayed for two months at our facility and had a practical exposure in clinical, surgical and outreach work.

Ophthalmic Skills Upgrading Training in Eye Care The Hospital conducted two 12 weeks ophthalmic skills upgrading courses in line with the Provincial Vision 2020 Plan for Western Province. The training was initially launched in 2007. We had in total 19 trainees. Some were from various districts in Western Kenya including:

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Sabatia Eye Hospital Annual Report 2008

1) Malava District 2) Emuhaya District 3) Mumias District 4) Bungoma North District, 5) Bungoma West District 6) Butere district, 7) Mt Elgon District, 8) Kapsabet District, 9) Kitale district,

Ongoing Skills Upgrading Course in Eye Care for Nurses

10) Teso District, 11) Lugari district and Vihiga District. We had trainees from other provinces sponsored by faith based organisations / non governmental organisations from Lodwar, Migori, Kimilili, and South Sudan. We appreciate the cooperation we get from all the stake holders in the programme. (SEH, CBM and MoH, through District Health Offices), We think this partnership effort between the Ministry of Health, CBM and Sabatia is the way forward in promoting “Vision 2020” implementation both at the National and provincial, district and community level. The training has empowered those involved, with basic and primary eye care knowledge and skills which can help them contribute in the effort of eliminating avoidable blindness. Our plan is to continue training new applicants, provide continue medical education (CME) workshops and support the trained nurses to improve the capacity to offer better services.

1.4 Vision 2020:The Right to Sight” Program in Western Province After the initiation of a Vision 2020 program for western province in 2006, we continued with the implementation of the plan in 2007. A memorandum of understanding was signed by the main stakeholders, namely the Ministry of Health, Christian Blind Mission and Sabatia Eye Hospital. We have so far trained 25 nurses from 11 districts in the province most of them have started eye care service at the district hospitals.

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Sabatia Eye Hospital Annual Report 2008

2. Administration, Human Resource Development and Hospital Security The hospital has improved its image and services by furnishing its offices, installing computers in most areas, providing internet access, establishing and managing units through units heads. The hostel staff canteen and guest house furnishing has uplifted the status of the hospital. We have the newly planted flowers and Cyprus which have grown up providing a friendly, beautiful and harmonious environment which creates a

Oud in Afrika Guests Visiting the Hospital

pleasant, relaxing and welcoming environment to our patients, guests, staff and trainees.

2.1 Computerization of the Hospital Management Systems / ICT A lot of effort has been put in the implementation of a software by installing Clinic gate to be utilized for clinical activities. After some months of experience we concluded that it did not serve us properly. We are currently developing a new database system to serve the entire hospital activities i.e. clinical, finance, human resource and Computerized dispensing of drugs in the pharmacy

supplies management. The database will enhance hospital’s capacity in monitoring

and evaluating hospital performance. The hospital bought more computers which have been installed in each department being a process of bringing down to the departmental level data entry, usage and analysis for better utilisation and control of supplies. Local Area Network (LAN) and server installation will highly upgrade the computerization process. The introduction of more computers has eased the process of periodical inventory system hence increasing checks and controls. Now with unit heads making monthly reports via the computers, it is possible to analyze and reduce wastage or poor utilization of consumables in all the units. The hospital is able to get its unit costs.

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Sabatia Eye Hospital Annual Report 2008

We look forward within this year 2009 to fully network all the departments and come up with a running Hospital Management and Information System (HMIS).

2.2 Security of the Hospital Sabatia eye hospital has been experiencing a good and stable security within and around its environment without any lapses since its time of inception. But it was in July 2008 when a serious security incidence happened. The hospital was attacked by criminals from the area who broke into the compound at night and attacked two of our visitors who are parents of one of our CBM co-worker’s Dr. Heiko Philippin. The guests sustained serious injuries which left one guest disabled to date. This serious security incidence at the hospital created an atmosphere of fear and insecurity. After this dreadful and vicious incident the hospital has re-evaluated its security measures and improved its security status with the generous help of our main partner CBM. The following major changes were made:•

The previous security company was terminated and a better one was contracted.

•

Central and residential alarm systems were installed.

•

Electric perimeter fence was constructed all around the compound.(Picture)

•

Supplementary metallic doors were added to residential houses, guest house and the hostel.

Staff are adapting to the new security measures to reduce exposing the hospital to security threats. Now with all this in place our hospital compound is a relatively safer place. The community and the local administration have tried to put in more effort in curbing the security threats around the hospital, which is an ongoing issue. The fact that some of the perpetrators of the incidence are still at large and are being seen in the surrounding is a continuous threat and frustration to all of us. We are continuously collaborating with the community and the local administration to bring these criminals to justice.

2.3 Hospital 2006-2008 strategic plan Review The hospital management, board of governance members and other stakeholders reviewed the three years strategic plan implementation, achievements, drawbacks and failures. A two days workshop

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Sabatia Eye Hospital Annual Report 2008

was organized at Rondo retreat in June and analized the hospital performance in line with the set objectives and targets. The review document compiled was distributed to partners and stakeholders. We feel that it has created a good base for future development a multi-year strategic plan.

2.4 Human Resource Development The hospital recruited several new staff members in the year 2008 in order to increase its efficiency and effectiveness in delivering quality eye care services. It recruited a Public Relations and outreach Co-coordinating officer to develop a Public Relations and marketing strategy, improve the coordination of mobile and outreach services and venture more into new underserved areas. A cataract surgeon to enhance our clinical services and a cleaner were employed as well. The search for a local ophthalmologist is still on; we also consider and utilize trainees who join us for attachment basis. In the course of the year an accountant resigned for greener pastures. The establishment of staff rotation within departments has greatly reduced the demand for new skills, improved sense of responsibility, ownership and multitasking, reduced the training time for a new employee. The widening bracket of benefits has also motivated staff. The hospital appreciates promotion of current staff in order to increase and improve the efficiency and effectiveness of service delivery.

2.5 Staff Development and Training Opportunities Sabatia Eye hospital has developed a training policy tailored to its staff needs in promoting staff capacity development with special interest to motivate staff. The hospital has supported more enrolled community nurses in upgrading. We have currently two nurses upgrading being the last batch . In total we have supported all of the seven enrolled community nurses in completing the upgrading course to Kenya registered nurse. The hospital has further supported training in other departments like Low Vision staff, who have undergone training in orientation and mobility, a course conducted in Tanzania, and refraction course conducted in Uganda at Ruharo eye centre. In the clinical area the hospital supported a staff to train in Guiding and Counseling in HIV and related diseases. The hospital sponsored staff to train in accounts and health care management, the picture shows our administrative Officer Mr. Sabwa who did his advanced diploma in health care management.

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Sabatia Eye Hospital Annual Report 2008

2.6 Performance Appraisals and Evaluation Performance evaluation is being done routinely for all staff twice a year. Training opportunities, Salary increment, incentives and other benefit packages are being offered based on proper performance evaluation and appraisal. An end year party was organized and all staff were offered a bonus of one month basic salary and a 7.5% basic salary increment 2.5% of the 7.5% was based on performance. The hospital plans in future to base benefits and training opportunities on performance, evaluation and merit.

2.7 Staff Welfare Initiative Active participation of staff in the running of their social related matters is encouraged through a recognized staff welfare association. The association takes care of staff social activities, assisting the bereaved staff families, organizing staff retreats, staff social activities and staff meetings. A one day staff retreat at Rondo Resort Center

The welfare is funded by donations and staff monthly contribution. It has a well structured management committee, comprising of Chairman, Secretary, Treasury and Overseer. The picture show Sabatia eye hospital staff during a one day retreat at Rondo resort center in nearby Kakamega forest.

2.8 Transport and Vehicle Management The hospital purchased a new ambulance which has greatly reduced the maintenance costs which we used to incur on the old vehicles. The bus, a 29 seater has reduced the cost of transport for those patients who can not access the base hospital and has significantly helped to strengthen the outreach service.

The New Purchased Ambulance/Land Cruiser

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Sabatia Eye Hospital Annual Report 2008

4. Finance and Supplies Management The year 2008 begun with many challenges for the hospital. Due to post election violence, the hospital was grounded for over three months without any meaningful work. The subsequent months were peaceful but with less activity due to high cost of living. The higher inflation rate also affected most patients as basic commodities prices went up including fuel which made traveling to the hospital more expensive to patients.

Our partners like Lions clubs who sponsor some of our poor patients were also directly affected by distraction of their business and properties in Kisumu hence spent most of their time trying to rebuild their business throughout the year.

The financial performance was therefore not as impressive as the management had projected. We had targeted to reduce the deficit before CBM funds to less than Ksh 2 Million. Looking at the unaudited report, income from traditional sources like admission, consultation, drugs and glass sales etc. dropped by over Ksh 2.3 million which translates to over 12.73% drop in income. The only income from the traditional sources that went up was sponsorship from Oud in Afrika as they maintained and increased their commitment in sponsoring poor patients. Summary of Income and Expenses from 2006-2008

30.00

28.52 H os pital Inc om e

24.15

25.00

23.18 21.81

K s h '000,000

20.00

18.74

CBM R ec urrent funds

15.35 15.00 10.86

11.61

12.26

10.00

Total O perational ex pens es

5.00

0.00 2006

2007

2008

Our positive performance during the year was given a boost by a new set of income called the management income which included interest income areas from our Ksh 20 million fixed deposit, ex-

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Sabatia Eye Hospital Annual Report 2008

change gain from our Euro account, additional fees from students for training and other miscellaneous incomes areas. This raised a total of Ksh 3.8 million in income generation. There was also the sponsorship of congenital cataract surgeries from the Standard Chartered Bank for children which raised another Ksh 1.664 million.

Due to high inflation rates of around 30% during the year the hospital performed relatively poor in areas of cost as this increased by over Ksh 3.6million representing a 15% increase. There were some specific increments associated with security expenses, personnel costs and electricity among others, Our deficit before CBM funds therefore increased by Over Ksh 0.525million to Ksh 5.94million Income from CBM in Ksh went up from Ksh 11.6m to Ksh 16.4million being a 41% increase, this was due to capital grant for purchase of a land cruiser and security support which amounted to Ksh 3,855,046. The increase was also due to favorable exchange rate at the prevailing rates. In general our deficit after CBM funds therefore increased by Over Ksh 0.165million to Ksh 6.68million. Summary of Deficit before Donor Funds From 2006-2008 30.00 27.64 25.11

25.00

23.18

22.67 20.00

K s h '000,000

10.00

24.15 21.81 Total O perational ex pens es

18.74

15.00

14.72

H os pital Inc ome

15.35

10.95 D efit B efore c bm funds

5.00 0.00 2004

2005

2006

-5.00

2007 -5.41

2008 -5.83

-7.82 -10.00 -12.60 -15.00

-14.66

-20.00

Although our sustainability index target was not achieved during the year we believe that this was just an isolated year due to the post election violence and we shall be back on truck in the year 2009 as projected.

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Sabatia Eye Hospital Annual Report 2008

4.1 Cost Containment Measures Over the last three years we have put in place a wide range of cost containment measures in areas like water usage, electricity, stationeries, medical supplies among others. Still, during the year 2008 there was some noticeable increase in expenses. The increase was mainly due to inflation of around 30%, general increase in salaries, electricity cost and recurrent security expenses. We hope that in the year 2009 we shall be able to report better performance which might be difficult due to increasing effects of the global economical crisis. Some of the measures we are putting in place include reducing electricity consumption, installing energy saving bulbs, solar energy, continuous review of prices with suppliers, monitoring of consumption through department reports and proper functioning of supplies management system.

5. Public Relations and Outreach Program Coordination There is now a Public relations and marketing section manned by our new employee. The hospital will be formulating a Pr. and Marketing strategy that will help in increasing and improving the coordination of outreach services, expand the hospital corporate clientele, expand our cooperation base with other organizations and strengthen the existing partners as well as our eye care service network.

6. Partnership Development International Partners We are grateful for our strong and committed partnerships with CBM, Oud in Afrika and Lions International (represented by several local Lions Clubs). We were able to perform several sponsored eye camps as well supporting needy blind patients. CBM additionally supported us to put in place security measures following the attack on guests of the hospital.

CBM staff from different programmes including Sabatia Eye Hospital, participating in the Standard Chartered Bank Marathon in Nairobi 2008.

National Partners We work with a number of partners in organizing and coordinating mobile clinics, eye camps and surgical safaris. We appreciate the continuous commitment and support of our local partners without whose collaboration, it could haven not been possible to help all those who have benefited. The

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Sabatia Eye Hospital Annual Report 2008

sponsorship support of children with congenital cataract by standard chartered bank has assisted many needy families. The hospital holds eye camps sponsored e.g. by sugar companies at various sugar cane farm areas which supply the company. This has benefited underserved low income areas to get eye care services. We are also grateful to many lions clubs who work with us like Kisumu Milimani, Equator, Kakamega, Host, Kitale and others for their commitment in serving the poor and blind people. Last but not least we nurture and appreciate our partnership with several individuals, faith based, private and Government institutions in our effort to provide eye care services to all. Our effort to implement ‘‘vision 2020’’ provincial and District plans has obtained strong and committed support from the Division of Ophthalmic Services (MoH), provincial and district health offices in western province.

7. Challenges and Problems encountered 1. Security incident encountered and at least two perpetrators still at large. 2. Difficulty to get a local ophthalmologist who can take over in the future. 3. Low turn over of patients related to various difficulties. 4. Poor economic conditions prevailing in the country.

8. Future Plans 1. Developing a Strategic plan 2010-2012 in 2009. 2. Developing a Governance manual fo the Board of Governance. 3. Assist in the strengthening of security in the area. 4. Expanding eye care services both in quality and volume. 5. We plan to tar macking the drive way in the hospital compound in 2009. 6. Strengthening all cost containment and sustainability efforts. 7. Strengthening ICT area and local area network with the new software 8. To start solar energy usage from the hostel and develop it further.

9. Conclusion The year was a challenging one from the start for what happened in the country, the economic difficulties and later with the dreadful security incident in the Hospital. Despite all the difficulties with the collaboration and support of all our partners, strong goodwill and commitment from our staff, we have done relatively well and ended the year with positive results. We are grateful to all who helped us through these difficult times.

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Sabatia Eye Hospital Annual Report 2008

3. The year 2008 in pictures