Declaration I, UWAYEZU Vincent, a student from the National University of Rwanda, Faculty of sciences , Department of Applied mathematics assert

that this report of the internship conducted from 15th May 2012 to 15th October 2012 in RUFUNGO Health Center , is my original work and it has not been produced and presented anywhere else before.

Signature: .. Date............................................................................

Supervisor: Signature .. Date....

Dedication I dedicate this report to The Almighty God My beloved parents My brothers and sisters My colleagues and friends

ii

Acknowledgement I am very thankful to Almighty God for his protection during my life because without his powerful love and grace I could not have accomplished the present work. We owe our high gratitude to everyone who has not failed to give his/her effort for the accomplishment of this work. I wish to acknowledge the help and contribution of the following people and institutions towards a successful completion of this Internship. My special thanks go to the entire staff of RUFUNGO Health Center led by the head of the center NDAHIMANA Jean Pierre for their supportive collaboration during my internship period into the organization, especially to my supervisor Mr. MUNYANEZA Innocent in charge of

Data Management to allow me conduct my training in the Statistics and Archives unit which falls under his control. My deep thankful emotion and attitude go to my beloved parents KANYARUKIGA Alphonse and NYIRABAGESERA Therese who made me grown up, Brothers and Sisters for their support. My great thanks are addressed to all teachers who taught me alongside my education from primary school, secondary level up to the NUR, especially the Faculty of sciences, Department of Applied mathematics for having made it possible for me to have this training at RUFUNGO Health Center in May-June 2012.

May almighty God bless you all!!! Vincent UWAYEZU

iii

Liste of abbreviations

CPC: Curative Primary Consultation RHC: Rufungo Heath Centre NUR: National University of Rwanda CPN-Prenatal Consultation PF- Family Planning service VCT- Voluntary Counseling Test MUSA-Mutuelle de Sante

iv

List of tables Table1. Medical staff Table 2. Curative Primary Consultation in 2011

List of figure Figure 1 Number of masculine patients received in 2011 Figure 2 Number of feminine patients received in 2011 Figure 3 The visit in Nyabagoyi village

vi

Contents
Declaration ..................................................................................................................................................... i Dedication ..................................................................................................................................................... ii Acknowledgement ....................................................................................................................................... iii Liste of abbreviations ................................................................................................................................... iv List of tables................................................................................................................................................. v List of figure ............................................................................................................................................... vi CHAPTER I. INTRODUCTION .................................................................................................................. 1 I.1. General background of the internship................................................................................................. 1 I.2. Internship ............................................................................................................................................ 1 I.4. The general objectives of the internship are: ...................................................................................... 2 I.5. Specific objectives .............................................................................................................................. 2 I.6. Methodology used .............................................................................................................................. 2 I.6.1. Documentation............................................................................................................................. 2 I.6.2. Observation .................................................................................................................................. 2 I.6.3. Interview ...................................................................................................................................... 2 I.6.4. Internal participation.................................................................................................................... 3 1.7. Organization of the report .................................................................................................................. 3 CHAPTER TWO: PRESENTATION AND DESCRIPTION OF RUFUNGO HEALTH CENTER .......... 4 II.0. Introduction ....................................................................................................................................... 4 II.1.Geographical situation of RUFUNGO Health Center ........................................................................ 4 II.2. Rufungo health center profile /demographics of the district of karongi ........................................ 5

II.3. Current status of rufungo health center (district hospital) ................................................................ 5 II.4. Mission of RHC ................................................................................................................................ 5 II.5. Objectives of RHC ............................................................................................................................ 6 II.6. Resources of RHC ............................................................................................................................. 6 II.7. Organization and functioning ............................................................................................................ 7 II.8 Main activities done in statistics unit ................................................................................................. 9 III.0. Introduction .................................................................................................................................... 10 III.1 Main activities done in statistics unit .............................................................................................. 10 III.2. Data collection ............................................................................................................................... 11 III.3.Data Analysis .................................................................................................................................. 12 vii

3.1. Analysis of CPC health center data of 2011 ................................................................................... 12 CHAPTER FOUR: EXPERIENCES FROM THE INTERNERSHIP AND THE PROBLEMS ENCOUNTERD ......................................................................................................................................... 15 IV.1. Experiences from the internship .................................................................................................... 15 IV.2. Problems encountered .................................................................................................................... 15 IV.3. Suggested solution to the problem for RHC .................................................................................. 15 IV.4. Suggested solution to the problem for NUR .................................................................................. 16 IV.4.1. The Strengths .......................................................................................................................... 16 IV.4.2. The Weaknesses...................................................................................................................... 16 5.1 Conclusion ........................................................................................................................................ 17 5.2 Recommendations ............................................................................................................................. 17 To the leader of RHC: ......................................................................................................................... 17 To the National university of Rwanda: ............................................................................................... 18 References ............................................................................................................................................... 19 Annexes ...................................................................................................................................................... 20 Karongi administrative map .................................................................................................................... 21 Localization of Rufungo health center .................................................................................................... 22

viii

CHAPTER I. INTRODUCTION

I.1. General background of the internship NUR is an institution whose mission is to train students whose desire is to bring sustainable answers to the needs of the Rwandan society in terms of welfare and socio-economic development as it aim is Excellence in education and service to the people, providing practical based competences in such a way that at the end of the academic courses they are ready to serve to the community effectively and efficiently any kind of business management. NUR has provided a one-month internship with the 4rd year students. in order to reinforce it students knowledge It is in this context that my training was carried out at RUFUNGO Health Center with the purpose of observing, filing and other practical works related to statistical field. This report includes various activities undertaken during this period of internship. It is divided into different parts such as, introduction, description of the area of internship, activities done, experience gained from internship, problems encountered and lastly conclusion and recommendations. I.2. Internship Internship provides students with opportunities to observe and develop management skills in order to gain professional experience reason why every 4rd year student of NUR must do it for a period given by the faculty as practical fulfillment for the award of a bachelors degree. The internship experience provides the students with an opportunity to test a selected career prior to graduation. The aim of performing internship is to prepare the students to do perform well in his domain. On completion of this practical work, the concerned students will be able to prepare the statutory return and also the accounts of any trading concerns and gain real world experiences. My internship started on 15th May and ended on 15th June 2012.It enables the students to harmonize what is learnt in class with reality on the professional ground. It is in this perspective that my training was carried out at RUFUNGO Health Center in data manager department. Internship exposes the students to actual activities carried out on the field.

I.4. The general objectives of the internship are: - Put into practice different theories leant in class. - Make a student getting experience about the work and knowing the reality at the field. I.5. Specific objectives - Know about modern statistical techniques and strategies for achieving planned activities in the statistical management of data, specifically in RUFUNGO Health Center. - Increase practical knowledge - Facilitate the integration in any work. To acquire the team sprit from the organization To match theoretical work learnt and practice To improve the knowledge of organization management To know data entry and analysis of health center statistics. To know how produced statistics are used in decision making.

I.6. Methodology used I.6.1. Documentation I consulted the documents that contain all information regarding RUFUNGO Health Center. I have read different document relating to the statistics, rules and regulations. I.6.2. Observation This method helped me where I used both participatory and non participatory observation. In non participatory observation, I used to observe and interview the workers at workplace while performing their duties. I noted down the relevant information communicated in participatory observation; I could take notes while performing the assigned work as part of training. I.6.3. Interview I performed personal interviews in collecting data. I used this technique on bid to know how different activities are performed and the interrelationship among them.

I.6.4. Internal participation

During the entire course of the training, I participated in various data management activities in RUFUNGO Health Center. This method was very important to me as I practiced both manual and computerized data processing transactions such as EXCEL. 1.7. Organization of the report This report is organized into five chapters each of which consisting of the following: The first chapter concerns the general introduction, objectives of the internship (general and specific objectives), methodology used, methods of data collection. The second chapter is related to the identification of RUFUNGO Health Center, background of RUFUNGO Health Center, objectives, mission. The third chapter, based on activities carried out in the period of internship. The fourth chapter, concerns with experiences gained in internship, problems encountered and suggestion solutions. The fifth chapter, concerns with General conclusion and recommendations.

CHAPTER TWO: PRESENTATION AND DESCRIPTION OF RUFUNGO HEALTH CENTER II.0. Introduction

RUFUNGO Health Center is a health center under control of KIBUYE Hospital, it deal with statistical data related for example to demography Family planning ,Pre-natal consultation, Morbidity , Economics Number of employees ,income, . Morbidity is the level of sickness and disability existing within a population. There is no overall indicator of morbidity, so it usually is looked at in terms of the incidence or prevalence of specific conditions, Family planning is the reduction of birth in order to increase the wealth of the family and to reduce the increasing of population. The goal of this unit is to collect medical statistics in order to keep them and make statistical reports to the direction of KIBUYE Hospital and the health center daily activities. Practitioners regularly see and use statistical results when making clinical decisions in patient care, and researchers are regularly challenged by statistical methods when planning investigation and appraising data. II.1.Geographical situation of RUFUNGO Health Center Location

RUFUNGO Health Center is the unit of KIBUYE Hospital. It is located in Rufungo cell, Rugabano sector, Karongi District, western Province. RUFUNGO Health Center is built in Rufungo cell near the road Kibuye-Gitarama at the other side of the road we have Mwendo cell located in Rutsiro district and serve 13 villages of Rufungo cell and Rutoyi cell those villages are the following;Nyabagoyi,Nganzo,Gatobo,Rugabe,Bisusa,Matyazo,Bwihe,Gitabi,Kavumu, Rukoko ,Karambo, bucensha and Rutoyi the region contains mountains .

II.2. Rufungo health center profile /demographics of the district of karongi

According to current statistics, the population of the District of Karongi is 277.139 inhabitants amounts to an area of 993 km2, an average density of 281 inhabitants per km2. The population distribution by gender shows that the number of females (156324) is higher than that of men (122811) or the respective proportions of 56% and 44% for the entire District. The population of the District of KARONGI is generally young, since the age of 25 represents about 60% of the total. The Karongi District is one of seven districts within the Province of West, it is located in the center of this province, it is bounded to the north by the districts Rutsiro and Ngororero, south by the districts Nyamasheke and Nyamagabe to the east by the districts of Muhanga and Ruhango and west by the Democratic Republic of Congo.

II.3. Current status of rufungo health center (district hospital)

RUFUNGO Health Center is a public institution, officially recognized a unit of the KIBUYE hospital. It is administratively under the authority of the District of Karongi. In addition to the population of its catchment area, it also serves the population of the district Rutsiro because it is located near the road and at the extremity of Karongi district the population near this health center living in rutsiro come to this health center. II.4. Mission of RHC Rufungo Health center mission is to provide quality health care according to the international standards, train health professionals, contribute to the development of human resources because the nearer Hospital is located far of the population this HC reduce the number of mortality because sometime people prefer to stay home when they are ill when the hospital is far.

II.5. Objectives of RHC RHC was assigned the following objectives:

Advocacy for Peoples development; Provide the support to the development of regional reference services Strengthen the capacity building (Human Resources development);

II.6. Resources of RHC The RHC possess three kinds of resources which help to accomplish its missions and vision: Financial resources, Materials and human resources. The patrimony affected to the RHC is composed of immovable and movable assets the scarce is from: funds ; Subsidies from the state ; The income of RHC;

TABLE1. Medical staff Nature Population beneficiary staff Average medical staff average staff beneficiary population for Medical

NUMBER

6949

10 (nurses)

1 nurse for 649 people

-It serves a population of 6949 coming from 13 villages of Karongi district and other neighboring district like Rutsiro.

II.7. Organization and functioning

All activities of RHC are coordinated by the Health Director through three directions such as: Nursing Direction; Accountancy ; Data management

Organisation chart of Rufungo Health Center

Health Comity

Management Comity

Head of Health Center

accountancy

Medical services

Medical Chief of staff

Other services

Accountant anComptability

Consultation

Data Manager

Health Community

C.P.N

Nutrition

Hygiene

P.F

MUSA

ARV

VCT Cleaners

Laboratory

Maternity

Vaccination

Services done by RHC a) CPC-Primary consultation b) Dressing services c) Vaccination services d) Administration e) VCT- Voluntary Counselling Test which work together with ARV services. f) CPN-Prenatal Consultation (PMTCT) g) PF- Family Planning service h) Maternity services i) Nutrition services j) Laboratory services k) Small surgery l) Social service m) Hygiene II.8 Main activities done in statistics unit Data collection in different services of RHC Analysis of medical statistics Making the reports submitted to KIBUYE Hospital: Daily report, weekly report, monthly report, and annually report.

CHAPTER THREE: ACTIVITIES CARRIED OUT IN THE PERIOD OF INTERNSHIP III.0. Introduction This chapter highlights the major activities that have been carried out by the trainee during the internship period of four weeks. As part of field training, the trainee was given the full freedom to consult documents and reports available in statistics unit and participate actively in everyday activities carried that unit. One of the objectives of the internship is to put into practice the theory learnt in the class. For achieving this objective the internee in the period of internship read the report showing the statistics produced in RHC, Participated in data collection and data entry of consultation and hospitalization in different clinical services, and the internee made analysis of medical statistics the internship have been done in the service of consultation . Those activities are apportioned in four weeks as follow: First week: Reading documents related to statistics and reports in statistics unit. Second week and Third week: Data collection in different clinical services and data entry. Fourth week: Participated in analysis of medical statistics, and to know how different reports are prepared. III.1 Main activities done in statistics unit Data collection in different services of RHC Analysis of medical statistics

10

Table 2 Curative Primary Consultation in 2011 Village Number of patients (Masculine) NYABAGOYI RUTOYI NGANZO GATOBO RUGABE BISUSA MATYAZO BUCENSHA BWIHE GITABI KAVUMU RUKOKO KARAMBO 49 75 16 93 75 97 31 157 189 78 72 84 69 Number of patients (feminine) 36 127 40 11 93 129 49 199 213 92 102 100 164

As the RHC has the objective of quality of health care, this is the indicators showing the number of patients consulted, As the table above shows, the people consulted are not the same if we compare region, the people of the region near RHC are more consulted than those who live far of the center, the service of CPC has more consulted patients than other services like CPC and PF. III.2. Data collection Data collection is a term used to describe a process of preparing and collecting data, for example, as part of a process improvement or similar project. The purpose of data collection is to obtain information to keep on record, to make decisions about important issues primarily; data are collected to provide information regarding a specific topic.

11

Data collection usually takes place early on in an improvement project, and is often formalized through a data collection plan which often contains the following activity. A formal data collection process is necessary as it ensures that data gathered are both defined and accurate and that subsequent decisions based on arguments III.3.Data Analysis

3.1. Analysis of CPC health center data of 2011 If we analyze very well we see that the number of attendance in RHC is according to the localization of village because if we see very well (figure 1) Nganzo has few masculine patients in 2011 and according to the geographic localization of nganzo this village is located far of the center let take of another village Matyazo this village also is located far of the Health Center r, their attendance is fewer according to the data we have those two regions are located near other Health center they attend those health center like Police Health Center located near Rugabano Sector .

Number of masculine patients received in 2011

KAVUMU

GITABI

BUCENSHA

FIGURE 1 Number of masculine patients received in 2011

KARAMBO

MATYAZO

BWIHE

RUKOKO

12

The attendance for the feminine also is according to the geographic situation of the villages (figure 2),we observe that gatobo and nyabagoyi attend the Health Center in few number

Number of feminin patients received in 2011

FIGURE 2 Number of feminine patients received in 2011

13

In order to know the reason of not attending the Health Center we have visited one of those village in order to collect data we have visited Nyabagoyi village and according to the data we have collected there the people said that they attend RHC but some people of that region who live at the extremity of the region attend Police Health center located near Rugabano sector.Figure 3 show the visite in Nyabagoyi village in order to know why they dont atternd the Health Center.

14

CHAPTER FOUR: EXPERIENCES FROM THE INTERNERSHIP AND THE PROBLEMS ENCOUNTERD IV.1. Experiences from the internship The experience gained in the period of internship was important in knowledge and skills, the capacity of linking of theoretical courses and practices done in statistics unit where I carried out my internship. The experience is summarized in the following areas: Application of theoretical knowledge: I have a time to put into practice, knowledge

gained in class. I have participated in data collection, data entry, and the analysis of medical statistics. Time management: I have learnt to be punctual as was supposed to reach the RHC

premises at the time scheduled before noon and afternoon. Interaction with employees: this gave me an opportunity to get experience in areas of

personnel of RHC work relationships and work conflict resolution. This was vital in preparing us for the future work environment. IV.2. Problems encountered The trainee encountered a number of problems in this endeavor to get full knowledge pertaining to training and these are: Lack of statistical software to be used in data analysis. Because of the system of collecting data in RHC is not computerized it was difficult to

conduct very well my internship. IV.3. Suggested solution to the problem for RHC

The RHC should buy and install software in machine, to help Statistician to make an

effective analysis at time reasoning. Due to the importance of computerized system, RHC should adopt this system to solve

the problem of delaying of submission of the report.

15

IV.4. Suggested solution to the problem for NUR The National University of Rwanda should provide the sufficient funds to the students for

achieving the internship objectives in better condition. The funds provided by the National University of Rwanda to carry out internship is

insufficient to help me in the period of internship compared to the amount of expenses incurred because during the internship we get no money to help us. IV.4.1. The Strengths

The following strengths were identified in RHC: Staff with diverse qualification, skills, ideas and motivation. The ability of preparing reports in both official languages. It generates its own income from the medical services delivered.

IV.4.2. The Weaknesses

The RHC has some kind of weaknesses in the followings areas:

No statistical software in statistics unit and lack computerized system in the institution. Lack of internet in the institution. Lack of a database for the whole organization. Absence of maintenance of computers. RHC doesnt consider the role of statistics in the improvement of institution.

16

CHAPTER FIVE: CONCLUSION AND RECOMMENDATIONS 5.1 Conclusion

The internship is more important to the students because students get professional experience and link the theoretical knowledge leant in class with the practical experience in the field in order to discover the reality between theories learnt in class and practice found out in field and to prepare the future employment of field to his next career sometime the reality on the field is not the same as the theoretical reality. During one month of internship that was conducted in RHC we participated in Planning, Statistics, We tried to assess the problems in statistics unit and impact of those problems, suggested solutions to those problems. Although RHC encountered some problems there are some improvement in its operations such as working conditions, construction of new building. As to the time reserved for the internship was short we did not conduct the internship in all domains we focuses in the domain of CPC and the obtained results show that people attend the HC according to their localization. 5.2 Recommendations

From the recommendation point, the various points are to be suggested and we would like to address the leader of RHC in order to develop RHC so as to fulfill its mission and objective and to NUR in order to reinforce the students during the internship. To the leader of RHC: To consider the role of statistics in decision making of the institution I recommend the leader of RHC to use statistics in decision making, because all decisions

taken without statistics are not relevant decision. RHC should improve the quality of statistical system in the institution, because statistics

shows where we are, where we want to go and help the institution to make comparison with other institutions. To purchase and install statistical software for helping statistician to achieve scientifically

and easily their objectives and their responsibilities.

To increase the number of employees in the institution; this will help institution to

provide health care and achieve the objectives and its mission. To install internet in the whole institution is very important to look for national and

international information so as to achieve better position of RHC. To set a database for the whole institution in order to assure a quick access to all data. To reinforce the service of data management in the institution.

To the National university of Rwanda: The National University of Rwanda to reinforce the capacity of the students should consider the following aspect: National University of Rwanda should provide enough time for training. National University of Rwanda should cooperate with other institutions in order to find

internship at time and easily, it means NUR should help the students to search the internship in the field or the domain of their studies. National University should provide enough money for trainees at time in order to

reinforce its students to work hard during the internship. National university of Rwanda should provide to students guidelines to follow while

conducting their internship efficiently.

18

References

1. Martin BLAND,an introduction to Medical Statistics, London, 1989,. 2. Jean PICANO, , Methodologie du raport de stage, Paris, Ellpses ,1990

19

Annexes

20

Karongi administrative map

21

Localization of Rufungo health center

Rufungo health center

22