1. health and fitness

THE REPUBLIC OF UGANDA
Annual Health Sector
Performance Report
Financial Year 2010/2011
Foreword
The Annual Health Sector Performance Report for 2010 - 11 provides progress of the
annual workplan as well as the overall health sector performance against the set targets
for the Financial Year 2010/11. The 2010/11 annual report also marks the beginning
of the Health Sector Strategic and Investment Plan 2010/11 – 2014/15. It also reports
on implementation progress against the sector priorities set at the 7th National Health
Assembly and the 16th Joint Review Mission. The Government of Uganda recognizes the
contribution of Health Development Partners, Civil Society, the Private Sector and all
Ugandans in the achievement of the progress reported in the sector performance. The
sector is committed to refocusing priorities to interventions aimed at making positive
progress towards achieving the National Development Plan targets and Millennium
Development Goals.
This report coincides with the launching of the Monitoring and Evaluation Plan for the
HSSIP 2010/11 – 2014/15. The Monitoring and Evaluation Plan has been aligned to the
Monitoring and Evaluation Strategy of the National Development Plan to regularly and
systematically track progress of implementation of priority initiatives of the HSSIP and
assess performance at all levels in accordance with the agreed objectives and performance
indicators. The sector will continue to prioritize interventions deÀned in the Uganda
National Minimum Health Care Package under a Sector-Wide Approach arrangement,
so as to maximize gains from invested resources. This will further be supported by the
International Health Partnerships, the Paris Declaration on Harmonization and Alignment
and the Accra Agenda for Action and related initiatives.
I wish to thank the Technical Working Groups, the Task force and Partners that compiled
this report.
For God and My Country
Hon. Dr. Ondoa D.J Christine
MINISTER OF HEALTH
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Dr. ChrisƟne Ondoa
Minister of Health
Dr. Richard Nduhura
Minister of State (General DuƟes)
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Dr. Asuman Lukwago
Ag: Permanent Secretary
Dr. Ruth Aceng
Director General Health Service
Dr. Nathan Kenya- Mugisha
Director Health Services
Clinical and Community Health
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Dr. Isaac EzaƟ
Director Health Services
Planning and Development
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Table of Contents
Foreword....................................................................................................................................................... iii
List of Tables ................................................................................................................................................. xi
List of Figures .............................................................................................................................................. xiii
Acronyms .................................................................................................................................................... xiv
ExecuƟve Summary..................................................................................................................................... xviii
1
CHAPTER ONE INTRODUCTION ........................................................................................................... 1
1.1
Background ................................................................................................................ ................. 1
1.2
Vision, Mission, Goal and Strategic ObjecƟves during the HSSIP 2010/11 – 2014/15 ............... 1
1.2.1
Vision................................................................................................................................... 1
1.2.2
Mission ................................................................................................................................ 1
1.2.3
Goal ..................................................................................................................................... 1
1.2.4
Strategic ObjecƟves ............................................................................................................ 1
1.3
Projected Demographics for 2010 .............................................................................................. 2
1.4
The framework for achieving Millennium Development Goals (MDGs), NaƟonal Development
Goals and HSSIP 2010/11 – 2014/15 ...................................................................................................... 2
1.5
2
The Annual Health Sector Performance Report FY 2010/11 ...................................................... 3
1.5.1
The draŌing process ........................................................................................................... 3
1.5.2
Sources of InformaƟon ....................................................................................................... 4
1.5.3
Overview of the report outline ........................................................................................... 4
OVERALL PROGRESS AND PERFORMANCE ......................................................................................... 6
2.1
Overall Summary of Progress towards NDP Indicators .............................................................. 6
2.1
Overall Summary Progress towards MDG, JAF and HSSIP 2010/11 – 2014/15 Indicators ......... 8
2.1.1
Health Impact Indicators..................................................................................................... 8
2.1.2
Morbidity: Level and Trends ............................................................................................... 11
2.1.3
Performance against lead indicators for HIV/AIDS, Malaria and TB................................... 12
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2.2
Health Services Coverage............................................................................................................ 15
2.3
Coverage with Other Health Determinants ................................................................................ 16
2.4
Health Quality and Outputs ........................................................................................................ 17
2.5
Health Investments ..................................................................................................................... 19
2.6
Benchmarking Uganda's progress relaƟve to 11 peer countries ................................................ 23
2.7
Summary of the Financial Report 2010/11 FY ............................................................................ 25
2.7.1
Trends of the health sector funding (2000/01-2010/11).................................................... 26
2.7.2
Financial Performance for Local Governments (LGs).......................................................... 27
2.8
Summary Assessment of the Health System / Health Sector Support System........................... 32
2.9
Global Fund (GF) Supported IntervenƟons 2010/11 .................................................................. 33
2.10
Global Alliance for Vaccines and ImmunisaƟon (GAVI) Progress 2010/11................................. 34
2.11
Health Partnerships Performance............................................................................................... 34
2.1
Decentralized Responses ............................................................................................................ 35
2.1.1
Progress made towards achieving internaƟonal resoluƟons and obligaƟons e.g. WHO,
ECSA, IHP+ ........................................................................................................................................... 38
2.2
Local Government Performance ................................................................................................. 41
2.2.1
2.3
District League Table Performance ..................................................................................... 41
Service Delivery ........................................................................................................................... 48
2.3.1
Hospital Performance ......................................................................................................... 48
2.3.2
Regional Referral Hospitals ................................................................................................. 49
2.3.3
General Hospitals ................................................................................................................ 56
2.3.4
FuncƟonality of HC IVs ........................................................................................................ 58
2.4
Assessment of Village Health Team (VHT) FuncƟonality ............................................................ 62
2.5
Conclusion ................................................................................................................ ................... 64
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3
ANNEX ....................................................................................................................... .......................... 65
3.1
Assessment of Performance against Planned Key Outputs in the MPS 2010/11 ....................... 65
3.2
The Compact for implementaƟon of the HSSIP 2010/11 – 2014/15 .......................................... 77
3.3
Delivery of the Uganda NaƟonal Minimum Health Care Package (UNMHCP) ......................... 80
3.3.1
Cluster 1: Health promoƟon, disease prevenƟon, and community health iniƟaƟves ...... 80
3.3.2
Cluster 2: Maternal and Child Health ................................................................................. 91
3.3.3
PrevenƟon and Control of Communicable Diseases ......................................................... 104
3.3.4
Diseases Targeted for EliminaƟon .................................................................................... 111
3.3.5
PrevenƟon and Control of Non-communicable CondiƟons.............................................. 116
3.4
Integrated Health Sector Support Systems ............................................................................... 132
3.4.1
Human Resources for Health ............................................................................................ 132
3.4.2
Health Infrastructure Development and Management .................................................... 133
3.4.3
Management of EssenƟal Medicines and Supplies........................................................... 135
3.4.4
NaƟonal Drug Authority .................................................................................................... 137
3.4.5
InformaƟon for Decision Making ...................................................................................... 138
3.4.6
Quality of Care .................................................................................................................. 140
3.4.7
Health Policy, Planning and Support Services ................................................................... 142
3.4.8
Legal and Regulatory Framework ..................................................................................... 147
3.4.9
Research ............................................................................................................................ 152
3.4.10
Uganda NaƟonal Health Research OrganisaƟon .............................................................. 152
3.4.11
Natural ChemotherapeuƟcs Research InsƟtute (NCRI) .................................................... 153
3.4.12
Uganda Virus Research InsƟtute (UVRI) ........................................................................... 155
3.4.13
Public Private Partnership for Health ............................................................................... 156
3.4.14
Health Services and Health Status in Recovery Areas ...................................................... 158
3.5
Monitoring and EvaluaƟon of ImplementaƟon of the HSSIP 2010/11 – 2014/15 ................... 163
3.6
Data Quality report ................................................................................................................... 165
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3.7
Progress on ImplementaƟon of the Priority AcƟons of the 16 th Joint Review Mission ............ 173
3.8
Progress on ImplementaƟon of the RecommendaƟons of the 7 th Annual Health Assembly ... 183
3.9
Annual Epidemics Update July 2010 to June 2011 .................................................................. 192
3.10
Development Partner Support Areas ....................................................................................... 198
3.11
District League Table 2010/11 .................................................................................................. 212
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List of Tables
Table 1: Demographic Information ..............................................................................................................2
Table 2: Performance against the 8 NDP indicators for the HSSIP 2010/11 -2014/15 Period .........6
Table 3: Top ten causes of hospital based mortality for all ages in 2010/11 FY ...................................9
Table 4: Top ten causes of morbidity among all ages from 2009/10 to 2010/11 FY ...........................12
Table 5: Performance against selected HIV/AIDS Programme lead indicators ....................................13
Table 6: Performance against selected Malaria Control Programme lead indicators .............................14
Table 7: Performance against the TB Programme Lead Indicators .........................................................14
Table 8: Performance for health services core indicators ..........................................................................15
Table 9: Performance for coverage for other health determinants and risk factors indicators during
2010/11 FY .............................................................................................................................................17
Table 10: Performance for health system output (availability, access, quality, safety) indicators ........18
Table 11: Performance for coverage for health investments and governance indicators .....................20
Table 12: Staffing Levels in the public sector filled by trained health personnel - October 2010 .......21
Table 13: Cadre: Population Ratio ................................................................................................................22
Table 14: Rank for key health indicators for 12 countries, including Uganda (WHO, 2011) ..............24
Table 15: Government allocation to the Health Sector 2000/01 to 2010/11 ........................................26
Table 16: Primary Health Care Grants FY 2000/2001-2010/11 in billions of Ug. Shillings ...............27
Table 17: Government of Uganda health sector budget performance for FY 2010/11 (excluding
donor projects) ........................................................................................................................................28
Table 18: Local Government Grant Performance for FY 2010/11 ........................................................29
Table 19: Financial Performance for Central Institutions and Referral Hospitals for FY 2010/11
(UGX Billion) ..........................................................................................................................................29
Table 20: Summary of performance by Vote Function .............................................................................32
Table 21: Summary Matrix for monitoring progress of implementation of the Compact ...................34
Table 22: HPAC Institutional representatives’ attendance Jul 2010 – Jun 2011 ....................................35
Table 23: Project Support to Local Governments ......................................................................................36
Table 24: Top 15 performing districts ..........................................................................................................42
Table 25: Bottom 15 performing districts ...................................................................................................42
Table 26: District ranking for the top new districts ..................................................................................42
Table 27: District ranking for the bottom new districts ...........................................................................42
Table 28: District ranking for districts with regional/national referral hospitals ...................................43
Table 29: District ranking for hard-to-reach districts .................................................................................44
Table 30: District ranking for Peace Recovery and Development Plan (PRDP) districts ....................44
Table 31: District ranking by district population ........................................................................................45
Table 32: Staffing levels for top ten districts
Table 33: Staffing Levels for Bottom ten districts .47
Table 34: Financial Performance for RRHs for FY 2010/11 (UGX Billions) .......................................49
Table 35: Positions filled in Regional Referral Hospitals ...........................................................................50
Table 36: Overall performance for Regional Referral and Large PNFP Hospitals ...............................51
Table 37: Key Hospital Outputs in RRHs and Large PNFP Hospitals...................................................53
Table 38: Selected Efficiency Parameters RRHs and Large PNFP hospitals 2010/11 .........................54
Table 39: Summary of Efficiency Parameters RRHs and Large PNFP hospitals 2010/11 ..................55
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Table 40: Outputs from the General Hospitals FY 2010/11 ....................................................................56
Table 41: Selected efficiency parameters for General Hospitals ...............................................................57
Table 42: HC IVs with 11 of the 11 functionality indicators ....................................................................59
Table 43: Provision of selected key health services by HC IVS ...............................................................60
Table 44: Progress in implementation of the Country Compact 2010/11 – 2014/15 during 2010/11
FY..............................................................................................................................................................77
Table 45: NUSAF2 support to Health Sector 2010-11 ........................................................................... 158
Table 46: District monthly reporting completeness rate and districts with poor completeness rate 166
Table 47: Facility reporting completeness rate and districts with poor completeness rate ................ 167
Table 48: Extreme and moderate outliers among data points for 2008/09 and 2010/11 for 4
indicators ............................................................................................................................................... 168
Table 49: Percentage difference between monthly data and end-of-year data at the national level, and
districts with a large discrepancy ....................................................................................................... 168
Table 50: Consistency ratio for ANC1 at national level, and districts with very low and very high
consistency ratios ................................................................................................................................. 170
Table 51: Comparison of coverage rates from surveys and from facility reports ............................... 170
Table 52: Top 15 and bottom 15 scoring districts based on ranking using adjusted district
populations. .......................................................................................................................................... 172
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List of Figures
Figure 1: Under 5 Mortality trends in Uganda.............................................................................................8
Figure 2: Trends in IP Mortality 2009 – 2011 .............................................................................................10
Figure 3: MMR Trends in Uganda ................................................................................................................11
Figure 4: Health facility-based maternal deaths in FY 2009/10 and 2010/11........................................11
Figure 5: The Density of Health Personnel GOU and PNFP ..................................................................21
Figure 6: Uganda's progress benchmarked relative to the peer countries over time for the period
1990 to 2010. ...........................................................................................................................................24
Figure 7: Trends in PHC Grant Allocations 2000/01 – 2010/11 ............................................................28
Figure 8: District population vs. total score .................................................................................................45
Figure 9: Filled staff positions in RRHs .......................................................................................................50
Figure 10: Volume of Outputs Regional Referral and Large PNFP hospitals .......................................51
Figure 11: Trends in Caesarean Section and Blood transfusion ...............................................................60
Figure 12: Reported number of Stillbirths by month .............................................................................. 94
Figure 13: Vitamin A Supplementation among under fives ................................................................... 103
Figure 14: Total average district league scores districts for Uganda and Karamoja region ............... 161
Figure 15: District league scores Karamoja ............................................................................................. 162
Figure 16: National health facility data quality assessment: summary of results ................................. 165
Figure 17: Trend in DTP3 coverage under 1 year of age (%), Uganda 2000-2010 ............................. 171
Figure 18: Comparison of HMIS and DHS coverage rates for institutional deliveries and ANC four
or more visits................................................................................................................................ 171
Figure 19: DPT3 Coverage by district FY2010/11............................................................................... 208
Figure 20: Deliveries in Government and PNFP facilities by district FY2010/11 .......................... 208
Figure 21: OPD utilization by district FY 2010/11 .............................................................................
209
Figure 22: HIV testing in infants born of HIV positive women by district FY 2010/11..............
209
Figure 23: Latrine coverage in households by districts FY 2010/11 ................................................... 210
Figure 24: Pregnant women receiving 2nd dose of Fansidar for IPT by district FY 2010/11 ........ 210
Figure 25: Pregnant women attending ANC 4th visit by district FY 2010/11.....................................211
Figure 26: Approved posts that are filled by district FY 2010/11..........................................................211
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Acronyms
ACT
AHSPR
AIDS
ANC
ART
ARVs
BFHI
CAO
CB-DOTS
CCM
CDC
CDD
CDP
CDR
CEmoC
CPR
CPT
CSO
CYP
DHO
DHMT
DLT
DOTS
DPs
DPT
EAC
ECSA-HC
EID
EMHS
EmOC
FP
FY
GAVI
GBV
GF
GH
GoU
HAART
HC
HCI USAID
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Artemisinin Combination Therapies
Annual Health Sector Performance Report
Acquired Immuno-Deficiency Syndrome
Ante Natal Care
Anti-retroviral Therapy
Antiretroviral Drugs
Baby Friendly Health Initiative
Chief Administrative Officer
Community Based TB Directly Observed Treatment
Country Coordinating Mechanism
Centres for Disease Control
Control of Diarrhoeal Diseases
Child Days Plus
Case Detection Rate
Comprehensive Emergency Obstetric Care
Contraceptive Prevalence Rate
Cotrimoxazole Prophylaxis
Civil Society Organization
Couple Years of Protection
District Health Officer
District Health Management Team
District League Table
Directly Observed Treatment, short course (for TB)
Development Partners
Diphtheria, Pertussis (whooping cough) and Tetanus vaccine
East African Community
East Central and Southern Africa - Health Community
Early Infant Diagnosis
Essential Medicines and Health Supplies
Emergency Obstetric Care
Family Planning
Financial Year
Global Alliance for vaccines and Immunization
Gender Based Violence
Global Fund
General Hospital
Government of Uganda
Highly Active Anti-Retroviral Therapy
Health Centre
Health Care Improvement Project
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HCT
HDP
HIV
HMBF
HMIS
HPAC
HRH
HSD
HSSIP
HSSP
ICU
IDSR
IEC
IMAM
IMCI
IPT
IRS
ITNs
JAF
JBSF
JICA
JMS
JRM
KDS
LG
LLINs
MCH
MDGs
MDR
MMR
MOFPED
MoGLSD
MOH
MOLG
MOPS
MOPS
MOU
MTEF
NCD
NCRI
HIV/AIDS Counselling and Testing
Health Development Partners
Human Immuno-Deficiency Virus
Home Based Management of Fever
Health Management Information System
Health Policy Advisory Committee
Human Resources for Health
Health Sub-Districts
Health Sector Strategic Investment Plan
Health Sector Strategic Plan
Intensive Care Unit
Integrated Disease Surveillance and Response
Information Education and Communication
Integrated Management of Acute Malnutrition
Integrated Management of Childhood Illness
Intermittent Presumptive Treatment for malaria
Indoor Residual Spraying
Insecticide Treated Nets
Joint Assessment Framework
Joint Budget Support Framework
Japan International Cooperation Agency
Joint Medical Stores
Joint Review Mission
Kampala Declaration on Sanitation
Local Government
Long Lasting Insecticide Treated Nets
Maternal and Child Health
Millennium Development Goals
Multi-drug Resistant
Maternal Mortality Ratio
Ministry of Finance, Planning and Economic Development
Ministry of Gender, Labour and Social Development
Ministry Of Health
Ministry of Local Government
Ministry of Planning and Survey
Ministry of Public Service
Memorandum of Understanding
Medium Term Expenditure Framework
Non Communicable Diseases
National Chemotherapeutic Research Institute
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NDA
NGOs
NHA
NHP
NMCP
NMS
NTDs
NTLP
OPD
OPM
OPV
ORS
ORT
PHA
PHAST
PHC
PLWHA
PMTCT
PNFP
PPPH
PRDP
RH
RRH
RUTF
SHSSPP
SLD
SMC
SMER
SP
STI
SUO
SWAP
TB
TMC
TSR
TT
TWG
UACP
UBOS
UBTS
UCI
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National Drug Authority
Non-Governmental Organisations
National Health Assembly
National Health Policy
National Malaria Control Programme
National Medical Stores
Neglected Tropical Diseases
National Tuberculosis and Leprosy Control Program
Out Patients Department
Office of the Prime Minister
Oral Polio Vaccine
Oral Rehydration Salt
Oral Rehydration Therapy
People with HIV/AIDS
Participatory Hygiene and Sanitation Transformation
Primary Health Care
People with HIV/AIDS
Prevention of Mother to Child Transmission
Private Not for Profit
Public Private Partnership for Health
Peace Recovery and Development Plan
Reproductive Health
Regional Referral Hospital
Ready to Use Foods
Support to the Health Sector Strategic Plan Project
Second Line Drugs
Senior Management Committee
Supervision, Monitoring, Evaluation and Research
Sulfadoxine/Pyrimethamine
Sexually Transmitted Infection
Standard unit of Output
Sector-Wide Approach
Tuberculosis
Top Management Committee
Treatment Success Rate
Tetanus Toxoid
Technical Working Group
Uganda Aids Control Program
Uganda Bureau of Statistics
Uganda Blood Transfusion Services
Uganda Cancer Institute
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UDHS
UGFATM
UHSSP
UHI
UNEPI
UNFPA
UNHRO
UNICEF
UNMHCP
UVRI
VHT
WHO
Uganda Demographic and Health Survey
Uganda Global Fund for AIDS, TB and Malaria
Uganda Health Systems Strengthening Project
Uganda Heart Institute
Uganda Expanded Programme on Immunization
United Nations Fund for Population Activities
Uganda National Health Research Organisation
United Nations Children’s Fund
Uganda National Minimum Health Care Package
Uganda Virus Research Institute
Village Health Teams
World Health Organisation
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Executive Summary
This Annual Health Sector Performance Report marks the beginning the Health Sector Strategic
and Investment Plan (HSSIP) 2010/11 -2014/15. The report mainly focuses on the progress of
the annual workplan as well as overall sector performance against the targets set for the FY
2010/11, the first year of the HSSIP 2010/11 -2014/15 but also provides progress in relation to
performance of the previous years. The development process of the AHSPR 2010/11 was widely
consultative with stakeholders from all departments of the Ministry of Health (MoH),
Development Partners (DPs) and Implementing Partners. The overall coordination and technical
support was provided by a MoH Task Force (TF).
Background
This Annual Health Sector Performance Report is the first report for the Health Sector Strategic
and Investment Plan (HSSIP) 2010/11 -2014/15. The delivery of the Uganda National Minimum
Health Care Package is central to the implementation of the HSSIP and the attainment of the
sector goals and objectives. This report focuses on the progress of the annual workplan, as well
as the overall sector performance against the targets set for the FY 2010/11, the first year of
the HSSIP 2010/11 -2014/15. The development process of the AHSPR 2010/11 was widely
consultative with involvement from all departments of the Ministry of Health (MoH),
Development Partners (DPs) and Implementing Partners. The overall coordination and technical
support was provided by a MoH Task Force.
Data
The report focuses on the core indicators of the monitoring and evaluation plan of HSSIP, which
are linked with the monitoring of the National Development Plan and international initiatives
such as the MDG. The report is based on the health facility and district reports gathered as part
of the HMIS, administrative sources and programme data, including both quantitative and
qualitative data. A thorough analysis of the quality of the HMIS data shows that overall
reporting can be considered fairly reliable, but that there is considerable variation between
districts which affects the league tables. Coverage estimates based on the HMIS data use
population projections to estimate the target populations and should be considered as only
indicative as the last census was conducted in 2002. No new household survey data were
available for this performance report. No separate verification of data quality and facility
service readiness (e.g. medicines availability) was conducted.
National progress and performance
Inputs and processes: money, policies and workforce
The total public health expenditure per capita decreased from UGX 24,423 (US$11.1) in
2009/10 to UGX 20,765 (US$ 9.4) in 2010/11, mainly because of a decrease in externally
contributions which only constituted 14% of total public health expenditure in 2010/11,
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compared with 39% in the three preceding years. The government expenditure on health as a
percent of total government expenditure remained around 9%, as it has been for the last
decade, well off from the Abuja target of 15% but on target for HSSIP 2010/11 (8.8%). The
amount spent on health, however, increased because of economic growth. Limiting the large
fluctuations in external funding for health and ways to increase the government contribution
should be priority areas for planning.
There was a remarkable increase in the proportion of villages/wards with trained village health
teams (VHTs), according to a survey in 2010, in line with the expansion to a further 18 districts.
Medical professionals however are well below the WHO minimum target of 23 health workers
per 10,000 population: Uganda had 15 health workers per 10,000, including 0.36 doctors, 0.71
clinical officers, 2.8 nurses and 1.4 midwives. The health sector efforts in ensuring attainment
and maintenance of an adequately sized, equitably distributed and appropriately skilled
workforce were hampered by the ban on recruitment as a result of a limited wage will. Overall,
56% of public sector positions were filled, short of the 60% target for 2010/11 FY. The shortfall
is greatest in district health units where 52% of 27,180 positions were filled. There is need to
advocate for increasing staffing levels for the entire critical cadre for effective and efficient
utilisation of health investments.
Among the central level vote functions, the Support to Health Sector Strategic Plan Project
performed best against planned outputs in the MPS (score 80%), followed by pharmaceutical
and other supplies (75%) and sector monitoring and quality assurance (60%). The majority of
the vote functions had performance moderate performance (40 – 80%) and the major
challenges were related to procurement for infrastructure development projects, inadequate
funding and delayed release of funds for other operational activities.
The Country Compact 2010/11 – 2014/15, signed by MoH, HDPs, CSOs and the private sector,
has 14 key planned outputs in the areas of planning and budgeting, monitoring programme
implementation and performance, and policy guidance and monitoring. Overall, only 4 of the
14 outputs received good marks (>80% implementation), 4 moderate (40-80%) and 6 were
rated as poor (<40%). The performance was poorest in planning and budgeting and adequate in
policy guidance and monitoring. There is need to establish an efficient M&E system for the
Compact and Senior Management Structures.
Considerable progress made towards achieving international resolutions and obligations
specifically East Central and Southern Africa Health Community. With the recruitment of a
Global Desk Officer, the sector expects better monitoring and documentation.
Service outputs
Drug availability improved signiĮcantly, with 43% of faciliƟes reporƟng no stock out of the six
tracer drugs in the Įrst and last quarters of 2010/11, up from 21% in the preceding year. The
proporƟon of Health Centre IV to provide comprehensive emergency obstetric care (blood
transfusion and Caesarian secƟon) remained low: 24% compared with 23% in the year before. TB
treatment success rates, an indicator of the quality of care, increased slightly from 66% to
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69%, but fell short of the 75% target of FY 2010/11. Access to HIV counseling and testing
services remained the same (38% of 4,980 facilities), but the percent of facilities offering
PMTCT services increased from 23% in FY 2009/10 to 32% in FY 2010/11.
Outpatient department (OPD) service utilization is an indicator of accessibility of the services.
There were 34.9 million OPD visits in FY 2010/11, compared with 36.8 million in the year
before. The average was 1.1 OPD visit per person per year (target 1.0 visit). The top three
diagnoses for OPD visits are malaria (36% of all visits), common cold or cough (19%) and
intestinal worms (5%), which was very similar to the years before.
Service coverage and determinants
There was varied performance in the health services coverage indicators, but overall trends
were positive. More women delivered in health facilities (39%, up from 33% in 2009/10), but
fewer pregnant women made four antenatal care visits (32%, down from 47%) and received
IPT2 for malaria risk reduction (43%, down from 47%). There is need to investigate the reversal
or stagnation of trends in the maternal health services. Immunization coverage with
pentavalent vaccine was 90%, up from 76% in the preceding year, and so was measles (85%, up
from 72%), most likely due to vaccination campaigns in many districts and strengthening of the
delivery system. Contraceptive use, measured by Couple Years of Protection and the UBOS
panel survey, also increased to 33% in 2010.
No reliable facility data were available to ascertain trends in coverage of HIV services, except
that almost all HIV positive people were initiated on co-trimoxazole (95%). TB case notifications
increased from 43,335 in FY 2009/10 to 45,546 in FY 2010/11, but it was estimated that case
detection rate remained low at 54%. The proportion of TB patients tested for HIV increased
from 72% to 81% and the percent HIV-TB patients started on CPT increased from 86% to 90%,
and both indicators were on FY 2010/11 target.
Performance assessment for coverage for other health determinants and risk factors is not
conclusive for the year under review. Information is available for only one (% of household with
latrine which improved from 69.7% to 71%) out of four indicators.
Health impact
There are no new child and maternal mortality data available until the UDHS 2011 results are
out. The maternal mortality reporting system is currently inadequate, but figures suggest
indicate that maternal mortality in hospitals and health centres, where 39% of deliveries take
place, is at least 200 per 100,000 live births, and national rates should be considerably higher.
Figures from the many hospitals are currently high and it should be a priority to develop a high
quality maternal mortality surveillance and response system. Malaria is the leading cause of
mortality among all ages in hospitals, causing 27% of 5,331 deaths, followed by anaemia (12%)
and pneumonia (11%).
A comparison with 11 peer countries in the African region shows that Uganda's performance on
coverage and health outcome indicators is about average for the group. Uganda does better
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than average on inputs (money, health workers), less than average on coverage of MCH
interventions, and about average on mortality. In terms of progress during 1990-2009 Uganda
made average or slightly better than average progress on most indicators.
Local government performance
Local Government performance assessment was done using an improved set of 12 indicators
(three management and nine access/quality/coverage indicators) for the 112 districts. In
general, there is better performance for the coverage indicators compared to the management
indicators. Kampala remains the top ranking district this year, followed by Bushenyi and
Kabarole. Bulambuli, a new district, is at the bottom of the league table. The national score for
the league table index is 58%; 3rd dose Pentavalent vaccine coverage 90%, OPD utilization 1.0;
HIV testing in infants born to HIV positive mothers 30%; latrine coverage 71%; IPT2 43%; 4th ANC
visit 32%; TB cure rate 77%; approved posts filled 52%; HMIS reporting 77%, completeness 94%,
timeliness 84%; planned DHMT meetings held 10%; medicines orders submitted timely 47%.
The 32 new districts had lower performance scores compared to existing districts, with
Kyegegwa being the highest scoring new district ranked at 48th (out of 111). All new districts
scored lower than the national average.
Hospital and HC IV performance
There are 13 Regional Referral Hospitals and 4 large PNFP hospitals. Masaka and Mbarara RRH
data were not available for analysis. Overall, 76% of the posiƟons were Įlled. The lowest rates
were for pharmacists (40%) and doctors (44%). Funds were released by the government to the
hospitals according to the budget (104%), with the excepƟon of Moroto RRH (66%). Most measures
indicate high uƟlizaƟon: 86% average bed occupancy (93% in 2009/10), 5.0 days average length of
stay and 1,802 standard units of output (SUO, an index of workload) per staī among the regional
referral and large PNFP hospitals. The SUO per staī ranges from 742 in Mengo RRH to 2,280 in
SoroƟ RRH.
The 78 reporting general hospitals also received government funds in accordance with the
budget (98%). Reporting of staffing was poor but in a sample of 26 public general hospitals on
average only 55% of the norm of 190 positions were filled. Bed occupancy rates were 69%,
down from 74% in 2009/10, while the average length of stay increased from 4.6 to 5.0 days.
The SUO per staff increased from 1,487 to 1,577, slightly lower than the RRHs. From the
information the average for three outputs are down compared to last year (2009/10), inpatient,
antenatal and immunization, while the outpatients, deliveries and major operations, including
cesarean sections have gone up. Of deliveries, 24% were done by Cesarean section.
The average outputs from each HC IV for outpatient, inpatient, deliveries and ART services,
were 21,028; 1,864; 1,996 and 292 respectively. Compared to 2009/10 many service utilization
indicators went down in 2010/11 except, deliveries, HIV counseling and testing, PMTCT and
Dental service utilization. The bed occupancy rate in 2010/11 declined compared to the year
before – down from 43% to 38%, in addition there was a reduction in average length of stay
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xxi
from 3 days in 2009/10 to 2.3 days. There were on average of 1,864 admissions in 2010/11. The
case fatality rate remained the same as the year before, 0.7%. Only 24% of the HC IVs were
‘functional’ in 2010/11 – an increase from 23% found in 2009/10.
Overall, the larger health faciliƟes - hospitals and health centres IV - play a key role in the
provision of health services in Uganda. The faciliƟes received resources according to budget but
are understaīed. The performance of the larger health faciliƟes appears adequate in terms of
eĸciency (bed occupancy, length of stay, SUO/staī) but there are important diīerences between
hospitals and HC IVs that need to be taken into account in allocaƟng resources. No data on the
quality of care were available, and it will be important to complement the access and eĸciency
data with such data in the coming years. In addiƟon, reporƟng needs to be improved urgently,
starƟng with maternal mortality.
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1 CHAPTER ONE INTRODUCTION
1.1 Background
The Ministry of Health (MOH) has been producing an Annual Health Sector Performance Report
(AHSPR) since 2000. The annual report is an institutional requirement produced to highlight
progress, challenges, lessons learnt and propose way of moving the health sector forward”. This
AHSPR for the Financial Year (FY) 2010/11 marks the beginning of the Health Sector Strategic
and Investment Plan (HSSIP) 2010/11 -2014/15. The report mainly focuses on the progress of
the annual workplan as well as overall health sector performance against the targets set for the
FY 2010/11, the first year of the HSSIP 2010/11 -2014/15. It takes into consideration the annual
performance in terms of 1) The effectiveness, responsiveness and equity in the health care
delivery system 2) How well the integrated support systems have been strengthened as well as
the status of programme implementation and overall development mechanisms. The sector
performance will be deliberated upon at the 17th Joint Review Mission (JRM) in October 2011.
1.2
Vision, Mission, Goal and Strategic Objectives during the HSSIP 2010/11 – 2014/15
1.2.1 Vision
A healthy and productive population that contributes to socio-economic growth and national
development.
1.2.2 Mission
To provide the highest possible level of health services to all people in Uganda through delivery
of promotive, preventive, curative, palliative and rehabilitative health services at all levels.
1.2.3 Goal
The overall goal for the Health Sector during HSSIP 2010/11 – 2014/15 is “To attain a good
standard of health for all people in Uganda in order to promote a healthy and productive life”
1.2.4 Strategic Objectives
To achieve this goal, the health sector shall focus on achieving universal coverage with quality
health, and health related services through addressing the following strategic objectives.
1. Scale up critical interventions for health, and health related services, with emphasis on
vulnerable populations.
2. Improve the levels, and equity in access and demand to defined services needed for health.
3. Accelerate quality and safety improvements for health and health services through
implementation of identified interventions.
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4. Improve on the efficiency, and effectiveness of resource management for service delivery in
the sector.
5. Deepen stewardship of the health agenda, by the Ministry of Health.
1.3 Projected Demographics for 2010
The projected population demographics for the period under review are based on the
population census of 2002 and annual projections by Uganda Bureau of Statistics (UBOS).
Table 1: Demographic Information
Demographic Variables
Proportion
Population
Total Population
100%
31,784,600
Children below 18 years
56%
17,799,376
Adolescents (10 – 24 years)
34.7%
11,029,256
Orphans (for children below 18 years)
10.9%
1,940,132
Infants below one year
4.3%
1,366,738
Children below 5 years
19.5%
6,197,997
Women of child bearing age (15 – 49 years)
23%
7,310,458
Women expected to become pregnant
5%
1,589,230
UBOS 2010 Midyear Projection
1.4
The framework for achieving Millennium Development Goals (MDGs), National
Development Goals and HSSIP 2010/11 – 2014/15
The delivery of the Uganda National Minimum Health Care Package (UNMHCP) is central to the
implementation of the HSSIP 2010/11 – 2014/15 and the attainment of the sector goals and
objectives. The NMHCP is aligned to the Second National Health Policy (NHP II) and National
Development Plan (NDP) 2010/11 – 2014/15, the overarching national policy and strategic
framework governing the health sector in Uganda. Additionally, the UNMHCP core strategies
are aligned to the Millennium Development Goals (MDGs), to which Uganda is a signatory. The
NDP (through sector plans) and the HSSIP 2010/11 – 2014/15 are being implemented in a
sector-wide approach (SWAp), which addresses the health sector as a whole in planning and
management, and in resource mobilization and allocation. The AHSPR 2010/11 is therefore one
of the major SWAp management tools that assess sector progress in achieving the HSSIP
2010/11 – 2014/15 outputs and outcomes.
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1.5 The Annual Health Sector Performance Report FY 2010/11
The objective of the AHSPR 2010/11 is to review the performance of the sector for the FY
2010/11 against targets, actions and indicators set out in the Ministerial Policy Statement (MPS)
2010/11 FY, MoH Activity Workplan 2010/11 FY, Joint Assessment Framework (JAF) under the
Joint Budget Support Framework (JBSF) and against the HSSIP 2010/11 – 2014/15 core
indicators.
Thus, the report provides progress on:
i)
Sector performance and annual trends for the NDP, JAF indicators and HSSIP
2010/11 – 2014/15 indicators;
ii)
Financial Report for the FY 2010/11 including a donor-expenditure analysis;
iii)
Overall health service coverage levels
iv)
Status of implementation of the Integrated Health Sector Support Systems and
governance at central level
v)
Local Government (District) performance using the League Table
vi)
The individual and collective contribution of the National, Regional Referral and
General Hospitals as well as the PNFP hospitals at similar levels;
vii)
Implementation progress on the delivery of the UNMHCP and health support
systems basing on planned outputs in the MPS 2010/11
viii)
Monitoring implementation of the HSSIP 2010/11 – 2014/15
ix)
Progress made towards the 7th National Health Assembly Resolutions and 16th
Joint Review Mission priorities.
The report also addresses the data quality issues in terms of completeness, accuracy, external
comparison and adjustments.
1.5.1
The drafting process
The development process of the AHSPR 2010/11 was widely consultative /with stakeholders
from all departments of the MoH, Development Partners (DPs) and Implementing Partners. The
overall coordination and technical support was provided by a MoH Task Force (TF). The
composition of the TF was drawn from all departments of the MoH and included chairpersons
and secretaries of the seven Technical Working Groups (TWGs). The TF had representation from
districts, Referral Hospitals, the Civil Society and Health Development Partners. A secretariat of
staff from the Health Planning and Quality Assurance Departments, and WHO provided overall
leadership of the preparation process in close collaboration with the TF and sub-committees.
The WHO – Uganda Country office facilitated the process of acquiring Consultants from WHO –
Geneva who provided technical support in reviewing the AHSPR report format. This was
through a development process which included a data analysis workshop. A Consultant was
recruited and provided support in the report compilation, formatting and collating process in
close collaboration with the Secretariat and TF. Meetings were held weekly, to assess progress
of development of the AHSPR and provide feed-back on the drafts. Draft submissions were
made by secretaries of TWGs/heads of Divisions and sections. Gaps identified were rectified by
the relevant submitting authority. The draft was presented to Senior Management Committee
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
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(SMC), Health Policy Advisory Committee (HPAC) and Senior Top Management (STM) for
comments and approval.
1.5.2 Sources of Information
The information used in compiling the AHSPR 2010/11 is both quantitative and qualitative. As it
is stipulated in the HSSIP 2010/11 monitoring and evaluation framework, the Health
Management Information System (HMIS) under the Resource Centre is the main source of
statistical data. In order to maintain consistency with previous reporting periods, this AHSPR
uses the HMIS aggregated monthly reports for the entire financial year. Population figures were
based on the 2010 midterm population projections from the UBOS statistical abstract. Several
indicators do not have new data, as they rely on household surveys, especially DHS.
The most important components of the HMIS are the health facility monthly and annual
reports. These reports are, like any source of data, prone to errors associated with incomplete
or inaccurate reporting. In order to maximize the quality of the statistics for the performance
indicators, a major effort was made to gather as much facility and district information as
possible, and assess for possible errors. A detailed report of the data quality assessment is
presented in an annex (section 6).
Other key sources of information included:
i. HSSIP 2010/11 – 2014/15
ii. Ministerial Policy Statement (MPS) 2010/11
iii. MoH activity plan 2010/11
iv. FY 2010/11 quarterly sector performance review reports
v. MoH programmes and other central level institutions reports
vi. MoH submissions from the Output Budgeting Tool (OBT) to the Ministry of Finance,
Planning and Economic Development (MoFPED)
vii. Previous AHSPR for the FY 2006/07, 2008/09 and 2009/10
viii. The HIV/AIDS Epidemiological Surveillance report 2010
ix.
Medicines availability study 2010
x.
Malaria Indicator Survey 2010
xi.
Uganda Demographic Health Survey (UDHS) reports
xii. Millennium Development Goal Report for Uganda 2010
xiii. Additional sources of information are included in the reference list
1.5.3
Overview of the report outline
The AHSPR 2010/11 is divided into three sections as follows;
Section 1 is an introduction that covers the background to the AHSPR 2010/11 FY in relation to
the framework for achieving the MDGs, NDP and HSSIP 2010/11 – 2014/15 goals, drafting
process and sources of information.
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Section 2 provides an overview of the sector performance for FY 2010/11 and includes the
overall performance of the sector against the HSSIP 2010/11 – 2014/15 indicators, JAF 3
indicators and; an assessment of central level performance against planned key outputs from
the MPS 2010/11; comparison of district performance using the District League Table; and
comparison of hospital performance using the Standard Unit Output (SUO).
Section 3 Annex detailing progress in implementation of priority activities under the;
1. Uganda National Minimum Health Care Package (UNMHCP).
2. Integrated Health Sector Support Systems.
3. Monitoring and Evaluation of the HSSIP 2010/11 – 2014/15.
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5
2
OVERALL PROGRESS AND PERFORMANCE
This chapter presents an overview of the overall progress and health sector performance for FY
2010/11. It therefore includes an assessment of performance of the sector using the HSSIP
2010/11 – 2014/15 core indicators marking progress towards achievement of the MDGs, NDP
2010/11 – 2014/15, JAF 3, MPS 2010/11 and Activity Plan 2010/11 targets.
2.1 Overall Summary of Progress towards NDP Indicators
Twenty six core indicators were identified to monitor progress in implementation of the HSSIP
2010/11 – 2-124/15. Of these, eight (8) indicators are used to monitor progress of the health
sector towards NDP targets. Table 1 summarizes the performance in the first year of the NDP
and the HSSIP 20/10 – 2014/15 for the NDP indicators.
Table 2: Performance against the 8 NDP indicators for the HSSIP 2010/11 -2014/15 Period
Baseline,
(year)
Indicator
NDP
Target
2009/10
Annualized
HSSIP Target
2010/2011
Performance
Trend from
HSSIP Baseline
Achievement
2010/2011
% pregnant women attending 4 ANC
sessions
47
60%
50%
32%
Reversal
% deliveries in health facilities
33
35%
40%
39%
Improving but
below target
% children under one year immunized
with 3rd dose Pentavalent vaccine (m/f)
76
90%
80%
90%
Positive
% U5 children with weight /age below
lower line (wasting) (m/f)
16%#
15%
15%
NA
No current
information
Contraceptive Prevalence Rate (CPR)
33%
34%
34%
NA
To be updated by
the UDHS-5
% of health facilities without stock outs
of any of the six tracer medicines in the
previous 6 months
21
28%
50%
43%
Positive
% of approved posts filled by trained
health workers
56
56%
60%
56%
Static
% Annual reduction in absenteeism rate
46
28%
20%
NA
Awaiting Panel
Survey findings
# 2006 data
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Assessment of the eight indicators revealed two having improved; one improved but not on
target; one static; one reversing; and there being no data for the other three, as the panel
survey findings and conduction of the UDHS are still awaited.
The proportion of deliveries in health facilities improved from 33% (2009/10) to 39% (2010/11);
proportion of under one year immunized with 3rd dose pentavalent vaccine from 76% (2009/10)
to 90% (2010/11); and proportion of health facilities without stock outs of any of the six tracer
medicines in the previous 6 months increased from 41% (09/10) to 47% (2010/11). The
improvement in proportion of deliveries could be attributed to the increased supply mama kits
through the essential medicines kit as districts including hospitals no longer have to pay for
mama kits at the NMS, as well as availability of other medicines and health supplies including
misoprostol. The marked increase in under one year immunized with 3rd dose pentavalent
vaccine could be attributed to the recent review of child days implementation and focus on
poorly performing districts, which included catch up immunization services; House - to - House
SIAs in 48 districts and, stimulation of districts to work towards improved performance; where
districts are prompted to do specific district assessment and come up with innovative ways to
improve routine immunization. In addition, monthly feedback was provided to all the 112
districts regarding their performance; and improvement was also registered in district supply of
vaccines and injection materials from the centre. The shift from ‘pull’ to a ‘push’ system and reintroduction of the essential medicines kit contributed to the reduction in stock out of tracer
medicines in the previous year. Further improvements have been realized in 2010/11 due to
increased allocations to Vote 116 and tracking of medicine distribution. The last mile delivery
introduced in May 2011 is anticipated to result in further improvements in medicines
availability.
The sector recorded a reversal in trends in proportion of pregnant women attending 4 ANC
sessions from 47% (09/10) to 32% (10/11). This is in contrast to the increase in deliveries at the
health facilities, and is probably due to the relative effort and campaign on facility deliveries
compared to ANC. In addition, failure to appreciate the importance of ANC by the mothers
remains a challenge. Another possible reason is the recent national mass distribution of ITNs in
the community; some mothers previously sought ANC services in anticipation of a net. Even
then, further investigations need to be carried out to establish the cause of the reversal in
trends to almost half of the expected target.
The level of staffing with trained health workers was static at 56% and this is attributed to no
recruitments taking place in the Local Governments during the year under review as directed by
the MoLG.
The three indicators not documented for the year under review are got from data sources
outside the MoH and not collected on an annual basis. The ongoing UDHS-5 will provide the
current levels for these three indicators which include % of U5 children with weight / age below
lower line (wasting); CPR. Information of the % of annual reduction in absenteeism rate will be
obtained from the annual panel survey conducted by UBOS.
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2.1 Overall Summary Progress towards MDG, JAF and HSSIP 2010/11 –
2014/15 Indicators
2.1.1
Health Impact Indicators
Five impact indicators are used to assess the analysis of impact of health service delivery. Four
measure the distribution of health across different life cohorts and these are; Maternal
Mortality Ratio (MMR), Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR), and Under
5 Mortality Rate. The fifth, proportion of household experiencing catastrophic payments,
measures financial risk (protection).
Indicators for maternal, neonatal, infant and child mortality are collected every five years
during the UDHS carried out by UBOS. For the year under review the UDHS 2006 indicators will
still be applied as the UDHS -5 was started at the end of the financial year 2010/11.
x
Maternal Mortality Ratio (1997 - 2006)
435 per 100,000 live births
x
Neonatal Mortality rate (2002 - 06)
29 per 1,000 live births
x
Infant Mortality Rate (2002 - 06)
76 per 1,000 live births
x
Under 5 mortality rate (2002 - 06)
137 per 1,000 live births
Three of the impact indicators (Maternal Mortality Ratio, Infant Mortality Rate, and Under 5
Mortality Rate) are monitored among the MDG targets.
MDG 4: Reduce Child Mortality
Target 4.A: Reduce, by two thirds, between 1990
and 2015, the under five mortality rate.
Figure 1: Under 5 Mortality trends in Uganda
Figure 1: Under 5 Mortality trends in Uganda
The MDG report for Uganda 2010 indicates slow
progress towards achievement of the set target.
Hospital based mortality data indicates that
malaria is the top most (27.2%) cause of under
five mortality followed by anaemia (12.1%),
pneumonia (11.4%), perinatal conditions (7.8%)
and septicaemia (5.0%). Most of the deaths
occur early during admission due to the delayed
presentation of most of these conditions at the hospital and shortages of blood for transfusion
in some facilities, as well as high chronic malnutrition and micronutrient deficiencies in the
populations. More than one third of the deaths in the first year of life occur in newborns 0-28
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days, mostly in the immediate period after birth and are due to perinatal conditions like birth
asphyxia, pre term birth and infection
Hospital Based Mortality for all Ages
A total of 13,761 hospital deaths were reported during 2010/11 FY. Malaria was the top (20.9%)
cause of mortality followed by AIDS (9.4%), pneumonia (7.8%), anaemia (7.6%) and tuberculosis
(3.9%) among the top five. The highest number of mortality was among males above 5 years
(36.1%) followed by male under 5 (20.2%), females above 5 years (25.1%) and female under 5
(18.5%). (See Table 3) Among children under 5 years malaria is the highest (27.2%) cause of
mortality followed by anaemia (12.1%), pneumonia (11.4%), Perinatal conditions (7.8%) and
septicaemia (5.0%) among the top five causes of mortality. This trend remains the same from
2009 to 2010 (see Figure 2).
Table 3: Top ten causes of hospital based mortality for all ages in 2010/11 FY
IPD Diagnosis
< 5 years Deaths
Male
1.
Malaria
Above 5 years
Deaths
Male
Female
Female
Total
%
762
686
883
549
2,880
20.9%
67
72
651
501
1,291
9.4%
Pneumonia
333
273
312
158
1,076
7.8%
Anaemia
358
287
192
208
1,045
7.6%
17
31
318
166
532
3.9%
Perinatal conditions (in New borns 0 to 28 days)
218
197
-
-
415
3.0%
Septicaemia
165
101
60
60
386
2.8%
Other Types of Meningitis
26
25
128
74
253
1.8%
Respiratory Infections (Other)
60
85
69
37
251
1.8%
Injuries - Road Traffic Accidents
18
8
172
43
241
1.8%
754
788
2,189
1,660
5,391
39.2%
2,778
2,553
4,974
3,456
13,761
100.0%
2.
AIDS
3.
4.
5.
Tuberculosis
6.
7.
8.
9.
10.
11.
All Others
Total
Source: HMIS 2010/11
Among adults malaria and AIDS are the top most causes of mortality a three year period.
Conclusions cannot be deduced now on the top ten causes of death in 2011 because available
data was for the first 6 months.
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Figure 2: Trends in IP Mortality 2009 – 2011
MDG 5: Improve Maternal Health
Target 5.A: Reduce by three quarters, between 1990 and 2015, the Maternal Mortality Ratio.
Target 5.B: Achieve, by 2015, universal access to reproductive health care
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Figure 3: MMR Trends in Uganda
The MDG report for Uganda 2010 indicates
although there has been a reduction in MMR, the
attainment of target 5A has been slow.
The HMIS indicates that on average countrywide
there has been a slight reduction in hospital based
maternal deaths from 1,143 maternal deaths
reported in the health facilities in 2009/10 to
1,015 that occurred in 2010/11. With over 500,000
deliveries occurring in health facilities, this
corresponds with a hospital maternal mortality
ratio of almost 200 per 100,000 live births. It must
be noted however that the quality of reporting of maternal deaths is variable between
institutions. The figures cannot be considered more than indicative and more work is urgently
needed to improve the quality of reporting and statistics.
Figure 4: Health facility-based maternal deaths in FY 2009/10 and 2010/11
140
120
100
80
2009/2010
60
2010/2011
40
20
0
Source: MoH HMIS
2.1.2
Morbidity: Level and Trends
There was decline in the number of reported new outpatient attendances for all ages
(34,853,345) compared to the previous FY where reported new outpatient attendances were
36,808,680. Overall, this implies an average of 1.0 OPD visit per person per year. Communicable
diseases are still the leading causes of morbidity with malaria ranking highest (36%) among all
age groups, followed by no pneumonia – cough or cold 19% and intestinal worms 5%. (See
Table 4)
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Table 4: Top ten causes of morbidity among all ages from 2009/10 to 2010/11 FY
2008/09
2009/10
2010/11
Diagnosis
New cases
%
New cases
%
New cases
%
1.
Malaria
11,748,978
37%
14,164,008
38%
12,614,609
36%
No Pneumonia- Cough or Cold
5,794,516
18%
6,851,602
19%
6,712,597
19%
Intestinal Worms
1,767,586
6%
1,866,559
5%
1,826,240
5%
Skin Diseases
1,117,313
4%
1,101,113
3%
1,118,221
3%
Diarrhoea-Acute
965,145
3%
1,031,914
3%
1,029,615
3%
Eye Conditions
748,997
2%
751,508
2%
935,445
3%
Gastro-Intestinal Disorders (Noninfective)
726,862
2%
817,146
2%
825,338
2%
Pneumonia
887,917
3%
912,263
2%
819,180
2%
Urinary Tract Infections
646,326
2%
1,297,733
4%
747,354
2%
Injuries = (Trauma due to Other
Causes)
627,412
2%
641,987
2%
657,542
2%
6,830,314
21%
7,372,847
20%
7,567,204
22%
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
All Others
Total
31,861,366 100%
36,808,680 100%
34,853,345 100%
Source: MoH HMIS 2008/09 to 2010/11 (Expected reports received 89% 2008/09; 91% 2009/10; 93% 2010/11)
2.1.3
Performance against lead indicators for HIV/AIDS, Malaria and TB
During the year under review malaria, Tuberculosis (TB) and HIV/AIDS prevention, control and
management interventions were among the key sector priorities. These three diseases are of
focus under MDG 6 and therefore need to actively monitor progress towards achieving the
MDG targets. Performance during the year 2010/11 shows positive but slow progress for most
of the program lead indicators and reversal in some indicators for example; % of household
sprayed with insecticides (99% in 2009/10 (in six districts) to 96% (in ten districts) in 2010/11)
we need to report this correctly, one might think this is a national l average yet it data for only 6
– 10 out of 112 districts, this should be stated here, better even to be quiet about because the
two figures are not comparable!, % of RBM partnership review meetings (75% in 2009/10 to
50% in 2010/11), TB Case Detection Rate (56% in 2009/10 to 54% in 2010/11) , even though the
number of notified cases went up) and TB treatment success rate (75% in 2008/09, 67% in
2009/10 and 69% in 2010/11). Overall there is marked improvement in TB program lead
indicators compared to HIV/AIDS and malaria.
MDG 6: Combat HIV/AIDS, Malaria and Other Diseases
12
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Target
Progress
Target 6.A: Have halted by 2010 and begun to reverse the spread
of HIV/AIDS
Reversal in progress
Target 6.B: Achieve, by 2010, universal access to treatment for
HIV/AIDS for all who need it.
On track
Target 6.C: Have halted by 2015 and begun to reverse the
incidence of malaria and other major diseases.
Slow
Source: Uganda MDG Report 2010
Table 5: Performance against selected HIV/AIDS Programme lead indicators
Indicator
2009/10
2010/11
Proportion of health facilities with
HCT services
37%
(1,840/4,980)
38%
(1,904/4,980)
Minimal scale up of HCT services up to HC II
level. Progress slow due to inadequate supply
of kits and availability of trained personnel
Proportion of health facilities with
PMTCT services
23%
(1,150/4,980)
32%
(1,589/4,980)
There is an increase in the number of facilities
providing PMTCT services
Proportion of pregnant women
accessing HCT in ANC
83% at 90%
reporting
82% at 70%
reporting
Not able to deduce actual performance due to
poor reporting. Need to strengthen M&E
component
Number of males circumcised
Not known as
the intervention
was very new
Not known as
Most circumcision is done by partners and not
captured in the HMIS. Need to include safe
male circumcision in the HMIS.
M= 999,728
M=833,393
F= 1,992,665
F=1,413,127
There is a big discrepancy between the
number of people counseled and tested and
the laboratory tests done (8,338,860).
T= 2,992,393
T= 2,246,520*
NA
NA
NA
NA
NA
NA
NA
NA
No. people counseled and tested for
HIV (m, f)
Number of HIV positives enrolled in
care
Number of HIV positives eligible for
ART
Number of eligible clients initiated on
ART
Number of HIV positives screened for
TB
Source: UACP Database
Comments
* HMIS data however 8,338,860 lab tests were done
No reliable facility data were available to ascertain trends in coverage of HIV services, except
that almost all HIV positive people were initiated on co-trimoxazole (95%).
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
13
The performance indicators for the MCP and NTLP show slow progress towards halting the
incidence of malaria and TB.
Table 6: Performance against selected Malaria Control Programme lead indicators
Indicator
% of under-fives with fever who
receive malaria treatment within 24
hours from a VHT
% of pregnant women who have
completed IPT2 uptake
% of households sprayed with
insecticide in the last 12 months
Case fatality rate (%) among malaria
in-patients under five
% of public and PNFP health facilities
without any stock outs of first line antimalarial medicines
% of planned RBM partnership review
meetings held
2009/10
2010/11
13.7 (UMIS)
No data
47 (HMIS)
43 (HMIS)
99
96.7
1.4 (HMIS)
1.2 (HMIS)
No national
data
39
75
50
Comment
Roll out of ACTs to community level still awaiting
release of AMFm and GF Round 10 grant currently
delayed but under negotiation.
VHTs in at least 27 districts are distributing ACTs
(procured by partners) as part of the iCCM, which
targets U5 children with malaria, pneumonia and
diarrhea.
Reduction. Need for new thoughts & approached on
improving performance
2009/10 results were from 6 districts while 2010/11
results are from 10 districts but still in the same
geographical area
Data yet to be validated and adjusted for the more
representative figures
Results from support supervision in 128 out of a total
of 363 health facilities in 34 Districts
Modalities for engagement with partners currently
under review including recent appointment of
partnership coordinator
Table 7: Performance against the TB Programme Lead Indicators
Indicator
2008/09
2009/10
2010/11
HSSIP Target
2010/11 FY
Case Detection Rate (CDR)
57%
56%
54%
60%
Treatment Success Rate (TSR)
75%
67%
70%
75%
Cure Rate in %
31%
28%
40%
NA
% TB patients tested for HIV
63%
72%
81%
80%
% HIV +TB patients started on CPT
71%
86%
90%
90%
43,862
43,335
45,546
NA
Total number of TB cases notified
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2.2 Health Services Coverage
There are eight core health service coverage indicators for monitoring the HSSIP 2010/11 –
2014/15 implementation. The routine HMIS is the major source of data for these indicators and
therefore progress reported monthly is aggregated for the annual performance report. Table 8
summarizes the sector performance in relation to the core HSSIP 2010/11 – 2014/15 health
service coverage indicators.
Table 8: Performance for health services core indicators
Indicator
Source
Baseline,
(year)
2010/11
NDP
Target
JAF 3
Target
HSSIP
Target
Achievement
Performance
Trend from
HSSIP Baseline
% pregnant women attending
4 ANC sessions
HMIS
47 (09/10)
60%
N/A
50%
32%
Reversal
% deliveries in health facilities
HMIS
33 (09/10)
35%
40%
40%
39%
Positive
% children under one year
immunized with 3rd dose
Pentavalent vaccine (m/f)
HMIS
76 (09/10)
90%
88%
80%
90%
Positive
% one year old children
immunized against measles
HMIS
72 (09/10)
N/A
N/A
75%
85%
Positive
% pregnant women who have
completed IPT2
HMIS
47 (09/10)
N/A
N/A
50
43%
Reversal
% of children exposed to HIV
from their mothers accessing
HIV testing within 12 months
EID
database
29 (08/09)
N/A
N/A
35
30%
Minimal
improvement
% U5s with fever receiving
malaria treatment within 24
hours from VHT (m/f)
NA
13.7
(09/10)
N/A
N/A
20
No data
No national figure
information –
CBHMIS not yet
established
% eligible persons receiving
ARV therapy (m/f)
UACP
database
53 (2009)
N/A
N/A
55
NA
No data
(m/f)
(m/f)
N/A: these are not NDP and or JAF 3 indicators respectively
Coverage for immunization services improved with proportion of under one year immunized
with third dose of pentavalent vaccine increasing from 76% in 2009/10 FY to 90% in 2010/11 FY.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
15
There was also remarkable improvement in the proportion of one year old children immunized
against measles from 72% to 85% achieving the HSSIP 2010/11 – 14/15 target of 75%.
The proportion of deliveries in health facilities increased from 33% to 39% above the NDP
(35%), but below the JAF 3 and HSSIP annualized targets (40%). There was a marked reversal in
trends for the proportion of women attending the 4 ANC sessions from 47% in 2009/10 to 32%
in 2010/11 FY. This is well below the NDP (60%) and HSSIP (50%) targets. The proportion of
pregnant women who completed second dose of suphadoxine/pyrimethamine for Intermittent
Presumptive Treatment (IPT) for malaria declined from 47% in 2009/10 to 43% in 2010/11.
There was a marked increase of Total Couple Year Protection (CYP) from 447,713 in 2009/10 to
787,390.43 in 2010/11. This increase was also reflected in the Panel Survey of 2010 that
indicated an increase of Contraceptive Prevalence Rate to 33%.
The proportion of children exposed to HIV from their mothers accessing HIV testing within 12
months was only 30% compared to 29% in 2009/10. This is very minimal progress and much
below the HSSIP target of 35% for the year under review.
The proportion of children under five years receiving malaria treatment within 24 hours from
VHT was not assessed due to lack of information. It is expected that this information will be
captured after rolling out of the HMIS 2010 which has a Community Information System
component.
Information on the proportion of eligible persons receiving ARV treatment therapy was not
available.
Overall there was varied performance in the health services coverage indicators with
remarkable improvement in immunization coverage indicators above the HSSIP annual targets
and reversal in progress in proportion of pregnant women attending 4 ANC sessions and
receiving IPT2. There is need to investigate the reversal or stagnation of trends in the maternal
health services.
2.3 Coverage with Other Health Determinants
Four core HSSIP 2010/11 – 2014/15 indicators provide information on the overall contribution
of coverage by services addressing other health determinants are having on the health status.
Only one indicator on coverage of other health determinants and risk factors has been assessed
in this report. This is because the source of information for the remaining indicators is not from
the routine HMIS or program databases.
The proportion of households with latrines increased from 69.7% in 2009/10 to 71% in
2010/11. This is a positive trend and is above the HSSIP 2010/11 – 2014/15 annual target
(68.5%). Information on household latrine coverage is generated from the annual
environmental health data collection tool.
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Current estimates for indicators on nutritional status for under fives will be obtained from the
ongoing UDHS – 5. Preliminary results from the UNPS conducted by UBOS in 2009/10 indicate
an increase of Contraceptive Prevalence Rate (CPR) to 33%. The ongoing UDHS – 5 survey, will
also further provide an update on the status of CPR.
Table 9: Performance for coverage for other health determinants and risk factors indicators during
2010/11 FY
Indicator
Source
% of households with
latrine
Baseline,
(year)
2010/11
NDP Target
JAF 3
Target
HSSIP
Target
Achievement
Performance
Trend from
HSSIP
Baseline
EHD Data
tool
69.7 %
(09/10)
N/A
N/A
68.5%
71%
On track
% U5 children with height
/age below lower line
(stunting) (m/f)
UDHS
38%
(2006)
N/A
N/A
36%
No data
No information
% U5 children with
weight /age below lower
line (wasting) (m/f)
UDHS
16%
(2006)
15%
N/A
15%
No data
No information
Contraceptive Prevalence
Rate
Uganda
National
Panel
Survey /
UDHS
33%
(09/10)
34%
34%
34%
No data
Will further be
updated by the
UDHS 2011/12
Performance assessment for coverage for other health determinants and risk factors is not
conclusive for the year under review. Information is available for only one (% of household with
latrine which improved from 69.7% to 71%) out of four indicators. If a similar trend is sustained
for all indicators in this category throughout the HSSIP there should be improvement in health
status particularly of children under five.
2.4 Health Quality and Outputs
Health quality and output indicators provide information on the direct output from investments
made in health services. They are a measure of improvements made in access, quality, and
safety of health services provided.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
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Table 10: Performance for health system output (availability, access, quality, safety) indicators
Indicator
Source
Baseline,
(year)
2010/11
NDP
Target
JAF 3
Target
HSSIP
Target
Achievem
ent
Performance
Trend from
HSSIP Baseline
% of new TB smear +
cases notified compared to
expected ( TB case
detection rate) (m/f)
NTLP
Database
56 (09/10)
N/A
N/A
60
53.9%
Reversal –
awaiting data
from Mualgo for
update
Per capita OPD utilization
rate (m/f)
HMIS
0.9 (09/10)
N/A
N/A
1.0
1.0
On track
% clients expressing
satisfaction with health
services (waiting time)
Survey
46 (2008)
N/A
N/A
50
No data
No current
information.
Survey to be
conducted
2011/12
Drug
availability
study 2011
21% (09/10)
28%
60%
50%
43%
Improving
HMIS
23 (09/10)
% of health facilities
without stock outs of any of
the six tracer medicines in
the previous 6 months (1st
line antimalarials,
Depoprovera, S/P, measles
vaccine, ORS, Cotrimoxazole)
% of functional Health
Centre IVs (providing
EMOC)
47% excluding
ACTs
(41% when
ACT are
excluded)
N/A
N/A
28
24%
Slight
improvement
/ h
d
d
l
N/A: these are not NDP and or JAF 3 indicators respectively
The proportion of new TB smear positive cases notified compared to expected (TB case
detection rate) has declined from 56% in 2009/10 to 54% in 2010/11. A number of factors
including uncertainty on magnitude of TB problem, the tendency for smear negative and EP TB
to increase disproportionately in areas with high HIV prevalence and HIV-TB co-infected rate
settings, poor R&R. Some districts also reported stock outs of laboratory reagents and supply of
poor quality laboratory reagents, this could have negatively impacted on the case detection.
Per capita Out Patients Department (OPD) utilization rate improved from 0.9 in 2009/10 to 1.0
2010/11 achieving the HSSIP annual target.
There is no national level information on the current status of client satisfaction (waiting time).
The National client satisfaction survey will be carried out during 2011/12 FY. Facility based
client satisfaction surveys were carried out by sites implementing 5S and findings indicated
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improvement in client satisfaction after introduction of 5S. About 80% of patients at Gombe GH
appreciated improvements on cleanliness and staff attitude, and 55% of them on waiting hours.
About 90 % of patients at Entebbe GH recognized the improvement on cleanliness, 60% of them
on staff attitude, and 30% of them on waiting time. (Monitoring Report of the JICA 5S Project in
Uganda, March 2011) A survey conducted by UNHCO in 8 districts showed that 61.4% of the
people interviewed in these districts are satisfied with the MCH services provided by the health
facilities.
The medicines availability study conducted in August 2011, shows that 43% of health facilities
did not have any stock out of the tracer medicines in the 1st and 4th quarters of FY 2010/11 and
47% when excluding ACTs. It is worth noting that facilities without stock out considering ACTs
were 21% in 2009/10. In the period under review, the country experienced some stock out
period of Cotrimoxazole tablets for HIV/AIDs prophylaxis, thereby creating an increased
pressure on what had been procured for routine treatment. As a result, the stock status was
this time round affected by stock out of Cotrimoxazole tablets.
Only 24% of the HC IVs were ‘functional’ in 2010/11 – a minimal increase from 23% found in
2009/10. HC IV functionality is being able to provide intervention in case of complications
during delivery, which includes the ability to provide a Caesarean Section and Blood
Transfusion; HC IVs have been judged “functional” if they have been able to carry out at least
one Caesarean Section.
The level of utilization of health services has improved as evidenced by the OPD utilization with
the highest utilization rate among females above 5 years (63%) compared to 37% among males
above 5 years. Utilization rate among females and males under five years is 51% and 48%
respectively.
Overall there is improvement in performance for most of the health systems output indicators
with the exception of TB case detection rate and client satisfaction where there is no current
data. The improvement in performance is an indication that availability, access and quality of
services are likely to have improved. Other studies like national client satisfaction survey and
Service Availability Readiness Assessment should be carried out to verify this.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
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2.5 Health Investments
Indicators on health investments provide information on the amount of investments available
for health services.
Village Health Teams:
According to a survey conducted by MoH / UNICEF, there was remarkable increase in the
proportion of villages / wards with trained VHTs from 31% in 2009/10 to 72% in 2010/11. Again
here we should mention that this is only for few districts where iCCM is implemented.
Health Financing:
Allocation to health as a percentage of total government budget reduced from 9.6% in 2009/10
to 8.9% but in line with the MTEF target.
Table 11: Performance for coverage for health investments and governance indicators
Indicator
Source
Baseline,
(year)
2010/11
NDP
Target
JAF 3 Target
HSSIP
Target
Achievement
Performance
Trend from
HSSIP
Baseline
% of approved posts
filled by trained health
workers
HRIS
56 (09/10)
56%
59%
60%
56%
Static
% Annual reduction in
absenteeism rate
UNPS
46 (09/10)
28%
20%
20%
No data
Awaiting Panel
Survey findings
(37%
absenteeism)
(Actual
Absenteeism
rate)
% of villages / wards with
trained VHTs
VHT
Situation
Analysis
Report
2010
31 (09/10)
NA
NA
50
72%
MoH/ UNICEF
Survey
General Government
allocation for health as %
of total government
budget
MTEF
9.6 (09/10)
NA
NA
8.8
8.9
On track
N/A: these are not NDP and or JAF 3 indicators respectively
Human Resources for Health
The proportion of approved posts filled by trained health workers stagnated at 56%.
Annual reduction in absenteeism rate is expected at 20% of the baseline which is 46%
absenteeism rate. Performance for this indicator is to be obtained in November from the
annual UNPS conducted by UBOS.
At the national level including all the hospitals, MoH institutions and LGs, the proportion of
filled positions by trained health workers stands at 56%. This calculation excludes those health
20
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workers who are not registered by health professional councils such as nutritionists,
administrators, nursing assistants and drivers. Furthermore, the calculation also does not
include administrative and support staff such as the accountants and secretaries. For this
indicator, there has been a fall from 75% in FY 2005/06 to 56% in FY 2010/2011 which can be
attributed to the increased number of health facilities and thereby increasing the overall
denominator. Furthermore, staffing norms were revised and increased in line with the
workload at the different levels of care. The staffing levels are better in referral hospitals than
in district health units, where only 52% of the posts are filled.
Table 12: Staffing Levels in the public sector filled by trained health personnel - October 2010
Cadre of Staff
Mulago
Butabika
RRHs
Districts Health
Units
DHOs
Total
Norms
Total
Filled % filled
Norms
Filled
Norms
Filled
Norms
Filled
Norms
Filled
Norms
Filled
Doctors
241
203
26
15
520
204
80
63
824
306
1,691
791
47%
Clinical Officers
45
56
12
14
395
261
0
5
2,598
1,678
3,050
2,014
66%
Nurses
940
846
154
127
1,371
1,102
80
10
9,098
4,721
11,643
6,806
58%
Midwives
121
95
0
0
701
477
0
0
4,536
3,002
5,358
3,574
67%
Pharmacists
8
4
2
2
36
13
0
2
40
3
86
24
28%
Dispensers
34
26
5
5
80
36
0
0
244
78
363
145
40%
Lab. Scientists
63
55
6
6
180
108
0
1
2,236
958
2,485
1,128
45%
Radiographers
33
28
2
3
53
35
0
0
80
22
168
88
52%
Health Assistants
0
0
0
0
0
0
0
0
2,573
1,570
2,573
1,570
61%
Other Medical
Related Staff
252
168
87
92
356
173
320
210
4,951
1,816
5,966
2,459
41%
Grand Total
1,737
1,481
294
264
3,692
2,409
480
291
27,180
14,154
33,383
18,599
56%
Percent filled
85.3
89.8
65.2
60.6
52.1
56
Source: Uganda Human Resources for Health Biannual Report October 2010 to March 2011
8,978
9,000
8,000
F
7,000
6,000
i
5,000
4,000
g
3,000
u
2,000
1,000
r 0
8,072
6,371
4,535
2,272
1,148
1,481
4,309
202
e
5: The Density of Health Personnel GOU and PNFP
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
21
Analysis of HRH data for both the public and PNFP sub-sectors put together indicated that the
country has 37,368 health workers. Out of these 8,978 (24%) are nurses and 4,535 (12%) are
midwives and 1,148 (3%) are doctors. The data also indicates that the nursing assistants still
form a big number of the health workers 6,371 (17%). This implies that more effort is needed to
recruit and retain the qualified health staff particularly at HC II, HC III and HC IV levels.
The density of health personnel is Uganda is still very low as shown by the health worker
population ratio in Table 13. Overall, there are 1.49 core health workers per 1,000 population,
still well below the WHO recommended minimum of 2.3 per 1,000.
Table 13: Cadre: Population Ratio
Health Worker
H/W : Population ratio
Density per 1,000 population
Doctors
1 : 27,687
0.036 / 1,000
Clinical Officers
1 : 13,990
0.071/ 1,000
Nurses
1 : 3,540
0.28 / 1,000
Midwives
1 : 7,009
0.14 / 1,000
Diagnostic Staff
1 : 21,462
0.047 / 1,000
Main challenges
x Poor attraction and retention of staff across the country remains critical. The situation gets
even worse for cadres like-; Doctors, Midwives, Anesthetic staff, Radiographers Pharmacists
and Dispensers.
x Limited funding for recruitment, salaries and wages has resulted into high vacancy levels.
x Inequitable distribution of Health Workers to districts due to peculiar disadvantages of such
districts has resulted into some districts not having the minimum staffing levels.
x The remuneration of health workers still remains a challenge. The needs of health workers
are much more than the monthly payments across all cadres. Another challenge results
from poor health worker attitudes. What make people efficient are their attitudes and this
stems from personal attributes of maturity.
x Observation of most health workers reveals reduced commitment which results into little
attention to professional standards. Some of the negative consequences have been
increased late coming and absenteeism of staff. In some cases, the public has lost
confidence in health workers.
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x
x
x
x
Poor attitude of health staff has a correlation with the selection procedures of student
health workers coming for training. Selection of students is done based on the academics
only without subjecting the would-be health workers to an entry interview for most of the
cadres. Students do not know what they are going in for. They are in most cases poorly
informed of what they need to do on qualifying.
The sector has also registered shortages of role models for various health professionals. The
health sector also faces poor and unsupportive work environment resulting into
dissatisfaction of health cadres.
There is generally constricted career structure with implications on promotions and new
appointments of health staff. This limitation is more marked at the district level.
There is lack of recognition of health workers by communities and political leaders. This
together with poor management and leadership in some cases within health facilities has
negated the positive gains reached in the health sector.
Recommendations for annual plan 2012/13
x Improve funding to the sector especially wage bill provisions to enhance both the numbers
and remuneration levels.
x Improve working conditions (Equipment and accommodation)
x Strengthen Management and supervision of health workers at all levels.
Apart from the remarkable increase in the proportion of villages / wards with trained VHTs
there is no improvement in the amount of health investments expected for delivery of quality
health services.
The health sector efforts in ensuring attainment and maintenance of an adequately sized,
equitably distributed and appropriately skilled workforce (60% target for 2010/11 FY) were
hampered by the ban on recruitment as a result of a limited wage will. There is need to
advocate for increasing staffing levels for the entire critical cadre for effective and efficient
utilisation of health investments.
2.6 Benchmarking Uganda's progress relative to 11 peer countries
Benchmarking performance helps to put national progress into perspective. There are many
issues that limit the comparability of the current situation and trends between countries, but
international statistics are useful to provide a rough idea. Table 14 using data from the WHO
World Health Statistics, compares the current situation in Uganda with 11 peer countries:
Burundi, DR Congo, Ethiopia, Ghana, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Zambia
and Zimbabwe. These countries are similar in terms of socio-economic development,
epidemiological situation and geographic location.
Uganda scores high on the health inputs (average rank of 3 out 12 for the 3 health input
indicators), but poorer on the coverage (average rank of 10 out of 12 for the 3 coverage
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
23
indicators) and health outcome indicators (average rank of 7 out 12 for the 3 outcome
indicators). Note that most data pertain to 2009 and 2010, and do not include the recent
2010/11 figures in this report, such as pentavalent /DTP3 coverage.
Table 14: Rank for key health indicators for 12 countries, including Uganda (WHO, 2011)
BEST
RANK
1
POOREST
2
3
4
6
7
8
9
10
11
12
UG
GNI per capita (PPP int.$) (2008)
UG
PER CAPITA TOTAL EXPENDITURE (PPP int. $) (2009)
INPUT
5
UG
GOVERNMENT EXPENDITURE ON HEALTH (% TOTAL GOVERNMENT EXPENDITURE) (2009)
UG
COVERAGE
BIRTHS ATTENDED BY SKILLED HEALTH PERSONNEL (%) (2009)
OUTCOME
CORE HEALTH WORKER DENSITY (2000-2010)
MATERNAL MORTALITY RATIO (2008)
UG
UG
DTP3 IMMUNIZATION COVERAGE AMONG 1-YEAR-OLDS (%) (2009)
UG
CONTRACEPTIVE PREVALENCE RATE (2001-2010)
UG
UG
UNDER FIVE MORTALITY RATE (2008)
UG
TOTAL FERTILITY RATE (2009)
Figure 6 examines the progress that Uganda has made during 1990 - 2009 compared to the
average progress of its peer countries. Economic growth was 1.6 faster in Uganda than the
average, but expenditure on health was much slower than in peer countries (70% slower).
Overall, the coverage and health outcome indicators indicate the progress in Uganda has been
slower than in the peer countries during 1990 - 2009. Although Uganda is ranked 12 out of 12
for 3rd dose pentavalent vaccine coverage, the increase over this period was nearly 1.5 times
greater than peer countries.
Figure 6: Uganda's progress benchmarked relative to the peer countries over time for the period 1990
to 2010.
General government
expenditure on health
-0.7
Per capita total exp.
(PPP int.$)
1.6
Births attended by
skilled health
personnel (%)
-0.1
DTP3 immunization
coverage among 1year-olds (%)
1.4
Maternal mortality
ratio
0.4
Under five child
mortality
0.1
-0.5
Total fertility rate
-1
-0.5
0
0.5
1
1.5
2
2.5
3
Figure 2: Uganda's progress benchmarked relative to the peer countries. The progress of the peer
countries has been standardized at 0.
The progress of the peer countries has been standardized at 0. (GGE= General government
expenditure on health as a percentage of total government expenditure, U5= Under five
mortality; SBA= Births attended by skilled health personnel; TFR= Total Fertility rate). (Source
WHO 2011)
24
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
2.7 Summary of the Financial Report 2010/11 FY
Health service delivery is financed by the government, private sources and development
assistance under the sector wide arrangement. Of the Government of Uganda expenditure on
health for the FY 2010/11, capital expenditure accounted for 17% of health sector public
expenditure while recurrent expenditure such as wages, utilities and other operational costs
accounted for 83%. Donor funding is mainly for development items. The GoU funds are
channeled through the MOH, LGs and the OPM.
Therefore, the ability of a health system to protect the poor against unaffordable health care
need and avoid impoverishment resulting from excessive health care costs (catastrophic
expenses) is the core of health care financing. This can be achieved through;
i.
ii.
Increasing government per capita expenditure on health and
Raising the proportion of household financing mobilized through prepayments
The Health Financing Review 2009/2010 points out that there has been significant increase in
the expenditure, from 16 US$ per person in 1999 - 2000, to the current total expenditure on
health of over US$ 27 per person per year (representing a 69% increase in total health
expenditure). However, this is less than US$ 44 per person per year the WHO World Health
Report 2010 defined as the current estimates needs for provision of an appropriate basic
package of services in low income settings.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
25
2.7.1
Trends of the health sector funding (2000/01-2010/11)
The trend in allocation of funds to the health sector shows that there has been a steady
increase in budget allocation over the past 10 years as illustrated in the table below.
Table 15: Government allocation to the Health Sector 2000/01 to 2010/11
Year
GoU
Funding
(Ushs bns)
Donor
Projects
and GHIs
(Ushs bns)
Total
(Ushs
bns)
Per
capita
public health
exp (UGX)
Per capita public
health exp (US $))
GoU health
expenditure
as % of total
government
expenditure
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
124.23
169.79
195.96
207.80
219.56
229.86
242.63
277.36
375.46
435.8
569.56
114.77
144.07
141.96
175.27
146.74
268.38
139.23
141.12
253.00
301.8
90.44
239.00
313.86
337.92
383.07
366.30
498.24
381.86
418.48
628.46
737.6
660
10,349
13,128
13,654
14,969
13,843
26,935
13,518
14,275
20,810
24,423
20,765
5.9
7.5
7.3
7.7
8.0
14.8
7.8
8.4
10.4
11.1
9.4
7.5
8.9
9.4
9.6
9.7
8.9
9.3
9.0
8.3
9.6
8.9
Analysis of the table above reveals the following;
i.
The GoU allocation to the health sector has been rising steadily over the last ten years,
owing to economic growth, but the proportion of the budget spent on health did not
increase.
ii.
The donor project component reduced significantly in FY 2010/11. The decline is on
account of the exit of some Development Partners, like DANIDA, from the sector.
p
The proportion of the total Government budget to health still averages at 9% which is
short of the Abuja target of 15%
iii.
26
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2.7.2
Financial Performance for Local Governments (LGs)
The overall PHC budget performance for financial year 2010/11 for LGs was Shs. 221.2 billion
out of an approved budget of Shs. 207.8 billion representing 106% budget out turn. This
funding excludes project funds and funds meant for medicines and health supplies. There was
over budget performance under PHC wages due to supplementary budget releases for health
workers salaries amounting to Shs 18.5 billion. The supplementary budget provision was due to
inadequate provision of funds for PHC wages for staff in post in financial year 2010/11. The
supplementary budget provision led to the over performance of the budget.
The worst budget performance for grants to LGs was under PHC development grant where Shs.
40.1 billion was released out of the approved budget of Shs 44.5 billion representing 90%
budget out turn.
General hospitals and NGO health facilities budget out turn was 98% and 97% respectively.
However some general hospitals and NGO hospitals did not receive the 4th quarter funds in
financial year 2010/11 due to non compliancy of the LGs in reporting to MoFPED on the health
facility inventories.
Key issues under LG Financing
i. Low per capita allocation for Health services especially at health centre levels.
ii. Prevalence of Off- Budget/project funding which necessarily do not address key sector
priorities.
iii. Inefficiencies in procurement of services and works.
Table 16: Primary Health Care Grants FY 2000/2001-2010/11 in billions of Ug. Shillings
FY
2000/01
2001/02
2002/03
2003/04
2004/05
2005/06
2006/07
2007/08
2008/09
2009/10
2010/11
PHC
PHC (NON- PHC NGOs ( GENERAL
PHC ( DEV'T
(WAGES) WAGE)
PNFP)
HOSPITALS
GRANT)
TOTAL
9.6
8.8
6.7
6.3
10
41.4
35
14.9
11.6
8.9
11
81.4
43.9
19.7
16.7
8.7
7.6
96.6
44.7
23.2
17.7
10.4
9.2
105.2
68
23.2
17.7
10.4
6.1
125.4
72
22.4
17.7
10.4
5.9
128.4
74.6
22.9
17.7
10.6
6.1
131.9
85.1
22.9
17.7
10.6
6.3
142.6
85.1
28.7
17.7
10.6
15.3
157.4
107.5
28.7
17.7
10.2
15.3
179.4
124.5
17.4
17.7
5.9
15.3
180.8
Source: Approved Budget Estimates of Revenue and Expenditure- MOFPED.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
27
Figure 7 shows that there has been steady increase in PHC wages over the last ten years, with
no increase in the remaining components of the PHC grant. In FY 2010/11, there was a 39%
decrease in the PHC Non-wage despite the increase in the number of districts. This severely
affected delivery of services including management services like support supervision at LG level.
Figure 7: Trends in PHC Grant Allocations 2000/01 – 2010/11
140
120
100
PHC( WAGES)
80
PHC (NON- WAGE)
60
PHC NGOs( PNFP)
40
GENERAL HOSPITALS
20
PHC( DEV'T GRANT)
0
Table 17: Government of Uganda health sector budget performance for FY 2010/11 (excluding donor
projects)
Item
Approved
Budget
(Ushs bns)
Budget
performance
(%)
Outturn
(Ushs bns)
Wage
178.07
195.94
110.04
Non-Wage
293.28
272.12
92.78
98.21
91.35
93.02
Development
28
Remarks
The difference was on account of a
supplementary budget passed to cover wage
shortfalls
The performance can be attributed to general
cuts across Government during the financial
year
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
As illustrated in Table 17, the amount released to cover wages was higher than the approved
budget. This is because the sector experienced wage shortfalls which resulted in a
supplementary budget allocation of Ushs. 17.86bn. The non-wage and development budgets
performed at an average of 92%. LGs performed at an average of 106% as illustrated in table
18.
Table 18: Local Government Grant Performance for FY 2010/11
Item
Budget( 000')
PHC Wages
Actual Release (000')
%
124,823,442
143,340,468
115
PHC Non-wages
14,355,550
14,229,320
99
PHC NGOs
16,848,318
16,352,712
97
General Hospitals
6,107,088
5,997,141
98
PHC Development
44,564,550
40,192,230
90
1,159,329
1,157,251
100
207,858,277
221,269,122
106
NGO Wage Subvention
Total
Table 19: Financial Performance for Central Institutions and Referral Hospitals for FY 2010/11 (UGX
Billion)
INSTITUTION
WAGE
NON WAGE
DEVELOPMENT
TOTAL
Approved Released Approved Released Approved Released Approved Released Performance
Budget
Budget
Budget
Budget
(%)
MoH
4.27
4.327
26.42
25.85
75.86
15.119
106.55
45.30
42.51
UCI
0.4
0.439
0.62
0.535
3
3
4.02
3.974
98.86
UHI
0.4
0.411
0.04
0.038
1.5
3
1.94
3.449
177.78
NMS
0
0
201.73
181.23
0
0
201.73
181.23
89.84
HSC
0.73
0.569
1.71
1.647
0.35
0.347
2.79
2.563
91.86
UBTS
1.46
1.48
1.79
1.79
0.07
0.038
3.32
3.308
99.64
Mulago
18
15.603
9.82
12.321
5.02
5.02
32.84
32.944
100.32
Butabika
2.24
2.371
3.15
3.148
27.19
RRHs
24.812
26.246
8.34
8.978
17.004
17.004
50.152
52.223
Total
52.312
51.445
253.621
235.538
129.989
51.158
435.922
425.391
Grant
Performance
(%)
98.34
92.87
32.58
39.36
97.6
100.40
100.40
104.00
97.6
Most institutions that had releases over and above the approved budget were on account of
the Wage grant that had been under provided in the budget. This necessitated passing a
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
29
supplementary budget and therefore a greater than 100% performance of the approved
budget.
Main achievements
x A study on the efficiency of hospitals and HC IVs was conducted and findings will be used to
inform resource allocation and utilization.
x A new resource allocation formula for the sector was developed and is now awaiting the
input of the private not for profit sub-sector. This is expected to further improve equity and
efficiency in resource allocation.
x The sector undertook a PNFP Hospital value for money audit.
x The sector also continued to lobby for and mobilize resources both locally and
internationally.
x A concept note on the Health Financing Strategy has been developed.
Major Challenges
x Inadequate funding for sector activities for example, the conditional grants to Local
Governments and PNFPs have not significantly changed yet population, administrative units
and prices have increased significantly
x Rising costs of goods and services distorted set plans
x Unplanned and unbudgeted for activities. Unforeseen and unbudgeted for but catastrophic
and urgent emergencies such as Ebola and Yellow Fever exerted pressure on operational
resources thus constraining other important activities.
x Off-budget sector funding: A number of health improving activities are funded outside the
sector wide mechanism that was established to align funding to sector priorities. This leads
to efficiency losses associated with funding activities that may be duplicative or outside the
priorities identified to achieve health outcomes.
x Weaknesses in the LG capacity in areas of financial reporting, leadership and financial
management
Recommendations
x Expedite plans with the International Finance Co-operation to finalize a financing
agreement to enable private health providers’ access affordable funds to improve on health
service delivery.
x Lobby for more funds to finance sector activities.
x Implement the revised resource allocation formula for the sector
x Conduct the national health accounts and disseminate its findings among policy makers
x Finalise the new Health Financing Strategy and implement strategies therein
x Analysis and review of the quarterly budget performance reports (BPR) and following up on
recommendations.
x Enhance periodic supervision, reporting to ensure efficient budget monitoring and
performance.
30
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
x
x
Reduce off budget funding by ensuring that all projects and donor inflows are aligned to
HSSIP and reflected in the budget.
Reduce out–of-pocket funding for health care by introducing prepayment systems like
health insurance.
Despite the very modest increment in general government allocation for health, efforts were
made to establish mechanisms for securing and allocating available resources e.g. new resource
allocation formula for the sector and PNFPs and development of the National Financing
Strategy.
The last published National Health Accounts (NHA) study for Uganda, covering financial years
1998/1999 to 2010/11; out of pocket expenditure was between 40% and 42% of overall
expenditure on health. Government per capita expenditure on health was USD 8.31. Given that
mobilization of prepaid resources health care financing has not progressed, it implies that the
financial burden on households between 2000/01 and 2010/11 has increased. The fiscal space
study (World Bank 2009), showed a twofold increase in out of pocket expenditure on health
between 2002/03 and 2004/05 from US$7 to US$14 per utilization.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
31
2.8 Summary Assessment of the Health System / Health Sector Support
System
The central level’s main roles are coordination and provide support functions like planning,
supervision, resource mobilization and development of the sector. This section analyses
progress in performance for the central level institutions which include the MoH headquarters,
departments, priority programs, projects, referral hospitals and semi-autonomous institutions.
The assessment is based on planned activities in the MPS FY 2010/11 (See section 3.1). Among
the central level vote functions the Support to Health Sector Strategic Plan Project (SHSSPP) had
the best level of performance (80%), against planned outputs, followed by pharmaceutical and
other supplies (75%), then sector monitoring and quality assurance (60%). Achievement of
planned key outputs under the various vote functions supporting health care service delivery
varied as summarized in the matrix below.
Table 20: Summary of performance by Vote Function
No. of key
planned
outputs
”40%
>40% - 80%
>80%
Comment
Health Systems Development
7
3/7 (43%)
2/7 (29%)
2/7 (29%)
Poor
SHSSPP
5
0/5 (0%)
1/5 (20%)
4/5 (80%)
Good
Clinical and Public Health
6
3/6 (50%)
3/6 (50%)
0/5 (0%)
Moderate
Uganda Cancer Institute
2
0/2 (0%)
1/2 (50%)
1/2 (50%)
Moderate
Uganda Heart Institute
2
0/2 (0%)
1/2 (50%)
1/2 (50%)
Moderate
Uganda Blood Transfusion Services
6
1/6 (17%)
3/6 (50%)
2/6 (33%)
Moderate
National Referral Hospitals – Mulago and
Butabika
4
0/4 (0%)
2/4(50%)
2/4 (50%)
Moderate
Sector Monitoring and Quality Assurance
5
0/5 (0%)
2/5 (40%)
3/5 (60%)
Good
Health Research
3
0/3 (0%)
2/3 (67%)
1/3 (33%)
Moderate
Pharmaceutical and Other Supplies
8
0/8 (0%)
2/8 (25%)
6/8 (75%)
Good
Policy, Planning & Support Services
15
2/15 (13%)
7/15 (47%)
6/15 (40%)
Moderate
Human Resources for Health
6
0/6 (0%)
3/6 (50%)
3/6 (50%)
Moderate
Vote Function
32
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2.9 Global Fund (GF) Supported Interventions 2010/11
The GF supported interventions in this financial year contributed towards the attainment of the
MDGs 4, 5, and 6 in relation to improving MCH as well as national and international health
goals.
During the reporting period, the GF disbursed $28,562,216.30 which was utilized on
procurement of ARVs, cotrimoxazole, HIV test kits, laboratory reagents, trainings for service
providers and printing of Information Education Communication (IEC) materials. This facilitated
the procurement of 70,443 doses of Cotrimoxazole, 172,000 doses of ARVs, 200,000 HIV tests,
10 CD4 count machines and their laboratory reagents. The balance of is $3,600,000 yet to be
spent on procurement of condoms. An additional USD 4M was in turn disbursed to subrecipients to conduct trainings and IEC activities.
The disbursement under the malaria grant worth USD 40,885,477 targeted providing Long
Lasting Nets for pregnant women and children under-5. It was used for procurement of
7,295,850 LNs through Voluntary Pooled Procurement (VPP). Additionally, USD 6,297,305 was
disbursed directly to the country for mostly Civil Society Organisation (CSO) implemented
activities of training, IEC/ BCC, registration, M&E, actual distribution and post distribution
activities. Phase 1 distribution was successfully completed in Central, Western and Northern
and Eastern Regions.
Additionally Uganda signed an agreement with the GF under the Affordable Medicines Facility
for Malaria (AMFm), where the GF subsidized ACTs by 95%. Under this grant 10 million doses of
ACTs have already been delivered into the country.
The GOU supported the TB program to purchase 180 microscopes and conduct training of 1,126
health workers in 38 districts.
The country developed and submitted a country proposal for R10 HIV, Malaria, TB and HSS,
which was approved by the GF board worth a total of USD 190M for five years. The country
also submitted Round 7 phase two which has been approved worth USD $ 130 million for three
years.
Following the 2008 recommendation by the Inspector General of the GF, a Focal Coordination
Office (FCO) was created. With GOU and GF, recruitment took place in October 2010 and the
team came fully on board in February 2011.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
33
2.10 Global Alliance for Vaccines and Immunisation (GAVI) Progress
2010/11
During the year under review Uganda received pentavalent vaccines worth USD $ 6,261,080 for
the Expanded Program for Immunization. The GAVI secretariat had a mission in country in May
2011 and an MOU has been drafted and has been cleared by the Solicitor General. As soon as
the GAVI secretariat signs the MOU then the Immunization Systems strengthening and Health
Systems Strengthening funds will become available for the EPI program to implement the
planned activities.
2.11 Health Partnerships Performance
2.11.1.1 The Compact for implementation of the HSSIP 2010/11 – 2014/15
At the beginning of HSSIP 2010/11 – 2014/15 a Country Compact was signed by MoH, HDPs,
CSOs and the private sector. This section assesses progress in implementation of the Compact
as well as the decentralized responses (partners’ technical and financial support for health).
The HPAC serves as the overall oversight and steering body for monitoring the implementation
of the Compact. The main areas of focus during the year under review are extracted from the
list of indicators for monitoring the Compact 2010/11 – 2014/15 (See section 3.2).
Table 21: Summary Matrix for monitoring progress of implementation of the Compact
No. of
key
planned
outputs
Area of Focus
”40%
>40% - 80%
>80%
Comment
Planning and Budgeting
5
4/5 (80%)
0/5 (0%)
1/5 (20%)
Poor
Monitoring programme implementation
and performance
6
2/6 (33%)
3/6 (50%)
1/6 (17%)
Moderate
Policy guidance and monitoring
3
0/3 (0%)
1/3 (33%)
2/3 (67%)
Good
34
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Table 22: HPAC Institutional representatives’ attendance Jul 2010 – Jun 2011
Month
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
MOH
(11)
HDP (4)
36%
73%
55%
55%
45%
64%
55%
36%
9%
45%
0%
64%
CSO (4)
125%
100%
125%
75%
100%
75%
75%
100%
100%
100%
0%
75%
100%
75%
75%
50%
0%
25%
50%
0%
75%
75%
0%
50%
NMS (1)
0%
0%
0%
100%
200%
100%
100%
0%
100%
100%
0%
0%
District
(1)
NRH (2)
0%
0%
0%
0%
100%
0%
100%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
RRH (1)
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
Line
Ministries
(5)
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
2.1 Decentralized Responses
Project Support to LGs is mainly towards the HIV/AIDS program activities with the highest
number of projects in the central region followed by the eastern and western. The SURE project
supporting access to essential medicines has a national level coverage.
Future assessments will analyse project support in relation to district performance for
supported interventions, however, there is need to note that despite the high level of project
support in the area of HIV/AIDS, there is slow progress in the programme indicators e.g.
number of exposed infants tested for HIV and number of eligible clients initiated on ART. Only
one project STRIDES is focusing on RH in particular FP service provision however there has been
tremendous improvement in the CYP from 582,804 in 2009/10 to 787,390 in 2010/11.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
35
Table 23: Project Support to Local Governments
Project
Area of
Support
Region
Central
East
Central
Eastern
Karamoja
Northern
South
West
West
Nile
Western
X
X
X
X
X
X
X
X
SURE
Medicines
STAR-SW
HIV/AIDS
SUSTAIN
HIV/AIDS
X
IRCU
HIV/AIDS
X
STAR-E
HIV/AIDS
NUMAT
HIV/AIDS
STAR-EC
HIV/AIDS
WORLD
BANK
Infrastructure
Development
X
X
X
STRIDES
RH
X
X
X
SDS
Strengthening
Decentralization
X
X
X
MALARIA
CONSORTIUM
Malaria
X
STOP
MALARIA
Malaria
X
UNFPA
RH
X
BAYLOR
HIV/AIDS
IDI
HIV/AIDS
X
MILDMAY
HIV/AIDS
X
WALTER
REED
PROJECT
HIV/AIDS
X
Total
Projects
36
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
12/17
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
8/17
11/17
4/17
5/17
8/17
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
7/17
11/17
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37
2.1.1
Progress made towards achieving international resolutions and obligations e.g. WHO,
ECSA, IHP+
During the period under review, the MoH participated in several Regional and International
fora where important decisions and commitments were made. Here below is a summary of the
progress of implementation of the resolutions.
Progress towards achieving the East African Community (EAC) recommendations of the forum
for Ministers responsible for Social development
The second meeting of the Forum for Ministers responsible for Social Development was held in
Burundi from 2nd to 7th October 2010. The meetings reviewed the proposed priority areas of
regional cooperation and made a number of important recommendations under the health
sector. Since then progress has been achieved as indicated in the table below.
Recommendation / Action
Achievement
Remarks
Partner states to make collective x The East Africa Public Health Laboratories
efforts in addressing issues such as
project has been operationalized to
communicable
diseases,
address communicable diseases and
pharmaceutical
products
and
country consultations have been carried
medicines.
out for pooled procurement of medicines.
x
Partner states to establish ‘’health x
services charters’’ at national level.
x
EAC partner states to develop and x
harmonize electronic early warning
and rapid response systems for
communicable disease outbreaks
and fast track the establishment of
the proposed’’ EAC Regional x
Integrated e-Health Information
system.
x
38
Project
approved and
Uganda is a
beneficiary
The
patients’
Charter spells
out
patients’
rights
and
responsibilities
and
the
responsibility
of
The MOH together with the Ministry
responsible for Public Service developed a health workers
Clients’ Charter for the Health Sector to the patients.
which highlights the commitments of the
health ministry to its clients.
There is a draft e-health policy and
strategic plan in place awaiting technical
assistance from the Commonwealth
Secretariat.
The
EAC
Medicines
Registration
Regulatory Harmonization project was
drafted with strong participation of
Uganda.
MoH together with Health Consumer
Organizations developed the Patients’
Charter which was launched in November
2010 and has been disseminated to all
districts of the country.
The DHIS 2 has been adopted by all
stakeholders in the health sector
The EAC Secretariat is strengthening the
East
African
Integrated
Disease
Surveillance Network (EADSNET) in order
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EAC partner states to promote multi x
sectoral collaboration in the
implementation of social and
reproductive health and rights
projects and programmes at both
national and regional levels in order
to enhance the reduction of x
maternal, neonatal and infant
mortality rates.
EAC partner states to integrate the x
regulation
and
practice
of
traditional, herbal, Complementary
and alternative medicine under the
national ministries responsible for x
health.
EAC Sectoral council of Ministers of x
Health to fast-track the EAC Regional
Study
on
Harmonization
of
‘’National Social Health Insurance
System’’ and to include the Terms of
Reference on recommendations and
mechanisms for the establishment
of ‘’Community Based Social Health
Insurance Schemes’’ at national
level, where feasible.
to enhance timely communication and
sharing of information on disease
outbreaks.
Following the assessment of the status of
MDGs, a multi sectoral framework was
developed to address bottlenecks in the
attainment of MDG 4 & 5 on Child and
Maternal Health, respectively.
Developed and reviewed the cost of the
operational plan on the roadmap to
accelerate reduction of maternal and
neonatal morbidity and mortality.
Government approved the principles for
enacting indigenous and complementary
medicine practice bill/act.
The Public Private Partnership for Health
(PPPH) policy was finalized and is in
cabinet for approval.
The NHIS act is undergoing stakeholder
consultations.
EAST, CENTRAL AND SOUTHERN AFRICA-HEALTH COMMUNITY (ECSA-HC)
The MOH participated in the ECSA-HC 52nd Health Ministers Conference which was held on 25th29th October, 2010 in Harare Zimbabwe under the theme Moving from knowledge to Action:
Harnessing Evidence to Transform Healthcare. Resolutions were made on Evidence based policy
making, Universal Health Coverage, MCH/RH/Family Planning (FP), Gender Based Violence
(GBV) and Child Sexual Abuse; HRH Leadership and Management for Quality Health Services,
Prioritizing Nutrition interventions, Strengthening Monitoring and Evaluation systems,
Strengthening response to MDR and XDR and Strengthening Partnerships for Health.
The MOH has responded to the different thematic areas of the resolutions. For instance the
health sector follows the use of evidence for policy formulation and decision making; in
addition the Uganda National Health Research Organization (UNHRO) has been established to
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
39
coordinate all health related research and facilitate dissemination and use; a National Health
Insurance scheme to address the issue of universal Health coverage is undergoing stakeholders’
consultations. The ECSA regional policy on GBV and child sexual abuse is being adopted by the
country, a motivation and retention strategy to address HRH issues was developed and is
undergoing costing; Plan to develop a holistic communication strategy to address human
nutrition habits and life styles is underway, and a nutrition hand book for the general public and
VHTs has been developed. A Non Communicable Diseases (NCDs) survey is underway. A
comprehensive Monitoring and Evaluation framework has been finalized.
40
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2.2 Local Government Performance
2.2.1
District League Table Performance
The objective of the district league tables is to assess the performance of the district given its
available resources. Eleven indicators were selected to evaluate and rank district performance:
8 coverage and quality of care indicators, given a collective weight of 75%; and 4 management
indicators, accounting for the remaining 25%. The indicators were selected for consistency with
the 26 core HSSIP 2010/11 – 2014/15 indicators, reliability of the data source, and frequency of
data collection. Routine HMIS data from the Resource Centre were the primary data source for
a majority of the indicators (Pentavalent Vaccine 3rd Dose coverage, institutional deliveries,
outpatient visits, Sulfadoxine / Pyrimethamine (SP) 2nd dose for IPT, 4th ANC visits, HMIS
timeliness and completeness of reporting, and District Health Management Team (DHMT)
meetings held); some of the indicator data were provided by MoH programmes such as
HIV/AIDS, TB, human resources and environmental health.
There were a number of issues pertaining to quality of the final data set, such as missing data,
outliers, and inconsistencies between monthly reports and end-of-year totals for HMIS data.
Despite efforts by the Resource Centre to follow up with districts, there were four districts that
failed to submit an annual report to the national level. These districts were given a score of zero
for some of the coverage indicators that were computed based on numbers from the annual
report. A few districts showed an uncommonly large discrepancy between the monthly reports
submitted by the district and the end-of-year total reported in the district annual report. These
were flagged and targeted for follow-up. One district, Alebtong, was removed from the league
table ranking due to large inconsistencies in the data over multiple indicators. Finally, district
population projections for 2011 provided by UBOS may contain inaccuracies as they are based
on 2002 census data. These issues are addressed in greater detail in the Data Quality Annex.
Due to the different set of indicators used to assess district performance and the addition of 32
new districts, a direct comparison cannot be made with the rankings in district league tables
from previous years. The actual rankings have to be interpreted with caution. Not only can the
quality of reporting be variable and cause errors in the performance rankings, also the
population denominators can be a source of error. First, they are based on a national average
growth rate projection of the 2002 census and some districts have had markedly different
growth rates. Second, clients do not stick to district boundaries and may seek services in other
districts which then get higher coverage and better rankings. However, Kampala remains the
top ranking district this year, and Kaabong remains among the bottom 10 districts. Table 22
shows the top and bottom 15 performing districts with their ranks and total scores. The full
district league tables can be seen in the Annex. The national average score was 58.4.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
41
Table 24: Top 15 performing districts
Total
District
Score
KAMPALA
77.5
BUSHENYI
74.2
KABAROLE
73.1
MBARARA
70.3
GULU
69.0
BUTALEJA
68.0
LYANTONDE
67.7
BULIISA
67.0
JINJA
66.7
KATAKWI
66.4
ABIM
66.4
RUKUNGIRI
65.8
MUKONO
65.3
KABERAMAIDO
65.2
SIRONKO
65.1
Table 25: Bottom 15 performing districts
Total
District
Score
ADJUMANI
42.7
LWENGO
41.8
LUUKA
41.6
NAPAK
41.6
GOMBA
41.2
MOYO
40.7
KOLE
40.4
BUHWEJU
40.1
NAMAYINGO
39.7
KAABONG
37.0
SERERE
30.1
AMUDAT
23.2
NTOROKO
22.9
KWEEN
17.8
BULAMBULI
17.8
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Rank
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
The 32 new districts showed lower performance compared to existing districts (see Table 24),
with Kyegegwa being the highest scoring new district ranked at 48th (out of 111). All new
districts scored lower than the national average. New districts tended to have less reliable
reporting and lost many points due to incomplete and missing reports. Four of the bottom five
performing districts failed to submit an annual district report, and thus could not be assigned
scores for some of the core coverage indicators such as Pentavalent 3rd dose coverage and
institutional deliveries. In addition, new districts were much more likely to have missing data on
HIV testing of infants, DHMT meetings and timeliness of medicine orders.
Table 26: District ranking gfor the top new districts
Total
District
Score
KYEGEGWA
56.2
BUTAMBALA
55.8
NWOYA
55.2
BUYENDE
54.8
ZOMBO
54.8
AGAGO
54.2
KALUNGU
53.8
RUBIRIZI
53.7
SHEEMA
52.5
KIBUKU
51.5
NGORA
50.8
BUVUMA
50.7
BUKOMANSIMBI 50.2
LAMWO
47.7
BUIKWE
46.2
KYANKWANZI
46.1
42
Rank
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
National
Rank
48
51
53
54
55
57
60
61
68
70
76
77
78
87
90
91
Table 27: District ranking for bottom new districts
Total
District
Score
OTUKE
45.8
MITOOMA
44.7
KIRYANDONGO 42.9
LWENGO
41.8
LUUKA
41.6
NAPAK
41.6
GOMBA
41.2
KOLE
40.4
BUHWEJU
40.1
NAMAYINGO
39.7
SERERE
30.1
AMUDAT
23.2
NTOROKO
22.9
KWEEN
17.8
BULAMBULI
17.8
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Rank
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
National
Rank
92
94
96
98
99
100
101
103
104
105
107
108
109
110
111
Districts with RRHs were generally found to have a higher score than those that did not (see
Table 26). Large facilities and hospitals can attract clients from neighbouring districts,
confounding district coverage estimates. This is particularly true for more specialized services
such as HIV testing of infants born to women with HIV. Of the 14 districts with regional/national
referral hospitals, five were ranked in the top 10 highest scoring districts: Kampala, Kabarole,
Mbarara, Gulu, and Jinja.
Table 28: District ranking for districts with regional/national referral hospitals
Total
District
Score
KAMPALA 77.5
KABAROLE 73.1
MBARARA 70.3
GULU
69.0
JINJA
66.7
MBALE
64.4
LIRA
64.2
MASAKA
63.0
KABALE
59.9
SOROTI
53.7
ARUA
52.7
HOIMA
48.9
MUBENDE 47.1
MOROTO 43.0
National
Rank Rank
1
1
2
3
3
4
4
5
5
9
6
16
7
17
8
21
9
33
10
62
11
66
12
84
13
88
14
95
Below
national
average
of 58.4
Three-quarters of hard-to-reach districts scored below the national average (see Table 27). This
indicates that being hard-to-reach could have an impact on district performance. Nonetheless,
four hard-to-reach districts ranked among the top 20 highest scoring districts: Gulu, Abim,
Mukono, and Kisoro. Eleven of the 25 hard-to-reach districts are also Peace Recovery and
Development Plan (PRDP) districts. Approximately half of PRDP districts score above the
national average (see Table 28), indicating that the PRDP infrastructure development funds may
be aiding in increasing scores for these districts.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
43
Table 29: District ranking for hard-to-reach Table 30: District ranking for Peace Recovery and
districts
Development Plan (PRDP) districts
Total
National
Total
National
District
Score Rank Rank
District
Score Rank Rank
GULU
69.0
1
5
GULU
69.0
1
5
ABIM
66.4
2
11
BULIISA
67.0
2
8
MUKONO
65.3
3
13
KATAKWI
66.4
3
10
KISORO
63.9
4
19
ABIM
66.4
4
11
BUKWO
58.9
5
37
KABERAMAIDO 65.2
5
14
KANUNGU
58.8
6
38
SIRONKO
65.1
6
15
Below
AMURU
57.6
7
42
MBALE
64.4
7
16
national
KITGUM
57.2
8
44
LIRA
64.2
8
17
average KAPCHORWA
MAYUGE
56.1
9
49
63.6
9
20
of 58.4 NEBBI
NWOYA
55.2
10
53
62.6
10
23
AGAGO
54.2
11
57
KUMI
61.8
11
25
PADER
53.8
12
59
PALLISA
61.5
12
26
BUNDIBUGYO 52.7
13
67
BUDAKA
61.3
13
27
KALANGALA
51.5
14
72
BUKWO
58.9
14
37
BUVUMA
50.7
15
77
DOKOLO
58.3
15
40
Below
KOTIDO
49.5
16
80
AMURU
57.6
16
42
national
NAKAPIRIPIRIT 49.1
17
82
KITGUM
57.2
17
44
average
of 58.4
LAMWO
47.7
18
87
OYAM
56.5
18
46
MOROTO
43.0
19
95
BUKEDEA
56.0
19
50
ADJUMANI
42.7
20
97
APAC
55.3
20
52
NAPAK
41.6
21
100
MASINDI
54.4
21
56
NAMAYINGO
39.7
22
105
PADER
53.8
22
59
KAABONG
37.0
23
106
SOROTI
53.7
23
62
AMUDAT
23.2
24
108
ARUA
52.7
24
66
NTOROKO
22.9
25
109
KOTIDO
49.5
25
80
KOBOKO
49.4
26
81
NAKAPIRIPIRIT 49.1
27
82
YUMBE
47.9
28
86
MOROTO
43.0
29
95
ADJUMANI
42.7
30
97
MOYO
40.7
31
102
KAABONG
37.0
32
106
The lowest scoring districts tended to have a small population (below 200,000), and the highest
scoring district Kampala also had the largest population. Beyond this, however, there did not
appear to be a strong relationship between the total score and the population size of the
district.
Smaller districts may have lower rankings because the people seek services outside of the
district.
44
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Figure 8: District population vs. total score
Table 31: District ranking by district population
Population under 100,000
District
LYANTONDE
BULIISA
ABIM
BUKWO
BUTAMBALA
NWOYA
KALANGALA
BUVUMA
OTUKE
BUHWEJU
NTOROKO
KWEEN
Total
Score
67.7
67.0
66.4
58.9
55.8
55.2
51.5
50.7
45.8
40.1
22.9
17.8
National
Rank Rank
1
7
2
8
3
11
4
37
5
51
6
53
7
72
8
77
9
92
10
104
11
109
12
110
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45
Population from 100,000 to 250,000
Population from 250,000 to 500,000
Total
District
Score
BUSHENYI
74.2
BUTALEJA
68.0
KATAKWI
66.4
KABERAMAIDO
65.2
SIRONKO
65.1
KISORO
63.9
KAPCHORWA
63.6
MASAKA
63.0
BUDUDA
62.7
MPIGI
62.1
KUMI
61.8
BUDAKA
61.3
NAMUTUMBA
59.4
KANUNGU
58.8
DOKOLO
58.3
AMURU
57.6
NAKASONGOLA
57.0
NAKASEKE
56.2
KYEGEGWA
56.2
BUKEDEA
56.0
BUYENDE
54.8
ZOMBO
54.8
IBANDA
54.2
PADER
53.8
KALUNGU
53.8
RUBIRIZI
53.7
BUNDIBUGYO
52.7
SHEEMA
52.5
MARACHA
52.2
KIBUKU
51.5
SEMBABULE
51.5
KIBOGA
51.5
AMOLATAR
51.3
NGORA
50.8
BUKOMANSIMBI 50.2
KOTIDO
49.5
KOBOKO
49.4
NAKAPIRIPIRIT
49.1
KALIRO
48.0
LAMWO
47.7
KYANKWANZI
46.1
MITOOMA
44.7
MOROTO
43.0
LUUKA
41.6
NAPAK
41.6
GOMBA
41.2
KOLE
40.4
NAMAYINGO
39.7
SERERE
30.1
AMUDAT
23.2
BULAMBULI
17.8
Total
District
Score
KABAROLE
73.1
MBARARA
70.3
GULU
69.0
JINJA
66.7
RUKUNGIRI
65.8
MBALE
64.4
LIRA
64.2
RAKAI
64.0
NEBBI
62.6
PALLISA
61.5
KAMWENGE
61.2
KAMULI
60.9
TORORO
60.9
ISINGIRO
60.2
IGANGA
59.9
KABALE
59.9
NTUNGAMO
59.4
MANAFWA
59.1
MITYANA
58.8
KAYUNGA
58.3
KITGUM
57.2
OYAM
56.5
MAYUGE
56.1
APAC
55.3
MASINDI
54.4
AGAGO
54.2
SOROTI
53.7
KYENJOJO
53.2
BUGIRI
52.8
LUWERO
49.6
KIRUHURA
48.9
HOIMA
48.9
YUMBE
47.9
AMURIA
47.0
BUIKWE
46.2
BUSIA
44.7
KIRYANDONGO 42.9
ADJUMANI
42.7
LWENGO
41.8
MOYO
40.7
KAABONG
37.0
Rank
1
2
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
National
Rank
2
6
10
14
15
19
20
21
22
24
25
27
34
38
40
42
45
47
48
50
54
55
58
59
60
61
67
68
69
70
71
73
74
76
78
80
81
82
85
87
91
94
95
99
100
101
103
105
107
108
111
National
Rank Rank
1
3
2
4
3
5
4
9
5
12
6
16
7
17
8
18
9
23
10
26
11
28
12
29
13
30
14
31
15
32
16
33
17
35
18
36
19
39
20
41
21
44
22
46
23
49
24
52
25
56
26
57
27
62
28
63
29
65
30
79
31
83
32
84
33
86
34
89
35
90
36
93
37
96
38
97
39
98
40
102
41
106
There appears to be a slightly positive relationship between district staffing levels (% of
approved posts that are filled) and the overall score. However this is partly to be expected as
staffing levels are one of the indicators included in the calculation of the overall score.
46
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Table 32: Staffing levels for top ten districts
District
KAMPALA
BUSHENYI
KABAROLE
MBARARA
GULU
BUTALEJA
LYANTONDE
BULIISA
JINJA
KATAKWI
Staffing National
level
Rank
123%
1
53%
2
79%
3
35%
4
73%
5
38%
6
38%
7
74%
8
57%
9
71%
10
Table 33: Staffing Levels for Bottom
ten districts
District
MOYO
KOLE
BUHWEJU
NAMAYINGO
KAABONG
SERERE
AMUDAT
NTOROKO
KWEEN
BULAMBULI
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Staffing National
level
Rank
51%
102
30%
103
25%
104
20%
105
42%
106
44%
107
33%
108
39%
109
64%
110
52%
111
47
2.3 Service Delivery
2.3.1
Hospital Performance
Essential Clinical Care is a key component of the UNMHCP. Hospitals are major contributors to
the outputs in essential clinical care and the community sees hospital functionality as a sign of a
working health system. Many problems of hospitals
Number
quickly come in to public knowledge and concern as has Hospital
been evidenced in recent press reports.
Public
66
According to the health facility inventory of January 2011
PNFP
61
there are 143 hospitals; the number of hospitals has been
increasing especially those belonging to the private PHP
16
sector. There is a very wide spread of hospital size and
143
out puts, and according to the minimum definition1 Total
criteria of hospitals according to the hospital policy many
hospitals especially private health practitioner hospitals do not satisfy the criteria of a hospital
but are nonetheless registered as hospitals. For example bed sizes vary from 18 to 355 for
general hospitals and from 120 to 482 for regional referral hospitals and large PNFP hospitals.
The assessment of hospitals within the annual health sector performance report is now in its
seventh year; there has been effort to analyze the functioning of hospitals. This analysis largely
looks at outputs of hospitals and relates inputs to outputs and outcomes. In order to have
uniform comparison of outputs of hospitals we will continue to use the Standard Unit of Output
(SUO).2 The SUO is a composite measure of outputs that allows for a fair comparison of
volumes of output of hospitals that have varying capacities in providing the different types of
patient care services. Basic efficiency indicators for resource use are generated and tables
comparing hospitals generated. Emphasis is on general and RRHs, however we recognize that a
suitable performance assessment for national referral hospitals is lacking and the current
assessment is not very appropriate for RRHs as well. There is need to develop a robust hospital
performance assessment methodology for all levels of hospitals and an accreditation scheme
that ensures basic standards and performance of a health unit that should be classified as a
hospital.
1
A hospital is defined as “A registered health care facility, public or private organisation, profit or not for profit,
devoted to providing curative, preventive, promotive and rehabilitative care, through outpatient, inpatient, and
community health services. It should have at least 60 beds, a high level of skilled medical personnel including
doctors, and be able to carry out major surgery and advanced investigative procedures including X-ray. It should
serve a population of at least 200,000 people”.
2
SUO stands for standard unit of output an output measure converting all outputs in to outpatient equivalents.
SUO total = 6(IP*15 + OP*1 + Del.*5 + Imm.*0.2 + ANC/MCH/FP*0.5) based on earlier work of cost comparisons.
48
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For the year 2010/2011, reports have been received from 85 general hospitals of which; only 78
had information that allows for fair analysis. The eleven RRHs and four large PNFP hospitals
(Nsambya, Rubaga, Mengo and Lacor) as previously will be analyzed in their own group. In this
group, 15 hospitals submitted data that would allow a fair analysis.
1.1.1
Regional Referral Hospitals
There are 13 RRHs in the country, but for the annual reporƟng exercise 4 large PNFP hospitals
(Nsambya, Rubaga, Mengo, and Lacor) with the scale and scope of RRHs are included in the group.
The full set should then be 17 hospitals. Reports were received from 15 out of the 17 hospitals
some of them incomplete.
a) Inputs
Finance
The total approved budget for RRHs was 50,152 Billion Shs. and actual release was 52,223
Billion Shs. The additional funding was mainly towards wage subvention. Overall budget
performance was 104%.
Table 34: Financial Performance for RRHs for FY 2010/11 (UGX Billions)
INSTITUTION
WAGE (,000,000)
NON WAGE
(,000,000)
DEVELOPMENT
(,000,000)
TOTAL (,000,000)
Performance
(%)
Approved Released Approved Released Approved Released Approved Released
Budget
Budget
Budget
Budget
Arua
Fort Portal
Gulu
Hoima
Jinja
Kabale
Masaka
Mbale
Soroti
Lira
Mbarara
Mubende
Moroto
Total
2.285
1.806
2.04
1.459
2.955
1.43
2.067
2.674
1.827
1.835
2.088
1.173
1.173
24.812
2.481
2.2
2.317
1.46
3.153
1.43
2.271
2.961
2.076
2.141
2.379
0.958
0.419
26.246
0.561
0.616
0.623
0.50
0.709
0.602
0.563
0.932
0.569
0.58
0.787
0.663
0.635
8.34
0.561
0.616
0.623
0.50
0.709
0.602
0.563
0.932
0.569
0.58
1.425
0.663
0.635
8.978
1.442
1.494
1.3
1.17
1.601
1.603
1.602
1.352
1.2
2.4
1
0.42
0.42
17.004
1.442
1.495
1.3
1.17
1.601
1.603
1.602
1.352
1.2
2.4
1
0.42
0.419
17.004
4.288
3.916
3.963
3.125
5.265
3.635
4.232
4.958
3.596
4.815
3.875
2.256
2.228
50.152
4.484
4.311
4.24
3.125
5.463
3.635
4.436
5.245
3.845
5.121
4.804
2.041
1.473
52.223
104.57
110.09
106.99
100.00
103.76
100.00
104.82
105.79
106.92
106.36
123.97
90.47
66.11
104%
The total number of staff in the 13 hospitals that provided the information is 3,859, on average
the number of staff per hospital is 297 (243 for RRHs only) but with a wide range from 117 to
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
49
555. Among the RRHs an analysis of positions filled against establishment was made. Table 33
shows variation among different cadres. Clearly, medical doctors and pharmacy staff are in
most shortage. Among hospitals the newly elevated hospitals – Moroto and Mubende are
worst affected with filled positions of 45% and 50% respectively as seen in Figure 9.
Table 35: Positions filled in Regional Referral Hospitals
Medical
Doctors
Nursing
Clinical
Officers
Pharmacy
Dispensers
Laboratory
Anaesthesia
All Medical
staff
Average
positions filled
44%
88%
77%
40%
49%
68%
68%
76%
Minimum
positions filled
13%
56%
41%
0%
20%
42%
31%
45%
Maximum
positions filled
72%
161%
125%
100%
120%
116%
140%
120%
Source: Hospital submissions for AHSPR 2010/11
Figure 9: Filled staff positions in RRHs
RRH
All Medical
Staff Filled
Positions
RRH
All Medical
Staff
Filled %120 %
140%
120%
120% 88%
120% 83%
80% 86% 83% 71% 76%
77%
100% 88%
140%
86% 83% 71%
83% 77% 70%
80%
76%
120%
80%
57%
70%
100%
50%57%
50%
45%
60%
80%
45%
60%
40%
40%
20%
20%
0%
0%
Positions %
b) Outputs
The outputs of the 11 regional RRHs and 4 large PNFP hospitals have been analyzed here below.
The 15 hospitals attended to 313,021 inpatients, 1,633,149 outpatients and 77,158 deliveries
among other outputs. On average each hospital attends to 20,868 inpatients, 108,877
outpatients. St. Mary Lacor hospital a large PNFP hospital has the highest SUO among the RRHs
and large PNFP hospitals. Masaka and Mbarara RRH data was not available for analysis. The
average SUO per staff for all hospitals combined was 1802. Soroti RRH and Kabale RRH had the
highest (2,280 and 2,112 respectively), while Gulu and Mengo RRH had the lowest (977 and 774
respectively).
50
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Major Operations
(N = 15)
Patient Days (N =
15)
435,007
46,406
4,738
313,021
1,458,422
42,114
6,254,510
108,877
9,283
5,144
29,000
3,094
316
20,868
97,228
2,808
416,967
Min
36,748
1,806
462
6,129
71
120
9,110
42,185
78
216,630
Max
206,090
23,064
7,885
93,771
9,810
482
60,145
168,493
10,572
574,841
Average
SUO (N = 15)
77,158
Admissions (N =
15)
Beds (N = 15)
139,244
Total
ANC (N = 15)
1,633,149
Hospital Name
FP visits (N = 14)
Immunizations (N
= 15)
Deliveries (N = 15)
OPD attendances
(N = 15)
Table 36: Overall performance for Regional Referral and Large PNFP Hospitals
NB: Catholic-faith based institutions do not provide conventional FP methods.
A comparison of volume of outputs based on the SUO has been made and is shown in figure 10.
Figure 10: Volume of Outputs Regional Referral and Large PNFP hospitals
600000
500000
SUO
400000
300000
200000
100000
St. Mary Lacor
Arua
Jinja
Rubaga
Nsambya
Fort Portal
Kabale
Soroti
Average
Lira
Mbale
Gulu
Mengo
Hoima
Mubende
Moroto
Mbarara
Masaka
0
a) Quality assessment
There was not sufficient information to make a more elaborate assessment of quality of care.
Hospital based deaths especially maternal deaths are an indicator of quality of care. The total
maternal deaths reported in 14 RRHs and large PNFP hospitals was 479 giving a mean death of
34 mothers per hospital per year with a minimum of zero (Moroto) and maximum of 183
(Hoima). Hoima certainly looks an outlier an audit to verify the truth of the data and/or the
causes of such a high number of maternal deaths are necessary. If correct, this would mean an
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
51
unlikely high MMR. The maternal mortality reporting system needs to be improved urgently.
Overall, hospital case fatality rate was 4.1% (deaths over admissions), with one outlier: Rubaga
hospital has 17.9% case fatality.
b) Efficiency of use of services
Regarding the scale of operation the mean hospital in this group is 316 beds, admits 20,868
patients and has a staff of 297. Generally the RRHs and the PNFP hospitals analyzed have a high
rate of utilization – Average bed occupancy is 86% compared to last year (2009/10) when it was
93%. Staff productivity is 1,534 SUO/Staff less than that for GHs (1,577). This is due to a more
complex case mix and higher skill mix of staff in RRHs compared to the GHs. The average length
of stay of 5.0 is the same as in GHs.
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53
Fort Portal
2,178
351
23,028
130,513
2,486
478,096
6,736
362
20,814
109,060
1,738
568,558
Admissions
Patient Days
Major
Operations
350,783
1,067
80,433
15,896
359
334,916
1,976
78,329
14,415
244
2,270
93,771
3,687
6,478
77,128
Hoima
Source: Hospital submissions for AHSPR 2010/11
SUO
Beds
FP Visits
2,196
44,939
9,405
Immunization
43,413
6,429
77,128
4,383
6,413
92,974
Gulu
6,705
5,335
23,064
ANC
Deliveries
206,090
Arua
OPD
Jinja
547,058
2,405
119,051
25,456
432
5,803
10,009
6,009
7,547
126,496
Lira
368,638
10,572
112,971
14,941
340
2,863
16,783
4,548
7,804
113,093
355,234
3,508
150,128
60,145
460
6,733
13,249
7,885
5,876
107,250
Mbale
Table 37: Key Hospital Outputs in RRHs and Large PNFP Hospitals
Moroto
193,149
78
42,185
9,338
150
631
6,129
462
1,806
48,325
Mubende
216,630
1,150
57,777
9,110
120
1,382
9,873
2,755
7,081
59,999
Kabale
475,246
3,275
97,881
18,504
280
9,810
14,376
5,754
10,206
156,033
Nsambya
490,419
3,101
80,915
17,567
319
71
48,074
7,621
15,642
171,488
St. Mary Lacor
574,841
3,455
168,493
26,396
482
-
23,240
3,564
6,933
152,966
Mengo
336,684
2,943
69,966
16,844
301
1,318
41,976
6,130
15,144
36,748
Rubaga
508,289
2,279
62,959
18,839
271
969
44,799
7,669
14,300
107,765
Soroti
455,969
2,081
97,761
21,728
267
3,446
14,971
4,651
4,821
99,666
6,254,510
42,114
1,458,422
313,021
4,738
46,406
435,007
77,158
139,544
1,633,149
Total
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773
130,513
5.7
102%
2,486
478,096
855
109,060
5.2
83%
1,738
568,558
Deaths
Patient
Days
Average
Length of
Stay
Bed
Occupancy
Rate
Major
Operations
Gulu
977
350,783
1,067
61%
5.1
80,433
424
15,896
359
359
244
184
1,820
334,916
1,976
88%
5.4
78,329
535
14,415
Hoima
Source: Hospital submissions for AHSPR 2010/11
SUO / Staff
SUO
1,799
23,028
Admissions
Beds
20,814
Arua
351
316
Fort Portal
362
Staffing
Positions
by Hospital
Jinja
1,392
547,058
2,405
76%
4.7
119,051
1,165
25,456
432
393
Lira
1,423
368,638
10,572
91%
7.6
112,971
726
14,941
340
259
1,211
60,145
460
1,057,804
3,508
89%
2.5
150,128
Mbale
1,400
193,149
78
77%
4.5
42,185
136
9,338
150
138
Table 38: Selected Efficiency Parameters RRHs and Large PNFP hospitals 2010/11
Moroto
54
Mubende
1,852
216,630
1,150
132%
6.3
57,777
427
9,110
120
117
Kabale
2,112
475,246
3,275
96%
5.3
97,881
627
18,504
280
225
Nsambya
1,790
490,419
3,101
69%
4.6
80,915
520
17,567
319
274
St. Mary Lacor
1,036
574,841
3,455
96%
6.4
168,493
1,086
26,396
482
555
Mengo
742
336,684
2,943
64%
4.2
69,966
176
16,844
301
454
Rubaga
1,320
508,289
2,279
64%
3.3
62,959
3,372
18,839
271
385
Soroti
2,280
455,969
2,081
100%
4.5
97,761
668
21,728
267
200
4,738
3,859
1,534
6,957,080
42,114
86%
5.0
1,458,422
12,701
313,021
Total
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55
316
120
482
117
555
Min
Max
Staffing Positions
by Hospital (n= 13)
297
Beds (N = 15)
Average
Admissions(N = 15)
60,145
9,110
20,868
Deaths (N = 15)
3,372
136
847
168,493
42,185
97,228
Patient Days
Table 39: Summary of Efficiency Parameters RRHs and Large PNFP hospitals 2010/11
7.6
2.5
5.0
Bed
Occupancy
Rate (N = 15)
132%
61%
86%
Major Operations
(N = 15)
10,572
78
2,808
SUO (N = 15)
1,057,804
193,149
409,240
2,280
742
1,534
SUO/Staff (N = 13)
Average Length Of
Stay (N = 15)
2.3.3
General Hospitals
a) Inputs
Finance
Government release to GHs during 2010/11 FY was 5,997,141,000 Ug. Sh. vs a budget of
6,107,088,000. This total to 98% of the budget estimate.
Human Resource
There is a very wide range of staff numbers in hospitals. According to the new staffing norms a
standard public GH should have 190 staff. PNFP and private hospitals with varying bed
capacities and workloads reported varying staff sizes and compositions. The staff numbers in
GHs ranged from 7 to 318 with an average of 116 staff per hospital. Human resource shortage
in hospitals remains a major challenge to service delivery. . In a sample of 26 public general
hospitals, the proportion of positions filled ranged/varied from 14 - 79% with a mean of 55%.
Outputs
As in the previous years, 5 main outputs have been used as indicators for volume of activity by
the hospitals, these are: Admissions, Outpatient visits, Deliveries, ANC and immunization.
Table 40: Outputs from the General Hospitals FY 2010/11
Number
reporting
Minimum
Maximum
Average
2010/11
Average
2009/10
Average
2008/09
Average
2007/08
9,801
74
18
355
132
142
123
130
546,540
74
398
19,201
7,386
8,472
7,271
3,194
Inpatient days
2,453,304
73
1,106
120,846
33,607
38,722
Out patients
3,495,844
76
1,891
581,154
45,998
42,455
32,197
33,185
108,046
70
43
4,808
1,544
1,419
1,389
1,465
44,518
73
1,873
610
561
555
617
245,268
78
15,542
3,144
3,568
12,197
14,329
24,543
73
1,307
336
299
1,063
911
636,066
75
1,043
35,771
8,481
8,730
13,009
13,323
12,526,623
78
1,504
581,764
160,598
178,777
439,848
453,348
Total
Beds
In patients
Deliveries
Major operations
ANC
Cesarean Section
Immunization
SUO
Source: Hospital submissions for AHSPR 2010/11. Note that figures for previous years are from Resource
Centre
56
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Hospital output indicators have been summed up in composite units – the SUO. With this
measure we can compare the volume of output or activity basing derived from the 5 main
indicators. The top ten hospitals with the highest outputs are: Iganga, Mityana, Bududa,
Busolwe, Tororo, Bwera, Kitgum St. Joseph, St. Kizito Matany, Kamuli Mission and Ishaka.
From the information the average for three outputs are down compared to last year (2009/10),
these are: inpatient, antenatal and immunization. While the outpatients, deliveries and major
operations, including cesarean sections have gone up. Decrease in admissions may be
attributable to stock outs and shortage of staff. Some hospitals notably Amudat and Gulu
Military Hospital were not able to do cesarean sections. By the time of writing this report
however, Amudat hospital started to do cesarean sections following efforts of Doctors with
Africa CUAMM and Italian Cooperation to train staff, rehabilitate the theatre and support the
hospital to recruit a Medical Officer. Notable is that 24% of all deliveries in the general hospitals
were done by Cesarean Section.
b) Efficiency of use of services
There isn’t a significant difference in efficiency indicators in the year 2010/11 compared to the
year before. There was a reduction in bed occupancy rate from 74% to 69%, on the contrary
there was an increase in SUO per staff in 2010, indicating activities other than the inpatient
have had a sizable increase. Again, it has not been possible to analyze efficiency for use of funds
because of lack of complete or reliable financial reports. In FY 2010/11, an average hospital
had the following indicators compared to the year before (in brackets): Average length of stay 5
(4.6) days; bed occupancy rate 69% (74%); one staff on average was producing 1,577. Although
some core activities like inpatient, ANC and immunization decreased, these were compensated
the increase in outpatient and deliveries, leading to a net increase in staff productivity overall
1,577 SUO/staff compared to 1,487 the year in 2009/10.
Table 41: Selected efficiency parameters for General Hospitals
Total
Min
Max
Average
2010/11
Average
2009/10
Staffing Positions by Hospital
(N = 71)
8,254
7
318
116
120
Total Number of Beds (N = 74)
9,801
18
355
132
142
546,540
398
19,201
7,386
8,472
355
2
34
5
4.6
Total
Min
Max
Average
2010/11
Average
2009/10
50%
16%
148%
69%
74%
111,976
213
8,876
1,577
1,487
Total Admissions (N = 74)
Average Length of Stay (N =
73)
Bed Occupancy Rate (N = 73)
SUO / Staff (N = 71)
Source: Hospital Submissions for AHSPR 2010/11
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
57
c) Quality of care
The information available could not allow an elaborate measurement and comparison of quality
of care among hospitals. Hospital based deaths especially maternal deaths are an indicator of
quality of care. The total maternal deaths reported in 70 general hospitals were 1,015 giving a
mean death of 14.5 mothers per hospital per year with a minimum of zero and maximum of
288. The top outliers need to be audited to verify the truth of the data and the causes of such a
high number of maternal deaths. These hospitals and the maternal deaths involved are: Amai
288, Kambuga 190, Nyapea 90, Iganga 43, Naggalama 30 and Mityana 23.
2.3.4
Functionality of HC IVs
A central feature of a health sub-district in Uganda is a health centre level IV, where there is no
hospital to serve a supervisor role. The key feature of the HSD Strategy was that each HSD of
approximately 100,000 people would have a Hospital or a Health Centre IV with the capacity to
provide basic promotive, preventive and curative services, including Emergency Surgical and
Obstetric Services and to supervise and support planning and implementation of services by the
lower health units in the zone. Extensive access to such services has been demonstrated to lead
to a big improvement in health status indicators even in poorer countries compared to the
much wealthier ones. Being a key strategy of the sector, the functionality of Health Centre IVs
has been reviewed every year in the last 5 AHSPRs.
a) Methodology
The District Annual Reports included information on HC IVs with input, management, output
and even outcome information. 88 HC IVs from 112 districts provided information of varying
degrees of completeness. Functionality was determined by outputs from selected components
of the minimum service standards i.e. Maternity (deliveries), Inpatient Blood Transfusion,
Theatre (caesarean section, Major and Minor surgery), HCT, PMTCT, ART, Long Term
Contraception and Outpatient services. This is similar to the analysis done in the previous
financial years.
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b) Level of HC IV Functionality
Data for 11 of the 12 functionality indicators was available. There was no data for long term FP
methods. Based on the 11 indicators 18 HC IVs scored 100%.
Table 42: HC IVs with 11 of the 11 functionality indicators
Number
HC IV
DISTRICT
1.
NAMAYUMBA
WAKISO
2.
BUKASA
KALANGALA
3.
KALANGALA
KALANGALA
4.
BUFUMBO
MBALE
5.
MWERA
MITYANA
6.
KYABUGIMBI
BUSHENYI
7.
SSEKANYONYI
MITYANA
8.
MUKONO.CO.U
MUKONO
9.
KIGOROBYA
HOIMA
10.
NABILATUK
NAKAPIRIPIRIT
11.
BUKWO
BUKWO
12.
MANJIYA
BUDUDA
13.
MPIGI
MPIGI
14.
KOTIDO
KOTIDO
15.
MIDIGO
YUMBE
16.
RUGAZI
RUBIRIZI
17.
KATAKWI
KATAKWI
18.
KIWANGALA
LWENGO
Outpatient, HIV Counseling and testing were available in all the HC IVs that submitted
information on the services available. Key primary reasons for establishing HC IV were to
provide cesarean section and blood transfusion; despite these being cardinal services in the
definition of a functional HC IV they are available in only 24% and 26% of the HC IVs
respectively. The trend in the last 3 years however is upward for each of these cardinal services
as shown in the figure 11.
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59
Figure 11: Trends in Caesarean Section and Blood transfusion
30%
Trend in Caesarean Section and Blood Transfusion in
HC IV
28%
25%
% providing
20%
15%
24%
23%
19%
17%
14%
26%
24%
19%
15%
10%
Caesarea…
5%
0%
2006/07
2007/08
2008/09
2009/10
2010/11
For outpatient, inpatient, deliveries and ART services, the average outputs from each HC IV
were 21,028; 1,864; 1,996 and 292 respectively. Note that the number of units reporting for
2010/11 was considerably smaller than in previous years. Compared to 2009/10 many service
utilization indicators went down in 2010/11 except, deliveries, HIV counseling and testing,
PMTCT and Dental service utilization. Table 42 shows these comparisons.
Table 43: Provision of selected key health services by HC IVS
2010/11
# offering
services
2009/10
2008/09
2007/08
Average
Outputs
10/11
% of
reports
#
offering
services
Average
Outputs
09/10
% of
reports
#
offering
services
Average
Outputs
08/09
% of
reports
#
offering
services
% of
reports
OPD
52
21,028
100%
117
28,833
98%
134
28,438
100%
93
100%
Deliveries
80
1,996
92%
115
557
97%
114
566
85%
86
92%
HCT
45
4,156
100%
110
3,434
92%
116
2,746
87%
81
87%
PMTCT
77
1,092
100%
112
908
94%
116
1,068
87%
85
91%
Dental
41
1,007
82%
86
18
72%
87
887
65%
66
71%
IPD
76
2,077
99%
80
2,894
67%
90
3,194
67%
65
70%
ART
40
292
83%
94
635
79%
96
214
72%
70
75%
Minor
Operations
49
282
64%
74
384
62%
68
429
51%
58
62%
60
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
2010/11
# offering
services
2009/10
Average
Outputs
10/11
% of
reports
LTFP
2008/09
2007/08
#
offering
services
Average
Outputs
09/10
% of
reports
#
offering
services
Average
Outputs
08/09
% of
reports
#
offering
services
% of
reports
57
98
48%
63
105
47%
38
41%
Major
Surgery
19
27
26%
40
71
34%
20
54
15%
28
30%
C/S
18
13
24%
27
28
23%
20
44
15%
26
28%
Blood
Transfusion
19
37
26%
28
207
24%
25
150
19%
16
17%
111
-
93%
134
-
100%
93
92%
Laboratory
-
Since the main objective of setting up HC IVs was to provide Comprehensive Emergency
Obstetric Care (CEmoC) – that is being able to provide intervention in case of complications
during delivery, which includes the ability to provide a Caesarean Section and Blood
Transfusion, HC IVs have been judged “functional” if they have been able to carry out at least
one Caesarean Section. Using these criteria, 24% of the HC IVs were ‘functional’ in 2010/11 – an
increase from 23% found in 2009/10.
c) Factors affecting HC IV Functionality
Just like the previous 3 FYs, there are a number of key issues that are associated with HC IV
functionality. These include: presence of appropriate infrastructure and equipment; presence
of qualified health workers especially medical officers; and LG management capacity and
interest in HC IV functionality.
Infrastructure and Equipment
There was no sufficient information to analyze infrastructure and equipment components of
functionality of HC IVs.
Service performance and outcomes
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
61
Service performance and outcomes
The bed occupancy rate in 2010/11 declined compared to the year before – down from 43% to
38%, in addition there was a reduction in average length of stay form 3 days in 2009/10 to 2.3
days. There was an average of 1,864 admissions in 2010/11. The death rate remained the same
as the year before, 0.7%.
d) Recommendations
The HC IVs are a key mechanism for increasing access to referral facility services and ensuring
that the lower units in the health sub-district do perform to their expectation as such HC IVs
greatly contribute to universal access to the UNMHCP elements that will directly impact health
outcomes. In the year 24% of the HC IVs can be considered ‘functional’. The sector needs to
devise mechanisms for ensuring that adequate resources and improvements in management
capacity are directed towards HC IVs if we are to achieve the maternal & child health MDGs.
i)
ii)
iii)
iv)
Efforts must be put in place to enable comprehensive assessment of HC IV functionality.
The year 2010/11 has had many gaps in information making it impossible to assess all
aspects of HC IV. All HC IVs should regularly submit their monthly and quarterly reports
to the districts and then to the Ministry of Health to ease the writing up of the annual
report.
There is need to increase resources for health centre IV particularly, drugs and supplies
and human resource since these are the key determinants of effective utilization of
services. Differential budgets based on the utilization volumes have to be adopted. The
budget for a HC IV fast becomes insufficient once the centre is fully functional.
Shortage of critical staff like medical officers, anesthetists, midwives continue to hinder
functionality of HC IVs, there is need to address motivational factors like staff housing
and other incentives to encourage staff to go and work in the HC IVs.
Health care quality indicators in line with those of hospitals need to be developed for
HC IVs.
2.4 Assessment of Village Health Team (VHT) Functionality
The VHT Strategy represents the commitment of Government of Uganda to promote Primary
Health Care in the communities in line with the 1978 WHO Alma Ata Declaration. VHTs are local
people who volunteer to serve their communities by carrying out a range of disease prevention
and health promotion activities.
As of June 2010, the number of districts that had fully implemented (to 100%) the VHT Strategy
stood at 51/93 (55%) districts. Additional thirty-nine districts were at different levels of
implementation of the VHT Strategy and 3 districts (Kibaale, Mubende and Sheema) had not
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started the implementation at all. During the year under review (2010/11), VHT Strategy was
established in 18 additional districts of: Lyantonde, Bullisa, Budaka, Namutumba, Moroto,
Kotido, Kaabong, Amudat, Nakapiripirit, Napak, Wakiso, Butambala, Gomba, Mpigi, Kalungu,
Masaka, Bukomansimbi and Lwengo. The country now has a total of 69/112 (62%) districts that
have fully implemented the VHT Strategy.
Functionality of the VHTs
Only districts with a proper register of trained VHTs, good coordination and monitoring
mechanism are able to state the number of active VHTs as well as those that had abandoned
the job. According to information available (2009/10 FY), only 30 districts had registers of
functional VHTs as defined by the numbers of VHTs who actively carry-out all, or part of their
roles and are regularly report on them to the nearest health facility. Estimates of VHT attrition
rates range from 0 - 50% with the lowest rates reported in districts that have regular refreshers,
supportive supervision, and provide incentives. Current information on functionality of VHTs is
expected to be routinely obtained through HMIS 2020 due to be rolled out in 2011/12 FY.
Challenges in VHT Strategy Implementation
Implementation of the VHT Strategy is costly and many districts may not be able to afford given
the present level of funding from government. Some districts have many partners supporting
VHTs while others have almost none, making it nearly impossible for them to start/expand VHT
implementation. There is therefore need to increase funding for VHT implementation.
Not all the districts have an up-to-date register of the VHTs trained and therefore cannot
precisely assess the proportion of the VHTs who are actively working or those who have fallen
out.
Printing of the different tools that the VHTs need to use requires huge sums of money which
has not been forthcoming. This particular challenge has direct implication to the functionality of
VHTs.
Experience gained from the implementation of the VHT strategy affirms that there are many
ways of motivating VHTs; monetary and non-monetary packages. However a unified approach
to motivation of VHTs has remained elusive and the investment in the same is minimal.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
63
Recommendations
The impact of VHTs could be more pronounced if activities were better planned and focused on
evidence-based interventions and epidemiological situation of each district. Effective
implementation of the VHT strategy requires a strong linkage with mentoring by the health
workers from the nearest health facilities.
Different partners need to support the VHT Strategy and not to set up parallel and conflicting
structures for short term interest. They should also support districts to motivate VHTs, using
appropriate methods.
2.5 Conclusion
Measured against the monitoring indicators, the health sector has performed considerably well
in view of the shortfalls in the required health system inputs which have remained static. Most
of the indicators showed an upward trend. This is particularly noted with proportion of health
facility deliveries, children under one year receiving 3rd dose pentavalent vaccine, percentage of
households with latrines, per capita OPD utilization and medicines availability. The most
notable shortcomings in health system inputs are chronic low under-funding to the sector
which affects the procurement of essential health commodities, timely implementation of
planned activities and maintenance of an effective work force.
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3 ANNEX
This section gives details of progress in implementation of priority activities under the;
1. Planned key outputs by vote function in the MPS 2010/11
2. Uganda National Minimum Health Care Package (UNMHCP)
3. Integrated Health Sector Support Systems
4. Monitoring and Evaluation of the HSSIP 2010/11 – 2014/15
3.1 Assessment of Performance against Planned Key Outputs in the MPS
2010/11
The planned key outputs and key achievements for FY 2010/11 are outlined under respective
vote functions in the tables below.
Ranking achievement
ч40% Red
>40% - 80% Yellow
>80% Green
1. Infrastructure Development
Planned Outputs
Key Achievements
Health Systems Development
i.
Theatre equipment installed in
10 HC IVs.
Rating
Equipment installed in 4/10
Comments
Late payment of GOU
contribution
Preinstall works done and
equipment shipped for 6/10
ii.
Office extension completed at
MoH headquarters.
iii.
Solar packages installed in
Adjumani, Moroto, Mubende,
Mityana, Kabale and Kibaale.
95% completed save for ground
floor burglar proofing & fixing
shelf shutters
Equipment installed in 4/6 while
contract for 2/6 signed in March
2011
60% completed in Rukungiri,
Kanungu, Luwero & Nakaseke.
Procurement delays
stalled progress.
Procurement delays
stalled progress.
Work completed in 4 (Kabale,
Mubende, Mityana &
Kibaale)out of 6 districts.
Commenced evaluation for
Units in Moyo, Buliisa, Gulu,
Pader, Soroti & Amolatar.
iv.
General rehabilitation carried
out in Yumbe hospital.
No work done
Procurement initiated but
not progressed.
v.
Medical wards constructed in
Rushere hospital
No work done
Procurement initiated but
not progressed.
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65
Planned Outputs
Key Achievements
Health Systems Development
vi.
Construction and equipping of
HC IVs in Kisozi and Buyiga.
No work done
vii.
Under the Health Systems
Strengthening Project
supported by the World Bank,
2 RRHs, 17 GHs and 27 HC IVs
rehabilitated. These include:
RRHs:- Mubende and Moroto.
General Hospitals:- Nakaseke,
Mityana, Itojo, Apac,
Kiryandongo, Masindi, Kitgum,
Anaka, Moyo, Nebbi, Kitgum,
Kawolo, Entebbe, Buwenge,
Bugiri, Iganga, Moyo, Nebbo,
Pallisa and Bukwo. HC IVs: Kasanda, Kiganda, Ngoma,
Mwera, Kyantingo, Kikamulo,
Kabuyanda and Mwizi.
80% revision of standard designs
for HC II – RRH progressing;
Rating
Comments
Procurement delays.
nd
Contracts signed on 2
June 2011.
Construction works
planned for second half
2011/12
Site surveys by Consultants at
beneficiary facilities completed; Tenders for procurement of
medical equipment submitted
to IDA as scheduled; Evaluation of bids for
procurement of vehicles
completed
Regional Referral Hospitals
i.
Finalise development plans for
RRHs
ii.
Functionalise Mubende and
Moroto hospitals as RRHs
iii.
Construction of residential
houses in 6 hospitals
¾ Gulu 80%
Information not available
Mubende and Moroto hospitals
functionalized as RRH
¾ Gulu stalled on ground
floor
Partial information
¾ Fort Portal at 60%
progress
iv.
Construction of roads and walk
ways in 9 hospitals
Information not available
v.
Construction of incinerators
and VIP latrines in 6 hospitals
Information not available
vi.
Completion of on-going
construction and rehabilitation
in 11 hospitals
vii.
Procurement of machinery,
equipment, furniture and
fixtures undertaken in 12
66
¾ Lira hospital on
schedule
Ultrasound units, Mobile X-ray,
Floroscopy unit, protective
screen, CR system supplied and
Information not available
Partial information
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Planned Outputs
Key Achievements
Health Systems Development
Comments
installed in Fort Portal, Lira,
Mubende and Hoima RRHs
hospitals
viii.
Rating
¾ Staff shuttle for Lira
Vehicles procured in 12
hospitals
Information not available
Activities under the Support to the Health Sector Strategic Project (SHSSP)
SHSSP is a five year project, worth 33million dollars commenced in FY 2007/08 and during the
Financial Year under review, the project was in its 4th year of implementation.
i.
Finalization of redevelopment
of Mbarara Referral Hospital
(phase 1)
By end of FY, Mbarara hospital
re-development which is
scheduled to be completed by 1
Nov. 2011 was about 78%
complete.
Work is progressing on
schedule.
ii.
Construction and rehabilitation
of 39 HCs in the 9 districts of
South
Western
Uganda
(Mbarara, Isingiro, Ibanda,
Kiruhura, Bushenyi, Rukungiri,
Kanungu,
Ntungamo
and
Kabale)
Completion
status
for
rehabilitation of the 39 HC by
the end of the FY was as follows:
The causes
included:
o
20 HC completed
handed over (51%);
o
11 HC were over 80%
complete (28%) and,
o
8 HC were between 60 –
80% complete (21%).
iii.
Completion of construction of
7 Mental Health Units at
Regional Referral Hospitals
delay
x
Delay in clearing
payment of VAT for
contractors had a
negative effect on
the progress of work.
x
Contractors’
weak
financial capacity
x
Bad sand from local
quarries leading to
re-doing
cracked
floors in 8 facilities;
x
Long
haulage
distances
of
materials
under
difficult
and
mountainous terrains
and
bad
road
network especially in
Kabale, Kanungu and
Rukungiri.
and
The 19 HC are therefore behind
schedule for reasons given in
the comments column. The
contract completion date for the
HCs is 1 October 2011.
of
Construction of the 7 mental
health units was completed and
commissioned during the FY and
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67
Planned Outputs
Key Achievements
Health Systems Development
Rating
Comments
all the units are in use (100%).
iv.
Equipment of all newly
constructed and rehabilitated
HCs
Medical
equipment
and
furniture for constructed /
rehabilitated
facilities
was
procured on schedule, delivered
and commissioned.
Where
the
HC
rehabilitation was not yet
complete,
the
HCs
however, were advised to
use the new equipment
in the old / existing HCs
as they await completion
of the rehabilitation
works.
v.
Train staff in RH and Mental
Health skills to improve their
capacities to manage common
conditions
All planned and on-going
programs training programs
funded by the Project (Inservices, Basic and Post
Graduate) were carried out as
planned
This was mainly possible
because
of
regular
releases of funds from
GOU
/
MOFPED
(counterpart funding) and
from the ADB.
There was varied performance in the various health infrastructure development projects.
Notably projects directly funded by GoU registered much slower progress than development
projects funded under SHSSPP and Uganda Health Systems Strengthening Project (UHSSP).
If better performance is to be registered in this and other areas in future, procurement
planning and delays experienced during the procurement processes need to be anticipated and
measures put in place to address them.
2. Health Care Service Delivery
Clinical and Public Health
i.
68
Planned Outputs
Achievements
Indoor residual spraying carried
out in 53 districts
IRS was done in 10 / 53 districts
in Northern Uganda (Apac,
Oyam, Kole, Pader, Agago,
Kitgum, Lamwo, Gulu, Amuru
and Nwoya) with good results.
Rating
Comments
A total of 869,861 /
899,716 (96.7%) houses
were sprayed with a
total population of
2,673,427 / 2,756,339
(97.0%)
being
protected.
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Planned Outputs
Achievements
Rating
Comments
ii.
Distribution of 10.39 million LLINs
Over 7.25 million LLINs were
procured through the Voluntary
Pooled Procurement (VPP)
mechanism of the Global Fund
and distributed to sub-county
level
Delayed reporting on
the phase 1 distribution
and irregular/prolonged
procurement
procedures.
iii.
The child survival strategy and
road map for reproductive and
maternal health rolled out to 40
districts.
Roadmap was rolled out to
20/40 districts.
Note that all districts
are implementing
activities that
contribute to the
targets specified in the
roadmap.
iv.
VHTs established in 40 additional
districts.
VHTs established in 18
additional districts.
Districts with 100%
coverage are 55 (49%).
Inadequate funding has
restricted establishing
new VHTs.
Inadequate funds to
scale up training of
VHTs
v.
The Kampala Declaration on
Sanitation scaled up in 40 districts.
Scaled up in 7/40 districts
Inadequate funds
vi.
The results of the NCD survey
disseminated at national and
district level.
Not done
No funds allocated
Performance against the key outputs under the for the Clinical and Public Health vote function
was overall below 80% with worst performance for IRS, scaling up of the KDS and NCD where
the survey has planned but not been conducted for 2 consecutive years now.
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69
Cancer Services – Uganda Cancer Institute
i.
Planned Outputs
Achievements
Rating
15,000 cancer patients treated
Effecting diagnosis of 31,566
Successful outreach
and supported
patients
Cancer awareness
programs boosted
patient numbers.
Effecting investigation of 31,566
patients and providing support
to 31,566 patients by year end
ii.
Completion of re-modeling cancer
administrative block and medical
ward
Comments
Completion of Cancer
ward in current FY.
On-going remodeling of Cancer
Administrative Block and
Medical Ward and New 6-level
Ward.
UCI was able to attend to more clients than planned however, was not able to complete remodeling of the administrative block and medical ward as planned.
Heart Services – Uganda Heart Institute
Planned Outputs
Achievements
Rating
Comments
i.
80 open heart, 100 closed heart
and thoracic surgeries, 10,000
echocardiograms, 10,000 ECGs, 50
stress tests and 80 endoscopy
exams performed.
30 (37.5%) open heart surgery,
163 (163%) closed heart
surgery, 5,800 (58%) ECHO,
5,075 (50%) ECGs, 25 (50%)
stress tests, 28 (35%)
endoscopies performed.
Higher utilization by
pediatric patients was
responsible for high
performance of the
closed heart surgery
and on the other hand
limited funding and
equipment breakdown
was responsible for
underperformance.
ii.
180 ICU/CCU patients admitted.
ICU 146, CCU 236
Need increase in
specialized staffs and
funding to cater for
high costs of
consumables.
Uganda Heart Institute performed fairly but limited by frequent breakdown of equipment and
lack of specialized staff compounded by inadequate funding for the high cost of consumables.
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Uganda Blood Transfusion Services
Planned Outputs
Achievements
Rating
Comments
i.
Collection, testing and distributing
200,000 units of blood
187,828 units of blood
collected;
ii.
6,000 blood collecting sessions
4,511 blood collection sessions
iii.
250,000 blood bags procured
150,000 procured
Stock outs experienced
due to inadequate
funding
iv.
Construction of blood banks in
Gulu and Fort Portal
Not done
Inadequate funding
v.
Quarterly support supervision
visits to Regional Blood Banks
4 supervision visits conducted to
the 7 Regional Blood Banks
There was no support
supervision due to lack
of funding.
vi.
Mobilization and recruitment of
new blood donor groups
Mobilization in schools and
community
High fuel costs leading
to scaling down of
activities; the prevailing
food crisis; the negative
publicity by the media
of the walk to donate
exercise.
National Referral Hospitals – Mulago and Butabika
Planned Outputs
Achievements
i.
Conduct 46 general outreaches
and attend to 2,400 patients
ii.
Conduct 51 forensic outreach
clinics
46 outreach clinics conducted,
2,396 patients attended to by
Butabika Hospital
Forensic outreaches conducted
629 patients were resettled to
their homes
iii.
Construction of 4 staff units
¾ staff units were constructed
iv.
Finalisation of the strategic and
development plan
Strategic and Development plan
for Mulago finalized
Rating
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Comments
Inadequate funding
71
3. Monitoring and Evaluation
Planned Outputs
Achievements
Rating
Comments
Sector Monitoring and Quality Assurance
i.
Quarterly sector performance
reviews
3 Quarterly Performance
reviews were held.
Quarter 1 and 2 reviews
held jointly (Mid-year
review) due to delayed
release of funds
ii.
Coordinate Senior Management
(SMC) Committee meetings
9/12 SMC meetings held
Observed improved
attendance of SMC
meetings
iii.
Quality assurance activities –
standards and guidelines
developed and disseminated
x
iv.
Support supervision visits to Local
Governments
v.
Inspection of health facilities
72
Among the policy issues
discussed and forwarded to
HPAC and Top management for
approval included; the JAF 4
targets and action points,
restructuring the basic package
TWG into separate 4 separate
TWGs to improve their
effectiveness, the revised HMIS
tools and the UNEPI annual
performance report that was
endorsed and forwarded to
GAVI secretariat.
Launched the Uganda
Clinical Guidelines (UCG)
2010; disseminated 9,000
copies to all 112 districts.
x Draft HSSIP 2010/11 -14/15
M&E Plan developed
x Draft Quality Improvement
Framework and Strategic
Plan developed.
4 Area Team visits conducted in
all 13 RRHs and the 112 Local
Governments.
Conducted in 59 districts as
planned.
Feedback to the district
leadership, MoH SMC,
th
HPAC and STM. 4
quarter visit funded by
the ICB project
Noted improvement in
duty attendance by
qualified staff
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4. Health Research
Planned Outputs
Achievements
i.
Uganda Demographic Health
Survey – 5 coordination
Coordination meetings
conducted
UDHS -5 data collection
started June 2011
ii.
Research in the areas of HIV,
malaria, plague, measles and
polio.
x
Report to be completed
2011/12.
iii.
UNHRO activities
Rating
National HIV Sero Survey in
progress. Data collection
completed.
x
Malaria program review
x
EPI Program review
Comments
No research agenda for
MoH
Three priority issues were
addressed:
x Access to skilled delivery
services by for pregnant
women.
x
Rational treatment of
malaria.
x
Task shifting to address
staffing challenges in the
sector.
5. Pharmaceutical and Other Supplies
i.
ii.
Planned Outputs
Achievements
Introduction of essential
medicines kit for HC IIs and IIIs.
Done
Implementation of the MOU for
planning and monitoring of
medicines procured and supplied
Rating
New Essential Medicines List of
Uganda, Laboratory List and
Supplies lists were developed
using a consultative process
MOU signed in April 2011
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Comments
Kit reviewed every six
months as agreed
initially.
Lists to be printed 1
quarter of the FY
2011/2012
st
There was delay in MoH
signing MoU.
Monitoring to begin in
Quarter 2 of 2011/12
73
Planned Outputs
Achievements
Rating
Comments
FY.
iii.
Monitoring of medicines and
health supplies
iv.
Mentoring of hospitals and health
facilities country wide on
quantification and ordering of
EMHS.
v.
Periodic review of the “Push
Policy” on distribution of EMHS.
x
Bi monthly stock status
reports made at national
level.
x Annual survey on the tracer
items conducted.
x Vendors for system
development have been
evaluated
442 facilities mentored and
supervised in the FY 2010/2011
Securing NMS
concurrence had to be
completed.
Review conducted for the
period Nov 2010 – April 2011.
Kit review includes a
detailed look at the
strengths and
challenges of the policy
which is implemented
through the kit
distribution mechanism
See (i) above.
Review report (May 2011)
available and shared.
There was delay in MoH
signing MoU with the
supporting partners.
Support received from
other Implementing
Partners e.g. over and
above GoU budget
vi.
Preparation of the Uganda Food
and Drug Administration Bill and
submission to Parliament.
Memo submitted to Cabinet in
the FY 2010/2011 which
referred it to the National
Planning Authority to coordinate
the various sector consultations
NPA report due to be
st
submitted to cabinet 1
quarter of FY
2011/2012
vii.
Medicines and health supplies
worth UGX 201.73bn procured
and distributed to the national
regional and district facilities.
Medicines and Health Supplies
worth 181.23 (89.8% of
projection) billion shillings
procured and distributed
A total of UGX 20.47
billion was not
disbursed/ released by
MoFPED.
viii.
Improve supply chain
management for essential
medicines, vaccines and other
health supplies.
NMS introduced the last mile
distribution to all health
facilities through third party
logistics distribution agencies.
Supplies getting to
health facilities faster
than before.
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6. Policy, Planning and Support Services
Planned Outputs
Achievements
i.
Finalization of the Second National
Health Policy
Completed and launched
ii.
Finalization of the HSSIP 2010/11 –
2014/15
Completed and operationalised
iii.
Produce Budget framework paper
2010/11
Completed
iv.
Produce the Ministerial Policy
Statement 2011/12
Completed
v.
Produce the audit and
accountability report
Audit reports submitted to PS
vi.
Produce the health sector
performance report 2009/10
Completed
vii.
Conduct efficiency studies
Data collection finalized
viii.
Review resource allocation criteria
Done
Review Social Health Insurance
Scheme.
Technical analyses of the
following were done;
ix.
•
•
•
•
x.
Policy consultation – 2 quarterly
Rating
Comments
The HSSIP M&E plan
has been finalized and
is due for launching at
the JRM Oct 2011.
Delayed accountability
by implementers
Benefit package,
Accreditation criteria,
Capacity needs,
Status and obstacles and
prospects of community
health insurance,
Reviewed 3 policy documents
(Malaria strategic plan, Mental
health policy & EPI program
review
Inadequate facilitation
Lengthy development
and review processes
xi.
Training in leadership and
management (UHSSP)
Curricula developed and Health
workers to train identified
Training to start
2011/12
xii.
Training in leadership and
Not done
Delays in project
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Planned Outputs
Achievements
Rating
management (ICBP)
Comments
implementation.
xiii.
Enhancing Public- Private
Partnership
PPPH Policy was endorsed by
TMC is lined up for
endorsement by Cabinet.
Process stalled now for
2 years
xiv.
Enhancing budget monitoring in
the sector
Done but not as planned
Inadequate funding
xv.
Inter-ministerial collaboration with
related sectors such as water and
sanitation
Cabinet memo has been drafted
to be submitted to the cabinet
secretariat.
Process required wide
consultation.
7. Human Resources for Health
During the HSSIP 2010/11 – 2014/15 the health sector is committed to attaining and
maintaining an adequately sized, equitably distributed, appropriately skilled, motivated and
productive workforce in partnership with the private sector, matched to the changing
population needs and demands, health care technology and financing.
i.
Planned Outputs
Achievements
Recruit 800 health workers
Recruited 1,006 health workers
13 Hospital Directors appointed
for RRHs
Rating
Comments
Inducted Hospital
Directors and Hospital
Administrators in all
RRHs
ii.
Carry out validation of health
workers in the newly upgraded
RRHs of Mubende and Moroto and
newly upgraded structures of UCI
and UHI.
Done
Some staff promoted.
iii.
Launching of the HSC regulations
for health workers.
Regulations made
Not launched due to
lack of functional HSC
iv.
Performance and career
enhancement training for
members and staff.
Had 3 day training. A number of
staff sponsored.
v.
Supervision of 50 districts and 6
RRHs.
25 districts and 4 RRHs
supervised
Monitoring visits
conducted to all PNFP
training institutions
(Nyakibale, Mutolere,
Kisiizi, Kagando, Ngora,
Kamuli, Nsambya,
Rubaga, Ishaka, Matanyi
and Kuluva)
vi.
Support District Service
Commissions.
Conducted 6 technical visits
Number determined by
demand from districts
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3.2 The Compact for implementation of the HSSIP 2010/11 – 2014/15
Table 44: Progress in implementation of the Country Compact 2010/11 – 2014/15 during 2010/11 FY
No
Indicator
Measurement
1.
i.
Ranking
Planning and Budgeting
MoH Annual Workplan
reflecting stakeholder
contribution (all
resources on plan)
Annual Workplan Analyzed
st
and Report submitted to 1
HPAC of FY
ii.
All new sector
investments are
appraised by SBWG
Reports from SWBG on
appraised Projects
submitted to HPAC
biannually
iii.
All planned
procurements
reflected in the
Comprehensive
Procurement Plan
Quarterly assessment of
implementation of
procurement plan to HPAC
iv.
Response to the
Auditor General’s
Report
Response to AG’s report
presented to HPAC
v.
Implementation of
Harmonized TA Plan
Progress towards
implementation of agreed
TA Plan
2.
i.
Achievement
Although this report was not
st
produced for the 1 HPAC of FY
2010/11, analyses of record of HPAC
discussions show no record of
discussion of the MoH annual work
plan.
Updating the MoH/DP Project
Database
The following projects were discussed
and reports submitted to HPAC for
endorsement;
x Global fund for sanitation
x Italian support for HSSIP
x TB laboratory strengthening
x GAVI ISS and HSS
All were endorsed by HPAC.
4 reports from FY 2010/11 due
Analysis of Planned vs Actual
procurements was not available due
to lack of a comprehensive
procurement plan.
Although MoH PDU produces monthly
reports to PPDA, the quarterly reports
were not submitted to HPAC.
It is proposed that since the AG’s
report is presented at JRM on
October, MoH holds internal
discussions on the recommendations
and presents the action plan to the
HPAC of Jan/Feb
No follow up
Monitoring Programme Implementation and Performance
Area Team Visits
Quarterly Reports
Presentation of reports to
HPAC within 30 days after
completion of Area Team
visits
x
An assessment of compliance due
for FY 2010/11
x
Reports were presented to HPAC
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No
Indicator
Measurement
Achievement
Visits were made as planned
x
Propose to include in the future,
a report on how the
recommendations from the visits
have been dealt with
th
ii.
MoH Quarterly
Performance
Assessment
3 quarterly performance
reviews took place
The 4 could not take place due the
JRM. The plan is to do 3 next FY due
the same reason.
iii.
Technical Review
Meeting
Present Report from TRM
to HPAC by 30 April
TRM for FY 2010/11 not held
iv.
Technical Working
Group meetings
Target 80% of TWG
meetings held
v.
Annual Health Sector
Performance Report
Submission of Final Report
th
by 30 September
The performance of TWGS was below
average
TWG reports were received in 4 out of
11 (36%) SMC meetings
In progress
Submission of Annual
Report to OPM
th
vi.
3.
Submission to OPM by 30
September
Process not budgeted for Report submitted on time
Policy Guidance and monitoring
i.
Senior Management
Committee
Proportion of planned
meetings held
ii.
Health Policy Advisory
Committee meetings
92% (11/12) of the
scheduled meetings took
place
iii.
Country Coordinating
Mechanism (CCM)
5/12 of the meetings
occurred on the scheduled
dates.
200% performance for CCM
meetings
Attendance of at least ¾ of
meetings by all members
78
x
75% of the scheduled 12 meetings
took place
Minutes available for verification.
Attendance of at least ¾ of meetings
by all members
HPAC was postponed a couple of
times for lack of quorum.
There were 8 meetings instead of the
originally scheduled 4 meetings but
none occurring on the scheduled
dates. All extra CCM meetings were
related to resource mobilization
activities for proposal development.
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Ranking
x
Although MoH PDU produces monthly status reports on procurement, the quarterly
review reports under finance and administration only captures procurement challenges.
x
There was no published meeting schedule for TWG meetings and therefore there is no
benchmark to compare with the TWGs that met. Some TWGs met more frequently than
others. 75% of the scheduled 12 SMC meetings took place with 4 (33.3%) of the 12
meetings taking place on the scheduled dates. Attendance for SMC meetings ranged
between 30% and 75% with an average of 55%. 25% of the meetings did not take place
due to dates coinciding with Area team visits. Supervision Monitoring Evaluation and
Research (SMER), Sector Budget, Maternal and Child Health (MCH), Human Resources
for Health (HRH), Medicines and Pharmaceutical supplies and to some extent Private
Public Partnership for Health (PPPH) TWGs were more consistent in reporting. There
was no report received from Hospitals, Infrastructure TWGs. In May 2011 Basic Package
TWG was dissolved into five TWGs: MCH, Environmental Health and Health Promotion,
Nutrition, Non Communicable Diseases (NCD) and National Disease Control (NDC). Of
these NCD, NDC and MCH submitted once (1 out of 11) 9 % after transforming into
individual TWGs.
x
The MOH attendance in HPAC meetings ranged between 9% to 73% with an average of
48%, while development partner’s attendance ranged between 75% and 100% with an
average of 75%. the DHO representative was consistent throughout the period under
review. Mulago and Butabika hospitals did not attend any meeting despite regular
reminders. The regional referral hospitals and general hospitals did not nominate
representatives to HPAC and therefore no attendance was registered. The participation
of development partners and civil society can be characterized as high. However when it
came to other line ministries, departments and agencies, while the MoFPED showed
consistency, the representatives from other line ministries did not attend HPAC and the
CCM despite several reminders. The poor attendance is attributed to lack of clear
understanding of the mandate and role of these committees. This partly demonstrates
the weak intersectoral collaboration.
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3.3 Delivery of the Uganda National Minimum Health Care Package
(UNMHCP)
Because of the limited resource envelope available for the health sector, the NHP II
recommends that a minimum health care package be delivered to all people of Uganda. This
package consists of the most cost-effective priority health care interventions and services
addressing the high disease burden that is acceptable and affordable within the total resource
envelope of the sector. The UNMHCP consists of the following cluster;
(i) Health Promotion, Disease Prevention and Community Health Initiatives, including
epidemic and disaster preparedness and response;
(ii) Maternal and Child Health
(iii) Prevention, Management and Control of Communicable Diseases and;
(iv) Prevention, Management and Control of Non-communicable Diseases.
This section analyses progress in implementation of the UNMHCP under the various clusters in
relation to the relevant HSSIP 2010/11 – 2014/15 core indicators, lead programme indicators of
focus during 2010/11 FY, annual workplan indicators (process implementation), main
achievements, challenges and recommendations.
3.3.1
Cluster 1: Health promotion, disease prevention, and community health initiatives
3.3.1.1 Health promotion and education
The key priority for health promotion and education is promoting individual and community
responsibility for better health.
Lead programme indicators
x Standards and guidelines (including criteria for gender sensitivity) for the production and
delivery of IEC messages developed and disseminated among institutions by 2011/2012.
x The proportion of districts with trained VHTs increased from 31%to 100% by 2014/2015.
x The proportion of health facilities with IEC materials maintained at 100%.
Annual workplan 2010/11 indicators
x Establishment and training of VHTs in 40 additional districts
x Motivation of VHTs i.e. Training; Recognition of VHTs; Provision of protective wear; Activity
related incentive; transport for VHTs in 40 districts
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x
x
Recruitment of full time Public and Media Relations Officer
Inventory of VHTs
Main achievements
x VHTs trained in 18 districts of Lyantonde, Bullisa, Budaka, Namutamba, Moroto, Kotido,
Kaabong, Amudat, Nakapiripirit and Napak, Wakiso, Butambala, Gomba, Mpigi, Kanungu,
Masaka, Bukomansimbi, Lwengo.
x Support supervision and monitoring of VHTs conducted in 40 districts
x Distributed 110,000 bicycles to VHTs
x Social mobilization to control emergencies and epidemics carried out in 75% of the districts
(Cholera, H1N1, Influenza, Yellow Fever outbreak and vaccination, Hepatitis E, Ebola,
Nutrition promotion and Child Days).
x Developed and disseminated the reviewed VHT training materials, strategy, operational and
supervision guidelines.
x Implemented MoH media relations programmes (press releases, media coverage, press
conferences)
Main challenges
x Inadequate funding to train VHTs countrywide
x Limited public education through the media
x Lack of adequate IEC and VHT training materials
x Restricted human resource structure for health education staff in the districts
Recommendations
x Intensify training, supervision and monitoring of VHTs
x Develop a mechanism to motivate and make VHTs functional
x Secure funding for public awareness and education through the media
x Support districts and lower lever social mobilization and advocacy activities.
x Intensify technical support supervision and monitoring
x Revitalize MoH/HP&E printing unit
There has been dismal progress in functionalization of VHTs, though supervision of VHTs was
carried out as planned. Social mobilization during outbreaks was adequately covered, this
could have been a result of the successful recruitment of a full time Communication Specialist.
Other social mobilization activities are hampered by inadequate funding and restricted
staffing for health education staff in the districts.
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3.3.1.2 Environmental Health
The environmental health component aims at contributing to the attainment of a significant
reduction of morbidity and mortality due to environmental health and unhygienic practices and
other environmental health related conditions.
Core HSSIP Indicator
x Latrine coverage (71% 2010/11)
Lead programme indicators
x Percentage of households with access to safe water.
x The proportion of districts implementing water quality surveillance and promotion of
safe water chain/consumption increased from 30% to 50% by the year 2015.
x The proportion of households with hand washing facilities with soap increased from
22% to 50% by 2015.
Annual plan 2010/11 top indicators
x Enforcement of Public Health Act
x Enacting sanitation ordinances and by-laws
x Promotion of hand washing with soap and observance of safe water chain in 10 districts
x Implementation Community Led Total Sanitation (CLTS), Kampala Declaration on
Sanitation (KDS) scaled up in 40 districts.
Main Achievements
x National latrine and hand washing coverage to increased from 69.7% to 71% and 22% to
25% respectively.
x Advocacy meetings on Kampala Declaration on Sanitation & the use of PHAST tools held
for participants from 7 districts of Budaka, Bududa, Bulambuli, Sironko, Butaleja, and
Kayunga & Pallisa.
x One hundred fifty six (156) district staffs from 13 districts were trained in processes of
enactment of ordinances and bye-laws. The staffs were drawn from the districts of
Kiboga, Nebbi, Namutumba, Mbale, Kibaale, Kiruhura, Lwengo, Sembabule, Kalungu,
Masindi Nakasongola, Luwero and Buikwe. However, only 39 districts are at various
stages of passing ordinances and bye-laws.
x Support supervision and monitoring carried out in 13 districts focusing on hand washing
with soap, sanitation and hygiene new initiatives, Open defecation free villages (ODF),
new latrines construction in the districts of Kamuli, Mayuge, Namayingo, Busia, Bugiri
and Namutumba Buyende, Kaliro, Iganga, Jinja, Masaka, Rakai and Lyantonde.
x The division has had a series of meetings with the Sanitation and Hygiene sub-sector
Working Group. This has yielded good results with the creation of a Sanitation and
Hygiene budget line in the Ministry of Finance Planning and Economic Development.
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Main Challenges
x Some planned activities like purchase of Public Health Legislation books, water quality
testing kits for districts, motor cycles, lactometers, uniforms and protective wear and
climate change/health awareness campaigns were not fulfilled due to limited funding.
x There are many gaps in environmental health staffing at all levels causing inefficiencies
in the areas of environmental health service delivery. Only 10% of the ADHOs in charge
of Environmental Health positions have been filled in the districts.
x Failure of Local Governments to formulate ordinances and by-laws on environmental
health and ensure that they are enforced.
Recommendations for 2012/13
x Increase funding to enable implementation of planned activities through the budget line
created in the MoFPED.
x Procure transport means and other equipment and accessories for the various levels of
service delivery
x Fast track the process of making and implementation of sanitation ordinances in Local
Governments
Overall there is minimal improvement in the implementation of environmental health and
sanitation interventions at district and community level e.g. rolling out of the Kampala
declaration on Sanitation which is long overdue. Local Governments are not effectively
playing their role in formulation of ordinances and bye-laws on environmental health. The
current inertia will not contribute to the component aim of significant reduction of morbidity
and mortality due to environmental health and unhygienic practices and other environmental
health related conditions.
3.3.1.3 Control of Diarrheal Diseases
Diarrheal diseases including acute watery diarrhea that is not cholera, dysentery and persistent
diarrhea are mainly due to poor sanitation, low safe water coverage, poor domestic and
personal hygiene practices and mass movement of populations. The main objective of the CDD
component is to strengthen initiatives for control and prevention of diarrhea at all levels.
Lead programme indicators of CDD
x The incidence of annual cases of cholera reduced from 3/100,000 to 1.5/100,000 by
2014/2015.
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x
The incidence of annual cases of dysentery reduced from 254/100,000 to 150/100,000
by 2014/2015.
x
The cholera specific case fatality rate reduced from 2.1% to <1.0% by 2014/2015.
x
The dysentery specific case fatality rate reduced from 0.08% to 0.01% by 2015.
x
The acute watery diarrhoea specific case fatality rate reduced from 0.9% to 0.4% by
2015.
Annual plan 2010/11 top indicators for CDD
x Training and capacity building for service providers; 15 District workshops (one per
district).
x Policies, laws, guidelines and strategies; updating CDD guidelines.
x Technical Support, monitoring and evaluation of service providers and facilities; CDD
supervisory visits to all districts at least twice a year.
x Coordination; inclusion of zinc and oral rehydration salts (ORS) on the essential
medicines list.
Main CDD achievements 2010/11
x Training and capacity building for service providers.
- Workshops on diarrhoea prevention and treatment were conducted for facility
based health workers in two districts (i.e. Mubende and Mityana).
- A workshop on quality of care in diarrhoea case management was conducted for
facility based health workers in Fort Portal (participants were from the districts of
Bundibugyo, Kabarole, Kamwenge, Kasese, Kyegegwa and Kyenjojo)
- Workshops on diarrhoea prevention and treatment were conducted for drug shop
attendants in five districts (i.e. Jinja, Mukono, Masaka, Kyenjojo and Koboko).
x Policies, laws, guidelines and strategies - Draft guidelines on management of diarrhoeal
diseases were developed as a guide for health workers; and Guidelines on quality
improvement in diarrhoea case management with emphasis on enhancing use of low
Osmolar ORS & zinc supplementation were developed.
x Technical Support, monitoring and evaluation of service providers and facilities:
- Control of Diarrhoeal Diseases (CDD) technical support supervision visits were
carried out in 54 out of the 112 districts. Other districts will be prioritised during FY
2011/2012
x Coordination; inclusion of zinc on the national essential medicines list. Low osmolar oral
rehydration salts (ORS) and zinc are now on the National Essential Drugs List. They are
stocked by the National Medical Stores and Joint Medical Stores and are available for
health facilities to requisition and use in the management of diarrhoeal diseases in
accordance with the national diarrhoea treatment policy and guidelines.
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Main challenges 2010/11
x Inadequate knowledge and practices of health workers regarding the current diarrhoea
treatment policy and guidelines
x Inadequate funding for required supplies and operations
x Inadequate access to safe water and low latrine coverage and use
Recommendations for annual plan 2012/13
x Capacity building for facility based health workers and VHTs covering all districts.
x Technical support supervision covering all districts
x Funding for supplies and operations enough for the needs of all districts
Most of the planned activities for control of diarrhoeal diseases were carried out. There is
need to ensure integration of CDD activities with health promotion and environmental health
divisions to sustain the gains.
3.3.1.4 School Health
The School Health Programme aims at improving the health status of the school children, their
families and teachers and to include appropriate health seeking behavior among this
population. It is expected that the school health programme will improve the health of school
children, reduce dropout rates and increase school performance.
Lead programme indicators
x The % of schools in Uganda providing basic health and nutrition services increased to 25 %
by 2015.
x The % of primary and secondary schools with safe water source within 0.5 km radius of the
school increased from 61% and 75% resp. to 80% by 2015.
x The % of schools with pupil per latrine stance ratio of 40:1 or better increased from 57% to 70% by 2015.
Annual plan 2010/11 top indicators (implementation)
x Trainers of Trainers workshops on school health component held in 30 districts
x Hold a workshop to discuss Draft School Health Policy
x Conduct School Health support supervision in 8 districts
Main achievements 2010/11
x In order to revitalize and strengthen the organization and management of the school health
program, a Medical Officer was assigned the responsibility to head the unit
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x
x
x
TOT conducted on School Health component conducted in 6 districts in Lango sub region.
(Aleptong, Otuke, Kole, Amolatar, Dokolo and Oyam districts)
In conjunction with Ministry of Education and Sports (MOES), and with support from United
Nations Fund for Population Activities (UNFPA) terms of reference for a consultant to
review the draft school health policy and align with NDP, HSSIP and MOES were drafted,
shared with MCH cluster and plans to recruit a consultant are underway.
Conducted support supervision in 7 Districts of Kiryandongo, Nakasongola, Luwero Pallisa,
Bugiri, Budaka & Mbale supervised
Main challenges 2010/11
x Understaffing in the school health unit makes it difficult to roll out the program and
coordinate implementation
x Lack of standards for school health program to guide implementation by districts,
development partners and schools
x Inadequate reliable local health data on school health makes it difficult to design
appropriate interventions.
Recommendations for annual plan 2012/13
x Accelerate the recruitment of staff for the school health unit
x District capacity for reporting, management and use of school health data for planning and
implementation at should be strengthened.
x Advocacy for school health programme needs to be stepped up to ensure leadership
support and commitment mostly at district level.
x
Strengthen collaboration between the Ministry of Health and Ministry of Education.
Capacity for implementation of the School Health Programme was strengthened through assignment
of a Desk Officer. The development of the School Health Policy and guidelines should be expedited to
ensure that all stakeholders are equipped with the guidelines and tools for programme
implementation. There were dismal activities geared at expanding the school health and nutrition
programme and expansion of the provision of clean water and improved sanitation to schools.
3.3.1.5 Epidemic Disaster Prevention, Preparedness and Response
The MoH is mandated to play a central role in the control, coordination and management of
disease outbreaks. The EDPPR unit is responsible for prevention, early detection and prompt
response to health emergencies and other diseases of public health importance.
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Lead programme indicators
x
x
x
x
The proportion of suspected disease outbreaks responded to within 48 hours of notification
increased from 52% to 80%.
The proportion of districts with functional epidemic preparedness and response committees
increased from 76% to 100%.
The proportion of districts with epidemic preparedness plans increased to 100%.
The timeliness and completeness of weekly and monthly surveillance reports maintained at
greater than 80%.
Annual plan 2010/11 top indicators (implementation)
x All districts under surveillance
x 30 districts oriented to prevent and control epidemics and other public health emergencies
x Number of technical supervision visits conducted
x Number of guidelines on prevention and control of epidemic and public health emergencies
disseminated
x Timeliness and completeness of weekly surveillance reports
Main achievements 2010/11
x During the period, July 2010 to June 2011, the MoH supported LGs to timely and effectively
respond to 100% of the 12 major outbreaks. Most commendable was the response to the
Ebola epidemic.
x Revised Standard Case Definition
x Built Epidemic Preparedness and Response capacity in 30 districts
x IDSR was carried out and the timeliness of weekly reporting is 82% and completeness is 86%
Main challenges 2010/11
x Weak laboratory network
x Inadequate human resource and lack of substantive district surveillance officers
x Weak communication channels intra-district and district to centre
Recommendations for annual plan 2012/13
x Merge surveillance and response for better coordination
x Focus on gaps for IHR compliance by working with partners
x Provide feedback on surveillance data to districts through print media
x Set up a revolving fund for immediate access in case of a reported outbreak for prompt
response and avoid spread of the disease
During the period, the majority of the reported outbreaks were due to Yellow Fever 41.7%
(5/12) displacing cholera which accounted for 50% (20/40) of the outbreaks reported in 2008/
2009. Yellow Fever re-emerged after four (4) decades without cases being reported in the
country. The other outbreaks reported during the period included: cholera 25% (3/12); Ebola
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8.3% (1/12); Polio 8.3% (1/12); Nodding disease 25% (3/12), rabies, hepatitis E virus, and
protein energy malnutrition (See details in Annex 3.9)
Of the 12 outbreaks reported during July 2010/ June 2011, 41.7% (5/12) of the outbreaks are
currently ongoing and these include: (a) Rabies in Bundibugyo, (b) Nodding disease in Kitgum,
Pader and Lamwo, and (c) Hepatitis E Virus in Kaabong.
Yellow Fever
Yellow Fever was the most frequent outbreak reported during July 2010/ June 2011. It
accounted for 41.7% (5/12) of the outbreaks reported during the period. A total of 273 suspect
Yellow Fever cases including 58 deaths (Case Fatality Rate 21.3%) were reported from 14
districts in Northern Uganda. A total of 13 cases were confirmed to have Yellow Fever from the
five the districts of Abim, Agago, Pader, Kitgum and Lamwo. A vaccination campaign was
conducted during the last week of January 2011 targeting all persons aged 6 months and above
in the districts of Abim, Agago, Kitgum, Lamwo and Pader. The overall Yellow Fever
immunization coverage in the five districts was 80%. A countrywide Yellow Fever risk
assessment is underway to inform the Yellow Fever vaccination policy in Uganda. Yellow Fever
case based laboratory backed surveillance is also being revitalized in the country.
Polio
This outbreak started on September 20, 2011 with a total of four (4) cases being confirmed
from Bugiri district. Before the outbreak, Uganda had been polio free since May 20, 2009 and
had been removed from the active polio outbreak list in December 2009. The cases originated
from Nawansonga village in Kithodha Parish of Bulesa Sub County. Wild Polio Virus (WPV) Type
1 genetically linked (97.46%) to the WPV isolated in Turkana region, North West Kenya on 3rd
February 2009 was isolated. Supplemental Immunization was implemented in 48 high risk
districts in North East, East and Northern Uganda using Monovalent OPV (type1). In the long
term, control of polio will rely heavily on improved routine coverage.
Ebola
During the period, suspect viral hemorrhagic fever cases were reported from 11 districts but
only one district (Luwero) had an Ebola case confirmed on May 13, 2011. The outbreak started
on May 1, 2011 with the index case being confirmed to have Ebola. A total of 25 contacts were
identified, followed up and investigated but just one contact (the brother of the deceased)
tested positive for Ebola Ig G. The outbreak was declared over on June 17, 2011.
Cholera
Though three (03) outbreaks were reported during the period only two (2) were confirmed to
be cholera. Two small outbreaks of suspected cholera were reported from Hoima in June 2011
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with 10 cases and no deaths; while the other outbreak was reported from Bundibugyo with 29
cases and 5 deaths. The outbreak in Nakapiripirit was relatively big with 217 case and 10 deaths
(CFR 4.6%) CFR is 1% expected in well managed outbreaks. The outbreak spread from the
neighboring district of Amudat with the initial cases being reported on October 18, 2011. The
affected sub-counties included: Kakomongole, Nakapiripirit Town Council, Namalu, Lorege, and
Lolachat. Latrine coverage was estimated at 3% and safe water coverage at 40-60% in the
district.
Protein Energy Malnutrition (PEM)
The cases were reported from Namutumba district starting June 2011 among children less than
five years. It was established the hailstones destroyed crops during March 2011 hence there
was food scarcity in the district in the subsequent months forcing homes to feed children on
alternate days on cassava bread and vegetables. A team from the MoH supported the district to
set up therapeutic treatment centres where assessments and treatment is being undertaken.
Head Nodding Disease
This is an emerging epileptic disorder that causes atonic seizures of the neck and upper limb
muscles following the sight of food. A survey undertaken during August 2010 by the MoH in 26
sub-counties in Kitgum, Pader, and Lamwo identified 1,876 cases. The etiology is still being
investigated but a response plan has been developed to manage the associated conditions
including: seizures, malnutrition, and onchocerciasis. Funds however need to be mobilized to
implement the plan.
Hepatitis E Virus
The outbreak started on August 18, 2009. The initial cases were linked to the consumption of
contaminated kwete (local brew) in Kaabong Town Council. Cases have been reported from
Sidok, Karenga and Kaabong sub-counties. Latrine coverage is low (1%) and a factor in the
spread of the disease. There was an upsurge in cases following the onset of rains in March 2011
that is currently being responded to by GoU and partners. However in the long term, control of
the outbreak will require investments in improving access to safe water and sanitation facilities
(latrines) in the district.
Despite the unusually high incidence of epidemic, disease outbreaks and disasters in 2010/11, the
response by health sector EDPPR teams was timely notably for the Ebola epidemic whereby only one
case was confirmed. Other responses were mainly hampered by inadequate logistics and lack of
epidemic preparedness plans and funds at all levels. The OPM should support strengthening of
intersectoral coordination mechanisms within the country and inter-country level on management of
epidemics.
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3.3.1.6 Occupational Health and Safety Programme
Due to the current increased industrial, agricultural (especially horticulture) development in
Uganda, threats from emerging and re-emerging diseases, there is need to scale up
interventions in Occupational Health. There is a need to promote Occupational Health services
and practices in workplaces with special emphasis on the high risk sectors.
Lead Programme Indicators
x Number of districts with functional Occupational health and safety committees.
Main achievements
x Occupational health and safety committees established and trained in 8 districts (Kamuli,
Busia, Namutumba, Mityana, Oyam, Kabarole, Mubende and Amolatar).
Occupational Health and Safety Programme in the sector is not well stipulated in the HSSIP 2010/11 2014/15 and not reflected in the MPS 2010/11. There is urgent need to strengthen the coordination
mechanism, planning and implementation of Occupational Health and Safety in the MoH.
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3.3.2
Cluster 2: Maternal and Child Health
MCH cluster is composed of five elements; Sexual and Reproductive Health (SRH), Newborn
care, Common childhood illnesses, Immunization and Nutrition. This emphasizes the link
between maternal and child health and the cumulative nature of health problems through the
entire lifecycle.
3.3.2.1 Sexual and Reproductive Health and Rights
The aim of the sexual and reproductive health and rights element is to reduce mortality and
morbidity relating to sexual and reproductive health, and rights. The right to sexual and
reproductive health rights programme is important as it aims at reducing maternal mortality
ratio, under five mortality, and total fertility rate, and improve sexual and reproductive health
of the people which are all key elements for achieving the MDGs 4, 5 and 6.
Core Indicators
x Maternal Mortality Ratio (maternal deaths per 100,000 live birth)
x % pregnant women attending 4 ANC sessions
x % deliveries in health facilities
x % pregnant women who have completed IPT2
x Contraceptive Prevalence Rate
x Number of stillbirths
Lead Programme Indicators
x The proportion of health facilities with no stock-outs of essential RH medicines and
health supplies increased from 35% to 70% by 2015.
x The proportion of health facilities that are adolescent-friendly increased from 10% to
75% by 2015.
x The % of health facilities with Basic and those with Comprehensive emergency obstetric
care increased from 10% to 50% by 2015.
x The proportion of pregnant women accessing comprehensive PMTCT package increased
from 25% to 80%.
x The unmet need for family planning reduced from 41% to 20% by 2015.
x The rate of adolescent pregnancy reduced from 24% to 15% by 2015.
Annual plan 2010/11 top indicators
x Implementation of the road map for accelerating reduction of maternal and newborn
mortality and morbidity in 40 districts
x Number of health workers trained in EMOC, MPDR, MIP, ASRH, RH/HIV integration and
focused ANC in 60 districts
x Number of maternal and perinatal death audits conducted
x Policies, laws, guidelines, plans and strategies developed and disseminated
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x
x
Number of technical supervision, monitoring and evaluation activities
Number of coordination meetings held
Main achievements
x 12 monthly MCH Technical Working Group meetings were conducted. Examples of issues
that were handled through this forum included Addendum for Community-Based provision
of Injectable Contraceptives; creation of alternative distribution mechanisms for
contraceptives to avoid piling up and expiry. Other coordination meetings held included 1
National Coordination meetings for Malaria in Pregnancy; 4 Quarterly National Maternal
and Perinatal Death Review (MPDR) committee meetings, 4 Quarterly Reproductive Health
Commodity Security (RHCS) meetings held.
x Reviewed the Adolescent Health policy, the strategy, job aides and Adolescent Health
training curriculum for peer and health workers. Developed the Adolescent-friendly service
standards and the Step by Step guide for Health workers. Maternal nutrition guideline was
finalized.
x Reviewed the Life Saving Skills training manuals and EmONC management Care protocols
x Printing and distribution of guidelines and tools
o 1,000 Registers on Integrated ANC, Maternity and Postnatal Care were printed.
o Printed 100 Maternal death notification booklets, 200 maternal death audit
booklets, 200 perinatal death audit booklets and 50 Maternal and Perinatal Death
Review (MPDR) guidelines that were distributed in 8 UNFPA focus districts.
o Five hundred (500) copies of MPDR strategy were printed and distributed.
o Twelve thousand (12, 000) mothers’ passports were also printed and distribution is
ongoing.
o 1,000 copies of VHT data collection tool, covering maternal health variables were
printed.
o 10,000 checklists for the WHO Medical Eligibility Criteria for family Planning(IUD,
Implants, DMPA, Oral contraceptives)
o 20,000family Planning cards
o 20,000 FP brochures in 6 different languages( (English, Luo, Ateso, Karamojong,
Lugbara and Luganda)
o 2000 posters on responsible fatherhood
o 200 copies of the Reproductive Health Choices for people living with HIV
o
x Public awareness building: Commemoration of Safe Motherhood day took place in Mityana
District.
x Training was carried out in various areas of Reproductive Health including; 30 health
workers (on Adolescent Health in Masaka district), 30 HWs (on RH Logistics management in
Tororo district), 18 HWs (on EmOC in Kamuli district), 30 HWs (on Malaria in pregnancy in
Lira district), 180 HWs and 30 TOTs (on SGBV in the districts of Kiboga, Mpigi, Kotido,
Moroto, Katakwi, Kaabong, Hoima, Kapchorwa, Serere, Kaberamaido, Soroti, Mubende,
Kanungu, Abim, Oyam). Teams from 4 Regional Referral Hospitals provided hands-on skills
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x
x
x
x
x
x
x
building on goal oriented ANC, Post Abortal Care (PAC), EmONC, MPDR, Family Planning
Long Term and Permanent Methods (LTPM), HIV/SRH Integration & SGBV, to 118 health
care workers in 10 health facilities in 4 districts of Mubende, Oyam, Kanungu and Katakwi.
Under the Fistula Care Project, Kitovu Mission hospital and Kagando Mission hospital
conducted 294 fistula repairs, trained 4 surgeons on fistula repair surgery, trained 3 health
care providers on Caesarean section, trained 679 health care workers on infection
prevention, trained 89 health care providers on quality improvement.
Technical support supervision on EmONC, HIV, PMTCT and FP was done in 21 districts.
Twenty (20) districts were assessed and guided on implementation of the Roadmap
(Kibaale, Hoima, Bulisa, Masindi, Kiryandongo, Nakasongaola,Luwero, Wakiso, Nakaseke,
Kiboga, Jinja, Kamuli, Kaliro, Mayuge, Luuka Masaka, Rakai, Lyantonde, Sembabule and
Lwengo).
Confidential inquiries in MPDR were carried out in Arua, Mityana, Buhinga in Fort Portal
and Apac hospitals.
Family Planning Quality of Care Assessment was done in order to identify gaps and
therefore guide prioritization.
Family Planning service provision outreaches were carried out through partnerships with
NGOs and professional Associations, and integration of service provision was also
encouraged in the health facilities.
More funding was mobilized for procurement of RH medicines, equipment and health
supplies including contraceptives.
Main challenges
x Insufficient skills in-service on the use of RH medicines and equipment recently introduced
in service delivery, e.g. MVA kits, Misoprostol, Magnesium sulphate, Emergency
Contraceptives and the Newborn resuscitation equipment.
x Insufficient suture materials in all hospitals leading to poor wound healing, gaping wounds
and burst abdomen
x Very low use of the Partogram to monitor labour progress at all levels of care leading to
late response and poor outcomes even for mothers who are coming early to health
facilities
x Failure of the HC IVs and many General hospitals in participating in Emergency Obstetrical
Care instead of continuously referring obstetrical emergencies to the Regional referral
Hospitals, thereby over-loading them and increasing the delay for women in labour in
reaching health facilities for Emergency Obstetrical Care. This has partially contributed to
some of the maternal deaths owing to the “third delay”.
x Insufficient numbers of doctors, midwives and anaesthetists to cover EmOC at HC IV,
General Hospitals and Regional Referral Hospitals.
x Piling up of RH supplies including contraceptives and Emergency contraceptives at NMS
and in some health facilities.
x No clear source of equipment for long term and permanent methods of Family planning
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ec
x
x
x
x
x
en a i ns
ann al lan
Should sensitize Members of Parliament of the need for in-service Continued Medical
Education, and Continued Professional Development.
There is a need to step up in-service capacity building efforts, including hands-on skills
building and technical supervision.
There is a need to engage the health training institutions so that they update their tutors in
the key RH skills that are being addressed in the in-service training to ensure sustainability
Should support the recruitment of core staff for RH, namely, doctors, midwives and
anaesthetists to cover EmOC at HC IV, GHs and RRHs.
Should strengthen the Public Private Partnerships in improving RH supplies distribution and
improving the utilization of services in the health facilities especially provision of the Long
Term and Permanent (LTPM) methods of FP.
Most of the planned activities at programme level were implemented as planned and output
demonstrated by increase in CYP (from 582,804 in 2009/10 to 787,390 in 2010/11), CPR and
deliveries in health facilities together with improvement of the Public Private Partnerships.
Whereas there is a remarkable increase in the number of deliveries in health facilities, there is
a reduction in the proportion of pregnant women attending 4 ANC sessions and the
proportion of pregnant women who have completed IPT2 is static at 47%. There is need for
continued sensitization on goal oriented ANC and promotion of early ANC attendance.
Stock out levels of essential RH medicines and health supplies as evidenced by the 47% stock
out levels of EMHS could be contributing to the low IPT2 coverage.
As seen from the Figure 14, number of stillbirths in health facilities is high and is a reflection
of obstetrical complications during pregnancy and childbirth. Therefore, ANC and skilled care
at birth especially EmOC, need to be strengthened; Perinatal Death auditing should also be
carried out in order to identify the risk factors so that they are addressed to reduce stillbirths.
ig e
e
e n
1,800
1,600
1,400
1,200
1,000
800
600
400
200
-
e
ill i hs
nh
2009/2010
2010/2011
Source: MoH HMIS
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3.3.2.2 Human Rights and Gender Mainstreaming
This element of the MCH cluster aims at preventing morbidity and mortality linked to human
rights violations and gender inequalities.
ea
ga
x
x
x
x
e n ica
s
An integrated strategy to address SGBV in the health sector developed and
disseminated.
Health service provision for survivors of rape scaled up in all district hospitals and 0
of HC IIIs.
PEP Kits available in all district hospitals and 0 of HC IIIs.
Health workers trained in clinical management of survivors of rape increased to 2 by
201 .
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in ica s
The Human Rights and Gender Team did not have an action plan for 2010/2011 as it was only
established in early 2011.
Main chie e en s
x An officer from MoH was assigned responsibility of Gender Desk Officer
x Developed an action plan for mainstreaming Human rights and gender
x Held stakeholders meeting to harmonise activities
x Developed trainers manual for mainstreaming human rights and gender concerns in health
programmes
x Several trainings were undertaken on SGBV.
x MoH has attended several intersectoral meetings with stakeholders from Ministries of
Gender, Internal Affairs and Justice to streamline issues related to the filling in of the police
form 3 in case of rape with major positive achievements in that the clinical officers and the
midwives will now be recognised as eligible health workers to fill the form and can testify in
court. The Police Form has now been separated into PFA for General assault and PF3B for
Victims of se ual violence. Pictograms have been introduced and mandatory testing of HIV
for offenders of se ual violence
ec
x
x
x
en a i ns
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For the Human Rights and Gender Team to continue the work of cross sectoral cooperation
Capacity building and technical assistance with the aim of promoting and protecting human
rights within the health sector.
To include structural indicators in upcoming health sector assessments.
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The MoH has made deliberate efforts to streamline health and gender by establishing a
Gender Desk and assigned officers (from the Planning Division and Reproductive Health
Division). Implementation of some activities has commenced. Further implementation of the
action plan will continue in FY 2011/12.
3.3.2.3 Newborn and Integrated Child Survival
The newborn and integrated child survival elements of the MCH cluster aim at improving
newborn and child health and survival by increasing coverage of high impact evidence based
interventions, in order to accelerate the attainment of MDG 4 and scale-up and sustain high,
effective coverage of a priority package of cost-effective child survival interventions in order to
reduce under five mortality.
e
x
x
x
x
x
x
in ica
s
Neonatal Mortality rate (per 1000 live births)
Infant Mortality Rate (per 1000 live births)
Under mortality rate (per 1000 live births)
U children with height /age below lower line (stunting) (m/f)
U children with weight /age below lower line (wasting) (m/f)
U s with malaria treated correctly within 24 hrs increased from 26 to 60
ea
ga
e in ica s
x The proportion of neonates seen in health facilities with septicaemia/pneumonia disease
reduced by 30
x Proportion of mothers of newborns 1-2 weeks practising clean cord and skin care, keeping
babies warm, e clusively breast feeding and recognize danger signs, increased by at least
30 from baseline figures
x U pneumonia managed with correct antibiotic increased from 17 to 0
x Inde of U s managed in an integrated manner at the facility using IMNCI increased from
30 - 60
x Health workers who are competent in newborn resuscitation upon completing of training
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in ica s
x Roll out child survival strategy in 40 districts
x Number of health workers trained in micro-planning in Child Days in 32 new districts
x Number of district trainers trained on child survival interventions in 40 districts
x Number of guidelines in Child Survival Interventions reviewed and printed
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Main achie e en s
x
x
x
x
x
x
x
x
Child Survival (CS) Strategy was revised and aligned with the HSSIP 2010/11 2014/1 and
200 copies printed. Two national level trainings of Mid-Level Managers on managing child
health programs were conducted
All districts implemented two rounds of Child Health Days but with varying degrees of
performance. Received a donation of de-worming drugs from CWW, World Vision and
World Food Programme and Vitamin A from UNICEF. Performance in Child Health Days
however deteriorated and actions to strengthen CDP were initiated
Developed a standard operations manual for implementing Child Days Plus activities,
including revision of the supervision and monitoring tools and targeted technical support
was provided to poorly performing districts in form of planning and supervision from the
national level
An integrated in-service training package “Helping Babies Breathe (HBB) guidelines
incorporating newborn resuscitation, e amination of normal newborn care, preterm and
sick newborn care were adopted and adapted for Uganda and the first national training for
14 trainers conducted in Masaka.
The national multi-disciplinary advisory committee continued to advocate for and
coordinate different efforts to improve newborn health including introduction of standards
based facility assessment/audit in 8 districts, review and dissemination of newborn/perinatal death audit tools in 32 districts to strengthen the reduction of avoidable
deaths at the facility
Post-natal home visits by VHT during the first week were introduced in 23 districts through
VHT iCCM trainings supported by UNICEF, Malaria consortium and International Rescue
Committee etc.
Agreement was reached to ensure IMCI standards implemented at facility before
introducing iCCM at VHT level. According to the supervision report of the last quarter,
districts are beginning to revitalize IMCI. Plans have been initiated to review the pilot of a
shorter abridged course for IMCI.
The referral/hospital package of IMCI was reviewed based on new evidence from WHO and
the pocket book for health-workers is under revision. A training on Emergency Triage and
Treatment was conducted in collaboration with the department of paediatrics to improve
severe illness case management
Main challenges
x Challenges for CDP implementation have been mostly in the area of logistics management,
monitoring performance and coverage, district ownership of the program, coordination of
key players and inadequate long term planning plus political support.
x Partners support most activities for newborn health and newborn activities are not well
integrated in district plans and other quality improvement activities. In addition whereas
audit has been adopted as a key strategy to build capacity and inculcate a culture of
continuous quality improvement, peri-natal death audit activities are not implemented
widely only 1 districts have initiated this and national death review teams are not
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functional, and even then there are very few national/ regional mentors and supervisors to
support districts.
Most health facilities still lack needed basic equipment, supplies and skills for newborn
health care especially equipment for new borne resuscitation and emergency care.
High turnover of staff affects the attainment of a critical mass of trained staff.
Irregular technical supervision and monitoring activities affecting institutionalization of IMCI
and continued improvement of management of common childhood conditions.
Shortages or irregular supply of drugs especially 1st line anti-malarial, de-worming drugs and
antibiotics for pneumonia.
Implementation of iCCM is highly dependent on e istence of VHT in villages many districts
are yet to roll out the VHT strategy. Data on performance of iCCM in early use districts are
still limited and affect planning and improvement of implementation.
x
x
x
x
x
ec
x
x
x
x
en a i ns
ann al lan
E pand the pool of national and regional newborn clinical audit teams consisting of hospital
clinical specialists, district health teams, financial administrators and NGOs to champion and
support lower level health facilities and communities in the catchment area to assess
newborn health service standard, introduce and maintain quality improvement approaches
in these units including regular perinatal death audits and reviews..
Mobilize e isting resources, including a number of hidden resources (local organizations,
traditional structures, groups) to integrate or build on newborn activities.
Review the IMCI implementation framework to reflect new development and build district
management capacity for child health programming in general and implementing IMCI in
particular.
Districts planning to implement iCCM should also plan to train health facility staff to
manage referred patients and supervise VHTs.
There is a 10% reduction in the number of children seen in health facilities with pneumonia
and 30% reduction in the number of children seen with septicaemia.
Diagnosis
Pneumonia
Perinatal conditions (in
New borns 0 to 28 days)
2008/09
No. of cases
% No. of cases
887,917
2009/10
% No. of cases
2010/11
%
3%
912,263
2%
819,180
2%
12,125 0.04%
16,102
0.04%
11,707
0.03%
There is need to scale up peri-natal death audits, provide the necessary equipment and
adequate medical supplies. Staff attrition and low staffing levels also affect service delivery.
These gaps are likely to be contributing to the slow progress in improvement of the
programme indicators.
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3.3.2.4 Expanded Programme for Immunisation
The mission of UNEPI is to contribute to the reduction of morbidity and mortality due to
childhood diseases to levels where they are no longer of public health importance. The
programme objective therefore is to ensure that all children are fully immunized against the
vaccine preventable diseases before their first birthday and all babies are born protected
against neonatal tetanus.
e
x
x
in ica
children under one year immunized with 3rd dose Pentavalent vaccine (m/f) (90 )
one year old children immunized against measles (m/f) (8 )
ea
ga
e in ica s
x Neonatal tetanus rates reduced and maintained at zero
x DPT-3/Pentavalent coverage for under 1 s increased from 74 - 80 in 2010/11
x Measles vaccination coverage by 12 months increased from 7 to 8 in 2010/11
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x Delivery of vaccines, injection materials and other immunization supplies
x EPI cold chain supervision in all districts
x Technical support supervision to districts
x Health workers trained on post certification interventions
Main achie e en s
x Received 1,422 fridges (287 solar fridges and 1,13 Electric and /or gas refrigerators), 1
refrigerated truck and 1 open caged truck with support from JICA for rehabilitation of the
cold chain systems and support vaccine delivery to districts. The fridges have been
distributed to the districts and used for setting District Vaccine Stores for new districts.
x Capacity building Refresher training of 726 Operational Level (OPL) Health Workers in 26
districts, 181 Mid Level Managers (MLM) from 34 districts, 30 Cold Chain Assistants for new
districts and tutors from 27 medical training institutions
x Maintained certification level surveillance for polio eradication and measles control.
x Application to GAVI for support to introduce Pneumococcal Vaccine into the routine
immunization programme was approved.
x Interrupted transmission of the wild polio virus in eastern Uganda by implementing 4
rounds of house-to house polio campaigns in 48 high risk districts with coverage above 9
in all rounds. In the 48 districts where House - to - House SIAs were done, emphasis was
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made on need to improve routine immunization and districts prompted to do specific
district assessment and come up with innovative ways to improve routine immunization.
Due to the polio response activities carried out supervision in the 3rd and 4th quarters of
the F to 26 poorly performing districts instead of all districts.
Improvement in the supply of vaccines, injection materials from the centre to the districts
Support supervision towards improving routine immunization (RED STRATEG ). The regional
IDSR support supervisors provide regular on job support supervision to the districts
Monthly feedback is given to districts indicating performance of all the 112 districts, which
stimulates districts to work towards better performance
There has been regular support to districts through national and international Stop
Transmission of Polio (STOP) teams that contribute to enhancement and and strengthening
of surveillance activities
The UNEPI with support from WHO supports districts to conduct continuous active search
for polio and measles
x
x
x
x
x
x
Main challenges
x Inadequate and irregular release of funds particularly PHC funds that has resulted in
irregularity of outreaches in almost all districts causing dropouts, irregular supply of logistics
to health facilities and lack of support supervision.
x Inadequate transport at district level for delivery of supplies to the lower levels, for going to
outreaches and carrying out support supervision.
x The threat of importation of the wild poliovirus from neighbouring countries where it is still
circulating.
x Advocacy/communication/mobilization activities primarily promote immunization by
periodic events, such as CHDs and NIDS, not use of routine health services
ec
x
x
x
en a i ns
ann al lan
Advocacy for increased funding for national, districts and health facilities to facilitate better
implementation of immunization activities at these levels.
The threat for wild polio virus importation from neighbouring countries still e ists (section
on EDPPR suggests the threat is real) and there is need to strengthen routine immunization
and surveillance activities at all levels. Mass polio vaccination may have to be carried out in
districts that are high risk whenever recommended.
Introduce new vaccines that will reduce infant morbidity and mortality from targeted
diseases.
The EPI programme was strengthened through acquisition of cold chain equipment including
2 trucks. District Vaccine Stores were set up in the districts, refresher training of OPL health
workers and technical support supervision conducted at all levels. Intensified capacity
remarkable improvement in coverage for Pentavalent 3rd dose coverage from 76% in 2009/10
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to 90% in 2010, above the 80% HSSIP target for the year under review. Under one year old
immunization coverage for measles improved slightly from 72% to 85%, achieving the 85%
HSSIP target for the year. A total of 1,628 Measles cases were investigated and 326 were
confirmed in FY 2010/2011. During 2011 UNICEF has given some additional funding to 26
districts to reduce large numbers of un-immunized children. The additional funds were given
for 2 quarters ranging from 15 - 20 million per quarter. Some districts like Mukono, Maracha,
Mayuge, Kamuli, Buvuma - has shown remarkable improvement.
A total of 125 suspected cases of neonatal tetanus were reported (HMIS 2010/11) and of
these 101 were confirmed.
There is need for increased for increased community mobilization to utilize the available
services and strengthening capacity of districts to conduct supervision and diseases
surveillance.
3.3.2.5 Nutrition
Implementation of nutrition interventions to scale up delivery of nutrition services involves the
MoH and other stakeholders.
Core HSSIP indicator
x % U5 children with height /age below lower line (stunting) (m/f)
x % U5 children with weight /age below lower line (wasting) (m/f)
Lead programme indicators
x Maternal Infant and Young Child Feeding practices improved (Exclusive breastfeeding,
Timely introduction of complementary feeds)
x Accessibility to appropriate and gender sensitive nutrition information and knowledge
increased
x Vitamin A Supplementation coverage among children 6 - 59 months
x Households consuming fortified foods(Salt, cooking oil, wheat flour) increased
x Nutrition services to health units and the community scaled up
Annual plan 2010/11 top indicators
x Baby Friendly Initiative Assessment (BFHI) conducted in 4 districts
x Develop service standards for what is expected in nutrition at all levels on health care
including VHT.
x Integrate and harmonise strategies and guidelines on micronutrients
x
Design nutrition interventions using data for advocacy purposes
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Main achievements
x Health facilities supported to support, protect and promote breastfeeding through the
Baby Friendly Health Facility Initiative (BFHI) with support from partners (IBFAN)
x A nutrition training package for VHTs developed; Community Nutrition strategy concept
developed; Population nutrition handbook finalized; Maternal Nutrition and the Integrated
Management of Acute Malnutrition (IMAN) guidelines finalised; Consensus on the
development of an integrated micronutrient strategy and policy framework developed and
Concept and draft 0 developed.
x Support supervision for the implementation of Bi-annual supervision of Child days plus done
x Training of health care providers in positive deviance hearth (best practices) with support
from World Vision and Strides for Family Health
x Training of health care providers in Emergency Nutrition Assessment for Standard
Methodologies for Relief and Transition (ENA for SMART)
Main challenges
x Lack of adequate funds for support supervision funding, government funds not enough to
support BFHI scaling- up.
x Blockage of financial support by UNICEF limited implementation (Child Days Plus, Launching
of IMAM guidelines, Nutrition Information systems)
x Not able to incorporate improved methods of assessing micronutrient bio-markers in UDHS5
Recommendations for annual plan 2012/13
x Improving Maternal Infant and Young Child Feeding Practices (Exclusive breastfeeding at 6
months increased from 60% to 80%., Timely complementary feeding increased from 73% to
80%)
x Scaling up the implementation of child days Plus nutrition related activities
x Improving consumption and access to micronutrient fortified foods
The nutrition program implemented planned activities which were mainly geared at
strengthening the national program policy and strategies and capacity building at district
level. Information on the impact of these interventions will be availed by the UDHS – 5
conducted in 2011.
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Figure 13: Vitamin A Supplementation among under fives
There was a decrease in the number of
children 6 – 59 months receiving 1st
and 2nd doses of Vitamin A
supplementation from 1,415,155 first
dose and 1,238,683 in 2009/10 to
1,370,353 1st dose and 1,064,899
second dose in 2010/11 FY.
1,600,000
1,400,000
1,200,000
1,000,000
800,000
600,000
400,000
200,000
0
1st Dose
2nd Dose
The number of reported cases of malnutrition among the under five OPD new attendances is
at 0.24% of all OPD diagnoses and the proportion has remained constant over the last 3
years.
2008/09
2009/10
2010/11
No. of
% cases
Diagnosis
No. of
cases
No. of
% cases
Severe Malnutrition
(Marasmus, Kwashiorkor,
Marasmic-kwash)
37,878
0.12% 43,927
0.12% 41,840
0.12%
Low Weight For Age
38,326
0.12% 44,350
0.12% 40,994
0.12%
76,204
0.24% 88,277
0.24% 82,834
0.24%
Total
Source: MoH HMIS
%
Malnutrition is still a major problem in Uganda. During the year under review an upsurge of
malnutrition cases was reported in Namutumba district. Presently the biggest gap is to
empower and support mothers to improve child feeding, hygiene and care seeking. The
ministry should review the adequacy and reach of child feeding messages, capacity of
providers in counselling mothers to improve community IMCI family care practices and design
approached to mitigate this situation.
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3.3.3
Prevention and Control of Communicable Diseases
The priority health care interventions in the cluster of prevention and control of communicable
diseases include; prevention and control of STI/HIV/AIDS; prevention and control of malaria;
prevention and control of tuberculosis and elimination and or eradication of some particular
diseases such as Leprosy, guinea worm, onchocerciasis, trachoma, lymphatic filariasis,
trypanosomiasis, soil transmitted helminthes and schistosomiasis.
The overall objective for the communicable cluster is to reduce the prevalence and incidence of
communicable diseases by at least 50% and thus contribute towards achieving the health
related MDGs.
3.3.3.1 Prevention and Control of STI/HIV/AIDS
The aim of the STI/HIV/AIDS component of the HSSIP 2010/11 – 2014/15 is to prevent
STI/HIV/TB transmission and mitigate the medical and personal effects of the epidemic.
Core HSSIP indicators
x % of children exposed to HIV from their mothers access HIV testing within 12 months
increased from 29% to 75% (m/f)
x % eligible persons receiving ARV therapy (m/f)
Lead programme indicators
x The proportion of people who know their HIV status increased from 38% to 70%.
x The proportion of people who are on ARVs increased from 53% in 2009 to 75% by 2015
among adults and from 10% to 50% in children less that 15 years of age.
x HCT services available in all health facilities including HC IIs, and at community level
(Proportion of health facilities with HCT services; Proportion of community structures with
HCT services)
x PMTCT services available in all health facilities up to HC III’s and 20% of HC IIs (Proportion of
health facilities with PMTCT services; Proportion of HC IIs with PMTCT services).
x ART services available in all health facilities up to HC IV and 20% of HC III by 2015.
(Proportion of health facilities with ART services; Proportion of HC IIs with ART services).
x Reduce the HIV prevalence from 6.7% to 5.5% in the general adult population (15 - 49
years).
Annual plan 2010/11 top indicators
x Increase ART accredited facilities from 340 to 400
x Initiate 48,000 people on ART
x Initiate PMTCT services in 30% of HC IIs
x Review and launch Safe Medical Circumcision (SMC), HCT, PMTCT policies and start
circumcision for about 1 million young people aged 15 – 35 yrs
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Main achievements 2010/11
x Health Sector HIV strategic Plan launched
x AIDS Indicator Survey (AIS) conducted and near completion
x 68,000 HIV patients initiated on ART, ~ 10,000 children & ART sites increased by 100
x MTCT of HIV reduced to 5% from 7% in over 1,200 health facilities; New state of the art EID
lab established at CPHL and > 15,000 exposed babies accessed EID services
x Over 5 million accessed HIV counselling and Testing
Main challenges 2010/11
x Low human resources for health both in quality and quantity and weak leadership at district
level
x Inadequate resources and weak community health systems
x Poor data management
Recommendations for annual plan 2012/13
x Train in Leadership for health services especially DHOs
x Change re-training of existing HRH to mentoring
x Scale up all HIV prevention services despite challenges
A new HIV/AIDS strategic plan was launched and the AIDS indicator survey is near
completion. This will provide information on the current HIV/AIDS situation in the community.
Over the years, significant gains were made in the control of HIV/AIDS and in the mid 2000s
there was a reversal of trends from 6% antenatal HIV prevalence in 2005 to 9.7% in 2006.
However, of recent, antenatal clinic prevalence from sentinel sites have indicated a
decreasing trend from 9.7% in 2006 to 7% in 2009. (The HIV/AIDS Epidemiological Surveillance
Report 2010).
3.3.3.2 Tuberculosis
Tuberculosis remains a major public health problem in Uganda. This is compounded by the
emerging multi drug resistant Tuberculosis (MDR TB) problem. The high prevalence of HIV
(6.4% in the general population and over 50% among TB patients) is contributory to fuelling the
epidemic and TB still remains a leading cause of mortality amongst people living with HIV/AIDS.
The aim of the TB program is to reduce the morbidity, mortality and transmission of
tuberculosis.
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Core HSSIP indicators
x % new smear positive cases notified compared to expected - target 60% in 2010/11 and
70% by 2015
Lead programme indicators
x Case Detection Rate (CDR) % - target 60% in 2010/11 and 70% by 2014/15
x Treatment Success Rate (TSR) % - target 75% in 2010/11 and 85% by 2014/15
x Cure Rate in %
x % TB patients tested for HIV – target 80% in 2010/11 and 100% by 2014/15
x % HIV + TB patients started on CPT – target 90% in 2010/11 and 100% in 2014/15
Annual plan 2010/11 top indicators (implementation)
x Programmatic Management of Drug Resistant TB (PMDT) initiated; in line with this:
o
PMDT guidelines and tools developed, printed and disseminated
o 52 HWs (4/regional hospital) trained on MDRTB management (see bullet 3 for
SLDs)
o Routine surveillance of drug resistant TB strengthened: 61 HWs trained on TB
Sputum Specimen
o Referral System (TSRS); samples from high risk TB patients routinely referred to
NTRL for drug susceptibility testing for routinely identifying drug resistant TB
o MDR – TB Ward modelled and renovated
x
Standard NTLP R&R tools printed and distributed to districts
x
Anti TB Drugs procured: for drug susceptible TB (first line drugs) with donor (GF) funds and
for drug resistant TB (second line drugs) with government and donor (GF) funds
x
Anti-TB drugs and reagents distributed to TB zones and from TB zones to districts once
every 2 months
x
Coordination and planning
o Quarterly program management, planning and review meetings held at national
and zonal levels. Zonal meetings in 3 zones (North West, Eastern and Kampala)
supported with government funds and the rest of zones with donor (GF, GLRA,
WHO and USAID) funds
o Quarterly National TB/HIV Coordination meetings held
o Annual program review and planning meetings held
x
Technical Support supervision:
o Supportive supervisions carried out from National to each Zone once every six
months
o Quarterly supportive supervision from Zonal level held to 25% of the districts in
the zone per quarter
o DTLS and SCHWs supported to hold monthly SS (planned under donors mainly GF
funding)
x
National TB Reference Laboratory renovated and refurbished with CDC support
x
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National Commemoration of World TB and Leprosy Days held
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Main achievements 2010/11
x
Programmatic Management of Multi-Drug Resistant TB (PMDT)
- PMDT guidelines were developed and printed
- 24 out of 52 HWs were trained on MDRTB management
- 56 HWs were trained on TSRS and 1,623 out of expected 2,764 samples referred for
routine drug susceptibility (MDRTB) testing. Of these, 93 were identified to have
MDRTB in addition to those already on the national MDR-TB register
x
Procured 25,463 blisters of first line anti-TB drugs; and distributed to districts through
zones every 2 months as planned
x
Coordination and planning meetings held
o Held 3 out of 4 planned quarterly program planning & review meetings at
national level; however zonal level meetings held ranged from 50% in some
zones to 100% in others
o Held 75% of the quarterly
x
Performance in Technical Support Supervision:
- 50% (i.e. one round) of planned Central level support supervision was held to each
zone
- Monthly District SS by DTLS conducted
x
NTRL was renovated and refurbished with support from Centers for Disease Control (CDC)
and is now executing all its role
In respect of the lead program indicators, the following achievements were realised in the year:
x
81% of the TB patients were tested for HIV compared to 72% the previous year,
x
90% of the HIV positive TB patients were on Co-trimoxazole Prophylaxis (CPT) compared
to 81 % the previous year
x
However, there was under performance in CDR, TSR and ART coverage with CDR declining
from 57% to 54%, TSR from 70% to 67% while ART coverage stagnated at around a quarter
(24%)
Main challenges 2010/11
x
x
Lack of funds for procurement of Second Line Drugs (SLDs) has constrained the initiation of
PMDT in the country. Other preparatory steps such as an MDRTB Focal Person, a Green
Light Committee approval to procure SLDs, HWs training on MDRTB, admission facilities
etc are already in place. Moreover, a backlog of 172 MDRTB patients is on the national
register awaiting SLDs!
Underperformance in key program indicators: decline in case detection and treatment
success rates to 53.9% and 67.3% respectively due to a number of factors including:
uncertainty on the actual magnitude of TB problem in the country, unfavourable
treatment outcomes as a result of deaths, poor recording and reporting leading to
unknown outcomes and high defaulter rates in some districts
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x
x
Inadequate GoU funding plus heavy reliance on Donor support and the complexities
including irregular flows associated with some of the donor funds such as GF resulted in
limited technical support supervision. This support is necessary to guide peripheral health
workers to implement quality TB/HIV care.
Lack of a dedicated GoU budget line for anti-TB especially second line drugs
Recommendations for annual plan 2012/13
x
Government (MOH/MOFPED) should establish a dedicated budget line for TB drugs and
procure SLDs in order to enable the NTLP enrol the backlog of MDRTB patients on
treatment. This would minimise amplification of MDRTB and decrease mortality among
MDRTB cases as well as decrease spread of drug resistant TB within the communities
x
Government (MOH/MOFPED) should set aside a complementary budget line to facilitate
the conduct of a population based national TB Disease prevalence survey aimed at
establishing the magnitude of TB disease and to act as a baseline for monitoring progress
towards MDG targets
x
GoU should provide adequate and regular funding to enable NTLP and District Health
Teams to intensify support supervision, to mentor Health Workers with a view to
improving the quality of TB/HIV services including the R&R provided.
The NTBLP focused on the emerging problem of MDT, developed the PMDT guidelines and
established structures for management of MDT, however a backlog of 178 MDRTB registered
patients await SLDs to be enrolled on treatment. Coordination and supervision activities were
not fully implemented at all levels due to inadequate funding.
In respect of the NTLP lead program indicators, there was increase in TSR from 67% to 70%,
the number of TB patients tested for HIV from 72% in 2009/10 to 81% in 2010/11; and 90% of
the HIV positive TB patients were on Cotrimoxazole Prophylaxis (CPT) compared to 81% the
previous year. However, the performance on CDR and ARTs was not as impressive: CDR
declined from 56% to 54%, while ART coverage stagnated at around a quarter (24%). Some of
the factors for the apparent decline in CDR could be: uncertainty on the true magnitude of TB
burden in the country (estimated cases are only but an estimate hence the need to carry out a
TB Disease Prevalence Survey to establish the exact magnitude); an altered picture with a
tendency for HIV positive TB cases to be smear negative rather than smear positive (the
proportion of EP also tends to increase in high HIV prevalence and high TB and HIV coinfection settings like Uganda); repeated stock outs and/or NMS supplying poor quality
laboratory reagents reported by some districts also negatively impacts on CDR. Low cure rate
(40%) could be due to unfavourable treatment outcomes as a result of deaths, poor recording
and reporting leading to unknown outcomes and high defaulter rates in high TB burden
Urban setting – Kampala, Masaka, Mbarara and Jinja.
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3.3.3.3 Malaria
Malaria contributes to a significant cause of morbidity and mortality in Uganda especially in the
under fives and pregnant women. The aim of the National Malaria Control Program (NMCP) is
to reduce the morbidity and mortality rate due to malaria in all age groups.
The mainstay of intervention strategies are; prompt case management using artemisinin
combination therapy (ACT), Long Lasting Insecticide Treated Mosquito Nets (LLINs), Indoor
Residual Spraying (IRS) using efficacious insecticides and IPT in pregnant women. Epidemic
preparedness and response IEC/BCC and monitoring and evaluation and research and health
systems strengthening are part and parcel of the strategy.
Core Indicators
x The proportion of pregnant women who have completed IPT2 uptake increased from 47% to
50% by June 2011.
x The proportion of under-fives with fever who receive malaria treatment within 24 hours
from a VHT increased from 13.7% to 20% by June 2011.
Programme Indicators 2010/11 FY
x Reduce the prevalence of malaria among under fives
x Proportion of households with at least one ITN increased
x Proportion of households sprayed with insecticide in the last 12 months increased
x The case fatality rate among malaria in-patients under five reduced
x The percentage of public and PNFP health facilities without any stock outs of first line antimalarial medicines increased
x Malaria studies conducted
Main achievements
x A total of 7,289,921 LLINs were distributed to beneficiaries
x The proportion of registered U5 who received GFATM LLINs was 92% (6,302,890 LLINS out
of 6,913,872); 91% (825,449 out of 909,607 registered PWA received LLINs; and 161,582 out
of 176,517 village officials involved in the registration and distribution exercises
countrywide
x A total of 869,861 out of 899,716 (or 96.7%) houses in the 10 districts of Amuru, Nwoya,
Gulu, Oyam, Kole, Apac, Lamwo, Kitgum, Agago and Pader were sprayed during the year
under review. In addition to houses sprayed in the previous FY a total of 2,673,427 out of
2,756,339 (97.0%) were protected with IRS during the period under review.
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x
x
x
x
x
20 million ACT treatments provided through GoU, PMI, DFID and Global Fund leading to
reduction in ACT stock outs from over 50% to 20%
21 districts trained and effectively using RDTs for malaria diagnosis. 2.4million RDT tests
provided under Global Fund and PMI
Last FY year the NMCP held 50% (2 out of 4) of the planned RBM partnership coordination
meetings
Malaria program review conducted
A draft Larviciding protocol, work plan and the budget for the four Larvicides (Aquatain
AMF, Bti, SAFE and Abate) submitted to NDA and other regulatory bodies, for approval
Main Challenges
x Lack of ACTs for rolling out HBMF to the community level
x Delayed disbursements by GF led to serious consequences at all levels of the distribution
system.
x Insecticide resistance to Pyrethroids coupled with some communities and
environmentalists’ resisting use of DDT left the program with a more expensive chemical,
Bendiocarp, which could not be sprayed to all the 53 targeted districts due to budgetary
constraints.
Recommendations for annual plan 2012/13
x The NMCP should ensure that macro-planning is strengthened through earlier engagement
of stakeholders and preparation of relevant plans and materials way ahead of anticipated
net arrival.
x MoH should set clear timelines for tracking LLIN movement from the manufacturers to
central warehouses to facilitate timely communication to NDA and UNBS.
x Because of the increasing and spreading resistance of malaria vectors to pyrethroids, IRS
using non-pyrethroid insecticides should be fully supported if the effectiveness of LLINs is to
be maintained because all nets are currently being treated with pyrethroids.
x GoU should increase funding for IRS in order to drastically reduce malaria transmission in
the country and maintaining the low transmission rates using LLINs.
x All funds for IRS should be released at ago to enable IRS to be implemented, not piecemeal
on a quarterly basis as the case is now!
There was progress in implementation of the mainstay interventions for control and
prevention of malaria during the year under review through increased access to ACTs,
distribution of LITNs, and IRS. IEC/BCC activities were not emphasized in the planned activities
and not reported if carried out. A malaria program review was carried out and this will
provide information for strategic program planning.
There was a decline in the proportion of women who completed two doses of IPT from 47% in
2009/10 to 43% in 2010/11. It was not possible to establish the proportion of under fives with
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fever who receive malaria treatment within 24 hours from VHT because of lack of a reporting
mechanism. The use of IRS, distribution of ITNs and availability of antimalarials are expected
to reduce the prevalence of malaria among under fives and case fatality among malaria in
patients.
3.3.4
Diseases Targeted for Elimination
The diseases targeted for elimination and/or eradication include: poliomyelitis, guinea worm,
onchocerciasis, measles, leprosy, trachoma lymphatic filariasis, trypanosomiasis and
schistosomiasis. The overall objective for this cluster is to achieve national and global targets
for elimination or eradication of targeted diseases.
3.3.4.1 Onchocerciasis
The aim of the onchocerciasis program is to eradicate onchocerciasis and its vector in all
endemic districts in Uganda
Lead Program indicators
x Simulium nivae eliminated in all endemic districts in Uganda.
x At least 75% therapeutic coverage in all affected communities and 100% geographic
coverage achieved in endemic districts
x CDTI activities integrated within their district health plans in all endemic districts to
sustain integration.
Annual plan 2010/11 top indicators
x Number of supervisory visits
x Number of health workers and community distributors trained.
x Number of advocacy on onchocerciasis conducted.
x Number of adult Simulium flies caught in a monitoring site per month/yr
x Coverage for mass treatment
Main achievements 2010/11
x Transmission of onchocerciasis has been interrupted in Wadelai, Itwara and Elgon foci
covering seven districts (Nebbi Mbale, Manafwa, Bududa, Sironko, Kabarole, Kyenjojo).
x 2,239,900 people from 4,775 communities were treated for onchocerciasis with
geographical of 95.7% and therapeutic coverage of 78% in 2010.
x Onchocerciasis vector eliminated in three foci (Itwara, Mpamba-Nkusi, Elgon).
x The development of draft Guidelines for Certification of onchocerciasis elimination in
Uganda.
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x
Initiation of mass treatment with ivermectin in the control of onchocerciasis involving
community participation in post-conflict district of Kitgum, Pader and Lamwo.
Main challenges 2010/11
x Maintaining the high geographic and therapeutic coverage in endemic districts.
x Demand for incentives by Community Medicine Distributors.
x Delay in release of operation funds at district level.
Recommendations for annual plan 2012/13
x The District Onchocerciasis Coordinators should ensure the attainment of high
geographical and therapeutic coverage in the affected communities.
x The Ministry should extend the training of VHTs to cover all the districts so as to
minimize the demand for incentives among the CMDs.
x The district Chief Administrative officers should ensure timely release of operational
funds.
The onchocerciasis program has successfully eliminated the simulium vector in three foci and
interrupted transmission in seven districts. A total of 8,410 cases of onchocerciasis were
reported in the OPD attendances in 2010/11, 8,404 reported in 2009/10 and 10,132 in
2008/10. There is need for sustained efforts to attain high geographical and therapeutic
coverage in affected communities as the sector works towards certification of onchocerciasis
elimination in Uganda.
3.3.4.2 Lymphatic Filariasis
The aim of the lymphatic Filariasis program is to reduce and ultimately interrupt transmission of
the disease in all endemic communities through the use of chemotherapy with Ivermectin and
albendazole.
Lead Program indicators for Lymphatic Filariasis
x Therapeutic coverage for the affected people with single annual dose of Invermectin and
Albendazole maintained.
x Geographical coverage for the affected communities with single annual dose of Invermectin
and Albendazole.
x Mapping of areas with lymphatic filariasis in all endemic districts completed by 2011/12.
x Morbidity and disability associated with lymphatic filariasis reduced
Annual plan 2010/11 indicators
x Number of tablets for each drug supplied and consumed during Mass Drug distribution
(MDA).
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x
x
x
x
Proportion of eligible population taking antifilarial medicines annually (>65%) and targeted
communities (100%).
Microfilariae prevalence in sentinel and spot check sites
Districts with antigenaemia rate above 1%
Hydrocelectomies done at district and national levels ,and Districts reporting lymphoedema
management
Main achievements 2010/11
x 20,553,500 and 12,561,500 tablets of Invermectin and Albendazole respectively procured
and distributed.
x All target districts received antifilarial medicines ( Awaiting districts reports to establish the
eligible population which received treatment)
x Sites in districts which have undergone 4-5 MDA rounds surveyed for microfilariae
prevalence
x Lymphatic filariasis map refined in 14 districts in central, Western and south western
Uganda
x 25 districts support supervised specifically for lymphatic filariasis with focus on morbidity
management (hydrocelectomy and lymphoedema management).
Main challenges 2010/11
x Delay in submission of reports from the districts
x Failure to include hydrocelectomy as a routine surgical activity
x Reports on non-filarial elephantiasis.
Recommendations for annual plan 2012/13
x The Neglected Tropical Disease Control program Secretariat should ensure that planning is
strengthened through engagement of stakeholders and preparation of relevant plans and
materials made prior to implementation.
x Government of Uganda should increase funding to address morbidity management
(hydrocelectomy at health centres and lymphoedema management at community level).
x Ministry of Health should provide transport to ease program supervision especially
monitoring and evaluation of program sentinel and spot–check sites.
The Lymphatic Filariasis program has sustained efforts in maintaining the therapeutic
coverage with single annual dose of ivermectin and biannual dose of albendazole.
Delay in submission of district and prevalence survey reports prevents effective program
monitoring. Vector elimination activities not prioritised.
3.3.4.3 Veterinary Public Health
The mandate of VPH unit is to prevent and mitigate the impact of zoonotic diseases thereby
improving the health of the population of Uganda. The most notable are; Highly Pathogenic
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Avian influenza (H5N1), pandemic influenza H1N1, Severe Acute Respiratory Syndrome (SARS),
Bovine Spongiform Encephalopathy / variant-Creutzfeld-Jakob Disease (Mad Cow Disease). In
Uganda, outbreaks of Ebola Heamorrhagic fever (HF) and Marburg HF have occurred with
increasing frequency in the last five years. There has also been a re-emergency of anthrax,
mange and plague which occur sporadically in wildlife and domestic animals and they
occasionally spill over and spread into the human populations. At the same time long
established zoonotic diseases such as rabies, bovine TB, brucellosis, cysticercosis and
hydatidosis have remained endemic among the population in most developing countries
including Uganda.
Lead programme indicators
x Zoonotic diseases technical guidelines, developed and disseminated by 2011/2013.
x The proportion of General Hospitals and RRH conducting proper laboratory diagnosis of
brucellosis increased by 20% and 50% by 2015 respectively
Annual plan 2010/11 top indicators
x Train health staff on emerging, re-emerging and endemic zoonotic diseases
investigations, prevention & control
x Develop, print & disseminate IEC materials on rabies
x Conduct technical support supervision to districts
Main achievements 2010/11
x Technical support supervision undertaken in 15 Districts of Apac, Soroti, Oyam, Dokolo,
Lira, Nakasongola, Luwero, Hoima, Masindi, Zombo, Nebbi, Arua, Bundibugyo, Mubende
and Mityana
x Developed, & translated rabies health education (IEC) materials in Ateso in the districts
of Kaberamaido, Soroti, Bukedea, Ngora and Kumi.
x Undertook an assessment on availability, quality, type and location of IEC materials on
zoonotic diseases in districts and health units in districts of Mityana, Kyegegwa,
Kyenjojo, Kabarole and Ntoroko
x Conducted training on rabies post exposure treatment and case management for health
workers in 5 regional referral hospitals of Jinja, Mbale, Soroti, Lira and Gulu
x Sensitized teachers and school children in 4 districts of Alebtong, Otuke, Kaberamaido
and Dokolo on prevention and response to influenza and other zoonotic diseases of
public health importance
Main challenges 2010/11
x Insufficient funds allocated for planned activities
x Under staffing of the division (one established post for one technical officer and two
technical assistants on short term contracts)
x
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Stock out of anti-rabies vaccine
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Recommendations for annual plan 2012/13
x Streamline the availability of human rabies vaccine and treatment regimen for rabies
post exposure prophylaxis.
x Zoonotic diseases technical guidelines developed and disseminated
x The proportion of General hospitals and RRH conducting proper laboratory diagnosis of
brucellosis increased by 20% and 50% by 2015 respectively.
The VPH unit built capacity for collaboration, investigation and management of zoonotic
diseases in a few districts. According to the MoH HMIS report, the number of reported cases
of animal/snake bites increased from 41,802 in 2009/10 to 42, 529 in 2010/11; and the
number of suspected rabies reduced from 200 IN 2009/10 to 145 in 2010/11.
Diagnosis
2008/09
Animal/ Snake Bite
Suspected Rabies
2009/10
20101/11
37,184
41,802
42,529
205
200
145
There is increased reporting and demand for post-exposure vaccination for rabies, which was
not readily available to districts for most of the year under review.
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3.3.5
Prevention and Control of Non-communicable Conditions
Uganda is currently experiencing dual epidemics of communicable and non communicable
diseases. The changing life styles have resulted in an increase in the prevalence of non
communicable diseases like Diabetes mellitus, cardiovascular diseases, chronic respiratory
diseases and cancer. It is an opportune moment for the ministry to give relevant attention to
non communicable diseases.
The diseases/conditions addressed by the cluster on Prevention and Control of NonCommunicable Diseases/Conditions include; Cardiovascular Diseases, cancers, Diabetes,
Chronic Obstructive Pulmonary Diseases and sickle cell disease.
3.3.5.1 Prevention and Control of NCD
The non communicable disease programme was established in 2006/07 Financial year to plan,
implement and coordinate actions aimed at preventing and controlling NCDs in Uganda. The
increasing urbanization and changing lifestyles is exposing most of the population to unhealthy
life styles and this is immensely contributing to the rising incidence of NCDs.
The aim of the NCD programme is to reduce morbidity and mortality attributable to NCDs
through appropriate interventions.
Lead programme indicators
x NCD survey carried out to determine;
o Prevalence of diabetes among >25 yr olds
o Prevalence of raised BP among >25 yr olds
o Prevalence of current daily tobacco smoking among >15 year olds
o Percentage of Health facilities with the capacity to provide adequate NCD
prevention and management services
x Coverage of cervical cancer screening
Annual plan 2010/11 top indicators (implementation)
x Report of the Uganda NCD Survey
x Coverage of cervical cancer screening
Main achievements 2010/11
x Uganda NCD Survey planning completed
x Draft 0 Uganda NCD policy developed
x Draft 0 of the Uganda cancer strategy developed
x MOU for establishing specialized services for management of Type 1 diabetes signed
x The Cervical cancer screening was costed although not yet funded.
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Main challenges 2010/11
x
x
x
x
x
x
x
Lack of reliable baseline data on the prevalence of NCDs and their risk factors. This is
delaying formulation of evidence based NCD policies as well as developing comprehensive
and integrated interventions against NCDs
Insufficient community awareness on NCDs, leading to high prevalence of NCD risk factors,
late presentation of patients to health facilities for proper treatment and poor treatment
outcomes
Inadequate capacity of the existing health system to provide quality NCD services,
specifically there is an insufficient number of adequately trained health workers and lack of
appropriate NCD screening, diagnostic and monitoring equipment at appropriate levels of
health care.
Unavailability/High cost of medicines and supplies for effective management of NCDs,
particularly at lower level health facilities.
Understaffing of the NCD Programme
Lack of funds to scale up screening for cervical cancer
Lack of funds to support operational activities for mass vaccination of HPV, yet free vaccines
were donated by MERCK.
Recommendations for annual plan 2012/13
x Implement the Action plan of the 2008 - 2013 Global Strategy for the prevention and
control of Non communicable diseases.
x Empower the NCD programme with more staff and required resources to enable it to fulfil
its mandate.
x Promote partnerships with Development Partners, the Academia, Civil Society
Organisations and others to strengthen the Ministry’s financial and technical capacity to
implement NCD prevention and control interventions
x Commence implementation of the cervical cancer strategy, beginning with scaling up of
cervical cancer screening and mass HPV vaccination.
Available data from the HMIS shows that the number of new patients attending OPD with
hypertension and diabetes is increasing annually.
Diagnosis
2008/09
2009/10
2010/11
% of total
% of total
% of total
OPD
OPD
OPD
Number
attendance Number
attendance Number
attendance
Hypertension
Diabetes
Mellitus
185,864
0.6%
190,065
0.5%
200,221
0.6%
81,420
0.3%
75,066
0.2%
86,010
0.2%
Source: MoH, HMIS
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The continued lack of community based data has delayed the formulation of evidence based
national NCD policies and strategies as well as the development of a comprehensive and
integrated action plan against NCDs in our population. There were limited public awareness
activities for prevention and control of NCDs.
3.3.5.2 Injuries, Disabilities and Rehabilitative Health
The element of injuries, disabilities and rehabilitative health aims at decreasing the morbidity
and mortality due to injuries, common emergencies and disabilities from visual, hearing and
age-related impairments. This can be due to damage or harm done to or suffered by a person
before or after birth. Such deprivation or loss of competency includes conditions like: deafness,
blindness, physical disability and learning disability.
Lead Programme Indicators
x Visual impairment reduced from an estimated level at 0.8% to 0.7%
x Hearing impairment reduced from 8% to 0.6%
x Provision of assistive devices to PWDs who need
x Reach 80% of the population with messages on disability prevention and rehabilitation.
x All Trachoma endemic districts reached with mass distribution of Azithromycin and
Tetracycline during Child Days Plus activities.
x Trachoma prevalence studies conducted in all suspected trachoma endemic districts.
x Increase provision of eye lid rotation surgical services to patients with Trachoma trichiasis
from 10% to 30%.
Annual Workplan Indicators
x Advocacy plan on disability prevention in place
x No and type of IEC materials produced
x No. of International Days commemorated
x No. of H/workers trained
x No. of Policies, Standard Guidelines and Strategic plans developed.
Main Achievements during 2010/201
x Low Vision guidelines produced and disseminated
x NTDs five year integrated strategic plan developed.
x 362 wheelchairs donated by the Church of the Later Day Saints distributed to PWDs.
x In collaboration with partners involved in Road Safety Campaign launched A Decade of
Action on Road Safety – 2010 – 2020 at Malaba.
x 32 health workers trained in wheelchair assessment and fitting.
x Twelve (12) OCOs trained in Low Vision assessment and refraction.
x In collaboration with ICRC Mbale orthopedic workshop re-activated for production of
assistive devices.
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Main Challenges
x Understaffing
x Inadequate support to orthopedic workshops
x Low priority accorded to disability programmes at all levels.
x Coordination of many stakeholders with varying interests.
Injuries and disabilities are an increasing problem as a result of road traffic accidents. Many of the
road traffic accident victims end up with permanent disabilities. Trauma due to other causes is among
the top ten causes of morbidity in Uganda.
2008/09
% of total
OPD
Number
attendance
Diagnosis
Injuries = (Trauma
due to Other Causes)
Injuries - Road
Traffic Accidents
Source: MoH HMIS
2009/10
% of total
OPD
Number
attendance
2010/11
% of total
OPD
Number attendance
627,412
2%
641,987
2%
657,542
2%
122,559
0.4%
124,727
0.3%
131,323
0.4%
CSOs have been actively involved in rehabilitation and provision of assistive devices. The proportion of
the population reached with messages on disability prevention and rehabilitation has increased in
trachoma endemic areas with support from Sight Saver International.
3.3.5.3 Mental Health
The mandate of the mental health program is policy formulation, planning, resource
mobilization, setting standards, capacity building, coordination of interventions that address
the high burden of mental health problems in Uganda, which stands at about 13% of the
burden of diseases. The program aims at ensuring increased access to primary and referral
services for mental health, prevention and management of substance abuse problems,
psychosocial disorders and common neurological disorders such as epilepsy.
Programme indicators
x Mental Health Law enacted by 2011/12
x Mental Health Policy finalized and operationalized by 2010/11
x Operationalise mental health units in all RRHs by 2010/11
x Community access to mental health services increased from 60% to 80%
x A community strategy for prevention of mental health problems developed by 2013/14
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Planned output 2010/11
x Commemoration of World Mental Health Day, World No Tobacco Day and the International
Day against Alcohol and Drug Abuse.
x Develop IEC materials for mental health, tobacco control and alcohol abuse control
x Orientation of Health Workers in use of the WHO ASSIST Tool for assessment of substance
abuse; and training of Regional Trainers in mental health service delivery
x Finalize drafting of the Mental Health Bill for presentation to Cabinet
x Development of a Communication Strategy for Mental Health community education
x Supervision of mental health services at 8 Regional Mental Health Units
Main achievements
x Mental Health Bill Drafted and ready for presentation to Cabinet
x Training of Regional Trainers in mental health with support of SHSSP Project
x Draft Communication Strategy for mental health education to the community developed
x Mental Health Policy Drafted and ready for presentation to Top Management
Main challenges
x Gross underfunding of the programme in relation to the mandates
x Lack of progress due to multi sectoral nature of activities e.g. Mental Health Bill drafting
x Programme is understaffed.
Recommendations for annual plan 2012/13
x Increase funding to the programme in order to complete consultation process for Mental
Health Policy, Tobacco Control Policy, Alcohol Control Policy and Drug Control Master Plan
x Strengthen inter sectoral collaboration through consultative meetings to hasten process of
policy development and implementation
x Implement the proposed restructuring to increase staff in the Mental Health Programme
A number of interventions were implemented to address the high burden of mental health
problems in Uganda. According to the MoH HMIS, reported new mental health problems
accounted for almost 1% of all new cases with epilepsy as the most common mental health
problem.
Diagnosis
Epilepsy
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2008/09
% of total
OPD
Number attendance
Number
176,851
185,709
0.6%
2009/10
2010/11
% of total
OPD
attendance
Number
0.5%
194,018
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0.6%
Other Forms
of Mental
Illness
Anxiety
Disorders
24,257
0.08%
29,147
0.08%
32,578
0.09%
20,456
0.06%
21,448
0.06%
23,693
0.07%
Depression
18,774
0.06%
20,523
0.06%
22,069
0.06%
Mania
13,591
0.04%
12,546
0.03%
17,290
0.05%
10,272
0.03%
9,429
0.03%
13,722
0.04%
9,508
273,709
0.03%
0.9%
8,632
287,434
0.02%
0.78%
12,361
315,731
0.04%
0.95%
Schizophrenia
Alcohol and
Drug Abuse
Total
Source: MoH HMIS
Community access to mental health services has been increased by the construction of mental health
units at Regional level and provision of essential mental health and anti-epilepsy drugs. There is need
for strengthening the program through increased community awareness and strengthening the legal
and policy environment for mental health service provision.
3.3.5.4 Oral Health
The aim of the oral health program is to improve the oral health of the people of Uganda by
promoting oral health and preventing, appropriately treating, monitoring and evaluating oral
diseases.
Lead programme indicators
x Oral health policy implementation guidelines developed and disseminated.
x The proportion of HC IVs with well equipped and functional dental units increased
x The proportion of the population with access to primary oral health care increased
Annual plan 2010/11 top indicators (implementation)
x Oral health care guidelines developed
x Sensitisation materials prepared
x Oral health education and screening for oral diseases
Main achievements
x Health workers have been trained on oral health care
x School teachers’ guide on oral health care developed
x School oral health education conducted.
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Main challenges
x Inadequate equipment in most hospitals and HC IVs.
x Lack of dental supplies infrastructure in the most districts.
x No recruitment of dentists in districts and dental oral health education coverage is still very
low due to low funding and under staffing.
Recommendations for annual plan 2012/13
x Integration of oral health into maternal and child health, nutrition, HIV/AIDS and school
health programmes.
x Procurement of dental materials and equipment for RRHs and GHs
x Equitable deployment of oral health workers in the districts.
The oral health policy implementation guidelines were not developed due to inadequate
resources. The number of new OPD attendances due to oral diseases and conditions was
535,650 in 2010/11, 551,810 reported in 2009/10 and 518,861 in 2008/09. The quality of
services offered to this high number of patients is affected by the lack of functional dental
units and inadequate oral health professionals at lower levels. There is need to prioritize
procurement of dental equipment and deployment of oral health workers in the districts.
3.3.5.5 Palliative Care
The aim of palliative care is to improve the quality of life of patients and their families facing
the problem associated with disease not responsive to cure, through the prevention and relief
of suffering by means of early identification, assessment and treatment of pain and other
symptoms, physical, psychological and spiritual.
Lead programme indicators
x Guidelines and standards for palliative care developed.
x All hospitals and HC IVs providing palliative care.
x Adequate stocks of appropriate medication and supplies at palliative care centers are
available.
Annual plan 2010/11 top indicators
x Roll out palliative care to Hospitals and lower level health facilities in central region
x Train village health teams in palliative care
x Ensure adequate stocks of oral morphine in NMS for use by palliative care centres in
Uganda
x Integrate palliative care in to health training school syllabus
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Main achievements 2010/11
x Palliative care centres functionalised in Namutumba and Mayuge districts
x VHTs trained and successfully integrated into palliative care activities in Namutumba and
Mayuge districts
x Oral morphine is available at National Medical Stores for order by accredited centres
x Palliative care has been successfully introduced in syllabus of health training institutions.
Main challenges 2010/11
x There is still limited appreciation of Palliative Care among most health facility managers, the
public and policy makers.
x Inadequate funding to meet the training needs for the health workers.
x There has been slow scale up of Palliative Care services to districts.
Recommendations for annual plan 2012/13
x Intensify on awareness creation amongst health workers, facility managers and policy
makers on palliative care
x Strengthen partnerships with development partners for further action and resource
mobilisation
x Increase the number of health workers with skills in palliative care
The Palliative care pilot model implemented in Namutumba and Mayuge district has
demonstrated the capacity of lower levels units in providing quality palliative care services
thus increasing access to palliative care. Lessons learnt should be used to scale up palliative
care services in other districts.
3.3.5.6 Nursing
The nursing profession provides the largest workforce in the health sector in a diverse
environment thus participating in a wide spectrum of service delivery. The department of
Nursing is responsible for promoting collaboration and coordination of nursing and midwifery
activities amongst stakeholders nationally and internationally while ensuring adherence to
ethics and standards.
Annual plan 2010/11 top indicators (implementation)
x Proportion of planned technical support supervision visits to identified health facilities
conducted
x Proportion of planned capacity building workshops (leadership, management and skills
building in clinical area) for nurses and midwives conducted
x Draft policy guidelines for nurses and midwives in place
x Collaboration and coordination meetings attended/conducted
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Main achievements
x Conducted 8 Technical Support supervision visits and mentored nurses and midwives in 2NRHs, 6
RRHs, 8GHs and 6 HC 1Vs; and carried out integrated interdepartmental support supervision
between the nursing departments, Reproductive Health Division to the 7 UNFPA supported
districts (Masindi, Kanungu, Kabong, Katakwi, Yumbe, Moroto and Amuria)
x Conducted Capacity building workshop for 25 nurse leaders in leadership and management
skills
x Drafted the Nurses and Midwives policy guidelines, started on the development (Nurses
and midwives strategic plan) of the implementation framework for HSSIP 2010/11 –
2014/15 for nurses and midwives, finalized the scheme of service for nurses and midwives
to incorporate new cadres e.g. comprehensive nurses, degree nurses; and developed a
proposal on the “Development and implementation for scope of practice for Nurses and
Midwives”.
x Conducted 3 coordination meetings to streamline and harmonize of nursing activities both
nationally and internationally; attended ECSACON scientific conference in Zambia.
Main challenges
x Inadequate resources for the implementation of planned activities
x Lack of orientation of newly posted nurse leaders at various levels in management and
taking up their tasks
x Lack of routine coordination meetings to harmonize nursing activities at various levels
x Unreliable transport for coordination and supervision
Recommendations for annual plan 2012/13
x Scale up technical support supervision visits and mentorship to enhance the provision of
quality nursing care
x Strengthen leadership and management skills for nurse leaders through capacity building
x Strengthen coordination and collaboration of nursing activities with key stakeholders
nationally and internationally.
Nurses and midwives cadre are among the critical cadre on demand in the health sector. High
attrition rate coupled with low staffing has made the few available overworked and less
motivated. There is need to review the staffing norms and implementation of the motivation
strategy in order to uplift the quality of services and reduce on absenteeism.
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3.3.5.7 Integrated Essential Clinical Care
The intervention of providing integrated essential clinical care aims at improving access to
equitable and quality clinical services at all levels in both the public and private health
institutions through:x Strengthening the capacity of hospitals to provide integrated care
x Increasing the range of health services provided by hospitals
Lead programme indicators
x The functionality of the HC IVs increased from 5% to 50% by 2014/15.
x Standards for best practice in hospitals established by 2012.
x Blood Transfusion Centres set up in all RRHs (2 each year)
x ICU/CCU established in 40% of the RRHs (1 ICU in RRH each year) by 2014/15
Annual plan 2010/11 top indicators (implementation)
x Professional mentorship from National and Regional Referral hospitals to general hospitals
and HC IVs
x Number of policies, laws, guidelines, plans and strategies developed (Internship policy
developed; national fistula strategy finalized; guidelines for Community Health Department
Developed; guidelines for infection control committees, human organ transplant bill)
x Number of integrated and technical support supervision visits to all RRHs and 126 general
hospitals
x Supervision of 5S-CQI-TQM in Tororo, Mbale, Busolwe, Kapchorwa, Entebbe and Masafu
hospitals.
x Quarterly supervision visits to Community Health Departments in hospitals
x Number of health workers trained (universal precautions and infection control; hospital
management)
x Number of meetings held (hospital managers, Medical Board, National Internship
Committee)
Main achievements
x The National Obstetric fistula strategy was finalized and is in print
x Guidelines for infection control committees is in final phases of development
x Guidelines for Health facility management committees/boards were revised
x All the 13 RRHS were supervised at least once during the year
x Some general hospitals received emergency supervision to Kitgum, Bududa, Apac, Kisiizi,
Mutolere, Nyakibale, Atutur, Gombe, Yumbe, Nebbi and Kamuli.
x 5S-CQI-TQM sites in Tororo, Mbale, Busolwe, Kapchorwa, Masafu, Gombe and Entebbe
hospitals were supervised in all the quarters.
x Health workers in health facilities in Masaka RRH were trained in universal precaution and
infection prevention and control
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x
Hospital managers meeting was held in Lira RRH, 4 National Internship Committee meetings
were held, 16 medical board meetings were held, 49 people were referred for treatment
abroad and 42 were retired on medical grounds.
Main challenges
x Lack of funding for the Professional mentorship from National and Regional Referral
hospitals to general hospitals and HC IVs program hampered implementation.
x Delayed and inadequate funding
x Lack of fund for referring retired and local citizen for treatment abroad
x Understaffing in the integrated curative division
Recommendations for annual plan 2012/13
x Solicit funding for the specialist outreach program from National to Regional, District and
HC IVs
x Networking with relevant departments
x Better staffing for the division
x More funding for the Medical Board activities
3.3.5.8 National Referral Hospitals
There are two national referral hospitals, Mulago and Butabika offering a range of specialized
care services.
Mulago Hospital
Mulago Hospital is the National Referral Hospital for those who require specialized and superspecialized care. Its official bed capacity is 1,643 beds. The average bed occupancy for FY 10/11
was 95%.
Annual plan 2010/11 top indicators
Target
Number of outpatient services to
700,000
Number of inpatients (New Admissions)
140,000
Number of patients requiring emergency services attended to
60,000
Number of patients who received specialized services
180,000
Number of Laboratory tests carried out
1,800,000
Number of radiological imaging carried out
60,000
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Main achievements 2010/11
Number of specialized outpatients attended to
120,201
Number of general outpatients attended to
730,012
Number of inpatients attended to
145,241
Number of emergency cases attended to
52,103
Number of Laboratory tests
1,202,259
Number of patients Imaged
63,552
Main challenges 2010/11
x Understaffing
x Under funding especially for recurrent expenditure like on food for patients
x High patient turn up
x Poor infrastructure especially for staff accommodation.
Recommendations for annual plan 2012/13
x Continue to work with MOH and KCCA to fast tract the decongestion of Mulago Hospital.
x Rehabilitate and construct staff houses.
x Advocate for increase of the budget.
Butabika Hospital
Butabika Hospital is the National referral hospital for Mental Health. It has 550 beds capacity
and bed occupancy was 126% in 2010/11
Lead Programme Indicators
x Number of inpatients
x Number of outpatients
x Number of outreach visits conducted.
x Number of support supervision visits registered.
x Number of staff houses constructed.
Annual Plan 2010/2011 Top Indicators (Implementation)
x 28,000 mental patients and 50,000 medical outpatients attended to.
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x
x
x
46 outreach clinics conducted, 2600 patients attended to.
4 staff houses constructed.
6,000 patients admitted, investigated and treated.
Main Achievements 2010/11
x Provided inpatient mental health services to 2,248 and 3,874 patients on first visit and readmission respectively
x Mental health outreach clinics where 2,396 patients were treated.
x Provided Mental Health Training to 471 students from various institutions of higher learning
x 629 patients were resettled to their homes.
x Provided general outpatient and PHC services to 28,131 in the specialized mental health
clinic and to 50,390 patients with general medical conditions
x Three staff houses constructed
Main Challenges 2010/11
x Inadequate funding
x High patient numbers vis – a - vis the available facilities.
x Understaffing
Recommendations for Annual Plan 2012/13
x Increase budget by 50%
x Operationalise the referral system for Mental Health Care.
x Approve proposed staffing structure and accordingly fill the vacant positions.
3.3.5.9 Diagnostic and Blood Transfusion Services
1. Uganda Blood Transfusion Services
The main goal of Uganda Blood Transfusion Services is to collect, process, provide safe and
adequate blood and blood products and promote safe blood transfusion practice. This is
through seven regional blood banks located in Mbarara, Mbale, Gulu, Fortportal, Kitovu, Arua
and Nakasero and six blood collection centers in Jinja, Soroti, Lira, Hoima, Rukungiri and Kabale.
In addition, it oversees a national blood donor education and recruitment programme as well
as handling education and training in blood safety. In playing these roles, Uganda Blood
Transfusion Services plays a central role in prevention of HIV/AIDS transmission and other
blood borne diseases e.g. Hepatis B, syphilis.
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Lead programme indicators
x Total number of blood units collected form voluntary non-remunerated donors
x % of donated blood screened in a quality controlled manner
x No. Of blood units discarded after screening
x Proportion of health units receiving 100% of blood units used for transfusion from UBTS
x Number of blood donors counselled for any TTI.
Annual plan 2010/11 top indicators (implementation)
x Number of blood donor mobilisation sessions
x Total number of units of blood collected and processed
x Number of regional blood banks constructed
x No of supervision visits carried out
Main achievements 2010/11
x 4,511 blood collection sessions held
x 187,828 out of 200,000 planned blood units collected from VNRBD
x Expansion of Nakasero Regional Blood Bank completed
x 227 health care facilities received blood
x 4 supervision visits undertaken
Main challenges 2010/11
x Inadequate funding
x Inadequate infrastructure
x Inadequate outreach to potential donors
Recommendations for annual plan 2012/13
x Increase funding for Blood transfusion activities – GOU/ Donors
x Construct RBBs for each regional Referral hospital
x Improve clinical interface for appropriate blood use
The UBTS is facing increasing demand for safe blood provision in respect to the growing population
and increasing access to services by functionalizing the HC IVs. Construction of the Regional Blood
Banks and procurement of consumables needs to be prioritized to enable the UBTS provide adequate
supplies of safe blood.
2. LABORATORY SERVICES
Lead programme indicators
x Percentage of health facilities with laboratory services fully supporting UNMHCP
x Percentage of laboratories that are successfully participating in EQA schemes
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x
x
Percentage of outbrea s with laboratory confirmation
Percentage laboratories certifie an accre ite by international an national agencies
Ann a p an 2
top indicators
x Number of gui elines policies evelope an implemente
x aboratories accre itation
x Percentage of laboratories successfully participating in e ternal uality assessment
x
x
x
x
x
ain ac ie ements 2
evelope an starte implementing a year strategic plan for laboratory services
evelope a laboratory testing menu EN classifie list of laboratory supplies stan ar list
of laboratory e uipment an laboratory physical infrastructure stan ar s for ifferent
levels of care
nitiate the preparation of
laboratories inclu ing national reference
national
referral hospital regional hospital an
general hospital for accre itation
A ministere proficiency panels to
laboratories with about
registering satisfactory
performance
Confirme
out of
of outbrea s investigate
ain c a enges 2
nappropriate management structure of laboratory services in the country
ac of regional role in the coor ination of laboratory uality assurance at lower level
facilities
x na e uate national laboratory information management systems
x
x
Recommendations or ann a p an 2 2
x E pe ite the restructuring process so as to improve on the laboratory services management
x
trengthen the role of regional hospital laboratories in coor ination of laboratory uality
assurance in lower level laboratories
The process of strengthening laboratory services in Uganda was started by developing a 5
year strategic plan for laboratory services. there is need to operationalise this strategy by
putting in place the relevant management structures, carry out accreditation and ensure
provision of adequate laboratory supplies.
. RA IOLO Y SERVICES
Lead programme indicators
x
o provi e a wi e range of uality iagnostic an imaging services
x
o con uct a research
x
o provi e support supervision to regional an istrict hospitals
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Ann a p an 2
top indicators imp ementation
x Number of mo ern ra iological e uipment procure in all hospitals
x Percentage of the e uipment properly maintenance throughout the year
x Number of support supervision carrie out to the upcountry hospitals to ascertain the
service elivery
ain ac ie ements 2
x
upplie imaging e uipment to HC an Hospitals
x
perational research was con ucte an publications ma e
x Continuing professional evelopment through wor shops an conferences by the various
associations that bring together a iation or ers were carrie out
ain c a enges 2
x
api echnology a vances re uire that we eep up ating our e uipments listless we fail to
get spare parts on the mar et
x
re uent brea owns an elaye repairs ue to lac of service contracts he service
contracts cannot be finance by the current bu getary allocations
x ac of consumable for the ra iological services
Recommendations or ann a p an 2 2
x Ensure that there are service contracts to enable repair the available e uipment in all
hospitals
x Procure mo ern ra iological e uipments as recommen e by NACME for hospitals country
wi e
x
treamline the supply of consumables for the ra iology services in hospitals
A limited range of radiology and imaging services are mainly provided by referral and general
hospitals and specialized diagnostic centres in the country. Imaging equipment was installed
in some HC IVs and hospitals and users trained. Most of the x-rays in hospitals are very old
requiring replacement. There is need to revamp the entire radiology and imaging services by
ensuring availability of functional equipment, trained personnel and provision of adequate
supplies. The new guidelines should be disseminated and operationalized.
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3.4 Integrated Health Sector Support Systems
uring H P
the sector will focus on putting in place the necessary inputs
that are nee e to ensure there is improve access to health services hese inputs relate to
the human resources infrastructure inclu ing e uipment C an transport an me ical
pro ucts
3.4.1
Human Resources for Health
he health sector is committe to attainment an maintenance of an a e uately si e
e uitably istribute appropriately s ille motivate an pro uctive wor force in partnership
with the private sector matche to the changing population nee s an eman s health care
technology an financing
Core SSI indicator
x
of posts fille by s ille Health wor ers
x
Annual re uction in absenteeism rate
Lead programme indicators
x Number of istricts with functional Human esource nformation ystem H
x Number of Human esource for Health managers traine in ea ership an Management
x Number of H traine in esults riente Management
x Percentage of health managers in H with signe Performance Agreements
x
x
x
x
x
x
an 2
top indicators imp ementation
Human resource au it report in istricts an
Hs
Number of newly recruite staff appointe
eploye an in ucte
raining in lea ership an management
egional eferral Payroll Monitoring report
Number of PN P health training institutions monitore
cale up the H H to istricts
ain ac ie ements
x H training was con ucte in an a itional
istricts an software installe
x Au it con ucte in all istricts iannual eports pro uce supporte by Ugan a Capacity
Programme
x
raining for
trainers was one by e ternal trainers from Capacity plus in ashington
uring November
ecember
he
H H lea ers receive a
training in
lea ership an management hese will champion the training of other H lea ers at both
central an istrict levels in the subse uent years
132
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
x
x
x
x
x
x
x
x
he first training course of
H lea ers from
s was con ucte at HM C Mbale for
Eastern egion
he istricts traine inclu e Mbale
utale a
usia Amolatar
Namutumba o olo an amuli
A total of
health wor ers were traine in mentoring
ut of these
were from
National egional eneral an Military Hospitals an
were from abale chool of ECN
abale egional Hospital an Health Centres he
mentors will mentor stu ents uring
practicum training
Progress has been ma e on institutionali ation of H lea ers at hospital level A position of
hospital irector for regional referral hospitals was create an the first batch of hospital
irectors was provi e with appointment letters
or to refine the performance management strategy was initiate with broa
consultation with sta ehol ers inclu ing the esults riente Management
M unit of
the M P
he raft strategy was presente to H H sta ehol ers in the Human esource
echnical or ing group for their input he strategy is being finali e by the ey
sta ehol ers
ain c a enges
na e uate resources to in uct all new staff
High attrition of health wor ers especially in istricts
ow wage bill
ow morale an high absenteeism
Recommendations or ann a p an 2 2
x mprove fun ing to the sector especially wage bill provisions to enhance both the numbers
an pay levels
x mprove wor ing con itions E uipment an accommo ation
x
trengthen Management an supervision of health wor ers at all levels
A range of planned activities were implemented towards improving the health workforce
however, significant improvements may not be achieved without addressing the issue of
numbers. The MoH should advocate for recruitment, remuneration and motivation of the
health workforce.
3.4.2
Health Infrastructure Development and Management
he health sector continues ensuring access to uality services through provision an
maintenance of functional efficient safe environmentally frien ly an sustainable health
infrastructure inclu ing laboratories an waste management facilities for the effective elivery
of the UNMHCP with priority being given to consoli ation of e isting facilities
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
133
At the beginning of H P
the proportion of househol s living within
wal ing istance to health facilities is estimate at
Most facilities are in a state of
isrepair o not have the re uire facilities for them to function effectively e g staff housing
water an energy theatres e uipment stores etc an re uire C an relate infrastructure
hese ten to compromise the efficiency uality an access of these services
Lead programme indicators
x
he proportion of the population of Ugan a living within m of a health facility increase
from
to
by
x
he number of health facilities increase by
by
x
he proportion of HC s an HC s with complete basic e uipment an supplies for
a ressing EmoNC increase to
x
he proportion of HC s an hospitals with functional ambulances for referral increase to
x
i ty percent of me ical e uipment are in goo con ition an maintaine
Ann a p an 2
top indicators
x Hospitals an health centres constructe an rehabilitate
x Hospitals an health centres e uippe
x Motor vehicles an other transport e uipment procure
x Capital wor s monitore supervise an appraise
ain ac ie ements
x
n sche ule rehabilitation of hospitals an supply of me ical e uipment in the Central
egion Masa a an Muben e Hs
x Health acilities nventory list prepare an rea y for printing
x
outine servicing an repair of solar energy pac ages an imaging e uipment an theatre
e uipment in Health facilities un er the Energy for ural ransformation E
an the
Country i e maging upply an nstallation
E Pro ects across the country
x Procurement of Consultants an contractors for construction of clinical laboratories at
ulu abale in a an ort Portal Hs an loo an s at ulu an ort Portal
x
upport to referral hospitals e ternally fun e pro ects istricts an the entire Health
ector in Health nfrastructure evelopment
ain c a enges
x nefficiencies in the procurement process both within an outsi e the Ministry process of
getting Contracts Committee awar s an approvals from olicitor eneral
x na e uate fun ing for the uantum of re uirements
x ate release by Mo PE as well as late payment to ervice provi ers lea ing to elaye
completion an payment of interest
134
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Recommendations or ann a p an 2 2
x
he entire procurement process within an without the ministry to be ma e more efficient
for timely e ecution of wor s
x
ufficient fun s to be vote towar s improvement of infrastructure throughout the
country inclu ing ring fence fun s for me ical e uipment maintenance
x Prompt payment of service provi ers to ensure timely completion an avoi ance of
interest on elaye payments
Progress in consolidating and renovating existing facilities as well as equipping facilities was
rather slow and therefore there was minimal increase in access to quality services. Facility
and inventory records were not updated and therefore difficult to monitor status. Local
Governments and central institutions should submit regular inventory reports so that the
sector can keep track of availability and functionality of the infrastructure and equipments.
3.4.3
Management of Essential Medicines and Supplies
ver the perio of the H P
essential efficacious safe goo
all times
priority will be given to increasing access to
uality an affor able me icines an other health supplies at
Core Indicators
x
he percentage of health units without monthly stoc outs of any in icator me icines
(43 % of health facilities did not have stock out of any of the six tracer medicines in the FY
2010/2011 – first line antimalarials, Depoprovera, SP, measles vaccine, ORS, Cotrimoxazole).
Lead programme indicators
x
he fun s in the M H bu get for procurement of EMH increase
x
he service level of NM for all EMH increase
x
he of N A bu get irectly finance by oU consoli ate fun s increase
x
ui elines for onate me icines evelope by
Ann a p an 2
top indicators
x Hol
an
UM AC meetings to up ate EMH an aboratory supplies lists an
two regional wor shops with the regional pharmaceutical persons
x
evelop integrate training materials in me icine an health supply logistic management
Establish a uantification procurement an planning unit QPPU
x Con uct support supervision in
units an provi e on ob training on Me icine ogistics
Management in lower level health facilities
x Procure
motor cycles to support strengthening of supply chain of EMH in
istricts
x Procure wo servers for MoH Hea uarters
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
135
x
x
x
x
x
x
ain ac ie ements
Con ucte eight
meetings three UM AC meetings an three wor shops to up ate
Health supplies lists he EMH an aboratory supplies lists are rea y for printing ne
regional meeting was hel for the regional pharmaceutical personnel
evelope integrate training materials for me icine an health supply logistic
management Establishe a uantification procurement an planning unit QPPU
Con ucte support supervision in
health units with a itional support from
mplementing Partners U E A EC an U A N
motor cycles procure with support from U E for Central an Eastern regions to
support the supervision of the supply chain for Essential Me icines an Health upplies
wo servers procure with support from U E to facilitate coor ination of the upply Chain
Management ystem between NM MoH an
istricts an the establishment of the
National Pharmaceutical nformation Portal
A new stores an ispensing soft ware programme was pilote in three hospitals Masa a
utabi a an ayunga with a plan to roll out uring the
ain c a enges
x ate processing of fun s lea ing to late e ecution of activities
x Persistent na e uate Human esources that affect the planning an
Me icines an Health upplies at all levels of care
x
irect bu get support to N A from overnment was not achieve
management of
Recommendations or ann a p an 2 2
x Continue capacity buil ing of the supply chain for essential me icines an health supplies
x Monitoring an support supervision of the me icines an health supplies management in
the sector
x
trengthening hospital planning an management of EMH
There is a positive trend in improving access to essential medicines and health supplies as
shown by the reduced level of stock outs from 41% in 2009/10 to 47% in 2010/11. Systems
strengthening interventions by the SURE project and increased funding for medicines from
government with last mile delivery need to be acknowledged and scaled up for even better
achievements.
136
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3.4.4
National Drug Authority
National rug Authority N A was establishe by the National rug Policy an Authority
N P A Act Cap
aws of Ugan a
evise e ition to promote use of safe
efficacious an goo uality me icines
Ann a p an 2
top indicators imp ementation
x nspection an licensing of rug outlets
pharmacies
rug shops
x nspection an licensing of local manufacturers
c MP au it an
follow up inspections
per factory
x Post Mar et urveillance upport upervision con ucte in
istricts
x
estruction of rugs tonnes per region per year
x
esting of samples rugs con oms me ical gloves an
Ns
rug samples
con om samples
gloves
x
etting of promotional materials
applications
x Pharmacovigilance activities
x
x
x
x
x
x
x
ain ac ie ements 2
icense
pharmacies an
rug shops
an
of planne respectively
All the
local pharmaceutical facilities were inspecte for renewal of annual license even
of them have so far been license while others are awaiting follow up inspections to review
their corrective actions prior to consi eration for licensing
upport supervision was con ucte in
istricts at regional level an
istricts for the
eterinary unit A total of
samples of pro ucts from ports of entry an the mar et
were pic e for analysis out of which
passe
faile an
are pen ing outcome of
analysis ut of the faile samples
pro uct recalls were carrie out were pre mar et
samples from ene n ustries t an these were eventually estroye while the rest were
counterfeit me icines unearthe uring operational Mamba that too place in uly
trips were ma e to uwero in ustries in Na asongola in which
tonnes of e pire
rugs were estroye
hese inclu e
tonnes of e pire pharmaceuticals from
overnment of Ugan a NM an
tonnes of e pire pharmaceuticals from N A hea
uarters an some of those aban one at the ports of entry
A total of
me icine samples were teste out of which
passe the tests an
samples
faile the tests
A total of
batches of male late con oms
batches of me ical gloves an samples from
overseas shipment containers recor e as batches of ong asting nsectici e treate
mos uito nets
N were teste
hile nine
batches
of me ical gloves faile
the tests one all samples of male late con oms an samples from the
containers of
Ns passe the tests one
eceive
applications for vetting promotional materials
a
Applications were approve
b
were re ecte
rote show cause letters to herbalists who put inappropriate a verts in the me ia but they
refuse to receive them claiming that they are not regulate by N A
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
137
x
x
x
x
x
x
x
x
x
x
x
upport supervision was con ucte in
Pharmacovigilance egional Centres in which
technical assistance in igiflow was given an review meetings hel on the progress of
Pharmacovigilance activities
wo egional Pharmacovigilance Centres were establishe in aramo a an Muben e
egional eferral Hospitals
health facilities an
health training institutions were visite
health wor ers an
stu ents were sensiti e
A s were receive at the National Pharmacovigilance Centre an first assessment
of the reports was one
istrict eterinary Professionals both private an public were sensiti e on
monitoring an reporting A verse rug events A Es in the istricts of ata wi oroti
Mbale u ungiri Ntungamo ban a iruhura asese an Mbarara
ain c a enges in Y 2
2
na e uate fun ing has affecte N A s activities
aps in the N P A Act
a
he Act oes not e plicitly provi e for regulation of cosmetics me ical an veterinary
evices health care pro ucts public health pro ucts chemicals for public health use
vaccines bloo an biological pro ucts
b he Act oes not provi e for effective enforcement an eterrent penalties N A oes
not have sufficient powers to effectively control illegal practices an counterfeits he
penalties are not sufficiently eterrent an this has partly encourage recurrent breach
of the law
nfiltration into the country of unauthori e me icinal pro ucts through the numerous
unregulate bor er points N A is unable to esignate nspectors of rugs at all bor er
points into Ugan a ue to ina e uate staffing
iberali ation of the me ia in ustry an abuse by herbalists is rampant
Conflicting an overlapping man ates of health professional bo ies have been e ploite by
some players in the pharmaceutical sector to violate the N P A Act e g rug outlets being
license by other health professional bo ies
3.4.5
Information for Decision Making
he health sector re uires reliable an accurate information to enable evi ence base ecision
ma ing sector learning an improvement Monitoring an evaluation aims at informing policy
ma ers about progress towar s achieving targets as set in the annual health sector plans an
the H P an to help provi e managers with a basis in ma ing ecisions
Core SSI indicators re e ant to program
x
imeliness of istrict HM reporting to the esource Centre ivision
x Completeness of istrict HM reporting to the esource Centre ivision
138
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Lead programme indicators
x
he proportion of implementing partners N s C s Private sector contributing to
perio ic reports
x Community base H establishe an lin e to HM by
x
he proportion of uarterly HM reports submitte
x Proportion of planne vali ation stu ies that are carrie out
x
he proportion of sub national entities istricts health facilities that have reporte on
the ey in icators as planne
Ann a p an 2
top indicators imp ementation
x
National HM ta ehol er coor ination meetings hel
x
raining of all istrict iostatisticians an HM focal persons in the revise ntegrate
HM tools
x mprovement of the M H internet ban wi th from M to M
x
e esigning of the M H website to allow for faster navigation an up ate information
access a ress www health go ug
x
inalisation of the e health policy an National H
x Proportion of technical support supervisions carrie out to encourage mentoring an
s ill transfer to istricts an health facility staff in ata management
ain ac ie ements 2
x Hel an nternational ata Use wor shop for all ata pro ucers an users an
National HM ta ehol er coor ination meetings
x
raine all
istrict iostatisticians an HM focal persons from lower level health
facilities in
istricts
health wor ers in the revise ntegrate HM tools
x Ac uire a server for H
an HM ata management
x mprove the MoH internet ban wi th from M to M with e tension of nternet
connectivity to remote sites of the MoH Chemotherapy an
eprosy programmes
x
e esigne of the MoH website to allow for faster navigation an up ate information
access a ress www health go ug
ain c a enges 2
x Un er staffing both in number an s ills mi given the increasing eman on the
esource Centre
H
PP M H
ata warehouse Enterprise Architecture
tan ar s Co es etc
x Un er fun ing to implement all activities relate to the man ate
x na e uate provision of Health ata capture tools for HM
x nability to capture health ata in the HM from private practitioners
x ac of a Corporate Anti irus to safe guar all Ministry e uipment
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
139
Recommendations or ann a p an 2 2
x ncrease fun ing to a ress the challenges towar s a successful implementation as
outline above the carrying out ata uality assessments continuous mentoring an
s ill improvement in ata han ling an management etc
x
aster restructuring process to review the numbers of staff an s ills mi re uire given
the increase wor loa an e pectations of the esource Centre as it is a cross cutting
ivision supporting the entire sector
x Provision of a Corporate Anti irus to safe guar all Ministry e uipment
Quality and timely data is essential for knowledge management. The sector revised the HMIS
and trained Health Information Assistants. There is need to increase access to IT services to all
districts so that timely data is submitted and feedback given. Use of data is still a problem
and therefore health workers at all levels need to be trained in use of information for decision
making.
3.4.6
Quality of Care
he H P
emphasi es the provision of high uality health services by all
his is ensure through regular supervision inspection mentoring uality improvement
interventions an establishment of ynamic interactions between health care provi ers an
consumers of health care with the view to improving the uality an responsiveness inclu ing
gen er responsiveness of health services provi e
Core SSI indicator
x
clients e pressing satisfaction with health services waiting time
Lead programme indicators
x Appropriate stan ar s gui elines an tools evelope an isseminate
x Proportion of planne support supervision visits that are carrie out
x National Quality mprovement ramewor an trategic Plan operational
x Mechanism for client right hol ers re ress establishe an operational
Ann
x
x
x
140
a p an 2
top indicators
tan ar s an gui elines evelope
tan ar s an gui elines isseminate
upport supervision provi e to ocal overnments an referral hospitals
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Ac ie ements
x aunche the Ugan a Clinical ui elines UC
an Patient Charter
an
isseminate
an
copies respectively to all
istricts
x n process of finalising the nfection Control an Prevention gui elines an the a iation
an maging gui elines
x
Area eam visits con ucte covering all
egional eferral Hospitals an the
ocal
overnments focusing on the H s public an private general hospitals an HC s
x
inali e raft for the National uality improvement framewor an trategic Plan
x
evelope concept notes for evelopment a national hospital accre itation system an
evelopment of a comprehensive supervision monitoring an inspection system an
submitte for procurement of consultancy services
x
evelope terms of reference for client satisfaction survey an procurement of consultant
initiate un er the UH P
x
tu y on Quality mprovement in Palliative Care in Mayuge an Namutumba istricts New
orn Care in Masa a an uwero istricts Patient nvolvement in yen o o asese ibale
Hoima yan wan i Masin i yegegwa an abarole istricts Pilot stu y con ucte on
Chronic Care Mo el in ui we ongoing with support from U A Health Care mprovement
Pro ect
x
ai en QM strengthening supporte by CA implemente in
istricts with focus
on improvement of the wor place environment
ain c a enges
x na e uate late release of fun s at all levels of health service
x ac of logistics e g soun means of transport fuel etc an a e uate number of
personnel in local government to con uct effective support supervision an monitoring
x Un er staffing in the health sector
Recommendations or ann a p an 2 2
x Mo PE to increase fun ing for the health services
x MoH to provi e logistical support for support supervision
x mprove staffing at all levels
A national client satisfaction survey was not carried out to determine the level of satisfaction
with health care service. The revised Uganda Clinical Guidelines were distributed in both soft
and hard copies to ensure provision of expected essential clinical care services especially at
primary health care level patient charter disseminated in all districts.
Quarterly support supervision visits were carried out to all LGs focusing on the DHOs,
hospitals and HC IVs. Observed improvement in areas of focus during follow up visits and
impromptu inspection visits. Staff attendance of duty is noted to have improved. Due to
inadequate funding, lack of supervision guidelines and skills, LGs are not carrying out
regular supervision of lower level health facilities. The MoH should build capacity of LGs to
carry out effective supervision.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
141
Development Partners are supporting implementation of quality improvement initiatives in
most of the districts and QAD developed the National Quality Improvement Framework and
Strategic Plan aiming at harmonization and institutionalisation of quality improvement.
3.4.7
Health Policy, Planning and Support Services
eview an evelop relevant Policies Acts an regulations governing health which are gen er
responsive an human rights compliant an to ensure their enforcement Currently there are
several obsolete laws an regulations in the sector that re uire revision in or er to better
ensure the en oyment of the rights they are suppose to support E amples inclu e the Public
Health Act the oo afety Act an the Mental Health Act he Policy Analysis Unit in the MoH
an Health Professional Councils are responsible for strengthening the legal an policy
environment con ucive for the elivery of the minimum health care
3.4.7.1 Policy Analysis
Lead programme indicators
x Number of policies reviewe an
evelope
Ann a p an 2
top indicators imp ementation
x Policy review meetings hel
x Health relate policies an regulations reviewe
x Emerging health issues con itions an therapeutic interventions that re uire new
legislation an policies i entifie
ain ac ie ements 2
x
A report complete NH
x
policy ocument PPPH rea y for submission to Cabinet
x
eviewe the Mental Health ill
x
eviewe the Malaria strategic plan
ain c a enges
x Un erstaffing
x ac of official communication e uipment mechanisms
x
low No fee bac on presente papers
ransport telephone
Recommendations or ann a or p an 2 2
x
eview of obsolete policies health laws
x Capacity for activity costing built
142
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
The degree of contribution of the Policy Analysis unit to the health sector policy review and
development was minimal. The plan was to review at least 2 policies quarterly but only 3 out
of 8 were reviewed. The Policy Analysis Unit needs to identify the obsolete laws and
regulations in the sector and develop a plan for review. The Policy Analysis unit needs to
facilitate coordination of policy development in MoH and other related sectors to ensure
harmonization and mainstreaming of health issues.
3.4.7.2 Planning
he aim of planning is to ensure efficiency in resource allocation management an utili ation
Core Indicators
x
eneral overnment allocation for health as
of total government bu get
Lead rogramme Indicators
x
evelopment of a health financing strategy by une
x
overnment per capita e pen iture on health increase to
by
Ann a p an 2
top indicators imp ementation
x Annual wor plan
evelope
x Annual performance report
x oint review report
x PPPHC report
x
perationalise the NH
x Capacity buil ing for all istricts in health services planning an management
x
inali ation of the National Health nsurance operationali ation frame wor bill
x
echnical review report
x Efficiency stu ies con ucte
x
x
x
x
ain ac ie ements 2
Con ucte an launche the NHP an H P
Annual report pro uce
Con ucte the oint eview Mission
uilt the Capacity of the secretariat an as
ermany an ra il
orce in health insurance in outh orea
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
143
x
x
x
x
x
x
x
x
echnical analysis an review of the esign of the scheme by the as orce sta ehol ers
an other collaborating partners P H orl an
H
overnments of ermany
wit erlan an rance
egional sensiti ation on the NH was carrie out in the East with istrict representatives
of the istricts in eso egion ororo egion an ugisu egion
Efficiency stu y con ucte
ain c a enges 2
he sectoral coor ination role by the planning ivision is not matche with the resources
inclu ing the time available
E pansion on the number of istricts not matching the resources an technical support for
planning
ectoral policies an strategies which are not evi ence base an researche especially in
the conte t of eterminants of health
imite capacity of local institutions to han le the eman an supply si es of NH
Abolition of user fees in publicly owne health centres an general wings of hospitals poor
uality of care pose both policy an operational ilemmas
Recommendations or ann a p an 2 2
x Establish a regional tier of a ministration an management for health services as a
strategy to strengthen oversight planning an management functions
x
oll out of the Health Economics an ystems nstitute policy
x
Carry out further technical stu ies especially in the area of human resources an NH
All planned workplans and reports were produced by all levels. Regional planning meetings
were conducted as planned. Other planned activities like the Technical Review Mission and
operationalisation of the NHIS were not achieved due to inadequate resources including time.
The increasing number of districts neutralizes all efforts in increasing funding to local
governments because of the increasing administrative costs and also stretched the central
level in their oversight role. Establishment of a regional tier of administration and
management for health services should be prioritized.
3.4.7.3 Finance and Administration Services
he epartment of finance an a ministration is compose of
a Minister s ffices
b enior op Management P
H
irectors offices
c A ministration ivision
Accounts ivision
e Personnel ivision
f Procurement an isposal Unit
g nternal Au it
h C Unit
144
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
esponsible for provi ing political irection giving policy gui ance an ren ering support
services to enable the Ministry fulfil its man ate of provi ing uality an e uitable preventive
an curative health services to public
3.4.7.4 Ministerial and Top Management
Ann a p an 2
indicators
x ssue wee ly press statements to isseminate the ministry s strategies to improve Health
Care Management
x nspect the elivery of health services in
Hs an
eneral Hospitals
x Hol monthly press conferences to up ate the public on the efforts of the ministry to
improve health service elivery
x Monitor me icines istribution storage allocation recor s an
ispensation system in
istricts
x
upervision of PHC activities in
istricts uarterly
x Monitor the functionality of HC s an HC s in
istricts uarterly
x
upport supervision of H s in
istricts uarterly
x
x
x
x
x
x
x
x
ain ac ie ements 2
ssue press statements on the outbrea of Ebola Hepatitis outbrea in asese an the
crac own on illegal Private Health institutions
nspecte service elivery in
Hs an
eneral Hospitals
Hel press conferences to up ate the public on the Ebola outbrea
orl Mi wifery ay
orl Malaria ay an epro uctive Health
nspecte the management of me ical supplies in several istricts
upervise PHC activities in several istricts
Monitore the functionality of HC s an
s in the istricts
i support supervision of H activities in all the regions
Manage to re furbish the Hon Minister s office
Ministerial and Top Management was actively involved in providing political direction, giving
policy guidance and monitoring service delivery.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
145
3.4.7.5 Administration and support services
Ann a p an 2
indicators
x Prepare an submit activity an financial reports for all the uarters st n r an th
to M PE
x Prepare an submit to PAC responses to all ueries raise on the accounts of the ministry
for financial year
an
x nspect the utili ation an accountability for PHC rants in the istricts
x nspect the utili ation of the evelopment u get in
Hs
x Ensure all the outstan ing financial a vances are accounte for
x nspect an assess the stan ar s of financial boo eeping maintenance of accounting
recor s an a herence to financial regulations an proce ures in the istricts
x nspect the utili ation of salaries for interns in
Hs
x Pay all staff emoluments in time
x Enter rame or Contracts with provi ers for procurement of vehicle repair services
tyres as well as clearing an forwar ing services
x Coor inate the organi ation of public events observances that fall within the uarter for
e ample orl Health ay
orl
e Cross ay nternational Nurses ay an
orl
Chil ren s ay
x Payroll monitoring in
Hs
x Complete an submit Cabinet Memoran a
x
x
x
x
x
x
x
x
x
x
x
x
x
x
ain ac ie ements 2
r
an th uarter prepare an submitte to
Activity an financial reports for the st n
M PE
esponses to ueries raise in Au it eports for
an the Management letter of
the Au itor eneral prepare an submitte to PAC an Au itor eneral respectively
nspecte utili ation of an accountability for PHC rants in all the regions
nspecte utili ation of the evelopment bu get in
Hs
All staff salaries for the months fully pai in time
rame wor contracts for procurement of stationery tonner an news papers approve
MCC while those for motor repairs will be rea y in the first uarter of
orl Health ay
orl e Cross ay nternational Nurses ay an
orl Chil ren s
ay orl Environment ay orl No obacco ay were observe
Manage to install the CC cameras for security
eamwor greatly improve in the P U
he P E is up to ate with most of the PP A reports
nitiation of the health sector procurement forum
Complete a number of framewor contracts e g stationery toners hotels a vertising
Pilote a mini procurement trac ing system
egistere goo rating in the Procurement Performance Measurement ystem by PP A
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x
x
x
x
x
x
x
x
x
x
x
x
x
he P E has not lost a single A ministrative review
eplace the van ali e computers on the th floor
a or c a enges
Unforeseen unbu gete but important an urgent e pen itures
ac of access to the M by staff who are ey in the processing of payments
ncomplete an irregular financial re uisitions from staff
Poor an elaye accountability from staff
rresponsible han ling of ueries raise by oversight an accountability agencies of
overnment
elays in submission of procurement plans an performance reports by user epartments
re uent interruptions an brea own of the M
User epartments o not a here to Procurement Plans an PP A egulations
ate initiation of procurements
elaye procurement evaluation processes
na e uate office space
The Administration and Support Services units rendered services to enable the Ministry fulfil
its mandate however delays in some areas like procurement affected implementation of
planned activities especially in capital development projects. The lack of space led to delay in
settling in of new officers and affects coordination within departments. There is urgent need
to reorganise and reallocate office space to improve efficiency in service delivery.
3.4.8
Legal and Regulatory Framework
Appropriate legislation an its enforcement provi e an enabling environment for
operationali ation of the policy an the H P an are essential for an effective health service
elivery system he Health Professionals Councils are responsible for
x
trengthening the legal an policy environment con ucive for the elivery of the minimum
health care pac age
x Promoting enforcement observance an a herence to professional stan ar s co es of
con uct an ethics
Lead rogram Indicators
x Number of relevant international legal instruments on health that have been omesticate
x Number of law enforcers traine in new legislation an policies to ensure implementation
of legislation an policies
x An effective regulatory environment an mechanism evelope
x An a e uate an functional staffing structure of Professional councils establishe over the
ne t five years
x A oint Professional Council with ecentrali e supervisory authorities establishe an
operationali e over the ne t five years
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147
3.4.8.1 Uganda Medical and Dental Practitioners’ Council
Ann a an or 2
2
x
o register an license ualifie practitioners an all private health units that meet the
re uirements of the Council
x
o con uct regular inspection of private clinics in ampala area an up country
x
o evelop gui elines for CP for practitioners with a view to ma ing CP more accessible
x
o con uct uarterly istrict supervision
x
o investigate all reporte cases of allege professional miscon uct an ta e appropriate
isciplinary measures
x
x
x
x
x
x
x
a or Ac ie ements
nspecte
Health units in ampala area nspecte
Health units upcountry his was
one in collaboration with other Professional Health Councils
orme an ensiti e the istrict upervisory Authorities in
istricts in Northern an
Eastern egions his was one in collaboration with other Professional Health Councils
he Council has establishe a functional Me ical icensure an E aminations oar which
has con ucte two roun s of e amination for oreign traine octors
he Council has an establishe web site www um pc com an publishe the egister of
Practitioners with Annual icenses in Newspapers
Complete oint inspection an accre itation of all East African Me ical an ental chools
together with other East African Me ical an ental Councils
Complete the raft proposal on establishment of National Health Professions Authority
an the report submitte to the Permanent ecretary
orme an riente the nterim CP Accre itation Committee
a or C a enges
x na e uate staffing at the Council especially the nspectorate
x na e uate transport Council has very ol vehicles
x oophole in the law to enforce Council ecisions
Recommendations or ann a p an 2 2
x Council must review the Act so as to enable it implement its man ate effectively
x Ministry of Health shoul assist the Council ac uire see money to buil its Hea uarters
x Ministry of Health shoul secon ey staff to Council to enable it operate fully
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3.4.8.2 Uganda Nurses and Midwives Council
Ann a p an 2
top indicators Imp ementation
x
egistration an enrolment of nurses an mi wives
x
echnical support supervision of health facilities an health training institutions
x nspection an approval of the new schools for nursing an mi wifery
x Con ucting continuous professional evelopment CP programmes
x
ensiti ation of the Nursing Mi wifery on ethical co e of con uct
ain ac ie ements
x
evelope a ive year trategic Plan
x
trengthene the registration
enrolment of Nurses an Mi wives who successfully
complete their courses of stu y
x nspecte Health acilities H s an Health raining nstitutions H s
x
x
x
x
ain c a enges
na e uate resources finance staff e uipments an transport
Many mushrooming illegal Nursing Mi wifery schools
orgery of aca emic an professional certificates
imite office space
Recommendations or ann a p an 2 2
x nspect chools Universities inten ing to open up Nursing an Mi wifery training
programmes
x nspect practicum areas for the training of nurses mi wives to assess suitability
x
trengthen the Enroll an egister Nurses Mi wives traine within an outsi e the country
x Con uct a nationwi e inspection of health facilities to assess their legality an capacity
x
trengthen collaboration with various sta e hol ers both within an outsi e the country
x Establish istrict upervisory Authorities
A in selecte istricts
x
ecentrali e some of the council services through the establishment of regional centres
x Complete the review of the UNMC Act
x
rgani e a sta ehol ers meeting to streamline issues relate to regulation
x
trengthen communication an information sharing through the establishment of a web
3.4.8.3 Uganda Allied Health Professionals Council
Lead programme Indicators
x All legible Allie Health Professionals registere
x All reporte cases of Malpractice investigate an isciplinary action ta en
x All Allie Health Professionals issue with annual practicing licenses
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Ann a p an 2
top indicators
x Number of Allie Health professionals registere
x Number of Allie Health units license
x Number of Annual practicing licenses issue
x Number of health facilities an training schools inspecte to access uality service
x Number of cases of unprofessional con uct investigate
x Minutes of Council an Committee meetings con ucte
x
eports of monthly uarterly an annual performance submitte
x Number of CP meetings con ucte
x Number of upport supervision visits con ucte
x Number of regional offices establishe
x Number of istrict an regional supervisors appointe
x
x
x
x
x
ain Ac ie ements 2
egistere
professionals renewe
Annual Practicing licenses an license
clinics
nspecte
new Allie Health raining nstitutions
nspecte private health facilities in central an western regions
Establishe
istrict supervisory Authorities in Eastern an Northern regions
ensiti e Chief A ministrative fficers CA s istrict Health fficers H s an Me ical
uperinten ents on renewal of Annual practicing licenses in central an Eastern regions
ain c
x Un
x ac
x na
a enges 2
erstaffing
of soun vehicles to carry out inspection in all health units
e uate office space
Recommendations or ann a p an 2
2
x Establishment of Allie Health Professionals egional ffices
x E pan ing the ecretariat by appointing egional upervisors Accountant A ministrative
officer
x
enting an office outsi e Ministry of health Hea uarters to accommo ate the new
officers
3.4.8.4 Pharmacy Council
Lead rogram Indicators
x Number of pharmacy stan ar s enforcement visits an oint HPCs activities inspections
carrie out
150
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x
x
x
x
Numbers of newly ualifie pharmacists egistere
eturn of the Pharmacy Profession an Pharmacy Practice ill to Parliament
a ette registere Pharmacists
Coor ination of internship training for pharmacists
Ann a an 2
imp ementation Indicators
x Number of practice units visite an supporte technically
x Number of pharmacists registere ga ette or e ga ette
x Number of internship meetings an activities participate in or coor inate
x Number of meetings hel to fine tune the Pharmacy Profession an Practice ill
Ac ie ements
x
ne University training pharmacy stu ents visite
x Pharmacy oar members appointe
x
ogether with other Health professional Councils establishe the istrict Health supervisory
authorities in Mbale ulu ira Amolatar o olo amuli ororo an ganga istricts an
ointly evelope a proposal for the Establishment of the NHP A
x
egistere
newly ualifie pharmacists uring the perio
x Carrie out oint Health professional Councils inspection of private health facilities an
refle ology units in ampala
ain C a enges
x
ragmente an wea regulatory frame wor
¾
elays in Enacting the Pharmacy Profession an Pharmacy Practice ill
¾
ifficulty in implementing the provisions of the Pharmacy an rugs Act
x na e uate esources
¾ inances ransport an other logistics
¾ Human esource shortages
x imite numbers of internship training centers an supervisors hin ering the inta e an the
training of intern pharmacists yet the numbers of interns are increasing yearly as the
private public schools release them into the mar et
Recommendations
x Ministry of Health to e pe ite the return of the pharmacy bill to parliament
x More fun s be allocate for Pharmacy Council activities for improve uality of
pharmaceutical care
x
here is nee for affirmative action in the training an eployment of Pharmacists an
nterns
x MoH shoul e pe ite the process of establishing the propose NHP A which will offer
a itional fun ing opportunities
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151
During the year under review all Professional Councils were vibrant and worked towards
streamlining enforcement and providing an enabling environment for effective health service
delivery. The Councils were able to jointly form and sensitize the District Supervisory
Authorities in 20 Districts in Northern and Eastern Regions; and submitted a proposal for
establishment of a National Professions Authority. The Councils need to be strengthened in
terms of human resource to cater for the big workforce.
3.4.9
Research
3.4.10 Uganda National Health Research Organisation
he health sector aims at creating a culture in which health research plays a significant role in
gui ing policy formulation an action to improve the health an evelopment of the people of
Ugan a he UNH is responsible for coor inating all the health relate research in Ugan a
Lead programme indicators
x A policy an legal framewor for effective coor ination alignment an harmoni ation of
research activities evelope by
x A prioriti e national research agen a evelope by
x nstitutions involve in con ucting research i entifie by
Ann a p an 2
top indicators imp ementation
x National research priorities coor inate an evelope
x
esearch aligne an harmonise
x Consultative meetings carrie out in selecte istricts
x nventory of research researchers an research institutions evelope
x
evelop the strategic plan an stan ar operating manuals
ain ac ie ements 2
x nventory of esearch nstitutions being collate together with in ivi ual researchers
inventories ongoing
x
raft report on research priorities for health available for further iscussion
x
or shop with Parliamentarians iscusse policy options for increasing access to s ille
atten ance for chil elivery hel in une
hree options were iscusse a e pan ing
elivery services to HC b use of nursing assistants an c promoting waiting homes near
hospitals
152
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x
x
research articles cleare an permission given for their publication
nception report for strategic plan only evelope
ain c a enges 2
x
iscussions are continuing with the sta ehol ers on fun ing to operationali e the Act No
fun ing yet has been allocate to Act
During 2010/11 FY UNHRO started the process of developing an inventory of research,
researchers and research institutions. An inception report for the UNHRO strategic plan and
standard operating manuals are under development and is expected to guide the alignment
and harmonisation of research activities in future. Funds should be allocated for
operationalizing the UNHRO Act.
3.4.11 Natural Chemotherapeutics Research Institute (NCRI)
he NC formerly Natural Chemotherapeutics esearch aboratory is a research an
evelopment centre un er the UNH create by an act of parliament the
UNH Act
he institution is man ate to carry out research on natural pro ucts plants animal parts an
minerals an the use of tra itional metho s in the management of human isease he
institute un erta es the research an evelopment of uality natural pro ucts an services for
improve health care elivery by applying both in igenous an mo ern scientific technologies
Ann a p an 2
top indicators imp ementation
x Ethno botanical an ethno pharmacological ata collection
x
evelopment of stan ar s for oo agricultural Practices
Practices MP for me icinal plants an herbal me icines
x
raining
x aboratory an fiel evaluation of selecte herbal formulae
x Hol th African ra itional Me icine ay
AP an
oo Manufacturing
ain ac ie ements in Y 2
2
x Ethno botanical an ethno pharmacological ata on selecte me icinal plants collecte
an authenticate from abale an o olo istricts he selecte plants were a e to the
establishe me icinal plants gar ens in the respective istricts tu ies to optimi e the use
of Natural pro ucts in the management of priority iseases initiate
tan ar i ation of
herbal formulae baseline stu ies on the effects of a formula evelope for elimination of
iggers carrie out in selecte areas in ganga istrict
families participate in the semi
fiel trials
Partnerships with tertiary institutions establishe preliminary plans to
etermine re uirements for establishing a me icinal plants gar en for arham University
carrie out
x
evelopment of stan ar s for oo Agricultural Practices AP an oo Manufacturing
Practices MP for me icinal plants an herbal me icines was one through support to
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
153
x
x
x
ra itional Health Practitioners HP s who un ertoo the initiative after un ergoing
training by the institute
raining staff un erwent training in professional evelopment staff members traine in
pro ect management
staff traine in customer care
staff traine in recor s
management staff traine in report an minutes writing staff traine in bioinformatics
staff in pharmaceutical an rational rug use
staff traine in ra itional Chinese
me icine techni ues an applications
stu ents from tertiary institutions inclu ing
Ma erere University Mbarara University of cience an
echnology an
yambogo
University traine in laboratory investigative techni ues
aboratory an fiel evaluation of selecte herbal formulae phytochemical analyses of
formulae me icinal plants carrie out pharmacological an to icological evaluation of
herbal formulations carrie out stan ar i ation of Herbal anti ote for poisons is ongoing
an authentication of ata on me icinal plants collecte is ongoing
he th African ra itional Me icine A M ay was hel in o olo istrict preparatory
meetings
symposium publicity on
local M station an publication of a news
supplement in the Monitor News paper were one as part of mar ing the ay
ain c a enges in Y 2
2
x
he very lengthy procurement process has ren ere most of the planne research wor
ifficult to complete on time Procurement of speciali e research re uirements li e
reagents an bio specimens has also hin ere wor because of the rules for pre
ualification an the volumes of supplies being sometimes small for suppliers to honour
x
elaye release of fun s to implement the planne outputs has resulte in late wor an
sometimes not in the efine uarters resource flow nee s to be streamline to enable
timely implementation of planne out puts
x
he available space at the institute is ina e uate for all the research activities the
institution un erta es here is nee for e pansion of the facilities
Recommendations or ann a p an 2 2 2
x
ormali e partnerships collaborations with sta ehol ers
iome ical wor ers
HPs
patients stu ents tra ers in herbal me icines an other sta ehol ers
x
evelop a ra itional Me icines programme
o operationali e e isting tra itional
me icine centers upgra ing of NC infrastructure support networ buil ing in the process
chain evelopment of herbal me icines an Natural pro ucts
x
trengthen collaboration with international sta ehol ers in Natural pro ucts research
NAP ECCA A NAP an E A AMA
x
ptimi e use of Natural pro ucts an tra itional health systems in management of priority
iseases
The NCRI implemented most of the planned activities despite challenges of lengthy procurement
processes and delayed release of funds resulting in late implementation. There is need to develop an
IEC program for promotion of the use of natural products and traditional health systems as
complementary to the conventional health systems.
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3.4.12 Uganda Virus Research Institute (UVRI)
U
is a semi autonomous un er UNH
he nstitute s broa mission is to carry out
scientific investigations concerning communicable iseases especially viral iseases of public
health importance an to a vise government on strategies for their control an prevention
Lead programme indicators
x Number of iseases monitore
x Number of outbrea s investigate
x Number of interventions evelope
Ann a p an 2
top indicators imp ementation
x aboratory surveillance of measles A P influen a illnesses H an syphilis carrie out
x HCs an homes monitore an surveillance carrie out for plague an vectors
x Number of interventions un er stu y
x Number traine to buil capacity in vector biology
x
x
x
x
x
x
x
x
x
x
x
x
x
ain ac ie ements 2
aboratory surveillance of measles A P H an syphilis carrie out
HCs an homes monitore an surveillance carrie out for plague an vectors
health facilities in est Nile monitore for influen a illnesses
ata analysis is ongoing to etermine prevalence of H an syphilis in ANC samples
Provector evice place in oors to ill Anopheles mos uitoes in
ran omly selecte
houses in ombe an Mwaalo villages
Msc stu ents traine to buil capacity in vector biology
entification of larvici es to control malaria ver
isolations ma e
rant application submitte for baseline entomological surveys on the islan s of a e
ictoria in preparation of release of MM in Ugan a
grant applications evelope an submitte Characteri ation of larval pathogens an
eveloping molecular tools for stu ying the population biology of mos uitoes of genus
Mansonia a vector of arboviruses
ain c a enges 2
ac of fun s to carry out fiel activities
No fun s were provi e for office supplies with outstan ing bills for utilities
elying heavily on grants an cooperate agreements
o motivate all staff to embrace the culture of research
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155
Disease monitoring, surveillance, investigation of outbreaks and interventions are carried out
periodically despite the inadequate government funding to UVRI. Research is heavily reliant
on grants and cooperative agreements and this is unsustainable. Government should
motivate all staff to embrace the culture of research by first adequately supporting existing
research institutions to carry out their mandate.
3.4.13 Public Private Partnership for Health
he MoH encourages an institutionali e the involvement of the private sector in the
provision of preventive promotive an curative health care to all Ugan ans through the public
private partnership approach he PPPH effectively buil s an utili es the full potential of the
public an private partnerships in the health sector
Lead programme indicators
x
he National Policy on PPPH is approve by the Cabinet by
x Number of istricts which have evelope a oint public private istrict Health Plan
x Number of istricts in which PHP sub sector contributes to the HM
Ann a p an 2
top indicators imp ementation
x Number of PPPH
ecisions implemente
x Number of istricts pro ucing integrate health wor plans with private sector sta ehol ers
x Proportion of bu gete
U subsi y to private sector that is a vance to PN Ps
x
x
x
x
x
ain ac ie ements 2
he raft policy ocument has been finalise one year ago but with the failure of approval
of the national Policy on PPPH the Partnership stagnate
ive egional or shops to isseminate the National Policy at istrict level has been
con ucte
An orientation wor shop was organi e for the twenty Pilot istricts t was atten e by
H s
istrict es
fficers for PPPH
iocesan Health Coor inators an relevant
representatives of the public an private sector at central an istrict level
wenty pilot istricts receive furniture an computer e uipment by the talian
Cooperation an the Health nitiative for Private ector U A
which provi e to
strengthen the PPPH istrict es fficers
A number of planning sessions were con ucte in five pilot istricts he sessions consiste
in the formation an orientation of the PN P an PHP Coor ination Committee for the
in a Moroto Mbarara ort Portal ulu Mbale
Mpigi Mityana yen o o asese Na asongola
156
a iso
a ai Hoima Arua
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
x
x
x
x
x
x
istrict an a Public Private istrict planning e ercise to formulate a oint integrate istrict
plan involving private sector sta ehol ers
he
on PPPH has improve its efficiency an the number of meetings con ucte
uring the year
he
is now chaire by the irector of Health ervices P
who
has provi e his a itional competences an technical input to the or ing roup
he
on PPPH has iscusse important aspects of the Partnership with the ob ective to
finali e the submission of the raft National Policy on PPPH to the Cabinet an evelop a
MoU governing the Partnership between the public an private sectors two ma or actions
liste among the th M resolutions
he
has finali e a new list of beneficiaries for the PN P facilities which will access a
cre it line for rugs ma e available by AN A Criteria for up ating the list every year
were iscusse an agree while the iscussion is still ongoing on the criteria for inclusion
of PHP facilities an N PN P he
starte wor ing on the allocation formula for the
government subsi ies
ain c a enges 2
ecuring a certificate of financial implications for the national Policy on PPPH too an
abnormally long time affecting timely approval of the policy
ac of an e plicit formal contractual arrangement between PN Ps an
U poses
continue allegations on misuse of public subsi ies by PN Ps
Continue with hol ing of
U subsi y to PN Ps by istrict officials an estimate
billion shillings was not passe on to PN Ps by istricts
imite progress on securing the
million ollar private sector financing facility from the
nternational finance Corporation ue to absence of an approve PPPH policy framewor
Recommendations or ann a p an 2 2
x Cabinet shoul e pe ite approval of the National Policy on PPPH to boost resource
mobili ation for PPPH
x
inali e the raft mplementation ui elines for the National Policy on PPPH an roll out
the policy framewor countrywi e
x
raft an sign an e plicit formal contractual agreement between the
U an recipients of
public subsi ies for health care
The prolonged process (over two years now) of approving the PPPH policy has derailed the momentum
the sector had gained towards institutionalization of the PPPH. Nevertheless the MoH has established
good collaboration arrangements with the PNFP providers and needs to extend to the PHP sub-sector
especially in providing information through the HMIS.
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157
3.4.14 Health Services and Health Status in Recovery Areas
3.4.14.1 Northern Uganda Action Fund (NUSAF2) support to Health Sector
ain ac ie ements 2
he NU A
for Community nfrastructure ehabilitation C approve an fun e pro ects
un er the Health ector in of the
istricts in the region he total approve pro ect amount
is
M an out of this
M has been release to the istricts he ma or beneficiary istricts
are u wo an Nebbi with an
subpro ects respectively he pro ects cover construction of
staff houses an
P latrines u wo is constructing staff houses Nebbi staff houses
ata wi an yam staff house each an Apac an umbe
P latrine each
Ta e
SA 2 s pport to ea t Sector 2
istrict
No
of
ubpro ects
otal u get U
Amount
U
st
rance
Apac
u wo
ata wi
Nebbi
yam
umbe
A
2
Note able summarise from NU A
ector
C
approve an fun e pro ects un er the Health
ain c a enges 2
he upta e of NU A investment in the Health sector has been very minimal compare to
other sectors as e hibite by only
istricts benefiting out of
istricts entitle NU A an
P P resources are community eman riven t has been reporte that the Health sector has
not create a e uate eman
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Recommendations for annual plan 2012/13
Un er NU A the health sector still has opportunities to access health financing for most of
the nee e infrastructure evelopment especially staff housing construction
o achieve this there is nee to imme iately revitalise the lin ages between the NU A an
Health ector at the national an ocal overnment levels A rapi infrastructure gap analysis
with a view of i entifying the most critical areas of support shoul be con ucte to fee into
proposals for NU A support
3.4.14.2 Karamoja Region
Bac gro nd to aramo a Region
aramo a region is locate in the North Eastern part of Ugan a an is home to the following
ma or ethnic groups the ie o ora o oth Matheni o an the hur he region s population
of ust over
people mainly practices agro pastoralism he region is compose of
seven istricts namely Moroto Napa Amu at Na apiripirit oti o aabong an Abim or
eca es aramo a region suffere generali e inter communal violence insecurity fuele by
cattle rai ing proliferation of small arms lac of water for animals an recurrent foo
insecurity ecause of these bac groun characteristics the region remains the remotest an
least evelope in the country with high levels of househol poverty illiteracy low access to
uality social services an high levels of morbi ity an mortality Un er five mortality in
aramo a is
higher than the national average of
live births while maternal
mortality ratio is
higher than the national average of
live births U
The Health System in Karamoja Region
The health system in Karamoja is comprised of 101 formal health facilities, about 2,987 VHTs of
which 99% have been trained, 10 Health Sub Districts, 7 District Health Offices and a host of
development partners. There is 1 Regional Referral Hospital, 4 General hospitals, 4 Health
Center IV’s, 33 Health Centre III’s and 59 Health Centre II’s. The recent past has seen increased
interest by the central government and development partners to revamp the region’s
development. Districts have benefited in the following key areas; human resources for health,
infrastructure, health information systems, equipments and service delivery. Sectoral
governance and stewardship is also being strengthened to enhance planning, implementation,
supervision, monitoring and evaluation of services. Some of the key development partners
involved in strengthening the health sector in Karamoja are but not limited to; WHO, UNICEF,
Italian Cooperation, Doctors with Africa CUAMM, International Rescue Committee, Faith Based
Organizations, Action Contre La Faim, MSF and CESVI.
In 2010, regional partners working under the auspices of the “ALIVE” partnership of UNICEF
commissioned a study titled “Comprehensive health facility functionality assessment for
Karamoja”. This assessment was carried out by CUAMM with contributions from all the key
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
159
stakeholders at all stages. It covered key input, process and result areas of all the six, WHO
proposed, health systems building blocks. The study results show that; 94% of the units had
management committees of which 99% had “expired”, 66% of the facilities had not done any
single staff meeting in a quarter and 50% of them had no copies of their own annual work
plans, only 14% and 29% of midwifery positions at HCII, and HCIII levels were filled. All-type
cadre absenteeism rate was 22.5% although this rate was as high as 45% among HCII’s in Abim.
Stock out rate for the 6 tracer medicines was registered at 77%. Close to half of all vaccine
“containing” facilities never updated temperature control charts for the week prior to the
survey.
About 40% of the facilities failed to submit monthly HMIS reports timely to the HSD. Majority of
the in charges could not readily estimate or identify the facility’s total income and expenditure
for the previous financial year-no clear records. The referral system is impeded in decreasing
order by lack of transport and communication capabilities (90.8%), financial constraints (5%),
difficulties in making definitive diagnosis (2%) and insecurity (2%). 10% of the HCIIs were able to
provide between 4 to 6 of the basic EMOC signals functions while only 15% of the HCIIIs could
provide all the 7. A number of HCIIs registered more than 3 deliveries per month. 2 of the 4
HCIVs do not provide the complete package of comprehensive EMOC signal functions.
Health sector interventions in Karamoja region
Health sector partners in Karamoja are increasingly making deliberate attempts to improve
health systems performance through investing in infrastructure, human resources, health
information systems, governance and service delivery. Such investments and expected results
thereof are being followed up through regular regional and district level review meetings.
These quarterly meetings (besides the monthly districts level health sector working group
meetings) are meant to help partners compare notes, share lessons and collectively identify
areas of continued need. Apart from providing technical support to District Health Teams in all
the 7 districts, CUAMM is passionate about making these fora ever meaningful.
Some of the key systems strengthening interventions in the region include;
1. Strengthening health systems governance through meaningful and regular planning and
review meetings among stakeholders and collaborative supervision of service delivery.
2. Building of a reliable health information system with demonstrable improvement in
information collection, reliability, storage, retrieval, analysis, reporting and use.
3. Development of human resources for health; training and recruitment of staff. For
example, CUAMM recruited 24 health workers for hard to reach facilities including 3
medical doctors and 21 nurses most of whom demonstrated good skills in midwifery.
Most of these personnel have since been absorbed into the district pay rolls. CUAMM is
currently supporting Matany nurse training school in various areas and implementing a
UNICEF supported scholarship program that is meant to generate 90 personnel
annually.
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4. Infrastructure development; building and rehabilitation of staff houses, theatres, drug
stores, maternity rooms, and water systems. 1 district drug store built in Kotido and a 2
in 1 staff house constructed in Kaabong in the Ik land of Morungole.
5. Research; operational research was carried out on the functionality of health facilities,
nutrition assessment and disease surveillance.
6. Service delivery; planning, implementation and supervision of both static and outreach
services. Hard to reach areas were served through integrated outreaches whose
package included Immunization, ANC plus (includes PMTCT) and general clinical care.
7. Establishment, training and tooling of VHTs-UNICEF, WHO, IRC and CUAMM are taking
the lead in this process. 100% coverage of villages with trained VHTs already attained.
Results of interventions
Districts in Karamoja registered an overall 15% improvement in district league posiƟons over the
period 2006/7 to 2009-10 (annual health sector performance reports). Figure 14 shows that the
region registered a steeper increase in total district league scores than the naƟonal average while
Įgure 15 shows that Abim, KoƟdo and Moroto contributed greatest to this regional trend.
Figure 14: Total average district league scores
districts for Uganda and Karamoja region
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161
Figure 15: istrict league scores Karamoja
Positive changes were registered in the following district league indicators; DPT3 coverage rose
by an average of 3% per annum, OPD utilization increased by about 6% per annum, the trend in
institutional deliveries has been increasing more steeply than the national rate, timeliness in
submission of OPD reports rose from 49% in 2005/06 to 82% in 2009/10. Utilization of PHC
funds also increased from 56% to 100% during the same period of time. In the year 2010/2011,
the region continued to register positive changes in some of these areas. Figure 3 below shows
trends in selected interventions over the past 3 years. OPD utilization in 2010/11 dropped by a
12 percentage points from that of 2009/10 while DPT3 coverage, first ANC visits, 4th ANC visits,
dropped by 1%, 3% and 3% respectively. On the other hand the proportion of pregnant women
tested for HIV remained at 89% and institutional deliveries increased from 12% to 14%. The
results demonstrate that, although progress is seen and is possible it remains fragile owing to
extra-systemic constraints beyond the control of local governments and their partners.
162
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3.5 Monitoring and Evaluation of Implementation of the HSSIP 2010/11 –
2014/15
Monitoring and evaluation (M E) of implementation of the HSSIP 2010/11 2014/15 is based
on periodic reporting and periodic reviews of information generated by the HMIS and other
official data sources like surveys. M E aims at informing policy makers about progress towards
achieving targets as set in the annual health sector plans and the HSSP and to help provide
managers with a basis in making decisions.
ead programme indicators
x The proportion of implementing partners (NGOs, CSOs, Private sector) contributing to
periodic reports
x Community based HIS established and linked to HMIS
x The proportion of planned periodic review that are carried
x Timeliness of reporting
x Completeness of reporting
x Proportion of planned validation studies that are carried out
x The proportion of sub national entities (districts, health facilities) that have reported as
planned
x Selected data disaggregated by age sex with concomitant gender analysis
Annual plan 2010/11 top indicators
x Number of sector performance review meetings held
x HSSIP 2010/11 2014/15 M E plan finalised
x Proportion of data validation exercises carried out
x The proportion of sub national entities (districts, health facilities) that have reported as
planned
x Timeliness of reporting
x Completeness of reporting
x Monitoring and evaluation studies carried out
Achievements
x Three health sector quarterly performance reviews were held with participation from all
departments and autonomous institutions.
x Finalized the HSSIP 2010/11 2014/15 M E Plan.
x Period progress reports submitted to OPM and MoFPED
x Participated in the UDHS -5 coordination committee meetings. Data collection carried out
by UBOS.
x SMER TWG supported the School of Public Health in protocol, progress and draft report
review for the Health System Assessment Survey.
x HIV Epidemiological surveillance report 2010 produced and disseminated by UACP
x HIV/AIDS indicator survey conducted. Data compilation ongoing by UACP
x PMTCT Data validation study conducted and disseminated by PMTCT program
x Tracer medicines availability study 2010, conducted and disseminated by Pharmacy
Division
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163
valuation Studies
x Malaria Programme Review 2011 conducted by UMCP. A binding MoU stipulating the way
forward was reviewed, adopted and signed by all in-country RBM partners on May 27,
2011 and disseminated. The finding to be used for developing a new malaria program
strategic plan.
x EPI Programme Review conducted by UNEPI and disseminated findings to key
stakeholders. The findings are being used to develop costed Multi-year plan for EPI that
will be used for resource mobilization.
Main challenges
x Structure for implementation of new roles and responsibilities for sector M E not defined.
x Performance review not conducted at sub national levels
x Annual oint Review Mission activities not budgeted for under the GoU budget
Recommendations for annual plan 2012/13
x Formalise M E implementation structure with clear roles and responsibilities.
x Clear budget allocations for operationalization of the HSSIP 2010/11 2014/15 M E plan
including funding for the oint Review Mission
x Support sub national levels to conduct regular performance review meetings
M&E activities were implemented though in an uncoordinated manner due to lack of an established
institutional structure for overall sector M&E. The HMIS component (Resource Centre) implemented
planned activities as planned focusing on data management. The QAD also implemented activities
related to sector performance review (quarterly); development of performance indicators for the
HSSIP and JAF; reporting to the OPM and MoFPED (OBT); and coordination of the SME&R TWG
activities. The QAD also took the central role in the development of the HSSIP 2010/11 – 2014/15 M&E
plan which when operationalized will guide the Country-led M&E system.
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3.6 Data Quality report
Figure 16: National health facility data uality assessment: summary of results
Area
ndicator
National Score
200
1
2
3
4
5
6
Completeness of district
reporting
Completeness of facility
reporting
Accuracy of event
reporting (zero/missing
values)
Accuracy of event
reporting (extreme
outliers)
Accuracy of event
reporting (moderate
outliers)
Accuracy of event
reporting (discrepancy
between monthly reports
and end-of-year report)
External data verification
2011
istricts ith lo
score
200
2011
% of monthly district reports received
98%
94%
3%
1
9%
1
% of expected monthly facility reports
received
% of monthly district reports that are
zero/missing values (average for 4
indicators)
% of district values that are extreme
outliers ( /-3 SD) (average for 4
indicators)
% of district values that are moderate
outliers ( /- 2SD) (average for 4
indicators)
% difference between monthly reports
and end-of-year report (average for 5
indicators)
92%
85%
9%
2
33%
2
3%
12%
4%
3
18%
3
0.3%
0.2%
8%
4
7%
4
4%
3%
35%
5
19%
5
NA
25%
9%
6
NA
NA
% of agreement between data in sampled Assessment not
done (last one
facility records and national records for
the same facilities for 3 core indicators
2008)
8
Accuracy of population
Estimated number of live births from
104
NA
projection
country projections divided by number
derived from UN population projections
8
8
101
101
21%
9
Accuracy of population
Projected population divided by the
22%
7
projection
expected population
10 External comparison:
Coverage from facility reports divided by
107
114
NA
DTP3
survey for the most recent comparable
year (2007)
11 External comparison:
Coverage from facility reports divided by
83
95
NA
Institutional deliveries
survey for the most recent comparable
year (2005)
1
% of districts with less than 80% completeness of monthly reporting
2
% of districts with monthly facility reporting rates below 80%
3
% of districts with more than 20% zero values
4
Number (%) of districts in which at least one of the monthly district values are extreme outliers in any of the four
indicators ( /-3 standard deviations from the district mean)
5
Number (%) of districts in which more than 5% of the values are moderate or worse outliers ( /-2 standard
deviations);
6
% of districts which are more than 33% difference between district monthly reported values and end-of-year
totals
7
The expected population is computed based on the first visit antenatal coverage rate;
8
Percent of districts which are more than 33% off the expected population;
7
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165
ntroduction
Almost no health data can be considered perfect. Data quality assessment is needed to
understand how much confidence can be put in the health data presented. Population-based
surveys employ standard well-accepted methods to assess and make adjustments for data
quality, with documentation of changes made and rigorous quality control mechanisms.
Administrative and health facility data are the basis for annual monitoring and also need to be
assessed in a systematic manner.
uality data on health sector performance should be available on a regular, preferably annual
basis. Population-based surveys are conducted only periodically, usually once every 3-5 years,
and as such do not always reflect current health realities. Health facility data are collected and
aggregated on a continuing basis and thus could present a timelier picture. Such data have a
number of limitations related to quality, such as missing values, bias, and computation errors.
Furthermore, to obtain population coverage rates, assumptions need to be made about the
denominators, the target population, which is prone to errors. This annex aims to describe the
data quality assessment and adjustment procedures for health facility data to meet the demand
for annual reporting on key indicators.
Reporting completeness rate
1. The Uganda Ministry of Health Resource Centre receives monthly outpatient and inpatient
reports from all districts. In addition, the districts report the totals once a year to the
Resource Centre. There is an element of timeliness in the completeness rate: all reports need
to be received before the 28th of the following month. Table 45 shows the monthly reporting
completeness for 2008/09 and 2010/11, as well as the districts with poor reporting. District
reporting completeness is slightly higher in 2009 (98%) compared to 2011 (94%). The
reporting completeness for 2011 may increase slightly as late submissions are sent from
districts and processed. All districts with poor reporting completeness in 2011 were new
districts, with the exception of Busia. In addition, while 108 of 112 districts submitted an
annual report (96%), the 4 districts that failed to submit one were new districts.
The district reporting completeness rate is computed as the total number of monthly district
reports received divided by the total expected number of reports. New districts from 2011 are
shown in bold.
Table 46: istrict monthly reporting completeness rate and districts ith poor completeness rate
National district monthly
reporting completeness rate
Number (%) of districts with
completeness rate below 80%
166
2008-200
80 districts
2010-2011
112 districts
98%
94%
2 (3%)
10 (9%)
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Districts with completeness
rate below 80%
Buliisa, Kabarole
Alebtong; Busia, Kole, uu a, engo,
Mitooma, Ngora, Ntoro o, N oya,
Sheema
2. All public and private-not-for-profit facilities are expected to report to the district every
month. The facility reporting completeness is defined as the total number of monthly facility
OPD reports received over the total expected number of monthly facility reports received x
100%. Table 46 shows the facility reporting completeness for 2008/09 and 2010/11, as well as
the districts with low completeness rates. Facility reporting completeness is higher for 2009
(92%) compared to 2011 (85%), although the latter may not fully account for late submissions.
As for district reporting completeness, many of the districts with poor reporting are new
districts. New districts from 2011 are shown in bold.
Table 47: Facility reporting completeness rate and districts ith poor completeness rate
National facility reporting
completeness rate
Number (%) of districts with
completeness rate below 80%
Districts with completeness
rate below 80%
2008-200
80 districts
2010-2011
112 districts
92%
85%
7 (9%)
37 (33%)
Amuria, Arua, Bugiri, Iganga,
Kabarole, Kamuli, Mayuge
Alebtong, Amuria, Budaka, uh eju,
ulambuli, Buliisa, Busia, utambala,
uvuma, uyende, Isingiro, Kaliro, Kalungu,
Kanungu, Kasese, Kibu u, Kiryandongo,
Kitgum, Kole, uu a, engo, Masaka
Mbarara, Mitooma, Moroto, Namayingo,
Nebbi, Ngora, Ntoro o, Ntungamo, N oya,
Rubiri i, Sembabule, Serere, Sheema,
Sironko, Soroti
Missing data and outliers
3. Missing data should be clearly differentiated from zero values in facility reports. However,
missing entries are often assigned a value of 0, making it impossible to distinguish between a
true zero value (zero events occurred that month) from a missing one (events occurred but
were not reported). The 2008-2009 monthly HMIS data had blank entries for missing monthly
reports, whereas the 2010-2011 data filled missing entries with 0. There were 22 districts in
2009 (28%) that had at least one missing/zero value in their monthly reports, compared to 68
districts (61%) in 2011. Four percent of districts in 2009 were missing 20% or more of their
values, compared to 18% in 2011.
4
5. The number of services provided may vary from month to month. Large fluctuations in the
numbers are however less probable. It is important to identify missing data and outliers, as
these can severely distort coverage rates, particularly at the district level. A large number of
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167
outliers is indicative of poorer data quality. Table 47 shows the number of extreme and
moderate outliers for 4 indicators. The percent of data points that were outliers showed little
variation between 2008/09 and 2010/11.
Table 48:
treme and moderate outliers among data points for 2008/0 and 2010/11 for 4 indicators
Number of e treme outliers
Moderate/e treme outliers outside
outside 3S of mean1 of data
2S of mean1 of data points
points
2008-2009
2010-2011
2008-2009
2010-2011
ANC1
2 (0.2%)
3 (0.2%)
44 (5%)
38 (3%)
DTP3
1 (0.1%)
2 (0.1%)
32 (3%)
40 (3%)
Institutional
deliveries
3 (0.3%)
2 (0.1%)
41 (4%)
40 (3%)
OPD
4 (0.4%)
4 (0.3%)
45 (5%)
46 (3%)
Total
10 (0.3%)
11 (0.2%)
162 (4%)
164 (3%)
1
ero values and missing data were excluded from the calculation of the means and standard
deviations. They were not included in the counts in the table.
Accuracy of reporting
6. Inaccurate reporting is harder to detect than incomplete reporting. This includes unintentional
and intentional errors. The Resource Centre conducts annual comparisons between the data
compiled from the district monthly reports and the totals reported by the districts at the end
of every year. The latter report may include more late reports than the monthly reports, and
may also be more prone to data entry errors. Table X compares monthly data with end-ofyear totals for 2010/11 for 5 indicators. There were a number of districts that showed a large
discrepancy between the two. Districts with a percentage difference greater than 33%
between these two values are shown in the table below.
Table 4 : ercentage difference bet een monthly data and end-of-year data at the national level, and
districts ith a large discrepancy
ifference
Number of districts
bet een monthly
istricts
ith discrepancy 33
and end-of-year
data1
Bukwo; Busia; Kiryandongo; Lyantonde;
Manafwa; Masaka; Masindi; Mayuge;
ANC1
74%
18 (16%)
Mbale; Mbarara; Mityana; Moroto;
Moyo; Mpigi; Mubende; Mukono;
Namayingo; Sembabule
Alebtong; Kapchorwa; Kiryandongo;
DTP3
10%
9 (8%)
Lyantonde; Mitooma; Otuke; Sheema;
Sironko; Soroti
Institutional
12%
7 (6%)
Alebtong; Buhweju; Kiryandongo;
168
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deliveries
1
OPD
16%
9 (8%)
IPT2
12%
8 (7%)
Total
25%
51 (9%)
Mbale; Sembabule; Sheema; Soroti
Alebtong; Amolatar; Busia; Kiboga;
Kiryandongo; Masaka; Mitooma;
Ntungamo; Sembabule
Alebtong; Buhweju; Busia;
Kiryandongo; Mitooma; Mubende;
Sembabule; Soroti
Between the mean of the non-zero monthly reports and the end-of-year total divided by 12.
7. No data verification exercise was conducted for 2010/11. The most recent data verification
exercise was conducted in 2008 by the Resource Centre5. A comparison was conducted
between the national level and facility data in all 80 districts for 3 monthly reports during the
preceding year. The data validation exercise established that the national level coverage rates
were too high for both IPT2 (ratio facility / national data was .95) and DPT3 (.92) and too low
for deliveries in health units (1.04). Overall, however, these errors are relatively small and
indicate good reporting.
opulation denominator accuracy
There are quite a few districts with coverage rates over 100% for indicators such as DTP3, which
is indicative of an inaccurate denominator. District populations in Uganda are based on
projections from the 2002 census, and may not sufficiently account for migration between
districts. Also district health services may attract clients from other districts and serve a
catchment population which is larger than the one living within the district boundaries. The
accuracy of the national population projection can be checked by comparing denominators
from the UBOS population projection with denominators derived from alternative sources. The
higher the level of consistency between denominators from different (reliable) sources, the
more confidence can be had in the accuracy of the population projections.
8. Alternative source for number of live births: An alternative estimate for the number of live
births can be computed using the most recent CBR estimate from the UN Population Division.
UBOS estimates live births to be 4.85% of the total population; CBR from the UNPD for 20052010 is 46.3 per 1000.
Consistency ratio (Estimated number of live births from UBOS)/(Estimated number of live
births using UNPD CBR) 1.04
9. Alternative population estimates (national and district) can be computed if the following data
are available: (1) accurate data on a numerator of an indicator (2) reliable population
estimates of coverage from surveys. Uganda has had a high rate of first visit antenatal care
(ANC1) coverage (over 90%) over many years (same rate in DHS2001 and DHS2006), with little
5
Ministry of Health. Report of the data validation exercise. Kampala. October 2008.
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169
variation across all nine regions (90-99%). Assuming that the ANC1 numerator from the facility
reports is correct (after data validation) and assuming a constant ANC1 coverage of 94% for all
districts, it is possible to assess the accuracy of the population projection at national and
subnational levels. An alternative estimate of the population is obtained by multiplying the
official population by the consistency ratio, the population coverage of the intervention based
on the facility reports divided by the assumed true population coverage based on the survey
data. The consistency ratio gives an idea of how close the intervention coverage from facility
reports is to the coverage obtained from survey data: the closer this ratio is to 1( 100%), the
higher the consistency. ANC1 coverage computed from facility reports is 95% for both
2008/09 and 2010/11, which yields a consistency ratio of 101% for the national population
projection. This suggests that the national population is approximately correct. The number of
districts that have a consistency ratio less than .67 (i.e. official population figure is too high,
resulting in ANC1 coverage that is too low) is 14 in 2011 (13% of districts). This is
approximately the same percentage as in 2009 (10%). In addition, the number of districts that
have a consistency ratio above 1.33 (i.e. the official population figure is too low, resulting in
ANC1 coverage that is too high) is 11 in 2011 (10% of districts), compared to 11% in 2009.
There was considerable overlap in the districts with under/over-estimated populations
between 2009 and 2011.
Table 50: onsistency ratio for AN 1 at national level, and districts ith very lo and very high
consistency ratios
2008-200
Consistency of national population
projection
80 districts
2010-2011 112 districts
101%
Districts with consistency ratio under
67% (official population is too high)
8 (10%)
Adjumani; Amuria; Buliisa;
Kaabong; Luwero; Moyo;
Nakapiripirit; Yumbe
Districts with consistency ratio over
133% (official population is too low)
9 (11%)
Abim; Budaka; Butaleja; Gulu;
Iganga; Kaliro; Kampala;
Lyantonde; Pallisa
101%
14 (13%)
Adjumani; Amudat; Amuria;
Kaabong; Kalungu; Kitgum;
Kween; Luuka; Lwengo; Moyo;
Napak; Ntoroko; Soroti; Yumbe
11 (10%)
Abim; Budaka; Buyende; Gulu;
inja; Kisoro; Kyegegwa;
Lyantonde; Nwoya; Serere;
Sheema
ternal comparison
10
11. A comparison with population based data obtained from surveys and community
research studies is also an important way to assess the quality of estimates generated by
health facility data. Table 50 shows a comparison of coverage rates for DTP3 and institutional
deliveries from population-based surveys and from facility reports.
Table 51: omparison of coverage rates from surveys and from facility reports
Most recent
survey
1
DTP3
79%
2
Deliveries
41%
1
National Service Delivery Survey 2008.
170
Facility reports HM S
2008-200
2010-2011
84%
34%
91%
39%
2
UDHS 2006.
Ratio overage from facility
data/coverage from survey 100
2008-200
2010-2011
107%
83%
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114%
95%
Figure 17 shows the DPT3 coverage trend generated from the HMIS reported data for children
under 1 year, as well as the results from the UDHS in 2006-07 and of the National Service
Delivery Survey 2008 for children 12-23 months (referring to under 1 immunization the year
before the survey). There is a large gap between the DHS results and the HMIS in 2005 which
suggested over-reporting in the HMIS. In 2007, however, there was no such gap, suggesting
good completeness of reporting.
The comparison of the results for the
indicator on four or more antenatal care
visits (ANC4 ) and delivery care between
the annual estimates generated by the
HMIS and the DHS results for three years
preceding the 2005/06 shows good
consistency. The correspondence of the
ANC 4 coverage rates for the period 20042006 is very good. The institutional delivery
rates in the DHS report are higher than
those reported by the HMIS. In the UDHS
2006, however, 29.1% of deliveries were in
public sector facilities and an additional 12% in private sector facilities. The latter includes notfor-profit and for-profit facilities. The HMIS includes not-for-profit facilities, but not for-profit
facilities.
Figure 17: Trend in T 3 coverage under 1 year
of age
, Uganda 2000-2010
Figure 18: omparison of HM S and HS coverage rates for institutional deliveries and AN four or
more visits
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171
Adjusted coverage rates
The district league tables can recomputed with the adjusted district populations. Table 51
shows the district league table scores and ranks (adjusted and unadjusted) of the top and
bottom 15 scoring districts for 2010/11, based on the ranking using the adjusted district
populations.
Districts that increased/decreased more than 40 places in the ranking are shown in bold.
Table 52: Top 15 and bottom 15 scoring districts based on ran ing using adjusted district populations
Adj
Adj Unadj Unadj
istrict
score ran
score
ran
Kampala
72.6
1
77.5
1
Kitgum
71 7
2
57 2
44
Katakwi
71.2
3
66.4
10
Kapchorwa 70.7
4
63.6
20
Masaka
69.3
5
63.0
21
Bushenyi
68.8
6
74.2
2
Moyo
67 8
7
40 7
102
Kabarole
67.7
8
73.1
3
Kumi
66.5
9
61.8
25
Mukono
66.2
10
65.3
13
Amuria
65 7
11
47 0
8
umbe
65 4
12
47
86
Bududa
64.8
13
62.7
22
Soroti
64 7
14
53 7
62
Mbarara
64.1
15
70.3
4
172
Adj
Adj Unadj Unadj
istrict
score ran
score
ran
Kibaale
45.2
98
50.9
75
Busia
45.0
99
44.7
93
Kibuku
44.9 100
51.5
70
Kyegeg a
44 3 101
56 2
48
Kiryandongo 44.0 102
42.9
96
Kole
42.6 103
40.4
103
Alebtong
42 1 104
Moroto
42.1 105
43.0
95
Sheema
42.1 106
52.5
68
uyende
41 6 107
54 8
54
Namayingo
41.4 108
39.7
105
Mubende
40.9 109
47.1
88
Amudat
40.7 110
23.2
108
Buhweju
39.8 111
40.1
104
Mitooma
37.8 112
44.7
94
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3.7 Progress on Implementation of the Priority Actions of the 16th Joint
Review Mission
Action
I.
Means
erification
of
rogress
omments
Health Financing
1. Review resource allocation Resource Allocation ¾ RAF has been reviewed ¾ The draft report will be
discussed in HPAC/TMC
Formula guide
and approved by SBWG
formula for the sector.
this financial year.
and SMC.
¾ The consultant is yet to
have
discussions ¾ The plan is to complete
/consultations with the
the process by anuary
CSO and PNFP Health
2012 and carry out
providers to develop the
dissemination by April
formula
for
NGO
2012 and use the
subsidies
formula for resource
¾ Other grant resource
allocation
in
FY
allocation formulas have
2012/13.
been widely discussed
and
ready
for
stakeholder
consultation.
of National
Health ¾ The technical team and ¾ The NHA for financial
2. Institutionalisation
year
2009/10
is
Accounts
steering committee have
National Health Accounts.
scheduled to start by
been formed and the
November 2011.
technical team trained
on NHA study.
¾ Road map, work plan
and proposal for NHA
institutionalization and
implementation
has
been developed and
approved in SBWG and
SMC
¾ The MOH with support
from ECSA and other
partners have set aside a
Budget for carrying out
NHA
exercise
this
financial year 2011/12.
¾ TORs for procurement of
a consultancy to offer
technical assistance has
been developed and
procurement process is
ongoing.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
173
Action
3. Develop a health financing
strategy.
4. Output based budgeting
and transparency.
5. Improve quarterly financial
reporting
and
accountability.
funding
for
6. Increase
hospital along the high way.
Means
of
erification
Health
Financing
Strategy
¾ Budget
estimates, BFP
and MPS for FY
2011/12
uarterly reports
Approved
2011/12
Budget
rogress
Consultations on going with
TMC
and
all
other
stakeholders on the contents
of the strategy
Budget estimates, BFP and
MPS developed with input
from all stakeholders using
the OBT.
All Health institutions and
policy makers consulted
during the preparation
process. The social services
committee of parliament
played a major role in the
agreed outputs.
There is been timely
preparation of OBT quarterly
financial
and
progress
reports to stakeholders.
There has been increased
funding to the Hospitals
along the highways.
omments
The strategy is expected to
be discussed in the RM
2011.
The TMC reviewed all the
work plans and Budgets to
ensure compliancy, value
for
money
and
transparency.
Timely accountability is still
a challenge
Feasibility studies have
been
carried
and
procurement processes are
ongoing.
17 General Hospitals and 2
RRHs along the high ways
will be rehabilitated this
financial year under the ICA,
GOU and World Bank
funding, 2 hospitals under
PHC development grant and
13 RRHs under the GOU
development grant.
The hospitals will be
equipped and ambulances
provided.
More drugs will be procured
and distributed to the
Hospitals,
II.
174
Human
Health
Resources
for
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Action
the
staff
1. Implement
motivation strategy to
enhance
attraction,
retention and productivity
(submit health system
strengthening
proposal
including HRH to GF).
Means
of
erification
uarterly and Annual
Progress Report FY
2010/11
rogress
omments
¾
All 24 districts covered
through payment of 30%
increments as wage
component.
Implemented by MOPS
¾
Sponsorship of students
by MoH for health
training at basic, postbasic and postgraduate
levels has targeted inservice health workers
and particularly those
hailing from hard to
reach and work districts
Due to inadequate funding
not all components have
been implemented
¾
2. Expedite
appointment,
deployment
professionals
the enrolled
midwives.
recruitment,
and
of
health
starting with
nurses and
3. Develop and
pre-service
strategy.
implement
training
4. Strengthen Leadership and
management skills at all
levels.
HRH Report
Occupational
Safety
Strategy for Health
(OSH) Hard to reach
Recruitment ban in LGs did
not allow
Need to lift recruitment ban
in
order
to
attain
appropriate staffing levels
HRD and Training
Policy and Strategy
A Consultancy firm has been
engaged to develop a Health
Sector Human Resources
Development and Training
Policy
Draft HRD and Training
Policy is expected by end of
st
1 quarter 2011/12 with
the support of Baylor
Uganda.
Training Reports
¾
With the technical support
of the MUK SPH and
Uganda
Capacity
Programme
¾
¾
A 24 week curriculum
for HRH Leadership and
Management (HRH LM)
course developed.
A pool of 16 National
HRH
LM
course
Facilitators were trained.
st
The 1 group of 26
district, hospital and
health
sub-district
health managers from 7
districts of eastern and
northern regions has
completed the first HRH
L M
course
and
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Funding the HRH LM plan
implementation and follow
up supervision remains a
175
Action
Means
erification
of
rogress
commissioned
with
district
L M
improvement plans.
III.
omments
big challenge.
Health nfrastructure
¾
existing
1. Consolidate
facilities to make them
functional.
Reports
ambulance
2. Develop
management strategy and
guidelines
Ambulance Strategy
and guidelines
and
referral
3. Districts
facilities should continue
securing land titles in a
phased manner.
Land Titles
Progressing slowly due to
inadequate finds
wholesome
4. Develop a
strategy
for
managing
medical waste starting from
segregation at source to
disposal materials.
Medical
Waste
Management
Strategy
Developing draft
1. Increase (double) resource
envelop for HC II 2m/ 2
month
HC III
3.8m/2
month
Allocation on Vote
116
It may not have doubled but
it increased substantially
2. Review and update the
standard list of essential
medicines, laboratory and
health supplies.
EMLH List
The medicine and health
supplies list were finalized
and ready for printing while
the laboratory list we still
need to have approval of the
different laboratory kits
from stakeholders
ssential Medicines
Health Supplies
IV.
176
HSSIP focus is on
consolidation of existing
facilities specifically staff
housing, maternity units
and
outpatient
departments
¾ Rehabilitation
and
equipment of RRHs
Being developed under the
UHSS project
and
We may not be able to print
them before RM
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Action
Means
of
erification
PPDA Regulations
Work in progress
The law has already been
amended at the moment
the regulations are being
drafted and we are involved
4. Align / coordinate all
partners dealing in EMHS
management
and
harmonize their training
programmes.
Reports
Many have come on board
5. All orders for health
supplies including ARVs
should be endorsed by the
DHO / MS.
Orders submitted
Not all orders are endorsed
by DHOs
This is a continues process
and it takes time for some
to appreciate the need to
align given the fact that
some of them pay more
allegiance to their funders
than MOH
Most of those that are sent
by e-mail do not go through
DHO
1. The National Policy on the
PPPH
should
be
expeditiously approved.
Approved National
Policy on PPPH by
Cabinet
st
2. Finalise and operationalise
a MOU governing the
Partnership between the
public and private sectors.
Signed
MOU
between GOU and
Private Sector
Was on agenda on 31
August, 2011, but was not
presented due to long a
Cabinet business list. On
agenda for next meeting
¾ Draft MOU for PNFPs
has been prepared.
¾ Draft for PHPs being
worked on with IFC
support
Securing the Certificate of
Financial implications from
the
MOFPED
delayed
th
(received on 24 August,
2011)
Lack of an approved PPPH
Policy limiting progress
and
3. Dissemination
implementation
of
partnership policy at district
level.
Reports
Dissemination has been done
in the 20 districts of
Nakapipipirit, Pader, Moroto,
Gulu, Kitgum, inja, Rakai,
Bushenyi,
Bundibugyo,
Kabale,
Nebbi,
Arua,
Mityana,
Mpigi,
Nakasongola,
Kyenjojo,
Kasese, Lira, Kabarole and
Masindi.
This was supported by the
Italian
Cooperation
in
Uganda, and the Health
Initiatives for the Private
Sector, a USAID supported
initiative.
The assumption was that
the PPPH Policy would be
passed in due course.
Reports
¾ Have developed job
aides in various areas of
RH (including Family
These
will
contribute
towards improvement of
quality of care in public and
for
the
3. Advocate
amendment of the PPDA
regulations to provide for
“procurement of medicines
other health supplies
under special procedures”
V.
VI.
ublic rivate
for Health
rogress
omments
artnership
Maternal and hild Health
1. Improve uality of Care in
govt. and PNFP facilities
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177
Action
supplies,
recruitment
management.
Means
erification
of
personnel
rogress
omments
Planning,
Maternal
Health,
Adolescent
Sexual and Reproductive
Health, Newborn care).
¾ Continued
to
build
capacity in maternal and
perinatal death auditing
as aimed at improving
quality of care.
¾ Training guidelines have
been reviewed on ASRH,
SGBV, and Integrated
RH/HIV
aimed
at
Continued
Medical
Education
and
professional
development for service
providers in the public
and private sectors.
¾ Working with CSOs
engaged in Reproductive
Health to build capacity
for Family Planning
service provision on
Long
Term
and
Permanent methods of
FP.
Some retired midwives with
training skills were utilized
for
supervision
and
supervision activities in the
training highlighted under
section 4.2.1. (above)
PNFP facilities
private sector.
and
the
Major CSOs involved in RH,
specifically Family Planning,
include
Reproductive
Health
Uganda
(RHU),
Marie Stopes Uganda,
PACE,
Family
Health
international 360, Uganda
Private
Midwives
Association.
2. Actively engage retired and
unemployed
skilled
attendants in the private
sector
(monitoring
supervision,
training,
mentoring,
data
management ) etc
Reports
3. Give incentives to mothers
to deliver in the public
health facilities e.g. Maama
kits, soap, suka’
in
Karamoja etc
NMS reports; HMIS
data.
More Maama kits were
procured and “pushed” to
HC IIIs, and supplied to HC
IVs and hospitals that
ordered for them.
This is reflected in the
increase in percentage of
pregnant women delivering
in health units recorded in
FY 2010/11.
4. Carry out maternal and
child death audits
MPD Audit Reports
Tools were made available to
districts that were trained in
MPDR. Districts highlighted
under section 4.2.1. (above)
Some hospitals like Kitgum,
Gulu, Apac, Nebbi that were
active in auditing deaths in
2009 were doing so under
project support. They
became less active in 2010
During the financial year, 915
178
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Action
Means
erification
of
rogress
maternal
deaths
were
reported to MoH from public
and PNFP facilities.
91 deaths were audited and
reports sent to MoH. The
audits were from Nsambya
hospital, inja RRH, Kayunga
GH, Kamuli GH, Naggalama
GH, Mubende GH, Moroto
RRH, Katakwi HC IV, Kanungu
GH, Nakaseke GH, Kiboga
GH and Gulu RRH.
omments
allegedly because they were
did not have funds.
Some hospital like Kiwoko,
Nakaseke have recorded
significant reduction in
maternal deaths due to
institutionalization of
maternal death audit.
These hospitals are now
concentrating on auditing
perinatal deaths.
In hospitals where the
hospital administrators are
actively involved in the
MPDR Committee, there is
better institutionalization
i.e. better facilitation of
MPDR committee meetings,
availability of tools and
implementation
of
recommendations
VII.
VIII.
ommunicable
ontrol
isease
community
1. Strengthen
disease surveillance and
early case detection.
Reports
Built Epidemic Preparedness
and Response Capacity in 30
districts
2. Advocate for enhanced
political participation and
support in delivery of health
services.
Advocacy reports
No activities reported
3. Training in leadership and
governance
e.g.
in
information management
and utilization
Training reports
16 HRH leaders received a
TOT training in leadership
and management.
o
Health managers
o
Other stakeholders
Non
iseases
Inadequate funding to train
and functionalise VHTs
country wide
The first training course of 32
HR leaders from 7 LGs was
conducted (Mbale, Butalejja,
Busia,
Amolatar,
Namutumba, Dokolo and
Kamuli)
ommunicable
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179
Action
1. Complete the Uganda NCD
Survey on NCDs, their risk
factors
and
social
determinants
2. Scale up NCD prevention
and management
o
Promotion of health
styles
o
Promote screening for
early detection
o
Capacity
building:
human
resource,
equipment, medicines
and supplies
Means
of rogress
erification
NCD Survey report
Procurement contract for
survey
equipment
and
furniture signed
Reports
¾ Framework Convention
on Tobacco Control
(FCTC)
partially
implemented.
omments
Insufficient funds allocated
to complete planned
activities
Procurement delays
Implementation of Global
strategies : on Diet, Physical
Activity and Health; Against
harmful use of alcohol to
start when funds are
available
¾ Screening for both
cervical and breast
cancers
has
been
conducted in the Teso
sub-region; Costing of
nationwide screening for Scaling up to start when
both cancers completed. funds are available
¾ MOU signed with Novo
Nordisk to supply free
insulin and diagnostic
equipment;
improve
infrastructure;
train
health
workers
to
manage type 1 Diabetes Support from Novo Nordisk
as well as educate and Life for a Child
children
and
their programme
families.
¾ Steering
Committee
established
to
implement MOU
Health
romotion and
nvironmental Health
IX.
1. Scale up training and
functionality
of
VHTs
country wide.
VHT Strategy Report
¾ VHT
Strategy
implemented
in
additional 18 districts
¾ Total
number
of
districts which have
fully established stands
at 69
¾ Trained VHTs in the 14
districts supported with
ob Aids, certificates,
protective wear and
identification badges.
¾ VHTs
180
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
in
Wakiso
Action
Means
erification
of
rogress
received bicycles from
WHO and Global Fund.
Public education through
the media is very expensive
and requires adequate
funding
2. Intensify public education
through the media and
public relations.
Activity reports
¾ Communication/ public
relations
specialist
recruited.
¾ Public
education
announcements
and
discussions have been
conducted on the print
and electronic media
districts
3. Facilitate
(logistically,
tools),
to
enable the staff inspect,
supervise and monitor
environmental
health
activities.
Activity Reports
Not done during the financial
year 2010/11 due to
inadequate funding.
MoH to procure uniforms
for Health Inspectors and
Health Assistants during the
FY 2011/12 if funds are
available.
4. Procure and distribute
existing
Public
Health
Legislation to all districts for
law
enforcement
in
collaboration
with
all
stakeholders.
Copies
of
PH
Legislation in districts
None procured
Inadequate funding,
5. Strengthen inter-sectoral
linkages and leveraging at
all levels to promote health.
Minutes
Inventory
The division to purchase
1000 copies of Public Health
Act during the FY 2011/12
¾ Creation of a Sanitation
and Hygiene budget line
in the Ministry of
Finance Planning and
Economic Development.
¾
X.
omments
¾ The division had a
series of meetings with
the Sanitation and
Hygiene
sub-sector
Working Group.
uarterly
Water, ¾ Progress has been
Sanitation and Hygiene
registered in the area
of
sanitation
and
(WASH) cluster meetings
hygiene with some of
for Karamoja region held
the Karamoja districts
supported by UNICEF.
achieving 10% latrine
coverage more from
the previous figures.
Nutrition
1. Develop service standards
for what is expected in
nutrition at all levels on
health care including VHT.
Service standards
Two meetings so far held to
develop the nutrition service
standards
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181
Action
Means
erification
2. Integrate and harmonise Strategies and
strategies and guidelines on guidelines
micronutrients.
nutrition
3. Design
interventions using data for
advocacy purposes.
of
rogress
omments
¾ Two day stakeholder
meetings to develop a
consensus held
¾ Concept and draft 0
developed
¾ Health care providers
used
Emergency
Nutrition
Assessment
(ENA) for SMART in the
assessment
and
designing response for
the malnutrition crisis in
Namutumba district.
Reports
¾ Data from nutrition
surveillance used in
strengthening
service
delivery
Nakapripirit
district
Supervision
Monitoring
and valuation
XI.
1. Review and adapt support Progress report
supervision tools for the
sector.
TOR
developed
for Procurement of Consultant
developing a comprehensive initiated with support from
supervision, monitoring and ICB Project
inspection strategy
2. Train District Health Teams Report
in
supervision
and
monitoring skills.
Not done
IF
and National
3. Harmonise
institutionalise
uality Strategic Plan
Improvement initiatives in
the health sector.
and Final draft of the National
IF and strategic plan ready
4. Operationalise the revised Revised HMIS in use
HMIS in public and private
health facilities as well as
community level (VHTs).
5. Develop a strategic plan for
UNHRO and health research
182
Strategic plan
Launched the HMIS 2020
Not funded
IF and strategy to be
operationalised 2011/12
Tools not yet printed and
therefore not in use.
Trained all (112) District
Biostasticians and HMIS FPs
in 50 districts
Inception report for the
strategic plan and operating
manuals
are
under
development
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3.8 Progress on Implementation of the Recommendations of the 7th Annual
y
Health Assembly
Means
erification
Resolution
1
of
Action
omments
Human Resources for Health
i.
Implement the hard-to-reach,
hard-to-stay,
and
staff
motivation
strategy
to
increase staff retention and
reduce attrition.
Implementation
reports
¾ Hard to reach strategy
was implemented by
MoPS.
Sponsorship list
¾ Motivation
and
retention component
was costed
Not implemented
due to lack of
funds.
¾ There are students
from the hard to reach
and work districts on
preferential
sponsorship
of
government solicited
funding.
ii.
Lobby
government
to
increase wages of health
workers.
Minutes
Negotiations ongoing
iii.
Districts that have not
reached 60% of their wage bill
should recruit.
HRH Report
Recruitment plan made but no
recruitment done
No
additional
funds
provided
under PHC.
iv.
Accelerate the strategy of
task shifting.
HRH TWG meeting
minutes.
¾ A situational analysis of
Task Shifting in Uganda
made and a report
highlights the types/forms,
magnitude and challenges
of the processes and
implementation.
¾ A high level stakeholders’
consultative workshop held
to share and a consensus
arrived at on key issues and
the way to go.
¾ A position paper of the
Ministry of Health was
further presented to a
HRH TWG meeting
minutes.
MoH
Position
Paper health work
force
rationalisation
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MoH
Position
Paper health work
force
rationalisation
183
Means
erification
Resolution
of
Action
omments
consensus meeting and it
came out with a policy brief
and proposed strategy
covering the following
items.
` Skills audit
` Calculating cost
potential
` Value of different roles
` Harmonizing roles as
necessary
` Different teaching and
learning strategies
` Analyses/Evaluations of
posts and competences
profiles
¾ The rationalising of utilising
HRH report is available and
has been forwarded for
further discussion at the
top management level.
v.
Recentralize the deployment
of key health workers such as
Medical Officers.
Amended Policy
Cabinet decision not taken
vi.
Review the curriculum of
Enrolled
Comprehensive
Nurses
and
Registered
Comprehensive Nurses.
Reviewed
curriculum
vii.
MoH to write circular to
districts banning recruitment
Circular
¾ A joint consultancy of local
and international level
experts was engaged to
evaluate
the
comprehensive
nurse
training program.
¾ It sought views from key
stakeholders
in
MoH,
MoES, MoPS, PNFPs, PHPs,
Training
institutions,
Service
providers,
the
alumni etc and developed a
report
with
recommendations that was
presented to the HRH TWG
and discussed.
Not done
184
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The
proposal
awaits the SMC
and
TMC’s
considerations and
responses.
¾ A workshop
for 30 key
representative
Means
erification
Resolution
of
Action
of Nursing Assistants, and to
work with MoE to phase out
training of Nursing Assistants.
omments
s of Nur w
¾
¾
viii.
DHOs should monitor and
ensure that schools training
nurses and midwives are
registered.
List of students
and
schools
practicing
in
district facilities
¾
NAs
with
appropriate
qualifications
are
preferentially
considered
when selecting
entrants
to
enrolled
nurse/midwife
ry courses.
The
above
issues
have
been regularly
articulated to
DHMTs
at
various fora of
interaction.
Gazetted health training
institutions have been put
in the media and forwarded
to the DHOs for reference,
public notification and
further action.
¾
ix.
2
Post
of
Medical
Superintendent should be
established
and
institutionalized
in
the
Ugandan Civil Service.
ssential Medicines
Health Supplies
i.
Staffing Norms
The professional councils
are monitoring the process
as they establish District
Health
Professionals
Supervisory Authorities to
regularly regulate the vice.
Position of Hospital Director
was RRH level was formalized
and the substantive officers
were appointed.
The other posts are
waiting for
finalization of the
restructuring
process.
and
Improve procurement and
supply chain management of
medicines
by
regularly
updating and monitoring the
3-year rolling plan
¾
A
uantification
Procurement
Planning
Unit ( PP) in place and
operational
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
185
Means
erification
Resolution
of
procurement plan (including
all development partners’
contributions) and monitoring
the performance indicators
for NMS and MS to ensure
sustainable availability of
drugs and health supplies at
both public and PNFP units.
ii.
iii.
In light of new policy shift,
develop and disseminate
guidelines for the supply and
distribution of drugs to all
stakeholders. The guidelines
should include a monitoring
mechanism.
Guidelines
monitoring
mechanism
place.
and
Set up a transparent drug
pricing system at NMS
Price catalogue
in
Action
omments
¾
Procurement
developed
disseminated
¾
MSS conducted
¾
MOU between MoH, MoLG
NMS signed
New list for HC II and III
developed and in use
¾
plan
and
Overall guidelines
development
process to be
started
and
completed in 2nd
quarter
of
FY
2011/2012
¾
NMS manuals to guide the
guidelines
development
sent to MoH
¾
Price catalogue provided to
MoH
Price
catalogue
revised every year
¾
Pre- printed order forms
distributed to HCIV and
Hospitals
Pre- printed order
forms printed by
NMS
iv.
NMS and MoH to prepare,
publish and circulate a
medicines and supplies price
list.
Price catalogue
Same as above
Same as above
v.
Build capacity at the user
units in medicines and health
supplies needs forecasting
and rational drug use.
Training reports
¾
MMS Trained in 45 districts
with support from SURE
¾
Health workers in 442
health
units
provided
support
Capacity building is
ongoing to cover
all the districts and
hospitals
with
support
from
Implementing
Partners
¾
Soft ware piloted in three
hospitals
3
ommunity nvolvement
i.
186
Mobilize funding to scale up
Budget for VHT
Government, UNICEF,
Projects and World
USAID
Vision
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
More funding still
needed
for
Resolution
Means
erification
VHTs across the country.
scale up
of
Action
omments
provided financial and logistical
support for VHT scale up.
monitoring
and
supervision of VHT
activities
HUMC reports
HUMC guidelines under review
Inadequate
funding for training
and
facilitating
HUMC operations
the
district
iii. Strengthen
partnerships with CSOs/NGOs
when rolling out the VHT
strategy.
VHT reports
Government, UNICEF, USAID
Projects, World Vision provided
financial and logistical support
for VHT scale up.
iv. Ban the use of professional
medical titles for people who
practice alternative medicine.
Circular
List of partners
supporting
VHT
establishment
ii.
Put in place and build
capacity of Health Unit
Management Committees.
4
Health Financing
i.
Develop
a
sustainable
strategy for financing the
PNFP sector: the PNFP
subsidy from GoU has
reduced from 22% to 20% and
user fees in the PNFP have
increased.
PNFP
financing
strategy
Not done
Awaits approval of
the
general
national Policy on
PPPH
ii.
Develop an evidence based
health financing policy and
strategy which can be used
for advocacy within and
outside government.
HF policy
strategy
¾
The process has started
concept note, consultative
meeting held to develop
policy questions and policy
action.
¾
A technical committee
Meeting has been held,
policy questions, roadmap
and draft policy outline
have been developed, by
technical committee
A meeting has
been planned to
obtain Senior Top
and
Top
Management
guidance
and
approve road map
and
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
187
Resolution
Means
erification
of
iii.
Lobby to increase PHC nonwage recurrent budget to
support operational costs
especially at HC IV level.
Budget
Discussions
ongoing
with
parliament and MOFPED to
increase per capita expenditure
on health
iv.
Review funding criteria of
districts with peculiar needs
e.g. border districts.
Fund
allocation
criteria
A comprehensive resource
allocation formula is being
finalized
with
technical
assistance from WHO.
Action
It gives a special treatise to
hard-to-reach districts and
border areas, in addition to
other criteria focused on
poverty differentials and other
peculiarities of different districts
v.
Accelerate
the
operationalization of National
Social
Health
Insurance
Initiative.
5
Malaria ontrol
i.
ii.
188
omments
Finalization of the
formula awaits a
consultant’s
meeting with the
PPH
TWG
to
finalize the PNFP
components.
Reports
Additional principles were
approved by Cabinet in
September 2011 and now the
bill is being re-drafted.
The bill shall be
tabled in Cabinet
before end of this
calendar year.
Intensify efforts to roll-out
proven effective malaria
control interventions like IRS
and ITNs.
Reports
7.2m nets distributed to PWAs
and 5s to all districts except 7
in Eastern Uganda. Awaiting
10.4m nets to achieve Universal
Coverage (1 net to 2 persons)
Delays have been
experienced in the
procurement cycle
and disbursement
of funds by GF
GOU to specifically budget
and fund Indoor Residual
Spraying.
Budget
2.4 and 2.9b provided for IRS in
last
and
current
FYs
respectively. Plan was to cover 3
districts of Katakwi, Kumi and
Bukedea
Using Carbamate
Bendiocarb, only
one district can be
covered with the
amount provided.
There
is
high
resistance
to
pyrethroids
that
would have been a
cheaper option
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Means
erification
Resolution
6
Maternal and hild Health
i.
Need to address the issue of
high maternal deaths by
focusing on EmOC and
reducing the unmet need for
FP.
of
Supervision
activity reports;
UDHS
Action
Planned action was to provide
EmOC supplies to needy health
facilities using the World bank
loan. The procurement process
has been initiated.
More
Family
Planning
commodities have been and
more are being procured.
Alternative distribution channel
for FP commodities to potential
FP users is being worked out to
increase access through both
the public and private sector,
ii.
Roll out and implement the
Child Survival Strategy.
¾
Reports
¾
¾
¾
7
Health nfrastructure
i.
Improve the release
effective
use
of
and
the
Budgetary
allocation
and
CS Strategy was reviewed
and aligned with HSSIP
2010/11 2014/15;
Scaled up implementation
of
the
integrated
community
case
management (iCCM) and
trained
and
equipped
13,882 VHTs in 24 districts
(92%);
Reviewed
early
implementation of iCCM in
Karamoja and Kyegegwa;
Secured TA to design MNCH
passport using existing child
health,
FP,
discharge,
referral, MF5 and women
passport;
Started HW on job skills
building on Helping Babies
Breathe and Managing sick
new born in HC III, IV and
Hospitals.
Increased capital development
fund for Regional Referral
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
omments
The acute human
resource shortages
(doctors
and
midwives
and
anaesthetists
should
be
addressed as soon
as possible. Having
EmOC and FP
supplies without
adequate numbers
of relevant skilled
service providers is
NOT sufficient to
achieve this.
Assumption that
regional teams and
districts will be
funded. Staffing
levels in the
division improve
Focus
consolidation
on
of
189
Resolution
Means
erification
of
development
budget
to
improve functionality of the
existing health infrastructure.
Planning
Guidelines
Hospitals
ii.
DHOs
should
regularly
provide and update the
infrastructure and equipment
inventory.
Inventory reports
Infrastructure and Equipment
inventory not submitted
iii.
Maintenance of equipment
should be prioritized.
Reports
Budget provision at Regional
Hospitals (except inja Masaka,
Mbarara and Mubende)
8
Health Sub- istricts
i.
Review the health sub district
concept.
Report
Consultant to conduct HSD
strategy evaluation is being
sourced under World Bank
financed
Uganda
Health
Systems Strengthening Project.
ii.
Prioritize HC IV functionality
particularly funding HC IVs.
Budget allocations
An additional Ushs 2bn was
given to local governments to
help functionalise HC IVs.
Work plans
NTD activities integrated with
Child Day Plus Activities. Carried
out mass deworming and
Action
Planning guidelines provided on
utilization of PHC Development
funds
omments
existing facilities
through
rehabilitation and
expansion
especially at HC III
level to provide
MCH services and
staff
accommodation
Health
Unit
Physical Inventory
Form (101) and
Equipment
Inventory
Form
(102) available and
should
be
th
submitted by 28
August every year
Report will provide
basis for reform of
the strategy to
support
HSSIP
implementation
Neglected iseases/ merging
diseases
i.
190
Pay attention to neglected
tropical
diseases
and
emerging diseases.
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Emerging problems
e.g.
jiggers
in
Busoga region
Means
erification
Resolution
of
Action
omments
azithromycin administration.
10
nvironmental Health
i.
Recommit LGs to the Kampala
Declaration on Sanitation
(1997) to enact and enforce
bye-laws/ordinances to raise
pit latrine coverage.
Reports
ii.
Share and promote successful
district/hospital experiences.
Reports
Brochures
iii.
Mobilize resources to address
climate change issues that
impact on Public Health.
Workplan
budget
iv.
Health units and health
workers should participate in
community activities that
mitigate the effects of global
warming such as tree
planting.
Reports
156 district staff were trained in
processes of enactment of
Ordinances and Bye- laws with
support from MoH (7 districts
MWE
supported
135
participants)
Holding Advocacy
meetings
with
districts that are
implementing
Development
of
Ordinances
and
Bye Laws.
and
Not done
Poor
documentation
and
No funds were forth coming for
Climate change activities.
Budget allocation
for Climate Change
by MoH in the next
financial year
Not done
No funds
allocated
FY10/11
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
were
for
191
192
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Bundibugyo
Hoima
Cholera
(suspected)
Cholera
(suspected)
10
29
217
4
No. cases
Ebola
Luwero
01
Ebola and other viral hemorrhagic fevers
Nakapiripirit
Bugiri
Affected
districts
Cholera
(confirmed)
Cholera
Polio
(confirmed)
Polio
Condition
01
0
5
10
0
No.
deaths
The index case was a 12 year old female from Nakisamata village, Ngalonkalu Parish, Zirobwe sub-county, Luwero
district who passed away on 6th May 2011 following a febrile hemorrhagic illness that lasted six days. Laboratory
The outbreak started on May 30, 2011 with cases being reported from Nkondo 1&2 villages, Nkondo Parish, Kabwoya
sub-county. All cases were treated at Sebigoro HCIII and discharged by June 4, 2011 without any fatalities.
Laboratory specimens were not obtained since antibiotics had been administered by the time the district rapid
response team went down to investigate the cases.
The initial cases were reported on February 9, 2011 from Bunyansiri parish, Ntotoro sub-county. A total 29suspect
cases with 5 deaths were reported during the period February 9-22, 2011. Laboratory confirmation of Cholera
outbreak was not done since we were unable to collect any stool samples.
Index case was reported on October 18, 2010, from Achele village, Tokora parish, Kakomongole sub-county.
Additional cases were reported from Nakapiripirit Town Council, Kakomongole, Namalu, Lorege, and Lolachat.
Outbreak confirmation was undertaken by Mbale regional referral hospital laboratory. Latrine coverage was estimated
at 3% and safe water coverage at 40-60% in the district. CTCs were set up at Nakapiripirit HCIII and Tokora HC IV
and cholera and sanitation kits were supplied by NMS, WHO & UNICEF.
The index case was a partially vaccinated 24 month old female from Nawansonga village in Kithodha Parish of Bulesa
Sub County with 20 September 2010 as the date of onset. Wild Polio Virus (WPV) Type 1 was isolated from the
laboratories (UVRI & NICD) and was genetically linked (97.46%) to the WPV isolated in Turkana region, North West
Kenya on 3rd February 2009. Three of her contacts were also confirmed to be infected. There was a decline in the
routine immunization coverage of DPT/OPV3 from 83% in FY 2008/09 to 76% in FY 2009/10. Supplemental
Immunization in 48 high risk districts in North East, East and Northern Uganda using Monovalent OPV (TYpe1) were
implemented using “The House to House strategy”.
Remarks
3.9 Annual Epidemics Update July 2010 to June 2011
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
193
Kamuli
VHF
(suspected)
Rabies
Bundibugyo
Bundibugyo
Suspect VHF
Rabies
Kyegegwa
Kampala,
Wakiso,
Nakaseke,
Bugiri, Kasese,
Gulu, Kabale,
Nakasongola
Affected
districts
Suspect VHF
(Alert,
Suspected)
Ebola
(confirmed)
Condition
96
2
17
1
39
No. cases
6
2
8
0
(CFR
25.7%)
10
(CFR
100%)
No.
deaths
Initial cases were reported on June 6, 2011 from Kasitu, Sindula, Ntotoro, Ngamba, Bukonzo, Bundibugyo Town
Council, and Nyahuka Town Council. 100 doses of rabies vaccine for humans and another 1,000 doses for animals
The initial case was a 35 year old female from Kamuli Town Council who was reported on June 25, 2011 by Kamuli
mission hospital where she presented with a febrile hemorrhagic illness; she died on the same day of admission. Test
results from UVRI were negative for Ebola & Marburg by PCR & Serology. The second case was a 15 year old girl 3days history of a febrile hemorrhagic illness. She passed away the same day she was admitted and test results were
negative for Ebola & Marburg.
The cases were reported during the period October 16-22, 2011 from Ntandi village, Kasitu sub-county and had febrile
hemorrhagic illness. The seven specimens submitted to UVRI tested negative for Ebola and Marburg by ELISA and
PCR.
The case was reported on August 6, 2010, and involved a 2.5 year old male seen in Bugiburi HCIII who presented
with 3-days history of a febrile hemorrhagic illness. The blood samples analyzed at UVRI were negative for Marburg
and Ebola antigens and antibodies (Ig G and Ig M).
cases and 22cases with 6deaths among suspect cases were investigated from Kampala, Wakiso, Luwero, Bugiri, K
Nakaseke, Kabale, and Gulu but they all tested negative for Ebola/ Marburg and Yellow Fever.
During the Ebola outbreak that occurred during the period May 6, 2011 to June 17, 2011, a total of 17 cases with 4
among alert
investigations by way of both real time PCR testing and Antigen detection by ELISA confirmed Sudan Ebola virus
(SEBOV). Phylogenetic analysis in CDC-Atlanta showed that the Bombo sequence is 99.3% similar to the Gulu 2000
strain. One contact (the brother to index case) tested positive for Ebola by IgG. The outbreak was declared over 17June-2011after two incubation periods elapsed following the death of the lone confirmed case on 6 May 2011 without
any additional confirmed cases.
Remarks
194
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Arua
Yellow Fever
(suspected)
Dengue fever
(confirmed)
Dengue Fever
(suspected)
Mogadishu
(Somalia)
Gulu, Arua,
Lira, Kaabong,
Kotido, Napak,
Nebbi, Yumbe,
Dokolo
Yellow Fever
(confirmed)
Agago, Pader,
Abim, Lamwo,
Kitgum
Affected
districts
Yellow Fever
Yellow Fever
Condition
106
167
97
10
No. cases
0
3
17
41
No.
deaths
The initial cases were reported on April 6, 2011from the Uganda sector of AMISOM troops in Somalia. The outbreak
was confirmed on July 8, 2011. Patients present with fever, general weakness & joint pains with vomiting; some few
had petechial hemorrhages in the skin, sub-conjunctival hemorrhage and jaundice. The majority of the cases present
with dengue fever but there also a few cases with Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome
(DSS). At least 34 cases have been confirmed in the laboratory either by PCR or serology. Several serotypes i.e.
DEN-1, DEN-2 and DEN-3 have been identified during the outbreak. Due to the risk of importation of the disease into
Uganda the following measures have been put in place: (a) Hold the troops in one central place [Bombo] for at least
one week and discharge those who don’t manifest with symptoms. (b) Re-activated the isolation ward in Bombo to
Cases presenting with fever, head ache, joint pains, epigastric pains, rigors, hiccups, mental confusion, and yellowing
of palms and eyes were reported from Ayayia village, Ayayia Parish, in Ajia sub-county starting 8 June 2011. A total of
10 cases with 3 deaths were reported over a three-week period starting June 8, 2011. The cases were admitted in
Agiya HC and Kuluva hospital. Laboratory testing was negative for Yellow Fever, Dengue and Hepatitis E Virus by
PCR and serology.
A total of 273 suspect Yellow Fever cases including 58 deaths (Case Fatality Rate 21.3%) were reported from 14
districts in Northern Uganda during the period November 2010 to April 2011. A total of 13 cases were confirmed to
have Yellow Fever from the five the districts of Abim, Agago, Pader, and Kitgum. A vaccination campaign was
conducted during the last week of January 2011 targeting all persons aged 6 months and above in the districts of
Abim, Agago, Kitgum, Lamwo and Pader. The overall Yellow Fever immunization coverage in the five districts was
80.1% (with Abim having a coverage of 120.5%; Agago at 80.7%; Lamwo at 73.9%; Kitgum at 77.6%; Pader at
75.9%).
were supplied to the district to facilitate response activities.
Remarks
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
195
Affected
districts
No. cases
Namutumba
Kasese
Moyo
Hepatitis B
Virus (HBV)
Hepatitis B
Virus (HBV)
Hepatitis B Virus (HBV)
Acute Protein
Energy
Malnutrition
(PEM)
67
86
818
Acute Protein Energy Malnutrition (PEM)
Condition
13
0
10
No.
deaths
The initial cases were reported starting February 2010, samples were sent to UVRI where the infection was confirmed.
The cases reported from the sub-counties of Moyo, Dufile, Gimara, Metu, Itula, Moyo TC, and Lefori. The prevalence
of HBV infection in West Nile region is one of the highest and stands at 18%, much higher than the national average
of 10% and the WHO threshold of 9%. The coverage for DPT3-Hep B+Hib was only 30% in Moyo during the FY
2008/09. Mobilization of communities needs to be enhanced to improve the coverage for this vaccine. A policy for
Following media reports on June 20, 2011 indicating an outbreak of HBV in Kasese
http://www.newvision.co.ug/D/8/12/758088 the MoH reviewed health facility data from six HU where HBV testing is
done including Bwera, Kagando, St. Paul HCIV, Rukooki HCIII, Bishop Masereka HCIII, & Kasese TC HCIII. A total of
86 cases of HBV were confirmed out of 924 patients tested; putting the positivity rate at 9.3% which is lower than the
national average of 10%. And besides the rate of 9.3% is over estimated as this was obtained from sick patients
attending HU hence this rate is definitely higher than the actual rate in the general population. There was therefore no
evidence of an outbreak of HBV infection in the district. The proportion of children receiving three doses of Hepatitis B
vaccine in Kasese district currently stands at 96%. A press release was issued [June 24, 2011] by the Hon. MoH to
clarify the erroneous media publication.
Cases of acute PEM were reported from Magada sub-county during the 3rd week of June 2011. Cases were also
reported from Mazuba, Kagulu and Nabiswegi Parishes in Magada sub-county and Kibale sub-county. The clinical
history indicates that most of the affected have malnutrition (marasmic kwashiorkor) since April 2011. The affected
areas experienced famine after crops were damaged by hail stones in March 2010. During the famine, families feed
on alternate days with just one meal per day; a typical meal being cassava/ maize bread and greens. Magada HCIII
and Nsinze HCIV were designated as therapeutic treatment centres. A team of pediatricians from Mwanamugimu unit
in Mulago supported the initial health facility-based assessments and management of cases. Cases were also treated
from the surrounding districts of Butaleja, Kumi, Pallisa, and Kibuku.
provide supportive care for the sick, and (c) Continue line-listing and surveillance in Mogadishu as well as ensure
supportive treatment (rehydration and paracetamol); and vector control measures in Mogadishu.
Remarks
196
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Affected
districts
Kitgum,
Lamwo &
Pader
Hepatitis E
Hepatitis E
Kotido
(confirmed)
(confirmed)
Kaabong
Hepatitis E Virus (HEV)
Human
Influenza
Human Influenza
Head nodding
disease
Head Nodding Disease
Condition
18
1008
27
1,876
No. cases
2
21
0
05
No.
deaths
Initial cases were reported starting from September 2009 till March 2011 and were reported from Kotido sub-county,
Panyangara sub-county, and Kotido Town Council. The affected areas have very low latrine coverage of up to 2%.
The outbreak started on August 18, 2009. The initial cases were linked to the consumption of Kwete in Kaaboong
Town Council. Cases have been reported from Sidok, Karenga and Kaabong sub-counties. Latrine coverage is low
(1%) and a factor in the spread of the disease. There was an upsurge in cases following the onset of rains in March
2011 that was responded to by GoU and partners.
The National Influenza Centre in UVRI maintains sentinel surveillance sites in Mbarara hospital, Arua hospital, Koboko
hospital, Kisenyi HC, Kiswa HC, Entebbe hospital, and Kitebi HC where patients presenting with Influenza Like Illness
(ILI) are investigated systematically. The data (as of May 27, 2011) indicates that out of 618 specimens analyzed this
year [2011], 27 specimens have yielded human influenza virus isolates with 24 being pandemic influenza A (H1N1)
2009; and 3 being seasonal flu B.
An investigation undertaken by MoH with support from CDC & WHO in August 2010 in 26 sub-counties in the 3
districts of Pader (5 s/c); Kitgum (12 s/c); and Lamwo (9 s/c) identified a total of 1,876 cases with 1,090 cases
originating from Pader; 307 cases from Lamwo; and 479 cases from Kitgum. The disease itself appears to be a novel
epileptic disorder that is characterized by atonic seizures which without treatment progress to grand mal epilepsy. The
etiology for now remains elusive but a response plan is in place to provide nutritional rehabilitation, chronic care clinics
to prescribe antiepileptic, bi-annual mass treatment with ivermectin, psychosocial support as well as addressing the
special education needs of these children and their families.
vaccinating health care workers against HBV has been developed and vaccines made available to vaccinate all health
care workers countrywide.
Remarks
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
197
Condition
Affected
districts
No. cases
No.
deaths
Nine cases have been confirmed by UVRI and response is being spearheaded by the District Task Force.
Remarks
3.10 Development Partner Support Areas
Health
Project name
Outturn 2010/11
Counterpart /
Implementing Partner
Outturn 2009/10
SECTOR
Outturn 2008/09
USA
Outturn 2007/08
1.
AED (Academy for
Educational
Development)
Engender Health
A2Z Micronutrient / MOST
0.4
0.4
0.5
0.2
ACQUIRE
1.8
1.2
0.0
0.0
10.3
12.6
7.2
3.0
3.0
3.4
4.5
Health
JSI (John Snow Inc)
AFFORD - Health Marketing
Initiative
Central Contraceptive
Procurement
DELIVER
9.0
Health
JHU (John Hopkins
University)
Multiple
0.6
0.6
1.4
3.8
Health
Macro International Inc
DHS Survey
0.6
0.6
1.0
0.0
Health
Minnesota International
Volunteers for Health
SCF (Save the Children
Fund) USA
JHU (John Hopkins
University )
0.2
0.2
0.0
0.0
0.3
0.3
0.0
0.0
0.8
1.0
3.1
2.7
0.0
0.0
1.0
0.0
Health
Health
Health
UNICEF
Grant Solicitation &
Management (GSM)-MIVH
Grant Solicitation &
Management (GSM)-SCF
Health Communication
Partnership (HCP2) -Broad
Communication
Immunization
Health
UNICEF
SMMORE
0.0
0.0
0.0
1.0
Health
ABT Associates
0.0
0.0
6.5
9.2
Health
RTI (Research Triangle
International)
AED (Academy for
Educational
Development)
Indoor Residual Spraying
(IRS)
Integrated Vector
Management
Netmark Plus
1.8
0.0
0.1
0.0
0.3
0.6
0.5
0.0
Health
New FP Initiative
0.0
1.0
1.7
2.0
Health
Quality
Assurance/Pharmacovigilance
RPM Plus
0.0
0.0
0.0
0.4
0.3
0.5
0.0
0.0
Health
Health
Health
Health
198
MSH (Management
Science for Health)
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Health
Outturn 2010/11
Outturn 2009/10
Project name
Outturn 2008/09
Counterpart /
Implementing Partner
Outturn 2007/08
SECTOR
Health
MSH (Management
Science for Health)
MSH (Management
Science for Health)
JHU (John Hopkins
University )
US Pharmacopeia Inc
(USP)
UN-WHO
HIV/AIDS
Chemonics
HIV/AIDS
HIV/AIDS
JHU (John Hopkins
University )
IHI
Capacity
0.0
0.0
0.0
2.1
HIV/AIDS
HCD
Capacity Project
0.5
0.8
1.3
0.0
HIV/AIDS
Deloitte & Touche
Civil Society Fund-FMA
0.0
9.3
13.1
8.6
HIV/AIDS
Chemonics
Civil Society Fund-M&E
0.0
0.0
0.0
2.0
HIV/AIDS
Chemonics
Civil Society Fund-TMA
0.0
0.0
0.0
2.0
HIV/AIDS
TASO
0.0
0.0
0.0
3.7
HIV/AIDS
0.0
0.0
0.0
0.5
HIV/AIDS
RHU (Reproductive
Health Uganda)
Multiple
Community Based HIV
Response
Community Based HIV
Response
Condom Procurement
1.5
1.5
2.0
2.0
HIV/AIDS
CARE USA
Core Initiative
9.8
13.7
5.5
6.0
HIV/AIDS
JSI Research
0.0
0.0
0.0
5.6
HIV/AIDS
MSH
District based HIV/AIDS
Program - East Central
Region
District based HIV/AIDS
Program - Eastern Region
District based HIV/AIDS
Program - South Western
Region
Education Sector Work Place
Policy (ESWAPI)
EGPAF (Elizabeth Glaser
Pediatric Aids Foundation)
0.0
0.0
0.0
5.6
0.0
0.0
0.0
3.6
0.4
0.4
0.0
0.0
3.9
4.6
5.0
0.0
Health
Health
Health
HIV/AIDS
HIV/AIDS
World Vision
HIV/AIDS
EGPAF
Securing Ugandan's Right to
Essential drugs (SURE)
STRIDES
0.0
0.0
0.0
5.3
0.0
0.0
0.0
5.2
Uganda Stop Malaria
0.0
0.0
1.6
3.9
US Pharmacopeia Drug
Quality and Info (USPDQ)
WHO Umbrella Grant
0.2
0.2
0.3
0.0
0.3
2.7
0.2
0.0
ACE Boosting Capacity
Uganda NGOs
Be A Man Campaign /YEAH
1.7
2.5
2.9
2.8
1.3
1.0
1.4
1.4
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
199
HIV/AIDS
Hospice Uganda
HIV/AIDS
Macro International Inc
HIV/AIDS
IRCU (Inter-Religious
Council of Uganda)
IRCU (Inter-Religious
Council of Uganda)
HIV/AIDS
HIV/AIDS
HIV/AIDS
HIV/AIDS
Outturn 2010/11
1.4
3.6
1.4
0.3
0.3
0.0
0.0
Faith Based HIV/AIDS
Initiative
Faith Based Network Model
0.0
0.0
0.0
5.4
6.5
5.7
6.3
0.0
HCI/URC
0.0
0.0
2.7
2.6
Emerging Markets
Group (EMG)
MJAP
HIPS Private Sector
0.0
0.0
3.1
3.4
HIV/AIDS C&T and PC
0.0
0.0
4.5
4.3
JHU (John Hopkins
University)
Social & Scientific
Systems
Male Circumcision
0.0
0.0
0.5
0.0
Monitoring & Evaluation of
Emergency Plan Progress
(MEEPP)
Northern Uganda Malaria
Aids & TB (NUMAT)
NuLife (Nutrition for PHAs)
1.9
2.3
2.0
2.5
6.1
5.8
8.1
6.8
0.0
0.0
1.9
2.6
HIV/AIDS
JSI (John Snow Inc)
HIV/AIDS
HIV/AIDS
University Research
Corp Int'l
Emerging Markets
HIV/AIDS
IHAA
HIV/AIDS
URC (University
Research Corp Int'l)
USAID - REDSO
Expand Access to Palliative
Care
Facility Survey
Outturn 2009/10
1.1
HIV/AIDS
HIV/AIDS
Project name
Outturn 2008/09
Counterpart /
Implementing Partner
Outturn 2007/08
SECTOR
0.0
1.4
2.0
2.7
1.5
Quality Assurance
1.0
1.7
0.0
0.0
Safety T Stop
0.3
1.8
2.2
2.2
SPEAR
0.0
0.0
0.8
1.5
Supply Chain Management
1.7
2.5
0.0
12.2
HIV/AIDS
TB/HIV (new)
0.5
0.9
0.4
0.0
HIV/AIDS
TBD HIV/AIDS Projects
0.0
0.0
3.3
0.0
TREAT
14.9
16.9
10.1
7.7
UPHOLD - AIC and TASO
21.5
21.8
19.7
0.0
HIV/AIDS
HIV/AIDS
HIV/AIDS
HIV/AIDS
HIV/AIDS
SECTOR
WVI (World Vision
International)
PSCM
JCRC (Joint Clinical
Research Centre)
JSI (John Snow Inc)
Counterpart /
Implementing Partner
Project name
97.0
121.8
TOTALS
200
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
136.5
Outturn 2010/11
0.0
Outturn 2009/10
2.6
Outturn 2008/09
1.2
Outturn 2007/08
PART – Work Place HIV/AIDS
Activity - MoES
PHA Networks
145.2
2.
SIDA / SWIDISH EMBASSY
Area of support
1.
2.
3.
4.
5.
3.
Sector budget Support Health
Maternal Health/SRHR
Management/Capacity Building
Adolescent sexual and reproductive Health
HIV prevention, care and treatment
Total expenditure for 2010/11
2010/11
Expenditure
(,000,000 USD)
8.2
3.2
1
0.87
1.60
14.87
ITALIAN COOPERATION
Area of support
Total expenditure
for 2010/11
1.
Policy formulation and health system
313.000 euro
2.
District health system strengthening
275.000 euro
3.
PHC and out reaches
200.000 euro
4.
Drugs and Equipment
109.000 euro
5.
Training and university support
132.000 euro
Total expenditure for 2010/11 (excludes
administration expenses for the
organization/institution)
1.029.000 euro
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
201
Implementing Partners Funded by Italian Cooperation
Name of partner
Amount received
UNICEF
1.050.000 euro
WHO
170.000 euro
Total to multilateral implementing agencies
1.220.000 euro
Districts supported by Italian Cooperation
Name of district
Area of support
20 pilot districts
District Planning on PPPH
Kaabong, Kotido, Abim, Moroto, Napak, Gulu , Pader,
Agago, Nwoya
District health system strengthening, PHC
Nakapiripirit, Amudat, Amuru
District health system strengthening, PHC,
infrastructure
7 districts in Acholi District planning
community health, operational research on
NTDs
Kitgum, Lamwo
District health system strengthening,
infrastructure, Drugs and equipment
1. Challenges
Internal:
Delay in funds disbursement process and unpredictability compounded by the international
financial crisis
At district level:
¾ Limited capacity in resulted oriented planning and efficient and coordinated use and
management of the scanty resources (often not completely absorbed), inadequate
problem solving approach, scarce and inconsistent information or data, inadequate
supervision, Insufficient accountability and responsibility mechanisms, few qualified
staff, lack of capacity in delegation, scarce professional integrity and ethical motivation
202
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At central level:
Limited coordination and communication with districts, difficult in utilizing efficiently the
limited resources, limited reliability of data and information, still insufficient result oriented
planning and problem solving approach, gaps in inter-departments communication
2. Proposed solutions
¾ Increase funds predictability (within the limit of the present financial global crisis) and
timeliness
¾ Strengthening the supervision process and the reporting system,
¾ Clear definition about roles, accountabilities, responsibilities and delegation levels
¾ Strengthening communication and coordination within departments and within MoH
and Districts and HSDs (minimizing gaps and distance, reducing the feeling of isolation
and impotence)
¾ Increasing the result oriented approach and problem solving attitude
¾ Engineering a performance based rewarding/remuneration (motivation) mechanism
oriented towards improving integrity and ethical professional motivation in health Staff
(new and realistic HRH policy and strategy)
¾ Improve the resources’ efficient use and absorption
¾ Coordinate the various grants and investment sources at central and peripheral level
¾ Increase Human resources and funds allocation to the sector
3. UNITED NATIONS POPULATION FUND
Area of support
1.
2.
3.
4.
Reproductive Health – Midwifery
Reproductive Health – Family Planning
HIV Care
Adolescent Reproductive Health
Total expenditure for 2010/11
Total expenditure
2010/11 (UGX)
2,772,748,997
18,849,867,701
1,674,577,740
1,292,546,219
24,589,740,657
Implementing Partners Funded by UNFPA
Area of Support
Name of partner
Midwifery services
Ministry of Health – RH Division
Population Secretariat
CDFU
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Amount received
UGX
913,405,145
56,000,000
404,463,852
203
Family Planning
ASRH
HIV/AIDS
UNFPA – Equipment to HFs
UNFPA – TA to MOH
Reproductive Health Uganda Consortium(RHU
PI, MSU, AIC)
Kanungu District
Mubende District
Yumbe District
Oyam District
Katakwi District
Moroto District
Kotido District
Kaabong District
UNFPA Commodities
Ministry of Gender, Labour and Social
Development (HIV/AIDS and ASRH
Uganda Red Cross Society
Ministry of Health - ACP
MGLSD
Reproductive Health (and AIC)
Uganda Catholic Secretariat
Church of Uganda
Popsec (UMSC, Other FBOs)
PACE
1,225,900,000
172,980,000
1,790,290,924
171,907,710
67,451,500
140,500,200
130,541,100
182,422,000
93,539,000
148,931,500
113,990,667
16,010,263,100
84,275,200
482,002,151
163,006,850
97,096,750
130,206,881
76,945,000
234,719,391
246,334,000
726,268,868
Support to central level MoH:
Programme
1. Reproductive Health - Midwifery
2. Reproductive Health – Family Planning
3. HIV Care
Amount
UGX
2,312,285,145
16,010,263,100
163,006,850
Districts supported
Name of district
Area of support
Kanungu District
Mubende District
Yumbe District
Oyam District
Katakwi District
Moroto District
Kotido District
Kaabong District
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Family Planning, Midwifery services
Amount of
funding UGX
171,907,710.00
67,451,500
140,500,200
130,541,100
182,422,000
93,539,000
148,931,500
113,990,667
204
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Challenges
x
x
x
x
x
x
x
x
x
Human resources for Health are inadequate with most health facilities having less
than 40 percent staffing positions filled
Lack of data collection tools at health facilities and service delivery site poses data
collection challenges and affects data quality and reliability
Infrastructure challenges related to inadequate space, dilapidated structures and
poor maintenance of buildings and equipment
A mixed policy on supply chain management – The ‘Push’ and ‘pull’ policies are
executed concurrently leading to mixed pictures with regard to contraceptives
stocks at different levels
Operations research not well factored into program interventions leading to poor
generation of strategic information for advocacy on key issues in the system
SRH/HIV integration is frustrated by structural, systemic and skills issues and a
culture that sanctifies verticalization of interventions
A weak support supervision and monitoring system in the health sector
Inadequate financing to RH
Poor mobilization for demand and utilization of services
Proposed solutions
x
x
x
x
x
More support will have to be given in the bonding and training of particularly
midwives
Support should be provided towards conducting National Health Accounts to enable
the tracking of resources for health
More investment should be made in system strengthening with particular focus on
infrastructure and medical technologies and supplies
The resource center should be support to develop and distribute data collection
tools
Operations research should be an in-built element in sector and national
development planning
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
205
4. UNICEF
Partners name
Area
District(s)
Total PCA Amount
(Cash + Supply)
USD
1.
SCiU (Milk Matters)
Nutrition
Karamoja
28,744
2.
IBFAN
Nutrition
National
39,301
3.
Malaria Consortium
Health
National
1,515,284
4.
CUAMM
Health
Karamoja
370,596
5.
ACF
Karamoja & Acholi
788,850
6.
IRC
Nutrition
Health,
Nutrition,
WASH & CAA
7.
CRS
H&N, CAA
Western
331,525
8.
CONCERN Worldwide
Nutrition
Karamoja
157,777
9.
AVSI
PMTCT, H&N
232,574
10.
UCS**
ALS
Acholi
Karamoja, Northern
& Western
11.
CoU
ALS
All
129,390
12.
C&D
ALS
351,225
13.
ASB
AS
Karamoja
Acholi, Karamoja,
Teso
14.
Africare
WASH
National
271,868
15.
Warchild Holland
Nutrition
National
36,078
16.
CESVI
Nutrition
Karamoja
108,125
17.
SNV
ALS
National
163,979
18.
BRAC
ALS
National
85,268
206
Karamoja & Acholi
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
537,465
229,361
99,993
19.
UMCS
ALS
National
90,755
20.
HealthNeed
Nutrition
33,688
21.
Baylor
CAA
North-East
Rwenzori, Acholi and
Karamoja
378,625
5. Department for International Development (DFID)
Area of support
1.
2.
3.
4.
Total expenditure
2010/11 £
HIV Prevention and care
Yellow Fever Epidemic Response
Implementation of the National Population Policy (procurement
of contraceptives)
Support to AIDS Indicator Survey
Total expenditure
4,000,000
592,903
1,323,326
200,000
6,116,229
Implementing Partners Funded by DFID
Name of partner
Civil Society Fund (Deloitte & Touche) – HIV
Prevention & care)
UN AIDS – HIV Prevention
UN Joint Programme on Population: Population
Programme
World Health Organisation
Civil Society Fund (Deloitte & Touche) - AIDS
indicator survey
Amount received
£3,000,000
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
£1,000,000
£1,422,960
£633,613
£200,000
207
Figure 19: DPT3 Coverage by district FY2010/11
Figure 20: Deliveries in Government and PNFP facilities by district FY2010/11
208
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
Figure 21: OPD utilization by district FY 2010/11
Figure 22: HIV testing in infants born of HIV positive women by district FY 2010/11
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
209
Figure 23: Latrine coverage in households by districts FY 2010/11
Figure 24: Pregnant women receiving 2nd dose of Fansidar for IPT by district FY 2010/11
210
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Figure 25: Pregnant women attending ANC 4th visit by district FY 2010/11
Figure 26: Approved posts that are filled by district FY 2010/11
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
211
241,500
403,200
427,200
374,700
206,200
77,100
76,900
475,700
163,000
55,200
BUSHENYI
KABAROLE
MBARARA
GULU
BUTALEJA
LYANTONDE
BULIISA
JINJA
KATAKWI
ABIM
District
1,597,800
Total Population
KAMPALA
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
191
91
84
97
93
106
110
98
113
93
136
%
55
36
13.7
15.0
67
30
71
50
70
55
63
56
12.5
14.6
13.9
15.0
15.0
14.7
15.0
13.9
15.0
8.3
5.4
10.0
4.6
10.6
7.5
10.5
8.2
9.5
8.4
14.0
2.4
1.0
1.7
1.0
2.8
1.2
1.8
1.0
1.3
1.0
1.1
10.0
10.0
57
75
41
118
9.7
10.0
27
47
69
106
10.0
10.0
10.0
10.0
118
103
9.5
10.0
61
%
10.0
Pentavalent Vaccine 3rd
Dose Coveragei
94
15
%
10
Deliveries in govt and
PNFP facilities
Score
15
OPD Per Capita
10
5.7
7.5
4.1
10.0
2.7
4.7
6.9
10.0
10.0
10.0
6.1
39
50
84
64
84
85
50
93
77
91
86
%
Coverage and quality of care (75)
Score
Score
HIV testing in children
born to HIV positive
womenii
Score
10
Latrine coverage in
households
3.9
5.0
8.4
6.4
8.4
8.5
5.0
9.3
7.7
9.1
8.6
Score
59
46
59
69
95
78
63
39
40
29
59
%
5
IPT2
3.0
2.3
2.9
3.4
4.7
3.9
3.1
2.0
2.0
1.5
3.0
Score
40
17
44
46
88
18
30
45
52
65
72
%
5
ANC4
2.0
0.9
2.2
2.3
4.4
0.9
1.5
2.3
2.6
3.3
3.6
Score
92
96
75
81
96
75
77
59
75
78
67
%
5
TB cure rateiii
4.6
61
71
57
3.8
4.8
74
38
4.1
4.8
38
3.7
6.1
7.1
5.7
7.4
3.8
3.8
7.3
73
3.8
7.9
79
3.5
5.3
10.0
53
123
%
10
35
2.9
3.8
3.9
3.3
Score
3.11 District League Table 2010/11
% Monthly reports sent
on time (2)
75
92
92
92
67
100
100
75
92
75
100
% Completeness monthly
reports (1)
100
100
100
100
100
100
100
92
100
100
100
% Completeness facility
reporting (1)
92
100
93
73
99
100
100
79
92
81
80
1
1
0
1
1
1
1
0
1
1
0
4.4
4.8
3.8
4.6
4.3
5.0
5.0
3.2
4.8
4.3
3.8
0
0
0
0
0
0
0
0
0
0
5
5
%
Management (25)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Score
67
100
67
0
0
100
17
84
0
100
0
%
5
Medicine orders submitted
timely
3.4
5.0
3.4
0.0
0.0
5.0
0.9
4.2
0.0
5.0
0.0
Score
212
Total Score
66.4
66.4
66.7
67.0
67.7
68.0
69.0
70.3
73.1
74.2
77.5
11
10
9
8
7
6
5
4
3
2
1
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
213
94
94
152
109
93
102
94
77
97
522,100
183,100
227,800
416,600
377,800
466,900
247,300
104,600
247,000
167,000
328,600
MUKONO
KABERAMAIDO
SIRONKO
MBALE
LIRA
RAKAI
KISORO
KAPCHORWA
MASAKA
BUDUDA
NEBBI
91
159
91
District
311,600
Total Population
RUKUNGIRI
%
13.7
15.0
14.6
11.5
14.2
15.0
13.9
15.0
15.0
14.1
14.0
13.6
64
24
57
34
60
31
46
50
36
44
45
56
9.6
3.5
8.5
5.1
9.1
4.7
7.0
7.5
5.4
6.5
6.7
8.4
1.1
1.0
0.3
1.3
1.6
1.1
0.9
0.9
1.2
1.1
0.8
1.5
15
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
%
10.0
10.0
3.3
10.0
10.0
10.0
9.0
9.3
10.0
10.0
7.9
10.0
23
77
81
47
11
20
66
43
25
76
32
54
2.3
7.7
8.1
4.7
1.1
2.0
6.6
4.3
2.5
7.6
3.2
5.4
79
63
93
65
55
97
72
65
91
50
89
97
OPD Per Capita
%
10
Deliveries in govt and
PNFP facilities
Score
10
10
Score
HIV testing in children
born to HIV positive
womenii
Score
Latrine coverage in
households
7.9
6.3
9.3
6.5
5.5
9.7
7.2
6.5
9.1
5.0
8.9
9.7
Score
64
36
26
31
20
48
46
42
36
59
51
50
%
5
IPT2
3.2
1.8
1.3
1.5
1.0
2.4
2.3
2.1
1.8
3.0
2.6
2.5
Score
1.6
1.9
32
39
1.6
1.4
29
32
3.1
1.9
1.5
2.0
2.6
62
38
29
41
52
1.4
1.3
25
27
2.5
50
%
5
ANC4
Score
77
52
60
78
75
93
86
81
85
120
67
88
%
5
TB cure rateiii
3.8
2.6
3.0
3.9
3.8
4.6
4.3
4.1
4.3
5.0
3.3
4.4
Score
51
42
48
63
71
55
75
64
71
63
52
38
%
10
Approved posts that are
fillediv
5.1
4.2
4.8
6.3
7.1
5.5
7.5
6.4
7.1
6.3
5.2
3.8
Score
% Monthly reports sent
on time (2)
83
100
83
67
100
75
92
83
92
83
100
100
% Completeness monthly
reports (1)
92
100
100
83
100
100
100
100
71
92
74
83
90
86
99
96
75
89
100
100
90
92
% Completeness facility
reporting (1)
100
100
1
1
0
1
1
1
0
1
1
1
1
0
5
4.3
4.9
3.4
4.0
4.9
4.4
3.8
4.6
4.6
4.6
4.9
3.9
0
0
75
0
0
0
0
0
0
100
0
%
Management (25)
Completeness of the
annual report (1)
HMIS reporting
completeness and
timeliness
Score
5
DHMT meetings held as
plannedv
0.0
0.0
3.8
0.0
0.0
0.0
0.0
0.0
0.0
5.0
0.0
Score
5.0
0.9
17
5.0
5.0
4.2
3.9
1.3
2.5
2.9
1.7
2.3
1.7
100
100
100
84
78
25
50
58
33
45
33
%
5
Medicine orders submitted
timely
Score
Coverage and quality of care (75)
Total Score
62.6
62.7
63.0
63.6
63.9
64.0
64.2
64.4
65.1
65.2
65.3
65.8
23
22
21
20
19
18
17
16
15
14
13
12
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
14.3
14.6
12.4
95
97
83
93
93
463,600
396,700
466,200
490,200
207,300
458,000
TORORO
ISINGIRO
IGANGA
KABALE
NAMUTUMBA
NTUNGAMO
86
15.0
102
468,700
KAMULI
12.9
13.9
13.9
14.3
95
KAMWENGE
317,000
169,300
BUDAKA
13.5
90
13.1
337,700
PALLISA
14.3
15.0
95
113
%
35
28
34
45
33
31
39
20
35
64
54
53
1.2
5.3
4.3
5.2
6.7
5.0
4.6
5.8
3.0
5.3
9.6
8.1
7.9
5.0
0.9
1.4
0.8
1.2
1.3
1.0
1.0
0.8
0.7
1.0
15
88
233,800
KUMI
District
209,400
Total Population
MPIGI
%
10
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
Deliveries in govt and
PNFP facilities
Score
OPD Per Capita
10.0
8.5
10.0
8.1
10.0
10.0
10.0
10.0
7.7
6.8
10.0
10.0
Score
21
22
38
30
16
47
22
49
62
17
87
19
%
10
HIV testing in children
born to HIV positive
womenii
2.1
2.2
3.8
3.0
1.6
4.7
2.2
4.9
6.2
1.7
8.7
1.9
Score
88
51
92
67
75
72
83
74
67
63
60
58
%
10
Latrine coverage in
households
8.8
5.1
9.2
6.7
7.5
7.2
8.3
7.4
6.7
6.3
6.0
5.8
Score
21
32
42
36
41
49
40
35
59
88
50
65
%
5
IPT2
1.1
1.6
2.1
1.8
2.0
2.4
2.0
1.8
3.0
4.4
2.5
3.2
Score
36
19
50
55
75
23
24
27
43
18
16
35
%
5
ANC4
1.8
1.0
2.5
2.7
3.7
1.1
1.2
1.3
2.2
0.9
0.8
1.8
Score
89
74
70
65
78
60
66
87
95
93
64
69
%
5
TB cure rateiii
4.5
3.7
3.5
3.3
3.9
3.0
3.3
4.3
4.7
4.6
3.2
3.5
Score
Coverage and quality of care (75)
63
54
48
73
40
49
49
74
58
60
27
42
%
10
6.3
5.4
4.8
7.3
4.0
4.9
4.9
7.4
5.8
6.0
2.7
4.2
% Monthly reports sent
on time (2)
100
100
100
100
83
100
83
100
83
83
92
83
% Completeness monthly
reports (1)
100
100
100
75
98
98
96
79
100
100
91
91
100
100
100
77
91
100
96
% Completeness facility
reporting (1)
100
83
92
100
100
0
1
1
0
1
1
0
1
0
0
0
1
3.7
5.0
5.0
4.0
4.5
4.9
3.6
5.0
3.3
3.5
3.8
4.6
0
75
0
0
0
0
0
0
0
0
0
50
%
%
0.0
3.8
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
2.5
59
100
0
78
67
75
92
33
67
84
34
33
5
5
5
Management (25)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
Score
Medicine orders submitted
timely
3.0
5.0
0.0
3.9
3.4
3.8
4.6
1.7
3.4
4.2
1.7
1.7
Score
214
Total Score
59.4
59.4
59.9
59.9
60.2
60.9
60.9
61.2
61.3
61.5
61.8
62.1
35
34
33
32
31
30
29
28
27
26
25
24
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
215
301,800
MITYANA
171,000
344,600
169,300
695,500
254,800
150,000
353,700
DOKOLO
KAYUNGA
AMURU
KASESE
KITGUM
NAKASONGOLA
OYAM
31,752,300
241,800
KANUNGU
National average
67,500
BUKWO
District
343,200
72
86
62
98
97
94
92
90
102
75
102
115
Score
10.8
12.9
9.3
14.7
14.5
14.2
13.8
13.5
15.0
11.2
15.0
15.0
41
38
47
48
27
37
27
39
52
37
19
1.4
0.5
6.1
0.9
0.9
1.0
0.8
0.7
5.7
7.1
7.2
4.1
5.5
4.0
1.0
1.4
7.8
5.8
1.0
1.4
0.4
5.6
2.8
3.4
5.2
10.0
9.0
9.4
10.0
8.1
7.2
9.5
10.0
10.0
10.0
4.5
30
10
72
32
44
23
29
30
12
40
8
11
3.0
1.0
7.2
3.2
4.4
2.3
2.9
3.0
1.2
4.0
0.8
1.1
71
73
53
78
35
61
62
71
87
93
79
73
Pentavalent Vaccine 3rd
Dose Coveragei
22
15
%
10
Deliveries in govt and
PNFP facilities
Score
%
10
OPD Per Capita
Score
15
%
10
HIV testing in children
born to HIV positive
womenii
Score
Total Population
MANAFWA
%
Latrine coverage in
households
7.1
7.3
5.3
7.8
3.5
6.1
6.2
7.1
8.7
9.3
7.9
7.3
Score
57
57
40
41
45
49
69
43
42
38
47
74
%
5
IPT2
2.9
2.8
2.0
2.1
2.3
2.4
3.4
2.1
2.1
1.9
2.3
3.7
Score
32
39
24
49
21
25
43
32
25
37
18
39
%
5
ANC4
1.6
2.0
1.2
2.5
1.1
1.2
2.2
1.6
1.3
1.9
0.9
1.9
Score
96
84
108
89
85
74
94
77
73
70
100
94
%
5
TB cure rateiii
4.8
4.2
5.0
4.5
4.3
3.7
4.7
3.9
3.6
3.5
5.0
4.7
Score
8.5
5.4
54
85
6.7
67
3.0
7.7
77
30
6.3
7.4
74
63
5.2
4.6
4.8
4.3
4.1
52
46
48
43
41
%
10
Approved posts that are
fillediv
Score
% Monthly reports sent
on time (2)
100
100
67
67
100
100
100
77
100
92
75
100
% Completeness monthly
reports (1)
100
100
92
92
100
100
100
94
100
100
100
100
% Completeness facility
96
93
75
78
95
100
92
85
88
68
91
97
1
0
1
0
1
1
1
1
0
1
1
0
5
5.0
3.9
4.0
3.0
4.9
5.0
4.9
3.8
3.9
4.5
4.4
4.0
0
0
0
0
0
10
0
0
75
100
%
Management (25)
reporting (1)
Completeness of the
annual report (1)
HMIS reporting
completeness and
timeliness
Score
5
DHMT meetings held as
plannedv
0.0
0.0
0.0
0.0
0.0
0.5
0.0
0.0
3.8
5.0
Score
33
33
11
0
17
67
33
47
11
45
33
89
%
5
Medicine orders submitted
timely
1.7
1.7
0.6
0.0
0.9
3.4
1.7
2.3
0.6
2.3
1.7
4.5
Score
Coverage and quality of care (75)
Total Score
56.5
57.0
57.2
57.2
57.6
58.3
58.3
58.4
58.8
58.8
58.9
59.1
46
45
44
43
42
41
40
39
38
37
36
Rank
148,500
429,300
171,100
96,700
326,300
51,100
248,000
208,600
316,800
271,700
242,800
KYEGEGWA
MAYUGE
BUKEDEA
BUTAMBALA
APAC
NWOYA
BUYENDE
ZOMBO
MASINDI
AGAGO
IBANDA
District
178,600
Total Population
NAKASEKE
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
86
80
72
92
105
153
86
94
113
92
87
71
%
12.8
12.0
10.7
13.8
15.0
15.0
12.9
14.1
15.0
13.8
13.1
10.6
32
41
30
41
81
66
35
77
47
30
35
65
15
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
Deliveries in govt and
PNFP facilities
4.8
6.1
4.5
6.2
12.2
9.8
5.2
11.5
7.1
4.4
5.2
9.7
Score
1.1
0.9
1.2
0.7
0.7
2.7
0.7
1.4
0.8
0.6
1.0
1.0
10
OPD Per Capita
10.0
8.9
10.0
7.1
7.2
10.0
6.9
10.0
7.9
6.4
9.6
10.0
Score
21
0
20
3
43
14
31
6
8
%
10
HIV testing in children
born to HIV positive
womenii
2.1
0.0
2.0
0.3
4.3
1.4
3.1
0.6
0.8
Score
89
39
67
82
78
44
71
54
65
55
78
80
%
10
Latrine coverage in
households
8.9
3.9
6.7
8.2
7.8
4.4
7.1
5.4
6.5
5.5
7.8
8.0
Score
21
35
49
52
47
88
50
41
54
40
52
43
%
5
IPT2
1.0
1.8
2.5
2.6
2.3
4.4
2.5
2.0
2.7
2.0
2.6
2.2
Score
38
31
33
35
24
37
25
27
20
25
49
22
%
5
ANC4
1.9
1.6
1.6
1.8
1.2
1.9
1.2
1.4
1.0
1.2
2.4
1.1
Score
62
84
71
77
66
85
96
69
90
81
73
62
%
5
TB cure rateiii
3.1
4.2
3.6
3.8
3.3
4.3
4.8
3.5
4.5
4.1
3.7
3.1
Score
Coverage and quality of care (75)
28
59
72
51
33
36
66
45
56
65
53
60
%
10
2.8
5.9
7.2
5.1
3.3
3.6
6.6
4.5
5.6
6.5
5.3
6.0
% Monthly reports sent
on time (2)
75
92
100
100
25
42
92
42
50
67
58
100
% Completeness monthly
reports (1)
92
100
100
100
100
58
100
92
92
92
100
100
88
96
98
100
77
40
92
75
82
93
96
91
0
1
1
1
0
0
0
1
0
1
1
0
3.3
4.8
5.0
5.0
2.3
1.8
3.8
3.5
2.7
4.2
4.1
3.9
0
100
0
25
0
0
0
0
0
0
0
0
5
5
%
Management (25)
% Completeness facility
reporting (1)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
0.0
5.0
0.0
1.3
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Score
67
11
0
0
33
100
33
17
%
5
Medicine orders submitted
timely
3.4
0.6
0.0
0.0
1.7
5.0
1.7
0.9
Score
216
Total Score
54.2
54.2
54.4
54.8
54.8
55.2
55.3
55.8
56.0
56.1
56.2
56.2
58
57
56
55
54
53
52
51
50
49
48
47
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
217
38
426,400
356,200
1,260,900
387,800
713,700
236,500
211,400
200,700
169,200
SOROTI
KYENJOJO
WAKISO
BUGIRI
ARUA
BUNDIBUGYO
SHEEMA
MARACHA
KIBUKU
12.2
15.0
100
81
10.3
13.4
12.2
15.0
13.9
13.8
69
89
82
109
93
92
15.0
120
119,500
RUBIRIZI
5.7
15.0
102
173,800
District
KALUNGU
11.4
6.8
6.2
41
6.2
5.6
5.6
3.2
4.6
4.7
4.7
3.9
2.7
45
41
37
38
21
31
31
31
26
18
8.1
0.8
0.9
0.8
1.1
8.6
8.0
10.0
8.0
6.7
0.7
0.8
7.0
7.3
0.7
0.7
8.1
7.7
9.3
8.8
0.8
0.8
0.9
0.9
2
2
5
14
51
16
11
28
145
15
2
62
0.2
0.2
0.5
1.4
5.1
1.6
1.1
2.8
10.0
1.5
0.2
6.2
Score
Total Population
76
Score
210,100
2.9
66
6.6
6.6
6.6
66
66
7.0
5.9
8.0
8.7
7.8
6.4
8.9
8.7
4.1
70
59
80
87
78
64
89
87
41
Pentavalent Vaccine 3rd
Dose Coveragei
20
15
%
10
Deliveries in govt and
PNFP facilities
Score
%
10
OPD Per Capita
Score
15
%
10
HIV testing in children
born to HIV positive
womenii
PADER
%
Latrine coverage in
households
Score
45
61
42
40
49
33
29
39
30
37
21
39
%
5
IPT2
2.3
3.1
2.1
2.0
2.4
1.7
1.5
2.0
1.5
1.8
1.1
2.0
Score
18
47
39
31
16
32
34
4
35
19
%
5
ANC4
0.9
2.3
2.0
1.5
0.8
1.6
1.7
0.2
1.7
0.9
Score
93
79
78
99
79
71
70
73
82
4.6
4.0
3.9
5.0
4.0
3.6
3.5
3.7
4.1
3.9
3.0
60
78
4.2
84
%
5
TB cure rateiii
Score
52
36
46
44
42
34
44
58
70
36
64
72
%
10
Approved posts that are
fillediv
5.2
3.6
4.6
4.4
4.2
3.4
4.4
5.8
7.0
3.6
6.4
7.2
Score
% Monthly reports sent
on time (2)
75
100
50
100
67
83
100
92
50
75
42
83
% Completeness monthly
reports (1)
92
100
75
100
100
100
100
100
92
100
100
92
% Completeness facility
reporting (1)
74
100
76
95
83
81
91
88
75
58
59
82
0
1
0
0
0
1
1
0
0
1
0
1
5
3.2
5.0
2.5
4.0
3.2
4.5
4.9
3.7
2.7
4.1
2.4
4.4
0
0
0
0
0
0
0
0
0
%
Management (25)
Completeness of the
annual report (1)
HMIS reporting
completeness and
timeliness
Score
5
DHMT meetings held as
plannedv
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Score
33
67
0
8
89
33
0
1.7
3.4
0.0
0.4
4.5
1.7
0.0
3.4
1.7
33
67
5.0
1.7
100
33
%
5
Medicine orders submitted
timely
Score
Coverage and quality of care (75)
Total Score
51.5
52.2
52.5
52.7
52.7
52.8
53.0
53.2
53.7
53.7
53.8
53.8
70
69
68
67
66
65
64
63
62
61
60
59
Rank
58,100
153,600
120,400
613,300
144,100
52,400
150,900
418,000
204,600
209,600
143,800
KALANGALA
KIBOGA
AMOLATAR
KIBAALE
NGORA
BUVUMA
BUKOMANSIMBI
LUWERO
KOTIDO
KOBOKO
NAKAPIRIPIRIT
District
210,900
Total Population
SEMBABULE
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
81
115
102
74
115
139
94
90
138
108
134
107
%
12.2
15.0
15.0
11.0
15.0
15.0
14.1
13.5
15.0
15.0
15.0
15.0
11
1.7
4.6
4.0
26
30
5.8
2.5
2.2
8.2
4.2
0.8
0.5
0.8
0.6
0.6
0.8
0.8
0.7
0.4
0.1
9.0
3.9
1.2
0.8
2.7
2.1
39
17
14
55
28
26
60
18
14
15
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
Deliveries in govt and
PNFP facilities
Score
10
OPD Per Capita
8.0
4.8
8.4
6.4
6.1
8.3
8.1
6.6
3.7
0.9
10.0
8.1
Score
12
4
14
3
9
11
40
1
0
12
%
10
HIV testing in children
born to HIV positive
womenii
1.2
0.4
1.4
0.3
0.9
1.1
4.0
0.1
0.0
1.2
Score
21
64
12
82
90
85
71
68
63
70
57
62
%
10
Latrine coverage in
households
2.1
6.4
1.2
8.2
9.0
8.5
7.1
6.8
6.3
7.0
5.7
6.2
Score
70
38
37
33
24
38
50
44
65
27
24
%
5
IPT2
3.5
1.9
1.8
1.6
1.2
1.9
2.5
2.2
3.3
1.3
1.2
Score
41
22
18
30
49
22
36
22
15
55
31
27
%
5
ANC4
2.1
1.1
0.9
1.5
2.5
1.1
1.8
1.1
0.7
2.7
1.6
1.4
Score
81
73
45
61
60
67
64
86
87
86
92
97
%
5
TB cure rateiii
4.1
3.7
2.2
3.0
3.0
3.3
3.2
4.3
4.4
4.3
4.6
4.9
Score
Coverage and quality of care (75)
60
55
67
69
30
27
32
46
83
43
50
44
%
10
6.0
5.5
6.7
6.9
3.0
2.7
3.2
4.6
8.3
4.3
5.0
4.4
% Monthly reports sent
on time (2)
100
75
83
83
50
83
17
100
42
100
100
100
% Completeness monthly
reports (1)
100
100
100
100
92
100
75
100
100
100
100
100
% Completeness facility
reporting (1)
99
88
91
93
99
74
63
100
98
101
90
74
1
1
1
0
0
0
0
1
0
1
0
0
5.0
4.4
4.6
3.6
2.9
3.4
1.7
5.0
2.8
5.0
3.9
3.7
0
0
0
0
0
0
0
0
5
5
%
Management (25)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
0.0
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Score
67
33
67
25
100
67
67
25
0
0
33
67
%
5
Medicine orders submitted
timely
3.4
1.7
3.4
1.3
5.0
3.4
3.4
1.3
0.0
0.0
1.7
3.4
Score
218
Total Score
49.1
49.4
49.5
49.6
50.2
50.7
50.8
50.9
51.3
51.5
51.5
51.5
82
81
80
79
78
77
76
75
74
73
72
71
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
219
133,700
80,600
281,200
188,800
KYANKWANZI
OTUKE
BUSIA
MITOOMA
7.6
51
15.0
12.3
82
221
15.0
132
11.4
76
407,100
AMURIA
BUIKWE
566,600
MUBENDE
11.5
8.3
77
132,300
LAMWO
8.7
55
58
466,400
YUMBE
11.7
344,200
78
202,200
KALIRO
10.8
11.4
72
499,100
HOIMA
11.4
0
31
26
17
39
21
25
45
34
19
41
16
%
0.0
4.6
3.9
2.6
5.9
3.2
3.8
6.8
5.1
2.9
6.1
2.3
2.3
0.9
0.6
0.7
0.5
0.8
1.3
0.5
0.3
0.8
0.9
15
76
76
District
280,200
Total Population
KIRUHURA
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
%
10.0
8.6
6.4
7.1
5.4
8.2
10.0
5.0
3.3
7.8
8.6
3
0.3
1.9
0.1
1
19
3.2
0.7
0.0
0.6
0.6
1.0
0.7
32
7
0
6
6
10
7
76
76
51
64
85
63
77
40
75
84
72
83
OPD Per Capita
%
10
Deliveries in govt and
PNFP facilities
Score
10
10
Score
HIV testing in children
born to HIV positive
womenii
Score
Latrine coverage in
households
7.6
7.6
5.1
6.4
8.5
6.3
7.7
4.0
7.5
8.4
7.2
8.3
Score
0
53
44
38
37
44
71
50
35
21
47
29
%
5
IPT2
0.0
2.6
2.2
1.9
1.9
2.2
3.5
2.5
1.7
1.0
2.4
1.4
Score
22
20
14
34
8
20
18
17
25
21
%
5
ANC4
1.1
1.0
0.7
1.7
0.4
1.0
0.9
0.9
1.3
1.0
Score
78
67
86
86
67
91
75
108
122
80
87
64
%
5
TB cure rateiii
3.9
3.4
4.3
4.3
3.3
4.5
3.7
5.0
5.0
4.0
4.3
3.2
Score
38
34
73
25
52
67
28
32
68
76
33
31
%
10
3.8
3.4
17
50
75
75
2.5
7.3
100
50
83
83
100
50
83
92
% Monthly reports sent
on time (2)
5.2
6.7
2.8
3.2
6.8
7.6
3.3
3.1
% Completeness monthly
reports (1)
25
67
92
100
100
92
100
100
100
100
100
100
% Completeness facility
reporting (1)
6
56
91
87
95
50
97
89
97
64
100
94
0
0
0
1
1
1
0
0
1
0
1
0
0.6
2.2
3.3
4.4
4.9
3.4
3.6
3.6
5.0
2.6
4.7
3.8
0
0
0
25
0
0
0
0
0
0
0
5
5
%
Management (25)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
0.0
0.0
0.0
1.3
0.0
0.0
0.0
0.0
0.0
0.0
0.0
Score
67
33
67
67
33
0
33
100
0
100
%
5
Medicine orders submitted
timely
3.4
1.7
3.4
3.4
1.7
0.0
1.7
5.0
0.0
5.0
Score
Coverage and quality of care (75)
Total Score
44.7
44.7
45.8
46.1
46.2
47.0
47.1
47.7
47.9
48.0
48.9
48.9
94
93
92
91
90
89
88
87
86
85
84
83
Rank
89
27
331,600
262,000
243,200
176,500
148,700
354,300
216,900
97,400
211,200
345,300
AD UMANI
LWEN O
LUUKA
NA AK
OMBA
MOYO
KOLE
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
BUHWE U
NAMAYIN O
KAABON
55
68
69
79
114
71
58
38
79
285,300
KIRYANDON O
District
121,300
Total Population
MOROTO
72
%
8.3
10.2
10.4
11.9
4.1
13.4
15.0
10.7
8.7
5.6
11.8
10.9
7
15
21
26
18
14
19
13
14
18
21
10
15
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
Deliveries in govt and
PNFP facilities
1.0
2.3
3.2
3.9
2.7
0.6
0.5
0.5
0.4
0.9
0.8
0.8
2.8
2.1
0.6
0.6
1.9
2.1
0.8
0.6
3.1
2.8
0.6
1.6
Score
10
OPD Per Capita
6.1
4.9
4.9
4.4
8.7
8.4
8.1
5.9
6.1
8.0
5.7
6.0
Score
8
2
20
7
1
47
%
10
HIV testing in children
born to HIV positive
womenii
0.8
0.2
2.0
0.7
0.1
4.7
Score
16
55
42
67
78
53
10
55
74
68
61
7
%
10
Latrine coverage in
households
1.6
5.5
4.2
6.7
7.8
5.3
1.0
19
38
50
50
20
26
24
13
24
7.4
5.5
21
44
50
%
6.8
6.1
0.7
Score
5
IPT2
0.9
1.9
2.5
2.5
1.0
1.3
1.2
0.7
1.2
1.0
2.2
2.5
Score
16
32
34
24
15
17
28
10
26
23
25
21
%
5
ANC4
0.8
1.6
1.7
1.2
0.8
0.8
1.4
0.5
1.3
1.1
1.3
1.1
Score
82
71
78
96
72
69
61
65
60
107
71
61
%
5
TB cure rateiii
4.1
3.6
3.9
4.8
3.6
3.5
3.1
3.3
3.0
5.0
3.6
3.1
Score
Coverage and quality of care (75)
42
20
25
30
51
28
50
42
50
67
60
38
%
10
4.2
2.0
2.5
3.0
5.1
2.8
5.0
4.2
5.0
6.7
6.0
3.8
% Monthly reports sent
on time (2)
75
50
25
42
100
42
100
42
17
75
33
83
% Completeness monthly
reports (1)
100
100
83
50
100
100
100
67
42
92
100
100
% Completeness facility
reporting (1)
83
76
54
50
100
86
100
67
27
90
49
75
1
0
0
0
0
1
0
1
1
0
1
0
4.3
2.8
1.9
1.8
4.0
3.7
4.0
3.2
2.0
3.3
3.2
3.4
0
100
0
0
0
0
50
0
75
5
5
%
Management (25)
Completeness of the
annual report (1)
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
0.0
5.0
0.0
0.0
0.0
0.0
2.5
0.0
3.8
Score
100
100
17
67
100
33
33
%
5
Medicine orders submitted
timely
5.0
5.0
0.9
3.4
5.0
1.7
1.7
Score
220
Total Score
37.0
39.7
40.1
40.4
40.7
41.2
41.6
41.6
41.8
42.7
42.9
43.0
106
105
104
103
102
101
100
99
98
97
96
95
Rank
A n n u a l H e a l t h S e c t o r P e r f o r m a n c e R e p o r t 2 0 1 0 / 11
221
101,100
76,000
94,600
118,900
AMUDAT
NTOROKO
KWEEN
BULAMBULI
49
7.3
4
%
0.6
0.4
3.7
10
15
2
5
89
%
10
0.2
0.5
8.9
6.4
4.3
43
64
6.8
0.3
85
78
99
81
6
%
0.2
0.6
%
5
82
13
%
5
6.0
68
2
60
%
10
5
52
64
3.9
4.3
39
33
44
5.0
4.1
4.1
%
10
5.2
6.4
3.9
3.3
4.4
% Monthly reports sent
on time (2)
17
67
75
67
42
% Completeness monthly
reports (1)
92
92
75
92
92
52
91
68
83
77
% Completeness facility
reporting (1)
0
0
0
0
0
5
1.8
3.2
2.9
3.1
2.5
0
0
75
0
0
%
5
0.0
0.0
3.8
0.0
0.0
Based on data from January 2010 - December 2010. (Data from January 2011 to June 2011 were not available at the time of publication.)
Based on data from 2009-2010, due to the time required to assess outcome.
Approved posts in the district league table exclude the central level and the semi-autonomous institutions.
ii
iii
iv
Districts were expected to conduct DHMT meetings quarterly. Districts that reported having more than 4 DHMT meetings a year were given a
score of 0 for poor reporting.
v
Based on data from district annual reports, HMIS. Districts that did not submit an annual report were given a score of 0.
i
0
84
%
Note: Alebtong district was excluded from the district rankings due to poor reporting and inconsistencies in the data over multiple indicators
(large discrepancies between annual report data and monthly OPD reports and very low reporting completeness rates).
128,700
District
Management (25)
Completeness of the
annual report (1)
Total Population
SERERE
%
15
Pentavalent Vaccine 3rd
Dose Coveragei
Score
Deliveries in govt and
PNFP facilities
Score
OPD Per Capita
Score
HIV testing in children
born to HIV positive
womenii
Score
Latrine coverage in
households
Score
IPT2
Score
ANC4
Score
TB cure rateiii
Score
Approved posts that are
fillediv
Score
HMIS reporting
completeness and
timeliness
Score
DHMT meetings held as
plannedv
Score
5
Medicine orders submitted
timely
0.0
4.2
Score
Coverage and quality of care (75)
Total Score
17.8
17.8
22.9
23.2
30.1
111
110
109
108
107
Rank