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AHSPR FY 2015-16

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THE REPUBLIC OF UGANDA
MINISTRY OF HEALTH
ANNUAL HEALTH SECTOR PERFORMANCE
REPORT
FINANCIAL YEAR
2015/2016
Hon.Dr. Aceng Ruth Jane
Minister of Health
Hon. Sarah Opendi
Minister of State for Health/
General Duties
Hon. Dr. Joyce Moriku
Minister of State for Health/
Primary Health Care
Dr. Asuman Lukwago
Permanent Secretary
Prof. Anthony Mbonye
Ag. Director General Health
Services
Dr. Henry G. Mwebesa
Director Health Services
Planning& Development
Annual Health Sector Performance Report for Financial Year 2015/16
TABLE OF CONTENTS
TABLE OF CONTENTS................................................................................................................ iv
LIST OF TABLES ........................................................................................................................... vi
LIST OF FIGURES .......................................................................................................................viii
ACRONYMS ........................................................................................................................................i
FOREWORD ......................................................................................................................................v
2 INTRODUCTION ......................................................................................................................... 1
2.1
2.2
2.3
2.4
Background.................................................................................................................................... 1
Vision, Mission, Goal and Strategic Objectives of the HSDP 2015/16 – 2019/20 ......................... 1
The Projected Demographics for FY 2015/16 ............................................................................... 2
The process of compiling the report ............................................................................................. 2
3 Overall Sector Performance and Progress ...................................................................... 3
3.1
3.2
3.3
3.4
3.5
3.6
Health Impact Indicators ............................................................................................................... 3
Performance against the key Health and Related Services Outcome Targets .............................. 7
Performance against the key Health Investment Output Targets .............................................. 11
Health Partnerships ..................................................................................................................... 29
Local Government Performance ................................................................................................. 33
Health Facility Performance ........................................................................................................ 37
4 ANNEXES .................................................................................................................................... 49
4.1
4.2
4.3
4.4
Annex One:Delivery of the Uganda National Minimum Health Care Package (UNMHCP). ........ 49
Annex Two: Integrated Health Sector Support Systems ............................................................. 75
Annex Three: Progress in Implementation of the 21st JRM Aide Memoire .............................. 101
Annex Four: Disaggregation of Key Performance Indicators .................................................... 109
Annual Health Sector Performance Report for Financial Year 2015/16
FOREWORD
The health of the population is central to socio economic transformation of the country. In
line with statutory requirements, Government reviews the annual performance of the health
sector in order to assess progress on agreed outputs , performance of the health sector and
come up with strategies and recommendations on how to improve health care service
delivery.
The annual Health Sector Performance Report for financial year 2015/16 provides progress of
the annual health sector work plan as well as the overall health sector performance against the
set targets agreed upon with key stakeholders in financial year 2015/16. The report is the first
annual review under the Health Sector Development Plan 2015/16-2019/2020. This report
shall be presented to stakeholders in the 22nd Joint Review Mission in which the sector shall
specifically review what has been achieved, what has not been achieved and the reasons why
the set targets have not been achieved. The review shall guide future planning and
programming and help to refocus priorities towards achieving the National Development plan
targets and the Sustainable Development Goals.
The sector will continue to prioritize interventions defined in the five year Health Sector
Development Plan with emphasis on efficiency and effectiveness in health service delivery.
The Government of Uganda recognizes the contributions of the Health Development partners,
the Civil Society Organizations, the private sector and the community in the achievement of
progress in financial year 2015/16.
Improvements in performance were made possible by the commitment of health providers
and health workers in the public and private sector, working under sometimes difficult
conditions especially in the hard to reach districts in the country. I commend the dedicated
and productive health workers and implore and appeal to those who are not dedicated to work
ethics in the health sector to improve so that the country health indicators improve to
acceptable levels.
I wish to thank members of Health Policy Advisory Committee and all partners for their
contributions in the preparation of the Annual Health Sector Performance report and co
financing the Joint Review Mission. Special gratitude to the MoH Planning Directorate that
ensured that this annual report and the accompanying documents are available to all the
participants.
For God and My Country
Hon. Dr. Aceng Jane Ruth
Minister of Health
Annual Health Sector Performance Report for Financial Year 2015/16
LIST OF TABLES
Table 1: Population Projections for FY 2015/16 ....................................................................... 2
Table 2: Leading causes of Under 5 in-patient mortality .......................................................... 4
Table 3: Trends in Maternal Mortality and Total Fertility Rate ................................................. 5
Table 4: Leading causes of maternal deaths among maternal deaths audited......................... 5
Table 5: Common factors underlying maternal deaths ............................................................. 6
Table 6: Performance against the Health Service Outcome targets ......................................... 7
Table 7: CYP by method ........................................................................................................... 10
Table 8: Performance against the Health Investment targets ................................................ 11
Table 9: Persons who fell sick by the first Source where Treatment (%) ................................ 12
Table 10: Comparison of source of services based on the HMIS data for 2015/16 FY ........... 13
Table 11: Median Distance (KM) to Health facilities visited by residence (2015) ................... 14
Table 12: Availability Indicator for the 41 commodities ......................................................... 14
Table 13: Progress in Maternal death notification and reporting ........................................... 15
Table 14: Trends in Government allocation to the Health Sector 2010/11 to 2015/16 ......... 19
Table 15: GOU Budget Performance for FY 2015/16 ............................................................. 20
Table 16: PHC Grants FY 2010/11 - 2015/16 in Ushs billions ................................................. 20
Table 17: PHC Non-wage Allocation By Service Delivery Strata Within The PHC System ....... 21
Table 18: Human Resource trends in the Public Sector 2010/11 to 2015/16 ......................... 21
Table 19: Staffing level at different level of service in public sector fy 2015/16 .................... 22
Table 20: Staffing at RRHs ........................................................................................................ 23
Table 21: Staffing level for health professionals disaggregated by cadres ............................. 23
Table 22: Overall staffing level in the public sector versus the PNFP sector .......................... 24
Table 23: HPAC Institutional representatives’ attendance ..................................................... 29
Table 24: Progress in implementation of the HSDP Compact during FY 2015/16 .................. 30
Table 25: Top 15 performing districts Table 26: Bottom 15 performing districts................ 34
Table 27: TOP and bottom 10 District ranking for new districts FY 2015/16 .......................... 35
Table 28: TOP AND BOTTOM 10 hard-to-reach districts as per the hard-to-reach DLT ......... 36
Table 29: Staffing levels for 10 Top and Bottom Districts ....................................................... 37
Table 30: Health facility outputs and Outcomes by level of care FY 2015/16 ........................ 37
Table 31: Budget Performance for National Referral Hospitals .............................................. 38
Table 32: SUO for National Referral Hospitals FY 2015/16 ..................................................... 39
Annual Health Sector Performance Report for Financial Year 2015/16
Table 33: Budget performance for RRHs ................................................................................. 39
Table 34: Outputs and Outcomes from Regional/large Hospitals ........................................... 40
Table 35: Cost per SUO in RRHs in FY 2015/16 ........................................................................ 41
Table 36: Leading causes of morbidity in RRHs in FY 2015/16 ................................................ 41
Table 37: Leading causes of death in RRHs in 2015/16 FY ...................................................... 42
Table 38: Leading causes of morbidity in General hospitals in 2015/16 FY ............................ 43
Table 39: leading cuases of Death in General Hospitals in FY 2015/16 .................................. 44
Table 40: Facility based Maternal Mortality ratio for GHs in 2015/16 FY ............................... 44
Table 41: Leading causes of morbidity at HC IVs in 2015/16 FY .............................................. 46
Table 42:Leading causes of mortality at HC IVs in 2015/16 FY................................................ 47
Table 43: Showing Total Number Staff In UCMB Health Facilities From 2011- 2016 ............. 67
Table 44: Showing Annual Outputs of UCMB Health Training Schools for 5 years ................. 68
Table 45: Progress of Renovation of 9 Hospitals ..................................................................... 92
Table 46: Infrastructure development projects status ............................................................ 94
Annual Health Sector Performance Report for Financial Year 2015/16
LIST OF FIGURES
Figure 1: Trends in Newborn, Infant and Child Mortality in Uganda (UDHS & WHS) ............... 3
Figure 2: Households’ Rating of Government Health facilities (%) ......................................... 16
Figure 3: Distribution of health professionals by employment status .................................... 25
Figure 4: Households by type of Toilet facility used (%).......................................................... 26
Figure 5: Households by Availability of Hand washing Facilities (%) ....................................... 27
Figure 6: Percentage of HIV+ pregnant women initiated on ART in FY 2015/16 ...................... 8
Figure 7: % of pregnant women completing IPT2 by district FY 2015/16 ............................... 32
Figure 8: % of Health Facility Deliveries by District FY 2015/16 .............................................. 11
Figure 9: % of pregnant women attending ANC 4th visit by district FY 2015/16 .................... 33
Figure 10: Latrine Coverage ..................................................................................................... 27
Figure 11: TB treatment success rate by District in 2015 ........... Error! Bookmark not defined.
Figure 12:Annual cholera cases in Uganda for the period 2013/14 to 2015/16 ..................... 50
Figure 13: Total OPD and Confirmed Malaria Cases in the 14 IRS Districts ............................ 59
Figure 14: Percentage of malaria laboratory confirmed cases FY 2015/16 ............................ 60
Figure 15: Trends in income for recurrent cost in UCMB network in the last 5 years ............ 65
Figure 16: Hospitals and HC IVs % Income by Source Figure 17: Lower Level Units Income by
Class
70
Figure 18: Weekly Surveillance Reporting by Region .............................................................. 85
Figure 19:Reporting rates by region October 2015 to April 2016 ........................................... 87
1
Annual Health Sector Performance Report for Financial Year 2015/16
ACRONYMS
ACT
AHSPR
AIDS
ANC
ART
ARVs
BFHI
CAO
CCM
CDC
CDD
CDP
CDR
CEmOC
CPR
CSO
CYP
DFID
DHO
DHMT
DLT
DOTS
DPT
EAC
ECSA-HC
EID
EMHS
CEmOC
eMTCT
FP
FY
GAVI
GBV
GFTAM
GH
GoU
HAART
HC
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
Country Coordinating Mechanism
Centres for Disease Control
Control of Diarrhoeal Diseases
Child Days Plus
Case Detection Rate
Comprehensive Emergency Obstetric Care
Contraceptive Prevalence Rate
Civil Society Organization
Couple Years of Protection
Department for International Development
District Health Officer
District Health Management Team
District League Table
Directly Observed Treatment, short course (for TB)
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
Comprehensive Emergency Obstetric Care
Elimination of mother-to-child transmission of HIV
Family Planning
Financial Year
Global Alliance for vaccines and Immunization
Gender Based Violence
Global Fund to fight TB, Aids and Malaria
General Hospital
Government of Uganda
Highly Active Anti-Retroviral Therapy
Health Centre
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Annual Health Sector Performance Report for Financial Year 2015/16
HDP
HMIS
HPAC
HRH
HSD
HSDP
HSSIP
IDSR
iCCM
IEC
IMAM
IMCI
IMR
IPT
IRS
ITNs
JICA
JMS
JRM
KOICA
LG
MDGs
MDR
MIP
MMR
MOFPED
MoGLSD
MOH
MOLG
MOPS
MOU
MPDR
MTEF
MTR
NCD
NCRI
NDA
NGOs
NHP
NMCP
Health Development Partners
Health Management Information System
Health Policy Advisory Committee
Human Resources for Health
Health Sub-Districts
Health Sector Development Plan
Health Sector Strategic Investment Plan
Integrated Disease Surveillance and Response
Integrated Community Case Management
Information Education and Communication
Integrated Management of Acute Malnutrition
Integrated Management of Childhood Illness
Infant Mortality Rate
Intermittent Presumptive Treatment for malaria
Indoor Residual Spraying
Insecticide Treated Nets
Japan International Cooperation Agency
Joint Medical Stores
Joint Review Mission
Korea International Agency for Cooperation
Local Government
Millennium Development Goals
Multi-drug Resistant
Malaria in pregnancy
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 Public Service
Memorandum of Understanding
Maternal Perinatal Death Review
Medium Term Expenditure Framework
Mid-Term Review
Non Communicable Diseases
National Chemotherapeutic Research Institute
National Drug Authority
Non-Governmental Organizations
National Health Policy
National Malaria Control Program
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Annual Health Sector Performance Report for Financial Year 2015/16
NMR
NMS
NPHC
NSDS
NTDs
NTLP
OPD
ORS
PHC
PLWHA
PMI
PMDT
PMTCT
PNFP
PPPH
PRDP
RH
RMNCAH
RRH
SDGs
SGBV
SLD
SMC
SMER
SP
STI
SUO
SWAP
TB
TFR
TMC
TSR
TWG
UACP
UBOS
UBTS
UCI
UDHS
UHC
UHSSP
Neonatal Mortality Rate
National Medical Stores
National Population and Housing Census
National Service Delivery Survey
Neglected Tropical Diseases
National Tuberculosis and Leprosy Control Program
Out Patients Department
Oral Rehydration Salt
Primary Health Care
People with HIV/AIDS
Presidential Malaria Initiative
Programmatic Management of Multi-Drug Resistant TB
Prevention of Mother to Child Transmission
Private Not for Profit
Public Private Partnership for Health
Peace Recovery and Development Plan
Reproductive Health
Maternal and Child Health
Regional Referral Hospital
Sustainable Development Goals
Sexual and Gender Based Violence
Second Line Drugs
Senior Management Committee
Supervision, Monitoring, Evaluation and Research
Sulfadoxine/Pyrimethamine
Sexually Transmitted Infection
Standard unit of Output
Sector-Wide Approach
Tuberculosis
Total Fertility Rate
Top Management Committee
Treatment Success Rate
Technical Working Group
Uganda Aids Control Program
Uganda Bureau of Statistics
Uganda Blood Transfusion Services
Uganda Cancer Institute
Uganda Demographic and Health Survey
Universal Health Coverage
Uganda Health Systems Strengthening Project
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Annual Health Sector Performance Report for Financial Year 2015/16
UHI
UNEPI
UNFPA
UNHRO
UNICEF
UNMHCP
USAID
USF
UVRI
VHT
WHO
WHS
Uganda Heart Institute
Uganda Expanded Program on Immunization
United Nations Fund for Population Activities
Uganda National Health Research Organization
United Nations Children’s Fund
Uganda National Minimum Health Care Package
United States Agency for International Development
Uganda Sanitation Fund
Uganda Virus Research Institute
Village Health Team
World Health Organization
World Health Statistics
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Annual Health Sector Performance Report for Financial Year 2015/16
2 INTRODUCTION
2.1 Background
The Annual Health Sector Performance Report (AHSPR) is an institutional requirement
compiled to highlight progress, challenges, lessons learnt and propose ways of moving the
health sector forward in relation to the National Development Plan (NDP), National Health
Policy, the National Health Strategy. The AHSPR Financial Year (FY) 2015/16 is the
sixteenth annual report produced by the Ministry of Health (MoH).This report is the first
annual report for the Health Sector Development Plan (HSDP) 2015/16 - 2019/20. The report
mainly focuses on the progress of the annual work plan as well as overall health sector
performance against the targets set for the FY 2015/16. The report takes into consideration
the annual performance in terms of the effectiveness, responsiveness and equity in the health
care delivery system, 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 during the 22nd Joint Review Mission (JRM) slated for
September 29th to 30th, 2016. The outcomes of the sector performance review are expected to
guide planning and programming for the next financial year.
2.2 Vision, Mission, Goal and Strategic Objectives of the HSDP 2015/16 –
2019/20
2.2.1 Vision
The vision of Uganda’s health sector is to have a healthy and productive population that
contributes to economic growth and national development.
2.2.2 Mission
The mission of the sector is to facilitate the attainment of a good standard of health by all
people of Uganda in order to promote a health and productive life.
2.2.3 Goal
The sector’s goal as stipulated in the HSDP is to accelerate movement towards Universal
Health Coverage (UHC) with essential health and related services needed for promotion of a
healthy and productive life.
2.2.4 Strategic Objectives
The overall strategic direction for the sector is provided by the strategic objectives of the
HSDP namely;
i.
To contribute to production of a healthy human capital for wealth creation through
provision of equitable, safe and sustainable health services.
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Annual Health Sector Performance Report for Financial Year 2015/16
ii.
iii.
iv.
To address the key determinants of health through strengthening inter sectoral
collaboration and partnerships.
To increase financial risk protection of households against impoverishment due to
health expenditures.
To enhance the health sector competitiveness in the region and globally.
2.3 The Projected Demographics for FY 2015/16
The population for the period under review has been projected from UBOS’s National
Population and Housing Census 2014 using a growth rate of 3%. The projected figures are
shown in table 1 below.
TABLE 1: POPULATION PROJECTIONS FOR FY 2015/16
Demographic Variable
Proportion
Total population
Males
Females
100%
48.6%
51.4%
Projected Population
(2015)
35,756,800
17,377,805
17,915,056
Children under 1 year
Children under 5 years
Children below 18 years
Adolescents and youth (young people) (10 – 24 years)
Expected pregnancies
Women of reproductive age(15-49 years
4.3%
17.7%
55.1%
34.8%
5%
20.2%
1,537,542
6,328,954
19,701,996
12,443,366
1,787,840
7,222,874
UBOS Mid-year population projections 2015
2.4 The process of compiling the report
The process of drafting the AHSPR was widely consultative with stakeholders from all
departments of MoH, Health Development Partners (HDPs) and Civil Society Organizations
(CSOs). The initial drafts were done by Technical Working Groups (TWGs) and collated by
the secretariate for writing the report i.e. MoH Planning Department.
Information used for compiling the report was both quantitative and qualitative and consisted
principally of data generated from the MoH HMIS - District Health Information Software
(DHIS)-2 for the FY 2015/16 supplemented by;
i.
Health Sector Development Plan (HSDP) 2015/16 to 2019/20
ii.
Ministerial Policy Statement (MPS) 2015/16
iii. Quarterly progress reports for the FY 2015/16
iv.
Output Budgeting Tool reports
v.
National Population and Housing Census, 2014
vi.
Uganda Demographic Health Survey, 2011
vii.
National Service Delivery Report, 2015
viii.
Uganda Hospital and HC IV survey 2014
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Annual Health Sector Performance Report for Financial Year 2015/16
3 Overall Sector Performance and Progress
This chapter highlights an overview of the sector performance of FY 2015/16. It focuses on
the performance indicators enshrined in the HSDP 2015/16 – 2019/20, Ministerial Policy
Statement of FY 2015/16 and annual workplans from different departments and institutions in
the sector.
3.1 Health Impact Indicators
The health impact indicators are used to assess the effect of service delivery on the population
and these include but not limited to;
1. Neonatal Mortality Rate (NMR)
2. Infant Mortality Rate (IMR)
3. Under five mortality Rate
4. Maternal Mortality Ratio (MMR)
5. Total fertility rate (TFR)
Figure 1 presents the trends in newborn, infant and child mortality in Uganda.The WHO
Statistics estimates for 2014 and 2015 have been used since the UDHS 2016 is yet to be
undertaken.
Per 1,000 live births
FIGURE 1: TRENDS IN NEWBORN, INFANT AND CHILD MORTALITY IN UGANDA (UDHS & WHS)
200
152
158
85
89
150
100
50
137
76
90
33
29
54
27
2001
2006
2011
69
45
23
66
44
22
2014
2015
0
1995
Neonatal Mortality
Infant Mortality
Under 5 Mortality
3.1.1 Neonatal Mortality Rate
Neonatal mortality rate (NMR) captures newborn deaths occurring in the first 28 days of life
and is expressed at the population level as a rate per 1,000 live births. There has been an
improvement in NMR from 27 (UDHS 2011) to 22 per 1,000 live births (WHS, 2015). This
improvement is due to training programs for skilled birth attendants and other health workers
launched by the MoHand availability of life saving commodities which have helped to raise
newborn care standards and the diagnosis and management of newborn sepsis including
referral of sick babies through the Integrated Community Case Management (iCCM).
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Annual Health Sector Performance Report for Financial Year 2015/16
With three years to go this performance falls short of the HSDP target of 16 per 1,000 live
births. Intensification of perinatal deaths surveillance and audits, strengthening community
awareness, perinatal health and quality of newborn care services should further accelerate the
reduction of preventable newborn deaths.
3.1.2 Infant Mortality Rate and Under Five Mortality Rate
The IMR stands at 44 per 1,000 (WHS, 2015) which is a significant improvement from IMR
of 54 per 1,000 live births (UDHS 2011). Regarding the Under Five Mortality Rate there has
been a significant reduction from 90 per 1,000 live births (UDHS 2011) to 66 per 1,000 live
births (WHS 2015).
This significant reduction in both indicators is largely attributed to intensified government
efforts to implement high impact child survival interventions. According to MoH HMIS
reports, malaria remains the leading cause of death among infants and the under-fives. In
2015/16, the disease was responsible for 43% of hospital-based under-five deaths. But
important to note is the significant increase in the number deaths attributed to malaria in this
FY against the declining trend in the previous 2 years. According to hospital records in
2015/16, the other leading causes of child fatalities are pneumonia (11%), anemia (10.6%)
and neonatal sepsis (6.3%).
TABLE 2: LEADING CAUSES OF UNDER 5 IN-PATIENT MORTALITY
Diagnosis
Malaria
2013/14 FY
No.
4,030
%
28.8
Diagnosis
Malaria
No.
3,059
%
22.6
Diagnosis
Malaria
2015/16 FY
No.
5,295
%
42.8%
Pneumonia
1,824
13.0
Pneumonia
1,659
12.2
Pneumonia
1,382
11.2%
Anaemia
1,620
11.6
1,476
10.9
Anaemia
1,312
10.6%
Perinatal Conditions
(in new borns 0 -7
days)
Neonatal Septicaemia
1,105
7.9
Perinatal Conditions (in
new borns 0 -7 days)
Anaemia
1,314
9.7
Neonatal Sepsis (07days)
778
6.3%
611
4.4
Neonatal Septicaemia
712
5.3
Diarrhoea – Acute
430
3.5%
Respiratory Infections
(Other)
Septicaemia
441
3.1
Septicemia
457
3.4
Septicaemia
347
2.8%
388
2.8
Diarrhoea – Acute
404
3.0
275
2.2%
Perinatal Conditions
(in newborns 8-28
days)
Diarrhoea – Acute
358
2.6
Injuries - (Trauma due to
other causes)
382
2.8
Injuries - (Trauma due
to other causes)
Respiratory Infections
(Other)
261
2.1%
337
2.4
375
2.8
2.0%
294
2.1
317
2.3
Injuries - Road Traffic
Accidents
Gastro-Intestinal
disorders (non
Infective)
244
Severe Malnutrition
(Kwashiorkor)
Injuries - Road Traffic
Accidents
Severe Malnutrition
(Kwashiorkor)
185
1.5%
2,994
14,002
21.4
100
3,399
13,552
25.1
100
Other
Total
1,849
12,358
15%
100
Others
Total
2014/15 FY
Others
Total
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Key interventions that have been scaled up to accelerate the reduction in child mortality
include immunization, increased use of Long Lasting Insecticide Treated Nets (LLINs),
elimination of mother to-child transmission of HIV (eMTCT), and improved water and
sanitation. Training programs for skilled birth attendants and other health workers launched
by the MoH have also helped to raise newborn care standards and the diagnosis and
management of common childhood illnesses including the iCCM.Also the strengthening and
scaling up immunization including introduction of the pneumococcal vaccine, eMTCT,
increased use of ITNs and improved sanitation have also contributed to this. More concerted
efforts are needed to sustain this and work towards the target at all levels.
3.1.3 Maternal Mortality Ratio (MMR)
The MMR has reduced to 320 per 100,000 live births (WHS 2015) from 438 per 100,000
(UDHS 2011). The reduction is attributed to Governments efforts in recruiting critical skilled
staff especially Medical Officers and midwives to functionalize HC IVs and IIIs, renovation
and equipping of hospitals and HC IVs plus improvements in the roads network, all which
have improved access to maternal health services.
TABLE 3: TRENDS IN MATERNAL MORTALITY AND TOTAL FERTILITY RATE
Indicator
UDHS 2011
WHO
(WHS, 2014)
MMR
438/100,000
360/100,000
TFR
6.2
NB: The WHS will be validated by UDHS 2016
WHO
(WHS, 2015)
320/100,000
5.8 (NPHC)
HSDP target
2019/20
320/100,000
5.1
In FY 2015/16, the leading causes of death are still Obstetric haemorrhage and sepsis
accounting for 39% and 20% respectively as well as Hypertensive disease and abortion
related death (Table4).
TABLE 4: LEADING CAUSES OF MATERNAL DEATHS AMONG MATERNAL DEATHS AUDITED
Cause
Obstetric haemorrhage
Obstructed labour and
uterine rupture
Pre-eclampsia and
eclampsia
Postpartum sepsis
Complications of unsafe
abortion
Other direct causes
Indirect causes aggravated
by pregnancy
Unknown
Total
2011/12
2012/13
2013/14
2014/15
2015/2016
Freq
131
72
%
31.5
17.3
Freq
75
5
%
34.7
2.3
Freq
94
30
%
34.9
11.2
Freq
99
19
%
42
8
Freq
96
22
%
39
9
45
10.8
22
10.2
46
17.1
28
12
23
9
75
63
18.0
15.1
20
21
9.3
9.7
32
35
11.9
13.0
25
7
11
3
49
23
20
9
30
0
7.2
0.0
3
70
1.4
32.4
32
0
11.9
0.0
35
10
15
4
12
16
5
7
0
0
0
0
0
0
15
6
5
2
416
100.0
216
100.0
269
100
238
100
246
100
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Annual Health Sector Performance Report for Financial Year 2015/16
Maternal death review committees also consider what may be the avoidable factors. Delay in
seeking care was still perceived as the common reason. Health system factors- especially lack
of blood was a major avoidable factor (Table 5).
TABLE 5: COMMON FACTORS UNDERLYING MATERNAL DEATHS
Delay
Factors
Underlying factors
Health
Seeking
Behaviour
A.
Personal/
Family/
Woman
factors
1. Delay of the
woman seeking
help
2. Lack of partner
support
3. Herbal
medication
4. Refusal of
treatment or
admission
5. Refused transfer
to higher facility
Total
Reaching
the health
service
point
B. Logistical
systems
1. Lack of transport
from home to
health facilities
2. Lack of transport
between health
facilities
Receiving
adequate
health care
C. Health
service
Lack of blood
products, supplies &
consumables
D. Health
personnel
problems
Total
Staff lack of
expertise
Absence of critical
human resource
Inadequate numbers
of staff
Total
2011/12
Freq
%
112
19
68
12
2012/13
Freq
%
2013/14
Freq %
2014/15
Freq %
2015/16
Freq %
101
65
110
63
46
56
103
60
26
17
35
20
22
27
41
24
18
12
17
10
5
6
10
6
17
10
8
5
-
-
8
5
5
6
9
5
8
5
11
7
6
3
4
5
8
5
164
100
156
100
176
100
82
100
171
100
13
54
19
51
17
49
13
42
18
42
11
46
18
49
18
51
18
58
25
58
24
100
63.3
56
47
44
35
32
33
100
43
85
42
22
20.1
24
20
20
16
19
20
31
15
11
10.1
24
20
25
20
19
20
59
29
7
6.4
16
13.3
36
29
26
27
28
14
100
120
100
125
100
96
100
203
100
69
109
37
100
Source: MPDR Report 2011/12, 2012/13, 2013/14, 2014/15, 2015/16
35
100
31
100
According to the MPDR report, 2015/16 there were 411 perinatal deaths reviewed and the
main causes of perinatal deaths include: birth Asphyxia (n=285, 69.3%), Infections (n=57,
13.9%), prematurity (n=44, 10.7%) Birth trauma (n=15, 3.6%), Congenital syphilis (n-8,
1.9%) and tetanus (n=2, 0.5%). The report also identified the commonest avoidable factors as
including delay of pregnant women seeking care, lack of transport and staff non-action.
3.1.4 Total Fertility Rate (TFR)
The TFR for Uganda stands at 5.8 (NPHC, 2014), which is a decline from 6.2 (NPHC 2000).
The general declining trend in TFR is associated with the changed attitude on the size of the
family with more preference for small families. This is due to underlying socio-economic
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Annual Health Sector Performance Report for Financial Year 2015/16
determinants like improved education for women, improved economic status combined with
improved child survival among other factors.
3.2 Performance against the key Health and Related Services Outcome Targets
The health and related services outcome indicators focus on communicable disease
prevention and control, and essential clinical and rehabilitative care. The sector performance
is highlighted in table 6 below focusing on comparison of performance with the previous FY
and the HSDP targets for 2015/16 FY.
TABLE 6: PERFORMANCE AGAINST THE HEALTH SERVICE OUTCOME TARGETS
Indicator
ART Coverage
HIV+ pregnant women not on HAART
receiving ARVs for eMTCT during
pregnancy, labour, delivery and
postpartum
TB case detection Rate (all forms)
IPT2 doses coverage for pregnant
women
IPT3 doses coverage for pregnant
women
In Patient malaria deaths per 100,000
persons per year
Malaria cases per 1,000 persons per
year
Under five vitamin A second dose
coverage
DPT3HibHeb3 Coverage
Measles coverage under 1 year
Bed occupancy rate
(Hospitals & HC IVs)
Average length of stay (Hospitals & HC
IVs)
Contraceptive prevalence Rate
Couple year of protection
ANC 4 Coverage
Performance
2014/15
Performance 2015/16
Achievement
Disaggregation
HSDP Target
2015/16
56%
88%
57%
72% (2013/14)
68.3%
85%
80%
(2014/15)
53.4%
(2014/15)
NA
83|%
55%
58%
NA
NA
93%
30
(2013/14)
460
(2013/14)
26.6%
(2013/14)
102.4%
(2014/15)
90%
(2014/15)
NA
50% (2013/14)
59% (2013/14)
NA
NA
4 (2013/14)
3 (2013/14)
30%
22
2,196,713
(2014/15)
37%
408
28%
103%
96%
83%
62%
52.2%
4
4
4
3
30%
(UDHS 2011)
2,232,225
RRH
GH
HC IV
NRH
RRH
GH
HC IV
M – 20
F – 23
M - 365
F – 480
M– 27%
F– 28%
M– 105%
F– 99%)
M – 96%
F – 93%
13
198
66%
95%
90%
62%
55%
4
4
4
3
39%
4,300,000
38%
37.5%
Health Facility deliveries
53%
55%
54%
HC IVs offering CEmOC services
33%
36%
55%
51%
62%
55%
38.5%
(75/198)
40.4%
55%
HC IVs conducting C/S
HC IVs conducting blood transfusion
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Annual Health Sector Performance Report for Financial Year 2015/16
•
ART coverage increased from 56% to 88% (898,197/1,196,547) above the HSDP
target of 57%.
•
HIV+ pregnant women not on HAART receiving ARVs for eMTCT during
pregnancy, labour, delivery and postpartum was 68.3% (34,357/50,323) in 2015/16
which was below the performance of 72% in 2013/14 and also below the HSDP
target.
FIGURE 2: PERCENTAGE OF HIV+ PREGNANT WOMEN INITIATED ON ART IN FY 2015/16
•
IPT3 coverage was not assessed this FY because the HMIS tools have not yet been
revised to capture this indicator. IPT2 coverage was used as a proxy measure and was
at 55% (982,276/1,787,840) in 2015/16 a slight increase from 53.4% in 2014/15.
•
In Patient malaria deaths recorded in 2015/16 were 22/100,000 persons which is a
significant decline from 30/100,000 in 2013/14. This is still far below the HSDP target
of 13/100,000 for FY 2015/16. More deaths occurred among females at 23/100,000
compared to 20/100,000 among males.
•
The number of malaria cases per 1,000 persons reduced from 460 in 2013/14 to 408 in
2015/16 way above the HSDP target of 198 per 1,000 in 2015/16. More females were
affected at 480 cases per 1,000 compared to 365 per 1,000 among males. Malaria is
still the top most cause of morbidity among all ages.
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Annual Health Sector Performance Report for Financial Year 2015/16
These indicators didn’t change much mainly due to the malaria epidemic in the ten
districts in Northern Uganda where
indoor residual spraying was conducted
and stopped in 2014.
Apart from the malaria epidemic and
the high incidence of malaria in a
number of districts, non-adherence to
test results still remains a major
challenge. A proportion of patients
with negative malaria tests receive
ACTs while a small proportion still
receive treatment without testing.
•
Under five Vitamin A second doses coverage was 28% (1,889,053/6,794,599) in
2015/16, with 27% coverage for males and 28% for females. Coverage was far below
the HSDP target (66%) for 2015/16. Despite the availability of Vitamin A, there has
been a decline in Vitamin A coverage over the last 3 years because the districts no
longer conduct Child Days or Family Health Days. A few districts however had
picked up the Child Days in their workplans and have continued to allocate some little
funds to this activity. There is need to integrate Vitamin A administration with EPI
activities.
•
DPT3 coverage was 103% (1,562,180/1,537,542) compared to 102.4% in 2014/15. Of
these 782,600 were males with coverage of 105% (782,600/747,246) among males,
and 779,580 were females with coverage of 99% (779,580/790,297).
•
Measles coverage improved from 90% in 2014/15 to 96% (1,443,015/1,537,542) in
2015/16 FY. Of these 718,100 were males with coverage of 96% (718,100/747,246)
among males, and 715,692 were females with coverage of 93% (715,692/790,297).
This was above the HSDP target of 90%.
•
The bed occupancy rate was highest for the RRHs at 83%, general hospitals at 62%
(an improvement from 50% in 2013/14) and 52.2% for HC IVs compared to 59% in
2013/14 FY. Bed occupancy rate in HC IVs was below the HSDP target of 55%. The
performance level of the various levels shows that there is need to improve the
functionality of the HC IVs and general hospitals to decongest the RRHs so that they
concentrate on delivering secondary level care.
•
The average length of stay for hospitals was 4 days and 3 days for HC IVs. All these
were within the HSDP target.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
There was no new data for contraceptive prevalence rate, however there was a slight
increase in the Couple Years of Protection (CYP) to 2,242,225 compared to 2,196,713
in 2014/15. Implants, IUDs and injectables were the highest contributors to the total
CYPs at 735,952 CYPs, 727,910 CYPs and 572,342 CYPs respectively.
TABLE 7: CYP BY METHOD
Data
Total CYP
Emergency contraceptives
Female condoms
IUD
Injectable
Male condoms
Oral micogynon
Oral other
Oral ovrette or another POP
Oral: Lofeminal
Tubal Ligation
Implant Users
Vasectomy
Total
1,078
Jul 2015 to
Jun 2016
28,975
CYP
Factor
0.0143
Total CYP
1,196
494,498
0.002
989
414
761,005
145,582
5
727,910
555,543
50,113
2,289,366
40,408,127
0.25
0.002
572,342
80,816
5,220
319,021
0.0143
4,562
435
27,197
0.0143
389
467
27,633
0.0143
395
560
35,405
0.0143
506
150,025
6,812
12.5
85,150
647,010
210,272
3.5
735,952
24,063
2,196,713
2,624
12.5
32,800
2,242,225
•
Antenatal care (ANC) coverage for the fourth visit was 38% (667,119/1,787,840) in
FY 2015/16 which was an increase from 36.6% in 2014/15 and above the HSDP
target of 37.5% for FY 2015/16.
•
Health facility deliveries improved from 53% (958,077/1,787,840) in 2014/15 to 55%
in 2015/16 and this was above the HSDP target (54%) for FY 2015/16.
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Annual Health Sector Performance Report for Financial Year 2015/16
FIGURE 3: % OF HEALTH FACILITY DELIVERIES BY DISTRICT FY 2015/16
•
The proportion of HC IVs offering CEmOC services (Caesarean Section and blood
transfusion) was 36% (72/198) compared to 33% in 2014/15. The number of HC IVs
conducting Caesarean Sections without blood transfusion services also increased
significantly to 62% (122/198) from 51% in the previous FY. Similarly there was an
increase in the % of HC IVs offering blood transfusion from 38.5% to 40.4% (80/198)
in 2015/16.
3.3 Performance against the key Health Investment Output Targets
The key health result areas under healthinvestments are health infrastructure, medicines and
health supplies, improving quality of care and responsiveness, health information, financing
and human resources. The sector performance is highlighted below focusing on comparison
of performance with the previous FY and the HSDP targets for 2015/16 FY. Summary of the
performance is in Table 8.
TABLE 8: PERFORMANCE AGAINST THE HEALTH INVESTMENT TARGETS
Indicator
New OPD Utilization rate
Hospital (Inpatient)admissions per
100 population
Population living within 5km of a
health facility
Performance
2014/15
Performance FY 2015/16
Achievement
1.2
1.2
6
(2013/14)
75%
7.2
100%
Disaggregation
M- 1.0
F - 1.5
HSDP Target
2015/16
1.1
7
77%
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Annual Health Sector Performance Report for Financial Year 2015/16
Indicator
Performance
2014/15
Performance FY 2015/16
Achievement
Disaggregation
HSDP Target
2015/16
64%
for the 6 tracer
medicines
16
(2013/14|)
118
87%
86%
13
15
119
114
32%
37%
38%
Under Five deaths among 1,000
under 5 admissions
17
(2013/14)
19
ART Retention rate
79%
(2014/15)
79%
79%
79%
82%
69%
(UHSSP, survey
2014)
88%
46%
(NSDS 2015)
71%
79.4%
88%
77%
(2014/15)
75%
74.5%
Availability of a basket of
commodities in the previous quarter
(% of facilities that had over 95%)
Facility based fresh still births (per
1,000 deliveries)
Maternal deaths among 100,000
health facility deliveries
Maternal death reviews
TB treatment success rate
Client satisfaction index
Timeliness of reporting (HMIS 105)
Latrine coverage
M - 15.1
F - 22.3
17.6
83%
3.3.1 Utilization of health services
•
•
The new OPD utilization rate for FY 2015/16 was 1.2 of which per capita utilization for
males was 1.0 and females 1.5 indicating that females utilize the OPD services more than
males.
Hospital (Inpatient) admissions were 7.2 per 100 population, compared to the HSDP
target of 7.1. There was an increase from 6 per 100 in FY 2013/14.
During the National Service Delivery Survey (NSD) conducted in 2015, information was
collected on the source of treatment sought for the sickness or injury suffered in the last 30
days before the survey. Table 9 shows the percentage distribution of persons that fell sick and
where they first sought treatment. At national level, the majority of persons who fell sick first
sought treatment from a Government health facility, which has persistently increased from
33% to 51%; followed by private health facilities which, has also increased from 29% to 36%
between 2004 and 2015.
There was a notable decrease in the proportion of persons that did not seek treatment from
4% in 2004 to less than 1% in 2015. A similar trend was observed for those that had used
self-medication from 11% in 2004 to 1% in 2015.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 9: PERSONS WHO FELL SICK BY THE FIRST SOURCE OF TREATMENT (%)
Source of treatment
2004
2008
2015
Government health facility
33.1
36.7
50.5
Private health facility
Pharmacy / drug shop
28.6
17.8
27.1
16.1
36.0
9.8
Religious / Mission facility
2.7
2.9
0.9
Home / self medication
10.6
8.0
0.6
Traditional healer
1.1
0.8
0.5
NGO health facility
1.0
0.8
0.5
Community health worker / VHTs
0.4
0.3
0.5
Other
0.9
0.3
0.6
None
3.8
7.1
0.03
Total
100
100
100
Disaggregation of the findings by sub-region, shows the proportion of persons that first
sought treatment for illness suffered in the last 30 days from a Government health facility
ranged from 26% in Kampala to 74% in Karamoja and West Nile respectively. The reverse
was true for private health facilities with 59% in Kampala followed by Central1 (50%) while
Karamoja registered the lowest (15%).
Table 10 below shows comparison of source of services in FY 2015/16 which also shows that
over 70% of the selected services are sought from the Public Sector
TABLE 10: COMPARISON OF SOURCE OF SERVICES BASED ON THE HMIS DATA FOR 2015/16 FY
Indicator
Public
PNFP
Private
Total
No.
%
No.
%
No.
%
No.
%
OPD
attendance
(New and reattendance)
35,369,304
79.8%
6,101,314
13.8%
2,826,032
6.4%
44,296,650
100
In patient
admission
Deliveries
DPT3
vaccinations
Measles
vaccinations
1,835,354
69.2%
733,991
27.7
83,985
3.1%
2,653,330
100
759,510
1,191,745
79.3%
76.3%
169,893
317,581
17.7%
20.3%
28,674
52,854
3.0%
3.4%
958,077
1,562,180
100
100
1,101,223
76.3%
290,891
20.2%
50,901
3.5%
1,443,015
100
3.3.2 Access to health facilities
According to the NSDS 2013, 75% of the population was living within 5km of a health
facility. The NSDS 2015, found that nationally, the median distance to the Government health
facility is 3 km compared to only 1.2 km for other health facilities. The majority of persons
who fall sick walk (60%) followed by those that use Public Motorcycle – Bodaboda (21%) to
Page | 13
Annual Health Sector Performance Report for Financial Year 2015/16
the health facilities. This implies that physical access to health facilities has been addressed
with the current health structure.
TABLE 11: MEDIAN DISTANCE (KM) TO HEALTH FACILITIES VISITED BY RESIDENCE (2015)
Sub-region
Government health facility
Other health facility
Rural
Urban
Total
Rural
Urban
Total
Kampala
2.4
2.4
0.9
1.0
Central 1
4.8
3.1
3.0
2.0
0.7
1.0
Central 2
3.2
2.4
1.6
1.0
1.0
1.6
Busoga
3.0
1.6
2.5
2.0
0.8
1.0
Bukedi
3.0
2.0
2.0
1.0
0.6
1.3
Bugisu
2.5
2.5
2.0
1.0
0.5
0.8
Teso
4.0
1.3
3.0
1.6
0.9
1.0
Karamoja
3.0
0.6
3.0
3.0
0.3
0.6
Lango
3.0
2.0
2.0
1.5
1.0
2.0
Acholi
4.8
2.0
4.8
4.8
2.0
2.0
West Nile
3.0
1.6
3.0
3.0
0.5
1.5
Bunyoro
5.0
1.9
3.0
1.6
1.0
1.6
Tooro
3.5
1.5
3.0
1.5
1.0
1.0
Ankole
3.5
1.5
3.0
2.0
1.0
2.0
PDRD Districts
Sporadically affected
3.2
2.0
3.0
2.0
0.8
2.0
Severely affected
4.0
2.0
4.0
3.0
2.0
2.0
Spillovers
3.0
2.0
2.0
1.5
0.5
1.0
Mountainous areas
2.0
1.0
2.0
1.0
1.0
1.0
Islands
6.0
1.5
1.0
0.5
0.5
1.5
National
3.2
2.0
3.0
1.6
0.9
1.2
3.3.3 Medicines and Health Supplies
In this period (2015/16), availability of health commodities as measured by a basket of 41
commodities was 87% and an average of 52% of health facilities that reported had over 95%
availability of the basket of commodities. ARV's and RMNCAH baskets had the highest
availability however more than a quarter of health facilities still experienced a stock out of
EMHS. In spite of the high availability, funding for EMHS through GoU did not increase
from 2014 stagnating at UGX 219 billion with a greater proportion of ARV, TB and
RMNCAH commodities funded by donors.
On the other hand average lead time for commodities to be delivered to the health facility
significantly reduced over the years from 59 days (ranging from 20 to 215 days) in 2010/11 to
35 days (range 0 to 120 days) in 2015. The National Medical Stores (NMS) set the maximum
lead time from receipt of facility order to delivery at the facility as 60 days. Adherence to the
order and delivery schedule and last mile delivery have played a critical role in improving the
lead time.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 12:AVAILABILITY INDICATOR FOR THE 41 COMMODITIES
Indicator 1:
Break down
Average %age availability of the basket of 41
Jan-Mar
Apr-Jun
Overall Average
%
n
%
N
%
EMHS (15 items)
84%
3,305
89%
3,686
86%
ARV (8 items)
86%
1,586
91%
1,318
89%
TB (2 items)
LAB (7 items)
80%
85%
1,125
2,853
85%
88%
1,135
3,423
83%
87%
RMNCAH (9 items)
Overall Average
87%
3,162
90%
3,583
89%
Indicator 2:
Break down
85%
89%
87%
% age of facilities with over 95% availability
Jan-Mar
%
n
Apr-Jun
%
Overall Average
N
%
EMHS (15 items)
44%
3,305
55%
2,015
49%
ARV (8 items)
TB (2 items)
43%
53%
1,586
1,125
58%
67%
755
759
50%
60%
LAB (7 items)
RMNCAH (9 items)
Overall Average
47%
38%
2,853
3,162
61%
56%
2,078
1,994
54%
47%
45%
59%
52%
Adherence to treatment guidelines is monitored for three common illnesses namely malaria,
mild or moderate upper respiratory tract infections and diarrhoea. Adherence to treatment
guidelines improved for all conditions with the greatest improvement for malaria at (82%),
diarrhoea (60%), Upper Respiratory Tract Infections (37%) respectively.
3.3.4
Improving Quality of Care
•
Facility based fresh still births (per 1,000 deliveries) reduced from 16 per 1,000 in
2013/14 FY to 13 per 1,000 in 2015/16. This surpassed the HSDP target of 15/1,000 for
2015/16.On the contrary the number of maternal deaths among 100,000 health facility
deliveries slightly increased to 119 from 118 per 100,000. This could be attributed to the
improved reporting.
•
In 2015/16 FY a total of 1,136 maternal deaths were reported through the MoH HMIS and
of these only 246 (22%) maternal deaths were notified and only 419 (37%)
reviewed/audited.
The MoH policy guidelines on maternal and perinatal deaths categorises maternal and
perinatal death as a notifiable event that has to be notified to the Ministry within 24 hours of
occurrence. It thence calls for a maternal- perinatal review within seven (7) days. It mandates
the existence of death registers where all deaths to women of reproductive age and perinatal
children who die should be recorded.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 13: PROGRESS IN MATERNAL DEATH NOTIFICATION AND REPORTING
Item
2010/11
Total number of deaths notified
Number of maternal deaths reported
through HMIS
% of maternal deaths notified compared
to reported in HMIS
•
•
•
•
2011/12 2012/13
2013/14
2014/15 2015/2016
13
45
129
371
238
246
1,005
1,206
1,169
1,147
1,019
1,136
1.3%
3.7%
11.0%
32.3%
23.4%
21.7%
The rate of under five deaths among 1,000 under 5 admissions was high at 19 per 1,000
which was an increase from 17 per 1,000 in 2013/14 FY. The HSDP target was 17.6 per
1,000.
ART retention rate stagnated at 79% in comparison with last FY and was below the
HSDP target of 83%.
TB treatment success rate also stagnated at 79% in comparison with last FY, and below
the HSDP target of 82%.
According to the NSDS Report 2015, the proportion of households that reported that the
overall quality of services provided at Government health facility was good increased
from 41% in 2008 to 46% in 2015. There was no change in the percentage of households
that indicated the responsiveness of the staff in Government as good in 2015 compared to
2008. On the other hand, the proportion of households that rated the availability of drugs
as good declined between 2008 and 2015 by four percentage points.
FIGURE 4: HOUSEHOLDS’ RATING OF GOVERNMENT HEALTH FACILITIES (%)
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Annual Health Sector Performance Report for Financial Year 2015/16
mTrac is a government led national program that focuses on strengthening the Health
Management Information System (HMIS), and more specifically identifying supply side
bottlenecks, monitoring response, and improving communication channels among health care
providers at all levels within the health system in Uganda. The primary motivation is to
improve data collection and transmission from frontline health facilities using structured SMS
reporting, which in turn provides timely and more disaggregated data on health service
quality in health systems. Currently over 35,000 health workers from 4,000 health facilities in
all 112 Districts are enrolled in mTrac. About, 2,000 District Health Team members are
registered in the system.
Additionally, a health service delivery complaints hotline is functional and provides a
platform for health workers and community members to report on any issues they face within
the health system. Progressively the system is being used for communication between
national and district staff and conversely with front line health professionals and as a survey
tool to gather other non-routine information that can support assessing quality of health
service delivery.
By June 2016, national health facility reporting rates was at
75.7%, with northern region at 85.4%, western region at 82.3%,
eastern region at 73.6% and lastly central region at 65.2%.
Facilities sendthe timely reports by Phone every Monday and
average national timeliness of reporting is at 75%. The
Information on the Health facility Weekly Surveillance Report
(HMIS 033b) aims at improving reporting on disease
surveillance and stock tracking for medicines in all health
facilities in Uganda. Data reported via SMS through mTrac is
immediately made available within DHIS2 for further analysis.
Supporting the HMIS component is an anonymous SMS Service Delivery Complaints toll
free hotline through which any community member can report health service-related issues,
including health centers closed during working hours and stock outs of essential drugs in
hospitals, Drug theft, Negligence, Malpractice, extortion, Fraud, Extortion and Absenteeism.
This information is available to the DHT on a dashboard who are the first action center.
Further analysis is done at MoH to filter out unclosed reports and any reports requiring
further investigations.
mTrac has been used for communication throughout all levels of stakeholders i.e. Various
departments, MoH, RRHs, DHTs and health facilities. For example the EPI Program used the
polling functionality to run rapid surveys on the vaccine stock levels throughout Uganda.
Over 95% responses were provided within 24hours providing data that is used in restocking
health facilities countrywide.
For the FY 2015/16, a total of 7,048 actionable reports were received through the MoH’s
anonymous SMS Service Delivery Complaints hotline from all 112 districts. Among the
reports received 3,091(43.8%) were actionable. Districts investigated and resolved 25% (769)
Page | 17
Annual Health Sector Performance Report for Financial Year 2015/16
of the total actionable reports whereas 29.1% (899) high priority reports of the total were
forwarded to the Medicines and Health Services Delivery Monitoring Unit for further follow
up.
•
Although the national HMIS system has been rolled out countrywide and generating
information from the lower level facilities, health facility reporting has not attained the
desired 80% of the national HMIS target in most health facilities. Timeliness of monthly
HMIS reporting declined from 88% in 2014/15 to 79.4% in 2015/16. This is mainly
attributed to the introduction of the new HMIS tools in July 2015. Some other issues that
are attributed to low reporting patterns which include; poor attitude of the health workers,
network irregularities in many rural parts of the country, poor training of lower facilities
by some DHTs, irregular supervision and follow-up to lower facilities.
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Annual Health Sector Performance Report for Financial Year 2015/16
3.3.5 Health Financing
The health system, including service delivery was financed by a multiplicity of stakeholders
namely; Government, Private firms, Households and Health Development Partners (HDPs).
Service delivery and developments in public facilities were mainly financed through
Government grants, concessional loans and grants from HDPs. Government continued to
support service delivery in the PNFP facilities by way of grants and seconding personnel.
•
•
The MoH undertook the 5th round of the National Health Accounts expenditure
tracking for the FY 2013/14. The per capita health expenditure stands at an average of
$56. The five-year Health Sector Development Plan (HSDP) recommended a
minimum of $73 per capita in the year 2015/16. Public health financing represents
17% of the total health expenditure, HDPs 41% and the private sector including the
households contribute 42% of the total health expenditure. The key message from the
findings is that the country still has 40% out of pocket expenditure which is still high.
The maximum recommended level of household out of pocket spending on health is
15% according to WHO. This is in line with World Health Assembly resolution of
2005 on universal coverage and sustainable health financing and as well as revisiting
the Paris Declaration that calls for greater Investments in the Health Sector.
General Government allocation for health as percentage of the total Government
budget has averaged at about 8% from 2010/11 to 2015/16, which is 1.8% short of
the HSDP target of 9.8%. This translates into a Government contribution of US $ 12
per capita expenditure on Health.
The trend in allocation of funds to the health sector shows that there has been a steady
increase in Government allocation to the health sector over the last five years. The increments
are majorly on account of the rising wage bill and the ongoing Development Partner
supported projects in the sector.
TABLE 14: TRENDS IN GOVERNMENT ALLOCATION TO THE HEALTH SECTOR 2010/11 TO 2015/16
Year
GoU
Funding
(Ushs bns)
Donor
Projects
and GHIs
(Ushs bns)
Total (Ushs
bns)
Per capita
public health
exp (Ushs)
Per capita
public
health exp
(US $)
2010/11
2011/12
2012/13
2013/14
2014/15
569.56
593.02
630.77
710.82
748.64
90.44
206.10
221.43
416.67
532.50
660
799.11
852.2
1,127.48
1,281.14
20,765
25,142
23,756
32,214
37,130
9.4
10.29
9
10
13.5
2015/16
818.86
451.94
1,270.8
36,830
11
GoU health
expenditure as
% of total
government
expenditure
8.9
8.3
7.8
8.7
8.5
6.4
The figures above are MTEF figures and exclude Non-Tax revenue collected by the sector institutions and spent at source
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Annual Health Sector Performance Report for Financial Year 2015/16
3.3.5.1
GoU Budget Performance for FY 2015/16
The overall GoU budget performance for the sector for FY 2015/16 was 100% even when
some sector institutions did not receive all their budgets. This is majorly on account of
supplementary funding received during the FY for Hepatitis B response (Ushs 11bn) and
payment of VAT arrears for the JICA rehabilitation works in Kabale,Hoima and Fort Portal
RRH (Ushs 2.4bn). Supplementary funding was also received for procurement of blood
collection supplies, test kits and heart services among others.
TABLE 15: GOU BUDGET PERFORMANCEFOR FY 2015/16
Institution
Approved budget
Release
101.04
7.75
13.12
11.55
218.61
4.37
8.65
41.77
9.33
83.19
17.19
283.14
14.14
5.00
818.86
105.89
8.53
13.33
11.55
216.61
4.66
8.58
42.58
7.21
82.78
17.19
283.14
14.14
5.00
821.20
Health
Uganda Aids Commission (Statutory)
Uganda Cancer Institute
Uganda Heart Institute
National Medical Stores
Health Service Commission
Uganda Blood Transfusion Service (UBTS)
Mulago Hospital Complex
Butabika Hospital
Regional Referral Hospitals
District NGO Hospitals/PHC
District PHC
District Hospitals
KCCA Health Grant
TOTAL HEALTH
3.3.5.2
%of budget
released
105%
110%
102%
100%
99%
107%
99%
102%
77%
100%
100%
100%
100%
100%
PHC Allocations (PHC NWR for FY 2015/16)
There was small increase in the PHC wage budget between FY 2014/15 and FY 2015/16 and
this explains the slight increase in staffing levels from 69% to 70% during the FY. The
increase in PHC Non wage from UGX 15.84 bn in FY 2014/15 to UGX 20.54 bn in FY
2015/16 was to increase funding for operationalization of the HSDs. All the additional funds
weretherefore allocated to HSD/Constituency Health Assembly activities.
TABLE 16: PHC GRANTS FY 2010/11 - 2015/16 IN USHS BILLIONS
FY
PHC
Wages
2010/11
2011/12
2012/13
2013/14
124.5
143.43
169.38
228.69
PHC
(Nonwage)
17.4
18.5
15.84
18.05
2014/15
2015/16
250.61
248.06
15.84
20.54
PHC
NGOS
(PNFP)
17.7
17.19
17.19
17.19
17.19
17.19
General
Hospitals
5.9
5.94
5.94
5.94
PHC
(Dev't
Grant)
15.3
44.43
34.81
30.08
5.94
5.94
30.08
26.41
Sanitation
Grant
Total
4.16
180.8
229.49
243.16
304.11
4.16
4.68
327.02
322.82
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Annual Health Sector Performance Report for Financial Year 2015/16
From table 17 below, about 22% of the NWR-funds go to administration at the DHO,
Municipal Health Office and HSD, 38% to General hospital services and only 40% to the
lower level health units. Furthermore a HC II has only Ushs 9,000 a day while a HC III has
on average Ushs 16,500 a day to deliver the package of health services required at that level
of care. It is therefore difficult to offer the desired level of service with so little a budget.
TABLE 17: PHC NON-WAGE ALLOCATION BY SERVICE DELIVERY STRATA WITHIN THE PHC SYSTEM
Level of health service Number of Total annual NWR Annual
average Monthly average
delivery
units.
allocation per level allocation
per per facility/ office
individual facility/
office
District Health Office
111
4,516,509,026
40,689,271
3,390,773
Municipal Health Office
22
235,160,769
10,689,126
890,760
Health Sub Districts
199
4,700,000,000
23,618,090
1,968,174
General Hospitals
100
16,662,087,057
166,620,871
13,885,073
HC IVs
192
4,276,194,936
22,271,849
1,855,987
HC IIIs
1,173
6,963,935,644
5,936,859
494,738
HC IIs
1,952
6,322,786,006
3,239,132
269,928
3.3.6 Human Resources for Health
It can be noted that health sector staffing improved slightly to 71% (42,530/60,384) in
2015/16 from 69% in 2014/15. This was a net increase of 747 health workers during the year.
The objective of the HSDP is to fill the current staffing norms in the public sector to at least
80% of the current staffing norms by 2019/20, by which time the structure of the whole health
workforce should have been reviewed.
TABLE 18: HUMAN RESOURCE TRENDS IN THE PUBLIC SECTOR 2010/11 TO 2015/16
Indicator
% of approved posts filled
by health workers (public
health facilities)
Number of health workers
(doctors,
midwives,
nurses) in public service
per 1,000 population
2010/11
2011/12
56%
58%
2012/13
63%
2013/14
69%
2014/15
2015/16
69%
71%
HSDP Target
2015/16
69%
Doctors
0.02
Midwives
0.13
Nurses
0.48
Doctors,
nurses &
midwives
0.03
0.04
0.25
0.25
0.46
0.5
0.74
0.75
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Annual Health Sector Performance Report for Financial Year 2015/16
The number of health workers per 1,000 population in Uganda is still far below the WHO
threshold of 2.3 doctors, nurses and midwives per 1,000 population. In 2015/16 FY the
number of doctors, nurses and midwives per 1,000 population was 0.74/1,000, of which
doctors were 0.03/1,000, midwives 0.25/1,000 and nurses 0.46/1,000.
3.3.6.1
Staffing by level of service
Central level institutions are better staffed (74%) than health institutions at Local Government
(LG) level. However, LGs have registered a marginal increase in staffing level from 69% in
2014/15 to 70% in 2015/16; while there was a decline in staffing level at central level, from
77% in 2014/15 to 74% in 2015/16. Overall staffing level in central level institutions has
decreased from 79% in FY 2013/14 to 74.1% in FY 2015/16.
Of the central level institutions, Uganda Virus Research Institute, Uganda Cancer Institute
and Uganda Heart Institute are the least staffed with levels of 38%, 67% and 57%
respectively.Of health facilities at LG levels, HCIIs and general hospitals are currently the
service levels with the most severe shortage, at 52% and 68% respectively.
TABLE 19: STAFFING LEVEL AT DIFFERENT LEVEL OF SERVICE IN PUBLIC SECTOR FY 2015/16
Cost Centre
# of Units
Approved
positions
Filled
% Filled
Central Institutions
1
MoH Headquarters
1
810
728
90%
2
Mulago NRH
1
2,339
1,933
83%
3
Butabika NRH
1
424
376
89%
4
Regional Referral Hosp
14
5,430
3,728
69%
5
MOH's Specialized Institutions:
Uganda Virus Research Institute
1
227
86
38%
6
Uganda Cancer Institute
1
272
183
67%
7
Uganda Heart Institute
1
192
110
57%
8
Uganda Blood Transfusion Services
1
251
236
94%
21
9,945
7,380
74%
112
1,232
1,039
84%
47
8,930
6,057
68%
Sub-total: Central Level
Local Governments
18
DHOs Offices
19
General Hospitals
20
HC IV
172
8,256
6,931
84%
21
HC III
920
17,451
13,753
79%
22
HC II
1,628
14,651
7,720
53%
23
Municipal Councils
28
224
193
86%
24
Town Councils (Big)
3
21
11
52%
25
Town Councils (Small)
121
605
193
32%
3,031
51,370
35,897
70%
Total National Level
3,052
Source: MoH HRH Biannual Report December 2015
61,315
43,277
71%
Sub-total LGs
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Annual Health Sector Performance Report for Financial Year 2015/16
Staffing in the Regional Referral Hospitals (RRHs) has fallen dramatically, from 79% in
2014/15, to 69% in 2015/16. One main reason for the decline is massive retirement of health
workers, not backed by timely replacement recruitment. RRHs with the most severe shortage
are Moroto (40%), Soroti (56%) and Hoima (59%).
TABLE 20: STAFFING AT RRHS
Hospital
Total
Norms
319
Filled
238
%
Filled
75%
Mbale RRH
Total
Norms
441
Fort Portal RRH
475
348
73%
Soroti RRH
Gulu RRH
450
309
69%
Hoima RRH
382
225
Jinja RRH
418
Kabale RRH
Masaka RRH
Arua RRH
Hospital
363
%
Filled
82%
439
247
56%
Lira RRH
357
270
76%
59%
Mbarara RRH
341
230
67%
362
87%
Mubende RRH
346
210
61%
377
248
66%
Moroto RRH
384
155
40%
352
239
68%
Naguru RRH
349
284
81%
5,430
3,728
69%
Total
Filled
Source: MoH HRH Biannual Report December 2015
3.3.6.2
Staffing in the public sector by cadre
Table 20 below shows an analysis of the staffing level in the public sector for health
professional cadres, disaggregated by type of cadre. It should be noted that these numbers are
aggregates for both central and LG institutions.
Overall, the total number of clinical officers and laboratory cadres appear adequate, relative
to the HSDP targets, although these numbers may be skewed towards the larger health
facilities. Other cadres are short of the HSDP target of achieving 80% staffing level by
2019/20. Of the essential cadres required to deliver the RMNCAH package, the cadres which
are severely short in number include theatre assistants (57%), doctors (49%), pharmacists
(40%), dispensers (40%) and anesthetic officers (27%).
TABLE 21: STAFFING LEVEL FOR HEALTH PROFESSIONALS DISAGGREGATED BY CADRES
No.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Cadre
Clinical Officers
Lab Technologists/Technicians/ Assistants
Nursing Staff (Registered and Enrolled)
Public Health Dental Officers
Midwives (Registered and Enrolled)
Orthopedic Officers
Psychiatric Clinic. & Psych Social Workers
Theatre Assistants
Health Inspectors
Doctors (Consultants, MOSG, MOs)
Total
%
Norms
Filled
Vacant
Filled
2,821
2,598
223
92%
3,020
2,447
573
81%
21,328
16,490
4,838
77%
365
276
89
76%
11,706
8,815
2,891
75%
346
227
119
66%
174
106
68
61%
421
238
183
57%
3,683
1,925
1,758
52%
2,156
1,047
1,109
49%
Page | 23
Annual Health Sector Performance Report for Financial Year 2015/16
11.
Radiographers and Imaging Staff
12.
Physio. & Occupational Therapists
13.
Health Educators
14.
Pharmacists
15.
Dispensers
16.
Ophthalmic Clinical Officers
17.
Anesthetic Officers
Source: MoH HRH Biannual Report December 2015
3.3.6.3
248
253
298
112
423
290
878
121
114
123
45
169
104
238
127
139
175
67
254
186
640
49%
45%
41%
40%
40%
36%
27%
Comparing staffing in the Public and PNFP sectors
21 belowcompares the total staffing levels in the public sector with the combined health work
force in the PNFP sector. Typically, staffing requirement in the PNFP sector is determined on
the basis of workload rather than a fixed standard norm. For comparison sake, this analysis
assumes that the public sector staffing norms also apply to similar institutions in the PNFP
sector. The analysis considers only health facilities affiliated to Uganda Catholic Medical
Bureau (UCMB), Uganda Protestant Medical Bureau (UPMB) and Uganda Muslim Medical
Bureau (UMMB). It does not include health workers deployed at the bureau and regional
coordination offices. Further, it also excludes one of the hospitals affiliated to one of the
bureaus, which declined to submit the requisite data for the analysis. The result of the analysis
is summarized in Table 21 below.
TABLE 22: OVERALL STAFFING LEVEL IN THE PUBLIC SECTOR VERSUS THE PNFP SECTOR
Cost Centre
Total health work force
Public Sector (central and DLG combined)
PNFP (UCMB, UPMB and UMMB)
Total HWF
No.
Units
of Total
Norms
Filled
% Filled
3,052
596
3,648
61,315
18,191
79,506
43,277
13,188
56,465
71%
73%
71%
Total of registrable health professionals
Public Sector (central and DLG combined)
3,052
PNFP (UCMB, UPMB and UMMB)
596
Total registrable health professionals
3,648
Source: MoH HRH Biannual Report December 2015
48,522
8,945
57,467
35,083
5,887
40,970
72%
66%
71%
Thus assuming the Ministry of Public Service structure applied to the PNFP sector, then the
current staffing in the PNFP sector would represent 73% of the filling rate of approved
positions for those health institutions, compared to 71% in the public sector. However, the
staffing level within the PNFP sub-sector varies widely between the bureaus, ranging from
28% to 88%. When compared on the basis of the number of registrable health professionals,
the PNFP sector comes out worse off than the public sector, at 66% of the required number
(ranging from 34 to 85%); compared to 72% filling rate in the public sector. Thus, sections of
the PNFP sector may be reliant on support staff as a coping mechanism for failing to attract
qualified health professionals.
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Annual Health Sector Performance Report for Financial Year 2015/16
3.3.6.4
Availability of Health Professionals in the Labour Market
Total number of health professionals registered in the country (Doctors, Nurses, Midwives,
Pharmacists, AHP) during 2015/16 stood at 83,000. This number represents health
professionals who appear in the Health Work Force registry kept by the 4 Health Professional
Councils. It excludes administrative, other support cadres and health professionals hitherto
unregistered. Figure 3 displays the number of registered health professionals by employment
status.
FIGURE 5: DISTRIBUTION OF HEALTH PROFESSIONALS BY EMPLOYMENT STATUS
Other
Public
42%
(35,083)
of
registered
health
, 42%
s
, 51%
professionals are currently employed in the
public sector, and at least 7% (5,887) are
employed in the PNFP sector. About half of
PNFP
the registered health professionals (42,030)
, 7%
are either private practitioners, employed by
NGOs, unemployed or have emigrated. Thus it is reasonable to conclude that there is a large
pool of health professionals in the labormarket, many of whom may not be in full-time
employment.
3.3.6.5
Reasons for staff shortage
The major limitation to filling the staffing gaps in both the public and PNFP sector is
inadequate and unpredictable wage. Other commonly cited factors include;
•
•
•
•
•
•
•
•
•
Limited capacity for systematic HRH planning
Inadequate advocacy for wage and HRH support
Limited capacity to attract and retain qualified staff
Difficult working conditions – no accommodation, inadequate social amenities,
Inadequate supply of some priority cadres: pharmacists, dispensers, lab. technologists,
lab technicians in critical shortage.
Poor quality of graduates affecting their employability
Unattractive compensation (PHN, Anesthetist, Dispensers)
Limited capacity of some districts to recruit
Dynamics in the labor market – rapid private sector growth, causing variation in terms
and conditions of service
3.3.7 Health promotion and environmental health
The NSDS 2015 results show that, four in every ten households in Uganda used a covered pit
latrine without a slab compared to only 2% that used flash toilets. The proportion of
households using a covered pit latrine without a slab in rural areas (45%) is twice that
reported for urban areas (22%). On the other hand, 30% of households used covered pit
latrine with a slab - with the majority in the urban areas (47%) compared to only 25% in rural
Page | 25
Annual Health Sector Performance Report for Financial Year 2015/16
areas. Overall, 6% of households do not have toilet facility. Variations at sub-regional levels
show that the majority of households in Kigezi used covered pit latrines with a slab (68%),
67% in West Nile used covered pit latrines without a slab while 44% in Karamoja and 28%
on the islands had no toilet facilities. High costs are the major factor limiting construction of
toilet facilities (45%) while ignorance is the major factor limiting the use.
FIGURE 6: HOUSEHOLDS BY TYPE OF TOILET FACILITY USED (%)
•
Though proper hand washing after toilet use is a hygienic practice, which is highly
recommended for good health rarely is it practiced. Close to eight in every ten
households (78%) did not have any functional hand washing facilities while only 8%
had hand washing facilities with both water and soap. This pattern is similar across
sub-regions although Ankole (19%) had the highest percent of household with hand
washing facilities with water and soap.
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Annual Health Sector Performance Report for Financial Year 2015/16
FIGURE 7: HOUSEHOLDS BY AVAILABILITY OF HAND WASHING FACILITIES (%)
Like the previous FY, during FY 2015/16 there was no significant investment in building the
capacity of Village Health Teams (VHTs) which remained at 75% of the villages in the
country having trained VHTs. Much effort was towards finalizing the Community Health
Extension Workers (CHEWs) policy and strategy.
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Annual Health Sector Performance Report for Financial Year 2015/16
FIGURE 8: LATRINE COVERAGE
Page | 28
Annual Health Sector Performance Report for Financial Year 2015/16
3.4 Health Partnerships
3.4.1 Progress in implementation of the HSDP Compact
This section assesses performance of the HPAC and progress in implementation of the
partnership commitments made in the HSDP Compact.
During the year under review, the MoH and health partners developed the Compact for
Implementation of the HSDP 2015/16 – 2019/20. The purpose is to maintain policy dialogue,
promote joint planning, and effective implementation and monitoring of the HSDP through a
sector wide approach.Implementation of the Compact is monitored by the MoH Health Policy
Advisory Committee (HPAC). HPAC is a stakeholder coordination mechanism which
supports the functions of the MoH Top Management in policy related issues and meets
monthly.
In terms of meetings, HPAC was able to hold 11out of the 12 scheduled meetings during FY
2015/16. Membership attendance of the meetings varies with remarkable decline in
representation from the MoH, HDP representatives. There is need to assess the functionality
of the HPAC and recommend strategies for improving attendance by the eligible
representatives.
TABLE 23: HPAC INSTITUTIONAL REPRESENTATIVES’ ATTENDANCE
Representatives
MoH (11)
HDP (4)
CSO (3)
Private (1)
NMS (1)
Medical Bureaus(2)
NRH (2)
Line Ministries (5)
2010/11
45%
88%
48%
NA
58%
N/A
0%
0%
Average Annual Attendance Rate
2011/12
2012/13
2013/14
2014/15
45%
41%
37%
65%
109%
138%
161%
108%
67%
44%
67%
50%
66%
58%
72%
33%
42%
92%
72%
67%
N/A
N/A
73%
46%
4%
4%
0%
17%
2%
8%
11%
7%
2015/16
38%
42%
64%
25%
67%
54%
13%
5%
Source: HPAC Minutes
According to the M&E framework for implementation of the Compact there was compliance
to 8 out of the 15 indicators assessed this FY, no compliance to 3 of the indicators and partial
compliance to 4 indicators as shown in table 24.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 24: PROGRESS IN IMPLEMENTATION OF THE HSDP COMPACT DURING FY 2015/16
No
Indicator
1
1.1
Planning and Budgeting
MoH Comprehensive Annual Workplan
reflecting stakeholder contribution
1.2
All new sector investments are appraised
by SBWG
Comprehensive procurement plan
developed and adhered to
1.3
1.4
Response to Auditor General's report
1.5
Implementation of harmonized TA Plan
2
Performance
Compliant / Non
compliant
Monitoring Programme Implementation and Performance
2.1
Quarterly Area Team Visits
2.2
MoH Quarterly Performance reviews
2.3
2.4
Technical Review Meeting
Technical Working Group meetings
2.5
2.6
2.7
2.8
Annual Health Sector Performance
Report
Submission of Annual Report to OPM
Joint Review Mission
MTR of HSDP
2.9
3
End of HSDP Evaluation
Policy Guidance and monitoring
3.1
3.2
Senior Management Committee
Health Policy Advisory Committee
3.3
Country Coordination Mechanism
Comments
MoH annual report not comprehensive.
A number of Partner supported
activities and budgets not reflected in
the inannual sector workplans
Not all projects appraised were
submitted to HPAC
Procurement plan developed but not
fully adhered to mainly due to delays in
initiation of procurements
Response to AG report presented to
HPAC
Guidelines for TA were not available
and there was no harmonized TA plan.
Guidelines to be disseminated during
FY 2016/17
Only 2 Area Team visits were
conducted due to inadequate funds
Reviewed quarter 1 & 2 only.
Constraint of funds
No TRM held
Irregular TWG meetings
Timely compilation of report
Timely reporting to OPM
Annual Reviews held timely
Meetings held monthly
Attendance of at least 3/4 of meetings
by all members
Attendance of at least 3/4 of meetings
by all members
3.4.2 Key Sector Challenges
a) Despite the achievements, the sector still faces several challenges in ensuring newborn
and child survival among which are;
b) Huge disease burden owing to mainly Malaria, Pneumonia and diarrhea in children.
c) Inadequate staffing at all levels a significant number of posts are not filled.
d) Inadequacy in the maintenance of medical equipment nationwide.
e) Monitoring of various disease outbreaks is not equitably funded.
f) Stocks outs of key commodities at facility level owing to incorrect quantification
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Annual Health Sector Performance Report for Financial Year 2015/16
g) Influx of refugees into the country puts pressure on existing resources and is a risk of
importation of vaccine preventable diseases.
h) During this period, Uganda was hit by a malaria epidemic in the ten former IRS
districts
i) Districts in the north where indoor residual spraying had ceased. The affected districts
experienced and upsurge in the number of malaria cases as reflected in the incidence
map below and this upsurge has reversed some of the gains in malaria control that had
been achieved in these areas.
j) Funding gaps for ARVs, Antimalarials and chemistry and haematology laboratory
reagents in the public sector.
k) There is inadequate funding for sector activities especially PHC Services.
l) There is a challenge of the alignment of off-budget funding to sector priorities.
m) There is skewed input mix in financing health facilities, for instance there have not
been commensurate funding for recurrent costs for utilities and/or maintenance arising
from the construction of new buildings and equipment especially for hospitals.
n) Unsatisfactory level of support supervision from districts to the lower level health
facilities. Many district lack capacity in terms of man power, transport and other
logistical requirements to conduct regular and effective support supervision.
3.4.3 Conclusion and Recommendations
The following conclusions and recommendations are made;
•
Improve district storage facilities for EMHS
•
Encourage and buttress the referral system in accordance with levels of care from the
lower facilities to reduce on the influx of patients at the National Referral Hospital
and RRHs.
•
The Government and HDPs need to increase investment in health towards meeting
recommended per capita health expenditure of minimum $84 per capita for low
income countries, if the country is to increase access to health care and improve
quality of services. With the current epidemiological profile, relative to our desired
level of health status, the per capita expenditure of Shs 148,000 ($56) may not move
the country towards achieving the Sustainable Development Goals (SDGs).
•
The Country needs to address high levels of Out-of-Pocket expenditure (40%) in order
to protect households from catastrophic. The country needs to explore alternative
ways of mobilizing domestic resources to improve financial sustainability including
the improvement of efficiency in resource use. Social Health Insurance and
community based health insurance and medical savings would enhance domestic
resource mobilisation efforts.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
The MoH needs to strengthen its stewardship role in coordinating donors and ensuring
alignment to country strategies to the Paris Declaration principles for more aid
effectiveness. In this regard, the development of strategic partnerships which allow
for predictability of funds over a longer period will ensure sustainability of funding.
•
The sector should committee resources for strengthening health (and community)
systems to engage in care and prevention of TB and leprosy. There is also need to
strengthen tools such as the intensified case finding guide and build capacity of health
workers to suspect and diagnose TB & leprosy cases.
FIGURE 9: % OF PREGNANT WOMEN COMPLETING IPT2 BY DISTRICT FY 2015/16
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Annual Health Sector Performance Report for Financial Year 2015/16
FIGURE 10: % OF PREGNANT WOMEN ATTENDING ANC 4TH VISIT BY DISTRICT FY 2015/16
3.5 Local Government Performance
The Uganda District League Table (DLT) was launched 2003 with a primary purpose of
comparing performance of districts to determine good and poor performers; providing
information to facilitate understanding of good and poor performance and to enable
application of corrective measures, increasing local government ownership of achievements,
and encouraging replication of documented good practices. Over the years the use of DLT has
gained importance in the overall health sector monitoring and it is an important tool for
managers and policy makers as a starting point for a comprehensive review of national and
individual district performance.
The DLT is composed of input, process , output and outcome indicators – e.g.deliveries in
health facilities, Out Patient Department attendance, latrine coverage, among others; in line
with the HSDP.The composite index employed is computed by weighting the agreed upon
indicators, ranking districts from best to worst performer.
3.5.1 District League Table (DLT) Performance
In this report, the 112 Districts are used as the units of analysis with key objectives of
comparing performance between districts; provide information to facilitate the analysis for
good and poor performance at districts and thus enable corrective measures which may range
from increasing the amount of resources (financial resources, human resources,
infrastructure) to the LG or more frequent and regular support supervision.
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Annual Health Sector Performance Report for Financial Year 2015/16
The DLT is not meant to embarrass LG leaders of poorly performing districts, but rather to
make them question why their district is performing poorly, and consider ways in which that
performance can improve.
The objectives of the DLT are;
• To compare performance between districts and therefore determine good and poor
performers.
• To provide information to facilitate the analysis for good and poor performance at
districts thus enable corrective measures.
• Appropriate corrective measures which may range from increasing the amount of
resources (funds, human resource, infrastructure) to the LG or more frequent and regular
support supervision.
• To increase LG ownership for achievements – the DLT to be included in the AHSPR to
be discussed at the NHAor JRM with political, technical and administrative leaders of
districts.
• To encourage good practices – good management, innovations and timely reporting.
For the FY2015/16, 14 indicators were used to evaluate and rank district performance: 6
coverage accounting for 45%, 4 quality accounting for 20%, 1 human resource accounting for
10% and 3 HMIS reporting accounting for 15 % totaling to 90%. The final percentage
performance was then computed by the formula % score (total score)/90*100 this is because
one of the 15 indicators (average district quality of care score) approved for assessing district
performance was not included in this year’s DLT.
The 111 existing districts excluding KCCA in FY2015/16 are used as the units of analysis for
LG performance.
Routine HMIS data was the primary data source for majority of the indicators (Pentavalent
Vaccine 3rd Dose coverage, institutional deliveries, outpatient visits, Sulfadoxine /
Pyrimethamine (SP) 2nd dose for IPT, 4thANC visits, HMIS timeliness and completeness of
reporting, and submission of inventory data; some of the indicator data were provided by
MoHprograms such as HIV/AIDS, TB, human resources, Environmental Health Division.
The top ten best performing districts in FY2015/16as ranked by the percentage (%) score
computed by (total score)/90*100 are; Lyantonde, Rukungiri, Mpigi, Gulu, Amuria, Lamwo,
Katakwi, Serere, Kabarole and Buyende. The lowest performance levels were noted in
Wakiso, Sembabule, Bulambuli, Kotido, Koboko, Moroto, Napak, Sironko, Amudat and
Buvuma
Tables 25 and 26 show the top and bottom 15 performing districts with their total scores and
ranks. The full DLT can be seen in the Annex.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 25: TOP 15 PERFORMING DISTRICTS
DISTRICT
% SCORE
Lyantonde
Rukungiri
Mpigi
Gulu
Amuria
Lamwo
Katakwi
Serere
Kabarole
Buyende
Buikwe
Dokolo
Iganga
Bushenyi
Soroti
77.2
77.0
74.2
74.1
73.5
73.3
72.8
72.7
72.6
72.5
72.5
72.3
72.2
72.2
72.0
TABLE 26: BOTTOM 15 PERFORMING DISTRICTS
RANK
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
DISTRICT
% SCORE
RANK
Luuka
Kibaale
Pader
Buliisa
Otuke
Wakiso
Sembabule
Bulambuli
Kotido
Koboko
Moroto
Napak
Sironko
Amudat
Buvuma
60.3
60.2
60.1
59.8
59.2
58.9
58.9
58.5
57.8
57.7
57.1
57.0
54.2
51.3
50.7
98
99
100
101
102
103
103
104
106
107
108
109
110
111
112
There is reasonable contrast between the district performance in FY2014/15 and current
FY2015/16. For instance the top performing district last FY was Gulu district with a score of
89% while this year the top performing district is Lyantonde with a score 77.2% indicating a
decline in total district performance of 11.8 percentage points. It should however be noted
that new indicators have been adapted this financial year for the league table.In terms of
individual districts, 7 districts (Lyantonde, Rukungiri, Gulu, Lamwo, Serere, Kabarole, and
Bushenyi) have sustained their presence in the top 15 performing list while 7 districts
including Jinja, Butambala, Lira, Mityana, Mbale, Luwero and Masaka have dropped from
the list. New entrants on this list in FY2015/16 include; Mpigi, Amuria, Buyende, Buikwe,
Dokolo, Katakwi and Iganga districts. The list appears to be a mixture of old, new and even
hard-to-reach districts, implying that it is possible for all districts to achieve improved
performance by being in the top 15 performing list.
TABLE 27: TOP AND BOTTOM 10 DISTRICT RANKING FOR NEW DISTRICTS FY 2015/16
District
Lamwo
Serere
Buyende
Mitooma
Buikwe
Ngora
Ntoroko
Agago
Butambala
Kole
%
Score
71.8
71.4
70.8
70.7
70.3
70.0
69.2
67.5
67.2
66.7
Rank
1
2
3
4
5
6
7
8
9
10
National
Rank
7
9
11
17
12
18
22
38
28
41
District
Kyegegwa
Kyankwanzi
Buhweju
Bukomansimbi
Luuka
Otuke
Bulambuli
Napak
Amudat
Buvuma
%
Score
61.0
60.6
60.1
59.5
59.1
57.2
56.4
54.8
49.9
47.8
Rank
22
23
24
25
26
27
28
29
30
31
National
Rank
79
84
94
95
98
102
105
109
111
112
In the new districts LT, only Lamwo, Serere and Agago maintained their presence in the top
10 performing districts in this category from FY2014/15. Districts which have joined the top
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Annual Health Sector Performance Report for Financial Year 2015/16
10 performing new districts in FY2015/16include Buyende, Mitooma, Buikwe, Ngora,
Ntoroko, Butambala and Kole.
TABLE 28: TOP AND BOTTOM 10 HARD-TO-REACH DISTRICTS AS PER THE HARD-TO-REACH DLT
District
Gulu
Lamwo
Ntoroko
Mukono
Agago
Namayingo
Kitgum
Mayuge
Bundibugyo
Nwoya
Abim
Amuru
Kisoro
Kaabong
Pader
Kotido
Moroto
Napak
Amudat
Buvuma
Total Score
73.4
72.7
70.2
69.6
68.2
67.9
66.5
66.2
65.8
65.8
62.3
61.9
61.4
60.6
59.3
57.1
56.4
56.1
50.7
49.5
Rank
1
2
3
4
5
6
7
8
9
10
17
18
19
20
21
22
23
24
25
26
National Rank
5
7
22
27
38
37
48
44
49
57
85
90
93
97
100
106
108
109
111
112
Regarding the hard-to-reach category performance for FY2015/16, Gulu remained the top
most performing with 73.4% which lower than it score (89.0%) in the same position last FY.
Other districts in this category FY2015/16 include Lamwo (72.7%) Ntoroko (70.2%),
Mukono (69.6%), Agago (60.7%) among others. Like last FY the bottom performing districts
in the hard-to-reach category are dominated by districts of the northern and Karamoja region
including Amuru (61.9%), Pader (59.3%), Abim (62.3%) Kaabong (60.6%), Kotido (57.1%),
Napak (56.1%), Moroto (56.4%) and Amudat (50.7). Others are Buvuma (49.5%), and Kisoro
(61.4%). There seems to be a consistent relationship between hard-to-reach districts and poor
performance. This implies that special attention should be given to these districts in order to
tackle the unique challenges in the districts. Although affirmative action has been applied, it
seems as a sector we need to review these strategies.
There appears to be a slightly positive relationship between district staffing levels (% of
approved posts that are filled qualified personnel in public health facilities) and the overall
score. For instance majority of the top 10 performing districts have staffing levels of over
70% with the other 3 having staffing levels of 60% and above. High staffing is a major
advantage but it must be quickly added that other factors like motivation, requisite skills,
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Annual Health Sector Performance Report for Financial Year 2015/16
equipment
performing
assessment
studies can
personnel.
and accommodation are equally relevant. However, 5 districts in the low
category reported similar staffing levels of over 70%. This calls for an in-depth
of the factors associated with staffing levels and general service delivery. Such
also capture factors that influence attraction, retention and productivity of health
TABLE 29: STAFFING LEVELS FOR 10 TOP AND BOTTOM DISTRICTS
District
Lyantonde
Rukungiri
Mpigi
Gulu
Amuria
Lamwo
Katakwi
Serere
Kabarole
Buyende
Staffing
Level
82.6
82.2
73.6
81.2
82.3
54.3
65.5
69.1
60.8
78.8
National
Rank
1
2
3
4
5
6
7
8
9
10
District
Wakiso
Sembabule
Bulambuli
Kotido
Koboko
Moroto
Napak
Sironko
Amudat
Buvuma
Staffing
level
71.3
54.4
86.8
70.8
31.1
78.1
41.3
75.4
19.7
65.9
National
Rank
103
104
105
106
107
108
109
110
111
112
In conclusion as earlier indicated the DLT has primary purpose of comparing performance of
districts to determine good and poor performers; providing information to facilitate
understanding of good and poor performance and to enable application of corrective
measures, increasing LG ownership of achievements, and encouraging replication of
documented good practices.In order to improve the quality and power of the DLT there is
need for better availability of accurate data on district characteristics, which may have
significant influencing on performance. It is therefore necessary for all stakeholders to
actively participate in supporting better data collection, transmission and use the information
from the DLT to make the necessary decisions at the various levels.
3.6 Health Facility Performance
The health facility performance was measured in terms of budget utilization (inputs) Standard
Unit of Output (Outputs), Facility based Fresh Still Births, Maternal Mortality ratio, in-patient
fatality rate and Perinatal Mortality rate (Outcomes) as well as Bed Occupancy rate, average
length of stay and cost per SUO (efficiency).The overall performance of the different levels
of care is shown in table 30 below. 31.7% of the outputs as measured by standard unit of
output are produced by HC IIIs while 22.2% are produced by HC IIs
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 30: HEALTH FACILITY OUTPUTS AND OUTCOMES BY LEVEL OF CARE FY 2015/16
Level
Admissions
Patient Days
Beds
Total OPD
Deliveries
Total ANC
Postnatal
Attendances
FP
Immunization
Caesarian
Sections
Major Operations
IPD Deaths
Fresh Still births
Macerated still
births
Newborn deaths
Perinatal Death
Rate
Maternal Deaths
BOR
ALOS
Maternal Death
Risk
FSB Risk
SUO 2015/16
National
RHs
RRHs
GHs
HC IVs
HC IIIs HC IIs
Clinic
88,427 43,2064 804,850
52,6206
704,968
76,217
25,303
330,645 1,710,4 3,121,75 1,294,58 1,568,89
151,316
32,480
41
5
2
2
2,115
5,665
13,985
6,788
15,138
1,788
419
2,731,1 4,180,52 4,274,02 15,137,5 16,082,8 1,195,2
219,574
70
2
8
18
66
09
23,674
85,814 204,702
170,670
359,228
104,857
9,132
2,265,19
41,113 195,659 445,389
662,512
3
758,484
32,181
1,928
119,217
214,728
232,474
783,293
110,538
856,086
730,797
3,238,01
2
302,514
3,004,23
9
2,874,56
0
6,588
35,487
118,183
240,838
40,931
221,742
640,203
519
1,027
4,452
892
30,352
59,608
12,710
1,874
561
547
52,552
92,087
24,657
3,303
12,755
23,780
3,228
2,076
1,578
5,249
5,594
2,850
329
931
748
988
168
594
229
175
1,527
1,179
3,147
3,718
1,792
1,971
3,067
3,581
739
955
101
39
2,000
92
82%
33
4,580
360
82%
4
10,168
391
61%
4
5,839
163
52%
3
9,498
68
28%
2
2,682
42
23%
2
315
5
21%
1
803
78
343
18
9,956,0
65
212
18
17,692,0
58
93
12
13,780,7
82
123
7
30,149,3
72
107
4
21,159,5
82
61
21
1,705,9
69
1,636,255
17,521
50,849
3.6.1 Performance of the National Referral hospitals
The country still has two national referral hospitals; Butabika and Mulago. Butabika is a
specialized hospital for mental health services. The budget performance for the National
referral Hospitals is shown in table 31 below.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 31: BUDGET PERFORMANCE FOR NATIONAL REFERRAL HOSPITALS
Hospital
APPROVED BUDGET (Bn)
RELEASES (Bn)
Wages
Wage
NonWage
Dev’t
EXPENDITURE (Bn)
NonWage
Dev’t
Wage
NonWage
Dev’t
Mulago
20.04
16.07
5.02
20.04
17.5
5.02
20.04
17.34
5.02
Butabika
3.79
3.71
0.07
3.13
4.0
0.07
3.13
3.98
0.07
23.83
19.78
5.09
23.17
21.5
5.09
23.17
21.32
5.09
Total
The performance of these hospitals is summarized in table 31 below. It is worth noting that
Mulago HMIS reporting was at only 50% during FY 2015/16 thus the low performance
for a National Referral Hospital.
TABLE 32: SUO FOR NATIONAL REFERRAL HOSPITALS FY 2015/16
Unit
Admissions
Patient Days
Beds
Total OPD
Deliveries
Total ANC
Postnatal Attendances
FP
Immunization
Caesarian Sections
Major Operations
IPD Deaths
Fresh Still births
Macerated still births
Newborn deaths (0-7days)
Perinatal Death Rate
Maternal Deaths
BOR
ALOS
Maternal Death Risk
FSB Risk
SUO 2015/16
Source: MoH DHIS-2 2015/16
Butabika NRH
2,486
76,101
550
54,852
179
639
0
59
37.9
30.6
92,359
Mulago NRH
85,941
254,544
1,565
164,722
11,455
41,113
1,928
6,409
40,292
519
1,027
4,393
892
561
547
174
92
44.6
3.0
803
77.9
1,543,895
3.6.2 Regional Referral Hospital Performance
The RRHs are meant to provide specialized services for a region of approximately 2,000,000
people in additional to general services for the host districts. The budget performance of the
public RRHs is shown in table 33 below. This excludes the value of medicines supplied to
these hospitals by the NMS.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 33: BUDGET PERFORMANCE FOR RRHS
Vote
RRH
163 Arua
164 Fortportal
165 Gulu
166 Hoima
167 Jinja
168 Kabale
169 Masaka
170 Mbale
171 Soroti
172 Lira
173 Mbarara
174 Mubende
175 Moroto
176 Naguru
Total
Wage
Nonwage
Development
Approved
budget
Release Actual Approved budget Release Actual Approved Release
3.10
2.798 2.80
1.775 2.747 2.295 0.750 0.729
3.55
3.078 3.07
1.894 2.232
1.92 0.600 0.520
2.96
2.617 2.60
2.700 2.648 2.258 1.470 1.426
2.86
2.230 2.22
2.115 2.253 2.065 1.400 1.224
3.74
3.576 3.58
2.279 2.250
2.25 0.600 0.598
2.50
2.359
0.533
2.36
1.824 2.317 2.317 0.600
2.69
2.689 2.34
1.998 1.994 1.928 1.200 1.079
3.95
3.494 3.49
3.135 2.904
2.91 0.600 0.539
2.78
2.522 2.52
2.065 2.036 2.021307 0.900 0.812
2.68
2.621 2.62
1.838 2.455 2.32776 0.600 0.538
3.39
2.942 2.66
2.186 3.411 2.830827 1.328 1.184
2.54
2.071 2.07
1.386 1.345 1.363 1.800 1.800
2.13
1.943 1.44
1.310 1.807
1.51 0.664 0.597
3.76
3.337 3.02
1.235 1.222 1.221671 1.394 1.307
42.63
38.28 36.79
27.74 31.62 29.22 13.91 12.89
Total
Actual Approved bRelease Actual
0.729
5.62 6.27 5.82
0.519
6.05 5.83 5.51
1.405
7.13 6.69 6.26
1.224
6.37 5.71 5.51
0.598
6.62 6.42 6.42
0.533
4.92 5.21 5.21
1.079
5.89 5.76 5.35
0.538
7.68 6.94 6.94
0.812
5.75 5.37 5.35
0.538
5.12 5.61 5.49
1.184
6.91 7.54 6.67
1.800
5.72 5.22 5.24
0.597
4.11 4.35 3.54
1.307
6.39 5.87 5.55
12.86
84.27 82.78 78.87
The performance of RRHs is shown in table 34 below. The regional referral and large PNFP
hospitals contributed 10.5% of the SUOs produced by health facilities in Uganda. The total
SUOs from Regional referral and Large PNFP Hospitals increased from 8,727,281 in FY
2014/15 to 9,956,065 in FY 15/16. Mbale RRH continues to produce significantly higher
SUOs that other RRHs mainly owing to a relatively higher population being served by the
hospital.
The bed occupancy rate in excess of 100% observed in Moroto, Soroti and Lira RRHs is
explained by the relatively high average length of stay (6.2, 5.1 and 8.8 days respectively).
Given that the average length of stay for these hospitals is higher than that of Mulago NRH
emphasis should be placed on reducing average length of stay to reduce bed occupancy rate.
Mubende RRH however has a bed occupancy rate of 100.4% and an average length of stay of
2.9 days it therefore probably requires an increase in the bed capacity.
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 34: OUTPUTS AND OUTCOMES FROM REGIONAL/LARGE HOSPITALS
The cost per SUO in RRH is shown in table35 below. If you combine the three efficiency
indicators namely: Bed occupancy rate, Average Length of Stay and Cost per SUO, Mbale
RRH hospital stands out as the most efficient RRH in the country.
Mbale REGIONAL REF HOSPITAL
Masaka REGIONAL REF HOSPITAL
Fort Portal Regional Ref erral Hospital
Gulu Regional Ref eral Hospital
Mbarara REGIONAL REF HOSPITAL
Mubende RR HOSPITAL
Arua REGIONAL REF HOSPITAL
Lira REGIONAL REF HOSPITAL
Hoima REGIONAL REF HOSPITAL
Soroti REGIONAL REF HOSPITAL
Jinja Regional Ref HOSPITAL
Kabale REGIONAL REF HOSPITAL
Moroto Regional Ref f eral HOSPITAL
Naguru Hospital - China Uganda Friendship
St. Mary's Hospital Lacor
Mengo HOSPITAL
Lubaga HOSPITAL
St. Francis Nsambya HOSPITAL
Total
1,000,426
709,114
692,127
759,313
718,777
544,106
584,993
531,113
527,436
498,721
590,719
375,236
254,298
387,102
646,574
424,556
396,050
315,406
9,956,065
6.94
5.35
5.51
6.26
6.67
5.24
5.82
5.49
5.51
5.35
6.42
5.21
3.54
5.55
78.86
Cost Per SUO (UGX)
Expenditure FY 15/16 (Bn)
SUO 2015/16
Health facility
TABLE 35: COST PER SUO IN RRHS IN FY 2015/16
6,937
7,545
7,961
8,244
9,280
9,630
9,949
10,337
10,447
10,727
10,868
13,885
13,921
14,337
7,921
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Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 36: LEADING CAUSES OF MORBIDITY IN RRHS IN FY 2015/16
While malaria remains the leading cause of morbidity in RRH NCDs like Diabetes Mellitus
and Epilepsy have also emerged as leading causes of morbidity reflecting the epidemiological
transition.
The inpatient fatality rate for RRH was 2.94% with inpatient fatality rates above 4% being
observed in Mbarara, Arua and Fort portal RRHs while inpatient fatality rates below 2% were
observed in Moroto, Naguru and Gulu RRH. The leading causes of mortality in RRH are
shown in table 37 below. Over 90% of the deaths among children under five years and 60%
of the deaths among patients above 5 years were due to treatable/preventable infections.
TABLE 37: LEADING CAUSES OF DEATH IN RRHS IN 2015/16 FY
Condition
Condition
Malaria
Neonatal Sepsis 0-7days
Pneumonia
Anaemia
Septicemia
Diarrhoea - Acute
Injuries: (Trauma due to other causes)
Injuries: Road Traffic Accidents
Gastro-intestinal disorders (non-infective)
Neonatal tetanus
Under 5
Deaths
% Under 5
Death
625
304
293
288
100
51
36
32
25
21
5 and
% 5 and
above
above
deaths death
31.1 Anaemia
377
9.4
15.1 Malaria total
329
8.2
14.6 Injuries: (Trauma due to other causes)
298
7.4
14.3 Pneumonia
292
7.3
5.0 Other Types Of Meningitis
290
7.2
2.5 New TB cases diagnosed: Bacteriologically confirmed
202
5.0
1.8 Injuries: Road Traffic Accidents
175
4.4
1.6 Hypertension (Old cases)
148
3.7
1.2 Other Cardiovascular Diseases
133
3.3
1.0 Septicemia
124
3.1
Maternal Mortality continued to be a major challenge in RRHs. The Facility based MMR for
RRHs in FY 2015/16 was 343.2 per 100,000. Hoima, Fort Portal and Mubende RRH had high
MMR of 805, 737 and 683 per 100,000 respectively while Naguru and Kabale had low MMR
of 83 and 95 per 100,000. Fresh Stillbirths and Perinatal Mortality rates at RRHs also
continued to be a major challenge with rates of 17.9/1000 and 34.3/1000 respectively.
Masaka RRH had the lowest FSB rate at 5.7/1000 while Mubende RRH had the highest FSB
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Annual Health Sector Performance Report for Financial Year 2015/16
rate at 43 per 1000. Naguru RRH had the lowest PNM rate at 12.2/100 while Jinja RRH had
the highest PNM rate at 85.7/1000.
3.6.3 General Hospital Performance
General Hospitals provide general hospital services to their host district and neighbouring
districts without hospitals. The general hospitals are financed under their respective District
local governments and their inputs are thus to some extent merged with the inputs of HCs.
The General Hospitals were however allocated UGX 5.94 billion for recurrent non wage and
UGX 8.2 billion for Capital development in FY 2015/16. Both their budget performance and
expenditure were 100%.
The general hospitals produced 18.6% of the health facility outputs as measured by the SUO.
The detailed performance of each general hospital is shown in Annex. The total SUO from
General Hospitals increased from 16,256,818 in FY 2014/15 to 17,692,056 in FY2015/16.
Iganga Hospital had the highest SUO 600,244 followed by Kitgum Hospital with 493,981
while 14 hospitals had SUOs less than 20,000 including Aber NGO Hospital with only 1,098
these should probably be re-classified to a lower level.
TABLE 38: LEADING CAUSES OF MORBIDITY IN GENERAL HOSPITALS IN 2015/16 FY
Condition
Under 5
No.
Condition
%
5 and above years
No.
Malaria
251,624
31.6%%
No pneumonia – cough or
cold
196,227
Tooth extractions
Diarrhoea – acute
%
Malaria
601,699
28.0%
24.6%
No pneumonia – cough or
cold
399,088
18.6%
120,576
45,966
15.1%
5.8%
Urinary Tract Infections
Tooth extraction
169,927
145,921
7.9%
6.8%
Pneumonia
36,938
4.6%
Other eye conditions
90,904
4.2%
Skin diseases
Other eye conditions
32,010
15,392
4.0%
1.9%
Skin diseases
Injuries (trauma due to other
causes)
87,894
65,772
4.1%
3.1%
Intestinal worms
Other types of anaemia
Urinary Tract Infections
15,262
13,749
11,354
1.9%
1.7%
1.4%
Pelvic Inflammatory Diseases
Intestinal worms
Diabetes Mellitus
59,429
59,052
50,785
2.8%
2.7%
2.4%
The leading causes of morbidity in General Hospitals are shown in table 38 above. Malaria
and Cough or cold without pneumonia remain the leading causes of attendance at general
hospital outpatients for both patients below and above 5 years. These may however reflect a
broad categorization of several disease entities and the sector should consider introduction of
the international classification of diseases to improve both diagnosis and reporting as well as
comply with international standards. Dental diseases injuries, eye diseases and Diabetes
Mellitus now appear among the leading causes of morbidity probably reflecting the
epidemiological transition to a mixture of communicable and non-communicable diseases.
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TABLE 39: LEADING CUASES OF DEATH IN GENERAL HOSPITALS IN FY 2015/16
Condition
Malaria
Under five
cause of death
No.
%
Condition
5 years and above
cause of death
No.
%
1,390
30.0%
Malaria
748
11.1%
Anaemina
670
14.4%
Pneumonia
555
8.2%
Pneumonia
Neonatal sepsis
655
389
14.1%
8.4%
551
328
8.2%
4.9%
Septicaemia
160
3.5%
Anaemia
Other cardiovascular
diseases
Hypertension
295
4.4%
Diarrhoea – acute
151
3.3%
Septicemia
287
4.3%
Injuries – trauma due to other
causes
Injuries - RTAs
145
3.1%
New TB cases
234
3.5%
134
2.9%
Injuries – RTA
229
3.4%
Respiratory infections
101
2.2%
Gastro-intestinal disorders
206
3.1%
93
2.0%
Injuries – Trauma due to
other causes
197
2.9%
Asthma
The overall Facility based Maternal Mortality ratio for general hospitals was 369/100,000.
While more than 40 hospitals reported no maternal deaths during the FY the hospitals in table
below had very high maternal mortality ratios which require urgent attention.
TABLE 40:FACILITY BASED MATERNAL MORTALITY RATIO FOR GHS IN 2015/16 FY
Hospital
Maternal Mortality Ratio per 100,000
Lugazi Scoul
2,239
Nakasongola Military
1,563
Senta Medicare clinic
1,170
Novik Hospital
830
Ishaka Adventist
784
St Francis Nagalama
735
Villa Maria
665
Adjumani
660
Nyapea
659
Ibanda
579
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Annual Health Sector Performance Report for Financial Year 2015/16
The fresh still birth rate for General hospitals was 17.8/1000. Murchison Bay hospital and
Gulu Military Hospital reported the highest fresh still birth rates of 106/100 and 97/1000
respectively. The Perinatal Mortality rate for general hospitals was 54.5/1000. Murchison Bay
Hospital and Senta Medicare clinic reported the highest perinantal mortality rates 334/1000
and 228/1000 respectively.
15 general hospitals reported bed occupancy rates above 100%, with Iganga Hospital
reporting the highest bed occupancy rate of 177%. The hospital has, with support from World
Bank, been renovated and expanded. The bed capacity will be revised upwards effective FY
2016/17. Some general hospital had high average length of stay notably Adjumani Hospital
7.7 days and Maracha Hospital 7.9 days which need to be addressed.
3.6.4 Health Centre IV Performance
The HC IV serves as the first referral facility providing comprehensive obstetric and newborn
care services in HSDs where there is no Hospital. HSDs on average cover a population of
100,000 people. The main objective of the HSD concept was to reduce maternal and perinatal
mortality by increasing access to comprehensive obstetric and newborn care services. Of the
206 recognized HC IVs in the country 194 submitted reports to MoH on a regular basis. 63%
of the HC IVs reported having carried out caesarean sections during FY 2015/16 and are thus
considered to have been providing comprehensive obstetric and newborn care services. This
shows a significant increase from 51% reported in FY 2014/15. However 83% of the HC IVs
reported having carried out a major operation implying that they may have capacity to
provide caesarean sections. 80 HC IVs (41%) provided blood transfusion services rising from
38% in FY 2014/15. The trends in percentage of HC IVs providing caesarean section and
blood transfusion are shown below. There is a positive trend that clearly demonstrates the
impact of salary enhancement for medical officers.
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Annual Health Sector Performance Report for Financial Year 2015/16
The HC IVs are financed under their respective District LGs and their inputs are thus merged
with those of other lower level HCs.
The detailed outputs and outcomes from HC IVs are provided in the Annex. HC IVs
generated 13,780782 SUOs equivalent to 14.5% of the total sector outputs. Mukono Town
Council HC IV with 216,116 SOUs had the highest number. 41 HC IVs had SOUs above
100,000 and if resources allow could be considered for upgrading to Hospitals. The bed
occupancy rate for HC IVs was 52.3% while the average length of stay for inpatients was 2.5
days. 13 HC IVs had a bed occupancy rate above 100% and may require expansion given that
their average length of stay was less than 3 days. PAG mission HC IV had an average length
of stay of 6.4 days which may need to be explored further.
TABLE 41: LEADING CAUSES OF MORBIDITY AT HC IVS IN 2015/16 FY
Condition
Malaria
No pneumonia – cough or
cold
Diarrhoea – acute
Skin diseases
Under 5
No.
338,238
275,945
Condition
%
39.0%
31.8%
62,334
36,858
7.2%
4.3%
Malaria
No pneumonia – cough or
cold
Urinary Tract Infections
Tooth extraction
Pneumonia
Intestinal worms
Other eye conditions
36,459
32,254
13,963
4.2%
3.7%
1.6%
Intestinal worms
Skin diseases
Pelvic inflammatory disease
Urinary Tract infection
12,004
1.4%
Injuries (trauma due to
other causes)
Other types of anaemia
7,115
0.8%
6,001
0.7%
5 and above years
No.
945,463
686,751
%
33.7%
24.5%
173,358
123,752
6.2%
4.4%
112,110
94,591
70,116
4.0%
3.4%
2.5%
Other sexually transmitted
infections
69,346
2.5%
Injuries (trauma due to other
causes)
Diarrhoea – acute
56,975
2.0%
54,511
1.9%
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Annual Health Sector Performance Report for Financial Year 2015/16
The leading causes of morbidity in HC IVs are shown in table 42 below. While infectious
diseases still dominate the list, the emergence of dental diseases and trauma as leading causes
of morbidity is worth noting. The leading causes of mortality are shown in table 42. Treatable
infections including malaria in pregnancy are still the major cause of mortality though injuries
due to road traffic accidents have also emerged as a major cause of mortality.
TABLE 42:LEADING CAUSES OF MORTALITY AT HC IVS IN 2015/16 FY
Condition
Under five
cause of death
No.
%
Condition
5 years and above
cause of death
No.
%
Malaria
972
47.3%
Malaria
306
16.3%
Pneumonia
224
10.9%
Malaria in pregnancy
150
8.0%
Anaemina
Diarrhoea – acute
205
73
10.0%
3,6%
Pneumonia
Anaemia
102
95
5.4%
5.1%
Respiratory infections
66
3.2%
HIV related
67
3.6%
Septicaemia
55
2.7%
Urinary Tract Infection
66
3.5%
Neonatal sepsis
52
2.5%
Abortions
66
3.5%
Gastro-intestinal disorders
Injuries (trauma due to other
causes)
Injuries – Road traffic accidents
47
37
2.3%
1.8%
New TB cases
Hypertension (old cases)
63
59
3.4%
3.1%
31
1.5%
Injuries – Road traffic
accidents
52
2.7%
The facility based Maternal Mortality ratio for HC IVs was 106/100,000. Rhino camp,
Namatala and Amolator HC IVs had high MMR of 2,578/100,000, 1,600/100,000 and
1,004/100,000 respectively and need support. More than 50% of HC IVs did not report any
maternal death. The fresh still birth rate for HC IVs was 11.9/1000. St Ambrose charity and
Busia HC IV reported the highest Fresh still birth rate of 132.2/1000 and 111.6/1000
respectively. 12 HC IVs reported no fresh stillbirth. The perinatal mortality rate for HC IVs
was 33.4/1000. Namatala and St Ambrose charity reported the highest perinatal mortality
rates i.e 424/1000 and 282/1000 respectively. HC IVs with high fresh stillbirth and perinatal
mortality will be supported to improve functionality and outcomes.
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Annual Health Sector Performance Report for Financial Year 2015/16
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Annual Health Sector Performance Report for Financial Year 2015/16
4 ANNEXES
4.1 Annex One:Delivery of the Uganda National Minimum Health Care Package
(UNMHCP).
This section details the progress on implementation of priority activities under the UNMHCP.
4.1.1 Health promotion, disease prevention, and community health initiatives
The key objectives of the division are Prevention and control of communicable and non communicable diseases (NCDs), capacity building of service providers, policies, laws,
guidelines dissemination and plans and strategies, technical support supervision monitoring
and supervision.
The following outputs were achieved;
i.
ii.
iii.
iv.
Raised awareness on cholera, teenage pregnancy, measles, HPV, Polio and safe
motherhood through radio spot messages and press conferences.
Reviewed IEC materials on measles, HPV, and nutrition for Karamoja region.
Developed Social behavior Change (SBCC) guidelines on Sexual and Reproductive
and HIV/AIDS.
Technical support supervision and monitoring in 10 districts in western region.
4.1.2 Environmental Health
This component aims at contributing to the attainment of a significant reduction of morbidity
and mortality due to: poor sanitation and hygiene, indoor pollution, poor food hygiene and
supply, unsafe water accessibility and other environmental health related conditions. This was
done through implementation of activities supported by the GoU, UNICEF and the Uganda
Sanitation Fund (USF) Program.
Emphasis was put on Improved Hygiene and Sanitation (ISH) and Kampala Declaration on
Sanitation (KDS +) strategies. The communities are reached through Community Led Total
Sanitation (CLTS) approach, Participatory Hygiene and Sanitation Transformation (PHAST).
The following were the achievements:
• Training and capacity building: Trained 25 Health Inspectorate staff from
Kayunga, Buikwe, Soronko, Manafwa & Bududa in Community Led Total
Sanitation (CLTS) approach with support from UNICEF, 35 Community
Extension Workers, 25 VHTs in CLTS in the districts of Hoima, Kiboga, Buikwe
with support from (World Vision) and Bukwo with support from Catholic Relief
Services and 12 MoH staff in Sanitation Wealth approach under the support of
WHO.
• Other out puts included; commemoration of National Sanitation Week with apex
celebrations held in Mbale district.
• Developed the Environmental Health Strategy 2015/16 – 2019/20,
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Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
•
Supported six districts with 6 motorcycles from UNICEF.
Supported 2 districts (Ntungamo and Kiruhura) in conducting Open Defecation
Free Verification.
The division also supported districts of Mbale, Soronko, Manafwa, Bududa,
Budaka, Kibuku, Pallisa, Butaleja Bulambuli and Namayingo during the outbreak
of cholera.
Supervised 14 districts in Busoga and Karamoja Sub Regions for jiggers
eradication programme.
Monitored and evaluated Health care waste management in the 14 districts of
Kitgum, Lamwo, Padero, Agago, Gulu, Oyam, Otuke, Lira, Kole, Dokolo, Soroti,
Katakwi, Moroto and Kotido.
4.1.3 Control of Diarrheal Diseases (CDD)
The mandate of CDD division is to prevent and control diarrheal diseases through promotion
and use of strategies that will reduce morbidity and mortality.
The following outputs were achieved;
•
•
•
Supported districts to prevent and control cholera outbreaks. Thirty one districts were
identified and equipped with skills for cholera outbreak prevention and control.
Cholera outbreaks were reported and controlled in 22 out of 112 districts.
Provided logistical and financial support to the districts with severe cholera outbreaks
namely; Bulambuli, Butaleja, Namayingo, Busia, Mbale, Sironko, Hoima, Nebbi,
Bukedea, Mayuge, Kayunga, Wakiso and Kampala.
Other districts with minor outbreaks were also supported with medical supplies for
cholera control. These districts were: Bududa, Manafwa, Budaka, Kapchorwa,
Zombo, and Arua, Buliisa, Buvuma and Palisa.
Though several gains were registered during the year 2015/16, there were a number of
challenges as well notable among them were:
•
Adverse weather condition namely El Nino rains whose effects were mitigated but
pronounced in the districts of eastern Uganda (Figure 12). As result of these rains, the
country recorded an upsurge of cholera cases in which 2,913 cases with 79 deaths and
Case fatality rate of 2.7% were reported during the FY.
FIGURE 11:ANNUAL CHOLERA CASES IN UGANDA FOR THE PERIOD 2013/14 TO 2015/16
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Annual Health Sector Performance Report for Financial Year 2015/16
Source: MOH, CDD reports
•
•
Poor sanitation and hygiene in affected communities especially the island
communities and on the landing sites.
Inadequate participation of other key sectors in promotion and preventive activities
(Local Governments, Water and Environment, etc) for cholera.
4.1.4 Maternal and Child Health
MCH cluster is composed of five sub programs: Sexual and Reproductive Health (SRH),
Newborn Health, Integrated Child Survival and Development, Immunization and Nutrition.
4.1.4.1
Sexual and Reproductive Health and Rights
The sexual and reproductive health rights interventions are aimed at reducing maternal
mortality, perinatal mortality, and total fertility rate, and improving sexual and reproductive
health of the people which are all key elements for achieving the SDG3.
The health sector and its development partners have continued to prioritize SRH services
during resource allocation as shown in table below. The sector was also able to recruit
additional critical cadres 59 doctors, 174 midwives, 26 Nursing officers midwifery and 148
Enrolled midwives, and 8 anesthetic officers to offer RH services among other cadres that
were recruited. As a consequence 100% of hospitals were able to offer comprehensive
emergency obstetric and neonatal care (EmONC) while all HCIIIs offer basic EmONC.
4.1.5 Newborn and Integrated Child Survival and Development
The sector’s major strategy is to end preventable newborn and the under five deaths by
increasing equitable coverage of high impact evidence based interventions in order to
accelerate the attainment of SDG 3, and to promote appropriate nutrition and proper growth
and development of children and adolescents.
The child survival strategy focuses on the following;Newborn care,infant and young child
feeding, prevention of malaria, management of new childhood illness, expanded program on
immunization, care of HIV exposed children, EMTCT, promotion of safe water access and
use, and safe sanitation.
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Annual Health Sector Performance Report for Financial Year 2015/16
The following outputs were achieved;
•
•
•
•
•
•
Revision of the sharpened plan for RMNCAH.
UNEPI successfully conducted mass polio campaign (SNIDS in October, 2015, February
2016 and NIDS in April 2016) so as to increase the population immunity. Uganda was
certified polio free after conducting mass polio and measles vaccinations.
UNEPI successfully introduced Inactivated Polio Vaccine (IPV) into routine
immunization schedule. UNEPI successfully switched from oral trivalent Oral Polio
Vaccine (tOPV) to bivalent Oral Polio Vaccine (bOPV) as part of meeting the Polio
Eradication and Endgame strategic plan 2013-2018
The child day’s strategy to provide supplementary packages in October and April each
year continued and countrywide the proportion of children covered was 79% and 85% in
October 2015 and April 2016 respectively. Increased community access to child survival
interventions and commodities
Increased capacity of facility-based staff to manage common childhood and newborn
illness through training in IMCI. This improved health worker skills in assessment and
management of common childhood illness and has a component for Emergency triage and
treatment for Hospital and HC IV based health workers.
Integrated Community Case Management (ICCM) expanded to 75 districts.Trained
2,350health workers in newborn resuscitation in order to improve newborn health and
survival bringing the percentage of health workers trained to 39 % within the last two
years.
4.1.6 Tuberculosis and Leprosy control
During the FY 2015/2016 the following tuberculosis control interventions were prioritized,
a) Early diagnosis of TB cases
b) Drug susceptibility testing and systematic screening for drug resistance among the
previously treated patients and high risk groups.
c) Treatment of all TB patients including emphasizing childhood TB management and
integration in Reproductive, Maternal, Child, and Adolescent Health (RMNCAH).
d) Collaborative TB/HIV activities and management of co-morbidities.
The following outputs were achieved;
•
National situation analysis were carried out and childhood TB guidelines and training
manuals were developed.
•
A total of 250 national trainers have been trained and they conducted mentorships on
peadiatric TB in 72 health facilities.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Capacity building of health workers to improve peadiatric TB surveillance was
initiated and together with the ongoing facility mentorships is expected to improve
case detection, contact tracing and treatment success for childhood TB cases.
•
During the year, the sector extended capacity building for private health practitioners
beyond Kampala to Wakiso, Mukono, Jinja and Buikwe districts. Trained over 220
clinicians and 108 laboratory personnel from 150 private health facilities who in turn
detected and enrolled over 1,370 TB patients on treatment.
•
The country has a network of 1,349 peripheral TB laboratories and 112 with PCR TB
machines in 106 Diagnostic and Treatment Units in 78 districts. During the FY, 88%
of peripheral labs participated in External Quality Assurance for smear microscopy
using the blinded rechecking method. The High False Negative rate country wide has
progressively reduced from 22% in 2006 to the current <5% rate. During the FY, only
6% and 4% of Diagnostic and Treatment Units assessed had more than 1% High False
Positive and 1% High False Negative respectively.
Key outcomes
• The overall TB case notification rate for FY 2015/16 was 121/100,000 indicating a
slight decline when compared to 124/100,000 in FY 2014/15. The overall number of
patients started on TB treatment continued to decline (45,268 in FY 14/15 compared
to 43,858 in FY 15/16) probably as a result of improved TB/HIV collaborative
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Annual Health Sector Performance Report for Financial Year 2015/16
activities. Bacterialogically confirmed TB cases declined from 29,288 to 28,326.
Pulmonary TB constituted 91% of TB cases notified while extra-pulmonary TB made
up 9% as opposed to the expected 15-20%. Clinically diagnosed TB continues to be
under-notified with 1 case for every 2.5 Pulmonary Bacteriologically confirmed cases
notified against a national target of 1 clinically diagnosed for every 1 pulmonary
bacteriologically confirmed case.
•
The treatment completion rate for the cohort of 2015 was 89.4% while the treatment
success rate was 79.3% and 51.2% were declared cured. Up to 5.4% of the patients
died while on treatment and 1% had treatment failure. The records of 3.7% of the
patients were incomplete mainly due to transfers out to other health facilities and their
records had not reverted back to the original health facility. In comparison of the
41,509 new patients notified in the year 2014/2015, a total of 74.7% were successfully
treated, 7.4% died, and 0.7% failed while 11.7% were lost to follow up and the
treatment outcomes of 5.5% were not recorded. Furthermore, retreatment patients had
improved outcomes with 71% success rate compared to previous years.
•
During the FY 2015/16, 3,079 (41% of the expected) childhood TB cases were
notified; and 10.1% under five years old had infectious Pulmonary TB. The treatment
success rate for childhood TB (2015 cohort) was 72% falling below the national target
of 85%. Due mainly to a shortage of medicines only about 5.7% (791/13,798) of the
documented under five years old contacts of infectious TB patients were initiated on
Isoniazid Preventive Therapy (IPT).
•
295 MDR-TB patients were enrolled on treatment; and 74% (target 70%) of the
MDR-TB patients enrolled in 2013 were successfully treated. However, low cure rates
and high unfavourable outcomes among drug susceptible TB cases, low DR-TB case
finding (20% against target of 50%), weak surveillance systems, poor flow of
GeneXpert test data, inadequate provision of patient adherence enablers (food and
transport refund), and low contact tracing remain a challenge to management of multi
drug resistant TB in the country.
4.1.7 Leprosy
Leprosy remains an endemic disease in Uganda. During FY, 266 new leprosy cases were
detected, 31% of them with grade 2 disabilities (against 5% target) and 6% of whom were
aged less than 15 years; a 90% MDT treatment completion rate was attained; and contact
surveillance remained the best screening strategy, yielding 13.1 new leprosy cases per 1,000
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Annual Health Sector Performance Report for Financial Year 2015/16
individuals screened. NTLP plans to maintain a national surveillance system, institute
systematic contact surveillance, map out leprosy hot spots and intensify case finding in them;
and sustain partnerships as well as urgently build the capacity of clinicians to suspect and
diagnose leprosy early so as to minimize disability and stop transmission. There is need to
include leprosy among neglected tropical diseases so that it benefits from the support coming
through for the neglected tropical diseases. Uganda has not prioritized leprosy among
neglected tropical diseases so far.
4.1.8 Prevention and Control of STI/HIV/AIDS
The AIDS Control Program of the MoH is mandated to spearhead the implementation of the
Public Health response to the HIV and AIDS epidemic in Uganda. This mandate is part and
parcel of the multi-sectoral HIV and AIDS response that is coordinated by the Uganda AIDS
Commission. In the implementation of the Public Health response, the AIDS Control
Program focuses on interventions that reduce the occurrence of new HIV infections, mitigate
the impact of the epidemic through the provision of prevention, care and treatment; and to
develop capacity for service delivery.
The 2011 AIDS Indicator Survey (AIS) established an HIV prevalence that was estimated at
7.3% in 2011. At the end of 2015, the number of people in the country living with HIV was
estimated at 1,461,756 (Adults 1,366, 107 and pediatric 95, 649). The epidemic
disproportionately affects certain geographical areas, women, urban residents and Key
populations. The main risk factors for HIV transmission in Uganda are multiple concurrent
sexual partnerships, mother-to-child transmission, and non-use of condoms, noncircumcision, and a high median viral load in HIV infected population.
The following outputs were achieved;
•
In partnership with Communication for Health Communities (CHC) project, HIV
messages were developed and disseminated through a variety of channels. The
messages were aired on 45 radio stations, 4 Television stations, and Road-side bill
boards in 112 districts and 200,000 posters and 300,000 leaflets on different themes.
•
The Program also conducted 4 IEC/BCC coordination meetings to review
performance of work plans. The stakeholders included Communication for Health
Communities, Uganda Health Marketing Group (UHMG), Reproductive Health
Uganda (RHU), AIDS Information Centre (AIC), Baylor College, UAC and
Strengthening TB and HIV/AIDS Eastern Uganda Project (STAR E).
•
In support of programs for eMTCT, the MoH in partnership with the office of the First
Lady and other stakeholders launched eMTCT campaigns year in four regions namely
Teso, South Western, Mid-Western, and Central 1& 2 regions. Through these
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Annual Health Sector Performance Report for Financial Year 2015/16
campaigns the uptake of EMTCT services were improved, and political and civil
leadership was mobilised for onward social mobilization for eMTCT services in
respective regions.
•
During 2015, 89 million male and female condoms were procured distributed in the
public and private sector. This represents a decline of 49% compared to the previous
year, and 85% short of projected annual need. This gap was compounded by delayed
deliveries from the Global Fund and National Drug Authority (NDA) post shipment
testing and clearance. Condom for the public sector are distributed to peripheral
outlets by National Medical Stores (NMS), while the Uganda Health Marketing Group
(UHMG) is an alternate distribution mechanism to implementing partners and private
not for profit (PNFPs) facilities. In addition, UHMG, the Program for Accessible
Health, Communication and Education (PACE), and Marie Stopes International (MSI)
Uganda also distributes condoms through social marketing.
•
An assessment of the comprehensive condom programming was conducted with
support from the Global Fund in conjunction with the Makerere University School of
Public Health. The assessment revealed significant achievements in supply and
commodity security; improved availability, access and utilization. Furthermore there
was better public trust in condoms supplied by government and the public sector
brand “Hot Pink” was one of the most preferred.
•
In 2015,HIV testing services were provided to a total of 11,742,311 individuals
including10,292,539 adults and 1,449,772 children. The target of testing 9,523,170
during the year was surpassed. The sero-positivity rate among adults and children was
3.0% which continued the trend observed from previous years. Based on the number
of people in chronic HIV care, it is now estimated that about 945,752/1,461,756
(64.7%) of People Living with HIV (PLHIV) by the end of 2015 know their status
(the first 90 of the 90-90-90 targets, of whom 834,931(54.1%) were on ART by end of
2015.
•
The Program revised the HIV Counseling and Testing Policy.
•
During 2015, a total of 556,546 young men were circumcised in facilities across the
country bringing the total number of circumcised males since 2012 to 2,604,823 or
62.0% of the initial target of 4.2 million young men to be circumcised by 2015. These
services were provided in 851 facilities (10 referral facilities, 103 hospitals, 150 HC
IVs, 273 HC IIIs, 212 HC IIs, 84 clinics, 18 and specialized clinics.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
By the end of 2015, all districts in the country were implementing Option B+.
PMTCT services were offered in 3,637 health facilities of all levels by July 2015.
These were comprised of 16 referral hospitals, 133 general hospitals, 191 HC IVs,
1,186 HC IIIs, and 2,327 HC IIs.
•
Out of 1,654,222 women that attended the first antenatal care visit during 2015,
1,522,367 (92%) had an HIV test, of whom 45,206 (3.0%) tested HIV positive, and
60,190 already knew and had their documented HIV sero-status before the current
pregnancy. In addition, 236,003 women were tested in other settings including the
post-natal clinic (PNC) (117,476), Family Planning / maternity (118,527) etc.
Therefore, the number of women who were counselled and tested and received test
results for PMTCT were 1,758,370 and overall, women with known HIV sero-status
in ANC, labour and postnatal were 1,818,560.
•
Out of the 1,818,560 who knew their sero-status, 126,961 were HIV sero-positive, i.e.
38,749 who tested HIV-positive in ANC, 60,190 who had a documented HIV-positive
sero-status prior to first ANC visit, 2,672 who tested HIV positive in maternity, 2,018
who tested HIV positive in PNC, and 3,785 who tested positive in ANC upon
retesting. About 97% of the HIV-positive women received ARVs for PMTCT namely:
70,207 who were on HAART before first ANC visit, and 47,680 who started on
Option B+ during antenatal, labour and delivery.
•
The Country is at the verge of virtual elimination of mother-to-child transmission. Our
data indicate that the number of children born with HIV infection in Uganda declined
by 86% between 2011 and 2015. At the end of 2015, only 3,487 new pediatric HIV
infections occurred in the Country.
•
During the reporting period, the AIDS Control Program continued to expand the Care
and Treatment portfolio. There were 1,461,756 HIV-infected adults in the country at
the end of 2015, of whom 1,196,547 were eligible and in need of ART according to
the 2013 WHO national treatment guidelines. The Country is in advanced stages of
adapting the 2016 WHO Prevention and Treatment guidelines, and when their
implementation begins in October 2016 all HIV infected individuals will be eligible
for treatment based on a policy known as "Test and Treat".
•
By end of 2015, there were 834, 931 individuals including 774,902 adults and 60,029
children on ART in 1,664 facilities across the country, having grown from 750,896
(694,627 adults and 56,269children) at the end of 2014. A total of 160,484 new adult
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Annual Health Sector Performance Report for Financial Year 2015/16
clients were enrolled during the year. By June 2016, the number of individuals on
ART had further increased to 898,197 (836,947 adults and 61,260 children). The
number of ART service delivery outlets increased modestly from 1,658 to 1,664
during the year through accreditation of ART services. The pace of accreditation of
new facilities slowed down due to the need to be more cost-efficient, taking into
account current patient loads in each facility.
•
Viral load monitoring of ART clients was rolled out further during the year. About
970 facilities sent samples for viral load tests at Central Public Health Laboratory
(CPHL) through the sample transport system. A total of 270,556 samples were tested.
Overall, 89.8% of samples had viral suppression; the detailed data can be found in the
laboratory section.
•
In the reporting period, the MoH, together with partners have been planning for a
large scale Uganda Population based HIV Impact Assessment Survey (UPHIA). The
Survey is being implemented with the support from ICAP at Columbia University as
well as the U.S. Centre for Disease Control and Prevention (CDC). The other partners
include Uganda Virus Research Institute (UVRI), Uganda AIDS Commission, Uganda
Bureau of Statistics, World Health Organization, UNAIDS, Westat and ICF Macro.
The Survey Field Work has currently commenced after being flagged off by the
Honorable Minister of Health and the US Ambassador to Uganda on the 23rdAugust
2016.
4.1.9 Malaria Control and Prevention
The Malaria Control Program spearheads malaria control in the country and in the pursuit of
this endeavor, it has conducted activities under Case Management and Integrated vector
management. These have been supported by Monitoring, Evaluation, Epidemic Response and
Surveillance and BCC activities.A number of these activities have been implemented as
presented below;
•
Rapid diagnostic kits for testing malaria and anti-malarial medicines have been
procured.
•
Overall from the HMIS, over the current reporting period, there were 408 malaria
cases per 1000 persons, 18 deaths per 100,000 persons and 93% of women received 2
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Annual Health Sector Performance Report for Financial Year 2015/16
IPT doses in this period. Despite the interventions, these indicators didn’t change
much due to largely the improved reporting and epidemic in Northern Uganda.
•
A survey to assess factors contributing to over consumption of artemisinin-based
combination therapy (ACTs) against low numbers of malaria cases was conducted.
•
In collaboration with PMI, The Global Fund, TASO and other partners, routine LLIN
distribution was done throughantenatal clinics and EPI. Besides, the country has
procured LLINs for mass distribution. A total of 24 million nets have been mobilized
and distribution is expected to commence in the last quarter of 2016.
•
During this FY, NMCP together with PMI and DFID continued with indoor residual
spraying in a total of fourteen (14) Districts. Out of these, nine districts are in the
eastern part of the country. These include; Namutumba, Tororo, Bugiri, Mayuge,
Serere, Pallisa, Budaka, Butaleja, Kaberamaido and Kibuku. The rest are in the north
and these include; Amolator, Dokolo, Lira, Otuke and Alebtong. The Total Malaria
cases and the Confirmed OPD Malaria cases in the 14 IRS districts in Eastern Uganda
decreased from the last FY as shown below;
FIGURE 12: TOTAL OPD AND CONFIRMED MALARIA CASES IN THE 14 IRS DISTRICTS
2000000
1500000
1000000
Total OPD Malaria
Cases
500000
Confirmed Malaria
Cases
0
2014/15
•
2015/16
In the bid to continuously ensure that staff at service delivery points have the requisite
skills for diagnosis and management of malariaand that they are updated on the
malaria control policies, integrated management of malaria (IMM) training has been
conducted in 50 districts and a total of 1,250 persons trained.
•
Quarterly supervision was done by the central team in 60 districts across the country,
routine data quality assessments were conducted across the country, integrated
management of malaria was done in 50 districts across the country.
•
The malaria communication strategy was finalized and launch.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Data quality audits were conducted in a number of districts and with focus on the high
level and high volume health facilities. More facilities will be covered in the next FY.
•
With support from DFID, UNICEF and WHO, under its capacity building plan,
NMCP received three technical staff.
•
Mapping of breeding sites has been done and currently Baseline entomological studies
are undergoing in two sub counties in Nakasongola.
•
The program renewed efforts to strengthen the Test, Treat and Track policy. Figure 14
shows the distribution of percentage malaria lab confirmed cases across the country.
•
The program mobilized resources from various partners, most especially Global Fund,
UNICEF, WHO, DFID, AMFM, and PMI. Funds for critical activities such as Malaria
commodities (ACT’s and RDTs), mass (countrywide) LLIN distribution, IIRS in the
10 Northern Epidemic districts have been secured. The Global fund awarded the
country a costed-extension of the malaria grant under which numerous activities are
funded.
FIGURE 13: PERCENTAGE OF MALARIA LABORATORY CONFIRMEDCASES FY 2015/16
4.1.10 Mental Health and Control of Substance Abuse
Key outputs during FY 2015/16
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Following the enactmentof thetobacco control Act 2015, the program initiated the
development of regulations for the different sections of the Act for effective
enforcement and implementation.
•
During the FY the program begun the process of finalizing the Alcohol Control
Policy.
•
Commemorated the National Mental Health day, the World No Tobacco Day and
International day on drug abuse and illicit trafficking. During these days the program
has raised public awareness through radio and television talk shows on tobacco
control drug abuse and Mental illnesses.
•
Provided support supervision to Mbale, Gulu, Lira, Jinja, Fort Portal, Kabale and
Soroti Regional Referral Mental Health units. From all these visits it was found that
the number of patients with Mental, Neurological and Substance use disorders has
substantially increased and all the units were challenged by stock out of all relevant
medicines.
•
75 health workers were trained in Inter Personal Psycho Therapy for Groups and also
with support from World Vision International begun the training of general Health
workers in Mental Health using the WHO-MHGAP interventional guide.
•
The program participated in research on integration of mental health into PHC by
various researchers and in management of depression among people with HIV in
Kitgum, Pader and Gulu in collaboration with Makerere University.
•
Disseminated the findings from the global adult tobacco survey conducted in 2013 at
regional level with an aim of stimulating districts to made plans for tobacco control.
4.1.11 Community Oral Health
Outputs for Oral Health during the FY 2015/2016 were as follows;
•
Support supervision was done in 12 dental units in RRHs.
•
Equipped 13 dental units with an assortment of dental materials for school oral health
program, two hospitals equipped with X- ray machines, 10 schools per 1 RRH
screened for oral disease,
•
Marked World Oral Health Day with dental camps in KCCA clinics, RRHs and at
Mulago dental school.
•
Developed guidelines on SOPs in Dental units, Hepatitis B, Injection Safety and
Palliative care,
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Capacity building for 15dentistsfrom national and RRHs, 20 Technicians, and 60
Public Health officers.
4.1.12 Central Public Health Laboratories
In the FY 2015/16 with support from CDC, the CPHL building in Butabika was completed
and commissioned at a cost of 29bn Uganda Shillings.The laboratory was set up to carry out
hepatitis B and HIV viral load tests.
4.1.13 Epidemiological Disease Surveillance (ESD)
The following activities were achieved during the FY 2015/16;
•
•
•
•
•
•
•
•
•
•
•
•
Capacity building for integrated diseases surveillance and response was conducted in
97 districts
2 districts for DTRACBEP supported Surveillance training.
26 weekly surveillance bulletins were published
3 monthly IDSR/IHR meetings were held
2 standard operating procedures for VHTs were developed
13 health workers from 8 eight regions were trained on the clinical management of
Viral Haemorrhagic Fevers (VHFs)
Typhoid disease outbreak was controlled in Kampala and Wakiso districts.
Investigations were carriedout on Podoconiasis disease outbreak in Kamwenge
district.
Funds were transferred to the districts of Agago, Amuru, Apac, Gulu, Kitgum, Kole,
Lamwo, Nwoya and Pader to support their respective district response plans to
malaria epidemic in Northern Uganda.
Technical support supervision was carriedout and conducted.
A stakeholders meeting with the district leaders on malaria epidemic in the districts of
Agago, Amuru, Apac, Gulu, Kitgum, Kole, Lamwo, Nwoya, Oyam and Pader in
northern Uganda was held to forge a way forward for the epidemic.
Investigated the suspected Viral Heamorrhagic Fever, (VHF)/yellow fever in Napak
district, strange disease (linked to Viral Heamorrhagic Fever), Rubella/Chicken pox
outbreak in Wakiso district, Measles in the districts of Kiruhura, Kamwenge,
Kyegegwa, Poisoning in Buikwe, Iganga and Tororo and cholera outbreaks in Hoima,
Buliisa, Mbale,Wakiso, Kampala and Masindi districts.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.1.14 Clinical services
• Conducted technical support supervision in the 13 RRHs as well as the following
general Hospitals; Tororo, St Anthony,St Francis Buluba, Maracha, Kuluva, Masafu,
Mityana and Kawolo Hospitals.
• Support supervision was also provided to the following HC IVs -Mukuju, Busia,
Nagongera, Mulanda, Olii, Mukono Kilembe, Kagando, Rwesande, St Paul,
Nyamirami and Kotomor HC II.
• Five mentoring and coaching sessions were conducted.
• The world Hepatitis day was celebrated in Ngora.
• Developed the Public Health Protocols which were launched in Sheema by H.E the
President of the Republic of Uganda.
4.1.15 Palliative Care
Palliative Care is an approach that improves the quality of life of patients and their families
facing the problems associated with life threatening illness, through the prevention and relief
of suffering by means of early identification and impeccable assessment and treatment of pain
and other problems, physical, psychosocial and spiritual.
Main achievements
•
•
•
•
•
•
•
Palliative Care policy was presented to Top management and endorsed for
presentation to Cabinet.
The communication strategy was developed up and is ready for presentation to the
TWG.
Consultative meetings were held on the Drug and Narcotic act with stakeholders.
Two stakeholders/multi-sectoral on UNGASS was held.
4 quarterly stakeholders meeting on Morphine were held.
2 Hospitals were trained on Palliative Friendly Initiative (Mbale Hospital & Gulu
Hospital).
Improved reconstitution and distribution of oral morphine.
4.1.16 Nursing Department
In the FY under review the following were achieved;
•
•
•
•
Three technical Support Supervision visits conducted in Northern and central region
Two Nurses, Midwives leaders Assistant District Health Officers (ADHO) meetings
were held with a total of 45 Nurses, Midwives and ADHOs
Q1& Q2 Students interviewed and Nurses and Midwives students supervised in their
final examinations.
Participated in the development of EAC Nurses and Midwives curriculum.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.1.17 Uganda National Health Research Organization
The following were the key outputs from UNHRO during the FY 2015/16;
•
•
•
•
•
•
•
•
7th (ANREC) Annual Conference on Research was held
A strategic Plan for 2016-2021was finalized and approved
Research findings on Eflornithine, Nifurtimex, and melasporol, Suramin were
reviewed
Knowledge translation workshop held to disseminate and review indigenous health
adaptation to climate change.
The Annual Traditional conference (ANTRAMEC) was held in August 2015 under
the Theme “Traditional medicine to generate partnership between scientists,
practitioners, and entrepreneurs”
Reviewed the establishment of the EAC Health Research Commission in Kigali, Sept
2015
UNHRO hosted a national stake holders conference on EAHRC in March 2016
Jointly launched the East African Health Research Commission in Nairobi, Mar 2016.
4.1.18 Uganda Blood Transfusion Services (UBTS)
The UBTS registered the following out puts;
• Continued supervision and coordination of operations of the 7 RBBs including
maintenance/ replacement of transport logistics and laboratory equipments.
• 232,331 cumulative units of blood were collected, Repeat blood donors were
maintained at 60% and all collected blood units were tested for TTIs and the safe
blood units were issued to all transfusing heath care facilities in the country.
• The discard rate for blood units collected was reduced to 5.3% against a target of 8%.
• Conducted quarterly audits of the seven Regional Blood Banks and blood collection
centres
4.1.19 Uganda Aids Commission
Uganda Aids Commission achieved the following outputs;
•
•
•
It convened 4 National Policy Coordination meetings about the Modes of transmission
study to guide planning and HIV response
Finalized the MARPS priority action plan 2015-2017 and the MARPS programming
and accountability framework
Disseminated the National Strategic Plan and all accompanying documents in 18
Local Governments
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Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
•
•
Joint Aids Review was convened and an Aide memoire was signed with 12
undertakings.
47 districts and13 Municipalities were supported in planning, resource mobilization
and sustaining the recently rejuvenated HIV and AIDS Coordination Structures.
They mapped partners operating in Uganda using the E-data base.
An electronic NADIC portal has been established hosting, the HIV Research
Database, NADIC Catalogue, Stakeholder Emapping Database and M&E Database
Video conferencing Equipment and ACs, Computers, all in one Printers procured
installed.
Commemorated World AIDS day, Philly Lutaaya and Candle light.
4.1.20 Uganda Catholic Medical Bureau (UCMB) performance
The UCMB is a health department of the Catholic Church in Uganda and plays the principal
roles of advocacy and lobby, coordination, mentorship & supervision and regulation of
catholic health services in Uganda—which entail a broad range of initiatives and activities
aimed at building and strengthening national health systems within a framework of
complementarily. The Bureau coordinates, represents and supports 294 registered health
facilities and 13 health training institutions. The health facilities comprise of 32 hospitals, 6
HC level IV, 178 HCs at level III and 77 HCs at level II.
4.1.20.1 Health Financing in UCMB Network in the FY 2015/2016
The financial contribution from the UCMB facilities amounted to 172.9 billion shillings in
the FY 2015/2016 an increase by 16% from the FY 2014/15 of network’s total income. The
increase was mainly due to increase in support from external aid and user fees collections,
which increased by 26% and 14% respectively in the period. The Government subsidy, which
was in form of PHC Conditional Grant to UCMB health facilities, and health training
institutions accounted for 9% of the budget in the FY 2015/2016, while user fees accounted
for 49% and donations accounted for 42% of the budget.
The introduction of the Straight Through Processing (STP) of PHC Grants to UCMB health
facilities improved on timeliness of receipt of the Grant and therefore the implementation of
the primary health care services in the previous two financial years.
Figure 15 below shows the proportionate contribution of the 3 major sources of income of
UCMB health facilities over the last 5-year period. Over the period within the UCMB
network health facilities, the proportion of External Aid to total income has increased while
user fees have remained fairly stable and the proportion of government subsidies reducing.
FIGURE 14: TRENDS IN INCOME FOR RECURRENT COST IN UCMB NETWORK IN THE LAST 5 YEARS
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Annual Health Sector Performance Report for Financial Year 2015/16
Source: Bureau databases
4.1.20.2 UCMB Contribution to the HSDP Outputs
The output from the UCMB hospitals and Lower Levels depict the performance on the most
important health indicators used for monitoring the HSDP performance for the FY
2015/2016. The cumulative values for the 3 of the 4 main services offered in the Hospitals
and LLU registered positive gains.
• New and Re-attendances decreased to 2,911,231 in FY 2015/16 from 3,212,863 in FY
2014/15 a decrease by 9.4% in the period.
• The total number of deliveries increased to 99,818 in FY 2015/16 up from 94,356 (2014/15)
an increase by 6% in the period under review.Significant maternity increases were noted in
lower level units, which reported a 17% increase in deliveries in the period while hospitals,
registered a slight increase of 3%.
• The number of immunizations increased to 2,147,856 in FY 2015/16 from 2,105,887 in FY
2014/15 an increase by 2% in the last one year.The increase was significant in UCMB
hospitals which registered an increase by 18% in the period while lower level health
facilities increase was 4%.
• Total number of admissions increased to 494,096 in FY 2015/16 from 460,006 FY 2014/15
an increase by 7% in the period under review.
• UCMB facilities counseled, tested and gave HIV results (HCT services) to a total of
677,553 individuals—an increase by 29% from FY 2014/15, 157,944 pregnant and lactating
women attending antenatal, postnatal and maternity services and 4,756 couples were also
counseled, tested and received results for HIV—an increase by 26.6% from the last FY.
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Annual Health Sector Performance Report for Financial Year 2015/16
UCMB contributed 9% of the entire country HIV counseling and testing outputs during the
year.
• A total of 91,687 individuals (8% of whom were children below 15 years) were provided
with comprehensive HIV services through the UCMB network of hospitals and Lower
Level Units across the country. Of these HIV patients, 85,017 (92% of total in HIV care)
were given antiretroviral therapy (ART). UCMB facilities contribute 10% of the total
number of individuals on ART in the country.
• In its efforts to enhance TB/HIV co-management, UCMB got an award through a WHO
funding mechanism to support the national TB program to scale up case finding and
treatment for TB using the GeneXpert diagnostic technology. Currently 2- 2 modular
GeneXpert machines are running these services in the districts of Tororo, Busia and Mpigi,
not only serving the host hospitals of Nkozi and St Anthony’s, but the entire districts. Over
the year, more than 1,482 patients were identified and put on treatment in addition to
identifying and referring 5 MDR cases to MoH managed MDR treatment center. The
biggest challenge to UCMB during the year under review was the inconsistent supply of TB
medicines and INH prophylaxis.
4.1.20.3 Status of Human Resource for Health in UCMB 2015/2016
The total workforce in the UCMB networks as at June 30th 2016 was 8,870 as compared to
8,527 as at June 30th 2015. This was a rise of about 4% over one year as shown in the table
below.
TABLE 43: SHOWING TOTAL NUMBER STAFF IN UCMB HEALTH FACILITIES FROM 2011- 2016
Years
2010/11
2011/12
2012/13
2013/14
2014/15
2015/16
HOSPITALS
5,068
5,355
5,435
5,502
5,618
5716
LLUs
2,522
2,688
2,790
2,920
3154
Total
7,590
8,043
8,225
8,422
2,909
8,527
8,870
Data Source: UCMB facility annual staffing report
Out of the 8,870 total staffing, the health facilities employed 61% of the qualified clinical
workforces, 5% were not clinically qualified and 34% were the non-clinical staff which are
administrative staff, and support.
4.1.20.4 Health Worker Support to the UCMB Facilities
The GoU through the MoH and DLGs supported UCMB health facilities with 8% of the total
clinical staff in 2015/16; this is a slight decline from the 9% support of last FY. Four hundred
and fourteen (414) clinical staffs were seconded to UCMB hospitals and lower level units in
FY 2015/16 by the GoU. However, Kilembe Mines hospital alone has 121 HRH seconded,
which accounts for 29.2% of the total seconded staffs to UCMB health facilities. Other
significant secondment of HRH ranging between 20 and 30 staff are also observed in Buikwe,
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Annual Health Sector Performance Report for Financial Year 2015/16
Lacor St Mary's, Maracha, and Lubaga Hospitals mainly also supporting HSD activities. The
bureau greatly appreciates this support.
The UCMB HRH partnership support by USAID/Strengthening Decentralization for
Sustainability (SDS), Mildmay Uganda, and Walter Reed, recruited and deployed to selected
UCMB health facilities 118 health workers in FY 2015/16, totaling to 355 supported qualified
clinical staffing in 89 UCMB health facilities in 92 districts of Uganda. The key cadres
supported include, Clinical Officer, Midwife, Nurse, Lab Technician, Medical Officer
Anaesthetic Assistant, Anesthetic Officer, Lab. Technologist, Laboratory Assistant, Pharmacy
Assistant, and Pharmacy Technician.
One of the HRH challenges in the high attrition rate.During the FY 2015/2016, most of the
departures were nurses at 34%, followed by midwives at 25%, 20% for administration and
support staff and to a lesser extent the medical officers and paramedical staff.
4.1.20.5 UCMB Health Training Institutions Contribution to Health Work Force
UCMB coordinates 13 Health Training Institutions (HTIs), with the objective to train an
optimal range of health care personnel of high moral and professional standards for PNFP
health care facilities and national health care institutions. The contribution of UCMB HTIs to
the National health work force in both Certificates and Diploma programs over the range of 5
years is shown in the table below.
TABLE 44: SHOWING ANNUAL OUTPUTS OF UCMB HEALTH TRAINING SCHOOLS FOR 5 YEARS
Programs
2010/11
2011/12
2012/13
2013/14
2014/15
Cumulative
No.of
Graduates
% share
by
Program
Certificate Nursing
80
148
176
230
349
983
24.4%
Certificate Midwife
97
137
250
292
401
1,177
29.2%
Certificate Comprehensive Nursing
255
145
131
33
39
603
15%
Certificate Clinical Laboratory
44
85
109
48
91
377
9.4%
Diploma Nursing
46
29
37
43
56
211
5.2%
Diploma Midwifery
39
0
0
0
0
39
0.97%
Diploma Nursing-Extension
49
39
67
55
50
260
6.45%
Diploma Midwifery-Extension
54
62
35
49
39
239
5.93%
Diploma Medical Clinical Laboratory
28
22
9
27
39
125
3.1%
E-Learning (EM)
Total
667
814
14
791
0
1,064
14
4,028
0.35%
692
In the last 5 FYs there has been a significant progressive reduction in the output by UCMB
HTIs of Certificate in Comprehensive Nursing cadres. This has been mainly due to increased
attention and focus to Midwifery cadres consistent with national policy on Maternal & Child
Health. The certificate midwifery outputs by UCMB Training Institutions has increased from
97 Enrolled midwives annually to 401 Enrolled midwives in FY 2015/16. This significant
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Annual Health Sector Performance Report for Financial Year 2015/16
increase has been largely attributed to GoU support in partnership with agencies including
mainly Baylor-Uganda, and UNFPA.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.1.21 Uganda Protestant Medical Bureau (UPMB) Performance FY 2015/2016
The UPMB is a national umbrella organization and Technical Organization registered as a
charitable, faith-based Non-Governmental Organization (NGO) founded in 1957 by the
Anglican Church of Uganda and Seventh Day Adventist Church Uganda Union and serves as
the technical arm of the Churches.UPMB has a Network of 290 health facilities with the
majority (80%) of the health facilities located in rural and remote areas and include 18
hospitals with 15 Health Training Institutions; 10 HC IVs; and 262 LLH facilities.
4.1.21.1 Health Financing in UPMB Facilities
During the FY 2015/16, UPMB facilities achieved a total income of Uganda Shillings
50,249,744,345 with Hospitals and HC IV’s contributing 73% of the annual income and
Lower level units contributing 27% of the annual income.
Some of the key interventions to improve health financing were community Health Insurance
initiatives led by Kisiizi, Bwindi Community and Kiwoko Hospitals which posted significant
enrolment of clients in their Community Health Insurance schemes. Trends have shown that
these facilities are reaching break even (sustainable) points. With this experience UPMB has
started scaling up Community Health Insurance Schemes across its entire Network facilities
in a phased manner.UPMB will therefore seek to engage with key partners and Government
in this endeavor.
FIGURE 15: HOSPITALS AND HC IVS % INCOME BY SOURCE
FIGURE 16: LOWER LEVEL UNITS INCOME BY CLASS
Others
14%
Training
fees
19%
Donations
32%
User fee
38%
Credit
line
3%
Pull
System
(Credit
Line)
PHC
8%
External
Aid
2%
PHC
16%
User
Fees
43%
Hospitals and HC IVs raised UGX 36,434,567,736 in annual income during the FY with user
fees, Donations and Training fees providing the highest source of revenue for the facilities.
PHC funds contribute 8% of the total income for hospitals.
Lower Level Units (HC IIs & HCIIIs) obtained an annual income of 13,815,176,609 Uganda
Shillings during the FY. User fees, In-kind Medical suppliesand PHC funds being the highest
source of resources for lower level units.
4.1.21.2 Human Resources for Health in UPMB Network
The total work force under the UPMB network as at 30thJune 2016 was 5,315 health workers
compared 5,187 health workers from the previous year indicating a 2.5% increment in
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Annual Health Sector Performance Report for Financial Year 2015/16
staffing levels. The achievement has been attributed to UPMB’s effort to support
implementation of the integrated Human Resource Information System (iHRIS) across the
network that has enhanced tracking of the health work force.
Partnerships with the GoU through the District LG and HDPs like USAID, CDC and BTC
through implementing agencies such as the SDS Program and Mildmay to name but a few,
UPMB facilities have been supported to recruit and second key staff to its facilities through
provision of salary support and equipment.
Although UPMB reported an increase in staff productivity and staffing levels, staff turnover
across the facilities remained a major concern. The network is affected by frequent staff
turnovers for especially critical positions like medical officers, clinical officers and nurses
which has affected service delivery.As the government embarks on recruitment of staff in the
public sector, there is need to address the HRH challenges across the entire health sector
including the PNFP health facilities.
4.1.21.3 Health Service Delivery in UPMB facilities
•
•
•
•
•
•
•
Bed capacity: UPMB Registered 4% increase in bed capacity from 3,624 during FY
2014/15 to 3,770 during FY2015/16
OPD Attendances increased by 108%. This has been attributed to Interventions like
Community Health Insurance, Improved staffing rates, new facility registrations and
technical support to improve in reporting using HMIS tools and DHIS II
In-patient admissions increased by 60.2% during the FY. The increase in staffing
rates, improved documentation and reporting.
First ANC attendances and deliveries at the facilities also improved by 40% and 78%
respectively. Capacity for facilities to provide ANC and maternal services has greatly
improved as more human resources for health are being recruited. The role of PMTCT
interventions have also been critical in improving MCH services at the facilities.
Immunizations increased by 360%.
There was a slight drop in utilization of family planning by 2.6% this financial year.
The drop is attributed to a number of Family planning projects at UPMB that came to
an end during the FY.
UPMB is working with a number of partners to scale up access to HIV care, treatment
and support services. By the close of the FY, the network was supporting 5.4% of the
People Living with HIV/AIDS (PLHIV) in Uganda with HIV care, treatment and
support services. A total 78 facilities were providing ART services and 102 providing
PMTCT services.
o Number of Individuals counselled, tested and received their results - 431,466
o %of Individuals who tested HIV Positive and linked to Care - 10,580
o Number of Pregnant women who received HTC at ANC - 60,193
o Number of Pregnant women initiated onto ART for PMTCT - 1,249
o Number of Individuals newly enrolled in HIV Care - 8,957
o Number of Individuals newly enrolled on ART - 7,145
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o Number of Individuals Active on ART - 46,995
4.1.22 Uganda Muslim Medical Bureau Performance 2015/16 FY
Uganda Muslim Medical Bureau (UMMB) is a national organization established by the
Uganda Muslim Supreme Council (UMSC) in 1999 to coordinate activities of Muslim nonprofit health facilities. The Bureau is the main link between these facilities, the government
and other stakeholders. By the end of the FY 2015/16 the membership of the bureau consisted
of 52 health facilities, one Nurses and Midwifery training institution and one Medical
Laboratory training institution. The bureau is in the process of establishing another health
training institution in Yumbe district.
• Increased technical support supervision of the member facilities especially in FYs
2013-14, 2014/15, and 2015/16 which saw a tremendous increase in reporting rates to
62%, 78% and 90% respectively in LLUs.
• The UMMB network continued providing Maternity services in year 2015/16, and
there has been a progressive increase since 2013/14 FY with 15.5% increase in
2014/15 and 19.5% increase in 2015/16. This is attributed to the availability of full
time qualified midwives at the units through support from HRH project of SDS and
Mildmay Uganda in the East, Central and Western regions. Training of midwives and
support supervision by UMMB secretariat has built the capacity of these service
providers and improved the quality of maternity departments in the network. HIV +
exposed infant rate reduced from 3.6% in 2014/15 to 3.4% in 2015/16. All this is
attributable to improvement in management of patients especially the HIV+ mothers
by the qualified midwives.
• The prevalence rate in ANC in hospitals was at 1.8%. Hospitals initiated 100% of
their HIV+ mothers permanently into HIV/AIDs chronic management clinics for life.
Post-natal cases increased to 1,957 in hospitals in 2015 compared to 1,533 post-natal
mothers for hospitals in 2014/15. The prevalence rate in ANC in LLUs was at 2.4%.
LLU initiated 100%, of the HIV+ mothers permanently into HIV/AIDs chronic
management clinics for life. Total immunization increased to 154,124 in 2015/16
compared to 124,679 in 2014/15 representing 2.5% increase. 14.8% of 154,124
children were fully immunized by June 2016. HCIIIs had the highest number of
children reached for immunization contributing 43% of the total Immunization across
the network. The UMMB network facilities continued providing reproductive health
services to all age categories in terms of FP.
• OPD utilization in hospitals increased by 99.7%. This is attributed to the improvement
in reporting, data management and training in HMIS for the hospitals.
Facility level Total FP users Total immunization Total ANC Attendance HCT services
Hospitals
1,454
48,763
9,525
18,612
HC IIIs
8,545
66,306
8,869
38,395
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HC IIs
TOTAL
•
•
Service
8,682
18,681
39,055
154,124
3,802
22,196
Both Hospitals and LLUs continued to provide inpatient services in the communities.
The performance is shown in the table below for inpatients. In-patient episodes had an
increasing trend in the year under review. The total number of clients during the year
increased by 40.4% across all network facility. The average length of stay (ALOS)
approximately measured at 3 days. The Bed occupancy Rate (BOR) was established at
25.2% at all levels.
On the already 12 ART sites that were in existence for 2014/15, Mityana UMSC HC
III was accredited as a full ART site in 2015/16, bringing the total to 13 ART sites.
2014/15
2015/16
Children
Male (15 yrs. Female
Children
Male (15 yrs. Female
under 15yrs
&above)
(above 15yrs) under 15yrs
&above)
(above 15yrs)
49
1,037
1,800
65
1,077
1,925
Pre
ART
ART
96
864
1,845
Total
145
1,901
3,645
Overall number of clients in chronic care and management 6240
to date (June 2016)
Source: UMMB Health Facilities’ HMIS106a 2015-16.
•
•
•
•
11,315
68,322
124
189
983
2,060
2,066
3,991
The 13 ART sites continued seeing and enrolling new clients on ART. A comprehensive
and holistic package is given including psycho-social support, family planning, treatment,
adherence counseling and support, CD4 monitoring, TB assessment and co-infection
management, HBC and follow up of bedridden clients, cohort analysis, STIs screening
and treatment, opportunistic infection management and nutrition supplements. As seen
above there was an increase in the number of clients reached in Pre-ART from 2,805
clients in 2014/15 to 3,179 clients in 2015/16 across all network Art sites representing a
13.3% increase. A total of 220 children below 15yrs were active on ART treatment by
June 2016.
In order to ensure that the member health facilities maintain the minimum required
qualified health workers, the bureau recruited and managed payroll of 56 health workers
in 17 health facilities. This support was from SDS and Mildmay Uganda. UMMB also
recruited on request 10 qualified health workers for deployment in other health facilities.
Two HC IIIs, namely Lugazi Muslim HC and Crescent Medical Centre, have started to
put up additional structures in order to upgrade to HC IV level. 8 other facilities have
renovated their buildings.
The bureau trained eight medicines monitoring supervisors in implementation of SPARS.
The supervisors were provided with motorcycles and laptops courtesy of USAID/Uganda
Health Supply Chain.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.2 Annex Two: Integrated Health Sector Support Systems
During HSDP 2015/16 –2019/20 the Ministry will focus on health systems strengthening
through its core functions of health investments, information management, supervision and
monitoring to ensure there is improved access to health services. .
4.2.1 Policy, Planning and Support Services
Under this function, the MoH is responsible for general strategic planning and policy
framework, resource mobilization, coordination of projects and development assistance,
Information management,Human Resource Management and Development, Public Private
Partnerships, international engagements among others.
During the FY 2015/16 the following outputs were delivered;
•
Annual work plan for MoH 2016/17
•
Annual Health Sector Performance Report 2014/15
•
Budget framework paper FY 2016/17,
•
Ministerial Policy Statement 2016/17
•
Health Financing Strategy 2015/16 – 2024/25
•
National framework for the RBF and its implementation manual
•
Health Planning guidelines for planning at LGs
•
PHC grant utilization guidelines.
•
Finalized the Design for the Health sector Basket Fund framework
•
Quarterly technical support supervision and monitoring to LGs and hospitals
•
Conducted the Private Sector Assessment.A draft PSA report is available and is
undergoing validation by a consultant before submission for review by the sector
governance organs
•
Developed a 5-year PPPH strategy with support from the Belgian Technical Agency
in Uganda.
•
Enrolled facilities to the Uganda Reproductive Health Voucher Scheme, supported by
the World Bank through a SIDA Grant of US $ 12 million.
•
Policies and guidelines finalized included; Palliative Care Policy, Rehabilitative and
Health Care Policy, Medical Internship Guidelines and Uganda Immunization Policy
•
Bills Submitted to Cabinet include; Uganda Human Organ Transplant and Tissue Bill
and the Uganda Health Service Management Institute Bill
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Bills passed into Acts by Parliament were; Uganda Allied Health professionals
Regulation, Uganda Cancer Institute Bill, 2015, Uganda Heart Institute Bill, 2015 and
Uganda Immunisation Act, 2016.
•
A number of Memoranda of Understanding (MoUs) were developed and signed.
•
The sector organized a Joint Review mission in October 2015 and agreed on several
undertaking in the Aide memoire progress on implementations is attached in the
annex. Subsequently the sector organized the Annual DHO’s meeting to review the
district health services as to make resolutions which will input in the JRM 2015/2016.
•
As part of efforts to enhance global health partnerships, the sector participated in the
following engagements; WHO World Health Assembly,East Central and South Africa
meetings, EAC TWG on health and climate change and African Union.
4.2.2 Human Resource Management and Development
In human resource management and development, the following were achieved;
•
Sponsored 59 continuing students in various health training institutions
•
Held 9 HRH stakeholders policy and planning meetings {(2) IST National meeting, 2
accreditation Joint Committee meeting, 2 HRHTWG meeting at MoH, 2 Training
Committee Meeting at MoH, 1 HRDD staff joint meeting (at Mbale HMDC)}.
•
Conducted only 2 Hosp. Boards Mgt training at Jinja and Gulu RRH and 43 HUMCs
in Mayuge district with Intrahealth-Uganda Partner support
•
127 Health Managers from Regional Performance Monitoring Teams, DHTs, General
Hospitals and HSDs trained in Governance, Leadership and Management.
•
71 Clinical Instructors from in Health Training Institutions were trained to improve on
their competencies in teaching at the practicum sites and Classrooms.
•
The Principles and the Cabinet Memo for transforming HMDC Mbale into a semi
autonomous institution are being developed.
•
Support supervision to 30 health institutions,
•
Sponsored training of 41 post-basic and post-graduates
4.2.3 Finance and Administration
The political leadership supervised the following outputs in Various Districts,
•
Launchedof iCCM in full in Sheema,
•
Administrative Monitoring & Supervision of sector activities in the districts of Mbale,
Lira, Jinja, Ntungamo, Kabarole,
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Annual Health Sector Performance Report for Financial Year 2015/16
•
Provided policy guidance through HPAC meetings to national and LG levels
•
Policy briefs to Cabinet and Parliament were developed,
•
Increased Global Health partnerships in Washington, Korea, Turkey and Indonesia.
Advocacy meetings with key stakeholders / Development partners within the country
& abroad were held in China, Japan and UK.
4.2.4 Bilateral Cooperation FY 2015/2016
•
•
•
•
•
•
•
•
•
•
Memorandum of understanding have been signed between MoH, through inter
institutional level MOUs, and through Joint Permanent Commissions (JPCs) as well
as through Regional Forum where agreed upon signed commitments are made for
implementation such as through Intergovernmental Government Regulatory
Authority, East African Community, African Union as well as through international
Forum such as China Africa Health Ministers’ Meetings, and India Africa Health
Forums.
Preparation for and participation in India Africa Summit of Heads of State October
2015
Preparation and participation in the 2nd China Africa Health Ministers’ Meeting in
Cape town October 2015, the delegation led by the Minister of Health
Bilateral Cooperation talks were held between the MoH of Uganda and South Africa
in October 2015; which lead to the eventual finalization and signing of the MOU on
health in Cape town in December 2015 by the Minister of Foreign Affairs on behalf of
GoU.
A delegation of MoH led by the Minister of Health participated in the Global Health
Security Agenda (GSHA) 2015 in Seoul September 2015; and visits made to Donga
A – ST Industry
A donation of Hepatitis B screening diagnostics was received from Donga – A ST, a
South Korea Pharmaceutical Company was by the MoH in October 2015. These have
been used for screening rural communities for Hepatitis B in various districts
including Bushenyi district in, Kanungu and Tororo Districts
Memorandum of understanding between Uganda and Republic of Korea was signed
on 29th May 2016 during President Park’s State Visit by the Ministers of Health in
attendance of the two Heads of Sate.
A Memorandum of Understanding was signed between Uganda Cancer Institute and
Korea Cancer Institute and Korea Foundation for International Health Care during
President Park’s Visit by the Institution heads in attendance of the Ministers of Health
of both countries on 28th May 2016
A project on Mobile health services to enable services reach the rural hard to reach
focusing on reproductive health with special emphasis on the adolescent girls.
A project on better girl health is now being implemented in Kamuli and Buyende
districts by KOICA in collaboration with MoH and the District LG health workers.
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•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
A donation of two ambulances and a medical mobile medical Van with in built
diagnostic facilities was donated to MoH during President Parks’s Visit
A donation of an antimalarial medicine, Pyramax, which of high quality and effective
against both Plasmodium falciparum and plasmodium Vivax worth USD500.000 was
received by the Ministry of Health of Uganda; donated by Shin Poong Pharmaceutical
Industry in Korea through the Ministry of Health and Welfare of Korea during
President Parks’s State visit equivalent to 187,000 doses.
The K - Project on Reproductive Health with focus on adolescent girls launched the
Uganda National Leaders’ Centre;Kampiringisa in Mpigi District.
The Better Girl Health Project is being implemented in Uganda in the districts of
Kamuli and Buyende in partnership with Korea International Agency for Cooperation
(KOICA).
The Memorandum of Understanding was signed with between Uganda Supra National
Reference Laboratory and the Korea Foundation for International Health Care
(KOFHI) on 28th May 2016.
The Memorandum of Understanding was signed between Uganda Cancer Institute and
Korea Cancer Institute and KOFHI on 28th May 2016.
Preparation for and participation in the Joint Permanent Commission Meeting
between Uganda and Kenya in Eldoret in March 2016.
Preparation for and participation in the IGAD Meeting of Health Ministers in August
2015.
Preparation for and participation in the India Global Exhibition of Services April
2016.
Preparation for and participation in India Global Exhibition of Services April 2016.
Participation in preparations and field activities for hosting of Delegation from
Ethiopia on Food Fortification July 2015.
Preparations and hosting of delegation from Egypt on assessment of health facilities
for renal dialysis May 2016.
Requirements for support to Mulago Hospital and China Uganda Friendship Hospital Naguru Hospital were quantified and Ministry of Health awaits Arab Republic of
Egypt to provide more renal Dialysis Machines for Mulago Hospital and to eventually
support capacity building for Renal Dialysis Health Workers.
Preparation for and participation in the second IGAD Regional Pharmaceutical
Regulatory meeting April 2016 in Khartoum.
Preparation for and participation in ongoing dialogue and preparations for Serbia
Pharmaceutical Investors to invest in Local production of pharmaceuticals in Uganda
May – June 2016 (still ongoing) through diplomatic channels).
Development of MOU for collaboration with India is ongoing through diplomatic
channels and consultations are still ongoing.
Capacity building was offered to Health Works by the Arab Republic of Egyptfor 2
Health workers.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
Capacity building of Health workers has taken place in Egypt on safety and infection
control (beneficiary program was Aids Control Program for 2 Health Workers through
the Bilateral Cooperation agenda.
Involvement of Regional Hospitals, Private Sector, Professional Associations is on going where required by invitations on bilateral cooperation activities abroad.
The State of Israel support towards rehabilitation of Mulago National Referral
Hospital was ceremoniously plaque unveiled on 4th July 2016, during the Prime
Minister of Israel State Visit; by the two heads of state during the 40th anniversary of
“Operation Jonathan” when Israel rescued her nationals at Old Entebbe airport that
had been hijacked by terrorists on 4th July 1976 Participation in
dialogues/consultations with Egypt, Israel, Turkey, India and Serbia are still ongoing.
Participation in National Organization Committee (NOC) and Ministry of Foreign
Coordination meetings for technical officers for Head of State Visits for State of Israel
and Israel Prime Minister, President Park Visit and President of Turkey State Visit.
4.2.5 Sector monitoring and quality assurance
The HSDP 2015/16 – 2019/20 emphasizes the provision of equitable, safe and sustainable
health services. This is coordinated by Quality Assurance Department (QAD) and is
addressed through development, dissemination and effective use of standards and guidelines;
regular supervision, inspection and mentoring; capacity building for quality improvement
interventions; and establishment of dynamic interactions between health care providers and
consumers of health services.
Key outputs
•
•
•
•
The bi-annual sector performance reviews were held in 2016 and report was
developed and shared with the key stakeholders. Regional Performance Monitoring
Teams (RPMTs) coordinated regional performance review meetings with support
from GFTAM.
The review of the Health Sector Quality Improvement Framework and Strategic Plan
(HS QIF & SP) was finalized and was scheduled for launch in the first quarter of
2016/17 FY. Reviewed the Support Supervision guidelines and draft available for
finalization next FY. The review of the Client Charters for the MoH headquarters,
Mbale, Gulu and Masaka Regional Referral was undertaken with support from the
MoPS. Development of the new Charters for these institutions is scheduled to take
place during 2016/17 FY. Service delivery standards were developed and finalized.
500 copies of the Uganda Clinical Guidelines (UCG 2012) were disseminated to 40
selected districts in different parts of Uganda. Key messages on Patient Rights and
responsibilities were developed and disseminated to the 42 districts supported by
Mild-May. Other guidelines disseminated included the Patient and the MoH Client
Charters, and the Quality Improvement Manual for Health Workers 2015.
Three out of the four planned support supervision visits (Area Team field visits) to
Local Governments, Regional Referral Hospitals, General Hospitals and HC IVs were
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Annual Health Sector Performance Report for Financial Year 2015/16
conducted. Some field visits were partly facilitated by GFTAM for quarter 1 and 2.
The major findings were shared with SMC and HPAC and included the following:
− General staffing has improved for a number of districts although lack of critical
staff is still a major challenge for majority of the districts in the country. There is
also a big shortage of staff accommodation, lack of uniforms and motivation for
health workers.
− NMS has been able to deliver EMHS to districts on a regular schedule. There is a
challenge to on how to handle the accumulation of expired medicines and health
supplies as the contract signed with Green label service providers and SDS in
some districts is expected to end soon.
− Maintenance of the new health infrastructure in districts such as Mityana,
Mubende and Hoima hospitals among others, has attracted increase in utility bills
in these units. Additional PHC funding is needed to address the challenge.
− HDPs continue to support service delivery especially for HIV/AIDs care and
support in districts. Coordination is also improving with regular quarterly
stakeholder coordination meetings which are normally chaired by the CAO.
− Some districts lack transport;(52 districts received GAVI vehicles and every sub
county received a motor cycle) waste management infrastructure; basic medical
equipment and adequate facilitation for PHC activities.
•
•
•
•
•
•
Four technical support supervision visits were carried out in Baylor and STAR-E
supported districts focusing on M&E and QI. The main focus was through couching
mentorship on functionality of the Quality Improvement Teams, documentation and
reporting.
QAD participated in the National Service Delivery Survey which was coordinated by
the MoPS. The report was shared and it depicted the proportion of those that did not
fall sick 30 days prior to the survey increased from 64% in 2008 to 74% in 2015.
Availability of medicines perceived to be good among the respondents declined from
26% to 22% in the same period.
A number of Implementing Partners have supported the MoH financially and
technically, to enable 42 districts and 14 RRHs; 23 general hospitals under the
UHSSP be assessed using the Health Facility Quality of Care Assessment Programme
(HFQAP). Average district quality of care score adopted as one of the District League
Indicators however, application will be after national scale up of the program in
2016/17 FY.
7 out of 12 (58%) Supervision, Monitoring, Evaluation and Research TWG meeting
weld held and resolutions submitted to Senior Management Committee.
2 out of the 4 planned quarterly National QI Coordination Committee meetings were
held.
Coordinated 10 out of 12 Senior Management Committee meetings and resolutions
submitted to HPAC for consideration and endorsement.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.2.6 Regulation
4.2.6.1
Uganda Medical and Dental Practitioners’ Council (UNMDPC)
The UMDPC is a government agency that has a mandate to regulate the training, practice and
discipline of the medical and dental practitioners in the Country. Its functions include
monitoring, supervising, maintaining and enforcing professional standards and medical
ethics, exercising disciplinary control and protecting society from abuse of medical and dental
care and research on human beings and to advise and make recommendations.
During the FY 2015/16 the council was able to complete the national internship guidelines
which are expected to streamline internship training in the sector. Review of the curricula for
medical and dental training. The 8 medical and dental schools were inspected by UMDPC as
well as the East African community, inadequate staff and inadequate infrastructure were
found to be major challenges and the medical and dental schools were given time bound
recommendations to fulfill.
A total of 418 doctors and dentists were admitted to the register, while 3014 out of 5119 were
given Annual Practicing Lincences (APL), the majority of those who did not receive APL did
not apply. The specialist register now has 1472 specialists of whom 854 were licenced to
practise in the country. 220 practitioners received temporary registration while over 100
practitioners were awarded certificates of good standing. A total of 2135 health facilities were
lincenced to operate in FY 2015/2016.
The council on average receives 50 complaints per and in FY 15/16 11 cases were
investigated and concluded while others are still being investigated. The council was also able
to print and distribute the registered practitioners copies of the following documents UMDPC
Act, code of professional ethics, minimum standards of operating health facilities as well as
guidelines for CPD and for filing complaints against practitioners. A fitness to practice
guideline was also finalized this FY. 37 CPD providers have been accredited.
New regional inspectors have been contracted to improve the inspection of health facilities in
the Country. In FY 2015/16, Council licensed 1641 health facilities with 44% in Kampala.
There are 87 hospitals and 1554 clinics supervised by Council.
Medical Licensing and Examination Board was established to ensure that persons who
register with the Medical and Dental Practitioners’ Council to practice Medicine and
Dentistry in Uganda meet minimum standards of training and acceptable level of competence.
87 candidates were handled FY 2015/16. In addition council conducted peer review
interviews for 18 specialists that sought to work in Uganda. This aims to ensure Council
registers qualified specialists. District Health Supervisory Authorities that were established by
the joint Health Professional Councils continue to operate and council inspected 58 out of the
110 DSAs in the country.
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Annual Health Sector Performance Report for Financial Year 2015/16
4.2.6.2
Uganda Allied Health Professionals Council 2015/2016
The Allied Health Professionals Council was established by Allied Health Professionals Act
Cap 268 of 1996 to regulate, supervise and control the training and practice of Allied Health
professionals in Uganda. Its functions are to regulate standards and conduct of allied health
professionals and register and monitor performance of allied health professionals. Its
objectives are include registration, lincencing, inspection of allied health professionals and
practice units across the country as well as inquiring and determining disciplinary matters
relating to the conduct of allied health professionals.
During FY 2015/16 a total 2,653 new allied health professionals were registered and 10,818
had their licences renewed. 1,531 health units and 652 laboratories were licenced. This
enabled the council to raise a total revenue of 2,062,719,115/= out of the annual budget
amounting to 2,864,740,000/= representing 72% budget performance.
The allied health professional’s regulations were approved by the Minister of Health to
simplify implementation of the AHPC Act. The council was also able to inspect and supervise
all health training institutions. 6 cases of mal-practice were investigated concluded and
disposed of.
The main challenges the council faces include lack of a clear definition of the scope of
authorized practice and failure of units to comply with set standards as well as lack of public
awareness of mandate of the council.
Over the medium term the council plans to build capacity of regional supervisory
authoritiesand develop and implement information, education and communication strategies
that will address community awareness of council’s mandate
4.2.6.3
Pharmacy Council
The Pharmacy Council is mandated enforce pharmaceutical standards and ethical codes of
conduct countrywide and is the professional body responsible for registration of pharmacists.
During the FY the council was able to finalize internship guidelines and continued to build
consensus on the proposed pharmacy bill. It continued to inspect pharmacy schools,
internship training centres and pharmacy practice centres. One case of Pharmacy malpractice
was reported and is being investigated.
4.2.6.4
National Drug Authority
The key achievements this FY were;
•
•
•
•
•
Recruited quality medical officer
Began training staff
Developed and revised implementation manuals
Customer satisfaction survey on going in the Process of changing from ISO 100:20159001:2015
Sensitized stakeholders about advertising and promotion of products by MDAs
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Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
Approved 24 clinical trial applications
Developed new guidelines and SOP for lincesing
Lincesed 69 pharmacies
Approved 109 medicine samples, 11 samples of LLINs, and 376 samples of condoms
4.2.7 Pharmaceutical Supplies and Health Products 2015/16
4.2.7.1
Pharmacy Division
The following key outputs were achieved by the pharmacy Division;
•
•
•
•
•
•
•
•
Developed and disseminated the following strategic documents and reports:
o National Medicines Policy (NMP) 2015 and National Pharmaceutical Sector
Strategic Plan (NPSSP) 2015/16-2019/20
o Reproductive Health Commodity Security Strategy (2016/17 -2020/21)
o Addendum to the Uganda Clinical Guidelines and EMHSLU 2012, focusing on
the 13 United Nations Lifesaving Commodities for mothers and children
o Alternative Distribution Strategy for contraceptives and selected reproductive
health Commodities developed
Six bi-monthly Central Level Stock Status reports were made through routine reviews of
stock status at warehouses and recommended inter- warehouse transfers.
Quarterly National SPARS performance reports showing performance of district and
health facility performance in medicines management were produced.
A Service Delivery Point Service (SDP) survey for availability of RH commodities and
services was conducted.
Estimated the ARV funding requirements to implement the proposed test and treat
guidelines for the 2016-2030 period and collaborated with USAID and US Centres for
Disease Control and Prevention to calculate the ARV funding gap (US$8.6 million) for
October 2016 to December 2016.
Conducted and updated national quantification and supply plans for;
o ARVs and Key Laboratory commodities for the Global Fund costed extension
Grant worth $36m
o Hepatitis B testing kits, vaccine and medicines
o Malaria commodities to be included in the concept note for the Global Fund grant
application for 2016 to 2017
Prepared a distribution list for 200 donated Selexon machines for Hepatitis B virus
testing, hepatitis B rapid tests, HBeAg, AFP and Crag LFA tests.
3001 facilitiesstarted Supervision, Performance Assessment and Recognition Strategy
(SPARS) Supervisions in 110 districts. 15,663 visits were performed leading to an
improvement in medicines management at health facility levels in the areas of stock and
storage management, ordering and reporting, prescribing quality and dispensing quality.
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Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
•
•
The SPARS supervision tool has also been revised to flexibly include random medicines
for which Pharmacy Division can quickly obtain stock status when needed.
Started the implementation of the peer strategyaimed at strengthening the management
support for medicines management from MoH PD to the health facilities. The 14 regional
pharmacist and 12 RPMT pharmacy persons have this year started providing quarterly
targeted support to district based Medicines Management Supervisors (MMS) and health
facilities. This activity will continue in the coming year with an expanded scope to
include support to ART and ordering and reporting, Vaccine management and rational
medicines use.
As part of capacity building the following trainings were conducted;
o Four 5 day logistics training courses on ordering and reporting for TB and
HIV/AIDS commodities for 107 facility staff members.
o 140 staff from 14 UNFPA supported districts trained in medicines supply chain
Management
o Trained 150 medicines management supervisors in SPARS, 110 practically
oriented, 107 in basic computer literacy, electronic data collection and submission.
This was done in collaboration with the USAID funded Uganda Health Supply
Chain
o Five day training of 15 QPPU, warehouse and Program logistics officers in
quantification and application of Quantimed and Pipeline tools for forecasting and
supply planning respectively.
o Training of 10 QPPU and program logistics staff in Quantification of TB
medicines and the use of QuanTB tool as an early warning system for monitoring
stocks of TB medicines.
o 441 health facility staff trained at both government and PNFP facilities as part of
the continued roll out of the Rx Solution in health facilities.
Distributed 450 shelving units to 818 health facilities.
Installed Rx solution in a total of 103 health facilities.
10,000 copies of Practical guidelines for dispensing for higher level facilities were
distributed.
The Appropriate Medicines Use Unit was established at the Division that has been
coordinating the revision of the UCG and EMHSLU 2016. Experts’ review of the 2012
UCG were solicited and discussed in a one stakeholders’ workshop in June 2016. The
input and recommendations are being consolidated in a draft that will be again submitted
to the MoH programs for final revision before final approval from top management.
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4.2.7.2
National Medical Stores
During the FY 2015/16 the NMS was able to;
•
Procure, store and distribute;
o RH supplies worth Shs 8 billion to health centers
o Immunization supplies amounting to Shs 9 billion to health facilities
o Laboratory commodities worth Shs 5billion to health facilities
o Specialized items amounting to Shs 18.104 billion for UHI,UCI,UBTS and
treatment of jiggers.
o Essential Medicines and Health Services basic kit to;

HC IIs worth Shs 11.163 billions

HC IIIs worth shs 18.36 billions

HC IVs worth shs 7.992 billions

General hospitals worth Shs 13.106 billions

RRHs worth Shs 13.024 billions

National referral hospitals worth SHS 12.366 billions
o Supplied ACTs, ARVs and Anti TB drugs to accredited facilities worth Shs 100
billions
•
Cleared the donated emergency supplies worth SHS 2.5 billion to health facilities
4.2.8 Information for Decision Making in Health Sector
The Health sector requires reliable and accurate information to enable evidence based
decision-making, sector learning and improvement. Over the HSDP period the sector aims at
increasing ownership, leadership, harmonization and coordination of the Health information
system including cascading Ehealth to lower level units.
Progress on implementation of health information activities is documented below.
•
•
Conducted two regional e-HMIS training for 29 districts from eastern Uganda and 30
districts from Western Uganda with support from WHO. The trainings aimed at
strengthening technical skills of district teams to support health facilities to improve data
collection, reporting (through mTRAC) or in DHIS2), utilization and feedback. A total of
118 Participants including biostatisticians and surveillance focal officers participated in a
4 day training.
From mid-2016, the reporting and analysis for Surveillance Indicators from health
facilities has drastically improved from 40% to the current over 70%.
Page | 85
Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
•
•
•
•
•
•
•
100
80
60
40
20
0
2015W1
2015W3
2015W5
2015W7
2015W9
2015W11
2015W13
2015W15
2015W17
2015W19
2015W21
2015W23
2015W25
2015W27
2015W29
2015W31
2015W33
2015W35
2015W37
2015W39
2015W41
2015W43
2015W45
2015W47
2015W49
2015W51
2016W1
2016W3
2016W5
2016W7
2016W9
Reporting Rate
FIGURE 17: WEEKLY SURVEILLANCE REPORTING BY REGION
Central Region
Northern Region
Western Region
MOH - Uganda
Eastern Region
Conducted a TOT for100 participants in OpenMRS across the country. OpenMRS is an
Electronic Patient Management Records System which was adopted in 2011 and it is
currently running in about 400 health facilities across the country.
Conducted a national stakeholder’s workshop of 60 participants whose objective was to
strengthen dissemination of information and receiving feedback for decision-making
purposes. Also, to promote accountability, ownership and involvement of all stakeholders
in strengthening health service delivery.
Finalize the eHealth Policy and Strategy Processes with support from WHO and UNICEF.
Conducted the data validation exercise on selected data elements generated by Mtrac for
the purpose of verifying data in the 2015/16 FY (process on going)
Supported the identification of requirements specification for the deployment of an
integrated health facility electronic management system (process on going)
Supported the designing, development and rolling out a situation room that will enable
political leaders, program managers, and technical departments at all levels to access all
the relevant diseases related data in an easy and interactive manner. This means using
automated, frequently updated data, and data visualization tools that are mobile and
accessible any time.
Supported a cascaded support supervision mechanism with a phased- out approach by the
DHT to the lower health facilities covered all the 112 districts of Uganda. The main
objective was to equip lower health facilities with mechanisms of generating health
information and intelligence to monitor the health status and health services. Hence
improving public health care leadership and evidence based decision-making capacities at
all levels.
Activity: Support additional training of Health workers in integrated disease
surveillance/HMIS to improve quality of data reported.
Conducted an eHMIS National TOT workshop which was aimed at building a robust team
to effectively carry out the regional trainings for the identified weak or poorly performing
districts.
The team was tasked with finding out; the causes of low reporting rates, why the quality
of data is poor and the challenges of data dissemination, utilization and access.
Conducted eHMIS training for the armed forces (Uganda police, Uganda Peoples Defense
Forces and Uganda Prisons); a total of 50 participants attended this training.
Page | 86
Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
Support Supervision of the 30 poorest reporting Districts
Refresher training on mTRAC an SMS based application was conducted which is used by
the health sector to facilitate timely submission of weekly surveillance data to all
stakeholders to monitor disease trends, epidemic outbreaks and track medicines
availability as well as Malaria case management.
Over the past seven months, the weekly reporting from regions stagnated at 59 - 77% in
western region with an average reporting rates of 75% during this period.
FIGURE 18:REPORTING RATES BY REGION OCTOBER 2015 TO APRIL 2016
100
95
90
81
78
80
70
69
60
59
54
50
40
79
72
68
74
64
62
55
95
85
83
81
71
82
77
68
57
57
Mar-16
Apr-16
67
50
45
38
30
20
10
0
Oct-15
Nov-15
Central
•
Dec-15
Eastern
Jan-16
Feb-16
Northern
Western
Over 600 health workers have been trained on the HMIS revised tools; additional
mentoring and couching was done to improve reporting and data use at a facility level.
4.2.9 Health Infrastructure Development and Maintenance (HIDM)
In the financial year 2015/16, the following were the accomplishments;
•
•
•
•
Analysis of the inventory data shows that on the average, 72% of the available medical
equipment is in good working condition although about 6% of this equipment is not being
put to use because of lack of qualified staff to use it, lack of reagents and other
consumables and power.
Medical Equipment Maintenance carried out in all RRHs, GHs and HCIVs through the
Regional Medical equipment maintenance workshops,
Maintenance of Solar energy systems installed under the ERT II Project in 665 HCs in 40
Districts and 96% of the solar systems are in good functional condition.
Developed a new Medical equipment inventory database system (NOMAD) for
equipment inventory management and maintenance planning,
Page | 87
Annual Health Sector Performance Report for Financial Year 2015/16
•
•
•
•
•
•
•
•
•
•
•
Collected Laboratory equipment inventory for all RRHs, GHs, HCIVs and 95% of the
HCIIIs as well as completing equipment inventory for all RRHs and 50% of the GHs and
HCIVs. An assessment of equipment utilization and performance for 17 Health facilities
under the UHSSP Project done.
Spare parts were secured for Solar systems 143HCs in Buliisa, Moyo, Gulu, Soroti,
Serere, Pader and Bududa Districts with support from the Nordic Development Fund
(NDF).
Three Framework Contracts for supply of Medical Equipment Spare parts were signed
and procured spare parts worth UGX 185 million for the Central workshop, Wabigalo.
A Framework Contract for Maintenance of solar systems in 155HCs in 20 Districts was
signed and will enable rehabilitation of over 365 solar systems that were procured and
installed under the phase I of the ERT Project.
A Framework contract for maintenance of Philips Imaging equipment was signed which
will enable rehabilitation of 49 X-ray machines and 45 Ultrasound scanners.
Distributed 7,000 Hospital beds and mattresses to Hospitals, HCIVs and HCIIIs
countrywide.
Commenced the procurement of a contract to supply and deliver 3,250 beds, beddings and
325 bedside lockers. Contract signing delayed by PPDA Investigation and Administrative
review.
Assorted Medical equipment procured and installed for casualty, Operating Theatre, ENT,
CSSD, Dental and Maternity ward in Hoima, Fort Portal and Kabale RRHs under JICA
funding.
23 Engineering and Biomedical Engineering Technicians were trained in basic
maintenance of the CD4 PIMA machines with support from the SUSTAIN/USAID
Project and IDI/CDC, 26 of them trained in the use and management of the NOMAD
Medical equipment inventory management software system aimed at enabling Regional
maintenance workshops to collect and maintain equipment inventory for health facilities
in their regions.
A draft training curriculum and training manual for maintenance of non-automated
laboratory equipment was prepared with support from the American International Health
Alliance (AIHA)/CDC/USAID support to aid standardize the training of technicians on
maintenance of laboratory equipment, Four Regional Medical Equipment Maintenance
workshops’ performance review meetings were organized and held in Mbale, Gulu, Arua
and Kabale RRHs and Technical support supervision and monitoring of health
infrastructure development in all RRHs and at least 50 LGs were carried out.
Completed implementation of the phase II of the ERT project with overall outputs and
achievements as summarized below:
Page | 88
Annual Health Sector Performance Report for Financial Year 2015/16
OutputIndicator
Funding
Planned
target
Actual
Achieved
Remark
OutputIndicator
Funding
Planned
target
Actual
Achieved
Remark
Number of HCs provided IDA/GEF
with modern lighting (i.e.
solar or hydroelectricity
NDF
power)
Amount of CO2 avoided per IDA/GEF
annum by using solar power
(Tons)
NDF
464
525 1
61HCs
target
112 2
143
298
281.9
70.1
93.3
43HCs above planned
target
Achieved 94.6% of the
planned target
33.1% above the planned
target
above
planned
 336.2kWp of solar power generation capacity was installed in 522 HCs under
IDA/GEF funding in 39 Districts.
 121.16kWp of solar power generation capacity was installed in 143 HCs under
NDF funding in 9 Districts.
 279 solar vaccine fridges were procured and installed under the ERTII Project.
 1,124 solar systems were installed for lighting and operation of low energy
consumption equipment for Staff houses.
 819 solar systems were installed for lighting and operation of low energy
consumption equipment for the OPD, Maternity, general ward and operation
theatres in HCII, HCIII & HCIVs.
For the ERTII beneficiary HCs, the overall access to modern lighting increased from 13% to
79% which will support provision of maternal and child health services, EmoC and
microscopy, a total of 104 HCIIs had solar vaccine fridges installation of solar vaccine to
improve immunisation services. With solar installations under ERTII, solar lighting, general
security and work environment was improved contributing to staff motivation.
1
2
This total includes 3 HCs connected to hydroelectricity for the first time as the only source of modern power
(i.e. Bwikara HCIII, Mabaale HC III and Isunga HC III.
Scope was increased by 12 additional HCs after an addendum was signed to include Bududa District.
Page | 89
Annual Health Sector Performance Report for Financial Year 2015/16
HCIII Centralized solar system
Battery Bank inside solar house
Microscope powered by solar power in
Obalanga HCIII laboratory
Vaccine Fridge in one of the beneficiary
HCs
Photo 5: Verification of a staff house solar
system by MoH Engineer
Photo 6: Maternity with solar power for
lighting in Rwebishengo HCIV
Page | 90
Annual Health Sector Performance Report for Financial Year 2015/16
•
A number of hospitals that were in dire condition were provided with funds from GoU
for renovation as summarized below;
Name of the facility Amount
Status of work
Pallisa
General
500,000,000 Renovation of maternity
Hospital
General ward and surgical
ward complete.
Main gate at 50% complete
Bugiri
General
700,000,000 Renovation of wards
Hospital
Complete
Water pump installations
Kaberamaido HC IV
Comments
Less
funds
released
100,000,000
Received
less
than the contract
sums
1,410,000,000 Built staff houses,
Funds
for
OPD and maternity ward upgrading HCIV
about 60%
to hospital
Procurement of equipment
• A total of 19 ambulances procured through the United Nations Office for Project Services
were distributed to health facilities and are now in use. The beneficiary hospitals were:
Itojo, Lyantonde, Nakaseke, Entebbe, Iganga, Bugiri, Bukwo, Buwenge, Moroto, Moyo,
Nebbi, Anaka, Apac, Kiryandongo, Masindi, Mityana, and Mubende. The ambulances were
supplied with adequate spare parts including a set of tyres. The Project also supported the
preparation of ambulance guidelines which were circulated countrywide.
• Two (2) Mobile workshop vehicles procured earlier from Cooper Motors Cooperation are in
use at Mubende and Moroto RRHs. Joh Achillies GmBH was awarded a contract to supply
two mobile workshop vehicles for Masaka and Jinja RRHs to facilitate medical equipment
maintenance. Advance payment was made and delivery is awaited.
• Installation of Local Area Networks (LAN) in health facilities; a study to design a unified
network solution for the sector; Implementation of Voice over Internet Protocol (VOIP)
between the MoH and the Health facilities; and procurement of computers and computer
accessories. Installation of LAN has been undertaken as part of the ongoing civil works
with the 9 Hospitals of which 8 hospitals have been completed and other works are
ongoing.
• Eight of the nine Hospitals under renovation were completed namely: Entebbe, Nakaseke,
Mityana, Kiryandongo, Nebbi, Anaka, Iganga and Nebbi. Moyo hospital still awaits
completion as summarized below,
Page | 91
Annual Health Sector Performance Report for Financial Year 2015/16
TABLE 45: PROGRESS OF RENOVATION OF 9 HOSPITALS
No Hospital
name, Status
Contractor
&
Contact amount
1
Mityana GH
Completed
(100%)
Sino Hydro Co
2
US$ 6,090,929.55
Nakaseke GH
Yanjian Uganda Ltd
3
US$ 5,090,612.23
Kiryandongo GH
US$ 5,654,229.90
Nebbi GH
China Railway No.5
Anaka GH
Excel
Ltd
6
Construction
US$ 6,545,233.13
Moyo GH
Comments
7 January The scheduled works were completed
2016.
and hospital was handed over to the
Hospital administration for use. Under
Defects Liability Period
30th July 14
The scheduled works were completed
2015
September and hospital was handed over to the
2015
Hospital administration for use. Under
Defects Liability Period
Completed
(100%)
2nd
August
2015
10
December
2015
The scheduled works were completed
and hospital was handed over to the
Hospital administration for use. Under
Defects Liability Period
30
Overall
progress is August
2015
at 97%
US$ 3,876,045.19
5
Extension
Deadline
Completed
(100%)
China
National
Complete
Plant
(COMPLANT)
4
Original
Contract
date
24
August
2015
Completed
(100%)
09
May All scheduled works are complete. The
2016
following facilities were handed over and
are in use: OPD, Casualty, Attendants
kitchen and laundry, expansion of Tblock, refurbishment of existing OPD,
Maternity and Children’s wards, staff
house, and water supply and sewage
line.
6 July 18
The scheduled works were completed
2015
September and hospital was handed over to the
2015
Hospital administration for use. Under
Defects Liability Period
Overall
6 July 30
progress is 2015
October
2015
Prism Construction at 85% and
is behind
Co. Ltd.
schedule.
US$ 4,541,931.32
The Contractor then had been instructed
to vacate site, however a meeting was
held on the 24th /03/ 2016 by the
Permanent Secretary in which the
contractor was asked to meet some
conditions including commitment to
complete works through a revised work
program, extension of securities and a
revised ESMP plan for submission to the
Bank to seek a No objection to facilitate a
Contract Extension. These conditions
have now been met and this
demonstrates commitment on the side of
the contractor to complete the works.
Page | 92
Annual Health Sector Performance Report for Financial Year 2015/16
No Hospital
name, Status
Contractor
&
Contact amount
7
Moroto RRH
Completed
(100%)
Excel Construction
Ltd
8
US$ 8,842,878.01
Entebbe GH
M/s China National
Aero
Technology
International
9
Completed
(100%)
Original
Contract
date
29 July
2015
14
August
2015
Extension
Deadline
Comments
6 October The scheduled works were completed
2015
and hospital was handed over to the
Hospital administration for use. Under
Defects Liability Period
10
December
2015
The scheduled works were completed
and hospital was handed over to the
Hospital administration for use. Under
Defects Liability Period
US$ 7,034,065.42
Iganga GH
31 July 6 March The scheduled works were completed
Overall
2016
and hospital was handed over to the
Progress is 2015
Hospital administration for use.
M/s China National at (100%)
Aero
Technology
International
US$ 4,933,884.78
Page | 93
1344
Way Forward
Conclude renovation Moyo GH, 26
HC IVs, Complete installation of Xray, dental and laundry equipment
Replace the rejected equipment
Additional funds of UG 250m are
required.
Capacity Development & System
Strengthening, Revitalizing Referral &
Counter-Referral systems in KCCA.
Expanding & Improving Specialised
Services in KCCA.
Page | 94
Need for training for technical staff,
An additional UG 17.9 billion be
Revise disbursement targets during
projects
Preparation of designs and Bid
documents
Additional funds of UG 51.7 are still
needed
Construction
expected
to
commence in Nov 2016
Completion of designs
Financing by the M/S Finasi/Roko
SPV in final stages
The detailed design and tender documents Insufficient funds that Additional 17.64 billion still needed
were finalised
project would require an to be allocated over project life
Studies for Busolwe GH awaiting approval additional UGX 17.64billion cycle.
Invitation for Bids was published.
Evaluation process for Kawolo civil works
ongoing
Public Works Investment
signed
Land secured
Designs in final stages
Challenges
Underperforming of the
contractor
at
Moyo
hospital,
delays
in
procurement
for
replacement of rejected
medical
equipment,
Limited
staffing
and
funding for renovated
hospitals
Agreement Insufficient
GoU
allocations on the project
that requires counterpart
Funding to the tune of
UGX 54.4 billion
Achievement
Completed renovation of 8/9 hospitals and
75% of 26 HC IVs
Procured and distributed general
equipment to 65 hospitals and 230 HC IVs,
19 ambulances to 19 hospitals Installation
of X-ray, Dental and laundry equipment,
Scholarship awards to 797 health workers,
HRIS rolled out to 31 districts
Delay in procurement,
encroachers on hospital
land, lack of space for staff
accommodation
Rehabilitation
when
patients are still in Hospital
Rehabilitation and To deliver the Uganda Design and Construction supervision A gap in understanding of
Expansion
of National
Minimum consultant procured, Technical staff operating procedures
Rehabilitation and To contribute to the
Construction
of delivery of the UNM HC
General hospitals Package
through
improvement
of
Accident,
Emergency
and Reproductive health
services
Support to Mulago Improve delivery of
Hospital
quality
services,
Rehabilitation
Decongest, Strengthen
Medical Education and
Research capacity
1243
1187
Construction and Construction
&
Equipping of the Equipping of a 240 bed
International
hospital
Specialised
Procurement
of
Hospital
of Specialised
medical
Uganda
equipment
1393
Specific objective
To improve sector
management,
Health
infrastructure, Access to
quality maternal and
new born health, Family
planning services
Project Name
Uganda
Health
Systems
Strengthening
Code
1123
TABLE 46: INFRASTRUCTURE DEVELOPMENT PROJECTS STATUS
Annual Health Sector Performance Report for Financial Year 2015/16
The Global Fund
Grants to fight
HIV/AID, Malaria
and Tuberculosis
0220
Scaling up prevention,
Care, Treatment and
Health
System
Strengthening.
Support
for
the
introduction of highly
Effective
Artemisinin-
Close monitoring and supervision
of works.
An additional of 1.8 billion be
allocated to the project.
Way Forward
allocated,
Need to complete the designs and
tender documents.
No Cost Extension should be
extended to allow time for
completion
of
remaining
constructions.
Village triggered 37%, Village declared Low absorption capacity in The project to be renewed for
ODF 58%, New latrines constructed 59%, LGs
another 4 yrs. (up to 2020).
Commission of UG Shs 7 billion for
Additional population served, New HWF
the renewal phase
installed 37%, improve latrine coverage
Counterpart funding of UGX Shs 7
84%people living in ODP 58%, adapting of
billion to be required.
HWWS 61%s
Signing of GSA for the extension
and expansion of the program.
TB GRANT, Successfully conducted TB Procurement delays
Instituting monthly and quarterly
prevalence survey, a number of shipments Understatement of grant review
Regular briefs to MoH top and
arrived at NMS and cleared, GOU budgets
procured 3.8 MoS of streptomycin Limited
community Senior management
injection.
involvement
Distribution of printed HMIS in
MALARIA GRANT, Funds advance to Weak referral network
progress.
implementers, conducted clinical audits, Digital migration to DHIS2 Scaling up DQA in progress.
Page | 95
Inadequate allocation for
GOU co- financing,
Delayed implementation
initiation due procurement
delays.
Counterpart funding of UG
2.751 billion required.
Uganda Sanitation To
increase
Fund
development
and
utilisation of sanitation
and hygiene facilities
aiming at reduction of
morbidity and mortality
rate
Site handed over & started, Contract for
supervision awarded to Ms. Zhonghao
Overseas Construction Engineer Co at a
price of US $ 5,592,885.18, Contract of
supervision to Ms. Joadah Consult at a
price US $ 210,000.
1218
Construction of 34 staff
housing
units
in
Karamoja,
assorted
medical equipment to be
provided by in-kind by
donor
Italian support to
the HSSP and
PRDP: Karamoja
staff housing
1185
1141
Project Name
Specific objective
Achievement
Challenges
Kayunga
and Health Care Package recruited, Procurement of a contractor has Limited funds.
Yumbe hospitals
(UNMHCP)
commenced.
Limited knowledge to
technical staff
GAVI
Vaccines TO strengthen health 4 insulated trucks to NMS, 12 cold rooms Delayed procurements for
and HSSP
systems&
ensure at NMS, 65 vehicles to 65 districts, 600 civil works for constructing
universal access to the motorcycles to HC IIIs, 1000 vaccine DMS and health workers
UNMHCP in order to carriers and 500 gas cylinders, houses.
reduce morbidity and Introduction of HPV vaccine, Inactivated
polio vaccine,
mortality.
Code
Annual Health Sector Performance Report for Financial Year 2015/16
ADB support to
UCI
Development of a
Specialised
Maternal
and
Neonatal Health
Care Unit in
Mulago
Rehabilitation of
Lira, Gulu & Arua
referral Hospitals
1345
---
1145
Way Forward
Invest
in
modification
of
infrastructure to support TB
infection control.
Expedite the process of hiring
consultants and development of
the training.
The work plan and procurement
plans have been revised to cover
up June 2017.
Additional funds of 4.18 billion
need to be allocated.
Accumulated VAT on civil The project is still on track and
works and consultants construction work as envisaged.
services.
GoU counterpart funding of
US $ 3.42 Million.
Delayed implementation of
the project, Failure to
secure counterpart for the
project FY 2015/16.
Lack of a Biomedical
Engineer to help in medical
equipment
specification
development.
Limited funds out of 12.18
billion 8 billion are
available.
Challenges
Page | 96
Proposal submitted to JICA for Grant Confirmation of funding Follow up of approval of financing
financing
from JICA
by JICA
The name should be changed to
“Rehabilitation and Equipping of
Hospitals in Uganda with JICA
support”
Specific objective
Achievement
Based
Combination 50 IMM trainings conducted, evaluation of
Therapy Treatment.
the SRs has been concluded, M& E Plan
printing and distribution done.
To address the crucial The project received its first disbursement
labour market shortages of USD 71,383.
highly professionals in The procurement of consultancy for design
oncology sciences and supervision of the multipurpose building to
cancer management in house the project, Office equipment and
Uganda
and
EAC furniture, evaluation report for the
region.
procurement of 3 project vehicles finalised,
developing specification for medical
equipment for Mayuge and Arua satellite
clinics was finalised, the training plan has
already been developed by Atraining
Advisory Committee ( TAC)
To
contribute
to A design consulted Ms Arch Design Ltd
reduction of maternal was hired at a cost of USD 542, 646, 50.
A supervising consultant,M/S Joadah
and neonatal morbidity,
To improve maternal consult Ltd Construction works
and child health care A procurement of a National Consultant to
services
develop up to date effective hospital and
clinical protocols.
Improve
training, Participated in the independent audit for Long procurement Process
for equipment
East Africa Public Regional diagnostics & East African Public Laboratories.
Health Laboratory Surveillance.
Support supervision and mentorship
Project Name
Code
Annual Health Sector Performance Report for Financial Year 2015/16
Code
Institutional
Capacity Building
Project Name
Networking
Project
(EAPHLNP)
Achievement
Challenges
provided to five satellite laboratories.
Operational research on three protocols
for entrices, Tuberculosis and malaria.
28 laboratory staff trained on quality
Management system.
Improve
effective Guidelines & implementation manual for Short project life span
delivery of an integrated RBF developed. Training for RBF
UNMHCP
implementation started. Grants to
approved facilities to improve service
delivery began.
Specific objective
Build
capacity
for
operational research,and
Knowledge Sharing
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 97
Accelerated implementation
Way Forward
Annual Health Sector Performance Report for Financial Year 2015/16
PHYSICAL PROGRESS OF RENOVATION OF HEALTH FACILITIES
Main Block at Entebbe GH-Commissioned by HE the President of the Republic of Uganda on May 3, 2016
Page | 98
Casualty, T Block, Operating theatre and cooking stoves at Kiryandongo GH
Annual Health Sector Performance Report for Financial Year 2015/16
Staff houses, T-block, duty room for female ward and Isolation ward at Nebbi GH
New Casualty already in use with its operating theatre in use, Nakaseke Hospital
Page | 99
Annual Health Sector Performance Report for Financial Year 2015/16
Contracts were signed for renovation of 26 HCIVs and the sites were handed over to the
contractors in June 2015. The HCIVs include: Kasanda, Kiganda, Ngoma, Mwera,
Kyantungo, Kikamulo, Kabuyanda, Mwizi, Kitwe, Rubare, Aboke, Aduku, Bwijanga,
Bullisa, Padibe, Atyak, Obongi, Pakwach, Buvuma, Budondo, Ntenjeru-Kojja, Buyinja,
Nankoma, Bugono, Kiyunga, Kibuku and
Theatre block at Budondo HCIV top left, Maternity ward at Ntejeru Kojja, top right, Maternity ward at
Buyinja HCIV bottom left; and maternity ward at Mwizi HCIV bottom right.
Page | 100
Priority Actions
1.2 Improved
quality of HRH
training
1.1 Improved
staffing levels to
deliver UHC
MoH - Top Management
Fast track the restructuring
process to meet the current
service delivery needs.
Include cadres like
Biomedical Engineers,
Counsellors
Ensure quality HRH training
through proper planning,
adequate practicum sites,
supervisors, equipment etc.
MoES, MoH - Clinical
Services Department,
Hospital Directors and
Professional Councils.
MoH - Human Resource
Department, MoLG,
MoFPED,
Responsibility
Recruitment of the critical
cadres specifically
anesthetists, midwives,
ophthalmic and dental
personnel.
1. HUMAN RESOURCES FOR HEALTH
Milestone
June 2016
By June 2016
By June 2016
Timeframe
4.3 Annex Three: Progress in Implementation of the 21st RJM Aide Memoire
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 101
Guidelines and tools for
supervision and inspection of
health training institutions
developed and launched by the
inter-ministerial committee in
October 2015.
Overall decentralised staffing
level at 70%. However the most
understaffed cadres in the sector
are Anaesthetic officers 27%,
Ophthalmic Clinical officers 36%,
Dispensers 40%, Pharmacists
40%, Physiotherapists and
Occupational therapists 45%,
imaging staff 49% and medical
doctors 49% . Some Districts still
have staffing levels below 50%
New structures approved by
cabinet. Implementation has
started.
Progress
1.5 Provision of
adequate wage
bill
1.3 Improved
budgetary
provisions and
supervision of
interns
1.4 Training of
anaesthetists
streamlined with
other courses to
increase on their
numbers
Milestone
Continue lobbying for
raising the wage bill
Complete the absorption and
regularization of Bonded
and Project staff in Govt.
payroll
Inservice training of Medical
Officers to give spinal and
ketamine anesthesia.
Recruitment should always
be aligned to available wage
Review process of training
anaesthetists to provide for
direct entry into the training
institution for anesthesia.
Health Committee of
Parliament
Pursue the policy of MoH
taking back management of
the health training
institutions for HRH.
Coordination and
information sharing
between Interns Committee,
Universities, MoE, MoH and
MoFPED.
Parliamentary Committee
of Health, LGs
MoH, MoFPED,
Public Service
Commission
MoH, LGs, HSC, DSCs,
MoFPEP
MoH - Clinical Services
Department
MoES, MoH - Human
Resource Development
MoES, MoH - Interns
Committee, MoFPED
Responsibility
Priority Actions
June 2016
June 2016
June 2016
June 2017
June 2017
June 2016
Timeframe
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 102
Accounting officers directed to
recruit only when wage budget
allows
Increase in Wage bill planned for
FY2017/18
Absorption planned for FY
2017/18 when additional wage
bill will be provided
Pending due to limited
resources.
New curriculum developed and
approved
New guidelines on internship
training developed to
comprehensively address
Internship training in the sector
Inter ministerial discussions on
this action have started
Progress
In consultation with HDPs
develop innovative financial
modalities (PBF, Pool Funds,
Priority Actions
Expedite process of
replacement for posts falling
vacant as soon as vacancies
arise.
Review and redefine concept
of hard to reach areas to
build the case for all hard to
reach areas.
1.8 Staff uniforms Provide budget for staff
uniforms
provided
2. HEALTH FINANCING
Lobby to increase
2.1 Increased
government funding (MTEF)
financing for
for implementation of the
health service
Health Sector Development
delivery
Plan
Develop evidence-based
rationale for increased
Government funding (MTEF)
for health to be shared with
MoFPED
Harnessing health related
resources from other sectors
1.6 Timely
recruitment to fill
posts that fall
vacant
1.7 All staff in
hard to reach
areas motivated
Milestone
June 2017
Inter-Ministerial
Committee, Intersectoral
Committees
MoH, Partners, CSOs
June 2016
June 2016
MoH Planning
Department
June 2016
MoH - Nursing
Department, MoFPED
June 2017
June 2017
MoPS
Senior Top Management,
Parliamentary Committee
for Health, CSOs
June 2916
Timeframe
MoH, LGs, Service
Commissions
Responsibility
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 103
RBF strategy and
Implementation manual finalised
Commitees in place and meetings
held
On going. To be included in the
sector’s BFP
Increased Funding planned in FY
2018/19
UGX 3 billion provided in FY
2016/17
Accounting Officers directed to
promptly declares vacancies to
the relevant service
commissions.
On going discussions with Mops
to review the areas
Progress
2.4 Reduced out
of pocket
payments
2.3 Framework
for Results Based
Financing (RBF)
in the health
sector defined
2.2 Improved
resource
allocation to
ensure equity
Milestone
Responsibility
Finalize and implement the
National Health Insurance
scheme (NHIS).
Conduct the assessment of
standard costs by level of
facility to produce a reliable
estimate of the input
requirements for each
district.
Define a national framework
for RBF in the Health Sector
based on the experiences
from pilots and bench
marking from Uganda and
other countries.
Finalize the operationalize
the Health Financing
Strategy (HFS)
MoH, MoFPED, Partners
MoH, Partners
March 2016
December
2015
Page | 104
Costing of the scheme reviewed
and Request for Certificate of
Financial Implications submitted
Health financing strategy
launched
Frame work developed
Costing done for HC IIs, IIIs, IVs
and General Hospitals under ICB
project
New resource allocation formula
disseminated during Regional LG
Budget workshops
June 2016
December
2016
Not held due to lack of funds
Progress
June 2016
Timeframe
MoH - Planning and Policy March 2016
Directorate, MoFPED,
PNFP
MoH - Planning, HDPs
etc.) to attract additional
resources for the sector
Joint planning and budgeting MoH - Planning
at regional and district level Department, LGs, HDPs,
Global initiatives, PNFP,
PHP, CSOs
Revise and disseminate the
MoH - Planning
resource allocation formula Department, MoFPED
to LGs and Health Facilities
Priority Actions
Annual Health Sector Performance Report for Financial Year 2015/16
Priority Actions
Regular update of health
3.2 Improved
facility inventories.
inventory
management at
facilities
4. SERVICE DELIVERY
Plan and budget for
4.1 Improved
3. HEALTH INFRASTRUCTURE
Budget provision for LG
3.1 Increased
Development projects which
funds for
were initiated before
infrastructure
development and reduction in PHC
Development Grant sent to
maintainance
LGs.
Increase budget provision
for running costs and
maintenance of equipment
and infrastructure of
rehabilitated hospitals
Procurement and fair
allocation of vehicles to LGs
Milestone
June 2016
Health Facility Managers
June 2016
MoH, HDPs
June 2016
June 2017
MoH, MoFPED
LGs - DHOs - Private
Facilities
June 2017
Timeframe
MoH - Senior Top
Management and
Planning Department
Responsibility
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 105
Health Facilities guided to plan &
Procured and Distributed 65
double cabin pick up trucks to
LGs
Health Facility Inventory in place
and currently being printed
Rehabilitated Hospitals allocated
more funds during FY 2016/17
Shs 9.5 Bn
LGs requested to submit Costed
plans/Arrears for inclusion in
budget for FY2017/18
in March 2016.
MoFPED requested for further
review of the costing to fit within
the MTEF and review down. To
forward new request for CFI to
MoFPED in October 2016.
Progress
Upgrading of Maternal health
and delivery capacity of the
HC II to HC IIIs to ensure
100% coverage of
Subcounties with HC IIIIs.
5. MEDICINES AND HEALTH SUPPLIES
Dissemination of guidelines
5.1 Proper
on management of donations
management of
Donations should be
donated
supplied in coordination
medicines and
with pharmacy division and
supplies
DHOs
Improve complementarities
5.2 Improve
and reduce overlapping in
coordination
between NMS, JMS the distribution of EMHS and
ART to the facilities
and MAUL
4.3 Upgrading of
HC II
4.2
Operationalizatio
n of the HC IV
June 2017
June 2016
June 2016
MoH - Pharmacy Division
MoH, NMS, JMS, MAUL
June 2017
June 2016
Timeframe
MoH, MoLG, MoFPED,
Partners
management of health care
& Partners
waste
Budget provision for medical MoH , MoFPED
waste disposal including
expired medicines
Improve staffing, equipment MoH, MoFPED, MoPS
and funding of HC IV
health care waste
management
Responsibility
Priority Actions
Milestone
Annual Health Sector Performance Report for Financial Year 2015/16
Page | 106
Facilities allocated to specific
warehouses, buffering and interhouse transfers done at central
level.
Guidelines disseminated
An additional UGX 4.7 billion
provided from FY 2016/17
towards the Constituency / HSD
Task Force meetings, health
camps, mentorship and
supervision activities
Proposed for 40 HC IIs under
URMNCAH project
budget for healthcare waste
management
Provided for under NMS
FY2016/17
Progress
Priority Actions
Institutionalize the roles of
Regional Performance
Monitoring Teams.
Revise Support Supervision
Guidelines and tools
Guidelines and tools for the
7.3 Resume
Regional Planning Regional Planning
extended to all
stakeholders
Strengthen Partnership
7.4 Improved
coordination in the MoH
Partnership
7.2 Improved
supervision and
monitoring
6. HEALTH INFORMATION
6.1 Improved data Budget allocation for
printing of new HMIS tools
quality
Train health workers in the
use of the new data tools
and mTrac.
Extend DHIS2 access rights
6.2 Increased
to lower facilities so that
HMIS data use
they can use their data.
7. GOVERNANCE AND LEADERSHIP
7.1 Inter sectoral Develop a clear center of
collaboration for authority to coordinate and
ensure effective interthe
sectoral collaboration at the
implementation
center and LGs
of HDSP
Milestone
March 2016
April 2016
MoH - Quality Assurance
Department
MoH, Planning
Department
MoH - Health Policy
Advisory Committee,
March 2016
June 2016
Sept 2016
June 2016
June 2016
June 2016
Timeframe
MoH, MoPS, MoFPED
OPM, MoH, MoLG, MOES,
MOGLSD, MOWE, MoFPED
MoH - Resource Centre,
HDPs
MoH - Resource Centre,
MoFPED
MoH - Resource Centre,
HDPs
Responsibility
Annual Health Sector Performance Report for Financial Year 2015/16
PPP Act 2015 enacted. MoU
being revised and PPPH
Page | 107
Revised planning guidelines in
place and is being printed. Soft
copies provided in this JRM
Final draft available
Being reviewed
Mechanisms in Place. Interministerial committees and
Technical Planning committees
at LG level
Still limited to district level due
to poor connectivity at health
facility level
UGX 1 billion allocated in FY
2016/17
Over 20,000 Health Workers
trained
Progress
coordination
mechanisms in
the health sector
7.5 Improved
regulation of
traditional and
complementary
practitioners
7.6 Improved
accountability of
public
expenditures
Milestone
National Drug Authority
and Professional
Councils
PS / US MoH
Development, Adoption and
Implementation of Action
Plan to address OAG annual
audit recommendations
PNFP, PHP, CSO
Responsibility
Enforcement of the existing
policies and regulations
Priority Actions
June 2016
June 2016
Timeframe
Annual Health Sector Performance Report for Financial Year 2015/16
Ongoing
Page | 108
Implementation guidelines for
PPPH in the PNFP sector
developed
On going
Progress
Annual Health Sector Performance Report for Financial Year 2015/16
4.4 Annex Four:Disaggregation of Key Performance Indicators
Indicator
Performance 2015/16
Achievement
ART Coverage
HIV+ pregnant women not on
HAART receiving ARVs for
eMTCT during pregnancy,
labour, delivery and postpartum
TB case detection Rate (all
forms)
IPT2 doses coverage for
pregnant women
1,196,547
68.3%
34,357
50,323
982,276
1,787,840
M
3,473
1,787,840
F
4,252
18,378,995
Total
7,725
35,756,800
M
F
Total
M (27%)
F (28%)
6,338,728
8,837,077
15,175,805
902,606
986,447
17,377,805
18,378,995
35,756,800
3,302,175
3,492,424
Total
1,889,053
6,794,599
M (105%)
782,600
747,246
F (99%)
779,580
790,297
Total
1,562,180
1,537,542
M
718,100 (96%)
747,246
F
715,692 (93%)
790,297
121/100,000
55%
In Patient malaria deaths per
100,000 persons per year
21
Malaria cases per 1,000
persons per year
408
Under five vitamin A second
dose coverage
28%
Measles coverage under 1 year
Bed occupancy rate
(Hospitals & HC IVs)
103%
96%
Total
1,443,015
Regional Referral
Hospital
General Hospital
4,686
9,395
15,255
HC IV
3,547
6,788
1,710,441
432,064
4
Regional Referral
Hospital
General Hospital
4,716,538
1,191,578
3
HC IV
1,279,980
521,991
83%
62%
52.2%
Average length of Stay
(Hospitals & HC IVs)
Contraceptive prevalence Rate
Couple year of protection
Denominator
898,197
NA
Coverage
Numerator
88%
IPT3 doses coverage for
pregnant women
DPT3HibHeb3
Disaggregation
4
1,537,542
5,665
30%
(UDHS 2011)
2,242,225
ANC 4+ Coverage
14%
248,076
1,787,840
ANC 4 Coverage
38%
667,119
1,787,840
Health Facility deliveries
55%
958,077
1,787,840
HC IVs offering CEmOC
services
36.4%
72
198
Annual Health Sector Performance Report for Financial Year 2015/16
Indicator
Performance 2015/16
Achievement
HC IVs conducting C/S
HC IVs conducting blood
transfusion
New OPD Utilization rate
Hospital (Inpatient)Admissions
per 100 population
Population living within 5km of
a Health Facility
Availability of a basket of
commodities in the previous
quarter (% of facilities that had
over 95%)
Facility based fresh still births
(per 1000 deliveries)
Under Five deaths among
1,000 under 5 admissions
122
198
80
198
1.0
1.5
M
F
17,983,547
26,313,103
17,377,805
17,915,056
1.2
Total
44,296,650
35,889,418
2,515,434
35,889,418
12,154
958,077
1,136
419
958,077
1,136
7.2
100%
87%
12.7
National Referral
Hospital
119
37%
Regional Referral
Hospitals
General
Hospitals
HC IVs
Total
15.1
M
9,695
642,001
22.3
F
13,125
587,620
18.6
Total
22,820
1,229,621
42,641
54,209
79%
TB treatment success rate
79%
Timeliness of reporting (HMIS
105)
Latrine coverage
Denominator
62%
ART Retention rate
Client satisfaction index
Numerator
40.4%
Maternal deaths among
100,000 health facility
deliveries
Maternal death reviews
Disaggregation
46%
(NSDS 2015)
79.4%
75%
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