HUMAN RESOURCES FOR HEALTH BI-ANNUAL REPORT

Transcription

1 Ministry of Health HUMAN RESOURCES FOR HEALTH BI-ANNUAL REPORT Improving HRH Evidence for Decision Making April 2012 September 2012 October 2012

2 Contents Acknowledgements... iii 1. INTRODUCTION The Context Health Facility inventory National level Staffing National referral hospitals Selected Health Professional staff PROPORTION OF APPROVED POSITIONS FILLED BY VARIOUS HEALTH PROFESSIONALS BY FACILITY LEVEL Health Professional staff by Health Facility level... 5 Table 2.1: Regional Referral Hospitals... 5 Table 2.2: District Health officers... 6 Table 2.3: General Hospitals... 6 Table 2.4: Health Center IV staffing... 7 Table 2.5: IIIs & II staffing SELECTED CADRES PER HEALTH FACILITY LEVEL Selected cadres per health facility level... 9 Table 3.1: Anesthetic Officers... 9 Table 3.2: Clinical Officers... 9 Table 3.3: Laboratory Assistants... 9 Table 3.4: Laboratory Technicians Table 3.5: Midwives Table 3.6: Nurses Table 3.7: Dispensers Table 3.8: Doctors Table 3.9: Public Health Dental Officers Table 3.10: Dental Surgeons Table 3.11: Health Educators Table 3.12: Health Inspectors Table 3.13: Laboratory Technologists i

3 Table 3.14: Occupational Therapist Table 3.15: Orthopedic Officers Table 3.16: Pharmacists Table 3.17: Physiotherapist Table 3.18: Medical Radiographers Summary of staffing by cadre in GoU Health Institutions (RRH, GH and Health Centres only) March Density of Nurses, midwives, clinical officers, laboratory assistants & doctors Financial implications of filling existing vacancies HRIS UPDATE IN UGANDA AS AT SEPTEMBER Districts with Computerized HRIS Rolling out HRIS to 74 districts Private Not-for profit (PNFP) as at March Assessment of Functionality of the District Service Commissions Key findings of the assessment Annex 1: SUMMARY OFVACANCIES FOR SELECTED CADRES IN DISTRICTS ii

4 Acknowledgements This is a Human Resources for Health Report which is an analysis of the data provided by the Ministry of Health of the Republic of Uganda with funding and technical support from the USAID funded Uganda Capacity program (UCP) covering the period April to September The Ministry of Health recognizes the invaluable contribution of UCP in providing both technical and financial support for HRH interventions. Thanks to UMDPC, UNMC, AHPC and PCU for useful data that is updated from time to time and for embracing HRIS that provides updated data on human resources in Uganda. We thank the PNFP umbrella organizations UPMB, UCMB and UMMB for providing the much needed information concerning the health facilities and HRH working in the PNFP subsector. We thank the local governments for participating in data collection, analysis and reporting. Finally, we thank the editorial team Mr. Francis Ntalazi and Mr.Kibwika-Muyinda (MoH), Dr. Charles Matsiko, Dr. Vincent Oketcho, Dr. Grace Namaganda, Ms Sarah Murungi and Mr.Isaac Kagimu (UCP) for working long and beyond the call of duty to work out the required numbers for inclusion in this report. Management recognizes the efforts of both technical and non technical staff in the health sector both in central and local governments that have given a hand in the production of this bi-annual report. Ministry of Health; P.O Box 7272; Kampala. iii

5 1. INTRODUCTION This is Human Resources for Health Bi-annual Report covering the period April 1, 2012 to September 30, The Health Sector Strategic and Investment Plan (HSSIP) target for human resource investment is to attain a minimum of 75% of the approved staffing norms by The HSSIP is cognisant of the fact that attaining this target is a challenge. As such, improvements in staff numbers are staggered across the years. This report provides information on the changes in staffing that has taken place during this period. 1.1 The Context The HRH situation in Uganda continues to be characterized by inadequate number and necessary skills to effectively respond to the health needs in the country. The critical shortage is further aggravated by gross mal-distribution of the scarce human resources, low staff productivity, low staff morale and poor attraction and retention especially in rural and hard to reach local governments. To further compound the HRH challenges is a complex and fragmented HRH management systems. Underlying the current HRH challenges is weak leadership at all levels of the health delivery system. This manifests as lack of individuals in responsible positions to; provide direction, align people, mobilize resources to achieve goals and to tackle the severe under-staffing of health units. The sector has inadequate consistent champions and advocates for HRH as high priority for resource allocation and support; has weak mechanisms for multi-stakeholder engagement to ensure that complex HRH issues are resolved at all levels; leadership is not linked to performance in service delivery, but strong in safeguards for due process and bureaucratic system and capacity for HRH is inadequate. A deeper analysis of the training of the current health leaders and managers reveals that their basic training did not cover HR leadership and management yet they manage the human resource on a daily basis. 1.2 Health Facility inventory Uganda has about 5,229 health facilities owned by Government of Uganda, PNFP and Private practitioners. All these health facilities have staffing implications. Government is planning to upgrade most of the health centre II to health centre III level. Table 1.1 shows a summary of the total health facilities in the country. 1

6 Table 1.1: Health facility inventory GoU GoU Gou PNFP Private Total NRH RRH Local Govt Hospitals IV III ,279 II 1, ,387 3,605 Total , ,488 5,229 Source: Health Facility inventory, July

7 1.3 National level Staffing At the national level, we did not collect new information during this period. The team working on the bi-annual re-analyzed the previous data that was available as at March 2012 and did not find any significant changes apart from the number of health facilities. The analysis is as presented in table 1.1 Table 1.2: National Level Staffing Summary as at March 2012 No Cost Centre No. of Units Total Norms Filled Vacant % Filled % Vacant 1 Mulago Hospital 1 2,801 2, % 13% 2 Butabika Hospital % 7% 3 Regional Referral Hosp 14 4,331 3,121 1,210 72% 18% 4 General Hospitals 47 7,600 4,751 2,849 63% 37% 5 DHOs Offices 112 1, % 43% 6 IV 166 7,920 4,768 3,152 60% 40% 7 III 962 5,634 3,363 2,271 60% 40% 8 II ,905 2,197 2,708 45% 55% 9 Urban Authorities ,216 10,083 10,133 50% 50% 2,779 55,073 31,788 23,285 58% 42% 3

8 1.4 National referral hospitals Table 1.3: Mulago Hospital as at March 2012 Cadre of staff/post Norms Filled Vacancy Excess % Filled Executive Director and Deputy Medical Consultants Medical officers Pharmacists and other Pharmacy Professionals Nurses Midwives Allied Health Professionals Administrative staff Support Staff TOTAL Table 1.4: Butabika Hospital as at March 2012 % Cadre of staff Norms Filled vacant Excess filled Director Medical officers Consultants Pharmacy Nursing Allied Health Professionals Administrative Support Staff TOTAL Selected Health Professional staff This HRH biannual presents data of approved positions filled for a selected number of cadres at each of the health facility levels from Regional Referral Hospitals down to IIs. The cadres include: laboratory technicians; nurses; laboratory assistants; clinical officers; midwives; anesthetic officers, dental surgeons; dispensers; doctors; health educators; health inspectors; laboratory technologists; occupational therapist; orthopedic officers; pharmacists; physiotherapists; public health dental officers and radiographer. The results are based on secondary analysis of the 2010 and 2011 biannual reports. 4

9 2. PROPORTION OF APPROVED POSITIONS FILLED BY VARIOUS HEALTH PROFESSIONALS BY FACILITY LEVEL 2.1 Health Professional staff by Health Facility level In this section, staffing levels for selected cadres are presented by level starting with the RRHs up to IIs. The section is intended to provide an overall picture of the staffing available in the country by health facility level. Table 2.1: Regional Referral Hospitals 13 Regional Referral Hospitals Cadre Total norm Total filled Vacancies % filled Orthopedic Officers % PHDOs % Midwives % Nurses 1,386 1, % Dental Surgeons % Occupational Therapist % Physiotherapist % Clinical Officers % Laboratory Assistant % Radiographers % Anesthetic Officer % Laboratory Technicians % Pharmacists % Laboratory Technologists % Dispenser % Doctors % Consultants % From the table above, we note that the key staffing shortage at RRH is among the Medical Consultants, Doctors (Medical Officers special grade and general medical officers), dispensers, laboratory technologists and pharmacists and to lesser extent laboratory technicians. 5

10 Table 2.2: District Health officers No. Job Title Approved Norm Total filled Vacancies % filled 1 District Health Officer % 2 Assistant DHO (Environ. Health) % 3 Assistant DHO (MCH/Nursing) % Total % Overall there is an acute shortage of Assistant DHOs (maternal health and environmental health) with 97 districts lacking at least one of these cadres. In addition, 34 districts do not have a DHO. To full staff the districts with one DHO, one Assistant DHO Maternal Health and one Assistant DHO environmental there would be need to recruit 34 DHOs and 194 ADHOs. The additional wage required to accomplish this would be 5.4 billion shillings. This as illustrated in table 2.3. Table 2.2 (b): District Health offers No. Job Title Vacancies Wage required 1 District Health Officer ,383,688 2 Assistant DHO (Environ. Health) 97 2,290,089,895 3 Assistant DHO (MCH/Nursing) 97 2,290,089,895 Total 228 5,437,563,478 Data was analyzed for a total of 47 general hospitals in the country. The filled and vacant positions for professional health workers were isolated. Information from this secondly analysis is summarized in table 2.3 below. Table 2.3: General Hospitals General Hospitals Cadre Total Norm Filled Vacant % filled Laboratory Assistant % Clinical Officers % Dental Surgeons % Orthopedic Officers % Health Inspectors % Laboratory Technicians % Public Health Dental Officers % Midwives 1, % Dispenser % Physiotherapist % Nurses 3,431 1,684 1,747 49% Anesthetic Officer % Radiographer % Doctors % Laboratory Technologists % 6

11 Health Educators % Occupational Therapist % Pharmacist % General hospitals are relatively well staffed with laboratory assistants, clinical officers, dental surgeons and orthopedic officers. On the other hand however the following cadres are in shortage when compared to the staffing norms: Pharmacists, occupational therapists, health educators, laboratory technologists, doctors, radiographers, anesthetic officers, nurses, physiotherapists and midwives. At the IV, some cadres such as the laboratory assistants and midwives seem to be present as indicated in table 2.4. Table 2.4: Health Center IV staffing IV Cadre Total Norm Filled Vacant % filled Midwives % Laboratory Assistant % Laboratory Technician % Clinical Officers % Public Heath Dental Officer % Nurses 1, % Health Inspectors % Medical Officers % Health Educators % Anesthetic Officer % Dispensers % In IVs although the proportion of approved norms for midwives is at 90%, workload studies show that the midwives at this level still face high work pressures. The norm for midwives at IV is 4 and these are expected to run the maternity ward 24 hours a day and run the busy ANC clinics providing routine ANC, PMTCT and child health services. Workload studies have shown that at least 8 midwives are required at a IV level to manage the workload appropriately and for quality health service delivery. As noted in the table, there is an acute shortage of dispensers, anesthetic officers, health educators, doctors at the IVs. Table 2.5: IIIs & II staffing 111s Cadre Total norm Total filled Vacancies % filled Midwives , % Clinical Officers % Laboratory Assistant % Nurses % Lab technician % 7

12 11s Cadre Total norm Total filled Vacancies % filled Nurses 1, % Midwives 1, % Like in IVs, the staffing for midwives when compared to the norms seems high. However workload studies show that IIIs need at least 4 midwives to accomplish the work they experience versus the 2 provided for in the norm. IIIs have a shortage of laboratory cadres and nurses as noted on the table above. There is also a shortage of midwives in IIs with 70% of the IIs having no midwife. 8

13 3. SELECTED CADRES PER HEALTH FACILITY LEVEL 3.1 Selected cadres per health facility level In this section, the staffing levels for selected cadres are presented by cadre across the health facility levels to demonstrate how the cadres are distributed across the health facility levels. Table 3.1: Anesthetic Officers Anesthetic Officers Health Unit Level Total Norm Filled Vacant % filled Regional Referral Hospitals % General Hospitals % IV % Total % Overall staffing level for anesthetic officers is 39%. The distribution is as has been reported in other HRH studies where the RRHs have the highest proportion of filled positions and the IVs having the least. There are 231 vacancies for anesthetic officers (IV 129, general hospitals 79 and RRHs 23) Table 3.2: Clinical Officers Clinical Officers Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % III % RRH % Total 3,134 2,064 1,070 66% On average 66% of the approved clinical officer positions are filled. The proportion of filled positions filled is highest for general hospitals (90%) and lowest for IIIs (59%). To fill all the clinical officer positions, there is need for an additional 1,070 clinical officer s majority of whom would be for IVs and IIIs. Table 3.3: Laboratory Assistants Laboratory Assistants Health Unit Level Total Norm Filled Vacant % filled Regional Referral Hospitals % General Hospitals % IV % III % Total 1, % Laboratory assistants are staffed at 61%. Total vacancies are 486 with majority of these being in IIIs. 9

14 Table 3.4: Laboratory Technicians Laboratory Technicians Health Unit Level Total Norm Filled Vacant % filled RRH % General Hospitals % IV % Total % Staffing for laboratory technicians is 70%. However 78 vacancies still remain unfilled. Table 3.5: Midwives Midwives Health Unit Level Total Norm Filled Vacant % filled General Hospitals 1, % IV % III , % II 1, % RRH % Total 5,995 3,771 2,224 63% Overall the proportion of approved midwife positions filled is 63%. There are 2,224 midwife positions not filled and majority of these are in IIs, IIIs and hospitals. Table 3.6: Nurses Nurses Health Unit Level Total Norm Filled Vacant % filled Regional Referral Hostpitals 1,386 1, % General Hospitals 3,431 1,684 1,747 49% IV 1, % III % II 1, % Total 9,928 5,050 4,878 51% The staffing level for nurses is at 51%. The health facilities with the highest staffing levels were RRHs and IIs. But findings from workload studies show that the staffing norms for nurses in IIIs, IVs and IIs are low compared to the workload they experienced. Workload studies show that IVs require on average 12 nurses versus the 8 provided for in the norm, IIIs require on average 7 nurses versus the 4 provided for in the norm. 4,878 nurse vacancies remain unfilled majority of the vacancies are in general hospitals. 10

15 Table 3.7: Dispensers Dispensers Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % RRH % Total % The staffing level for dispensers was found to be 36%. IVs in particular have an acute shortage of dispensers having only 21% of the approved filled. 211 positions remain unfilled 131 of these in IVs. Table 3.8: Doctors Doctors Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % RRH % Total 1, % With an overall staffing level of 38% there is an acute shortage of doctors in the health sector. This shortage is wide spread affecting all levels of facility levels. There is need to recruit 744 doctors for the hospitals and IVs. Table 3.9: Public Health Dental Officers Public Health Dental Officers Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % RRH % Total % Overall 72% of the approved norms for PHDOs are filled with the RRHs having the highest number of this cadre. Table 3.10: Dental Surgeons Dental Surgeons Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % Overall 77% of the approved norms for dental surgeons are filled with the highest filling rate being in general hospitals. 11

16 Table 3.11: Health Educators Health Educators Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % Total % As noted in the table above, there is an acute shortage of health educators in hospitals and IVs. A total of 180 positions of health educators remain vacant. Table 3.12: Health Inspectors Health Inspectors Health Unit Level Total Norm Filled Vacant % filled General Hospitals % IV % Total % Overall 53% of the approved norms for health inspectors are filled with the highest filling rate being in general hospitals. A total of 177 positions remain vacant. Table 3.13: Laboratory Technologists Laboratory Technologists Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % Generally there is a shortage of laboratory technologists. The shortage affects the general hospitals more than RRHs. Table 3.14: Occupational Therapist Occupational Therapist Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % There is a shortage of occupational therapists in general hospitals which have on 30% of approved positions filled. 12

17 Table 3.15: Orthopedic Officers Orthopedic Officers Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % Orthopedic officers are generally more available in the hospitals (overall average is 84%). 45 positions remain unfilled. Table 3.16: Pharmacists Pharmacists Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % The shortage of pharmacists is critical especially in general hospitals. Overall only 30% of the approved positions for pharmacists are filled leaving 64 vacancies. Table 3.17: Physiotherapist Physiotherapist Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % Overall the staffing level of physiotherapists was 63% with the vacancy rate of 37%. Table 3.18: Medical Radiographers Radiographers Health Unit Level Total Norm Filled Vacant % filled General Hospitals % RRH % Total % Overall the staffing level of Medical Radiographers was 51% with the vacancy rate of 49%. 13

18 3.2 Summary of staffing by cadre in GoU Health Institutions (RRH, GH and Health Centres only) March 2012 Table 3.19: Filled and vacant positions in GoU Health Insstitutions Cadre % filled Vacancies Pharmacist 30% 64 Health Educators 31% 180 Dispenser 36% 211 Medical Officer 38% 744 Anesthetic Officer 39% 231 Laboratory Technologists 41% 89 Nurses 51% 4,878 Radiographer 51% 51 Health Inspectors 53% 177 Laboratory Assistant 61% 486 Midwives 63% 2,224 Physiotherapist 63% 43 Clinical Officers 66% 1,070 Laboratory Technicians 70% 78 Occupational Therapist 70% 128 Public Health Dental Officers 72% 106 Dental Surgeons 77% 68 Orthopedic Officers 84% 45 Average/Total 55% 10,873 Overall the staffing level for the selected health professionals is 5 5% with a total of 10,873 vacancies. In descending order of shortage, pharmacist, health educators, dispensers, doctors, anesthetic officers, laboratory technologists, nurses and radiographers are the cadres in critical shortage. 14

19 3.3 Density of Nurses, midwives, clinical officers, laboratory assistants & doctors Analysis was done of the nurses, midwives, clinical officers, laboratory assistants and doctors. The results of this analysis are presented in Figure 1 below: Figure 1 Number of selected clinical and diagnostic staff in GoU health institutions 15

20 Figure 2: Occupational therapists, PHDOs, health inspectors, anesthetic officers, dispensers, dental surgeons and orthopedic officers 16

21 4. Financial implications of filling existing vacancies Cadre % filled Vacancies Total annual salary & allowances Total wage required Pharmacist 30% 64 13,738, ,238,848 Dispenser 36% 211 9,431,401 1,990,025,704 Doctors 38% ,738,107 10,221,151,608 Anesthetic Officer 39% 231 9,431,401 2,178,653,733 Laboratory Technologists 41% 89 9,431, ,394,728 Nurses 51% 4,878 5,952,471 29,036,151,372 Radiographer 51% 51 9,431, ,001,473 Laboratory Assistant 61% 486 5,952,471 2,892,900,690 Midwives 63% 2,224 5,952,471 13,238,294,517 Physiotherapist 63% 43 9,431, ,550,262 Clinical Officers 66% 1,070 9,431,401 10,091,599,541 Laboratory Technicians 70% 78 9,431, ,649,312 Occupational Therapist 70% 128 9,431,401 1,207,219,384 Public Health Dental Officers 72% 106 9,431, ,728,553 Dental Surgeons 77% 68 13,738, ,191,276 Orthopedic Officers 84% 45 9,431, ,413,065 Health Educators 31% 180 9,431,401 1,697,652,259 Health Inspectors 53% 177 9,431,401 1,669,358,055 Average/Total 55% 10,873 79,922,174,380 Source of salary data is 2012/13 salary structure To fill the norms for the above selected cadres would require a total of 79.9 billion shillings. 17

22 Figure 1: Laboratory technicians, health educators, laboratory technologist, radiographers, physiotherapists and pharmacists 18

23 5. HRIS UPDATE IN UGANDA AS AT SEPTEMBER Districts with Computerized HRIS This Map shows (In green) the Districts (74) with Computerized HRIS to date. The districts are not at the same level of HRIS implementation. Training of data managers and mentoring is ongoing. During the period under review, the districts where HRIS is established were given extensive technical support directly through coaching visits or online trouble shooting in collaboration with USAID funded Uganda Capacity Program. The interns and HRIS resource persons at the centre and at the regional level played a pivotal role in this support as a way of further building their capacity in the management of the HRIS. Key areas of support included retraining data users and managers in cases where there were staff movements and as a refresher to those who were trained earlier. The data managers were further coached on how to keep the system up to date and how to generate different reports from the system. The coaching visits were also used as an opportunity to discuss in detail with users the different reports and gain a deeper understanding of the unique needs. In total 372 staff were trained majority of whom were in districts. 19

24 5.2 Rolling out HRIS to 74 districts The roll out of HRIS to 74 districts has been a collaborative venture. The MoH supported by USAID funded Uganda Capacity Program has worked with the school of computing Makerere University and other development partners to further build capacity for HRIS. The students of Makerere University join the IT team on attachment for industrial training over a period of 6 months. In addition to internship, UCP has supported the training of 8 lecturers in HRIS. As a result of this collaboration, all the databases have been kept functional throughout this period. Below is a map showing the geographical roll-out of HRIS in 74 districts by various partners and year of establishment. Key: Below are the names of the districts matching the numbers displayed on the map above 20

25 Id Name HRIS Supported Established Id Name HRIS Supported Established 1 KAMPALA No 57 MPIGI Yes UCP ADJUMANI Yes UCP MUBENDE Yes WHO ARUA Yes UCP MUKONO Yes UCP BUNDIBUGYO Yes Baylor MITYANA Yes WHO BUSIA Yes WHO NAKASEKE No 6 BUTALEJA Yes UCP NAKASONGOLA Yes UCP KABALE Yes UCP RAKAI Yes UCP KANUNGU Yes UCP SSEMBABULE Yes UCP KASESE Yes Baylor WAKISO Yes Capacity KISORO Yes UCP HOIMA Yes WHO KOBOKO Yes UCP KIBAALE Yes UCP MANAFWA Yes UCP MASINDI Yes UCP MBALE Yes WHO BULIISA No 14 MOYO Yes UCP AMURIA No Baylor NEBBI Yes UCP BUKEDEA Yes Baylor PALLISA Yes UCP KABERAMAIDO No Baylor BUDAKA Yes UCP KUMI Yes UCP RUKUNGIRI Yes UCP SOROTI Yes UCP SIRONKO Yes UCP KATAKWI No Baylor TORORO Yes WHO KABAROLE Yes Capacity YUMBE No 77 KAMWENGE Yes Baylor ABIM No 78 KYENJOJO Yes WHO KAABONG No 79 BUDUDA Yes UCP KOTIDO No 80 AMUDAT No 25 NAKAPIRIPIRIT No 81 BUIKWE No 26 MOROTO No 82 BUYENDE No 27 BUKWA Yes Baylor KYEGEGWA Yes Baylor KAPCHORWA Yes UCP LAMWO No 29 AMOLATAR Yes Capacity OTUKE No 30 APAC Yes UCP ZOMBO No 31 LIRA Yes Capacity ALEBTONG No 32 OYAM Yes Capacity BULAMBULI Yes Baylor DOKOLO Yes UCP BUVUMA No 34 GULU Yes NUMAT GOMBA No 35 AMURU No 91 KIRYANDONGO No 36 PADER Yes NUMAT KYANKWANZI No 37 KITGUM Yes NUMAT LUUKA No 38 BUGIRI Yes UCP NAMAYINGO No 39 IGANGA Yes UCP NTOROKO Yes Baylor JINJA Yes UCP SERERE No Baylor MAYUGE Yes UCP KALUNGU No 42 KALIRO Yes UCP BUKOMANSIMBI No 43 NAMUTUMBA Yes UCP BUTAMBALA Yes UCP KAMULI Yes UCP LWENGO No 45 MBARARA Yes WHO MITOOMA No 21

26 Id Name HRIS Supported Established Id Name HRIS Supported Established 46 BUSHENYI Yes WHO RUBIRIZI No 47 NTUNGAMO Yes UCP SHEEMA No 48 IBANDA Yes WHO BUHWEJU No 49 ISINGIRO Yes UCP NGORA No Baylor KIRUHURA Yes UCP NAPAK No 51 KAYUNGA Yes UCP KIBUKU Yes Baylor KALANGALA Yes UCP NWOYA No 53 KIBOGA No 109 KOLE No 54 LUWERO Yes UCP AGAGO No 55 LYANTONDE No 111 MARACHA No 56 MASAKA No 112 KWEEN Yes Baylor

27 Map of Uganda showing the geographical roll-out of HRIS according to year of Establishment 23

28 Map of Uganda showing the geographical location of HRIS and Partner support 24

29 Hris Website at MoH: Health workers Registration and Licensure Status You can also send SMS type doctor <space> full names of doctor and send to

30 6. Private Not-for profit (PNFP) as at March 2011 In the Private-Not-for profit (PNFP) health facilities there were only 12,383 health workers in all the three umbrella organizations namely Uganda Catholic Medical Bureau (UCMB), Uganda Protestant Medical bureau (UPMB) and Uganda Moslem Medical Bureau (UMMB) as of June 30, Of these 7,488 were in the UCMB network, 3,856 in the UPMB network and 1,039 in the UMMB network. UCMB alone as of June 30 th 2011 there were 225 doctors, 2011 nurses, and 2825midwives (all calibers put together) out of the total workforce of 7,488 in its network. However, the country needs about twice this number of professional health workers in order to address the current health needs. Table 6.1 Cadres of health workers in the UCMB Network Cadre # of Staff Doctors 225 Nurses 2,011 Midwives 2,825 All others 2,427 Total 7, Assessment of Functionality of the District Service Commissions District Service commissions in Uganda were assessed to find out their functionality to address human resource needs. The assessment was conducted using a questionnaire which was administered to representatives of various DSCs. The questionnaire required the respondents to describe the situation pertaining to their individual service commissions. The results were analyzed using a simple excel sheet. 7.1 Key findings of the assessment The assessment findings indicate that the DSCs are at differing levels of functionality as per the assessment conducted. Some few are well equipped to handle the planned recruitment while the rest shall need support in order to prepare them adequately to handle recruitment of staff in local governments. Results of the analysis are summarized table 7.1 below. 26

31 Table 7.1 Summary of the findings of the 104 DSCs Assessed Indicator Total DSCs fully constituted with a chairperson and 4 members 26 DSCs without quorum (less than 3 members) 11 DSCs with less than 3 members inducted 44 DSCs about to expire in 3 months and below 9 DSCs which have not handled a recruitment in the last one year 23 DSCs with no Substantive Secretary appointed 63 DSCs with SPO and PO in addition to SEC DSC (Hoima) 1 DSCs with a PO in addition to the SEC DSC 15 DSCs without a computer 36 According to the set standards, a functional DSC is expected to have a substantive Secretary to the Commission at the level of Principal Personnel Officer, a Personnel Officer, a Records Assistant, a Stenographer / Copy typist and an Office Assistant. It should also have a substantive Chairperson and four Commission Members. In the table above we note that not all the DSCs meet these criteria. DSCs fully constituted with a chairperson and four members. DSCs were asked to mention whether they were fully constituted or not. The information obtained was analyzed to establish if there was a substantive chairperson and other four members. Results out of this analysis are presented in table 7.2 below. 7.2 The list of districts with chairpersons and other 4 members by region S/ No. District Service Commission Region Chairperson # Members Term of office for quorum # Inducted 1 Abim Northern years 0 2 Arua Northern years 5 3 Buikwe Central months 5 4 Bukedea Eastern Years 5 5 Bundibugyo Western months 5 6 Bushenyi Western years 5 7 Dokolo Northern months 5 8 Gomba Central months 5 9 Gulu Northern Years 5 10 Hoima Western years 5 27

32 11 Ibanda Western months 3 12 Iganga Eastern years 0 13 Kasese Western Years 3 14 Katakwi Eastern years 2 15 Koboko Northern Years 5 16 Kyenjojo Western years 5 17 Lira Northern years 5 18 Mbarara Western years 5 19 Mityana Central years 5 20 Mpigi Central years 2 21 Mubende Central years 4 22 Nakasongola Central months 3 23 Namutumba Eastern years 0 24 Otuke Northern years 3 25 Serere Eastern months 3 26 Zombo Northern years 0 Out of the 104 DSCs assessed only 26 have all the positions for the Commission members filled. These DSCs have an advantage that they can appropriately handle large volumes of applicants when it comes to interviewing. The DSC in this category can easily split into several interview panels when need arises. A service commission with less members would take longer time to interview large numbers of applicants compared to the one which is fully constituted. DSCs with no required membership to form a quorum for transacting business Further analysis of the data collected indicated that some DSCs did not have the required number of members to transact business. This is a requirement under the laws of Uganda particularly the Local Government Act. Findings out of this analysis are summarized in table 7.3 below. 28

33 Table 7.3: The DSCs which do not form a quorum S/ No. District Service Commission Region Chairperson # Members Tot. Members 1 Amudat Northern Busia Eastern Kabale Western Kabarole Western Kalungu Central Kotido Northern Kyankwanzi Central Luuka Eastern Luwero Central Nakaseke Central Soroti Eastern From the table above, some districts have 1 member and others have 2 members of DSC out the total 5 required. For any service commission to conduct usual business there is a requirement to have at least three members on the commission. In the absence of that requirement the commission cannot transact any business whatsoever. There are 11 DSCs which do not fulfill this requirement at the moment and this means that if their districts are to recruit health workers as planned they cannot rely on their service commissions. As an alternative the law provides that these districts have to liaise with neighbouring DSCs to lend them a hand to enable them recruit the needed workers. DSCs with less than three commission members inducted. DSCs were asked as to whether their members were inducted according to standard when they were recruited. Some of them indicated that they were inducted but others were not inducted according to the set standards. Findings out of this analysis are summarized in table 7.3 below. 29

34 Table 7.4: The DSCs whose members were not properly inducted S/ No. District Service Commission Region Chairperson Term of office for quorum # Members Tot. Members # Inducted 1 Abim Northern years 0 2 Adjumani Northern years 1 3 Apac Northern years 0 4 Bududa Eastern months 0 5 Bugiri Eastern months 2 6 Bukwo Eastern years 1 7 Buliisa Western months 0 8 Busia Eastern months 0 9 Buyende Eastern years 0 10 Iganga Eastern years 0 11 Jinja Eastern months 0 12 Kabale Western years 0 13 Kabarole Western Kaliro Eastern months 1 15 Kalungu Central Kamuli Eastern years 0 17 Katakwi Eastern years 2 18 Kayunga Central Years 2 19 Kibuku Eastern Years 0 20 Kisoro Western months 2 21 Kotido Northern years 1 22 Kween Eastern months 0 23 Kyankwanzi Central months 2 24 Luuka Eastern months 0 25 Luwero Central years 2 26 Lyantonde Central years 0 27 Masaka Central years 1 28 Mayuge Eastern months 0 29 Mbale Eastern years 1 30 Moroto Eastern months 0 31 Moyo Northern months 0 32 Mpigi Central years 2 33 Nakaseke Central years 0 34 Namayingo Eastern months 0 35 Namutumba Eastern years 0 36 Nebbi Northern years 1 37 Ngora Eastern months 0 38 Ntoroko Western years 2 30

35 39 Pader Northern months 2 40 Pallisa Eastern Years 0 41 Soroti Eastern year 2 42 Wakiso Central months 1 43 Yumbe Northern years 0 44 Zombo Northern years 0 The induction for new members of a commission is very crucial in preparing them to undertake the tasks ahead of them. When new members are not inducted properly they face challenges in making decisions, more so when the commission has to break into sub panels in order to handle large numbers of interviewees. This may affect their functionality and they may end up making inappropriate decisions in the course of their daily work. There are 44 district service commissions which fall in this category which is 39% of the total districts. DSCs about to expire in three months time and less The validity of the contract time for the members of a service commission is paramount because it affects their legality in conducting commission business. Given the time urgency of the planned recruitment there are 9 DSCs whose service time may expire before they bring the planned recruitment of health workers to a logical conclusion. These need urgent attention to ensure that the exercise runs smoothly without undue interruptions. This includes districts without commissions in place as well (category of less than 3 commission members). Here below are the DSCs affected. Table 7.5 gives details of these districts. Table 7.5 DSC about to expire in 3 months time or less S/ No. District Service Commission Region Chairperson # Members Tot. Members Term of office for quorum 1 Amudat Northern Budaka Eastern Months 3 Kaabong Eastern months 4 Kabarole Western Kalungu Central Kapchorwa Eastern months 7 Kisoro Western months 8 Kole Northern Kyankwanzi Central months 31

36 DSCs which have not handled a recruitment in the last one year period This particular indicator relates to the acquired experience by a DSC to deal with recruitments. At this time we expect district service commissions to receive numerous applications which will require innovations from the DSC members on how to go about the whole process. Further analysis indicated that a number of districts have not handled a recruitment in the last one year. Findings of this analysis are indicated in table 7.6. Table 7.6 DSC that have not recruited in the last one year S/ No. District Service Commission Region Date of last recruitment handled 1 Adjumani Northern July Amudat Northern 3 Arua Northern 4 Buikwe Central December Buliisa Western 6 Busia Eastern November Kabale Western 8 Kabarole Western 9 Kalungu Central 10 Kamwenge Western May Kapchorwa Eastern June Kasese Western June Kotido Northern October Kumi Eastern April Luuka Eastern 16 Lyantonde Central 0 17 Mpigi Central April Mukono Central June Nakaseke Central December Namayingo Eastern 21 Nebbi Northern December Oyam Northern Sembabule Central July 2011 As indicated in the table above, a total of 23 DSCs did not handle any recruitment in the last one year. This implies that the DSCs may need some technical assistance in 32

37 handling the planned recruitment for health workers. This group is critical because it has 9 members who do not appear to have handled any recruitment at all in the past. These are Amudat, Arua, Buliisa, Kabale, Kabarole, Kalungu, Luuka, Lyantonde and Namayingo. DSCs with no substantively appointed secretary to the commission Members of the DSC were asked as to whether they have substantively appointed secretaries to their commissions. The presence of a substantively appointed secretary to the commission at the appropriate level of principal personnel officer translates into appropriate interpretation of the legal requirements and proper functioning of the DSC. The list below indicates 63 DCSs which have not confirmed the appointments of the incumbents in the position of secretary to the DSC. Table 7.7 Districts with no substantively appointed Secretaries S/ No. District Service Commission Region (Sec DSC) Appointment Level (PPO, etc) Other Assisgnments 1 Abim Northern Acting SAS SAS / ACAO 2 Agago Northern Acting SAS Clerk to Council 3 Alebtong Northern Acting PO 4 Amolatar Northern Acting SPO 5 Amudat Northern Acting SPO 6 Apac Northern Acting SPO 7 Bududa Eastern Acting SAS Sec District land board 8 Bugiri Eastern Acting SAS SAS Sub county 9 Buhweju Western Acting Dist. Env. Officer 10 Buikwe Central Acting Sports Officer 11 Bukedea Eastern Acting SPO Clerk to Council 12 Bukomansimbi Central Acting SPO 13 Bukwo Eastern Acting SPO 14 Butaleja Eastern Acting PO 15 Butambala Central Acting SPO 16 Buvuma Central Acting PO 17 Buyende Eastern Acting SPO 18 Dokolo Northern Acting PO 19 Ibanda Western Acting PO 20 Iganga Eastern Acting Ass. CAO ACAO 21 Isingiro Western Acting PO 22 Kaabong Eastern Acting SAS ACAO 33

38 S/ No. District Service Commission Region (Sec DSC) Appointment Level (PPO, etc) Other Assisgnments 23 Kabarole Western Acting PO Payroll management 24 Kalangala Central Acting PAS ACAO 25 Kaliro Eastern Acting PO 26 Kalungu Central Acting SPO 27 Kamuli Eastern Acting PPO 28 Kanungu Western Acting SPO 29 Kasese Western Acting PO 30 Katakwi Eastern Acting ARO 31 Kiruhura Western Acting PO 32 Kitgum Northern Acting PO PO - Kitgum Hospital 33 Kotido Northern Acting PO 34 Kween Eastern Acting SAS 35 Kyankwanzi Central Acting PO 36 Lira Northern Acting PO 37 Luuka Eastern Acting PO 38 Luwero Central Acting PPO Clerk to Council 39 Lwengo Central Acting SAS SAS 40 Masaka Central Acting SPO CAO's Office 41 Mitooma Western Acting PO 42 Mityana Central Acting PAS 43 Moroto Eastern Acting SPO PO - Moroto Hospital 44 Moyo Northern Acting PO 45 Nakasongola Central Acting SPO 46 Namayingo Eastern Acting SPO 47 Namutumba Eastern Acting SAS 48 Napak Eastern Acting PPO Clerk to Council 49 Nebbi Northern Acting SAS 50 Ngora Eastern Acting PO 51 Ntoroko Western Acting PO 52 Ntungamo Western Acting SPO 53 Nwoya Northern Acting SPO Clerk to Council 54 Otuke Northern Acting SAS ACAO 55 Oyam Northern Acting SPO Subcounty chief 56 Pader Northern Acting SAS Town Clerk 57 Pallisa Eastern Acting PO 58 Rubirizi Western Acting SAS ACAO 59 Sheema Western Acting SAS 60 Sironko Eastern Acting PO 61 Wakiso Central Acting SPO Deputy Town Clerk 62 Yumbe Northern Acting SPO 34

39 District Service (Sec DSC) S/ No. Commission Region Appointment Level (PPO, etc) Other Assisgnments 63 Zombo Northern Acting SAS Town Clerk Results indicate that many of the DSCs are below the recommended level of PPO while others are at the same time committed to other assignments within the district; meaning that they cannot give full time dedication to the affairs of the DSC. Most outstanding are the secretaries for Buhweju DSC (District environment officer), Buikwe (Sports officer), Iganga (ACAO) and Katakwi (Assistant Records Officer) who may not have the requisite technical skills for handling DSC affairs. DSCs with at least a personnel officer in addition to the DSC Secretary In order for the incumbent Secretary to the DSC to appropriately carry out their functions there is need for a technical back up of the appropriate cadres. DSCs were asked as to whether there is at least a personnel officer in addition to the Secretary of the DSC. Results are as indicated in table 7.8 Table 7.8 Districts with at least a personnel officer in addition to the DSC secretary S/ No. District Service Commission Region Technical back up cadres SPO 1 Budaka Eastern 1 2 Bugiri Eastern 1 3 Butambala Central 1 4 Buvuma Central 1 5 Hoima Western Kaberamaido Eastern 1 7 Kotido Northern 1 8 Mubende Central 1 9 Mukono Central 1 10 Nakasongola Central 1 11 Namayingo Eastern 1 12 Namutumba Eastern 1 13 Nebbi Northern 1 14 Otuke Northern 1 15 Wakiso Central 1 PO 35

40 Findings indicate that many DSCs are operating without this technical back up and it affects the way they conduct business especially where the incumbent secretary to the DSC is not of the appropriate level. There is a total of only 15 DSCs with the appropriate technical back up to support the secretary of the DSC. It should be noted that it is only Hoima DSC which has all the required numbers of Commission members and technical support cadres. 36

41 DSCs with no computers to conduct business S/ No. In order for the DSC to conduct business smoothly there is need for equipment such as computers and printers which are used in the process of generating short lists for candidates and communicating with the candidates. DSCs were asked as to whether they had computers and printers to help them work efficiently and effectively. Findings out of this analysis are as indicated in table 7.9 Table 7.9: DSCs with no computers to conduct business District Service Commission Region # Computers # working # scanners # printers # Photocopiers # telephones 1 Abim Northern No 2 Adjumani Northern No 3 Agago Northern No 4 Alebtong Northern No 5 Amolatar Northern 1 0 No 6 Amudat Northern No 7 Apac Northern 1 0 No 8 Buhweju Western No 9 Buikwe Central Yes 10 Bukomansimbi Central yes 11 Buliisa Western No 12 Butambala Central No 13 Buvuma Central Yes 14 Buyende Eastern No 15 Gomba Central No 16 Kaabong Eastern 1 0 No 17 Kabarole* Western No 18 Kalungu Central 19 Kamwenge Western No 20 Katakwi Eastern No 21 Kibaale Western No 22 Kole Northern 23 Kween Eastern No 24 Kyankwanzi Central No 25 Kyegegwa Western No 26 Luuka Eastern No 27 Lwengo Central No 28 Maracha * Northern No 29 Masindi Western 1 No 30 Napak Eastern No 37 Access to Internet

42 S/ No. District Service Commission Region # Computers # working # scanners # printers # Photocopiers # telephones 31 Ngora Eastern No 32 Ntoroko Western No 33 Nwoya Northern Yes 34 Otuke Northern No 35 Pader Northern No 36 Serere Eastern No 37 Tororo Eastern Yes 38 Zombo Northern No Access to Internet A total of 38 DSCs indicated that they did not have access to computers to enable them conduct business in an efficient manner implying that the majority of them did not have access to internet services. However, further analysis indicated that some districts such as Kasese were supported by UCP with computers. 38

43 Annex 1: SUMMARY OFVACANCIES FOR SELECTED CADRES IN DISTRICTS No. 1 Abim District DHO Medical Officer U4U Clinical Officer U5U Nursing Officer (Nursing) U5U Nursing Officer (Midwifery) U5U Laboratory Technologist U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Laboratory Assistant U7U Enrolled Nurse U7U Enrolled Midwife U7U Anesthetic Attendant U8U Sub-total Abim District Adjumani District DHO District Health Officer U1EU Medical Officer U4U Clinical Officer U5U Nursing Officer (Nursing) U5U Nursing Officer (Midwifery) U5U Laboratory Technologist U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Laboratory Assistant U7U Enrolled Nurse U7U Enrolled Midwife U7U Records Assistant/H. Inf. Asst. U7U Nursing Assistant U8U Anesthetic Attendant U8U Sub-total Adjumani District

44 No. 3 Agago District DHO District Health Officer U1EU Assistant DHO (Environ. Health) U2U Assistant DHO (MCH/Nursing) U2U Clinical Officer U5U Nursing Officer (Nursing) U5U Laboratory Technician U5U Laboratory Assistant U7U Enrolled Nurse U7U Enrolled Midwife U7U Nursing Assistant U8U Sub-total Agago District Alebtong District DHO District Health Officer U1EU Assistant DHO (Environ. Health) U2U Assistant DHO (MCH/Nursing) U2U Clinical Officer U5U Nursing Officer (Nursing) U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Enrolled Nurse U7U Enrolled Midwife U7U Records Assistant/H. Inf. Asst. U7U Nursing Assistant U8U Sub-total Alebtong District

45 5 Amolatar District DHO District Health Officer U1EU Assistant DHO (Environ. Health) U2U Assistant DHO (MCH/Nursing) U2U Nursing Officer (Nursing) U5U Nursing Officer (Midwifery) U5U Laboratory Technician U5U Dispenser U5U Laboratory Assistant U7U Enrolled Midwife U7U Records Assistant/H. Inf. Asst. U7U Nursing Assistant U8U Sub-total Amolatar District Amudat District DHO District Health Officer U1EU Assistant DHO (Environ. Health) U2U Assistant DHO (MCH/Nursing) U2U Clinical Officer U5U Nursing Officer (Nursing) U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Laboratory Assistant U7U Enrolled Nurse U7U Enrolled Midwife U7U Records Assistant/H. Inf. Asst. U7U Nursing Assistant U8U Sub-total Amudat District

46 7 Amuria District DHO Medical Officer U4U Clinical Officer U5U Nursing Officer (Nursing) U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Enrolled Nurse U7U Enrolled Midwife U7U Nursing Assistant U8U Sub-total Amuria District Amuru District DHO Sub-total 3 Medical Officer U4U Nursing Officer (Midwifery) U5U Laboratory Technician U5U Dispenser U5U Anesthetic Officer U5U Enrolled Nurse U7U Enrolled Midwife U7U Records Assistant/H. Inf. Asst. U7U Sub-total Amuru District