Annual Health Sector Performance Report

Transcription

1 The Republic of Uganda MINISTRY OF HEALTH Annual Health Sector Performance Report Financial Year 2012 / 2013 Affari Esteri allo Sviluppo Ministero degli [Annual Health Sector Performance Report 2012/13 FY] Printed with the contribution of the Italian Cooperation Page i

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3 Foreword The Annual Health Sector Performance Report for 2012/13 Financial Year provides progress of the annual workplan as well as the overall health sector performance against the set targets for the Financial Year 2012/13 with a comparative analysis of the previous trends and progress towards achieving the HSSIP 2010/ /15 targets. The report shall be discussed at the 19th Annual Health Sector Joint Review Mission and 9th National Health Assembly based on the assessment of what has been achieved and what has not, and reasons why, to guide future programming. The sector is committed to refocusing priorities to interventions aimed at making positive progress towards achieving the National Development Plan targets and Millennium Development Goals. The sector will continue to prioritize interventions defined in the Uganda National Minimum Health Care Package under a Sector-Wide Approach arrangement, with emphasis on recommendations of the HSSIP 2010/ /15 Mid-Term review. This will further be supported by the International Health Partnerships, the Paris Declaration on Harmonization and Alignment and the Accra Agenda for Action and related initiatives. The Government of Uganda recognizes the contribution of Health Development Partners, Civil Society, the Private Sector and all Ugandans in the achievement of the progress reported in the sector performance. Improvements in performance were made possible by the multitude of all categories of health workers in the sector, working under sometimes challenging conditions, especially in the rural and hard-to-reach parts of the Country. I commend the dedicated and productive health workers, and I implore those health workers whose work ethic, behaviour and conduct hold back sector progress, and appeal to them to improve. I wish to thank the HPAC for their contribution in the preparation of the Joint Review Mission. Special gratitude goes to the JRM Secretariat, Task Force and Subcommittees that ensured that this annual report was compiled and presented as scheduled. For God and My Country Ruhakana Rugunda (Dr.) MINISTER OF HEALTH [Annual Health Sector Performance Report 2012/13 FY] Page iii

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5 Table of Contents Foreword...iii List of Tables...vii List of Figures...ix Acronyms...x Executive Summary... xiv 1 CHAPTER ONE INTRODUCTION Background Vision, Mission, Goal and Strategic Objectives during the HSSIP 2010/ / Vision Mission Goal Strategic Objectives Projected Demographics for The Annual Health Sector Performance Report FY 2012/ The drafting process Overview of the report outline O VERALL PROGRESS AND PERFORMANCE AGAINST THE KEY SECTOR OUTPUTS Overall Summary Progress towards JAF 5 and HSSIP 2010/ /15 Core Indicators Health Impact Indicators Morbidity: Level and Trends Health Services Coverage Coverage with Other Health Determinants Health Quality and Outputs Health Investments Summary of the Financial Report 2012/13 FY Trends of the health sector funding 2000/ / Financial Performance for Local Governments (LGs) Summary for Human Resources for Health (HRH) Progress in Implementation of the JAF 5 Targets Implementation of the Ministerial Policy Statement 2012/13 FY Assessment of Performance against Planned Key Outputs for the MoH Headquarters Global Fund (GF) Supported Interventions 2012/ Global Fund for TB, HIV/AIDS and Malaria Global Alliance for vaccines and Immunization (GAVI) Health Partnerships Performance Public- Private Partnerships Private Not-For Profit (PNFP) Sub-Sector Private Health Practitioners (PHP) Sub-Sector PHP Contribution to selected HSSIP 2010/ /15 outputs Civil Society Organizations [Annual Health Sector Performance Report 2012/13 FY] Page v

6 2.11 Local Government Performance District League Table (DLT) Performance Hospital Performance Regional Referral Hospitals General Hospital Performance Functionality of HC IVs Quality of Care ANNEX Delivery of the Uganda National Minimum Health Care Package (UNMHCP) Cluster 1: Health promotion, disease prevention, and community health initiatives Control of Diarrheal Diseases Epidemic Disaster Prevention, Preparedness and Response (EDPPR) Cluster 2: Maternal and Child Health Prevention and Control of Communicable Diseases Diseases Targeted for Elimination Prevention and Control of Non-communicable Conditions Integrated Health Sector Support Systems Human Resources for Health Health Infrastructure Development and Management Management of Essential Medicines and Supplies National Medical Stores National Drug Authority Information for Decision Making Quality of Care Health Policy, Planning and Support Services Legal and Regulatory Framework Research Uganda National Health Research Organisation Natural Chemotherapeutics Research Institute (NCRI) Uganda Virus Research Institute (UVRI) Public Private Partnership for Health Monitoring and Evaluation of Implementation of the HSSIP 2010/ / League Tables 2012/13 FY vi Page [Annual Health Sector Performance Report 2012/13 FY]

7 List of Tables Table 1: Demographic Information... 2 Table 2: Comparison of Maternal deaths notified by facilities to those reported through HMIS... 5 Table 3: Trends in IP Mortality (Under 5)... 7 Table 4: Top ten causes of hospital based mortality for all ages in 2012/ Table 5: Top ten causes of morbidity among all ages from 2008/09 to 2012/13 FY... 8 Table 6: Performance for Health Services Coverage Indicators Table 7: % of facilities that have tracer items for child immunization services among facilities Table 8: % of facilities that have tracer items for ARV services among facilities that provide this service Table 9: % of facilities that have tracer items for malaria services among facilities that provide this service Table 10: Key outputs of the USF Program 2012/ Table 11: Performance for coverage for other health determinants and risk factors indicators during 2012/13 FY Table 12: Waiting time for clients before being attended to and length of the visit Table 13: % of Health Facilities with No Stockout For the 6 Tracer Medicines 2012/13 FY Table 14: HC IV Functionality 2011/12 to 2012/13 FY Table 15: Performance for health system output (availability, access, quality, safety) indicators Table 16: Summary of HRH status in public health Table 17: VHT Establishment by June Table 18: Performance for coverage for health investments and governance indicators Table 19: Government allocation to the Health Sector 2000/01 to 2011/ Table 20: Primary Health Care Grants FY 2000/ /13 in billions of Ug. Shillings Table 21: Summary of the recruitment rates by cadre Table 22: Progress in Implementation of JAF 5 Targets Table 23: Summary of Achievements under Health Systems Development Table 24: Summary of Achievements under Clinical and Public Health Table 25: Summary of Achievements under Supervision and Monitoring Table 26: Summary of Achievements under Research Table 27: Summary of Achievements under Pharmaceutical and Other Supplies GAVI Table 28: Summary of Achievements under National Medical Stores Table 29: Summary of Achievements under Planning, Policy and Support Services Table 30: Summary of Achievements under Health Service Commission Table 31: Summary of Achievements under Uganda Cancer Institute Table 32: Summary of Achievements under Uganda Heart Institute Table 33: Summary of Achievements under Uganda Blood Transfusion Services Table 34: Summary of Achievements under Mulago Hospital Table 35: Summary of Achievements under Butabika Hospital Table 36: Key Outputs for Regional Referral Hospitals in the MPS 2012/ Table 37: HPAC Institutional representatives attendance Table 38: Progress in implementation of the Country Compact during 2012/13 FY Table 39: Contribution of UPMB Health Facilities to the HSSIP Outputs Table 40: DHIS2 Registered Health Facilities Categorized by Specified Ownership Table 41: PHP Maternal and Child Health Outputs Table 42: District League Table National Averages 2010/ /13 FYs Table 43: Top 15 performing districts Table 44: Bottom 15 performing districts Table 45: District ranking for new districts Table 46: Staffing levels for top 10 districts Table Table 47: Staffing levels for Bottom 10 districts Table 48: Regional Referral Hospital Ownership [Annual Health Sector Performance Report 2012/13 FY] Page vii

8 Table 49: Financial Performance for 14 RRHs for FY 2012/13 (UGX Billions) Table 50: Staffing at the 14 RRHs Table 51: Positions filled in RRHs and Large PNFPs Table 52: Key Hospital Outputs and Ranking of RRHs and Large PNFP Hospitals 2012/13 FY Table 53: Summary of Key Outputs for RRHs and Large PNFPs Table 54: Summary of Overall performance for the RRHs and Large PNFP Hospitals 2012/13 (N=18) Table 55: Selected Efficiency Parameters for RRHs and Large PNFP Hospitals 2012/ Table 56: Selected Quality of Care Parameters for RRHs and Large PNFP Hospitals 2012/ Table 57: General Hospital Ownership Table 58: Summary of Outputs from the General Hospitals FY 2012/13 (N=110) Table 59: The Top 15 Performing Hospitals Table 60: Selected efficiency parameters for General Hospitals Table 61: Comparison of Maternal Deaths and Fresh Still Births to Deliveries Table 62: Positions filled in HC IVs 2012/ Table 63: Numbers of C/S performed by each HC IV in 2012/13 FY Table 64: Summary of Outputs from the HC IVs FY 2012/13 (N=193) Table 65: The Top 15 Performing HC IVs Table 66: Efficiency & Usage Measurements of HC IVs Table 67: General Service readiness index and domain scores by facility type, ownership and location Table 68: District League Table 2012/13 FY Table 69: General Hospital League Table Table 70: Risk of Maternal Death Table 71: Risk of a Fresh Still Birth Table 72: HC IV League Table viii Page [Annual Health Sector Performance Report 2012/13 FY]

9 List of Figures Figure 1: Health facility-based maternal deaths in FY 2009/10 and 2012/ Figure 2: % of facilities that have tracer items for ANC services among facilities that provide this service Figure 3: Percentage of facilities that have tracer items for FP services among facilities providing FP Figure 4: Health units reporting stock out overtime Figure 5: % of facilities that have tracer items for TB services among facilities that provide this service Figure 6: Trends in PHC Grant Allocations 2000/ /13 FYs Figure 7: Effect of the recruitment on staffing status on HC IVs & HC IIIs Figure 8: Trend of % of health workers in post working at the different levels of health facilities Figure 9: Staffing in UPMB hospitals Figure 10: SUO in UPMB hospitals Figure 11: Staff productivity in UPMB Hosps. 2012/ Figure 11: Staff productivity in UPMB Hosps. 2012/ Figure 12: Trends in income for recurrent operations Figure 13: Volume of Outputs for RRHs and Large PNFPs 2011/ /13 FYs Figure 14: Trends in Caesarean Section and Blood transfusion Figure 15: Trends in Caesarean Sections performed in the SMGL Project Districts Figure 16: General Service readiness index and domain scores Figure 17: Blood Collection over the Years [Annual Health Sector Performance Report 2012/13 FY] Page ix

10 Acronyms ACT Artemisinin Combination Therapies AHSPR Annual Health Sector Performance Report AIDS Acquired Immuno-Deficiency Syndrome AMREF African Medical and Research Foundation ANC Ante Natal Care ART Anti-retroviral Therapy ARVs Antiretroviral Drugs BFHI Baby Friendly Health Initiative CAO Chief Administrative Officer CB-DOTS Community Based TB Directly Observed Treatment CCM Country Coordinating Mechanism CDC Centres for Disease Control CDD Control of Diarrhoeal Diseases CDP Child Days Plus CDR Case Detection Rate CEmOC Comprehensive Emergency Obstetric Care CPR Contraceptive Prevalence Rate CPT Cotrimoxazole Prophylaxis CSO Civil Society Organization CYP Couple Years of Protection DHO District Health Officer DHMT District Health Management Team DLT District League Table DOTS Directly Observed Treatment, short course (for TB) DPs Development Partners DPT Diphtheria, Pertussis (whooping cough) and Tetanus vaccine EAC East African Community ECSA-HC East Central and Southern Africa - Health Community EID Early Infant Diagnosis EMHS Essential Medicines and Health Supplies EmOC Emergency Obstetric Care FP Family Planning FY Financial Year GAVI Global Alliance for vaccines and Immunization GBV Gender Based Violence GFTAM Global Fund to fight TB, Aids and Malaria GH General Hospital GoU Government of Uganda HC Health Centre x Page [Annual Health Sector Performance Report 2012/13 FY]

11 HCT HDP HIV HMIS HPAC HRH HSD HSS HSSIP HSSP ICU IDSR IEC IMAM IMCI IPT IRS JAF JBSF JICA JMS JPP JRM KDS LG LLINs MCH MeTA MDGs MDR MIP MMR MoFPED MoGLSD MoH MoLG MoPS MoU MPDR MTEF HIV/AIDS Counselling and Testing Health Development Partners Human Immuno-Deficiency Virus Health Management Information System Health Policy Advisory Committee Human Resources for Health Health Sub-Districts Health Systems Strengthening Health Sector Strategic Investment Plan Health Sector Strategic Plan Intensive Care Unit Integrated Disease Surveillance and Response Information Education and Communication Integrated Management of Acute Malnutrition Integrated Management of Childhood Illness Intermittent Presumptive Treatment for malaria Indoor Residual Spraying Joint Assessment Framework Joint Budget Support Framework Japan International Cooperation Agency Joint Medical Stores Joint Program on Population Joint Review Mission Kampala Declaration on Sanitation Local Government Long Lasting Insecticide Treated Nets Maternal and Child Health Medicines Transparency Alliance 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 [Annual Health Sector Performance Report 2012/13 FY] Page xi

12 MTR NCD NCRI NDA NGOs NHA NHP NMCP NMS NTDs NTLP OPD OPM OPV ORS ORT PHA PHAST PHC PLWHA PMDT PMTCT PNFP PPPH PRDP RH RRH RUTF SGBV SHSSPP SLD SMC SMER SP STI SUO SWAP TB TMC TSR Mid-Term Review Non Communicable Diseases National Chemotherapeutic Research Institute National Drug Authority Non-Governmental Organizations National Health Assembly National Health Policy National Malaria Control Programme National Medical Stores Neglected Tropical Diseases National Tuberculosis and Leprosy Control Program Out Patients Department Office of the Prime Minister Oral Polio Vaccine Oral Rehydration Salt Oral Rehydration Therapy People with HIV/AIDS Participatory Hygiene and Sanitation Transformation Primary Health Care People with HIV/AIDS 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 Regional Referral Hospital Ready to Use Foods Sexual and Gender Based Violence Support to the Health Sector Strategic Plan Project Second Line Drugs Senior Management Committee Supervision, Monitoring, Evaluation and Research Sulfadoxine/Pyrimethamine Sexually Transmitted Infection Standard unit of Output Sector-Wide Approach Tuberculosis Top Management Committee Treatment Success Rate xii Page [Annual Health Sector Performance Report 2012/13 FY]

13 TT Tetanus Toxoid TWG Technical Working Group UACP Uganda Aids Control Program UBOS Uganda Bureau of Statistics UBTS Uganda Blood Transfusion Services UCI Uganda Cancer Institute UDHS Uganda Demographic and Health Survey UGFATM Uganda Global Fund for AIDS, TB and Malaria UHSSP Uganda Health Systems Strengthening Project UHI Uganda Heart Institute UNEPI Uganda Expanded Programme on Immunization UNFPA United Nations Fund for Population Activities UNHCO Uganda Health Users/Consumers Organization UNHRO Uganda National Health Research Organisation UNICEF United Nations Children s Fund UNMHCP Uganda National Minimum Health Care Package USF Uganda Sanitation Fund UVRI Uganda Virus Research Institute VHRC Voices for Health Rights Coalition VHT Village Health Team WASH Water and Sanitation Hygiene WHO World Health Organisation WVU World Vision Uganda [Annual Health Sector Performance Report 2012/13 FY] Page xiii

14 Executive Summary Background The annual sector performance report is an institutional requirement produced to highlight progress, challenges, lessons learnt and propose ways of moving the sector forward. The Annual Health Sector Performance Report (AHSPR) 2012/13 Financial Year (FY) is the third annual report for the Health Sector Strategic and Investment Plan (HSSIP) 2010/ /15. The report mainly focuses on the progress of the annual workplan as well as overall sector performance against the targets set for the FY 2012/13 as well as trends in performance for selected indicators over the previous FYs. The development process of the AHSPR 2012/13 was widely consultative with stakeholders from all departments of the Ministry of Health (MoH), Development Partners (DPs), Bilateral Agencies, Implementing Partners (IPs) and Civil Society Organizations (CSOs). The overall coordination and technical support was provided by the MoH AHSPR Task Force. Data The report focuses on the core indicators of the Monitoring and Evaluation (M&E) Plan for Implementation of the HSSIP, which are linked with the monitoring of the National Development Plan (NDP) and international initiatives such as the Millennium Development Goals (MDGs). The report is based on the health facility and district reports gathered as part of the Health Management Information System (HMIS), administrative sources and programme data, including both quantitative and qualitative data. Coverage estimates based on the HMIS data use the UBOS mid-year population projections to estimate the target populations and should be considered as only indicative as the last census was conducted in National progress and performance Inputs and Processes: Money, Policies and Workforce The amounts of investments (human resources and finances) for health from GOU continue to be below the HSSIP targets which were already below the globally recommended targets. Financial investment in health by GOU shows a further decline over the years from 9.6% in 2009/10 to 7.4% in 2012/13. The percentage of approved posts filled by health workers (Public facilities) increased from 58% in 2011/12 to 63% in 2012/13. Assessment of availability of existing human resource (absenteeism monitoring) through the National Panel Surveys does not provide timely information for decision making towards improvement of the existing workforce. The VHT concept is promoted through training of VHTs of which 75% have been established and only 55% villages have trained VHTs. In 2012/13 FY not a single district/vht was trained on the VHT Strategy. [Annual Health Sector Performance Report 2012/13 FY] Page xi xiv Page [Annual Health Sector Performance Report 2012/13 FY]

15 Service Outputs The health sector achieved the HSSIP targets for 3 out of the 5 indicators determining availability, access, quality and safety of health services. The stabilization of per capita OPD utilization above 1 i.e. 1.2 in 2011/12 and 1.1 in 2012/13 could be related to the progressive improvement in medicines availability in both public and private health facilities. Such positive changes in service utilization and availability of medicines could be verified further through client feedback mechanisms e.g. timely and regular client satisfaction surveys. Project and institutional specific client satisfaction studies conducted for projects evaluation or institutional assessments generally indicate that the general level of client satisfaction is improving over the years. The availability of the 6 tracer medicines (first line antimalarials (ACTs), Depoprovera, Sulphadoxine / Pyrimethamine, measles vaccine, ORS and Cotrimoxazole) in both public and private health facilities has continued to improve over the last four years with the percentage of facilities without stock out of any of the 6 tracer medicines increasing from 21% in 2009/10 to 48% in 2011/12 and is now 53% in 2012/13. This is a positive trend though below the HSSIP target of 60% for 2012/13. There was remarkable improvement in the functionality of HC IVs from 25% in 2011/12 to 36% HC IV performing C/S in 2012/13. There was also a slight increase in the percentage of HC IVs providing blood transfusion services from 26% in 2011/12 to 27% in 2012/13. One of the factors that could be contributing to the remarkable increase in the indicator for % of HC IVs performing C/S is the improved reporting from 96 to 179 HC IVs in 2011/12 and 2012/13 respectively as a result of using the DHIS-2 system for reporting. Over the years, poor functionality of HC IVs was attributed to inadequate human resource specifically Medical Officers. During 2012/13 FY the MoH undertook major recruitment for all HC IVs and HC IIIs and the effect of this recruitment will be analyzed in the subsequent FY. The MoH needs to carry out further analysis to identify additional factors affecting functionality of HC IVs. TB Case Detection Rate declined from 57% to 55% whereas TB Treatment Success Rate which is a quality indicator increased from 71.1% in 2011/12 to 79% in 2012/13. Service Coverage and Determinants The health sector realized improvement in 6 out of the 8 core indicators for health service coverage with two of health service coverage indicators above the HSSIP target for 2012/13. The percentage of children under one year immunized with DPT 3 was 87% (1,319,860 out of 1,520,347 children of whom 85% were males & 88% females). The DPT 3 coverage achieved is [Annual Health Sector Performance Report 2012/13 FY] Page xii [Annual Health Sector Performance Report 2012/13 FY] Page xv

16 above the HSSIP target (83%) for the year. The percentage of one year old children immunized against measles was 85% (1,285,020 out of 1,520,347 children) a decline from 89% in 2011/12. The sector achieved the measles immunization coverage target (85%) for the year. The health sector also maintained a positive trend in performance for the HIV/AIDS prevention, care and treatment services. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 32% in 2011/12 to 46% (47,444 children) in 2012/13 though still below the HSSIP target (55%) for the year. There was also remarkable improvement in the percentage of eligible persons receiving ARV therapy to 76% (total of 566,444 of whom 524,603 adults and 41,520 children) from 59% in 2011/12. This achievement was also above the HSSIP target (65%) for the year. In FY 2012/13 193,000 new patients were enrolled on the life saving ART against the planned target of 110,000 new patients. This enrolment for the first time exceeded the number of estimated new infections (140,000) over the same period marking a tipping point in the ART programme. This was a result of strengthened programs of; accelerated accreditation of health facilities, scale up of Option B+, Web Based ARV Ordering Systems, supply chain rationalization which strengthened the PSM and improved overall support to health facilities by the MoH and Implementing Partners. The coverages for all RH indicators are still below the HSSIP targets. The percentage of deliveries in health facilities increased slightly from 40% to 41%. The percentage of pregnant women who completed IPT 2 increased from 44% to 47% in 2012/13. Human resource constraints especially skilled health workers and adequate numbers at lower levels was still a challenge during the larger part of 2012/13 FY. The health sector realized significant increase in funding and supply of essential RH medicines and health supplies, and improvement in staffing levels for critical cadres at HC IVs and HC IIIs during 2012/13. These resources are being distributed and are expected to have a positive impact on the outputs of the RH program. The community needs to be mobilized to maximize use of the interventions and availability of RH supplies and commodities for the sector to realize improvements in coverage for all RH services. The findings of the UDHS 2011 showed improvement in coverage for 3 out of the 4 other health determinants and risk factors indicators as reported in the AHSPR 2011/12 FY. The Couple Years of Protection (CYP) computed from the HMIS shows a remarkable increase from 1,780,578 in 2011/12 to 3,275,403 in 2012/13 FY. This is mainly due to the FP revitalization strategies implemented during the year, specifically the increased funding for procurement of RH commodities including contraceptives. The latrine coverage (all types) reduced to 68% in 2012/13 from 71% in 2011/12. [Annual Health Sector Performance Report 2012/13 FY] Page xiii xvi Page [Annual Health Sector Performance Report 2012/13 FY]

17 2011/12 to 3,275,403 in 2012/13 FY. This is mainly due to the FP revitalization strategies implemented during the year, specifically the increased funding for procurement of RH commodities including contraceptives. The latrine coverage (all types) reduced to 68% in 2012/13 from 71% in 2011/12. [Annual Health Impact Health Sector Performance Report 2012/13 FY] Page xiii The MoH recommends implementation of the Child Survival strategy at all levels of care in order to achieve the MDG 4. The UDHS 2011 findings showed improvement in all the newborn and integrated child survival performance indicators in the 5 years prior to the survey. The sector continues providing key interventions like Vitamin A supplementation, ICCM, mass deworming and health education to sustain improvement of the under five nutritional status and reduction of anaemia as demonstrated by the UDHS and HMIS reports. There is need to continue community mobilization and involvement in the new community based interventions. Data from the 2011 AIDS Indicator Survey (AIS) revealed an increase in the HIV prevalence among adults from 6.4% in 2004/05 to 7.3% in This trend is attributable to both new infections and improved survival as more PLHIV access ART. Access to a comprehensive range of HIV/AIDS care services has been improved through accelerated accreditation of ART sites which increased number of health facilities providing ARVs to 1,160 excluding specialized clinics, research programmes and private clinics. A total of 400,000 out of 1,000,000 (40%) males targeted received Safe Male Circumcision. As of March 2013, the coverage for PMTCT services was 85% of hospitals, 97% of HC IVs, 93% of HC IIIs and 24% of HC IIs providing PMTCT services. Approximately 90% of pregnant women were tested for HIV during ANC. The proportion of pregnant women living with HIV receiving ARVs increased from 50% in 2009 to 96% in Among 53,451 pregnant women who received ARVs between October 2012 and March 31 st 2013 at 2,087 sites, 33% received PMTCT option A, 38% received option B+ and 29% were already on ART before their first ANC. There was an increase in the number of malaria patients reported in the Outpatients from 13,263,620 in 2011/12 to 15,997,210 in 2012/13. Malaria remained the leading cause of morbidity and mortality among all age groups and accounted for 20.6% (5,079/24,651) of all inpatient deaths in 2012/13. The sector improved malaria case management through increased access to ACTs and use of Rapid Diagnostic Tests at HC IIs and IIIs without microscopes. Indoor Residual Spraying was conducted in the 10 target districts for the last 2 years with up to 92% coverage, protecting more than 2.6 million people. There was remarkable reduction of indoor resting vector population reduction as well as remarkable reduction of malaria prevalence in target districts. A total of 21 million LLINs were procured and distribution to be completed by January The MoH should conduct the Malaria Indicator Survey to provide up to date data on performance against the National Malaria Control Program lead indicators. Community utilization of the malaria interventions e.g. sleeping under LLINs, and uptake of IPT 2 are still very low. Prompt treatment of malaria is also still low. There is need to strengthen community response in utilization of the malaria interventions like sleeping under LLINs and uptake of IPT [Annual Health Sector Performance Report 2012/13 FY] Page xiv in the country. Overall there is positive progress in the TB program lead indicators although this is slow for core Page xvii indicator TB Case Detection [Annual Rate. Health TB Sector Treatment Performance Success Report Rate 2012/13 increased FY] from 71.1% in 2011/12 to 79% in 2012/13. There was an increase in the proportion of TB patients tested for HIV to 89% from 80% (above HSSIP target of 80% for the year). ART uptake for TB/HIV co-infected patients also increased to 57% from 48% though still below the HSSIP target (60%) for the year. DOTS

18 response in utilization of the malaria interventions like sleeping under LLINs and uptake of IPT in the country. Overall there is positive progress in the TB program lead indicators although this is slow for core indicator TB Case Detection Rate. TB Treatment Success Rate increased from 71.1% in 2011/12 to 79% in 2012/13. There was an increase in the proportion of TB patients tested for HIV to 89% from 80% (above HSSIP target of 80% for the year). ART uptake for TB/HIV co-infected patients also increased to 57% from 48% though still below the HSSIP target (60%) for the year. DOTS coverage increased from 47% in 2011/12 to 55% in 2012/13. There is need for further integration of TB/HIV services at health facility level. To improve TB treatment outcomes there is need to tap into the trained VHTs who will increase community participation in supporting patients to complete treatment. Monitoring Implementation of the Ministerial Policy Statement During 2012/13 FY the MoH planned for a number of significant infrastructure development projects focusing on rehabilitation and equipping hospitals and HC IVs. Largely most of the planned outputs under health systems development (infrastructure) from GoU and support from various DPs were achieved. The sector should plan and allocate sufficient resources for operation and maintenance of both medical equipment and infrastructure including vehicles. Two new vaccines (PCV and HPV) were launched; scale up is ongoing with training of health workers and distribution of vaccines. EmONC equipment was procured and distributed under the UHSSP. However, technical support supervision remains inadequate and interventions like MPDR have not been embraced positively by health workers resulting in low reporting and review of maternal and perinatal deaths compared to those reported under the HMIS. There was timely and coordinated response to disease outbreaks in the country largely due to an efficient surveillance system. The various health research institutions undertook research activities focusing on malaria, other outbreaks due to highly pathogenic viruses and other endemic diseases e.g. plague yellow fever. The NMS continued supplying medicines and health supplies to public health facilities and achieved several of the planned outputs. Notably there was increased access to maama kits to 82% of mothers delivering in public health facilities. During the year NMS commenced supply of medicines and health supplies to all health facilities in the UPDF, Police Force and Prison services. A total of 45,350 uniforms were procured for all cadres and will be distributed during 2013/14 FY. All the semi-autonomous institutions including; Mulago National Referral Hospital, Butabika [Annual National Health Referral Sector Mental Performance Hospital, Report Regional 2012/13 Referral FY] Hospitals, Uganda Cancer Institute, Uganda Page xv Heart Institute, Uganda Blood Transfusion Services showed improvement in provision of secondary and tertiary referral services and specialized services and infrastructure development. The major challenge was inadequate resources (financial and human). Monitoring Implementation of the Country Compact The sector performed fairly well in implementation of the compact. There was compliance with 10 out of the 16 measurement indicators. All the 3 performance indicators under its key xviii functions Page of policy guidance [Annual and monitoring Health Sector were Performance achieved Report through 2012/13 attendance FY] of most of the planned meetings for the governance structures. The sector was complaint against 5 out of the 8 indicators for monitoring programme

19 National Referral Mental Hospital, Regional Referral Hospitals, Uganda Cancer Institute, Uganda Heart Institute, Uganda Blood Transfusion Services showed improvement in provision of secondary and tertiary referral services and specialized services and infrastructure development. The major challenge was inadequate resources (financial and human). Monitoring Implementation of the Country Compact The sector performed fairly well in implementation of the compact. There was compliance with 10 out of the 16 measurement indicators. All the 3 performance indicators under its key functions of policy guidance and monitoring were achieved through attendance of most of the planned meetings for the governance structures. The sector was complaint against 5 out of the 8 indicators for monitoring programme implementation and performance especially through quarterly performance reviews, annual sector performance review and reporting, and is on track regarding the MTR of the HSSIP. However, failure by the MoH to conduct regular supervision and monitoring of programme implementation in the districts was a big setback in realization of the mandate of the centre. Only two out of the five indicators measuring performance of the planning and budgeting processes were achieved. There was slow progress in achieving the remaining 3 outputs due to leadership and governance issues. Public Private Partnership for Health The health sector benefits from the partnerships with the private sector in form of the Private Health Providers, PNFP and CSO arms. There was contribution in form of advocacy, supporting and monitoring service delivery from all these stakeholders in the sector performance discussed above. In this annual report the contribution from some of the PHP and CSOs has been documented. The major challenges faced include inability to generate comprehensive reports from the private sector. This is largely due to lack of HMIS tools, capacity gaps on utilization of HMIS tools, lack of feedback on reported data, failure to appreciate the need to report, and failure to transmit filled HMIS data sets with most PHP facilities lacking required human resource, equipment and infrastructure to effectively report. Local Government Performance Local Government performance assessment was done using an improved set of 11 indicators (three management and nine access/quality/coverage indicators) for the 111 districts. There is an improvement in the DLT national average performance from 57% in 2011/12 to 63% in 2012/13. The improvement in performance was observed for almost all indicators with the [Annual Health Sector Performance Report 2012/13 FY] Page xvi exception of ANC 4 th visit and completeness of monthly reports. The top ten districts in 2012/13 were; Gulu, Kabarole, Nwoya, Masaka, Kyegegwa, Bushenyi, Abim, Jinja, Luwero and Kyenjojo. The lowest performance levels were noted in Kaabong and Amudat. Hospital Performance Hospital outputs were assessed using the Standard Unit of Output (SUO). The 14 RRHs and 4 large PNFPs hospitals (Lacor, Nsambya, Mengo and Lubaga) attended to a total of; 2,537,666 outpatients; 89,626 deliveries and 339,670 admissions among other outputs. On average each hospital attends to; 140,981 outpatients, conducted 4,979 deliveries and 19,981 admissions. The SUO for these hospitals increased from 5,361,005 in 2011/12 to 8,189,908 in 2012/13. Average staff productivity [Annual increased Health Sector to 2,724 Performance from 1,534 Report SUO/Staff 2012/13 FY] in 2011/12. Mbale Page RRH and xix Masaka RRH had the highest SUOs of 858,116 and 792,551 respectively. A total of 110 hospitals offering general hospital services and reporting through the DHIS2 were

20 in 2012/13. The improvement in performance was observed for almost all indicators with the exception of ANC 4 th visit and completeness of monthly reports. The top ten districts in 2012/13 were; Gulu, Kabarole, Nwoya, Masaka, Kyegegwa, Bushenyi, Abim, Jinja, Luwero and Kyenjojo. The lowest performance levels were noted in Kaabong and Amudat. Hospital Performance Hospital outputs were assessed using the Standard Unit of Output (SUO). The 14 RRHs and 4 large PNFPs hospitals (Lacor, Nsambya, Mengo and Lubaga) attended to a total of; 2,537,666 outpatients; 89,626 deliveries and 339,670 admissions among other outputs. On average each hospital attends to; 140,981 outpatients, conducted 4,979 deliveries and 19,981 admissions. The SUO for these hospitals increased from 5,361,005 in 2011/12 to 8,189,908 in 2012/13. Average staff productivity increased to 2,724 from 1,534 SUO/Staff in 2011/12. Mbale RRH and Masaka RRH had the highest SUOs of 858,116 and 792,551 respectively. A total of 110 hospitals offering general hospital services and reporting through the DHIS2 were assessed. They collectively attended to a total of; 3,754,144 outpatients; conducted 150,276 deliveries and 690,621 admissions among other outputs. On average each hospital attends to; 35,080 outpatients, 1,392 deliveries and 6,412 admissions. The total SUO for GHs has increased from 10,506,636 in 2011/12 to 15,129,354 in 2012/13 with notable increase in performance for admissions, outpatient attendances and deliveries. The minimum SUO for GHs was 2,529 and maximum 523,549. There was a decline in the immunization contacts at the GHs. The 5 top performing hospitals were Iganga, Busolwe, Bwera, Mityana and Pallisa GHs respectively. In addition to performing Caesarean Sections, 193 HC IVs were also assessed using the SUO. In total HC IVs attended to 4,473,744 outpatients; conducted 123,610 deliveries; and admitted 395,898 patients. The mean outpatient attended to was 23,468, mean deliveries 661 and mean admission 2,234. The total SUO for HC IVs was 11,413,220 with a maximum of 304,048 and minimum of 4,148. The minimum SUO for HC IV level is higher than the minimum (2,529) SUO for GHs. The 5 top performing HC IVs in 2012/13 were Bugobero HC IV, Kawempe HC IV, Mukono Town Council HC IV, Serere HC IV and Luwero HC IV. The Service Availability and Readiness Assessment survey conducted in June 2013 showed that the general service readiness index was 61% with the availability of standard precautions for infection prevention at 83%, basic equipment at 79% and basic amenities at 62%. Service availability was highest in the referral hospitals and progressively decreased by level of care. There were also higher levels of service availability in private facilities compared to public and similarly higher for urban compared to rural facilities. [Annual The sector Health should Sector focus Performance on interventions Report 2012/13 geared FY] at improving service delivery at the Page primary xvii care level specifically through improving the existing health infrastructure, provision of basic equipment, dissemination of guidelines for standard precautions and infection prevention and control, providing appropriate diagnostic facilities and essential medicines by level of care. All this should be augmented with provider training to enhance their knowledge and skills. xx Page [Annual Health Sector Performance Report 2012/13 FY]

21 1 CHAPTER ONE INTRODUCTION 1.1 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 Sector Strategic Plan and annual workplans. The AHSPR 2012/13 FY is the thirteen annual report produced by the Ministry of Health (MoH). This report is the third annual report for the Health Sector Strategic and Investment Plan (HSSIP) 2010/ /15. The report mainly focuses on the progress of the annual workplan as well as overall health sector performance against the targets set for the FY 2012/13. The report takes into consideration the annual performance in terms of: 1) the effectiveness, responsiveness and equity in the health care delivery system. 2) How well the integrated support systems have been strengthened as well as the status of programme implementation and overall development mechanisms. The sector performance will be deliberated upon during the 19 th Joint Review Mission (JRM) and 9 th National health Assembly (NHA), September 23 rd to 26 th, The outcomes of the sector performance review are expected to guide future planning and programming. 1.2 Vision, Mission, Goal and Strategic Objectives during the HSSIP 2010/ / Vision A healthy and productive population that contributes to socio-economic growth and national development Mission To provide the highest possible level of health services to all people in Uganda through delivery of promotive, preventive, curative, palliative and rehabilitative health services at all levels Goal The overall goal for the Health Sector during HSSIP 2010/ /15 is To attain a good standard of health for all people in Uganda in order to promote a healthy and productive life Strategic Objectives To achieve this goal, the health sector shall focus on achieving universal coverage with quality health, and health related services through addressing the following strategic objectives. [Annual Health Sector Performance Report 2012/13] Page 1 [Annual Health Sector Performance Report 2012/13 FY] Page 1

22 1. Scale up critical interventions for health, and health related services, with emphasis on vulnerable populations. 2. Improve the levels, and equity in access and demand to defined services needed for health. 3. Accelerate quality and safety improvements for health and health services through implementation of identified interventions. 4. Improve on the efficiency, and effectiveness of resource management for service delivery in the sector. 5. Deepen stewardship of the health agenda, by the MoH. 1.3 Projected Demographics for 2012 The projected population demographics for the period under review have been calculated basing on the annual population projection of 35,356,900 reported in the State of Uganda Population Report 2012 by Uganda Bureau of Statistics (UBOS). Table 1: Demographic Information Demographic Variables Proportion Population Total Population 100% 35,356,900 Children below 18 years 56% 19,799,864 Adolescents and youth (young people) (10 24 years) 34.7% 12,268,844 Orphans (for children below 18 years) 10.9% 3,853,902 Infants below one year 4.3% 1,520,347 Children below 5 years 19.5% 6,894,596 Women of reproductive age (15 49 years) 23% 8,132,087 Expected number of pregnancies 5% 1,767,845 UBOS 2012 Midyear Projection 1.4 The Annual Health Sector Performance Report FY 2012/13 The objective of the AHSPR 2012/13 is to review the performance of the sector for the FY 2012/13 against target for the HSSIP 2010/ /15 core indicators, actions and indicators set out in the Ministerial Policy Statement (MPS) 2012/13 FY, Joint Assessment Framework (JAF) 5 under the Joint Budget Support Framework (JBSF). The report provides an assessment of what has been achieved and what has not, and explains some of the reasons for the level of [Annual Health Sector Performance Report 2012/13] Page 2 2 Page [Annual Health Sector Performance Report 2012/13 FY]

23 performance. This report provides the health sector performance against selected indicators for the last FY with comparison of performance over the previous four FYs. Thus, the report provides progress on: i) Sector performance based on the JAF 5 indicators and HSSIP 2010/ /15 indicators for the FY 2012/13 ii) Financial Report for the FY 2012/13 including a donor-expenditure analysis iii) Overall health service coverage levels iv) Status of implementation of the key sector outputs as outlined in the MPS 2012/13 and the Compact for Implementation of the HSSIP 2010/ /15 v) Local Government (District) performance using the League Table vi) The individual and collective contribution of the National, Regional Referral Hospitals (RRHs) and General Hospitals (GHs) as well as the Private Not-For Profit (PNFP) hospitals at similar levels vii) Implementation progress on the delivery of the Uganda National Minimum Health Care Package (UNMHCP) and health support systems The drafting process The development process of the AHSPR 2012/13 was widely consultative with stakeholders from all departments of the MoH, Health Development Partners (HDPs), Bilateral Agencies, Implementing Partners and Civil Society Organizations (CSOs). The Health Policy Advisory Committee (HPAC) and Senior Management Committee (SMC) provided guidance and monitored progress in the entire process. The overall coordination and technical support to Technical Working Groups (TWGs), and Departments was provided by the MoH AHSPR Task Force. The composition of the Task Force was drawn from all departments of MoH, CSOs and HDPs. Regular meetings were held with various TWGs, to assess progress in development of the AHSPR. The information used in compiling the AHSPR 2012/13 is both quantitative and qualitative. This AHSPR uses the HMIS aggregated monthly reports from the District Health Information Software (DHIS)-2 for the entire FY. Other key sources of information included: i. HSSIP 2010/ /15 ii. Ministerial Policy Statement (MPS) 2012/13 iii. MoH activity plan 2012/13 iv. Biannual sector performance review reports (Q1 & 2 and Q3 & 4) 2012/13 v. MoH programmes and other central level institutions reports [Annual Health Sector Performance Report 2012/13] Page 3 [Annual Health Sector Performance Report 2012/13 FY] Page 3

24 vi. Output Budgeting Tool (OBT) reports to the Ministry of Finance, Planning and Economic Development (MoFPED) vii. Annual Health Sector Performance Reports 2011/12 FY viii. Uganda Demographic Health Survey (UDHS) reports ix. Service Availability and Readiness Assessment Reports (SARA) 2012 and Overview of the report outline The AHSPR 2012/13 FY is divided into three sections as follows; Section 1 is an introduction that covers the background to the AHSPR 2012/13 FY in relation to the framework for achieving the HSSIP 2010/ /15 goals, drafting process and sources of information. Section 2 provides an overview of the sector performance for FY 2012/13 and includes the overall performance of the sector against the HSSIP 2010/ /15 core indicators; an assessment of central level performance against planned key outputs from the MPS 2012/13; contribution of the private sector; progress towards global partnerships; assessment of district performance using the District League Table (DLT); assessment of hospital performance and the functionality of HC IVs. Section 3 is an annex to the report detailing the specific component/ program lead indicators and targets and the progress in implementation of priority activities during 2012/13 FY based on the UNMHCP as well as the health service support system. [Annual Health Sector Performance Report 2012/13] Page 4 4 Page [Annual Health Sector Performance Report 2012/13 FY]

25 2 OVERALL PROGRESS AND PERFORMANCE AGAINST THE KEY SECTOR 2 OVERALL OUTPUTS PROGRESS AND PERFORMANCE AGAINST THE KEY SECTOR OUTPUTS This chapter presents an overview of the overall progress and trends in health sector This chapter performance presents for FY an 2012/13. overview It of therefore overall includes progress an assessment and trends of performance in health sector of the sector performance using the for HSSIP FY 2012/ /11 It therefore 2014/15 includes core indicators an assessment and marking of performance progress of towards the sector achievement using of the the HSSIP JAF 2010/11 5, MPS and 2014/15 MoH Activity core indicators Plan targets and marking for 2012/13 progress FY. towards achievement of the JAF 5, MPS and MoH Activity Plan targets for 2012/13 FY. 2.1 Overall Summary Progress towards JAF 5 and HSSIP 2010/ / Overall Core Summary Indicators Progress towards JAF 5 and HSSIP 2010/ /15 Core Indicators Health Impact Indicators The Health four Impact impact Indicators indicators (Maternal Mortality Ratio [(MMR), Neonatal Mortality Rate (NMR), The four impact indicators (Maternal Mortality Ratio [(MMR), Neonatal Mortality Rate (NMR), Infant Mortality Rate (IMR), and Under 5 Mortality Rate] used to assess the analysis of impact Infant Mortality Rate (IMR), and Under 5 Mortality Rate] used to assess the analysis of impact of health service delivery were assessed in the UDHS 2011 and trends analyzed in the AHSPR of health service delivery were assessed in the UDHS 2011 and trends analyzed in the AHSPR 2011/ /12. The fifth, proportion of household experiencing catastrophic payments, measures financial risk The fifth, proportion of household experiencing catastrophic payments, measures financial risk (protection) was 43% for FY 2009/10 (National Health Accounts (NHA) Report, 2013). The target (protection) was 43% for FY 2009/10 (National Health Accounts (NHA) Report, 2013). The target for 2012/13 for 2012/13 FY was FY 19%. was The 19%. NHA The for NHA 2010/11, for 2010/11, 2011/ /12 and 2012/13 and 2012/13 are yet to are be done. yet to be done. Notification Notification of maternal of maternal deaths deaths is mandatory is mandatory but very but few very deaths few were deaths notified were i.e. notified 0.6%, 3.6%, i.e. 0.6%, 3.6%, 7% and 7% 11% and of 11% the of deaths the deaths reported reported in HMIS in were HMIS notified were notified in 2009, in 2010, 2009, , and and 2012 respectively. respectively. Notification Notification of maternal of maternal deaths is deaths mandatory is mandatory but has improved but has improved slightly over slightly the over the years. years. Table 2: Table Comparison 2: Comparison of Maternal of Maternal deaths notified deaths by notified facilities by to facilities those reported to those through reported HMIS through HMIS Item Item Total number Total number of deaths of notified deaths notified Total number Total number of deaths of reported deaths reported in HMIS in HMIS 1,143 1,143 1,005 1,005 1,844 1,844 1,160 1,160 % of HMIS % of reported HMIS reported deaths notified deaths notified 0.6% 0.6% 3.6% 3.6% 7.0% 7.0% 11% 11% Source: HMIS, MPDR Report , 2012 Source: HMIS, MPDR Report , 2012 [Annual Health Sector Performance Report 2012/13] Page 5 [Annual Health Sector Performance Report 2012/13] Page 5 [Annual Health Sector Performance Report 2012/13 FY] Page 5

26 Routine reporting through the HMIS shows that out of the 724,806 deliveries that were reported through HMIS in 2012/13, 1,160 deaths occurred. Figure 1 shows the trend in the monthly institutional maternal deaths with a decline in deaths during 2012/13. Figure 1: Health facility-based maternal deaths in FY 2009/10 and 2012/ Jul Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Source: MoH HMIS Inpatient Mortality Malaria was still the leading cause of in-patient mortality for all age groups. In under five children mortality trends due to malaria increased from 28% in 2011/12 to 30.7% in 2012/13. Pneumonia was the second most cause of under five mortality (12.2%) followed by anaemia (11.6%) in 2012/13 FY. The proportion of under fives dying due to pneumonia decreased from 14.9% in 2011/12 to 12.2% in 2012/13; whereas the proportion of under fives dying due to anaemia increased from 9.5% to 11.6%. Mortality due to neonatal conditions is also high accounting for 13.3% of all under five deaths. [Annual Health Sector Performance Report 2012/13] Page 6 6 Page [Annual Health Sector Performance Report 2012/13 FY]

27 Table 3: Trends in IP Mortality (Under 5) Table Table 3: 3: Trends Trends in in in IP IP Mortality Mortality (Under (Under 5) 5) Diagnosis % Diagnosis 2010 % Diagnosis 2011 % Diagnosis 2012 % Diagnosis 2013 % Diagnosis % Diagnosis 2013 % Malaria 2009 % % Diagnosis Diagnosis % % Diagnosis Diagnosis % % Diagnosis Diagnosis % % Diagnosis Diagnosis % % Malaria 35.8 Malaria Malaria 28.17% Malaria 30.7 Anaemia Malaria Malaria Anaemia Malaria Malaria Anaemia Malaria Malaria Malaria Pneumonia Malaria 28.17% 28.17% 14.85% 28.17% Malaria Malaria Pneumonia Malaria Pneumonia Anaemia Anaemia Anaemia Pneumonia Anaemia Anaemia Pneumonia Anaemia Pneumonia Pneumonia Anaemia Pneumonia 14.85% 14.85% 9.46% 14.85% Pneumonia Pneumonia Anaemia Pneumonia Pneumonia 8.46 Pneumonia 9.4 Pneumonia Anaemia 9.46% Anaemia 11.6 Perinatal Pneumonia Pneumonia Perinatal Pneumonia Perinatal Anaemia Respiratory Anaemia 9.46% 9.46% Anaemia Perinatal Anaemia Conditions Perinatal 4.12 Perinatal 3.74 Perinatal 7.78 Respiratory 8.78% Perinatal Conditions 8.5 Conditions Perinatal 4.12 Perinatal Conditions 3.74 Perinatal Conditions Perinatal 7.78 Respiratory Infections Respiratory 8.78% Perinatal (0 Perinatal Conditions 7 days) Conditions 8.5 Conditions Conditions Conditions Infections 8.78% 8.78% (0 7 days) Conditions Conditions Conditions Infections Perinatal Infections (0 7 Neonatal days) (0 7 days) Septicemia 2.82 Septicemia Septicemia Septicemia Perinatal 3.70% Neonatal 4.8 Conditions Perinatal Conditions Perinatal 3.70% Septicaemia Neonatal Septicaemia 4.8 Septicemia Septicemia Septicemia Septicemia % Neonatal 3.70% 4.8 Respiratory Conditions Acute Diarrhoea 2.59 Severe 2.43 Respiratory Conditions Septicaemia 4.8 Septicaemia Severe 2.72 Septicemia 2.62% Diarrhoea Acute 3.4 Malnutrition Severe 2.43 Infection Respiratory Infection 2.72 Septicemia 2.62% Diarrhoea Acute 3.4 Acute Diarrhoea Respiratory Septicemia Septicemia 2.62% 2.62% Diarrhoea Diarrhoea Acute Acute 3.4 Malnutrition Infection 3.4 Infection Diarrhoea Diarrhoea AIDS 1.96 Acute Diarrhoea AIDS AIDS % 2.57% Septicemia Septicemia Acute Diarrhoea Acute Diarrhoea AIDS AIDS Acute Acute Diarrhoea Diarrhoea AIDS AIDS % 2.57% Septicemia Septicemia 2.8 Severe Respiratory 1.91 Severe Severe Severe Acute 2.8 Severe Acute Respiratory Respiratory % 2.06% Severe Malnutrition Severe Respiratory Infection Respiratory Malnutrition Severe Severe Malnutrition Severe Malnutrition Severe Infections Respiratory 1.91 Infections Respiratory % Respiratory Injuries 1.54 Injuries % 2.0 Malnutrition Malnutrition Infection - AIDS Infection Malnutrition Acute Malnutrition Malnutrition Acute Diarrhoea Diarrhoea 1.84 Malnutrition Infections % 1.38% Severe Severe Malnutrition Infections Malnutrition Respiratory Infection Respiratory (Trauma) Injuries (Trauma) Injuries Severe Severe 1.54 AIDS Severe AIDS Acute Severe Severe Acute Diarrhoea Diarrhoea % 1.38% Severe Severe Malnutrition Malnutrition 1.9 Infection Infection (Trauma) 1.9 Severe Severe (Trauma) Perinatal Conditions Severe Malnutrition Malnutrition Malnutrition Severe Perinatal Conditions Malnutrition Severe Severe 1.14 Malnutrition Severe Severe 1.42 Malnutrition Severe 1.29 Malnutrition Severe 1.18% (in Perinatal new borne Conditions Malnutrition (Marasmic Malnutrition (Marasmic (Marasmic- Malnutrition 1.29 Malnutrition Severe 1.18% (in Perinatal new borne Conditions (Marasmic- Malnutrition 1.14 Kwash) Kwash) (Marasmic- Malnutrition 1.42 Kwash) (Marasmic- Malnutrition 1.29 (Marasmus) Malnutrition 1.18% days) (in new borne (Marasmic (Marasmic (Marasmic (Marasmus) Malnutrition 1.18% days) (in new borne Kwash) (Marasmic- Kwash) (Marasmic- Kwash) (Marasmic- (Marasmus) days) Kwash) Source: MoH HMIS Kwash) Kwash) (Marasmus) days) Source: Kwash) MoH HMIS Kwash) Kwash) Source: MoH HMIS Source: MoH HMIS Hospital Based Mortality for all Ages Hospital Based Mortality for for all all Ages Ages Hospital Based Mortality for all Ages A total of 24,651 (10,530 among under fives and 14,121 among adults) hospital deaths were A reported total of during 24, /13 (10,530 FY. among Hospital under based fives fives mortality and and 14,121 14,121 data among indicates among adults) that adults) malaria hospital hospital was deaths the deaths top were were A total of 24,651 (10,530 among under fives and 14,121 among adults) hospital deaths were reported most (20.6%) during cause 2012/13 of all deaths FY. FY. Hospital followed based by pneumonia mortality data 11.6% data indicates and anaemia that that malaria 10.6%. malaria Table was was the 4 the top top reported during 2012/13 FY. Hospital based mortality data indicates that malaria was the top most (20.6%) cause of of all all deaths followed by by pneumonia 11.6% 11.6% and and anaemia 10.6%. 10.6%. Table Table 4 4 Table 4: Top ten causes of hospital based mortality for all ages in 2012/13 most (20.6%) cause of all deaths followed by pneumonia 11.6% and anaemia 10.6%. Table 4 Table 4: Top ten causes of of hospital based mortality for for all all ages ages in 2012/13 in Table Rank 4: Top ten causes of IPD hospital Diagnosis based mortality for all ages Total in 2012/13 Under 5 5 and Over % Rank 1 Malaria IPD Diagnosis 5,079 Total Total 2,623 Under Under ,456 and 5 and Over Over 20.6 % % Rank IPD Diagnosis Total Under 5 5 and Over % 1 2 Malaria Pneumonia 2,849 5,079 5,079 1,427 2,623 2,623 1,422 2,456 2, Pneumonia Anaemia Malaria 2,614 2,8495,079 1,339 1,4272,623 1,275 1,422 2, , Perinatal Conditions (in new borns 0-7 days) 1, Anaemia Pneumonia 2,6142,849 1,3391,427 1,275 1,422 1, Other Types Of Meningitis - IPD Perinatal Anaemia Conditions (in (in new new borns borns days) days) 1,474 6 Other Tuberculosis 5711,474 2, , , Other 7 Perinatal Types Injuries Conditions Of - (Trauma Of Meningitis (in - new IPD Due To Other - IPD borns 0-7 days) 628 Causes) , Other 8 Tuberculosis Injuries Types Of Meningitis - IPD Road Traffic Accidents Injuries 9 Injuries Other - Tuberculosis Tuberculosis - (Trauma (Trauma Due (new smear Due To To Other positive Other Causes) cases) Causes) Injuries 10 Injuries - Septicemia - Road - Road (Trauma Traffic Traffic Due Accidents Accidents To Other Causes) Tuberculosis Tuberculosis Injuries - Road (new All Others (new Traffic smear smear Accidents positive cases) 464 positive cases) 9, , , Septicemia 10 Septicemia Total Tuberculosis (new smear positive cases) 24, , , Source: 10 MoH All HMIS All Septicemia Others 9,095 Others 9, ,331 3, ,764 5, Total Total All Others 24,651 24,651 9,095 10,530 10,530 3,331 14,121 14,121 5, Source: MoH Source: MoH Total HMIS HMIS 24,651 10,530 14, Source: MoH HMIS [Annual Health Sector Performance Report 2012/13] Page 7 [Annual Health Sector Performance Report 2012/13] Page 7 [Annual Health Sector Performance Report 2012/13] Page 7 [Annual Health Sector Performance Report 2012/13] Page 7 [Annual Health Sector Performance Report 2012/13 FY] Page 7

28 2.1.2 Morbidity: Level and Trends There was an increase in the number of new outpatient attendances for for all all ages ages to to 43,415,359 compared to 36,507,794 in the 2011/12 FY. Communicable diseases are are still still the the leading causes of morbidity with malaria ranking highest (36.8%) among all age groups, followed cough or or cold cold 29.1% and intestinal worms 5.5% (See Table 5). There was a significant increase in in the the number of malaria patients from 13,263,620 in 2011/12 to 15,997,210 in in 2012/13. The number of of patients with cough or cold also increased significantly from 8,855,816 in in 2011/12 to to 12,650,981. Table 5: Top ten causes of morbidity among all ages from 2008/09 to 2012/13 FY FY Diagnosis 2008/ / / / /13 New Cases % New Cases % New Cases % New Cases %% New New Cases % % Malaria 11,748, ,164, ,614, ,263, ,997, % 36.8% No No Pneumonia -- Cough or or Cold 5,794, ,851, ,712, ,855, ,650, % 29.1% Intestinal Worms 1,767, ,866, ,826, ,018, ,403, % 5.5% Skin Skin Diseases 1,117, ,101, ,118, ,112, ,458,967 1,458, % 3.4% Acute Acute Diarrhoea 965, ,031, ,029, ,181,737 1,181, ,357,165 1,357, % 3.1% Eye Eye Conditions Conditions 748, , , , , , , , ,134,641 1,134, % 2.6% Urinary Urinary Tract Tract Infections Infections 646, , ,297,733 1,297, , , , , ,125,133 1,125, % 2.6% Pneumonia Pneumonia 887, , , , , , , , ,046,440 1,046, % 2.4% Gastro-Intestinal Gastro-Intestinal Disorders (Non 726, , , , Disorders (Non 726, , , , Infective) Infective) Ear Nose and Throat Ear Nose and Throat , % (ENT) Conditions , % (ENT) Conditions Injuries (Trauma due Injuries (Trauma due 627, , , , , % to other causes) 627, , , , , % to other causes) All Others All Others 6,830,314 6,830, ,372,847 7,372, ,567,204 7,567, ,984,951 5,984, ,770,596 4,770, % 11.0% Total Total 31,861,366 31,861, ,808,680 36,808, ,853,345 34,853, ,507,794 36,507, ,415,359 43,415, % 100% Source: MoH HMIS Source: MoH HMIS [Annual Health Sector Performance Report 2012/13] Page 8 [Annual Health Sector Performance Report 2012/13] Page 8 8 Page [Annual Health Sector Performance Report 2012/13 FY]

29 2.2 Health Services Coverage There are eight core health service coverage indicators for monitoring the HSSIP 2010/ /15 implementation. The performance against these indicators is presented in this section. 1) The percentage of women attending the 4 ANC visits declined from 34.2% in 2011//12 to 31% in 2012/13 FY. This is far below the HSSIP target (55%) for 2012/13. 2) The percentage of deliveries in health facilities increased from 38.1% in 2011/12 to 41% in 2012/13. The 41% delivery rate in health facilities is far below the 65% HSSIP target for 2012/13. 3) Coverage for immunization services showed an increase in the percentage of under one year immunized with third dose of pentavalent vaccine (DPT 3 ) from 85% in 2011/12 to 87% (1,319,860 children out of 1,520,347 target, of which 88% were males and 85% females) which is above the HSSIP target (83%) for the year. The DPT 3 coverage of 85% in 2012/13 is above the HSSIP target (83%) for 2012/13. 4) Regarding measles immunization, 85% (1,285,020 children out of 1,520,347 target, of which 86% were males and 83% females) of one year old children were immunized against measles in 2012/13 FY. The sector achieved the HSSIP target of 85% for 2012/13 but a decline from 89% measles coverage in 2011/12. 5) The percentage of pregnant women who completed second dose of Sulphadoxine / Pyrimethamine (S/P) for Intermittent Presumptive Treatment (IPT) for malaria increased from 44% in 2011/12 to 47% in 2012/13. The current IPT 2 coverage is also below the HSSIP target for 2012/13 of 60%. 6) The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 32.3% in 2011/12 to 46% in 2012/13. This is below the target (55%) for 2012/13. Prevalence of HIV among those tested was 9%, a significant decline from 19% in The consolidation of Early Infant Diagnosis (EID) testing at the Central Public Health Laboratory (CPHL) has significantly reduced unit costs (from $22 to $5 per EID test), and reduced results turnaround time from over 45 days to 2 weeks. By June 2013, facility coverage for EID was 1,521 facilities including 100% of referral hospitals, 100% of GHs and 100% of HC IVs, 84% of HC IIIs, and 5.6% of HC IIs. 7) The percentage of children under five years receiving malaria treatment within 24 hours from VHT was not assessed due to lack of information. Only 34 out of 111 districts are [Annual implementing Health Sector iccm Performance and there is Report no regular 2012/13] reporting through the Community HMIS. Page 9 8) The percentage of eligible people receiving ARV treatment therapy increased from 59% in 2011/12 to 76% which is above the HSSIP target (65%) for 2012/13. By June 2013 a cumulative total of 566,444 (524,603 adults and 41,520 children) out of an estimated [Annual Health Sector Performance Report 2012/13 FY] Page 9 740,000 who were in need of ART. In the reporting period, a total of 194,000 people were enrolled on ART far exceeding the target of 110,000 that had been planned.

30 7) The percentage of children under five years receiving malaria treatment within 24 hours from VHT was not assessed due to lack of information. Only 34 out of 111 districts are 7) The percentage of children under five years receiving malaria treatment within 24 hours implementing from VHT was iccm not assessed and there due is no to regular lack of information. reporting through Only 34 the out Community of 111 districts HMIS. are implementing iccm and there is no regular reporting through the Community HMIS. 8) The percentage of eligible people receiving ARV treatment therapy increased from 59% in 8) 2011/12 The percentage to 76% of which eligible is people above receiving the HSSIP ARV target treatment (65%) therapy for 2012/13. increased from By June 59% 2013 in a cumulative 2011/12 to total 76% which of 566,444 is above (524,603 the HSSIP adults target and (65%) 41,520 for children) 2012/13. out By June of an 2013 estimated a 740,000 cumulative who total were of in 566,444 need of (524,603 ART. In adults the reporting and 41,520 period, children) a total out of 194,000 of an estimated people were 740,000 who were in need of ART. In the reporting period, a total of 194,000 people were enrolled on ART far exceeding the target of 110,000 that had been planned. enrolled on ART far exceeding the target of 110,000 that had been planned. Table Table 6 summarizes summarizes the the trends trends in in performance performance for for the the eight eight core core health health services services coverage coverage indicators. Table 6: 6: Performance for Health Services Coverage Indicators Indicator Source 2008/ / /112011/ / / /13 HSSIP HSSIP Achievement Achievement Performance Performance Trend Trend Target from 2011/12 Target from 2011/12 for for 2012/13 % pregnant women 2012/13 Negative and far % attending pregnant 4 ANC women HMIS 39% 47% 32% 34.2% 55% 31% below the Negative HSSIP and far attending sessions 4 ANC HMIS 39% 47% 32% 34.2% 55% 31% target below by 24% the HSSIP sessions % deliveries in Positive target trend but by 24% HMIS 34% 33% 39% 38.1% 65% 41% % health deliveries facilities in below HSSIP Positive target trend by but HMIS 34% 33% 39% 38.1% 65% 41% 24% health facilities below HSSIP target by % children under 87% 24% one year immunized % with children 3 rd dose under HMIS 85% 76% 90% 85% 83% 87% On track and above 88% 85% one Pentavalent year immunized vaccine HSSIP target Male Female with (m,f) 3 rd dose HMIS 85% 76% 90% 85% 83% On track and above 88% 85% Pentavalent % one year vaccine HSSIP target old Male 85% Female (m,f) children immunized HMIS 81% 72% 85% 89% 85% On track and achieved 86% 83% against measles the HSSIP target % one year old Male Female 85% (m,f) children immunized % pregnant women HMIS 81% 72% 85% 89% 85% On track and achieved 86% 83% Positive trend but still against who have measles completed HMIS 44% 47% 43% 44.2% 60% 47% below HSSIP the HSSIP target by target Male Female (m,f) IPT2 13% % pregnant of children women Positive Positive trend but trend still but still Indicator Source 2008/ / / / /13 who exposed Indicator have to completed HIV from Source HMIS 2008/09 44% 2009/10 47% 2010/11 43% 2011/ % 60% 47% 2012/13 below HSSIP below HSSIP target by target by EID their mothers NA 29% 30% 32.3% HSSIP HSSIP 55% Achievement Achievement Performance Performance 9% Trend Trend IPT2 accessing HIV database 46% 13% Target Target from 2011/12 from 2011/12 % of children Positive trend but still testing within 12 for for exposed to HIV from below HSSIP target by months EID 2012/ /13 their mothers NA 29% 30% 32.3% 55% iccm implemented 9% % U5s with fever in accessing HIV database 46% iccm implemented in receiving malaria only 34 districts, only [Annual treatment within Health 24 Sector HMIS Performance 70% Report 13.7%* 2012/13] No data No data 60% No data only 34 districts, only testing within % Page U5s accessing 10 treatment within 24 HMIS 70% 13.7%* No data No data 60% No data 43.5% U5s accessing months hours from VHT treatment within 24 hrs hours from VHT from treatment VHTs within 24 hrs % eligible persons Positive trend from and VHTs % receiving eligible persons ARV above HSSIP Positive target trend by and [Annual Health Sector ACP Performance 48% Report 53% 2012/13] 48% 59.3% 65% 76% Page 10 receiving therapy (m,f) ARV above 11% HSSIP target by ACP 48% 53% 48% 59.3% 65% 76% therapy (m,f) 11% The health sector realized improvement in 6 out of the 8 core indicators for health service The coverage. health One sector of health realized service improvement coverage indicators 6 out was of the above 8 core the HSSIP indicators target for and health also the service sector achieved the set target for 2012/13 in only one indicator. The percentage of children coverage. One of health service coverage indicators was above the HSSIP target and also the under one year immunized with 3 rd dose Pentavalent vaccine which increased from 85% in sector achieved the set target for 2012/13 in only one indicator. The percentage of children 2011/12 to 87% (88% males & 85% females) in 2012/13 above the 83% target for 2012/13. The under percentage one year of one immunized year old children with immunized 3 rd dose Pentavalent against measles vaccine declined which 89% increased in 2011/12 from to 85% 85% in 2011/12 (86% males to 87% & 83% (88% females) males in & 2012/13 85% females) achieving in the 2012/13 HSSIP target above (85%) the 83% for 2012/13 target for 2012/13. The 10 Page [Annual Health Sector Performance Report 2012/13 FY] percentage of one year old children immunized against measles declined 89% in 2011/12 to 85% (86% The SARA males 2013 & 83% findings females) (Table in 2012/13 7) show that achieving non-availability the HSSIP of target EPI guidelines (85%) for and 2012/13 lack of staff trained in EPI at some facilities could be the major factors affecting the immunization program service delivery.

31 The health sector realized improvement in 6 out of the 8 core indicators for health service The health sector realized improvement in 6 out of the 8 core indicators for health service coverage. One of health service coverage indicators was above the HSSIP target and also the coverage. One of health service coverage indicators was above the HSSIP target and also the sector achieved the set target for 2012/13 in only one indicator. The percentage of children sector achieved the set target for 2012/13 in only one indicator. The percentage of children under one year immunized with 3 rd under one year immunized with 3 rd dose Pentavalent vaccine which increased from 85% in dose Pentavalent vaccine which increased from 85% in 2011/12 to 87% (88% males & 85% females) in 2012/13 above the 83% target for 2012/13. The 2011/12 to 87% (88% males 85% females) in 2012/13 above the 83% target for 2012/13. The percentage percentage of of one one year year old old children children immunized immunized against against measles measles declined declined 89% 89% in in 2011/ /12 to to 85% 85% (86% (86% males males & 83% 83% females) females) in in 2012/ /13 achieving achieving the the HSSIP HSSIP target target (85%) (85%) for for 2012/ /13 The SARA 2013 findings (Table 7) 7) show that that non-availability of of EPI EPI guidelines guidelines and and lack lack of of staff staff trained in EPI at some facilities could be be the the major factors affecting the the immunization program program service delivery. Table 7: % of facilities that have tracer items for child immunization services among facilities Staff and Guidelines Equipment Medicines and and Commodities Readiness Score Score Guidelines available EPI 51% At least one staff trained EPI 44% Single use syringes 99% 99% Sharps Sharps container 97% 97% Cold Cold box box with with ice ice packs packs 96% 96% Vaccination cards Vaccination cards 88% 88% Refrigerator 79% Refrigerator 79% Measles vaccine 80% Measles vaccine 80% DPT-HiB+HepB vaccine 79% DPT-HiB+HepB vaccine 79% Polio vaccine 78% Polio vaccine 78% BCG vaccine 76% BCG vaccine 76% %of facilities with all items 19% %of facilities with all items Mean availability of tracer items 19% 80% Mean availability Source: of SARA tracer items % Source: SARA 2013 [Annual Health Sector Performance Report 2012/13] Page 11 In [Annual FY 2012/13 Health Sector 193,000 Performance new patients Report were 2012/13] enrolled on the life saving ART against the Page planned 11 target of 110,000 new patients. This enrolment for the first time exceeded the number of estimated new infections (140,000) over the same period marking a tipping point in the ART programme. By end of June 2013, 566,444 (524,603 adults and 41,520 children) eligible persons were on ARVs. This was a result of efforts by the AIDS Control Program to accelerate accreditation of health facilities, scale up of Option B+ for EMTCT, introduction of Web Based ARV Ordering Systems and supply chain rationalization which strengthened the PSM; as well as improved overall support to health facilities by the MoH and Implementing Partners. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 32% to 46% in 2012/13 though still below the HSSIP target (55%). % eligible persons receiving ARV therapy which increased from 59% in 2011/12 to 76% in 2012/13 also above the HSSIP (65%) for 2012/13. The availability of trained staff for ART prescription and availability of guidelines in facilities assessed during the SARA 2013 was at 93% and 88% indicating good access to ART services. Availability of the 3 first line ARVs was at 86%. However, there is still low availability of the diagnostic services for patient follow up and this could compromise the quality of the ART [Annual Health Sector Performance Report 2012/13 FY] Page 11 program. Table 8: % of facilities that have tracer items for ARV services among facilities that provide this service

32 The availability of trained staff for ART prescription and availability of guidelines in facilities assessed during the SARA 2013 was at 93% and 88% indicating good access to ART services. Availability of the 3 first line ARVs was at 86%. However, there is still low availability of the diagnostic services for patient follow up and this could compromise the quality of the ART program. Table 8: % of facilities that have tracer items for ARV services among facilities that provide this service Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score At least 1 trained staff ART prescription and Guidelines available ART CD4 or viral load Renal function test Liver function test Complete blood count (CBC) 3 first line ARVs Percent of facilities with all items Mean availability of tracer items 15% 13% 13% 12% 9% 46% 88% 86% 93% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage availability Source: SARA 2013 There was some improvement registered in the RH indicators; The percentage of deliveries in [Annual health facilities Health Sector from Performance 38% in 2011/12 Report to 2012/13] 41% in 2012/13 though still below the HSSIP Page target There was some improvement registered in the RH indicators; The percentage of deliveries in 12 (65%) for 2012/13. The percentage of pregnant women who completed IPT 2 increased from 44% health facilities from 38% in 2011/12 to 41% in 2012/13 though still below the HSSIP target in (65%) 2011/12 for 2012/13. to 47% The in 2012/13, percentage below of pregnant the HSSIP women target who (60%) completed for 2012/13. IPT 2 increased from 44% in 2011/12 to 47% in 2012/13, below the HSSIP target (60%) for 2012/13. The SARA 2013 findings indicate that among facilities that provide malaria services including IPT, The availability SARA 2013 findings of S/P is indicate 83% that however, among the facilities availability that provide of guidelines malaria for services IPT is including only 41% and IPT, availability of S/P is at 83% however, the availability of guidelines for IPT is only 41% and only 23% have at least one trained staff in IPT. These could be contributing to the low uptake of only 23% have at least one trained staff in IPT. These could be contributing to the low uptake of IPT 2 IPT 2. Table 9: % of facilities that have tracer items for malaria services among facilities that provide this service Table 9: % of facilities that have tracer items for malaria services among facilities that provide this service Staff and and Guidelines Diagnostics Medicines Medicines and Commodities and Commodities Readiness Readiness Score Score Guidelines available diagnosis and and treatment treatment of malaria of malaria 68% 68% At least 1 trained staff diagnosis and treatment of malaria At least trained staff diagnosis and treatment of malaria 61% 61% Guidelines available IPT 41% Guidelines available IPT At least 1 trained staff IPT 23% 41% At least 1 trained staff IPT Malaria diagnostic capacity 23% 89% First-line Malaria antimalarial diagnostic in-stock capacity First-line antimalarial IPT drug in-stock 89% 83% 89% 89% Paracetamol cap/tab IPT drug 77% 83% Paracetamol cap/tab ITN 15% 77% Percent of facilities with all items ITN 3% 15% Mean availability of tracer items 61% Percent of facilities with all items 3% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Mean availability of tracer items 61% Percentage availability 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Source: SARA 2013 Percentage availability 12 Page Source: The health SARA sector 2013 has made very [Annual little Health progress Sector towards Performance increasing Report 2012/13 the percentage FY] of pregnant women attending 4 ANC sessions. There was a decline in the percentage of pregnant women attending 4 ANC sessions to 31% in 2012/13 from 34% in 2012/13. This achievement is far below the HSSIP target for 2012/13 by 24%. The health sector has made very little progress towards increasing the percentage of pregnant women attending 4 ANC sessions. There was a decline in the percentage of pregnant women

33 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage availability Source: SARA 2013 The health sector has made very little progress towards increasing the percentage of pregnant women attending 4 ANC sessions. There was a decline in the percentage of pregnant women attending 4 ANC sessions to 31% in 2012/13 from 34% in 2012/13. This achievement is far below the HSSIP target for 2012/13 by 24%. Some of the factors leading to low coverage for RH services could be explained by the inadequate number of trained staff and low availability of ANC guidelines. The SARA 2013 findings show availability of at least one trained staff for ANC to be 52% and only 44% of facilities had ANC guidelines. Figure 2: % of facilities that have tracer items for ANC services among facilities that provide this service [Annual Health Sector Performance Report 2012/13] Page 13 Staff and Guidelines Equipment Diagnostics Medicines and Commodities Readiness Score At least one trained staff antenatal care 52% Guidelines available antenatal care 44% Blood pressure apparatus 90% Urine dipstick protein test 43% Haemoglobin test 36% Folic acid tablets 85% Tetanus toxoid vaccine Iron tablets 78% 74% Percent of facilities with all items 6% Mean availability of tracer items 63% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage availability Source: SARA 2013 There was significant increase in funding and supply of essential RH medicines and health supplies. Staffing levels for critical cadres at HC IVs and HC IIIs increased during 2012/13. The community needs to be mobilized to maximize use of the interventions and availability of RH supplies and commodities for the sector to realize improvements in coverage for all RH services. The indicator on % U5s with fever receiving malaria treatment within 24 hours from VHT has not been assessed since the beginning of the HSSIP. iccm was implemented in only 34 districts. Only 43.5% of U5s with fever receiving malaria treatment within 24 hours from VHT in the 34 iccm districts. These achievements need to be sustained and improved through strengthening of the EPI, HIV/AIDS and RH programmes and facilitation of the districts and community structures for continued mobilization. [Annual Health Sector Performance Report 2012/13 FY] Page 13

34 2.3 Coverage with Other Health Determinants 2.3 Coverage with Other Health Determinants The 2.3 overall Coverage contribution with of Other interventions Health Determinants for improving health outcomes is assessed by coverage The overall with contribution other health of determinants. the interventions Only one for (% improving of households health with outcomes latrine) of is the assessed four by coverage The overall with contribution other health of determinants. the interventions Only for one improving (% of households health outcomes with latrine) is assessed of the four by core indicators is assessed annually. The remaining three; % of U5 children with height/age coverage core indicators with other is assessed health annually. determinants. The remaining Only one (% three; of households % of U5 children with latrine) with of height/age the four below lower line (stunting) and % of U5 children with weight/age below lower line (wasting) below core indicators lower line is (stunting) assessed annually. and % of The U5 children remaining with three; weight/age % of U5 below children lower with line height/age (wasting) and Contraceptive Prevalence Rate (CPR) were assessed in the UDHS 2011 and reported upon and below Contraceptive lower line (stunting) Prevalence and Rate % of (CPR) U5 children were assessed with weight/age in the UDHS below 2011 lower and reported line (wasting) upon in the AHSPR 2011/12. and in the Contraceptive AHSPR 2011/12. Prevalence Rate (CPR) were assessed in the UDHS 2011 and reported upon in the AHSPR 2011/12. 1) The proportion of households with latrines (all types of latrines) decreased from 70% in 1) The proportion of households with latrines (all types of latrines) decreased from 70% in 1) 2011/12 The 2011/12 proportion to to 68% 68% in of in 2012/ /13. households This This is with below is below latrines the the HSSIP (all HSSIP target types target (70.5%) of (70.5%) latrines) for 2012/13 for decreased 2012/13 FY. FY. from 70% in 2011/12 to 68% in 2012/13. This is below the HSSIP target (70.5%) for 2012/13 FY. Since FY FY 2011/12, 2011/12, Uganda Uganda received received financial financial support support from from the the Global Global Sanitation Sanitation Fund Fund (GSF) (GSF) to to support Since FY the the 2011/12, Uganda Uganda Sanitation received Fund Fund Program financial Program (USF) support (USF) in improving in from improving the sanitation Global sanitation Sanitation and hygiene and Fund hygiene in 15 (GSF) in 15 to districts support (Pallisa, the Uganda Kibuku, Sanitation Bukedea, Fund Kumi, Kumi, Program Ngora, Ngora, Serere, (USF) Serere, Soroti, in improving Soroti, Katakwi, Katakwi, sanitation Amuria, Amuria, Kaberamaido, and Kaberamaido, hygiene in 15 Dokolo, districts Amolatar (Pallisa, Kibuku, in in Eastern Bukedea, Uganda; Kumi, and and Mbarara, Ngora, Mbarara, Serere, Bushenyi Bushenyi Soroti, and and Sheema Katakwi, Sheema in Amuria, the in South the Kaberamaido, South West). West). The Dokolo, latrine Amolatar coverage in in in Eastern the the districts Uganda; increased and Mbarara, from from 73% Bushenyi 73% in 2011/12 in 2011/12 and to Sheema 79% to in 79% 2012/13. in in the 2012/13. South West). The latrine coverage in the 15 districts increased from 73% in 2011/12 to 79% in 2012/13. Table 10: Key outputs of of the the USF USF Program 2012/13 Table Indicator 10: Key outputs of the USF Program FY FY 2011/ / /12 FY 2012/13 FY 2012/13 Cumulative Cumulative 5 year 5 year Achieved Achieved Indicator FY 2011/12 FY 2012/13 total Cumulative total target 5 target year (%) Achieved (%) Target Target Achieved Achieved Target Target Achieved Achieved total target (%) triggered Target 1,025 Achieved 934 Target 1,397 Achieved Villages triggered 1, ,397 1,605 1,605 3,002 3,002 5,827 5, Villages declared declared triggered ODF ODF 1,025 1, ,977 1,977 1, , ,154 1,154 3,002 5,827 5, People Villages living declared in ODF ODF areas 615,000 1, , ,186,200 1, , ,400 1,154 3,496,200 5, People living in ODF areas 615, ,400 1,186, , ,400 3,496, New People latrines living constructed in ODF areas 615,000 40, ,400 25,685 1,186,200 53, ,000 55, ,400 81,341 3,496, , New latrines constructed 40,000 25,685 53,580 55,656 81, , Additional New latrines Population constructed using latrines 240, ,110 25, ,900 53, ,280 55, ,390 81,341 1,227, , Additional Population using latrines 240, , , , ,390 1,227, New Additional hand Population washing facilities using latrines 100, , ,110 43, , , ,280 65, , ,390 1,227, , New hand washing facilities 100,000 43, ,012 65, , , Households New hand washing hand washing facilities with 100,000 57,179 43, ,012 73,863 65, , , , Households soap hand washing with 100,000 57, ,012 73, , , Households hand washing with 100,000 57, ,012 73, , , soap Latrine soap coverage (%)* % 79.0 Latrine coverage (%)* % 79.0 Latrine coverage (%)* % 79.0 Source: USF Progamme Report Source: Source: USF USF Progamme Progamme Report Report The sector continues monitoring progress in the delivery of contraceptive services at the program The sector level continues using the monitoring HMIS. progress There progress was in the in a the remarkable delivery delivery of contraceptive increase of contraceptive in the services Couple services at the Years at the of program Protection level (CYP) using from the the 1,780,578 HMIS. HMIS. There in There 2011/12 was was a to remarkable a 3,275,403 remarkable increase increase 2012/13 the FY. in Couple the CYP Couple is Years the estimated Years of of Protection protection (CYP) provided from by 1,780,578 FP services in in 2011/12 during to a to one-year 3,275,403 in period, 2012/13 in 2012/13 based FY. CYP FY. upon is CYP the the is estimated the volume estimated of all protection contraceptives provided sold or by by distributed FP FP services free during during of charge a a one-year to clients period, period, during based based that upon period. upon the volume the volume of all of all contraceptives sold or or distributed free free of charge of charge to clients to clients during during that that period. period. [Annual Health Sector Performance Report 2012/13] Page 15 [Annual The SARA Health 2013 Sector findings Performance (Figure 3) Report Report show 2012/13] the 2012/13] mean availability of FP tracer items was Page at 15 Page 74% 15 by June Figure 3: Percentage of facilities that have tracer items for FP services among facilities providing FP 14 Page Staff and Guidelines [Annual Equipment Health Sector Performance Medicines and Report Commodities 2012/13 FY] Readiness Score At least one trained staff family planning Guidelines available family planning 49% 44%

35 The SARA 2013 findings (Figure 3) show the mean availability of FP tracer items was at 74% by June The SARA 2013 findings (Figure 3) show the mean availability of FP tracer items was at 74% by Figure June 3: Percentage of facilities that have tracer items for FP services among facilities providing FP Figure 3: Percentage Staff and of facilities Guidelines that have Equipment tracer items for Medicines FP services and among Commodities facilities providing Readiness FP Score Staff and Guidelines At least one trained staff family planning Equipment Medicines and Commodities 49% Readiness Score Guidelines available family planning 44% At least one trained staff family planning 49% Guidelines Blood pressure apparatus 86% available family planning 44% Blood Injectable pressure contraceptives apparatus 86% 94% Injectable contraceptives Condoms Combined oral contraceptive Condoms pills 84% 94% 84% 84% Percent Combined of oral facilities contraceptive with all items pills Mean Percent availability of facilities of with tracer all items 21% 21% 84% 74% Mean availability of tracer items 0% 10% 20% 30% 40% 50% 60% 74% 70% 80% 90% 100% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage availability Percentage availability Source: SARA 2013 Source: SARA 2013 Table Table summarizes the trends in in performance for for the the four four core core health health determinates determinates and and risk risk factors indicators. Table 11: Performance for coverage for other health determinants and and risk risk factors indicators during during 2012/ /13 FY FY 2012/ /13 Indicator Source 2008/ / / / / / / /12 HSSIP HSSIP Achievement Achievement Performance Performance Target Target Trend Trend from from 2011/ /12 % of households with latrine EHD 67.5% 69.7 % 71% 70% 70.5% 68% Negative trend % of households with latrine Data EHD 67.5% 69.7 % 71% 70% 70.5% 68% Negative trend and below HSSP Data tool and below HSSP target by 2.5% % U5 children with height UDHS tool 38% 38% 38% 33% 32% 33% On track target and by 2.5% %/age U5 below children lower with line height -2 SD UDHS (2006) 38% (2006) 38% (2006) 38% (2011) 33% 32% (2011) 33% above On HSSIP track and /age (stunting) below lower line -2 SD (2006) (2006) (2006) (2011) (2011) target above by 1% HSSIP (stunting) target by 1% % U5 children with weight UDHS 16% 16% 16% 14% 13% 14% On track %/age U5 below children lower with line weight -2 SD UDHS (2006) 16% (2006) 16% (2006) 16% (2011) 14% 13% (2011) 14% On track /age (underweight) below lower line -2 SD (2006) (2006) (2006) (2011) (2011) (underweight) Contraceptive Prevalence Survey / 24% 33%* 33%* 30% 41% 30% Below HSSIP Rate Contraceptive UDHS Prevalence Survey / 24% 33%* 33%* (2011) 30% 41% (2011) 30% target Below by 11% HSSIP Rate UDHS (2011) (2011) target by 11% The UDHS 2011 findings showed improvement in coverage for three out of the four other health determinants and risk factors indicators as reported in the AHSPR 2011/12 FY. The CYP computed [Annual Health from Sector the HMIS Performance shows a Report remarkable 2012/13] increase from 1,780,578 in 2011/12 to Page 3,275, in 2012/13 FY. This is mainly due to the FP revitalization strategies implemented during the year [Annual Health Sector Performance Report 2012/13] Page 16 Specifically, Government procured RH commodities including contraceptives worth USD 12.2 million (including USD 8.6 million from the World Bank) in 2012/2013. UNFPA procured RH commodities worth USD 3.7 million while USAID procured RH commodities worth USD 4 million thus reducing stock out rates at facilities. The latrine coverage (all types) declined to 68% in 2012/13 from 70% in 2011/12. [Annual Health Sector Performance Report 2012/13 FY] Page 15

36 2.4 Health Quality and Outputs The five core indicators for health quality and output provide information on the direct output from investments made in health services. They are a measure of improvements made in access, quality, and safety of health services provided. 1) The proportion of new TB smear positive cases notified compared to expected (TB CDR) has decreased from 57.2% in 2011/12 to 54.5% in 2012/13, and is still below the annual HSSIP target of 70%. This is indicator is however no longer monitored globally among the TB programme specific indicators. TB Treatment Success Rate increased from 71.1% in 2011/12 to 79% in 2012/13. 2) Per capita Out Patients Department (OPD) utilization rate has continued to be above the annual HSSIP target of 1.0 at 1.1 (15,094,349 males, 15,094,349 females) in 2012/13 compared to 1.2 in 2011/12. 3) The level of client satisfaction based on waiting time was 71% and 72% in 2009/10 and 2010/11 respectively (National Panel Surveys). This was an improvement from 46% at the Mid-term evaluation of HSSIP II used as the baseline at the beginning of the HSSIP 2010/ /15. National client satisfaction surveys were not conducted during 2011/12 and 2012/13. The planned national client satisfaction survey is to be conducted in 2013/14. A number of project specific studies/reviews were conducted regarding client and health workers satisfaction e.g. the 5S Project mid-term evaluation mainly in the Regional Referral Hospitals (RRHs); the Annual Client Satisfaction Surveys in Uganda Catholic Medical Bureau (UCMB) hospitals (29); the Client Satisfaction Survey by Uganda Protestant Medical Bureau (UPMB); and the Client Satisfaction Survey by Uganda National Health Consumers Organization (UNHCO). The 5S Project mid-term evaluation conducted by JICA in 13 RRHs (Mbale, Soroti, Jinja (without 5S), Masaka, Mubende, Arua, Gulu, Lira, Moroto, Fort Portal (without 5S), Hoima, Kabale & Mbarara (without 5S); 8 GHs (Bududa, Bugiri, Busolwe, Kapchorwa, Masafu, Tororo, Entebbe & Gombe); and 4 HC IVs (Busia, Mukuju, Mulanda & Nagongera) showed that; on the whole, general satisfaction with health services improved whereby 67.4% patients or caregivers (1,534 out of 2,277) replied good or very good to the question What do you think about health services of this health facility?, going up from result of the baseline survey in 2012 (55.8%, 1,367 out of 2,452). [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

37 On the whole, 45.8% of the respondents (1,043 out of 2,277) replied No to the question Do you feel you have to wait long before you get services in the health facility? in the mid-term survey in In the baseline survey in 2012, 47.5% (1,160 out of 2,440) did not feel waiting long. Therefore, as the impression of patients or caregivers, waiting time was not reduced. The findings from the UCMB annual client satisfaction surveys show that during the year 2013, 12/29 hospitals improved the satisfaction rate (compared to the 9/29 hospitals in 2012 with the rate ranging from 79% to 96%) with waiting time with rate ranging from 80% to 96%. The majority of the patients / clients rated waiting for care and treatment between ½ hr and 2 hrs. The likely problems of waiting time in OPD is related to the capacity of the hospital to recruit adequate clinical staff that meet the workload and increasing utilization of the facilities. There were 21/ 29 hospitals in 2013 that improved the general satisfaction rate with rates ranging from 60% to 91% as compared to the 9/29 hospitals that improved their rate (rates ranging from 63% to 81% ) in the year A client satisfaction survey conducted in 2012 by UPMB in 84 facilities targeting clients accessing Maternal and Neonatal Health and other RH services. This survey assessed the general level of client satisfaction which showed that there was a high level of satisfaction with MNH services reflected in 85.5% and 89.5% of clients from MNH and Non MNH implementing facilities respectively. The study did not assess the clients perception on waiting time however; it established how much time clients have wait before being attended to and the time or duration for the entire visit at UPMB Member Health Units. Summary of the statistics indicate that over 80% of the clients are attended to as soon as they visit the facility, that is, within a period of 30 minutes. 5.4% of the clients however spent more than one hour before being attended to. Close to 80% of the clients spend the recommended time of two or less hours at the facility when they come to access health care. Table 12: Waiting time for clients before being attended to and length of the visit Source: UPMB Client and Facility Satisfaction Survey 2012 [Annual Health Sector Performance Report 2012/13] Page 19 [Annual Health Sector Performance Report 2012/13 FY] Page 17

38 Another client satisfaction survey (Clients satisfaction with services in public health facilities in Uganda: An assessment of Citizens empowerment and medicines availability) conducted by UNHCO in 10 districts (Nebbi, Soroti, Iganga, Wakiso, Mbarara, Oyam, Nwoya, Kapchorwa, Pallisa and Kasese), in The draft report findings indicate that the aggregate level of satisfaction with the process of care and redress mechanisms was at 32%. The results from key informant interviews indicated that long waiting time was the commonest cause of dissatisfaction identified by 38% of the interviewees while inadequate medicines was cited by 42%. Other challenges mentioned but with low frequency were rude staff, poor sanitation and non-availability of staff over weekends and at night, and some staff demanding for money for treatment and in extreme cases facilities closing out for a whole week or opening for some selected days. 4) The availability of the 6 tracer medicines has continued to improve over the last four years with the percentage of facilities without stock out of any of the 6 indicator medicines (first line antimalarials (ACTs), Depoprovera, Sulphadoxine/pyrimethamine, measles vaccine, ORS and Cotrimoxazole) in the last six months of the FY increasing from 21% in 2009/10 to 48% in 2011/12 and is now 53% in 2012/13. This is a positive trend though below the HSSIP target of 60% for 2012/13. NB: The AHSPR 2011/12 reported availability of the six tracer medicines of 69.5% which is varying with 48% availability reported for the same year in this report. This is attributed to the change in the reporting system where the DHIS-2 had just been introduced and there was a mix up in the method of reporting (DHIS-2 and the aggregated district reporting) and use of different version of report forms. This partly accounts for the variation in the output. Currently all data for the two FYs has been captured through the DHIS-2 system. Table 10 shows the proportion of health facilities with no stock out for the 6 tracer medicines by quarter during 2012/13. The availability of individual medicines at facilities is reported to be high with an average of 65% in the last 6 months of the FY. However, the standard required is that all the tracer medicines should be available at any one in all facilities. Using health facility of the 3,873 health units (public and private) reporting in the last six months of FY 2012/13, 2,036 (53%) reported no stockout in any of the tracer medicines during that period. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

39 Tracer Medicines No Stockout 2012/13 Table 13: of Health Facilities with No Stockout For the Tracer Medicines 2012/13 FY Table 13: % of Health Facilities with No Stockout For the 6 Tracer Q1 Medicines Q2 2012/13 FY Q3 Q4 Tracer Medicines Tracer 1. Medicines ACT 85.8% No Stockout 2012/ % 90.4% 92.9% No Stockout 2012/13 2. Measles vaccine Q1 93.7% Q2 94.0% Q3 93.6% Q4 94.5% Q1 1. ACT 85.8% Q2 91.2% Q3 90.4% Q4 92.9% 3. ORS Sachets 86.9% 87.8% 84.5% 84.2% 1. ACT 85.8% 91.2% 90.4% 92.9% 2. Measles vaccine 93.7% 94.0% 93.6% 94.5% 4. Cotrimoxazole 90.7% 91.8% 83.4% 80.2% 2. Measles vaccine 93.7% 94.0% 93.6% 94.5% 3. ORS Sachets 86.9% 87.8% 84.5% 84.2% ORS Depo-Provera Sachets 86.9% 88.9% 87.8% 89.7% 84.5% 96.6% 84.2% 97.3% 4. Cotrimoxazole 90.7% 91.8% 83.4% 80.2% Cotrimoxazole 90.7% Sulphadoxine/ Pyrimethamine (Fansidar) 92.9% 91.8% 94.6% 83.4% 94.2% 80.2% 92.5% 5. Depo-Provera 88.9% 89.7% 96.6% 97.3% Prop. 5. Depo-Provera No Stock-out- in any of the Six Tracer medicines 88.9% 63.7% 89.7% 68.6% 96.6% 65.4% 97.3% 65.3% 6. Sulphadoxine/ Pyrimethamine (Fansidar) 92.9% 94.6% 94.2% 92.5% Source: MoH HMIS Prop. 6. No Sulphadoxine/ Stock-out- in Pyrimethamine any of the Six (Fansidar) 92.9% 94.6% 94.2% 92.5% Tracer medicines 63.7% 68.6% 65.4% 65.3% Prop. No Stock-out- in any of the Six Tracer medicines 63.7% 68.6% 65.4% 65.3% Source: MoH HMIS Source: MoH HMIS By June 2013 mtrac had been fully rolled out nationally in every district and at every health By June 2013 mtrac had been fully rolled out nationally in every district and at every health By facility June 2013 in Uganda. mtrac Data had been from fully mtrac rolled shows out nationally that the in proportion every district of and health at every units health reporting below facility Uganda. Data from mtrac shows that the proportion of health units reporting below facility minimum Uganda. stock Data levels from (of mtrac ACTs) shows and proportion that the proportion of health of health units units reporting reporting stock below out (of ACTs) minimum stock levels (of ACTs) and proportion of health units reporting stock out (of ACTs) minimum over the stock period levels of (of mtrac ACTs) implementation and proportion of has health continued units reporting to show stock a steady out (of decline. ACTs) This is over the period of mtrac implementation has continued to show steady decline. This is over selected the period from of the mtrac two weeks implementation in 2012 (34 has and continued 35) at the to show beginning a steady of the decline. FY, two This weeks is in 2012 selected from the two weeks in 2012 (34 and 35) at the beginning of the FY, two weeks in 2012 selected (47 and from 48) the in the two middle weeks in of 2012 the (34 FY and 2012, 35) two at the weeks beginning (11 and of the 12) FY, at two the weeks start in of 2012 the year 2013 (47 and 48) in the middle of the FY 2012, two weeks (11 and 12) at the start of the year 2013 (47 and and two 48) weeks in the middle ending of the FY financial 2012, two year weeks (25 (11 and and 26). 12) The at the trends start in of the year selected 2013 indicators and two weeks ending the financial year (25 and 26). The trends in the selected indicators and indicate indicate two weeks an an improvement improvement ending the financial in performance performance year (25 and notably notably 26). stockout stockout The trends and facilities and in the facilities selected reporting reporting indicators on time. The on time. The indicate an improvement in performance notably stockout and facilities reporting on time. The health health units units reporting reporting also also improved improved overtime overtime as result as a of result national of national coverage coverage in all the Phases. in all the Phases. health units reporting also improved overtime as a result of national coverage in all the Phases. Figure 4: Health units reporting stock out overtime Figure 4: Health units reporting stock out overtime Figure 4: Health units reporting stock out overtime % % % % % % 30% 30% 21.6% 20.1% % % 21.6% 13.6% % 20.1% % % 11.2% 12.9% 13.7% 20% 13.6% 13.6% 13.1% 13.1% 13.5% 15% % 12.9% 13.7% 11.2% 12.9% 13.7% 20% 13.5% 15% % % % 228 5% 0% 0 0% 0 WEEK34 WEEK35 WEEK47 WEEK48 WEEK11 WEEK12 WEEK25 WEEK26 WEEK34 WEEK35 WEEK47 WEEK48 WEEK11 WEEK12 WEEK25 WEEK WEEK WEEK WEEK WEEK WEEK WEEK WEEK Total Reporting 2012 Health 2012 units 2012 Total 2013 Health units 2013 with stockout 2013 Total Reporting Health units Total Health units with stockout Proportion Total Reporting with stockout Health units Total Health units with stockout Proportion with stockout Proportion with stockout Number of of Health units Number of Health units Table 13: % of Health Facilities with No Stockout For the 6 Tracer Medicines 2012/13 FY 5) HC IV functionality remarkably increased from 25% in 2011/12 to 36% in 2012/13. HC IV 5) HC IV functionality remarkably increased from 25% in 2011/12 to 36% in 2012/13. HC IV functionality is being able to provide intervention in case of complications during delivery, 5) functionality HC IV functionality is being able remarkably to provide increased intervention from in case 25% of in complications 2011/12 to during 36% delivery, in 2012/13. HC IV [Annual functionality Health Sector is Performance being able Report to provide 2012/13] intervention in case of complications Page during 21 [Annual Health Sector Performance Report 2012/13] Page 21 delivery, [Annual Health Sector Performance Report 2012/13] Page 21 Proportion with Stockout 45% 40% 35% 30% 25% 20% 13.5% 15% 10% 5% 0% WEEK Proportion with Stockout [Annual Health Sector Performance Report 2012/13 FY] Page 19

40 which includes the ability to provide a Caesarean Section and Blood Transfusion. In this which includes the ability to to provide a Caesarean Section and Blood Transfusion. In In this assessment functionality is carrying out at least a Caesarean Section. There was also, a slight assessment functionality is is carrying out at at least a Caesarean Section. There was also, a slight increase in the percentage of HC IVs providing blood transfusion from 26% in 2011/12 to increase in in the percentage of HC IVs providing blood transfusion from 26% in in 2011/12 to to 27% in 2012/13. The number of HC IV assessed for functionality increased from in 96 in 27% in 2012/13. The number of HC IV assessed for functionality increased from 96 in 2011/12 to 179 in 2012/13 as a result of using the DHIS-2 system which provides facility 2011/12 to 179 in 2012/13 as a result of using the DHIS-2 system which provides facility based data. Further analysis of the functionality of HC IVs is is in sub-section based data. Further analysis of the functionality of HC IVs is in sub-section Table 14: HC IV Functionality 2011/12 to 2012/13 FY Table 14: HC IV Functionality 2011/12 to 2012/13 FY FY HC IVs providing Blood HC IVs carrying out FY HC IVs providing Blood HC IVs carrying out Transfusion Transfusion Caesarian Caesarian Section Section Number Number %% Number Number % % 2011/12 23/96 23/96 26% 26% 24/96 24/96 24% 24% 2012/13 49/179 27% 27% 64/179 64/179 36% 36% Source: MoH HMIS Table 15 summarizes performance for for the the 5 5 core core health system output output indicators discussed above. Table 15: Performance for health system output (availability, access, quality, safety) safety) indicators Indicator Source 2012/ / / / / / / /12 HSSIP HSSIP Achievement Performance Performance Target Target Trend Trend from from 2011/ /12 % of of of new TB TB smear smear + cases notified notified compared compared to to to expected expected (TB (TB case case detection detection rate) rate) Per Per capita capita OPD OPD utilization utilization rate rate % clients clients expressing expressing satisfaction satisfaction with with health health services services (waiting (waiting time) time) % of of health health facilities % of health facilities without without stock stock outs outs of of without stock outs of any any of of the the 6 tracer tracer any of the 6 tracer medicines medicines in in the the medicines in the previous previous 6 months months previous 6 months % of of functional functional HC HC IVs IVs % of functional HC IVs (performing (performing C/S) C/S) (performing C/S) NTLP NTLP 57.4% 57.4% 56% 56% 53.9% 53.9% 57.2% 57.2% 70% 70% 54.5% 54.5% Negative Negative trend trend Database Database and and below below the the HSSIP HSSIP target target by by by 16.5% 16.5% HMIS HMIS On track On track males; 0.9 males; females 1.3 females Survey Survey 46% 46% 71% 71% 72% 72% NA NA NA 60% 60% No No current No current No No data No since data since data data data 2010/ /11 UNPS UNPS UNPS UNPS HMIS HMIS 26% 26% 21% 21% 43% 43% 48% 48% 60% 60% 53% 53% Positive trend trend HMIS 26% 21% 43% 48% 60% 53% Positive trend though though below below though below HSSIP HSSIP target target by by HSSIP target by 7% 7% 7% HMIS HMIS No No data data 23% 23% 24% 24% 25% 25% 38% 38% 36% 36% Positive Positive trend trend HMIS No data 23% 24% 25% 38% 36% Positive trend [Annual [Annual Health Health Sector Sector Performance Performance Report Report 2012/13] 2012/13] Page Page [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

41 The health sector achieved the annual HSSIP targets for 2 out of the 5 indicators determining availability, access, quality and safety of health services; i.e. per capita OPD utilization and % of functionally HC IVs (performing C/S). The stabilization of per capita OPD utilization at above 1.0 for the last 2 years could be related to the progressive improvement in medicines availability from 21% at the beginning of the HSSIP (2010/11) to 53% in 2012/13 and other parameters like improved infrastructure, attitude and availability of staff. The sector does not have the current (2012/13) national status of proportion of clients expressing satisfaction with health services specifically on waiting time. Albeit that different institutional client satisfaction surveys show an increase in general client satisfaction. There was remarkable improvement in the functionality of HC IVs from 25% in 2011/12 to 36% HC IV performing C/S in 2012/13. There was also a slight increase in the percentage of HC IVs providing blood transfusion services from 26% in 2011/12 to 27% in 2012/13. One of the factors that could be contributing to the remarkable increase in the % of HC IVs performing C/S was the improved reporting from 96 to 179 HC IVs in 2012/13 as a result of using the DHIS-2 system. Over the years, poor functionality of HC IVs was attributed to inadequate human resource specifically Medical Officers. During 2012/13 FY the MoH undertook major recruitment for all HC IVs and HC IIIs and the effect of this recruitment will be analyzed in the subsequent FY. The MoH needs to carry out further analysis to identify additional factors that could be contributing to this improvement. The progressive improvement in availability of the 6 tracer medicines from 21% in 2009/10 to 48% in 2011/12 and 53% in 2012/13 is attributed to a number of interventions that were implemented to increase access to medicines including increased funding for medicines and health supplies. Although there was a positive trend it was still below the annual HSSIP target for 2012/13 of 60%. The sector realized a decline in the percentage of new TB smear positive cases notified compared to expected (TB CDR) from 57.2% in 2011/12 to 54.5% in 2012/13 and was also still below the annual HSSIP target of 70%. There is need to review this indicator as core HSSIP indicator and replace it with another programme relevant indicator as it is no longer monitored globally as recommended by WHO. The mean availability of tracer items for TB services was at 65% in % of facilities offering TB services had guidelines for diagnosis and treatment of TB, and 68% had at least one [Annual Health Sector Performance Report 2012/13] Page 23 [Annual Health Sector Performance Report 2012/13 FY] Page 21

42 staff trained in the diagnosis and treatment of TB. The slow progress in TB CDR could be attributed to other factors like negative staff attitude and low uptake of from the community due to stigma and lack of awareness. Figure 5: % of facilities that have tracer items for TB services among facilities that provide this service Staff and Guidelines Diagnostics Medicines and Commodities Readiness Score Guidelines available diagnosis & treatment of TB At least 1 trained staff diagnosis & treatment of TB Guidelines available management of HIV & TB co-infection At least 1 trained staff management of HIV & TB co-infection Guidelines available TB infection control At least 1 trained staff TB infection control At least 1 trained staff MDR-TB Guidelines available MDR-TB System for diagnosis of HIV among TB clients HIV diagnostic capacity TB microscopy All first-line TB medications Percent of facilities with all items Mean availability of tracer items 13% 25% 36% 69% 68% 65% 64% 60% 53% 65% 95% 81% 72% 87% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage availability Source: SARA 2013 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

43 2.5 Health Investments The 4 indicators on health investments provide information on the amount of investm available 2.5 Health for Investments health services. The sector realized a positive trend in only one of the indicators. The 4 indicators on health investments provide information on the amount of investments available for health services. The sector realized a positive trend in only one of these 4 indicators. 1) 2.5 The Health percentage Investments of approved post filled by health workers (public facilities) improved f 58% in 2011/12 to 63% in 2012/13 (Table 13). Staffing level at district level exclu referral hospitals improved from 55% in 2011/12 to 60.5% in 2012/13 with a signifi increase in staffing levels at HC IIIs and HC IVs to 70% and 71% respectively. This w result of recruitment of 7,619 health workers (7,211 GoU funding & 408 GFTAM); inclu both the trained health workers, administrative and support staff in public health facili Only 34 districts met the HSSIP target of 70% for the year under review. Districts Kiruhura, Bududa, Lamwo, Gomba, Kaabong and Buhweju had staffing levels ranging f The 4 indicators on health investments provide information on the amount of investments 1) available The percentage for health of services. approved The post sector filled realized by health a workers positive (public trend facilities) in only one improved of these from 4 indicators. 58% 2011/12 to 63% in 2012/13 (Table 13). Staffing level at district level excluding referral hospitals improved from 55% in 2011/12 to 60.5% in 2012/13 with a significant 1) increase The percentage in staffing of approved levels at post HC IIIs filled and by HC health IVs to workers 70% and (public 71% facilities) respectively. improved This was from a result 58% in of 2011/12 recruitment to 63% of 7,619 in 2012/13 health workers (Table 13). (7,211 Staffing GoU funding level at & district 408 GFTAM); level excluding including both referral the hospitals trained health improved workers, from administrative 55% 2011/12 and to support 60.5% staff in 2012/13 in public with health a significant facilities. Only increase 34 districts in staffing met levels the at HSSIP HC IIIs target and of HC 70% IVs to for 70% the and year 71% under respectively. review. Districts This was like a result Kiruhura, of recruitment Bududa, Lamwo, of 7,619 Gomba, health Kaabong workers and (7,211 Buhweju GoU funding had staffing & 408 levels GFTAM); ranging including from both 28% 28% to the 35%. to trained 35%. health workers, administrative and support staff in public health facilities. Only Table Table 34 16: Summary 16: districts Summary met of HRH of the status HRH HSSIP in status target public health in public of 70% health for the year under review. Districts like Kiruhura, Bududa, Lamwo, Gomba, Kaabong and Buhweju had staffing levels ranging from Cost Cost Centre Centre No. No. Total Total Filled Filled Vacant % Vacant Filled % % Filled % 28% to 35%. of of Norms Norms Vacant Vacant Table 16: Summary of HRH Units status Units in public health Mulago Hospital 1 2,801 2, % 13% Mulago Hospital 1 2,801 2, % 13% Butabika Cost Centre Hospital No. 1 Total 424 Filled 393 Vacant 33 % Filled 93% % 8% RRHs Butabika Hospital of Norms 13[1] 4, ,121 1, % 33 Vacant 28% 93% 8% Units DHO s RRHs Office [1] 1,232 4, , % 1,210 43% 72% 28% Mulago Hospital 1 2,801 2, % 13% General Butabika DHO s Hospital Hospital Office , ,232 4, , % 93% % 8% 57% 43% HC RRHs IV General Hospital 13[1] ,112 4,331 7,980 5,731 3,121 4,842 2,384 1,210 71% 72% 3,138 29% 28% 61% 39% HC DHO s III Office ,214 1,232 12, , % 57% 30% 43% HC IV 169 8,112 5,731 2,384 71% 29% HC General II Hospital 1, ,364 7,980 6,428 4,842 7,936 3,138 45% 61% 55% 39% Municipal HC III Council , , % 5,144 55% 70% 30% HC IV 169 8,112 5,731 2,384 71% 29% HC II 1,596 14,364 6,428 7,936 45% 55% Big HC III Town , , , % 70% 65% 30% Small Municipal Town Council % 42 70% 45% 55% HC II 1,596 14,364 6,428 7,936 45% 55% Total Municipal Big Town Council 2, , , , % 45% 49 59% 55% 35% 65% Source: Big LG Small Town Staffing Town levels from 11 the MoH 88 HRH 75 Biannual report & Refferal 35% 309 Hospital 65% levels 30% form the 70% MoH HRH Biannual Small Report Town % 70% Total 2,936 57,050 35,903 21,152 63% 59% Total 2,936 57,050 35,903 21,152 63% 59% 2) Source: The % LG reduction Staffing in levels absenteeism from the rate MoH had HRH not Biannual been reported 2013 for the & Refferal last 2 years. Hospital The levels results form the MoH Source: LG Staffing levels from the MoH HRH Biannual report 2013 & Refferal Hospital levels form the MoH HRH Biannual of the Report last two 2012 panel survey findings from UBOS obtained this year indicate that Biannual Report ) The % reduction in absenteeism rate had not been reported for the last 2 years. The re of of the the last last two two panel panel survey survey findings findings from UBOS from obtained UBOS this obtained year indicate this year that indicate 2) The % reduction in absenteeism rate had not been reported for the last 2 years. The results [Annual Health Sector Performance Report 2012/13] Page 25 [Annual Health Sector Performance Report 2012/13] Page 25 [Annual Health Sector Performance Report 2012/13] [Annual Health Sector Performance Report 2012/13 FY] Page 23 Pag

44 absenteeism rate at HC III and HC II level had increased by 2% from 46% in 2009/10 to 48% in 2010/11 instead of a decrease by 20% as per set target. 3) The percentage of villages / wards with trained Village Health Teams (VHTs) decreased from 78% in 2011/12 to 55% in 2012/13. This is below the HSSIP target of 75% for the year. There was seemingly a positive trend in the percentage of villages with trained VHTs from 31% in 2009/10 to 72% in 2010/11, 78% in 2011/12 FY and now a significant decline to 55% (31,295 out of 57,017 villages/wards) in 2012/13 FY. In 2012/13 only the Training of Trainers (ToT) was conducted in Sheema district; in 2011/12 VHT training was carried out in only one district (Nakaseke) and in 2010/11 in only Lyantonde district. These few trainings could not have raised the % of trained VHTs from 31% at the baseline 2009/10 to 78% in 2011/12. It is worth noting there is no established mechanism for tracking the VHT training and information used in the previous reports was based on quarterly supervision visit reports and adhoc VHT strategy performance reports from the respective districts without specifying the number of villages trained. During the year under review there was deliberate tracking of VHTs trained based on the UNICEF 2009 VHT Situation Analysis Report and the quarterly support supervision reports. During 2012/13 FY 70,000 torches and 140,000 batteries were procured and distributed to VHTs countrywide targeting those active in home based care of malaria. In addition 17,925 VHT registers were procured for registering all pregnant women and distribution on going under the UHSSP. A number of partners supported training VHTs in specific programme areas e.g. HIV/AIDS, Malaria, ICCM, RH. Following the launch of the Revised VHT Strategy in 2010/11 FY a number of districts have established VHTs with 75% of districts having 100% coverage however the progress in training in not in tandem with the establishment. This has resulted in de-motivation and attrition of the established VHTs. Table 17: VHT Establishment by June 2013 DISTRICT NUMBER & % OF DISTRICTS COVERAGE 100% coverage 84 (75%) 50 99% coverage 6 (5%) (Kalangala, Kanungu, Kisoro, Mukono, Nakasongola, Ngora) Below 50% Source: HP&E Division 19 (17%) (Buikwe, Bulambuli, Busia, Buvuma, Buyende, Iganga, Jinja, Kabale, Kampala, Kayunga, Manafwa, Mityana, Namayingo, Pallisa, Rakai, Sembabule, Sheema, Sironko and Tororo) [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

45 4) 4) General General Government allocation for for health as as % of the total Government budget has has shown 4) General shown a negative Government trend trend over over allocation the the last last 2 for years, health declining as % of from the 8.3% total in Government 2011/12 to budget to 7.4% in has in 2012/13. shown a This This negative is is below trend the the over 9.8% the target last for 2 years, the year declining which is from also below 8.3% in the 2011/12 Abuja target to 7.4% of of 15%. in 2012/13. This is below the 9.8% target for the year which is also below the Abuja target of 15%. Table summarizes the trends in performance for the four core health investments and Table 18 summarizes the trends in performance for the four core health investments and governance indicators. governance indicators. Table 18: Performance for coverage for health investments and governance indicators Table 18: Performance for coverage for health investments and governance indicators Table 18: Performance for coverage for health investments and governance indicators 2012/ /13 Indicator Indicator Source Source 2008/ / / / / / / /12 HSSIP HSSIP Achievement Achievement Performance Performance Target Target Trend Trend from from 2010/ /11 of HRIS but %% of of approved approved HRIS HRIS 56% 56% 56% 56% 58% 70% 63% Improved but but posts filled by still below posts posts filled filled by by still still below health workers HSSIP target health health workers HSSIP target (public health by 7% (public health by by 7% facilities) facilities) annual Panel NA Baseline year 2% No data 20% No data No Panel % annual Panel NA Baseline year 2% No data 20% No data No Panel reduction in Survey (increase) reduction Survey reduction in in Survey absenteeism (Absenteeism (increase) reduction Survey from results since absenteeism (Absenteeism rate rate 46%) (Absenteeism from results since previous 2010/11 rate rate rate 46%) (Absenteeism rate 48%) previous 2010/11 rate 48%) year year of villages HMIS 75% 31% 1 72% 78% 75% 55% Below HSSIP %% of of villages / / HMIS wards with 75% 31% 11 72% 78% 75% 55% Below HSSIP target by wards trained wards with VHTs with target 20% by by trained General trained VHTs VHTs MTEF 8.3% 9.6% 8.9% 8.3% 9.0% 7.4% Negative 20% 20% General Government General MTEF MTEF 8.3% 8.3% 9.6% 9.6% 8.9% 8.9% 8.3% 9.0% 9.0% 7.4% 7.4% trend Negative Negative below Government allocation Government for trend trend HSSIP & below below target allocation for HSSIP target health allocation as for of HSSIP target health as % of total health gov t as % of total gov t budget total gov t budget budget The The amount amount of of investments investments (human (human resources resources and and finances) finances) for for health health from from GoU GoU are are below below the the HSSIP The amount targets of which investments were already (human below resources the globally and finances) recommended for health targets. from GoU The are health below sector the HSSIP targets which were already below the globally recommended targets. The health sector has HSSIP demonstrated targets which progress were already in only below one [% the of globally approved recommended posts filled targets. by health The workers health sector has demonstrated progress in only one [% of approved posts filled by health workers (public (public health has demonstrated facilities)] out progress of the four in only core indicators one [% of for approved health investments posts filled by and health governance. workers (public health facilities)] out of the four core indicators for health investments and governance. health facilities)] out of the four core indicators for health investments and governance. Staffing Staffing in in public public health health facilities facilities improved improved from from 58% 58% in in 2011/ /12 to to 63% 63% in in 2012/ /13 though though still still below below Staffing the the in HSSIP HSSIP public target target health (70%) (70%) facilities for for improved the the year. year. from The The 58% increase increase 2011/12 in in staffing staffing to 63% level level in 2012/13 was was a result result though of of still the the targeted targeted below the recruitment recruitment HSSIP target for for HC HC (70%) IVs IVs for and and the IIIs IIIs year. in in 2012/ /13. The increase District District in level level staffing staffing staffing level increased increased was a result from from 55% 55% of the to to targeted recruitment for HC IVs and IIIs in 2012/13. District level staffing increased from 55% to 1 1 New VHTs established using revised guidelines New VHTs established using revised guidelines [Annual 1 New VHTs Health established Sector using Performance revised guidelines Report 2012/13] Page 27 [Annual Health Sector Performance Report 2012/13] Page 27 [Annual Health Sector Performance Report 2012/13] Page 27 [Annual Health Sector Performance Report 2012/13 FY] Page 25

46 60.5%. The total number (7,619) of new health workers recruited into the system from GoU funds (7,211) and GFTAM (408) is relatively low due to internal movements i.e. health workers moving from hospitals to HC IVs and HC IIIs and from one rural district to a more urban district and from a lower cadre to a senior position. Hence the net increase in staffing is not significant. The results of the last panel survey findings of 2010/11 received in 2013 indicated absenteeism at HC II and III level had increased by 2% from 46% in 2009/10 to 48% in 2010/11 instead of a decrease by 20% as per set target. There is need to establish an institutional mechanism for actively monitoring and reporting timely regarding staff absenteeism. Coverage of communities with trained VHTs has reportedly decreased from 78% to 55% which is below the HSSIP target of 75% for 2012/ (75%) districts had 100% VHT coverage (established) but the training is not in tandem with the establishment resulting in de-motivation and attrition. Only the ToT was conducted in Sheema district. There are a number of challenges in tracking training and functionality of VHTs in addition to lack of funds for the strategy roll. There are a number of partners supporting VHT training and providing tools but they are using a programmatic (HIV/AIDS, Malaria, FP) approach. The Partners need to coordinate their VHT support more closely with the MoH and the DHOs. Focus should be on an integrated approach other than programmatic. The core indicator selected for monitoring the VHT strategy should be revised to Percentage of districts that have trained their VHTs to 100%. Monitoring performance based on villages/wards has been a challenge due to the ever increasing number of villages as a result of the creation of new administrative structures (districts, subcounties, parishes and villages). Financial investment in health by GOU shows a decline over the last 2 years from 8.3% in 2011/12 to 7.4% in 2012/13 below the annual HSSIP target of 9.8%. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

47 2.5.1 Summary of the Financial Report 2012/13 FY Health service delivery is financed by the government, private firms and households and donor funds under the sector wide arrangement. The government is responsible for running and financing all public health facilities. In addition, the government directly supports the Private Not for Profit (PNFP) sector through non-wage operational funding and health worker support to PNFP health facilities and health training schools. Government occasionally supports the PNFP sector with other in-kind items like pharmaceuticals, equipment and general infrastructure. On the other hand, private financing for health takes the form of funds from households and private firms out-of-pocket and insurance prepaid or healthcare re-imbursable financing. The National Health Accounts (NHA) Study for the health expenditures for FY 2009/10 shows that public funds account for 22% of total health expenditure, 50% was private funds (and particularly 42% from households) and 34% was donor financed. Total Health Expenditure (THE) per capita was estimated at USD 51 which shows an increase from earlier studies (USD 32 in 2005/6) but is still below the WHO recommended estimate (USD 60) that is needed to provide the minimum health care package. In the FY 2012/13, government allocation to the health sector was U Shs billion. Out of this government funding, U Shs billion (88%) was for recurrent budget while remaining U Shs billion (12%) was for capital development. Of the recurrent budget, U Shs billion was for essential medicines, health supplies and other pharmaceutical products procured through the NMS, while U Shs billion was for non-wage operational budget funding for sector institutions. Out of the capital development budget U Shs billion was donor financed projects while U Shs 78 billion was domestic development grant. Of the GoU budget for health (excluding donor) for the FY 2012/13, capital expenditure accounted for 12% of health sector public expenditure while recurrent expenditure such as wages, utilities and other operational costs accounted for Trends of the health sector funding 2000/ /13 The trend in allocation of funds to the health sector shows that there has been a steady increase in budget allocation over the past 13 years as illustrated in the Table 20. Analysis of the table above reveals the following; i. The decline in budget allocation in FY 2010/11 notwithstanding, the GoU allocation to the health sector has been rising steadily over the last decade. Most of the increment [Annual Health Sector Performance Report 2012/13] Page 29 [Annual Health Sector Performance Report 2012/13 FY] Page 27

48 ii. ii. however is on the wage component of of the the budget and and is is meant meant for for payment payment of salaries of salaries for staff in post. Although the budget allocation for health has has been increasing, the the proportion of the of the GoU budget allocated to the health sector still still averages at at 8% 8% which which is short is short of the of the HSSIP target of 10% and the Abuja target of of 15% Table Table 19: 19: Government Government allocation allocation to to the the Health Health Sector Sector 2000/ /01 to to to 2011/ /12 Year Year GoU GoU Donor Donor Total Total Per Per Per capita capita Per Per Per capita capita capita public public public GoU GoU GoU health health health Funding Funding Projects Projects (U (U Shs Shs public public health health health health exp exp exp (US (US (US $)) $)) $)) expenditure expenditure (U (U Shs Shs bns) bns) and and GHIs GHIs bns) bns) exp exp exp (UGX) (UGX) as % as as of % total of of total total (U (U Shs Shs bns) bns) government government expenditure expenditure 2000/ / ,349 10, /02 13, / ,128 13, / / , / ,654 13, / / , / / ,969 13,843 14, / / / ,843 26,935 13, / / / ,935 13,518 26, / / / ,518 14,275 13, / / / ,275 20,810 14, / / / , ,423 20, / / , / ,765 24, / / / ,765 20, / / / , / / , Source: Approved Budget Estimates of Revenue and Expenditure 23,756 - MoFPED Source: Source: Approved Approved Budget Budget Estimates Estimates of of Revenue Revenue and and Expenditure Expenditure - MoFPED MoFPED Financial Performance for Local Governments (LGs) The overall Financial PHC budget Performance performance Local for FY Governments 2011/12 for (LGs) was U Shs billion out of an The approved overall budget PHC budget of U Shs. performance billion for representing FY 2011/12 86% for budget LGs was out U turn. Shs billion out of an approved budget of U Shs billion representing 86% budget out turn. Key issues under LG Financing Key i. issues Low per under capita LG allocation Financing for health services especially at HC levels. i. ii. Low Prevalence per capita of allocation off-budget/project for health funding services which especially necessarily at HC levels. do not address key sector ii. Prevalence priorities. of off-budget/project funding which necessarily do not address key sector iii. priorities. Inefficiencies in procurement of services and works. iii. Inefficiencies in procurement of services and works. [Annual Health Sector Performance Report 2012/13] Page 30 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

49 Table 20: Primary Health Care Grants FY 2000/ /13 in billions of Ug. Shillings Table FY 20: Primary Health PHC Care Grants PHC (Non- FY 2000/ /13 PHC NGOs in billions General of Ug. Shillings PHC (Dev t Total FY 2000/01 PHC Wages PHC (Non- Wage PHC NGOs (PNFP) General Hospitals PHC (Dev t Grant) Wages 9.6 Wage 8.8 (PNFP) 6.7 Hospitals 6.3 Grant) 10 Total / / / / / / / / / / / / / / / / / / / / / / / / / Source: Source: Approved Approved Budget Budget Estimates Estimates of Revenue of Revenue and Expenditure and Expenditure - MoFPED - MoFPED Figure Figure 6 6 shows shows that that there there has has been been steady steady increase increase PHC in PHC wages wages over decade over decade with no with no significant increase the in the remaining remaining components of the of PHC the Grant. PHC Grant. Figure 6: 6: Trends in PHC in PHC Grant Grant Allocations 2000/ / / /13 FYs FYs PHC (WAGES) PHC (NON- WAGE) PHC NGOs ( PNFP) PHC (WAGES) PHC (NON- WAGE) PHC NGOs ( PNFP) GENERAL HOSPITALS PHC ( DEV'T GRANT) GENERAL HOSPITALS PHC ( DEV'T GRANT) Source: Approved Budget Estimates of Revenue and Expenditure - MoFPED Source: Approved Budget Estimates of Revenue and Expenditure - MoFPED [Annual Health Sector Performance Report 2012/13] Page 31 [Annual Health Sector Performance Report 2012/13] Page 31 [Annual Health Sector Performance Report 2012/13 FY] Page 29

50 There is inadequate funding for sector activities for example, the conditional grants to LGs and PNFPs have not significantly changed yet population, administrative units and prices have increased significantly. During the last two years, the MoH utilized a significant proportion of the budget on unplanned and unbudgeted for but catastrophic and urgent emergencies such as Ebola and Marburg. These exerted pressure on operational resources thus constraining other important activities. The sector continues facing the challenge of off-budget sector funding. A number of health improving activities are funded outside the SWAP that was established to align funding to sector priorities. This leads to efficiency losses associated with funding activities that may be duplicative or outside the priorities identified to achieve health outcomes. There are also weaknesses in the institutional including LG capacity in areas of financial reporting, leadership and financial management. The health sectors needs to continue lobbying for additional funds to finance sector activities and establishment of a protected funding for health services supervision and monitoring to minimize the effect of item ceilings and cuts in government budgets on requisite services support supervision and monitoring. The sector should also consider implementation of evidence based innovations in health financing like performance based financing with view to improving the efficiency of government financing. The MoH should track and align off budget funding by ensuring that all projects and donor inflows are aligned to HSSIP and reflected in the budget Summary for Human Resources for Health (HRH) During 2012/13 FY the MoH together with the political and Civil Society partners advocated for and requested government to address the HRH crisis urgently by recruiting additional health workers to mitigate the challenges of understaffing both at the centre and LGs. In September 2012, GoU approved the recruitment of a total 6,172 (actual need for HC IIIs and IVs at the time was 10,210 vacancies) health personnel at HC IIIs and IVs. Although the national target was to recruit a total of 6,172 health workers, 10,210 vacancies were advertised based on actual need. 86% of the candidates that were offered the job reported to work. Enrolled Nurses, Clinical Officers, Laboratory Technicians and Assistants had the highest recruitment rates. Dispensers, Nursing Officers, Midwives, Public Health Dental Officers, Theater Assistants, Ophthalmic Clinical Officers and Anesthetic Officers were among the cadres who turned up least. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

51 Table 21: 21: Summary of of the the recruitment rates by by cadre Cadre No. No. of of positions No. No. of of positions % advertised filled Nurses (all (all categories) 3,108 2,688 86% Clinical Officers (all (all categories) 1, % Laboratory Technicians and and Assistants 1, % Midwives (all (all categories) 1,610 1,067 66% Other cadres 1,997 1,270 64% Doctors (all (all categories) % Dispensers % Anesthetic Officers and and Assistants % Total 10,210 7,211 71% Source: HRH Biannual report October 2012 March 2013 As As noted from the figure the overall recruitment rate for for all all cadres was at at 71% i.e. i.e. 7,211 out of of 10,210 jobs advertised. It It should be be noted however that this is is based on on data received from the districts at at different times starting in in March to to June The actual number of of staff who reported to to work therefore could be be higher if if more health workers reported for for work after data had been submitted. The effect of of the national recruitment exercise on on staffing levels in in HC HC IVs IVs and HC HC IIIs IIIs was assessed by by comparing the staffing levels in in 2012 as as per the audit report and the current staffing levels after recruitment. The results are summarized in in Figure Figure 7: 7: Effect of of the the recruitment on on staffing status on on HC HC IVs IVs & HC HC IIIs IIIs 80% 80% 70% 70% 60% 60% 50% 50% 40% 40% 30% 30% 20% 20% 10% 10% 0% 0% 71% 71% 70% 70% 70% 70% 61% 61% 60% 60% 60% 60% 56% 56% 60% 60% 57% 57% HC HC IV IV HC HC III III Total Source: MoH HRH Biannual Report October 2012 March 2013 It It can be be noted that the overall staffing levels at at HC HC IVs IVs and HC HC IIIs IIIs improved from 57% in in 2012 to to 70% after the recruitment. The highest improvement was in in HC HC IIIs IIIs which made a a 14% increment moving from 56% to to 70%. The staffing levels for for HC HC IIs IIs have increased albeit slowly [Annual Health Sector Performance Report 2012/13] Page [Annual Health Sector Performance Report 2012/13 FY] Page 31

52 from 36% and stabilized at 45%. On the other hand the staffing levels for GHs which have been relatively fair and stable declined by 1% after the recent recruitment a fact attributed to the fact that some hospitals lost doctors to HC IV due to the enhanced pay for doctors at HC IV. The result of this is improved service coverage in rural areas served by the LLHUs. See Figure 5. Figure 8: Trend of % of health workers in post working at the different levels of health facilities Source: MoH HRH Biannual Report October 2012 March 2013 In addition to the recruitment by GoU, the MoH obtained support from the GFTAM and PEPFAR to recruit 600 and 1,220 health workers respectively. During the year under review 408 out of 600 health workers were recruited under the GFTAM support. The MoH also advertised for the 1,220 under PEPFAR to be filled in August/September Recommendations The following may need to be considered to improve staffing; 1) Recruitment in FY 2013/14 since the staff wage is likely to be available given that not all the health workers recruited were new. Priority should be given to District Health Offices and districts with staffing less than 50%. 2) The sector with partners should support retention strategies particularly at HC IVs and HC IIIs. Provision of staff accommodation is one such retention strategy which needs to be considered for support. 3) Recentralize the recruitment and deployment of doctors to enable rural attachment to increase opportunity for redeployment. This should be enhanced with scholarships for further studies after 2 years of rural posting. 4) MoH to liaise with Ministry of Education and Sports (MoES) to increase training of Anaesthetic Officers, Ophthalmic Clinical Officers, Dispensers and Midwives. 5) Revitalize the training of Theatre Assistants, Anaesthetic Assistants and start the training of Cold Chain Assistants. 6) The MoH should plan for absorption of the health workers recruited under partner support into the mainstream Public Service. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

53 Progress Progress in in Implementation Implementation of of the the JAF JAF 5 Targets 5 Targets The The MoH MoH in in partnership partnership with with HDPs HDPs operate operate within within the the Joint Joint Budget Budget Support Support Framework Framework (JBSF). (JBSF). Annual Annual performance performance assessment assessment is is conducted conducted and and stakeholders stakeholders agree agree on priority on priority actions actions and and set set annual annual performance performance targets targets based based on on previous previous performance performance and and availability availability of resources. of resources. The The JBSF JBSF is is in in its its fifth fifth year year of of implementation. implementation. This This section section presents presents progress progress towards towards the the targets targets and priority actions for JAF and Progress priority actions in Implementation for JAF 5. of the JAF 5 Targets All The All the the MoH five five in indicators partnership indicators monitored monitored with HDPs under operate under JAF JAF within 5 5 are are the part Joint part of Budget of the the 26 Support 26 core core HSSIP Framework HSSIP indicators indicators (JBSF). and and progress Annual progress performance has has been discussed discussed assessment under under is conducted the the respective respective and stakeholders indicator indicator domains. agree domains. on However, priority However, actions it is it worth is and worth noting set noting annual that that performance up to date information targets information based was was on available previous available performance for only only three three and out availability out of the of the five of five indicators. resources. indicators. The Information JBSF is in for its the fifth other year two two of indicators implementation. indicators is is obtained obtained This section from from surveys presents surveys conducted progress conducted by towards UBOS by UBOS and the and these targets these have and not priority been actions able to to for provide provide JAF 5. timely timely information information for for annual annual assessment. assessment. Table All Table the 22: 22: five Progress indicators Implementation monitored of of JAF under JAF 5 5 Targets Targets JAF 5 are part of the 26 core HSSIP indicators and progress Theme Theme has been Indicator Indicator discussed under Source Source the respective Type Type of of Baseline indicator Baseline domains. Target Target Actual However, Actual Comment(s) it is Comment(s) worth noting that up to date information was Indicator available Indicator for 2011/ /12 only three N+1 out N+1 of the five indicators. FY FY Information for the other two indicators is obtained from surveys 12/13 conducted by UBOS and 12/13 1 these have not been able to rate provide in UBOS timely information Outcome HC for II annual 25% assessment. 1 Absenteeism Absenteeism rate in UBOS Outcome HC II 25% 20% 20% NA NA No results No results for the Panel for the Panel government health health Annual Annual Survey Survey for 2012 for 2012 Table 22: Progress in facilities Implementation (HC (HC II, II, III III of JAF Panel Panel 5 Targets HC HC III III 30% 30% 24% 24% NA NA Theme Indicator and IV) 2 2 Source Survey Survey Type of Baseline Target Actual HC IV 50% 40% Indicator 2011/12 HC IV 50% N+1 40% NA Comment(s) NA FY 2 2 Deliveries in % deliveries in in HMIS HMIS Outcome Outcome 40% 40% 45% 45% 41% 41% Slow progress. Slow progress. Recent Recent 12/13 HFs (Public health facilities (MoH) (MoH) MDG MDG recruitment recruitment for HC IVs for HC and IVs and 1 Absenteeism and PNFPs) Absenteeism (Public and PNFPs) rate in UBOS Outcome HC II 25% 20% NA No IIIs, results and IIIs, provision for and the provision Panel of of government health Annual Survey BeMOC BeMOC for are 2012 expected are expected to to facilities (HC II, III Panel HC III 30% 24% NA lead to lead improvement to improvement in in and IV) 2 Survey subsequent subsequent years. years. 3 No of HMIS HC IV 50% 48% 40% 75% NA 3 No Stock out Proportion of health HMIS Outcome 48% 75% 53% 53% There is There general is general status for the facilities without (MoH) MDG MDG improvement improvement in availability in availability 2 Deliveries in % deliveries in HMIS Outcome 40% 45% 41% Slow progress. Recent 66 tracer stock-outs for for 66 for the for individual the individual HFs (Public health facilities (MoH) MDG recruitment for HC IVs and medicines / tracer medicines / / medicines medicines and supplies, and supplies, and PNFPs) (Public and PNFPs) IIIs, and provision of Health supplies (GoU and e.g. Availability e.g. Availability of ACTs of is ACTs is BeMOC are expected to supplies Theme in the Indicator Source Type of Baseline Target PNFPs) Actual 92% Comment(s) in 92% public in facilities. public facilities. Indicator lead to improvement in 2011/12 N+1 previous 6 FY subsequent years. months 3 No Stock out Proportion of health HMIS Outcome 48% 12/13 75% 53% There is general status for the facilities without (MoH) MDG improvement in availability Cross-cutting 4 Sanitation issues: % of households MoH, Outcome 70% 73% 68% Negative trend 6 tracer stock-outs with access for to 6 safe UBOS MDG for the individual medicines / tracer and effective medicines / medicines and supplies, Health supplies sanitation (GoU and e.g. Availability of ACTs is 5 supplies Population in the PNFPs) Contraceptive UBOS Outcome 30% 35% 30% 92% From in UDHS public 2011 facilities. previous growth 6 prevalence rate Panel months Survey There is no report for the Panel Survey 2012 Cross-cutting issues: [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY] Page 33 [Annual Health Sector Performance Report 2012/13] Page 35

54 2.7 Implementation of the Ministerial Policy Statement 2012/13 FY This 2.7 section Implementation analyses progress of in the performance Ministerial for Policy the central Statement level institutions 2012/13 which FY include This the section MoH headquarters analyses progress departments, in performance referral hospitals for the and central semi-autonomous level institutions institutions. which include The the assessment MoH headquarters is based on departments, planned activities referral in the hospitals MPS FY 2012/13. and semi-autonomous institutions. The assessment is based on planned activities in the MPS FY 2012/13. Achievement of planned key outputs under the various vote functions supporting health care Achievement service delivery of varied. planned key outputs under the various vote functions supporting health care service delivery varied Assessment of Performance against Planned Key Outputs for the MoH Headquarters Assessment of Performance against Planned Key Outputs for the MoH Headquarters 1. Health Systems Development 1. During Health 2012/13 Systems FY Development the MoH planned for a number of significant infrastructure development During 2012/13 FY the MoH planned for a number of significant infrastructure development projects focusing on rehabilitation and equipping hospitals and HC IVs. Largely most of the projects focusing on rehabilitation and equipping hospitals and HC IVs. Largely most of the planned outputs under health systems development (infrastructure) from GoU and support planned outputs under health systems development (infrastructure) from GoU and support from various DPs were achieved. However, several are behind schedule because of the long from various DPs were achieved. However, several are behind schedule because of the long processes of design review and procurements. Delays in getting approved designs have been processes of design review and procurements. Delays in getting approved designs have been associated with cost escalations for most projects as a result of the long period between associated with cost escalations for most projects as result of the long period between appraisal appraisal of of projects projects and and approval approval of of designs. designs. It It is is recommended that that project designs are approved before conclusion of of loan loan agreements. The The sector should plan and allocate sufficient resources for operation and maintenance of of both medical equipment and infrastructure including vehicles. Table 23: Summary of Achievements under Health Systems Development Planned Outputs Achievements Comments on Performance Vote MoH i. i. Continuation of of Buyiga HC III: staff houses, general and Works were were rolled rolled over over Construction Construction works works at at maternity wards were roofed. Pits Pits latrines, latrines, from from the the previous previous FY FY Kisozi Kisozi and and Buyiga Buyiga HC HC IIIs. IIIs. medical medical waste waste pit pit and and placenta placenta excavated excavated and slabs cast. and slabs cast. Kisozi HC III: Completed and handed over to Kisozi HC III: Completed and handed over to the district in December 2012 the district in December 2012 Uganda Health Systems Strengthening Project (UHSSP)-World Bank Uganda Health Systems Strengthening Project (UHSSP)-World Bank ii. Rehabilitation works Prepared standard engineering designs for An application for ii. started Rehabilitation in: 2 works RRHs health Prepared facilities standard from engineering HC IIs to RRHs. designs for An application for additional funding of US $ (Mubende started in: and 2 Moroto), RRHs Advertised health facilities and evaluated from HC IIs bids to RRHs. for civil works additional 65million funding was submitted of US $ 17 (Mubende GHs and 27 and HC IVs Moroto), for Advertised 13 Hospitals and evaluated to be renovated bids for under civil works 65million to the World was Bank submitted to 17 GHs and 27 HC IVs UHSSP. for 13 Hospitals The Bid evaluation to be renovated report under is before to cater the for World the Bank remaining to 6 the UHSSP. World The Bank Bid evaluation for review report and no is objection. before cater Contracts for 9 hospitals under Phase 1 hospitals for the and remaining 27 HC IVs. 6 the World Bank for review and no objection. (Mityana, Contracts Nakaseke, for 9 hospitals Kiryandongo, under Phase Nebbi, 1 hospitals and 27 HC IVs. Anaka, (Mityana, Moroto, Nakaseke, Entebbe Kiryandongo, Iganga) Nebbi, are expected Anaka, Moroto, be signed Entebbe by and October Iganga) 2013 are and [Annual Health Sector Performance expected Report 2012/13] to be signed by October 2013 and Page 37 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

55 Planned Outputs Achievements Comments on Performance actual construction is expected to commence in November 2013 for a period of 18 months. General and specialized medical equipment worth US$ 8 million were delivered in the country. The equipment were delivered and distributed to the 46 health facilities that will be renovated under UHSSP. Procured 2 mobile workshop trucks for Mubende and Moroto RRHs. Bid evaluation for procurement of 19 ambulances has been concluded. Energy for Rural Transformation (ERT) Project iii. Installation of solar energy systems in HCs in the following 22 Districts; Amuru, Kitgum, Adjumani, Apac, Dokolo, Kaberamaido, Moroto, Nakapiripirit, Moyo, Gulu, Pader, Amolatar, Soroti, Bullisa, Bukwo, Sironko, Mbale, Mayuge, Katakwi, Amuria, Masindi & Bundibugyo. African Development Bank (ADB) Project i. Develop Mulago Hospital complex Master Plan ii. Complete designs for remodeling of Lower Mulago Hospital complex bills of quantities for remodeling Lower Mulago. Installation of solar power was completed in 230 HCs (12 out of 22 districts) as follows; Kitgum (27), Dokolo (11), Kaberamaido (16), Apac (28), Adjumani (27), Amuru (29), Nakapiripirit (12), Moroto (15), Buliisa (9), Gulu (26), Agago (15) and Pader (15). Contracts for installation of solar power for 157 HCs were signed as follows; [Bukwo (14), Sironko (20), Mbale (10), Mayuge (24), Katakwi (21), Amuria (24), Masindi (26) and Bundibugyo (19) Districts] and shipment of solar equipment commenced. Maintenance of solar energy systems was carried out in all beneficiary HCs. The Consultant to prepare the 30 years master plan for Mulago NRH was procured and work is ongoing. The master plan will be ready in the second quarter of FY 2013/14. The Consultant was procured and work is ongoing. Bid documents and scope of work will be finalized and advertised in the second quarter of FY 2013/14. Reinforce measures to minimize theft of solar equipment Work is progressing on schedule Work is progressing on schedule iii. Procurement of 10 ambulances for improving the referral system in Kampala metropolitan area. iv. Finalize the designs and supervise the construction of Kawempe and Kiruddu GHs Ambulance specifications were prepared and sent to ADB for approval. Advertising to start next FY (2013/14). The designs and bid documents were completed, works advertised and evaluation of bids carried out. Contracts will be awarded in the first quarter of FY 2013/14. Process is behind schedule by 3 months because of the long process of reviewing the designs. [Annual Health Sector Performance Report 2012/13] Page 38 [Annual Health Sector Performance Report 2012/13 FY] Page 35

56 Planned Outputs Achievements Comments on on Performance Islamic Development Bank i. i. Development of of bills of quantities for the Maternal and Neonatal hospital and The process of recruiting a consultant for detailed engineering designs and bills of quantities for the women s hospital is in Construction of of the the hospital is is expected to to commence in in third documents for advanced stages. quarter of of FY FY 2013/14. procurement of of a prospective contractor and consultant for works. Italian Support to to HSSP and PRDP i. i. Staff housing (88 units) will be be constructed at at HC IIIs in in Architectural designs for construction of staff housing in the Karamoja region are ready. the the Karamoja Region districts of of Kaabong, Abim, Kotido, Moroto, Amudat, The Ministry is waiting for signing of the financing agreement. Napak and Nakapiripirit. Proposals for construction supervision were evaluated. Spanish Debt Swap i. i. Reconstruction of of Kawolo MoFPED has confirmed the availability of Itojo hospital to to be be and and Itojo Hospitals USD 8 million under the Spanish Debt Swap renovated under the the for reconstruction of Kawolo hospital UHSSP Designs completed, and advertising for the contractor in Uganda and Spain (restricted bidding) will take place in November Recruitment of a supervision consultant is is ongoing in Spain JICA West i. i. Engineering Studies for Civil Civil Works for for Kabale and Hoima RRHs as as well as studies for for equipping Kabale, Hoima and Fort Portal RRHs Detailed designs and equipping requirements were undertaken by Consultants in Japan. Discussions on the final designs and equipment requirements will be finalized with the Government by July Execution of works is expected to commence in in January Clinical and Public Health Most of of the planned activities for MCH were implemented and noted improvement in in some of of the the key key outputs e.g. immunization coverage for DPT 3 and IPT 2. Two new vaccines (PCV and HPV) were launched; scale up is is ongoing with training of health workers and distribution of of vaccines. EmONC equipment has been procured and distributed under the UHSSP. However, technical support supervision remains inadequate and interventions like MPDR have not been embraced [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

57 positively by health workers resulting in low reporting and review of maternal and perinatal deaths compared to those reported under the HMIS. positively by health workers resulting in low reporting and review of maternal and perinatal deaths There compared efforts to facilitate those reported the VHTs under through the HMIS. provision of tools e.g. VHT registers, torches and There batteries. are efforts However, to facilitate progress the in establishment VHTs through of provision VHTs this of tools year has e.g. been VHT registers, minimal with torches only and 1 batteries. out of the However, planned 10 progress established. in establishment There still a of big VHTs problem this year in coordination has been minimal of partner with support only 1 out and of capacity the planned building 10 for established. VHT implementation. There is still a big problem in coordination of partner support and capacity building for VHT implementation. For the last 5 years the NCD survey has not been conducted due to lack of funds, yet this is an For important the last survey 5 years considering the NCD survey the growing has not problem been conducted of NCDs in due the country. to lack of funds, yet this is an important survey considering the growing problem of NCDs in the country. There was timely and coordinated response to disease outbreaks in the country largely due to There an efficient was timely surveillance and coordinated system. response to disease outbreaks in the country largely due to an efficient surveillance system. The ACP is on course towards Universal access targets of 80% for ART but below target for SMC The ACP is on course towards Universal access targets of 80% for ART but below target for SMC Malaria prevention and control measures were implemented focusing on effective case Malaria prevention and control measures were implemented focusing on effective case management, IPT, universal coverage with LLINs, IRS and use of RDTs in case management. management, IPT, universal coverage with LLINs, IRS and use of RDTs in case management. Reports from supervision visits indicate that use of RDTs has reduced on over prescription of Reports from supervision visits indicate that use of RDTs has reduced on over prescription of ACTs. Analysis of HMIS data shows that malaria is still the leading cause of morbidity and ACTs. Analysis of HMIS data shows that malaria is still the leading cause of morbidity and mortality for all ages. mortality for all ages. Major Major steps steps have have been been undertaken undertaken in in reducing reducing TB TB incidence incidence through through improved improved case case detection, detection, confirmation and and treatment of both non-complicated and and MDR MDR TB. TB. The The NTRL NTRL was was voted voted as as the the best best laboratory in in East and Central Africa and certified as as a Supra National Laboratory for for the the region by by WHO. Table 24: Summary of Achievements under Clinical and Public Health Planned Outputs Achievements Comments on on Performance Maternal and Child Health i. i. Procuring and distributing Emergency Obstetric and Neonatal Under UHSSP Emergency Obstetric Care Care equipment worth US$ (EmONC) (EmONC) lifesaving million was delivered and and medicines, medicines, FP FP equipment equipment distribution distribution is is ongoing ongoing in in and commodities to health and commodities to health Hospitals and 165 HC IVs. Hospitals and 165 HC IVs. facilities Maintenance contracts have been facilities Maintenance contracts have been signed for high value equipment signed for high value equipment ii. Improving the referrals Procured 27 ambulances and 3 Supported by UNFPA (Kanungu, ii. Improving the referrals tricycles Procured 27 ambulances and 3 Supported Mubende, by Yumbe, UNFPA Katakwi, (Kanungu, The tricycles process of preparing guidelines Mubende, Kaabong, Yumbe, Kotido, Moroto Katakwi, and for The managing process of of preparing ambulances guidelines is Kaabong, Oyam); ICB-BTC Kotido, Moroto (Kyegegwa, and ongoing. for managing of ambulances is Oyam); Ntoroko, ICB-BTC Kabarole, (Kyegegwa, Bundibugyo, ongoing. Ntoroko, Kabarole, Bundibugyo, [Annual Health Sector Performance Report 2012/13] Page 40 [Annual Health Sector Performance Report 2012/13] Page 40 [Annual Health Sector Performance Report 2012/13 FY] Page 37

58 Planned Outputs Achievements Comments on Performance Coordination and management of a functional ambulance network system comprised of motorized ambulances and 16 tricycle ambulances under SMGL Project iii. Support supervision One round of Area Team Visits was conducted in 55 districts supported by UHSSP Kasese (Bwera and Kilembe Hosp.), Kisoro, Arua (DHO & Kuluva Hosp.), Yumbe, Zombo, Maracha and Adjumani); and Saving Mothers Giving Life (SMGL) Partners (Kamwenge, Kabarole, Kyenjojo, Kibale) supported by USAID and CDC. Included Women Members of Parliament Quarterly technical support supervision visits were not conducted as planned due to inadequate GoU funds iv. Conducting maternal and perinatal death reviews v. Community sensitization and mobilization using radio talk shows vi. Build capacity of RRHs to provide routine fistula services. vii. Support Midwives and VHTs to identify and register all pregnant mothers. viii. Introduction of Pneumococcal vaccine to protect children against pneumonia. 474 maternal deaths and 161 perinatal death reviews were carried out in all referral hospitals and selected GHs Procured 18 radio stations to mobilize community to increase demand of RH services countywide. Community Dialogue meetings. Running mass media campaigns on safe motherhood and community sensitization through drama/theatre groups. Routine fistula services conducted in 18 hospitals country wide (13 RRHs, Mulago, Kagando, Kitovu, Kamuli, Lacor, Kisizi and Virika) 1,658 fistula repairs were done Coaching and mentoring of 2 new fistula surgeons is ongoing 17,925 VHT registers procured and distribution ongoing supported by UHSSP 4,000 VHT members trained and equipped to provide community mobilization and door to door enumeration of births & deaths Launched by H.E President of Uganda in Iganga district in April 2013 Health workers are being trained PCV vaccination to commence across the country in September 2013 Remains low compared to maternal and perinatal deaths reported in the DHIS-2. Health workers fear incrimination. UHSSP Supported Supported by Baylor Uganda UNFPA supports all RRHs by provision of consumables EngenderHealth supports Kagando, Kitovu and Hoima Training ongoing by other Partners Supported by the SMGL Project in Rwenzori region Supported by GAVI WHO providing technical assistance [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

59 Planned Outputs Achievements Comments on Performance ix. Vaccination against the Human Papilloma Virus (HPV) will be rolled out to a further 12 Districts namely; Bududa, Busia, Lira, Isingiro, Kamwenge, Katakwi, Kayunga, Mityana, Nebbi, Oyam, Rukungiri and Ntungamo. x. Immunize up to 90% of the children against DPT xi. Carry out 2 mass polio campaigns xii. Finalize the Micronutrient guidelines and the print and distribute the Child Survival Strategy to all districts and 10 training institutions. xiii. Develop School health support supervision tools Veterinary Public Health i. Undertake routine Zoonotic diseases surveillance and control, and advocacy in high risk districts for rabies, Influenza, and brucellosis. HIV/AIDS i. Enroll 110,000 eligible people on ART In addition to the pilot district of Ibanda and Nakasongola, HPV vaccination was rolled out to the 12 districts. All districts conducted 3 rounds of vaccination among the targeted girls. Achieved 87% (1,319,860 out of 1,520,347 children) for DPT 3 coverage Conducted 2 rounds of polio campaigns Micronutrient guidelines development in final stages Child Survival Strategy distributed to all districts and training institutions Not done Trained 40 data managers in Soroti, Kaberamaido, Amuria and Katakwi on influenza and other zoonotic disease surveillance and control Conducted technical support supervision for Marburg and Ebola outbreaks Disseminated guidelines for surveillance in Tororo, Namayingo, Busia, Bugiri, Rukungiri, Mitooma and Sheema. 193,000/110,000 (193%) eligible people were enrolled on ART Vaccines donated by MERCK Support from Catholic Medical Mission Board, PATH and WHO Above the HSSIP target of 85% for 2012/13 FY. In 2011/12 JICA procured 1,037 fridges, 77 freezers and 500 gas cylinders which were distributed to all districts. This coupled with various immunization campaigns, OPL training for HWs; intensified supervision; and mobilization by political leaders could explain the improved performance. Support Avian Human Influenza Preparedness and Response Project Enrollment on ART was 193,000 significantly exceeding the HSSIP target of 110,000. ACP are on course towards Universal access targets of 80% for ART [Annual Health Sector Performance Report 2012/13] Page 42 [Annual Health Sector Performance Report 2012/13 FY] Page 39

60 Planned Outputs Achievements Comments on Performance ii. 1,000,000 males circumcised Malaria iii. Effective malaria case management iv. Prevention of malaria in pregnancy - IPT v. Universal coverage with Long Lasting Insecticide Treated Nets (LLINs) vi. vii. Indoor residual spraying (IRS) Scaling up use of Rapid Diagnostic Tests (RDTs). 400,000/1,000,000 (44%) males circumcised 11,178 Health workers in 103 districts trained in integrated malaria case management country wide 30 million doses of ACTs were procured under Affordable Medicines and distributed to both public and private health facilities Seventy thousand (70,000) torches and 140,000 batteries were procured and distributed to VHTs countrywide targeting those active in home based care of malaria. IPT 2 coverage increased from 44% in 2011/12 to 47% in 2012/13 Procured 21 million mosquito nets. Six hundred fifty one thousand eight hundred and sixty nets (651,860) were distributed in Bugiri, Soroti, Kaliro and Busia districts. Another 500,000 mosquito nets donated by World Vision were distributed in the districts of Busia and Soroti in May Routine fill in continuous distributions through Antenatal clinics was conducted in 34 districts. IRS was conducted in ten districts (Kole, Nwoya, Amolatar, Gulu, Amuru, Agago, Oyam, Lamwo, Kitgum and Pader) of Northern Uganda covering an estimated 850,000 houses. This was done twice thus protecting more than 3 million people. One round of spraying was done in Kumi district. RDTs procured and distributed to HC IIs and IIIs without microscopes. This has improved diagnostic capacity at lower [Annual Health Sector Performance Report 2012/13] Page 43 Inadequate kits due to limited manufacturer capacity for SMC kits Inadequate number of trained circumcisers Slow pace in demand creation for men above 30 years and MARPS. Under reporting due to lack of harmonized M&E tools There is need to increase awareness on availability of affordable medicines for malaria VHT support from GFTAM This could be attributed to the increased availability of the S/P which is among the six tracer medicines. Supported by GFTAM (15.5m), DFID (5m), World Vision (0.5m) Supported by Presidential Malaria Initiative (PMI) RDTs were procured under the AMFm Grant of the GFTAM 40 Page [Annual Health Sector Performance Report 2012/13 FY]

61 Planned Outputs Achievements Comments on Performance Tuberculosis viii. Increase of Directly Observed Treatment Short Course (DOTS) of TB coverage from 70% to 75% ix. Scale up of Multi-Drug Resistant (MDR) TB treatment to RRHs starting with Arua, Mbarara, Mbale, Gulu and Fort Portal. Health Education and Promotion i. Establish VHTs in 10 more districts ii. Conduct health awareness and sensitization in 85 districts. Non-Communicable Diseases i. Conduct the National NCD survey ii. Develop the National cancer control policy and Strategy Pharmacy i. Support supervision and on job training on medicine management activities in 84 hospitals and 480 lower level health units conducted level health units and reduced on over prescription of ACTs. DOTS coverage increased from 47% in 2011/12 to 55% in 2012/13 Management of MDR TB was initiated and strengthened at 9 sites namely Mulago NRH, Mbarara, Mbale, Masaka, Fort Portal, Gulu and Arua RRHs as well as Kitgum and Iganga GHs. There are currently over 120 patients on treatment at different sites in the country. 4 Gene Xpert machines introduced and deployed under TB reach project bringing the total number of machines in the country to 42. The National TB Reference Laboratory was certified as a Supra National Laboratory for the region by WHO Established VHTs in Sheema district only and conducted Training of Trainers in Sheema district Conducted 14 sensitization and health awareness activities in a range of districts. (Refer to Annex ) Protocol and budget have been revised and approved The draft cancer policy and strategy have been presented to the NCD TWG for comments. Undertook monitoring and supervision activities using the SPARS (Support Supervision and Performance Assessment) approach in 60 districts. Trained 450 HWs in medicines management and designated 250 as Medicine Management Supervisors Gene Xpert machines supported by FIND and UCMB Inadequate GoU funding to establish and conduct basic training of VHTs in the remaining district. Lack of funds has delayed implementation of this study Supported by SURE and UHSSP ii. Finalize, print and Printed 11,500 copies of the Uganda Supported by SURE Project [Annual Health Sector Performance Report 2012/13] Page 44 [Annual Health Sector Performance Report 2012/13 FY] Page 41

62 iii. iii. iii. iv. iv. iv. Planned Outputs Achievements Comments on Performance disseminate 1,000 Clinical Guidelines 2012 and 6,000 copies Planned Planned Essential Outputs Outputs Medicines List for Achievements of Essential Medicines and Health Comments on on Performance disseminate Uganda (EMLU), 1,000 1,000 disseminate 1,000 Clinical Clinical Supplies. Guidelines Guidelines and and 6,000 6,000 copies copies Essential Medicines Health Supplies List for Essential Medicines List for of Essential Medicines and Health Uganda List (EHSL) (EMLU), and 1,000 of Essential Medicines and Health Uganda (EMLU), 1,000 Supplies. Dissemination is ongoing to be Essential Health Laboratory Supplies List Supplies. Essential Health Supplies completed in 2012/13 List for (EHSL) Laboratory and 1,000 Supplies List (EHSL) and 1,000 Dissemination is ongoing to be Essential Conduct Laboratory survey on List Dissemination is ongoing to be completed Not done in 2012/13 Indicator now monitored through for Essential Laboratory Laboratory Supplies List availability of six completed in 2012/13 the DHIS-2 Conduct for tracer Laboratory items survey in Supplies on health Not done Indicator now monitored through availability Conduct facilities survey of six on Not done Indicator the DHIS-2 now monitored through tracer availability Review items the of in six health Not done No the funds DHIS-2 facilities tracer National items Drug in Policy health Review facilities the Not done No funds National Review the Drug Policy Not done No funds National Drug Policy 3. Sector Monitoring and Quality Assurance 3. The Sector sector Monitoring performance and Quality reviews Assurance were carried out biannually and reports compiled and The 3. disseminated. Sector sector Monitoring performance The sector and reviews Quality was able Assurance were to share carried experiences, out biannually best practices and reports and challenges compiled and in disseminated. The implementation sector performance The of sector the MoH was reviews workplan. able were to Action share carried areas experiences, out were biannually identified best practices and most reports were and compiled followed challenges and up. in implementation disseminated. The of the sector MoH was workplan. able to Action share areas experiences, were identified best practices and most and were challenges followed up. in The JRM was conducted successfully with review of the overall sector performance and the implementation of the MoH workplan. Action areas were identified and most were followed up. The priority JRM actions was conducted for the subsequent successfully FY were with identified review of and the agreed overall upon. sector During performance the same and forum the priority The outstanding JRM actions was performers conducted the subsequent were successfully recognized FY were with and identified review rewarded. of and the However, agreed overall upon. sector During performance supervision the same remains and forum the outstanding priority weak largely actions performers due to the inadequate subsequent were recognized funding FY were for and this identified rewarded. key activity. and However, agreed upon. sector During supervision the same remains forum weak outstanding largely due performers to inadequate were recognized funding for and this rewarded. key activity. However, sector supervision remains weak largely due to inadequate funding for this key activity. Table 25: Summary of Achievements under Supervision and Monitoring Table 25: Summary of Achievements under Supervision and Monitoring Planned Outputs Achievements Comments on Table Planned 25: Summary Outputs of Achievements Achievements under Supervision and Monitoring Performance Comments on i. Conduct three MoH Two biannual reviews were conducted covering the four Performance i. Conduct Planned quarterly Outputs reviews three MoH Two Achievements quarters biannual during reviews which were progress conducted in implementation covering the of four the Comments on quarterly reviews quarters during which progress in implementation of the Performance departmental and semi-autonomous institutional workplans i. Conduct three MoH departmental Two biannual reviews and semi-autonomous were conducted institutional covering the workplans four were reviewed. Reports were compiled, printed and quarterly reviews were quarters reviewed. during which Reports progress were compiled, in implementation printed and of the disseminated. disseminated. departmental and semi-autonomous institutional workplans Representatives of DPs and CSOs participated in the reviews. Representatives were reviewed. of Reports DPs and were CSOs compiled, participated printed and the reviews. ii. Hold one Pre JRM field The Pre-JRM visits were carried out in 16 districts. the ii. Hold visit one and Pre annual JRM JRM field The disseminated. Pre-JRM visits were carried out in 16 districts. the findings were discussed in the 18 th JRM visit and annual JRM findings Representatives were discussed of DPs and in the CSOs 18 th participated JRM in the reviews. The 18 th ii. Hold one Pre JRM field The 18 Pre-JRM th JRM was held as scheduled and was attended by 350 was visits held were as scheduled carried out and was in 16 attended districts. by the 350 participants representing MPs, LGs, MoH, line ministries, visit and annual JRM participants findings were representing discussed the MPs, 18 th LGs, JRM MoH, line ministries, HDPs, CSO, Private Sector and academia. The aide memoire HDPs, The 18CSO, th JRM Private was held Sector as scheduled and academia. and was The attended aide memoire by 350 was prepared and signed. was participants prepared representing and signed. MPs, LGs, MoH, line ministries, HDPs, CSO, Private Sector and academia. The aide memoire was prepared and signed. [Annual [Annual Health Health Sector Sector Performance Performance Report Report 2012/13] 2012/13] Page Page [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

63 iii. iii. iii. Midterm Midterm review review of of of the the the iii. HSSIP HSSIP Midterm review of the iv. Undertake HSSIP 3 quarterly iv. iv. Undertake 3 quarterly iv. supervision Undertake 3 visits quarterly per supervision visits per district supervision visits per district v. Disseminate district Infection v. v. Disseminate Infection v. Control, Disseminate Quality Infection Control, Assurance Control, Quality Quality manual and support Assurance supervision manual and guidelines support supervision to 111 to districts guidelines to 111 districts The The MTR MTR of of the the HSSIP 2010/ / /15 is is is ongoing. ongoing. The The The report report The MTR will will of be be the presented presented HSSIP 2010/11 and and disseminated disseminated 2014/15 is at at ongoing. the the th th th The JRM. JRM. Only report one will out be of presented the three and Area disseminated Team Visits at was the conducted 19 th JRM. at Only one out of the three Area Team Visits was conducted at at the Only end one of out the of FY, the covering three Area only Team 66 out Visits of the was 112 conducted districts at the end of the FY, covering only 66 out of the 112 districts the end of the FY, covering only 66 out of the 112 districts Printed 6,500 copies of Infection Control and Prevention Printed 6,500 copies of Infection Control and Prevention guidelines Printed 6,500 (1,500 copies by WHO of Infection and 5,000 Control by ICB-BTC and Prevention project). guidelines (1,500 by WHO and 5,000 by ICB-BTC project). However, guidelines not (1,500 yet by disseminated WHO and 5,000 because by ICB-BTC of funding project). gaps. Initiated However, the not procurement yet disseminated process because for development of funding gaps. of of the Initiated comprehensive the procurement support process supervision for development strategy and of review the comprehensive of the support support supervision supervision guidelines strategy and review of the support supervision guidelines There was no There was no no There funding was no funding funding 4. Health Research Health Research The various health research institutions undertook research activities focusing on malaria, other The on The various health research institutions undertook research activities focusing on malaria, other outbreaks due to highly pathogenic viruses and other endemic diseases e.g. plague yellow to outbreaks outbreaks due due to to highly highly pathogenic pathogenic viruses viruses and and other other endemic endemic diseases diseases e.g. e.g. plague plague yellow fever. yellow fever. Table fever. 26: Summary of Achievements under Research Table 26: 26: Summary of of Achievements under Research Table Planned 26: Summary Outputs of Achievements under Achievements Research Comments on Planned Outputs Achievements Comments on on Planned Outputs Achievements Comments Performance Performance on i. Conduct studies in traditional Safety studies of the Artemisia annual grown i. i. Conduct studies in in traditional Safety studies of the Artemisia annual grown Performance remedies for control and in Oyam district carried out in laboratory i. Conduct remedies studies for for in control traditional and Safety in Oyam studies district of the carried Artemisia out annual in laboratory grown treatment of Malaria. animals. remedies treatment of of for Malaria. control and in animals. Oyam district carried out in laboratory ii. ii. ii. Develop UVRI client charter UVRI client charter completed and launched in treatment Develop UVRI of Malaria. client charter animals. UVRI client charter completed and launched in in June ii. Develop UVRI client charter UVRI June client charter completed and launched in iii. iii. iii. Continue Continue research research on on on the the the June Community Community 2013 surveys surveys conducted conducted in in in Pader, Pader, Supported Supported by by by CDC, CDC, CDC, WHO WHO WHO nodding iii. nodding Continue nodding syndrome syndrome research on the Community Kitgum and Lamwo. and and surveys conducted in Pader, Supported and AFENET AFENET AFENET by CDC, WHO nodding syndrome Epidemiologically described Kitgum and Lamwo. the the the Nodding The The Nodding and The 44 AFENET research research research studies studies studies to to to Syndrome Syndrome be be Epidemiologically described the Nodding The be funded funded funded by by 4 research by GoU GoU studies GoU have have have to Obtained Obtained Syndrome postmortem postmortem specimens specimens awaiting not not awaiting be not taken taken funded taken off off by off because GoU because have analysis the the money was was released analysis the money was released Obtained postmortem specimens awaiting late. not taken off because late. iv. iv. Mosquito Larva Control Small analysis scale efficacy and safety trials of of 3 the money was released iv. Mosquito Larva Control Small scale efficacy and safety trials of 3 candidate larvicides were conducted in in Wakiso late. iv. Mosquito Larva Control candidate Small scale larvicides efficacy were and conducted safety trials in Wakiso district. Large scale trials are now being done of 3 district. candidate Large larvicides scale were trials conducted are now being Wakiso done in Nakasongola district. in district. Nakasongola Large scale district. trials are now being done in Nakasongola district Pharmaceutical and Other Supplies Global Fund and GAVI 5. Pharmaceutical and Other Supplies Global Fund and GAVI There is is very slow progress in initiating implementation of the planned GAVI supported There is very slow progress in initiating implementation of the planned GAVI supported 5. activities Pharmaceutical particularly and due Other to Supplies delayed finalization Global Fund and and approval GAVI of of workplans and budgets activities There is particularly very slow progress due to delayed in initiating finalization implementation and approval of the of planned workplans GAVI and supported budgets through the the MoH structures. through activities the particularly MoH structures. due to delayed finalization and approval of workplans and budgets Table Table 27: 27: Summary of of Achievements under Pharmaceutical and Other Supplies GAVI GAVI Table through 27: Summary the MoH of structures. Achievements under Pharmaceutical and Other Supplies GAVI Table 27: Summary of Achievements under Pharmaceutical and Other Supplies GAVI [Annual [Annual Health Health Sector Sector Performance Performance Report Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13] Page 46 [Annual Health Sector Performance Report 2012/13] Page 46 [Annual Health Sector Performance Report 2012/13 FY] Page 43

64 5. Pharmaceutical and Other Supplies Global Fund and GAVI There is very slow progress in initiating implementation of the planned GAVI supported activities particularly due to delayed finalization and approval of workplans and budgets through the MoH structures. Table 27: Summary of Achievements under Pharmaceutical and Other Supplies GAVI Planned Outputs Achievements Comments on on Planned Outputs Achievements Performance Comments on [Annual Health Sector Performance Report 2012/13] Page 46 i. i. Procure Pentavalent and Procured 1,991,950 doses of Performance i. Pneumococcal Procure Pentavalent vaccines and 1,000 and Pentavalent Procured 1,991,950 vaccine doses procured of vaccine Pneumococcal carriers (1 vaccines per facility) and and 1,000 VHT Vaccine Pentavalent carriers vaccine not procured procured Kits. vaccine carriers (1 per facility) and VHT Evaluation Vaccine carriers of bids not for procured procurement Kits. of Evaluation VHT kits of completed bids for procurement ii. ii. Assess performance of VHTs and Not done of VHT kits completed Funds not not released ii. operationalise Assess performance the VHT Strategy of VHTs and Not done Funds not released iii. iii. Mapping operationalise of of private the VHT clinics Strategy in Kampala Not conducted Funds not not released iii. and and Mapping 100 health of private workers clinics from in Kampala private Not conducted Funds not released clinics and 100 in in health Kampala workers trained from on how private to manage clinics in immunization Kampala trained services. on how to iv. iv. Evaluation manage immunization of of private services. sector Not done Funds Funds not not released released iv. involvement Evaluation in in of EPI EPI private and and other sector MCH Not done Funds not released activities activities involvement in EPI and other MCH v. v. Support Support activities community community participation participation in in Not Not done done Funds Funds not not released released v. health health Support service service community delivery delivery participation to to improve improve in Not done Funds not released immunization immunization health service delivery to improve immunization Pharmaceutical and Other Supplies National Medical Stores 6. Pharmaceutical and Other Supplies National Medical Stores The NMS continued supplying medicines and health supplies to public health facilities and The The NMS continued supplying medicines and health supplies to to public health facilities and and achieved several of the planned outputs. Notably there was increased access to maama kits to achieved several of the planned outputs. Notably there was increased access to to maama kits kits to to 82% of mothers delivering in public health facilities. NMS procured and supplied medicines and 82% of of mothers delivering in public health facilities. NMS procured and supplied medicines and and health supplies worth Shs billion during the FY. This excludes money for specialized health supplies worth U Shs billion during the FY. This excludes money for for specialized supplies for specialized units worth Shs billion and emergency donations worth Shs. supplies for specialized units worth U Shs billion and emergency donations worth U Shs. Shs. 2.5 billion. During the year NMS commenced supply of medicines and health supplies to all 2.5 billion. During the year NMS commenced supply of medicines and health supplies to to all all health facilities in the UPDF, Police Force and Prison services. health facilities in the UPDF, Police Force and Prison services. However, NMS should liaise with the MoH, Hospitals and districts to ensure adequate supply of However, NMS should liaise with the MoH, Hospitals and districts to ensure adequate supply of of up to date HMIS tools and other medical stationery. up to date HMIS tools and other medical stationery. Table 28: Summary of Achievements under National Medical Stores Table 28: Summary of Achievements under National Medical Stores Planned Outputs Achievements Comments on Planned Outputs Achievements Performance Comments on on i. Take up managing the Storage and distribution of all vaccines was transferred from Performance i. i. storage Take up and managing distribution the UNEPI Storage to and NMS distribution of all vaccines was transferred from of storage all vaccines and distribution UNEPI to NMS ii. of Roll of all out vaccines the distribution Level Quantity 454,208 maama ii. ii. of Roll Maama out the Kits distribution to match Level Quantity kits 454,208 were maama of the of Maama number Kits of to deliveries match HC 3 207,046 distributed kits kits were in the Government number of deliveries Health HC 3 207,046 compared distributed to in facilities in Government Health HC 4 118, ,294 compared to to facilities HC 4 118,481 deliveries 555,294 in HOSPITALS (GHs, RRHs & NRHs) 128,681 public deliveries facilities in in HOSPITALS (GHs, RRHs & NRHs) 128,681 public public facilities [Annual Health Sector Performance Report 2012/13] Page 47 [Annual Health Sector Performance Report 2012/13] Page Page Page [Annual Health Sector Performance Report 2012/13 FY]

65 iii. Continue serving an increased number of ART iii. Continue serving an centres increased up to number HC III level of ART centres up to HC III level iv. Continue supporting all iv. specialized Continue supporting institutes, all RRHs, specialized GHs and HC institutes, IV the RRHs, quantification GHs and HC of IV their in medicines the quantification and medical of their supplies medicines requirements and medical v. Ensuring supplies requirements the continuous v. availability Ensuring the of continuous Vital and Essential availability medicines of Vital and medical Essential supplies medicines under and the medical Vital, Essential, supplies under Nonessential the Vital, Essential, (VEN) Nonessential (VEN) framework vi. Procure framework and distribute vi. medical Procure stationary and distribute and uniforms medical stationary for medical and workers uniforms and for more medical blood testing workers kits and for more UBTS. blood testing kits for UBTS. Total 454,208 Total 454,208 Served different levels of ART centres 1. HC III's Served different levels of ART centres HC HC IV's III's GHs HC IV's RRHs GHs NRHs RRHs Made 5. improvements NRHs - 2 in aligning the Orders from Health facilities Made improvements with their procurement in aligning the plans Orders from Health facilities with their procurement plans Supplied essential medicines and health supplies to all public Supplied health essential facilities, medicines including and UPDF, health Police supplies Force to all and Prison public services. health facilities, including UPDF, Police Force and Supplied Prison services. Vaccines, gas and other immunization materials to Supplied all 112 Vaccines, districts, including gas and other new immunization PCV to pilot materials district of to Iganga all 112 districts, including the new PCV to pilot district Regionalized of Iganga the Basic kit for HC II and HC III Regionalized the Basic kit for HC II and HC III Uniforms Procured for only districts that submitted names Uniforms Procured for only districts that submitted names Doctors,Pharmacists,Dental Surgeons 2,600 Doctors,Pharmacists,Dental Surgeons 2,600 Allied Health Professionals 11,550 Allied Health Professionals 11,550 Health Inspectors 5,500 Health Inspectors 5,500 Nurses and Midwives 20,500 Nurses and Midwives 20,500 Nursing Assistants 5,200 Nursing Assistants 5,200 Total 45,350 Total 45,350 Blood Testing Kits for UBTS QUANTITY Blood Testing Kits for UBTS QUANTITY HIV AG/AB COMBO MICROPLATE ELISA 480T 57,600 HIV AG/AB COMBO MICROPLATE ELISA 480T 57,600 HBS AG/AB MICROPLATE V3 480T 57,600 HBS AG/AB MICROPLATE V3 480T 57,600 ANTI HCV TEST KIT 129,600 ANTI HCV TEST KIT 129,600 TOTAL 244,800 TOTAL 244,800 between Jul 2012 and June between Jul This 2012 and June translates to This 82% access to translates to maama kits 82% access to Supply of ARVs maama kits stabilized Supply of ARVs stabilized Uniforms will be Uniforms distributed will to be distributed districts after to an districts official after launch. an official launch. A number of A districts number have of districts not yet have not submitted yet staff submitted names and staff names measurements and measurements for uniforms. for uniforms Planning, Planning, Policy Policy and and Support Support Services Services The The MoH MoH Planning Planning Department Department was was able able to to coordinate, coordinate, compile compile and and submit submit sector sector planning planning and and reporting reporting documents documents including including the the BFP BFP and and MPS MPS 2013/14, 2013/14, quarterly quarterly progress progress (OBT) (OBT) reports. reports. The The department department coordinated coordinated 8 regional regional planning meetings which which were were largely largely funded funded by by HDPs; HDPs; [Annual [Annual Health Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY] Page 45

66 disseminated the planning guidelines to all LGs; and carried out budget monitoring. The NHA report for the FYs 2008/09 and 2009/10 was printed and distributed to all sector institutions. Development of the Comprehensive Health Financing strategy delayed but process has picked up up pace and anticipated to be completed in 2013/14 FY. There is limited sector funding hampering implementation of the hard to reach / stay strategy. Mapping development partner activities at at National, Regional and district level is very crucial for coordination of of DP support to to the sector. However, this was not achieved. The sector has developed and reviewed a number of bills and regulations which are supposed to to be be presented to Cabinet but there was no progress realized. Table 29: 29: Summary of of Achievements under Planning, Policy and Support Services Planned Outputs Achievements Comments on on Performance i. i. Compile quarterly activity & Produced quarterly activity & financial reports Reports submitted late financial reports (OBT) and submitted to MoFPED and OPM due to to delays in in submission by by programs and projects ii. ii. Finalize and disseminate the Health Financing Strategy not finalized. The list for for non-bureau comprehensive Health National wide stakeholders consultations accredited PNFP facilities Financing strategy and held is is yet to to be be harmonized Resource allocation formula Resource allocation formula still in draft and their outputs for for and the NHA report The NHA Survey for FY 2008/09 and inclusion in in the the formula 2009/10 was concluded and 1,000 copies are yet to to be be availed. of the report distributed iii. iii. Implement the hard to to reach / The 30% top up allowance for health Limited funding stay strategy and the staff workers paid in hard to reach / stay areas hampering motivation strategy. through the districts implementation of of the the Other motivation strategies implemented entire strategy in piece meal e.g. accommodation, occupational health and safety. Construction of of staff Scholarships were awarded to 257 HWs to to houses supported under pursue medical courses including 91 HWs NUSAF 22 and PRDP from hard to reach areas and 166 HWs pursuing specialized disciplines such as Scholarships awarded ENT, Radiology, Anaesthesia & under the UHSSP Orthopaedics. iv. iv. Supervision and inspection of Followed up PRDP/NUSAF II activities in in 36 Not all all districts followed sector activities out of 56 (64%) implementing districts, to to up up due to to slow approval review the Health Worker Staff houses process for for funds infrastructure development. Budget monitoring carried out in v. v. Hold National, Regional and National planning meeting not held No No funding for for the the district planning meetings and 8 out of 11 regional planning meetings National Planning National DHO s meetings. were held (Lira Sub-region, Central region meeting and Soroti Sub-region to be held in in [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

67 Planned Outputs Achievements Comments on Planned Outputs Achievements Comments Performance on 2013/14). 62 LGs participated in drafting Performance Challenges in their 2013/14). district 62 annual LGs participated action plans in drafting using the new their planning district annual guidelines. action plans using the Challenges transferring funds from transferring Partners to funds MoH delayed from Six new districts planning were guidelines. supported in climatic change Six districts preparedness were supported and response in climatic planning. change preparedness and response Partners implementation to MoH delayed implementation No funds for the DHO DHO planning. meeting not held No meeting funds for the DHO vi. Develop policies aimed at Finalized, DHO meeting launched not and held distributed the Public meeting PPPH Policy guidelines vi. harmonizing Develop policies partnerships. aimed at Private Finalized, Partnership launched and for Health distributed policy. the Public PPPH being Policy finalized guidelines vii. Hold harmonizing one stakeholders partnerships. meeting Not Private done Partnership for Health policy. being finalized vii. on Hold mapping one stakeholders development meeting partner on mapping activities at development National, Regional partner and activities district at level. National, Not done viii. Compile, Regional print and district & disseminate level. Compiled and finalized the 2011/12 MoH viii. the Compile, following print reports: & disseminate HMIS Annual Compiled Statistical and finalized Abstract the and 2011/12 3 quarterly MoH Quarterly the following Reports, reports: Annual HMIS HMIS Annual reports Statistical Abstract and 3 quarterly work Quarterly plan for Reports, FY 2013/14, Annual HMIS reports Report on Gender inequality budget work monitoring plan for FY reports, 2013/14, LG Supported by USAID- Discrimination Report Gender Assessment inequality was mentoring budget monitoring reports, reports, efficiency LG Supported by USAIDdisseminated Discrimination at Assessment central level. was Intrahealth - Uganda of mentoring health facilities reports, study efficiency report, disseminated at central level. Intrahealth - Uganda health sector statistical Efficiency of health facilities study report Capacity Program of health facilities study report, abstract health 2013, sector HSSIP statistical MTR finalized Efficiency of health facilities study report Capacity Program report, abstract quarterly 2013, audit HSSIP reports, MTR finalized Initiated the HSSIP MTR procurement report, quarterly reports, audit reports, Initiated the HSSIP MTR NHA, Quarterly audit reports done AHSPR printing procurement reports, NHA, AHSPR FY 2011/12 Quarterly audit reports done AHSPR printing AHSPR FY 2011/12 AHSPR FY 2011/12 compiled, printed and supported by WHO AHSPR FY 2011/12 compiled, printed and disseminated supported by WHO disseminated ix. Develop / compile the Health All were achieved ix. Develop / compile the Health All were achieved sector policy issues paper sector policy issues paper 2013/14, PHC grant guidelines 2013/14, PHC grant guidelines 2013/14, BFP 2013/14 and 2013/14, BFP 2013/14 and MPS FY 2013/14 MPS FY 2013/14 x. x. Follow Follow up up the the following following bills; bills; The The bills bills were were not not followed followed up up No No facilitation facilitation Indigenous Indigenous and and complimentary complimentary Medicines Medicines Bill, Bill, National National Health Health Insurance Insurance Bill, Bill, Amendments Amendments to to the the Public Public Health Health Act, Act, Amendments to to the the Mental Health Health Act, Act, transformation of of NDA NDA to to National Food and Drug Authority, Pharmacy profession and and practice Bill Bill and the Health Tertiary Institutions Bill Human Resource Management Health Service Commission Most of of the activities planned by the HSC were achieved and on schedule. The results of of the interviews conducted for recruitment of health workers at the central level and the RRHs could [Annual Health Sector Performance Report 2012/13] Page [Annual Health Sector Performance Report 2012/13 FY] Page 47

68 not be be released for most of the vacant posts due to the inadequate wage bill. The MoH to to ensure that there is is clearance from MoPS before declaring vacancies to the HSC for filling. Table 30: 30: Summary of of Achievements under Health Service Commission Planned Outputs Achievements Comments on on Performance i. i. Fill, Fill, replace and address all existing gaps of of HWs of of various categories at Eight (8) health managers and 10 Consultants were recommended to H.E There was limited recruitment due to to MoH Headquarters, NRH, RRHs, the President for appointment. inadequate wage bill bill specialized units like UBTS, Prisons Fifty three (53) health workers were allocation Health Service and China-Uganda recruited for Moroto and Jinja RRHs. Friendship Referral Hospital (Naguru) Vacancies (352) in HC IIIs & IVs under and and KCCA Health Directorate KCCA were filled. numbering approximately 1,020 HW. ii. ii. Continuation of of the the Review of of the Reviewed the following documents; Guidelines for for the the Recruitment of i. i. Guidelines for the Recruitment of of HWs in in Health Health Workers in in LGs LGs and Urban LGs and Urban Authorities. Authorities ii. ii. The Draft Management Structures for for GHs and HC IVs and the report was was submitted to the MoH and and Ministry of of Public Service. iii. iii. Scheme Scheme of of Nursing Nursing Cadre Cadre iii. iii. Complete Complete the the competency competency profiling profiling Not Not done done for for high high level level health health managers managers iv. iv. Provide Provide support support supervision supervision in in Provided Provided support support supervision supervision to to districts districts districts and 4 RRHs as well as and RRHs as well as technical support to 8 districts and 4 RRHs as well as and 4 RRHs as well as technical support to 8 technical support to 8 DSCs DSCs and other central Government technical support to 8 DSCs DSCs and 5 other central Government health institutions. health institutions. v. Print & disseminate 3,000 Copies of Printed and distributed 3,000 Copies of v. Print & disseminate 3,000 Copies of Printed and distributed 3,000 Copies of Health Workers Code of Conduct and Health Workers Code of Conduct and Health Workers Code of Conduct and Health Workers Code of Conduct and Ethics, and 400 Copies of HSC Ethics. Ethics, and 400 Copies of HSC Ethics. Guidelines for the Recruitment of Guidelines for the Recruitment of Health Workers in LGs and Urban HSC Regulations were gazetted and Health Workers in LGs and Urban Authorities. HSC Regulations were gazetted and printed. Authorities. printed. vi. Performance and Career Training carried out vi. Performance and Career Training carried out enhancement training will be carried out enhancement for Members training and will Staff be of carried the Commission out for Members and Staff of the vii. Develop Commission the e-recruitment system The concept note and ToR were developed Supported under vii. Develop the e-recruitment system The concept note and ToR were developed Supported UHSSP under UHSSP 9. Uganda Cancer Institute The 9. Uganda Uganda Cancer Cancer Institute Institute was able to provide a range of services which included; The Uganda Cancer Institute was able to provide a range of services which included; Outpatients: 12,096 patients; Inpatients: 2,652 patients; Physiotherapy: 2,652 patients and Outpatients: 12,096 patients; Inpatients: 2,652 patients; Physiotherapy: 2,652 patients and medical social support: 14,748 patients. The Institute carried out Laboratory: 69,156 medical social support: 14,748 patients. The Institute carried out Laboratory: 69,156 investigations and Imaging: 9,870 investigations. investigations and Imaging: 9,870 investigations. The [Annual Institute Health achieved Sector Performance almost all of Report the planned 2012/13] outputs aimed developing the Institute. Page The 51 5 year [Annual strategic Health plan Sector is being Performance finalized Report and over 2012/13] 70% of the planned works were completed. Page The 51 cancer research coordination structures have been established and the research agenda being finalized. 48 Page [Annual Health Sector Performance Report 2012/13 FY] Table 31: Summary of Achievements under Uganda Cancer Institute Planned Outputs Achievements Comments on Performance i. Develop a 5 year strategic plan. Development of the 5 year strategic plan is

69 year strategic plan is is being finalized and over 70% of the planned works were year strategic plan is being finalized and over 70% of the planned works were completed. completed. The The cancer cancer research research coordination coordination structures structures have have been been established established and and the the research research agenda agenda being being finalized. finalized. Table 31: Summary of Achievements under Uganda Cancer Institute Table 31: Summary of Achievements under Uganda Cancer Institute Planned Outputs Achievements Comments on Planned Outputs Achievements Comments on Performance Performance i. Develop a 5 year strategic plan. i. i. Develop a 5 year strategic plan. Development of the 5 year strategic plan is Development of the year strategic plan is is being being finalized finalized ii. ii. ii. Remodeling Remodeling existing existing facilities facilities The The remodelling remodelling of of TB TB Ward Ward was was finalized finalized to to and and completion completion of of the the accommodate accommodate patients patients originally originally from from the the construction construction and and Lymphoma Lymphoma Treatment Treatment Centre Centre ward. ward. operationalisation operationalisation of of of the the new new Relocated and remodelled remodelled the the Laboratory, Laboratory, the the Cancer Cancer ward. ward. Solid Tumour Centre Centre ward ward and and set set up up a temporally kitchen Continued with the the construction construction of of of the the six six six floors Cancer Ward Ward and and during during this this FY, FY, FY, Plumbing, Electrical installation installation and and fitting fitting were were completed. iii. iii. iii. Construct the the Mayuge satellite The construction of of Mayuge Mayuge Clinic Clinic was was completed completed Waiting Waiting furnishing furnishing center. center. but but not yet operational and and commissioning. commissioning. To To To be be operational operational in in in 2013/ /14 iv. iv. iv. Clinical Clinical outreach outreach services services to to be be visits visits were were made made providing providing cancer cancer screening screening piloted piloted in in in Mbarara Mbarara and and Arua Arua services to 5,468 people services to 5,468 people RRHs. RRHs. Made five (5) Mobile Cancer care and continuity Made five (5) Mobile Cancer care and continuity clinics outreach visits to the two pilot sites of clinics outreach visits to the two pilot sites of Mbarara and Arua hospitals Mbarara and Arua hospitals v. v. Establish the Research v. Establish the Research The Research Directorate was established The Research Directorate was established Directorate, Scientific Review Directorate, Scientific Review The Scientific Review Board was established The Scientific Review Board was established Board and an operational multidisciplinary Cancer Management disciplinary Cancer Management Management Team is in place to Management Team is in place Board and an operational multi- Operational Multi-disciplinary Cancer Operational Multi-disciplinary Cancer Team to develop the research Team to develop the research Development of the Research Agenda is is in agenda and enhance the quality Development of the Research Agenda is in agenda and enhance the quality process of of cancer care. process of cancer care. vi. vi. Construction of of the 3 Level 25% of the works done vi. Construction - of the Level 25% of the works done USAID - Fred Hutchinson USAID Fred Hutchinson building building Uganda Uganda Heart Heart Institute Institute The The The Uganda Uganda Heart Heart Institute Institute provides provides specialized specialized heart heart care care services. services. The The The Catheterization Catheterization Laboratory Laboratory was was was completed completed in in in September September and and therefore therefore was was not not not able able able to to to achieve achieve the the the set set set target of to be of is below target target target of of patients patients to to be be catheterized. catheterized. The The number number of of open open heart heart surgeries surgeries is is below below target target due to inadequate funding for the required supplies. There are also low numbers of trained [Annual Health Sector Performance Report 2012/13] Page 52 [Annual [Annual specialists; Health Health Sector Sector inadequate Performance Performance skills mix Report Report leading 2012/13] 2012/13] to stress, mistakes/errors that may compromise Page Page on quality. A new and deliberate funding mechanism based on the expected outputs/ numbers of procedures has to be considered. A tariff system that caters for the overall cost of the procedures is recommended. Table 32: Summary of Achievements under Uganda Heart Institute Planned Outputs Achievements Comments on Performance i. Fully operationalise the newly Catheterization facility was completed and installed cardiac catheterization operationalized. 95 patients have been facility and operation theatre to served and 51 open heart surgeries were handle 500 Catheterization done. procedures and 300 open heart surgeries per year. [Annual Health Sector Performance Report 2012/13 FY] Page 49

70 quality. A new and deliberate funding mechanism based on the expected outputs/ numbers of of A new and deliberate funding mechanism based on the expected outputs/ numbers of procedures has to be considered. tariff system that caters for the overall cost of of the procedures has to be considered. A tariff system that caters for the overall cost of the procedures is is recommended. procedures is recommended. Table 32: Summary of Achievements under Uganda Heart Institute Table 32: Summary of Achievements under Uganda Heart Institute Planned Outputs Achievements Comments on Planned Outputs Achievements Comments on Performance Performance i. i. Fully operationalise the newly Catheterization facility was completed and i. Fully operationalise the newly Catheterization facility was completed and installed cardiac catheterization operationalized. 95 patients have been installed cardiac catheterization operationalized. 95 patients have been facility facility and and operation operation theatre theatre to to served served and and open open heart heart surgeries surgeries were were handle handle Catheterization Catheterization done. done. procedures and 300 open heart procedures and 300 open heart surgeries per year. surgeries per year. ii. ii. Undertake outreach and support and ii. Undertake outreach and support Conducted outreach and support support supervision visits to to RRHs and one 13 and one supervision visits to 14 RRHs and one supervision visits to 13 and one GH GH GH GH GH (Kiwoko). (Kiwoko) Uganda Blood Transfusion Services UBTS was able to Blood UBTS was able to to achieve 83.2% of their blood collection target and construct 2 Regional Blood Banks (Gulu and Fort in the to 4. Banks (Gulu and Fort Portal) increasing the number of Regional Blood Banks in in the country to to There is need for to costs and procure adequate blood There is is need for additional funding to cover operational costs and procure adequate blood collection and testing kits as well as create an additional blood collections teams to to increase collection and testing kits as well as create an additional 2 blood collections teams to increase from the current 20 to 22 teams. from the current 20 to 22 teams. Table 33: Summary of Achievements under Uganda Blood Transfusion Services Table 33: Summary of Achievements under Uganda Blood Transfusion Services Planned Outputs Achievements Comments on Planned Outputs Achievements Comments on Performance Performance i. Increase blood collection by Collected and distributed 201,365 units of safe i. i. Increase blood collection by Collected and distributed 201,365 units of safe 10% from 220,000 units to blood (83.2%) against target of 242,000. This 10% from 220,000 units to blood (83.2%) against a target of 242,000. This 242,000 units however still falls short of the WHO 242,000 units however requirement still of falls short 1% of of the total the WHO population requirement (340,000 units). of 1% of the total population ii. Complete construction of (340,000 Construction units). of Gulu and Fort-Portal regional Supported by CDC ii. ii. Complete Gulu and Fort construction Portal Regional of Construction blood banks was of Gulu and completed. Fort-Portal regional The buildings Supported have by by CDC Gulu blood and banks; Fort Portal Furnish Regional and blood been handed banks was over. completed. The buildings have blood equip the banks; constructed Furnish Gulu and been handed over. equip and the the Fort constructed Portal Regional Gulu and and blood Fort Fort banks Portal Regional iii. blood blood Procure banks banks two vehicles for Procured one vehicle iii. iii. Procure Planned Procure Outputs Achievements Comments on blood collection two two vehicles for for Procured one vehicle blood blood collection collection Performance iv. Construct central stores at The construction process for the stores at the [Annual the Headquarters Health Sector Performance headquarters Report 2012/13] has begun and drawings have Page 53 [Annual [Annual Health Health Sector Sector Performance Report 2012/13] Page Page been secured. v. Promote appropriate clinical A survey to assess blood utilization practices in Supported by CDC / use of blood in hospitals by health facilities was undertaken PEPFAR sensitizing clinicians; formation of Hospital Transfusion committees in hospitals and monitoring blood use through support supervision. 12. Mulago National Referral Hospital Mulago National Referral Hospital continues to offer various specialized services as well as serving as a first referral facility for the surrounding community. The hospital installed an 50 oxygen Pageplant with a capacity [Annual of filling Health six Sector (25 Performance litre) gas cylinders Report 2012/13 per FY] hour. This is expected to improve the availability of oxygen as a life saving medical supply. The hospital is addressing the issue of staff accommodation by construction of 2 blocks of 50 housing units.

71 formation of Hospital Transfusion committees in Transfusion committees in hospitals and monitoring hospitals and monitoring blood use through support blood use through support supervision. supervision Mulago Mulago National National Referral Referral Hospital Hospital Mulago Mulago National National Referral Hospital continues to offer various specialized services as as well well as as serving serving as as a a first first referral facility for the surrounding community. The hospital installed an an oxygen plant plant with with a capacity of of filling six (25 litre) gas cylinders per hour. This is is expected to to improve the the availability of of oxygen as a life saving medical supply. The hospital is is addressing the the issue of of staff accommodation by construction of 2 blocks of 50 housing units. The The hospital has a problem of maintenance of both the new and old specialized medical equipment. The MoH should increase allocations to Mulago NRH to sustain operations of the hospital. Table 34: 34: Summary of of Achievements under Mulago Hospital Planned Outputs Achievements Comments on on Performance i. i. Offer various specialized Offered specialized services services ,000 inpatients 129,447/150,000 (86.3%) inpatients ,230 outpatients 556,713 (63.9%) outpatients ,791 emergencies 42,541(69.9%) emergencies ,000 specialized cases 1,492,592/2,073,120 (72%) investigations - - 2,073,120 investigations 2,760 (138%) major operations - - 2,000 2,000 major major operations ii. ii. Construction of of an an oxygen Installed the oxygen plant with a capacity of of six six gas gas plant plant cylinders per per hour and Magnetic Resonance Imaging. iii. iii. Construction Construction of of housing housing Commenced the the first phase construction of of Units Units units units for for staff staff of of staff staff houses houses and and completed completed the the guest guest house. house. 13. Butabika National Referral Mental Hospital Butabika National Referral Mental Hospital was able to achieve most of the planned outputs. All the planned outreaches were conducted, outpatient targets were achieved and the [Annual Health Sector Performance Report 2012/13] Page 54 [Annual construction Health works Sector progressed. Performance The Report bed 2012/13] occupancy rate is over 130% over the years Page despite 54 opening new mental health units in RRHs. The MoH should allocate funds and intensify community sensitization on mental health. Strengthen capacity at the RRH mental health units especially staffing. Table 35: Summary of Achievements under Butabika Hospital Planned Outputs Achievements Comments on Performance i. Attend to; 28,500 mental outpatients 52,000 medical outpatients 6,500 admissions Attended to; 26,389 (93%) mental outpatients 39,129 (75%) medical outpatients 6,790 (104%) admissions ii. Carry out: 5,500 laboratory investigations 1,200 x-rays 1,200 ultrasounds Conduct 60 outreach clinics in which 3,000 patients will be seen and 750 patients resettled. Carried out: 24,100 (438%) laboratory investigations 738 (62%) x-rays 1,079 (90%) ultrasounds 57 (95%) Outreach clinics conducted at the five centres of Nkokonjeru, Kawempe Maganjo, Nansana, Kitekika, and Kitebi. 2,930 (98%) patients were seen. 913 (122%) patients were resettled to their homes within Kampala and [Annual Health Sector Performance Report 2012/13 FY] Page 51

72 construction works progressed. The bed occupancy rate is over 130% over the years despite construction works progressed. The bed occupancy rate is over 130% over the years despite opening new mental health units in RRHs. opening new mental health units in RRHs. The The MoH MoH should should allocate allocate funds funds and and intensify intensify community community sensitization sensitization on on mental mental health. health. Strengthen Strengthen capacity capacity at at the the RRH RRH mental mental health health units units especially especially staffing. staffing. Table Table 35: 35: Summary Summary of of Achievements under Butabika Hospital Table 35: Summary of Achievements under Butabika Hospital Planned Outputs Achievements Comments on on Planned Outputs Achievements Comments on Performance Performance i. i. Attend to; to; Attended to; i. Attend to; Attended to; 28,500 mental outpatients 26,389 (93%) mental outpatients 28,500 mental outpatients 26,389 (93%) mental outpatients 52,000 medical outpatients 39,129 (75%) medical outpatients 52,000 medical outpatients 39,129 (75%) medical outpatients 6,500 admissions 6,790 (104%) admissions 6,500 admissions 6,790 (104%) admissions Carry out: Carried out: Carry out: Carried out: 5,500 laboratory investigations 1,200 24,100 (438%) laboratory investigations 5,500 laboratory investigations 1,200 24,100 (438%) laboratory investigations x-rays 738 (62%) x-rays x-rays 738 (62%) x-rays 1,200 1,200 ultrasounds ultrasounds 1,079 1,079 (90%) (90%) ultrasounds ultrasounds ii. ii. ii. Conduct Conduct outreach outreach clinics clinics in in which which (95%) (95%) Outreach Outreach clinics clinics conducted conducted at at at 3,000 3,000 patients patients will will be be seen seen and and the the five five centres centres of of Nkokonjeru, Nkokonjeru, patients patients resettled. resettled. Kawempe Kawempe Maganjo, Maganjo, Nansana, Nansana, Kitekika, Kitekika, and and Kitebi. Kitebi. 2,930 (98%) patients were were seen. seen. 913 (122%) patients were were resettled to to to their homes within Kampala and and upcountry. iii. iii. iii. Construct a kitchen, OPD shade and 1 Storeyed staff house (4 (4 (4 in in in 1) 1) 1) concrete seats for the Diagnostic Block. completed. Completion of the storeyed staff house 1 Storeyed house ( 4 in in in 1 ) ) under of of of 4 units started in FY 2011/12 and construction 90 completed construction of of 4 unit storeyed staff house. 14. Regional Referral Hospitals The 13 RRHs provided secondary referral services in their catchment areas and were able to to collectively achieve 140% (282,482/201,334) of the IP target, 154% (1,901,306/1,234,800) of of OPD attendance target, 178% (1,166,576/654,870) of the lab investigations. However, only achieved 6% (14,584/243,450) of the FP target, 32% (107,964/341,200) of of immunizations and 29% (57,294/194,443) of ANC visits planned in the MPS. Almost all RRH have developed hospital master plans, have ongoing capital development projects and collaborated with training institutions in the catchment areas. 55 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

73 Table 36: Key Outputs for Regional Referral Hospitals in the MPS 2012/13 Planned Key Outputs Achievements Arua Jinja Fort Portal Gulu Hoima Kabale Lira In total offer specialized services attend to: 201,334 Inpatients 20,182 25,185 22,027 7,715 16,501 11,538 18, ,440 specialized Out NA NA NA NA NA NA NA Patients 1,234,800 general OPD 176, , , , , , ,499 attendance 68,453 X-ray imaging NA NA NA NA NA NA NA 654,870 lab tests 107, ,044 55,530 79,503 57,032 74,930 95,116 FP services to 243, , ,295 1,671 people 341,200 immunizations 14,716 9,891 5,325 11,460 7,450 5,393 15, ,443 antenatal cases 7,023 5,565 3,581 5,305 4,522 2,863 4,991 Completion of ongoing works and provision of medical equipment. Medical Equipment has been procured. Construction works are all on-going Eye Unit completed Ongoing works on construction of the private wing Completion and equipping of Private Ward and Administration Building Construction of administration block resumed. To be completed September Works resumed for the 4 level staff house to be completed Dec 2013 OPD renovation completed and commissioned HIV clinic renovation (by SUSTAIN) to be completed Aug Renovation of Completed staff accommodation. 3 storeys. 30 apartments. Installation of water reservoir tank Renovation of kitchen and laundry Installation of shelves in records department Renovation of pediatric ward Supply and installation of central autoclave Supply of assorted equipment like oxygen Operating theatre / ICU Complex Completed. Partial equipping of ICU and operating theatre Installation of Intercom and Wireless internet for the hospital Complete Expansion & Renovation of HIV clinic by SUSTAIN complete Construction & equipping a centralized laboratory by [Annual Health Sector Performance Report 2012/13] Page 56 [Annual Health Sector Performance Report 2012/13 FY] Page 53

74 Planned Key Outputs Achievements Arua Jinja Fort Portal Gulu Hoima Kabale Lira Completing hospital master / strategic investment plans. Collaboration with teaching institutions to train and mentor health workers. Under ICB/MOH project. SIP near completion Arua Nursed training school, Arua Medical lab training school, other students on attachments during recess times, project trainings. Completed Draft strategic Investment Plan Available Intern Doctors, Nurses and Pharmacists deployed by MoH Collaborate with Jinja school of Nursing & Midwifery, Jinja Lab. Training Sch., Sch. of OCOs, UCU, MUK CHS, International Institute of health sciences, St. Eliza school of comprehensive nursing & St Elizabeth s Institute of Health Professionals Intern doctors, Fort Portal School of Clinical Officers, Virika Nurses Training School, Fins Nurses training School, and Mountain of the Moon School of Nursing and Public Health Children s storeyed block completed (By Soleterre Italy) Construction of radiology department commenced (By Italian cooperation Purchased office furniture worth 60 m Purchased eye dep t operating microscope and generator Completed Master and investment plan completed. Collaborate with Gulu University Medical school and Gulu school of clinical officers. Students from several institutions around the country also send students for practical placements especially in counseling. Most of our training is by SUSTAN. Collaborate with Basingstoke Hospital UK, they train our staff concentrators, suction machine Renovation of four staff houses Remodeling of isolation unit Hospital master plan completed Training of students from Kabale school of comprehensive nursing. Training of students from Kabale institute of health sciences. Supervising internees from different universities and institutions. SUSTAIN is near completion Did EIA and design for Incinerator Completed 3 years back and being used Clinical Training facility for 3 Nurse training Institutions in Lira. Clinical Training facility for BSc. Midwifery for Gulu University Collaborate with a group of American specialists who come and provide mentorships to staffs in the fields of Neonatal care, Anesthesia & Obs. & Gyn. yearly [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

75 Key Outputs for Regional Referral Hospitals in the MPS 2012/13 Planned Key Outputs Achievements Masaka Mbale Mbarara Moroto Mubende Soroti In total offer specialized services attend to: 201,334 Inpatients 35,688 48,966 29,083 11,223 14,917 21, ,440 specialized Out NA NA NA NA NA NA Patients 1,234,800 general OPD 209,032 85, ,185 53,051 86, ,629 attendance 68,453 X-ray imaging NA NA NA NA NA NA 654,870 lab tests 128,290 80,977 51,232 30, , ,207 FP services to 243,450 people 991 1, ,455 1, ,200 immunizations 8,006 5,667 9,764 2,607 5,751 6, ,443 antenatal cases 6,088 3,888 4,391 1,802 4,666 2,609 Completion of ongoing works and provision of medical equipment. Completing hospital master / strategic investment plans. Collaboration with teaching institutions to train and mentor health workers. NA A staff accommodation unit has been completed, 2 gates were fully constructed and sewerage system repaired One 4level storied staff house of 8 units near completion. A promise of supply of medical equipment based on a loan scheme initiated by MoH. Construction 6 units of staff houses worth (476,000,000/=) Procurement of medical equipment worth (20,000,000/=), ICT Equipment worth (20,000,000/=) office furniture worth (10,000,000/=) Parking yard half completed, two VIP latrines completed, two water tanks constructed, incinerator constructed, medical equipment procured NA Completed Hospital master Plan completed. Not completed Strategic master plan completed NA Collaboration with both gov t and private health training institutions is on-going, the latest is Busitema University Draft MoU between hospital and MUST in place Training and mentorship activities going on between hospital and Mulago consultants. Attachments for 15 students from various training institutions for periods varying from 1-2 months MOU signed with Kalungi nursing school a private institution NA NA NA [Annual Health Sector Performance Report 2012/13] Page 58 [Annual Health Sector Performance Report 2012/13 FY] Page 55

76 2.8 Global Fund (GF) Supported Interventions 2012/ Global Fund for TB, HIV/AIDS and Malaria The Focal Coordination Office (FCO) was created to facilitate the Country Coordinating Mechanism (CCM) and the Principal Recipient (PR) perform their functions of grant oversight, program management, coordination, Quality Assurance/Supervision, Monitoring and Evaluation, Operational Research (SM&E,OR), and reporting. This FY the Global Fund supported interventions which contributed towards the attainment of the MDGs 4, 5, and 6 in relation to improving MCH as well as national and international health goals. During the 2011/12 FY the country signed five-year GF grants for Round 10 Malaria, TB and Health Systems Strengthening (HSS), all worth a total of USD 100,395,436. An additional 2 three-year grants worth USD 218,116,205 were signed, namely; HIV Round 7 phase II grant worth USD 154 million; and Malaria Round 7 Phase II USD 64,116,205. The HIV Round 7 Phase 2 grant aims to reduce incidence and mitigate effects of HIV as well as strengthen national capacity to manage a multispectral response has a total grant amount of USD 127 million, with USD 104 M mainly meant for commodities for PR1, and PR2 USD 54 million for supportive activities. Out of USD 42,840,357 disbursed in December 2012, USD 39,565,386 and 3,802,866 was used to procure ARVs and Condoms respectively via Voluntary Pooled Procurement as well as test kits, while USD 168,674 was sent to top up funds for In- Country PSM costs bringing them up to USD 5,233,385. A follow on USD 450,684 meant for studies on PMTCT uptake and MAPRS, Cohort analysis and STI Quality assessment has been cleared for release while USD 1,462,506 previously meant for M&E and other tempting areas had been reprogrammed to procure CD4 reagents. Currently there are good stocks of adult ARVs, and low stocks of NVP Syrups and laboratory commodities with contingency plans finalized for their procurement with funds from PEPFAR and DFID. For Malaria grants AMFm, Round 7 and Round 10 grants, the country has continued to use the USD 5.6 million into Country to grant support activities among them integrated malaria training and follow up in 78 districts, HBMF in 33 Districts; From the rest of the AMFm funds USD 6.5 million and 12 million were for procurement of 15.7 million RDTs and USD 11 million ACT doses through VPP respectively, all of which were delivered between December 2012 and July In addition to the Round 7 grant where 7.2 million LLINs were distributed in 2009/10, more 15.5 million LLINs were procured through GF, 11.3 million are already in-country while procurement for the remaining 4.5 million is ongoing. Another 5.0 million LLINs are being procured from DFID/PMI while 0.5 million from World Vision were distributed immediately after the launch on May 10, 2013 to achieve universal coverage in districts of Soroti and Busia. From Malaria 10 grant procurement of ACTs and ACTs worth USD 19 million is ongoing. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

77 To date the Round 10 TB Single Stream Funding has received USD 11 million of the total USD 17 million grant which was used for procurement of medicines for 1 st drugs to treat uncomplicated TB and 2 nd Line to treat MDR TB, TB prevalence survey was initiated and is underway, anti TB drug quality testing and other supportive activities are in due process of implementation. Procurement of protective wear for PMDT health workers and Refresher course to prison health workers on TB and TB co-infection were also done during this period. The HSS Round 10 grant received has a total of USD 25 million, 4.06 million of which is for is for implementation through the Public Sector. Of this USD 2.01 million was disbursed during this period and it was used for advertisement, recruitment and procurement of equipment for Regional Performance Monitoring Teams; Recruitment of Health workers managed to get 408 out of 600 planned. The funds were also used for procurement and distribution of HMBF forms, 30 DADI motorcycles, and computers and fridges. During this FY the FCO completed Progress Updates and Disbursement requests for the periods Jan-June 2012, July to December 2012 as well as January to June The FCO hosted 4 Country Team missions in September 2012, February, May, and July 2013 to streamline Grant implementation. It conducted Support Supervision, participated in the GF/LFA DQA and oversaw distribution of various commodities in over 100 districts as well as the assessment of SR capacity for GF implementation Global Alliance for vaccines and Immunization (GAVI) Annually, GAVI continues to provide the Pentavalent vaccine (DPT-HepB+Hip). In FY2012/2013 GAVI supported Uganda with pentavalent vaccines worth UShs 27.3 billion while GoU cofinancing was UShs 1.31 billion. During the FY 2012/13, review of the work plans and budgets for implementation of GAVI supported activities under Health Systems Strengthening and Immunization Support Services was finalized. The work plans and budgets were approval by various structures of the MoH and GAVI Secretariat. A number of procurement activities were initiated and ongoing including, procurement of vehicles, motorcycles, VHT kits, computers, office equipment and recruitment of staff. During the same period, consultancy services for civil works for construction of vaccine stores, medicine stores and staff houses were advertised and evaluation is ongoing. A total of UShs.1.25 billion out of the recovered funds was disbursed to districts for revitalization of immunization services. During the same review period, with GAVI support, a new vaccine Pneumococcal vaccine was introduced in Iganga district and roll out to other districts is ongoing. A total of USD 1,372 was received from GAVI to support introduction activities and UShs 2.23 billion was disbursed to the districts. [Annual Health Sector Performance Report 2012/13] Page 60 [Annual Health Sector Performance Report 2012/13 FY] Page 57

78 2.9 Health Partnerships Performance This section assesses progress in implementation of the Compact for implementation o HSSIP as well as the decentralized responses (partners technical and financial suppor 2.9 Health Partnerships Performance health). This section assesses progress in implementation of the Compact for implementation of the 2.9 Health Partnerships Performance HSSIP as well as the decentralized responses (partners technical and financial support for This section assesses The Compact progress for in Implementation implementation of of the the Compact HSSIP 2010/11 for implementation 2014/15 of the health). HSSIP as well as the decentralized responses (partners technical and financial support for The Compact for implementation of the HSSIP is an instrument aimed at maintaining p health). The Compact for Implementation of the HSSIP 2010/ /15 dialogue, promoting joint planning and ensuring implementation and monitoring of the H The /11 Compact The Compact for 2014/15. implementation for Implementation The partnership of the HSSIP of the in HSSIP is this an instrument 2010/11 compact 2014/15 aimed is between at maintaining the Government policy of Ug dialogue, promoting joint planning and ensuring implementation and monitoring of the HSSIP The (MoH) Compact and for HDPs, implementation PNFP, the of Private the HSSIP Health is an instrument Practitioners aimed (PHP) at maintaining and CSOs policy and are collect 2010/ /15. The partnership in this compact is between the Government of Uganda dialogue, (MoH) referred promoting and HDPs, to as PNFP, health joint planning the sector Private partners. and ensuring implementation and monitoring of the HSSIP Health Practitioners (PHP) and CSOs and are collectively 2010/ /15. The partnership in this compact is between the Government of Uganda referred to as health sector partners. (MoH) and HDPs, PNFP, the Private Health Practitioners (PHP) and CSOs and are collectively referred to as health sector partners. HPAC meets monthly to receive, discuss and make recommendations on policy issues HPAC progress meets monthly reports to submitted receive, discuss through and the make Senior recommendations Management on Committee. policy issues and progress reports submitted through the Senior Management Committee. HPAC meets monthly to receive, discuss and make recommendations on policy issues and Attendance of HPAC meetings by the various stakeholders varied with the HDP representat Attendance progress reports of HPAC submitted meetings through by the the various Senior stakeholders Management varied Committee. with the HDP representatives progressively progressively attending attending more consistently more consistently than all other than members. all other members. Attendance of HPAC meetings by the various stakeholders varied with the HDP representatives Table progressively Table 37: HPAC 37: HPAC Institutional attending Institutional more representatives consistently representatives attendance than all attendance other members. Average Annual Attendance Rate Table Representatives 37: HPAC Institutional representatives attendance Average Annual Attendance Rate 2010/ / / / / /13 MoH Representatives (11) 45% Average Annual 45% Attendance Rate 41% MoH (11) 45% 45% 41% HDP (4) 2010/11 88% 2011/12 109% 2012/13 138% CSO MoH HDP (11) (3) (4) 48% 45% 88% 67% 45% 109% 44% 41% 138% Private HDP CSO (4)(1) (3) 88% NA 48% 109% 66% 67% 138% 58% 44% NMS CSO Private (3) (1) (1) 58% 48% NA 42% 67% 66% 92% 44% 58% District Private NMS (1) (1) 17% NA 58% 66% 8% 42% 58% 92% NRH NMS District (2) (1) (1) 58% 0% 17% 42% 4% 8% 92% 4% 58% RRH District (1) 0% 0% 0% NRH (1) (2) 17% 0% 8% 4% 58% 4% Line NRH Ministries (2) (5) 0% 2% 4% 8% 4% Source: RRH HPAC (1) Minutes 0% 0% 0% RRH (1) 0% 0% 0% Line Line Ministries Ministries (5) (5) 0% 0% 2% 2% 8% 8% Source: Source: HPAC HPAC Minutes Minutes Three areas of focus extracted from the list of indicators for monitoring implementation of the Compact 2010/ /15 were used for the assessment. These are planning and budgeting, Three areas of focus extracted from the list of indicators for monitoring implementation of the monitoring programme implementation and performance, and policy guidance and monitoring. Compact 2010/ /15 were used for the assessment. These are planning and budgeting, Of these three areas the sector performed well in policy guidance and monitoring through monitoring programme implementation and performance, and policy guidance and monitoring. attendance of most of the planned meetings for the governance structures. Of these three areas the sector performed well in policy guidance and monitoring through attendance of most of the planned meetings for the governance structures. Only two out of the five indicators measuring performance of the planning and budgeting attendance of most of the planned meetings for the governance structures. processes were achieved. There was slow progress in achieving the remaining 3 outputs due to Only two out of the five indicators measuring performance of the planning and budgeting processes were achieved. There was slow progress in achieving the remaining 3 outputs due to [Annual Health Sector Performance Report 2012/13] Page 61 Three areas of focus extracted from the list of indicators for monitoring implementation o Compact 2010/ /15 were used for the assessment. These are planning and budge monitoring programme implementation and performance, and policy guidance and monito Of these three areas the sector performed well in policy guidance and monitoring thr Only two out of the five indicators measuring performance of the planning and budg processes were achieved. There was slow progress in achieving the remaining 3 outputs du [Annual Health Sector Performance Report 2012/13] Page 61 [Annual Health Sector Performance Report 2012/13] 58 Page [Annual Health Sector Performance Report 2012/13 FY] Pa

79 leadership and governance issues. The Departments of Planning and Administration should address leadership these and three governance indicators issues. to ensure The compliance Departments the of current Planning FY. and Administration should address these three indicators to ensure compliance the current FY. The sector performed well in monitoring programme implementation and performance The sector performed well in monitoring programme implementation and performance especially through quarterly performance reviews, annual sector performance review and especially through quarterly performance reviews, annual sector performance review and reporting, and is on track regarding the MTR of the HSSIP. However, failure by the MoH to reporting, and is on track regarding the MTR of the HSSIP. However, failure by the MoH to conduct regular supervision and monitoring of programme implementation in the districts was conduct regular supervision and monitoring of programme implementation in the districts was a big setback in realization of the mandate of the centre. In addition the TWG continued to a big setback in realization of the mandate of the centre. In addition the TWG continued to meet irregularly, thus affecting coordination and provision of technical guidance. meet irregularly, thus affecting coordination and provision of technical guidance. The The MoH MoH leadership leadership needs to to prioritize sector sector performance performance monitoring monitoring activities activities to the to the districts districts by by providing reliable, regular and adequate resources. In In view view of of the the importance importance of TWGs, of TWGs, MoH MoH Senior Top Top Management should put in in place mechanisms to to monitor monitor the the functionality of the of the TWGs. Table 38: 38: Progress in implementation of the Country Compact during 2012/13 FY FY No No Indicator Measurement Achievement Complaint Complaint / Non / Non Complaint Complaint Planning and and Budgeting i. i. MoH MoH Annual Workplan reflecting Annual Work plan plan analyzed and and Non Complaint Non Complaint stakeholder contribution (all report submitted to to 1 st 1 st HPAC HPAC of of FY FY Workplan Workplan resources resources on on plan) plan) development Annual development Annual workplan workplan analyzed analyzed but not but not started late and submitted to HPAC. started late and submitted to HPAC. stakeholder stakeholder contribution not contribution not captured ii. All new sector investments are Reports from SBWG on appraised GAVI and IDB Projects were Non Complaint captured ii. All appraised new sector by SBWG investments are Projects Reports submitted from SBWG to HPAC on appraised GAVI and IDB Projects were Non Complaint appraised and reports submitted to appraised by SBWG Projects submitted to HPAC HPAC appraised and reports submitted to iii. All planned procurements Quarterly assessment of HPAC Non Complaint iii. All planned procurements Quarterly assessment of Not done reflected in the Comprehensive implementation of procurement plan Non Complaint Not done reflected Procurement in the Plan Comprehensive to implementation HPAC of procurement plan iv. Procurement Response to Plan the Auditor Response to HPAC to AG s report presented The Auditor General s report was Complaint iv. Response General s to Report the Auditor to Response HPAC to AG s report presented presented The Auditor HPAC General s report was Complaint General s Report to HPAC presented to HPAC v. Implementation of Harmonized Progress towards implementation of Non Complaint v. Implementation Technical Assistance of Harmonized (TA) Plan agreed Progress TA towards Plan implementation of No implementation Harmonized Non Complaint TA Technical Assistance (TA) Plan agreed TA Plan No implementation Plan Harmonized not TA disseminated Plan not 2. Monitoring Programme Implementation and Performance disseminated 2. i. Area Team Visits Quarterly Presentation Monitoring of Programme reports to HPAC Implementation Not done and Performance Non Complaint Reports within 30 days after completion of i. Area Team Visits Quarterly Presentation of reports to HPAC Not done Non Complaint Area Team visits Only one Area Reports within 30 days after completion of Team visit was Area Team visits conducted Only one in Q4 Area ii. MoH Quarterly Performance 3 quarterly performance reviews All four quarters were reviewed in Complaint Team visit was Assessment took place two biannual meetings conducted in Q4 ii. MoH Quarterly Performance 3 quarterly performance reviews All four quarters were reviewed in Complaint iii. Assessment Technical Review Meeting Present took place Report from TRM to HPAC Not two done biannual meetings Non Complaint by 30 April iii. Technical Review Meeting Present Report from TRM to HPAC Not done Non Complaint [Annual Health Sector Performance by Report 30 April 2012/13] Page 62 [Annual Health Sector Performance Report 2012/13] Page 62 [Annual Health Sector Performance Report 2012/13 FY] Page 59

80 No Indicator Measurement Achievement Complaint / Non Complaint iv. Technical Working Group meetings Target 80% of TWG meetings held 40% of TWG meetings held. There are 14 TWGs but meetings held Non Complaint v. Annual Health Sector Performance Report vi. Joint Review Mission performance review Submission of Final Report by 30 th September Aide Memoire presented to HPAC by November 30 irregularly Done vii. Mid-Term review of the HSSIP Completion of MTR by May 2013 MTR process initiated in November 2012 and report to be presented at the JRM in September 2013 viii. Submission of Annual Report to OPM Submission to OPM by 30 th September Done Submitted Complaint Complaint Complaint Complaint 3. Policy Guidance and monitoring i. Senior Management Committee Proportion of planned meetings held 11/12 (92%) of planned meetings held ii. Health Policy Advisory Committee meetings Proportion of the scheduled meetings took place All the 12 scheduled HPAC meetings took place. Complaint Complaint Proportion of the meetings occurred on the scheduled dates. All the 12 HPAC meetings took place on the scheduled dates. iii. Country Coordinating Mechanism (CCM) Performance for CCM meetings Attendance of at least ¾ of meetings by all members 8 meetings were held out of the expected 4 but irregular attendance by some members Complaint [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

81 Public- Public- Private Private Partnerships Private Private Not-For Not-For Profit Profit (PNFP) (PNFP) Sub-Sector Uganda Uganda Protestant Protestant Medical Medical Bureau (UPMB) Performance FY FY The The UPMB UPMB is a is national a national umbrella umbrella organization that supports and and coordinates coordinates the the activities activities of of health health units units affiliated affiliated to to the the Protestant churches in in Uganda. These These churches churches include include Church Church of Uganda, of Uganda, Seventh-day Seventh-day Adventist Adventist Union, Union, Elim Church, Deliverance Church, Church, Full Full Gospel Gospel Church, Church, Pentecostal Pentecostal Assemblies Assemblies of of God God and and Church of of God. These units units include include hospitals, hospitals, 6 HC 6 HC IVs and IVs and lower lower level level health health units. units. Seven of of the hospitals run run health-training institutions institutions for for nurses, nurses, laboratory laboratory cadres cadres and and other other PHC PHC level cadres. The The units units are are all all faith faith based based and and PNFP PNFP with with a common goal of of providing providing affordable, affordable, good good quality quality health health care care to to Ugandans Ugandans regardless regardless of of ethnicity and religious creed. creed. Accessibility Accessibility to to drugs drugs and and medical medical supplies supplies for for member member units units is is ensured through the the Joint Joint Medical Medical Store Store (JMS), (JMS), founded founded and and owned owned jointly jointly by by UPMB UPMB and and Uganda Uganda Catholic Medical Bureau (UCMB). (UCMB). a) Staffing a) Staffing UPMB in UPMB hospitals hospitals By the By the end end of of FY FY 2012/ /13 UPMB UPMB had had a total of 2,859 2,859 health health workers. workers. There There has has been been a gradual increase increase the in the number number of of staff staff as as shown in in Figure 9. There 9. There are are no no standardized standardized staffing staffing norms for the UPMB UPMB facilities facilities and and therefore therefore the the level level of of staffing against against the the norms norms cannot cannot be be assessed. 4,000 4,000 3,000 3,000 2,000 2,000 1,000 1, No. No. of of staff staff 1,989 1,989 2,339 2,339 2,859 2,859 Figure Figure 9: 9: Staffing Staffing in in UPMB UPMB hospitals hospitals b) Staff b) Staff productivity productivity in in UPMB UPMB hospitals (Standard Unit of of Output Output per per staff) staff) The The indicator indicator Staff Staff productivity productivity (Staff (Staff SUO) SUO) is is obtained by by computing the the SUO SUO for for each each facility facility and and dividing dividing it by it by the the total total number number of of staff staff available for the the period period under under review review implying implying the the staff staff SUO SUO has has a direct a direct relationship relationship with with the the hospital SUO and and an an inverse inverse relationship relationship with with the the total total number number of staff of staff at at the the facility. facility. Figure Figure shows shows the the SUO SUO for for UPMB UPMB hospitals for the the prevoius three three FYs. FYs. FY FY 2011/ /2012 registered registered the the highest highest SUO SUO and and lowest lowest staff productivity. Northern Northern Region Region has has the the second second lowest lowest standard standard unit unit of of output output but but highest staff productivity while while Western Western region region which which has has the the highest highest standard standard unit unit of of output output has has the the second staff productivity. Figure Figure 10: SUO 10: SUO in UPMB in UPMB hospitals hospitals Figure Figure 11: 11: Staff Staff productivity productivity in UPMB in UPMB Hosps. Hosps. 2012/ /13 [Annual [Annual Health Health Sector Sector Performance Performance Report Report 2012/13] Page Page Number of of Staff Staff [Annual Health Sector Performance Report 2012/13 FY] Page 61

82 Figure 10 shows the SUO for UPMB hospitals for the prevoius three FYs. FY 2011/2012 registered the highest SUO and lowest staff productivity. Northern Region has the second lowest standard unit of output but highest staff productivity while Western region which has the highest standard unit of output has the second staff productivity. Figure 10: SUO in UPMB hospitals Figure 11: Staff productivity in UPMB Hosps. 2012/13 [Annual Health Sector Performance Report 2012/13] Page 64 3,000, ,757, ,000, ,757, ,500,000 2,316, ,000, ,757, ,500,000 2,272,047 2,316, ,000, ,500,000 2,316,178 2,272, ,000, ,500,000 2,272, ,000, ,500,000 1,000, ,500, ,000, , ,000, , ,000 FY FY FY SUO 0-0 FY FY FY FY FY FY SUO SUO 1,200,000 1,400 1,059,211 1,200,000 1,400 1,000,000 1,178 1,059,211 1,200 1,200,000 1,400 1,000,000 1,059,211 1,178 1,200 1, ,000 1,000, ,264 1, ,200 1, , , , , , , , , , , , , , , , , , , , ,000 Central East West North Central SUO East Staff SUO - West North Central East West North SUO Staff SUO SUO Staff SUO c) Financial Summary for UPMB hospitals Figure 12: Trends in income for recurrent operations c) In the Financial c) Financial Summary Summary FY, the for for cash UPMB UPMB inflow hospitals from user fees increased in relative and absolute terms for 120.0% Figure Figure 12: 12: Trends Trends in in income income for for recurrent recurrent operations operations In UPMB the In the hospitals by FY, 2% FY, the in the comparison cash cash inflow with from the user fees 100.0% previous fees increased increased year. User relative in fees relative continue and and absolute to be the terms major for 120.0% 24.5% 22.3% 17.3% UPMB source UPMB hospitals of hospitals income by for by 2% 2% the in in hospitals comparison financing with the 80.0% previous approximately year. User 50% of fees the overall recurrent to cost 100.0% previous year. User fees continue to be the major 21.3% 22.1% 21.5% 22.3% 17.3% 24.5% 22.3% 17.3% source incurred source of by income of health income facilities for for the the to hospitals deliver services. financing 60.0% 80.0% 11.5% 7.6% 8.3% For the approximately previous 50% three 50% of FYs, of the the user overall fee as recurrent a source of cost 21.3% 21.3% 40.0% 22.1% 21.5% 22.1% 21.5% incurred income incurred has by increased health by health averagely facilities to by to 2% deliver each services. year. 60.0% 11.5% 11.5% External donation both in kind and in cash 45.8% 7.6% 8.3% 47.9% 49.9% 20.0% 7.6% 8.3% For the For previous the previous three three FYs, FYs, user user fee fee as as a source of 40.0% contribute between 21% and 22%. There was a income income has has increased increased averagely by by 2% 2% each year. slight decline (0.2%) in Donations from 21.5% to 0.0% External External donation donation both both in in kind kind and and in in cash 45.8% 47.9% 49.9% 20.0% FY % 47.9% 49.9% 20.0% FY FY %. Government subsidies to UPMB hospitals contribute contribute between between 21% 21% and and 22%. 22%. There was a User Fees continue to show a positive trend with a 0.7% and slight slight decline decline (0.2%) (0.2%) in in Donations Donations from from 21.5% 21.5% to 0.0% 0.0% Gov't subsidy (Money & drugs) FY % increase for FY 2011/2012 and 2012/2013 FY Donations FY FY FY FY %. 21.3%. Government Government subsidies subsidies to to UPMB UPMB hospitals hospitals Other incomes FY respectively. Government subsidies include User Fees continue to show a positive trend with a 0.7% and User Fees continue to show a positive trend with a 0.7% and Gov't subsidy (Money & drugs) PHC conditional grant to hospitals, schools and Gov't subsidy (Money & drugs) 3.2% increase for FY 2011/2012 and 2012/2013 Donations 3.2% increase for FY 2011/2012 and 2012/2013 Other Donations incomes HSD FY management respectively. and Government credit line drugs. subsidies In 2012/2013 include FY, further analysis Other indicates incomes that 80% of FY the respectively. government subsidy Government is in form subsidies of PHC conditional include PHC conditional grant to hospitals, schools and grant to the hospitals with only 6.6% PHC allocated conditional to credit grant line drugs. to hospitals, schools and HSD management and credit line drugs. In 2012/2013 FY, further analysis indicates that 80% of HSD d) UPMB management contribution and credit to the HSSIP line drugs. outputs In 2012/2013 FY, further analysis indicates that 80% of the government subsidy is in form of PHC conditional grant to the hospitals with only 6.6% the government subsidy is in form of PHC conditional grant to the hospitals with only 6.6% allocated to credit line drugs. allocated [Annual Health to credit Sector line Performance drugs. Report 2012/13] Page 65 d) UPMB contribution to the HSSIP outputs d) UPMB contribution to the HSSIP outputs [Annual Health Sector Performance Report 2012/13] Page 65 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

83 The The outputs from from all all the the UPMB UPMB hospitals in Table in Table shows shows the the contribution of UPMB of UPMB hospitals to to the the outputs indicators used used for for monitoring the the HSSIP HSSIP 2010/ /15 performance for for the the FY 2012/2013. FY Table Table 39: 39: Contribution of UPMB of UPMB Health Health Facilities to the to the HSSIP HSSIP Outputs Outputs Output Output 2011/ / / /13 OPD OPD Attendance 584, , , ,045 Inpatients 116, , , ,265 Deliveries 51,675 51,675 30,331 30,331 Immunizations 284, , , ,167 SUO SUO 2,757,621 2,316,178 Source: Source: UPMB UPMB e) e) HIV HIV Prevention, Care Care and and Treatment Thee Thee period period July July June - June 2013, 2013, UPMB UPMB under under the the NESH NESH project project has has directly supported a total a total of of facilities (Kabarole Hospital in Kabarole in district, Amai Amai Community Hospital in Amolatar in district, Ruharo Ruharo Hospital in Mbarara in district, Rugarama Hospital in Kabale in Kabale district, JOY JOY medical Centre Centre and and St. St. Stephens Hospital in Kampala in district district to provide to comprehensive HIV HIV prevention, care care and and treatment services to people to people living living with with or affected or with with HIV/AIDS. HIV HIV Counselling and and Testing Number of people of people counseled, tested tested and and received results results = 31,847 = 31,847 Number testing testing HIV HIV positive and and referred to care to care = 2,451 = 2,451 PMTCT PMTCT Number of women of who who newly newly attended ANC ANC =6,079 =6,079 Number of pregnant of women counseled = 7,191 = 7,191 Number of women of who who had had an an HIV HIV test test at the at the facility facility = 5,580 = 5,580 Number of HIV of HIV positive pregnant women who who received ARVs ARVs drugs drugs for for PMTCT PMTCT = 385 = 385 Number of women of with with documented HIV HIV positive status status entry at entry = 456 = 456 Early Early Infant Infant Diagnosis (EID) (EID) D1. D1. Number of HIV-exposed of infants infants (<18 (<18 months) getting getting a 2a nd 2DNA nd DNA PCR PCR D2. D2. Number of HIV-exposed of infants infants initiated on on Cotrimoxazole prophylaxis st 1 st D3. D3. Number of DNA of DNA PCR PCR results results returned from from the the lab lab 2 nd 2 nd D4. D4. Total Total number of HIV-exposed of infants infants who who had had a serological/rapid a HIV HIV test test Total Total at 18 at 18 months or older or older Positive 1 1 D5. D5. Number of DNA of DNA PCR PCR results results returned from from the the lab lab that that are are positive D6. D6. Number of HIV-exposed of infants infants whose whose DNA DNA PCR PCR results results were were given given to to caregiver [Annual D7. D7. Number Health Health of Sector referred of Sector Performance HIV HIV positive-infants Report Report 2012/13] who who enrolled in care in care at an at an ART ART Page Page clinic clinic Safe Safe Male Male Circumcision Number of males of males reached with with SMC SMC services for for HIV HIV prevention = 13,667 = 13,667 [Annual Health Sector Performance Report 2012/13 FY] Page 63 ART ART Services Total Total of adults of adults and and children receiving ART ART between the the periods July July June - June

84 D7. Number of referred HIV positive-infants who enrolled in care at an ART clinic 22 Safe Male Circumcision Number of males reached with SMC services for HIV prevention = 13,667 ART Services Total of adults and children receiving ART between the periods July June 2013 Number of adults and children currently on ART = 13,250 Number of adults on ART = 12,222 Number of children on ART = 1,028 Number of adults and children in care = 16,459 TB/HIV Number of HIV-positive patients who were screened for TB in HIV care or treatment settings = 964 Number of HIV-positive patients in care or treatment (pre-art or ART) who started TB treatment = 79 Number of TB patients who had an HIV test = 213 Number HIV-positive incident TB cases that received treatment for TB and HIV- on ART = Private Health Practitioners (PHP) Sub-Sector The PHP Sub-sector health service response has been coordinated through respective PHP Umbrella Organizations (Federation of Private Health Professionals) and member-based Professional Associations [Uganda Private Midwives Association (UPMA), Uganda Private Nurses Association (UPNA), Uganda Allied Health Private Practitioners Association (UAHPPA) Uganda Private Medical Practitioners Association (UPMPA), Pharmaceutical Society of Uganda (PSU) whose membership constitute privately owned PHP facilities countrywide. Currently, the PHP Sub-sector comprises of more than 4,000 facilities nationwide ranging from Lower Level Units providing Outpatient and In-patient services (Drug shops, Day Care clinics, domiciliary units, Nursing homes/in-patient clinics, Pharmacies) up to tertiary level facilities (Hospitals). Information reported in this AHSPR is based on only 222 PHP facilities that reported any health output data through the national HMIS/DHIS 2 for the period under review. This indicates that more than 85% of PHP facilities did not report through the DHIS-2 out of the total PHP facilities (1,488) registered under the 2012 MoH Health facility inventory. [Annual Health Sector Performance Report 2012/13] Page 67 As indicated in table 38, only 514 PHP facilities are currently registered with the DHIS-2 Health facility inventory representing 9.2% of the total DHIS-2 registered national health facilities disaggregated at the central (MoH-RC) level by specified ownership. Table 40: DHIS2 Registered Health Facilities Categorized by Specified Ownership Category Ownership Number Proportion of total Specified by Ownership Government % 64 Page Private-Not-For-Profit % [Annual Health Sector Performance Report 2012/13 FY] NGO % Private-For-Profit (PHP) % Non-specified by ownership % Total 5, %

85 As indicated in table 38, only 514 PHP facilities are currently registered with the DHIS-2 Health facility inventory representing 9.2% of the total DHIS-2 registered national health facilities As facility As indicated inventory table representing 38, only % PHP of facilities the total are DHIS-2 currently registered national with the health DHIS-2 facilities Health disaggregated at the central (MoH-RC) level by specified ownership. disaggregated facility inventory at the representing central (MoH-RC) 9.2% of level the by total specified DHIS-2 ownership. registered national health facilities Table disaggregated 40: DHIS2 Registered at at the central Health (MoH-RC) Facilities Categorized level by specified by Specified ownership. Ownership Table 40: DHIS2 Registered Health Facilities Categorized by Specified Ownership Category Ownership Number Proportion of total Table 40: 40: Category DHIS2 Registered Health Facilities Ownership Categorized by Specified Ownership Number Proportion of total Specified by Ownership Government % Specified by Ownership Government % Category Private-Not-For-Profit Ownership Number 801 Proportion 14.2% of of total Private-Not-For-Profit % Specified by by Ownership Government NGO % 1.7% NGO % Private-For-Profit Private-Not-For-Profit % Private-For-Profit (PHP) (PHP) % 9.2% Non-specified NGO % Non-specified by by ownership ownership % 23.4% Total Private-For-Profit (PHP) % Total 5,606 5, % 100% Source: Non-specified by by ownership % Source: MoH MoH DHIS2 DHIS2 Health Health Facility Facility Inventory Inventory Total 5, % Source: MoH MoH DHIS2 Health Facility Inventory PHP PHP Contribution Contribution to to selected selected HSSIP HSSIP 2010/ /15 outputs The The current current PHP PHP outputs outputs Contribution generated generated to selected from from the the HSSIP /11 DHIS-2 reporting 2014/15 PHP outputs facilities correspond to to some of The of The the the current current vital vital health health outputs indicators indicators generated used used from to to the monitor monitor 222 DHIS-2 the HSSIP reporting 2010/11 PHP facilities 2014/15 correspond for for the the reporting to to some some period period of of the the 2012/ /2013. vital vital health health indicators used used to to monitor the HSSIP 2010/ / /15 for for the the reporting reporting period period 2012/ /2013. OPD OPD services: services: The The total total New New and Re-attendance clients handled by reporting PHP facilities are are 293,633 OPD OPD services: services: new new cases cases The The and total total and 75,712 New New and and re-attendances. Re-attendance Re-attendance clients clients handled handled by by reporting reporting PHP PHP facilities facilities are are 293,633 new cases 75,712 re-attendances. Table 293,633 Table 41: 41: PHP new PHP Maternal cases and and 75,712 Child Health re-attendances. Outputs Table 41: PHP Maternal and Child Health Outputs Outputs by Regional disaggregation Table 41: PHP Maternal and Child Health Outputs Central West East North Total Outputs by Regional disaggregation No No of of Facilities Central West 80 Outputs by Regional East 28 disaggregation 15 North Total 222 No Proportions of Facilities Central 44.6% 99 West 36% % East 28 North 6.8% % Total No Proportions of Facilities 44.6% 99 36% % % % 222 DPT3 Proportions DPT3 doses 44.6% 7,094 2,697 36% 12.6% 1,090 1, % 12, % Measles DPT3 doses doses 8,355 7,094 2,774 2,697 1,090 1,535 1,981 1,939 12,862 14,603 4 Measles DPT3 th th 4 th ANC doses visits doses 7,094 3,013 8,355 2,697 3,521 2,774 1,535 1, ,939 1, ,603 12,862 7,671 Source: Measles 4 th ANC MoH doses visits HMIS 8,355 3,013 2,774 3,521 1, , ,671 14,603 Source: 4 th ANC visits MoH HMIS 3,013 3, ,671 Source: Maternal MoH services: HMIS The total number of deliveries conducted in the reporting PHP facilities were Maternal 33,296 services: (5%) out The of the total 651,598 number deliveries of deliveries reported conducted countrywide. in the A reporting total of of 7,671 PHP facilities (2%) out out Maternal of of services: The total number of deliveries conducted in the reporting PHP facilities were the 33, ,284 (5%) fourth out of ANC the 651,598 visits were deliveries conducted reported in the countrywide. PHP facilities. A total These of 7,671 outputs (2%) are out are were attributable 33,296 (5%) out of the 651,598 deliveries reported countrywide. A total of 7,671 (2%) out of the 507,284 to to 222 fourth DHIS-2 ANC reporting visits were PHP conducted facilities countrywide in the PHP facilities. and the These contribution outputs to to the are the sector of attributable the 507, fourth DHIS-2 ANC reporting visits were PHP conducted facilities countrywide in the PHP and facilities. the contribution These outputs to the are indicators can be improved if all facilities reported through the established system. attributable sector indicators to 222 can DHIS-2 be improved reporting if all PHP facilities facilities reported countrywide through the and established the contribution system. to the Child sector Care indicators services: can The be total improved number if all of facilities DPT 3 immunizations reported through (doses) the performed established in system. PHP facilities were 12,862 with the Central region accounting to over 55% (7,094) of the total DPTPage 68 [Annual Health Sector Performance Report 2012/13] 3 doses Page 68 given [Annual in all Health DHIS-2 Sector reporting Performance PHP health Report facilities. 2012/13] Page 68 [Annual Health Sector Performance Report 2012/13] Page 68 The total number of measles immunizations performed in PHP facilities were 14,603 the Central region PHP facilities contributing to over 57% of the total measles doses given in all DHIS-2 reporting PHP health facilities. Generating comprehensive reports from PHP facilities through the national HMIS/DHIS-2 remains a leading challenge in monitoring and coordination of service provided to-date. Identified reporting challenges in the PHP Sub-sector include: Lack of HMIS tools, capacity gaps on utilization of HMIS tools, lack of feedback on reported data, failure to appreciate the need to report, and failure to transmit filled HMIS data sets with most PHP facilities lacking required human resource, equipment and infrastructure to effectively report. There is need to strengthen [Annual reporting Health Sector systems Performance in the Report PHP 2012/13 sub-sector FY] addressing the identified Page 65 challenges for private facilities to effectively report through the DHIS-2. PHP Umbrella / Professional Organizations are embarking on establishing an information flow and exchange

86 Identified reporting challenges in the PHP Sub-sector include: Lack of HMIS tools, capacity gaps on utilization of HMIS tools, lack of feedback on reported data, failure to appreciate the need to report, and failure to transmit filled HMIS data sets with most PHP facilities lacking required human resource, equipment and infrastructure to effectively report. There is need to strengthen reporting systems in the PHP sub-sector addressing the identified challenges for private facilities to effectively report through the DHIS-2. PHP Umbrella / Professional Organizations are embarking on establishing an information flow and exchange system to manage and streamline health data reporting, utilization and feedback mechanisms emphasizing ownership. In addition, under the HSSIP key priority interventions, HMIS/DHIS 2 utilization training for PHP hospitals has been earmarked for implementation Civil Society Organizations Civil Society is an integral element of the health system in Uganda and contributes in various ways to providing health services and advocating for improvement in health service provision. There are very many CSOs at different levels of health service delivery in the country including representation at the MoH HPAC and the relevant TWGs. Consolidating the contributions of the CSOs to the overall health sector performance has not been an area of focus for the sector. The PPPH Policy was launched and the implementation guidelines will be disseminated to all partners in the private sector including CSOs. The MoH plans to work more closely with the CSOs through a well streamlined CSO Coordination Framework Contribution by Uganda National Health Consumers Organization 1) Maternal Health Project (MHP) The MoH launched the MHP project in 2011 and is implemented by the Voices for Health Rights Coalition (VHRC) in the 8 districts of Oyam, Mayuge, Sheema, Mubende, Mityana, Soroti, Nwoya and Hoima. The MHP is supported by Swedish Government through SIDA. The UNHCO is the lead agency of the project. The project goal is to contribute to reduction of maternal mortality [Annual Health in Uganda. Sector It Performance focuses of following Report 2012/13] four result areas; Page 69 i. Target communities aware of their rights and demand quality MSHRS ii. Good access and high utilization of MSHRS in the target communities iii. Key duty bearers held accountable for delivery of MSHRS iv. MHP implementing partners and the secretariat (UNHCO) have capacity to implement The project is implemented by 9 member organizations of the VHRC which include; Reproductive Health Uganda (RHU), THETA, Sickle Cell Association of Uganda, Epilepsy Support Association of Uganda, Mental Health Uganda, Joyce Fertility Support Centre - Uganda, Health rights Action Group (HAG) and Action group for health, Human Rights and HIV/AIDS (AGHA). MHP implementation model includes community dialogues, door to door home visits, media campaigns, drama performances, radio talk shows, support to integrate outreaches, capacity building and facilitating VHTs and HUMCs, advocating and lobbying of LGs, linkage of grass issues to national level advocacy. VHTs were given registers for pregnant women and follow them up but there have been consistent challenges including some pregnant women who die in villages in TBAs or die when they are at the gate of health facilities. MHP 66 Page contributions to the health [Annual sector Health Sector Performance Report 2012/13 FY] 308 VHTs trained and facilitated to conduct house to house visits, register and follow of pregnant mothers, carry sensitization and mobilization 33 HUMCs reactivated and facilitated on quarterly basis to carry out staff monitoring,

87 issues to national level advocacy. VHTs were given registers for pregnant women and follow them up but there have been consistent challenges including some pregnant women who die in villages in TBAs or die when they are at the gate of health facilities. MHP contributions to the health sector 308 VHTs trained and facilitated to conduct house to house visits, register and follow of pregnant mothers, carry sensitization and mobilization 33 HUMCs reactivated and facilitated on quarterly basis to carry out staff monitoring, management relationships between community members and health workers, service reviews 40 health facilities supported to integrate maternal health into the routine immunization service outreaches 44 health facilities supported to establish/strengthen functional feedback and redress mechanisms Demand & Utilization Increased in supported facilities:1 st ANC increased by 8.9% [68.6% at baseline and 77.5% to MHP - MTR]; 4 th ANC increased by 8.1% [34% at baseline to 42.1% at MHP - MTR]; Skilled delivery increased by 6.3% [41.1% at baseline to 47.4% at MHP - MTR]; and Contraceptive prevalence 14.4% [19.2% at baseline to 33.5% at MHP - MTR] 2) Advocacy UNHCO was involved in a number of advocacy activities which included; [Annual Health Sector Performance Report 2012/13] Page 70 Together with MPs, & CSOs engaged in budget advocacy that achieved a U Shs. 49.2bn investments in recruitments and salary enhancement Health promotion through consistent health media campaigns both print and electronic i.e. NTV, news papers, radio talk shows in the 8 districts and Kampala. Successfully advocated for removal of taxes on RH commodities Popularization of maternal health through petitioning constitutional court on the right to life and maternal health right. This popularized maternal health in the media limelight and the public Tabling and passage of 8 out of 10 maternal health resolutions by the 9 th Parliament 3) Health surveys UNHCO participated / conducted a number of health surveys including; a) Assessing the extent to which resources allocated to the health facilities affect access to essential medicines, A citizen Report card on selected public facilities in Bushenyi and Lira districts was developed. In response to the above Community monitoring project is being implemented in Bushenyi, Sheema, Masaka and Oyam. Midterm review is yet to be done b) Medicines availability study in Kalangala, Kasese, Dokolo and Wakiso. This was a qualitative study which provided benchmarks against which MeTA efforts in increasing transparency in procurement and supply of medicines in public health facilities would be measured. The status of the availability of essential medicines in all the health facilities across the four surveyed districts has improved, with most facilities reporting having stocks but experienced some minimal stock outs. c) Clients satisfaction [Annual with health Health Sector services Performance in public Report health 2012/13 facilities FY] study in Oyam, Page Iganga, 67 Wakiso, Soroti, Nwoya, Pallisa, Nebbi, Mbarara, Kapchorwa and Kasese. This was cross section conducted by a multi-stakeholder alliance called Medicines Transparency Alliance (MeTA)

88 procurement and supply of medicines in public health facilities would be measured. The status of the availability of essential medicines in all the health facilities across the four surveyed districts has improved, with most facilities reporting having stocks but experienced some minimal stock outs. c) Clients satisfaction with health services in public health facilities study in Oyam, Iganga, Wakiso, Soroti, Nwoya, Pallisa, Nebbi, Mbarara, Kapchorwa and Kasese. This was cross section conducted by a multi-stakeholder alliance called Medicines Transparency Alliance (MeTA) involving MoH (Chair), NMS, NDA, KPI, JMS and CSOs. The study was spear headed by UNHCO as a member of MeTA. d) Our commitments, our realities; Uganda s maternal and child mortality in the face up to This study was investigating the extent of implementation of Uganda s health commitments to the Maputo Plan of action, MDGs 2 & 5, HSSIP 2010/ /15, NHP II, NDP, 130bn World Bank Project. All the above studies have/are informing national level advocacy and policy processes. The details of the above studies are available in hard copies and on UNHCO website. 4) [Annual Quality Health improvement Sector Performance through Report popularizing 2012/13] emerging issues Page 71 VHR launched a campaign to popularize TBA crisis in order for government to focus on addressing the challenges that force mothers to TBAs but also functionalizing government s position on TBAs. 5) Social accountability: The Power of Community Monitoring in Influencing Change in Health Care Delivery. The community scorecards have been successfully implemented in over 20 districts of Uganda involving communities, sub-county and district staff and basing on findings and recommendations developed a framework for the application of the Civil Society Coalition on decentralized services, health inclusive. This intervention has improved coordination between the different stakeholders in the districts, strengthened and complemented the efforts so far made by building the capacity of community structures to monitor medicines availability in health facilities; increasing community awareness on the right to access to essential medicines and demand and holding the duty bearers accountable and providing sustainable mechanisms which are legally enforceable civil society and partners are working toward transforming the Patients Charter into a legally binding document. 6) Use of ICT to improve the health outcomes In 2011, another maternal health project was launched in the districts of Kamuli, Luweero and Lyantonde with the ICT component. Through the use of mobile phones both men and women including pregnant mothers register on the SMS platform through a short code. Pregnant women are registered during home visits and reminders are sent to them to attend the 4 scheduled ANC visits as well as deliver from health facilities. Awareness messages are also sent to community members. The project has increased the number of women attending the 1st ANC, communities are able to give feedback on the platform anonymously and there issues are followed up by the district which has led to improved health service delivery AGHA Report on RMNCH 68 Page AGHA operates in the districts [Annual of Health Pallisa, Sector Budaka, Performance Lyantonde Report 2012/13 and Mityana. FY] The key activities during 2012/13 were; advocacy, training of HUMCS on their roles and responsibilities, training of CSOs reproductive health rights and policies, orientation of health workers on their ethical codes of conduct and patient s rights, holding district dialogue meeting on Maternal health

89 ANC, communities are able to give feedback on the platform anonymously and there issues are followed up by the district which has led to improved health service delivery AGHA Report on RMNCH AGHA operates in the districts of Pallisa, Budaka, Lyantonde and Mityana. The key activities during 2012/13 were; advocacy, training of HUMCS on their roles and responsibilities, training of CSOs reproductive health rights and policies, orientation of health workers on their ethical codes of conduct and patient s rights, holding district dialogue meeting on Maternal health services and gaps and community sensitization on maternal health services and rights. Key Outputs/ Achievements 4 talk shows held. Increased collaboration by district officials to participate in the talk shows [Annual on MNCH Health issues Sector in Performance the district. Report 2012/13] Page 72 Trained HUMCs and increased awareness on their roles and responsibilities 4 CBOs and 160 health workers oriented and able to respect patients rights 4 meeting held and district was able to prioritize provision of maternal health services Increased demand for maternal health services by women Increased political will toward maternal, newborn and child health service delivery Contribution by World Vision Uganda (WVU) World Vision Uganda s health sector interventions aim at complimenting government s efforts to promote access to quality health care to its citizenry and contribute to the achievement of MDGs 4, 5 and 6. In this report, WVU provides a summary of interventions implemented in FY 2012/13 in the sectors of health, nutrition, water sanitation and hygiene. The health interventions by WVU cover about 25 districts spread in different parts of Uganda. Specific project models applied include: Timely and Targeted Counseling (10 sub counties) Community Case Management (8 sub counties), Community PMTCT, Community Led sanitation (12 sub counties), Safe Male Circumcision (under the SPEAR project), Value Based Life Skills, Positive Deviance Hearth (16 sub counties) and Citizen Voice & Action/Child Health Now Campaign (21 districts). Among 11 sub counties implementing iccm WVU promoted treatment of diarrhoea using ORS and zinc. BCC messages have contributed to improved health seeking behaviour. WVU distributed LLINs in 12 sub counties and conducted BCC for malaria prevention by VHTs targeting high risk households. WVU implements three main HIV/AIDS projects namely SPEAR, Church Partnership project and Care treatment and support project, implemented through Area Development Programmes. The SPEAR project covers 66% (35 sub counties) and the key components of the project are; sexual and behavioral prevention, access to HCT and ART, PMTCT, and SMC, and the activities have targeted the following districts; Kibaale, Mbale, Soroti and Hoima. The targeted communities coverage for women counselled, tested and received HIV results is higher than the national average of 72%. WVU continues to invest in sustainable access to water, sanitation and hygiene interventions in [Annual Health Sector Performance Report 2012/13 FY] 10 ADPs covering Northern, Western and Central Uganda. Page 69 [Annual Health Sector Performance Report 2012/13] Page 73

90 sexual and behavioral prevention, access to HCT and ART, PMTCT, and SMC, and the activities have targeted the following districts; Kibaale, Mbale, Soroti and Hoima. The targeted communities coverage for women counselled, tested and received HIV results is higher than the national average of 72%. WVU continues to invest in sustainable access to water, sanitation and hygiene interventions in 10 ADPs covering Northern, Western and Central Uganda. Under the U-WASH project, 265 water sources were established in partnership with the [Annual Health Sector Performance Report 2012/13] Page 73 communities (28 shallow drilled wells, 16 hand dug wells and 171 boreholes) directly benefiting 62,445 people in various regions of the country in FY 12. WVU is a focal point of two strategic coalitions that provide advocacy platforms for influencing policy changes and practices in favor of especially women and children, as well as their families. The coalitions are; i. The Uganda Civil Society Coalition on Scaling up Nutrition (UCCSUN) focuses on initiatives aimed at scaling up nutrition. The coalition has about 25 members ii. Civil Society Coalition on Maternal Newborn and Child health focuses on following-up implementation of Government commitments under the EWEC. The coalition is composed of about 52 CSOs. For FY 12/13, the coalitions in collaboration with MoH, lobbied Parliament and additional UShs.49.5 was allocated to the health sector for staff recruitment and motivation. In the same year, representatives of UCCOSUN worked with OPM and developed a strategy for rolling out the Uganda Nutrition Action Plan. Drawing from outcomes of the district level health assembly held in Kiboga, the coalitions contributed to Uganda s position paper supporting the resolution on commodities. At the World Health Assembly, the resolution was passed and this will contribute significantly to improvement of MNCH. Other global initiatives the coalitions contribute to were; the hunger summit in London (2013) and the discussion on the Post 2015 development work after the expiry of the current MDGs Challenges faced by CSOs The major challenge faced by CSOs is uncoordinated work of different partners causing duplication and health wastage. Other challenges faced result from the health system challenges e.g. TBAs continue to deliver mothers; poor and dilapidated infrastructure of some of the health facilities, lack of ambulances in most of the facilities, inadequate human resources for health providers both technical and support, poor road network and unequal distribution, training and facilitation of VHTs. Recommendations 1. The CSOs should work towards harmonization of all partner work. 2. The MoH should take a clear position on TBAs 3. There is need to increase capital development funds for the health facilities 4. VHTs need to be identified, trained and facilitated to work. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

91 2.11 Local Government Performance The key implementers of the UNMHCP include the LGs (111 districts and 25 municipalities) and KCCA under decentralization policy with technical guidance of the MoH. LGs offer a range of PHC services with focus on: Reproductive and child health services Routine immunization through static and outreach services HIV/AIDS, Malaria and TB services Health promotion and disease prevention Sanitation and hygiene Management of disease and epidemic outbreaks VHTs capacity enhancement Monitoring, supervision and inspection of PHC service delivery in both public and private facilities including schools District League Table (DLT) Performance The 111 districts excluding KCCA are used as the units of analysis for LG performance. KCCA has been excluded in the DLT assessment because of the peculiar organization and level of service delivery characterized by many referral level facilities. This has found to be causing skewing in previous assessments and by virtue of the large number of referral facilities KCCA has always been considered by other districts as having a higher edge over them in the DG assessment. The DLT is used as a tool for assessing LG performance in the health sector. 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 behind 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 NHA or JRM with political, technical and administrative leaders of districts. To encourage good practices good management, innovations and timely reporting. The DLT is not meant to embarrass LG leaders of poorly performing districts, but rather to make them question why there district is performing poorly, and considering ways in which that performance can improve. [Annual Health Sector Performance Report 2012/13] Page 75 [Annual Health Sector Performance Report 2012/13 FY] Page 71

92 Eleven indicators are used to evaluate and rank district performance: 8 coverage and quality of care indicators, given a collective weight of 75%; and 4 management indicators, accounting for the remaining 25%. The indicators were selected for consistency with the 26 core HSSIP 2010/ /15 indicators, reliability of the data source, and frequency of data collection. Routine HMIS data from the RC were the primary data source for a majority of the indicators (Pentavalent Vaccine 3 rd Dose coverage, institutional deliveries, outpatient visits, Sulfadoxine / Pyrimethamine (SP) 2 nd dose for IPT, 4 th ANC visits, HMIS timeliness and completeness of reporting, and District Health Management Team (DHMT) meetings held); some of the indicator data were provided by MoH programmes such as HIV/AIDS, TB, human resources, environmental health division and NMS. There is an improvement in the DLT national average performance from 56.8% in 2011/12 to 63% in 2012/13. The improvement in performance was observed for almost all indicators with the exception of ANC 4 th visit and completeness of monthly reports. 1. DPT 3 coverage increased from 80% in 2011/12 to 87% 2012/13 and this could be attributed to the procurement and distribution of 1,037 vaccine fridges, 77 freezers and 500 gas cylinders to all districts in the previous FY. This increased the number of the static immunization sites and therefore better access to EPI services. In addition there were various immunization campaigns, OPL training for HWs; intensified supervision; and mobilization by political leaders could explain the improved performance. 2. Despite the distribution of 454,208 maama kits to public facilities (there were 555,294 deliveries in the public facilities in the same period) and increased supply of medicines and health supplies in 2012/13 there was only a 1% increase in deliveries from 38% in 2011/12 to 39% in 2012/ The per capita OPD utilization was 1.1 in 2012/13 compared to 1.2 in 2011/12. This has stabilized above 1 (HSSIP target) for the last two years. 4. The percentage of children born to HIV positive mothers who were tested before 12 months of age significantly improved from 32% in 2011/12 to 45% in 2012/13. This increase could be attributed to the reduced results turnaround time from over 45 days to 2 weeks. By June 2013, facility coverage for EID was 1,521 facilities including 100% of referral hospitals, 100% of GHs and 100% of HC IVs, 84% of HC IIIs, and 5.6% of HC IIs. There is also significant Partner support in the districts in the HIV/AIDS Care and Treatment Programmes. 5. Household latrine coverage in the LGs has stagnated at 68% for the previous two years. The USF Program implemented on the 15 districts (Pallisa, Kibuku, Bukedea, Kumi, Ngora, Serere, Soroti, Katakwi, Amuria, Kaberamaido, Dokolo, Amolatar in Eastern Uganda; and [Annual Mbarara, Health Bushenyi Sector Performance and Sheema Report in the 2012/13] South West) shows an increase in coverage for Page these 76 districts from 73% in 2011/12 to 79% in 2012/ The percentage of pregnant women who completed IPT 2 also increased from 46% in 2011/12 to 48% in 2012/13. This is still far below the HSSIP target of 60%. There has been 72 Page increase in the supply of [Annual the six Health tracer Sector medicines Performance including Report 2012/13 S/P FY] to all health facilities and quarterly stock out levels of S/P during 2012/13 were below 10%. There is urgent need for establishing other reasons for the persistent low uptake of IPT 2.

93 Serere, Soroti, Katakwi, Amuria, Kaberamaido, Dokolo, Amolatar in Eastern Uganda; and Mbarara, Bushenyi and Sheema in the South West) shows an increase in coverage for these districts from 73% in 2011/12 to 79% in 2012/ The percentage of pregnant women who completed IPT 2 also increased from 46% in 2011/12 to 48% in 2012/13. This is still far below the HSSIP target of 60%. There has been increase in the supply of the six tracer medicines including S/P to all health facilities and quarterly stock out levels of S/P during 2012/13 were below 10%. There is urgent need for establishing other reasons for the persistent low uptake of IPT 2. No Stockout 2012/13 Q1 Q2 Q3 Q4 Sulphadoxine/ Pyrimethamine (Fansidar) 92.9% 94.6% 94.2% 92.5% Source: MoH HMIS 7. The percentage of women attending the 4 ANC visits also declined from 34% in 2011//12 to 30% in 2012/13 FY. This is far below the HSSIP target (55%) for 2012/13. The MoH under the UHSSP procured 18 radio stations to mobilize communities to increase the demand for RH services countrywide. The MoH also procured 17,925 VHT registers to support midwives and VHTs in identifying and registering all pregnant mothers. Distribution of the registers is ongoing and there is some partner support in training VHTs. 8. TB Treatment Success Rate improved from 61% to 79%. This is a measure of quality and is an indication that the quality of care in TB treatment has improved compared to the previous FY 9. The percentage of approved post filled by health workers (public facilities) improved from 54% in 2011/12 to 61% in 2012/13. This was a result of recruitment of 7,619 health workers (7,211 GoU funding & 408 GFTAM). Only 34 districts met the HSSIP target of 70% for the year under review. Districts like Kiruhura, Bududa, Lamwo, Gomba, Kaabong and Buhweju had staffing levels ranging from 28% to 35%. 10. Overall there was improvement in the HMIS reporting with the percentage of monthly reports sent on time improving from 78% to 80%; the percentage of completeness of facility reporting from 87% to 95%. However, there was a decline in the percentage completeness on monthly reports from 89% to 79%. The DHIS-2 was rolled out and training conducted in all the 111 districts and KCCA. This is expected to improve on both the timeliness and completeness of reports from all facilities. The DHOs and District Biostasticians / Health Information Assistants have access to the DHIS-2 and should use it to monitor the district and facility reporting. [Annual Health Sector Performance Report 2012/13] Page 77 [Annual Health Sector Performance Report 2012/13 FY] Page 73

94 11. The proportion of medicines orders submitted timely improved from 28% to 35% of districts The The proportion of of medicines orders submitted timely improved from 28% 28% to to 35% 35% of of districts submitting orders timely. The timeliness is assessed based on orders submitted by the all submitting orders timely. The The timeliness is is assessed based on on orders submitted by by the the all all the hospitals and HC IVs in the district which are under the Pull System. the the hospitals and and HC HC IVs IVs in in the the district which are are under the the Pull System. 12. The indicators on percentage of the DHMT meetings held was assessed due to change from The The indicators on on percentage of of the the DHMT meetings held held was was assessed due due to to change from the manual reporting system to DHIS-2 where this indicator is not captured. the the manual reporting system to to DHIS-2 where this this indicator is is not not captured. Table 42: District League Table National Averages 2010/ /13 FYs Table 42: 42: District League Table National Averages 2010/ /13 FYs FYs Population Population Population DPT3 DPT3 Coverage Coverage (%) (%) DPT3 Deliveries Deliveries Coverage in gov t in (%) gov t and Deliveries and PNFP PNFP in facilities gov t facilities (%) and (%) PNFP facilities (%) OPD OPD Per Per Capita Capita OPD HIV HIV Per testing testing Capita in children HIV children testing born in born to HIV to HIV positive children positive women born women to (%) HIV (%) positive women (%) Latrine Latrine coverage coverage in in households Latrine households coverage (%) (%) in households (%) IPT2 IPT2 (%) (%) IPT2 (%) ANC ANC 4 (%) 4 (%) ANC 4 (%) TB TB TSR TSR (%) (%) TB TSR (%) Approved Approved posts posts filled Approved filled (%) (%) posts filled (%) % Monthly % Monthly reports reports sent % Monthly sent time time reports sent on time % Completeness % Completeness monthly % Completeness monthly reports reports monthly reports % Completeness % Completeness facility % Completeness facility reporting reporting facility reporting Medicine Medicine orders orders submitted Medicine submitted orders timely timely (%) submitted (%) timely (%) National National Average Average (%) National (%) Average (%) 2010/11 31,752, /11 31,752, /12 33,544, /12 33,544, /13 33,568, /13 33,568, The top ten districts in 2012/13 were; Gulu, Kabarole, Nwoya, Masaka, Kyegegwa, Bushenyi, The The top top ten ten districts in in 2012/13 were; Gulu, Kabarole, Nwoya, Masaka, Kyegegwa, Bushenyi, Abim, Jinja, Luwero and Kyenjojo. The lowest performance levels were noted in Kaabong and Abim, Jinja, Luwero and and Kyenjojo. The The lowest performance levels were noted in in Kaabong and and Amudat. Amudat. Tables 44 and 45 show the top and bottom 15 performing districts with their ranks and total Tables and and show the the top top and and bottom performing districts with with their ranks and and total scores. The full district league tables can be seen in the Annex Table 68. scores. The The full full district league tables can can be be seen in in the the Annex Table Table 43: Top 15 performing districts Table 43: 43: Top Top performing districts TOTAL DISTRICT SCORE TOTAL RANK DISTRICT SCORE RANK Gulu Kabarole Gulu Nwoya Kabarole Masaka Nwoya Kyegegwa Masaka Bushenyi Kyegegwa Abim Bushenyi Jinja Abim Luwero Jinja Jinja Kyenjojo Luwero Kalungu Kyenjojo Lira Kalungu Mpigi Lira Lira Kamuli Mpigi Kamwenge Kamuli Kamwenge Table 44: Bottom 15 performing districts Table 44: 44: Bottom performing districts TOTAL DISTRICT SCORE TOTAL RANK DISTRICT SCORE RANK Pader Napak Pader Sembabule Napak Kotido Sembabule Kiryandongo Kotido Bukomansimbi Kiryandongo Adjumani Bukomansimbi Yumbe Adjumani Amuria Yumbe Moroto Amuria Kween Moroto Ntoroko Kween Moyo Ntoroko Kaabong Moyo Amudat Kaabong Amudat There was improvement in the performance of some of the 31 new districts (Table 46), with [Annual Health Sector Performance Report 2012/13] Nwoya showing the greatest improvement from the 17 th position in 2011/12 to 3 rd Page 78 [Annual Health Sector Performance Report 2012/13] out Page of Page districts. In the current district performance assessment 9 of the new districts scored above the national average compared to 6 in 2011/12 and only one in 2010/11. New districts have also improved on the reporting and all the DLT variables were filled for all districts. 74 Page Total National Total National District Score Rank Rank District Score Rank Rank NWOYA KYANKWANZI Table 45: District ranking for new [Annual districts Health Sector Performance Report 2012/13 FY]

95 Nwoya showing the greatest improvement from the 17 position in 2011/12 to 3 out of 111 districts. In the current district performance assessment 9 of the new districts scored above the national average compared to 6 in 2011/12 and only one in 2010/11. New districts have also improved on the reporting and all the DLT variables were filled for all districts. Table 45: District ranking for new districts District Total Score Rank National Rank District Total Score Rank National Rank NWOYA KYANKWANZI KYEGEGWA BUYENDE KALUNGU BUHWEJU BUTAMBALA MITOOMA RUBIRIZI LAMWO AGAGO LWENGO NGORA GOMBA ZOMBO KIBUKU BUIKWE KOLE NATIONAL AVERAGE 63.0 LUUKA OTUKE NAPAK NAMAYINGO KIRYANDONGO BUVUMA BUKOMANSIMBI SERERE KWEEN SHEEMA NTOROKO BULAMBULI AMUDAT There appears to be no significant relationship between district staffing levels (% of approved posts that are filled) and the overall score. However this needs to be studied further when assessing delivery of services at higher levels i.e. HC IV and hospitals. The DLT indicators mainly assess delivery of PHC services across all levels of care. Table 46: Table 46: Staffing 46: Staffing levels for levels for top top for top districts 10 districts Table 47: Table 47: Staffing 47: Staffing Levels Levels for for Bottom for Bottom districts 10 districts District District National National National National Staffing Staffing level level Rank Rank District District Staffing Staffing level level Rank Rank Gulu Gulu 87% 87% Adjumani Adjumani 72% 72% Kabarole Kabarole 60% 60% Yumbe Yumbe 67% 67% Nwoya Nwoya 49% 49% Amuria Amuria 62% 62% Masaka Masaka 64% 64% Moroto Moroto 61% 61% Kyegegwa Kyegegwa 71% 71% Kween Kween 66% 66% Bushenyi Bushenyi 80% 80% Ntoroko Ntoroko 58% 58% Abim Abim 70% 70% Moyo Moyo 71% 71% Jinja Jinja 78% 78% Kaabong Kaabong 35% 35% Luwero [Annual Luwero Health Sector 71% Performance 71% Report /13] Amudat Amudat 45% 45% 110 Page Kyenjojo Kyenjojo 60% 60% Bukomansimbi 61% 61% It It is is necessary It is necessary for for stakeholders for stakeholders at at all all at levels all levels to to further to further analyze analyze the the information the information from from the the DLT the DLT to DLT to to identify identify gaps and gaps and develop and develop plans plans for for bridging for bridging the the gaps. the gaps. Deliberate Deliberate action action should should be be taken be taken to to support to support districts districts with low with low performance low performance if if the the if sector the sector is is to is to make make sound sound progress progress towards towards achieving achieving the the MDGs. the MDGs. [Annual Health Sector Performance Report 2012/13 FY] Page 75

96 2.12 Hospital Performance Hospitals contribute tremendously to the outputs of essential clinical care as a key component of 2.12 the UNMHCP. Hospital The Performance assessment of hospitals within the AHSPR is now in its ninth year. This Hospitals contribute tremendously to the outputs of essential clinical care as a key component analysis largely looks at outputs of hospitals and relates inputs to outputs and outcomes. of the UNMHCP. The assessment of hospitals within the AHSPR is now in its ninth year. This According to the MoH Health Facility Inventory July, 2012 the total number of hospitals (public analysis largely looks at outputs of hospitals and relates inputs to outputs and outcomes. and private) is 152. Of these 2 are National Referral Hospitals (Mulago and Butabika), 14 are According to the MoH Health Facility Inventory July, 2012 the total number of hospitals (public RRHs and 136 are GHs. and private) is 152. Of these 2 are National Referral Hospitals (Mulago and Butabika), 14 are RRHs and Regional 136 are Referral GHs. Hospitals For the Regional year 2012/13, Referral reports Hospitals have been received from all the 14 RRHs (public) and the 4 large For PNFP the hospitals year 2012/13, (Nsambya, reports Rubaga, have Mengo been received and Lacor) from through all the the 14 DHIS-2. RRHs (public) The performance and the 4 of large PNFP the 18 hospitals (Nsambya, has been be Rubaga, analyzed Mengo in this and section. Lacor) through the DHIS-2. The performance of the 18 hospitals has been be analyzed in this section. Table 48: Regional Referral Hospital Ownership 2012 Table 48: Regional Referral Hospital Ownership 2012 Government NGO Private Total RRHs & Large PNFPs Government 14 NGO 4 Private 0 Total 18 Source: RRHs MoH & Large Health PNFPs Facility Inventory 14 July Source: MoH Health Facility Inventory July 2012 The assessment for the RRHs will focus on the inputs (finances and human resource) and the The assessment for the RRHs will focus on the inputs (finances and human resource) and the key outputs. key outputs. a) Inputs a) Inputs Finance Finance The The total total approved approved budget budget for for RRHs RRHs was was U U Shs. Shs. 81,576 81,576 billion billion Shs. Shs. and and actual actual release release was was U Shs. U Shs. 78,265 78,265 billion billion Shs. The additional additional funding funding was was mainly mainly towards towards wage wage subvention. subvention. Overall Overall budget budget performance was 96%. Financial performance for for the the 4 4 large large PNFP PNFP hospitals hospitals has has not not been been included in the analysis due to lack of of the the comprehensive financial reports reports from from these these hospitals. hospitals. Table 49: Financial Performance for 14 RRHs for for FY FY 2012/13 (UGX (UGX Billions) INSTITUTION WAGE (,000,000) NON WAGE (,000,000) DEVELOPMENT TOTAL TOTAL (,000,000) (,000,000) Performance Performance (%) (%) (,000,000) (,000,000) Approved Released Approved Released Approved Approved Released Released Approved Approved Released Released 2012/ /132011/ /12 Budget Budget Budget Budget Budget Budget Budget Arua Arua 2,732 2,726 2,726 1,020 1,020 1,020 1,020 3,750 3,750 3,110 3,110 7,502 7,502 6,856 6,856 91% 91% 100% 100% Fort Portal Fort Portal 2,819 2,819 2,683 2,683 1,180 1,180 1,180 1,180 2,049 2,049 1,579 1,579 6,048 6,048 5,442 5,442 90% 90% 55% 55% Gulu Gulu 2,674 2,674 2,674 2,674 1,133 1,133 1,133 1,133 4,000 4,000 3,492 3,492 7,807 7,807 7,299 7,299 93% 110% 93% 110% Hoima 2,042 2, ,100 1,983 5,872 4,755 81% Hoima 2,042 2, ,100 1,983 5,872 4,755 81% Jinja 3,433 3,365 1,197 1,197 2,402 2,021 7,032 6,583 94% Jinja 3,433 3,365 1,197 1,197 2,402 2,021 7,032 6,583 94% Kabale 2,003 2, ,000 2,105 5,742 4,848 84% 108% Kabale 2,003 2, ,000 2,105 5,742 4,848 84% 108% Masaka 2,475 2, ,360 1,859 5,738 5,237 91% Masaka Mbale 2,475 3,385 2,475 3, , ,473 2, , ,738 5,355 5,237 8,562 91% 160% 102% Mbale 3,385 3,384 1,774 4, ,355 8, % 102% [Annual Health Sector Performance Report 2012/13] Page 81 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

97 INSTITUTION INSTITUTION INSTITUTION WAGE WAGE WAGE (,000,000) (,000,000) (,000,000) NON NON WAGE WAGE NON (,000,000) WAGE (,000,000) (,000,000) DEVELOPMENT DEVELOPMENT DEVELOPMENT TOTAL TOTAL (,000,000) TOTAL (,000,000) (,000,000) Performance Performance Performance (%) (%) (%) (,000,000) (,000,000) (,000,000) Approved Approved Released Released Approved Approved Released Released Released Approved Approved Approved Released Released Released Approved Approved Approved Released Released Released 2012/ / / / / /12 Budget Budget Budget Budget Budget Budget Budget Budget Budget Budget Soroti Soroti 2,373 2,373 2,373 2, ,400 4,400 4,400 3,359 3,359 3,359 7,645 7,645 7,645 6,604 6,604 6,604 86% 86% 86% Lira Lira 2,420 2,420 2,392 2,392 3,329 3,329 3,168 3, ,949 5,949 5,949 6,295 6,295 6, % 106% 106% 88% 88% 88% Mbarara Mbarara 2,982 2,982 2,939 2,939 1,031 1,031 1,031 1,0312,040 2,040 2,040 1,396 1,396 1,396 6,053 6,053 6,053 5,366 5,366 5,366 89% 89% 89% Mubende Mubende 1,384 1,384 1,510 1, ,466 2,466 2,466 2,392 2,392 2,392 97% 97% 97% Moroto Moroto 1,349 1,349 1,140 1, ,000 1,000 1, ,989 2,989 2,989 2,526 2,526 2,526 85% 85% 85% Naguru Naguru 1,862 1,862 1,665 1,665 1,899 1,8992,730 2,730 2,7301,617 1,617 1,617 1,105 1,105 1,105 5,378 5,378 5,378 5,500 5,500 5, % 102% 102% Total Total 33,933 33,933 33,371 33,371 16,989 16,989 20,358 20,358 20,358 30,654 30,654 30,654 24,533 24,533 24,533 81,576 81,576 81,576 78,265 78,265 78,265 96% 96% 96% Source: Source: MoH MoH Financial Financial Report Report Human Human Human Resources Resources Resources The RRHs have staffing of about 72% for all cadres including medical and support staff. Masaka The The RRHs RRHs have have staffing staffing of about of about 72% 72% for all for cadres all cadres including including medical medical and and support support staff. staff. Masaka Masaka is staffed up to 90% followed by Soroti with 81%. Moroto is the only hospital in this category is staffed is staffed up to up 90% to 90% followed followed by Soroti by Soroti with with 81%. 81%. Moroto Moroto is the is only the only hospital hospital in this in this category category staffed below the 50% mark and its staffing level is still 46%. (Source HRH Biannual Report staffed staffed below below the the 50% 50% mark mark and and its staffing its staffing level level is still is still 46%. 46%. (Source (Source HRH HRH Biannual Biannual Report Report March 2012). March March 2012). 2012). Table 50: Staffing at the 14 RRHs Table Table 50: Staffing 50: Staffing at the at 14 the RRHs 14 RRHs Hospital Approved Filled Vacant % filled 1. Masaka Hospital Hospital Approved 316 Approved Filled 283 Filled Vacant 33 Vacant % 90% filled % filled Masaka Soroti Masaka % 90% 90% Soroti Gulu Soroti % 81% 81% Gulu Jinja Gulu % 79% 79% Jinja Fort Portal Jinja % 79% 79% Fort Mbarara Portal Fort Portal % 74% 74% Mbarara Lira Mbarara % 74% 74% Lira Mbale Lira % 73% 73% Mbale Hoima Mbale % 73% 73% Hoima Mubende Hoima % 67% 67% Mubende China-Uganda Mubende Friendship % 66% 66% China-Uganda Arua China-Uganda Friendship Friendship % 65% 65% Arua Kabale Arua % 63% 63% Kabale Moroto Kabale % 54% 54% 14. Total 14. Moroto Moroto 4, , , % 46% 46% Source: Total MoH Total HRH Biannual report March ,678 4,678 3,347 3,347 1,267 1,267 72% 72% Source: Source: MoH MoH HRH Biannual HRH Biannual report report March March Table 52 shows the positions filled by critical medical staff by hospital. Nsambya hospital has the highest number of medical staff followed by Mengo and Lacor with 453 staffs, 397 and 339 Table Table 52 shows 52 shows the positions the positions filled filled by critical by critical medical medical staff staff by hospital. by hospital. Nsambya Nsambya hospital hospital has has respectively. The least staffed referral hospitals are Moroto, Mubende and Hoima with 97 the highest the highest number number of medical of medical staff staff followed followed by Mengo by Mengo and and Lacor Lacor with with staffs, staffs, and and respectively. [Annual Health The Sector The least Performance least staffed staffed referral Report referral 2012/13] hospitals hospitals are are Moroto, Moroto, Mubende Mubende and and Hoima Hoima Page with 82 with staffs, 112 and 118 respectively. Moroto RRH has no Medical Doctors, no Pharmacist and lacks [Annual [Annual Health Health Sector Sector Performance Report Report 2012/13] 2012/13] Page Page an Anaesthetist. Overall the cadres of Pharmacists and Anaesthetists are the least staffed in the referral hospitals. Table 51: Positions filled in RRHs and Large PNFPs RRH Medical Doctors [Annual Health Sector Clinical Performance Report 2012/13 FY] Page 77 Nursing Officers Pharmacy Dispensers Laboratory Anaesthesia All Medical Staff 2012/13 Arua China Uganda Friendship

98 staffs, 112 and 118 respectively. Moroto RRH has no Medical Doctors, no Pharmacist and lacks staffs, 112 and 118 respectively. Moroto RRH RRH has has no no Medical Medical Doctors, Doctors, no Pharmacist no Pharmacist and lacks and lacks an Anaesthetist. Overall the cadres of Pharmacists and Anaesthetists are the least staffed in an an Anaesthetist. Overall the cadres of of Pharmacists and and Anaesthetists are the are least the least staffed staffed in in the referral hospitals. the referral hospitals. Table 51: Positions filled in RRHs and Large PNFPs Table 51: Positions filled in RRHs and Large PNFPs All Medical Clinical All Medical All RRH Medical Nursing Clinical Pharmacy Dispensers Laboratory Anaesthesia Medical RRH Doctors Nursing Officers Medical Pharmacy Dispensers Laboratory Laboratory Anaesthesia Anaesthesia Staff Doctors Officers Staff 2012/13 Staff 2012/13 Arua staffs, 112 and 118 respectively Moroto 7 RRH has no 1 Medical 2 Doctors, no 11 Pharmacist 2 and lacks 2012/ Arua Arua China an Anaesthetist. Uganda Friendship Overall 10 the cadres 92 of Pharmacists 14 1 and Anaesthetists 4 are 6 the least 2 staffed in 153 China China Uganda Friendship Fort 153 the Portal Fort Fort referral Portal Portal hospitals Gulu Gulu Gulu Hoima Table 178 Hoima Hoima 51: Positions filled in RRHs and Large 85 PNFPs Jinja 118 Jinja Jinja All Kabale Kabale Kabale Medical Clinical Medical Lira RRH 130 Lira 8 Nursing Pharmacy 1 1 Dispensers Laboratory 10 3 Anaesthesia Lira Doctors Officers Staff Masaka 173 Masaka Masaka / Mbale 192 Mbale Mbale Arua Mbarara Mbarara Moroto China Uganda Friendship Moroto Mubende Fort Portal Mubende Soroti Gulu Soroti Nsambya Hoima Nsambya Mengo Jinja Mengo Rubaga Kabale Rubaga Lacor Lira Lacor Total Masaka , ,830 3, Total Average Mbale , , Average Minimum Mbarara Minimum Moroto Maximum Maximum Mubende Source: MoH HMIS Source: Soroti MoH HMIS Nsambya b) b) Outputs Mengo In b) order Outputs In to of outputs of hospitals we will continue to use the Rubaga order to have uniform 22 comparison In Standard order to Unit have of Output uniform (SUO) comparison of 7 outputs 7 of hospitals 20 we will 5 continue 6 to use the 256 The SUO of is a outputs composite of measure hospitals of we outputs will that continue allows to for use a the Standard Lacor Unit of Output 20 (SUO) 3 Standard fair comparison Unit of of Output volumes (SUO) of output The SUO 14 is a composite 2 measure 0 of outputs 17 that allows 5 for a 339 Total 309 2,662 The of SUO hospitals 219 is composite that 46 have varying measure 61 capacities of outputs 224 in providing that allows 78 the for 3,830 Average fair comparison of volumes fair different comparison types of of patient volumes 15 of output care of services. output 145 of of 14 hospitals The hospitals 3 that have varying standard that unit have of output varying 2 capacities attempts capacities 10 in providing the to attribute in providing 4 the the 213 Minimum different types of patient 0 care services. 53 The 4 standard 0 unit of 0 output attempts 6 to attribute 0 the 97 Maximum different final outputs types of of patient hospital care a relative services. weight The standard based on unit previous of output cost attempts analyses to taking attribute the the final outputs of a hospital 73 a 281 relative weight 22 based 10 on previous 20 cost 42 analyses 8 taking the 453 Source: final outpatient outputs MoH HMIS contact of as hospital the standard relative of reference. weight The based SUO on converts previous all outputs cost analyses to outpatient taking the outpatient contact as the standard of reference. The SUO converts all outputs to outpatient outpatient equivalents. contact The basis of the this standard parameter of reference. rests on the The evidence SUO converts that the cost all outputs of managing to outpatient one equivalents. b) Outputs The basis of this parameter rests on the evidence that the cost of managing one equivalents. inpatient is 15 The times basis the of cost this managing parameter one rests outpatient, on the one evidence immunization that the 0.2 cost times of more, managing one one In inpatient order to is 15 have times uniform the cost comparison managing one of outputs outpatient, of hospitals one immunization we will continue 0.2 times to more, use one the inpatient is 15 times the cost managing one outpatient, one immunization 0.2 times more, one Standard Unit of Output (SUO) 3 The SUO is a composite measure of outputs that allows for a fair comparison of volumes of output of hospitals that have varying capacities in providing the 3 SUO stands for standard unit of output an output measure converting all outputs in to outpatient equivalents. 3 different types of patient care services. The standard unit of output attempts to attribute the 3 SUO total stands = (IP*15 for standard + OP*1 unit + Del.*5 of output + Imm.*0.2 an output + ANC/MCH/FP*0.5) measure converting based on all earlier outputs work in of to cost outpatient comparisons. equivalents. SUO final SUO total stands outputs = (IP*15 for of standard + a OP*1 hospital unit + Del.*5 of output a + Imm.*0.2 relative an output + weight ANC/MCH/FP*0.5) measure based converting based previous all on outputs earlier cost in work to analyses outpatient of cost comparisons. taking equivalents. the SUO [Annual total = Health (IP*15 Sector + OP*1 Performance + Del.*5 + Imm.*0.2 Report 2012/13] + ANC/MCH/FP*0.5) based on earlier work of cost comparisons. Page 83 [Annual outpatient Health contact Sector as Performance the standard Report of reference. 2012/13] The SUO converts all outputs to outpatient Page 83 [Annual equivalents. Health The Sector basis Performance of this parameter Report 2012/13] rests on the evidence that the cost of managing Page one 83 inpatient is 15 times the cost managing one outpatient, one immunization 0.2 times more, one 3 SUO stands for standard unit of output an output measure converting all outputs in to outpatient equivalents. SUO total = (IP*15 + OP*1 + Del.*5 + Imm.*0.2 + ANC/MCH/FP*0.5) based on earlier work of cost comparisons. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

99 delivery 5 times more and one (ANC+MCH+FP) client 0.5 times the cost of managing one delivery 5 times more and one (ANC+MCH+FP) client 0.5 times the cost of managing one outpatient. outpatient. The 14 RRHs and 4 large PNFPs hospitals attended to a total of; 2,537,666 outpatients; 89,626 The 14 RRHs and 4 large PNFPs hospitals attended to a total of; 2,537,666 outpatients; 89,626 deliveries and 339,670 admissions among other outputs. On average each hospital attends to; deliveries and 339,670 admissions among other outputs. On average each hospital attends to; 140, ,981 outpatients, outpatients, conducted conducted 4,979 4,979 deliveries deliveries and and 19,981 19,981 admissions. admissions. The The SUO SUO for these for these hospitals hospitals increased increased from from 5,361,005 5,361,005 in in 2011/ /12 to 8,189,908 to 8,189,908 in 2012/13. in 2012/13. The The average average SUO SUO for all for all referral hospitals combined combined was was 475, ,300. Mbale Mbale RRH RRH and and Masaka Masaka RRH RRH had had the the highest highest (858,116 and and 792,551 respectively), while while Mengo Mengo Hospital Hospital and and China-Uganda China-Uganda Friendship Friendship hospital had had the the lowest (132,132 and and 131, ,297 respectively). The The low low performance performance of Mengo of Mengo is is largely attributed to to non-reporting on on inpatient data. data. Table 52: Key Hospital Outputs and and Ranking of RRHs of RRHs and and Large Large PNFP PNFP Hospitals Hospitals 2012/ /13 FY FY RRH RRH Admissions Admissions Total OPD Total OPD Deliveries Deliveries Total ANC Total ANC Total FP Visits Total FP Visits Postnatal Visits Postnatal Visits Immunization Immunization SUO 2012/13 SUO 2012/13 SUO 2011/12 SUO 2011/12 Mbale Mbale 48,966 48,966 85,301 85,301 6,604 6,604 4,693 4,693 1,552 1,552 2,099 2,099 5,667 5,667858, , , ,384 Masaka Masaka 35,688 35, , ,032 8,296 8,296 7,773 7, ,472 1,472 8,006 8, , , , ,051 Mbarara Mbarara 29, ,185 10,181 7, , , ,072 29, ,185 10,181 7, , , ,072 Jinja Jinja 25, ,387 6,030 6,904 1,540 1,107 9, , ,412 25, ,387 6,030 6,904 1,540 1,107 9, , ,412 Fort Portal Fort Portal 22, ,665 3,690 5, , , ,103 22, ,665 3,690 5, , , ,103 Lacor 24, ,632 4,174 5,284 NA 1,398 6,, ,562 NA Lacor 24, ,632 4,174 5,284 NA 1,398 6,, ,562 NA Arua 20, ,689 5,335 9, ,048 14, , ,543 Arua 20, ,689 5,335 9, ,048 14, , ,543 Lira 18, ,499 5,330 7,670 1, , , ,630 Lira 18, ,499 5,330 7,670 1, , , ,630 Soroti 21, ,629 4,276 3,209 1, , , ,887 Soroti Nsambya 21, ,629 4,276 3,209 1, , , ,887 12, ,245 5,352 9,556 NA 4,856 12, ,167 NA Nsambya Hoima 12, ,245 5,352 9,556 NA 4,856 12, ,167 NA 16, ,654 4,776 5, , , ,829 Lubaga Hoima 14,559 16, , ,654 5,902 4,776 13,471 5,609 NA 812 2, ,886 7, , ,842 NA 389,829 Kabale Lubaga 11,538 14, , ,544 4,046 5,902 4,250 13,471 2,295 NA 9872,815 5,393 11,886336, , ,029 NA Gulu Kabale 7,715 11, , ,321 4,696 4,046 6,381 4, , ,4605,393334, , , ,029 Mubende Gulu 14,917 7,715 86, ,178 3,383 4,696 5,450 6,381 1, ,751 11,460332, , , ,548 Moroto Mubende 11,223 14,917 53,051 86, ,383 2,110 5, , ,6075,751225, , , ,872 Mengo Moroto 11,223 NA 95,549 53,051 5, ,926 2, , ,9652,607132, ,951 NA 188,681 China Mengo Uganda NA 95,549 5,591 10, ,737 10, ,132 NA Friendship 5,701 35,390 1,461 3, ,422 2, ,297 NA China Uganda Total Friendship 339,670 5,701 2,537,666 35,390 89,626 1, ,893 3,171 15, ,0241,422151,9872,399 8,189, ,297 5,361,005 NA Source: Total MoH HMIS 339,670 2,537,666 89, ,893 15,412 23, ,987 8,189,908 5,361,005 Source: MoH HMIS [Annual Health Sector Performance Report 2012/13] Page 84 [Annual Health Sector Performance Report 2012/13] Page 84 [Annual Health Sector Performance Report 2012/13 FY] Page 79

100 Table 53: 53: Summary of of Key Key Outputs Outputs for for RRHs RRHs and and Large Large PNFPs PNFPs RRH RRH Admissions Admissions Total OPD Total OPD Deliveries Deliveries Total ANC Total ANC Total FP Total Visits FP Visits Postnatal Visits Postnatal Visits Immunization Immunization SUO 2012/13 SUO 2012/13 SUO 2011/12 SUO 2011/12 Total 339, ,670 2,537,666 2,537,666 89,626 89, , ,893 15,412 15,41223,024 23,024151, ,987 8,189,908 8,189,908 5,361,005 5,361,005 Average 19,981 19, , ,981 4,979 4,979 6,605 6,605 1,027 1,027 1,279 1,279 8,444 8,444454, , , ,836 Min 7,715 7,715 35,390 35, ,110 2, ,399 2,399131, , Max 48,966 48, , ,032 10,181 10,181 13,471 13,471 2,295 2,295 4,856 4,85615,562 15,562858, , , ,384 Source: MoH MoH HMIS HMIS NB: Catholic-faith based institutions do do not not provide provide conventional conventional FP methods. FP methods. A comparison of of volume of of outputs outputs based based on on the the SUO SUO has has been been made made and and is shown is shown in Figure in Figure 13. Among the the RRHs RRHs assessed in in 2012/13, 2012/13, only only Gulu Gulu RRH RRH had had a reduction a reduction in the in SUO the SUO from from 430,548 to to 334,344 SUO. SUO. This This could could be be attributed attributed to the to the reduction reduction observed observed in the in number the number of of beds reported in in the the DHIS-2 from from in in 2011/ /12 to 100 to 100 in 2012/13. in 2012/13. Figure 13: 13: Volume of of Outputs Outputs for for RRHs RRHs and and Large Large PNFPs PNFPs 2011/ / / /13 FYs FYs Standard Unit Ooutput 900, , , , , , , , , Mbale Mbale Masaka Masaka Mbarara Mbarara Jinja Jinja Fort Portal Fort Portal Lacor Lacor Arua Arua Lira Soroti Lira Average Soroti Nsambya Average Nsambya Hoima Hoima Lubaga Lubaga Kabale Kabale Gulu Mubende Gulu Mubende Moroto Moroto Mengo China Mengo Uganda China Uganda SUO SUO 2012/ /13 SUO SUO 2011/ /12 Source: MoH MoH HMIS HMIS Table summarizes the the performance of of the the RRHs RRHs and and large large PNFPs PNFPs in 2012/13 in 2012/13 in comparison in comparison to 2011/12 FY. FY. Overall there there was was an an increase increase in the the total total SUO SUO from from 5,361,003 5,361,003 in 2011/12 in 2011/12 to to 8,154,160 in in 2012/13 for for all all the the 5 5 outputs outputs assessed. assessed. It is It worth is worth noting noting that that in 2011/12 in 2011/12 FY only FY only the 13 public RRHs were were assessed. Despite Despite of of the the increase increase the in the number number of hospitals of hospitals assessed assessed in 2012/13 FY FY there was was a a decline decline in in the the total total number number of ANC of ANC attendances, attendances, immunizations immunizations and and FP visits. [Annual Health Sector Performance Report Report 2012/13] 2012/13] Page Page Page [Annual Health Sector Performance Report 2012/13 FY]

101 Table 54: Summary of Overall performance for the RRHs and Large PNFP Hospitals 2012/13 (N=18) Table 54: Summary of Overall Total performance for the Average RRHs and Large PNFP Hospitals Minimum 2012/13 (N=18) Maximum Output 2011/ /13 Total 2011/ /13 Average 2011/ /13 Minimum 2011/ /13 Maximum OPD Output 1,580,313 2,537, / /13 121, / /13 140, /12 39, /13 35, /12 181, /13 209,032 attendances (n = 13) (n = 18) OPD 1,580,313 2,537, ,670 Admissions NA attendances (n = 13) (n=17) = 18) 121,563 NA 140,981 19,981 39,306 NA 35,390 7, ,939 NA 209,032 48,966 Total Admissions ANC 92, , ,670 (n = NA 12) (n (n=17) = 18) 7,681 NA 19,981 4,769 NA 836 7,715 1,802 19,102 NA NA 48,966 8,278 Deliveries Total ANC 72,324 92, ,893 89,626 (n (n = 13) 12) (n (n = 18) 5,563 7,681 4,769 4, , ,102 8,998 8,278 10,181 8,278 Immunizations Deliveries 192,347 72, ,987 89,626 (n = 9) 13) (n = 18) 21,372 5,563 4,979 8,444 7, , ,998 39,219 8,998 10,181 15,562 10,181 41, , ,987 15,412 FP Immunizations visits 21,372 3,206 8,444 1,027 7,297 7, ,399 2, ,219 39,219 6,965 15,562 15,562 2,295 (n (n (n = = 13) 9) 9) (n (n = 15) 18) Post 41,672 41,672 15,412 FP FP visits visits natal 23,024 3,206 1,027 1, ,965 6,965 2,295 2,295 (n (n NA = 13) 13) = 15) 15) NA 1,279 NA 184 NA 4,865 visits (n=18) Post Post natal natal 5,361,003 23,024 23,024 NA NA 8,189,908 SUO NA NA 1,279 1,279 NA NA NA NA 4,865 4,865 visits visits (n=18) (n=18) 412, , , , , ,116 (n = 13) (n = Source: MoH HMIS SUO 5,361,003 5,361,003 8,189,908 8,189, , , , , , ,116 SUO (n = 13) (n = 18) 412, , , , , ,116 (n 13) (n 18) Source: MoH HMIS Source: MoH HMIS c) Efficiency Regarding c) Efficiency the scale of hospital outputs the mean hospital in this group has 287 beds, admits 19,981 c) Efficiency Regarding patients the scale and had of hospital a staffing outputs of 193. the Generally mean hospital the RRHs in this and group the PNFP has hospitals 287 beds, analyzed admits have Regarding the scale of hospital outputs the mean hospital in this group has 287 beds, admits 19,981 a high patients rate of and utilization had a staffing Average of 193. bed Generally occupancy the is RRHs 86% and similar the last PNFP year hospitals (2011/12) analyzed which was 19,981 patients and had staffing of 193. Generally the RRHs and the PNFP hospitals analyzed have also a high 86%. rate Average of utilization staff productivity Average bed increased occupancy to 2,724 is 86% from similar 1,534 last SUO/Staff year (2011/12) in 2011/12. which The have a high rate of utilization Average bed occupancy is 86% similar last year (2011/12) which was mean also 86%. average Average length staff of stay productivity is 5 days increased with a minimum to 2,724 of from 3 days 1,534 and maximum SUO/Staff 7 in days. 2011/12. was also 86%. Average staff productivity increased to 2,724 from 1,534 SUO/Staff in 2011/12. The mean average length of stay is 5 days with a minimum of 3 days and maximum 7 days. The mean average length of stay is days with minimum of 3 days and maximum 7 days. [Annual Health Sector Performance Report 2012/13] Page 86 [Annual Health Sector Performance Report 2012/13] Page 86 [Annual Health Sector Performance Report 2012/13] Page 86 [Annual Health Sector Performance Report 2012/13 FY] Page 81

102 Table 55: Selected Efficiency Parameters for RRHs and Large PNFP Hospitals 2012/13 Hospital Filled Medical Staff Positions Beds Admissions Major Operations Deaths Deliveries Patient Days Average Average Length Length of of Stay Stay Bed Bed Occupancy Occupancy Rate Rate SUO SUO SUO/Staff SUO/Staff Arua ,182 2, ,335 90, % 78.2% 512, ,549 2,589 2,589 China Uganda , ,461 24,382 24, % 66.8% 130, , Fort Portal ,027 1,558 6,094 3,690 3,690 88,832 88, % 65.6% 542, ,376 2,870 2,870 Gulu Gulu ,715 1,128 1, ,696 4,696 46,010 46, % 126.1% 333, ,328 1,873 1,873 Hoima Hoima ,501 16,501 2,340 2, ,776 4,776 78,440 78, % 96.8% 430, ,800 3,651 3,651 Jinja Jinja ,185 25,185 2,092 2,092 1,079 1,079 6,030 6, , , % 66.8% 573, ,073 2,617 2,617 Kabale Kabale ,538 11,538 1,473 1, ,046 4,046 70,396 70, % 76.5% 334, ,131 2,570 2,570 Lira Lira ,065 18,065 1,761 1, ,330 5, , , % 72.9% 482, ,732 2,790 2,790 Masaka Masaka ,688 35,688 2,261 2,261 1,778 1,778 8,296 8, , , % 90.4% 790, ,477 4,117 4,117 Mbale Mbale ,966 3,184 1,759 6, , % 855,888 3, ,966 3,184 1,759 6, , % 855,888 3,410 Mbarara Mbarara ,083 6,182 1,188 10, , % 646,483 3, ,083 6,182 1,188 10, , % 646,483 3,282 Moroto Moroto , , % 225,333 2, , , % 225,333 2,323 Mubende Mubende ,917 1, ,383 62, % 330,868 2, ,917 1, ,383 62, % 330,868 2,954 Soroti Soroti ,392 2, ,276 96, % 466,468 2, ,392 2, ,276 96, % 466,468 2,621 Nsambya Nsambya ,902 2, ,352 38, % 428, ,902 2, ,352 38, % 428, Mengo Mengo 397 NA NA NA NA 5,591 NA NA NA 129, NA NA NA NA 5,591 NA NA NA 129, Lubaga Lubaga ,559 2, ,902 40, % 409,955 1, ,559 2, ,902 40, % 409,955 1,601 Lacor Lacor ,026 3, , , % 532,306 1, ,026 3, , , % 532,306 1,570 Total Total 3,830 4, ,670 37,387 17,027 89,626 1,484, ,154,160 42,959 3,830 4, ,670 37,387 17,027 89,626 1,484, ,154,160 42,959 Average ,981 2,199 1,002 4,979 87, % 475,322 2,724 Average ,981 2,199 1,002 4,979 87, % 475,322 2,724 Min , , % 130, Min , , % 130, Max ,966 6,182 6,094 10, , % 855,888 4,117 Max ,966 6,182 6,094 10, , % 855,888 4,117 Source: MoH HMIS Source: MoH HMIS NB: Mengo Hospital did not report on Inpatients in the DHIS-2. NB: Mengo Hospital did not report on Inpatients in the DHIS-2. d) Outcomes d) Outcomes Hospital based deaths especially maternal deaths fresh still births are an indicator of quality of Hospital based deaths especially maternal deaths fresh still births are an indicator of quality of care. The total maternal deaths reported in 14 RRHs and 4 PNFP hospitals were 2,183 giving a care. The total maternal deaths reported in 14 RRHs and 4 PNFP hospitals were 2,183 giving a mean death of 125 mothers per hospital per year with a minimum of 3 in Moroto RRH and mean death of 125 mothers per hospital per year with a minimum of 3 in Moroto RRH and maximum of 306 in Mbarara RRH. The risk of dying during delivery was highest in Fort Portal maximum of 306 in Mbarara RRH. The risk of dying during delivery was highest in Fort Portal RRH, followed by Mubende and Masaka hospitals (a mother died for every 148, 178 and 202 RRH, followed by Mubende and Masaka hospitals (a mother died for every 148, 178 and 202 deliveries respectively). The risk was lowest in Kabale, Gulu and Mengo hospitals (a mother deliveries respectively). The risk was lowest in Kabale, Gulu and Mengo hospitals (a mother [Annual Health Sector Performance Report 2012/13] Page 87 [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

103 died died for for every every 1,349, 1,349, and and deliveries deliveries respectively). respectively). There There is is need need to to analyze analyze the the factors factors responsible responsible for for this. this. The The risk risk of of a a fresh fresh still still birth birth was was highest highest in in Mubende, Mubende, followed followed by by Arua Arua and and Mbale Mbale Hospitals Hospitals (a (a fresh fresh still still birth birth was was delivered delivered for for every every 17, 17, and and deliveries) deliveries) respectively. respectively. The The risk risk of of a fresh a fresh still still birth birth was was lowest lowest in in Moroto, Moroto, followed followed by by Lubaga Lubaga and and China China Friendship Friendship hospital hospital (a (a fresh fresh still still birth birth was was delivered delivered for for every every 252, 252, and and deliveries) deliveries) respectively. respectively. Table 56: 56: Selected Quality of Care Parameters for RRHs and Large PNFP Hospitals 2012/13 Table 56: Selected Quality of Care Parameters for RRHs and Large PNFP Hospitals 2012/13 Hospital Hospital Filled Filled Medical Medical Staff Staff Positions Positions All All Deaths Maternal Deaths Fresh Still Still Births Births Deliveries Deliveries A Maternal A Maternal death death compared to compared to to number of number deliveries of of deliveries Risk of fresh Risk stillbirth of of fresh stillbirth compared to compared number of to to number deliveries of of deliveries SUO SUO SUO/Staff SUO/Staff Arua Arua 198 Arua ,335 1: 1: deliveries 1:31 1:31 deliveries 512, ,549 2, ,335 1: 213 deliveries 1:31 deliveries 512,549 2,589 2,589 China China Uganda China Uganda 153 Friendship ,461 1:487 deliveries 1:146 1:146 deliveries 130, , Friendship ,461 1:487 deliveries 1:146 deliveries 130, Fort Fort Portal 189 Fort Portal 189 6, ,690 1:148 deliveries 1:59 1:59 deliveries 542, ,376 2,870 6, ,690 1:148 deliveries 1:59 deliveries 542,376 2,870 2,870 Gulu Gulu 178 Gulu ,696 1:939 deliveries 1:138 1:138 deliveries 333, ,328 1, ,696 1:939 deliveries 1:138 deliveries 333,328 1,873 1,873 Hoima 118 Hoima ,776 1:208 deliveries 1:38 1:38 deliveries 430, ,800 3, ,776 1:208 deliveries 1:38 deliveries 430,800 3,651 3,651 Jinja Jinja 219 Jinja 219 1, ,030 1:548 deliveries 1:34 1:34 deliveries 573, ,073 2,617 1, ,030 1:548 deliveries 1:34 deliveries 573,073 2,617 2,617 Kabale 130 Kabale ,046 1:1,349 deliveries 1:46 1:46 deliveries 334, ,131 2, ,046 1:1,349 deliveries 1:46 deliveries 334,131 2,570 2,570 Lira Lira 173 Lira ,330 1:533 deliveries 1:53 1:53 deliveries 482, ,732 2, ,330 1:533 deliveries 1:53 deliveries 482,732 2,790 2,790 Masaka 192 Masaka 192 1, ,296 1:202 deliveries 1:38 1:38 deliveries 790, ,477 4,117 1, ,296 1:202 deliveries 1:38 deliveries 790,477 4,117 4,117 Mbale Mbale 251 Mbale 251 1, ,604 1:348 deliveries 1:32 1:32 deliveries 855, ,888 3,410 1, ,604 1:348 deliveries 1:32 deliveries 855,888 3,410 3,410 Mbarara 197 Mbarara 197 1, ,181 1:351 deliveries 1:37 1:37 deliveries 646, ,483 3,282 1, ,181 1:351 deliveries 1:37 deliveries 646,483 3,282 3,282 Moroto Moroto :503 deliveries 1:252 1:252 deliveries 225, ,333 2, :503 deliveries 1:252 deliveries 225,333 2,323 2,323 Mubende 112 Mubende ,383 1:178 deliveries 1:17 1:17 deliveries 330, ,868 2, ,383 1:178 deliveries 1:17 deliveries 330,868 2,954 2,954 Soroti Soroti 178 Soroti ,276 1;214 deliveries 1:50 1:50 deliveries 466, ,468 2, ,276 1;214 deliveries 1:50 deliveries 466,468 2,621 2,621 Nsambya 453 Nsambya ,352 1:487 deliveries 1:96 1:96 deliveries 428, , ,352 1:487 deliveries 1:96 deliveries 428, Mengo 397 Mengo 397 NA 46 5,591 1:799 deliveries 1:122 1:122 deliveries 129, , NA ,591 1:799 deliveries 1:122 deliveries 129, Lubaga 256 Lubaga ,902 1:492 deliveries 1:190 1:190 deliveries 409, ,955 1, ,902 1:492 deliveries 1:190 deliveries 409,955 1,601 1,601 Lacor Lacor 339 Lacor ,174 1:348 deliveries 1:126 1:126 deliveries 532, ,306 1, ,174 1:348 deliveries 1:126 deliveries 532,306 1,570 1,570 Total Total Total 3,830 17, ,907 89,626 1:325 Deliveries 1:47 1:47 deliveries 8,154,160 8,154,160 42,959 3,830 17, ,907 89,626 1:325 Deliveries 1:47 deliveries 8,154,160 42,959 42,959 Source: MoH HMIS Source: MoH HMIS Availability Availability of of qualified qualified staff staff is is one one of of the the components components of of quality quality of of care. care. There There is a is tendency a tendency to to have have more more maternal maternal death death and and fresh fresh still still births births in in hospitals hospitals with with high high staff staff workloads workloads as as computed computed from from the the SUO/staff. SUO/staff. The The MoH MoH should should consider consider application application of of the the Workload Workload Indicator Indicator Staffing Staffing Norms Norms during during deployment deployment of of staff staff to to RRHs. RRHs. [Annual Health Sector Performance Report 2012/13] Page 88 [Annual Health Sector Performance Report 2012/13] Page 88 [Annual Health Sector Performance Report 2012/13 FY] Page 83

104 General Hospital Performance This section presents findings for the assessment of general hospital performance. There are 136 GHs in the country providing; preventive, promotive outpatient curative, maternity, inpatient, emergency surgery and blood transfusion and laboratory services. In addition to general curative services, GHs provide in service training, consultation and research to community based health care programmes. The assessment is largely based on the data aggregated through the DHIS-2. Out of the 132 GHs (excluding 4 large PNFP hospitals), 116 are registered and regularly report to the MoH RC through the DHIS2. Most of the non-reporting hospitals are Private hospitals within Kampala. The following specialized hospitals were not included in this analysis; Benedictine Eye Hospital, Cure Children s Hospital, Holy Innocent s Children s Hospital; Mild May Uganda and Ngora NGO hospital. Table 57: General Hospital Ownership 2012 Government NGO Private Total GHs Human Resource The number of staff in GHs was not analyzed due to the change from the manual annual reports to the DHIS-2. This variable will be included in the revised HMIS tools to be able to capture it per reporting hospital. The HRH Biannual report October 2012 to March 2013 provides staffing level for the public GHs as 61%. a) Outputs Hospital performance is assessed using 5 main outputs which include; admissions, outpatient visits, deliveries, ANC and immunization. The hospital indicators have been summed up in composite units the SUO. The 110 hospitals assessed attended to a total of; 3,754,144 outpatients; conducted 150,276 deliveries and 690,621 admissions among other outputs. On average each hospital attends to; 35,080 outpatients, conducted 1,392 deliveries and 6,412 admissions. See Table 58. The total SUO for GHs has increased from 10,506,636 in 2011/12 to 15,129,354 in 2012/13 with notable increase in performance for admissions, outpatient attendances and deliveries. The minimum SUO for GHs was 2,529 and maximum 523,549. There was a decline in the [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

105 immunization immunization contacts contacts at at the the GHs. GHs. The The SUO SUO / / Staff Staff was was not not analyzed analyzed due due to to lack lack of staffing of staffing levels levels per per hospital. Table Table 58: 58: Summary of Outputs from from the the General General Hospitals Hospitals FY FY 2012/ /13 (N=110) (N=110) Output Output Total 2012/13 Number reporting % Reporting rate rate Minimum Minimum Maximum Maximum Average 2012/13 Average 2012/13 Total 2011/12 Total 2011/12 Number reporting Number 2011/12 reporting 2011/12 Average 2011/12 Average 2011/12 Average 2010/11 Average 2010/11 Admissions 690, % ,007 6,412 6, , , ,644 8,644 7,386 7,386 Total Outpatients 3,754, % ,213 35,080 35,080 3,150, ,646 51,646 45,998 45,998 Deliveries 150, % ,670 5,670 1,392 1, , , ,040 2,040 1,544 1,544 Totall ANC Visits 234, % ,292 8,292 2,169 2, , , ,409 5,409 3,144 3, % 3 2, NA NA NA NA Postnatal Visits 41, % 3 2, NA NA NA NA FP Visits 47, % 1 10, NA NA NA NA FP Visits 47, % 1 10, NA NA NA NA Immunization 513, % 61 29,965 4, , ,380 8,481 Immunization 513, % 61 29,965 4, , ,380 8,481 SUO 15,129,354 2, , ,781 10,506, , ,598 SUO 15,129,354 2, , ,781 10,506, , ,598 Source: MoH HMIS Source: MoH HMIS The number of GHs reporting for all outputs significantly improved during the same period The number of GHs reporting for all outputs significantly improved during the same period however, further analysis shows a decline in the average outputs for all the indicators. This however, further analysis shows a decline in the average outputs for all the indicators. This could be attributed to the result of more hospitals reporting but with varying levels of could be attributed to the result of more hospitals reporting but with varying levels of performance as observed in the minimum and maximum performance against each output. performance as observed in the minimum and maximum performance against each output. There is need to carry out further analysis to appreciate the individual hospital contribution to There these is outputs. need to It carry is also out worth further noting analysis that to the appreciate Catholic Faith-Based the individual hospitals hospital do contribution not provide to these modern outputs. contraceptive It is also methods worth thus noting the that lower the level Catholic of reporting Faith-Based for FP services. hospitals do not provide modern contraceptive methods thus the lower level of reporting for FP services. The 5 top performing hospitals were Iganga, Busolwe, Bwera, Mityana and Pallisa GHs The respectively. 5 top performing While the 5 hospitals lowest performing were Iganga, hospitals Busolwe, were Bwera, Uganda Mityana Martyr s, and Lamezia, Pallisa Old GHs respectively. Kampala, Divine While Mercy the and 5 lowest Hunter performing Foundation hospitals Hospitals. were The majority Uganda of Martyr s, GHs with Lamezia, low SUO Old Kampala, scores are Divine private Mercy hospitals and which Hunter tend Foundation to have low Hospitals. bed capacity The (below majority the of recommended GHs with low 45 SUO scores for hospitals). are private Ranking hospitals for all which GHs is tend in Table to 72 have in the low Annex. bed capacity (below the recommended 45 for hospitals). Ranking for all GHs is in Table 72 in the Annex. [Annual Health Sector Performance Report 2012/13] Page 90 [Annual Health Sector Performance Report 2012/13] Page 90 [Annual Health Sector Performance Report 2012/13 FY] Page 85

106 Table 59: The Top 15 Performing Hospitals Table 59: The Top 15 Performing Hospitals Hospital Hospital Admissions (109) Admissions (109) Admissions (109) Total OPD (110) Total OPD (110) Total OPD (110) Deliveries (110) Deliveries (110) Deliveries (110) Iganga Iganga 21,007 21, , ,213 5,670 5,670 6,440 6, ,069 1,069 10,181 10,181523, , Busolwe Iganga Busolwe 19,727 21,007 19, ,213 92,686 92,686 1,657 5,670 1,657 2,508 6,440 2, , ,181 3, , ,549 3, , Bwera Busolwe Bwera 16,018 19,727 16,018 83,779 92,686 83,779 3,638 1,657 3,638 6,340 2,508 6, , ,412 3, , ,208 1,430 10, , Mityana Bwera Mityana 15,085 16,018 15,085 60,683 83,779 60,683 4,976 3,638 4,976 5,854 6,340 1, ,091 1,430 10,412 6, , ,391 5,854 1,052 1,091 6, , Pallisa Mityana Pallisa 14,320 15,085 14,320 77,964 60,683 77,964 3,002 4,976 3,002 3,652 5,854 3,652 1, , ,873 8,873 6, , , , Kawolo Pallisa 13,073 14,320 84,028 77,964 3,598 3,002 6,255 3, ,784 8, , , Kawolo 13,073 84,028 3,598 6, , ,222 6 Tororo Kawolo 14,364 13,073 65,538 84,028 3,316 3,598 4,870 6,255 2, ,813 5, , , Tororo 14,364 65,538 3,316 4,870 2, , ,542 7 Kamuli Tororo 11,724 14,364 87,553 65,538 1,801 3,316 3,430 4,870 2, , ,952 4, , , Kamuli 11,724 87,553 1,801 3, ,207 5, ,347 8 Angal Kamuli St. Luke 15,320 11,724 25,677 87,553 1,998 1,801 2,856 3, , ,269 5, , , Angal St. Luke 15,320 25,677 1,998 2, , ,301 9 Ibanda Angal St. Luke 15,196 15,320 17,171 25,677 2,741 1,998 2,455 2, NA 69 4,944 6, , , Ibanda Entebbe Ibanda 15,196 10,014 15,196 17,171 73,265 17,171 2,741 4,294 2,741 2,455 8,292 2, , NA 4, NA 261, ,989 4, , , Entebbe Itojo Entebbe 10,014 12,575 10,014 73,265 49,048 73,265 4,294 1,912 4,294 8,292 1,036 1,695 8,292 1, , , ,647 9, , , Itojo Kisoro Itojo 12,575 10,790 12,575 49,048 65,329 49,048 1,912 2,907 1,912 1,695 5,414 1, , , ,702 2, , , Atutur Kisoro Kisoro 10,790 10,267 10,790 65,329 72,517 65,329 2,907 1,769 2,907 5,414 1,999 5, ,702 4,751 8, , , , Bugiri Atutur Atutur 10,267 10,681 10,267 72,517 58,941 72,517 1,769 2,473 1,769 1,9995, ,751 5,307 4,751237, , , Bugiri Source: MoH HMIS 10,681 10,681 58,941 58,941 2,473 2,473 5,008 5, ,307 5,307235, , Source: MoH HMIS ANC Total (110) Postnatal Visits (105) b) Efficiency of use of services The b) hospitals Efficiency assessed of use of had of services a bed capacity ranging from 15 (i.e. Divine Mercy Hospital) to 368 The (i.e. hospitals Kuluva Hospital) assessed per had hospital. a a bed bed capacity There are ranging also from variances from 15 (i.e. 15 (i.e. in Divine the Divine number Mercy Mercy Hospital) of beds Hospital) to because 368 to 368 of non-reporting (i.e. Kuluva Hospital) or poor per reporting hospital. of There in-patient are are also also data variances in the in DHIS-2 the in the number e.g. number Kibuli of beds of Hospital, beds because because UPDF of 2of nd Division non-reporting Hospital, or poor Ngora reporting NGO Hospital, of of in-patient Namungoona data data in the in Orthodox the DHIS-2 DHIS-2 e.g. Hospital e.g. Kibuli Kibuli and Hospital, 5Hospital, th Military UPDF UPDF 2Division nd 2 nd hospital Division Hospital, some of which Ngora did NGO not Hospital, report the Namungoona number Orthodox of beds. Orthodox Hospital Hospital and 5and th Military 5 th Military Division Division hospital some of which did did not not report report the the number number of beds. of beds. There was a reduction in the average number of admission from 8,644 in 2011/12 to 6,138 in 2012/13. There There was Similarly a reduction there in in was the the average a average reduction number number in Bed of admission of Occupancy admission from Rate from 8,644 (BOR) 8,644 in 2011/12 from in 2011/12 64% to to 6,138 54%. to 6,138 in Iganga in 2012/13. hospital 2012/13. had Similarly Similarly the there highest there was was BOR a a reduction reduction at 173% in in Bed followed Bed Occupancy Occupancy by Bwera Rate Rate (BOR) GH (BOR) from with from 64% 168%, to 64% 54%. Itojo Iganga 54%. GH Iganga 162%, Mityana hospital hospital GH had had 145% the the highest highest and Pallisa BOR BOR 140%. at at 173% 173% Such followed followed high BORs by by Bwera are Bwera likely GH GH with to affect with 168%, 168%, the Itojo quality Itojo GH 162%, of GH services 162%, delivered. Mityana GH 145% and Pallisa 140%. Such high BORs are likely to affect the quality of services Mityana GH 145% and Pallisa 140%. Such high BORs are likely to affect the quality of services delivered. The delivered. average length of stay in 2012/13 was 4 days compared to 3.5 days in 2011/12. The SUO The per staff average was length not analyzed of stay in due 2012/13 to non-availability was 4 days compared of the current to 3.5 GH days staffing 2011/12. levels. The Detailed SUO The average length of stay in 2012/13 was 4 days compared to 3.5 days in 2011/12. The SUO performance staff was for not each analyzed hospital due is shown to non-availability in the Hospital of League the current Table GH 69 staffing the Annex. levels. Detailed per staff was not analyzed due to non-availability of the current GH staffing levels. Detailed performance for each hospital is shown in the Hospital League Table 69 in the Annex. performance for each hospital is shown in the Hospital League Table 69 in the Annex. [Annual Health Sector Performance Report 2012/13] Page 91 [Annual Health Sector Performance Report 2012/13] Page 91 [Annual Health Sector Performance Report 2012/13] Page 91 ANC Total (110) ANC Total (110) Postnatal Visits (105) Postnatal Visits (105) FP Visits (82) FP Visits FP Visits (82) (82) Immunization (109) Immunization (109) (109) SUO (110) Ranking SUO SUO (110) (110) Ranking Ranking 86 Page [Annual Health Sector Performance Report 2012/13 FY]

107 Table 60: Selected efficiency parameters for General Hospitals Output Total Min Max Average Average Average Table 60: Selected efficiency parameters for for General Hospitals 2012/ / /11 Medical Staffing Positions NA NA NA NA Output Total Min Min Max Max Average Average Average Average Total Number of Beds (n=110) 12, / / / / / /11 Admissions (n=114) 699,676 NA NA 81 21,007 NA 6,084 NA 8,644 7,386 Medical Staffing Positions NA NA NA NA Average Length of of Stay (n=114) Total Number of Beds (n=110) 12, Bed Occupancy Rate (%) (n=116) 6233% 0% 81 21, % 6,084 54% 8,644 64% 7,386 69% Admissions (n=114) 699, ,007 6,084 8,644 7,386 SUO (n=116) of Stay 15,260, , , ,684 Average Length of Stay (n=114) , , SUO/Staff Bed Occupancy Rate Rate (%) (%)(n=116) (n=116) 6233% NA 6233% 0% NA 0% 173% NA 1, % 54% 54% 64% 2,747 64% 69% 1,577 69% Source: SUO (n=116) MoH HMIS 15,260,506 2, , , , ,598 SUO (n=116) 15,260,506 2, , , , ,598 SUO/Staff SUO/Staff NA NA NA NA NA NA 1,209 1,209 2,747 2,747 1,577 1,577 Source: Source: MoH MoH HMIS HMIS c) Outcomes The total maternal deaths reported under the DHIS-2 for the 110 out of 116 hospitals that reported c) Outcomes c) Outcomes conducting deliveries were 526 giving a mean death of 5 mothers per hospital per year The total maternal deaths reported under the DHIS-2 for the 110 out of 116 hospitals that The with total a maternal minimum deaths of 0 in reported some hospitals under the and DHIS-2 maximum for of the 3110 maternal out of deaths 116 hospitals in Mityana that reported conducting deliveries were 526 giving a mean death of 5 mothers per hospital per hospital. reported conducting deliveries were 526 giving a mean death of 5 mothers per hospital per year with minimum of in some hospitals and maximum of 31 maternal deaths in Mityana year with a minimum of 0 in some hospitals and maximum of 31 maternal deaths in Mityana Table hospital. 61: Comparison of Maternal Deaths and Fresh Still Births to Deliveries hospital. Deliveries Maternal Death FSB Table 61: Comparison of Maternal Deaths and Fresh Still Births to Deliveries Table Total 61: Comparison of Maternal Deaths 150,276 and Fresh Still Births 526 to Deliveries 3,652 Minimum Deliveries Maternal Death FSB Deliveries 12 Maternal 0 Death FSB 0 Maximum Total 150, ,652 Total 150,276 5, ,652 Average Minimum Minimum 1, Source: Maximum MoH HMIS 5, Maximum 5, Average 1, Source: MoH HMIS The Average risk of dying during delivery was highest 1,366 in Kiryandongo 5 followed by St. 33 Anthony s Hospital Source: MoH HMIS Tororo, Rugarama and St. Joseph s Kitovu hospitals. A mother died for every 56, 61, 67 and 76 The risk of dying during delivery was highest in Kiryandongo followed by St. Anthony s Hospital deliveries The risk of respectively). dying during delivery The risk was highest lowest in in Kiryandongo Atutur, Nebbi, followed General by Military, St. Anthony s Masafu Hospital and Tororo, Rugarama and St. Joseph s Kitovu hospitals. A mother died for every 56, 61, 67 and 76 Kiwoko Tororo, hospitals. Rugarama A and mother St. Joseph s died for Kitovu every hospitals. 1,769; 1,437; A mother 1,416; died 1,387 for every and 56, 1,031 61, deliveries 67 and 76 deliveries respectively). The risk was lowest in Atutur, Nebbi, General Military, Masafu and respectively). Kiwoko deliveries hospitals. respectively). (Table 70 in Annex) A mother The died risk for was every lowest 1,769; in Atutur, 1,437; Nebbi, 1,416; General 1,387 and Military, 1,031 Masafu deliveries and respectively). Kiwoko hospitals. (Table A 70 mother in Annex) died for every 1,769; 1,437; 1,416; 1,387 and 1,031 deliveries The risk of a fresh still birth was highest in Kitgum, followed by St. Joseph Kitovu, Maracha, respectively). (Table 70 in Annex) Rakai The risk and of Bamu a fresh Hospitals. still birth A was fresh highest still birth in Kitgum, was delivered followed for by St. every Joseph 9; 12; Kitovu, 12; 16 Maracha, and 16 deliveries Rakai The risk and of respectively). Bamu a fresh Hospitals. still The birth risk A was fresh of a highest fresh still birth still in Kitgum, birth was delivered was followed lowest for in by every Nakasero, St. Joseph 9; 12; followed Kitovu, 12; 16 by Maracha, and Senta 16 Medical deliveries Rakai and Clinic, respectively). Bamu Murchison Hospitals. The Bay, risk A fresh of Buwenge a fresh still birth still NGO birth was and was delivered Masafu lowest hospitals. in for Nakasero, every A 9; fresh followed 12; still 12; 16 birth by Senta and was 16 delivered Medical deliveries Clinic, for respectively). every Murchison 576; 409; The Bay, 226; risk Buwenge of 208 a fresh and 173 NGO still deliveries birth and was Masafu respectively). lowest hospitals. in Nakasero, (Table A fresh 71 followed still in Annex) birth by was Senta delivered Medical Clinic, for every Murchison 576; 409; Bay, 226; Buwenge 208 and 173 NGO deliveries and Masafu respectively). hospitals. (Table A fresh 71 in still Annex) birth was delivered for every 576; 409; 226; 208 and 173 deliveries respectively). (Table 71 in Annex) [Annual Health Sector Performance Report 2012/13] Page 92 [Annual Health Sector Performance Report 2012/13] Page 92 [Annual Health Sector Performance Report 2012/13] Page 92 [Annual Health Sector Performance Report 2012/13 FY] Page 87

108 Functionality of of HC HC IVs IVs According to the Health Sub-District (HSD) concept, a HC HC IV IV is is the the first first referral facility facility where where there is no hospital to to serve a supervisor role. The The total number of of HC HC IVs IVs is is 193; 193; of of these these are government, 15 NGO and 8 privately owned. The key key feature of of the the HSD HSD strategy was was that that each HSD, which has an approximately 100,000 people, would have a Hospital or or a a HC HC IV. IV. The The facility should have the capacity to to provide basic preventive, promotive, outpatient curative, maternity, inpatient health services, emergency surgery and blood transfusion and and laboratory services. In addition, it it should supervise and support planning and implementation of of services by the lower health units in its area of of jurisdiction. Being a key strategy of of the the sector, the the functionality of HC IVs has been reviewed every year in in the last 6 AHSPRs. The DHIS2 has enabled all 193 HC IVs to provide information for for assessment of of inputs, management and outputs compared to last FY when only 88 (45.6%) HC IVs reported. a) Staffing Levels The HRH Biannual report October 2012 to March 2013 shows that following the recruitment drive in 2012/13 FY staffing levels at the public HC IVs increased from 60% in in 2011/12 to to 71% in in 2012/13. There is need to follow up and report the actual number of of posted health workers who reported and assumed duty. Table 59 provides the positions filled in reporting HC IVs by critical cadres as as reported through the DHIS-2. Staffing levels for the nursing cadre are still very low for this level of of facility. Table 62: Positions filled in HC IVs 2012/13 Staff Position No. reporting Average % of of Rec. Positions Filled % of of HC HC IVs IVs Understaffed Medical Officers Anaesthetic Assist Clinical Officers Registered Nurse/Midwife Enrolled Nurse/Midwife Lab Tech Assist Lab Assist Nursing Assist Theater Attendants/Cleaners Cleaners/Porters Askaris Paramedical Staff Source: MoH HMIS [Annual Health Sector Performance Report 2012/13] Page Page Page [Annual Health Sector Performance Report 2012/13 FY]

109 b) Outputs Functionality of HC IV is determined by outputs from selected components of the minimum b) Outputs service standards i.e. maternity (deliveries), inpatient, blood transfusion, theatre (caesarean Functionality b) Outputs of HC IV is determined by outputs from selected components of the minimum service Functionality section, major standards of HC and i.e. IV minor maternity is determined surgery), (deliveries), by HCT, outputs PMTCT, inpatient, from selected ART, long blood transfusion, components term contraception theatre of the (caesarean minimum and outpatient section, service services. standards major i.e. minor maternity surgery), (deliveries), HCT, PMTCT, inpatient, ART, long blood term transfusion, contraception theatre and (caesarean outpatient services. section, major and minor surgery), HCT, PMTCT, ART, long term contraception and outpatient services. Since the main objective of setting up HC IVs was to provide Comprehensive Emergency Since Obstetric the main Care objective (CEmOC) of setting that is up being HC IVs able was to to provide intervention Comprehensive in case Emergency of complications Obstetric Since during the delivery, Care main (CEmOC) objective which includes that of setting is being the up ability able HC to IVs to was provide to intervention provide a caesarean Comprehensive in case section of complications and Emergency blood transfusion, during Obstetric delivery, Care (CEmOC) which includes that the is being ability able to provide to provide a caesarean intervention section in and case blood of complications for this assessment HC IVs have been judged functional if they have been transfusion, able to carry out at for during this delivery, assessment which HC includes IVs have the been ability judged to provide functional a caesarean if they have section been and able blood to transfusion, carry out at least one caesarean section. Using these criteria, 37% (72 out of 193) of the HC IVs were least for this one assessment caesarean HC section. IVs have Using been these judged criteria, functional 37% (72 if they out have of 193) been of able the to HC carry IVs out were at functional in 2012/13, an increase from 24% reported in the previous 3 years. Provision of functional least one caesarean in 2012/13, section. an increase Using these from 24% criteria, reported 37% (72 in the out previous of 193) 3 of years. the HC Provision IVs were of functional blood transfusion services almost stagnated between 24% and 26% for the last three years blood transfusion in 2012/13, services an almost increase stagnated from 24% between reported 24% in the and previous 26% for 3 the years. last Provision three years of (2009/10 blood (2009/10 transfusion to to 2011/12) 2011/12) services with with a almost slight a slight increase stagnated increase to 27% between to in 27% 2012/13 24% in 2012/13 and FY (Figure 26% FY for 14). (Figure the last 14). three years (2009/10 to 2011/12) with a slight increase to 27% in 2012/13 FY (Figure 14). Figure 14: Trends in Caesarean Section and Blood transfusion Figure 14: Trends in Caesarean Section and Blood transfusion Figure 14: Trends in Caesarean Section and Blood transfusion 40% 40% 37% 35% 37% 40% 35% 30% 37% 35% 30% 26% 25% 25% 24% 26% 25% 30% 25% 24% 24% 19% 23% 27% 20% 26% 25% 25% 24% 15% 15% 23% 25% 27% 20% 24% 19% 24% 10% 15% 15% 23% 25% 27% 20% 19% 15% 15% 5% 10% 10% 0% 5% 5% 0% 0% 2008/ / / / / / / / /10 Financial 2010/ /11 Year 2011/ / / /13 Financial Financial Year Year % of HC IVs providing CS % of HC IVs providing blood transfusion Percentage Percentage % of % HC of IVs HC providing IVs providing CS CS % of HC % IVs of providing HC IVs providing blood transfusion blood transfusion Source: MoH HMIS Source: MoH HMIS Source: MoH HMIS Mukono Church of Uganda, St. Paul and Kabuyanda HC IVs had the highest number of C/S performed Mukono Church in 2012/13. of Uganda, Table 63 St. shows Paul and the HC Kabuyanda IVs and numbers HC IVs had of C/S the performed. highest number of C/S performed Mukono in Church 2012/13. of Table Uganda, 63 shows St. Paul the HC and IVs Kabuyanda and numbers HC of C/S IVs performed. had the highest number of C/S performed in 2012/13. Table 63 shows the HC IVs and numbers of C/S performed. [Annual Health Sector Performance Report 2012/13] Page 94 [Annual Health Sector Performance Report 2012/13] Page 94 [Annual Health Sector Performance Report 2012/13] Page 94 [Annual Health Sector Performance Report 2012/13 FY] Page 89

110 Table 63: Numbers of C/S performed by each HC IV in 2012/13 FY HC IV Deliveries No. of C/S HC IV Deliveries No. of C/S Mukono c.o.u 1, Kiyumba St. paul hc 1, St. Joseph of Kyamulibwa Kabuyanda 1, Tokora bishop asili ceaser 1, namayumba St. ambrose charity buvuma Mukono T.c. 4, Kasangati 2, Mpigi 1, butebo Serere 1, Mitooma Rukunyu Magale nyahuka 1, nyamuyanja Kabwohe 1, azur 1, bugobero Kiyunga ntara hc iv alebtong Kibaale Kinoni Kyegegwa 1, ntwetwe Rwekubo aboke Kyarusozi nyimbwa Kakindo adumi bukuku 1, busia 1,551 6 Kakumiro 1, Wakiso 1,249 6 Wagagai Kaberamaido Kotido luwero 1,746 5 Kiganda Midigo Kibiito Kidera aduku budadiri 1,425 3 Rwesande ishongororo busaru butenga bumanya Kalagala amuria 1, Koboko 1,704 2 anyeke Mwera bukwa busiu pag Mission buwenge benedict Medical centre Kihiihi dokolo nabilatuk Kawempe 4, obongi Kakuuto pakwach Source: MoH HMIS [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

111 In addition to the improved health facility reporting through the DHIS-2, the increase in functionality of HC IVs during 2012/13 FY could be attributed to efforts under some RH projects In addition to the improved health facility reporting through the DHIS-2, the increase in like the Saving Mothers Giving Life (SMGL) Project under Baylor Uganda in the districts of In addition functionality to the of improved HC IVs during health 2012/13 facility reporting FY could through be attributed the DHIS-2, to efforts the under increase some in RH projects Kyenjojo, Kabarole, Kamwenge and Kibale, among other projects (Figure 15). functionality of HC IVs during 2012/13 FY could be attributed to efforts under some RH projects like the Saving Mothers Giving Life (SMGL) Project under Baylor Uganda in the districts of like Figure the 15: Saving Trends in Mothers Caesarean Giving Sections Life performed (SMGL) in the Project SMGL Project under Districts Baylor Uganda in the districts of Kyenjojo, Kabarole, Kamwenge and Kibale, among other projects (Figure 15). Kyenjojo, Kabarole, Kamwenge and Kibale, among other projects (Figure 15). Figure 15: Trends in Caesarean Sections performed in the SMGL Project Districts Figure 15: Trends in Caesarean Sections performed in the SMGL Project Districts Figure 15: Trends 3,000 in Caesarean Sections performed in the SMGL Project Districts 2,000 3,000 1,000 3,000 3,000 2,000 2,000-2,000 1,000 KABAROLE KAMWENGE KIBAALE KYENJOJO 1,000 1, /11 1, KABAROLE /12 - KAMWENGE KIBAALE KYENJOJO KABAROLE KAMWENGE KIBAALE KYENJOJO 2010/11 KABAROLE 2,722 KAMWENGE 71 KIBAALE 702 KYENJOJO 152 1, / / /11 1,738 2,901 1, , /12 2, / /12 2,722 2, /13 2, , / /13 2, /11 2, / / ,270 1, / / / / / / / / /13 Source: MoH HMIS Source: MoH HMIS Source: Source: MoH HMIS MoH HMIS Number Number of of C/S C/S of C/S Number of C/S The recruitment of health workers for HC IVs and IIIs is also expected to lead to improvements The in the recruitment outputs at of this health level. workers However, for HC most IVs of and the IIIs newly is also recruited expected health to lead workers to improvements reported at The recruitment of health workers for HC IVs and IIIs is also expected to lead to improvements in the the end outputs of the at FY this and level. their impact However, is expected most of to the be newly reflected recruited in the subsequent health workers years. reported at in the outputs at this level. However, most of the newly recruited health workers reported at the end of the FY and their impact is expected to be reflected in the subsequent years. HC IV the performance end of the has FY been and their assessed impact using is expected the SUO as to well. be reflected A total of in 193 the HC subsequent IVs reporting years. HC through IV performance HC the IV performance DHIS-2 has were been has assessed. using been assessed In total the using HC SUO IVs as the attended well. A total SUO as to of well. 4,473, HC IVs A total outpatients; reporting of 193 HC IVs reporting through the DHIS-2 were assessed. In total HC IVs attended to 4,473,744 outpatients; conducted through 123,610 the deliveries; DHIS-2 were and admitted assessed. 395,898 In total patients. HC IVs The mean attended outpatient to 4,473,744 attended conducted 123,610 deliveries; and admitted 395,898 patients. The mean outpatient attended outpatients; to was conducted 23,468, mean 123,610 deliveries deliveries; 661 and and mean admitted admission 395,898 2,234. See patients. Table 64. to was 23,468, mean deliveries 661 and mean admission 2,234. See Table 64. The mean outpatient attended to was 23,468, mean deliveries 661 and mean admission 2,234. See Table 64. The The total total SUO SUO for for HC HC IVs IVs was was 11,413,220 11,413,220 with with a minimum minimum of of 4,148 4,148 and and maximum maximum of of 304, ,048. Table Table 64: 64: The Summary total SUO of of Outputs for HC from IVs the was HC IVs 11,413,220 FY 2012/13 (N=193) with a minimum of 4,148 and maximum of 304,048. Table 64: Summary of Outputs from the HC IVs FY 2012/13 (N=193) Total Table Admissions 64: Summary Total OPD of Outputs Deliveries from the Total HC IVs ANC FY 2012/13 Post Natal (N=193) FP Visits Immunization SUO Admissions (n=181) (n=193) OPD Deliveries (n=192) Total (n=193) ANC Visits Post (n=190) Natal FP (n=188) Visits Immunization (n=193) (n=193) SUO (n=181) (n=193) Total (n=192) (n=193) Visits (n=190) (n=188) (n=193) (n=193) Admissions OPD Deliveries Total ANC Post Natal FP Visits Immunization SUO Total 395,898 (n=181) 4,473,744 (n=193) 123,610 (n=192) 353,679 (n=193) 64,362 Visits (n=190) 79,953 (n=188) 669,794 11,413,220 (n=193) (n=193) Total Total 395,898 4,473, , ,679 64,362 79, ,794 11,413,220 Maximum 12, ,504 4,613 13,733 10,462 14,395 31, ,048 Maximum 12, ,504 4,613 13,733 10,462 14,395 31, ,048 Maximum Minimum Total 12, , ,504 1,106 4,473,744 4, ,610 13, ,679 10,462 64,362 14,395 79,953 31, ,048 4, ,794 11,413,220 Minimum 9 1, ,148 Average Minimum Maximum 2, ,90223,468 1, , ,613 1,884 13, , ,395 3,598-4,148 60,110 31, ,048 Average 2,234 23, , ,598 60,110 Average Minimum 2, ,468 1, , , ,110-4,148 Average 2,234 23, , ,598 60,110 The 5 top performing HC IVs in 2012/13 were Bugobero HC IV, Kawempe HC IV, Mukono Town Council The 5 top HC performing IV, Serere HC HC IV IVs and in Luwero 2012/13 HC were IV. Bugobero See Table HC 73 for IV, Kawempe ranking all HC HC IV, IVs. Mukono Town Council The HC 5 IV, top Serere performing HC IV and HC Luwero IVs in HC 2012/13 IV. See were Table Bugobero 73 for ranking HC all IV, HC Kawempe IVs. HC IV, Mukono Town [Annual Council Health HC Sector IV, Performance Serere HC IV Report and Luwero 2012/13] HC IV. See Table 73 for ranking all HC Page IVs. 96 [Annual Health Sector Performance Report 2012/13] Page 96 [Annual Health Sector Performance Report 2012/13] Page 96 [Annual Health Sector Performance Report 2012/13 FY] Page 91

112 Table 65: The Top 15 Performing HC IVs Table 65: The Top 15 Performing HC HC IVs IVs HC HC IV HC IV = = IV = 193 Bugobero Kawempe Bugobero Bugobero Kawempe Mukono Kawempe T.C. Mukono T.C. Serere Mukono T.C. Serere Luwero Serere Luwero Luwero PAG PAG Mission Mission Nyahuka PAG Mission Nyahuka Nyahuka Pakwach Pakwach Busia Busia Kumi Kumi Kyangwali Kyangwali Mpigi Mpigi Amuria Amuria Kabuyanda Anyeke Anyeke Kabuyanda Anyeke Source: MoH HMIS Source: MoH HMIS Source: MoH HMIS Total OPD Total Total OPD OPD Total ANC Total Total ANC ANC Post Natal Visits Post Post Natal Natal Visits Visits [Annual Health Sector Performance Report 2012/13] Page 97 [Annual Health Sector Performance Report 2012/13] Page 97 Deliveries Deliveries Immunization 101,504 2, , , , ,504 2, , , , ,504 92,626 13,733 2,812 4, , ,827 13, ,902 4, , , ,626 13,733 4,353 4,613 31, , , ,626 13,733 4,353 4,613 31, , , ,795 8,831 10,462 4,204 24,159 1,022 5, , ,795 8,831 10,462 4,204 24,159 1,022 5, , ,582 39,795 2,441 8,831 10, ,592 4,204 24,159 4,043 1, ,705 5, , , ,582 2, ,592 4, , , ,821 40,582 4,421 2, ,746 1,592 4,018 4, ,669 6, , , ,821 4, ,746 4, , , ,449 49,821 1,169 4, , ,168 4, ,499 5, , , ,449 1, , , , ,951 32,449 2,880 1, , ,276 3, ,560 6, , ,920 24,951 2, ,335 2, , , ,222 24,951 24,222 1,947 2,880 1, , ,499 2, , ,532 5,532 6, , , , ,222 40,028 40,028 1,947 4,517 4, ,499 1,551 1,551 11,167 11, ,843 5,532 3, , , , ,028 48,146 2,477 4,517 2, , , ,804 4,804 1,744 1, ,530 3,530 3, , , , ,331 48,146 2,363 2,363 2, ,173 3,173 4, , ,904 4,904 3, , , , ,255 25,255 26,331 4,331 4,331 2, ,893 1, ,738 3,738 3, ,558 4,558 4, , , , ,128 24,128 25,255 2,430 2,430 4, ,236 1,236 1,893 5,601 5,601 3, ,865 4,865 4, , , , ,813 19,813 24,128 3,896 3,896 2, ,801 1,801 1,236 3,348 3,348 5, ,824 4,824 4, , , , ,034 19,813 36,034 1,471 3,896 1, ,801 3,862 3, , ,994 4, ,784 3, , , ,034 1, , , , Compared to FY 2011/12 more HC IVs were assessed for efficiency and usage. Despite realizing Compared to FY 2011/12 more HC IVs were assessed for efficiency and usage. Despite realizing an Compared an increase increase to in in FY the the 2011/12 number number more of beds of beds HC the IVs total the were number total assessed of number for admissions of efficiency declined admissions and declined usage. from from Despite 551, ,695 realizing to to 395,898, an 395,898, increase the the in number number the number of deaths of deaths of beds reported reported the increased total increased number from from of 1,276 admissions to 4,276. 1,276 to 4,276. declined The bed The from occupancy bed 551,695 occupancy to rate 395,898, rate was 46.6% was 46.6% the number and average and average of deaths length length reported of stay 2.6 of stay 2.6 increased days. days. from 1,276 to 4,276. The bed occupancy rate was 46.6% and average Table 66: length Efficiency of & stay Usage 2.6 Measurements days. of HC IVs Table 66: Efficiency & Usage Measurements of HC IVs Output Table 66: Efficiency & Usage Measurements 2012/2013 of HC IVs Number Output of Beds 6, /2013 3, Admissions Output Number of Beds 395, /2013 6, , ,466 Deaths Admissions Number of Beds 4, ,898 6,065 1,276551,695 3,466 CFR Deaths Admissions 1.08% 395,898 4, ,695 1,276 Patient CFR Deaths Days 1,031, % 4, ,866 1, Bed Patient CFR Occupancy Days 46.6% 1,031, % 32.4% 535, Average Bed Patient Occupancy Length Days of Stay 2.6 1,031, % 3 535, % Average Source: Length MoH of Stay HMIS Bed Occupancy 46.6% % 3 These variations could Average Source: be Length attributed MoH of Stay HMIS to the change in 2.6 the reporting system 3 from the manual annual reports to the DHIS-2 Source: which MoH HMIS provided facility data. These variations could be attributed to the change in the reporting system from the manual annual These variations reports to could the DHIS-2 be attributed which provided to the facility change data. in the reporting system from the manual annual reports to the DHIS-2 which provided facility data. [Annual Health Sector Performance Report 2012/13] Page 97 Deliveries Immunization FP Visits FP Visits FP Visits Admissions Admissions SUO SUO SUO Ranking Ranking Ranking 92 Page [Annual Health Sector Performance Report 2012/13 FY]

113 Quality of Care General services readiness refers to the overall capacity of health facilities to provide general health services. Readiness is defined as the availability of components required to provide services in the following five domains: basic amenities basic equipment standard precautions for infection prevention diagnostic capacity essential medicines Availability of health care components is one of the 8 elements of quality of care. The SARA 2013 provides an assessment of this element in 207 facilities which included referral hospitals, general hospitals, HC IVs, HC IIIs and HC IIs including public and private facilities. The findings show that the general service readiness index was 61% with the availability of standard precautions for infection prevention at 83%, basic equipment at 79% and basic amenities at 62% (Figure 16). Availability of the tracer medicines (ACTs, Cotrimoxazole tablets, Depoprovera, Measles vaccine, ORS, Sulphadoxine / Pyrimethamine) was at 41% in public facilities. Figure 16: General Service readiness index and domain scores Index 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 61% 62% General service readiness index Basic amenities mean score 79% Basic equipment mean score 83% Standard precautions mean score 47% Diagnostics mean score 35% Essential medicines mean score The findings show that the availability of all domains for general service readiness was highest in the referral hospitals and progressively decreased by level of care. There were also higher levels of availability in private facilities compared to public and similarly higher for urban compared to rural facilities. [Annual Health Sector Performance Report 2012/13] Page 98 [Annual Health Sector Performance Report 2012/13 FY] Page 93

114 67: index and domain scores by facility type, ownership and location Table Table 67: 67: General Service Service readiness readiness index index and and domain domain scores scores by facility by facility type, type, ownership ownership and location and location General Service Basic Basic Standard Diagnostics Tracer Medicines General General Service Basic Basic Basic Basic Standard Standard Diagnostics Diagnostics Tracer Tracer Total Medicines readiness Index amenities Equipment Precautions for readiness Service Index amenities amenities Equipment Equipment Precautions Precautions for for Medicines number of readiness infection infection prevention infection facilities Index prevention prevention & & control control control Facility type type 88% 93% 95% 62% 82% 77% National // RRH 88% RRH 88% 93% 93% 95% 95% 62% 62% 82% 82% 77% 13 77% General hospital IV hospital 76% 74% 95% 44% 73% 49% and HC HC IV 76% IV 76% 74% 74% 95% 95% 44% 44% 73% 73% 49% 34 49% 69% 70% 86% 34% 63% 51% HC III 69% III 69% 70% 70% 86% 86% 34% 34% 63% 63% 51% 68 51% 52% 53% 70% 27% 29% 31% HC II 52% II 52% 53% 53% 70% 70% 27% 27% 29% 29% 31% 94 31% Managing authority 56% 55% 75% 35% 40% 41% Public 56% 56% 55% 55% 75% 75% 35% 35% 40% 40% 41% % 68% 72% 84% 26% 58% Private 68% 68% 72% 72% 84% 84% 26% 26% 58% 58% 17% 71 Urban/Rural 68% 72% 84% 36% 58% Urban 68% 68% 72% 72% 84% 84% 36% 36% 58% 58% 21% 92 56% 54% 74% 28% 38% Rural 56% 56% 54% 54% 74% 74% 28% 28% 38% 38% 40% 117 Source: Source: SARA SARA 2013 The in the and avaialability are likely to contribute to the The The observed disparities in in the the service service readiness readiness and and avaialability avaialability are likely are likely to contribute to contribute to the to the Many patients seek care for common conditions and weaknesses in the referral system. system. Many Many patients patients seek seek care care for common for common conditions conditions and and preventive services from the referral facilities. The much lower percentage of urban facilities with all six medicines is likely due to higher concentration of private facilities. The sector should focus on interventions geared at improving service delivery at the primary The sector should focus on interventions geared at improving service delivery at the primary care level specifically through improving the existing health infrastructure, provision of basic care The level sector specifically should focus through on interventions improving geared the existing at improving health service infrastructure, delivery at provision the primary of basic equipment, dissemination of guidelines for standard precautions and infection prevention and equipment, care level specifically dissemination through of guidelines improving the for existing standard health precautions infrastructure, and infection provision prevention of basic and control, providing appropriate diagnostic facilities and essential medicines by level of care. All control, equipment, providing dissemination appropriate of guidelines diagnostic for standard facilities precautions and essential and medicines infection prevention by level of and care. All this should be augmented with provider training to enhance their knowledge and skills. this control, should providing be augmented appropriate with diagnostic provider facilities training and to enhance essential their medicines knowledge by level and of skills. care. All this should be augmented with provider training to enhance their knowledge and skills. Report 2012/13] Page 99 [Annual [Annual Health Sector Performance Report Report 2012/13] 2012/13] Page 99 Page Page [Annual Health Sector Performance Report 2012/13 FY]

115 SECTION 4: ANNEX [Annual Health Sector Performance Report 2012/13] Page 101 [Annual Health Sector Performance Report 2012/13 FY] Page 95

116 3 ANNEX This section gives details of progress in implementation of priority activities under the; 1. Uganda National Minimum Health Care Package (UNMHCP) 2. Integrated Health Sector Support Systems [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

117 3.1 Delivery of the Uganda National Minimum Health Care Package (UNMHCP) Because of the limited resource envelope available for the health sector, the NHP II recommends that a minimum health care package be delivered to all people of Uganda. This package consists of the most cost-effective priority health care interventions and services addressing the high disease burden that is acceptable and affordable within the total resource envelope of the sector. The UNMHCP consists of the following cluster; (i) Health Promotion, Disease Prevention and Community Health Initiatives, including epidemic and disaster preparedness and response; (ii) Maternal and Child Health (iii) Prevention, Management and Control of Communicable Diseases and; (iv) Prevention, Management and Control of Non-communicable Diseases. This section analyses progress in implementation of the UNMHCP under the various clusters in relation to the relevant HSSIP 2010/ /15 core indicators, lead programme indicators of focus during 2012/13 FY, annual workplan indicators (process implementation), main achievements, challenges and recommendations Cluster 1: Health promotion, disease prevention, and community health initiatives Health Promotion and Education The key priority for health promotion and education is promoting individual and community responsibility for better health. Lead programme indicators Standards and guidelines (including criteria for gender sensitivity) for the production and delivery of IEC messages developed and disseminated among institutions by 2011/2012. The proportion of districts with trained VHTs increased from 31% to 100% by 2014/2015. The proportion of health facilities with IEC materials maintained at 100%. Key outputs 2012/13 IEC materials developed, printed and disseminated 5,000 posters Social mobilization activities conducted in the districts Hold quarterly meetings with health stakeholders Roll out the EPI communication strategy in the country districts VHTs established in 10 districts Orientation of district VHT training on new born care in 12 selected districts 240 VHTs Technical support supervision of VHT trainers Quarterly supervision of health educators carried out [Annual Health Sector Performance Report 2012/13] Page 103 [Annual Health Sector Performance Report 2012/13 FY] Page 97

118 Main Achievements Developed Marburg and Ebola IEC materials translated and distributed to districts - 3,500 posters. Developed IEC/BCC materials to support LLIN campaign and community sensitization on larviciding trails. Supported AHIP in development of advocacy video on 5 Zoonotic diseases. IEC materials on zoonotic diseases disseminated in the districts of Kisoro, Kabale, Kanungu, Rukungiri, Ntungamo, Mbarara and Isingiro. Supported in the review and update of nutrition health promotion materials. Conducted social mobilization for; UPDF activities including cleaning hospitals and safe male circumcision in Hoima, Kibaale, Gulu and Lira; for safe motherhood day in Kenjonjo; on prevention and control of Marburg in Kabale, Ibanda, Mbarara and Rukungiri districts; on Ebola in Luwero district (14 s/counties); for World AIDS Day in Rakai district; for the launch of Universal Distribution of LLINs and World Malaria Day in Soroti district; for Polio campaigns; sociological support to larviciding in Nakasongola; support to IRS in Ngora and Kumi; marking of World Fistula day in Soroti district; marking World Population Day in Ngora district; HIV Campaigns on the launch of Option B+ in Ntungamo and Lira districts; the African Vaccination week in the Busoga region; the launch of PCV vaccine in Iganga district. Mothers trained on child care prevention and control of diarrheal diseases in Kikoni Kampala. Conducted high level advocacy meetings with MPs, Religious leaders and media personnel in preparation for PCV introduction. Disseminated EPI communication strategy in North, Mid Western, South East, Eastern and Central Uganda involving 30 districts. VHT established in Sheema district and conducted ToT on VHT implementation in Sheema district Conducted IEC/ BCC quarterly meetings on HIV/AIDS & TB with stakeholders in Busoga region. Conducted orientation of district VHT trainers on New born care in 10 selected districts and 200 VHT trainers were trained. Conducted technical support supervision of VHT trainers in selected districts of Serere, Kaberamaido, Amuria, Katakwi and Amolatar. Technical support supervision carried out in Serere, Kaberamaido, Amuria, Katakwi and Amolatar, Kibuku and Kamuli districts, West Nile, Acholi Sub region, Bugisu, Eastern, Mid- Northern, and Lango Sub region. Challenges The single most important challenge has been inadequate and uncertain release and access to funds for implementation of planned activities, for example, only Shs. 8 million was accessed for VHT training in the whole year as opposed to about Shs. 250 million planned. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

119 Recommendations Maintenance of the Film vans used for mobilization and sensitization is a big problem due to lack of funds Technical capacity for health promotion both at the centre and districts need to be strengthened if the core mandates of the Division is to be achieved and maintained Control of Diarrheal Diseases Diarrheal diseases including acute watery diarrhea, cholera, dysentery and persistent diarrheal are mainly due to poor sanitation, low safe water coverage, poor domestic and personal hygiene practices and mass movement of populations. The main objective of the CDD component is to strengthen initiatives for control and prevention of diarrhea at all levels. Lead programme indicators of CDD The incidence of annual cases of cholera was 1.53/ 100,000 persons (5,232 cholera cases and Uganda population projection for FY of 34.1 million). The cholera specific case fatality rate 2.3% (5,232 cases and 121 deaths). The incidence of annual cases of dysentery reduced to 148/100,000 persons (A total of 50,453 endemic dysentery, non outbreak type. Epidemic dysentery incidence was zero). Dysentery specific case fatality rate. Acute watery diarrhoea specific case fatality rate Key Outputs 2012/13 Communities sensitized on diarrhea prevention and management. Guidelines for prevention and control of diarrhoeal diseases disseminated to communities. Health workers trained in early diagnosis/identification and confirmation, case management of diarrhoeal diseases. Diarrheal disease outbreaks controlled (cholera and epidemic dysentery) Main Achievements 2012/13 Districts and communities were supported to prevent and control diarrheal diseases and outbreaks through promotion effective interventions such as; breast feeding, safe water handling and use, provision of medicines for prevention and treat diarrhea, management of the sick, health education via (IEC, radio messages, meeting, demonstration of good practices etc.) Guidelines on prevention and control of cholera were disseminated with priority to cholera high risk districts Kasese, Bundibugyo, Ntoroko, Mbale, Tororo, Nebbi, Arua, Koboko, Buliisa and Hoima. Promotion and use of improved Oral Rehydration Salt and Zinc was stepped up (Restors and Zinkid) in collaboration with the private sector. ICCM address diarrhea diseases among others. [Annual Health Sector Performance Report 2012/13] Page 105 [Annual Health Sector Performance Report 2012/13 FY] Page 99

120 District with cholera outbreaks were supported with the resulting reduction in annual reported cholera cases compared to last year (see figure below). Consolidated gains in surveillance by capacity building of districts for early diagnosis / identification and confirmation of cholera outbreaks-enhanced surveillance. Most at risk districts were prioritized namely; Kasese, Rukungiri, Mbale, Manafwa, Tororo, Busia and Butaleja, Bundibugyo. Collaboration with Ministry of Water, Natural resources and environment was enhanced. Districts received guidance on priority setting for utilization of the sanitation grant to cause much impact. The priority was on water quality testing, building and maintenance of the water sources, open free defecation, home improvement campaigns among others. The use of new workable initiatives in the community was explored. For example purification of water to control cholera in Kasese district using sand filter was promoted. Kasese district: Safe water promotion harnessing simple, affordable technology in partnership with the local entrepreneur [Annual Health Sector Performance Report 2012/13] 100 Page [Annual Health Sector Performance Report 2012/13 FY] Page 106

121 Challenges Challenges Challenges Adverse weather conditions resulting in population displacement, destruction of sanitary Adverse weather conditions resulting in population displacement, destruction of sanitary Adverse facilities weather and contamination conditions resulting of water in sources. population This was displacement, quite pronounced destruction in Kasese of sanitary and facilities and contamination of water sources. This was quite pronounced in Kasese and facilities Ntoroko Ntoroko and districts. districts. contamination of water sources. This was quite pronounced in Kasese and Ntoroko Inadequate Inadequate districts. operation operation funds funds at at central central and and district district level level to to support support diarrheal diarrheal preventive preventive and and Inadequate control control activities. activities. operation Diarrhea Diarrhea funds can can at be be central prevented prevented and district through through level implementation to support diarrheal implementation of of elements preventive elements of of PHC. and PHC. control Inadequate Inadequate activities. human human Diarrhea recourses recourses can be in in prevented most most districts through to implement implementation priority of priority interventions. elements of PHC. interventions. Many Many Inadequate districts districts have have human gaps gaps in in recourses staffing staffing levels levels in most of of Health districts Inspectors, implement Health priority Assistants interventions. and and Public Public Health Many Health districts Nurses. Nurses. have gaps in staffing levels of Health Inspectors, Health Assistants and Public Health Nurses. Addressing the the challenges Addressing the challenges Through strengthening collaboration with other key stakeholder such as as MoLG, Water Through strengthening collaboration with other key stakeholder such as MoLG, Water Natural Resource and Environment, MoES, religious leaders, private sector etc Natural Resource and Environment, MoES, religious leaders, private sector etc Advocacy for for recruitment, deployment and retention of environment health staffs; Advocacy for recruitment, deployment and retention of environment health staffs; additional funding for preventive activities. additional funding for preventive activities Epidemic Epidemic Disaster Disaster Prevention, Prevention, Preparedness Preparedness and and Response Response (EDPPR) (EDPPR) The is to of The The MoH MoH is is mandated mandated to to play play a central central role role in in the the control, control, coordination coordination and and management management of of disease outbreaks. The EDPPR unit is is early reporting and and disease outbreaks. The EDPPR unit is responsible for prevention, early detection, reporting and and and prompt initial to of of public conformation and prompt initial response to health emergencies and other diseases of public health health health importance. Lead Lead Lead programme indicators Indicator Indicator Indicator Achievement Achievement 2010/ / / / / /13 The proportion of suspected disease outbreaks 52% 57% 61% The The proportion of of suspected disease outbreaks 52% 57% 61% responded to within 48 hours of notification responded to to within hours of of notification Proportion of districts with functional epidemic 76% 81% 82% Proportion preparedness of and of districts response with committees functional epidemic 76% 81% 82% preparedness and and response committees Proportion of districts with epidemic preparedness 62% 69% 73% Proportion plans of of districts with with epidemic preparedness 62% 69% 73% plans Timeliness plans of weekly reporting 82% 85% 84% Timeliness Completeness of of weekly of weekly reporting weekly 82% reports 87% 85% 88% 84% 84% 89% Completeness of of weekly weekly reports 87% 88% 89% 89% Key output 2012/13 FY Key Key output New output 2012/13 suspected FY disease FY outbreaks investigated. New Daily/weekly/monthly/ New suspected disease disease outbreaks IDSR/ investigated. NTF coordination meeting for prevention, mitigation and Daily/weekly/monthly/ control IDSR/ of public Health emergencies. IDSR/ NTF NTF coordination meeting for for prevention, mitigation mitigation and and control control of of public public Health Health emergencies. emergencies. [Annual Health Sector Performance Report 2012/13] Page 107 [Annual Health Sector Performance Report 2012/13] Page 107 [Annual Health Sector Performance Report 2012/13] Page 107 [Annual Health Sector Performance Report 2012/13 FY] Page 101

122 Rapid response to all major public health emergencies - ordering, supply and delivery of emergency medicines and supplies, conduct needs assessment, capacity support to affected districts. Conduct emergency technical support supervision and follow up of districts affected by disease outbreaks and epidemics. Guideline developed and disseminated to affected districts and communities. Main Achievements Over 11,000 Democratic Republic of Congo refugees were supported to resettle refugees in Kisoro and Kamwenge districts. Water quality testing, chlorination, outreach services to displaced communities and enhanced disease surveillance in addition to prepositioning of the buffer medical stocks in Kasese following the floods. Daily/ weekly/ monthly epidemic task force meetings were held to coordinate response and mobilize additional resources to support emergency activities. This was done at both national and district levels. Active and passive surveillance including tracing of contact cases and suspects for meningococcal meningitis, typhoid, measles, dysentery, Ebola, cholera, malaria and others. Timeliness of weekly district reporting stood at an average of 84% while health facility completeness was 89%. Technical support supervision was carried to all district affected with major PHEs and those at highest risk of outbreaks. The districts covered were: Arua, Koboko, Mbarara, Kibaale, Luwero, Kampala, Ibanda, the neighbouring districts to these and other border districts where movements were rampant. Capacity building (training of health workers) to effectively respond to PHEs was done in districts with disease outbreaks and those at highest risk especially neighbouring the affected districts and border districts. Destruction of vectors especially Simuliam flies (black flies) which are associated with the nodding disease syndrome. Research to better understand the factors related to disease outbreaks of Ebola in Luwero and nodding disease was done. Challenges 1. Serial outbreaks - one disease outbreak after the other within a period of less than six month against resource constraint. 2. Adverse weather conditions flush floods in Kasese district which destroyed properties and contaminated water sources and sanitary facilities. 3. Inadequate and/or late release of funds at national and district levels. There is no adequate standby fund to launch sufficient response to address a major PHE. Very often the sector reallocated funds from other planned activities which affect the annual plan. 4. Influx of refugees from neighbouring countries mainly from Democratic Republic of Congo. The refugees add to local needs and overwhelm the local capacity. 5. [Annual Emerging Health and Sector Remerging Performance disease Report outbreaks 2012/13] whose epidemiology is poorly understood Page 108 ecological studies on Ebola and research on nodding disease have not yet documented Cluster 2: Maternal and Child Health MCH cluster is composed of five elements; Sexual and Reproductive Health (SRH), Newborn 102 care, Page Common childhood illnesses, [Annual Health Immunization Sector Performance and Report Nutrition. 2012/13 This FY] emphasizes the link between maternal and child health and the cumulative nature of health problems through the entire lifecycle.

123 5. Emerging and Remerging disease outbreaks whose epidemiology is poorly understood ecological studies on Ebola and research on nodding disease have not yet documented Cluster 2: Maternal and Child Health MCH cluster is composed of five elements; Sexual and Reproductive Health (SRH), Newborn care, Common childhood illnesses, Immunization and Nutrition. This emphasizes the link between maternal and child health and the cumulative nature of health problems through the entire lifecycle Sexual and Reproductive Health and Rights The aim of the sexual and reproductive health and rights element is to reduce mortality and morbidity relating to sexual and reproductive health, and rights. The right to sexual and reproductive health rights programme is important as it aims at reducing maternal mortality ratio, perinatal, and total fertility rate, and improve sexual and reproductive health of the people which are all key elements for achieving the MDGs 4, 5 and 6. Core HSSIP Indicators Maternal Mortality Ratio (maternal deaths per 100,000 live birth) increased from 435/100,000 to 438/100,000 UDHS 2011 % pregnant women attending 4 ANC sessions. Achieved 31% 2012/13, HSSIP target 55% for 2012/13. % deliveries in health facilities. Achieved 41% 2012/13, HSSIP target 65% for 2012/13. % pregnant women who have completed IPT 2. Achieved 47% 2012/13, HSSIP target 60% for 2012/13. Contraceptive Prevalence Rate. Achieved 30% 2011/12 UDHS findings. Lead Programme Indicators The proportion of health facilities with no stock-outs of essential RH medicines and health supplies increased from 35% to 70% by The proportion of health facilities that are adolescent-friendly increased from 10% to 75% by The % of health facilities with Basic and those with Comprehensive emergency obstetric care increased from 10% to 50% by The proportion of pregnant women accessing comprehensive PMTCT package increased from 25% to 80%. The unmet need for FP reduced from 41% to 20% by The rate of adolescent pregnancy reduced from 24% to 15% by Key output Indicators 2012/13 EmONC lifesaving medicines, FP equipment and commodities procured and distributed to health facilities [Annual Health Sector Performance Report 2012/13] Page 109 [Annual Health Sector Performance Report 2012/13 FY] Page 103

124 Referrals for RH services improved Technical support supervision conducted in all districts Conduct maternal and perinatal death reviews in all hospitals Conduct Community sensitization and mobilization using radio talk shows Support Midwives and VHTs to identify and register all pregnant mothers. Main achievements There has been increased funding especially by the GoU from $ 3.3 million to $ 6.9 million. The DPs also increased funding for these commodities as follows: UNFPA $ 7.5 M and USAID $ 8 M. This has greatly improved availability of RH commodities including contraceptives thus reducing stock out rates at facilities. Government procured RH commodities including contraceptives worth USD 12.2 million (including USD 8.6 million from the World Bank) in 2012/2013. UNFPA procured RH commodities worth USD 3.7 million while USAID procured RH commodities worth USD 4 million. Emergency Obstetric and Neonatal Care equipment worth USD 2 million was procured and delivered in the country. Equipment worth approximately USD 2 million is in transit and will be distributed to 230 Government health facilities (65 Hospitals and 165 HC IVs). UNFPA also procured equipment for 8 UNFPA supported districts up to HC IIIs worth USD 700,000. A total of 27 ambulances and 3 tricycles were procured using funds from UNFPA, ICB -BTC and SMGL partners supported by USAID and CDC. Procured 18 regional Radio stations to mobilize the community to increase demand of RH services country wide. 474 maternal deaths and 161 perinatal death reviews were carried out in all RRHs and selected GHs. 17,925 VHT registers procured and distribution ongoing supported by UHSSP During the FY 2013/14, health providers will be mentored on the new technologies and new equipment on Emergency Obstetric and Newborn Care, Post abortion Care, Long Term and Permanent FP and scale up MPDR. Challenges Inadequate critical cadre of Health workers to offer RH services at all levels Long procurement processes Low demand for Reproductive Health services. Lack of vital tools like partograph, MPDR and side effects management protocols The new financial guidelines that require allowances to be paid directly to participants / beneficiaries Human Rights and Gender Mainstreaming Health, human rights and gender mainstreaming is mandated with institutionalizing human rights and gender into the health sector, at decision making and at all levels of service delivery. [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

125 Lead Programme Indicators Health service provision for survivors of rape scaled up in all district hospitals and 50% of HC IIIs. PEP Kits available in all district hospitals and 50% of HC IIIs. Health workers trained in clinical management of survivors of rape increased to 25% by Key output Indicators 2012/13 Mainstream gender and human rights at decision making and service delivery levels Integrating gender and human rights in planning and implementation in the sector Main Achievements Developed sexual and gender based violence (SGBV) safety centres guidelines Established five SGBV safety centres in the five regional referral hospitals (Moroto, Lira, Gulu, Masaka, and Mbarara). Pilot tested the health, human rights and gender manual for health professionals in two training sites. Sensitized senior management committee of MoH on health, human rights and gender Developed a trainers guide for the HR and G manual for health professionals manual. Challenges Funding for programme activities was not forth coming, hence implementation relied on other sector funds for program development and implementation The HHR &G focal office lacked tools to facilitate work Recommendations Health human rights and gender should as well be given priority just like any other program development work Set aside funds to facilitate implementation of gender and human rights work Newborn and Integrated Child Survival The aim of Newborn and Integrated Child Survival element is to increase coverage of high impact evidence based interventions order to accelerate the attainment of MDG 4, promote proper growth and early child development. Core HSSIP indicators Neonatal Mortality rate (per 1,000 live births). Achieved 27% Infant Mortality Rate (per 1,000 live births). Achieved 54% Under 5 mortality rate (per 1,000 live births). Achieved 90% U5s with malaria treated correctly within 24 hrs. [Annual Health Sector Performance Report 2012/13] Page 111 [Annual Health Sector Performance Report 2012/13 FY] Page 105

126 Lead programme indicators (Process) Children aged 0-59 months with suspected pneumonia receiving appropriate antibiotics increased from 30% to 47% by (UDHS 2011) Children aged 0-59 months with diarrhoea in the last two weeks treated with ORS and Zinc increased from 2% to 50% (ORT 48%, Zinc 2%). Problem of availability of zinc. Since 2011/12 FY MoH through NMS is supplying zinc to health facilities. Newborn/mother pair checked twice in 1 st week of life (1 st visit within 24 hours) increased from 26% to 33%. UDHS 2011 Facilities managing children using IMNCI standards. Achieved 52% in 2011/12 ICCM trained VHTs with zero stock out of essential medicine (ORS, Zinc, Amoxicillin, 1 st line ACT and rectal artesunate). Key output Indicators 2012/13 Mid Level Managers training on managing child health programs and through the UNICEF/CODES child health district service management project in five districts. Printed 450 copies of the MCH handheld records/passport and distributed them to 13 districts. Also developed a user and implementers guideline for the MCH passport A landscape analysis of plans, programs and commodities for child, newborn, maternal and RH was conducted. This analysis will lead into development of a more sharpened integrated costed RMNCH plan. In addition a plan was developed and submitted to the UN commission on life saving commodities for women and children. Two quarterly child health dialogues were also developed and disseminated. Main achievements 2012/13 All districts in Uganda implement two rounds of Child Health Days but with varying degrees of performance. A proposal for assessment of impact of mass deworming was developed but is yet to be conducted due to lack of funds Introduced policy for co-packaging of ORS and Zinc plus Zinc distribution as OTC medicine for childhood diarrhoea management Developed tools for conducting a study on quantification of ICCM medicine and commodities survey. Updated IMCI guidelines to include newborn screening and management of sickle cell disease in under fives. Developed mentoring guidelines for Helping Babies Breathe curricula. An integrated in-service training package Helping Babies Breathe (HBB) guidelines incorporating newborn resuscitation, examination of normal newborn care, preterm and sick newborn care was used to mentor 116 facility staff and supplied them with mannequins, ambubags and suction bulbs Adopted and introduced QI in newborn health training using the collaborative approach Revised and introduced policy for use of antenatal corticosteroids for stimulation of lung maturation and management of premature labour [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

127 The national multi-disciplinary advisory committee continued to advocate for and coordinate different efforts to improve newborn health including introduction of standards based facility assessment/audit in 8 districts, review and dissemination of newborn/perinatal death audit tools in 32 districts to strengthen the reduction of avoidable deaths at the facility Post-natal home visits by VHT during the first week were introduced in 35 districts through VHT iccm trainings supported by UNICEF, Malaria consortium and International Rescue Committee etc. The adaptation of the WHO iccm computer assisted learning (ICATT) was finalized and the referral/hospital IMCI pocket book revised based on new evidence from WHO. Training on Emergency Triage and Treatment (ETAT) was conducted to improve severe illness case management. Challenges Challenges have been mostly in the area of logistics management, monitoring performance and overage, district ownership of the program, coordination of key players and inadequate long term planning plus political support. Partners support most activities for newborn health and newborn activities are not well integrated in district plans and other quality improvement activities. High turnover of staff in districts and health units which affects the attainment of a critical mass of trained staff in the units. Inadequate resources for training, production of training and other implementation materials further limited district training, supervision and monitoring activities. Irregular technical supervision and monitoring activities affecting institutionalization of IMCI and continued improvement of IMCI. Low implementation of community IMCI affecting family care practices including timely and correct care seeking. Implementation of iccm is highly dependent on existence of VHTs, many districts are yet to roll out the VHT strategy, inadequate funds for production of job aids, registers for VHTs; supervision of VHTs by facility staff is very limited, medicine supply for VHTs is mostly by partners and the NMS has not started distributing supplies. Recommendations 1. Strengthen Child Days Plus planning, implementation and monitoring especially quality of data, finalize the communication plan, develop and disseminate relevant IEC materials; develop a five year implementation plan and capacity building for CDP; integrated CDP in national budgets and all district plans, expand partnerships for CDP including other sectors and private sector, conduct operational research on CDP including cost effectiveness studies to inform the improvement of implementation 2. Expand the pool of national and regional newborn clinical and perinatal death audit teams. NGOs to champion and support lower level health facilities and communities in the catchment area to assess newborn health standard, introduce and maintain quality improvement approaches in these units. [Annual Health Sector Performance Report 2012/13] Page Mobilize existing resources to integrate or build on newborn activities. 4. Review the IMCI implementation framework to reflect new development and build district management capacity for child health programming in general and implementing IMCI in particular. 5. Building awareness of the right to health and survival of newborns and under fives through [Annual Health Sector Performance Report 2012/13 FY] Page 107 an advocacy plans and materials, partnerships and alliances with professional bodies in obstetrics and neonatology, private sector, other sectors.

128 improvement approaches in these units. 3. Mobilize existing resources to integrate or build on newborn activities. 4. Review the IMCI implementation framework to reflect new development and build district management capacity for child health programming in general and implementing IMCI in particular. 5. Building awareness of the right to health and survival of newborns and under fives through an advocacy plans and materials, partnerships and alliances with professional bodies in obstetrics and neonatology, private sector, other sectors Expanded Programme for Immunization The mission of UNEPI is to contribute to the reduction of morbidity and mortality due to childhood diseases to levels where they are no longer of public health importance. The programme objective therefore is to ensure that all children are fully immunized against the vaccine preventable diseases before their first birthday and all babies are born protected against neonatal tetanus. Core HSSIP indicators % children under one year immunized with 3 rd dose pentavalent vaccine. Achieved 87%, 2012/13 target (85%) % one year old children immunized against measles. Achieved 85%, 2012/13 target (85%) Lead programme indicators Neonatal tetanus rates reduced and maintained at zero. Non Polio Acute flaccid poliomyelitis rates maintained at greater than 2 per 100,000, and cases of paralysis due to wild polio virus maintained at zero. Main Achievements The Immunization Communication Strategy was developed and has been rolled out to over 50% of the districts for implementation. A Costed draft Policy on immunization has been developed and is in the final stages of approval. Training guidelines for the introduction of the PCV were developed, printed and distributed to all districts. 400 copies of Immunization practice in Uganda manuals were printed and distributed both at the centre and to districts Health workers have been trained in 82 districts in PCV introduction into routine immunization. Training for 81 EPI Mid Level Managers (MLM) for Mubende, Bunyoro and Busoga sub regions Recruited 3 mentors who have continuously mentored the trained MLM in the areas of disease surveillance, data management and routine immunization Trained 197 health workers in Operational Level Health Workers (OPL) course in districts of [Annual Health Sector Performance Report 2012/13] Page 114 Busia, Iganga, Kabale, Kapchorwa and Rukungiri. HPV vaccination is being done in 14 districts: Busia, Bududa, Katakwi, Kayunga, Lira, Oyam, Trained national RED Trainers using external consultants for regions of Masaka, Bunyoro and West Nile. Capacity building workshops on RED implementation were provided to 20 districts to 108 address Page the issue of high [Annual numbers Health of Sector un-immunized Performance children Report 2012/13 FY] Nebbi, Mityana, Kamwenge, Isingiro, Ntungamo, Rukungiri, Nakasongola and Ibanda. All these districts conducted 3 rounds of HPV vaccination among the targeted girls. Conducted measles and polio campaigns.

129 Trained 197 health workers in Operational Level Health Workers (OPL) course in districts of Busia, Iganga, Kabale, Kapchorwa and Rukungiri. HPV vaccination is being done in 14 districts: Busia, Bududa, Katakwi, Kayunga, Lira, Oyam, Trained national RED Trainers using external consultants for regions of Masaka, Bunyoro and West Nile. Capacity building workshops on RED implementation were provided to 20 districts to address the issue of high numbers of un-immunized children Nebbi, Mityana, Kamwenge, Isingiro, Ntungamo, Rukungiri, Nakasongola and Ibanda. All these districts conducted 3 rounds of HPV vaccination among the targeted girls. Conducted measles and polio campaigns. Conducted AFP surveillance which is a foundation for IDSR activities in the country. At the national level polio certification indicators have been achieved. One external in depth surveillance review was conducted; recommendations made and key activities were implemented to strengthen AFP surveillance system within the national IDSR system. Established two regional EPI/IDSR support supervision hubs as an interface to strengthen AFP and EPI surveillances in a group of districts. A total of nine regions (Arua, Hoima, Kabale, Mbarara, Masaka, Jinja, Kabarole, Mbale and Soroti) are currently supported by WHO financially and technically. Conducted cold Chain maintenance in all the districts of Uganda. Repair of the cold rooms at the central vaccine store was done GAVI supported government to introduce new vaccines into routine immunisation program. These include the pneumococcal vaccine (PCV) that was launched in Uganda in April, There has been increased involvement of politicians in issues pertaining to immunization more so through the Uganda Parliamentary Forum for Immunization (UPFI) at national level and tabling of the motion on immunization bill in parliament. In order to meet the goals of Polio Eradication Initiative (PEI) two (2) rounds of SIAs House to House polio campaign were conducted in 2012 in 37 districts Challenges Inadequate and delayed release of funds Human Resource constraints at all levels Low stock levels of vaccines at district level due to wrong quantification Inadequate monitoring tools like Child Health Cards, TT cards, Child Registers, Vaccine and Injection Materials Control Books and Tally sheets Emerging resistant groups against immunization e.g. Triple 6 (Gospel Church) in Eastern Uganda Lack of transport e.g. vehicles and motorcycles for EPI activities at all levels Inadequate social mobilization activities for uptake of routine immunization services Lack of a budget line for procurement of cold chain spare parts and tools Operation funds for immunization program not protected at all levels [Annual Health Nutrition Sector Performance Report 2012/13] Page 115 Implementation of nutrition interventions to scale up delivery of nutrition services involves the MoH and other stakeholders. Core HSSIP indicator % U5 children with height /age below lower line (stunting). Achieved 33%, UDHS 2011 % U5 children with weight /age below lower line (wasting). Achieved 14%, UDHS 2011 Lead programme indicators Maternal Infant and Young Child Feeding practices improved (Exclusive breastfeeding, Timely introduction [Annual of complementary Health Sector Performance feeds). Report 2012/13 FY] Page 109 Accessibility to appropriate and gender sensitive nutrition information and knowledge increased. Vitamin A Supplementation coverage among children 6-59 months.

130 Core HSSIP indicator % U5 children with height /age below lower line (stunting). Achieved 33%, UDHS 2011 % U5 children with weight /age below lower line (wasting). Achieved 14%, UDHS 2011 Lead programme indicators Maternal Infant and Young Child Feeding practices improved (Exclusive breastfeeding, Timely introduction of complementary feeds). Accessibility to appropriate and gender sensitive nutrition information and knowledge increased. Vitamin A Supplementation coverage among children 6-59 months. Households consuming fortified foods (Salt, cooking oil, wheat flour) increased. Nutrition services to health units and the community scaled up. Key Outputs Indicators 2012/13 Dissemination of nutrition messages through media Improve coordination among the different stakeholders in addressing nutrition interventions Commemoration of the World Breastfeeding Week and other Nutrition days Strengthening Baby Friendly Health Initiatives for optimal Infant and Young Child Feeding Follow up and supporting factories to enforce the Mandatory Regulations on food fortification Finalization of the comprehensive guidelines on prevention, management and control of micronutrient deficiencies Main achievements At total of 5 different Nutrition messages were disseminated through media, nationwide through radio spots for 20 days on 10 radio stations. The World Breastfeeding Week 2012 commemorated in August with the MoH as the guest of honour. Over 100 religious leaders sensitized during the commemoration. There was a training of health workers on BFHI in 10 districts in Northern Region. Followed up and supported 12 industries to implement the Mandatory Regulations on Food Fortification by 1 st July Micronutrient guidelines were also developed and in final processes now. Challenges The main challenge was delay of funds and some not being released as per the work plan. While the funding is still low for nutrition, there are also challenges with low staffing and inadequate coordination. [Annual Health Sector Performance Report 2012/13] Page 116 Recommendations There is need to increasing on the funding to bridge the challenges that are currently back stopping the key interventions that have been identified. More efforts also should be focus on public sensitization and education through different channels including media among others. There is also need to address the human resource gaps for nutrition at all levels Prevention and Control of Communicable Diseases The priority health care interventions in the cluster of prevention and control of communicable diseases include; prevention and control of STI/HIV/AIDS; prevention and control of malaria; prevention and control of tuberculosis and elimination and or eradication of some particular diseases such as Leprosy, guinea worm, onchocerciasis, trachoma, lymphatic filariasis, 110 trypanosomiasis, Page soil transmitted [Annual helminthes Health Sector and Performance schistosomiasis. Report 2012/13 FY] The overall objective for the communicable cluster is to reduce the prevalence and incidence of communicable diseases by at least 50% and thus contribute towards achieving the health

131 There is also need to address the human resource gaps for nutrition at all levels Prevention and Control of Communicable Diseases The priority health care interventions in the cluster of prevention and control of communicable diseases include; prevention and control of STI/HIV/AIDS; prevention and control of malaria; prevention and control of tuberculosis and elimination and or eradication of some particular diseases such as Leprosy, guinea worm, onchocerciasis, trachoma, lymphatic filariasis, trypanosomiasis, soil transmitted helminthes and schistosomiasis. The overall objective for the communicable cluster is to reduce the prevalence and incidence of communicable diseases by at least 50% and thus contribute towards achieving the health related MDGs Prevention and Control of STI/HIV/AIDS The STD/AIDS Control program continued to implement the Public Health Response to the HIV/AIDS epidemic. Objectives of the Uganda AIDS Control Programme To prevent further transmission of the STD/HIV/AIDS epidemic To mitigate the impacts of HIV/AIDS through the provision of care and support to the infected and affected. To strengthen capacity for HIV/AIDS prevention and control at the national, district and community levels. Core HSSIP indicators Proportion of children exposed to HIV from their mothers access HIV testing within 2 months 2012 was 39% against the NSP target of 50% by 2015 Number and proportion of eligible persons receiving ART. In FY 2012/13, the performance on this indicator was 76%- a total of 566,444 people were on ART out of 740,000 who were in need. Lead programme indicators The proportion of people years who know their HIV status increased for women from 13% in 2005 to 66% in 2011 and for men from 11% in 2005 to 44%. The proportion of people who are on ARVs increased from 63% in 2011 to 76% in 2013 among adults and from 27% to 36% in children less that 15 years of age. HCT services are available in all hospitals and HC IVs, 80% of HC IIIs and in about 30% of HC [Annual IIs. Overall, Health Sector 38% of Performance health facilities Report have 2012/13] HCT services. Page 117 PMTCT services are available in all health facilities up to HC IIIs and 20% of HC IIs (% of health facilities with PMTCT services; % of HC IIs with PMTCT services). ART services available in all health facilities up to HC IV and 20% of HC III. This is an improvement from 89% of HC IVs and 8% of HC IIIs and 2% of HC IIs who had ART services by the end of 2011 Reduce the HIV prevalence from 6.4% to 5.5% in the general adult population (15-49 years). Key output Indicators 2012/13 Number of safe male circumcisions performed (400,000/1,000,000) Number of ART sites accredited to increase access to ART services Number of health workers trained in HIV Care and treatment Annual Antenatal HIV surveillance conducted. Major Achievements [Annual Health Sector Performance Report 2012/13 FY] Page 111 Finalized and implemented the Comprehensive HIV/AIDS communication Strategy. Carried out campaigns on the Elimination of mother to Child Transmission of HIV and HIV

132 Number of ART sites accredited to increase access to ART services Number of health workers trained in HIV Care and treatment Annual Antenatal HIV surveillance conducted. Major Achievements Finalized and implemented the Comprehensive HIV/AIDS communication Strategy. Carried out campaigns on the Elimination of mother to Child Transmission of HIV and HIV Counseling and Testing. Talk-shows were conducted nationally and at district levels on FM radio stations to create awareness of the of the HIV/AIDS epidemic. HIV/AIDS messages were also disseminated on Television and in radio spots on primary prevention and for promotion of uptake of services. Quantification and procurement and distribution of condoms both through the public and social marketing were conducted. Approximately 120 million male condoms were received between January and July Distribution through the public and social marketing were aimed at increasing demand for male and female condoms, improving access and utilization, strengthening the condom supply chain management, as well as monitoring and evaluation. To improve access to treatment, the ACP accelerated accreditation of health facilities, introduced and trained health workers in all regions in Web based ordering of ARVs and rationalized the supply chain to improve logistics for procurement, warehousing and distribution of drugs and laboratory commodities. In addition, the number of facilities providing ART was 1,073 at the end of June These facilities include two national referral, 13 RRHs, 114 general/district hospitals, and 187 (100%) HC IVs, and 700 out of 1,114 (63%) HC IIIs and 2 out of 3,008 HC II. The number of individuals accessing ART were 566,123 (76.5% coverage) by end of June The program rolled the implementation of the EMTCT plan in the Country. Activities for roll out included training of health workers in all regions of the Country, distribution of drugs and commodities, mentorship and supervision of health workers involved in the programs. [Annual Health Sector Performance Report 2012/13] Page 118 The First Lady of Uganda was co-opted in these activates and working with the MoH was able to perform a national launch of the roll out in Ntungamo district as well as conduct high profile regional EMTCT campaigns in Lira, Tororo and Moroto districts for the respective regions. As of March 2013, 2,138 health facilities (48%) were providing PMTCT services, including 129 hospitals, 187 HC IV and 1,034 HC III and 733 HC II. Among 53,451 pregnant women who received ARVs between October 2012 and March 31 st 2013 at 2,087 sites, 33% received PMTCT option A, 38% received option B+ and 29% were already on ART before their first ANC. Aproximately 400,000 men were circumcised. The implementation of SMC is done through a combination of surgery in static health facilities and out-reach surgery in camps. The program is manly supported through PEPFAR support that supports the bulk of the activities through a range of implementing partners. In order to improve on the efficiency in delivery of services, the ACP participated in Health systems strengthening activities. These included strengthening of the coordination of ACP activities, supply chain rationalization of HIV drugs and other health commodities, increased coverage of laboratory services by establishment of 78 hubs for sample transportation, accreditation of health centres to provide HCT, PMTCT, and ART services, ARV web-based ordering and reporting for commodities; establishment of the Regional Performance Monitoring Teams, recruitment of Health Workers with support from the Global Fund and PEPFAR and rationalization of Implementing Partners to improve coordination in the 112 Page [Annual Health Sector Performance Report 2012/13 FY] decentralized response. These activities improved the delivery of services for HCT, EMTCT, SMC and ART. Challenges

133 systems strengthening activities. These included strengthening of the coordination of ACP activities, supply chain rationalization of HIV drugs and other health commodities, increased coverage of laboratory services by establishment of 78 hubs for sample transportation, accreditation of health centres to provide HCT, PMTCT, and ART services, ARV web-based ordering and reporting for commodities; establishment of the Regional Performance Monitoring Teams, recruitment of Health Workers with support from the Global Fund and PEPFAR and rationalization of Implementing Partners to improve coordination in the decentralized response. These activities improved the delivery of services for HCT, EMTCT, SMC and ART. Challenges Condom programs were however constrained by the slow pace of post shipment testing, resulting in small quantities of commodities being available for distribution Tuberculosis Tuberculosis remains a major public health problem in Uganda. Efforts to control TB in the country are being compounded by the emerging Multi Drug Resistant Tuberculosis (MDR TB) problem, and the high HIV prevalence of 7.3% among the general population (2011 serosurvey) and over 50% of TB patients are co-infected with HIV (2011 TB cohort). The aim of the TB program is to reduce the morbidity, mortality and transmission of tuberculosis. Core HSSIP indicators % new smear positive cases notified compared to expected. Achieved 57.2% in 2011/12, target 60% in 2011/12. Lead programme indicators Case Detection Rate (CDR). Achieved 54.5% % in 2012/13, target 60% in 2012/13. [Annual Treatment Health Success Sector Performance Rate (TSR). Achieved Report 2012/13] 77% in 2012/13, target 78% in 2012/13. Page 119 Cure Rate. Achieved 39% in 2011/12 target was 45%. % TB patients tested for HIV. Achieved 89% in 2012/13, target 80% in 2012/13. % HIV + TB patients started on CPT. Achieved 95% in 2012/13, target 90% in 2012/13. % of HIV + TB patients started on ART. Key output Indicators 2012/13 Initiate and roll out programmatic management of multi drug resistant TB Commemorate the world TB and leprosy days Conduct performance review meetings at the National and operational Zonal levels Conduct quarterly technical support supervision and mentorships on services and TB commodities Revise the TB/HIV policy guidelines Main achievements Management of MDR TB was initiated and strengthened at 9 sites namely Mulago National Hospital, Mbarara RRH, Mbale RRH, Masaka RRH, Fort Portal RRH, Gulu RRH, Arua RRH, Kitgum GH and Iganga GH. There are currently over 120 patients on treatment at different sites in the country. A mixed Model of management for MDR strategy was adopted to allow for both hospitalization and ambulatory treatment of Drug resistant TB patients at the same time. This has allowed MDR TB patients to be initiated and treatment centres and followed up at nearby health facilities. The International Leprosy day and World TB day were commemorated in Luuka and Masaka Districts respectively. Trainings on MDR TB management were done for Mulago National Hospital, Mbarara RRH, Mbale RRH, Masaka [Annual RRH, Fort Health Portal Sector Performance RRH, Gulu Report RRH, 2012/13 Arua RRH, FY] Kitgum GH and Iganga PageGH Gene xpert machines supported by FIND and UCMB introduce and deployed under TB reach project NTRL certified as a Supra National Laboratory ( SRL ) for the region by WHO

134 hospitalization and ambulatory treatment of Drug resistant TB patients at the same time. This has allowed MDR TB patients to be initiated and treatment centres and followed up at nearby health facilities. The International Leprosy day and World TB day were commemorated in Luuka and Masaka Districts respectively. Trainings on MDR TB management were done for Mulago National Hospital, Mbarara RRH, Mbale RRH, Masaka RRH, Fort Portal RRH, Gulu RRH, Arua RRH, Kitgum GH and Iganga GH 4 Gene xpert machines supported by FIND and UCMB introduce and deployed under TB reach project NTRL certified as a Supra National Laboratory ( SRL ) for the region by WHO All quarterly performance review meetings were conducted for the National and all Zones and all districts reports on TB and leprosy received Technical support supervision was done in selected health facilities in the country side, and some prison health facilities to strengthen their TB control and TB IC practices Revised TB/HIV guidelines to ease collaboration, coordination and integration of TB/HIV services for the benefit of co infected patients and HIV patients presumed to have TB Progress was made in the implementation of the National TB prevalence survey, with the MoH entering into a memorandum of understanding with the School of Public Health Leprosy Control Main achievements 2012/13 [Annual 309 Health new patients Sector Performance notified in Report Of 2012/13] which 258 were of advanced disease (Multi Page bacillary 120 leprosy) and 51 were of pauci-bacillary leprosy There were 23 child leprosy patients indicating continued transmission of leprosy. There were adequate supplies of leprosy medicines donated by WHO and leprosy surveillance and contact tracing was conducted supported by German TB and leprosy relief association Challenges Inadequate funds for programme running Inadequate staffing and office space Procurement delays for of medicines and essential health supplies MDR TB rollout- Many patients need to be put on treatment enablers such as food, transport, training TB IC supplies are critical Limited community involvement to TB care due to funding and low awareness. The TB/Leprosy program is grossly underfunded to function fully Low community awareness about TB and Leprosy Late leprosy diagnosis, with Permanent disabilities. Recommendations Need to increase allocations for TB leprosy operational activities and allocate special fund for MDR TB management to support scale up of MDR TB. Need to advise or authorize RRHs to commit resources to support the feeding of MDR TB patients. Need to support strengthening of community involvement for TB and leprosy control Malaria The mandate of the National Malaria Control Programme (NMCP) is to control and prevent malaria morbidity and mortality, and thereby minimize the social effects and economic losses attributable to malaria in the country. The NMCP implements a combination of proven cost effective interventions against malaria with emphasis on both prevention and prompt 114 treatment Page to prevent deaths. [Annual Health Sector Performance Report 2012/13 FY] Core Indicators The proportion of pregnant women who have completed IPT 2 uptake.

135 Malaria The mandate of the National Malaria Control Programme (NMCP) is to control and prevent malaria morbidity and mortality, and thereby minimize the social effects and economic losses attributable to malaria in the country. The NMCP implements a combination of proven cost effective interventions against malaria with emphasis on both prevention and prompt treatment to prevent deaths. Core Indicators The proportion of pregnant women who have completed IPT 2 uptake. The proportion of under-fives with fever who receive malaria treatment within 24 hours from a VHT. Lead program indicators Reduce the prevalence of malaria among the under fives from 44.7% to 20%. The percentage of under-fives and pregnant women having slept under an LLIN the previous [Annual night Health increased Sector from Performance 32.8% to 80% Report and 2012/13] from 43.7% to 80% respectively. Page 121 Proportion of households sprayed with insecticide in the last 12 months increased from 5.5% to 30% by Proportion of households with at least one LLIN increased from 46.7% to 85% in The case fatality rate among malaria in-patients under five reduced from 2% to 1% by Key Outputs 2012/13 Hold general staff meetings, planning and review meetings Procure anti malarial commodities like ACTs and RDTs Commemorate important global and national days/events Distribute Long Lasting Insecticide Nets (LLINs) to achieve Universal Coverage Conduct operational research on efficacy and safety of mosquito larvicides Carry out Indoor Residual spraying in 10 districts in Northern Uganda and 2 in eastern Uganda Carry out cross cutting supporting interventions for malaria prevention and control Main achievements World Malaria Day was commemorated together with the official launch of the LLIN Universal Coverage campaign in Soroti district Procured 21 Million LLINs for Universal Coverage. In addition 651,860 LLINs were distributed in Bugiri, Mayuge, Kaliro and Serere districts. With support from World Vision LLINs for universal coverage were distributed in Soroti and Busia districts. Routine fill-in continuous distributions through ANC clinics was conducted in 34 districts IRS was conducted in 10 districts of Northern Uganda. Approximately 850,000 houses were sprayed twice with up to 92% coverage, protecting about three million people. 1 round of spraying was done in Kumi district. There was remarkable reduction of indoor resting vector population reduction as well as remarkable reduction of malaria prevalence in target districts. Small scale efficacy and safety trials of 3 candidate larvicides were conducted in Wakiso district. Large scale trials commenced in Nakasongola district. 70,000 torches and 140,000 batteries were procured and distributed to VHTs as a motivational package in the whole country. The beneficiaries were VHTs who are active in Home Based Management of Malaria. Training of health workers in integrated management of malaria was conducted countrywide. Support supervision was done in selected health facilities in all the districts of the country. The Ministry adapted a new treatment policy introducing a safer, easy to administer and more efficacious medicine to treat severe malaria. Under the Affordable medicine facilitymalaria (AMFm) over 30 million doses of subsidized ACTs were procured for both the public [Annual Health Sector Performance Report 2012/13 FY] Page 115 and private sector.

136 70,000 torches and 140,000 batteries were procured and distributed to VHTs as a motivational package in the whole country. The beneficiaries were VHTs who are active in Home Based Management of Malaria. Training of health workers in integrated management of malaria was conducted countrywide. Support supervision was done in selected health facilities in all the districts of the country. The Ministry adapted a new treatment policy introducing a safer, easy to administer and more efficacious medicine to treat severe malaria. Under the Affordable medicine facilitymalaria (AMFm) over 30 million doses of subsidized ACTs were procured for both the public and private sector. Cross cutting supporting interventions including advocacy, social mobilization and [Annual behavioral Health Sector change Performance communication, Report monitoring 2012/13] and evaluation, drug efficacy studies Page 122 and drug resistance monitoring were conducted. Challenges Inadequate funds for programme running Inadequate staffing and office space Procurement delays of medicines and essential health supplies Vehicle fleet is very old and expensive to maintain Emergence of Insecticide resistance especially Pyrethroids Key Recommendations Timely disbursement and front-loading of funds for seasonally related activities such as IRS and Larviciding Fill in vacant staffing positions at the NMCP Increase domestic funding for malaria control activities Diseases Targeted for Elimination The diseases targeted for elimination and/or eradication include: poliomyelitis, guinea worm, onchocerciasis, measles, leprosy, trachoma, lymphatic filariasis, trypanosomiasis and schistosomiasis. The overall objective for this cluster is to achieve national and global targets for elimination or eradication of targeted diseases Sleeping Sickness Lead Program indicators Access to diagnostic procedures and treatment of sleeping sickness for communities to increase from 40% to 80% by Key output Indicators 2012/13 Surveys in all sleeping sickness outbreak districts. Supervision of treatment for sleeping sickness in 15 endemic districts Main achievements 2012/13 Surveys done in Kaberamaido, Dokolo, Kole, Alebtong, Otuke, Kibuku and Namutumba districts. Supervision conducted in 9 treatment centres in T. rhodesiense focus. 116 Page [Annual Health Sector Performance Report 2012/13 FY] [Annual Health Sector Performance Report 2012/13] Page 123

137 Guinea Worm Eradication Programme Mandate of the Programme 1. Maintain zero transmissions status following certification of guinea worm eradication by continuing to advocate for provision of safe drinking water, stepping up active surveillance, case search and close support supervision to the 16 formerly guinea worm endemic districts 2. To contain 100% of any Guinea worm case that may be reported by continuous sensitization of health workers and communities, Lead Program indicators Simulium nivae eliminated in all endemic districts in Uganda. At least 75% therapeutic coverage in all affected communities and 100% geographic coverage achieved in endemic districts CDTI activities integrated within their district health plans in all endemic districts to sustain integration. Key Outputs A new Cash reward developed, announced and publicised Guinea worm rumours Investigated and reported as they come Integrate Guinea worm surveillance with other programmes Hold Cross border meetings with Counterparts in neighbouring countries. Quarterly support supervision to the 16 formerly endemic districts Support the National Certification Committee to perform bi- annual supervision. Main Achievements Cash reward Increased from 100,000/= to 500,000/= per confirmed case. 56, 000 Posters for announcing new reward developed, printed and 10,000 distributed One cross border meeting held at Entebbe One meeting to integrate surveillance activities held with IDSR Two support supervisions held in Northern and West Nile regions. Supervision by the NCC held in Northern and West Nile regions. Challenges Lack of reliable vehicle in the programme continued to interfere with supervision and proper response to rumours. Inadequate funding has forces to ration technical support supervision Recommendations The programme will continue with reward publicity the next FY. The programme will continue to press the authorities or WHO to allocate it a sound vehicle which can do long distance running The programme should be supported with more funds in order to sustain close supervision [Annual and publicity Health Sector the new Performance reward Report 2012/13] Page Veterinary Public Health The mandate of VPH unit is to prevent and mitigate the impact of zoonotic diseases thereby improving the health of the population of Uganda. The most notable are; Highly Pathogenic [Annual Health Sector Performance Report 2012/13 FY] Avian influenza (H5N1), pandemic influenza H1N1, Severe Acute Respiratory Syndrome Page (SARS), 117 Bovine Spongiform Encephalopathy / variant-creutzfeld-jakob Disease (Mad Cow Disease). In Uganda, outbreaks of Ebola Heamorrhagic fever (HF) and Marburg HF have occurred with increasing frequency in the last five years. There has also been a re-emergency of anthrax,

138 3.1.7 Prevention and Control of Non-communicable Conditions The programme should be supported with more funds in order to sustain close supervision and publicity the new reward Veterinary Public Health The mandate of VPH unit is to prevent and mitigate the impact of zoonotic diseases thereby improving the health of the population of Uganda. The most notable are; Highly Pathogenic Avian influenza (H5N1), pandemic influenza H1N1, Severe Acute Respiratory Syndrome (SARS), Bovine Spongiform Encephalopathy / variant-creutzfeld-jakob Disease (Mad Cow Disease). In Uganda, outbreaks of Ebola Heamorrhagic fever (HF) and Marburg HF have occurred with increasing frequency in the last five years. There has also been a re-emergency of anthrax, mange and plague which occur sporadically in wildlife and domestic animals and they occasionally spill over and spread into the human populations. At the same time long established zoonotic diseases such as rabies, bovine TB, brucellosis, cysticercosis and hydatidosis have remained endemic among the population in most developing countries including Uganda. Lead programme indicators Zoonotic diseases technical guidelines developed and disseminated by 2012/2013. The proportion of GHs and RRH conducting proper laboratory diagnosis of brucellosis increased by 20% and 50% by 2015 respectively. Key output Indicators 2012/13 Zoonotic diseases investigations and advocacy in high risk districts for rabies, Influenza, brucellosis and other zoonotic diseases in Uganda conducted. Train 60 health staff on emerging, re-emerging and endemic zoonotic diseases investigations, prevention & control Posters on rabies and Influenza printed and disseminated. 5,000 pcs of translated fact sheets on rabies procured Districts (8) technically supervised on control of zoonotic diseases Main Achievements 2012/13 Conducted support supervision of disease outbreaks such as Marburg and Ebola Hemorrhagic fevers, rabies and influenza Organized a multi-sectoral team of technical staff from MoH, MAAIF and UWA and collected domestic animal and wildlife samples for Ebola ecological studies in Luwero district to determine the source of Ebola and possible mode of transmission of the virus to the human index cases. Developed a draft framework for strengthening the implementation of the One Health Approach to zoonotic diseases prevention and control through multi-sectoral collaboration with key sectors. Trained 40 data managers from Soroti, Kaberamaido, Amuria, Katakwi on Influenza and other zoonotic diseases surveillance and control. [Annual Published Health Sector and Performance disseminated Report Posters, 2012/13] Fliers and leaflets, protocols and Guidelines Page 125 on rabies, Influenza, anthrax, brucellosis and other zoonotic diseases in English, and six major local languages and finalized the production of an Advocacy Video on these zoonotic diseases. Conducted technical support supervision on zoonotic diseases and dissemination of; i) Case definitions and action thresholds for integrated disease surveillance ii) Training manual for food handlers, Veterinary and Public Health Inspectors to a number of districts e.g. Tororo, Namayingo, Busia, Bugiri, Rukungiri, Mitooma and Sheema 118 Page Conducted an assessment [Annual of Health capacity Sector Performance for zoonotic Report diseases 2012/13 surveillance FY] and laboratory investigations in Iganga, Kamuli, Mayuge, Kaliro, Namutumba and Bugiri districts

139 rabies, Influenza, anthrax, brucellosis and other zoonotic diseases in English, and six major local languages and finalized the production of an Advocacy Video on these zoonotic diseases. Conducted technical support supervision on zoonotic diseases and dissemination of; i) Case definitions and action thresholds for integrated disease surveillance ii) Training manual for food handlers, Veterinary and Public Health Inspectors to a number of districts e.g. Tororo, Namayingo, Busia, Bugiri, Rukungiri, Mitooma and Sheema Conducted an assessment of capacity for zoonotic diseases surveillance and laboratory investigations in Iganga, Kamuli, Mayuge, Kaliro, Namutumba and Bugiri districts Prevention and Control of Non-communicable Conditions Uganda is currently experiencing dual epidemics of communicable and non communicable diseases. The changing life styles have resulted in an increase in the prevalence of non communicable diseases like Diabetes mellitus, cardiovascular diseases, chronic respiratory diseases and cancer. It is an opportune moment for the ministry to give relevant attention to non communicable diseases. The diseases/conditions addressed by the cluster on Prevention and Control of Non- Communicable Diseases/Conditions include; Cardiovascular Diseases, cancers, Diabetes, Chronic Obstructive Pulmonary Diseases and sickle cell disease Prevention and Control of NCD The non communicable disease programme was established in 2006/07 Financial year to plan, implement and coordinate actions aimed at preventing and controlling NCDs in Uganda. The increasing urbanization and changing lifestyles is exposing most of the population to unhealthy life styles and this is immensely contributing to the rising incidence of NCDs. The aim of the NCD programme is to reduce morbidity and mortality attributable to NCDs through appropriate interventions. Lead programme indicators Prevalence of diabetes among >25 yr olds Prevalence of raised BP among >25 yr olds Prevalence of current daily tobacco smoking among >15 year olds Percentage of Health facilities with the capacity to provide adequate NCD prevention and management services Coverage of cervical cancer screening Main achievements 2012/13 Launched HPV vaccination and rolled it out to 14 districts Sensitized communities on the prevention and control of NCDs [Annual Increased Health cervical Sector Performance cancer screening Report centers 2012/13] from 15 to 30 Page 126 Commemorated major NCDs World days to raise awareness (World Cancer day in Sheema, World Diabetes day in Tororo, World Heart day in Kampala, World Health day in Budaka, World Sickle Cell day in Luwero) Injuries, Disabilities and Rehabilitative Health The element of injuries, disabilities and rehabilitative health aims at decreasing the morbidity and mortality due to injuries, common emergencies and disabilities from visual, hearing and age-related impairments. This can be due to damage or harm done to or suffered by a person before or after birth. Such deprivation or loss of competency includes conditions like: deafness, blindness, physical disability and learning disability. Key output Indicators 2012/13 [Annual Health Sector Performance Report 2012/13 FY] The number of meetings held between the various stakeholders in disability issues. Page 119 The number of surveys carried out The number of orthopaedic workshops supported and supervised The number of rehabilitation staff trained

140 and mortality due to injuries, common emergencies and disabilities from visual, hearing and age-related impairments. This can be due to damage or harm done to or suffered by a person before or after birth. Such deprivation or loss of competency includes conditions like: deafness, blindness, physical disability and learning disability. Key output Indicators 2012/13 The number of meetings held between the various stakeholders in disability issues. The number of surveys carried out The number of orthopaedic workshops supported and supervised The number of rehabilitation staff trained The number of policies, guidelines and standards developed The number of assistive devices distributed Number of districts supervised on rehabilitation services. Main Achievements Commemorated older person s day on 1/10/2012 Kyankwanzi District, World Sight Day on 15/10/2012 in Gulu District. Held National Prevention of Blindness Committee Meetings in July 2012 and February 2013 respectively. Participated in development and dissemination of The Standard Disability Data Collection Tool with partners. Conducted helmet use observations at 18 Boda Boda stages. Carried out pre and post evaluation of 9 Boda Boda workshops targeting 100 Boda Boda riders each Conducted injury surveillance at Mulago National Referral and Mbale Regional Referral Hospitals Carried out MDA for trachoma prevention in 34 endemic districts Carried out baseline surveys for trachoma prevalence in 6 districts Carried out an evaluation of Arua, Gulu, Mbarara, Mbale and Fort Portal orthopaedic workshops. They are operating below functional capacity and need equipment. 12 Ophthalmic Clinical Officers trained in refraction course for six weeks at Masaka RR Hospital Helmet vaccine Initiative project to promote helmet use by Boda boda cyclists to prevent injuries [Annual Distributed Health Sector 67 locally Performance made wheelchairs Report 2012/13] made in Arua, Gulu and Mulago orthopaedic Page 127 workshops supported by The Church of Jesus Christ of Latter Day Saints. And 500 wheelchairs donated by Children International to Fort portal, Mbarara, Jinja, Budaka, Hoima and Mukono Districts. Rehabilitation and health Care Policy on disability ready to be presented to Cabinet; Manual on Primary Eye care developed & disseminated; Injury Policy guidelines developed still in draft form; Develop National Wheelchair Standards and Guidelines and disseminated them to Fort Portal, Mbarara, Mbale, Arua and Gulu Regional Referral orthopaedic workshops and the Trachoma action plan developed Support supervision was done to Buliisa, Masindi and Kiryandongo in the west and Jinja, Iganga, Kamuli Trachoma endemic districts. Carried out support supervision of Trachoma Mass drug distribution of Azithromycin and tetracycline in 35 districts. Support supervision was carried out in the five Regional referral Hospital orthopaedic workshops. Challenges Understaffing 120 Under Page funding [Annual Health Sector Performance Report 2012/13 FY] Disability issues are very broad, complex & remain poorly understood & prioritized at various levels.

141 Oral Health Carried out support supervision of Trachoma Mass drug distribution of Azithromycin and tetracycline in 35 districts. Support supervision was carried out in the five Regional referral Hospital orthopaedic workshops. Challenges Understaffing Under funding Disability issues are very broad, complex & remain poorly understood & prioritized at various levels Mental Health The programme has the mandate to implement interventions to address the high burden of mental health problems which contribute about 13% of the burden of disease. Over the last two years, there have been tremendous improvements in the availability of medicines used for treatment of mental and neurological illnesses at all levels of care. Programme indicators Mental Health Law enacted by 2011/12 Mental Health Policy finalized and operationalized by 2010/11 Operationalise mental health units in all RRHs by 2010/11 Community access to mental health services increased from 60% to 80% A community strategy for prevention of mental health problems developed by 2013/14 Main Achievements Mental Health Bill finalized and letters of compliance received from Ministries of Finance and Justice. It has been submitted to cabinet. Mental Health Policy Draft ready for presentation to Top Management Community Sensitization through Public education during celebration of World Mental Health Day, World No Tobacco Day and International Day Against Drug Abuse Supervised only 3 mental health units out of 13 RRHs [Annual Health Sector Performance Report 2012/13] Page 128 Coordination of psycho- trauma services for conflict and disaster affected populations Challenges Gross underfunding of the programme in relation to the mandates, did not receive any GOU funds during the year. There have been delays in finalizing policy documents due to multi sectoral nature of Mental Health activities e.g. Mental Health Bill, tobacco control policy drafting Programme is understaffed Recommendations Increase funding to the programme in order to complete consultation process for drafting the Alcohol Control Policy, Mental Health Community Strategy and the National Drug Control Master Plan Strengthen inter sectoral collaboration through consultative meetings to hasten process of policy development and implementation Implement the proposed restructuring to increase numbers and variety of mental health care providers/staff at all levels. Strengthen Support Supervision to enhance functionality of Mental Health Units at RRHs The program needs to be supported to provide Public education and create public awareness not only during the celebration of the World Mental Health day, World No Tobacco Day or [Annual International Health Sector Day Performance against Report Alcohol 2012/13 and FY] Drug Abuse, but also Page through 121 developing sustained mental health media campaigns.

142 Strengthen inter sectoral collaboration through consultative meetings to hasten process of policy development and implementation Implement the proposed restructuring to increase numbers and variety of mental health care providers/staff at all levels. Strengthen Support Supervision to enhance functionality of Mental Health Units at RRHs The program needs to be supported to provide Public education and create public awareness not only during the celebration of the World Mental Health day, World No Tobacco Day or International Day against Alcohol and Drug Abuse, but also through developing sustained mental health media campaigns Oral Health The aim of the oral health program is to improve the oral health of the people of Uganda by promoting oral health and preventing, appropriately treating, monitoring and evaluating oral diseases. Lead programme indicators Oral health policy implementation guidelines developed and disseminated. The proportion of HC IVs with well equipped and functional dental units increased. The proportion of the population with access to primary oral health care increased. Key output Indicators 2012/13 Support supervision visits to 13 dental units in the RRHs (Mubende, Masaka, Mbarara, Hoima, Mbale, Jinja, Gulu, Fort Portal, Kabale and Arua) Conduct 2 specialist outreaches Oral health education and screening for oral diseases and ART treatment in 40 primary schools conducted. Commemorate the Internal Oral Health Day. [Annual Main achievements Health Sector 2012/13 Performance Report 2012/13] Page dental units supervised. Dental camps held in Arua and Mbarara with Uganda Dentists Association. 2 schools screened in Arua and 4 schools in Mbarara. The International Oral Health Day stakeholders meeting held in Kampala sponsored by Colgate Palmolive. Challenges Lack of vehicles to travel upcountry to carryout support supervision. Inadequately staffed dental units affects optimum delivery of services. Inadequately equipped dental units deter dentists from working in RRHs. Lack of funds to carry out screening for oral diseases Recommendations Improved facilitation for improved support supervision. Equipping dental units to optimize service delivery. Encouraging dentists to work in the equipped units at RRHs. Increased funding for screening for oral diseases Nursing The nursing profession provides the largest workforce in the health sector in a diverse environment thus participating in a wide spectrum of service delivery. The department of Nursing is responsible for promoting collaboration and coordination of nursing and midwifery 122 activities Page amongst stakeholders [Annual nationally Health Sector and Performance internationally Report 2012/13 while FY] ensuring adherence to ethics and standards. Key output Indicators 2012/13

143 Nursing The nursing profession provides the largest workforce in the health sector in a diverse environment thus participating in a wide spectrum of service delivery. The department of Nursing is responsible for promoting collaboration and coordination of nursing and midwifery activities amongst stakeholders nationally and internationally while ensuring adherence to ethics and standards. Key output Indicators 2012/13 Proportion of planned technical support supervision visits to identified health facilities conducted Proportion of planned capacity building workshops (leadership, management and skills building in clinical area) for nurses and midwives conducted. Draft policy guidelines for nurses and midwives in place. Collaboration and coordination meetings attended/conducted. Major Achievements 50% (4) technical support supervision visits were conducted in Gulu and Lira RRH and 6 general hospitals namely; Anaka, Kitgum, Kalongo, Apac, Amolatar and Oyam. - Management committees on infection control, training, disciplinary, Blood safety, Research committees strengthened. - Specific technical/administrative challenges encountered during the routine maternal [Annual and Health new Sector born Performance care services Report provision 2012/13] determined and appropriate actions were Page taken. 130 Nurse leadership workshop on capacity building conducted for 25 nurse leaders from the 14 RRHs. Ethics and improved quality of nursing care emphasized. Through Egyptian Technical Corporation 6 nurses and midwives has been trained in various nursing and midwifery courses. Drafted the Uniform Policy, Nursing policy and the Strategic Plan, and School Nurses guidelines. Developed the Scheme of Service for the Nursing Cadre to Ministry of Public Service. Held 3 National Uniforms Task Force meetings to coordinate the procurement of uniforms with NMS. Submitted uniform specifications to NMS ready for procurement starting with the nurses and midwives. Strengthened coordination and collaboration of nursing services. These efforts have been strengthened between MOE, Public Services, Uganda Nurses &Midwives Council and other Nursing Professional bodies. Under the support of Regional Centre for Quality Health Care/ ECSACON 80 midwives participated in the training of Help Baby Breath Plus initiative. Commemorated the International Day of Nurses in Mbarara and International Midwives day in Oyam Districts. Held the International Midwives Conference that was held in Kampala. Major challenges Inadequate human and financial resources for the implementation of planned activities. Unreliable transport for coordination and supervision. Recommendations Facilitation of department to carry out its mandate in scaling up support supervision, mentoring and coordination of nursing activities through increased budget allocation and provision of reliable transport Integrated Essential Clinical Care Integrated essential clinical care is mandated to improve access to equitable and quality clinical services in both public and [Annual private Health health Sector Performance institutions Report through: 2012/13 FY] Page 123 Strengthening the capacity of health facilities to provide integrated clinical and rehabilitative care Increasing the range of health services provided by health facilities.

144 Recommendations Facilitation of department to carry out its mandate in scaling up support supervision, mentoring and coordination of nursing activities through increased budget allocation and provision of reliable transport Integrated Essential Clinical Care Integrated essential clinical care is mandated to improve access to equitable and quality clinical services in both public and private health institutions through: Strengthening the capacity of health facilities to provide integrated clinical and rehabilitative care Increasing the range of health services provided by health facilities. Lead program indicators: The functionality of health center IVs increased from 5% to 50% by 2014/15 Standards for best practice in hospitals established by 2012 Blood transfusion centers set up in all RRHs (2 each year) ICU/CCU established in 40% of the RRHs (1 ICU in RRH each year) by 2014/15 Key output indicators and targets for 2012/13 [Annual Professional Health Sector mentorship Performance from Report National 2012/13] and regional hospitals to general hospitals Page and 131 Health center IVs. Development of Policies and guidelines. Integrated support supervision to regional and general hospitals conducted Number of meetings held - Medical board, Internship committees, hospital managers, hospital technical working group Coordination of palliative care activities in hospitals Coordination of surgical and obstetric fistula activities Support supervision on 5S-Kaizen-TQM activities in 8 target hospitals Respond to and manage epidemics Main achievements Developed draft zero of hospital manual, reviewed the final draft of obstetric fistula management tools and was presented to the Hospital TWG, finalized the Medico-legal policy for presentation to the Hospital TWG and prepared the Cabinet memo for Optometrists. Developed draft guidelines for management of Hepatitis B in Uganda and draft safe male circumcision health care waste management guidelines. Conducted support supervision in 7 Regional referral hospitals: Mubende, Fort Portal, Hoima, Jinja, Mbale, Soroti and Arua Held 18 medical board meetings at Mulago National referral hospital, 4 internship committee meetings. Conducted one induction course for medical interns, supervised internship training centers at Mulago, Mengo, Nsambya, Rubaga, Jinja, Mbale, Soroti, Lira, Gulu, Arua, Kalongo, Lacor, Kitovu, Mbarara, Masaka, Kabale, Fort-Portal and KIU Hospitals and carried out accreditation visits to five potential interns training sites at Bombo General Military hospital, Kiwoko, St. Josephs hospital, Virika, Kilembe and Kagando hospitals Four Palliative care workshops were held in Mbale, Arua, Kasese and Gulu and one stakeholders meeting was held at Ministry of Health Headquarters Obstetric fistula camps were held in Hoima, Mulago, Soroti, Arua, Lira, Kitovu and one surgical camp was held in Fort Portal. Carried out supervision and mentoring of 5S-Kaizen-TQM activities in Hoima, Arua, Tororo, Mbale, Kapchorwa, Mubende and Lira hospitals. Responded to one cholera epidemic in Bududa, coordinated case management of Ebola 124 outbreak Page in Luwero and [Annual Kibaale Health and Sector Marburg Performance outbreak Report 2012/13 in South FY] western Uganda and spearheaded the National response to Nodding Syndrome in Pader, Kitgum, Lamwo, Amuru, Gulu, Lira and Oyam

145 stakeholders meeting was held at Ministry of Health Headquarters Obstetric fistula camps were held in Hoima, Mulago, Soroti, Arua, Lira, Kitovu and one surgical camp was held in Fort Portal. Carried out supervision and mentoring of 5S-Kaizen-TQM activities in Hoima, Arua, Tororo, Mbale, Kapchorwa, Mubende and Lira hospitals. Responded to one cholera epidemic in Bududa, coordinated case management of Ebola outbreak in Luwero and Kibaale and Marburg outbreak in South western Uganda and spearheaded the National response to Nodding Syndrome in Pader, Kitgum, Lamwo, Amuru, Gulu, Lira and Oyam Challenges Delayed release and inadequate funding Low level of coordination with partners Inadequate inter- departmental coordination [Annual Recommendations Health Sector Performance Report 2012/13] Page 132 Improvement on financial management Improve coordination at departmental and partner levels Diagnostic and Blood Transfusion Services Uganda Blood Transfusion Services UBTS through its Vision and Mission is mandated to make available adequate quantities of safe blood and blood components for the clinical management of patients requiring transfusion at health facilities. In this task UBTS closely works with the Uganda Red Cross Society (URCS) in voluntary blood donor recruitment through a formalized MoU. Lead programme indicators Total number of blood units collected form voluntary non-remunerated donors. % of donated blood screened in a quality controlled manner. No. of blood units discarded after screening. Proportion of health units receiving 100% of blood units used for transfusion from UBTS. Number of blood donors counselled for any TTI. Main achievements 2012/13 Blood collection has increased annually from 131,226 units in FY2007/8 to over 203,819 units in 2011/12. Blood collection operation is dependent on the 20 mobile blood collection teams travelling everyday to the field in order to collect blood. Blood collection for FY 2012/13 was 201,365 units of blood against a planned target of 242,000 units of blood (83.2% achievement). This however still falls short of the WHO requirement of 1% of the total population (340,000 units). UBTS has increased its capacity to issue blood to all transfusing healthcare facilities in Uganda (from HC IV). The construction process for the stores at the headquarters has begun and drawings have been secured. Construction of Gulu and Fort-Portal RBB was completed with a grant from CDC and the buildings have been handed over. 156,916 blood donors were recruited of which 60% are repeat blood donors and inputs for blood collection and processing, including blood bags, test kits, cold chain equipment and laboratory consumables were procured. [Annual Health Sector Performance Report 2012/13 FY] Page 125

146 Figure 17: Blood Collection over the Years Blood Units JULY JUNE 2006 JULY JUNE200 7 JULY JUNE 2008 JULY JUNE 209 ULY JUNE 2010 JULY JUNE 2011 JULY JUNE 2012 JULY JUNE 2013 Series Challenges Creation of 2 additional blood collection teams Procurement of office furniture and equipment for the newly constructed Gulu and Fort- Portal RBB Construction of a RBB in Moroto Accreditation of UBTS Rent for office space at Arua RBB Additional funding to cover operational costs and to NMS to deliver adequate supplies and cover handling charges. Recommendations We had planned to create an additional 2 blood collections teams to increase from the current 20 to 22 teams, but funds for the additional 2 teams have not been allocated. o Creation of 2 additional blood collection teams o Procurement of office furniture and equipment for the newly constructed Gulu and Fort-Portal RBB o Construction of a RBB in Moroto o Accreditation of UBTS o Rent for office space at Arua RBB o Additional funding to cover operational costs and procure adequate blood collection and testing kits [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

147 Central Public Health Laboratories Lead programme indicators Percentage of health facilities with laboratory services fully supporting UNMHCP Percentage of laboratories that are successfully participating in EQA schemes Percentage of outbreaks with laboratory confirmation Percentage laboratories certified and accredited by international and national agencies Key output Indicators 2012/13 Number of specimen referral hubs established Number of laboratories being mentored in laboratory quality systems using the SLMTA approach Number of laboratories refurbished to conform to national physical infrastructure standards Number of laboratories participating successfully in external quality assessment schemes Main achievements 2012/13 Broke ground for the construction of the National Health Laboratories building at Butabika Engaged MoH Top Management in the supervision of laboratory services in the country: his has improved advocacy for laboratory services and has prompted the Ministry to engage CDC Uganda to support the construction of a laboratory in Mbarara Regional Referral Hospital. Scaled up specimen referral and transportation network hubs from 19 to 78 Scaled up the quality improvement processes in preparation for certification / accreditation using the SLMTA approach to an additional 55 laboratories. Tested 82,133 babies for HIV at the early infant diagnosis laboratory: (more than 90% of the target of 90,000 babies). Drew up a plan for initiation of National Viral Load testing for ART monitoring Won international best practices awards at the African Society of Laboratory Medicine Conference: 3 Uganda laboratories, (the Infectious Diseases Institute, CPHL EID laboratory and NTRL) won best practices awards at the African Society for Laboratory Sciences in Cape Town in Improved the physical infrastructure in 22 laboratories to conform to national minimum standards: Undertook activities to improve the laboratory supply chain management including: Conducting a comprehensive assessment of the laboratory supply chain network, Rationalization of the laboratory supply chain. Challenges 2012/13 Significant stock-outs of many critical supplies notably HIV test kits, CD4, hematology and chemistry reagents due to challenges of transitioning to the newly rationalized supplies chain management system. PEPFAR pulled out of funding of laboratory supplies for diagnosis of opportunistic infections [Annual as well Health as laboratory Sector Performance waste management Report 2012/13] supplies and now restricts funding strictly Page to HIV 135 test kits and tests for ART monitoring. No alternative funding has been obtained to fill this gap possing a risk for stock outs of supplies for OIs, waste management and non-hiv related lab supplies. A high turnover of laboratory personnel retards quality improvement programs as trained personnel leave. This has compromised the drive towards certification and accreditation of laboratories using the SLMTA approach. [Annual Health Sector Performance Report 2012/13 FY] Page 127 There was a delay of release of funds from development partners to some of the implementing partners to support the laboratory hubs leading to failure to meet hub activity targets. Capacity to prepare and administer proficiency panels remains too low to cover all labs in

148 PEPFAR test kits pulled and tests out for of funding ART monitoring. of laboratory No alternative supplies for funding diagnosis has of been opportunistic obtained infections to fill this as gap well possing as laboratory a risk for stock waste outs management of supplies supplies for OIs, and waste now management restricts funding and non-hiv strictly related to HIV test lab supplies. kits and tests for ART monitoring. No alternative funding has been obtained to fill this gap A high possing turnover a risk of for laboratory stock outs personnel of supplies retards for OIs, quality waste improvement management programs and non-hiv as trained related lab personnel supplies. leave. This has compromised the drive towards certification and accreditation of A laboratories high turnover using of the laboratory SLMTA approach. personnel retards quality improvement programs as trained personnel There was leave. a delay This of has release compromised of funds the from drive development towards certification partners and to accreditation some of the of laboratories implementing using partners the SLMTA to support approach. the laboratory hubs leading to failure to meet hub There activity was targets. a delay of release of funds from development partners to some of the implementing Capacity to prepare partners and to administer support proficiency the laboratory panels hubs remains leading too to low failure to cover to meet all labs hub in activity the country. targets. Capacity Poor response to prepare rates for and proficiency administer panels: proficiency Only panels 27 50% remains of the too laboratories low cover provide all labs timely in the responses country. to the various proficiency testing panels administered to them. Rewards and Poor penalties response may have rates to for be proficiency adopted as panels: incentives. Only 27 50% of the laboratories provide timely responses to the various proficiency testing panels administered to them. Rewards and penalties may have to be adopted as incentives. 3.2 Integrated Health Sector Support Systems During HSSIP 2010/ /15 the sector will focus on putting in place the necessary inputs that 3.2 are Integrated needed, to Health ensure Sector there Support is improved Systems access to health services. These inputs relate to During the human HSSIP resources, 2010/ /15 infrastructure the sector (including will focus equipment, on putting ICT in and place transport), the necessary and medical inputs that products. are needed, to ensure there is improved access to health services. These inputs relate to the human resources, infrastructure (including equipment, ICT and transport), and medical products Human Resources for Health The health sector is committed to attainment and maintenance of an adequately sized, equitably Human distributed, Resources appropriately for Health skilled, motivated and productive workforce in partnership The with health the private sector sector, is committed matched to to the attainment changing population and maintenance needs and of demands, adequately health sized, care equitably technology distributed, and financing. appropriately skilled, motivated and productive workforce in partnership with the private sector, matched to the changing population needs and demands, health care technology Core HSSIP and indicator financing. % of posts filled by skilled Health workers Core % HSSIP Annual indicator reduction in absenteeism rate % of posts filled by skilled Health workers Lead % programme Annual reduction indicators absenteeism rate Number of districts with functional Human Resource Information System (HRIS) Lead Number programme of Human indicators Resource for Health managers trained in Leadership and Management Number of districts RRH trained with in functional Results Oriented Human Resource Management. Information System (HRIS) Number Percentage of of Human health Resource managers for in Health RRH with managers signed trained Performance in Leadership Agreements. and Management Number of RRH trained in Results Oriented Management. [Annual Key Percentage output Health Indicators Sector of health Performance 2012/13 managers Report in RRH 2012/13] with signed Performance Agreements. Page 136 HRIS rolled out to 40 districts [Annual Scholarships Health Sector awarded Performance to 150 essential Report 2012/13] health cadres in hard to reach areas and 88 Page for those 136 pursuing specialized priority disciplines. Scholarships awarded to 47 Managers of health facilities to pursue Masters in hospital management and Advanced Diploma in health services management at Nkozi University. Guidelines for implementing customized ROM in the health sector developed and disseminated. Institutional performance contracts rolled out in 3 pilot hospitals (Gulu, Mbale and Masaka) Recruitment and Payroll monitoring. Assess recruitment needs in RRHs Implement the public service reward and recognition scheme. Verify seconded Health workers in PNFP s in all regions. 128 Page Conduct comprehensive [Annual HR Audit Health in Sector the districts Performance and Report RRHs. 2012/13 FY] Main achievements 2012/13 Training of Trainers for HRIS conducted in March A contract for the supply of

149 pursuing specialized priority disciplines. Scholarships awarded to 47 Managers of health facilities to pursue Masters in hospital management and Advanced Diploma in health services management at Nkozi University. Guidelines for implementing customized ROM in the health sector developed and disseminated. Institutional performance contracts rolled out in 3 pilot hospitals (Gulu, Mbale and Masaka) Recruitment and Payroll monitoring. Assess recruitment needs in RRHs Implement the public service reward and recognition scheme. Verify seconded Health workers in PNFP s in all regions. Conduct comprehensive HR Audit in the districts and RRHs. Main achievements 2012/13 Training of Trainers for HRIS conducted in March A contract for the supply of computers, printers and photocopiers for each of the 40 districts signed and expected to be delivered by September scholarships were awarded to essential health cadres in hard to reach areas and for those pursuing specialized priority disciplines. 47 managers of health facilities were awarded scholarships. Cumulatively 93 managers have been trained since 2011/12. Guidelines for implementing ROM in the health sector developed and awaiting approval by Senior Management. Draft institutional performance contracts were developed in partnership with MoPS. A total of 7,619 HWs out of 10,810 posts advertised were recruited under GoU and partners support bringing staffing levels to 63% from 58%. Payroll monitoring undertaken in 14 RRHs in liaison with MoPS. The reward and recognition scheme was disseminated and the 14 RRHs guided on the establishment of the rewards and sanctions committees. The MoH Headquarters rewards and sanctions committee was established. Verifed Health workers seconded in PNFP s in all regions HRH audit was undertaken in all public health facilities and a report compiled. Challenges Understaffing of Human Resource Division limiting ability to undertake all planned activities. Limited funding for recruitment of health workers. Coordination of the multiple implementing partners. Delayed approval of the new MoH and RRH structures Health Infrastructure Development and Management [Annual Objective Health is to Sector ensure Performance availability Report of a network 2012/13] of functional, efficient and sustainable Page health 137 infrastructure for effective health services delivery closer to the population Lead programme indicators The proportion of the population of Uganda living within 5 km of a health facility increased from 72% to 90% by The number of health facilities increased by 30% by The proportion of HC IIIs and HC IVs with complete basic equipment and supplies for addressing EmoNC increased to 100%. The proportion of HC IVs and hospitals with functional ambulances for referral increased to 100%. 60% of medical equipment are in good condition and maintained. Key output Indicators 2012/13 Buyiga and Kisozi HCIII constructed and equipped. [Annual Health Sector Performance Report 2012/13 FY] Page 129 Installation of solar energy packages completed in HCs 18 Districts (i.e. Amuru, Kitgum, Adjumani, Apac, Dokolo, Kaberamaido, Moroto, Nakapiripirit, Moyo, Gulu, Pader, Amolatar, Soroti & Bullisa).

150 addressing EmoNC increased to 100%. The proportion of HC IVs and hospitals with functional ambulances for referral increased to 100%. 60% of medical equipment are in good condition and maintained. Key output Indicators 2012/13 Buyiga and Kisozi HCIII constructed and equipped. Installation of solar energy packages completed in HCs 18 Districts (i.e. Amuru, Kitgum, Adjumani, Apac, Dokolo, Kaberamaido, Moroto, Nakapiripirit, Moyo, Gulu, Pader, Amolatar, Soroti & Bullisa). 34 incinerators installed in Hospitals Staff housing constructed at HC IIIs in the seven Karamoja Region Districts of Kaabong, Abim, Kotido, Moroto, Amudat, Napak and Nakapiripirit. Proposals for consultancy services for design & supervision received and evaluated. Renovation of old MoH Head quarters at Wandegeya and Wabigalo Central workshop Master plan for the Uganda Virus Research Institute developed 4 Trained Bio-Medical Engineering Technicians trained. Medical equipment spare parts procured. Guidelines on donated medical equipment and accessories developed. Support supervision to RRHs, GHs and districts conducted. Main achievements 2012/13 District Infrastructure Support Programme (DISP) Staff houses in Buyiga HCIII roofed and finishing started. General/maternity ward in Buyiga HC III roofed, window and door frames fitted. Pit latrines, medical waste pit and placenta pit for Buyiga HC III excavated and slabs completed. Kisozi HC III constructed, equipped and commissioned New OPD, Maternity, and 8 staff house units. Energy for Rural Transformation Project (ERT) Installation of solar power completed in 183 HCs - Kitgum (27), Dokolo (11), Kaberamaido (16), Apac (28), Adjumani (27), Amuru (29), Nakapiripirit (12), Moroto (15), Buliisa (6), Gulu [Annual (7) and Health Pader Sector (5). Performance Report 2012/13] Page 138 Shipment of solar equipment for Bukwo, Sironko, Mbale, Mayuge, Katakwi, Amuria, Masindi and Bundibugyo districts commenced. Report on performance of MoH standard solar energy packages prepared. Maintenance of solar energy systems carried out in all beneficiary HCs. Imaging and Theatre Equipment Project (ORET) Installation of 17 incinerators completed and construction of 17 incinerator sheds ongoing. Solar lighting set installed on Kalungu HC III maternity ward. Generators installed in Bukedea and Butenga HC IV. Maintenance of imaging and HC IV theatre equipment carried out. Various spare parts procured and installed. Italian support to HSSP and PRDP Proposals for consultancy services for design & supervision received. Evaluated but not started due to non release of funds. Institutional Support to MoH Bids for repair of MoH Headquarter roof and Wabigalo External works opened and 130 evaluated. Page Contract not [Annual signed Health due to Sector non Performance release of Report funds. 2012/13 FY] Other Capital Activities - OFF BUDGET NUSAF 2 (Northern Uganda Social Action Fund)

151 Italian support to HSSP and PRDP Proposals for consultancy services for design & supervision received. Evaluated but not started due to non release of funds. Institutional Support to MoH Bids for repair of MoH Headquarter roof and Wabigalo External works opened and evaluated. Contract not signed due to non release of funds. Other Capital Activities - OFF BUDGET NUSAF 2 (Northern Uganda Social Action Fund) The project takes place in the 55 PRDP districts (48 districts of North Bunyoro, West Nile, Acholi, Lango, Teso, Elgon and Bukedi as well as the 7 districts of Karamoja) Karamoja has its own implementation modality. The health sector interventions for Community Infrastructure Rehabilitation (CIR) cumulatively since 2009 are subprojects as follows: staff houses - complete with kitchen, latrine, bathing shelter and basic solar lighting; 3 Maternity wards; 14 OPDs; 2 General wards; 2 solar power installations and 8 VIP latrine blocks. Over the last fiscal year, progress was as follows: - 24 at pre-construction, 59 at foundation level, 61 at walling, 81 at roofing, 9 on finishes and 15 were complete. SUSTAIN (Strengthening Uganda s Systems for Testing AIDS Nationally) Works progressed for renovation and improvement of laboratories and HIV/AIDS Clinics at: Lira RRH, Gulu RRH, Gombe GH, Arua RRH and Soroti RRH. Carried out evaluation of renovation and remodelling requirements for facilities for SMC at 13 hospitals: Nebbi, Mubende, Moyo, Mbale, Masaka, Kawolo, Kabale, Gulu, Gombe, Jinja, Entebbe, Soroti, Lira and Moroto. [Annual Initiated Health a Sector programme Performance renovation Report 2012/13] and supporting seven regional medical equipment Page 139 maintenance workshops JICA Central and West Completed works at Mubende and Masaka RRH were commissioned by H.E. the Vice President and the Ambassador of Japan in March 2013 AIDSTAR-One (AIDS Support and Technical Assistance Resources) Installed and operationalized a 1,000 kg Central high temperature Incinerator at Iganga for Health Care West Management (HCWM) in Eastern Uganda Prepared Guidelines and National Manual for managing SMC generated waste Trained Central & District Trainers as well as operational level health workers Introduced the HCWM project in 10 expansion districts in Eastern Uganda Carried out Technical Support Supervision in 6 districts Recurrent Expenditure At least 1 Medical equipment maintenance visit made to each of 12 Hospitals and the 43 HC IVs in Central region. Medical equipment inventory update carried out in 23 hospitals and 1 HC IV country wide under JICA 5S Project. Selected Infrastructure projects in RRHs and District LGs supervised. Challenges There was no budget allocation for Maintenance of Medical Equipment for Central Region HID surrendered [Annual 60% of Health its recurrent Sector Performance budget Report (190.5M) 2012/13 to Wabigalo FY] workshop. Minimum Page 131 of 336.7M is need for Wabigalo workshop a lot at current funding levels. Maintenance Contract from maintenance of Imaging equipment for 18 Hospitals and 30 HC IVs under ORET Phase 1 expired in August 2011 and there was no adequate allocation to

152 HC IVs in Central region. Medical equipment inventory update carried out in 23 hospitals and 1 HC IV country wide under JICA 5S Project. Selected Infrastructure projects in RRHs and District LGs supervised. Challenges There was no budget allocation for Maintenance of Medical Equipment for Central Region HID surrendered 60% of its recurrent budget (190.5M) to Wabigalo workshop. Minimum of 336.7M is need for Wabigalo workshop a lot at current funding levels. Maintenance Contract from maintenance of Imaging equipment for 18 Hospitals and 30 HC IVs under ORET Phase 1 expired in August 2011 and there was no adequate allocation to procure another Contract (Approx U Shs. 2.5 bn is needed). Recommendations Sufficient budget should be allocated for maintenance of both medical equipment and building infrastructure for health Appropriate procurement method for medical equipment spare parts needs to be agreed up on. Direct and restricted bidding should be accepted as the only options and not open bidding due to their specialized nature & small quantities to make business sense in most cases. Funds voted for budgeted items should be released in full and on time to enable timely execution Management of Essential Medicines and Supplies [Annual Core Indicators Health Sector Performance Report 2012/13] Page 140 The percentage of health units without monthly stock outs of any indicator medicines (49% of health facilities did not have stock out of any of the six tracer medicines in the FY 2011/12 first line antimalarials, Depoprovera, SP, measles vaccine, ORS, Cotrimoxazole). Lead programme indicators The funds in the MoH budget for procurement of EMHS increased The service level of NMS for all EMHS increased The % of NDA budget directly financed by GoU (consolidated funds) increased Guidelines for donated medicines developed by 2012 Major Achievements 2012/13 Harmonized the procurement and distribution of pharmaceuticals to include lab commodities through rationalization of ARVs, TB, Lab commodities and Cotrimoxazole supply management and streamlined reporting (One Supplier One Facility) Finalized the review and printed the Uganda Clinical Guidelines (UCG) - new 2012/13 version. Finalized the review and printed the Essential Medicines and Health Supplies List Uganda (EMHSLU) 2012/13. Integration of TB commodities at NMS to strengthen, harmonize, streamline and optimize supply chain systems. Continued Implementation of Supervision, Performance, Assessment Strategy (SPAS) country wide in the management of EMHS with support from Implementing Partners. Established a mechanism for coordinating information management in the pharmaceutical sector with the establishment of the M&E unit. Fully operationalized the Quantification and Procurement Planning Unit (QPPU) within the Pharmacy Division as a single centralized system for quantifying National requirements for 132 Page EMHS and coordinating [Annual contributors Health Sector supply Performance planning Report to ensure 2012/13 that FY] appropriate products, adequate quantities are supplied on a timely basis. ARV web based ordering (WAOs) rollout.

153 supply chain systems. Continued Implementation of Supervision, Performance, Assessment Strategy (SPAS) country wide in the management of EMHS with support from Implementing Partners. Established a mechanism for coordinating information management in the pharmaceutical sector with the establishment of the M&E unit. Fully operationalized the Quantification and Procurement Planning Unit (QPPU) within the Pharmacy Division as a single centralized system for quantifying National requirements for EMHS and coordinating contributors supply planning to ensure that appropriate products, adequate quantities are supplied on a timely basis. ARV web based ordering (WAOs) rollout. Challenges Guidelines and lists not yet widely disseminated due to inadequate resources. Freeze of e-health development initiatives has hindered implementation of the Pharmaceutical Information Portal (PIP) Breakdown of the server, power surges and other technical issues have had an impact on the efficiency of the ARV web based ordering (WAOs) rollout. Shortages in laboratory supplies due to apparent absolute dependence on donor financing for Laboratory Supplies for critical and priority programmes. Most of the above achievements have been realized with support from development [Annual partners Health who Sector are Performance winding Report down 2012/13] in the following year which will impact Page on 141 the sustainability of the achievements and organizational structures of the pharmaceutical sector management. Recommendations Conduct an assessment on equity in budget allocation for EMHS and revisit resources allocation criteria to achieve equity in financing and management of EMHS. Government to increase financing in the pharmaceutical sector for sustainability of SPAS with the pending exit of the IP s. All IP s supporting districts in medicines management should embrace SPAS National Medical Stores The mandate of NMS is to procure, store and distribute essential medicines and other medical supplies primarily to public health facilities Core Indicators The percentage of health units without monthly stock outs of any indicator medicines (49% of health facilities did not have stock out of any of the six tracer medicines in the FY 2011/12 first line antimalarials, Depoprovera, SP, measles vaccine, ORS, Cotrimoxazole). Main achievements 2012/13 Supplied essential medicines and medical supplies to all Health facilities, including UPDF, Police Force and Prison services. Supplied Vaccines, gas and other immunization materials to all 111 districts and KCCA, including the new PCV to pilot district of Iganga Regionalized the Basic kit for HC II and HC III Made improvements in aligning the Orders from Health facilities with their procurement plans Responded to all the medical emergencies and epidemics in the country with required additional supplies Continued with the embossment of medicines and medical supplies- now at 97% Continued with the last mile delivery of medicines to health facilities [Annual Health Sector Performance Report 2012/13 FY] Page National Drug Authority National Drug Authority (NDA) was established by the National Drug Policy and Authority

154 Supplied Vaccines, gas and other immunization materials to all 111 districts and KCCA, including the new PCV to pilot district of Iganga Regionalized the Basic kit for HC II and HC III Made improvements in aligning the Orders from Health facilities with their procurement plans Responded to all the medical emergencies and epidemics in the country with required additional supplies Continued with the embossment of medicines and medical supplies- now at 97% Continued with the last mile delivery of medicines to health facilities National Drug Authority National Drug Authority (NDA) was established by the National Drug Policy and Authority (NDP/A) Act, Cap. 206 (Laws of Uganda 2000 Revised edition). The NDA mandate is to ensure availability, at all times drugs which are of good quality, safe, efficacious and cost-effective to the entire population of Uganda, as a means of providing satisfactory healthcare and safeguarding the appropriate use of drugs. [Annual Key output Health Indicators Sector Performance 2012/13 Report 2012/13] Page 142 Dossiers evaluated. Proportion of the premises (pharmacies and drug shops) inspected by December of every year. GMP inspection of local and foreign pharmaceutical manufacturing sites conducted. 95% of the Verification Certificates processed within 5 working days of application. All consignments presented to the Inspector inspected within 24hours. Post marketing surveillance conducted. Health personnel sensitised on adverse event reporting. Public sensitised Main achievements 2012/13 A total of 976 pharmacies were licensed; 604 retail and 372 wholesale pharmacies; 6,140 drug shops were licensed. Inspection of 12 local manufacturing facilities was carried out, and 9 facilities complied with cgmp; 118 foreign facilities were inspected for cgmp compliance; 103 passed and 15 failed; and 29 GMP assessments of foreign pharmaceutical manufacturing sites through document review were evaluated and all were approved. 3,761 consignments were handled at the various ports of entry; released 3,691, rejected 04, queried 66. NDA was able to train 100 health workers in Kampala and 60 health workers from upcountry stations on pharmacovigilance. Developed 2,000 sensitization materials which were disseminated in various fora including a workshop held in July 2012 with media and other stakeholders about advertising of medicines. This workshop also addressed issues of advertising herbal medicines. 663 health workers were sensitized on ADR monitoring. Support supervision was carried out in 10 established regional Pharmacovigilance Centres and 93 health facilities were visited. Support to 3 regional centers was given by provision of new computers and 10 pharmacovigilance centers were given office imprest to facilitate them in carrying out pharmacovigilance activities. Held 5 talk shows on Top Radio, Namirembe FM and Top TV on drug promotion and advertising of herbal medicines and food supplements. Held sensitization workshops on herbal medicine regulation in the districts of Adjumani, Moyo, Yumbe, Nebbi, Arua and Koboko. NDA continued to run information spots on radios, newspapers and televisions to alert the 134 Page [Annual Health Sector Performance Report 2012/13 FY] public against drug hawkers, unlicensed outlets and use of SMS drug information facility. The messages are monitored by Synovate and also aimed to re-emphasize the public s need to be more vigilant against unscrupulous or illegal operators. NDA organized a meeting with the Media and Stakeholders to sensitize them about the

155 them in carrying out pharmacovigilance activities. Held 5 talk shows on Top Radio, Namirembe FM and Top TV on drug promotion and advertising of herbal medicines and food supplements. Held sensitization workshops on herbal medicine regulation in the districts of Adjumani, Moyo, Yumbe, Nebbi, Arua and Koboko. NDA continued to run information spots on radios, newspapers and televisions to alert the public against drug hawkers, unlicensed outlets and use of SMS drug information facility. The messages are monitored by Synovate and also aimed to re-emphasize the public s need to be more vigilant against unscrupulous or illegal operators. NDA organized a meeting with the Media and Stakeholders to sensitize them about the current unethical advertising of herbal medicines in Uganda. Held 18 FREE on air interactive one to two hours talk-shows on 14 FM radios and 3 televisions. Namely; Radio Sapientia, Prime FM, Namirembe FM, Kingdom FM, Voice of [Annual Africa, Health and, Sector Bilali FM, Performance Radio Simba, Report Pearl 2012/13] of Africa FM, Mboona FM, Etop Radio, Radio Page fm, Top radio, Metro FM, Community FM, FM J, UBC TV, Top TV and Record TV. Procured equipment for the laboratory to facilitate the testing of medicine samples: A total of 348 batches of medicine samples were tested, 321 passed and 27 failed the tests. A total of 226 batches of male Latex condoms were tested; 221 passed and 05 failed. Out of 454 samples of medical gloves tested, 439 passed and 15 failed the test done at the NDQCL. 148 LLINs were tested and all passed. NDA developed a customer identification system that gives unique identifiers (Facility Identification Numbers) to each drug outlet (pharmacy, drug shop and manufacturing facility) in order track each drug outlet in the country and also facilitate bank reconciliations. Cabinet approved the NDA/NFDA transformation on 25 th July The Draft NFMA Bill was finalised and discussed by NDA Senior Management in February, April and May Further consultations with the MoH, MAAIF and stakeholders are ongoing Information for Decision Making The health sector requires reliable and accurate information to enable evidence-based decision making, sector learning and improvement. Monitoring and evaluation aims at informing policy makers about progress towards achieving targets as set in the annual health sector plans and the HSSP and to help provide managers with a basis in making decisions. Core HSSIP indicators Timeliness of district HMIS reporting to the RC Division. Completeness of district HMIS reporting to the RC Division. Lead programme indicators The proportion of implementing partners (NGOs, CSOs, Private sector) contributing to periodic reports. Community based HIS established and linked to HMIS by The proportion of quarterly HMIS reports submitted. Proportion of planned validation studies that are carried out. The proportion of sub national entities (districts, health facilities) that have reported on the key indicators as planned. Africa, and, Bilali FM, Radio Simba, Pearl of Africa FM, Mboona FM, Etop Radio, Radio 5 fm, Main Top Achievements radio, Metro FM, Community FM, FM J, UBC TV, Top TV and Record TV. Incorporation Procured equipment of the Community/VHT for the laboratory data to facilitate into the mainstream the testing of HMIS. medicine samples: In A total order of to 348 improve batches quality of medicine of data, samples and timeliness were tested, of reporting, 321 passed the Ministry and 27 failed has customized the tests. and A total rolled of 226 out batches the electronic of male Latex system condoms of reporting were tested; of HMSI 221 data passed i.e. the and DHIS2, 05 failed. where Out all of [Annual Health Sector Performance Report 2012/13 FY] districts are submitting data via the web to the Ministry. This has also greatly improved Page samples of medical gloves tested, 439 passed and 15 failed the test done the NDQCL. data 148 LLINs sharing were where tested all and persons all passed. with access rights can access the data and use it at any time. NDA developed a customer identification system that gives unique identifiers (Facility [Annual Health Sector Performance Report 2012/13] Page 144

156 Africa, and, Bilali FM, Radio Simba, Pearl of Africa FM, Mboona FM, Etop Radio, Radio 5 fm, Top radio, Metro FM, Community FM, FM J, UBC TV, Top TV and Record TV. Procured equipment for the laboratory to facilitate the testing of medicine samples: A total of 348 batches of medicine samples were tested, 321 passed and 27 failed the tests. A total of 226 batches of male Latex condoms were tested; 221 passed and 05 failed. Out of 454 samples of medical gloves tested, 439 passed and 15 failed the test done at the NDQCL. 148 LLINs were tested and all passed. NDA developed a customer identification system that gives unique identifiers (Facility Identification Numbers) to each drug outlet (pharmacy, drug shop and manufacturing facility) in order track each drug outlet in the country and also facilitate bank reconciliations. Cabinet approved the NDA/NFDA transformation on 25 th July The Draft NFMA Bill was finalised and discussed by NDA Senior Management in February, April and May Further consultations with the MoH, MAAIF and stakeholders are ongoing Information for Decision Making The health sector requires reliable and accurate information to enable evidence-based decision making, sector learning and improvement. Monitoring and evaluation aims at informing policy makers about progress towards achieving targets as set in the annual health sector plans and the HSSP and to help provide managers with a basis in making decisions. Core HSSIP indicators Timeliness of district HMIS reporting to the RC Division. Completeness of district HMIS reporting to the RC Division. Lead programme indicators The proportion of implementing partners (NGOs, CSOs, Private sector) contributing to periodic reports. Community based HIS established and linked to HMIS by The proportion of quarterly HMIS reports submitted. Proportion of planned validation studies that are carried out. The proportion of sub national entities (districts, health facilities) that have reported on the key indicators as planned. Main Achievements Incorporation of the Community/VHT data into the mainstream HMIS. In order to improve quality of data, and timeliness of reporting, the Ministry has customized and rolled out the electronic system of reporting of HMSI data i.e. the DHIS2, where all districts are submitting data via the web to the Ministry. This has also greatly improved data sharing where all persons with access rights can access the data and use it at any time. There has been tremendous harmonisation of data collection tools at facility level, reducing [Annual on the Health aspects Sector of Performance duplication Report and existence 2012/13] of silos of data collection systems across Page 144 the health sector. There is now existence of a harmonised database. Data collection tools are further going to be harmonised just after the mid-term review of the HSSIP. Data Demand and Use Manuals were developed and 34 districts were trained with an aim to improve data sharing at district and lower levels, generation of district level league tables, and analysis done at health facility level. RC organised semi annual HMIS stakeholder meetings, where HMIS data was disseminated. 136 Also PageHMIS quarterly reports [Annual were Health generated Sector Performance and disseminated Report 2012/13 during FY] the quarterly review meetings. Ahead of the MTR of the HMIS paper based tools, consultations have started with the Private Sector with an aim to ensure that health indices are reported through the HMIS. But

157 health sector. There is now existence of a harmonised database. Data collection tools are further going to be harmonised just after the mid-term review of the HSSIP. Data Demand and Use Manuals were developed and 34 districts were trained with an aim to improve data sharing at district and lower levels, generation of district level league tables, and analysis done at health facility level. RC organised semi annual HMIS stakeholder meetings, where HMIS data was disseminated. Also HMIS quarterly reports were generated and disseminated during the quarterly review meetings. Ahead of the MTR of the HMIS paper based tools, consultations have started with the Private Sector with an aim to ensure that health indices are reported through the HMIS. But it is important to note that some private facilities have already started reporting through the HMIS system. The MoH senior staff e.g. the programmatic M&E Officers, and key technical staff were trained in the DHIS2 and this has greatly improved on user satisfaction as far as availability of data is concerned since all who have access rights can access data from the system in real time. Publication of immunization indicators in the newspapers on a quarterly basis hence improving information sharing and feedback from the Centre to districts. Partners supported a harmonised system through the printing of the integrated HMIS tools and made them available for the districts they are supporting. This has helped bridge the gap of lack of enough data collection tools in the health facilities. National ehealth Policy and Strategy developed. Challenges Inadequate human resource both in numbers and skills mix to enable the RC comfortably serve all its stakeholders Inadequate data collection tools (like Child health cards, patient files, registers, etc) in the health facilities to enable data capture using harmonised data collection tools for the sector. Inadequate qualified staff at district and lower level facilities to handle health data, as these will boost data use and appreciate the components of the health information system. Some MoH Technical programmes like ACP and TB have continued to develop, print and distribute parallel data collection tools and yet all routine data collection tools are supposed to be harmonised and integrated into the mainstream HMIS to avoid silos of information systems in the sector and promote a single monitoring system. Accelerated Implementation of the ehealth roadmap Quality of Care The HSSIP 2010/ /15 emphasizes the provision of high quality health services by all. [Annual This is Health ensured Sector through Performance regular Report supervision, 2012/13] inspection, mentoring, quality improvement Page 145 interventions; and establishment of dynamic interactions between health care providers and consumers of health care with the view to improving the quality and responsiveness (including gender responsiveness) of health services provided. Core HSSIP indicator % clients expressing satisfaction with health services (waiting time) Lead programme indicators Appropriate standards, guidelines and tools developed and disseminated. Proportion of planned support supervision visits that are carried out National Quality Improvement Framework and Strategic Plan operational Mechanism for client/right [Annual Health holders Sector redress Performance established Report 2012/13 and operational. FY] Page 137 Key output Indicators 2012/13 Standards and guidelines developed

158 % clients expressing satisfaction with health services (waiting time) Lead programme indicators Appropriate standards, guidelines and tools developed and disseminated. Proportion of planned support supervision visits that are carried out National Quality Improvement Framework and Strategic Plan operational Mechanism for client/right holders redress established and operational. Key output Indicators 2012/13 Standards and guidelines developed Standards and guidelines disseminated Support supervision provided to LGs and referral hospitals Health facilities implementing QI initiatives Perfromance reviews conducted Major Achievements Two out of four planned performance review meetings for implementation of the MoH workplan were carried during the period under review. Biannual review reports were compiled printed and disseminated. The 18 th Joint Review Mission (JRM) for 2012/13 FY and the Aide memoire was signed. The Annual Health Sector Performance Report (AHSPR) 2012 was compiled, printed and distributed. The MoH Client Charter was reviewed where 7,000 copies of the charter were printed and the dissemination process was initiated with a launch on 22 nd February Client Charters for the 3 RRHs of Masaka, Mbale and Gulu Hospitals were developed and launch is due in 2013/14 FY. The rest of the RRHs were supported and developed draft copies of the charter. Other guidelines which were developed and printed include 2,000 copies of the National Infections Prevention and Control Guidelines; 500 copies of the Uganda Clinical Guidelines (UCG) 2012; 5,600 copies of National Quality Improvement Framework and Strategic Plan (QIF &SP), 1,500 copies of the 5S Guidelines and Hand book, Governance and Management Guidelines for MoH Structures (not yet printed) and 700 copies of the Standards on Diagnostic Imaging and Therapeutic Radiology for Uganda. Two out of the four planned support supervision visits (Area Team) to LGs were carried out. [Annual The Health National Sector QIF Performance &SP was has Report been rolled 2012/13] out in 7 districts in Rwenzori and 8 districts Page 146 in Busoga regions respectively. 5S implementation started in Mulago National Referral Hospital, the 8 RRHs. National Quality Improvement Conference was successfully held in June It was facilitated by HealthQual, ASSIST, JICA and other partners. Challenges Delays in procurement process for the consultancy to conduct the Client Satisfaction Survey for the MoH. All result areas for the department were affected significantly by the very low and at times no quarterly releases of funds to implement the various planned activities. Most of the guidelines developed and printed have not yet been disseminated to the stakeholders due to lack of funds. Support supervision is affected by the aging fleet of vehicles in the MoH. Most areas to supervise and monitor are hard reach with poor road network which require sound means of transport to ease movement of supervising teams. Lack of resources which has caused slow progress in rolling-out QIF &SP to cover the remaining regions and health facilities in the country. 138 Page [Annual Health Sector Performance Report 2012/13 FY] Health Policy, Planning and Support Services Review and develop relevant Policies, Acts and regulations governing health which are gender responsive and human rights compliant and to ensure their enforcement. Currently there are

159 Most of the guidelines developed and printed have not yet been disseminated to the stakeholders due to lack of funds. Support supervision is affected by the aging fleet of vehicles in the MoH. Most areas to supervise and monitor are hard reach with poor road network which require sound means of transport to ease movement of supervising teams. Lack of resources which has caused slow progress in rolling-out QIF &SP to cover the remaining regions and health facilities in the country Health Policy, Planning and Support Services Review and develop relevant Policies, Acts and regulations governing health which are gender responsive and human rights compliant and to ensure their enforcement. Currently there are several obsolete laws and regulations in the sector that require revision in order to better ensure the enjoyment of the rights they are supposed to support. Examples include the Public Health Act, the Food Safety Act, and the Mental Health Act. The Policy Analysis Unit in the MoH and Health Professional Councils are responsible for strengthening the legal and policy environment conducive for the delivery of the minimum health care Planning The aim of planning is to ensure efficiency in resource allocation, management and utilization. Core Indicators General Government allocation for health as % of total government budget Lead Programme Indicators Development of a health financing strategy by June 2011 Government per capita expenditure on health increased to 12$ by 2014/2015. Key output Indicators 2012/13 Coordination of sector planning and resource mobilization Conduct annual DHO S Meeting [Annual Develop Health Sector and produce Performance annual Report work 2012/13] plan for 2012/2013 Page 147 Create awareness on health and climate change Follow-up PRDP/LRDP/NUSAF II activities in implementing districts. Major Achievements 2012/13 Conducted the Regional planning meetings (covering 62 districts) the remaining 50 districts will be covered in the upcoming period. Developed and produce and distributed the MoH Work plan 2012/2013. Created awareness on health climate change in LGs (10 in Eastern, 10 in Mid Western Uganda). Followed up PRDP/NUSAF II activities in 36 implementing districts, to review the Health Worker Staff houses infrastructure development. Challenges Accessing funds for planned activities remain a challenge. Transport for district and Regional Planning activities is a major constraint Finance and Administration Services The department of finance and administration is composed of; (a) Minister s Offices [Annual Health Sector Performance Report 2012/13 FY] (b) Senior Top Management (PS, DGHS, Directors offices) Page 139 (c) Administration Division (d) Accounts Division (e) Personnel Division

160 Accessing funds for planned activities remain a challenge. Transport for district and Regional Planning activities is a major constraint Finance and Administration Services The department of finance and administration is composed of; (a) Minister s Offices (b) Senior Top Management (PS, DGHS, Directors offices) (c) Administration Division (d) Accounts Division (e) Personnel Division (f) Procurement and Disposal Unit (g) Internal Audit (h) ICT Unit Responsible for providing political direction, giving policy guidance and rendering support services to enable the Ministry fulfil its mandate of providing quality and equitable preventive and curative health services to public Ministerial and Top Management Key output Indicators 2012/13 Issue weekly press statements to disseminate the ministry s strategies to improve Health Care Management. Hold monthly press conferences to update the public on the efforts of the ministry to improve health service delivery. Inspect the delivery of health services in 14 RRHs and 45 GHs. [Annual Monitor Health medicines Sector Performance distribution, Report storage, 2012/13] allocation, records and dispensation system Page 148 in districts. Supervision of PHC activities in 111 districts. Monitor the functionality of HC IVs and HC IIIs in 111 districts. Support supervision of DHTs in 111 districts. Major achievements 2012/13 Issued press statements on different issues in the MoH to keep all stakeholders informed on the key strategic and policy issues affecting the health sector. Responded to queries raised in Audit Reports for FY2009/2010, addressed the issues raised in the management letter by the Auditor General and Public Accounts Committee for FY 2011/12 Monitored utilization of and accountability for PHC Grants in all the regions across the country. Inspected utilization of the Development budget in all 13 RRHs. Worked were able to achieve regular and timely payment of all staff salaries at the MoH headquarters. Coordinated the organization and commemoration of important natiaonal days like the Leprosy day, World Health Day, International Nurses day, World Tobbaco day, and Nutrition day among others. Verified all domestic arrears at the MoH headquarters and guided on the appropriate action to take. Challenges Inadequate office space for staff despite the commissioning of the new office block at the 140 headquarters. Page [Annual Health Sector Performance Report 2012/13 FY] Continued accumulation of domestic arrears which has lead to a huge bill the MoH has to pay. Delays to make the IFMS accessible to the vote controllers, which hinders effective budget

161 Leprosy day, World Health Day, International Nurses day, World Tobbaco day, and Nutrition day among others. Verified all domestic arrears at the MoH headquarters and guided on the appropriate action to take. Challenges Inadequate office space for staff despite the commissioning of the new office block at the headquarters. Continued accumulation of domestic arrears which has lead to a huge bill the MoH has to pay. Delays to make the IFMS accessible to the vote controllers, which hinders effective budget monitoring and implementation. Poor response on the requirement to have procurement plans and performance reports by user departments. Budget Pressures to cater for unforeseen and unbudgeted for activities like recurrent disease outbreaks in the country Budget and Finance Key output Indicators 2012/13 Prepare and submit activity and financial reports for all the quarters to MoFPED. Inspect and assess the standards of financial book keeping, maintenance of accounting records and adherence to financial regulations and procedures in the districts. [Annual Inspect Health the Sector utilization Performance and accountability Report 2012/13] for PHC Grants in the Districts. Page 149 Inspect the utilization of the Development Budget in 14 RRHs. Major achievements The NHA Survey report for FYs 2008/09 and 2009/10 was printed and circulated. The Health Financing Strategy is under development showing options for financing the health services. A draft resource allocation formula for PHC grants is available and will be applied when additional resources are identified. This will be important to minimize reduction in allocations that some LGs may suffer as a result of the formula that shifts allocations based on population to deprivation and health status weighted population base. The allocation for all GHs will be output based. A study on efficiency assessment of hospitals and HC IVs was finalized. Challenges Inadequate funding for sector activities for example, the conditional grants to LGs and PNFPs have not significantly changed yet population, administrative units and prices have increased significantly. Unplanned and unbudgeted for activities. Unforeseen and unbudgeted for but catastrophic and urgent emergencies such as Ebola and Marburg exerted pressure on operational resources thus constraining other important activities. Off-budget sector funding: A number of health improving activities are funded outside the sector wide mechanism that was established to align funding to sector priorities. This leads to efficiency losses associated with funding activities that may be duplicative or outside the priorities identified to achieve health outcomes. Weaknesses in the LG capacity in areas of financial reporting, leadership and financial management. Recommendations Lobby for more funds to finance sector activities. [Annual Health Sector Performance Report 2012/13 FY] Page 141 Institute a protected funding for health services supervision and monitoring to minimize the effect of item ceilings and cuts in government budgets on requisite services support supervision and monitoring.

162 to efficiency losses associated with funding activities that may be duplicative or outside the priorities identified to achieve health outcomes. Weaknesses in the LG capacity in areas of financial reporting, leadership and financial management. Recommendations Lobby for more funds to finance sector activities. Institute a protected funding for health services supervision and monitoring to minimize the effect of item ceilings and cuts in government budgets on requisite services support supervision and monitoring. Disseminate the findings from the NHA Accounts survey to policy makers. Finalise the new Health Financing Strategy and implement strategies therein. Enhance periodic supervision, reporting to ensure efficient budget monitoring and performance. Track and align off budget funding by ensuring that all projects and donor inflows are aligned to HSSIP and reflected in the budget. Reduce out of-pocket funding for health care by introducing prepayment systems like health insurance. Study innovations in health financing like performance based financing with view to [Annual improving Health the Sector efficiency Performance of government Report 2012/13] financing. Page Legal and Regulatory Framework Appropriate legislation and its enforcement provide an enabling environment for operationalization of the policy and the HSSIP and are essential for an effective health service delivery system. The Health Professionals Councils are responsible for; Strengthening the legal and policy environment conducive for the delivery of the minimum health care package Promoting enforcement, observance and adherence to professional standards, codes of conduct and ethics Lead Program Indicators Number of relevant international legal instruments on health that have been domesticated Number of law enforcers trained in new legislation and policies to ensure implementation of legislation and policies. An effective regulatory environment and mechanism developed. An adequate and functional staffing structure of Professional councils established over the next five years. A Joint Professional Council with decentralized supervisory authorities established and operationalized over the next five years Uganda Medical and Dental Practitioners Council (UNMDPC) The mandate of UNMDPC is to regulate and enforce standards of practice and supervise Medical and Dental Education in Uganda Main Achievements Reserved 200 million for the building of the Council House Lead the 26 Consultations on the formation of the National Health Authority. Recruited 2 key Staff Improved Compliance of practitioners to acquire their licenses Formed 30 new District Supervisory Authorities and supported them Published all the licensed Practitioners for the year Page [Annual Health Sector Performance Report 2012/13 FY] Challenges Council is operating under Weak registration derived from UMDPC Act. Though Council recruited the Accountant and the Administrator, Council still lacks more key

163 Main improving Achievements the efficiency of government financing. Reserved 200 million for the building of the Council House Lead Legal the 26 and Consultations Regulatory Framework on the formation of the National Health Authority. Appropriate Recruited 2 legislation key Staff and its enforcement provide an enabling environment for operationalization Improved Compliance of the policy of practitioners and the HSSIP to acquire and are their essential licenses for an effective health service delivery Formed system. 30 new The District Health Supervisory Professionals Authorities Councils are and responsible supported for; them Strengthening Published all the the licensed legal and Practitioners policy environment for the year conducive 2013 for the delivery of the minimum health care package Challenges Promoting enforcement, observance and adherence to professional standards, codes of conduct Council is and operating ethics under Weak registration derived from UMDPC Act. Though Council recruited the Accountant and the Administrator, Council still lacks more key Lead staff Program in Accounts, Indicators Legal and Registration Number Despite all of Council relevant efforts, international routine legal inspections instruments of the on health units that are have still been a challenge. domesticated Number of law enforcers trained in new legislation and policies to ensure implementation of legislation and policies. [Annual effective Health Sector regulatory Performance environment Report and 2012/13] mechanism developed. Page 151 An adequate and functional staffing structure of Professional councils established over the next five years. A Joint Professional Council with decentralized supervisory authorities established and operationalized over the next five years Uganda Medical and Dental Practitioners Council (UNMDPC) The mandate of UNMDPC is to regulate and enforce standards of practice and supervise Medical and Dental Education in Uganda Main Achievements Reserved 200 million for the building of the Council House Lead the 26 Consultations on the formation of the National Health Authority. Recruited 2 key Staff Improved Compliance of practitioners to acquire their licenses Formed 30 new District Supervisory Authorities and supported them Published all the licensed Practitioners for the year 2013 Challenges Council is operating under Weak registration derived from UMDPC Act. Though Council recruited the Accountant and the Administrator, Council still lacks more key staff in Accounts, Legal and Registration Despite all Council efforts, routine inspections of the health units are still a challenge Research [Annual Health Sector Performance Report 2012/13] Page Uganda National Health Research Organisation The health sector aims at creating a culture in which health research plays a significant role in guiding policy formulation and action to improve the health and development of the people of Uganda. The UNHRO is responsible for coordinating all the health related research in Uganda. Lead programme indicators A policy and legal framework for effective coordination, alignment and harmonization of research activities developed by A prioritized national research agenda developed by Institutions involved in conducting research identified by Key output Indicators 2012/13 [Annual Health Sector Performance Report 2012/13 FY] Page 143 Policy, consultation, planning and monitoring Develop Health research policy and strategic plan Disseminate the national research policy and strategic plan :

164 A policy and legal framework for effective coordination, alignment and harmonization of research activities developed by A prioritized national research agenda developed by Institutions involved in conducting research identified by Key output Indicators 2012/13 Policy, consultation, planning and monitoring Develop Health research policy and strategic plan Disseminate the national research policy and strategic plan : Develop Agenda for reproductive health research Main achievements 2012/13 Four Board retreats meeting with stakeholders on health research strategic plan development were planned including one national consultative meeting with stakeholders including the UNCST to discuss and agree on ethics guidelines. The 3 Board meetings were held on the 27th Sept 2012 and also on 14th Feb 2013to discuss the final draft strategic plan. Annual Conference consultation jointly held with the Uganda National Council of Science and Technology. Ethical standards were discussed and adopted on the on the 13 th July Report available as planned Final drafts for research health policy and the strategic plan discussed and approved by top management of MoH. Held consultations for the dissemination of the policy and the strategic plan for research with key stakeholders Visited selected districts for final inputs and comments Held a workshop in June 2013 to share and disseminate final research health policy and the strategic plan. Final Report available as planned. A report on RH research priorities was developed in consultation with the Uganda Obstetrics /Gynaecology Association and FHI. The national health research agenda priorities will be developed in the FY 2013/ Natural Chemotherapeutics Research Institute (NCRI) The NCRI formerly Natural Chemotherapeutics Research Laboratory is a research and development centre under the UNHRO created by an act of parliament, the 2009 UNHRO Act. [Annual The institution Health Sector is mandated Performance to carry Report out research 2012/13] on natural products (plants, animal parts Page and 152 minerals) and the use of traditional methods in the management of human disease. The institute undertakes the research and development of quality natural products and services for improved health care delivery by applying both indigenous and modern scientific technologies. Key output Indicators 2012/13 Useful Traditional Medicines identified, collected, evaluated and documented Staff training in selected short term professional areas Training of Traditional Health Practitioners (THPs) in Sustainable utilization and Development of Traditional Medicine Traditional Medicine development Programme established Develop institutional strategic plan Main achievements in FY 2012/13 53 Medicinal plants were collected documented and phytochemical analysis carried out. Pre- clinical validation of 4 selected herbal products was carried out. Safety studies of the Artemisia annual grown in Oyam district carried out in laboratory animals. 34 farmers / herbalists from Kaetale and Capchebai villages planted the Moringa oliefera 144 seeds Page that were distributed [Annual to them Health by Sector the Performance institution Report in their 2012/13 respective FY] gardens. Collection of Xanthoxylum chalebeum (Fagara), Warburgia Salutaris, and Phyllanthus niruri specimens collected. Collection and documentation of medicinal used in Mubende district to treat prioritized diseases in different communities.

165 Main achievements in FY 2012/13 53 Medicinal plants were collected documented and phytochemical analysis carried out. Pre- clinical validation of 4 selected herbal products was carried out. Safety studies of the Artemisia annual grown in Oyam district carried out in laboratory animals. 34 farmers / herbalists from Kaetale and Capchebai villages planted the Moringa oliefera seeds that were distributed to them by the institution in their respective gardens. Collection of Xanthoxylum chalebeum (Fagara), Warburgia Salutaris, and Phyllanthus niruri specimens collected. Collection and documentation of medicinal used in Mubende district to treat prioritized diseases in different communities. Identification and collection of plants used as ingredients for the anti HIV/AIDS formulae done; plants to be analyzed for safety in the laboratory. Activity carried out with management committees of Kawete (Iganga), Nakazzi (Luwero) and Atur (Dokolo) community centers for traditional medicine. Assessed levels of re-infestation of jiggers in communities in Nawandala subcounty, Iganga district treated with a herbal formula JESE001 developed at the laboratory in collaboration with a herbalist. Training of 25 THPs and VHT in Dokolo district in development of herbal products, proper diagnosis in the treatment and management of uncomplicated malaria and conservation of wild medicinal plants. 25 farmers and herbalists trained in good cultivation practices, establishment of demonstration gardens and conservation techniques. 30 herbalists from Bushenyi district and 25 herbalists from Busia district and 25 herbalists from Adjumani district trained in formulation and manufacture of properly processed, packaged and labelled herbal products and Good agricultural Practices respectively as a means of standardizing herbal medicines. Data on indigenous knowledge on use of herbal medicine in the management of lifestyle [Annual diseases Health collected Sector Performance in Mubende Report District. 2012/13] Data from 25 herbalists who treat type II Page diabetes 153 collected 54 herbalists and VHTs in Dokolo district identified practices and practitioners involved in indigenous practices in the community, Best practices documented and disseminated to practitioners. Held consultations with various stakeholder and research partners as part of the strategic plan development. Information on traditional medicine research and practices disseminate to stakeholders through media including Bukedde news paper, CBS FM station targeting central and Eastern regions Uganda Virus Research Institute (UVRI) UVRI is a semi-autonomous under UNHRO. The Institute s broad mission is to carry out scientific investigations concerning communicable diseases especially viral diseases of public health importance and to advise government on strategies for their control and prevention. It is responsible for the provision of quality assurance and quality control, conducting research on viruses associated with human cancers, build capacity and support disease prevention and intervention strategies in Uganda. Lead programme indicators Number of diseases monitored Number of outbreaks investigated Number of interventions developed Key output Indicators 2012/13 [Annual Health Sector Performance Report 2012/13 FY] Determine prevalence of HIV + Syphilis on ANC surveillance samples (13,000 samples Page to 145 be tested from ANC HIV sentinel sites in a year. Provide support supervision to 1,500 sites To provide 13,000 PT panels to HIV testing sites

166 Lead programme indicators Number of diseases monitored Number of outbreaks investigated Number of interventions developed Key output Indicators 2012/13 Determine prevalence of HIV + Syphilis on ANC surveillance samples (13,000 samples to be tested from ANC HIV sentinel sites in a year. Provide support supervision to 1,500 sites To provide 13,000 PT panels to HIV testing sites Main achievements 2012/13 13,000 tested for HIV and 10,000 samples tested for syphilis. 188 sites benefited from support supervision 15,583 PT panels distributed Public Private Partnership for Health The MoH encourages and institutionalized the involvement of the private sector in the provision private partnership of preventive, approach. promotive The and PPPH curative effectively health builds care and to all utilizes Ugandans the full through potential the public of the private public and partnership private partnerships approach. The in the PPPH health effectively sector builds and utilizes the full potential of the public and private partnerships in the health sector [Annual Lead programme Health Sector indicators Performance Report 2012/13] Page 154 Lead The programme National Policy indicators on PPPH is approved by the Cabinet by 2011 The Number National of districts Policy on which PPPH have is approved developed by a the joint Cabinet public-private by 2011 District Health Plan Number of of districts which in which have PHP developed sub-sector a joint contributes public-private to the HMIS. District Health Plan Number of districts in which PHP sub-sector contributes to the HMIS. Key output Indicators 2012/13 Key Disseminate output Indicators and institutionalize 2012/13 the PPPH policy in order to improve the performance of the Disseminate health system and institutionalize the PPPH policy in order to improve the performance of the health system Main achievements 2012/13 Main The achievements PPPH Policy was 2012/13 disseminated to 60 LGs during the regional planning meetings The Have PPPH commenced Policy was on disseminated building institutional to 60 LGs during arrangements the regional for planning operationalizing meetings the PPPH Have policy commenced by securing on financial building and institutional technical support arrangements to form for coordination operationalizing structures the at PPPH the policy central by (PPP securing Coordination financial Unit) and and technical Local Government support to levels- form coordination BTC, USAID and structures IFC support at the central PHC funds (PPP(U Coordination Shs billion) Unit) was and extended Local Government to the private levels- sector BTC, (PNFPs USAID and and IFC PHPs) support for PHC PHC activity funds implementation (U Shs billion) was extended to the private sector (PNFPs and PHPs) for PHC activity Two monitoring implementation and supervision field activities conducted for 34 recipients of PHC funds Two from monitoring Government and supervision field activities conducted for 34 recipients of PHC funds from The Implementation Government guidelines for the PPPH Policy have been completed and await review The by SMC Implementation and TMC guidelines for the PPPH Policy have been completed and await review by With SMC DFID and support, TMC RBF is being implemented in PNFP facilities in the Acholi and Lango With regions, DFID with support, focus on RBF essential is being medicines, implemented and health in PNFP systems facilities strengthening. the Acholi and Lango regions, with focus on essential medicines, and health systems strengthening. 3.3 Monitoring and Evaluation of Implementation of the HSSIP 2010/ /15 Monitoring 3.3 Monitoring and evaluation and Evaluation (M&E) of of implementation Implementation of of the the HSSIP HSSIP 2010/ / / /15 is based Monitoring periodic and reporting evaluation and (M&E) periodic of reviews implementation of information of the generated HSSIP 2010/11 by the 2014/15 HMIS and is based other on official periodic data reporting sources like and surveys. periodic M&E reviews aims at of informing information policy generated makers by about the progress HMIS and towards other official achieving data targets sources as like set surveys. in the annual M&E aims health at informing sector plans policy and makers the HSSP about and progress to help towards provide achieving managers targets with a basis set in making the annual decisions. health sector plans and the HSSP and to help provide managers with a basis in making decisions. 146 Lead Page programme indicators [Annual Health Sector Performance Report 2012/13 FY] Lead The programme proportion indicators of implementing partners (NGOs, CSOs, Private sector) contributing to The periodic proportion reports of implementing partners (NGOs, CSOs, Private sector) contributing to periodic Community reports based HIS established and linked to HMIS

167 on periodic reporting and periodic reviews of information generated by the HMIS and other official data sources like surveys. M&E aims at informing policy makers about progress towards achieving targets as set in the annual health sector plans and the HSSP and to help provide managers with a basis in making decisions. Lead programme indicators The proportion of implementing partners (NGOs, CSOs, Private sector) contributing to periodic reports Community based HIS established and linked to HMIS The proportion of planned periodic review that are carried Timeliness of reporting Completeness of reporting Proportion of planned validation studies that are carried out The proportion of sub national entities (districts, health facilities) that have reported as [Annual planned Health Sector Performance Report 2012/13] Page 155 Selected data disaggregated by age & sex with concomitant gender analysis Key output Indicators 2012/13 Number of sector performance review meetings held Monitoring and evaluation studies carried out Major Achievements 2012/13 Two out of three sector quarterly performance reviews were held with participation from all departments and autonomous institutions. The 18 th JRM conducted on schedule Compiled, printed and disseminated the AHSPR 2011/12. Biannual progress reports submitted to MoFPED and OPM Compiled and submitted the sector progress report 2011/12 for monitoring implementation of the NDP to the National Planning Authority. Orientation and dissemination of the M&E Plan for implementation of the HSSIP 2010/ /15 M&E Plan conducted in 22 districts. Conducted the SARA 2013 Conducted a Mid-term evaluation of the 5S-CQI-TQM Project Mid Term Evaluation of the HSSIP 2010/ /15 Challenges Structure for implementation of roles and responsibilities for sector M&E functions not defined. Program M&E units not linked to the QAD for proper coordination of sector M&E activities. Inadequate funds to facilitate regular sector performance review meetings at all levels including the Annual JRM. Gaps in use of M&E results at all levels Recommendations Formalise M&E implementation structure with clear roles and responsibilities. Strengthen linkage between program M&E units and the QAD. Clear budget allocations for operationalization of the HSSIP 2010/ /15 M&E plan including funding for the JRM. Support sub national levels to conduct regular performance review meetings [Annual Health Sector Performance Report 2012/13 FY] Page 147 [Annual Health Sector Performance Report 2012/13] Page 156

168 3.4 League Tables 2012/13 FY Table 68: District League Table 2012/13 FY HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Gulu 1 Kabarole 2 Nwoya 3 Masaka 4 Kyegegwa 5 Bushenyi 6 Abim 7 Jinja 8 Luwero 9 Kyenjojo 10 Kalungu 11 Lira 12 Mpigi 13 Kamuli 14 Kamwenge 15 Mityana 16 % % % [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

169 HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Lyantonde 81,800 88% % % % % % % % % 50% 79% % Rukungiri 326,000 82% % % % % % % % % 58% 93% % Kiboga 172, % % % % % % % % % 100% 100% % Iganga 517,000 83% % % % % % % % % 100% 100% % Mbarara 454,800 76% % % % % % % % % 42% 88% % Butambala 100,900 71% % % % % % % % % 100% 100% % Nakasongola 159,800 87% % % % % % % % % 100% 97% % Budaka 183,700 95% % % % % % % % % 92% 97% % Amolatar 130, % % % % % % % % % 92% 98% % Kabale 502,100 84% % % % % % % % % 100% 98% % Nebbi 355,100 73% % % % % % % % % 83% 94% % Rubirizi 126, % % % % % % % % % 100% 99% % Agago 314,700 92% % % % % % % % % 67% 83% % Dokolo 189,700 78% % % % % % % % % 100% 98% % Rakai 493,000 83% % % % % % % % % 83% 95% % Mukono 565, % % % % % % % % % 100% 100% % Katakwi 184,000 93% % % % % % % % % 100% 97% % Nakaseke 197,500 65% % % % % % % % % 100% 99% % Isingiro 432,100 87% % % % % % % % % 100% 100% % % % % [Annual Health Sector Performance Report 2012/13] Page 158 [Annual Health Sector Performance Report 2012/13 FY] Page 149

170 District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely HMIS reporting completeness and timeliness Total Score Rank Score Score Score Score Score Score Score Score Score Score Score 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) % % % % % Hoima 575,100 71% % % % % % % % % 92% 95% % Sironko 245, % % % % % % % % % 100% 100% % Mbale 453, % % % % % % % % % 92% 95% % Kumi 267,000 81% % % % % % % % % 100% 100% % Oyam 391, % % % % % % % % % 75% 87% % Manafwa 380, % % % % % % % % % 100% 98% % Kiruhura 311, % % % % % % % % % 100% 100% % Kalangala 70,800 79% % % % % % % % % 100% 107% % Ngora 164,400 92% % % % % % % % % 83% 92% % Busia 306,000 74% % % % % % % % % 83% 98% % Namutumba 224, % % % % % % % % % 75% 93% % Zombo 225,300 86% % % % % % % % % 92% 99% % Butaleja 228,800 78% % % % % % % % % 100% 100% % Buikwe 441,100 81% % % % % % % % % 58% 92% % National Average 33,568,500 87% % % % % % % % % 79% 94% % Kanungu 257,300 74% % % % % % % % % 83% 98% % Kaberamaido 207,700 83% % % % % % % % % 67% 90% % Bukedea 194,400 97% % % % % % % % % 92% 95% % % % % [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

171 HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Soroti 339,300 67% % % % % % % % % 17% 87% % Kitgum 257,600 79% % % % % % % % % 67% 91% % Ntungamo 491,200 65% % % % % % % % % 100% 97% % Kayunga 365,700 99% % % % % % % % % 100% 100% % Kisoro 257,800 93% % % % % % % % % 100% 100% % Otuke 88,800 99% % % % % % % % % 92% 97% % Maracha 205,600 78% % % % % % % % % 100% 100% % Mubende 633, % % % % % % % % % 58% 92% % Namayingo 243, % % % % % % % % % 50% 88% % Buvuma 56, % % % % % % % % % 67% 92% % Ibanda 261,900 82% % % % % % % % % 75% 92% % Pallisa 375,400 81% % % % % % % % % 92% 95% % Bundibugyo 275,100 77% % % % % % % % % 92% 98% % Amuru 183,600 87% % % % % % % % % 0% 73% % Apac 360,500 85% % % % % % % % % 25% 83% % Bugiri 447, % % % % % % % % % 42% 91% % Kasese 774,800 90% % % % % % % % % 8% 82% % Buliisa 82, % % % % % % % % % 100% 100% % Tororo 500,300 78% % % % % % % % % 83% 92% % % % % [Annual Health Sector Performance Report 2012/13] Page 160 [Annual Health Sector Performance Report 2012/13 FY] Page 151

172 HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Serere 309,600 56% % % % % % % % % 100% 100% % Sheema 224,400 63% % % % % % % % % 67% 89% % Bulambuli 128,600 98% % % % % % % % % 0% 69% % Masindi 371,600 68% % % % % % % % % 100% 100% % Arua 801,400 82% % % % % % % % % 0% 77% % Mayuge 477,700 71% % % % % % % % % 100% 95% % Wakiso 1,429,500 81% % % % % % % % % 83% 91% % Kyankwanzi 190,800 86% % % % % % % % % 100% 99% % Buyende 273, % % % % % % % % % 58% 90% % Buhweju 103,200 99% % % % % % % % % 100% 100% % Bududa 187, % % % % % % % % % 42% 83% % Mitooma 200,500 68% % % % % % % % % 67% 87% % Kapchorwa 119,300 59% % % % % % % % % 75% 93% % Koboko 251,800 85% % % % % % % % % 67% 96% % Lamwo 178,100 74% % % % % % % % % 100% 100% % Lwengo 269,900 82% % % % % % % % % 58% 92% % Bukwo 76,300 96% % % % % % % % % 100% 100% % Kibaale 717,500 67% % % % % % % % % 100% 98% % Gomba 154,900 93% % % % % % % % % 75% 94% % % % % [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

173 HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Alebtong 233, % % % % % % % % % 17% 82% % Kaliro 224,000 74% % % % % % % % % 25% 85% % Kibuku 188,000 68% % % % % % % % % 75% 95% % Kole 239,600 73% % % % % % % % % 58% 74% % Nakapiripirit 171, % % % % % % % % % 100% 100% % Luuka 269,800 93% % % % % % % % % 100% 98% % Pader 243,200 68% % % % % % % % % 0% 78% % Napak 209, % % % % % % % % % 100% 100% % Sembabule 223,900 79% % % % % % % % % 83% 95% % Kotido 248, % % % % % % % % % 100% 100% % Kiryandongo 334,500 70% % % % % % % % % 100% 97% % Bukomansimbi 155,400 65% % % % % % % % % 25% 83% % Adjumani 399,700 32% % % % % % % % % 100% 95% % Yumbe 589,500 58% % % % % % % % % 100% 100% % Amuria 441,200 49% % % % % % % % % 83% 96% % Moroto 143,800 61% % % % % % % % % 100% 100% % Kween 107,700 51% % % % % % % % % 0% 63% % Ntoroko 88,400 64% % % % % % % % % 75% 96% % Moyo 444,700 20% % % % % % % % % 100% 99% % % % % [Annual Health Sector Performance Report 2012/13] Page 162 [Annual Health Sector Performance Report 2012/13 FY] Page 153

174 HMIS reporting completeness and timeliness 111 Districts % Monthly reports sent on time (2) % Completeness monthly reports (1) % Completeness facility reporting (1) Completeness of the annual report (1) District Total Population DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV positive women Latrine coverage in households IPT2 ANC4 TB success rate Approved posts that are filled Medicine orders submitted timely Total Score Rank Score Score Score Score Score Score Score Score Score Score Score % % % % % Kaabong 422,300 68% % % % % % % % % 83% 96% % Amudat 120,500 57% % % % % % % % % 100% 100% % National Average 33,568,500 87% % % % % % % % % 79% 94% % % % % [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]

175 Table 69: General Hospital League League Table Table Hospital Admissions Admissions (109) (109) Total OPD (110) Total OPD (110) Deliveries (110) Deliveries (110) ANC Total (110) ANC Total (110) Postnatal Visits (105) Postnatal Visits FP Visits (105) (82) Iganga Iganga 21,007 21, ,213 5,670 6, ,213 5,670 6,440 1, ,181 1, ,549 10, ,549 1 Busolwe Busolwe 19,727 19,727 92,686 1,657 2, ,686 1,657 2, , ,208 3, ,208 2 Bwera 16,018 83,779 3,638 6, ,430 10, ,391 3 Bwera 16,018 83,779 3,638 6, ,430 10, ,391 Mityana 15,085 60,683 4,976 5,854 1,052 1,091 6, , Mityana Pallisa 15,085 14,320 60,683 4,976 5,854 77,964 3,002 3, , ,091 8,873 6, , , Pallisa Kawolo 14,320 13,073 77,964 3,002 3,652 84,028 3,598 6, ,784 8, , , Tororo Kawolo 14,364 13,073 65,538 84,028 3,316 3,598 4,870 6,255 2, ,813 5, , , Kamuli Tororo 11,724 14,364 87,553 65,538 1,801 3,316 3,430 4, ,4411, ,952 4, , , Angal Kamuli St. Luke 15,320 11,724 25,677 87,553 1,998 1,801 2,856 3, ,207 6,269 5, , , Ibanda Angal St. Luke 15,196 15,320 17,171 25,677 2,741 1,998 2,455 2, NA 69 4,944 6, , , Entebbe Ibanda 10,014 15,196 73,265 17,171 4,294 2,741 8,292 2,4551, NA 9,989 4, , , Itojo Entebbe 12,575 10,014 49,048 73,265 1,912 4,294 1,695 8, , ,647 9, , , Kisoro Itojo 10,790 12,575 65,329 49,048 2,907 1,912 5,414 1, ,702 2, , , Atutur Kisoro 10,267 10,790 72,517 1,769 1, ,329 2,907 5, , ,720 8, , Bugiri Atutur 10,681 10,267 58,941 2,473 5, ,517 1,769 1, , ,940 4, , Kagadi 11,693 33,608 3,164 4, , , Bugiri 10,681 58,941 2,473 5, , , Yumbe 10,903 50,787 2,338 1, , , Kagadi 11,693 33,608 3,164 4, , , Kayunga 9,365 72,766 2,167 2, ,431 6, , Yumbe Kalongo Ambrosoli Memorial 10,903 11,835 50,787 2,338 1,993 28,103 2,477 3,171 1, ,635 5, , , Kayunga Gombe 9,365 10,340 72,766 2,167 2,837 47,934 2,573 2, ,431 3,630 6, , , Ishaka Kalongo Adventist Ambrosoli Memorial 11,979 11,835 16,910 28,103 3,188 2,477 4,506 3, , ,995 4, , , Nebbi Gombe 10,664 10,340 46,766 47,934 1,437 2,573 3,155 2, ,855 3, , , St. Ishaka Joseph's Adventist Kitgum 11,015 11,979 38,046 16,910 2,121 3,188 2,271 4, NA 715 7,970 7, , , Adjumani Nebbi 8,976 10,664 59,883 46,766 1,629 1,437 3,035 3, ,262 3, , , Nakaseke St. Joseph's Kitgum 8,576 11,015 58,376 38,046 2,502 2,121 2,618 2, NA 4,488 7, , , Kiboga Adjumani 9,310 8,976 39,598 59,883 2,685 1,629 4,273 3,0351, ,390 4, , , Masafu Nakaseke 7,625 8,576 68,538 58,376 1,387 2,502 3,753 2, ,745 4, , , Kitgum Kiboga 8,233 9,310 58,498 1,567 2, ,598 2,685 4, ,438 4, ,575 3, , Masindi Masafu 8,201 7,625 40,778 3,542 6, ,538 1,387 3,753 1, , ,794 4, , Matany 9,205 39, , NA 8, , Kitgum 8,233 58,498 1,567 2, , , Kamuli Mission 9,018 31,392 2,242 3, , , Masindi 8,201 40,778 3,542 6, ,036 9, , Kisiizi NGO 8,425 38,592 1,910 5,015 NA 207 9, , Matany Lyantonde 9,205 7,419 39,352 57,152 1, ,720 2, NA 2,343 8, , , Kitagata Kamuli Mission 5,119 9,018 90,174 31,392 1,500 2,242 3,262 3, , , , , Kagando Kisiizi NGO 9,534 8,425 16,307 38,592 1,801 1,910 3,103 5, NA 1, ,093 9, , , [Annual Health Sector Performance Report 2012/13] Page 164 Kiryandongo Lyantonde 8,548 7,419 31,266 57,152 1,564 1,310 3,682 2, ,269 2, , , Hospital Admissions (109) Total OPD (110) Deliveries (110) ANC Total (110) [Annual Health Sector Performance Report 2012/13] Page 164 Postnatal Visits (105) [Annual Health Sector Performance Report 2012/13 FY] Page 155 FP Visits (82) FP Visits (82) Immunization (109) Immunization (109) Immunization SUO (109) (110) Kilembe 8,548 28,920 2,290 1, NA 5, , St. Karolii Lwanga Nyakibale 9,232 16,729 2,395 2, NA 4, , Kalisizo 7,404 44,972 2,181 2, , , Apac 6,645 53,888 1,889 4, ,547 6, , Kumi NGO 7,599 43,504 1,432 1, , , St. Joseph Kitovu 8,860 22,200 1,520 1, NA 3, , Bududa 7,752 39, , , , Mutolere (St. Francis) 8,580 20,215 1,814 2, , , General Military 5,512 68,243 1,416 1, , , Kiwoko 7,180 32,083 2,061 3, , , SUO (110) SUO (110) Ranking Ranking Ranking

176 Hospital Rushere Community 3,799 17, , ,965 79, [Annual Health Sector Performance Report 2012/13] Page 165 Kanginima 4,479 6, NA 3,691 75, Nakasongola Military 1,838 24, , Page [Annual Health Sector Performance Report 2012/13 FY] Rubongi Military 1,264 29, , Admissions (109) Total OPD (110) Ho F Im Kitagata 5,119 90,174 1,500 3, , , Kagando 9,534 16,307 1,801 3, ,265 5, , Kiryandongo 8,548 31,266 1,564 3, , , Kilembe 8,548 28,920 2,290 1, NA 5, , St. Karolii Lwanga Nyakibale 9,232 16,729 2,395 2, NA 4, , Kalisizo 7,404 44,972 2,181 2, , , Deliveries (110) Apac 6,645 53,888 1,889 4, ,547 6, , Kumi NGO 7,599 43,504 1,432 1, , , Kitagata St. Joseph Kitovu 5,119 8,860 90,174 22,200 1,500 1,520 3,262 1, NA 3,690 3, , , Kagando Bududa 9,534 7,752 16,307 39,903 1, ,103 1, , ,093 6, , , Kiryandongo Mutolere (St. Francis) 8,548 8,580 31,266 20,215 1,564 1,814 3,682 2, ,269 4, , , Kilembe General Military 8,548 5,512 28,920 68,243 2,290 1,416 1,737 1, NA 23 5,131 2, , , St. Kiwoko Karolii Lwanga Nyakibale 9,232 7,180 16,729 32,083 2,395 2,061 2,783 3, NA 4,752 4, , , Kalisizo Kapchorwa 7,404 6,616 44,972 39,337 2,181 1,470 2,700 2, ,217 3, , , Apac Naggalama, St Francis 6,645 7,078 53,888 29,330 1,889 1,816 4,211 3, ,547 NA 6,941 5, , , Kumi Murchison NGO Bay 7,599 2, ,219 43,504 1, ,235 2, ,803 1, , , St. Katakwi Joseph General Kitovu 8,860 7,094 22,200 28,285 1,520 1,050 1,140 1, NA 3,519 3, , , Bududa Aber NGO 7,752 6,449 39,903 29,451 1, ,706 4,304 2, ,438 6, , , Mutolere Virika (St. Francis) 8,580 7,247 20,215 16,909 1,814 1,944 2,631 1, NA 4,326 3, , , General Nkozi Military 5,512 6,299 68,243 30,387 1,416 1,948 1,699 1, ,324 4, , , Kiwoko Bundibugyo 7,180 5,595 32,083 39,736 2,061 1,484 3,073 2, ,776 4, , , Kapchorwa Kambuga 6,616 4,874 39,337 49,548 1,470 1,180 2,524 2, ,886 2, , , Naggalama, Moyo St Francis 7,078 4,538 29,330 55,765 1, , NA 5,386 2, , , Murchison Buikwe St. Charles Bay Lwanga 2,231 6, ,219 21, ,762 1, NA 1,836 3, , , Katakwi Comboni General 7,094 5,725 28,285 32,319 1, ,893 1, NA 3,787 3, , , Aber Kuluva NGO 6,449 6,295 29,451 19,032 1, ,304 1,471 2, ,438 7, , , Virika Villa Maria 7,247 4,991 16,909 30,289 1,944 1,314 1, NA 29,965 3, , , Nkozi Bwindi Community 6,299 4,999 30,387 31,728 1,948 1,264 1,721 1, ,139 2, , , Bundibugyo Buluba 5,595 5,108 39,736 32,240 1, , NA 4,420 2, , , Kambuga Nyapea 4,874 6,080 49,548 14,724 1,180 1,201 2,071 2, ,674 4, , , Moyo Kaabong 4,538 4,749 55,765 35, , ,844 2, , , Buikwe Kyenjojo St. Charles Lwanga 6,538 4,761 21,422 27,988 1, ,502 3, ,017 NA 3,518 5, , , Comboni Rakai 5,725 4,133 32,319 37,868 1, ,176 1, NA 3,570 2, , , Hospital Admissions (109) Total OPD (110) Deliveries (110) Kuluva Ruharo Mission 6,295 4,569 19,032 29, , ,704 1, , , Villa KIU Teaching Maria 4,991 5,402 30,289 16,498 1, NA 29,965 1, , , Bwindi Kakira Worker's Community 4,999 3,465 31,728 46,645 1, , ,537 1, , , [Annual Health Sector Performance Report 2012/13] Page 165 Buluba Kabarole 5,108 4,828 32,240 13,493 1, , NA 20,896 2, , , Nyapea Kisubi 6,080 3,760 14,724 30,757 1,201 1,492 2,145 2, ,380 9, ,172 97, Kaabong Dabani 4,749 5,090 35,712 8, , NA 90 19,844 2, ,162 90, Kyenjojo Maracha 4,761 4,836 27,988 12,678 1, , ,017 NA 5,173 2, ,625 89, Rakai Abim 4,133 3,719 37,868 29,834 1, , ,864 1, ,249 89, Ruharo Anaka Mission 4,569 3,483 29,936 24, , ,669 3, ,205 83, KIU Rugarama Teaching 5,402 3,967 16,498 17, , ,660 2, ,886 80, St. Francis Nyenga 3,432 19, , NA 2,192 75, Amudat 3,165 15, ,048 2,112 10,071 3,008 71, Lugazi Scoul 3,114 18, ,060 1,346 67, Nakasero 2,720 20, NA 6,392 65, Lwala 3,371 6, , NA 2,534 60, St. Anthony's Tororo 2,888 8, NA 1,925 53, Bukwo General 1,257 26, , Nkokonjeru 1,849 12, , NA 2,207 44, Amai Community 2,212 6, , ,989 42, ANC Total (110) ANC Total (110) Postnatal Visits (105) Postnatal Visits (105) FP Visits (82) FP Visits (82) Immunization (109) Immunization (109) SUO (110) SUO (110) Ranking Ranking

177 Anaka 3,483 24, , ,716 83, Rugarama 3,967 17, , ,089 80, Rushere Community 3,799 17, , ,965 79, Kanginima 4,479 6, NA 3,691 75, St. Francis Nyenga 3,432 19, , NA 2,192 75, Amudat 3,165 15, ,048 2,112 10,071 3,008 71, Hospital Admissions (109) Lugazi Scoul 3,114 18, ,060 1,346 67, Total OPD (110) Deliveries (110) Nakasero 2,720 20, NA 6,392 65, Lwala 3,371 6, , NA 2,534 60, Kitagata St. Anthony's Tororo 5,119 2,888 90,174 8,034 1, , NA 3,690 1, ,165 53, Kagando Nakasongola Military 9,534 1,838 16,307 24,605 1, , , , ,738 53, Kiryandongo Rubongi Military 8,548 1,264 31,266 29,232 1, , , ,834 48, Kilembe Bukwo General 8,548 1,257 28,920 26,709 2, , NA 5, ,703 46, St. Nkokonjeru Karolii Lwanga Nyakibale 9,232 1,849 16,729 12,795 2, ,783 1, NA 4,752 2, ,790 44, Kalisizo Amai Community 7,404 2,212 44,972 6,136 2, ,700 1, ,217 2, ,353 42, Apac Namungoona Orthodox 6,645 1,354 53,888 16,625 1, ,211 1, ,547 NA 6,941 3, ,964 41, Kumi Gulu Military NGO 7,599 1,057 43,504 21,930 1, , ,803 1, ,089 38, St. Kida Joseph Kitovu 8,860 1,985 22,200 3,787 1, , NA 3, ,204 36, Bududa Bamu 7,752 1,993 39,903 4, , , ,809 36, Mutolere Mayanja Memorial (St. Francis) 8,580 1,323 20,215 12,874 1, , ,326 1, ,477 34, General Kibuli Military 5,512 NA 68,243 28,773 1, ,699 1, NA 23 2,324 2, ,384 33, Kiwoko Buwenge NGO 7,180 1,075 32,083 6,022 2, ,073 2, ,776 3, ,826 27, Kapchorwa UPDF 2 nd Division 6, ,337 16,788 1, , , ,838 27, Naggalama, Galilee Community St Francis General 7,078 1,184 29,330 5,512 1, , ,122 NA 5,386 2, ,492 25, Murchison Oriajini Bay 2,231 1, ,219 2, , ,836 1, ,005 25, Katakwi Gulu Independent General 7, ,285 7,187 1, , ,787 5, ,269 22, Aber Kabasa NGO Memorial 6,449 1,053 29,451 1,986 1, , , ,438 4, ,726 19, Hospital Admissions (109) Total OPD (110) Deliveries (110) Virika Mbarara Community 7, ,909 4,619 1, , NA 82 3, ,722 17, Nkozi Saidina Abubakar Islamic 6, ,387 8,678 1, , ,139 2, ,601 17, Bundibugyo 5Th Military Division 5, ,736 15,122 1, , , ,455 16, [Annual Health Sector Performance Report 2012/13] Page 166 Kambuga Senta Medicare 4, ,548 8,279 1, , ,398 2, ,508 15, Moyo Uganda Martyrs 4, ,765 3, NA 2, ,773 13, Buikwe Lamezia St. Charles Lwanga 6, ,422 2, , NA 3, ,512 12, Comboni Old Kampala 5, ,319 6, , NA 1 3,325 3, ,202 9, Kuluva Divine Mercy 6, ,032 1, , , ,244 4, Villa Hunter Maria Foundation 4, , , NA 82 29, ,207 2, Bwindi Total Community 690,621 4,999 3,754,144 31, ,276 1, ,625 1,368 41, , ,042 2,537 15,129, , Buluba 5,108 32, NA 2, , Nyapea 6,080 14,724 1,201 2, , , Kaabong 4,749 35, , , , Kyenjojo 4,761 27,988 1,626 3, ,017 5, , Rakai 4,133 37,868 1,175 1, , , Ruharo Mission 4,569 29, , , KIU Teaching 5,402 16, , , ANC Total (110) ANC Total (110) Postnatal Visits (105) Postnatal Visits (105) FP Visits (82) FP Visits (82) Immunization (109) Immunization (109) SUO (110) SUO (110) Ranking Ranking [Annual Health Sector Performance Report 2012/13] Page 165 [Annual Health Sector Performance Report 2012/13 FY] Page 157

178 Table Table 70: 70: Risk Risk of of Maternal Death Death Table Table 71: 71: Risk Risk of of a Fresh a Fresh Still Still Birth Birth Maternal Risk Risk of Maternal of Hospital Deliveries Deaths Deaths Death Death Hospital Deliveries Fresh Fresh Still Still Birth Birth Risk Risk of a of FSB a FSB Atutur Atutur 1,769 1, :1,769 1:1,769 deliveries Nakasero :576 1:576 deliveries Nebbi Nebbi 1,437 1, :1,437 1:1,437 deliveries Senta Senta Medicare Clinic Clinic :409 1:409 deliveries General General Military Military 1,416 1, :1,416 1:1,416 deliveries Murchison Bay Bay :226 1:226 deliveries Masafu Masafu 1,387 1, :1,387 1:1,387 deliveries Buwenge NGO NGO :208 1:208 deliveries Kiwoko Kiwoko 2,061 2, :1,031 1:1,031 deliveries Masafu Masafu 1,387 1, :173 1:173 deliveries Moyo Moyo :960 1:960 deliveries Kisoro Kisoro 2,907 2, :153 1:153 deliveries Ruharo Ruharo Mission Mission :796 1:796 deliveries Bwera Bwera 3,638 3, :140 1:140 deliveries Kitgum Kitgum 1,567 1, :784 1:784 deliveries Katakwi Katakwi 1,050 1, :131 1:131 deliveries Kalongo Kalongo Ambrosoli Pallisa Pallisa 3,002 3, :751 1:751 deliveries Memorial 2,477 2, :130 1:130 deliveries Kitagata Kitagata 1,500 1, :750 1:750 deliveries Anaka Anaka :128 1:128 deliveries Kisoro Kisoro 2,907 2, :727 1:727 deliveries St. Anthony's St. Tororo Tororo :122 1:122 deliveries Entebbe Entebbe 4,294 4, :716 1:716 deliveries Yumbe Yumbe 2,338 2, :117 1:117 deliveries Kibuli Kibuli :715 1:715 deliveries Ruharo Ruharo Mission Mission :114 1:114 deliveries Masindi Masindi 3,542 3, :708 1:708 deliveries Namungoona Orthodox :109 1:109 deliveries Tororo Tororo 3,316 3, :663 1:663 deliveries St. Joseph's St. Kitgum Kitgum 2,121 2, :101 1:101 deliveries Bwera Bwera 3,638 3, :606 1:606 deliveries Kakira Kakira Worker's :92 1:92 deliveries Mutolere (St. (St. Francis) Francis) 1,814 1, :605 1:605 deliveries Kawolo Kawolo 3,598 3, :92 1:92 deliveries Abim Abim :601 1:601 deliveries Mayanja Mayanja Memorial :92 1:92 deliveries Kamuli Kamuli 1,801 1, :600 1:600 deliveries Angal Angal St. Luke St. Luke 1,998 1, :91 1:91 deliveries Nakasero :576 1:576 deliveries Lugazi Lugazi Scoul Scoul :90 1:90 deliveries Ishaka Ishaka Adventist 3,188 3, :531 1:531 deliveries Entebbe Entebbe 4,294 4, :89 1:89 deliveries Kaabong :524 1:524 deliveries Kibuli Kibuli :89 1:89 deliveries Gombe Gombe 2,573 2, :515 1:515 deliveries Nebbi Nebbi 1,437 1, :85 1:85 deliveries Kisubi Kisubi 1,492 1, :497 1:497 deliveries Atutur Atutur 1,769 1, :84 1:84 deliveries Bududa Bududa :496 1:496 deliveries Kitagata Kitagata 1,500 1, :79 1:79 deliveries Kalongo Kalongo Ambrosoli Memorial 2,477 2, :495 1:495 deliveries General General Military Military 1,416 1, :79 1:79 deliveries Iganga Iganga 5,670 5, :473 1:473 deliveries Nkokonjeru :78 1:78 deliveries Kagando 1,801 1, :450 1:450 deliveries Kida Kida :78 1:78 deliveries Kawolo Kawolo 3,598 3, :450 1:450 deliveries Apac Apac 1,889 1, :73 1:73 deliveries Lyantonde 1,310 1, :437 1:437 deliveries Kisubi Kisubi 1,492 1, :65 1:65 deliveries Bwindi Bwindi Community 1,264 1, :421 1:421 deliveries Bukwo Bukwo :64 1:64 deliveries St. Karolii St. Karolii Lwanga Lwanga Nakaseke 2,502 2, :417 1:417 deliveries Nyakibale 2,395 2, :63 1:63 deliveries Kyenjojo 1,626 1, :407 1:407 deliveries Oriajini Oriajini :61 1:61 deliveries Kisiizi Kisiizi NGO NGO 1,910 1, :382 1:382 deliveries Pallisa Pallisa 3,002 3, :61 1:61 deliveries Apac Apac 1,889 1, :378 1:378 deliveries Nakaseke 2,502 2, :61 1:61 deliveries [Annual Health Sector Performance Report 2012/13] Page Page Page [Annual Health Sector Performance Report 2012/13 FY]

179 Maternal Hospital Deliveries Deaths Risk Risk of of Maternal Death Hospital Deliveries Fresh Still Still Birth Birth Risk Risk of of a FSB a FSB Kumi Kumi NGO NGO 1, :358 deliveries Moyo :60 1:60 deliveries Kagadi 3, :352 deliveries Matany :59 1:59 deliveries Maracha :344 deliveries Mutolere (St. (St. Francis) 1, :59 1:59 deliveries St. St. Karolii Lwanga Nyakibale 2, :342 deliveries Bwindi Community 1, :57 1:57 deliveries Kalisizo 2, :312 deliveries KIU KIU Teaching :57 1:57 deliveries St. St. Joseph's Kitgum 2, :303 deliveries Galilee Community :53 1:53 deliveries Rakai 1, :294 deliveries Nkozi 1, :53 1:53 deliveries Busolwe 1, :276 deliveries Amudat :52 1:52 deliveries Mayanja Memorial :276 deliveries Tororo 3, :52 1:52 deliveries Kiboga 2, :269 deliveries Abim Abim :50 1:50 deliveries Katakwi 1, :263 deliveries Adjumani 1, :49 1:49 deliveries Uganda Martyrs :248 deliveries Naggalama, St St Francis 1, :49 1:49 deliveries Kambuga 1, :236 deliveries Kisiizi NGO NGO 1, :49 1:49 deliveries Dabani :234 deliveries Ishaka Adventist 3, :48 1:48 deliveries Kilembe 2, :229 deliveries Rugarama :48 1:48 deliveries Ibanda 2, :228 deliveries Kiryandongo 1, :47 1:47 deliveries Buikwe St. St. Charles Lwanga :222 deliveries Kambuga 1, :47 1:47 deliveries Virika 1, :216 deliveries Buikwe St. St. Charles Lwanga :47 1:47 deliveries Yumbe 2, :213 deliveries Kilembe 2, :45 1:45 deliveries St. St. Francis Nyenga :207 deliveries Kiwoko 2, :45 1:45 deliveries Aber Aber NGO NGO 1, :203 deliveries Kuluva :44 1:44 deliveries Kabarole 1, :198 deliveries Gulu Gulu Independent :44 1:44 deliveries Nkozi 1, :195 deliveries Kaabong :44 1:44 deliveries Villa Villa Maria 1, :188 deliveries Bududa :43 1:43 deliveries Bundibugyo 1, :186 deliveries Busolwe 1, :41 1:41 deliveries Nkokonjeru :183 deliveries Uganda Martyrs :41 1:41 deliveries Naggalama, St St Francis 1, :182 deliveries Dabani :41 1:41 deliveries Itojo Itojo 1, :174 deliveries Nyapea 1, :40 1:40 deliveries Nyapea 1, :172 deliveries St. St. Francis Nyenga :39 1:39 deliveries Mityana 4, :161 deliveries Villa Villa Maria 1, :38 1:38 deliveries Matany :159 deliveries Kamuli 1, :37 1:37 deliveries Kuluva :155 deliveries Buluba :36 1:36 deliveries Adjumani 1, :148 deliveries Mityana 4, :36 1:36 deliveries Bugiri 2, :145 deliveries Kagando 1, :36 1:36 deliveries Kayunga 2, :144 deliveries Aber Aber NGO NGO 1, :36 1:36 deliveries Kamuli Mission 2, :140 deliveries Kalisizo 2, :36 1:36 deliveries Lwala :134 deliveries Kabarole 1, :36 1:36 deliveries Buluba :105 deliveries Kapchorwa 1, :33 1:33 deliveries [Annual Health Sector Performance Report 2012/13] Page 169 [Annual Health Sector Performance Report 2012/13 FY] Page 159

180 Maternal Risk Risk of Maternal of Fresh Fresh Hospital Deliveries Deaths Deaths Death Death Hospital Deliveries Still Still Birth Birth Risk Risk of a of FSB a FSB Angal Angal St. St. Luke Luke 1,998 1, :95 1:95 deliveries Kagadi Kagadi 3,164 3, :33 1:33 deliveries Rushere Community :92 1:92 deliveries Masindi Masindi 3,542 3, :33 1:33 deliveries Buwenge NGO NGO :89 1:89 deliveries Kumi Kumi NGO NGO 1,432 1, :31 1:31 deliveries Amudat Amudat :87 1:87 deliveries Amai Amai Community :31 1:31 deliveries St. St. Joseph Joseph Kitovu Kitovu 1,520 1, :76 1:76 deliveries Gombe Gombe 2,573 2, :30 1:30 deliveries Rugarama :67 1:67 deliveries Bugiri Bugiri 2,473 2, :30 1:30 deliveries St. St. Anthony'S Tororo Tororo :61 1:61 deliveries Lyantonde 1,310 1, :30 1:30 deliveries Kiryandongo 1,564 1, :56 1:56 deliveries Virika Virika 1,944 1, :29 1:29 deliveries 5 th Military 5 th Military Division :0 1:0 deliveries Iganga Iganga 5,670 5, :29 1:29 deliveries Amai Amai Community :0 1:0 deliveries Comboni :29 1:29 deliveries Anaka Anaka :0 1:0 deliveries Rushere Community :29 1:29 deliveries Bamu Bamu :0 1:0 deliveries Kayunga 2,167 2, :29 1:29 deliveries Bukwo Bukwo :0 1:0 deliveries Kiboga Kiboga 2,685 2, :29 1:29 deliveries Comboni :0 1:0 deliveries Bundibugyo 1,484 1, :29 1:29 deliveries Divine Divine Mercy Mercy :0 1:0 deliveries Itojo Itojo 1,912 1, :27 1:27 deliveries Galilee Galilee Community :0 1:0 deliveries Ibanda Ibanda 2,741 2, :23 1:23 deliveries Gulu Gulu Military Military :0 1:0 deliveries Lwala Lwala :22 1:22 deliveries Gulu Gulu Independent :0 1:0 deliveries UPDF UPDF 2 nd 2Division nd :22 1:22 deliveries Hunter Hunter Foundation :0 1:0 deliveries Kamuli Kamuli Mission Mission 2,242 2, :21 1:21 deliveries Kabasa Kabasa Memorial :0 1:0 deliveries Kyenjojo 1,626 1, :19 1:19 deliveries Kakira Kakira Worker's :0 1:0 deliveries Bamu Bamu :16 1:16 deliveries Kanginima :0 1:0 deliveries Rakai Rakai 1,175 1, :16 1:16 deliveries Kapchorwa 1,470 1, :0 1:0 deliveries Maracha :12 1:12 deliveries Kida Kida :0 1:0 deliveries St. St. Joseph Joseph Kitovu Kitovu 1,520 1, :12 1:12 deliveries KIU KIU Teaching :0 1:0 deliveries Kitgum Kitgum 1,567 1, :9 1:9 deliveries Lamezia :0 1:0 deliveries 5 th 5Military th Military Division :0 1:0 deliveries Lugazi Lugazi Scoul Scoul :0 1:0 deliveries Divine Divine Mercy Mercy :0 1:0 deliveries Mbarara Community :0 1:0 deliveries Gulu Gulu Military Military :0 1:0 deliveries Murchison Bay Bay :0 1:0 deliveries Hunter Hunter Foundation :0 1:0 deliveries Nakasongola Military Military :0 1:0 deliveries Kabasa Kabasa Memorial :0 1:0 deliveries Namungoona Orthodox :0 1:0 deliveries Kanginima :0 1:0 deliveries Old Old Kampala :0 1:0 deliveries Lamezia :0 1:0 deliveries Oriajini Oriajini :0 1:0 deliveries Mbarara Community :0 1:0 deliveries Rubongi Military Military :0 1:0 deliveries Nakasongola Military Military :0 1:0 deliveries Saidina Saidina Abubakar Islamic Islamic :0 1:0 deliveries Old Old Kampala :0 1:0 deliveries Senta Senta Medicare Clinic Clinic :0 1:0 deliveries Rubongi Military Military :0 1:0 deliveries UPDF UPDF 2 nd 2Division nd :0 1:0 deliveries Saidina Saidina Abubakar Islamic Islamic :0 1:0 deliveries [Annual Health Sector Performance Report 2012/13] Page Page Page [Annual Health Sector Performance Report 2012/13 FY]

181 Table 72: Table HC IV 72: League HC IV Table League Table HC IV = 193 HC IV = 193 Total OPD Total OPD Total ANC Post Total Natal ANC Visits Post Deliveries Natal Visits Immunization Deliveries Immunization FP Visits FP Visits Admissions Admissions SUO Ranking SUO Ranking Bugobero Bugobero 101, ,504 2,812 2, , , ,902 12, , , Kawempe Kawempe 92,626 92,626 13,733 4,353 13,733 4,613 4,353 31,827 4,613 31, ,111 4, , , Mukono T.C. Mukono T.C. 39,795 39,795 8,831 10,462 8,831 10,462 4,204 24,159 4,204 24,159 1,022 1,022 5,448 5, , , Serere Serere 40,582 40,582 2,441 2, , ,592 4,043 4, ,705 6, , , Luwero Luwero 49,821 49,821 4,421 4, , ,746 4,018 4, ,669 5, , , PAG Mission PAG Mission 32,449 32,449 1,169 1, , , ,499 6, , , Nyahuka Nyahuka 24,951 24,951 2,880 2, , ,335 2,276 2, ,560 6, , , Pakwach Pakwach 24,222 24,222 1,947 1, , , ,532 5, , , Busia Busia 40,028 40,028 4,517 4,517 1,551 11,167 1,551 11, ,843 3, , , Kumi Kumi 48,146 48,146 2,477 2, , ,804 1,744 1,744 3,530 3, , , Kyangwali Kyangwali 26,331 26,331 2,363 2, , , ,904 4, , , Mpigi Mpigi 25,255 25,255 4,331 4, , ,893 3,738 3, ,558 4, , , Amuria Amuria 24,128 24,128 2,430 2, , ,236 5,601 5, ,865 4, , , Kabuyanda Kabuyanda 19,813 19,813 3,896 3, , ,801 3,348 3, ,824 4, , , Anyeke Anyeke 36,034 36,034 1,471 1, , , ,994 3, , , Kitwe Kitwe 25,633 25,633 3,803 3, , ,267 5,746 5, ,325 4, , , Omugo Omugo 30,934 30,934 2,608 2, , , ,993 3,993 96,603 96, Kaberamaido Kaberamaido 33,133 33,133 1,302 1, , , ,897 3,897 95,652 95, Kasangati Kasangati 34,326 34,326 5,593 5, , ,011 7,719 7, ,904 2,904 92,855 92, Rubaare Rubaare 28,720 28,720 2,520 2, , ,284 5,383 5, ,666 3,666 92,818 92, Mukono C.O.U Mukono C.O.U 22,789 22,789 1,896 1, , ,405 5,331 5, ,033 4,033 92,702 92, Azur HC Azur HC 6,763 6,763 1,538 1, , ,746 5,125 5, ,915 4,915 91,426 91, Nagongera Nagongera 31,008 31,008 2,679 2, , , ,585 3,585 91,418 91, Koboko Koboko 22,309 22,309 3,987 3, , ,163 1,704 13, ,685 3,685 91,221 91, Tokora Tokora 16,510 16, , , ,736 4,736 89,861 89, Budadiri Budadiri 18,813 18,813 3,001 3, , ,425 8,245 8, ,968 3,968 89,208 89, Midigo Midigo 22,449 22,449 1,656 1, , , ,099 4,099 89,170 89, Kigorobya Kigorobya 25,023 25,023 2,122 2, , , ,840 3,840 88,621 88, Nakasongola Nakasongola 33,071 33,071 1,675 1, , , ,320 3,320 88,122 88, Kibuku Kibuku 34,071 34,071 2,145 2, , ,068 3,007 3, ,109 3,109 88,045 88, Mulanda Mulanda 26,795 26,795 2,692 2, , , ,707 3,707 87,904 87, Kabwohe Kabwohe 32,608 32,608 2,081 2, , ,365 2,751 2, ,077 3,077 87,441 87, Dokolo Dokolo 21,736 21,736 1,439 1, , , ,062 4,062 87,266 87, Bishop Asili Bishop Ceaser Asili Ceaser 20,764 20, , ,017 3,084 3,084 3,965 3,965 86,463 86, [Annual [Annual Health Sector Health Performance Sector Performance Report 2012/13] Report 2012/13] Page 171 Page 171 [Annual Health Sector Performance Report 2012/13 FY] Page 161

182 HC IV = 193 HC IV = 193 Total OPD Total OPD Total ANC Post Total Natal ANC Visits Post Deliveries Natal Visits Immunization Deliveries Immunization FP Visits FP Visits Admissions Admissions SUO Ranking SUO Ranking Kihiihi Kihiihi 20,815 20,815 2,269 2, , , ,992 3,992 86,440 86, Rugazi Rugazi 29,817 29,817 2,485 2, , ,211 5,843 5, ,044 3,044 84,192 84, Lalogi Lalogi 40,283 40,283 1,575 1, , , ,589 2,589 83,763 83, Mukuju Mukuju 25,714 25,714 1,989 1, , , ,478 3,478 83,059 83, Rukunyu Rukunyu 18,021 18,021 1,178 1, , , ,951 3,951 82,256 82, Busiu Busiu 22,726 22,726 1,573 1, , , ,631 3,631 81,971 81, Bukomero Bukomero 30,319 30,319 3,336 3, , , ,842 2,842 81,452 81, Semuto Semuto 34,932 34,932 1,938 1, , , ,744 2,744 79,969 79, Budaka Budaka 27,737 27,737 2,547 2, , ,056 2,648 2, ,978 2,978 79,514 79, Atirir Atirir 29,108 29,108 1,647 1, , , ,849 2,849 76,309 76, Amach Amach 34,919 34, , ,592 1,289 1,289 2,470 2,470 76,173 76, Mitooma Mitooma 35,447 35,447 1,583 1, , , ,411 2,411 75,754 75, Butebo Butebo 16,993 16,993 2,372 2, , , ,482 3,482 75,732 75, Kibaale Kibaale 14,767 14,767 2,487 2, , , ,589 3,589 75,524 75, Buwenge Buwenge 24,293 24,293 1,830 1, , , ,992 2,992 74,903 74, Bumanya Bumanya 23,289 23,289 2,020 2, , , ,105 3,105 74,545 74, Kinoni Kinoni 18,340 18,340 1,443 1, , , ,436 3,436 73,510 73, Muyembe Muyembe 25,046 25,046 2,766 2, , , ,767 2,767 72,976 72, Kyegegwa Kyegegwa 21,972 21,972 2,187 2, , ,090 3,333 3, ,902 2,902 72,912 72, Kiyunga Kiyunga 28,886 28,886 2,210 2, , , ,542 2,542 71,983 71, Bufumbo Bufumbo 20,890 20,890 1,511 1, , , ,090 3,090 71,531 71, Ogur Ogur 27,604 27,604 1,713 1, , , ,436 2,436 71,099 71, Bukedea Bukedea 20,676 20,676 2,716 2, , ,253 5,558 5, ,762 2,762 71,096 71, Busesa Busesa 30,539 30,539 2,698 1,119 2,698 1, , , ,227 2,227 70,155 70, Patongo Patongo 30,233 30,233 2,275 2, , ,920 1,579 1,579 2,224 2,224 70,153 70, Princes Diana Princes Diana 16,632 16,632 1,312 1, , , ,233 3,233 69,829 69, Bubulo Bubulo 27,180 27,180 1,748 1,853 1,748 1, , , ,444 2,444 69,585 69, Kidera Kidera 18,516 18,516 1,989 1, , , ,020 3,020 68,872 68, Rwashamaire Rwashamaire 20,416 20,416 2,410 2, , ,156 2,713 2, ,694 2,694 68,677 68, Wakiso Wakiso 27,794 27,794 4,066 4, , ,249 9,407 9, ,014 2,014 68,608 68, Buyinja Buyinja 22,459 22,459 1,730 1, , ,362 1,230 1,230 2,664 2,664 67,979 67, Ntwetwe Ntwetwe 26,196 26,196 2,832 2, , , ,304 2,304 67,868 67, [Annual [Annual Health Sector Health Performance Sector Performance Report 2012/13] Report 2012/13] Page 172 Page Page [Annual Health Sector Performance Report 2012/13 FY]

183 HC IV = 193 HC IV = 193 Total OPD Total OPD Total ANC Post Total Natal ANC Visits Post Deliveries Natal Visits Immunization Deliveries Immunization FP Visits FP Visits Admissions Admissions SUO SUO Ranking Ranking Kotido Kotido 19,211 19, ,035 1, ,952 2,952 66,337 66, Kakuuto Kakuuto 28,092 28,092 1,702 1, ,799 2, ,252 2,252 65,830 65, Pajule Pajule 15,395 15,395 1,848 1, ,284 2, ,035 3,035 65,199 65, Kitebi Kitebi 48,145 48,145 7,559 7, , ,138 6,769 6,769 1,043 1,043 64,792 64, River Oli River Oli 25,716 25,716 1,563 1, ,294 4, ,408 2,408 64,777 64, Bukuku Bukuku 25,649 25,649 2,515 2, , ,136 1,610 1,610 14,395 14,395 1,620 1,620 64,652 64, Nankoma Nankoma 22,269 22,269 2,553 2, ,365 5, ,372 2,372 63,862 63, Bwizibwera Bwizibwera 21,933 21,933 1,590 1, ,883 2, ,416 2,416 63,021 63, Obongi Obongi 22,959 22, ,403 1, ,467 2,467 62,893 62, Magale Magale 9,823 9,823 1,636 1,303 1,636 1, , ,730 3,052 3,052 62,824 62, Amolatar Amolatar 27,854 27,854 2,440 2, ,635 3, ,931 1,931 62,715 62, Kyabugimbi Kyabugimbi 30,753 30,753 1,972 1, ,010 3, ,791 1,791 62,227 62, Karenga Karenga 17,385 17, ,098 3, ,830 2,830 61,972 61, Kangulumira Kangulumira 22,464 22,464 3,080 3, , ,142 7,981 7, ,948 1,948 61,099 61, Ntara Ntara 15,777 15,777 1,681 1, ,060 3, ,590 2,590 60,955 60, Kiganda Kiganda 29,280 29,280 2,550 2, ,201 3, ,648 1,648 60,946 60, Nabilatuk Nabilatuk 16,009 16,009 1,086 1, ,068 4, ,761 2,761 60,374 60, Kakindo Kakindo 25,331 25,331 2,889 2, ,260 6, ,857 1,857 59,813 59, Bugembe Bugembe 32,508 32,508 2,880 2, , ,132 6,294 6, ,150 1,150 58,589 58, Rhino Camp Rhino Camp 19,543 19,543 1,194 1, ,011 3, ,337 2,337 58,015 58, Kyarusozi Kyarusozi 22,818 22,818 1,764 1, ,652 1, ,941 1,941 57,915 57, Kanungu Kanungu 20,622 20, ,463 1, ,234 2,234 57,585 57, Naam Okora Naam Okora 21,113 21, ,276 2, ,186 2,186 57,554 57, Kazo Kazo 34,623 34,623 2,308 2, ,483 3, ,150 1,150 56,553 56, Kakumiro Kakumiro 22,178 22,178 2,856 2, , ,037 3,801 3, ,778 1,778 56,302 56, Kikyo Kikyo 22,635 22, ,448 1, ,079 2,079 55,688 55, St. Ambrose St. Charity Ambrose Charity 4,313 4,313 1,611 1, ,799 2, ,033 3,033 55,533 55, Bbaale Bbaale 26,306 26,306 1,739 1, ,021 2, ,718 1,718 55,468 55, Buliisa Buliisa 19,825 19,825 1,547 1, ,519 4, ,065 2,065 55,260 55, Aduku Aduku 21,235 21,235 2,332 2, ,344 4, ,779 1,779 54,830 54, Kassanda Kassanda 28,068 28,068 2,810 2, ,390 3, ,279 1,279 54,111 54, Namayumba Namayumba 27,965 27,965 2,301 2, ,853 2, ,406 1,406 53,946 53, [Annual [Annual Health Sector Health Performance Sector Performance Report 2012/13] Report 2012/13] Page 173 Page 173 [Annual Health Sector Performance Report 2012/13 FY] Page 163

184 HC IV = 193 HC IV = 193 Total OPD Total OPD Total ANC Post Total Natal ANC Visits Post Deliveries Natal Visits Immunization Deliveries Immunization FP Visits FP Visits Admissions Admissions SUO Ranking SUO Ranking St. Paul St. Paul 9,490 9,490 1,386 1, , ,019 2,958 2, ,514 2,514 53,730 53, Kalangala Kalangala 36,744 36,744 1,255 1, , , ,649 53, Kibiito Kibiito 28,988 28,988 2,416 2, , , ,152 1,152 52,349 52, Nankandulo Nankandulo 25,414 25,414 1,409 1, , , ,450 1,450 51,839 51, Nyamuyanja Nyamuyanja 24,442 24,442 1,123 1, , , ,586 1,586 51,540 51, Benedict Medical Benedict centre Medical centre 25,105 25, , ,114 1,513 1,513 49,907 49, Apapai Apapai 26,635 26,635 1,178 1, , , ,281 1,281 49,568 49, Nsinze Nsinze 20,050 20,050 1,326 1, , , ,638 1,638 49,362 49, Ndejje Ndejje 23,095 23,095 3,297 3, , , ,114 1,114 48,288 48, Muko Muko 24,296 24,296 1,397 1, , , ,349 1,349 48,167 48, Kapelebyong Kapelebyong 24,044 24,044 1,058 1, , , ,394 1,394 47,685 47, Bwijanga Bwijanga 18,743 18,743 2,909 2, , , ,601 1,601 47,602 47, Karugutu Karugutu 25,201 25,201 1,287 1, , , ,262 1,262 47,038 47, Adumi Adumi 25,635 25,635 1,280 1, , , ,162 1,162 46,532 46, Kebisoni Kebisoni 22,436 22,436 1,550 1, , , ,292 1,292 46,399 46, Rugaaga Rugaaga 18,397 18,397 2,301 2, , , ,615 1,615 46,351 46, Maddu Maddu 24,818 24,818 1,740 1, , , ,215 1,215 46,332 46, Mpumudde Mpumudde 26,640 26,640 2,476 2, , , ,265 46, Namwendwa Namwendwa 22,885 22,885 1,729 1, , , ,156 1,156 45,492 45, Shuuku Shuuku 21,541 21,541 1,329 1, , , ,370 1,370 45,451 45, Walukuba Walukuba 39,799 39,799 2,142 2, , , ,033 45, Toroma Toroma 18,853 18, , , ,484 1,484 44,827 44, Orum Orum 21,150 21, , , ,389 1,389 44,655 44, Hamurwa Hamurwa 25,896 25,896 1,435 1, , , ,007 1,007 44,332 44, Awach Awach 16,828 16, , , ,629 1,629 44,250 44, Kiwangala Kiwangala 30,372 30,372 1,252 1, , , ,162 44, Alebtong Alebtong 22,290 22,290 1,701 1, , , ,143 1,143 43,887 43, Kiruhura Kiruhura 22,597 22,597 1,277 1, , , ,229 1,229 43,657 43, Nyimbwa Nyimbwa 19,972 19,972 1,396 1, , , ,390 1,390 43,584 43, Wagagai Wagagai 25,468 25, , , ,005 1,005 43,186 43, Ssembabule Ssembabule 19,847 19,847 3,462 3, , , ,181 1,181 42,823 42, Rwekubo Rwekubo 26,732 26,732 1,077 1, ,720 42, [Annual [Annual Health Sector Health Performance Sector Performance Report 2012/13] Report 2012/13] Page 174 Page Page [Annual Health Sector Performance Report 2012/13 FY]

185 HC IV = 193 HC IV 193 HC IV = 193 Total OPD Total OPD Total OPD Total ANC Total ANC Total ANC Post Natal Visits Post Natal Visits Post Natal Visits Deliveries Deliveries Deliveries Immunization Immunization Immunization FP Visits FP Visits FP Visits Admissions Admissions Admissions SUO SUO SUO Ranking Ranking Ranking Rubuguri Rubuguri 21,547 21, ,718 1, ,160 1,160 41,726 41, Kyazanga Kyazanga 21,300 21,300 2,202 2, ,667 1, ,106 1,106 40,915 40, Kalagala Kalagala 16,129 16,129 1,369 1, ,143 3, ,427 1,427 40,856 40, Kityerera Kityerera 20,767 20,767 2,751 2, ,635 3,635 1,004 1, ,113 40, St. St. Joseph St. Joseph of of the the of Good the Good Shephard Shephard 9,430 9, ,380 1,380 1,889 1,889 39,788 39, Kyamulibwa Kamwezi Kamwezi 23,386 23,386 1,213 1, ,687 1, ,408 39, Atiak Atiak 18,320 18, ,636 2, ,279 1,279 39,332 39, Lwengo Lwengo 26,853 26,853 1,469 1, ,644 2, ,237 39, Ishongororo 18,895 18,895 2,552 2, ,716 2, ,022 1,022 38,844 38, Bukulula Bukulula 27,921 27,921 1,107 1, ,980 1, ,760 38, Buvuma Buvuma 20,137 20,137 1,368 1, ,896 10, ,673 38, Bugono Bugono 17,325 17,325 1,200 1, ,513 1, ,197 1,197 38,656 38, Chahafi Chahafi 19,290 19,290 1,533 1, ,617 1, ,097 1,097 38,533 38, Ruhoko Ruhoko 19,515 19,515 1,387 1, ,034 1,034 38,162 38, Budondo Budondo 20,960 20,960 1,436 1, ,315 2, ,057 37, Bukwa Bukwa 9,206 9, ,259 2, ,663 1,663 37,011 37, Padibe Padibe 18,227 18, ,184 2, ,003 1,003 36,607 36, Rubaya Rubaya 21,052 21,052 1,162 1, ,538 1, ,502 36, Kigandalo Kigandalo 20,026 20,026 1,875 1, ,231 3, ,044 36, Ssekanyonyi 20,991 20,991 1,095 1, ,621 1, ,801 35, Buwasa Buwasa 27,299 27,299 1,212 1, ,010 2, ,164 35, Kaproron Kaproron 14,916 14,916 1,408 1, ,388 3, ,112 1,112 35,002 35, Nsiika Nsiika 20,340 20, ,571 1, ,954 34, Mungula Mungula 16,360 16, ,263 1, ,039 1,039 34,365 34, Kojja Kojja 18,694 18,694 2,493 2, ,535 6, ,940 33, Bugangari Bugangari 20,926 20,926 1,360 1, ,449 2, ,814 33, Busanza Busanza 22,478 22, ,339 33, Masindi Masindi Military/Army Barracks Barracks 17,921 17, ,990 32, Kiyumba Kiyumba 17,621 17,621 1,027 1, ,911 1, ,803 31, Mparo Mparo 17,338 17, ,641 31, Buhunga Buhunga 17,534 17, ,377 31, Mwera Mwera 16,600 16, ,767 2, ,446 30, [Annual [Annual Health Health Sector Sector Performance Report Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY] Page 165

186 HC IV = 193 Total OPD Total ANC Post Natal Visits Deliveries Immunization FP Visits Admissions SUO Ranking Bushenyi 17,582 1, , , Kikuube 23,240 2, , , ASTU 28, ,701 29, Butiru 26,951 1, , , Aboke 18,084 2, , , Buwambo 18,037 1, , , Madi-Opei 14, , , Ngora Gvt 21, , , Namatala 23,729 1, , , Kamukira 24, , Kyannamukaaka 17, , , Ntungamo 18,018 2, , , Ngoma 17, , , Maziba Gvt 11,741 1, , Kataraka 20, , , Rwesande 3,342 1, , ,068 22, Busaru 1,106 1, ,108 1,208 21, Ntuusi 13,861 1, , Butenga 15,004 1, , , Luwunga Barracks 11, , Bugamba 11,166 1, , , Franciscan 3, , Bukasa 11, , Kyantungo H 6, , , North Kigezi 1, , Mbarara Municipal Council 9,417 1, , , Makonge 6,574 1, , , Mitandi 2, , , Mbarara Municipal 6,294 1, , , Pearl Medical Center 6, , Hiima Iaa (Uci) 4, , [Annual Health Sector Performance Report 2012/13] Page Page [Annual Health Sector Performance Report 2012/13 FY]