MINISTRY OF HEALTH STATISTICAL ABSTRACT

Transcription

1 THE REPUBLIC OF UGANDA MINISTRY OF HEALTH STATISTICAL ABSTRACT MINISTRY OF HEALTH P O Box Kampala Uganda Tel Fax E mail resourcecentre health go ug, Website http www health go ug 1

2 TABLE OF CONTENTS ACKNOWLEDGEMENT... 4 LIST OF TABLES GENERAL INFORMATION Demographic Characteristics HEALTH INPUTS Financing in the Health Sector Off budget funding Challenges in Budgeting Health financing Mechanisms National Referral hospitals General Hospitals and HC IVs Regional Referral hospitals Hospital Performance FY 2009/ HEALTH OUTPUTS Key Health Indicators for FY 2009/ The League table Timeliness and Completeness of HMIS reporting Outpatient Diagnosis Indicators Immunization Indicators Laboratory indicators for FY 2009/ HIV/AIDS INDICATORS FY 2009/ HUMAN RESOURCES FOR HEALTH APPENCIDES

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4 ACKNOWLEDGEMENT The Ministry of Health Resource center division wishes to acknowledge and appreciate the variable and valuable technical input and dedication of the Resource Center team towards the development of this statistical abstract The Ministry further wishes to acknowledge in a special way the following people and institutions who have contributed immensely towards the development and finalization of this statistical abstract Names Title Organization Dr Eddie Mukooyo ACHS Resource center MoH Mrs Caroline Kyozira Senior Bio statistician MoH Mrs Juliet Nansonga Senior Information Scientist MoH Herbert Mulira Data Management officer MoH Ms Zaituni Nassanga Computer operations Officer MoH Mr Lumu Albert Database Administrator MoH Katongole Peterson Data manager MoH Balwanaki Carolyn Data management officer MoH Thomas Rutaro Statistician UBOS The Ministry is equally very grateful for the support cooperation and collaboration rendered by the Uganda Bureau of Statistics towards the development of the statistical abstract of 4

5 ABBREVIATIONS ACP ALOS ANC ARI ART BCG BOR C S CPR CTX CYP DOT AIDS Control Program Average Length of Stay Antenatal Care Acute Respiratory Infection Anti Retroviral Therapy Bacillus Calmette Guérin vaccine Bed Occupancy Rate Caesarian Section Contraceptive Prevalence Rate Cotrimoxazole Couple Years of Protection Directly Observed Treatment DPT Hep Hib Diphtheria Pertussis Tetanus Hepatitis B Haemophilus Influenza b ENT FDS FY GoU HC HCT HIV HMIS HRD HSDs HSSP IPD IPT Ear Nose and Throat Financial Decentralization Strategy Financial Year Government of Uganda Health Center HIV Counseling Testing Human Immune Virus Health Management Information System Human Resources Development Health Sub Districts Health Sector Strategic Plan In Patient Department Intermittent Presumptive Treatment 5

6 ITN JMS KIU LTFP Insecticide Treated Net Joint Medical Stores Kampala International University Long Term Family planning methods MoFPED Ministry of Finance Planning and Economic Development MOH MTEF NHA NMS NTLP OPD ORS PHC PHC CG PHP PMTCT PNFP STI SUO SWAP TB TT UBOS UNMHCP USD Ministry of Health Mid Term Expenditure Fund National Health Assembly National Medical Stores National Tuberculosis Leprosy Program Out Patient Department Oral Dehydration Salt Primary Health Care Primary Health Care Conditional Grant Private Health Practitioners Prevention of Mother to Child Transmission Private Not for Profit Sexual Transmitted Infections Standard Unit of Output Sector Wide Approaches Tuberculosis Tetanus Toxoid Uganda Bureau of Statistics Uganda National Minimum Health Care Package United States Dollar 6

7 LIST OF TABLES Table 2.1: Health sector DP expenditure for 2008/ / Table 2.2: Health financing trends over HSSPI and HSSPII (2000/ /010) funding (nominal terms) Table 2.3: Distribution of functional Health Units by Health Facility Level and Ownership Table 2.4: National Health Facility Availability Standards and 2009 situation Table 2.5: Key Outputs from Regional Hospitals FY 2009/ Table 3.1: Outpatient Indicators Table 3.2: Comparison of HIV/AIDS indicators for two FYs Table 3.4: Ten causes of Morbidity in Uganda 2009/ Table 3.5: Summary of diseases of Epidemic potential LIST OF FIGURES Figure 1.1 Census population, 1969, 1980, 1991 and 2002 and mid- year (2010) projection (in millions) Figure 2.1: Sources of health financing in Uganda Figure 2.2: Distribution of general hospitals and HC IVs by region for the Figure 2.3: Bed capacity for Regional Referral Hospitals Figure 3.1: Summary of Key Health indicators for FY 2008/9, 2009/ Figure 3.2: Trends in the League table general performance in the financial years 2006/07, 2007/08, 2008/09 and 2009/ Figure 3.3: Timeliness and Completeness in reporting of Inpatient and outpatient reports 2007/8, 2008/9, 2009/ Figure 3.5: Proportion of laboratory test for Malaria and TB 2009/ Figure 3.6: Proportion PMTCT services Utilization in Uganda (n= )

8 Figure 3.7: Proportion of population who tested for HIV/AIDS and are Eligible for ART and those started on ART Figure 3.9: Stock Out of Essential drugs Figure 4.1: Posts filled at different levels in public health facilities (MoH, 2009)

9 1.0 GENERAL INFORMATION 1.1 Demographic Characteristics Uganda covers square kilometers of which square kilometers is land area The country is divided into Districts as of FY all of which have a decentralized local governance system Uganda has one of the highest growth rates in the world standing at a rate of per annum and higher than the Sub Saharan Africa average of The proportion of the population living within kms of a health facility is currently at in from in Access to health care facilities has been limited by poor infrastructure lack of medicines and other health supplies shortage of human resources in the public sector low salaries lack of accommodation at health facilities and other factors that constrain access to quality service delivery especially in the rural areas where the majority of the population lives The Government of Uganda developed a Health Sector Strategic Plan to improve the health care delivery system of which access to health services is a component The Population census conducted in puts the total population of Uganda at million persons while the projected midyear Ugandan population by UBOS is million as showed in figure below 9

10 Figure 1.1 Census population, 1969, 1980, 1991 and 2002 and mid- year (2010) projection (in millions) We notice that Uganda s population has continued to grow over a period of time It increased from million in to million in at an average annual growth rate of between and More than half of Uganda s population percent is females as shown in the Table below Table 1.1: Demographic characteristics and health indicators Region National Target Population Northern Eastern Western Central Total Female 3,786,952 4,316,624 4,148,820 4,274,920 16,527,316 Male 3,495,648 3,984,576 3,829,680 3,946,080 15,255,984 Children < 1yr 313, , , ,503 1,366,688 Children >5yrs 1,471,084 1,676,841 1,611,656 1,660,642 6,420,223 Children >15yrs 3,568,474 4,067,588 3,909,465 4,028,290 15,573,817 Expected Births 353, , , ,719 1,541,494 Expected 364, , , ,050 1,589,165 Pregnancies Expected TB cases 21,849 24,907 23,937 24,663 95,356 Total 13,374,495 15,245,163 14,652,518 15,097,867 58,370,043 10

11 2.0 HEALTH INPUTS These are the building blocks and important inputs in the implementation of the Uganda National Minimum Health Care Package UNMHCP The delivery of the UNMHCP is largely dependent on Finance Human resource Infrastructure equipment medicines and other health supplies The HSSP II objective for the health infrastructure development was to ensure that of the population lies within km walking distance to access a well equipped health facility regardless of level of facility 2.1 Financing in the Health Sector Financing is one of the six interdependent health system building blocks the others being the workforce services technology information and governance The per capita health expenditure in Uganda is estimated at USD of which the public sector contributes development partners and household MOH NHA More than of the household expenditure is spent on out of pocket health expenses The per capita requirement for the provision of UNMHCP in all facilities was estimated at USD in and is expected to rise to USD in the financial year HSLP Africa limited This trend has important implications on service delivery as it implies the need for further priority setting based on the UNMHCP 2.2 Off budget funding Development assistance continues to play a major role in financing health services but a bigger proportion of this is off Budget This means that there is high expenditure of donor funding for off budget activities Ministry Of Health has information on general budget support and project support to the Health 11

12 sector but not off budget support According to MOFPED report in FY off budget funding constituted USD $ million while the overall health budget stood at US $ million Ministry of Health has had a difficult time tracking donor off budget support as most donors chose where to direct the off budget support and this support may or may not necessarily be within MOH set priorities This brings in a challenge for the MOH in tracking how much money the donors give to the health sector Reports from about HDPs in financial year indicated that about Billion Ushs was off budget support to the health sector It is also important to note that most of the health financing by HDPs largely goes to the three diseases of HIV AIDS TB Malaria and Blood Transfusion services For example of the funding for Uganda Blood Transfusion Services is from donors Table 2.1: Health sector DP expenditure for 2008/ /10 Name of Development Partner Project support to Health Sector for FY 2008/09 in Million USD Project support to Health Sector for FY 2009/10 in Million USD On Budget Off Budget On Budget Off Budget DANIDA Sweden Germany World Food Programme African Development Bank Ireland JAPAN Belgium Italy European Union UNICEF UNFPA WHO

13 World Bank (IDA) DFID USAID Austria PEPFAR Norway GAVI GFATM Netherlands 1.77 GRAND TOTAL Source; MOFPED Budget speeches financial years 2008/9-2010/ Challenges in Budgeting Resources for curative and preventive medicines are still inadequate Remuneration of health workers is still very low and has not created sufficient motivation to attract qualified health workers to work in hard to reach areas Investments for basic infrastructure have not met the need for quality service provision in the health facilities Growth of essential medicines budget is not in line with the increasing needs for medicines of the population PHC Non wage budgetary allocation in the sector is not based on clear rationale formula and capital development allocation is based on needs assessment 13

14 Table 2.2: Health financing trends over HSSPI and HSSPII (2000/ /010) funding (nominal terms) Year GoU Funding Donor Projects and GHIs Per capita public health exp (UGX) Per capita public health exp (US $)) GoU health expenditure as % of total government expenditure 2000/ , / , / , / , / , / , / , / , / , /10* , Source; PER 2006, and AHSPR 2008/9.Provisional Budget out-turn 2009/ Health financing Mechanisms This section provides a review of HSSP I and HSSP II Health financing mechanisms in line with set objectives Figure 2.1: Sources of health financing in Uganda Source; AHSPR 2008/09 14

15 The figure above shows that households constitute a major source of health financing followed by donors and then government Households spend about of their household consumption expenditure on health although no user fees are paid in lower level government health units Recent studies show that of all ACTs are paid for of the households in Uganda are experiencing catastrophic payments with considerable variations by wealth quintile and region to were pushed into impoverishment because of medical bills Catastrophic health expenditure actually increased from to between and despite the elimination of user fees in Private health insurance which is largely subsidized by employers on behalf of employees is for a few only The establishment of the National Health Insurance Scheme as a health financing mechanism which is in advanced planning stages will gradually address the above issues Functionality of health facilities largely depends on adequate staffing levels financial inputs availability of equipment and availability of minimum required services Functionality of health centre VIs remains a big challenge as districts in rural areas have poor staff attraction and retention abilities which has greatly affected the adequacy of health care service delivery in such areas 15

16 Table 2.3: Distribution of functional Health Units by Health Facility Level and Ownership Health Facility Level Hospital Health centre IV Health centre III Health centre II GOVT PNFP PFP GOVT PNFP PFP GOVT PNFP PFP Total Source: Ministry Health, Infrastructure Division, 2004, 2006 and 2010 The total number of health facilities in Uganda in is of which Government of Uganda owns the private sector owns while the PNFPs own According to HSSP I the number of health facilities by level were HC IIs HC IIIs HC IVs general hospitals RRHs and NRHs The households that were living within kilometers from a health facility by the beginning of HSSP I were only But by this had increased to which demonstrated that a lot of health facilities were constructed during the implementation of HSSP I The proportion of the population living within kilometers of a health facility is however still at Because of the limited resource envelope with which the health sector operates a minimum package of health services has been developed for all levels of health care for both the private and the public sector and health services provision is based on this package 16

17 Table 2.4: National Health Facility Availability Standards and 2009 situation Type of facility Indicator Health Facility Population Ratio Current Situation standard National Referral Hospital Regional Referral Hospital General Hospital Health Centre IV Health Centre III Health Centre II VHT or per HH s 2.5 National Referral hospitals There are two National Referral Hospitals Butabika hospital which was established in and the only mental health hospital in the country and Mulago hospital which is the biggest National Referral Hospital These national referral hospitals provide comprehensive specialized services teaching services and health research 2.6 General Hospitals and HC IVs General hospitals provide a large output for outpatient and inpatient services and also provide support supervision to lower level health facilities and maintain linkages with communities through Community Health Departments CHDs They however face serious resource constraints financial human poor infrastructure etc which contribute significantly to the reduction in the standards of quality output in these health facilities Currently there are NRHs RRHs and general hospitals PNFP and PHP hospitals With decentralization the public general hospitals are 17

18 managed by the district local governments while the RRHs even though have been granted self accounting status are still managed by the MOH Headquarters All health facilities currently provide for more people than they are supposed to Figure 2.2: Distribution of general hospitals and HC IVs by region for the 2010 Hospitals HC IVs Central Northern Eastern Western Source : Ministry of Health Infrastructure division, Regional Referral hospitals These hospitals provide specialist services such as psychiatric ear nose and throat ENT radiology pathology ophthalmology high level surgical pediatrics Obstetrics and gynecology and medical services in addition to services offered at the general hospitals 18

19 Figure 2.3: Bed capacity for Regional Referral Hospitals Mubende 100 Kabale 122 Hoima 139 Soroti 150 Fort portal 200 Hospital Arua Mbarara Bed Capacity Lira 254 Mbale 302 Masaka 330 Gulu 335 Jinja

20 2.8 Hospital Performance FY 2009/10 Table 2.5: Key Outputs from Regional Hospitals FY 2009/10 Hospital Beds Admissions Major Deaths Total New ANC C S Total DPT IPT Blood Name Operations OPD ANC th Deliveries Transfusions Visit Arua Soroti Lira Gulu Jinja Kabale Hoima Fort Portal Mbale Mbarara Source: Ministry of Health-Resource Centre (Annual Reports 2009/10) 20

21 3.0 HEALTH OUTPUTS This section presents a summary of some of the key health outputs including the district League Table and the HSSP II indicators These indicators are used to measure the national and district performance in management and health service delivery 3.1 Key Health Indicators for FY 2009/10 Figure 3.1: Summary of Key Health indicators for FY 2008/9, 2009/ The League table The District League table compares sector performance between districts using management and service delivery output indicators The management indicators show the use of the PHC CG expenditure on key inputs proportion of the fiscal decentralization strategy allocated to the health sector and the management of health data 21

22 The National level league table performance average improved steadily in the last three years with a decline in as shown in figure below Figure 3.2: Trends in the League table general performance in the financial years 2006/07, 2007/08, 2008/09 and 2009/ Percentage / / / /10 years Source: Ministry of Health-Resource Center 3.3 Timeliness and Completeness of HMIS reporting This shows the district submission status of the outpatient and inpatient monthly reports to the Resource Centre where T represents a timely report report received by the th of the next month L for a late report report received after the th of the next month and N for no report from a particular district for the month In FY the timely reporting for outpatient increased from to This could have been contributed to by a number of factors like increased HMIS feedback to the districts HMIS regional feedback meetings organized by the Resource Centre Division increased HMIS support 22

23 supervision from National to district and health facility level plus efforts by various Development Partners at district level to provide HMIS reporting tools and support through various ways On the other hand timeliness of inpatient reporting for the same period was This shows an increase from in The completeness indicator also increased from to It should be noted that timelines and completeness for outpatient was higher than that for inpatient reporting Figure 3.3: Timeliness and Completeness in reporting of Inpatient and outpatient reports 2007/8, 2008/9, 2009/ Percentage /8 2008/9 2009/10 Inpatient Completeness Outpatient completeness Source: Ministry of Health-Resource Center 3.4 Outpatient Diagnosis Indicators The summary of outpatient indicators for FY is shown in table below Government and PNFP OPD utilization per person per year OPD Per Capita is among the HSSPII major indicators It measures utilization of health services in both government and PNFP health facilities and is used as the national proxy for access to health care services 23

24 It is expected that each individual should visit a health unit at least once in a year During FY this indicator stood at while it was in the previous financial year Much as we notice an improvement it is still below the HSSP II target of Table 3.1: Outpatient Indicators Indicator FY FY Health Facilities reporting OPD utilization OPD Per Capita Proportion OPD new attendances Proportion OPD re attendances Source: Ministry of Health-Resource Centre 3.5 Immunization Indicators From the figure below the national performance of DPT HepB Hib which is a proxy measure for overall immunization performance for the FY was which is still below the HSSP II target of 24

25 Figure 3.4: Immunization Indicators for 2008/09 and 2009/ Percentage DPT3 BCG Measles Polio 3 Source: Ministry of Health-Resource Center 2009/ /9 3.7 Laboratory indicators for FY 2009/10 Figure below shows the proportion of Malaria OPD cases tested proportion of malaria slides tested positive by all ages and the TB Positivity rates in Among the OPD tested for malaria were positive and tested positive for TB implying that malaria cases were still higher 25

26 Figure 3.5: Proportion of laboratory test for Malaria and TB 2009/ Percentages OPD Tes ted for Malaria Malaria s lides+ve TB s lides+ve Laboratory test Source: Ministry of Health-Resource Centre 3.8 HIV/AIDS INDICATORS FY 2009/ PMTCT INDICATORS FY 2009/10 The prevention of mother to child infection indicator measures the proportion of births taking place in health facilities that are protected from acquiring HIV AIDS infection during birth The number of pregnant women who were tested for HIV was in compared to in while the number of pregnant women who tested positive was in decrease compared to which was This indicates a In addition pregnant women who were positive and getting ARVs out of those tested positive was in while in was The statistics indicate an increase compared to the previous 26

27 year The number of pregnant women given ARVs treatment was This shows an increase in compared to where the number was persons Figure 3.6: Proportion PMTCT services Utilization in Uganda (n= ) 90% 80% 83 70% 60% 50% 40% 30% 20% 10% 0% Pregnant Women Given Pregnant Women Given Pregnant Women ARVs for ARVs for Treatment Positive for HIV Prophylaxis(PMTCT) Pregnant Women Tested for HIV Source: Ministry of Health-Resource Centre ART SERVICES INDICATORS FY 2009/10 The Anti Retroviral Therapy drugs are given to Eligible HIV AIDS positive patients from selected health facilities The proportion of clients started on ART was in while the proportion of people eligible for ART was This indicates that not all HIV AIDS clients Eligible actually receive ART 27

28 Figure 3.7: Proportion of population who tested for HIV/AIDS and are Eligible for ART and those started on ART. % of clients Eligible for ART 58% % of clients Started on ART42% Source: Ministry of Health-Resource Centre HCT SERVICES INDICATORS FY 2009/10 HIV Counseling and Testing services are essential for the Health sector and stake holders to know the HIV status among the population in Uganda The HCT services indicators include HIV counseling HIV testing from the laboratory received results from laboratory Number receiving results Number tested positive from laboratory HIV confirmed cases with confirmed TB and HIV cases started on CTX Contrimoxazole prophylaxis Information on HCT coverage is collected by the AIDS control program ACP but also through routine HMIS reports from health facilities 28

29 Table 3.2: Comparison of HIV/AIDS indicators for two FYs Indicator Proportion of Clients tested for HIV AIDS out of those counseled Proportion of Clients who tested for HIV AIDS and received results from the laboratory Proportion of Clients who tested positive for HIV AIDS out of the total number that were tested from the laboratory Proportion of clients aged less than yrs who tested HIV out of the total clients aged less than yrs who tested for HIV from the laboratory Proportion of clients aged yrs who tested HIV out the total clients aged yrs who tested for HIV in the laboratory Proportion of clients aged above yrs who tested HIV compared to the total clients aged above yrs who tested from the laboratory Proportion of Clients who tested positive for HIV AIDS with confirmed TB out of the total number that tested positive for HIV AIDS from the laboratory Proportion of Clients who tested positive for HIV AIDS and were started on Cotrimoxazole out of the total number that tested HIV AIDS positive from the laboratory 29

30 3.8.4 Maternal Health and Family Planning Indicators FY 2009/10. The proportion of pregnant women who received the second dose of Fansider IPT was in while in was and was There has been a decline in the number of pregnant women who received IPT in implying that actually fewer pregnant women have accessed the second dose of fansider Figure 3.8: IPT Coverage TREND OF COVERAGE FOR IPT2 2009/10, 38% 2007/08, 39% 2008/09, 43% Source: Ministry of Health-Resource Centre 30

31 3.8.5 Family planning users for FY 2009/2010 Family planning allows individuals and couples to anticipate and attain their desired number of children and spacing and timing of their birth It is achieved through use of contraceptive methods The number of New users was more than the Revisits indicating that more people have started using contraceptives Table Family planning users for FY New users Revisits Condom Injectable IDU Copper Natural Lo femenal Microgynon Oral Other Ovrette Other methods 31

32 3.8.5 Stock out of Essential Drugs in FY 2009/10 A stock out of a given drug implies that a health facility didn t have that particular drug at some point in time during the FY Figure below presents data on stock outs of essential drugs with Quinine having a high rate of stock out followed by Fansider at and the First line drugs for malaria at Figure 3.9: Stock Out of Essential drugs Percentage Stock Outs 16% 14% 12% 10% 8% 6% 4% 2% 0% STOCK OUTS Cotrimoxazole Tabs Depo-provera Fansidar First Line Drug for Malaria HIV Testing Kits Confirmatory HIV Testing Kits Screening HIV Testing Kits Tie-Breaker Measles Vaccine ORS Sachets Quinine Medicines Source: Ministry of Health-Resource Centre Figure above shows data on stock outs of essential drugs namely first and second line drugs for malaria ORS measles vaccines and HIV test kits among others 32

33 3.8.6 Causes of Morbidity for FY 2009/10 This section presents an analysis of the causes of morbidity from the out patient records The statistics indicate that Malaria has been the highest cause of morbidity in Uganda for this period of the last two years No Pneumonia Cough or Cold was the second Table 3.4: Ten causes of Morbidity in Uganda 2009/10. Ranking Diagnosis Name Cases Percent Malaria No Pneumonia cough or cold Intestinal worms Diarrhea Acute Skin Diseases Sexually Transmitted Infections Gastro Intestinal Disorder Pneumonia Urinary Tract Infection Eye Conditions Source: Ministry of Health-Resource Centre Diseases of Epidemic Potential for FY 2009/10 The diseases of epidemic potential are surveyed on weekly basis The table below indicates cases that were surveyed in It is observed that 33

34 more cases of Dysentery were reported in as compared to In addition more cases of Rabies were also reported Other Emerging Infectious increased drastically compared to and these include among others smallpox tuberculosis and scabies Other Viral Haemorrhagic fevers decreased in compared to and these included Ebola and Marburg among others Table 3.5: Summary of diseases of Epidemic potential Diagnosis Name Reported cases Reported cases Acute Flaccid Paralysis Cholera Dysentery Guinea Worm Measles Meningitis Meningococcal Plague Rabies Tetanus Neonatal days Yellow Fever Other Emerging Infectious Diseases Other Viral Haemorrhagic Fevers Source: Ministry of Health-Resource Centre 34

35 4.0 HUMAN RESOURCES FOR HEALTH Human Resources for Health are essential for the effective operation of the health systems and an important input in the attainment of HSSP II objectives The level of staffing is still low and the regional distribution remains inequitable This is specifically seen in areas that are poorly resourced in terms of social infrastructure and amenities Other limitations that have greatly curtailed HRH are Limited funding for recruitment lengthy recruitment processes and delays in handling the recruitment process at district level Low training outputs and high attrition rates The outputs from the training institutions do not match service requirements Poor retention which is accelerated by poor motivational factors like poor work environment and remuneration Human Resources for Health HRHs remain in short supply both in numbers and in skills mix to effectively respond to the health needs in Uganda The HIV AIDS epidemic has also increased demand on HRHs because of the special skills required for HIV AIDS prevention and treatment 35

36 Figure 4.1: Posts filled at different levels in public health facilities (MoH, 2009) Percentages Mulago Butabika RRH GH HCIV HCIII HCII Health Facilitie s Source: Ministry of Health-Resource Centre (Annual Reports 2009/10) The figure above shows the proportion of filled posts at different levels of health care From HC II right to NRHs The majority of the vacancies in the public health sector are at HC II level at which are predominantly located in rural communities From November to date only of the approved positions at National level are filled yet still for all levels of health care and all cadres the HRH situation is critical Critical cadres for instance medical officers clinical officers are still thin on ground for example in Hoima and Kabale Regional Referral hospitals with and medical officers respectively There is however a marked improvement in some cadres like the nurses In order to improve HRH capacity efforts should be put in place to ensure optimal recruitment of health workers to fill critical vacancies in the sector and provision of the necessary incentives to have them stay at their work stations to provide the necessary services to the population they serve 36

37 APPENCIDES APPENDIX I: Distribution of Target population by Districts, 2009/10 District/ Region Male Female Children > 1yr Expected Pregnancies Expected Births Children > 5yrs Expected TB cases Children >15yrs Northern Abim Adjumani Amolatar Amuria Amuru Gulu Apac Arua Dokolo Koboko Kotido Kitgum Moroto Moyo Lira Nyadri Oyam Pader Yumbe Nebbi Nakapiripirit Source: Ministry of Health-Resource Centre 37

38 EASTERN Budaka Bududa Bugiri Bukedea Bukwo Busia Butaleja Iganga Jinja Kaliro Kamuli Kaberamaido Katakwi Kumi Mayuge Mbale Manafwa Sironko Soroti Tororo Nanutumba Pallisa Kaabong Kapchorwa Source: Ministry of Health-Resource Centre 38

39 WESTERN Bullisa Bundibugyo Bushenyi Hoima Ibanda Isingiro Kabale Kabarole Kibaale Kamwenge Kanungu Kasese Kiruhura Kisoro Kyenjojo Masindi Mbarara Ntungamo Rukungiri Source: Ministry of Health-Resource Centre 39

40 CENTRAL Kalangala Kampala Kayunga Kiboga Luwero Lyantonde Masaka Mityana Mpigi Mubende Mukono Nakaseke Nakasongol a Rakai Ssembabule Wakiso National 15,255,98 16,527,3 1,366, 1,589,16 total ,541,490 6,420, ,573,817 Source: Ministry of Health-Resource Centre 40

41 APPENDIX II: Number of Health Units in a District that had a Stock out of medicines 2009/2010 Districts Cotrimoxazo le Tabs Depo- Provera Fansidar First Line Drug for Malaria HIV Testing Kits Confirmator y HIV Testing Kits Screening HIV Testing Kits Tie- Breaker Measles Vaccine ORS Sachets Quinine ABIM ADJUMANI AMOLATAR AMURIA AMURU APAC ARUA BUDAKA BUDUDA BUGIRI BUKEDEA BUKWO BULIISA BULISA BUNDIBUGYO BUSHENYI BUSIA BUTALEJA DOKOLO GULU HOIMA IBANDA IGANGA ISINGIRO

42 Districts Cotrimoxazo le Tabs Depo- Provera Fansidar First Line Drug for Malaria HIV Testing Kits Confirmator y HIV Testing Kits Screening HIV Testing Kits Tie- Breaker Measles Vaccine ORS Sachets Quinine JINJA KAABONG KABALE KABAROLE KABERAMAIDO KALANGALA KALIRO KAMPALA KAMULI KAMWENGE KANUNGU KAPCHORWA KASESE KATAKWI KAYUNGA KIBAALE KIBOGA KIRUHURA KISORO KITGUM KOBOKO KOTIDO KUMI KYENJOJO LIRA LUWERO

43 Cotrimoxazo le Tabs Depo- Provera Fansidar First Line Drug for Malaria HIV Testing Kits Confirmator y HIV Testing Kits Screening HIV Testing Kits Tie- Breaker Measles Vaccine ORS Sachets Quinine Districts LYANTONDE MANAFWA MASAKA MASINDI MAYUGE MBALE MBARARA MITYANA MOROTO MOYO MPIGI MUBENDE MUKONO NAKAPIRIPIRIT NAKASEKE NAKASONGOLA NAMUTUMBA NEBBI NTUNGAMO NYADRI OYAM PADER PALLISA RAKAI RUKUNGIRI SIRONKO

44 Cotrimoxazo le Tabs Depo- Provera Fansidar First Line Drug for Malaria HIV Testing Kits Confirmator y HIV Testing Kits Screening HIV Testing Kits Tie- Breaker Measles Vaccine ORS Sachets Quinine Districts SOROTI SSEMBABULE TORORO WAKISO YUMBE Grand Total Source: Ministry of Health-Resource Centre 44

45 APPENDIX III: District league Table 2009/10 Ranking District Population No. of HSDs Total No. of Health Units % %District HMIS Outpatient returns submitted timely Score % children <1 received 3 doses of DPT according to schedule Total Govt and NGO OPD utilization per person per year Pit Latrine Coverage % Deliveries in Govt and NGO health facilities Proportion of new smear positive TB cases notified compared to expected % Score Score % Score 1 KAMPALA % 5 100% % % 10 96% % 5 50% MITYANA % 5 92% % % 8 52% % 5 50% TORORO % 5 92% % % 6 67% % 5 50% JINJA % 5 63% % % 7 57% % 5 50% KABAROLE % 3 81% % % 8 44% % 5 50% ABIM % 4 191% % % 10 56% % 5 50% RUKUNGIRI % 4 86% % % 6 45% % 5 50% MBALE % 5 94% % % 10 45% % 5 50% MPIGI % 4 95% % % 7 35% % 5 50% DOKOLO % 5 89% % % 7 82% % 5 50% GULU % 5 89% % % 10 37% % 5 50% AMOLATAR % 5 117% % % 8 46% % 5 50% MUKONO % 5 65% % % 5 60% % 5 50% KANUNGU % 5 83% % % 5 51% % 5 50% MASAKA % 5 89% % % 7 31% % 5 50% RAKAI % 5 65% % % 7 37% % 5 50% % Score Score % % Pregnant women receiving 2nd dose Fansidar for IPT Score % Proportion of PHC funds spent on drugs(at NMS and JMS)** Score % % PHC funds disbursed that are expended Score FDS Flexibility Gain Score % HIV/AIDS Service Availability* Score Total Score Ranking 45

46 17 MBARARA % 3 50% % % 9 36% % 5 50% LYANTONDE % 3 78% % % 10 52% % 5 50% LIRA % 5 71% % % 9 53% % 5 50% OYAM % 5 94% % % 7 76% % 5 50% NEBBI % 5 76% % % 5 45% % 5 50% KAYUNGA % 5 78% % % 4 46% % 5 50% BUSIA % 5 96% % % 6 40% % 5 50% KIBOGA % 5 77% % % 6 51% % 5 50% NTUNGAMO % 5 87% % % 4 27% % 5 50% KAMWENGE % 5 100% % % 5 34% % 5 50% MANAFWA % 5 123% % % 5 59% % 5 50% KABALE % 5 83% % % 3 34% % 5 50% BUTALEJA % 5 90% % % 2 54% % 5 50% KITGUM % 5 71% % % 6 78% % 5 50% National Average % 4 76% % % 6 47% % 5 50% PADER % 5 74% % % 7 53% % 5 50% BUSHENYI % 3 95% % % 5 26% % 5 50% NAKASEKE % 5 57% % % 5 58% % 5 50% BUDUDA % 5 147% % % 3 40% % 5 50% KUMI % 4 76% % % 3 51% % 5 50% AMURU % 2 68% % % 8 50% % 5 50% IBANDA % 4 81% % % 6 20% % 5 50% ISINGIRO % 3 82% % % 4 49% % 5 50% KASESE % 3 96% % % 3 54% % 5 50% NAMUTUMBA % 5 87% % % 3 37% % 5 50% WAKISO % 5 85% % % 4 43% % 5 50% ARUA % 4 81% % % 6 54% % 5 50% KALANGALA % 5 175% % % 5 31% % 5 50% LUWERO % 3 53% % % 7 68% % 5 50% KISORO % 5 74% % % 3 14% % 5 50%

47 46 KAPCHORWA % 5 61% % % 2 52% % 5 50% APAC % 5 63% % % 6 46% % 5 50% SSEMBABULE % 5 80% % % 5 20% % 5 50% KIBAALE % 4 47% % % 6 66% % 5 50% NAKASONGOLA % 5 71% % % 5 35% % 5 50% KATAKWI % 4 80% % % 4 48% % 5 50% KABERAMAIDO % 3 71% % % 3 46% % 5 50% IGANGA % 5 70% % % 4 25% % 5 50% KYENJOJO % 4 71% % % 3 28% % 5 50% KOTIDO % 5 104% % % 3 70% % 5 50% BUDAKA % 4 96% % % 1 54% % 5 50% BUGIRI % 4 82% % % 3 42% % 5 50% PALLISA % 4 63% % % 4 55% % 5 50% KALIRO % 5 84% % % 3 30% % 5 50% KIRUHURA % 4 74% % % 3 23% % 5 50% MAYUGE % 4 60% % % 5 44% % 5 50% SIRONKO % 4 78% % % 5 43% % 5 50% BUKEDEA % 3 65% % % 2 57% % 5 50% KOBOKO % 5 90% % % 3 23% % 5 50% SOROTI % 1 43% % % 3 81% % 5 50% MOROTO % 3 74% % % 9 52% % 5 50% BUNDIBUGYO % 4 64% % % 3 27% % 5 50% YUMBE % 5 52% % % 1 67% % 5 50% MOYO % 5 27% % % 2 75% % 5 50% HOIMA % 3 39% % % 5 35% % 5 50% MUBENDE % 5 50% % % 4 44% % 5 50% BUKWO % 5 98% % % 1 50% % 5 50% NAKAPIRIPIRIT % 4 71% % % 4 67% % 5 50% BULIISA % 4 63% % % 3 52% % 5 50% NYADRI % 3 56% % % 1 61% % 5 50%

48 76 KAMULI % 5 79% % % 2 29% % 5 50% MASINDI % 3 41% % % 5 43% % 5 50% ADJUMANI % 2 33% % % 3 50% % 5 50% AMURIA % 3 55% % % 2 49% % 5 50% KAABONG % 5 44% % % 1 62% % 5 50% *Population figures based on the 2010 mid - term population projections from the UBOS which were derived from the population census of 2002 Note: Monthly HMIS reports used to derive all indicators * 48

49 APPENDIX IV: PMTCT AND ART SERVICES FOR 2009/10 District ANC New No. of Pregnant Women Tested for HIV No. of Pregnan t Women Positive for HIV No. of Pregnant Women Given ARVs for Prophylaxis( PMTCT) No. of Pregnant Women Given ARVs for Treatment No. Eligible for ART 49 No. Started on ARVs ABIM ADJUMANI AMOLATAR AMURIA AMURU APAC ARUA BUDAKA BUDUDA BUGIRI BUKEDEA BUKWO BULISA BUNDIBUGYO BUSHENYI BUSIA BUTALEJA DOKOLO GULU HOIMA IBANDA IGANGA ISINGIRO JINJA KAABONG KABALE KABAROLE KABERAMAIDO KALANGALA KALIRO KAMPALA KAMULI KAMWENGE KANUNGU KAPCHORWA KASESE KATAKWI KAYUNGA

50 KIBAALE KIBOGA KIRUHURA KISORO KITGUM KOBOKO KOTIDO KUMI KYENJOJO LIRA LUWERO LYANTONDE MANAFWA MASAKA MASINDI MAYUGE MBALE MBARARA MITYANA MOROTO MOYO MPIGI MUBENDE MUKONO NAKAPIRIPIRIT NAKASEKE NAKASONGOLA NAMUTUMBA NEBBI NTUNGAMO NYADRI OYAM PADER PALLISA RAKAI RUKUNGIRI SIRONKO SOROTI SSEMBABULE TORORO WAKISO YUMBE Grand Total ,412,895 74,238 59,158 32, Source: Ministry of Health-Resource Centre 50