THE REPUBLIC OF UGANDA MINISTRY OF HEALTH ANNUAL HEALTH SECTOR PERFORMANCE REPORT

THE REPUBLIC OF UGANDA MINISTRY OF HEALTH ANNUAL HEALTH SECTOR PERFORMANCE REPORT Financial Year 2014/2015

THE REPUBLIC OF UGANDA MINISTRY OF HEALTH Annual Health Sector Performance Report Financial Year 2014/2015

yy Annual Health Sector Performance Report for Financial Year 2014/15 Hon. Dr. Elioda Tumwesige Honourable Minister of Health Hon. Sarah Opendi Minister of State for Health/ Primary Health Care Hon. Dr. Chris Baryomunsi Minister of State for Health/ General Duties i

yy Annual Health Sector Performance Report for Financial Year 2014/15 2014/15 yy 2014/15 Dr. Asuman Lukwago Permanent Secretary Hon. Dr. Elioda Tumwesige Honourable Minister of Health Dr. Jane Ruth Aceng Director General Health Services Hon. Sarah Opendi Minister of State for Health/ Primary Health Care Hon. Dr. Chris Baryomunsi Minister of State for Health/ General Duties Dr. Henry Mwebesa Ag. Director of Health Services/ Planning and Development Prof. Anthony Mbonye Director Health Services/ Community and Clinical Services ii i

yy Annual Health Sector Performance Report for Financial Year 2014/15 iii

yy Annual Health Sector Performance Report for Financial Year 2014/15 FOREWORD The Annual Health Sector Performance Report for 2014/15 Financial Year provides analysis of health sector performance against set targets, goals and objectives for the Financial Year 2014/15 with a comparative analysis of the previous trends towards achieving the HSSIP 2010/11 2014/15 targets. The report is premised on an analysis of commitments in the National Development Plan, Ministerial Policy Statement, Budget Framework Paper, the HSSIP, the 20th JRM Aide Memoire and the annual sector workplans at various levels. The report is discussed at the Annual Health Sector Joint Review Mission, and is 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 implementing the strategies of the National Health Policy II, and achieving the National Development Plan targets and Millennium Development Goals. The sector continues 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 2010/11-2014/15 Mid-Term review. This is further supported by the resolutions of the World Health Assembly, 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 the community in the reported sector performance. Sector performance cannot be improved and sustained without the dedicated efforts of all categories of health workers, 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, to improve. I wish to thank the Health Policy Advisory Committee members for always giving policy guidance to the sector and 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. For God and My Country Hon. Dr. Elioda Tumwesigye, MP MINISTER OF HEALH iv

yy Annual Health Sector Performance Report for Financial Year 2014/15 TABLE OF CONTENTS FOREWORD... iv LIST OF FIGURES... vi TABLES... vii ACRONYMS... ix Executive Summary... xvi CHAPTER ONE... 1 1 Introduction... 1 1.1 Background... 1 1.2 The process of compiling the report... 1 1.3 Outline of the report... 1 CHAPTER TWO... 3 2 Overall sector performance and progress... 3 2.1 Overall sector performance and progress... 3 2.1.1 Health Impact Indicators... 3 2.2 Health Output Indicators... 8 2.3 Other health determinants and risk factors and behaviour... 10 2.4 Service access, readiness, quality and safety... 11 2.4.1 Health Investments and Governance... 13 2.5 Local Government Performance... 30 2.5.1 District League Table (DLT)... 30 2.5.2 Regional Performance Level Performance... 35 2.6 Hospital Performance... 37 2.6.2 National referral hospitals... 39 2.6.3 General Hospital Performance... 47 2.6.4 Functionality of HC IVs... 51 3 Achievements against Planned Outputs in the MPS 2014/15... 54 3.1.1 Finance and Administration... 54 3.1.2 Planning... 55 3.1.3 Quality Assurance... 57 3.1.4 Clinical and Community... 58 3.1.5 Communicable Disease Prevention and Control... 66 3.1.6 Semi-Autonomous Institutions... 75 3.1.7 Regulatory Bodies... 79 3.1.8 PNFP Sub-Sector... 84 4 Annex... 93 v

yy Annual Health Sector Performance Report for Financial Year 2014/15 LIST OF FIGURES Figure 1: institutional maternal mortality ratio during hssip period... 4 Figure 2: Number of registered health workers 2014/2015... 13 Figure 3: Distribution of the health workforce by employment status... 13 Figure 4: GoU health expenditure as of total government expenditure... 18 Figure 5:Government allocation to the Health Sector 2010/11 to 2014/15... 18 Figure 6: Per capital public health exp (US $)... 18 Figure 7: Trends in PHC Grant Allocations FY 2010/11-2014/15 in Ushs billions... 21 Figure 9: A map of Uganda showing percentage of reports with action taken during 2014/15 FY... 27 Figure 8: Top ten conditions among under fives and above in 2014/15 FY... 38 Figure 9: Volume of Outputs for RRHs and Large PNFPs 2014/15 2013/14 2012/13 FYs. 43 Figure 10: Recurrent / SUO and Bed Occupancy Rate in RRHs... 45 Figure 11: Histogram for distribution of ALOS 2014/15... 49 Figure 12: Trends in Caesarean Section and Blood transfusion 2008/09-2014/15... 52 Figure 13: Post Bank Assessed Homes and WASH Loans provided... 63 Figure 14: The improved latrine facilities constructed after provision of the WASH Loans... 63 Figure 15: Number of active ART clients in the country: 2003 December 2014... 68 Figure 16: National Malaria Prevalence... 73 Figure 17: Trends in ITN Ownership and Use... 73 Figure 18: Blood Collection for FY 2004/05 to 2014/2015... 77 Figure 19: Natural Family Planning Contacts in UCMB Hospitals in 5 years... 86 Figure 20: Staffing in UPMB hospitals, HC IVs and LLUs... 89 Figure 21: Standard Unit of output in UPMB hospitals... 90 vi

yy Annual Health Sector Performance Report for Financial Year 2014/15 TABLES Table 1: Comparison of the Impact Indicators Performance aagainst the HSSIP Targets... 3 Table 2: Comparison of Maternal deaths notified by facilities to those reported through HMIS... 4 Table 3: Causes of maternal deaths over the HSSIP period... 5 Table 4: Common factors underlying maternal deaths... 6 Table 5: Leading causes of Under 5 In-patient Mortality... 7 Table 6: Performance for health services core indicators... 9 Table 7: Progress against the Other health determinants and risk factors and behaviour... 10 Table 8: Availability of individual tracer medicines 2010/11-2014/15... 11 Table 9: Progress against the service access and quality indicators... 12 Table 10: Staffing level in various public sector institutions... 14 Table 11: Staffing levels in Regional Referral Hospitals... 15 Table 12: Staffing by cadre... 15 Table 13: Performance of investments and governance indicators over the past 5 years... 16 Table 14: Government allocation to the Health Sector 2010/11 to 2014/15... 17 Table 15: Institutional Budget Performance 2014/15 FY... 19 Table 16: Budget Categories... 19 Table 17: Primary Health Care Grants FY 2010/11-2014/15 in Ushs billions... 20 Table 18: Average PHC Non-wage allocation by level to public health facilities and DHOs 2014/15 FY... 20 Table 19: Report statistics over the months in the year of 2014 /15... 25 Table 20: Action taken by stakeholders or relevant action centers during the period... 26 Table 21: 10 Districts with Highest Number of Action Taken... 26 Table 22: HPAC Institutional representatives attendance... 28 Table 23: Progress in implementation of the Country Compact during FY 2014/15... 28 Table 24: Progress in implementation of the IHP+ commitments... 29 Table 25: Trends in national average performance in the DLT... 31 Table 26: Fifteen (15) Top and Bottom performing districts FY 2014/15... 32 Table 27: District ranking for Districts Excluding district with RRHs... 32 Table 28: District ranking for hard-to-reach districts as per the DLT... 33 Table 29: District ranking for new districts... 33 Table 30: district ranking by Region 2014/15 FY... 35 vii

yy Annual Health Sector Performance Report for Financial Year 2014/15 Table 31: Top ten causes of hospital based mortality for all ages 2014/2015... 38 Table 32: Financial Performance for 14 RRHs for FY 2014/15 (UGX Billions)... 40 Table 33: Key Hospital Outputs and Ranking of RRHs and Large PNFP Hospitals... 41 Table 34: Summary of Key Outputs for RRHs and Large PNFPs... 42 Table 35: Selected Efficiency Parameters for RRHs and Large PNFP Hospitals FY 2014/15... 44 Table 36: Selected Quality of Care Parameters for RRHs and Large PNFP Hospitals 2014/15 46 Table 37: Summary of Outputs from the General Hospitals FY 2014/15 (N=132)... 48 Table 38: The Top 15 high volume General Hospitals... 48 Table 39: Summary of Outputs from the HC IVs FY 2014/15 (N=195)... 52 Table 40: Summary of Efficiency & Usage Measurements of HC IVs... 53 Table 41: Performance on TB outcome and Output indicators... 70 Table 47: UCMB Facility Staffing... 84 Table 43: FAMILY PLANNING SERVICES IN UCMB HEALTH FACILITIES... 85 Table 44: UCMB facilities performance in Key HIV indicators in FY 2014/15... 86 Table 45: 5-Year Trend of UCMB Health Facilities Average Cost/SUO and Average User Fees/SUO... 88 Table 46: Trends in income for recurrent cost in UCMB network (Hospitals + LLHFs)... 88 Table 48: Key Outputs for the UMMB Facilities... 91 Table 49: Staff training in UMMB Facilities... 92 Table 50: DLT ranking for the 112 districts 2014/15 FY... 93 Table 51: DLT ranking for the 14 districts 2014/15 FY with Referral Hospitals... 97 Table 52: Ranking of the 31 New Districts 2014/15 FY... 98 Table 53: League Table for Hard to reach Districts... 100 Table 54: Regional Ranking 2014/15... 103 Table 55: General Hospital Performance... 111 Table 56: Summary of General Hospital Performance... 117 Table 57: Outputs and Ranking of HC IVs 2014/15... 117 viii

yy Annual Health Sector Performance Report for Financial Year 2014/15 ACRONYMS ACT AHSPR AIDS AMREF ANC ART ARVs BFHI CAO CB-DOTS CBO CCM CDC CDD CDP CDR CEmOC CLTS CPR CPT CSO CYP DHIS DHO DHMT DLT DOTS DPs DPT DQA EAC EAPHL ECSA-HC EID EMHS EmOC emtct FP FY Artemisinin Combination Therapies Annual Health Sector Performance Report Acquired Immuno-Deficiency Syndrome African Medical and Research Foundation Ante Natal Care Anti-retroviral Therapy Antiretroviral Drugs Baby Friendly Health Initiative Chief Administrative Officer Community Based TB Directly Observed Treatment Community Based Organization Country Coordinating Mechanism Centres for Disease Control Control of Diarrhoeal Diseases Child Days Plus Case Detection Rate Comprehensive Emergency Obstetric Care Community Led Total Sanitation Contraceptive Prevalence Rate Cotrimoxazole Preventive Therapy Civil Society Organization Couple Years of Protection District Health Information Software District Health Officer District Health Management Team District League Table Directly Observed Treatment, short course (for TB) Development Partners Diphtheria, Pertussis (whooping cough) and Tetanus vaccine Data Quality Assessment East African Community East African Public Health Laboratories East Central and Southern Africa - Health Community Early Infant Diagnosis Essential Medicines and Health Supplies Emergency Obstetric Care Elimination of Mother-to-Child Transimission Family Planning Financial Year ix

yy Annual Health Sector Performance Report for Financial Year 2014/15 GAVI GBV GFTAM GH GoU HAART HC HCT HDP HIV HMBF HMDC HMIS HPAC HPC HRH HSD HSS HSSIP HSSP ICB ICCM ICU IMCI IDSR IEC IMAM IMCI IPT IRS ITNs JAF JBSF JICA JMS JPP JRM KCCA KDS LG LLHF Global Alliance for vaccines and Immunization Gender Based Violence Global Fund to fight TB, Aids and Malaria General Hospital Government of Uganda Highly Active Anti-Retroviral Therapy Health Centre HIV/AIDS Counselling and Testing Health Development Partners Human Immuno-Deficiency Virus Home Based Management of Fever Health Manpower Development Centre Health Management Information System Health Policy Advisory Committee Health Professional Council Human Resources for Health Health Sub-Districts Health Systems Strengthening Health Sector Strategic Investment Plan Health Sector Strategic Plan Institutional Capacity Building Integrated Community Case Management Intensive Care Unit Integrated Management of Childhood Illnesses Integrated Disease Surveillance and Response Information Education and Communication Integrated Management of Acute Malnutrition Integrated Management of Childhood Illness Intermittent Presumptive Treatment for malaria Indoor Residual Spraying Insecticide Treated Nets Joint Assessment Framework Joint Budget Support Framework Japan International Cooperation Agency Joint Medical Stores Joint Program on Population Joint Review Mission Kampala City Council Authority Kampala Declaration on Sanitation Local Government Lower Level Health Facility x

yy Annual Health Sector Performance Report for Financial Year 2014/15 LLINs Long Lasting Insecticide Treated Nets LTFPM Long Term Family Planning Methods MCH Maternal and Child Health MDGs Millennium Development Goals MDR Multi-drug Resistant MIP Malaria in pregnancy MKCCAP Mulago Hospital and the City of Kampala Project MMR Maternal Mortality Ratio MOFPED Ministry of Finance, Planning and Economic Development MoGLSD Ministry of Gender, Labour and Social Development MOH Ministry Of Health MOLG Ministry of Local Government MOPS Ministry of Public Service MOU Memorandum of Understanding MOWE Ministry of Water and Environment MPDR Maternal Perinatal Death Review MDR/XDR Multi-drug and extra-drug resistant TB MTEF Medium Term Expenditure Framework MTR Mid-Term Review NCD Non Communicable Diseases NCRI National Chemotherapeutic Research Institute NDA National Drug Authority NGOs Non-Governmental Organizations NHA National Health Assembly NHP National Health Policy NMCP National Malaria Control Programme NMS National Medical Stores NTD Neglected Tropical Disease NTLP National Tuberculosis and Leprosy Control Program ODF Open Defecation Free OOP Out-Of-Pocket Payments OPD Out Patients Department OPM Office of the Prime Minister OPV Oral Polio Vaccine ORS Oral Rehydration Salt ORT Oral Rehydration Therapy PHA People with HIV/AIDS PHAST Participatory Hygiene and Sanitation Transformation PHC Primary Health Care PLWHA People with HIV/AIDS PMDT Programmatic Management of Multi-Drug Resistant TB xi

yy Annual Health Sector Performance Report for Financial Year 2014/15 PMTCT PNFP PPPH PRDP QI RH RPMT RRH RMNCAH SDS SGBV SLD SMC SMER SP SPARS STI SUO SWAP TB TMC TSR TT TWG UACP UAIS UBOS UBTS UCI UCMB UDHS UGFATM UHSSP UHI UMIS UMMB UNEPI UNFPA UNHRO UNICEF UNMHCP Prevention of Mother to Child Transmission Private Not for Profit Public Private Partnership for Health Peace Recovery and Development Plan Quality Improvement Reproductive Health Regional Performance Monitoring Team Regional Referral Hospital Reproductive health maternal, newborn and child health Strengthening Decentralization for Sustainability Sexual and Gender Based Violence Second Line Drugs Senior Management Committee Supervision, Monitoring, Evaluation and Research Sulphadoxine/Pyrimethamine Supervision Performance Assessment Recognition Strategy Sexually Transmitted Infection Standard unit of Output Sector-Wide Approach Tuberculosis Top Management Committee Treatment Success Rate Tetanus Toxoid Technical Working Group Uganda Aids Control Program Uganda AIDS Indicator Survey Uganda Bureau of Statistics Uganda Blood Transfusion Services Uganda Cancer Institute Uganda Catholic Medical Bureau Uganda Demographic and Health Survey Uganda Global Fund for AIDS, TB and Malaria Uganda Health Systems Strengthening Project Uganda Heart Institute Uganda Malaria Indicator Survey Uganda Muslim Medical Bureau Uganda Expanded Programme on Immunization United Nations Fund for Population Activities Uganda National Health Research Organization United Nations Children s Fund Uganda National Minimum Health Care Package xii

yy Annual Health Sector Performance Report for Financial Year 2014/15 UPMB USF UVRI VHT WHO Uganda Protestant Medical Bureau Uganda Sanitation Fund Uganda Virus Research Institute Village Health Team World Health Organization xiii

yy Annual Health Sector Performance Report for Financial Year 2014/15 Summary assessment of the 26 HSSIP core indicators Indicator Overall progress Baseline Achievement 2014/15 HSSIP Target MMR 435/100,000 (UDHS 2006) IMR 76/1,000 (UDHS 2006) Under 5 Mortality Rate 137/1,000 (UDHS 2006) NMR 29/1,000 (UDHS 2006) Proportion of households 28 experiencing catastrophic (2009/10) payments pregnant women attending 4 ANC sessions 360/100,000 (WHS 2014) 45/1,000 (WHS 2014) 69/1,000 (WHS 2014) 23/1,000 (WHS 2014) 37 (NHA 2011/12) 131/100,000 41/1,000 56/1,000 23/1,000 13 32 36.6 60 deliveries in health facilities 39 52.7 90 children under one year immunized with 3 rd dose Pentavalent vaccine 90 102.4 85 one year old children immunized against measles pregnant women who have completed IPT 2 of children exposed to HIV from their mothers accessing HIV testing within 12 months U5s with fever receiving malaria treatment within 24 hours from VHT ART coverage among those in need 85 90.0 95 43 53.4 70 30 58 75 No data No data 85 53 56 57 (2013 WHO Guidelines) Households with a pit latrine 71 77 72 U5 children with height /age below lower line (stunting) U5 children with weight /age below lower line (wasting) 38 (2006) 16 (2006) Contraceptive Prevalence Rate 24 of new TB smear + cases notified compared to expected (TB case detection rate) TB Treatment Success Rate (2006) 39.8 (2009/10) 68.6 (2009/10) 33 28 (UDHS 2011) 14 10 (UDHS 2011) 30 43 (UDHS 2011) 45 70 79 85.0 xiv

yy Annual Health Sector Performance Report for Financial Year 2014/15 Per capita OPD utilisation rate 1.0 (2009/10) of health facilities without 41 stock outs of any of the six tracer medicines in previous 3 (2009/10) months of functional HC IVs 24 (providing EMOC) (2009/10) clients expressing satisfaction with health services of approved posts filled by health workers (public health facilities) annual reduction in absenteeism rate of villages / wards with trained VHTs 46 (2008/09) 56 (2009/10) 46 (09/10) (Absenteeism) 72 (09/10) 1.2 1.0 64 80 45 50 69 70 69 75 No data 20 reduction from previous year 75 100 GoU health expenditure as of total government expenditure 9.6 (09/10) 8.5 10 xv

yy Annual Health Sector Performance Report for Financial Year 2014/15 Executive Summary The annual sector performance report (AHSPR) highlights progress, challenges, lessons learnt and proposes mechanisms for improvement. The report focuses on the progress in implementation of commitments in the Ministerial Policy Statement, overall sector performance against the targets set for the FY 2014/15, and trends in performance for selected indicators over the previous FYs. The compilation process of the was participatory with involvement of all the 14 Technical Working Groups and Senior Management Committee. The overall coordination and technical support was by the MoH Joint Review Mission Task Force. Data The report focuses on the core indicators for monitoring performance of the HSSIP 2010/11-2014/15 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 routine Health Management Information System (HMIS), administrative sources and programme data, including both quantitative and qualitative data. Generation of output indicators for this report largely utilized data from the integrated HMIS, with completeness of monthly reporting for the year under review standing at 83 up from 74 in 2013/14 and timeliness of 88 from 70 in 2013/14. Coverage estimates in the HMIS data uses the UBOS 2013 mid-year population projections to estimate the target populations. Health impact Impact is assessed using MMR, NMR, IMR, U5MR, and incidence of catastrophic household expenditure on health. The WHO Health Statistics Series 2014 report shows positive trends, with a progressive and constant reduction of all mortality indicators as compared to the previous ten to fifteen years. In particular IMR and U5MR showed a significant decline with the likelihood of achieving the MDG and HSSIP targets. The MMR stands at 360 per 100,000 (WHO 2014) live births [that of Kenya is 400 per 100,000 live births (WHO 2014) and Tanzania is 460 per 100,000 (World Bank 2012)]. This is below the HSSIP and MDG and HSSIP target of 131 per 100,000 live births. The HMIS reports show that the institutional maternal death rates have dropped from 146 per 100,000 in 2013/14 to 118 per 100,000 in 2014/15. There has been progressive decline over the five years in average annual facility based maternal deaths from 194 per 100,000 lives (2010/11) live births to 118 per 100,000 live births in 2014/15. In addition to increased institutional deliveries, this could be attributed to improved effective ANC to prevent, detect, and treat problems such as malaria, anaemia, HIV/AIDS and other infections, which are important indirect causes of maternal death, and the scale up of quality improvement interventions in hospitals e.g. Maternal and Perinatal Death notification and reviews and use of partographs. xvi

yy Annual Health Sector Performance Report for Financial Year 2014/15 The three classic delays (home, on the way, and at facility) must be addressed to reign in unacceptably high maternal morbidity and mortality. The top causes of maternal deaths in 2014/15 FY included 1) haemorrhage (42), 2) pregnancy related hypertension (12) and 3) postpartum sepsis (11). The high burden of maternal and perinatal deaths needs to be addressed through implementation of the target interventions for targeted populations. Service coverage Despite increase in staffing levels, availability of EMHS, all Reproductive Health (RH) indicators are still below the HSSIP targets. The percentage of pregnant women attending at least 4 ANC sessions increased only slightly from 32.4 in 2013/14 to 36.6 in 2014/15 (target was 60). The percentage of deliveries in health facilities remarkably increased from 44.4 in 2013/14 to 52.7 in 2014/15) and IPT2 coverage increased from 49 to 53.4. Despite improved efforts at recruitment and deployment, human resource constraints (adequacy, distributional disparities and skills) still adversely affect the delivery of quality RH services. There is need to available appropriate numbers of skilled RH providers and mobilize the community to utilize RH services. The sector has sustained the good progress in immunization of children over the HSSIP period. The percentage of children under one year immunized with 3 rd dose of pentavalent vaccine now stands at 102.4 (104.5 males & 99.5 females), from 93 (91 males & 95 females in 2013/14. The percentage of one year old children immunized against measles stands at 90 compared to 87 in 2013/14. These achievements need to be sustained and propelled further through further strengthening existing EPI services and targeting poorly performing districts, hard to reach areas and populations. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 54 to 58 in 2014/15 and also short of the target of 75 by the end of the HSSIP. The percentage of people who are on ARVs increased from 48 (680,514 / 1,405,268) in 2013/14 to 750,896 (56) by 2014 of those in need (adults 694,627(58) and children 56,269 (38). Risk factors and behaviour Latrine coverage is improved from 74.6 in 2013/14 to 77 surpassing the HSSIP target of 72. This is attributed to the creation of a District Sanitation Fund in 89 districts, the Uganda Sanitation Fund Project in 30 districts. The status of coverage for the other health determinants i.e. wasting, stunting and Contraceptive Prevalence Rate was not assessed during this HSSIP period since there was no Demographic Health Survey since 2010. Service access, readiness, quality and safety TB case detection rate (TB CDR) increased from 36.6 in 2013/14 to 45 in 2014/15 far below the HSSIP target of 70. TB Treatment Success Rate was 79 compared to 80.7 in xvii

yy Annual Health Sector Performance Report for Financial Year 2014/15 2013/14. The slow progress relates to inadequate systems for TB case detection, adherence monitoring (poor DOT) and testing relapses for drug sensitivity. Per capita OPD utilization from 1.0 in 2013/14 to 1.2 in 2014/15. OPD utilization rate was consistently achieved throughout the HSSIP period. The medicines situation in the public sector has improved significantly in the last five years, facilities reporting no stock outs of the indicator items. The percentage of health units with no stock outs of any indicator medicines in the previous six months was at 64 in 2014/15 from 57 in 2013/14 and 43 in 2010/11. The larger proportion going to HIV, TB and malaria commodities with the smaller proportion of about $1 going to basic EMHS. This is not adequate to meet the population medicines need. The percentage of HC IVs conducting cesarean section was 51 and 38 were able to perform blood transfusion during FY 2014/15. This represents an improvement, as compared to the previous FY which reported 45 and 36 respectively. The percentage of clients expressing satisfaction with health services improved from 46 in 2008 to 69 (barely short of the HSSIP target of 70) in 2014 under the UHSSP Client satisfaction Survey. The common reasons in support of the Customer Satisfaction index included availability of caring personnel, medicines, free medical services. Health investments and Governance There has been a gradual improvement in the level of investments into the health sector over the HSSIP period. The percentage of approved posts filled by health workers in the public sector increased from 69 to 70 in 2014/15. Over the HSSIP period there was improvement from 56 in 2010/11 and this was as a result of the recruitment drive that was supported by government and Development Partners in 2013. During this FY there was no significant investment in building the capacity of Village Health Teams (VHTs) and has remained at 78 of the villages in the country having trained VHTs. Much effort was towards reviewing the VHT concept, studying establishment of the Community Health Extension Workers (CHEWs) and development of a CHEW policy and strategy. Financial investment in health by GoU declined from 8.7 in 2013/14 to 8.5 in 2014/15 FY of the overall National Budget. This is short of the HSSIP target of 10. Budget performance for the appropriated GoU budget was 100. This translates into a government contribution of US$ 13.7 per capita on health (The per capita public expenditure increased from US$12 to US$13.7 due to additional government, GAVI and Global Fund financing). This is still below the recommended per capita government expenditure on health of US $ 34 per capita as per the WHO Commission of Macro Economics and Health (CMH). It is also below the HSSIP target of per capita government expenditure on health of US $ 17. xviii

yy Annual Health Sector Performance Report for Financial Year 2014/15 Recurrent expenditure was 52 of the total expenditure while 48 was development expenditure (of which 42 is donor-funded, and 6 GoU funded). There is inadequate funding for sector activities especially PHC Services. Only Ushs 327 billion excluding the medicines budget was allocated as recurrent budget to run health service delivery. There is a challenge of the alignment of off-budget funding to sector priorities and skewed input mix in financing health facilities. There has not been commensurate funding for recurrent costs for utilities and/or maintenance arising from the construction of new buildings and equipment especially for hospitals at all levels. According to the National Health Accounts (NHA) reports, the level of out of pocket (OOP) expenditure, as percentage of the Total Health Expenditures, has been increasing in real terms in the past years though reducing in percentage terms. It was estimated at 42 in FY 2009/10 (NHA, 2013). The OOP expenditure was 37 in 2012/13 (NHA, 2014), showing a reduction, attributed to increased partner support for health, mostly through the private sector. The high OOP on health care negatively impacts on households incomes and affects household demand for, and access to health care. Consequently, the proportion of people facing catastrophic expenditure leading to house hold impoverishments, especially of the lower income quintiles is high. Significant progress has been made in the rehabilitation of infrastructure and supply of new equipment in the sector at various levels. Work was done at National, RRHs, in KCCA, and selected General hospitals. In addition, work was done at in Local Governments in the areas of staff houses, maternity wards, OPD and Transport among others. Investments in health infrastructure has continued and this included construction of new and rehabilitation of old infrastructure at various levels, provision of medical equipment and hospital furniture; provision of solar lighting, improvement of operations and maintenance of health infrastructure; strengthening the referral system by providing ambulances, general transport and Information Communication and Technology (ICT) equipment and services in selected health facilities; and renovation/construction of selected health facilities. Monitoring Implementation of the Country Compact and IHP+ Functionality of the HPAC is very crucial in monitoring implementation of the Compact and provision of advice on the implementation of the HSSIP and policies. Attendance of HPAC meetings by the various stakeholders was varied, with the HDP representatives attending more consistently than other members. There is less than satisfactory presence of Private Sector Representatives, while most concerning is the very low participation of other Line Ministries, RRHs and district representatives, whose activities have a significant influence on the determinants of health, and thus on overall population health. Central Level Performance The sector has prioritized stewardship, resource mobilization, standards and guidelines development, monitoring and supervision. A situation analysis of the supervision, xix

yy Annual Health Sector Performance Report for Financial Year 2014/15 monitoring and inspection (SMI) system in the health sector showed that there is inadequate leadership at all levels to demand and enforce regular SMI and ensuring followup of the recommended actions. The established structures (RPMTs, DHTs, Hospital Boards and HUMCs) for monitoring health sector performance are not functioning optimally. There is lack of comprehensive plans, poor coordination of the SMI activities of different programs and at all levels; thus overwhelms districts and facilities. The SMI framework needs to be strengthened to harmonize monitoring and supervision. Hospital Performance The MoH Health Facility Inventory July, 2013 the total number of hospitals (public and private) is 155. Of these 2 are National Referral Hospitals (Mulago and Butabika), 14 are RRHs and 139 are GHs. In terms of ownership, 65 are government owned, 63 private not for profit - PNFP and 27 are Private. There are 139 GHs in the country providing; preventive, promotive outpatient curative, maternity, inpatient, emergency surgery and blood transfusion and laboratory services. The 14 RRHs and 4 large PNFP hospitals assessed registered an increase in SUO in 2014/15 compared to 2012/13 from 8,727,279 to 9,598,602. Mbale hospital continues to lead in volume of outputs pushed by the very high number of admissions 70,183 (37 higher than 2013/14). Masaka retains the second slot registering a 36 increase compared to the year before. Hoima, St. Marys Lacor, Moroto all registered more than 20 increases. For reasons yet to be established Kabale had a 29 reduction in outputs compared to the year before. Hospital based deaths especially maternal deaths and fresh still births are indicators of quality of care. The total maternal deaths reported in 14 RRHs and 4 PNFP hospitals were 321 with a mean death of 18 mothers per hospital per year with a minimum of 2 in Mengo and maximum of 37 in Mbarara RRH. The total SUO for GHs has increased from 15,514,147 in 2013/14 to 16,256,818 this is generally attributed to increased number of hospitals reporting in the DHIS2 from 133 to 132. The average outputs were lower for all the listed outputs in the table below except for postnatal and family planning. The minimum SUO for GHs was 708 and maximum 543,117. The range in outputs is so big and calls in to question the classification of some health units as hospitals. The 5 top performing (high volume) hospitals were Iganga, Busolwe, Kitgum, Mityana and Tororo. Compared to the year 2013/14, Busolwe and Kitgum are new entrants to the top 5. Bwera and Kawolo dropped off the top 5. Among the PNFP the highest volume hospital is Angal St. Luke. The 5 lowest volume hospitals were JCRC, Kitintale, Ntinda, Middle East Bugolobi and Family Care hospital. There is need to re-visit the level classification of some of the very low volume hospitals. These hospitals tend to have very low bed capacities well below the minimum number (60) defined in the definition of hospitals by the hospital policy. xx

yy Annual Health Sector Performance Report for Financial Year 2014/15 Maternal deaths were reported in 79 GHs, a total of 407 deaths compared to 449 in 2014/15 were recorded giving an average of 5 (5.8 in 2013/14) deaths per hospital. However taking the denominator as hospitals conducting deliveries (126) the average death per hospital is 3.2. The minimum is 0 and the maximum is 18 as observed in Iganga. Public-Private Partnership in Health The health sector benefits from the partnerships with the private sector (PNFPs, Private Health Providers and CSOs). To strengthen the partnership and operationalize the national policy on PPPH, MoH has established a PPP Unit. The Unit will facilitate collaboration among partners under the stewardship of the MoH. The contribution from the private sector to the achievement of the national health objectives is included in this report, which gives a good overview of PNFP performance, mainly from UCMB and UPMB. Contribution from some of the PHP and CSOs has also been documented. The inability to generate comprehensive reports from the private sector is still a major challenge, though some significant contribution is from PHPs and CSOs. This is largely due to lack of HMIS tools, capacity gaps in utilization of HMIS tools, and lack of feedback on reported data. However, the introduction of DHIS2 has considerably improved the reporting rate for PNFP facilities. At the same time, most PHP facilities are still lacking the required human resources, equipment and infrastructure to effectively report. The PNFPs continue to provide significant inputs (financing, infrastructure, skilled human resources, training, etc) into the health system, despite growing evidence of declining financing. 65 of training capacity especially for nurses and midwives is by the PNFP training schools. Data from DHIS2 indicates that over 40 of outputs are from PNFPs. The sub-sector is critical to the health system as it has a more diversified geographical distribution that enables deeper service reach, and has been critical in sustaining service provision during times of conflict and epidemic outbreaks. Local Government Performance There is an improvement in the DLT national average performance from 74 in 2013/14 to 78.6 in 2014/15. The improvement in performance was observed for all indicators. Among all the 112 LGs the top five are Gulu (89), Kampala (87.4), Kabarole (85.4), Jinja (84.7) and Rukungiri (84). The bottom five LGs in performance are Nakapiripit (60.9), Kotido (60.2), Buvuma (59.3), Bulambuli (57.3) and Amudat (46.6). Among the 98 LGs excluding the 14 districts with referral hospitals, the top five LGs in this category are Rukungiri (84), Butambala (83.4), Lamwo (82.6), Mityana (82.5) and Lyantonde (82.4). At least 5 of the 31 new districts achieved total scores above the national average of 78.6. These are Butambala (83.4), Lamwo (82.6), Serere (82.2), Agago (80.3) and Nwoya (78.6). xxi

yy Annual Health Sector Performance Report for Financial Year 2014/15 Overall, during the FY 2014/15, 48 districts registered improvement while 64 districts declined, based on the DLT performance indicators. In terms of total scores, Gulu and Soroti regions registered the highest scores (79.2 and 77.6 respectively) while Mbale and Moroto regions registered the lowest scores (69.1 and 61.4 respectively). However, of the 12 regions, only Gulu region scored above the national average of 78.6. xxii

CHAPTER ONE 1 Introduction 1.1 Background The Annual Health Sector Performance Report (AHSPR) 2014/15 highlights progress, challenges; lessons learnt and propose ways of enhancing sector performance. This fourteenth AHSPR marks the last year for the Health Sector Strategic and Investment Plan (HSSIP) 2010/11-2014/15. Progress over 2014/15 is reviewed for: i) Effectiveness of interventions, responsiveness and equity in the health care delivery system, ii) Comparison with performance trends for the core indicators with the previous year s performance and against the target for the year. Since this is the last year of the HSSIP trends over the last 5 years are also reflected, iii) How well the integrated support systems have been strengthened, iv) Status of programme implementation. The report takes into account the undertakings and commitments of the following documents: National Development Plan (NDP I) 2010/11 2014/15, the second National Health Policy (NHP II) 2010/11 2019/20, HSSIP 2010/11 2014/15, Millennium Development Goals (MDG), Medium Term Expenditure Framework (MTEF), Budget Framework Paper (BFP) and Ministerial Policy Statement 2014/15, the 2013/14 Joint Review Mission Aide memoire and quarterly progress reports. 1.2 The process of compiling the report The development process of the commenced with development of the concept note and the constitution of a Task Force. The composition of the Task Force was drawn from all departments of MoH, private sector and HDPs to ensure representation of all key stakeholders. The respective Ministry of Health (MoH) Technical Working Groups (TWGs) were responsible for compiling and reviewing the information and data presented by programme areas. The Health Policy Advisory Committee (HPAC) and Senior Management Committee (SMC) provided guidance and monitored progress of the entire process. Sources of information of used in compiling the AHSPR were mainly; the HMIS aggregated monthly reports from the District Health Information Software (DHIS2), programme and project reports, survey reports and studies, quarterly sector performance reports and surveillance data. Population figures used for the league table analysis were based on the UBOS 2014 population census. 1.3 Outline of the report The first chapter presents the background to the Annual Health Sector Performance Report. Chapter two reports on performance based on specific indicators in the M&E Framework, the 1

chapter is organized by level of indicators i.e. impact, outcome, outputs, and inputs. It also includes an analysis of district, hospital and Health Center (HC) IV performance as ranked by the league tables and Standard Unit Output (SUO). Chapter 3 provides detail on performance of the different departments, divisions and programmes in delivery of the Uganda National Minimum Health Care Package (UNMHCP), and the health system support functions and Private-Not-For-Profit (PNFP) sector. 2

CHAPTER TWO 2 Overall sector performance and progress 2.1 Overall sector performance and progress This section provides an overview of the sector performance against the HSSIP performance indicators for FY 2014/15 and progress on implementation of recommendations in the Aide Memoire of the 20 th Joint Review Mission (JRM). Special focus has been put on assessing performance against commitments of the Ministerial Policy Statement (MPS) for FY 2014/15, and performance of districts, hospitals and HC IVs in service delivery. 2.1.1 Health Impact Indicators Over the HSSIP period, the health sector aimed at improving the following health impact indicators: Maternal Mortality Ratio 1 (MMR), Neonatal Mortality Rate 2 (NMR), Infant Mortality Rate 3 (IMR), Under-5 Mortality Rate 4 and mitigating impact of catastrophic payments for health care on households as a proxy measure for financial risk (protection). TABLE 1: COMPARISON OF THE IMPACT INDICATORS PERFORMANCE AAGAINST THE HSSIP TARGETS Indicator UDHS 2006 baseline UDHS 2011 WHO (2014 World Health Statistics series) 2015 HSSIP target MMR 435/100,000 438/100,000 360/100,000 131/100,000 IMR 76/1,000 54/1,000 45/1,000 41/1,000 Under 5 Mortality Rate 137/1,000 90/1,000 69/1,000 56/1,000 NMR 29/1,000 27/1,000 23/1,000 23/1,000 Proportion of households experiencing catastrophic payments 28 (2009/10) 37 (NHA 2011/12) Source: UDHS 2006, 2011, NHA 2011/12 and WHO statistics series 2014 49 13 Table 1 above presents progress on the impact indicators against HSSIP targets of 2015. The WHO statistics series 2014 results have been used since the NHA 2013/14 is still underway and the UDHS 2015 is yet to be undertaken. According to the WHO Health Statistics series report 1 Maternal Mortality Ratio: Number of mothers dying per 100, 000 live births 2 Neonatal Mortality Rate: Number of deaths during the first completed 28 days of life per 1000 live births 3 Infant Mortality Rate: Number of deaths of children aged less than 1 year dying per 1000 live births 4 Child Mortality Rate: Number of deaths of children aged less than 5 years dying per 1000 live births 3

MMR per 100,000 live births Annual Health Sector Performance Report for Financial Year 2014/15 2014, there is progress in all the impact indicators with the exception of the of households experiencing catastrophic health expenditure. The sector made significant progress and is likely to achieve HSSIP targets for child mortality rates by end of 2015, but it s unlikely to achieve targets for Maternal Mortality Ratio. 1) Maternal Mortality Over the HSSIP period, significant achievements have been realized in reducing institutional maternal mortality by approximately 40 as shown in Figure 2 below. The HMIS data shows that the risk of a mother dying in the health facility while giving birth reduced from 194/100,000 (2 deaths in 1,000) in 2010/11 FY to 118/100,000 in 2014/15 FY which approximates to 1 maternal death in 1,000 live births. This is a 40 reduction over the HSSIP period. This could be attributed to the FIGURE 1: INSTITUTIONAL MATERNAL MORTALITY RATIO DURING HSSIP PERIOD improvements in the health facility maternal healthcare delivery systems, improving the implementation of effective RMNCAH interventions at all levels. During the HSSIP period there was specific focus on scaling up of maternal and perinatal death notification and review at hospital and HC IV level. Table 2 shows an annual increase in the number of maternal; deaths notified from 129 (6.4 of maternal deaths reported through HMIS) in 2012/13 FY to 371 (21.3 of facility maternal deaths reported through HMIS) in 2013/14. The Maternal Perinatal Death Review (MPDR) report for the FY 2014/15 is under compilation and will be reported on in the 2015/16 report. TABLE 2: COMPARISON OF MATERNAL DEATHS NOTIFIED BY FACILITIES TO THOSE REPORTED THROUGH HMIS 200 180 160 140 120 100 80 60 40 20 0 2010/11 2011/12 2012/13 2013/14 2014/15 Item 2010/11 2011/12 2012/13 2013/14 Total number of deaths notified from MPDR 13 45 129 371 Number of maternal deaths reported through HMIS 1,005 1,206 1,169 1,147 Expected Number of Maternal Deaths (0.00438*live births) 2,330 2,581 2,009 1,740 of maternal deaths notified compared to total maternal deaths 0.6 1.7 6.4 21.3 of maternal deaths notified compared to reported in HMIS 1.3 3.7 11.0 32.3 4 194 148 168 Financial Year 146 118

Source: MoH HMIS 2014/15 and MPDR 2013/14 Table 3 below presents categories of the main causes and trends of maternal deaths during the HSSIP period. It is observed that Obstetric haemorrhage is still the highest cause of maternal deaths (42). There was significant reduction in maternal deaths due complications of unsafe abortion from 13 in 2013/14 to 3 in 2014/15. TABLE 3: CAUSES OF MATERNAL DEATHS OVER THE HSSIP PERIOD Causes 2011/12 2012/13 2013/14 2014/15 Freq Freq Freq Freq Obstetric haemorrhage 131 31.5 75 34.7 94 34.9 99 42 Obstructed labour and 72 17.3 5 2.3 30 11.2 19 8 uterine rupture Pre-eclampsia and eclampsia 45 10.8 22 10.2 46 17.1 28 12 Postpartum sepsis 75 18.0 20 9.3 32 11.9 25 11 Complications of unsafe 63 15.1 21 9.7 35 13.0 7 3 abortion Other direct causes 30 7.2 3 1.4 32 11.9 35 15 Indirect causes aggravated 0 0.0 70 32.4 0 0.0 10 4 by pregnancy Unknown 0 0 0 0 0 0 15 6 Total 416 100.0 216 100.0 269 100 238 100 Source: Maternal Perinatal Death Reports, 2012/13, 2013/2014 and 2014/2015 Health seeking behavior issues were the major underlying factors for maternal deaths, followed by health delivery systems issues, then adequacy or availability of health services (Table 4). In the health seeking behavior, most factors related to delay of the woman seeking help (56) although this reduced from 63 in 2013/14. During the FY 2014/15 the following major investments were made in relation to maternal health services: Procurement of partographs and protocols on post partum heamorrhage, post abortion care, use of magnesium sulphate and Helping Babies Breath (HBB). Distribution of ambulances to Anaka, Moyo, Nebbi, Kiryandongo, Masindi, Apac, Nakasero, Mityana, Itojo, Entebbe, Iganga, Buwenge, Bukwo, Moroto, Kitgum, Mubende, Lyantonde, Bugiri and Pallisa hospitals. Infrastructure developments in twenty six HC IVs (theatres, maternity wards, bore holes, walk ways) is ongoing. 5

TABLE 4: COMMON FACTORS UNDERLYING MATERNAL DEATHS Delay Factors Underlying factors 2011/12 2012/13 2013/14 2014/15 Freq Freq Freq Freq Health Seeking Behaviour A. Personal/ Family/ Woman factors 1. Delay of the woman 112 68 101 65 110 63 46 56 seeking help 2. Lack of partner support 19 12 26 17 35 20 22 27 3. Herbal medication 17 10 18 12 17 10 5 6 4. Refusal of treatment or 8 5 - - 8 5 5 6 admission 5. Refused transfer to higher 8 5 11 7 6 3 4 5 facility Total 164 100 156 100 176 100 82 100 Reaching the health 1. Lack of transport from 13 54 19 51 17 49 13 42 service point B. Logistical systems home to health facilities 2. Lack of transport between 11 46 18 49 18 51 18 58 health facilities Total 24 100 37 100 35 100 31 100 Receiving C. Health 1. Health service 54 17 - - 0 0 0 - adequate health service communication breakdown 2. Lack of blood products, 69 22 56 47 44 35 32 100 care supplies &consumables D. 1. Staff non-action 62 20-0 - 0 0 - Health 2. Staff over-sight 60 19-0 - 0 0 - personnel 3. Staff misguided action 32 10-0 - 0 0 - problems 4. Staff lack of expertise 22 7 24 20 20 16 19 35 5. Absence of critical human 11 3 24 20 25 20 19 35 resource 6. Inadequate numbers of staff 7 2 16 7 36 29 26 48 Total 317 100 120 100 125 100 54 100 Source: MPDR Report 2011/12, 2012/13, 2013/14, 2014/15 2) Child Mortality Rates The IMR of 54 (UDHS 2011) per 1,000 live births and World Health Statistics series (2014) estimate of 45 per 1,000 live births both fall short of the HSSIP target of 41 per 1,000 live births. Similarly the Under 5 Mortality Rate target of 69 per 1,000 live births fell short of the HSSIP target of 56 per 1,000. This was considerable improvement despite the inability to meet the planned targets. According to the HMIS reports, malaria and pneumonia remain the leading causes of under 5 inpatient mortality accounting for 22.6 and 12.2 of all deaths respectively (Table 5). There is an apparent reduction in the percentage of under five inpatient deaths due to malaria from 28.8 in 2013/14 to 22.6 in 2014/15. Over the last three years the percentage of under five inpatient 6

deaths due to other respiratory infections has markedly reduced and in 2014/15 it was not recorded among the top ten causes. TABLE 5: LEADING CAUSES OF UNDER 5 IN-PATIENT MORTALITY 2012/13 FY 2013/14 FY 2014/15 FY Diagnosis No. Diagnosis No. Diagnosis No. Malaria 3,796 27.6 Malaria 4,030 28.8 Malaria 3,059 22.6 Pneumonia 1,827 13.3 Pneumonia 1,824 13.0 Pneumonia 1,659 12.2 Anaemia 1,620 11.8 Anaemia 1,620 11.6 Perinatal Conditions (in new borns 0-7 days) Perinatal Conditions (in new borns 0-7 days) Neonatal Septicaemia Respiratory Infections (Other) 1,105 8.0 Perinatal Conditions (in new borns 0-7 days) 611 4.4 Neonatal Septicaemia 441 3.2 Respiratory Infections (Other) 1,476 10.9 1,105 7.9 Anaemia 1,314 9.7 611 4.4 Neonatal 712 5.3 Septicaemia 441 3.1 Septicemia 457 3.4 Septicemia 388 2.8 Septicaemia 388 2.8 Diarrhoea Acute Perinatal 358 2.6 Perinatal 358 2.6 Injuries - (Trauma Conditions (in Conditions (in due to other new borns 8-28 newborns 8-28 causes) days) days) Diarrhoea 337 2.4 Diarrhoea 337 2.4 Injuries - Road Acute Acute Traffic Accidents Severe Malnutrition (Kwashiorkor) 295 2.1 Severe Malnutrition (Kwashiorkor) 294 2.1 Severe Malnutrition (Kwashiorkor) 404 3.0 382 2.8 375 2.8 317 2.3 Others 2,995 21.7 Others 2,994 21.4 Others 3,399 25.1 Total 13,773 100 14,002 100 13,552 100 Source: MoH HMIS *Injuries other than road traffic accidents 7

2.2 Health Output Indicators Performance of the core output indicators for the HSSIP and the 2014/15 FY is highlighted as follows; The percentage of pregnant women attending at least 4 ANC sessions increased from 32.4 in 2013/14 to 36.6 in 2014/15 (target was 60). The percentage of deliveries in health facilities remarkably increased from 44.4 in 2013/14 to 52.7 in 2014/15. The HSSIP targets for percentage of women attending at least 4 ANC sessions, deliveries in health facilities, women who completed IPT2 were not met. The percentage of children immunized with the 3 rd dose pentavalent vaccine increased from 93 (91 males & 95 females in 2013/14 to 102.4 (104.5 males & 99.5 females). The percentage of one year old children immunized against measles increased to 90 (92.3 males and 87.7 females) compared to 87 in 2013/14. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 54 to 58 in 2014/15 and also short of the target of 75 by the end of the HSSIP. A total of 70,634 exposed to HIV from their mothers received PCR 1 test and of these 4,185 (5.9) were HIV positive compared to 6.3 (3,402/54,013) in 2013/14. The sector has realized significant progress in increasing the number of children exposed to HIV from their mothers receiving the first PCR test from 22,705 in 2011/12 to 54,013 in 2013/14 and this increased to 70,634 in 2014/15. The percentage of babies born to HIV positive mothers testing positive at first PCR has also reduced from 6.3 in 2013/14 to 5.9 in 2014/15. This is attributed to the sustained efforts and scale up of the EMTCT programme with active participation of the Honorable First Lady. The percentage of people who are on ARVs increased from 48 (680,514 / 1,405,268) in 2013/14 to 750,896 (56) by 2014 of those in need (adults 694,627(58) and children 56,269 (38). 8

TABLE 6: PERFORMANCE FOR HEALTH SERVICES CORE INDICATORS Indicator Source 2010/11 2011/12 2012/13 2013/14 2014/15 HSSIP Target pregnant women HMIS 32 35 31 32.4 36.6 60 attending 4 ANC sessions deliveries in health HMIS 39 40 41 44.4 52.7 90 facilities children under one HMIS 90 85 83 85 91 95 104.5 99.5 85 year immunized with 3 rd (M) F) (M) (F) (M) (F) dose Pentavalent 87 93 102.4 vaccine one year old children HMIS 85 89 86 83 85 88 92.3 87.7 95 immunized against (M) (F) (M) (F) (M) (F) measles 85 87 90.0 pregnant women who have completed IPT2 of children exposed to HIV from their mothers accessing HIV testing within 12 months U5s with fever receiving malaria treatment within 24 hours from VHT ART coverage among those in need HMIS 43 44 47 49 53.4 70 EID database 30 32.3 46 54 58 75 HMIS No data No data No data No data No data 85 ACP 53 59.3 83 based on 2010 WHO Guidelines (52 based on 2013 WHO Guidelines) 48 (680,514 / 1,405,268) NA 57 (2013 WHO Guidelines) 9

2.3 Other health determinants and risk factors and behaviour Latrine coverage is improved from 74.6 in 2013/14 to 77 surpassing the HSSIP target of 72. This is attributed to the creation of a District Sanitation Fund in 89 districts, the Uganda Sanitation Fund Project in 30 districts. There was increased advocacy with 60 district leaders signing commitments to implement hygiene and sanitation resolutions. A total of 72 villages were able to achieve 100 latrine coverage and access to hand washing. A total of 2,046 villages were triggered during the FY, with 549 (27) becoming ODF. Over 4 years, a total of 6,026 villages have been triggered with 2,534 villages (42 of those triggered) reported to be ODF. Progress in relation to the following indicators; U5 children with height /age below lower line (stunting), U5 children with weight /age below lower line (wasting) and Contraceptive Prevalence Rate (CPR) is still based on the UDHS 2011 (Table 7). Couple Years of Protection (CYPs) was used to monitor access to FP services in health facilities and there was a decline from 4,059,810 in 2013/14 to 3,308,142. 2011/2012 2012/2013 2013/2014 2014/2015 Couple Years of Protection 1,780,578 3,275,403 4,059,810 3,308,142 TABLE 7: PROGRESS AGAINST THE OTHER HEALTH DETERMINANTS AND RISK FACTORS AND BEHAVIOUR Indicator Source 2010/11 2011/12 2012/13 2013/14 2014/15 HSSIP Target Households with a pit latrine Program Reports 71 68 70 74.6 77 72 U5 children with height /age below lower line (stunting) U5 children with weight /age below lower line (wasting) Contraceptive Prevalence Rate UDHS 38 (2006) UDHS 16 (2006) UDHS 24 (2006) 33 No data No data No data 28 14 No data No data No data 10 30 No data No data No data 43 10

2.4 Service access, readiness, quality and safety This section provides an overview of the sector performance in relation to service access, readiness, quality and safety. TB case detection rate (TB CDR) increased from 36.6 in 2013/14 to 45 in 2014/15 far below the HSSIP target of 70. TB Treatment Success Rate was 79 compared to 80.7 in 2013/14. Consequently, TB death rate increased over the HSSIP period from 4.7 in 2010/11 to 4.9 by 2013/14 and 6 by 2014/15. The slow progress relates to inadequate systems for TB case detection, adherence monitoring (poor DOT) and testing relapses for drug sensitivity. Community link services for tracing contacts with TB patients and patients support for adherence are functioning less than optimal due to lack of sustainable funding. OPD utilization is a proxy measure for access to services and the sector realized increase in Per capita OPD utilization from 1.0 in 2013/14 to 1.2 in 2014/15. OPD utilization rate was consistently achieved throughout the HSSIP period. The medicines situation in the public sector has improved significantly in the last five years, facilities reporting no stock outs of the indicator items. The percentage of health units with no stock outs of any indicator medicines in the previous six months was at 64 in 2014/15 from 57 in 2013/14 and 43 in 2010/11. Availability of individual tracer medicines in the previous six was high for most of the items with the exception of ORS which was at 79 and Artmenther/Lumenfantrine which has stagnated at 87 for the last 2 years (Table 8). TABLE 8: AVAILABILITY OF INDIVIDUAL TRACER MEDICINES 2010/11-2014/15 Indicator Achievements Target 2010/11 2011/12 2012/13 2013/14 2014/15 2014/15 Availability of individual tracer medicines in the previous six months Artmenther/Lumenfantrine 83 83 78 87 87 100 Cotrimoxazole tab 480mg 61 82 94 87 92 100 Depo-provera 92 91 88 96 96 100 Oral Rehydration Salt 89 90 81 71 79 100 Sulphadoxine / Pyrimethamine 96 89 88 88 88 100 Measles Vaccine 81 91 87 94 92 100 Per capita government expenditure on EMHS in the FY 2014/15 was about US$ 2.4 which is below the estimated requirement in the HSSIP of US$ 12. The larger proportion going to HIV, TB and malaria commodities with the smaller proportion of about US$1 going to basic EMHS. This is not adequate to meet the population medicines need. Donor support to medicine financing 11

has come in to cover part of the gap and private sector mainly through out of pocket expenditure. 5 Human resources inadequacies, capital investment and logistical management issues (orders versus actual supplies) are hindering the public sector mandate of providing medicines to meet the requirements for universal access. 51 (100/195) of the HC IVs were functional meaning able to do cesarean section and this is the HSSIP target of 50. For blood transfusion 38 (75/195) were able to provide this service. Those able to provide both cesarean section and blood transfusion were 33 (65/195). There is an improvement compared to the functionality of 2013/2014 when 45 (88 out of 196) of the HC IVs were able to do cesarean section and 36 able to do blood transfusion. The percentage of clients expressing satisfaction with health services improved from 46 in 2008 to 69 (barely short of the HSSIP target of 70) in 2014 under the UHSSP Client satisfaction Survey. The common reasons in support of the Customer Satisfaction index included availability of caring personnel, medicines, free medical services. Client satisfaction surveys conducted by the Medical Bureaus show higher levels of satisfaction compared to the public facilities e.g. in the UPMB facilities general satisfaction was 83. TABLE 9: PROGRESS AGAINST THE SERVICE ACCESS AND QUALITY INDICATORS Indicator Source 2010/11 2011/12 2012/13 2013/14 2014/15 HSSIP Target TB case detection rate NTLP reports/ HMIS 39.8 39.2 38.6 36.6 45 70 TB Treatment Success Rate NTLP reports 68.6 69.8 71.3 80.7 79 85.0 Per capita OPD utilisation rate of health facilities without stock outs of any of the six tracer medicines in previous 3 months of functional HC IVs clients expressing satisfaction with health services HMIS 1.0 1.2 1.1 1.0 1.2 1.0 Annual Drug availability survey 43 49 53 57 64 80 HMIS 24 25 27 45 51 (100/195) MoH survey 46 71 72-69 Panel Panel (UHSSP Survey Survey Survey) 50 70 5 Annual Pharmaceutical Sector Performance Report 2013/2014 12

2.4.1 Health Investments and Governance 2.4.1.1 Human Resources Records from the Health Professional Councils (HPCs) indicate that the total number of health workers available in the health market as of August 2015 was 81,982, compared to 63,872 in September 2014, an increase of 28 in just one year. This increase in the health workforce does not represent a similar surge in outputs from Health Training Institutions. Rather, it most probably reflects an improvement in licensure of health workers by the HPCs. Over the past one year, the HPCs have intensified their efforts in actively tracking and registering professional health workers, and in validating the inventory using the electronic Human Resource for health Information System (HRIS); through Regional Teams and District Health Supervisory Authorities (DHSAs). As shown in Figure 2, two-thirds (55,206) of the workforce are constituted by Nurses and Midwives. FIGURE 2: NUMBER OF REGISTERED HEALTH WORKERS 2014/2015 60000 55206 50000 40000 40047 30000 20000 21015 18624 Sep-14 Aug-15 10000 0 AHP Nurses & Midwives 4623 4811 Doctors 578 950 Pharmacists Source: MOH/USAID/SHRH Project FIGURE 3: DISTRIBUTION OF THE HEALTH WORKFORCE BY EMPLOYMENT STATUS Other, 29,654, 36 PNFP, 9,798, 12 Public, 42,530, 52 This number (81,982) represents the stock of qualified health workers available for recruitment in both public and private sector. Records from the HPCs show that 42,530 (52) are currently employed in the public sector; at least 9,798 (12) are employed in the PNFP sector, while about one-third (29, 654) are either private practitioners, unemployed or have emigrated. Source: MoH and USAID/SHRH Project Reports, 2015 13

Staffing level in Public Sector Table 10 shows the distribution of the 42,530 health workers employed in the public sector by type of institution. This number represents the health workers who were in post. They consist of health workers already on payroll (40,938), new recruits who had reported on duty but are not yet on payroll (1092); and health workers hired on contracts by various Implementing Partners (500). These Human Resource for Health (HRH) data were aggregated to form the national staffing levels for public institutions comprising the MoH headquarters, National Referral Hospitals, 3 central specialized institutions, 14 Regional Referral Hospitals (RRH), 47 General Hospitals (GH), 166 HC IVs, 962 HC IIIs and 1,321 HC IIs. Staffing levels are presented for each of these levels. TABLE 10: STAFFING LEVEL IN VARIOUS PUBLIC SECTOR INSTITUTIONS Type of Institution Units Approved Staffing level Filling rate positions On Recruits Contract Total According Total payroll Jul 15 on duty staffing to payroll Central level institutions RRH 14 4,744 3,717 22 3,739 78 79 Butabika 1 424 349-349 82 82 Mulago Complex 1 2,801 1,792-1,792 64 64 UBTS 1 242 240-240 99 99 UCI 1 213 125-125 59 59 UHI 1 190 134-134 71 71 MOH 1 810 728 104 832 90 103 Sub-total 9,424 7,085 126 7,211 75 77 Local Governments District staffing 112 46,851 30,950 1,092 374 32,416 66 69 Municipla Councils 22 176 111-111 63 63 KCCA 17 3,933 2,792-2,792 71 71 Sub-total 50,960 33,853 1,092 374 35,319 66 69 NATIONAL TOTAL 60,384 40,938 1,092 500 42,530 68 70 Source: MOH and USAID/SHRH Project Reports, 2015 The overall staffing level at central-level institutions has declined slightly, to 77, from 79 in FY 2014/15. Although RRHs are generally better staffed, staffing is notably low in Moroto (44), Mubende (56) and Naguru RRHs (66), as shown in Table 11. The figures for last year were 41, 55 and 67 respectively. 14

Staffing in the public sector by cadre An analysis was carried out for selected clinical cadres at the district level for staff who were on payroll as of July 2015. Overall, Nursing officers and Nursing Assistant are in excess of the staffing norms at the district level as shown in Table 12. The number of clinical officers and enrolled nurses are also fairly adequate (94 and 85 respectively). The following health cadres are severely in short supply: Pharmacists/dispensers (37), Anaesthetic staff (23), ophthalmic cadres (15) dental staff (13) and Cold chain technicians (CCT) (5). TABLE 11: STAFFING LEVELS IN REGIONAL REFERRAL HOSPITALS Name Approved On payroll On contract Total Filling rate staffing Arua 293 296 5 301 101 Fort Portal 326 317 0 317 97 Gulu 321 301 4 305 94 Hoima 308 223 3 226 72 Jinja 421 362 0 362 86 Kabale 340 240 3 243 71 Lira 340 265 0 265 78 Masaka 312 242 1 243 78 Mbale 372 355 2 357 95 Mbarara 329 288 0 288 88 Moroto 349 155 3 158 44 Mubende 349 196 0 196 56 Naguru 344 227 0 227 66 Soroti 340 250 1 251 74 Grand Total 4,744 3,717 22 78 81 Source: MoH and USAID/SHRH Project Reports, 2015 TABLE 12: STAFFING BY CADRE Cadre Norm Actual Filling rate Medical Officers 849 536 63 Clinical Officers 2,538 2,382 94 Nursing Officers (N&MW) 2,895 3,029 105 Enrolled Nurse 6,961 5,923 85 Enrolled midwife 4,918 3,428 70 Pharmacist/Dispenser/PharmAsst. 307 115 37 Dental: Surg/Asst/PHDO 354 45 13 Lab Technologist / Technician/Asst 2,444 2,066 85 Ophthalmic 213 31 15 15

Cadre Norm Actual Filling rate Anaesthetic 639 148 23 Nursing Assistant 4,421 4,659 105 Theatre Assistant 332 0 0 Radiographer 94 33 35 Orthopaedic / Physiotherapist 301 103 34 CCT 639 31 5 Source: MoH and USAID/SHRH Project Reports, 2015 Table 13 displays the performance of key indicators for health investments and governance. The overall national staffing level of 42,530 health workers in the public sector represents a filling rate of 70 of approved positions (norm) in the sector, an increase of 1 from 69 in last Financial Year. In keeping with previous trends, central-level institutions are better staffed (77) than the district health systems (69). However, staffing at the district level has risen to 69, from 68 at the end of FY 2014/15. This increase is attributed to new recruitments & contracting health workers under development partners. The new recruits and contract workers included mainly nurses, midwives, doctors and laboratory staff. TABLE 13: PERFORMANCE OF INVESTMENTS AND GOVERNANCE INDICATORS OVER THE PAST 5 YEARS Indicator Source 2010/11 2011/12 2012/13 2013/14 2014/15 HSSIP Target of approved posts filled by health workers (public health facilities) annual reduction in absenteeism rate of villages / wards with trained VHTs HRIS 56 58 63 69 70 75 Survey No data No data 71 attendance (Panel Survey) Public:34. 1 NGO:14.6 * No data 20 reduction from previous year HMIS 72 78 No data 75 75 100 HRH mapping shows that some districts are still in red - having staffing below 50 which means it is difficult for them to implement the minimum health care package with the size of health workforce that have. The maps in Annex Figure 30 show that in 2010, the number of districts falling under this category was almost one half of the total districts. The situation has since 16

changed with increases recruitment of health workers. In 2014, the figure shows more green (more than 75 staffing) in most parts of the country including Karamoja region. During this FY there was no significant investment in building the capacity of Village Health Teams (VHTs) and has remained at 75 of the villages in the country having trained VHTs. Much effort was towards reviewing the VHT concept, studying establishment of the Community Health Extension Workers (CHEWs) and development of a CHEW policy and strategy. 2.4.1.2 Health Financing The trend in allocation of funds to the health sector shows that there has been an increase in budget allocation over the past 5 years of the implementation of the HSSIP as illustrated in the Table 14. The increment is largely attributed to additional wage allocation and project external financing towards health. TABLE 14: GOVERNMENT ALLOCATION TO THE HEALTH SECTOR 2010/11 TO 2014/15 Year GoU Funding (Ushs bns) Donor Projects and GHIs (Ushs bns) Total (Ushs bns) Per capita public health exp (UGX) Per capita public health exp (US $) GoU health expenditure as of total government expenditure 2010/11 569.56 90.44 660 20,765 9.4 8.9 2011/12 593.02 206.10 799.11 25,142 10.29 8.3 2012/13 630.77 221.43 852.2 23,756 9 7.8 2013/14 710.82 416.67 1127.48 32,214 10 8.7 2014/15 748.64 532.50 1,281.14 37,130 13.5 8.5 The GoU health expenditure as a percentage of the total Government expenditure has been fluctuating over the 5 years with an average of 8.4 over the 5 years. The variation has been on account of increasing total health expenditure but with some sectors like energy and works getting a relatively bigger share of the increase. 17

UGX (Billions) Annual Health Sector Performance Report for Financial Year 2014/15 FIGURE 4: GOU HEALTH EXPENDITURE AS OF TOTAL GOVERNMENT EXPENDITURE 9 8 7 6 5 4 3 2 1 0 8.9 8.7 8.3 8.5 7.8 2010/11 2011/12 2012/13 2013/14 2014/15 The total public sector budget in Medium Term Expenditure Framework (MTEF) increased from UGX 1,127 Billion in FY 2013/14 to UGX 1,282 Billion in 2014/15 representing 14 increase. The total allocation translated to US$ 13.7 per capita public health financing in FY 2014/15. The increase was majorly for human resource recruitment and wages. FIGURE 5:GOVERNMENT ALLOCATION TO THE HEALTH SECTOR 2010/11 TO 2014/15 1400 1200 1127.48 1281.14 1000 800 660 799.11 852.2 600 400 200 0 2010/11 2011/12 2012/13 2013/14 2014/15 FIGURE 6: PER CAPITAL PUBLIC HEALTH EXP (US $) The per capita public expenditure increased from $10 to $13.5 in FY 2014/15 due to additional financing from government and global health financing initiatives. Out of the Shs 1,281 billion, Shs 1,254 billion (excluding import taxes) was released in the FY 2014/2015, constituting 98 release of the budget. The unspent funds were due to delays in 18

B u d R g e l t e a s B B e u u d d g g R e e t t l r e a l B s a u e s d B g u e d R t g e l r t e a l s e B e a u s d B e g u e d t g R e r t l e a l B s a u e s d e g d e t Annual Health Sector Performance Report for Financial Year 2014/15 procurement processes and unpaid wages. Program budget implementation was also affected by reallocations within the MoH budget for critical expenses which had to be incurred. Table 15 shows the institutional budget performance in the FY. TABLE 15: INSTITUTIONAL BUDGET PERFORMANCE 2014/15 FY Institution Wage (billion) Nonwage (billion) Development (billion) Total (billion) RRH 39.6 37.6 95 15.5 16.5 106 13.5 12.9 96 68.6 67 98 HSC 0.95 0.98 104 2.8 2.9 104 0.4 0.3 100 4.15 4.18 101 Mulago 19.9 20.5 103 13.2 14.3 108 5.0 5.0 100 38.1 39.8 104 Butabika 3.7 4.1 108 3.6 4.7 130 1.8 2.2 120 9.1 11 121 UAC 1.4 1.3 93 5.4 5.4 100 0.1 0.1 100 6.9 6.8 99 UHI 2.2 1.6 74 1.4 1.4 100 5.5 5.5 100 9.1 8.5 93 UCI 2.2 1.8 81 1.1 1.2 105 7.1 8.7 123 10.4 11.7 113 NMS 218 218 100 218 218 100 UBTS 1.9 1.5 79 4.1 2.84 69 0.4 0.4 104 6.4 4.74 74 MoH 6.5 7.1 110 29.7 29.49 99 13 10.9 84 49.2 47.49 97 PHC 250 251 100 39.0 38.9 100 33.3 33.3 100 322.3 323.2 100 KCCA Health 3.6 3.6 100 1.3 1.3 100 0.1 0.1 100 5 5 100 Grant District Health 4.5 4.5 100 Sanitation Grant TOTAL 332.3 331 99 335 337.1 101 80.1 79.5 99 751.5 751.9 100 In the FY 2014/15, the allocation to wage and the non wage recurrent constituted an equal share of the total public budget at 26 each while the Development budget including the Donor contribution constituted 48. The details are as shown in the table 16. TABLE 16: BUDGET CATEGORIES Budget Sources FY 2013/14 of the FY (UShs of the total (UShs Bn) total budget Bn) 2014/15 budget Recurrent- wage 305.67 27 332.71 26 Recurrent-Non wage 331.5 30 335.95 26 Sub total Recurrent 637.17 57 668.66 52 Domestic dev t Grant 73.65 6 79.98 6 Donor 416.67 37 532.50 42 Subtotal Development 490.32 43 612.48 48 Total Budget performance 1,127.49 100 1,281.14 100 Source: MTEF FY 2015/16 19

Primary Health Care Allocations (PHC NWR FY 2014/15) There has been steady increase in PHC wages over decade with no significant increase in the remaining components of the non wage PHC grant. The result shows overall increment in PHC allocation. The lack of relatively commensurate investments between non wage allocation, development grant annual increases and additional staff recruited into the health sector means that the recurrent costs for the maintenance of the infrastructure and carrying out immunization outreaches is inadequate. This affects the productivity at the health facilities governance issues notwithstanding. Excluding medicines and health suppliers, PHC grants represent 30 of the total health sector budget. TABLE 17: PRIMARY HEALTH CARE GRANTS FY 2010/11-2014/15 IN USHS BILLIONS FY PHC Wages PHC (Non- wage) PHC NGOS General Hospitals PHC (Dev't Grant) Sanitation grant Total 2010/11 124.5 17.4 17.7 5.94 15.3 181.04 2011/12 143.43 18.5 17.19 5.94 44.43 229.49 2012/13 169.38 15.84 17.19 5.94 34.81 243.16 2013/14 228.69 18.05 17.19 5.94 30.08 4.16 304.11 2014/15 250.607 15.839 17.195 9.14 30.08 4.16 327.020 Source: Approved Budget of revenue and expenditure FY 2014/15-MoFPED TABLE 18: AVERAGE PHC NON-WAGE ALLOCATION BY LEVEL TO PUBLIC HEALTH FACILITIES AND DHOS 2014/15 FY PHC Non Wage Grant Allocations top PHC facilities (Ush. 15.84 bn). Level of health service delivery Number Ratios Number (Adjusted for ratios) Total annual NWR allocation per level Annual average per individual facility/ office Monthly average per facility/ office DHOs + Municipality 137 2 137 3,168,000,000 23,124,088 1,927,007 HC IV 166 4 664 2,071,444,609 12,478,582 1,039,882 HC III 868 2 1736 5,415,704,579 6,239,291 519,941 HC II 1662 1 1662 5,184,850,812 3,119,645 259,970 20

FIGURE 7: TRENDS IN PHC GRANT ALLOCATIONS FY 2010/11-2014/15 IN USHS BILLIONS Challenges Uganda, like many other developing countries, faces numerous challenges financing its health system. The unrelenting burden of disease and the ever increasing costs of medicines and the associated new technologies continue to overwhelm the system. To compound all this, Uganda has one of the fastest growing populations in the world, which puts pressure on the current health system. The other challenges in the sector are increasing costs, which will in the medium term continue to be of concern. The main cost drivers include;(a) increased demand for RMNCAH services as a consequence of a rapidly growing population due to high fertility; (b) increase in the NCDs burden due to demographic and urban transition when communicable diseases are still high on the agenda; (c) high public demand for access to high quality but affordable care as a result of the marketing of new expensive technologies; and, (d) the high cost of improving health infrastructure in keeping with the need to move services closer to the community. There is inadequate funding for sector activities especially PHC Services. Only Ushs. 327 Billion excluding medicines budget was allocated to run health service delivery. In FY 2014/15, the sector experienced a challenge of the alignment of some off-budget funding to sector priorities. Funding for operational costs such as; running the referral system, maintenance of facilities and vehicles, utility bill payments, carrying out outreaches has been a constraint to scaling up health service delivery in LGs and referral hospitals in the year under review. General Government allocation for health as percentage of the total Government budget has averaged about 8.4 from 2010/11 to 2014/15, which is 1.6 short of the HSSIP target of 10 of the budget by 2014/15. The allocation still below the recommended per capita government 21

expenditure on health of US$ 34 per capita as per the WHO Commission of Macro Economics and Health. It is also below the HSSIP target of US $ 17 per capita government expenditure on health. Ability to mobilize general public revenues (compulsory prepayment) depends on the level of economic development. The reality is that whereas Uganda s tax revenues as percent of GDP have risen from 6.5 in 1989/90 to 14.2 in 2012/13, the tax base is still small with 50 of the revenues generated by only a few large taxpayers. According to the National Health Accounts (NHA) reports, the level of out of pocket (OOP) expenditure, as percentage of the Total Health Expenditures, has been increasing in real terms in the past years though reducing in percentage terms. It was estimated at 42 in FY 2009/10 (NHA, 2013). The OOP expenditure was 37 in 2012/13 (NHA, 2014), showing a reduction, attributed to increased partner support for health, mostly through the private sector. The high OOP on health care negatively impacts on households incomes and affects household demand for, and access to health care. Consequently, the proportion of people facing catastrophic expenditure leading to house hold impoverishments, especially of the lower income quintiles is high. Quarterly reporting by LG Health offices to the MoH on quarterly performance has been a big challenge. Only about 40 of the LGs submit timely quarterly reports and this affects comprehensiveness of national health reports, accountability and timely reporting of performance of the health sector. Way Forward The questions on fiscal space for health should be addressed; (a) how to increase government contribution to health; (b) how to make the health system operations more efficient; (c) how to harness the contribution of the untapped, not easy to tax large sector comprised of small farmers and informal players; and, (d) how to increase insurance contributions, in the quest to meeting government s goal of UHC with a minimum package of essential services. The finalization of the Health Financing Strategy is one of the policy documents that can be used to expand the fiscal space for health. One of the possible health financing interventions, to mitigate the high OOP expenditure is introduce Performance Based Financing (PBF) and the National Health Insurance Scheme (NHIS) The sector needs to reprioritize and spend more funds for PHC if the inequities in health service delivery are to be minimized and preventive, promotive and curative services are to be scaled up. Financial reporting, accountability, leadership and financial management need to be improved at all levels of the health system. 22

2.4.1.3 Health Infrastructure and Equipment Investment in health infrastructure has continued and this included construction of new and rehabilitation of old infrastructure at various levels, provision of medical equipment and hospital furniture; provision of solar lighting, improvement of operations and maintenance of health infrastructure; strengthening the referral system by providing ambulances, general transport and Information Communication and Technology (ICT) equipment and services in selected health facilities; and renovation/construction of selected health facilities. Specific achievements under infrastructure over the FY 2014/15 include; The distribution of general, specialized medical equipment and instruments under UHSSP. Procurement and distribution of 19 ambulances worth of US$ 1.5 million. Procurement of two (2) mobile workshop vehicles procured for Mubende and Moroto RRHs. Renovation and expansion civil works ongoing in the following hospitals: Mityana, Nakaseke, Kiryandongo, Nebbi, Anaka, Moyo, Entebbe and Iganga GHs; and Moroto RRH under UHSSP. Under GoU, the following hospitals are being renovated; Adjumani, Kiboga, Bundibugyo and Kapchorwa. Kawolo hospital is under renovation with support from Spanish Aid. Contracts were signed and work commenced for renovation of 26 HC IVs under UHSSP: Kasanda, Kiganda, Ngoma, Mwera, Kyantungo, Kikamulo, Kabuyanda, Mwizi, Kitwe, Rubare, Aboke, Aduku, Bwijanga, Bullisa, Padibe, Atyak, Obongi, Pakwach, Buvuma, Budondo, Ntenjeru-Kojja, Buyinja, Nankoma, Bugono, Kiyunga, Kibuku and Budaka. Updated the health facilities inventory list for 2014 and developed equipment database for 95 of HC IIIs in the country. Mapping of Health facilities in the 112 districts was also done and geo-referenced maps produced with support from UBOS, OPM, WHO and CDC. The exact location of health facilities was captured using Global Positioning System devices, commonly referred to as GPS s to enable analysis of physical accessibility. This should give the possibility to have a reliable estimate of the proportion of the Ugandan population living within 5 km of a health facility. In addition, solar power was installed in 55 additional HCs bringing the total under the ERT II to 665 HCs, and maintenance of solar systems in 519 HCs in 23 districts was undertaken. Procured medical equipment for selected health facilities in Arua and Rwenzori regions. Procured one Ambulance to replace accident ambulance in West Nile region. 23

Successfully procured and installed a digital X-Ray machine for Kilembe Mines hospital. Procured Public Address systems for all district Health Offices in the Arua and Rwenzori regions, including RRHs. Procured engraving equipment and digital cameras for all districts Arua and Rwenzori regions including RRHs and HMDC. Procured ICT equipment for the Fort Portal and Arua RRHs. Procurement of Ambulance Uniforms for District Ambulance teams in the two regions. Procurement of solar equipment for selected DHOs in the two regions (to be awarded) Sinking boreholes at Kyenjojo Hospital and Water Harvesting System at Virika Hospital. NUSAF 11 project Ushs. 7,748,978,745/= to 160 Staff House subprojects and Ushs. 1,682,725,491/= for 20 OPDs. all the 443 staff houses, 3 Maternity Wards, 2 General Wards, 34 OPDs, 2 stand alone solar power installation subprojects, 7 Fencing subprojects and 8 stand alone VIP latrines worth Ushs. 46,504,762,380/= funded under NUSAF2 Project have been completed. Construction works commenced and are at roofing stage for both Hoima and Kabale RRHs and shipment of medical equipment for Fort Portal, Hoima and Kabale RRH commenced - JICA support. Developed a 30-year Master Plan and 5-year Investment Plan for Mulago NRH. Kawempe and Kiruddu HCs are being upgraded to general referral hospital status of about 170 beds each. Works will be completed by 31 st December 2015. By close of the FY, the overall progress of work was 64.0 for Kiruddu and 52 for Kawempe. Mulago NRH is undergoing extensive rehabilitation including revamping electromechanical works and equipping the hospital with state of the art medical equipment to provide advanced medical services. The overall progress of phase I, which represents 60 of the total works, is at 50. Phase II and III will be undertaken during FY 2015/16. Procurement of Medical equipment for Kawempe and Kiruddu at US $ 4M for each Hospital and is at evaluation of bids stage. The medical equipment and furniture is projected to be installed around December 2015. Procurement of Medical equipment for Mulago hospital was split into two categories: front load and main procurement. Contracts for 10 Lots of front loaded medical equipment worth US $ 8.2M were signed in October 2014 and delivered in April 2015 loaded equipment. By close of the FY, verification of the equipment for compliance to specifications was still ongoing. Construction of a 320 bed Maternal & Neonatal Health Care Unit at Mulago commenced funded by Islamic Development Bank. 24

2.4.1.4 Governance Looking at sector governance, the sector stewardship has been changing at the highest level, leading to frequent changes in stewardship direction. There has been high turnover at Senior and Top management of the MoH during the HSSIP period. There were also some gaps in technical departments that were limiting capacity to provide comprehensive guidance. At the district level, the functionality of the management and stewardship structures like the Social Services / Health Committee, District Health Management Teams (DHMTs), District Health Teams (DHTs) in some districts was supported through projects like Strengthening Decentralization for Sustainability (SDS), though many persons managing the districts lack the necessary skills and expertise. Using mtrac, client feedback / redress was managed under the anonymous hotline (Service delivery complaints toll-free number for people to call or SMS to express opinions about health service-related issues, e.g. good service, HCs closed during working hours, stock-outs of essential medicines in facilities) and U-Report (U-Reporters participate in weekly SMS dialogue on community issues, are informed about services in their areas, and provide regular feedback on developmental issues. - The anonymous hotline where we receive feedback from the community on health service delivery; in the FY 2014/15 received 9214 reports from communities all over Uganda. - 3,687 (40) reports were actionable; i.e. each report submitted had some information that could be used for follow up e.g. district, health facility, village, subcounty in addition to the complaint / compliment. - 2,184 reports i.e. 24 had the location mentioned in addition to the complaint / compliment whereas 7030 76 were lacking location data for follow up. - All 112 district communities all over the country at least submitted a report or more during the FY; with Wakiso, followed by Mbarara having the highest. TABLE 19: REPORT STATISTICS OVER THE MONTHS IN THE YEAR OF 2014 /15 Month No of Reports Month No of Reports July 684 January 673 August 579 February 398 September 530 March 421 October 2,441 April 481 November 767 May 461 December 621 June 358 25

The increase in number of reports received in October was due to the high number of inquiries on the Epidemic outbreak at the time of Marburg. Table 20 summarizes the action taken so far on the reports submitted:- TABLE 20: ACTION TAKEN BY STAKEHOLDERS OR RELEVANT ACTION CENTERS DURING THE PERIOD Number Percentage Actionable Reports 3,687 100.0 Number of Reports Assigned to Districts 2,180 59.1 Number of Reports with District Missing 7,030 76.3 District Reports Open 555 26.6 District Reports Escalated 71 3.3 District Reports Ignored 0 0.0 District Reports Claimed 160 7.3 District Reports Closed 1,394 63.9 District Reports Action Taken 1,307 60.0 District Reports Action Taken by MHSDMU 618 3.5 TABLE 21: 10 DISTRICTS WITH HIGHEST NUMBER OF ACTION TAKEN District Action Taken Total Reports Masaka 81 104 78 Wakiso 73 116 63 Mbarara 58 74 78 Mukono 48 48 100 Bukomansimbi 43 46 93 Lwengo 41 41 100 Mbale 38 45 84 Mpigi 36 68 53 Kasese 29 45 64 NB: Please note that all the above reports summarize the action taken by DHTs and relevant national stakeholders. 26

FIGURE 8: A MAP OF UGANDA SHOWING PERCENTAGE OF REPORTS WITH ACTION TAKEN DURING 2014/15 FY 2.4.1.5 Partnerships With regard to sector partnerships, most of the existing structures for partnership engagement are largely moribund, and not providing the needed forums for sector engagement. Some partners are therefore sidestepping these structures, and providing support that is not coordinated and harmonized. The SWAp process and the HPAC functionality are therefore compromised, with current focus primarily on statutory actions (e.g. endorsing proposals) as opposed to being forum for dialogue. The Technical Working Groups (TWGs) and Intersectoral coordination functionality are sub optimal, and there is limited real engagement of some stakeholder groups. Merit however needs to be given to the tenacity of the partnership and coordination structures, like HPAC and Health Development Partners (HDPs) forum which have largely continued to exist in spite of this environment. In the Compact for implementation of the HSSIP, Partners and GoU made commitments for technical and financial assistance for the HSSIP implementation. The partnership in the Compact draws from all sectors, including HDPs, PNFP, PHP and CSOs, which are collectively referred to as health sector partners. This section assesses progress in implementation of the partnership commitments made in the HSSIP Compact. The commitments in the Compact focus on maintaining policy dialogue, promoting joint planning and supporting implementation and monitoring of the HSSIP. The HPAC provides overall oversight and stewardship for monitoring implementation of the Compact. 27

In the HSSIP, three areas were planned for monitoring implementation of the Compact 2010/11 2014/15, and these have been assessed for this reporting, including: Planning and budgeting, Monitoring programme implementation and performance, and Policy guidance and monitoring. Performance in these areas of the Compact is here below presented. TABLE 22: HPAC INSTITUTIONAL REPRESENTATIVES ATTENDANCE Representatives Average Annual Attendance Rate 2010/11 2011/12 2012/13 2013/14 2014/15 MoH (11) 45 45 41 37 65 HDP (4) 88 109 138 161 108 CSO (3) 48 67 44 67 50 Private (1) NA 66 58 72 33 NMS (1) 58 42 92 72 67 Medical Bureaus (2) N/A N/A N/A 73 46 District (1) 17 8 58 18 0 NRH (2) 0 4 4 0 17 RRH (1) 0 0 0 0 0 Line Ministries (5) 0 2 8 11 7 Source: HPAC Minutes 2014/15 TABLE 23: PROGRESS IN IMPLEMENTATION OF THE COUNTRY COMPACT DURING FY 2014/15 # Compact Indicator Targets/Means of Verification 1.0. Planning and Budgeting Achievement Comments 1.1. MoH Annual Work plan reflecting stakeholder contribution Partners' support is captured in the plan Not all resources in one MoH Annual Work plan Some donors still prefer off-budget support 1.2. All new sector investments are appraised by SBWG 1.3. All planned procurements reflected in the Comprehensive procurement plan Submission of new projects to SBWG Adherence to procurement plan Increase in submission of new projects to SBWG Annual integrated comprehensive procurement plans were made SBWG met regularly to review new projects. Procurement plan followed. 28

# Compact Indicator Targets/Means of Verification 1.4. Response to Auditor Timely response to AG's General's report report 1.5. Implementation of harmonized Technical Assistance (TA) Plan HPAC approval of ToRs & procurement of short & long term TA 2.0. Monitoring Programme Implementation and Performance Achievement Response to all audit reports were made. TA procurement is implemented under individual projects, but not consolidated into one TA plan. Comments Advise of the AG s advice is being used in improving accountability systems There is still need for better coordination of TA support. 2.1. Area Team Visits - Quarterly Reports 2.2. MoH Quarterly Performance Assessment 2.3. Technical Review Meeting 2.4. Technical Working Group meeting 2.5. Annual Health Sector Performance Report 2.6. Submission of Annual Report to OPM 2.7. Joint Review Mission - review of performance 2.9. End of HSSIP Evaluation 3.0. Policy Guidance and monitoring Presentation of reports to HPAC within 30 days after completion of visits Presentation of reports to HPAC within 30 days after completion of MoH quarterly review. Present of report from TRM to HPAC by 30 April Target 80 of TWG meetings held Submission of Final Report by 30 Sept Submission to OPM by 30 September Aide Memoire presented to HPAC by 30 Nov Completion of end of HSSIP review by December 2015 Briefs on Area Team reports submitted to HPAC. One annual performance assessment was done (covering all the four quarters). TRM not done 70 of TWGS held meetings and briefs informing policy presented to senior management and HPAC. Report written, discussed at the 20 th JRM and disseminated Bi-annual and GAPR submitted to OPM on time. The JRM was held on schedule and Not done to inform the HSDP Reports submitted though after 2 months. Report yet to be submitted. Funding was limited Some TWG need to be revived and to sit regularly. AIDE Memoire was signed in January 2015. The activity was not budgeted for 3.1. Senior Management Committee 3.2. Health Policy Advisory Committee 3.3. Country Coordination Mechanism 12 SMC meetings 11/12 SMC meetings were held Technical issues from TWGs discussed. 12 meetings All 12 meetings were held Discussed issues with policy implications. 4 meetings CCM met quarterly and had other adhoc meetings. International Health Partnerships+ Most of the targets for Aid Effectiveness (Paris Declaration and IHP+ indicators) assessed in 2014 showed significant progress on the country performance (Table 24). TABLE 24: PROGRESS IN IMPLEMENTATION OF THE IHP+ COMMITMENTS 29

Issue monitored Government Indicator Achievement Associated DP indicator 1. Health development cooperation A sector results 100 Development is focused on framework in place Partners use the results that meet developing country results countries priorities framework 2. Civil Society operated in an environment which maximized its engagement in and contribution to development 3. Health development cooperation is more predictable Government supports meaningful participation of CSOs in health sector policy processes including planning, coordination & review mechanisms. Government funds disbursed predictably Projected government expenditure on health provided for 3 years. 4. Health aid is on budget A national health plan in place that has been jointly assessed. 5. Mutual accountability among health development cooperation actors is strengthened through inclusive reviews 6. Effective institutions: developing countries systems are strengthened and used; Financial & Procurement Systems Source: IHP+ Country Card, 2014 Mutual assessment mechanisms in place. Quality of country public financial management systems (score) 2.5 Local Government Performance 80 Development Partners support meaningful engagement of CSOs Not available DP funds disbursed predictably 100 Government has information on DP expenditure plans for three years ahead 100 DP Cooperation reported on budget 100 DPs use mutual assessments mechanisms 3.26 out of 6 DPs use country public financial management systems Achievement 2014 98 78 76 34 (Most HDP indicative expenditure is for annual) 49 2.5.1 District League Table (DLT) The DLT is a tool used to assess district performance and identify areas of strengths and weakness and use it to identify ways in which that performance can improve. In this report, the 112 districts are used as the units of analysis with key objectives of comparing performance between districts; provide information to facilitate the analysis for good and poor performance at districts and thus enable corrective measures which may range from increasing the amount of resources (financial resources, human resources, infrastructure) to the LG or more frequent and regular support supervision; and increase LG ownership of achievements/ performance. The specific objectives of the DLT are: 76 43 30

Financial Year Population DPT3 Coverage () Deliveries in gov t and PNFP facilities () OPD Per Capita HIV testing in children born to HIV+ women () Latrine coverage in households () IPT2 () ANC 4 () TB TSR () Approved posts filled () Monthly reports sent on time Completeness monthly reports Completeness facility reporting Medicine orders submitted timely () National Average () Annual Health Sector Performance Report for Financial Year 2014/15 To compare performance between districts and therefore determine good and poor performers. To provide information to facilitate the analysis for good and poor performance at districts thus enable corrective measures. Appropriate corrective measures which may range from increasing the amount of resources (funds, human resource, infrastructure) to the LG or more frequent and regular support supervision. To increase LG ownership for achievements the DLT to be included in the AHSPR to be discussed at the NHA or JRM with political, technical and administrative leaders of districts. To encourage good practices good management, innovations and timely reporting. For the year 2014/15, ten indicators were used to evaluate and rank district performance: 8 coverage and quality of care indicators, given a collective weight of 80; and 2 management indicators, accounting for the remaining 20. The indicators were selected for consistency with the 26 core HSSIP 2010/11 2014/15 indicators. The primary data source for majority of the indicators were derived from the routine HMIS and some of the indicator data was provided by the respective MoH programmes such as HIV/AIDS, TB and environmental health division. Data validation of the DHIS2 data was conducted in 16 districts with annual reporting rates below 50 prior to finalization of the DLG. Annual reporting rates less 50. There is an improvement in the DLT national average performance from 74 in 2013/14 to 78.6 in 2014/15. The improvement in performance was observed for all indicators. TABLE 25: TRENDS IN NATIONAL AVERAGE PERFORMANCE IN THE DLT 2010/11 31,752,300 90 39 1 30 71 43 32 77 52 77 94 85 47 58 2011/12 33,544,573 80 38 1.2 32 68 46 34 61 54 78 89 87 28 57 31

2012/13 33,568,500 87 39 1.1 45 68 48 30 79 61 80 79 94 35 63 2013/14 36,652,480 93 44 1.0 97.5 72 49 32 80 70 70 74 90 99 74 2014/15 34,844,095 102 53 1.2 94.7 74 53 37 80 71 88 83 96 94 78.6 Table 26 shows the top and bottom 15 performing districts among the 112 districts with their ranks and total scores. The full district league tables can be seen in the Annex Table 50. The top five LGs in performance are Gulu (89), Kampala (87.4), Kabarole (85.4), Jinja (84.7) and Rukungiri (84). The bottom five LGs in performance are Nakapiripit (60.9), Kotido (60.2), Buvuma (59.3), Bulambuli (57.3) and Amudat (46.6). TABLE 26: FIFTEEN (15) TOP AND BOTTOM PERFORMING DISTRICTS FY 2014/15 District Rank District Rank Gulu 89.0 1 Manafwa 65.6 98 Kampala 87.4 2 Wakiso 65.2 99 Kabarole 85.4 3 Kibuku 64.6 100 Jinja 84.7 4 Yumbe 64.3 101 Rukungiri 84.0 5 Sembabule 63.9 102 Butambala 83.4 6 Buyende 63.0 103 Lira 83.4 7 Kween 62.8 104 Lamwo 82.6 8 Kaabong 62.8 105 Mityana 82.5 9 Buhweju 62.2 106 Lyantonde 82.4 10 Moroto 60.9 107 Serere 82.2 11 Nakapiripirit 60.9 108 Mbale 81.4 12 Kotido 60.2 109 Bushenyi 81.1 13 Buvuma 59.3 110 Masaka 80.7 14 Bulambuli 57.3 111 Luwero 80.3 15 Amudat 46.6 112 Table 27 shows the top and bottom 15 performing districts among the 98 districts excluding the 14 districts with referral hospitals. The top five LGs in this category are Rukungiri, Butambala, Lamwo, Mityana and Lyantonde. TABLE 27: DISTRICT RANKING FOR DISTRICTS EXCLUDING DISTRICT WITH RRHS District Total Rank National Rank District Total Rank National Rank Rukungiri 84.0 1 5 Mayuge 65.6 84 97 Butambala 83.4 2 6 Manafwa 65.6 85 98 32

Lamwo 82.6 3 8 Wakiso 65.2 86 99 Mityana 82.5 4 9 Kibuku 64.6 87 100 Lyantonde 82.4 5 10 Yumbe 64.3 88 101 Serere 82.2 6 11 Sembabule 63.9 89 102 Bushenyi 81.1 7 13 Buyende 63.0 90 103 Luwero 80.3 8 15 Kween 62.8 91 104 Agago 80.3 9 16 Kaabong 62.8 92 105 Nebbi 80.2 10 18 Buhweju 62.2 93 106 Katakwi 79.8 11 19 Nakapiripirit 60.9 94 108 Kaberamaido 79.1 12 21 Kotido 60.2 95 109 Oyam 78.9 13 22 Buvuma 59.3 96 110 Dokolo 78.7 14 23 Bulambuli 57.3 97 111 Mukono 78.7 15 24 Amudat 46.6 98 112 The hard to reach districts have mixed performance with some of them in the top 15 and others in the bottom 15. TABLE 28: DISTRICT RANKING FOR HARD-TO-REACH DISTRICTS AS PER THE DLT Top 5 Hard-To-Reach Bottom 5 Hard-To-Reach District Rank District RANK Gulu 89.0 1 Moroto 60.9 22 Lamwo 82.6 2 Nakapiripirit 60.9 23 Agago 80.3 3 Kotido 60.2 24 Mukono 78.7 4 Buvuma 59.3 25 Nwoya 78.6 5 Amudat 46.6 26 At least 5 of the 31 new districts achieved total scores above the national average of 78.6. TABLE 29: DISTRICT RANKING FOR NEW DISTRICTS Total National Total National District Rank Rank District Rank Rank Butambala 83.4 1 6 Gomba 68.4 16 82 33

Lamwo 82.6 2 8 Mitooma 68.2 17 83 Serere 82.2 3 11 Rubirizi 67.9 18 85 Agago 80.3 4 16 Ntoroko 67.8 19 86 Nwoya 78.6 5 25 Zombo 67.8 20 87 National 78.6 Luuka 66.6 21 91 Otuke 76.7 6 40 Napak 66.5 22 92 Kyegegwa 76.2 7 42 Kole 66.2 23 93 Buikwe 75.7 8 48 Kyankwanzi 66.0 24 95 Ngora 75.2 9 50 Kibuku 64.6 25 100 Kalungu 75.2 10 51 Buyende 63.0 26 103 Sheema 74.5 11 54 Kween 62.8 27 104 Kiryandongo 71.7 12 68 Buhweju 62.2 28 106 Bukomansimbi 71.6 13 69 Buvuma 59.3 29 110 Namayingo 70.4 14 76 Bulambuli 57.3 30 111 Lwengo 69.3 15 79 Amudat 46.6 31 112 34

2.5.2 Regional Performance Level Performance The health sector has 12 regions based on the referral hospitals catchment areas namely; Kampala, Jinja, Mbale, Soroti, Lira, Moroto, Gulu, Arua, Hoima, Fort Portal, Mbarara and Masaka. Overall, during the FY 2014/15, 48 districts registered improvement while 64 districts declined, based on the DLT performance indicators. In terms of total scores, Gulu and Soroti regions registered the highest scores (79.2 and 77.6 respectively) while Mbale and Moroto regions registered the lowest scores (69.1 and 61.4 respectively). However, of the 12 regions, only Gulu region scored above the national average of 78.6. The table below summarizes performance ranking of districts within the different regions for FY 2014/15. TABLE 30: DISTRICT RANKING BY REGION 2014/15 FY Arua- Jinja- Masaka- Mbarara- Rank Rank Rank 2,661,000 3,609,484 1,856,922 4,347,294 Rank Nebbi 1 Jinja 1 Lyantonde 1 Rukungiri 1 Koboko 2 Iganga 2 Masaka 2 Bushenyi 2 Arua 3 Kamuli 3 Rakai 3 Isingiro 3 Adjumani 4 Namutumba 4 Kalungu 4 Kanungu 4 Zombo 5 Bugiri 5 Kalangala 5 Kiruhura 5 Maracha 6 Namayingo 6 Bukomansimbi 6 Kabale 6 Moyo 7 Luuka 7 Lwengo 7 Mbarara 7 Yumbe 8 Kaliro 8 Sembabule 8 Sheema 8 Fort Portal- Rank Mbale- Rank Mayuge 9 3,716,204 Ntungamo 9 2,589,652 Buyende 10 Mbale 1 Kisoro 10 Kabarole 1 Central Rank Tororo 2 Ibanda 11 Kyenjojo 2 7,390,170 Busia 3 Mitooma 12 Kamwenge 3 Kampala 1 Pallisa 4 Rubirizi 13 Kyegegwa 4 Butambala 2 Budaka 5 Buhweju 14 Bundibugyo 5 Mityana 3 Sironko 6 Moroto- Kasese 6 Luwero 4 Kapchorwa 7 988,429 Rank Ntoroko 7 Mukono 5 Bududa 8 Abim 1 Gulu- Rank 1,511,614 Mpigi 6 Bukwo 9 Napak 2 Gulu 1 Nakaseke 7 Butaleja 10 Kaabong 3 Lamwo 2 Kayunga 8 Manafwa 11 Moroto 4 Agago 3 Buikwe 9 Kibuku 12 Nakapiripirit 4 Nwoya 4 Mubende 10 Kween 13 Kotido 6 35

Kitgum 5 Nakasongola 11 Bulambuli 14 Amudat 7 Soroti- Amuru 6 Gomba 12 1,703,720 Rank Pader 7 Wakiso 13 Serere 1 Hoima- Rank Buvuma 14 Soroti 2 2,399,988 Lira- Rank 2,069,618 Katakwi 3 Hoima 1 Lira 1 Kaberamaido 4 Kiboga 2 Oyam 2 Kumi 5 Masindi 3 Dokolo 3 Amuria 6 Kibaale 4 Amolatar 4 Ngora 7 Kiryandongo 5 Otuke 5 Bukedea 8 Buliisa 6 Apac 6 Kyankwanzi 7 Alebtong 7 Kole 8 36

2.6 Hospital Performance The total number of hospitals (public and private) in Uganda is 155. Of these 2 are National Referral Hospitals (Mulago and Butabika), 14 are RRHs and 139 are GHs. In terms of ownership, 65 are government owned, 63 PNFP and 27 are private. Hospitals are major contributors to outputs of essential clinical care and take up a large volume of human and financial resources. In the financial year 2014/15 almost similar to the year before, hospitals produced 54 of all inpatient admissions, 19 of total outpatients, and 36 of all deliveries. Owing to the new DHIS2 reporting from hospitals has improved compared to the previous years although completeness remains a challenge. Information analyzed is from 93 of GHs (listed in DHIS2), 100 of Regional hospitals and National referral hospitals, there was an improved reporting by private hospitals compared to the year before. Analysis of hospital information largely looks at outputs of hospitals and relates inputs to outputs and outcomes. We will continue to use the Standard Unit of Output (SUO) 6. The SUO is a composite measure of outputs that allows for a fair comparison of volumes of output of hospitals that have varying capacities in providing the different types of patient care services. The SUO attempts to attribute the final outputs of a hospital a relative weight based on previous cost analyses taking the outpatient contact as the standard of reference. The SUO converts all outputs to outpatient equivalents. The basis of this parameter rests on the evidence that the cost of managing one inpatient is 15 times the cost managing one outpatient, one immunization 0.2 times more, one delivery 5 times more and one (ANC+MCH+FP) client 0.5 times the cost of managing one outpatient. Basic efficiency indicators for resource use are generated and tables comparing hospitals generated. 2.6.1.1 Main causes of mortality and morbidity in hospitals Malaria, respiratory infections including pneumonia, diarrhea, worms, skin diseases, eye infections, injuries, ear nose and throat diseases and urinary tract/pelvic inflammatory diseases / Sexually Transmitted Diseases (STDs) are the commonest causes of morbidity in hospitals as shown in the figures below. Non-infectious diseases are increasingly prominent as causes of morbidity notably hypertension, and injuries other than road traffic accidents and injuries due to road traffic accidents. 6 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. 37

FIGURE 9: TOP TEN CONDITIONS AMONG UNDER FIVES AND ABOVE IN 2014/15 FY 2.6.1.2 Hospital Based Mortality for all Ages A total of 22,504 death among under fives and 8,949 among adults hospital deaths were reported during 2014/15 FY. Malaria remains the top most 13.8 cause of all deaths followed by pneumonia and anemia as shown in the table below. Perinatal condition are featuring more prominently unlike the year before, contributing to 5.8 of all death. Like the year before, injuries, tuberculosis and cardiovascular conditions still feature prominent. TABLE 31: TOP TEN CAUSES OF HOSPITAL BASED MORTALITY FOR ALL AGES 2014/2015 Conditions Under 5 5 and Over Total Malaria 1,725 1,380 3,105 13.8 Pneumonia 1,132 1,053 2,185 9.7 Anaemia 1,000 947 1,947 8.7 Perinatal Conditions (in new borns 0-7 days) 1,301 0 1,301 5.8 Injuries - Road Traffic Accidents 201 555 756 3.4 Other Tuberculosis 69 681 750 3.3 Cardiovascular Diseases (Other) 52 645 697 3.1 Septicemia 326 330 656 2.9 Injuries - (Trauma Due To Other Causes) 231 417 648 2.9 Neonatal Septicaemia 567 0 567 2.5 Others 15,900 2,941 18,841 44.0 Total 22,504 8,949 31,453 100.0 38

2.6.2 National referral hospitals 2.6.2.1 Mulago National Referral Hospital Mulago Hospital is the main NRHand a teaching hospital for the Makerere College of Health Sciences it also serves as a general hospital for Kampala City; currently it has a bed capacity of 1,790. Inputs In 2014/15 Mulago had 1,880 staff 7 this constituted 67 of the staffing positions leaving a gap of 581 staff to be filled. Mulago hospital had an annual budget of 38.14 billion in 2014/15. The total release was 39.73 billion, 104 of the budget. Outputs The patient load in Mulago hospital continues to be too heavy and affecting quality of services. During the year, there were 829,817 outpatient visits; 761,573 inpatients; 61,568 emergencies; 28,759 total ANC visits; 39,081 deliveries, 11,120 postnatal visits; 1,738,652 lab tests; 33,949 x- rays; 27,142 ultrasound scans; 49,680 immunization contacts; 13,397 major surgeries; 9,701 FP contacts. The bed occupancy rate for the hospital was 63. 2.6.2.2 Butabika Mental Referral Hospital Butabika hospital offers super specialized and general mental health services, conducts mental health training, carries out mental health related research and provides support to mental health care services in the country for economic development. During the FY, the hospital had 359 staff representing 85 of approved positions. The hospital used the following financial resources to deliver the services in 2014/15. The hospital had an approved budget of 9.11 billion and received 10.86 billion in the course of the year. During the year Butabika had the following outputs; 7,436 patients admitted.; 29,253 lab investigations carried out, 1,218 in X-rays and 1,298 in Ultrasound scans; 26,961 Mental Outpatients were treated in the mental health clinic, child health mental clinic, Alcohol drug unit and trauma; 49,200 Outpatients treated in the OPD clinics i.e. General, Dental, Orthopedics, Family planning, Minor surgery, HIV/AIDS, Eye, TB and STD. 60 outreach clinics were conducted,; 13,074 patients seen in outreach clinics; 21 visits to regional mental units; 614 resettled upcountry; 274 resettled in Kampala/ Wakiso; 1,148 patients were 7 MoH Human Resource for Health Biannual Report April 2015 39

rehabilitated to normal functioning; and 138 patients were reintegrated into the community and are now engaged in gainful employment. 1,234 students were received from various institutions of higher learning for mental health placement. These included; undergraduates, postgraduates of different specialties, student nurses as well as Clinical Officers. 4 Mental Health Research activities conducted.; A research on Health seeking for Epilepsy among patients at Butabika Hospital was conducted.; Study on Prevalence and correlation of Hypertension, diabetes and Metabolic syndrome in newly diagnosed patients with severe mental illness; A research on Violence among children with mental illness was conducted; and Research of Exposure to interpersonal traumas and Post-traumatic Stress Disorder with severe mental illness in Butabika Hospital. Regional Referral Hospitals Regional referral hospitals are meant to provide specialized and general health care, train workers and conduct research in line with the requirements of the MoH. For the year 2014/15, reports have been received from all the 14 RRHs (public) and the 4 large PNFP hospitals (Nsambya, Rubaga, Mengo and Lacor) through the DHIS2 and other hospital reports. It makes sense to analyze them in the RRHs group as they would be outliers under GHs. Inputs - Finance The total approved budget for RRHs was UShs. 68.573 billion Shs. and actual release was UShs. 67.038 billion. Overall, the percentage of the funds released against the approved budget was 106 in non-wage, 96 in development budgets but only 94 for the wage budget. The total budget performance was 98. Financial performance for the 4 large PNFP hospitals has not been included in the analysis due to lack of the comprehensive financial reports from these hospitals. (Table 32) TABLE 32: FINANCIAL PERFORMANCE FOR 14 RRHS FOR FY 2014/15 (UGX BILLIONS) Institution Wage Nonwage Development Total Performance Approved Approved Approved Approved budget Release budget Release budget Release budget Release 2014/15 2013/14 Arua 2,975 2,975 1,382 1,394 1,000 1,000 5,357 5,369 100 95 Fort Portal 3,432 2,998 1,306 1,365 700 700 5,438 5,063 93 100 Gulu 2,546 2,557 931 968 1,151 898 4,628 4,423 96 96 Hoima 2,458 2,294 963 1,019 1,200 1,200 4,621 4,513 98 96 40

Institution Wage Nonwage Development Total Performance Approved Approved Approved Approved budget Release budget Release budget Release budget Release 2014/15 2013/14 Jinja 3,617 3,665 957 1,001 1,000 1,000 5,574 5,666 102 98 Kabale 2,385 2,223 1,293 1,292 700 695 4,378 4,210 96 98 Lira 2,569 2,567 1,094 1,360 1,000 1,000 4,663 4,927 106 95 Masaka 2,574 2,515 1,066 1,044 1,100 933 4,740 4,492 95 100 Mbale 3,826 3,758 1,882 2,186 800 720 6,508 6,664 102 100 Mbarara 3,279 2,921 1,147 1,183 1,000 993 5,426 5,097 94 86 Moroto 1,734 1,787 817 820 1,000 890 3,551 3,497 98 100 Mubende 2,138 2,138 788 788 1,000 1,000 3,926 3,926 100 99 Soroti 2,617 2,655 1,090 1,190 800 800 4,507 4,645 103 100 CUFH - Naguru 3,420 2,536 816 905 1,020 1,105 5,256 4,546 86 90 Total 39,570 37,589 15,532 16,515 13,471 12,934 68,573 67,038 98 96 Source: MoH Financial Report, FY 2014/15 Human Resources As of April 2015 8, the 14 RRHs had a total staffing of 3,820, this represented 81 of the established positions with a total staffing gap of 924. Outputs These 18 hospitals produced more outputs in the year 2014/15 compared to the year before; a total of, 3,177,200 outpatients (2013/14 = 2,856,343); 107,619 deliveries (2013/14 = 99,648) and 384,550 admissions (2013/14 = 346,704) among other outputs. On average each hospital attended to; 176,511 outpatients (2013/14 = 158,686), conducted 5,979 deliveries (2013/14 = 5,536) and 21,364 admissions (2013/14 = 19,261). Similarly the hospitals have registered an increase in SUO in 2014/15 compared to 2013/14 from 8,727,279 to 9,598,602. Mbale hospital continues to lead in volume of outputs pushed by the very high number of admissions 70,183 (37 higher than 2013/14). Masaka retains the second slot registering a 36 increase compared to the year before. Hoima, St. Marys Lacor, Moroto all registered more than 20 increases. For reasons yet to be established Kabale had a 29 reduction in outputs compared to the year before. TABLE 33: KEY HOSPITAL OUTPUTS AND RANKING OF RRHS AND LARGE PNFP HOSPITALS Facility Admissi ons Total OPD Deliverie s in unit Total ANC Postnatal Attend Family Planning visits Immuni zation SUO 2014/15 SUO 2013/14 Mubende 15,526 103,012 4,431 5,518 4,852 1,466 4,908 364,957 340,977 8 MoH Biannual Human Resource for Health Report April 2015 41

Facility Admissi ons Total OPD Deliverie s in unit Total ANC Postnatal Attend Family Planning visits Immuni zation SUO 2014/15 SUO 2013/14 Masaka 34,933 294,481 9,732 7,314 1,475 1,414 4,055 873,049 641,723 Lubaga 14,076 161,836 5,527 12,073 2,746 NA 19,515 411,924 439,521 Mengo 6,262 249,911 5,122 9,909 3,487 114 12,040 378,614 322,815 Moroto 12,977 47,526 808 1,358 3,888 145 1,947 249,306 206,090 Lira 20,882 349,810 6,235 7,509 225 1,527 8,478 700,541 627,248 CUFH - Naguru 14,568 162,887 7,848 13,889 547 2,035 7,814 430,445 366,559 St. Francis Nsambya 5,676 164,469 5,623 8,815 3,330 NA 13,346 286,466 354,525 St. Mary's Lacor 22,927 137,160 4,236 4,022 766 NA 4,716 505,582 422,108 Gulu 21,685 150,513 4,627 5,248 411 935 6,633 503,547 496,101 Arua 19,304 199,039 5,677 7,996 1,679 615 9,677 524,064 445,462 Soroti 20,898 147,934 4,950 3,527 1,870 1,724 5,067 490,728 492,468 Jinja 23,265 160,193 6,233 6,378 372 2,992 3,770 545,958 551,635 Hoima 19,756 266,820 6,290 6,392 122 968 5,186 599,388 488,062 Mbale 70,183 102,597 9,921 3,921 9,076 1,518 3,342 1,212,873 885,840 Kabale 14,028 63,133 4,209 4,209 454 1,610 2,600 298,255 420,493 Mbarara 25,732 147,330 9,449 6,736 6,682 918 3,962 588,515 599,069 Fort Portal 21,872 268,549 6,701 5,161 243 951 5,400 634,392 626,585 Total 384,550 3,177,200 107,619 119,975 42,225 18,932 122,456 9,598,602 8,727,281 Source: MoH HMIS TABLE 34: SUMMARY OF KEY OUTPUTS FOR RRHS AND LARGE PNFPS Facility Admissions Total OPD Deliveries in unit Total ANC Postnatal Attendances Family Planning Immunization SUO 2014/15 SUO 2013/14 Total 384,550 3,177,200 107,619 119,975 42,225 18,932 122,456 9,598,602 8,727,281 Average 21,364 176,511 5,979 6,665 2,346 1,262 6,803 533,256 484,849 Minimum 5,676 47,526 808 1,358 122 114 1,947 249,306 206,090 Maximum 70,183 349,810 9,921 13,889 9,076 2,992 19,515 1,212,873 885,840 Source: MoH HMIS Figure 11 shows the variation of SUO in the last three years. 42

FIGURE 10: VOLUME OF OUTPUTS FOR RRHS AND LARGE PNFPS 2014/15 2013/14 2012/13 FYS Source: MoH HMIS Efficiency Efficiency has been analyzed by comparing output to these inputs. The ratios calculated here are not adjusted for quality differences and should be interpreted with caution. The first efficiency indicator is utilization of beds, a more efficient hospital should have a high Bed Occupancy Rate (BOR) and vice versa, similarly the Average Length of Stay (ALOS) should be shorter for better efficiency. However WHO defines optimum bed efficiency as 85 BOR. Table 35 below shows variation across hospitals. The average BOR is 76 minimum 16 (there is a possibility of this being an error owing to incomplete reports) and maximum 139. Hospitals with BOR between 80 and 90 are considered optimally operating while those below that or above that need to make corrective actions to attain optimum state. One action is to address the ALOS more frequent rounds and setting discharge criteria. The second efficiency indicator analyzed is utilization of recurrent funds (wage and non-wage, excluding development). The recurrent cost per SUO and the recurrent cost per bed are shown in the table 35 and figure 12 below. The average recurrent cost per SUO is UGX 5,637 otherwise explained as 1 outpatient equivalent takes UGX 5,637 to produce. The minimum recurrent cost per SUO was shown by Masaka hospital (UGX 4,077) and the maximum UGX 11,785 shown by Kabale hospital. Recurrent cost per bed follows a similar pattern to that of recurrent cost/suo; the average cost per bed is UGX 9,521,999, the minimum UGX 8,883,117 (Mbarara hospital) and the maximum is UGX 34,410,000 (CUFH Naguru hospital). 43

Ultimately, efficiency has to be measured in financial terms; as such the recurrent cost per SUO can be considered the reference efficiency. Hospitals that have demonstrated high efficiencies are those that have managed to increase the utilization of their services TABLE 35: SELECTED EFFICIENCY PARAMETERS FOR RRHS AND LARGE PNFP HOSPITALS FY 2014/15 Facility Beds IPD Patient Days SUO BOR ALOS Recurrent Cost Recurrent cost / SUO Recurrent cost / Bed Mubende 197 58,596 364,957 81 3.8 2,926,000,000 8,017 14,852,792 Masaka 330 109,424 873,049 91 3.1 3,559,000,000 4,077 10,784,848 Lubaga 269 55,749 411,924 57 4.0 Mengo 301 17,490 378,614 16 2.8 Moroto 182 82,077 249,306 124 6.3 2,607,000,000 10,457 14,324,176 Lira 400 106,972 700,541 73 5.1 3,927,000,000 5,606 9,817,500 CUFH - Naguru 100 50,688 430,445 139 3.5 3,441,000,000 7,994 34,410,000 St. Francis Nsambya 195 14,259 286,466 20 2.5 St. Mary's Lacor 482 148,945 505,582 85 6.5 Gulu 374 83,947 503,547 61 3.9 3,525,000,000 7,000 9,425,134 Arua 322 89,006 524,064 76 4.6 4,369,000,000 8,337 13,568,323 Soroti 256 99,850 490,728 107 4.8 3,845,000,000 7,835 15,019,531 Jinja 442 113,519 545,958 70 4.9 4,666,000,000 8,546 10,556,561 Hoima 276 88,872 599,388 88 4.5 3,313,000,000 5,527 12,003,623 Mbale 477 144,543 1,212,873 83 2.1 5,944,000,000 4,901 12,461,216 Kabale 244 81,975 298,255 92 5.8 3,515,000,000 11,785 14,405,738 Mbarara 462 115,793 588,515 69 4.5 4,104,000,000 6,973 8,883,117 Fort Portal 373 112,038 634,392 82 5.1 4,363,000,000 6,877 11,697,051 Total 5,682 1,573,743 9,598,602 54,104,000,000 Average 316 87,430 533,256 76 4.1 3,864,571,429 5,637 9,521,999 Minimum 100 14,259 249,306 16 2.1 2,607,000,000 4,077 8,883,117 Maximum 482 148,945 1,212,873 139 6.5 5,944,000,000 11,785 34,410,000 Source: MoH HMIS and Hospital Financial Reports 44

FIGURE 11: RECURRENT / SUO AND BED OCCUPANCY RATE IN RRHS Outcomes Hospital based deaths especially maternal deaths and fresh still births are indicators of quality of care. The total maternal deaths reported in 14 RRHs and 4 PNFP hospitals were 321 giving a mean death of 18 mothers per hospital per year with a minimum of 2 in Mengo and maximum of 37 in Hoima RRH. The risk of dying during delivery was highest in Hoima RRH, followed by Jinja and Soroti hospitals (a mother died for every 170, 201 and 206 deliveries respectively). This indicates a general improvement compared to 2013/14 where the risk was highest in Mubende RRH, followed by Arua and Hoima hospitals (a mother died for every 116, 162 and 165 deliveries respectively).the risk was lowest in Mengo, Nsambya and Kabale hospitals (a mother died for every 2,561, 1,874 and 1,403 deliveries respectively). For outliers, a follow up of these deaths to establish causes and related factors is necessary. The risk of a fresh still birth was highest in Mubende, followed by Hoima and Arua Hospitals (a fresh still birth was delivered for every 22, 25 and 36 deliveries) respectively. The risk of a fresh still birth was lowest in Gulu, followed by Lubaga and Mengo (one fresh still birth was delivered for every 185, 178 and 160 deliveries) in the above mentioned hospitals respectively. 45

TABLE 36: SELECTED QUALITY OF CARE PARAMETERS FOR RRHS AND LARGE PNFP HOSPITALS 2014/15 Facility IPD Admissions Deliveries in Unit IPD Deaths Maternal Deaths Fresh Still Births Maternal Death compared to Deliveries Risk of Fresh Still Birth compared to Deliveries Mubende 15,526 4,431 307 21 205 211 22 Masaka 34,933 9,732 1,829 23 130 423 75 Lubaga 14,076 5,527 308 23 31 240 178 Mengo 6,262 5,122 90 2 32 2,561 160 Moroto 12,977 808 141 3 13 269 62 Lira 20,882 6,235 866 19 106 328 59 CUFH -Naguru 14,568 7,848 201 6 60 1,308 131 St. Francis Nsambya 5,676 5,623 144 3 43 1,874 131 St. Mary's Lacor 22,927 4,236 1,145 12 82 353 52 Gulu 21,685 4,627 357 7 25 661 185 Arua 19,304 5,677 919 12 158 473 36 Soroti 20,898 4,950 565 24 90 206 55 Jinja 23,265 6,233 1,022 31 136 201 46 Hoima 19,756 6,290 612 37 251 170 25 Mbale 70,183 9,921 982 34 254 292 39 Kabale 14,028 4,209 357 3 77 1,403 55 Mbarara 25,732 9,449 1,705 30 152 315 62 Fort Portal 21,872 6,701 905 31 145 216 46 Total 384,550 107,619 12,455 321 1,990 11,504 1,419 Average 21,364 5,979 692 18 111 335 54 Minimum 5,676 808 90 2 13 170 22 Maximum 70,183 9,921 1,829 37 254 2,561 185 Source: MoH HMIS 46

2.6.3 General Hospital Performance There are 139 GHs in the country providing; preventive, promotive outpatient curative, maternity, inpatient, emergency surgery and blood transfusion and laboratory services. The list of GHs in the DHIS2 (144) is not harmonized with that of the health facility inventory of clinical department. The assessment is largely based on the data aggregated through the DHIS2. 135 hospitals had information in system, 4 PNFP large volume hospitals have been excluded as they have been analyzed with RRHs. Thus we have 132 hospitals in this analysis. (See Annex Table 55) Inputs Human Resource Staffing information in GHs was not analyzed due scarcity of information in the DHIS2. Finance The 43 public hospital had an allocation of Ush 5,943,066,857.99 for recurrent non-wage, 100 was released during the year. An additional Ush 3,200,000,000 was released for rehabilitation of Kiboga, Adjumani, Kapchorwa and Bundibugyo hospitals. Lack of staffing costs make it difficult to estimate the real cost of running GHs. Outputs Hospital performance is assessed using 5 main outputs which include; admissions, outpatient visits, deliveries, ANC/FP/PNC (Antenatal care, Family planning, Postnatal care) and immunization. The hospital indicators have been summed up in composite units the SUO. A total of 4,125,600 outpatient visits were made; the hospitals also conducted 173,258 deliveries and 730,313 admissions among other outputs. On average each hospital attended to; 31,493 outpatients, conducted 1,364 deliveries and 5,938 admissions. See Table 37 below. The total SUO for GHs has increased from 15,514,147 in 2013/14 to 16,256,818 this is generally attributed to increased number of hospitals reporting in the DHIS2 from 123 to 132. The average outputs were lower for all the listed outputs in the table below except for postnatal and family planning. The minimum SUO for GHs was 708 and maximum 543,117. The range in outputs is so big and calls in to question the classification of some health units as hospitals. 47

Facility Admissions Total OPD Deliveries Total ANC Postnatal Attendances Family Planning Immunization S UO 2014/15 Rank Annual Health Sector Performance Report for Financial Year 2014/15 TABLE 37: SUMMARY OF OUTPUTS FROM THE GENERAL HOSPITALS FY 2014/15 (N=132) # reporting Reporting Minimum Maximum Average Total 2014/15 Total 2013/14 # Reporting 2013/14 Average 2013/14 Admissions 123 85 37 23,624 5,938 730,313 688,024 114 6,035 Total OPD 131 91 0 148,381 31,493 4,125,600 3,849,271 120 32,077 Deliveries 127 88 1 6,481 1,364 173,258 159,460 115 1,387 Total ANC 125 87 0 8,738 1,965 245,578 432,427 118 3,665 Postnatal 121 84 5 5,469 525 63,521 55,124 113 488 Family Planning 100 69 1 8,863 545 54,482 41,804 93 450 Immunization 127 88 0 27,121 5,057 642,209 1,286,885 123 10,462 SUO 132 92 708 543,117 123,158 16,256,818 15,514,147 123 126,131 Source: MoH HMIS The 5 top performing (high volume) hospitals were Iganga, Busolwe, Kitgum, Mityana and Tororo. Compared to the year 2013/14, Busolwe and Kitgum are new entrants to the top 5. Bwera and Kawolo dropped off the top 5. Among the PNFP the highest volume hospital is Angal St. Luke. The 5 lowest volume hospitals were JCRC, Kitintale, Ntinda, Middle East Bugolobi and Family Care hospital. There is need to re-visit the level classification of some of the very low volume hospitals. These hospitals tend to have very low bed capacities well below the minimum number (60) defined in the definition of hospitals by the hospital policy. TABLE 38: THE TOP 15 HIGH VOLUME GENERAL HOSPITALS Iganga 23,624 148,381 6,481 7,303 2,349 1,122 12,922 543,117 1 Busolwe 13,427 116,082 1,896 2,048 882 182 3,945 329,312 2 Kitgum 15,186 84,480 2,770 2,705 748 289 5,579 329,107 3 Mityana 14,533 64,275 5,763 6,431 1,971 1,221 7,685 317,434 4 Tororo 14,083 63,432 5,158 6,040 2,718 193 7,452 306,433 5 Bwera 14,360 61,258 4,318 7,572 318 2,054 15,831 306,386 6 Pallisa 14,458 57,445 3,626 3,928 3,240 1,135 8,837 298,364 7 Kawolo 11,704 89,820 3,764 5,521 755 2,828 9,308 290,614 8 Apac 14,121 51,355 2,222 4,744 365 725 6,977 278,592 9 48

Facility Admissions Total OPD Deliveries Total ANC Postnatal Attendances Family Planning Immunization S UO 2014/15 Rank Annual Health Sector Performance Report for Financial Year 2014/15 Angal St. Luke 15,142 31,231 2,537 2,802 367 NA 5,830 273,797 10 Atutur 11,543 78,229 1,737 2,535 805 550 5,792 263,162 11 Ibanda 15,078 21,862 2,447 1,958 264 NA 5,301 262,438 12 Kayunga 11,319 68,930 3,045 3,017 544 904 7,533 257,679 13 Kagadi 14,134 21,917 3,729 4,625 559 359 9,463 257,236 14 Nebbi 12,667 49,810 2,367 3,885 327 528 8,539 255,728 15 Source: MoH HMIS Efficiency of use of services With the information available, we can only assess efficiency in utilization of beds. That is Bed occupancy rate and average length of stay. There was no financial or staff information available to do other efficiency analysis. The range of bed capacity was 15 beds (Senta Medicare) to 552 beds for KIU Teaching hospital Ishaka. The average BOR was 57. A majority (100) of hospitals were operating below the efficient range of 80-90 bed occupancy; these hospitals can produce more without a large input of additional resources. They are not maximizing their fixed factors of production. Only 8 (Kayunga, Kiboga, Bududa, Atutur, Adumani, Apac, Kisoro and Kitagata) hospitals are operating within the efficiency range, however 14 (Gombe, Mityana, Nakaseke, Bugiri, Iganga, Katakwi General, Pallisa, Kaabong, Nebbi, Angal St. Luke, Yumbe, Bundibugyo, Bwera and Kiryandongo) hospitals are operating beyond the efficiency range BOR greater than 90. FIGURE 12: HISTOGRAM FOR DISTRIBUTION OF ALOS 2014/15 Outcomes The ALOS similarly has a very wide variance, the average is 3.8 days; the maximum ALOS is 8 days observed in Nakasongola Military, Gulu Military, Mildmay, Maracha and Matany. This is due to a case mix that has more patients needing longer rehabilitation or chronic care. For the current resources used in GHs, we are not getting the best return in terms of productivity. 49

Maternal deaths were reported in 79 GHs, a total of 407 deaths compared to 449 in 2013/14 were recorded giving an average of 5 deaths per hospital. However taking the denominator as hospitals conducting deliveries (126) the average death per hospital is 3.2. The minimum is 0 and the maximum is 18 observed in Iganga. Overall there was a maternal death for every 265 deliveries compared to 241 in 2013/14. The 5 hospitals with the highest risk of a maternal death were: Buliisa 1 death in 55 deliveries, Nyapea 1 in 80, Mt. Elgon 1 in 81, Dabani 1 in 100 and Buluba 1 in 118. The causes of maternal deaths in these hospitals needs to be investigated to reduce on the maternal death to deliveries ratio. 5 hospitals with the lowest risk of a maternal death were: Entebbe 1 death in 2,579 deliveries, Kalisizo 1 death in 2,340, Nakaseke 1 death in 2,390, Bombo 1 death in 2,063 Atutur hospital 1 death in 1,737 deliveries. Fresh stillbirths were reported in 104 hospitals, a total of 3,282 fresh still births were recorded, minimum 1 (Kitintale, Uganda Martyrs, Ruth Gaylord, Kakira and Kida hospitals) and maximum 152 (Iganga hospital). Overall the risk of having a fresh still birth taking total deliveries as the denominator is 1 in 43 deliveries. The minimum risk is 1 in 720 deliveries in St. Karoli Lwanga hospital Nyakibale and maximum is 1 in 12 deliveries in Dabani. 50

2.6.4 Functionality of HC IVs The key feature of the HSD strategy is that each HSD, which has an approximately 100,000 people, would have a Hospital or a HC IV. The facility should have the capacity to provide basic preventive, promotive, outpatient curative, maternity, inpatient health services, emergency surgery and blood transfusion and laboratory services. In addition, it should supervise and support planning and implementation of services by the lower health units in its area of jurisdiction. The total number of HC IVs is 206; of these 182 are government, 17 NGO and 7 privately owned. Information was available for 195 HC IVs in the DHIS2 and this form the basis of the analysis below. Inputs Human Resource Staffing information in GHs was not analyzed due scarcity of information in the DHIS2. Finance Staffing information in GHs was not analyzed dues to lack of reliable information on individual hospital financial performance. Outputs Functionality of HC IV is determined by outputs from selected components of the minimum service standards i.e. maternity (deliveries), inpatient, blood transfusion, theatre (caesarean section, major and minor surgery), HCT, PMTCT, ART, long term contraception and outpatient services. Since the main objective of setting up HC IVs was to provide Comprehensive Emergency Obstetric Care (CEmOC) that is being able to provide intervention in case of complications during delivery, which includes the ability to provide a caesarean section and blood transfusion, as such HC IVs have been judged functional if they have been able to carry out at least one caesarean section. Using these criteria, 51 (100/195) of the HC IVs were functional meaning able to do cesarean section. For blood transfusion 38 (75/195) were able to provide this service. Those able to provide both cesarean section and blood transfusion were 33 (65/195). There is an improvement compared to the functionality of 2013/2014 when 45 (88 out of 196) of the HC IVs were able to do cesarean section and 36 able to do blood transfusion. Figure 14 shows the trend of these functionality indicators over the years. Government efforts and a number of partner efforts to make HC IVs functional are beginning to pay off. The recruitment of health workers for HC IVs and IIIs contributed to observed improvements. 51

FIGURE 13: TRENDS IN CAESAREAN SECTION AND BLOOD TRANSFUSION 2008/09-2014/15 Source: MoH HMIS There are 14 HC IVs that perform more than 200 Cesarean sections a year like in many hospitals these are: Bishop Asili Ceaser HC IV, Mpigi HC IV, Mukono T.C. HC IV, Mukono CoU HC IV, Serere HC IV, Rwekubo HC IV, Kabuyanda HC IV, Rukunyu HC IV, St. Paul HC IV, St. Ambrose Charity HC IV, Kakumiro HC IV, Kyegegwa HC IV, Rubaare HC IV. These HC IVs need to be recognized and funded differently from other HC IVs. In total HC IVs attended to 4,218,757 outpatients; conducted 156,352 deliveries; and admitted 453,036 patients. The mean outpatient attended to was 21,635, mean deliveries 810 and mean admission 2,489 as shown in the table 39. The total SUO for HC IVs was 12,217,35 with a minimum of 2,295 and maximum of 199,837. TABLE 39: SUMMARY OF OUTPUTS FROM THE HC IVS FY 2014/15 (N=195) Admissions Total OPD Deliveries Total ANC Postnatal Attendances Family Planning Immunization Total 453,036 4,218,757 156,352 358,278 84,813 76,593 807,302 12,217,356 Minimum 59 0 9 0 4 4 0 2,295 Maximum 7,181 47,879 5,761 11,867 5,425 4,134 34,397 199,837 Valid Average 2,489 21,635 810 1,847 442 412 4,205 62,653 # reporting 182 195 193 194 192 186 192 195 SUO The 5 top performing HC IVs in 2014/15 were Mukono T.C, Luwero, Serere, Kitebi, Kumi. In 2014/15 the number of beds increased, from 6,324 in 2013/14 to 8,034; as expected. admissions also increased from 424,828 the year before to 453,036, with more admissions death 52

also increased. While the ALOS remained more or less the same, the BOR decreased to 38.7 from 49. Table 40 shows the comparisons. TABLE 40: SUMMARY OF EFFICIENCY & USAGE MEASUREMENTS OF HC IVS Output 2014/15 2013/2014 2012/2013 Number of Beds 8,034 6,324 6,065 Admissions 453,036 424,828 395,898 Deaths 3,643 4,621 4,276 Case Fatality Rate 1 1.1 1.08 Patient Days 11,36,300 1,125,651 1,031,096 Bed Occupancy 38.7 49 46.6 Average Length of Stay 2.5 2.6 2.6 Source: MoH HMIS 53

3 Achievements against Planned Outputs in the MPS 2014/15 This section highlights the performance of the MoH against the key outputs of the MPS by implementation level i.e. department, division or unit. These key outputs are derived from the core functions of the MoH headquarters are; policy formulation and dialogue, planning, setting regulations, standards and guidelines, supervision, monitoring, resource mobilization, HR capacity development and technical support, infrastructure development, health systems research and development and coordination of health programmes and projects. 3.1.1 Finance and Administration The achievements of F&A during the FY 2014/15 include; - 10 political supervisions of sector activities in the LGs & Referral Hospitals done; three briefs to Cabinet & four briefs to Parliament were made; 24 Press statements / briefings on sector matters were issued. - Board of survey was conducted and 54 vehicles were boarded off. - Responses to internal Audit, Auditor Generals and Public Accounts Committee reports for FY 2013/2014 were submitted. - Decentralization of payroll was implemented and salaries paid by 26th of every month. - 135 cases for confirmation for study leave were submitted to Service Commissions for action; 191 critical positions were cleared at MoH Hqtrs, UVRI & RRHs submitted to Commissions for filling. - Health Service Commission recommended 387 decisions (new appointments, promotions, re-designation) and these were implemented. - Performance agreements for all RRH Hospital Directors were monitored. - Areas of Bilateral Cooperation identified and the MOUs drafted and approved by Solicitor General for the following countries: DRC, Ethiopia and South Africa. MoU of Ethiopia was signed and is under implementation. The MoU with Republic of South Africa and DRC ready for signing. MOUs drafted for Cuba, India and South Korea and submitted for Solicitor General Approval Bankable Project for rehabilitation of Masindi and Abim Hospital submitted to Ministry of Foreign Affairs for incorporation into the upcoming India - Africa Summit meeting for bilateral cooperation negotiations. - Participated in the: Joint Border Commission meeting between Uganda and Kenya (October 2014); Lake Victoria Basin Commission meeting (Bujumbura - March 2015) and made input towards improvement of the Public Health, Sanitation and Environment Project; Joint Ministerial Commission DRC August 2014; International Public Health Conference Salud- Cuba February 2015; bilateral cooperation dialogue at MoH with the 54

Challenges following delegations: Cuba, India, Germany; coordination meetings at Ministry of Foreign Affairs for bilateral cooperation with Iran, Ethiopia, DRC, India; country collaborative meetings with International Organization for Migration. a) Frequent interruptions and breakdown of the IFM System. b) Last minute budget cuts by MoFPED. c) Inadequate office space. Despite the opening of the new office extension, this has remained a challenge as a number of staff are still not accommodated. 3.1.2 Planning In order to guide the sector and facilitate formulation of sector policies and strategies the Planning Department accomplished the following; Planning - Completed the MPS, Budget Frame work paper and developed the Annual Workplan, FY 2015/16. - Printed and disseminated PHC grant guidelines for FY 2014/15; prepared and reviewed the LG negotiation paper with LGFC and ULGA; disseminated NHA report for FY 2011/12. - Developed the draft Health Sector Development Plan (2015/16-2019/20), continued work on the draft Health Financing Strategy; prepared the AHSPR for the FY 2013/14; organized the 20th JRM; and held a DHO s consultative meeting. - Supported all LGs in preparing health sector component of district budgets and plans; carried out 4 workplan performance monitoring supervision and planning mentorship in 6 RRHs, 14 GHs and 25 LGs; and 1consultative meeting on the NDP II was conducted in Lira. Policy Analysis - In terms of policies and Acts, the following were accomplished; reviewed the Public Health Act & National Drug Authority Act, conducted 1 Policy workshop on Policy Formulation, Guided the development of the Palliative Health Care Policy & School Health Policy and developed a Policy Brief on Supply of Essential Life Saving Commodities. - Furthermore, the following were drafted, costed and submitted to Cabinet; Principles of National food and medicines Authority Bill 2014, Principles of Uganda Cancer institute Bill 2014,Principles of National health laboratories services Bill 2014, Protocol for elimination of illicit trade in tobacco products and Uganda Immunization Policy. 55

Human Resource Development - A concept to establish Health Manpower Development Center (HMDC) at Mbale as an autonomous institution with an Act of Parliament was finalized and is ready for presentation to cabinet. - Rehabilitation and upgrading of HMDC infrastructure: classrooms, dining hall, staff houses; installation of Local Area Network and internet; re-design of student hostels (self-contained) with support from ICB project. - Rolled-out of national Governance, Leadership & Management training course health managers at district, HSD and facility level in 15 districts and 2 RRHs. - Capacity building activities within the district and RRH workplans through Execution Agreements (Arua and Fort Portal). - Secured 350 bursaries for midwifery from Baylor Uganda, processed scholarships for 50 postbasic & post-graduate under GoU funding. - With support from ICB Project, Hospital Management Boards of 3 RRHs and 5 GHs were inducted in Leadership and Management. In addition, 90 Health Managers of RRHs, DHTs, GHs and HSDs all from West Nile and Rwenzori regions were also inducted - Another 62 health managers at lower level health facilities have completed the online course (in leadership & management) and 295 are still on the same course. Fifteen DHTs were trained in conducting Training Needs Assessment and they developed Training Plans (Rakai, Lyantonde, Lwengo, Sembabule, Bukomansimbi, Luweero and Nakaseke, Nakasongora, Buikwe, Kalungu, Kayunga, Mpigi, Kampala, Mubende and Mityana). - With support from MKCCAP 35 Top level Managers and 60 Mid level Managers trained in Governance and Leadership in Masaka; 40 Health workers trained in Use and Maintenance of medical equipment in Mulago Hospital; 15 Health workers trained in Renal transplant techniques in India; 6 H/W on the equipment committee attended a learning exhibition for medical equipment; 10 went for a benchmarking trip to Kourle Bou Hospital in Ghana; 240 Nurses trained in infection control measures; 15 Nurses trained in pulmonology in Mulago Hospital; and 13 H/W trained in physiotherapy. - One out of two inter-ministerial standing committee meetings between MoH and MOES was held to address issues pertaining to health training institutions. Resource Center - The Resource Center conducted 3 data validation exercises supported by GAVI and Global Fund. - 8 Support Supervision visits - 17 training & mentorship workshops in HMIS tools & e-hmis, - Produced final draft Statistical Abstract, - Developed the HMIS manual, 56

- Held 9 e-health TWG meetings - Finalized the e-health strategy. - Re-designed the MoH Website with support from ICB Project. - RPMTs worked with partners to improve the quality of data in the DHIS2. - Assessed the ICT capacity in districts with support from GFTAM. - Migration of training database from TASO to MoH Resource Centre initiated. - Developed Community-HMIS training materials. 3.1.3 Quality Assurance Major Achievements were; - The review of implementation of the MoH work-plan for 2014/15 FY was conducted in August 2015. Report was compiled and disseminated to key stakeholders. - Quarterly Regional Health Forum meetings held in West Nile and Rwenzori regions, for sharing and learning, as well as coordination of regional health systems and support with support from ICB project. - 36 regional quarterly review meetings were organized by RPMTs with support from GFTAM. - The Quality Improvement Manual (2015) for the health sector was developed. Guidelines for development of the Client Charters in the health sector and the Key Client Charter messages for the Lower level health Facilities were developed. Other guidelines disseminated were the Uganda Clinical Guidelines (UCGs) which were made available to 21 districts in Eastern and Central region, and the Health Sector QI Framework and Strategic plan to 35 districts in the Teso sub-region. - Client Charters were disseminated to 7 RRHs. Client Charter key messages were also distributed to 65 districts including GHs and HC IVs to increase awareness and participation of the community to have feedback that could be used to increase health sector performance. The activity shall be extended to cover rest of the country during the new FY. - The Pre-JRM field visits took place in September 2014 and the report was shared during the 20 th JRM meeting. - The Health Sector Support Supervision, Monitoring and Inspection strategy was finalised and shared within the Sector Monitoring and Evaluation TWG. The strategy shall be rolled out in 2015/16. - QI Teams have been established in many districts and health facilities predominantly for Rwenzori, South-Western and West Nile regions. A total of 54 National QI facilitators were trained. - One out of the four planned support supervision field visits (Area Teams) took place to cover the 112 LGs. Impromptu inspection visits were conducted for 35 districts and reports were shared with both the district and the responsible MoH officials for action and follow-up. 57

3.1.4 Clinical and Community Clinical Services The Clinical Services Department achieved the following; - Developed draft policies on Palliative care and Control of Hepatitis B; a Bill on tobacco control was tabled in Parliament waiting to be passed into law, participated in the control of Typhoid in Kampala, and the malaria outbreak in Northern Uganda. - Supervised the 13 RRHs, 8 GHs and 5 LLHFs; health workers from 13 hospitals were trained in quality control using the concepts of 5S and Continuous Quality Improvement. - A number of international days were celebrated among which were World Oral Health Day, World No Tobacco Day, World Nursing/Midwifery Day, and World Hepatitis Day which aimed at increasing public awareness of services available at government health facilities. - Specialists camps were held on Fistula repair and dental treatment. The departments coordinated 12 meetings for the medical board to refer patients abroad and also approved requests for early retirement. - Initiated the Uganda National Ambulance services programme. Palliative Care - Palliative Care Policy developed and ready for presentation to Top Management; draft - Palliative Care communication strategy developed; - Capacity built for health workers in 8 districts; - Four districts accredited from July 2014 to June 2015 and districts providing palliative care raised from 86 to 90; - Stakeholders meetings held; - Support supervision provided for accredited palliative care units and Annual Hospice and Cancer Day marked in Rakai District. Mental Health - The Mental Health Bill was passed by Cabinet, printed, gazetted now awaiting tabling to Parliament; Tobacco Control Policy developed - Mental Health Strategic plan printed and disseminated to Jinja Kamuli and Kitgum districts. - Supported the mover of the Tobacco Control Bill in parliament, it was passed on 28th July 2015 58

- National Mental Health day celebrated on 10/11/14 at Grand Imperial hote; World No Tobacco Day on 31st May 2015 at MoH gardens; and International day vs drug abuse and illicit trafficking on 25/06/15 at MoH board room - Radio and Television talk shows conducted on tobacco control drug abuse and Mental illnesses. - Support supervision to Mbale, Gulu, Lira and Soroti RRH Mental Health units. - Monthly Tobacco control coordination meetings held Pharmacy - Updated the National Medicines Policy and developed the National Pharmaceutical Sector Strategic Plan (2015-2020); Developed and disseminated dispensing guidelines to all HC IIs one per copy and HC III two per copy in the 112 districts; Developed a draft addendum of UCG 2012 on RMNCAH and printed 5,000 copies and 2,000 additional copies of UCG 2012. - Bimonthly stock status reports were produced. - 360 health workers from 40 districts were trained in logistic management of vaccines. - Supervised 155 health facilities in 30 districts in medicines management related activities and undertook an assessment of procurement planning at selected hospitals and HC IVs. - Planned and monitored procurement of ARV's, TB, Malaria, Lab, Cotrimoxazole, Condoms and RH commodities ; Initiated procurement of ARVs, Condoms, Cotrimoxazole, Syphillis kits and Safe Male Circumcision commodities for 2015/2016 following the approved grants, covering the period between July 2015 and December 2017 and signed on June 25, 2015. In addition, Initiated the implementation of the awarded $20m Health Systems Strengthening Grant; Quantified requirements for Hepatitis B treatment, female condoms and the 13 lifesaving commodities 9under the UN- Commission. - Reviewed the national indicator on availability of tracer medicines, which will now include 41 high-volume products used to diagnose, prevent, and treat Uganda s 10 most common diseases or conditions. The programs covered include immunization, HIV/AIDS, malaria, tuberculosis, and RMNCAH. The revision took into consideration the newly revised HMIS 105 section that will track data on the 41 commodities. Challenges Inadequate and irregular releasing of funds delays implementation of support supervision. Inadequate human resources at points of service delivery lowers the quality of services delivered. About 90 of people in Uganda who need palliative care not receiving the services 9 59

Inadequate knowledge on palliative care at all levels Community Health Department This department is comprised of the RH, Child Health, Environmental Health, Vector Control, Veterinary Public Health, Disability and Rehabilitation, NCDs, School Health, Public oral health and hygiene, Health Education and Promotion and Nutrition. The achievements were; RMNCAH - Safe Motherhood day commemorated in Tororo District; Family Planning National conference held in Kampala. - Carried out Family Planning camps in Amudat, Arua, Bundibugyo, Gulu, Kitgum and Nakapiripirit districts. - Annual Stakeholder s meeting on Teenage Pregnancy in Sheema District; 2 national stakeholders meeting on ICCM and Newborn health were respectively held. - Carried out IMCI, school health, control of diarrhoeal diseases, and Integrated Child Health Days supervision in Bundibugyo and Ntoroko districts. - Mentored 351 Health workers on Emergency Obstetric and Newborn Care Districts of Sheema, Masindi, Pallisa, Wakiso, Kaabong, Kiboga, Namayingo, Bududa, Buyende and Kabale; Mentored 120 Health workers on Adolescent health in Arua, Amudat, Bundibugyo, Gulu, Kitgum, and Nakapiripit. - Trained 349 service providers in Long Term Family Planing Methods (LTFPM) in Soroti, Dikolo, Katakwi, Kaliro, Iganga, and Moyo Districts; trained 600 VHTs on Sayana press as Community based FP method in Katakwi, Kumi, Iganga, Amuria, Mubende, Gulu districts; Primary School teachers trained in life saving skills including Sexual Reproductive Health and Sexuality Education in Kampala district. - Developed and launched the Family Planning Costed Implementation Plan; printed 500 Copies of child health strategies; aligned newborn care and children guidelines with the revised HBB Plus curriculum (basic and hospital standards, newborn care standards and implementation framework; finalized guidelines on teenage pregnancy management; finalized maternal death surveillance and response guidelines. UNEPI - Revised Immunization practice in Uganda, Child cards, HMIS tools & printed IEC materials to include new vaccines information. 60

- Conducted support supervision in all districts for only one quarter; conducted active surveillance in districts with poor surveillance through the national and international STOP teams. - Held 4 out of the planned 12 EPI technical meetings; conducted 4 Regional review surveillance meetings. - Conducted two rounds of polio supplementary immunization activities (one national and one sub-national targeting high risk districts) were conducted in children aged 0 59 months. The National coverage for the first round was 106 and 99 for the second round; and 2nd round Periodic Intensified Routine Immunization activities in 20 districts. - Effective Vaccine Management Assessment was done through training of field assessors and actual assessment through administration of a questionnaire in selected districts. Findings were shared in a feedback meeting that was attended by 224 participants from 112 districts. - Cold chain maintenance was conducted in 112 districts to ensure that the vaccines are kept in optimal conditions. - Conducted Comprehensive review of the Immunization Program and PCV 10 post introduction evaluation (PCV-10 PIE) as recommended by WHO. Environmental Health and Sanitation - IEC materials on hygiene and sanitation were finalized and are due for distribution and dissemination. - 89 districts received funds from District Sanitation Conditional Grants, an average of UGX 23 million. Most districts used the money to carry out Community Led Total Sanitation (CLTS) triggering of communities and follow up of triggered communities to ensure they become Open Defecation Free (ODF), while some districts carried out home improvement campaigns aimed to get 100 latrine coverage in the target communities, with improved homesteads and attainment of ODF status. - During FY 2014/15, UGX 2.18 bn (USD 764,774) was disbursed to 30 districts supported by the Uganda Sanitation Fund Project. A total of 2,046 villages were triggered during the FY, with 549 (27) becoming ODF. Over 4 years, a total of 6,026 villages have been triggered with 2,534 villages (42 of those triggered) reported to be ODF. - During FY 2014/15, UNICEF provided UGX 548 million to 16 districts to support school sanitation and CLTS implementation. A total of 182 villages were reported to have been triggered with funding from UNICEF. - There was increased advocacy and as a result, leaders from 60 districts signed commitments to implement hygiene and sanitation resolutions. A total of 72 villages were able to achieve 100 latrine coverage and access to hand washing. 61

- With support from SNV project working with local NGOs, on rural sanitation in 7 districts in West Nile region and 8 districts in the Rwenzori region, 1,047 villages have been triggered, of which 472 villages (45) have been declared ODF after one year of implementation. - The National Hand Washing Initiative (SNV is the new Secretariat) revised the Behaviour Change Communication (BCC) campaign and tool kit. Translated BCC campaign materials are available on request at the Hand washing secretariat (Visit www.handwashing.ug for details). - The access to hand washing facilities at the toilet is estimated at 33.2 and improvement from 21 five years ago. The best performing districts were Mbarara (93), Bukomansimbi (78), Kyenjojo (78), Moyo (78) and Kumi (75). The worst performing districts included Butaleja, Kaabong, Kiboga, Moroto, Nakapiripirit and Napak. These districts have both low sanitation and hand washing coverage, with no ODF villages. Most rural households cannot afford to make a lump sum payment for the improved sanitation. To address this, several financing institutions have developed financing mechanisms to finance sanitation e.g. Post Bank Ltd. lent out UGX 931,460,000 to 370 people over a period of 1 year for sanitation, under its WASH loan. - According to the district reports the pupil: latrine stance ratio is 1:67 and this is a marginal improvement on what was reported last year. Only 7 districts meet the national target of a pupil: latrine stance ratio of less than 1:40. During FY 2014/2015, Kampala City Council Authorities (KCCA) constructed toilets in public schools and the pupil: stance ratio improved from 67:1 to 53:1. - UNICEF supported the construction of 23 latrines with 115 stances at primary schools in Kabarole, Lira, Ntoroko and Mukono, serving at least 4,600 pupils and constructed an 18 stance Biogas producing latrine in Tororo serving more than 720 pupils with sanitary facilities and cooking gas. 62

- Support was also extended to the Appropriate Technology Centre through the Ministry of Water and Environment (MOWE) towards the establishment of a low cost sanitary pad making project, so far covering 2 schools in Mukono district. FIGURE 14: POST BANK ASSESSED HOMES AND WASH LOANS PROVIDED FIGURE 15: THE IMPROVED LATRINE FACILITIES CONSTRUCTED AFTER PROVISION OF THE WASH LOANS (Photos courtesy of Post Bank Soroti) Vector Control - Launched tsetse and trypanosomiasis sleeping sickness Awareness regional information centre for six districts in northern Uganda. - Schistosomiasis baseline surveys conducted in Kibuku, Bukedea, Nakapiripirit, Napak, Zombo, Lyantonde, Sembabule and Sheema districts; Schistosomiasis Impact assessment surveys conducted in Busia, Kaberamaido, Serere, Soroti, Kamwenge, Rubirizi, Gomba 63

and Mpigi districts; Trachoma impact assessments conducted in Moroto, Kabong, Nakapiripirit, Amudat, Napak, Agago, Pader and Kotido districts. - Conducted trichiasis surgeries in 17 districts of Busoga region and Karamoja regions, The NTD Secretariat launched the Trachoma Action Plan. Veterinary Public Health - Conducted support supervision of hospitals in laboratory diagnosis of brucellosis in 10 districts in central and eastern Uganda was conducted. Health Education and Promotion - High level visit with key partners that included, UNICEF, WHO, World Vision, PACE, IRC and MoH was conducted in Sheema. - One dissemination meeting held for religious leaders. - Over 50,000 posters 10,000 leaflets developed, and printed on Marburg, Typhoid and cholera, lifesaving commodities, teenage pregnancy, Family Planning; disseminated IEC materials on Ebola, Marburg, Typhoid, cholera, Family Planning in 60 districts in western and eastern regions. - Carried out community film show sensitisations on Marburg outbreak, Safe Male Circumcision, EMTCT, Family planning, Ebola and ANC services in 50 districts. - Trained 40 district leaders namely; DHEs and surveillance Focal Persons, Health workers, and VHTs from districts bordering South Sudan on Viral Hemorrhagic Fevers from Southwest and northern. Disability and Rehabilitation - World sight and White Cane day cerebrated at Kampala Naguru Hospital; Older person s day cerebrated in Yumbe district; Disability day cerebrated in Kayunga district. - Radio programs on refractive errors evaluated in Arua, Yumbe, Moyo and Mbale districts held. Also held a workshop to finalize the draft Advocacy Strategy on refractive errors in Kampala. - Held regional trainings on Leadership and governance for Child Eye Health in (Kampala, Mbale Mbarara and Gulu); carried out capacity building of (12) Clinicians and (16) Technicians in wheelchair assessment, fitting and maintenance at LDS Church Kampala. - Received 270 wheelchairs for People With Disabilities and distribution still ongoing, MoH and Uganda National Bureau of Standards reviewed and passed the National Wheelchair Standards and Guidelines 2015 version. - Ophthalmic Clinical Officers Conference held in Mukono district. 64

Non-Communicable Diseases (NCDs) - NCD survey has been finalized in 2015 and report is being written for dissemination. - Developed a draft NCD policy, strategic plan which is being costed, NCD training materials for health facilities and recording tools for health facilities, draft NCD guidelines on diet and physical activity; draft NCD IEC materials. - Procured medical equipment for health facilities. - NCDs regional trainings conducted in the central, western, eastern and northern regions. - NCDs patient education meetings held in HC IVs, RRHs and NRHs. - Screening of NCDs has been done in Entebbe and the State house - Nakasero. Over 300 people were screened for NCDs at both gatherings. - Community sensitization workshops for leaders in the western region converging political leaders; RDC, CAO, LC V chairmen and their executives etc., religious leaders, VHTs, cultural leaders and district officials. Community sensitizations on NCDs through drama done in Entebbe. School health programme - Sports competitions in schools (both primary and secondary) been conducted in the Mukono and Mbarara district. Six schools per region participated with a total of 126 pupils per region. - Drama competitions in schools (both primary and secondary) in the Wakiso and Kamuli district. Six schools per region participated with a total of 200 schools per region - Health education talks in schools in 3 school in Wakiso,1 school in Isingiro and Kamuli district. Public Oral Health and Hygiene - Technical support supervision on public oral health and hygiene (33 in Eastern, 21 in Western, 20 districts in Northern). - Supervision on implementation of the National oral health policy was done in Masaka, Rakai, Kiruhura, Mbarara, Lwengo and Kalungu Districts. Health Education and Promotion - 2,500 spot messages disseminated on 66 radio stations, 4 TV stations and 2 newspapers on Marburg, Ebola, Typhoid, cholera, family planning and teenage pregnancy. - Held 2 orientation workshops for community leaders on Marburg/ Ebola prevention and control strategies in central, western districts. - 15 press conferences on Marburg outbreak and Ebola, typhoid, teenage pregnancy, and Fistula, family planning. 65

- Rapid response provided to Marburg outbreak in Kampala, Kasese, Mpigi and Kamwenge districts. - Cholera in Kasese and Moyo districts and typhoid in central region contained. - Emergency technical supervision done in the districts of Kampala, Mukono,Wakiso, Kasese, Busia, Buliisa, Kayunga and Mbale. - Ebola sensitization and elaboration of the National Ebola Preparedness Workplan in 5 districts in Ruwenzori region conducted. Challenges noted in 2014/2015 Inadequate funding Shortage of human resources Importation of infection from neighboring countries. Slow behavior change 3.1.5 Communicable Disease Prevention and Control Control of Diarrheal Diseases Key Achievements - 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). Epidemic Disaster Prevention, Preparedness and Response As a result of successful implementation of the above planned activities the following achievements were registered: - Resettlement of Sudanese refugees in Northern Uganda: The sector worked with other stakeholders to resettle over 60,000 Sudanese refugees in refugee camps in Northern Uganda. These refugees are still hosted mainly in the districts of Arua, Adjumani and Kiryandongo. - Control and prevention of Meningococcal meningitis outbreak: an epidemic of meningococcal meningitis was detected, confirmed and controlled through immunization of most at risk communities in Arua and Adjumani districts. - Mitigation of the deadly floods in Kasese district: Kasese district was affected by serious floods during the month of may 2014. During this period the district was supported to 66

strengthen preparedness against epidemics as result no disease outbreak was registered due to floods. - Control of cholera outbreaks in Moyo and Namayingo districts: During the 4 th quarter of the financial year 2014/15, the two districts reported outbreaks of cholera in villages along the shores of the Nile and Lake Victoria respectively. These outbreaks were as result of poor sanitation and hygiene in these communities. Detection was quick for both outbreaks and control achieved to zero cases within two weeks of confirmation of outbreaks. A total of 78 cases and 4 deaths and 110 cases with 2 deaths were recorded in Moyo and Namayingo districts respectively. Efforts to consolidated activities to prevent similar outbreaks in future are ongoing in these districts. - EAPHL Project Steering Committee meetings, Regional Advisory Panel meetings, Regional TWG meetings and Viral Hemorrhagic Fever simulation meetings were organized and attended members from all the 5 East Africa Member States. HIV/AIDS Prevention and Control The AIDS Control Program registered significant achievements in the reporting period. With respect to prevention, the following outputs were made; - Facilitated quarterly BCC TWG Meetings and worked with UAC based message clearing house to review and provide guidance on quality improvement of HIV messages. - Developed and disseminated tailored print and electronic messages. With support from Communication for Healthy Communities, the OBULAMU Campaign messages were developed and disseminated. These messages were disseminated through billboards, posters, brochures, radio and TV. - Conducted tailored time bound BCC Campaigns namely Protect the Goal targeting young people using sports. This Campaign was launched by his Excellency the President. - Conducted 4 Regional EMTCT Campaigns for West Nile (Arua), East Central (Jinja), Mid-Western (Hoima) and Central (Masaka) regions with the office of the First Lady. - The Comprehensive Condom Programming strategy was reviewed. - A total of 172, 201,292 (56 of estimated national need) condoms were procured and distributed in the country. - Held a meeting of 25 districts which were identified as poorly performing in emtct using the indicators for- provision of ART to mothers, ARVs for prophylaxis to babies and MTCT positivity rate among babies tested. - Developed a draft protocol and initiated a process to measure the impact of the emtct program in Uganda with support from the AIDS Development Partners and Implementing Partners and the global Interagency Task Team for emtct to This study will help measure the attainment of the Uganda emtct plan. 67

- The program developed a draft policy for tetanus immunization in response to the tetanus adverse events. In the new policy, there are proposals for booster immunization doses for target eligible males, which will be costed. - Introduced viral load monitoring through a centralized viral load laboratory at CPHL supported by the sample transport network. Since August 2014 to August 2015, a total of 132,000 viral load tests have been conducted. - The Early Infant Diagnosis (EID) has continued to scale up services and last year over 98,000 tests were conducted and over 70,000 babies from 2,239 health facilities. - Conducted the 2014 round of the annual sentinel surveillance survey. - Worked with partners to prepare a protocol to conduct the 2015-2016 Population HIV Impact Assessment.. The protocol is now ready and will be submitted to Institutional Review Boards at the Uganda Virus Research Institute, and to partner IRBs at the Centers for Disease Control (Atlanta) and ICAP (New York). - Quarterly TWG meetings for the BCC/IEC, Most at Risk Populations, ART/PMTCT, and Condom TWGs were conducted to provide coordination to stakeholders. - Conducted a technical review of the Public health response to the HIV and AIDS epidemic. The review brought together- AIDS development Partners, RPMTs, 112 DHOs, and Implementing Partners. - The AIDS Control program and the NTLP spearheaded the development of the joint TB- HIV Concept Note of the Global Fund New Funding Model and obtained over 171 million dollars for the period 2015-2018. The grants for these funds were signed in June and became operational in July 2015. - The AIDS Control Program provided technical input and reviewed the processes of the preparations for the PEPFAR COP15 process. The COP 15 will form the basis of the USG implementation for the FY 2016/2017. FIGURE 16: NUMBER OF ACTIVE ART CLIENTS IN THE COUNTRY: 2003 DECEMBER 2014 68

Performance against the key program indicators - In 2014/15, 688,313 men were circumcised. To date a total of 2.4 million men have been circumcised since the program was initiated. - The percentage of people who are on ARVs increased from 53 in 2009 to 750,896 (56) by 2014 of those in need (adults 694,627(58) and children 56,269 (38). This coverage is based on the new HIV prevention and Treatment guidelines in which the number of people in need has gone up significantly. This coverage is based on the new HIV prevention and Treatment guidelines in which the number of people in need has gone up significantly. If this had been calculated based on the old guidelines the coverage would be in the range of 85. - HCT services available in all health facilities up to HCIIIs and to about 30 HC IIs (38 of health facilities with HCT services). All districts are implementing community level HCT; however, this is entirely dependent on the support from partners. - PMTCT services 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). - The proportion of HIV infected pregnant and lactating mothers enrolled on ARVs for emtct increased from 52 in 2011 to 112,905 (95) in 2015. - The number of people who tested for HIV in the reporting period was 10,273,927 out of a target of 7,421,024. Most of these tests were conducted in health facilities based on the PITC approach. The proportion of population who know their HIV status were last determined in the 2011 AIS and was 45 for men and 66 for women. This indicator will be determined again in the PHIA next year. - Access to ART services increased through accreditation of more sites. The number of health facilities providing ART increased from 407 in 2011 to 1,658 by the end of 2014 - Reduced the number of health facilities reporting stock out of HIV commodities (HIV Test kits and FDC ARVs for emtct) from 50 in July 2013 to less than 3 in December 2014. Challenges Human Resources: The withdrawal of USG funding to Human Resources for the AIDS Control Program has affected program performance. The morale of staff previously funded by the USG through CDC support has gone down. A number of Senior staff have left their posts Funding Gaps: Funding for the AIDS Control Program activities was a challenge in the last year. Funding from Government to the Program has remained sub-optimal mainly as a result of the history of previous donor funding. The New funding regulations from USG meant that resources from USG are not available to support many of the planned activities which are now deemed unallowable. There are also funding gaps for HIV and AIDS 69

Commodities including HIV test kits, Safe Male Circumicision Kits, Laboratory commodities and drugs- ARVs and co-trimoxazole. TB and Leprosy Prevention and Control Program Progress on implementation of planned key activities - Construction of the National Tuberculosis Reference Laboratory is ongoing at Butabika. The physical structure is due for completion by end of the year 2015. - 20 more GeneXpert machines were procured bringing the total to 102 machines that are at various stages of being installed and put to use. - Trained staff from 89 health facilities in MDR-TB management centres to provide follow-up treatment; trained health workers in SPARS (Supervision, Performance Assessment, Recognition Strategy), which includes Logistics Management Information System to assure good stock management for anti-tb medicines and supplies, - IPT guidelines were developed and disseminated to all TB diagnostic and treatment facilities in 7 regions. - In collaboration with ACP, the NTLP strengthened systems for HIV/TB based on the One Stop Centre model through support supervision and mentorship. - Sustained community-based directly observed therapy (CB DOT) through support of CSOs and Community Based Organisations (CBO) by TB and TB/HIV IPs and support from the Global Fund. - Conducted four quarterly reviews to quality assure data and assess performance of the progress; improvement actions identified were implemented for continuous improvement of programme performance. With support from IPs, trained all Zonal TB/Leprosy Supervisors and staff in selected health facilities in data quality audit (DQA). Revision of recording and reporting tools was finalized and tools were integrated in the DHIS2. TABLE 41: PERFORMANCE ON TB OUTCOME AND OUTPUT INDICATORS Indicator HSSIP Baseline 2010/11 2011/12 2012/13 2013/14 2014/15 TB CNR 10 increased - 79.0 78.2 75.4 70.2 71-2014/15 target TB CDR increased 57.3 39.8 39.2 38.6 36.6 45 70 TB CR increased 32.0 30.0 31.6 33.2 48.8 50 80.0 10 CNR Case Notification Rate; CR Cure Rate; TSR Treatment Success Rate; DOT Directly Observed Therapy; TSR Drug Sensitivity Test; DTU Diagnostic and Treatment Units; CPT Co-trimoxazole Preventive Therapy; ART Anti-retro Viral Therapy. 70

Indicator HSSIP Baseline 2010/11 2011/12 2012/13 2013/14 2014/15 2014/15 target TB TSR - 68.6 69.8 71.3 80.7 79 85.0 TB death rate 4.7 4.7 4.6 4.6 4.9 6 2.5 of TB cases on DOT 48.0 35.7 40.7 46.0 49.5 68 100 of smear positive relapses done DST false negative tests DTUs reduced of TB patients tested for HIV TB/HIV patients started on CPT TB/HIV patients started on ART No. DR-TB patients enrolled on treatment - 86.0 84.0 89.0 88.0 54 75-13.0 11.0 9.0 9.0 - < 5 71.0 79.8 83.7 87.8 93.9 96 100 88.0 92.6 92.8 95.1 97.5 98 100 18.5 27.9 40.0 56.4 74.2 86 50-6 23 96 219 243 100 Performance on most programmatic indicators (CR, TSR, DOT, testing for HIV, TB/HIV on CPT, TB/HIV on ART and MDR-TB enrolment on treatment) improved greatly from HSSIP baseline values. The Programme surpassed HSSIP 2014/15 target for TB/HIV patients started on ART, and was close to achieving targets for of TB patients tested for HIV and of TB/HIV patients started on CPT. The Programmes was not able to achieve targets for indicators related to treatment success and cure rates, perhaps as a results of low adherence to treatment as evidenced by low achievement on DOT. Consequently, TB death rate increased over the HSSIP period. Moreover, CNR, CDR, DST and reduction of false negative tests declined over the period. The achievement relates to inadequate systems for TB case detection, adherence monitoring and testing relapses for drug sensitivity, as well as enrolment of MDR-TB patients on second line treatment 11. Community link services for tracing contacts with TB patients and patients support for adherence are functioning less than optimal due to lack of sustainable funding. This also affects follow-up of MDR-TB patients for enrolment into care and treatment. Major challenges Unknown burden of TB in the population: this affects accurate setting of targets for coverage and treatment outcomes. 11 Report of Joint External Review of National TB Programme in the Republic of Uganda, 2013. 71

Inadequate resources allocated for implementation of supportive activities for TB/leprosy control: for over half the HSSIP period, implementation of supportive activities that enhance programme performance was very limited due to severely reduced funding. Building capacity for nationwide rollout of programmatic management of MDR-TB: inadequate funding for supportive activities during the review period stagnated roll-out and setting systems for MDR-TB management. Sustaining awareness about the detection of leprosy among health workers and communities, and active search through screening of contacts with index cases in the households and community are the mainstay method for early detection, prevention of disability and further infection spread by isolation of cases. The long insidious onset of symptoms makes early detection and prevention of disability due to leprosy difficult. As a result, patients and health workers recognised leprosy late, when the disease has progressed to irreversible disability. Malaria Main achievements - Indoor Residual Spraying (IRS): IRS has now been shifted to 14 new districts in the Lango and East central districts - Launch of the larviciding project activities and community sensitization. - Conducted a Malaria Indicator Survey (UMIS). The 2014 showed impressive results/achievement in malaria control in Uganda. The national prevalence of malaria has dropped from 42 to 19 since 2009. - Received funding from the GF NFM of 121 M USD for the period 2015-2016 following a successful Concept Note application process. Implementation of activities on-going - Completed a Malaria Operational Planning exercise for FY 2016 funding by USAID/PMI. Developed a M&E Monitoring Plan for the UMRSP - With support from DFID developed a USD 12.4 M Capacity Development Plan for the NMCP that aligns with the UMRSP 2014-2020 - Produced four quarterly malaria bulletins highlighting important interventions coverage and routine and surveillance data trends - Integrated support supervision was done in selected health facilities in all the districts of the country. - Cross cutting supporting interventions including advocacy, social mobilization and behavioural change communication, monitoring and evaluation, drug efficacy studies and drug resistance monitoring were conducted. 72

FIGURE 17: NATIONAL MALARIA PREVALENCE FIGURE 18: TRENDS IN ITN OWNERSHIP AND USE Laboratories - Critical laboratory equipment were installed and made operational at the EAPHL 5 project sites (Mulago, Mbale, Arua, Mbarara and Lacor Hospital. - In line with the Stepwise Laboratory Improvement Process Towards Accreditation, one round of independent laboratory assessment was conducted in November 2014 and laboratory audit was carried out by the African Society for Laboratory Medicine in January 2015. - Health workers have been trained on a number of topical areas. One hundred (100) health workers were trained in laboratory information management system and 35 in internal audit. - Plans to conduct operational research on Malaria, TB and Enterics were initiated. Research teams were trained, sites prepared for data collection and data collection was expected to start in August 2015. Money for the activity was disbursed to the Principal Investigators. 73

- Laboratory mentorship was conducted at the 5 satellite sites. This was done in each of the 4 quarters by the 6 project laboratory mentors. - Critical laboratory equipments were procured and installed at the satellite laboratories; and are now functional. - Developed Laboratory Information Management System - Cloud based video conferencing equipment procured and installed at Mbale, Mbarara, Lacor and Arua Hospitals. Endemic and epidemic disease control services - No cross border outbreak occurred. 2 cross border meetings held in Kenya and Uganda. VHF table tops simulation of all EAC countries including Democratic Republic of Congo. - 30 health workers from Bugiri district trained in IDSR. - Study sites prepared and Arua to start operational research on Malaria, TB and Enterics in Sept 2015. Nursing Department Achievements - Conducted, 8 technical Support supervision visits to 2 NRH, 4 RRHs, 14 GHs and 5 HC Vs. - Carried out one integrated support supervision in Kotido and Kaabong districts supported by UNFPA. - Two QI mentorships conducted in Mubende and Kabale RRH. - Nurses and midwives addressed on issues of absenteeism, attitude and discipline and nurses and midwives scheme of service. - Consultative meeting for nursing policy held. - With support from AMREF, the department trained 10 midwives in Leadership, management and Governance; trained 12 health facilities in the concept of 5S. - Celebrated nurses International Day, Midwives International Day and International Women s Day - Held 3 nurse leaders meetings at wellness center in Mulago complex - Reviewed midwives curriculum 74

3.1.6 Semi-Autonomous Institutions Uganda Virus Research Institute (UVRI) During the financial 2014/15, UVRI; - Provided 4,014 sites with DTS PT, sprayed 9 villages in Arua, Nebbi and Zombo which reported plague cases and/or with rats, - carried support supervision and monitoring in the 4 UVRI field stations, - completed phase 2 of the national HIV testing algorithms. - extended the repository and stores in preparation for HIA, an inverter house, renovated the Rockefeller building, constructed a training center with WT funds, - Provision HBV diagnostics, - research on-going (Rota virus, HIVDR, AFP due to NPEV, Zoonoses among others), - more equipment for Influenza installed & commissioned. Uganda Cancer Institute (UCI) In FY 2014/2015 UCI; - Conducted 3,600 against the targeted 3,990 new patient admissions, 50 Oncology surgical, 44 major surgical operations and 120 minor surgical operations were performed. - 17,029 Chemotherapy reconstitutions were provided and 602 bone marrow aspirates and biopsies safely performed. - Through static cancer clinics and outreaches, a total of 7,181 persons were screened for cancer; with 2,980 screened for breast cancer, 1,975 for cervical cancer, 573 prostate cancer, 336 for other cancers including hepatitis B and other chronic illnesses while 337 were referred for further care. - 16 Visiting Nursing officers, 35 Students involved in screening were enrolled for training in cancer screening. - Carried out 225,000 Education messages and awareness campaigns which included radio announcements and TV programs. - Primary designs of the radiotherapy Bunker that will house all imaging equipment necessary for cancer imaging services, were completed and the final process for development of the designs is almost complete. - The new six level cancer ward has been completed and is being equipped so as to reduce the current level of congestion at the Institute. - The UCI Bill is being developed through supporting benchmarking studies with similar or related outputs. 75

Challenges Inadequate stocks of essential medicines and anti cancer drugs. Inadequate supply of key specialized sundries like bone marrow needles. The lengthy procurement process delayed the final signing of contracts and delivery of the various equipment(s) that were procured. Uganda Heart Institute (UHI) Key achievements of UHI were as follows; - Conducted 90 (ninety) open heart surgeries out of the planned 100, the variation was as a result of delayed procurement process of specialized equipment which was delivered towards the end of the FY. - Performed 240 closed heart surgeries performed out of the planned 250, the variance was as a result of delay in recruitment of critical staff delayed thus gross understaffing during the first three quarters. Secondly, the delayed procurement process of specialized equipment that was delivered towards the end of the financial year contributed also to the lowered performance target. - Performed 9,450 ECHO s out of the planned 12,000 Echocardiography due to similar reasons mentioned above. - Conducted 261 cath-lab procedures as compared to the planned 400 procedures. - Out of the targeted 260 stress tests, 246 stress tests were performed, 87 out of the planned 100 pacemakers were performed, and 134 out of the planned 200 Holter monitoring were conducted. - A total of 17,109 (136.8 of the target) outpatients were seen, this was over and above the planned number for the period. That was as a result of high patient demand. Similarly, 1,663 (166.3) patients were admitted above the planned. - Facilitated expatriates for short term transfer of skills to local cardiologists and surgeons for heart surgeries. Cath-lab and surgical staff were trained in cardiology and cardiothoracic surgery. - Carried out support supervision to the 14 RRHs and to 120 specialized groups. Challenges Delays in procurement of the necessary equipment, most of which were only received towards the end of the FY. Delay in the recruitment process of the necessary staff by the Health Service Commission led to failure to fully operationalize the equipment and available resources. 76

Uganda Blood Transfusion Services (UBTS) Key achievements for UBTS during 2014/15 FY were; - 235,407 units of blood were collected against a target of 254,100 (92.6) and voluntary blood donation still stands at 100. - Arua and Masaka received Architect machines for testing blood. - Improved supply of quality blood products through testing all blood for TTIs and continued to operate an effective nationwide Quality Assurance program that ensures safety of the entire Blood transfusion process from vein to vein. - UBTS is working towards Africa Society of Blood Transfusion (AfSBT) Accreditation. - Blood distribution centers in Hoima, Masaka, Kabale, Rukungiri, Jinja and Soroti were established. - Expanded blood collection capacity to operate adequately within a decentralized health care delivery system; 20 mobile blood collection teams are in place plus 2 new teams created in Lira and Angal to make it 22 blood collection teams. - Introduced the Community Resource Persons program for mobilization of communities to donate more blood rather than relying on schools as our major source of blood. FIGURE 19: BLOOD COLLECTION FOR FY 2004/05 TO 2014/2015 According the information above which was captured from the blood and blood utilization survey, most of the blood goes for maternal and child health conditions (60) which includes anemia, surgery, hemorrhage, PPH followed by internal medicine and surgery (36) which includes malaria, cancer, HIV and anemia. According to the graph, UBTS is able to supply about 68 of the total blood requests by all health facilities in the country by type (2012/13 FY). 77

The main challenge faced by UBTS is the increase in demand for safe blood transfusion due to the improved health care delivery system in Uganda especially for Heart Surgery, Cancer treatment, HIV/AIDS related illnesses. Thus UBTS has an important task of meeting this increased demand which require additional resources. Uganda National Health Research Organization (UNHRO) Key Achievements 2014/15 - Policy, consultation, planning and monitoring services done; 2 out of 4 Board meetings held. Held stakeholder consultations on preparatory initiatives by IAVI to develop a vaccine in Uganda. - UVRI Strategic Plan finalised, the second draft UCI Strategic Plan 2014/17 developed. - Developed priorities on research agenda in collaboration with the CDC and Makerere School of Public Health. The second revised draft was discussed by a stakeholder seminar held May 2015. - Revised Ethical standards for research involving human beings finalized and launched July 2014 at 6 th ANREC; organized and prepared the 7 th Annual National Research Conference on Ethics. - Developed data base/inventories for on-going research in country: Collected, collated and analysed technical, location and expertise in on-going health research. - Information sharing and Knowledge translation of findings into policy done: 127 scientific manuscripts were prepared and cleared for publication in international journals; a national workshop to discuss better HIV laboratory services and improved delivery was held in March 2015. DG/UNHRO published titled Managing Ebola from rural to urban slum settings: experiences from Uganda in March 2015; The book was launched by HE President Museveni on May 1, 2015 during the Labour Day celebrations in Kisoro; Malaria- discussed with stakeholders the effectiveness of mass drug treatment for the control of malaria; Reproductive Health 2 workshops held to discuss the three options from research systematic reviews that could improve RH indicators. The three options were: i) strengthening services at HC III ii) extending delivery to HC II and III) application of ambulatory facilities and accommodation pre delivery. - Three grants proposals (Malaria, HIV/TB, Ebola were developed and submitted to EDCTP and WHO for funding; Memorandum of understanding between UNHRO / Busitema University being developed. National Medical Stores - Continued with the Procurement and Distribution of Vaccines. 78

- Procured and distributed hospital mattresses to all GHs and HC IVs. - NMS finalised the acquisition of 10 acres of land at Kajjansi. This land is intended for immediate expansion of NMS by building a new state of art Warehouse and Administration block. The Construction is due to begin in FY 2015/2016. - NMS pioneered and experimented the therapy for treatment of Jiggers. This was tested and found effective. It is awaiting the roll out by the MoH. - Two more Customer Care Regional Offices were opened and adequately equipped with Human Resources and other tools of operations, in Arua and Moroto. This brought the number of Customer Care Regional Offices to Nine, which has brought NMS much closer to its clients. - As part of Corporate Social Responsibility (CSR), NMS finalised the Procurement of an Oxygen Plan for Mbarara RRH. Installation is expected to be completed by October 2015. National Chemotherapeutics Research Institute - Laboratory evaluation of medicinal plants materials collected is ongoing. (Mitiyana analyses completed). Follow up of patients and review of patient records to be done (Emmanuel and Mitiyana sample). - 200 THPs, VHTs and Community leaders trained on Herbal medicine manufacture and value addition in line with the NDA guide lines for regulation and sale of herbal medicines; 100 THPs, VHTs and traders in Herbal medicines in Wakiso and Kampala districts trained on herbal medicines regulation and standardization. - 40 THPs trained on conservation of medicinal plants; 23 endangered medicinal plants documented, and collected for laboratory evaluation and herbarium specimen collection; 8 medicinal plants were scientifically identified. - Baseline assessment of nutritional needs conducted in Wakiso and Jinja districts. - Baseline survey conducted in Kampala on 20 herbal drug outlets and information disseminated to researchers. 3.1.7 Regulatory Bodies National Drug Authority (NDA) - Dossier evaluation conducted and approved 196 Human & 30 veterinary drugs for registration - Inspection and Licensing of pharmacies and drug shops was done; 943 pharmacies were inspected of which 938 pharmacies were approve and done; all previously licensed drug shops was were inspected of which 7,534 (75) drug shops were licensed. 79

- Inspected facilities for Good Pharmacy Practices (GPP); 1,002 (100) outlets were inspected, out of which 486 were certified. - Post Marketing Surveillance and Support Supervision activities conducted; 3,613 drug outlets and clinics were inspected countrywide, 935 outlets were closed for various reason, including clinics displaying medicines, illegal operations, and unsuitable premises. - Conducted 100 cgmp inspection of foreign pharmaceutical manufacturing sites; 102 foreign facilities were inspected, 81 reports were presented, 21 reports pending presentation, and 27 complied through document review assessment. - Conducted GMP inspection of local private manufacturing facilities; 14 local facilities were inspected; 08 facilities were licensed. - Processed verification certificates for drug imports and exports; 7816 Verification certificates were issued, of which Imports for unregistered drugs=884, Provisional import permits=579, Exports=251 Narcotic/psychotropic substances Permits=81 Queried=142. - Inspection of drugs at ports of entry done; 4,659 consignments inspected of which: - Released: 4,548 Rejected: 5 Queried: 106 - Testing of samples (drugs, condoms and medical gloves); Tested 188 drug samples of which 177 passed the tests done and 11 failed tests were done. Tested 360 condom samples; 328 passed and 32 batches failed. Tested 146 glove samples of which 134 Passed and 12 batches Failed, Tested 74 LLINs and all passed. - Sensitized health workers on drug regulation, ADR monitoring & reporting. In total, 1061 health workers were sensitized in various parts of the country. 165 health workers from private drug outlets were sensitized. - Management of ADR reports done; 471 reports received of which 167 were entered into Vigiflow. - Established and maintained a database for promotional materials. Received at least 80 promotional materials, vetted and entered in the database; 144 applications were approved, 4 applications were rejected. - Evaluated Protocols for clinical trials. Received - 32 applications, Approved 27 applications & Rejected 05. 4 expert reviewers co-opted to review BCG Trial. Conducted site visits to JCRC Kampala, Fort portal, Mbarara, MRC sites in Masaka and Kyamulibwa, IDRC Tororo and Mbale Hospital. - NDA/National Food and Drug Administration transformation process fast tracked. Presented to Cabinet & obtained approval of additional Principles for the proposed NFMA Bill. Challenges - Gaps in the NDP&A Act - Inadequate office space and storage facilities have remained a challenge especially in light of proposed staff increases. 80

- Staffing and motivation of the regional pharmacovigilance centre coordinators remains a challenge. The coordinators are MoH employees and are routinely transferred causing a high turnover and need for more support supervision and orientation. - Increasing litigation against NDA by stakeholders. Uganda Medical and Dental Practitioners Council (UNMDPC) The following were the achievements of the UMDPC; - Assessed 36 foreign trained doctors for using theory and clinical exams and 13 foreign, trained specialist Doctors (Peer Review) for purpose of registration - Conduct 5 field operations for investigations and 3 cases are I court while 2 are at police - Developed one tool on standards for HU inspections and was applied pretested in 16 districts - In collaboration with other Professional Councils we supported the formation and operations of 8 District Health authorities in Karamoja while 8 were supported in Teso region. - Printed and distributed 4,690, copies of literature on what constitutes professional misconduct and the subsequent punishments. - Produced 6,632 copies of the Act and 4,690 copies of guidelines on complaints. - Two Regional ethical sensitization meeting; Conducted university ethical sensitization. - Supervised and inspected 280 out of the 400 targeted health facilities in Kampala and 370 out of planned 900 health facilities upcountry. - Hosted 22 against 30 cases on medical inquiries. - Carried out Community sensitization 4 TV shows and 12 Radio Talk shows. Pharmacy Council - Enforcement of adherence to professional standards and ethics in Jinja, Bugiri, Iganga, Mbale and Soroti. - Registered of 78 newly qualified Pharmacists. - Practice standards enforced in 12 districts. - One quality assurance visit to Pharmacy Schools and Internship Centers. Allied Professionals Council Achievements of Allied Professional Council over the reporting period are: - Nine Health training institutions were inspected. - The registrar s office carried out support supervision to four (4) regional offices (Mbale, Jinja, Masaka (Entebbe, Wakiso, Buikwe) and Soroti) to evaluate their functionality and to sensitize professionals/ and employers on council mandate. - Quality Assurance officer supported inspection of Medical laboratories in Serere, Kampala, Gulu, Arua, Kabale, Lira, Kabarole and Hoima. 81

- Registered and Renewed 1,221 units against the 1,500 Allied health units planned annual output target. - Renewed Annual Practicing Licenses of 12,025 professionals more than the 10,000 annual planned output target. - Registered 3,035 professionals compared to 2,791 annual planned output target. - Registered 357 Labs against the 951 annual planned output target. - Inspected 2,669 health facilities countrywide compared 1,365 annual planned output target. - Conducted and concluded 10 disciplinary investigations for negligence, misconduct or malpractice and 5 cases are ongoing. - Supported professional Career development in 17 professional Associations compared to 20 professional associations Annual planned output target. - An up-to-date register of allied health professionals was gazetted and 200 copies distributed to relevant stakeholders. - Supervisory authorities at all Regional and National Referral Hospitals were appointed and oriented. Uganda Nurses and Midwives Council Achievements during the period under review - 5,518 registered and enrolled of 5,472 registered on first attempt and 46 went through attachment. - Registration of Nurses/midwives trained outside Uganda were 43 applied but 35 registered and 8 are undergoing orientation. The applicant were from German, India, Serbia, Britain, Korea, Netherland, USA, Tanzania, Italy, Philippine, Pakistan, Canada & Japan. - Establishment and renewal of private maternity homes, domiciliary and clinics the total was 400 facilities of which 50 were new and 350 were renewals i.e. 386 midwives, 37 new and 349 renewals. - Establishment and renewal of private general clinics of 100 facilities i.e. 30 were new while 70 were renewal i.e. 93 nurses, 26 new,67 renewals. - Conducted Technical support in 2 regions: Central (Mukono, Buikwe, Nakaseke, ) and near East (Jinja, Kamuli and Iganga. Institutions visited: Mukono Diocese NTS, Mukono HC IV, Mukono COU Hospital, Lugazi NTS, Kawolo Hospital, Kiwoko hospital & Kiwoko NTS; Jinja NTS, Jinja Hospital,International Institute of Health Sciences, St. Joseph Hospital Kamuli, Buwenge HC IV. - Inspection of health units in Eastern Region Jinja, Iganga, Mbale and Soroti districts by the 4 health professional councils. - 8 schools were inspected to assess suitability to commence training for nurses and midwives at St. Johnas International School Buikwe; Mityana Institute NTS Mityana; St. 82

Joseph Hospital School of N&M Kitgum; Uganda Martys Institute, Luuka;, Access school of Nursing Nakaseka; NESDA Sch of Comprehensive Nursing Bugiri; Bweyale NTS Bweyale; Maracha NTS Maracha. (only 2 accredited). - Schools intending to start new N&M programmes 4 schools visited: Kamuli NTS, Nkumba University, Gulu University School of Nursing, Iganga School of Nursing, Ibanda NTS, Lacor school of Nursing, and Rakai Comp. school of Nursing (none accredited). - schools inspected provisionally licensed schools to ascertain sustainability for full registration: Lira Constituent College; Florence Nightingale; Kampala University; Kyetume school of Nursing; St. Johns NTS, Rwashamire; and Ntungamo Health Training Institute; Alice Anume NTS. - Establishment and operationalization of the DHSAs for improving the quality of health service provision 7 districts sensitized and 7 DHSAs established. - Conducted CPD in Moroto, Mbarara, Hoima, Fort Portal, Arua & Soroti RRHs, Princess Diana HCIV, Iriri HCIV and Matany Hospital. - 2 quarterly committee meetings held to review council performances. 02 Disciplinary hearings conducted and cases concluded. 46 DC cases were handled Way forward and recommendations To strengthen collaboration with key stakeholders Recruitment of staff to run the regional satellite centers Mobilize more resources to effectively carry out regulatory mandate 83

3.1.8 PNFP Sub-Sector 3.1.8.1 Uganda Catholic Medical Bureau (UCMB) performance The UCMB is a health department of the Catholic Church in Uganda coordinates, represents, and supports 281 accredited health facilities and 13 heath training institutions. The health facilities comprise of 32 hospitals, 5 HC IVs, 169 HC IIIs, and 75 HC IIs. The total workforce in the UCMB network as at June 30 th 2015 was 8,566 as compared to 8,422 as at June 30 th 2014 reflecting a 1.7 increase in total staffing from last FY in the network health facilities. In the last 5 years there has been progressive increase in total staffing of health facilities in the UCMB network with remarkable increases for LLHFs. The increase is partly due to PEPFAR support for HRH in the PNFP health facilities. TABLE 42: UCMB FACILITY STAFFING Years 2010/11 2011/12 2012/13 2013/14 2014/15 HOSPITALS 5,068 5,355 5,435 5,502 5,618 LLUs 2,522 2,688 2,790 2,920 2,948 Total 7,590 8,043 8,225 8,422 8,566 Source: UCMB Facility Annual Staffing Report Over the last years the MoH or District LGs have supported UCMB health facilities with health workers. In 2014/15, GoU seconded 9 of the qualified clinical health workers to UCMB health facilities. PEPFAR through the USAID/Strengthening Decentralization for Sustainability (SDS) and CDC/Mildmay HRH projects are implementing an HRH partnership project with UCMB in Uganda and they support 5 of the qualified clinical staffing (i.e. 230 health workers) of the entire UCMB network health workforce. The two projects are supporting 89 UCMB health facilities in 92 districts of Uganda with key cadres including Medical Officers, Medical Clinical Officers, Midwives, Nurses, Laboratory Personnel, Anesthetic Assistants, Anesthetic Officers, Pharmacy Assistants and Technicians. This has significantly contributed to health workforce stability, availability of qualified health personnel in hard-to-reach areas and improved staffing levels of mainly rural health facilities. The religious organisations contributed 12 of the clinical health workforce and 2 were expatriate clinicians. Overall, one in three (28) clinically qualified health workers in UCMB health facilities are supported from partners Government, Religious organisations and Donors while the bulk (72) are locally remunerated from internally generated resources. The labour turnover in UCMB health facilities and generally in the PNFP health sub-sector remains high though there has been stability in LLHFs and decreases in hospitals in the last 3 years. In FY 2014/15, average staff turnover in UCMB health facilities was 23--Medical 84

Officers and Nurses topping the departing HRH for hospitals and lower level facilities respectively. Specifically, in the year under review, HRH turnover in UCMB-affiliated hospitals was 15 while in LLHFs was 31. The major reasons for staff turnover in 2014/15 were better Remuneration jobs (25), Disciplinary/Contract termination (22) followed by recruitment by Government and further studies respectively. The outputs from the UCMB hospitals and Lower Levels depict the performance on the most important health indicators used for monitoring the HSSIP III performance for the FY 2014/2015. There are indicators of progressively increased contribution to national outputs. OPD services: New and Re-attendance for Outpatients increased slightly by 1 from 3,074,691 in FY 2013/14 to 3,103,926 in FY 2014/15. Maternity services: Total number of deliveries increased by 3 from 91,238 in FY 2013/14 to 94,356 in FY 2014/15. Child care: The number of immunizations increased by 3 from 1,969,794 in FY 2013/14 to 2,028,888 in in FY 2014/15. In-Patient services: Total number of Admissions in UCMB Facilities decreased by 3 from 449,934 in FY 2013/14 to 436,506 in FY 2014/15. In the a 10-year period, Total OPD attendances in UCMB Hospitals and LLHFs has increased from 1 million to 3 million contacts in a year, maternal deliveries have increased by 36.3, Total Immunisations have increased by 17.8 while Total Admissions have slightly decreased by 1.7 in the same period. The SUO in UCMB Hospitals has decreased by 5 in the last one year while for LLUs has decreased by 8. Over the last 5 years, the SUO has been either stagnant or decreasing. This is due to various factors including general improvements in health service delivery in the country particularly public health facilities. TABLE 43: FAMILY PLANNING SERVICES IN UCMB HEALTH FACILITIES UCMB Hospitals 2010/11 2011/12 2012/13 2013/14 2014/15 Natural Family Planning Contacts 3,250 7,390 5,806 5,684 9,315 UCMB Lower Level Health Units 2010/11 2011/12 2012/13 2013/14 2014/15 Natural Family Planning Contacts 23,648 14,966 12,979 1,659 12,700 Family Planning service delivery in the UCMB Hospitals has increased in the last 5 years while there has been a decline in the Lower Level Health facilities. The factors for reduction in the contacts for Natural Family Planning services in LLUs is mainly due to HRH capacity technical & skill, as well as limitations in reporting of these activities in the HMIS. 85

FIGURE 20: NATURAL FAMILY PLANNING CONTACTS IN UCMB HOSPITALS IN 5 YEARS The significant (64) increase in Natural Family Planning contacts in the Hospitals in the year under review is attributable to the 18-month Natural Plan Project run by CRS/UCMB with support from Georgetown University, USA in 3 Hospitals that was aimed at increasing availability, and accessibility of Natural Methods of Family Planning which included Capacity building, Demand creation and a community involvement approach to service delivery. NFP uptake increased significantly during project period. TABLE 44: UCMB FACILITIES PERFORMANCE IN KEY HIV INDICATORS IN FY 2014/15 Category HCT Number of individuals counseled and tested for HIV and given their results at UCMB facilities during the year. HIV/ART Number of new patients enrolled in HIV care at UCMB facilities during the year. Cumulative Number of individuals on ART ever enrolled in HIV care at UCMB facilities this year. Number of HIV positive patients active on pre-art Care at UCMB facilities. Number of HIV positive cases who received CPT at last visit in the year at UCMB facilities. Number of new patients started on ART at UCMB facilities during the year. Total Number of individuals CURRENT on ART in UCMB facilities. TOTAL NUMBER OF HIV INDIVIDUALS CURRENT IN HIV CHRONIC CARE. Children <15 Years 15 Years and above Total 53,927 614,488 668,415 1,088 15,315 16,403 6,061 72,530 78,591 712 10,016 10,728 5,756 75,868 81,624 1,663 15,304 16,967 5,757 74,715 80,472 6,469 84,731 91,200 The number of persons who underwent HIV counseling, testing and receipt of results in UCMB health facilities in 2014/15 was 668,415 an increase by 27.4 from 2013/14. The improvement was mainly due to increased accessibility to HCT services by children (15 years and below) 86

who increased by 40 in one year. In FY 2014/15, 16,967 new patients were initiated on ART in UCMB health facilities, an increase from 2013/14 by 68.9. The total number of HIV individuals currently in HIV Chronic Care in UCMB health facilities has reduced in the last one year by 42.4 (due to revisions of guidance on initiation based on CD4 count) and a decrease of individuals currently on ART by 14.7 in the same period mainly due to improvement in ART services through accreditation of most HCIII of the public health sector which resulted into more transfer outs, hence the reduction observed. There was an 83 reduction in the number of HIV positive patients active on pre-art Care in UCMB health facilities during the FY 2014/2015 and this was due to the roll out of new HIV clinical guidelines with cut off CD4 increased to 500 from 350 CD4 and it resulted into more enrollment on ART hence reducing the pre-art patient pool. The AIDS Care and Treatment (ACT) Project, is a USG-funded project implemented by the Registered Trustees of the Uganda Episcopal Conference (UEC) through the Uganda Catholic Medical Bureau (UCMB). The project provides comprehensive HIV/AIDS Prevention, Care, and Treatment Services, and strengthens existing health systems in 19 UCMB facilities (Lacor, Aber, Kalongo, St. Joseph's Kitgum, Angal, Nyenga, St. Anthony Tororo, Naggalama, Nsambya, Kisubi, Lubaga, Virika, Bishop Asili, Villa Maria, Comboni Kyamuhunga, Kitovu, Nkozi, Kasanga PHC III and Kamwokya Christian Caring Community). The project health facilities together with satellite health facilities collectively serve a catchment area spanning more than 30 districts, with rural, hard to reach, poor and disadvantaged clients. A total of 160,019 patients were counseled, tested and received HIV test results in FY 2014/15 accounting for 24 of the entire UCMB health facility network for HCT services, 9,648 (6) patients were identified as positive and 6,148 (64) of the HIV positive patients were linked in care. There was an increase by 4 of persons accessing HIV counseling and testing services at the project sites in the last 1 year. Health Financing in the UCMB Network: FY 2014/15 The financial contribution from UCMB health facilities amounted to 148.7 billion shillings in the FY 2014/2015 a 0.5 increase from last FY. The increase in total income was attributed mainly to a 12 increase in User fees collections. GoU subsidies including the PHC conditional grant to UCMB facilities and the MOH- DP Bursary funds for UCMB Health Training Institutions increased to UGX. 13.8 Billion in FY 2014/15 from UGX.12.9 Billion in FY 2013/14 a 7 increase in Government subsidies in the FY 2014/15. This accounted for 11 of the income for UCMB Health Facilities in the FY. In the same period Donor funding reduced by 13. User fees 87

11.04 10.49 11 46.10 48.71 51 42.9 40.80 38 Annual Health Sector Performance Report for Financial Year 2014/15 account for 51 of the Total Income for recurrent operations for UCMB health facilities in FY 2014/15 and Donations accounted for 38. TABLE 45: 5-YEAR TREND OF UCMB HEALTH FACILITIES AVERAGE COST/SUO AND AVERAGE USER FEES/SUO UCMB Hospitals 2010/11 2011/12 2012/13 2013/14 2014/15 Average Cost per SUO 10,254 12,298 14,432 17,544 22,361 Average User Fees per SUO 3,636 5,123 6,169 6,854 10,764 UCMB LLUs 2010/11 2011/12 2012/13 2013/14 2014/15 Average Cost per SUO 2,412 3,224 3,399 3,357 7,280 Average User Fees per SUO 4,653 5,992 5,567 6,308 4,411 User fee collections in Hospitals account for 40 of the recurrent expenditure while in LLHFs support from GoU subsidies PHC-CG contribute significantly to recurrent expenditure which partly explains the decrease in user fee/suo while the cost/suo is high. UCMB LLHFs have been gradually reducing nominal user fee charges through flat-rate user fee charging in some facilities; the level of budget support from government always influences this effort. The external donation both in kind and in cash for recurrent operations slightly decreased in absolute and relative terms of contributions to the UCMB budget by 2 and 3 respectively. TABLE 46: TRENDS IN INCOME FOR RECURRENT COST IN UCMB NETWORK (HOSPITALS + LLHFS) 150,000,000,000 Trends in Income for Recurrent Operations in UCMB Facilities 130,000,000,000 110,000,000,000 37 90,000,000,000 70,000,000,000 50,000,000,000 30,000,000,000 10,000,000,000 (10,000,000,000) 43 35 38 27 30 30 28 50 48 44 15 40 42 45 46 44 28 2 53 47 2 42 68 84 77 16 23 31 30 45 38 30 30 28 24 18 17 13 12 1998-991999-002000-012001-022002-032003-042004-052005-062006-072007-082008-092009-102010-112011-122012-132013-142014-15 Aid User Fees Govt. Subsidies (money and drugs) Source: Bureaux databases 88

In FY 2014/15, the Total Expenditure for UCMB health facilities (Hospitals & LLUs) was UGX. 138 Billion-- an increase by 2.7 from the year 2013/14. UCMB health facilities spent UGX. 37.2 Billion on Medicines & Supplies, an increase by 11.7 from FY 2013/14. Hospitals account for majority (82.9) of this expenditure. A third (34.7) of the Medicines & Supplies procurements were from Joint Medical Store (JMS) which offers affordable financing terms including 3-month credit facilities and last-mile distribution to ensure ready availability of medicines & supplies to health facilities. UCMB Health Facility procurements from JMS have increased by 10.26 in the last one year to UGX.12.9 Billion in FY 2014/15, and efforts are underway to further improve JMS procurements. 3.1.8.2 Uganda Protestant Medical Bureau (UPMB) performance during the FY 2014/15 UPMB is one of the three religious medical bureau networks in Uganda. The bureau is the health technical arm of the Church of Uganda (CoU) and the Seventh Day Adventist Church (SDA). By the end of the FY 2014/15, the Bureau had a network of 283 health units scattered across Uganda Figure 21: Staffing in UPMB hospitals, HC IVs and LLUs UPMB is committed to ensuring that member health facilities meet the recommended staffing numbers across all levels of care. A total of 88 health workers were recruited with support from the Strengthening Decentralization for Sustainability HRH Project and MildMay Uganda to address the challenge (72 and 11 HWs recruited by SDS and MildMay respectively). The staff are distributed across 38 health facilities across the network (31 SDS and 7 Mild May). There is however a sustainability gap anticipated as the Projects support winds up in Dec 2015 and March 2016 respectively. Over the previous three FYs, statistics show an increasing trend in the number of clients seeking outpatient services in UPMB hospitals and HC IVs. The FY registered close to 20 increase in outpatient contacts. Other indicators showing an increasing trend include Antenatal care and Family planning services as well as hospital bed capacities. Immunization and deliveries across UPMB hospitals and HC IVs continued to show a downward. 89

In-patient summary statistics UPMB Hospitals and HC IVs In-patient episodes continued to show a decreasing trend the total number of clients admitted during the FY fell by 9.5 compared to admission in the FY 2013/14. The ALOS approximately remained at 4 days. The BOR slightly reduced from 35.5 in 2013/14 to 33.4 in 2014/15. FY Total bed capacity OPD attendance Admissions Deliveries ANC and FP Immunization 2014-15 3,624 634,406 107,838 27,956 124,794 256,540 2013-14 3,577 532,568 119,179 34,177 102,328 285,169 2012-13 3,101 515,166 130,282 32,984 102,878 325,724 2011-12 1882 547,755 55,099 44,203 84,378 233,770 FIGURE 22: STANDARD UNIT OF OUTPUT IN UPMB HOSPITALS The indicator Staff productivity (Staff SUO) is obtained by computing the SUO for each facility and dividing it by the total number of staff available for the period under review implying the staff SUO has a direct relationship with the hospital SUO and an inverse relationship with the total number of staff at the facility. Figure 27 shows the total SUO for UPMB hospitals for the FY 2010-11 to FY 2014-15. The primary vertical axis represents the SUO for the four FYs while the secondary vertical axis represents the staff SUO. UPMB hospitals registered a decline in the total SUO and staff productivity during the FY. Pictorial for infrastructure support to some member health facilities in Busoga Diocese Bunyiro HC II Before After 90

3.1.8.3 UGANDA MUSLIM MEDICAL BUREAU The Bureau coordinates the activities of all member health facilities and is the main link between these facilities (Muslim-Founded PNFPs), the government and other stakeholders. Currently the bureau membership consists of 5 hospitals, 2 HC IVs, 24 HC IIIs and 23 HC IIs and totaling to 54 PNFP facilities. The main achievements in the reporting period are summarized in the table below showing key indicators. TABLE 47: KEY OUTPUTS FOR THE UMMB FACILITIES Output No of patients Total OPD attendance 275,868 Total ANC 21,916 ANC 1st Visits 10,304 Total Admissions 31,161 Mothers Tested 10,304 Option B+ mothers tested positive 369 Total HCT 72,248 Deliveries 5,629 HIV+ Deliveries 245 Tested HCT clients tested positive to HIV 2,363 Total HIV/AIDs Pre ART 3,869 Total ART 3,303 Total Immunization: children immunised 153,129 Total Malaria Tests 124,966 Total number of clients received FP 30,924 Deductions ANC services; 47 of total ANC are first visits, 100 of ANC first visits were tested for HIV of which 3 were HIV+ on first ANC visit. All the 3 (100) were initiated on option B+ and in chronic HIV/AIDs care and management at the respective facilities. Maternity: 4 of total deliveries were positive. This service is particularly still under performing due to lack of equipment especially in the lower level facilities. HIV/AIDs management: a total of 72,248 were counseled and tested for HIV of which 2,363 were positive representing 4 prevalence rate far below the national rate of 7.6. 91

A total of 3,869 clients were in care for all network facilities by end of June 2015. The total number of ART clients is 3,303 among network facilities. Training of staff was conducted in the network facilities. In partnership with different organizations we carried out the trainings as shown in the table below. TABLE 48: STAFF TRAINING IN UMMB FACILITIES Topic Organising Institution Number of Participants Health Management Information System (HMIS) TASO UGANDA 21 District Information system II (DHIS 2) TASO UGANDA 10 Elimination of Mother To Child HIV Transmission UMMB / MILDMAY 32 Integrated Human Resources Information system (I-HRIS) Intrahealth 31 Founder bodies and HUMC leadership workshop UMMB / MILDMAY 42 Total Trained (July 14 /June15) 146 92

District (112 Districts) Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 4 Annex TABLE 49: DLT RANKING FOR THE 112 DISTRICTS 2014/15 FY Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 GULU 443733 155.4 15.0 86.4 13.0 2.6 10.0 211.2 10.0 73.0 7.3 69.4 3.5 45.2 2.3 90.3 4.5 126.9 10.0 74.3 100.0 100.0 79.5 8.8 93.4 4.7 89.0 KAMPALA 1516210 132.7 15.0 118.8 15.0 2.5 10.0 259.7 10.0 99.0 9.9 50.2 2.5 66.1 3.3 82.0 4.1 302.0 10.0 31.2 0.0 54.4 10.1 2.8 95.4 4.8 87.4 KABAROLE 474216 130.6 15.0 69.0 10.4 1.6 10.0 180.9 10.0 81.0 8.1 47.9 2.4 46.6 2.3 83.8 4.2 86.8 8.7 98.0 100.0 99.9 93.5 9.8 90.9 4.5 85.4 JINJA 468256 123.9 15.0 77.0 11.6 1.9 10.0 95.8 9.6 81.3 8.1 58.2 2.9 42.3 2.1 54.0 2.7 94.7 9.5 77.8 100.0 97.7 51.5 8.3 99.2 5.0 84.7 RUKUNGIRI 320567 86.7 13.0 63.4 9.5 1.7 10.0 87.7 8.8 98.9 9.9 46.9 2.3 42.6 2.1 76.3 3.8 118.4 10.0 98.5 100.0 99.8 100.0 9.9 91.1 4.6 84.0 BUTAMBALA 100471 115.2 15.0 280.6 15.0 1.6 10.0 110.4 10.0 67.0 6.7 58.2 2.9 33.7 1.7 75.9 3.8 54.5 5.4 100.0 95.8 99.5 0.0 7.9 100.0 5.0 83.4 LIRA 410516 99.9 15.0 53.5 8.0 1.7 10.0 144.9 10.0 80.8 8.1 58.8 2.9 32.0 1.6 88.9 4.4 90.5 9.0 92.4 95.8 96.9 84.8 9.3 100.0 5.0 83.4 LAMWO 134050 175.3 15.0 91.4 13.7 2.2 10.0 94.5 9.4 40.0 4.0 98.5 4.9 74.7 3.7 83.0 4.2 45.1 4.5 89.1 75.0 95.3 65.0 8.3 96.6 4.8 82.6 MITYANA 331266 105.1 15.0 61.4 9.2 1.2 10.0 370.3 10.0 89.0 8.9 56.8 2.8 40.4 2.0 78.9 3.9 57.1 5.7 98.6 100.0 99.5 98.2 9.9 98.8 4.9 82.5 LYANTONDE 94573 97.0 14.6 70.5 10.6 2.3 10.0 226.8 10.0 86.0 8.6 78.4 3.9 61.1 3.1 54.5 2.7 47.2 4.7 89.8 100.0 100.0 100.0 9.7 91.3 4.6 82.4 1 SERERE 211720 114.2 15.0 67.3 10.1 1.2 10.0 120.5 10.0 80.0 8.0 83.0 4.2 25.7 1.3 94.1 4.7 48.2 4.8 95.5 100.0 100.0 77.3 9.4 95.6 4.8 82.2 1 MBALE 492804 116.8 15.0 62.3 9.3 1.2 10.0 59.8 6.0 93.2 9.3 52.2 2.6 35.5 1.8 78.2 3.9 94.3 9.4 86.3 100.0 99.8 72.3 9.0 100.0 5.0 81.4 1 BUSHENYI 235621 86.3 12.9 70.7 10.6 1.5 10.0 118.4 10.0 91.8 9.2 43.9 2.2 50.6 2.5 68.6 3.4 78.0 7.8 72.7 41.7 88.3 95.0 7.6 96.4 4.8 81.1 1 MASAKA 296649 101.2 15.0 88.2 13.2 2.0 10.0 264.7 10.0 84.0 8.4 45.9 2.3 33.8 1.7 57.3 2.9 66.2 6.6 83.1 12.5 78.4 60.6 6.3 85.7 4.3 80.7 1 LUWERO 458158 135.6 15.0 54.6 8.2 1.3 10.0 99.5 10.0 78.0 7.8 62.1 3.1 40.8 2.0 71.0 3.5 76.8 7.7 87.3 62.5 92.3 100.0 8.6 87.6 4.4 80.3 1 AGAGO 227486 137.2 15.0 79.1 11.9 1.4 10.0 58.3 5.8 47.0 4.7 69.6 3.5 59.5 3.0 58.5 2.9 88.0 8.8 97.1 95.8 99.5 100.0 9.8 97.9 4.9 80.3 1 SOROTI 252994 104.2 15.0 77.5 11.6 2.2 10.0 78.2 7.8 78.6 7.9 72.9 3.6 43.1 2.2 59.8 3.0 59.5 6.0 81.1 95.8 98.6 62.2 8.6 91.8 4.6 80.2 1 NEBBI 385220 90.8 13.6 65.7 9.9 1.3 10.0 177.3 10.0 77.0 7.7 57.1 2.9 45.0 2.3 78.3 3.9 51.8 5.2 95.9 100.0 100.0 100.0 9.9 98.2 4.9 80.2 1 KATAKWI 165553 101.7 15.0 59.7 9.0 2.0 10.0 93.1 9.3 73.2 7.3 60.3 3.0 35.9 1.8 91.4 4.6 51.2 5.1 96.0 100.0 98.2 92.3 9.7 100.0 5.0 79.8 1 HOIMA 573903 91.5 13.7 56.5 8.5 1.5 10.0 106.2 10.0 74.0 7.4 65.3 3.3 44.1 2.2 60.9 3.0 70.4 7.0 94.3 100.0 100.0 69.1 9.2 98.5 4.9 79.3 2 KABERAMAIDO 213374 101.8 15.0 46.6 7.0 1.3 10.0 87.5 8.7 77.6 7.8 61.8 3.1 23.0 1.2 85.7 4.3 88.4 8.8 89.2 100.0 100.0 28.0 8.2 100.0 5.0 79.1 2 OYAM 388011 114.9 15.0 63.5 9.5 0.7 6.7 76.9 7.7 89.9 9.0 74.3 3.7 51.1 2.6 91.3 4.6 80.3 8.0 62.1 54.2 94.2 100.0 7.8 88.1 4.4 78.9 2 DOKOLO 182579 101.2 15.0 43.1 6.5 1.0 9.6 93.3 9.3 86.0 8.6 63.6 3.2 37.0 1.8 96.1 4.8 56.5 5.6 91.1 100.0 100.0 75.0 9.2 100.0 5.0 78.7 2 MUKONO 599817 105.7 15.0 46.8 7.0 0.9 8.5 457.7 10.0 81.0 8.1 55.9 2.8 30.3 1.5 66.3 3.3 79.1 7.9 94.6 100.0 100.0 100.0 9.8 92.7 4.6 78.7 2 NWOYA 128094 133.3 15.0 47.2 7.1 1.1 10.0 83.8 8.4 74.6 7.5 48.3 2.4 31.8 1.6 94.9 4.7 80.3 8.0 100.0 100.0 100.0 100.0 10.0 78.1 3.9 78.6 2 NATIONAL 34844095 102.4 15.0 52.7 7.9 1.2 10.0 94.7 9.5 73.7 7.4 53.4 2.7 36.6 1.8 80.3 4.0 70.7 7.1 88.4 83.4 95.6 66.3 8.5 94.1 4.7 78.6 AVERAGE KUMI 258073 92.4 13.9 57.0 8.5 1.5 10.0 54.0 5.4 91.0 9.1 57.1 2.9 42.1 2.1 74.7 3.7 88.6 8.9 90.1 75.0 97.2 100.0 9.1 97.7 4.9 78.5 2 KITGUM 204012 105.7 15.0 77.5 11.6 1.6 10.0 137.5 10.0 50.5 5.1 66.7 3.3 48.0 2.4 83.7 4.2 70.3 7.0 75.3 4.2 81.1 3.6 4.8 98.4 4.9 78.4 2 KIBOGA 148606 112.2 15.0 75.5 11.3 1.2 10.0 148.3 10.0 51.0 5.1 73.5 3.7 41.0 2.0 68.4 3.4 47.2 4.7 95.7 100.0 98.0 0.0 7.8 100.0 5.0 78.1 2 93

District (112 Districts) Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 ISINGIRO 492116 102.1 15.0 47.5 7.1 1.4 10.0 73.9 7.4 90.4 9.0 45.7 2.3 34.8 1.7 92.2 4.6 80.6 8.1 82.5 50.0 80.6 97.0 7.8 100.0 5.0 78.1 2 IGANGA 506388 92.5 13.9 57.9 8.7 1.2 10.0 53.6 5.4 75.0 7.5 56.5 2.8 32.5 1.6 90.3 4.5 87.1 8.7 100.0 100.0 100.0 100.0 10.0 99.0 4.9 78.0 3 KANUNGU 252075 94.9 14.2 52.1 7.8 1.3 10.0 65.2 6.5 93.0 9.3 54.5 2.7 50.5 2.5 87.9 4.4 63.4 6.3 93.9 95.8 97.5 100.0 9.7 90.3 4.5 78.0 3 AMOLATAR 146904 111.9 15.0 38.9 5.8 1.0 9.6 102.5 10.0 78.2 7.8 46.8 2.3 25.7 1.3 78.5 3.9 75.4 7.5 97.4 100.0 99.0 100.0 9.9 92.5 4.6 77.9 3 MPIGI 251512 103.2 15.0 63.7 9.6 1.1 10.0 63.6 6.4 65.3 6.5 64.0 3.2 44.4 2.2 79.0 4.0 70.8 7.1 98.1 100.0 100.0 46.2 8.9 97.6 4.9 77.7 3 TORORO 526378 99.2 14.9 55.1 8.3 1.6 10.0 74.3 7.4 82.1 8.2 62.3 3.1 53.2 2.7 53.2 2.7 60.6 6.1 95.2 91.7 98.0 77.8 9.2 98.4 4.9 77.4 3 KYENJOJO 423991 105.9 15.0 52.2 7.8 0.8 7.6 151.0 10.0 86.0 8.6 61.7 3.1 45.7 2.3 69.0 3.5 63.6 6.4 80.0 100.0 99.4 40.4 8.2 96.8 4.8 77.2 3 KAMWENGE 421470 94.3 14.1 51.8 7.8 0.8 7.9 91.5 9.2 78.1 7.8 54.0 2.7 42.6 2.1 92.1 4.6 75.1 7.5 95.8 58.3 94.2 100.0 8.9 92.1 4.6 77.2 3 NAKASEKE 197703 78.5 11.8 62.7 9.4 1.3 10.0 101.5 10.0 83.8 8.4 57.2 2.9 32.3 1.6 78.5 3.9 66.3 6.6 92.8 95.8 95.9 0.0 7.6 100.0 5.0 77.2 3 KIRUHURA 328544 92.4 13.9 36.8 5.5 1.1 10.0 92.9 9.3 90.5 9.1 67.0 3.3 55.8 2.8 88.0 4.4 62.8 6.3 80.2 62.5 88.2 58.5 7.5 96.0 4.8 76.8 3 RAKAI 518008 96.7 14.5 47.4 7.1 1.5 10.0 121.7 10.0 86.0 8.6 58.0 2.9 42.9 2.1 77.6 3.9 59.9 6.0 92.3 50.0 87.7 17.1 6.7 98.7 4.9 76.8 3 OTUKE 105617 98.3 14.7 34.2 5.1 1.0 10.0 156.2 10.0 58.0 5.8 56.1 2.8 28.8 1.4 76.9 3.8 97.9 9.8 91.0 87.5 97.4 36.4 8.1 100.0 5.0 76.7 4 KABALE 534160 81.5 12.2 49.6 7.4 1.6 10.0 51.1 5.1 87.1 8.7 49.2 2.5 42.0 2.1 85.3 4.3 96.5 9.6 96.4 100.0 100.0 95.9 9.8 97.8 4.9 76.7 4 KYEGEGWA 277379 91.5 13.7 35.3 5.3 0.7 7.2 179.6 10.0 81.6 8.2 59.4 3.0 42.7 2.1 83.4 4.2 81.5 8.1 85.0 100.0 100.0 100.0 9.6 97.4 4.9 76.2 4 AMURIA 270601 111.8 15.0 46.6 7.0 1.2 10.0 76.5 7.6 78.9 7.9 68.7 3.4 23.0 1.1 97.1 4.9 65.4 6.5 92.3 100.0 99.9 2.7 7.8 95.8 4.8 76.1 4 APAC 368786 88.0 13.2 42.2 6.3 0.9 9.0 92.3 9.2 78.3 7.8 38.5 1.9 34.3 1.7 93.5 4.7 82.7 8.3 91.4 95.8 96.3 71.9 9.0 98.4 4.9 76.1 4 KAMULI 490255 133.9 15.0 57.5 8.6 1.2 10.0 36.8 3.7 78.0 7.8 65.4 3.3 43.5 2.2 83.7 4.2 70.2 7.0 99.4 100.0 100.0 100.0 10.0 81.0 4.0 75.8 4 MBARARA 474144 86.6 13.0 62.3 9.3 1.4 10.0 407.6 10.0 98.0 9.8 41.8 2.1 49.0 2.4 82.3 4.1 39.9 4.0 81.4 0.0 81.7 90.5 6.7 85.5 4.3 75.8 4 KAYUNGA 370210 103.8 15.0 45.5 6.8 1.0 9.7 59.8 6.0 71.2 7.1 60.0 3.0 41.9 2.1 63.6 3.2 77.9 7.8 99.7 100.0 100.0 100.0 10.0 100.0 5.0 75.7 4 BUIKWE 436406 93.2 14.0 43.5 6.5 1.1 10.0 119.5 10.0 75.0 7.5 57.2 2.9 33.7 1.7 76.9 3.8 64.1 6.4 98.7 95.8 98.8 13.5 8.1 94.8 4.7 75.7 4 KOBOKO 208163 107.9 15.0 42.2 6.3 1.0 9.8 45.3 4.5 78.0 7.8 52.8 2.6 31.8 1.6 65.7 3.3 122.2 10.0 99.0 95.8 99.5 100.0 9.9 93.5 4.7 75.5 4 NGORA 142487 107.4 15.0 61.2 9.2 1.2 10.0 71.8 7.2 83.0 8.3 60.5 3.0 36.1 1.8 78.7 3.9 32.6 3.3 89.6 91.7 97.9 66.7 8.8 95.3 4.8 75.2 5 KALUNGU 184131 69.0 10.4 49.6 7.4 1.1 10.0 142.1 10.0 90.8 9.1 50.3 2.5 45.3 2.3 92.5 4.6 54.3 5.4 86.1 100.0 98.3 46.2 8.5 100.0 5.0 75.2 5 BUNDIBUGYO 224145 137.6 15.0 41.0 6.2 1.3 10.0 55.1 5.5 72.0 7.2 57.8 2.9 26.6 1.3 75.5 3.8 95.4 9.5 85.8 91.7 96.0 90.0 9.1 92.1 4.6 75.1 5 ARUA 785189 148.5 15.0 89.6 13.4 1.8 10.0 35.5 3.6 69.8 7.0 69.8 3.5 43.8 2.2 48.9 2.4 49.8 5.0 96.9 87.5 97.0 30.6 8.2 95.9 4.8 75.0 5 SHEEMA 246636 68.7 10.3 62.7 9.4 2.3 10.0 34.2 3.4 88.9 8.9 53.7 2.7 51.5 2.6 79.2 4.0 85.2 8.5 93.1 100.0 98.3 100.0 9.7 100.0 5.0 74.5 5 NTUNGAMO 489323 89.5 13.4 43.9 6.6 0.9 8.9 673.9 10.0 94.6 9.5 40.5 2.0 27.1 1.4 73.9 3.7 75.0 7.5 82.4 54.2 89.7 13.0 6.5 100.0 5.0 74.4 5 NAMUTUMBA 253260 108.4 15.0 37.2 5.6 1.0 10.0 58.0 5.8 84.1 8.4 56.4 2.8 34.0 1.7 96.5 4.8 63.1 6.3 64.1 95.8 96.9 97.0 8.7 95.2 4.8 73.9 5 AMURU 190516 113.2 15.0 35.1 5.3 1.3 10.0 52.2 5.2 72.0 7.2 66.6 3.3 32.9 1.6 91.3 4.6 79.8 8.0 93.2 79.2 93.1 80.0 8.8 92.7 4.6 73.6 5 MUBENDE 688819 104.5 15.0 40.3 6.1 0.8 8.3 114.6 10.0 82.0 8.2 61.3 3.1 29.6 1.5 65.7 3.3 54.4 5.4 94.7 91.7 96.1 45.8 8.5 80.6 4.0 73.3 5 BUSIA 325527 96.0 14.4 54.9 8.2 1.6 10.0 57.5 5.7 87.5 8.8 57.6 2.9 28.4 1.4 84.1 4.2 46.9 4.7 84.2 100.0 99.4 3.4 7.6 100.0 5.0 72.9 5 MASINDI 292951 85.2 12.8 57.4 8.6 1.4 10.0 52.7 5.3 77.0 7.7 50.0 2.5 54.8 2.7 72.6 3.6 68.0 6.8 89.9 100.0 100.0 7.5 7.8 100.0 5.0 72.9 6 KIBAALE 788714 90.7 13.6 39.6 5.9 0.5 5.3 96.7 9.7 78.8 7.9 50.3 2.5 22.8 1.1 86.5 4.3 77.8 7.8 95.3 100.0 100.0 100.0 9.9 97.2 4.9 72.9 6 KALANGALA 53406 83.8 12.6 26.1 3.9 1.9 10.0 398.0 10.0 69.0 6.9 35.6 1.8 28.3 1.4 98.9 4.9 78.3 7.8 93.5 95.8 99.2 100.0 9.7 75.8 3.8 72.9 6 NAKASONGOLA 181863 76.0 11.4 42.5 6.4 1.6 10.0 74.7 7.5 87.0 8.7 58.9 2.9 44.4 2.2 90.8 4.5 81.3 8.1 65.5 62.5 92.5 0.0 6.0 96.9 4.8 72.6 6 KISORO 287179 86.2 12.9 60.4 9.1 1.5 10.0 34.2 3.4 75.0 7.5 41.4 2.1 33.3 1.7 79.1 4.0 66.9 6.7 100.0 100.0 100.0 100.0 10.0 100.0 5.0 72.3 6 94

District (112 Districts) Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 KASESE 702029 106.8 15.0 46.2 6.9 1.1 10.0 52.3 5.2 84.8 8.5 53.2 2.7 42.4 2.1 96.3 4.8 70.2 7.0 49.5 16.7 69.4 90.0 5.7 85.8 4.3 72.2 6 ABIM 109039 87.0 13.0 49.1 7.4 1.6 10.0 84.6 8.5 56.6 5.7 44.0 2.2 33.4 1.7 68.7 3.4 68.1 6.8 86.3 83.3 96.8 94.7 9.1 82.6 4.1 71.8 6 BUGIRI 390076 106.6 15.0 37.4 5.6 1.0 9.8 52.0 5.2 82.2 8.2 58.6 2.9 29.0 1.5 86.2 4.3 47.4 4.7 88.7 100.0 100.0 100.0 9.7 96.5 4.8 71.7 6 KIRYANDONGO 268188 112.6 15.0 42.2 6.3 0.9 9.2 66.2 6.6 67.5 6.8 66.3 3.3 30.7 1.5 54.6 2.7 53.2 5.3 95.7 100.0 100.0 100.0 9.9 100.0 5.0 71.7 6 BUKOMANSIMBI 151075 90.3 13.5 22.0 3.3 0.8 7.8 96.9 9.7 91.6 9.2 37.6 1.9 21.4 1.1 88.6 4.4 57.3 5.7 99.5 100.0 100.0 100.0 10.0 100.0 5.0 71.6 6 PADER 183723 118.7 15.0 32.5 4.9 1.2 10.0 129.5 10.0 54.0 5.4 58.9 2.9 37.4 1.9 67.2 3.4 72.7 7.3 84.6 75.0 90.6 0.0 6.8 82.1 4.1 71.6 7 PALLISA 386074 96.3 14.4 53.8 8.1 1.0 9.8 22.2 2.2 82.9 8.3 68.5 3.4 28.8 1.4 98.3 4.9 60.0 6.0 83.6 95.8 97.5 24.2 7.8 98.5 4.9 71.4 7 BUDAKA 208439 94.9 14.2 52.8 7.9 0.9 9.3 25.8 2.6 58.4 5.8 72.3 3.6 32.9 1.6 94.2 4.7 72.9 7.3 94.1 100.0 97.1 62.5 9.0 98.4 4.9 71.0 7 ADJUMANI 232813 77.1 11.6 53.8 8.1 2.2 10.0 25.5 2.5 83.0 8.3 47.8 2.4 34.1 1.7 78.4 3.9 82.6 8.3 91.2 100.0 98.5 80.0 9.3 91.2 4.6 70.6 7 SIRONKO 297154 92.6 13.9 27.7 4.1 0.9 8.7 107.2 10.0 77.0 7.7 38.1 1.9 22.2 1.1 95.3 4.8 61.8 6.2 96.7 50.0 89.6 27.6 7.1 97.2 4.9 70.4 7 IBANDA 248083 82.6 12.4 48.9 7.3 1.5 10.0 92.1 9.2 87.0 8.7 40.9 2.0 30.2 1.5 70.8 3.5 52.1 5.2 46.7 29.2 78.6 73.3 5.8 93.1 4.7 70.4 7 NAMAYINGO 223229 103.6 15.0 29.3 4.4 1.2 10.0 98.4 9.8 48.3 4.8 63.4 3.2 33.1 1.7 86.5 4.3 35.1 3.5 74.2 100.0 100.0 100.0 9.2 88.8 4.4 70.4 7 ALEBTONG 225327 98.2 14.7 33.2 5.0 0.6 6.5 56.0 5.6 81.4 8.1 53.9 2.7 27.6 1.4 80.5 4.0 91.5 9.2 83.3 79.2 93.3 61.5 8.1 100.0 5.0 70.3 7 BUKEDEA 188918 96.7 14.5 53.8 8.1 0.7 6.6 47.7 4.8 80.8 8.1 61.0 3.0 23.7 1.2 80.1 4.0 63.1 6.3 100.0 100.0 100.0 0.0 8.0 100.0 5.0 69.6 7 LWENGO 275450 117.0 15.0 24.9 3.7 0.9 8.6 69.4 6.9 76.0 7.6 44.5 2.2 30.6 1.5 87.3 4.4 56.7 5.7 99.2 100.0 99.6 40.6 8.8 98.2 4.9 69.3 7 KAPCHORWA 104580 79.1 11.9 48.0 7.2 1.8 10.0 41.9 4.2 77.0 7.7 51.0 2.5 26.6 1.3 93.0 4.6 64.3 6.4 92.1 100.0 99.8 0.0 7.8 100.0 5.0 68.7 8 BULIISA 113569 79.2 11.9 30.9 4.6 0.8 8.5 66.6 6.7 68.6 6.9 61.5 3.1 21.2 1.1 91.9 4.6 66.2 6.6 99.2 100.0 100.0 100.0 10.0 94.1 4.7 68.6 8 GOMBA 160075 100.3 15.0 25.5 3.8 0.9 8.8 71.6 7.2 55.0 5.5 47.3 2.4 21.8 1.1 81.9 4.1 56.8 5.7 96.9 100.0 100.0 94.7 9.8 100.0 5.0 68.4 8 MITOOMA 185519 105.5 15.0 28.9 4.3 1.1 10.0 32.4 3.2 91.1 9.1 36.3 1.8 38.2 1.9 88.4 4.4 65.5 6.5 90.3 100.0 99.8 4.2 7.8 81.1 4.1 68.2 8 BUDUDA 211683 104.1 15.0 26.4 4.0 1.0 9.6 26.1 2.6 75.0 7.5 38.0 1.9 19.0 1.0 71.7 3.6 86.6 8.7 85.6 100.0 100.0 100.0 9.6 93.4 4.7 68.0 8 RUBIRIZI 129283 79.0 11.9 32.0 4.8 1.0 9.7 83.6 8.4 83.7 8.4 54.0 2.7 44.0 2.2 77.6 3.9 47.3 4.7 81.6 0.0 69.8 89.5 6.3 100.0 5.0 67.9 8 NTOROKO 66422 101.2 15.0 33.8 5.1 1.1 10.0 13.5 1.3 66.9 6.7 39.8 2.0 33.7 1.7 86.7 4.3 75.0 7.5 91.7 91.7 98.3 100.0 9.5 93.3 4.7 67.8 8 ZOMBO 240368 94.1 14.1 43.2 6.5 0.7 7.3 45.8 4.6 76.0 7.6 43.7 2.2 42.3 2.1 73.2 3.7 51.9 5.2 98.2 100.0 100.0 78.9 9.5 100.0 5.0 67.8 8 BUKWO 89253 94.5 14.2 26.7 4.0 1.8 10.0 17.7 1.8 80.0 8.0 50.3 2.5 34.8 1.7 100.0 5.0 55.3 5.5 100.0 100.0 100.0 100.0 10.0 100.0 5.0 67.7 8 BUTALEJA 245873 78.5 11.8 55.5 8.3 1.5 10.0 29.9 3.0 68.0 6.8 68.0 3.4 29.6 1.5 90.8 4.5 52.3 5.2 99.7 100.0 100.0 4.2 8.1 100.0 5.0 67.6 8 MARACHA 186176 112.8 15.0 51.9 7.8 1.1 10.0 8.5 0.8 70.0 7.0 41.7 2.1 41.0 2.1 91.8 4.6 51.0 5.1 95.2 100.0 95.5 0.0 7.7 90.2 4.5 66.7 9 LUUKA 241453 96.0 14.4 24.7 3.7 1.0 9.9 29.8 3.0 65.0 6.5 22.9 1.1 16.8 0.8 88.5 4.4 126.6 10.0 71.0 62.5 88.5 100.0 8.0 93.7 4.7 66.6 9 NAPAK 145219 148.2 15.0 67.1 10.1 1.0 10.0 10.9 1.1 13.1 1.3 56.2 2.8 52.2 2.6 56.8 2.8 71.2 7.1 89.9 62.5 95.8 92.9 8.7 100.0 5.0 66.5 9 KOLE 241878 91.4 13.7 36.9 5.5 0.5 5.0 63.2 6.3 86.0 8.6 46.7 2.3 25.5 1.3 94.3 4.7 36.9 3.7 100.0 100.0 100.0 100.0 10.0 100.0 5.0 66.2 9 MOYO 137489 70.4 10.6 45.7 6.9 2.6 10.0 14.2 1.4 91.0 9.1 47.4 2.4 38.0 1.9 70.0 3.5 59.0 5.9 99.6 100.0 100.0 95.2 9.9 93.7 4.7 66.2 9 KYANKWANZI 214057 98.2 14.7 22.6 3.4 0.6 6.0 72.6 7.3 55.0 5.5 53.0 2.7 23.2 1.2 79.1 4.0 64.2 6.4 97.0 100.0 100.0 100.0 9.9 100.0 5.0 66.0 9 KALIRO 236927 99.3 14.9 32.1 4.8 0.7 6.9 33.1 3.3 70.0 7.0 53.5 2.7 32.5 1.6 83.1 4.2 75.6 7.6 74.2 95.8 99.4 40.0 7.9 100.0 5.0 65.8 9 MAYUGE 479172 92.3 13.8 37.6 5.6 0.8 8.1 56.4 5.6 67.2 6.7 52.7 2.6 30.0 1.5 87.2 4.4 60.3 6.0 82.6 12.5 88.5 62.8 6.6 90.9 4.5 65.6 9 MANAFWA 352864 110.0 15.0 30.6 4.6 0.7 6.7 25.0 2.5 75.0 7.5 43.7 2.2 21.1 1.1 96.4 4.8 70.7 7.1 85.5 100.0 99.8 78.3 9.1 100.0 5.0 65.6 9 WAKISO 2007700 76.5 11.5 26.7 4.0 0.6 6.4 115.7 10.0 89.5 9.0 28.6 1.4 16.4 0.8 74.0 3.7 82.0 8.2 71.4 4.2 81.2 53.7 5.7 90.3 4.5 65.2 9 KIBUKU 202630 74.1 11.1 52.5 7.9 0.9 8.8 28.3 2.8 81.6 8.2 58.0 2.9 28.1 1.4 95.0 4.8 53.5 5.4 56.1 91.7 98.3 0.0 6.5 100.0 5.0 64.6 10 95

District (112 Districts) Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 YUMBE 485582 82.3 12.4 46.3 6.9 0.8 7.9 18.1 1.8 53.5 5.4 46.6 2.3 39.1 2.0 73.4 3.7 71.5 7.2 100.0 100.0 100.0 100.0 10.0 95.1 4.8 64.3 10 SEMBABULE 283630 92.6 13.9 16.3 2.5 0.7 6.8 51.1 5.1 71.0 7.1 39.5 2.0 21.6 1.1 99.4 5.0 62.3 6.2 96.2 100.0 99.6 100.0 9.9 89.8 4.5 63.9 10 BUYENDE 320468 94.6 14.2 35.0 5.3 0.5 5.3 35.4 3.5 85.0 8.5 51.1 2.6 28.0 1.4 73.0 3.7 74.4 7.4 48.9 50.0 85.9 68.2 6.4 94.2 4.7 63.0 10 KWEEN 95623 82.9 12.4 15.3 2.3 1.2 10.0 11.8 1.2 83.5 8.4 45.3 2.3 18.1 0.9 100.0 5.0 63.9 6.4 99.1 91.7 98.3 61.1 9.0 100.0 5.0 62.8 10 KAABONG 169274 187.4 15.0 59.3 8.9 1.6 10.0 11.6 1.2 19.1 1.9 56.7 2.8 48.8 2.4 40.4 2.0 46.2 4.6 87.0 95.8 99.5 100.0 9.5 87.5 4.4 62.8 10 BUHWEJU 124044 83.5 12.5 25.1 3.8 0.9 9.3 32.1 3.2 78.3 7.8 42.5 2.1 25.0 1.3 94.6 4.7 49.3 4.9 75.0 50.0 78.6 100.0 7.6 100.0 5.0 62.2 10 MOROTO 104539 99.6 14.9 44.9 6.7 1.5 10.0 12.1 1.2 2.2 0.2 50.9 2.5 35.3 1.8 71.3 3.6 86.4 8.6 91.7 87.5 96.8 0.0 7.4 77.5 3.9 60.9 10 NAKAPIRIPIRIT 169691 96.5 14.5 40.7 6.1 0.9 8.6 10.6 1.1 22.3 2.2 41.7 2.1 29.6 1.5 95.5 4.8 60.5 6.1 95.1 79.2 94.9 100.0 9.3 94.1 4.7 60.9 10 KOTIDO 178909 121.9 15.0 54.9 8.2 1.1 10.0 16.1 1.6 25.1 2.5 56.4 2.8 32.0 1.6 68.0 3.4 64.9 6.5 88.2 0.0 89.2 0.0 5.3 63.7 3.2 60.2 10 BUVUMA 89960 77.9 11.7 15.8 2.4 0.6 6.3 179.9 10.0 36.0 3.6 32.7 1.6 7.8 0.4 87.2 4.4 62.7 6.3 95.5 100.0 100.0 0.0 7.9 96.0 4.8 59.3 11 BULAMBULI 177322 64.8 9.7 18.2 2.7 0.8 8.5 39.8 4.0 69.9 7.0 29.8 1.5 15.7 0.8 85.6 4.3 57.1 5.7 100.0 100.0 100.0 5.3 8.1 100.0 5.0 57.3 11 AMUDAT 111758 94.7 14.2 32.3 4.8 0.6 5.8 15.2 1.5 10.3 1.0 33.3 1.7 15.7 0.8 47.8 2.4 36.0 3.6 95.8 95.8 99.4 100.0 9.8 20.0 1.0 46.6 11 96

District Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Rank Annual Health Sector Performance Report for Financial Year 2014/15 TABLE 50: DLT RANKING FOR THE 14 DISTRICTS 2014/15 FY WITH REFERRAL HOSPITALS Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 GULU 443,733 155.4 15.0 86.4 13.0 2.6 10 211.2 10.0 73.0 7.3 69.4 3.5 45.2 2.3 90.3 4.5 126.9 10.0 74.3 100.0 100.0 79.5 8.8 93.4 4.7 89.0 1 1 KAMPALA 1,516,210 132.7 15.0 118.8 15.0 2.5 10 259.7 10.0 99.0 9.9 50.2 2.5 66.1 3.3 82.0 4.1 302.0 10.0 31.2 0.0 54.4 10.1 2.8 95.4 4.8 87.4 2 2 KABAROLE 474,216 130.6 15.0 69.0 10.4 1.6 10 180.9 10.0 81.0 8.1 47.9 2.4 46.6 2.3 83.8 4.2 86.8 8.7 98.0 100.0 99.9 93.5 9.8 90.9 4.5 85.4 3 3 JINJA 468,256 123.9 15.0 77.0 11.6 1.9 10 95.8 9.6 81.3 8.1 58.2 2.9 42.3 2.1 54.0 2.7 94.7 9.5 77.8 100.0 97.7 51.5 8.3 99.2 5.0 84.7 4 4 LIRA 410,516 99.9 15.0 53.5 8.0 1.7 10 144.9 10.0 80.8 8.1 58.8 2.9 32.0 1.6 88.9 4.4 90.5 9.0 92.4 95.8 96.9 84.8 9.3 100.0 5.0 83.4 5 7 MBALE 492,804 116.8 15.0 62.3 9.3 1.2 10 59.8 6.0 93.2 9.3 52.2 2.6 35.5 1.8 78.2 3.9 94.3 9.4 86.3 100.0 99.8 72.3 9.0 100.0 5.0 81.4 6 12 MASAKA 296,649 101.2 15.0 88.2 13.2 2.0 10 264.7 10.0 84.0 8.4 45.9 2.3 33.8 1.7 57.3 2.9 66.2 6.6 83.1 12.5 78.4 60.6 6.3 85.7 4.3 80.7 7 14 SOROTI 252,994 104.2 15.0 77.5 11.6 2.2 10 78.2 7.8 78.6 7.9 72.9 3.6 43.1 2.2 59.8 3.0 59.5 6.0 81.1 95.8 98.6 62.2 8.6 91.8 4.6 80.2 8 17 HOIMA 573,903 91.5 13.7 56.5 8.5 1.5 10 106.2 10.0 74.0 7.4 65.3 3.3 44.1 2.2 60.9 3.0 70.4 7.0 94.3 100.0 100.0 69.1 9.2 98.5 4.9 79.3 9 20 KABALE 534,160 81.5 12.2 49.6 7.4 1.6 10 51.1 5.1 87.1 8.7 49.2 2.5 42.0 2.1 85.3 4.3 96.5 9.6 96.4 100.0 100.0 95.9 9.8 97.8 4.9 76.7 10 41 MBARARA 474,144 86.6 13.0 62.3 9.3 1.4 10 407.6 10.0 98.0 9.8 41.8 2.1 49.0 2.4 82.3 4.1 39.9 4.0 81.4 0.0 81.7 90.5 6.7 85.5 4.3 75.8 11 46 ARUA 785,189 148.5 15.0 89.6 13.4 1.8 10 35.5 3.6 69.8 7.0 69.8 3.5 43.8 2.2 48.9 2.4 49.8 5.0 96.9 87.5 97.0 30.6 8.2 95.9 4.8 75.0 12 53 MUBENDE 688,819 104.5 15.0 40.3 6.1 0.8 8.3 114.6 10.0 82.0 8.2 61.3 3.1 29.6 1.5 65.7 3.3 54.4 5.4 94.7 91.7 96.1 45.8 8.5 80.6 4.0 73.3 13 58 MOROTO 104,539 99.6 14.9 44.9 6.7 1.5 10 12.1 1.2 2.2 0.2 50.9 2.5 35.3 1.8 71.3 3.6 86.4 8.6 91.7 87.5 96.8 0.0 7.4 77.5 3.9 60.9 14 107 Average 7,516,132 112.6 14.6 69.7 10.3 1.7 9.9 144.5 8.1 77.4 7.7 56.7 2.8 42.0 2.1 72.1 3.6 94.2 7.8 84.3 76.5 92.7 60.5 8.0 92.3 4.6 79.5 NATIONAL 34,844,095 102.4 15.0 52.7 7.9 1.2 10.0 94.7 9.5 73.7 7.4 53.4 2.7 36.6 1.8 80.3 4.0 70.7 7.1 88.4 83.4 95.6 66.3 8.5 94.1 4.7 78.6 97

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV+ women Latrine coverage IPT2 ANC4 TB success rate Approved posts that are filled HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 TABLE 51: RANKING OF THE 31 NEW DISTRICTS 2014/15 FY Coverage and quality of care (75) Management (25) District 15 15 10 10 10 5 5 5 10 10 5 BUTAMBALA 100471 115.2 15.0 280.6 15.0 1.6 10.0 110.4 10.0 67.0 6.7 58.2 2.9 33.7 1.7 75.9 3.8 54.5 5.4 100.0 95.8 99.5 0.0 7.9 100.0 5.0 83.4 LAMWO 134050 175.3 15.0 91.4 13.7 2.2 10.0 94.5 9.4 40.0 4.0 98.5 4.9 74.7 3.7 83.0 4.2 45.1 4.5 89.1 75.0 95.3 65.0 8.3 96.6 4.8 82.6 SERERE 211720 114.2 15.0 67.3 10.1 1.2 10.0 120.5 10.0 80.0 8.0 83.0 4.2 25.7 1.3 94.1 4.7 48.2 4.8 95.5 100.0 100.0 77.3 9.4 95.6 4.8 82.2 AGAGO 227486 137.2 15.0 79.1 11.9 1.4 10.0 58.3 5.8 47.0 4.7 69.6 3.5 59.5 3.0 58.5 2.9 88.0 8.8 97.1 95.8 99.5 100.0 9.8 97.9 4.9 80.3 NWOYA 128094 133.3 15.0 47.2 7.1 1.1 10.0 83.8 8.4 74.6 7.5 48.3 2.4 31.8 1.6 94.9 4.7 80.3 8.0 100.0 100.0 100.0 100.0 10.0 78.1 3.9 78.6 NATIONAL 34844095 102.4 15.0 52.7 7.9 1.2 10.0 94.7 9.5 73.7 7.4 53.4 2.7 36.6 1.8 80.3 4.0 70.7 7.1 88.4 83.4 95.6 66.3 8.5 94.1 4.7 78.6 OTUKE 105617 98.3 14.7 34.2 5.1 1.0 10.0 156.2 10.0 58.0 5.8 56.1 2.8 28.8 1.4 76.9 3.8 97.9 9.8 91.0 87.5 97.4 36.4 8.1 100.0 5.0 76.7 KYEGEGWA 277379 91.5 13.7 35.3 5.3 0.7 7.2 179.6 10.0 81.6 8.2 59.4 3.0 42.7 2.1 83.4 4.2 81.5 8.1 85.0 100.0 100.0 100.0 9.6 97.4 4.9 76.2 BUIKWE 436406 93.2 14.0 43.5 6.5 1.1 10.0 119.5 10.0 75.0 7.5 57.2 2.9 33.7 1.7 76.9 3.8 64.1 6.4 98.7 95.8 98.8 13.5 8.1 94.8 4.7 75.7 NGORA 142487 107.4 15.0 61.2 9.2 1.2 10.0 71.8 7.2 83.0 8.3 60.5 3.0 36.1 1.8 78.7 3.9 32.6 3.3 89.6 91.7 97.9 66.7 8.8 95.3 4.8 75.2 KALUNGU 184131 69.0 10.4 49.6 7.4 1.1 10.0 142.1 10.0 90.8 9.1 50.3 2.5 45.3 2.3 92.5 4.6 54.3 5.4 86.1 100.0 98.3 46.2 8.5 100.0 5.0 75.2 1 SHEEMA 246636 68.7 10.3 62.7 9.4 2.3 10.0 34.2 3.4 88.9 8.9 53.7 2.7 51.5 2.6 79.2 4.0 85.2 8.5 93.1 100.0 98.3 100.0 9.7 100.0 5.0 74.5 1 KIRYANDONGO 268188 112.6 15.0 42.2 6.3 0.9 9.2 66.2 6.6 67.5 6.8 66.3 3.3 30.7 1.5 54.6 2.7 53.2 5.3 95.7 100.0 100.0 100.0 9.9 100.0 5.0 71.7 1 98

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV+ women Latrine coverage IPT2 ANC4 TB success rate Approved posts that are filled HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) District 15 15 10 10 10 5 5 5 10 10 5 BUKOMANSIMBI 151075 90.3 13.5 22.0 3.3 0.8 7.8 96.9 9.7 91.6 9.2 37.6 1.9 21.4 1.1 88.6 4.4 57.3 5.7 99.5 100.0 100.0 100.0 10.0 100.0 5.0 71.6 1 NAMAYINGO 223229 103.6 15.0 29.3 4.4 1.2 10.0 98.4 9.8 48.3 4.8 63.4 3.2 33.1 1.7 86.5 4.3 35.1 3.5 74.2 100.0 100.0 100.0 9.2 88.8 4.4 70.4 1 LWENGO 275450 117.0 15.0 24.9 3.7 0.9 8.6 69.4 6.9 76.0 7.6 44.5 2.2 30.6 1.5 87.3 4.4 56.7 5.7 99.2 100.0 99.6 40.6 8.8 98.2 4.9 69.3 1 GOMBA 160075 100.3 15.0 25.5 3.8 0.9 8.8 71.6 7.2 55.0 5.5 47.3 2.4 21.8 1.1 81.9 4.1 56.8 5.7 96.9 100.0 100.0 94.7 9.8 100.0 5.0 68.4 1 MITOOMA 185519 105.5 15.0 28.9 4.3 1.1 10.0 32.4 3.2 91.1 9.1 36.3 1.8 38.2 1.9 88.4 4.4 65.5 6.5 90.3 100.0 99.8 4.2 7.8 81.1 4.1 68.2 1 RUBIRIZI 129283 79.0 11.9 32.0 4.8 1.0 9.7 83.6 8.4 83.7 8.4 54.0 2.7 44.0 2.2 77.6 3.9 47.3 4.7 81.6 0.0 69.8 89.5 6.3 100.0 5.0 67.9 1 NTOROKO 66422 101.2 15.0 33.8 5.1 1.1 10.0 13.5 1.3 66.9 6.7 39.8 2.0 33.7 1.7 86.7 4.3 75.0 7.5 91.7 91.7 98.3 100.0 9.5 93.3 4.7 67.8 1 ZOMBO 240368 94.1 14.1 43.2 6.5 0.7 7.3 45.8 4.6 76.0 7.6 43.7 2.2 42.3 2.1 73.2 3.7 51.9 5.2 98.2 100.0 100.0 78.9 9.5 100.0 5.0 67.8 2 LUUKA 241453 96.0 14.4 24.7 3.7 1.0 9.9 29.8 3.0 65.0 6.5 22.9 1.1 16.8 0.8 88.5 4.4 126.6 10.0 71.0 62.5 88.5 100.0 8.0 93.7 4.7 66.6 2 NAPAK 145219 148.2 15.0 67.1 10.1 1.0 10.0 10.9 1.1 13.1 1.3 56.2 2.8 52.2 2.6 56.8 2.8 71.2 7.1 89.9 62.5 95.8 92.9 8.7 100.0 5.0 66.5 2 KOLE 241878 91.4 13.7 36.9 5.5 0.5 5.0 63.2 6.3 86.0 8.6 46.7 2.3 25.5 1.3 94.3 4.7 36.9 3.7 100.0 100.0 100.0 100.0 10.0 100.0 5.0 66.2 2 KYANKWANZI 214057 98.2 14.7 22.6 3.4 0.6 6.0 72.6 7.3 55.0 5.5 53.0 2.7 23.2 1.2 79.1 4.0 64.2 6.4 97.0 100.0 100.0 100.0 9.9 100.0 5.0 66.0 2 KIBUKU 202630 74.1 11.1 52.5 7.9 0.9 8.8 28.3 2.8 81.6 8.2 58.0 2.9 28.1 1.4 95.0 4.8 53.5 5.4 56.1 91.7 98.3 0.0 6.5 100.0 5.0 64.6 2 BUYENDE 320468 94.6 14.2 35.0 5.3 0.5 5.3 35.4 3.5 85.0 8.5 51.1 2.6 28.0 1.4 73.0 3.7 74.4 7.4 48.9 50.0 85.9 68.2 6.4 94.2 4.7 63.0 2 KWEEN 95623 82.9 12.4 15.3 2.3 1.2 10.0 11.8 1.2 83.5 8.4 45.3 2.3 18.1 0.9 100.0 5.0 63.9 6.4 99.1 91.7 98.3 61.1 9.0 100.0 5.0 62.8 2 BUHWEJU 124044 83.5 12.5 25.1 3.8 0.9 9.3 32.1 3.2 78.3 7.8 42.5 2.1 25.0 1.3 94.6 4.7 49.3 4.9 75.0 50.0 78.6 100.0 7.6 100.0 5.0 62.2 2 99

h d i s tr i c t s Total ) Popul ation (UBO S Aug 2014) N a T ti o o t n a a l l S R c a o n r k e Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) Total Total Population (UBOS Aug 2014) DPT3 Coverage Deliveries in govt and PNFP facilities OPD Per Capita HIV testing in children born to HIV+ women Latrine coverage IPT2 ANC4 TB success rate Approved posts that are filled HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) District 15 15 10 10 10 5 5 5 10 10 5 BUVUMA 89960 77.9 11.7 15.8 2.4 0.6 6.3 179.9 10.0 36.0 3.6 32.7 1.6 7.8 0.4 87.2 4.4 62.7 6.3 95.5 100.0 100.0 0.0 7.9 96.0 4.8 59.3 2 BULAMBULI 177322 64.8 9.7 18.2 2.7 0.8 8.5 39.8 4.0 69.9 7.0 29.8 1.5 15.7 0.8 85.6 4.3 57.1 5.7 100.0 100.0 100.0 5.3 8.1 100.0 5.0 57.3 3 AMUDAT 111758 94.7 14.2 32.3 4.8 0.6 5.8 15.2 1.5 10.3 1.0 33.3 1.7 15.7 0.8 47.8 2.4 36.0 3.6 95.8 95.8 99.4 100.0 9.8 20.0 1.0 46.6 3 TABLE 52: LEAGUE TABLE FOR HARD TO REACH DISTRICTS Coverage and quality of care (75) Management (25) 100

Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Annual Health Sector Performance Report for Financial Year 2014/15 15 15 10 10 10 5 5 5 10 10 5 GULU 443,733 155.4 15.0 86.4 13.0 2.6 10.0 211.2 10.0 73.0 7.3 69.4 3.5 45.2 2.3 90.3 4.5 126.9 10.0 74.3 100 100 79.5 8.8 93.4 4.7 89.0 1 LAMWO 134,050 175.3 15.0 91.4 13.7 2.2 10.0 94.5 9.4 40.0 4.0 98.5 4.9 74.7 3.7 83.0 4.2 45.1 4.5 89.1 75.0 95.3 65.0 8.3 96.6 4.8 82.6 2 AGAGO 227,486 137.2 15.0 79.1 11.9 1.4 10.0 58.3 5.8 47.0 4.7 69.6 3.5 59.5 3.0 58.5 2.9 88.0 8.8 97.1 95.8 99.5 100 9.8 97.9 4.9 80.3 3 1 MUKONO 599,817 105.7 15.0 46.8 7.0 0.9 8.5 457.7 10.0 81.0 8.1 55.9 2.8 30.3 1.5 66.3 3.3 79.1 7.9 94.6 100 100 100 9.8 92.7 4.6 78.7 4 2 NWOYA 128,094 133.3 15.0 47.2 7.1 1.1 10.0 83.8 8.4 74.6 7.5 48.3 2.4 31.8 1.6 94.9 4.7 80.3 8.0 100 100 100 100 10.0 78.1 3.9 78.6 5 2 KITGUM 204,012 105.7 15.0 77.5 11.6 1.6 10.0 137.5 10.0 50.5 5.1 66.7 3.3 48.0 2.4 83.7 4.2 70.3 7.0 75.3 4.2 81.1 3.6 4.8 98.4 4.9 78.4 6 2 KANUNGU 252,075 94.9 14.2 52.1 7.8 1.3 10.0 65.2 6.5 93.0 9.3 54.5 2.7 50.5 2.5 87.9 4.4 63.4 6.3 93.9 95.8 97.5 100 9.7 90.3 4.5 78.0 7 3 BUNDIBUGY O 224,145 137.6 15.0 41.0 6.2 1.3 10.0 55.1 5.5 72.0 7.2 57.8 2.9 26.6 1.3 75.5 3.8 95.4 9.5 85.8 91.7 96.0 90.0 9.1 92.1 4.6 75.1 8 5 AMURU 190,516 113.2 15.0 35.1 5.3 1.3 10.0 52.2 5.2 72.0 7.2 66.6 3.3 32.9 1.6 91.3 4.6 79.8 8.0 93.2 79.2 93.1 80.0 8.8 92.7 4.6 73.6 9 5 KALANGALA 53,406 83.8 12.6 26.1 3.9 1.9 10.0 398.0 10.0 69.0 6.9 35.6 1.8 28.3 1.4 98.9 4.9 78.3 7.8 93.5 95.8 99.2 100 9.7 75.8 3.8 72.9 10 6 KISORO 287,179 86.2 12.9 60.4 9.1 1.5 10.0 34.2 3.4 75.0 7.5 41.4 2.1 33.3 1.7 79.1 4.0 66.9 6.7 100 100 100 100 10.0 100.0 5.0 72.3 11 6 ABIM 109,039 87.0 13.0 49.1 7.4 1.6 10.0 84.6 8.5 56.6 5.7 44.0 2.2 33.4 1.7 68.7 3.4 68.1 6.8 86.3 83.3 96.8 94.7 9.1 82.6 4.1 71.8 12 6 BUGIRI 390,076 106.6 15.0 37.4 5.6 1.0 9.8 52.0 5.2 82.2 8.2 58.6 2.9 29.0 1.5 86.2 4.3 47.4 4.7 88.7 100.0 100.0 100.0 9.7 96.5 4.8 71.7 13 6 PADER 183,723 118.7 15.0 32.5 4.9 1.2 10.0 129.5 10.0 54.0 5.4 58.9 2.9 37.4 1.9 67.2 3.4 72.7 7.3 84.6 75.0 90.6 0.0 6.8 82.1 4.1 71.6 14 7 ADJUMANI 232,813 77.1 11.6 53.8 8.1 2.2 10.0 25.5 2.5 83.0 8.3 47.8 2.4 34.1 1.7 78.4 3.9 82.6 8.3 91.2 100.0 98.5 80.0 9.3 91.2 4.6 70.6 15 7 NAMAYINGO 223,229 103.6 15.0 29.3 4.4 1.2 10.0 98.4 9.8 48.3 4.8 63.4 3.2 33.1 1.7 86.5 4.3 35.1 3.5 74.2 100.0 100.0 100.0 9.2 88.8 4.4 70.4 16 7 NTOROKO 66,422 101.2 15.0 33.8 5.1 1.1 10.0 13.5 1.3 66.9 6.7 39.8 2.0 33.7 1.7 86.7 4.3 75.0 7.5 91.7 91.7 98.3 100.0 9.5 93.3 4.7 67.8 17 8 BUKWO 89,253 94.5 14.2 26.7 4.0 1.8 10.0 17.7 1.8 80.0 8.0 50.3 2.5 34.8 1.7 100.0 5.0 55.3 5.5 100.0 100.0 100.0 100.0 10.0 100.0 5.0 67.7 18 8 NAPAK 145,219 148.2 15.0 67.1 10.1 1.0 10.0 10.9 1.1 13.1 1.3 56.2 2.8 52.2 2.6 56.8 2.8 71.2 7.1 89.9 62.5 95.8 92.9 8.7 100.0 5.0 66.5 19 9 101

(26 hard to Reach districts) Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Rank National Rank Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 MAYUGE 479,172 92.3 13.8 37.6 5.6 0.8 8.1 56.4 5.6 67.2 6.7 52.7 2.6 30.0 1.5 87.2 4.4 60.3 6.0 82.6 12.5 88.5 62.8 6.6 90.9 4.5 65.6 20 9 KAABONG 169,274 187.4 15.0 59.3 8.9 1.6 10.0 11.6 1.2 19.1 1.9 56.7 2.8 48.8 2.4 40.4 2.0 46.2 4.6 87.0 95.8 99.5 100.0 9.5 87.5 4.4 62.8 21 10 MOROTO 104,539 99.6 14.9 44.9 6.7 1.5 10.0 12.1 1.2 2.2 0.2 50.9 2.5 35.3 1.8 71.3 3.6 86.4 8.6 91.7 87.5 96.8 0.0 7.4 77.5 3.9 60.9 22 10 NAKAPIRIPIRI T 169,691 96.5 14.5 40.7 6.1 0.9 8.6 10.6 1.1 22.3 2.2 41.7 2.1 29.6 1.5 95.5 4.8 60.5 6.1 95.1 79.2 94.9 100.0 9.3 94.1 4.7 60.9 23 10 KOTIDO 178,909 121.9 15.0 54.9 8.2 1.1 10.0 16.1 1.6 25.1 2.5 56.4 2.8 32.0 1.6 68.0 3.4 64.9 6.5 88.2 0.0 89.2 0.0 5.3 63.7 3.2 60.2 24 10 BUVUMA 89,960 77.9 11.7 15.8 2.4 0.6 6.3 179.9 10.0 36.0 3.6 32.7 1.6 7.8 0.4 87.2 4.4 62.7 6.3 95.5 100.0 100.0 0.0 7.9 96.0 4.8 59.3 25 11 AMUDAT 111,758 94.7 14.2 32.3 4.8 0.6 5.8 15.2 1.5 10.3 1.0 33.3 1.7 15.7 0.8 47.8 2.4 36.0 3.6 95.8 95.8 99.4 100.0 9.8 20.0 1.0 46.6 26 11 Average 5,487,590 112.9 14.3 48.4 7.3 1.4 9.5 91.6 5.6 54.4 5.4 54.1 2.7 36.5 1.8 78.4 3.9 69.2 6.8 90.0 81.6 96.5 74.9 8.7 87.4 4.4 70.5 NATIONAL 34,844,095 102.4 15.0 52.7 7.9 1.2 10.0 94.7 9.5 73.7 7.4 53.4 2.7 36.6 1.8 80.3 4.0 70.7 7.1 88.4 83.4 95.6 66.3 8.5 94.1 4.7 78.6 102

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 TABLE 53: REGIONAL RANKING 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District NEBBI 385220 90.8 13.6 65.7 9.9 1.3 10.0 177.3 10.0 77.0 7.7 57.1 2.9 45.0 2.3 78.3 3.9 51.8 5.2 95.9 100.0 100.0 100.0 9.9 98.2 4.9 80.2 KOBOKO 208163 107.9 15.0 42.2 6.3 1.0 9.8 45.3 4.5 78.0 7.8 52.8 2.6 31.8 1.6 65.7 3.3 122.2 10.0 99.0 95.8 99.5 100.0 9.9 93.5 4.7 75.5 ARUA 785189 148.5 15.0 89.6 13.4 1.8 10.0 35.5 3.6 69.8 7.0 69.8 3.5 43.8 2.2 48.9 2.4 49.8 5.0 96.9 87.5 97.0 30.6 8.2 95.9 4.8 75.0 ADJUMANI 232813 77.1 11.6 53.8 8.1 2.2 10.0 25.5 2.5 83.0 8.3 47.8 2.4 34.1 1.7 78.4 3.9 82.6 8.3 91.2 100.0 98.5 80.0 9.3 91.2 4.6 70.6 ZOMBO 240368 94.1 14.1 43.2 6.5 0.7 7.3 45.8 4.6 76.0 7.6 43.7 2.2 42.3 2.1 73.2 3.7 51.9 5.2 98.2 100.0 100.0 78.9 9.5 100.0 5.0 67.8 MARACHA 186176 112.8 15.0 51.9 7.8 1.1 10.0 8.5 0.8 70.0 7.0 41.7 2.1 41.0 2.1 91.8 4.6 51.0 5.1 95.2 100.0 95.5 0.0 7.7 90.2 4.5 66.7 MOYO 137489 70.4 10.6 45.7 6.9 2.6 10.0 14.2 1.4 91.0 9.1 47.4 2.4 38.0 1.9 70.0 3.5 59.0 5.9 99.6 100.0 100.0 95.2 9.9 93.7 4.7 66.2 YUMBE 485582 82.3 12.4 46.3 6.9 0.8 7.9 18.1 1.8 53.5 5.4 46.6 2.3 39.1 2.0 73.4 3.7 71.5 7.2 100.0 100.0 100.0 100.0 10.0 95.1 4.8 64.3 Arua-Region 2661000 98.0 13.4 54.8 8.2 1.4 9.4 46.3 3.7 74.8 7.5 50.8 2.5 39.4 2.0 72.5 3.6 67.5 6.5 97.0 97.9 98.8 73.1 9.3 94.7 4.7 70.8 KAMPALA 1516210 132.7 15.0 118.8 15.0 2.5 10.0 259.7 10.0 99.0 9.9 50.2 2.5 66.1 3.3 82.0 4.1 302.0 10.0 31.2 0.0 54.4 10.1 2.8 95.4 4.8 87.4 BUTAMBALA 100471 115.2 15.0 280.6 15.0 1.6 10.0 110.4 10.0 67.0 6.7 58.2 2.9 33.7 1.7 75.9 3.8 54.5 5.4 100.0 95.8 99.5 0.0 7.9 100.0 5.0 83.4 MITYANA 331266 105.1 15.0 61.4 9.2 1.2 10.0 370.3 10.0 89.0 8.9 56.8 2.8 40.4 2.0 78.9 3.9 57.1 5.7 98.6 100.0 99.5 98.2 9.9 98.8 4.9 82.5 LUWERO 458158 135.6 15.0 54.6 8.2 1.3 10.0 99.5 10.0 78.0 7.8 62.1 3.1 40.8 2.0 71.0 3.5 76.8 7.7 87.3 62.5 92.3 100.0 8.6 87.6 4.4 80.3 MUKONO 599817 105.7 15.0 46.8 7.0 0.9 8.5 457.7 10.0 81.0 8.1 55.9 2.8 30.3 1.5 66.3 3.3 79.1 7.9 94.6 100.0 100.0 100.0 9.8 92.7 4.6 78.7 103

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District MPIGI 251512 103.2 15.0 63.7 9.6 1.1 10.0 63.6 6.4 65.3 6.5 64.0 3.2 44.4 2.2 79.0 4.0 70.8 7.1 98.1 100.0 100.0 46.2 8.9 97.6 4.9 77.7 NAKASEKE 197703 78.5 11.8 62.7 9.4 1.3 10.0 101.5 10.0 83.8 8.4 57.2 2.9 32.3 1.6 78.5 3.9 66.3 6.6 92.8 95.8 95.9 0.0 7.6 100.0 5.0 77.2 KAYUNGA 370210 103.8 15.0 45.5 6.8 1.0 9.7 59.8 6.0 71.2 7.1 60.0 3.0 41.9 2.1 63.6 3.2 77.9 7.8 99.7 100.0 100.0 100.0 10.0 100.0 5.0 75.7 BUIKWE 436406 93.2 14.0 43.5 6.5 1.1 10.0 119.5 10.0 75.0 7.5 57.2 2.9 33.7 1.7 76.9 3.8 64.1 6.4 98.7 95.8 98.8 13.5 8.1 94.8 4.7 75.7 MUBENDE 688819 104.5 15.0 40.3 6.1 0.8 8.3 114.6 10.0 82.0 8.2 61.3 3.1 29.6 1.5 65.7 3.3 54.4 5.4 94.7 91.7 96.1 45.8 8.5 80.6 4.0 73.3 NAKASONGOLA 181863 76.0 11.4 42.5 6.4 1.6 10.0 74.7 7.5 87.0 8.7 58.9 2.9 44.4 2.2 90.8 4.5 81.3 8.1 65.5 62.5 92.5 0.0 6.0 96.9 4.8 72.6 GOMBA 160075 100.3 15.0 25.5 3.8 0.9 8.8 71.6 7.2 55.0 5.5 47.3 2.4 21.8 1.1 81.9 4.1 56.8 5.7 96.9 100.0 100.0 94.7 9.8 100.0 5.0 68.4 WAKISO 2007700 76.5 11.5 26.7 4.0 0.6 6.4 115.7 10.0 89.5 9.0 28.6 1.4 16.4 0.8 74.0 3.7 82.0 8.2 71.4 4.2 81.2 53.7 5.7 90.3 4.5 65.2 BUVUMA 89960 77.9 11.7 15.8 2.4 0.6 6.3 179.9 10.0 36.0 3.6 32.7 1.6 7.8 0.4 87.2 4.4 62.7 6.3 95.5 100.0 100.0 0.0 7.9 96.0 4.8 59.3 Central-Region 7390170 100.6 14.0 66.3 7.8 1.2 9.1 157.1 9.1 75.6 7.6 53.6 2.7 34.5 1.7 76.6 3.8 84.7 7.0 87.5 79.2 93.6 47.3 8.0 95.1 4.8 75.5 KABAROLE 474216 130.6 15.0 69.0 10.4 1.6 10.0 180.9 10.0 81.0 8.1 47.9 2.4 46.6 2.3 83.8 4.2 86.8 8.7 98.0 100.0 99.9 93.5 9.8 90.9 4.5 85.4 KYENJOJO 423991 105.9 15.0 52.2 7.8 0.8 7.6 151.0 10.0 86.0 8.6 61.7 3.1 45.7 2.3 69.0 3.5 63.6 6.4 80.0 100.0 99.4 40.4 8.2 96.8 4.8 77.2 KAMWENGE 421470 94.3 14.1 51.8 7.8 0.8 7.9 91.5 9.2 78.1 7.8 54.0 2.7 42.6 2.1 92.1 4.6 75.1 7.5 95.8 58.3 94.2 100.0 8.9 92.1 4.6 77.2 KYEGEGWA 277379 91.5 13.7 35.3 5.3 0.7 7.2 179.6 10.0 81.6 8.2 59.4 3.0 42.7 2.1 83.4 4.2 81.5 8.1 85.0 100.0 100.0 100.0 9.6 97.4 4.9 76.2 BUNDIBUGYO 224145 137.6 15.0 41.0 6.2 1.3 10.0 55.1 5.5 72.0 7.2 57.8 2.9 26.6 1.3 75.5 3.8 95.4 9.5 85.8 91.7 96.0 90.0 9.1 92.1 4.6 75.1 104

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District KASESE 702029 106.8 15.0 46.2 6.9 1.1 10.0 52.3 5.2 84.8 8.5 53.2 2.7 42.4 2.1 96.3 4.8 70.2 7.0 49.5 16.7 69.4 90.0 5.7 85.8 4.3 72.2 NTOROKO 66422 101.2 15.0 33.8 5.1 1.1 10.0 13.5 1.3 66.9 6.7 39.8 2.0 33.7 1.7 86.7 4.3 75.0 7.5 91.7 91.7 98.3 100.0 9.5 93.3 4.7 67.8 Fort Portal-Region 2589652 109.7 14.7 47.0 7.1 1.1 9.0 103.4 7.3 78.6 7.9 53.4 2.7 40.0 2.0 83.8 4.2 78.2 7.8 83.7 79.8 93.9 87.7 8.7 92.6 4.6 75.9 GULU 443733 155.4 15.0 86.4 13.0 2.6 10.0 211.2 10.0 73.0 7.3 69.4 3.5 45.2 2.3 90.3 4.5 126.9 10.0 74.3 100.0 100.0 79.5 8.8 93.4 4.7 89.0 LAMWO 134050 175.3 15.0 91.4 13.7 2.2 10.0 94.5 9.4 40.0 4.0 98.5 4.9 74.7 3.7 83.0 4.2 45.1 4.5 89.1 75.0 95.3 65.0 8.3 96.6 4.8 82.6 AGAGO 227486 137.2 15.0 79.1 11.9 1.4 10.0 58.3 5.8 47.0 4.7 69.6 3.5 59.5 3.0 58.5 2.9 88.0 8.8 97.1 95.8 99.5 100.0 9.8 97.9 4.9 80.3 NWOYA 128094 133.3 15.0 47.2 7.1 1.1 10.0 83.8 8.4 74.6 7.5 48.3 2.4 31.8 1.6 94.9 4.7 80.3 8.0 100.0 100.0 100.0 100.0 10.0 78.1 3.9 78.6 KITGUM 204012 105.7 15.0 77.5 11.6 1.6 10.0 137.5 10.0 50.5 5.1 66.7 3.3 48.0 2.4 83.7 4.2 70.3 7.0 75.3 4.2 81.1 3.6 4.8 98.4 4.9 78.4 AMURU 190516 113.2 15.0 35.1 5.3 1.3 10.0 52.2 5.2 72.0 7.2 66.6 3.3 32.9 1.6 91.3 4.6 79.8 8.0 93.2 79.2 93.1 80.0 8.8 92.7 4.6 73.6 PADER 183723 118.7 15.0 32.5 4.9 1.2 10.0 129.5 10.0 54.0 5.4 58.9 2.9 37.4 1.9 67.2 3.4 72.7 7.3 84.6 75.0 90.6 0.0 6.8 82.1 4.1 71.6 Gulu-Region 1511614 134.1 15.0 64.2 9.6 1.6 10.0 109.6 8.4 58.7 5.9 68.3 3.4 47.1 2.4 81.3 4.1 80.5 7.7 87.7 75.6 94.2 61.2 8.2 91.3 4.6 79.2 HOIMA 573903 91.5 13.7 56.5 8.5 1.5 10.0 106.2 10.0 74.0 7.4 65.3 3.3 44.1 2.2 60.9 3.0 70.4 7.0 94.3 100.0 100.0 69.1 9.2 98.5 4.9 79.3 KIBOGA 148606 112.2 15.0 75.5 11.3 1.2 10.0 148.3 10.0 51.0 5.1 73.5 3.7 41.0 2.0 68.4 3.4 47.2 4.7 95.7 100.0 98.0 0.0 7.8 100.0 5.0 78.1 MASINDI 292951 85.2 12.8 57.4 8.6 1.4 10.0 52.7 5.3 77.0 7.7 50.0 2.5 54.8 2.7 72.6 3.6 68.0 6.8 89.9 100.0 100.0 7.5 7.8 100.0 5.0 72.9 105

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District KIBAALE 788714 90.7 13.6 39.6 5.9 0.5 5.3 96.7 9.7 78.8 7.9 50.3 2.5 22.8 1.1 86.5 4.3 77.8 7.8 95.3 100.0 100.0 100.0 9.9 97.2 4.9 72.9 KIRYANDONGO 268188 112.6 15.0 42.2 6.3 0.9 9.2 66.2 6.6 67.5 6.8 66.3 3.3 30.7 1.5 54.6 2.7 53.2 5.3 95.7 100.0 100.0 100.0 9.9 100.0 5.0 71.7 BULIISA 113569 79.2 11.9 30.9 4.6 0.8 8.5 66.6 6.7 68.6 6.9 61.5 3.1 21.2 1.1 91.9 4.6 66.2 6.6 99.2 100.0 100.0 100.0 10.0 94.1 4.7 68.6 KYANKWANZI 214057 98.2 14.7 22.6 3.4 0.6 6.0 72.6 7.3 55.0 5.5 53.0 2.7 23.2 1.2 79.1 4.0 64.2 6.4 97.0 100.0 100.0 100.0 9.9 100.0 5.0 66.0 Hoima-Region 2399988 95.7 13.8 46.4 7.0 1.0 8.4 87.0 7.9 67.4 6.7 60.0 3.0 34.0 1.7 73.4 3.7 63.9 6.4 95.3 100.0 99.7 68.1 9.2 98.5 4.9 72.8 JINJA 468256 123.9 15.0 77.0 11.6 1.9 10.0 95.8 9.6 81.3 8.1 58.2 2.9 42.3 2.1 54.0 2.7 94.7 9.5 77.8 100.0 97.7 51.5 8.3 99.2 5.0 84.7 IGANGA 506388 92.5 13.9 57.9 8.7 1.2 10.0 53.6 5.4 75.0 7.5 56.5 2.8 32.5 1.6 90.3 4.5 87.1 8.7 100.0 100.0 100.0 100.0 10.0 99.0 4.9 78.0 KAMULI 490255 133.9 15.0 57.5 8.6 1.2 10.0 36.8 3.7 78.0 7.8 65.4 3.3 43.5 2.2 83.7 4.2 70.2 7.0 99.4 100.0 100.0 100.0 10.0 81.0 4.0 75.8 NAMUTUMBA 253260 108.4 15.0 37.2 5.6 1.0 10.0 58.0 5.8 84.1 8.4 56.4 2.8 34.0 1.7 96.5 4.8 63.1 6.3 64.1 95.8 96.9 97.0 8.7 95.2 4.8 73.9 BUGIRI 390076 106.6 15.0 37.4 5.6 1.0 9.8 52.0 5.2 82.2 8.2 58.6 2.9 29.0 1.5 86.2 4.3 47.4 4.7 88.7 100.0 100.0 100.0 9.7 96.5 4.8 71.7 NAMAYINGO 223229 103.6 15.0 29.3 4.4 1.2 10.0 98.4 9.8 48.3 4.8 63.4 3.2 33.1 1.7 86.5 4.3 35.1 3.5 74.2 100.0 100.0 100.0 9.2 88.8 4.4 70.4 LUUKA 241453 96.0 14.4 24.7 3.7 1.0 9.9 29.8 3.0 65.0 6.5 22.9 1.1 16.8 0.8 88.5 4.4 126.6 10.0 71.0 62.5 88.5 100.0 8.0 93.7 4.7 66.6 KALIRO 236927 99.3 14.9 32.1 4.8 0.7 6.9 33.1 3.3 70.0 7.0 53.5 2.7 32.5 1.6 83.1 4.2 75.6 7.6 74.2 95.8 99.4 40.0 7.9 100.0 5.0 65.8 MAYUGE 479172 92.3 13.8 37.6 5.6 0.8 8.1 56.4 5.6 67.2 6.7 52.7 2.6 30.0 1.5 87.2 4.4 60.3 6.0 82.6 12.5 88.5 62.8 6.6 90.9 4.5 65.6 BUYENDE 320468 94.6 14.2 35.0 5.3 0.5 5.3 35.4 3.5 85.0 8.5 51.1 2.6 28.0 1.4 73.0 3.7 74.4 7.4 48.9 50.0 85.9 68.2 6.4 94.2 4.7 63.0 106

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District Jinja-Region 3609484 105.1 14.6 42.6 6.4 1.1 9.0 54.9 5.5 73.6 7.4 53.9 2.7 32.2 1.6 82.9 4.1 73.5 7.1 78.1 81.7 95.7 82.0 8.5 93.9 4.7 71.6 LIRA 410516 99.9 15.0 53.5 8.0 1.7 10.0 144.9 10.0 80.8 8.1 58.8 2.9 32.0 1.6 88.9 4.4 90.5 9.0 92.4 95.8 96.9 84.8 9.3 100.0 5.0 83.4 OYAM 388011 114.9 15.0 63.5 9.5 0.7 6.7 76.9 7.7 89.9 9.0 74.3 3.7 51.1 2.6 91.3 4.6 80.3 8.0 62.1 54.2 94.2 100.0 7.8 88.1 4.4 78.9 DOKOLO 182579 101.2 15.0 43.1 6.5 1.0 9.6 93.3 9.3 86.0 8.6 63.6 3.2 37.0 1.8 96.1 4.8 56.5 5.6 91.1 100.0 100.0 75.0 9.2 100.0 5.0 78.7 AMOLATAR 146904 111.9 15.0 38.9 5.8 1.0 9.6 102.5 10.0 78.2 7.8 46.8 2.3 25.7 1.3 78.5 3.9 75.4 7.5 97.4 100.0 99.0 100.0 9.9 92.5 4.6 77.9 OTUKE 105617 98.3 14.7 34.2 5.1 1.0 10.0 156.2 10.0 58.0 5.8 56.1 2.8 28.8 1.4 76.9 3.8 97.9 9.8 91.0 87.5 97.4 36.4 8.1 100.0 5.0 76.7 APAC 368786 88.0 13.2 42.2 6.3 0.9 9.0 92.3 9.2 78.3 7.8 38.5 1.9 34.3 1.7 93.5 4.7 82.7 8.3 91.4 95.8 96.3 71.9 9.0 98.4 4.9 76.1 ALEBTONG 225327 98.2 14.7 33.2 5.0 0.6 6.5 56.0 5.6 81.4 8.1 53.9 2.7 27.6 1.4 80.5 4.0 91.5 9.2 83.3 79.2 93.3 61.5 8.1 100.0 5.0 70.3 KOLE 241878 91.4 13.7 36.9 5.5 0.5 5.0 63.2 6.3 86.0 8.6 46.7 2.3 25.5 1.3 94.3 4.7 36.9 3.7 100.0 100.0 100.0 100.0 10.0 100.0 5.0 66.2 Lira-Region 2069618 100.5 14.5 43.2 6.5 0.9 8.3 98.2 8.5 79.8 8.0 54.8 2.7 32.8 1.6 87.5 4.4 76.5 7.6 88.6 89.1 97.1 78.7 8.9 97.4 4.9 76.0 LYANTONDE 94573 97.0 14.6 70.5 10.6 2.3 10.0 226.8 10.0 86.0 8.6 78.4 3.9 61.1 3.1 54.5 2.7 47.2 4.7 89.8 100.0 100.0 100.0 9.7 91.3 4.6 82.4 MASAKA 296649 101.2 15.0 88.2 13.2 2.0 10.0 264.7 10.0 84.0 8.4 45.9 2.3 33.8 1.7 57.3 2.9 66.2 6.6 83.1 12.5 78.4 60.6 6.3 85.7 4.3 80.7 RAKAI 518008 96.7 14.5 47.4 7.1 1.5 10.0 121.7 10.0 86.0 8.6 58.0 2.9 42.9 2.1 77.6 3.9 59.9 6.0 92.3 50.0 87.7 17.1 6.7 98.7 4.9 76.8 KALUNGU 184131 69.0 10.4 49.6 7.4 1.1 10.0 142.1 10.0 90.8 9.1 50.3 2.5 45.3 2.3 92.5 4.6 54.3 5.4 86.1 100.0 98.3 46.2 8.5 100.0 5.0 75.2 107

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District KALANGALA 53406 83.8 12.6 26.1 3.9 1.9 10.0 398.0 10.0 69.0 6.9 35.6 1.8 28.3 1.4 98.9 4.9 78.3 7.8 93.5 95.8 99.2 100.0 9.7 75.8 3.8 72.9 BUKOMANSIMBI 151075 90.3 13.5 22.0 3.3 0.8 7.8 96.9 9.7 91.6 9.2 37.6 1.9 21.4 1.1 88.6 4.4 57.3 5.7 99.5 100.0 100.0 100.0 10.0 100.0 5.0 71.6 LWENGO 275450 117.0 15.0 24.9 3.7 0.9 8.6 69.4 6.9 76.0 7.6 44.5 2.2 30.6 1.5 87.3 4.4 56.7 5.7 99.2 100.0 99.6 40.6 8.8 98.2 4.9 69.3 SEMBABULE 283630 92.6 13.9 16.3 2.5 0.7 6.8 51.1 5.1 71.0 7.1 39.5 2.0 21.6 1.1 99.4 5.0 62.3 6.2 96.2 100.0 99.6 100.0 9.9 89.8 4.5 63.9 Masaka-Region 1856922 93.5 13.7 43.1 6.5 1.4 9.1 171.3 9.0 81.8 8.2 48.7 2.4 35.6 1.8 82.0 4.1 60.3 6.0 92.5 82.3 95.4 70.6 8.7 92.4 4.6 74.1 MBALE 492804 116.8 15.0 62.3 9.3 1.2 10.0 59.8 6.0 93.2 9.3 52.2 2.6 35.5 1.8 78.2 3.9 94.3 9.4 86.3 100.0 99.8 72.3 9.0 100.0 5.0 81.4 TORORO 526378 99.2 14.9 55.1 8.3 1.6 10.0 74.3 7.4 82.1 8.2 62.3 3.1 53.2 2.7 53.2 2.7 60.6 6.1 95.2 91.7 98.0 77.8 9.2 98.4 4.9 77.4 BUSIA 325527 96.0 14.4 54.9 8.2 1.6 10.0 57.5 5.7 87.5 8.8 57.6 2.9 28.4 1.4 84.1 4.2 46.9 4.7 84.2 100.0 99.4 3.4 7.6 100.0 5.0 72.9 PALLISA 386074 96.3 14.4 53.8 8.1 1.0 9.8 22.2 2.2 82.9 8.3 68.5 3.4 28.8 1.4 98.3 4.9 60.0 6.0 83.6 95.8 97.5 24.2 7.8 98.5 4.9 71.4 BUDAKA 208439 94.9 14.2 52.8 7.9 0.9 9.3 25.8 2.6 58.4 5.8 72.3 3.6 32.9 1.6 94.2 4.7 72.9 7.3 94.1 100.0 97.1 62.5 9.0 98.4 4.9 71.0 SIRONKO 297154 92.6 13.9 27.7 4.1 0.9 8.7 107.2 10.0 77.0 7.7 38.1 1.9 22.2 1.1 95.3 4.8 61.8 6.2 96.7 50.0 89.6 27.6 7.1 97.2 4.9 70.4 KAPCHORWA 104580 79.1 11.9 48.0 7.2 1.8 10.0 41.9 4.2 77.0 7.7 51.0 2.5 26.6 1.3 93.0 4.6 64.3 6.4 92.1 100.0 99.8 0.0 7.8 100.0 5.0 68.7 BUDUDA 211683 104.1 15.0 26.4 4.0 1.0 9.6 26.1 2.6 75.0 7.5 38.0 1.9 19.0 1.0 71.7 3.6 86.6 8.7 85.6 100.0 100.0 100.0 9.6 93.4 4.7 68.0 BUKWO 89253 94.5 14.2 26.7 4.0 1.8 10.0 17.7 1.8 80.0 8.0 50.3 2.5 34.8 1.7 100.0 5.0 55.3 5.5 100.0 100.0 100.0 100.0 10.0 100.0 5.0 67.7 BUTALEJA 245873 78.5 11.8 55.5 8.3 1.5 10.0 29.9 3.0 68.0 6.8 68.0 3.4 29.6 1.5 90.8 4.5 52.3 5.2 99.7 100.0 100.0 4.2 8.1 100.0 5.0 67.6 108

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District MANAFWA 352864 110.0 15.0 30.6 4.6 0.7 6.7 25.0 2.5 75.0 7.5 43.7 2.2 21.1 1.1 96.4 4.8 70.7 7.1 85.5 100.0 99.8 78.3 9.1 100.0 5.0 65.6 KIBUKU 202630 74.1 11.1 52.5 7.9 0.9 8.8 28.3 2.8 81.6 8.2 58.0 2.9 28.1 1.4 95.0 4.8 53.5 5.4 56.1 91.7 98.3 0.0 6.5 100.0 5.0 64.6 KWEEN 95623 82.9 12.4 15.3 2.3 1.2 10.0 11.8 1.2 83.5 8.4 45.3 2.3 18.1 0.9 100.0 5.0 63.9 6.4 99.1 91.7 98.3 61.1 9.0 100.0 5.0 62.8 BULAMBULI 177322 64.8 9.7 18.2 2.7 0.8 8.5 39.8 4.0 69.9 7.0 29.8 1.5 15.7 0.8 85.6 4.3 57.1 5.7 100.0 100.0 100.0 5.3 8.1 100.0 5.0 57.3 Mbale-Region 3716204 91.7 13.4 41.4 6.2 1.2 9.4 40.5 4.0 77.9 7.8 52.5 2.6 28.1 1.4 88.3 4.4 64.3 6.4 89.9 94.3 98.4 44.1 8.4 99.0 4.9 69.1 RUKUNGIRI 320567 86.7 13.0 63.4 9.5 1.7 10.0 87.7 8.8 98.9 9.9 46.9 2.3 42.6 2.1 76.3 3.8 118.4 10.0 98.5 100.0 99.8 100.0 9.9 91.1 4.6 84.0 BUSHENYI 235621 86.3 12.9 70.7 10.6 1.5 10.0 118.4 10.0 91.8 9.2 43.9 2.2 50.6 2.5 68.6 3.4 78.0 7.8 72.7 41.7 88.3 95.0 7.6 96.4 4.8 81.1 ISINGIRO 492116 102.1 15.0 47.5 7.1 1.4 10.0 73.9 7.4 90.4 9.0 45.7 2.3 34.8 1.7 92.2 4.6 80.6 8.1 82.5 50.0 80.6 97.0 7.8 100.0 5.0 78.1 KANUNGU 252075 94.9 14.2 52.1 7.8 1.3 10.0 65.2 6.5 93.0 9.3 54.5 2.7 50.5 2.5 87.9 4.4 63.4 6.3 93.9 95.8 97.5 100.0 9.7 90.3 4.5 78.0 KIRUHURA 328544 92.4 13.9 36.8 5.5 1.1 10.0 92.9 9.3 90.5 9.1 67.0 3.3 55.8 2.8 88.0 4.4 62.8 6.3 80.2 62.5 88.2 58.5 7.5 96.0 4.8 76.8 KABALE 534160 81.5 12.2 49.6 7.4 1.6 10.0 51.1 5.1 87.1 8.7 49.2 2.5 42.0 2.1 85.3 4.3 96.5 9.6 96.4 100.0 100.0 95.9 9.8 97.8 4.9 76.7 MBARARA 474144 86.6 13.0 62.3 9.3 1.4 10.0 407.6 10.0 98.0 9.8 41.8 2.1 49.0 2.4 82.3 4.1 39.9 4.0 81.4 0.0 81.7 90.5 6.7 85.5 4.3 75.8 SHEEMA 246636 68.7 10.3 62.7 9.4 2.3 10.0 34.2 3.4 88.9 8.9 53.7 2.7 51.5 2.6 79.2 4.0 85.2 8.5 93.1 100.0 98.3 100.0 9.7 100.0 5.0 74.5 NTUNGAMO 489323 89.5 13.4 43.9 6.6 0.9 8.9 673.9 10.0 94.6 9.5 40.5 2.0 27.1 1.4 73.9 3.7 75.0 7.5 82.4 54.2 89.7 13.0 6.5 100.0 5.0 74.4 KISORO 287179 86.2 12.9 60.4 9.1 1.5 10.0 34.2 3.4 75.0 7.5 41.4 2.1 33.3 1.7 79.1 4.0 66.9 6.7 100.0 100.0 100.0 100.0 10.0 100.0 5.0 72.3 109

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District IBANDA 248083 82.6 12.4 48.9 7.3 1.5 10.0 92.1 9.2 87.0 8.7 40.9 2.0 30.2 1.5 70.8 3.5 52.1 5.2 46.7 29.2 78.6 73.3 5.8 93.1 4.7 70.4 MITOOMA 185519 105.5 15.0 28.9 4.3 1.1 10.0 32.4 3.2 91.1 9.1 36.3 1.8 38.2 1.9 88.4 4.4 65.5 6.5 90.3 100.0 99.8 4.2 7.8 81.1 4.1 68.2 RUBIRIZI 129283 79.0 11.9 32.0 4.8 1.0 9.7 83.6 8.4 83.7 8.4 54.0 2.7 44.0 2.2 77.6 3.9 47.3 4.7 81.6 0.0 69.8 89.5 6.3 100.0 5.0 67.9 BUHWEJU 124044 83.5 12.5 25.1 3.8 0.9 9.3 32.1 3.2 78.3 7.8 42.5 2.1 25.0 1.3 94.6 4.7 49.3 4.9 75.0 50.0 78.6 100.0 7.6 100.0 5.0 62.2 Mbarara-Region 4347294 87.5 13.1 48.9 7.3 1.4 9.8 134.2 7.0 89.2 8.9 47.0 2.4 41.0 2.1 81.7 4.1 70.1 6.9 83.9 63.1 89.4 79.8 8.1 95.1 4.8 74.3 ABIM 109039 87.0 13.0 49.1 7.4 1.6 10.0 84.6 8.5 56.6 5.7 44.0 2.2 33.4 1.7 68.7 3.4 68.1 6.8 86.3 83.3 96.8 94.7 9.1 82.6 4.1 71.8 NAPAK 145219 148.2 15.0 67.1 10.1 1.0 10.0 10.9 1.1 13.1 1.3 56.2 2.8 52.2 2.6 56.8 2.8 71.2 7.1 89.9 62.5 95.8 92.9 8.7 100.0 5.0 66.5 KAABONG 169274 187.4 15.0 59.3 8.9 1.6 10.0 11.6 1.2 19.1 1.9 56.7 2.8 48.8 2.4 40.4 2.0 46.2 4.6 87.0 95.8 99.5 100.0 9.5 87.5 4.4 62.8 MOROTO 104539 99.6 14.9 44.9 6.7 1.5 10.0 12.1 1.2 2.2 0.2 50.9 2.5 35.3 1.8 71.3 3.6 86.4 8.6 91.7 87.5 96.8 0.0 7.4 77.5 3.9 60.9 NAKAPIRIPIRIT 169691 96.5 14.5 40.7 6.1 0.9 8.6 10.6 1.1 22.3 2.2 41.7 2.1 29.6 1.5 95.5 4.8 60.5 6.1 95.1 79.2 94.9 100.0 9.3 94.1 4.7 60.9 KOTIDO 178909 121.9 15.0 54.9 8.2 1.1 10.0 16.1 1.6 25.1 2.5 56.4 2.8 32.0 1.6 68.0 3.4 64.9 6.5 88.2 0.0 89.2 0.0 5.3 63.7 3.2 60.2 AMUDAT 111758 94.7 14.2 32.3 4.8 0.6 5.8 15.2 1.5 10.3 1.0 33.3 1.7 15.7 0.8 47.8 2.4 36.0 3.6 95.8 95.8 99.4 100.0 9.8 20.0 1.0 46.6 Moroto-Region 988429 119.3 14.5 49.8 7.5 1.2 9.2 23.0 2.3 21.2 2.1 48.5 2.4 35.3 1.8 64.1 3.2 61.9 6.2 90.6 72.0 96.1 69.7 8.4 75.1 3.8 61.4 110

Total Population (UBOS Aug 2014) Monthly reports sent on time (3) Completeness monthly reports (2) Completeness facility reporting (3) Completeness of the annual report (2) 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 HMIS reporting completeness and timeliness Medicine orders submitted timely Total Annual Health Sector Performance Report for Financial Year 2014/15 Coverage and quality of care (75) Management (25) 15 15 10 10 10 5 5 5 10 10 5 District SERERE 211720 114.2 15.0 67.3 10.1 1.2 10.0 120.5 10.0 80.0 8.0 83.0 4.2 25.7 1.3 94.1 4.7 48.2 4.8 95.5 100.0 100.0 77.3 9.4 95.6 4.8 82.2 SOROTI 252994 104.2 15.0 77.5 11.6 2.2 10.0 78.2 7.8 78.6 7.9 72.9 3.6 43.1 2.2 59.8 3.0 59.5 6.0 81.1 95.8 98.6 62.2 8.6 91.8 4.6 80.2 KATAKWI 165553 101.7 15.0 59.7 9.0 2.0 10.0 93.1 9.3 73.2 7.3 60.3 3.0 35.9 1.8 91.4 4.6 51.2 5.1 96.0 100.0 98.2 92.3 9.7 100.0 5.0 79.8 KABERAMAIDO 213374 101.8 15.0 46.6 7.0 1.3 10.0 87.5 8.7 77.6 7.8 61.8 3.1 23.0 1.2 85.7 4.3 88.4 8.8 89.2 100.0 100.0 28.0 8.2 100.0 5.0 79.1 KUMI 258073 92.4 13.9 57.0 8.5 1.5 10.0 54.0 5.4 91.0 9.1 57.1 2.9 42.1 2.1 74.7 3.7 88.6 8.9 90.1 75.0 97.2 100.0 9.1 97.7 4.9 78.5 AMURIA 270601 111.8 15.0 46.6 7.0 1.2 10.0 76.5 7.6 78.9 7.9 68.7 3.4 23.0 1.1 97.1 4.9 65.4 6.5 92.3 100.0 99.9 2.7 7.8 95.8 4.8 76.1 NGORA 142487 107.4 15.0 61.2 9.2 1.2 10.0 71.8 7.2 83.0 8.3 60.5 3.0 36.1 1.8 78.7 3.9 32.6 3.3 89.6 91.7 97.9 66.7 8.8 95.3 4.8 75.2 BUKEDEA 188918 96.7 14.5 53.8 8.1 0.7 6.6 47.7 4.8 80.8 8.1 61.0 3.0 23.7 1.2 80.1 4.0 63.1 6.3 100.0 100.0 100.0 0.0 8.0 100.0 5.0 69.6 Soroti-Region 1703720 103.8 14.8 58.7 8.8 1.4 9.6 78.7 7.6 80.4 8.0 65.7 3.3 31.6 1.6 82.7 4.1 62.1 6.2 91.7 95.3 99.0 53.7 8.7 97.0 4.9 77.6 NATIONAL 34844095 102.4 15.0 52.7 7.9 1.2 10.0 94.7 9.5 73.7 7.4 53.4 2.7 36.6 1.8 80.3 4.0 70.7 7.1 88.4 83.4 95.6 66.3 8.5 94.1 4.7 78.6 TABLE 54: GENERAL HOSPITAL PERFORMANCE 111

Facility Admissions Patient Days Beds Total OPD Deliveries Total ANC Postnatal Attendances FP Immunization Caesarian Sections Major operations IPD Deaths Fresh Still births Maternal deaths BOR ALOS Maternal Death Risk FSB Risk SUO 2014/15 Annual Health Sector Performance Report for Financial Year 2014/15 Iganga 23,624 62,653 104 148,381 6,481 7,303 2,349 1,122 12,922 1,735 3,208 476 152 16 165 2.7 405 43 543,117 Busolwe 13,427 22,188 100 116,082 1,896 2,048 882 182 3,945 359 626 164 23 8 61 1.7 237 82 329,312 Kitgum 15,186 66,043 248 84,480 2,770 2,705 748 289 5,579 238 532 192 17 5 73 4.3 554 163 329,107 Mityana 14,533 69,591 122 64,275 5,763 6,431 1,971 1,221 7,685 1,474 2,329 333 84 18 156 4.8 320 69 317,434 Tororo General 14,083 58,170 214 63,432 5,158 6,040 2,718 193 7,452 485 974 280 65 3 74 4.1 1,719 79 306,433 Bwera 14,360 56,868 120 61,258 4,318 7,572 318 2,054 15,831 1,183 1,734 275 31 10 130 4.0 432 139 306,386 Pallisa 14,458 57,965 129 57,445 3,626 3,928 3,240 1,135 8,837 168 497 156 67 9 123 4.0 403 54 298,364 Kawolo 11,704 31,201 113 89,820 3,764 5,521 755 2,828 9,308 731 1,011 193 25 6 76 2.7 627 151 290,614 Apac 14,121 44,948 149 51,355 2,222 4,744 365 725 6,977 209 452 1,846 30 7 83 3.2 317 74 278,592 Angal St. Luke 15,142 98,026 260 31,231 2,537 2,802 367 5,830 612 1,183 507 57 14 103 6.5 181 45 273,797 Atutur 11,543 31,627 100 78,229 1,737 2,535 805 550 5,792 41 373 62 27 1 87 2.7 1,737 64 263,162 Ibanda 15,078 37,691 190 21,862 2,447 1,958 264 5,301 766 1,175 387 103 12 54 2.5 204 24 262,438 Kayunga 11,319 33,164 104 68,930 3,045 3,017 544 904 7,533 670 1,027 279 93 11 87 2.9 277 33 257,679 Kagadi 14,134 44,101 160 21,917 3,729 4,625 559 359 9,463 734 1,118 131 108 11 76 3.1 339 35 257,236 Nebbi 12,667 42,317 120 49,810 2,367 3,885 327 528 8,539 398 612 164 29 4 97 3.3 592 82 255,728 Yumbe 11,716 46,372 116 50,264 2,480 2,731 814 757 11,894 555 805 198 38 11 110 4.0 225 65 242,934 Lyantonde 9,759 25,291 100 80,797 2,087 4,281 219 225 6,030 502 632 67 33 6 69 2.6 348 63 241,186 Kalongo Ambrosoli Memorial 12,799 66,386 271 25,526 3,247 3,034 847 1,199 6,206 369 565 180 32 3 67 5.2 1,082 101 237,527 Adjumani 10,436 49,428 154 63,515 1,840 2,317 754 278 5,289 456 1,986 250 38 5 88 4.7 368 48 231,987 Kamuli 10,052 193,06.3 100 63,015 1,968 3,555 2,960 882 7,117 257 477 86 45 6 53 1.9 328 44 228,757 Entebbe 8,268 20,450 122 67,246 5,158 8,738 1,356 194 14,732 1,219 1,523 120 53 2 46 2.5 2,579 97 225,146 Katakwi General 10,683 36,066 100 47,795 1,535 2,059 577 503 6,027 128 236 67 10 99 3.4 154 218,490 Kilembe 12,031 53,004 435 23,589 2,368 1,811 192 6,282 844 1,791 326 63 10 33 4.4 237 38 218,152 Bugiri 9,634 39,239 104 54,514 2,623 4,742 861 902 6,351 598 1,665 223 108 10 103 4.1 262 24 216,662 112

Kitagata 8,226 31,077 100 78,581 2,088 2,474 948 470 3,947 669 1,041 97 32 85 3.8 65 215,146 Bududa 9,519 29,429 100 61,931 1,246 1,957 608 396 8,102 219 238 161 28 4 81 3.1 312 45 214,047 Itojo 10,074 41,558 165 48,609 2,198 1,605 1,637 96 4,109 489 951 144 67 9 69 4.1 244 33 213,200 Gombe 9,930 34,374 100 46,141 2,889 3,011 420 381 4,996 657 969 228 80 9 94 3.5 321 36 212,441 Kiryandongo 10,253 36,791 104 36,146 2,019 4,200 10 351 8,212 288 472 161 58 3 97 3.6 673 35 203,959 Masafu General 8,619 23,335 95 59,782 1,679 2,247 739 195 5,592 253 333 87 29 4 67 2.7 420 58 200,171 Kiboga 9,319 30,612 100 39,527 3,096 3,988 1,520 42 3,229 457 638 150 72 4 84 3.3 774 43 198,213 Masindi 9,188 27,128 161 32,649 3,744 6,926 51 802 11,617 536 771 1,661 60 6 46 3.0 624 62 195,402 Kisoro 8,318 44,593 142 50,867 2,805 3,883 144 488 4,565 472 798 172 25 2 86 5.4 1,403 112 192,833 Kaabong 9,113 33,527 100 41,318 1,258 1,705 514 181 12,795 190 240 61 41 2 92 3.7 629 31 188,062 Aber Ngo 9,088 44,592 184 36,433 2,145 3,766 795 11,094 449 743 349 61 4 66 4.9 536 35 187,977 Matany 9,404 76,234 284 33,307 1,005 2,079 765 17,452 260 721 237 16 4 74 8.1 251 63 184,304 Kiu Teaching 10,104 33,607 552 22,921 1,329 1,918 186 553 2,360 476 1,104 1,078 15 17 3.3 89 182,927 Bombo General Military 8,341 38,774 193 43,901 2,063 2,375 11 1,018 4,535 501 778 372 45 1 55 4.6 2,063 46 181,940 Kisiizi NGO 8,152 53,387 304 37,317 2,152 3,881 29 125 8,689 598 1,450 180 33 48 6.5 65 174,112 Mutolere (St. Francis) 9,089 52,600 200 21,856 2,139 2,748 80 369 5,332 780 1,548 176 39 2 72 5.8 1,070 55 171,551 Kumi NGO 7,194 44,223 210 54,510 1,494 1,065 188 294 4,164 407 1,033 134 38 1 58 6.1 1,494 39 171,496 Ishaka Adventist 9,182 21,533 104 16,604 2,568 2,737 1,186 7,133 1,024 1,293 161 54 4 57 2.3 642 48 170,562 St. Joseph'S Kitgum 9,056 66,743 270 22,467 1,708 2,249 1,394 7,529 306 704 250 13 2 68 7.4 854 131 170,174 Kalisizo 6,742 19,856 105 53,936 2,340 3,331 259 482 6,249 700 867 88 43 1 52 2.9 23,40 54 170,052 Nakaseke 6,594 33,479 100 53,126 2,309 2,193 102 99 4,679 914 1,244 134 27 1 92 5.1 2,309 86 165,714 Koboko 8,452 21,943 105 24,378 1,953 3,772 181 582 10,983 158 227 121 25 2 57 2.6 977 78 165,387 Kagando 8,658 46,530 233 19,703 1,541 2,563 311 2,119 6,601 846 1,796 361 39 4 55 5.4 385 40 161,095 Kapchorwa 6,887 28,451 135 43,940 1,865 2,500 122 1,215 4,013 419 724 146 55 4 58 4.1 466 34 159,291 Kiwoko 7,486 37,610 231 28,989 2,098 2,915 519 268 6,612 724 1,037 235 30 3 45 5.0 699 70 154,942 Kyenjojo 6,933 15,834 94 30,938 2,241 2,849 1,262 1,517 8,076 303 482 43 44 2 46 2.3 1,121 51 150,567 Bundibugyo 6,029 34,268 104 47,930 1,670 2,768 185 251 6,407 515 771 131 42 8 90 5.7 209 40 149,598 Kamuli Mission 6,778 18,419 160 25,210 1,960 3,855 5,469 100 4,425 414 813 231 102 16 32 2.7 123 19 142,277 113

Nakasero 5,845 21,986 154 44,393 1,206 0 4,297 660 1,032 123 2 39 3.8 603 138,957 Rakai 5,220 11,088 75 49,068 1,517 1,597 182 249 3,643 227 477 57 56 6 41 2.1 253 27 136,696 Murchison Bay 1,628 5,051 166 103,499 776 3,050 203 1,660 1 27 3 8 3.1 259 133,758 Anaka 6,415 23,031 100 26,664 1,178 2,283 1,097 377 4,156 105 125 84 13 1 63 3.6 1,178 91 131,489 St. Karolii Lwanga Nyakibale 7,066 24,687 169 14,635 1,679 1,887 635 4,055 705 1,365 159 4 8 40 3.5 210 420 131,092 Moyo 4,456 18,257 167 50,948 981 856 477 223 2,592 180 308 84 15 2 30 4.1 491 65 123,989 St. Francis Naggalama 4,854 16,265 460 35,248 1,469 2,391 388 4,643 501 858 142 37 6 10 3.4 245 40 117,721 Nkozi 4,839 15,045 100 27,749 1,615 1,791 1,298 721 4,384 489 567 115 23 4 41 3.1 404 70 111,191 Kibuli 3,959 8,956 133 40,000 1,714 2,512 234 98 8,219 552 865 30 6 18 2.3 286 111,021 St. Joseph Kitovu 5,510 24,011 200 19,289 1,338 1,029 36 3,694 567 1,356 184 42 10 33 4.4 134 32 109,900 International Kampala 1,769 7,062 97 74,117 1,165 2,297 851 3,016 288 1,189 12 20 4.0 108,654 Kuluva 5,763 36,434 391 12,564 1,224 2,262 179 672 9,162 370 463 201 32 5 26 6.3 245 38 108,518 Buluba 4,479 16,715 126 32,533 1,063 955 596 3,000 512 671 112 25 9 36 3.7 118 43 106,409 Kisubi 3,600 11,620 158 39,122 1,404 2,075 782 14,929 493 833 66 17 1 20 3.2 1,404 83 104,556 Virika 5,223 13,471 207 19,311 913 1,009 417 6,617 498 1,018 154 22 5 18 2.6 183 42 104,257 Kambuga 4,158 13,510 100 30,682 1,076 1,898 69 1,221 2,420 81 180 50 10 3 37 3.2 359 108 100,510 Comboni 4,125 10,720 110 32,632 552 1,090 247 2,346 202 375 59 9 2 27 2.6 276 61 98,405 Kakira Worker's 3,196 7,255 78 47,060 352 665 118 639 1,983 63 12 1 25 2.3 352 97,868 Ruharo Mission 4,169 15,536 104 29,992 640 621 8 189 1,534 340 526 27 8 41 3.7 80 96,443 Abim 3,431 13,287 120 37,102 590 696 449 14 1,685 36 60 39 8 2 30 3.9 295 74 92,434 Nyapea 4,703 10,581 139 11,873 1,358 1,823 373 86 5,957 575 757 167 41 17 21 2.2 80 33 91,540 Maracha 4,687 37,596 200 14,790 833 927 651 6,826 215 426 185 48 7 52 8.0 119 17 91,414 Kabarole 4,341 7,572 68 14,537 863 1,084 376 305 27,121 319 512 36 18 5 31 1.7 173 48 90,274 Holy Innocents Children's 4,129 9,372 55 21,886 0 1,731 0 70 47 2.3 84,167 Mildmay Uganda 193 1,606 42 79,035 4 538 261 135 615 0 8 10 8.3 82,540 Villa Maria 4,148 17,387 126 12,108 1,199 1,018 285 2,276 515 757 137 35 3 38 4.2 400 34 81,430 Rubongi Military 2,444 9,737 65 40,339 152 742 198 592 1,173 0 13 2 1 41 4.0 152 76 78,760 Bwindi Community 3,291 14,157 111 20,769 1,374 1,233 305 683 2,385 337 576 55 22 2 35 4.3 687 62 78,592 114

Buikwe St. Charles Lwanga 4,067 12,052 86 9,886 1,007 1,328 320 3,147 215 340 73 21 2 38 3.0 504 48 77,379 Rugarama 3,524 18,351 136 20,029 303 1,071 79 842 1,969 85 172 92 3 37 5.2 101 75,794 Amudat 4,133 13,637 113 8,733 559 845 846 108 5,153 50 83 92 20 33 3.3 28 75,453 Lugazi Scoul 2,955 6,773 47 24,050 219 911 223 8,863 2,060 26 3 4 39 2.3 55 74,881 Kanginima 4,065 11,701 45 6,193 190 723 689 513 5,268 112 29 3 71 2.9 63 70,134 St. Francis Nyenga 3,129 11,944 81 15,716 669 1,842 617 160 4,448 217 325 78 19 1 40 3.8 669 35 68,195 Dabani 3,824 7,271 72 5,924 401 621 377 2,809 127 211 181 34 4 28 1.9 100 12 66,350 Benedictine Eye 2,768 7,446 239 21,141 0 0 1,403 9 2.7 62,661 Lwala 3,165 17,194 100 10,153 692 1,147 184 3,711 146 235 232 24 1 47 5.4 692 29 62,496 Bukwo General 1,809 4,202 32 31,967 335 1,115 340 181 2,612 56 93 18 12 36 2.3 28 62,117 St. Anthony's Tororo 3,216 14,029 172 8,740 542 636 213 3,775 181 396 95 6 2 22 4.4 271 90 60,870 Ngora Ngo 2,548 12,180 103 16,581 132 91 247 7,703 46 168 39 32 4.8 57,171 Rushere Community 2,539 8,499 90 10,478 523 1,403 138 121 6,437 239 341 57 20 1 26 3.3 523 26 53,296 Nakasongola Military 1,381 11,488 113 23,558 113 322 635 85 865 14 18 2 28 8.3 57 45,532 Novik 0 41,853 168 687 123 1,839 706 0 44,159 Namungoona Orthodox 1,733 3 40 11,885 545 1,303 763 3,085 62 85 9 8 0 0.0 68 42,255 Mukwaya General 753 1,385 62 27,356 237 524 103 46 1,318 85 156 10 3 6 1.8 79 40,436 Nkokonjeru 1,758 4,788 61 9,618 530 1,041 168 68 1,983 103 164 43 3 2 22 2.7 265 177 39,673 UPDF 2nd Div. 955 4,383 40 22,774 35 608 97 79 924 0 6 30 4.6 37,851 St. Catherine 0 34,971 118 202 97 19 821 0 35,884 Gulu Military 1,203 9,878 114 15,794 88 390 9 125 1,185 0 172 24 8.2 34,778 Mount Elgon 972 2,444 41 13,581 162 244 92 1,740 789 56 213 25 2 2 16 2.5 81 81 30,167 Amai Community 1,498 7,306 87 3,374 373 942 87 351 3,438 64 148 38 13 1 23 4.9 373 29 29,087 Buwenge NGO 1,100 3,048 41 3,722 762 1,621 757 852 5,776 3 75 4 20 2.8 26,802 Pioneer 1,256 3,662 16 7,832 3 0 0 8 19 63 2.9 26,687 5th Military Division 774 3,374 50 14,009 90 335 22 90 602 17 194 18 4.4 26,413 Mayanja Memorial 1,004 2,191 100 8,826 285 281 49 116 2,682 154 278 14 5 6 2.2 57 26,070 Mbarara Community 1,094 1,848 145 7,327 112 473 28 9 1,690 52 102 3 3 1.7 24,890 115

Gulu Independent 708 2,888 81 6,652 63 122 13 71 21,840 20 61 15 10 4.1 22,058 Paragon Kampala 528 593 22 10,603 477 934 229 132 1,896 182 209 2 6 7 1.1 80 21,935 Galilee Community General 958 108 24 4,918 260 412 497 63 2,983 54 105 3 1 0.1 21,671 Oriajini 1,016 2,739 48 2,972 404 665 144 107 4,232 0 14 7 16 2.7 58 21,536 Cure Children's 949 5,047 40 5,418 0 91 92 1525 19 35 5.3 19,671 Uganda Martyrs 489 770 17 8,376 256 485 34 1,693 73 105 1 12 1.6 256 17,589 Saidina Abubakar Islamic 413 937 20 9,568 164 403 9 46 2,431 42 53 5 5 1 13 2.3 164 33 17,298 Kida 898 1,661 32 2,077 195 515 99 29 1,657 40 72 19 1 14 1.8 195 17,175 Senta Medicare Clinic 187 496 15 9,301 207 349 233 2,091 51 86 1 9 2.7 13,850 Kololo 0 10,945 271 1,012 457 103 445 0 13,175 Kabasa Memorial 661 2,532 45 1,321 47 477 782 159 1,920 2 5 15 3.8 12,564 Buliisa 310 896 20 7,215 55 287 7 18 0 0 1 3 1 12 2.9 55 18 12,296 Bamu 179 758.8 0 5,133 319 294 10 24 220 47 60 118 12 4.2 27 9,621 Old Kampala 95 224 20 7,734 15 40 9 1,679 2 3 3 2.4 9,594 Tumu 204 533 50 2,999 35 40 5 1 256 14 30 2 3 2.6 6,308 Ruth Gaylord 149 227 28 2,900 53 109 44 189 7 1 1 2 1.5 53 5,514 Bethany Women and Family 0 4,728 72 143 60 11 163 0 5,228 Divine Mercy 183 89 33 1,690 1 28 6 1 5 2 1 0.5 4,455 JCRC Clinic Mengo 0 1,563 114 191 36 72 1,684 0 2,619 Kitintale 0 1,420 29 60 26 88 825 0 1 29 1,817 Ntinda 37 2 23 622 16 16 13 4 4 12 15 6 0 0.1 1,274 Middle East Bugolobi 0 1,110 0 13 0 0 1,117 Family Care 0 534 9 19 5 70 410 0 708 Kigezi Health Care Foundation III 0 0 0 0 0-116

Summary Admissions Patient Days Beds Total OPD Deliveries Total ANC Postnatal Attendances FP Immunization Caesarian Sections Major operations IPD Deaths Fresh Still births Maternal deaths BOR ALOS Maternal Death Risk FSB Risk SUO 2014/15 Annual Health Sector Performance Report for Financial Year 2014/15 TABLE 55: SUMMARY OF GENERAL HOSPITAL PERFORMANCE Minimum 37 2 0 0 1 0 5 1 0 1 0 1 1 1 0 0.0 55 12 708 Maximum 23,624 98,026 552 148,381 6,481 8,738 5,469 8,863 27,121 1,735 3,208 1,846 152 18 2 8 2,579 603 543,117 Total 730,313 2,776,176 15,235 4,125,600 173,258 245,578 63,521 54,482 642,209 40,093 73,180 18,476 3,282 407 57 442 45,811 8,185 16,256,818 # of hospitals 123 123 122 131 127 125 121 100 127 106 116 120 104 79 122 123 79 104 132 reporting Valid Average 5,937.50 22,571 125 31,493 1,364 1,965 525 545 5,057 378 631 154 32 5 50 3.8 265 43 123,158 TABLE 56: OUTPUTS AND RANKING OF HC IVS 2014/15 117

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank MukonoT.C. HC IV 7181 8747 52 47879 5761 11867 2949 2302 34397 742 813 40 4 33 2 199,837 1 Luwero HC IV 5778 8611 50 38967 2116 4815 2554 365 7472 91 133 64 25 7 0 141,578 2 Serere HC IV 6684 21236 84 27855 1622 2292 549 144 4476 244 702 613 44 27 138,613 3 Kitebi HC III 4462 5347 24 42990 3201 10913 671 1477 19745 0 0 0 2 6 4 136,405 4 Kumi HC IV 5211 10404 38 47332 645 1917 490 1131 7711 0 0 0 3 5 132,033 5 Amuria HC IV 5988 16591 70 29417 1373 1861 887 285 4973 125 458 48 20 27 1 128,613 6 Kakuuto HC IV 5510 22865 62 36886 721 1607 106 150 3316 126 173 717 45 10 2 124,736 7 Budaka HC IV 5904 8911 35 24526 1689 2697 233 82 3864 0 21 103 16 10 0 123,810 8 Pakwach HC IV 5364 15797 76 31019 1020 2124 322 1606 4082 17 24 129 99 15 3 119,421 9 Busia HC IV 4199 6195 34 41535 1807 5440 142 449 11326 58 81 2 33 21 1 118,836 10 Budadiri HC IV 5921 14686 61 16659 1819 2905 316 358 7820 144 188 137 42 54 4 117,923 11 Kasangati HC IV 3867 8275 31 36974 2475 6626 232 200 13003 31 36 0 1 13 0 113,484 12 Mpigi HC IV 4715 8936 47 24709 2422 4389 627 108 7240 356 467 13 17 25 0 111,554 13 Kibuku HC IV 5028 7762 33 28783 1076 2089 52 29 4070 3 89 120.5 20 2 0 111,482 14 Kabuyanda HC IV 5564 19498 57 15744 1968 2495 493 703 2872 400 509 115 36 65 1 111,464 15 Kaberamaido HC IV 3788 11518 128 47758 896 1673 155 326 3306 53 270 11 35 14 1 110,796 16 Azur HC III 5687 14622 73 11999 1863 1830 541 661 5526 102 152 0 75 18 1 109,240 17 Nyahuka HC IV 4688 12788 81 27055 1558 3159 71 165 3226 192 271 249 31 12 2 107,508 18 118

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Nankandulo HC IV 4326 6118 37 35633 810 1944 1017 569 3466 0 3 184 29 5 1 107,031 19 Dokolo HC IV 4516 26471 74 29865 900 1400 492 761 8336 150 409 701 81 40 3 105,099 20 Buyinja HC IV 4419 10766 26 32241 838 2085 394 218 1817 0 31 0 17 10 2 104,428 21 Kibaale HC IV 5310 6533 34 14599 1408 2109 208 409 3929 190 242 32 15 16 2 103,438 22 Namwendwa HC IV 4503 13038 45 21619 1715 2677 1634 404 4398 159 189 1104 32 14 1 100,976 23 Magale HC IV 4691 12725 163 22946 916 1656 1680 6387 40 111 361.2 63 31 0 100,836 24 Buwenge HC IV 5031 13899 32 18752 841 1842 1175 167 3683 58 71 0 16 3 0 100,751 25 Omugo HC IV 4239 8173 29 28215 1038 1930 64 815 8361 0 0 0 14 8 0 100,067 26 Tokora HC IV 5462 10170 34 13278 453 868 1436 70 3476 93 101 298 45 6 3 99,355 27 Wakiso HC IV 2657 4106 26 41097 1673 5205 251 518 28042 16 87 22 8 4 1 97,912 28 Butebo HC IV 4301 9835 32 23141 1287 2734 308 331 5200 0 16 252 12 9 1 96,818 29 Kitwe HC IV 4374 11975 51 19028 1590 3967 112 262 7622 6 9 27 18 21 1 96,283 30 PAG Mission HC IV 4885 27415 181 18783 453 1212 651 165 3652 56 173 651 103 3 0 96,067 31 Kyangwali HC IV 4540 16342 32 21068 841 2548 251 696 3616 0 30 656 71 13 1 95,844 32 Kabwohe HC IV 3960 8681 33 26554 1438 2484 142 155 3568 151 167 58 28 16 1 95,248 33 Mulanda HC IV 3561 12907.5 61 29640 1155 3497 1095 968 3783 0 112 0 21 11 0 92,367 34 Rukunyu HC IV 4622 14978 64 12685 1445 895 1413 324 4347 453 652 589 107 48 6 91,425 35 Midigo HC IV 4269 15169 73 19675 958 1508 252 279 5954 31 121 19626 29 11 2 90,710 36 119

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Anyeke HC IV 3423 12844 70 31557 1100 1729 159 411 3548 93 2855 45 42 9 0 90,261 37 Bumanya HC IV 4217 10036 30 21480 703 1832 205 120 3266 71 201 44 9 6 0 89,982 38 Kangulumira HC IV 2478 3622 25 41607 1331 3657 1843 553 7401 0 61 0 13 1 0 89,939 39 Mukono Co UHC IV 3672 9950 48 24942 1317 2234 689 8107 440 633 415 207 12 3 89,690 40 Kibiito HC IV 2327 4328 37 42601 1835 3160 781 315 3603 166 237 19 20 0 89,530 41 Rubaare HC IV 2620 18354 54 35477 1974 2503 1604 965 6292 225 284 33 20 21 2 88,441 42 River Oli HC IV 3807 11028 56 17956 1505 3089 570 147 16850 0 1 0 1 13 0 87,859 43 Kidera HC IV 3794 8066 30 24586 698 1941 630 176 7135 1 108 0 8 4 0 87,787 44 Ogur HC IV 2669 7553 38 37890 996 1168 61 261 7720 0 24 0 12 9 0 85,194 45 Bukomero HC IV 3366 4282 44 24306 1261 2613 173 242 7556 0 0 0 4 8 0 84,126 46 Bukedea HC IV 3364 13320 42 24299 1263 2564 262 639 5793 0 104 0 9 17 0 83,965 47 Mungula HC IV 3564 12892 40 26152 662 957 104 94 2205 23 71 0 10 9 1 83,941 48 Ishongororo HC IV 3621 10851 35 21545 1142 2598 23 141 4631 73 101 8 10 2 1 83,877 49 Nankoma HC IV 3612 9182 31 21276 881 2606 1006 465 6236 0 12 0 1 5 0 83,147 50 Princes Diana HC IV 3553 17577 39 23697 709 1505 608 208 3500 7 21 0 1 6 0 82,398 51 Kyabugimbi HC IV 3085 6493 30 27447 1234 2330 344 771 3685 95 117 0 3 4 0 82,352 52 Nagongera HC IV 3132 6048 43 24466 1252 3245 806 567 6588 0 3 0 3 14 0 81,333 53 Kigorobya HC IV 3293 5368 32 25324 907 2235 26 838 2562 0 0 0 8 5 0 81,316 54 120

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Ntwetwe HC IV 3642 7719.5 39 17260 1218 2816 306 443 7487 36 43 0 17 24 0 81,260 55 Semuto HC IV 2895 5239 24 32191 651 1935 150 43 4017 0 0 0 4 9 0 80,738 56 Kiganda HC IV 3024 5917 22 21883 1806 3640 230 584 4449 179 226 0 8 45 1 79,390 57 Lalogi HC IV 2286 6012 936 40129 571 1537 372 533 4184 0 0 44 37 3 0 79,332 58 Rugazi HC IV 3459 7431 39 19980 1035 1885 57 167 3385 0 0 18 8 12 1 78,772 59 Kotido HC IV 3676 10174 77 19560 551 590 621 119 1545 90 93 0 24 21 1 78,429 60 Rwashamaire HC IV 3295 9314 34 18723 1540 2256 144 495 2998 106 163 50 17 8 0 77,895 61 Mitooma HC IV 1829 4429 41 45142 574 1704 76 248 5673 65 73 0 2 2 0 77,596 62 Naam Okora HC IV 3354 8531 36 21831 714 1078 311 233 2906 0 0 0 16 3 0 77,103 63 Amolatar HC IV 3195 8564 44 22135 935 2101 163 242 3673 31 32 0 22 6 0 76,723 64 Bufumbo HC IV 3301 8429 33 21542 738 1375 361 713 3426 19 34 57 6 11 0 76,657 65 Bishop Asili Ceaser HC IV 3348 11085 100 19851 960 524 193 1241 353 589 580 73 39 4 75,478 66 Aduku HC IV 3278 10847 102 16160 1326 2585 177 365 5760 106 160 101 441 21 3 74,676 67 Ruhoko HC IV 2946 6389 45 21537 1227 2132 27 117 2167 111 136 74 44 11 1 73,433 68 Kyegegwa HC IV 3012 9939 37 18410 1312 2302 586 350 4279 221 314 130 43 49 4 72,625 69 ATIRIR HC IV 2946 6638 34 23400 577 1262 312 215 3937 0 0 0 2 0 72,157 70 Muyembe HC IV 2852 3629 34 22717 834 1935 288 64 4095 37 63 0 16 8 0 71,630 71 Mukuju HC IV 2331 8496 26 27924 794 2590 1853 761 5408 0 0 0 3 3 0 70,543 72 121

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Karenga HC IV 2941 9740 64 22042 399 979 305 51 3132 0 0 7 27 1 0 69,446 73 Apapai HC IV 2759 5063 25 24404 440 946 198 186 3346 0 0 0 2 9 0 69,323 74 Alebtong HC IV 2330 8733 59 27473 877 1851 89 344 6713 29 75 0 36 5 1 69,293 75 Busiu HC IV 3138 5456 42 16069 887 1425 415 282 3143 18 111 114 103 8 0 69,264 76 Aboke HC IV 2673 9855 28 20204 1050 2226 145 415 5069 54 108 0 11 10 0 67,956 77 Bwizibwera HC IV 2990 9629 32 15784 779 1824 2201 766 3549 8 8 0 7 2 1 67,634 78 Kinoni HC IV 2831 6283 27 18543 908 1373 740 267 1587 67 75 0 12 0 67,055 79 Nsinze HC IV 2403 5328 50 24454 823 1753 293 1055 3919 0 0 0 3 2 0 66,948 80 Amach HC IV 2458 6731 52 23694 817 1423 246 4022 0 0 0 9 10 0 66,288 81 Rwekubo HC IV 2701 7127 19 16992 1481 1107 40 329 2339 645 876 68 9 42 1 66,118 82 Kihiihi HC IV 2683 10495 64 19111 813 2196 300 1058 3502 29 623 16 26 3 1 65,898 83 Bugobero HC IV 2344 4610 47 20089 884 2425 1013 1000 15152 25 104 12 2 2 0 64,918 84 Busesa HC IV 2360 3957 24 21738 912 2560 366 731 2246 2 2 226 2 8 0 63,976 85 Kyarusozi HC IV 2387 5003 30 21724 683 1549 391 1073 2170 10 14 48 31 8 0 62,885 86 Nakasongola HC IV 2323 5762 52 22470 729 1740 107 195 3550 0 68 0 8 9 0 62,691 87 Nabilatuk HC IV 2964 4729 40 14997 370 620 124 22 2678 2 36 32 20 2 1 62,226 88 Kebisoni HC IV 2070 3282 111 22970 1269 1512 782 201 2713 87 206 0 1 13 0 62,155 89 Obongi HC IV 2264 7646 50 24651 463 922 177 171 1865 9 92 167 29 10 0 61,934 90 122

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Kiyunga HC IV 2127 2990 30 21641 1077 2623 921 587 3977 6 24 0 8 13 0 61,792 91 Namayumba HC IV 1898 3213 20 27367 835 2556 50 98 1977 34 114 12 131 3 0 61,759 92 Bbaale HC IV 1963 5676 17 28034 459 1869 306 472 2983 0 11 0 10 0 61,694 93 Bugono HC IV 1962 2313 20 24980 795 1800 490 1443 1394 0 90 0 6 3 1 60,530 94 Ndejje HC IV 1474 2493 19 28113 1150 3570 755 4 9225 0 6 0 4 7 0 59,983 95 Kakindo HC IV 2416 5148 52 13939 1136 3543 62 233 9108 260 260 0 15 31 3 59,600 96 Karugutu HC IV 2099 4593 36 23995 482 1367 56 169 2885 1 11 9 11 2 0 59,263 97 Kapelebyong HC IV 2142 6502 47 23045 473 1161 314 189 2170 0 0 0 1 1 0 58,806 98 Bubulo HC IV 2028 2168 34 20345 941 2228 2026 673 4063 0 1 0 2 7 0 58,746 99 Kakumiro HC IV 1973 5685 70 17532 1351 2955 504 385 5786 201 229 14 12 11 0 56,961 100 Buliisa HC IV 2406 5955 36 15244 576 1262 40 138 4771 0 0 0 24 5 1 55,888 101 Bugangari HC IV 1455 3710 22 29575 515 1380 466 351 2514 0 0 0 1 0 55,576 102 Pajule HC IV 2417 6390 37 13489 659 1418 647 387 3675 0 0 0 11 3 0 55,000 103 Orum HC IV 2278 5752 35 16572 494 928 626 249 2763 52 94 32 21 9 0 54,666 104 Ngora Gvt HC IV 1567 2619 23 26412 523 1413 105 118 2687 0 0 0 1 0 53,887 105 Benedict Medical centre HC IV 1129 2941 67 33773 435 662 466 1395 110 254 46.5 10 1 0 53,726 106 Rhino Camp HC IV 2266 3915 30 13590 844 1246 180 287 4743 0 0 0 12 63 0 53,605 107 Mpumudde HC IV 1256 1154 26 25037 934 2467 3233 630 3482 0 0 0 1 2 0 52,408 108 123

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Kiwangala HC IV 1385 4285 13 26258 542 1465 411 293 7139 26 28 0 3 1 0 52,255 109 Awach HC IV 1948 4833 31 18831 558 941 427 218 2475 0 28 0 8 3 0 52,129 110 Kityerera HC IV 1314 1634.4 9 25772 771 2742 432 545 4365 0 0 0 190 1 0 52,070 111 Shuuku HC IV 1608 4309 28 23264 620 1512 102 377 2501 30 32 0 4 4 0 51,980 112 Kanungu HC IV 1829 1593 41 19363 655 1059 143 369 2186 0 0 0 12 2 1 51,296 113 Kigandalo HC IV 975 1552 16 31367 630 2026 276 420 3954 0 2 0 2 5 0 51,294 114 Padibe HC IV 1744 4036 36 20617 556 703 222 384 1985 12 45 11 35 4 0 50,609 115 Madi-Opei HC IV 1415 3288 39 26081 364 852 198 718 2364 0 0 0 11 2 0 50,483 116 Busaru HC IV 2960 8537 54 2786 323 1084 88 5472 13 47 227 36 4 0 50,481 117 Bukuku HC IV 1395 2808 6 19584 1041 2452 1250 4134 3826 78 92 0 3 2 1 50,397 118 Chahafi HC IV 1671 4574 24 20756 447 1517 311 206 1819 0 0 2 0 49,437 119 Bukulula HC IV 951 1830 21 32741 174 1110 413 173 3183 0 0 29 5 0 49,361 120 Bugembe HC IV 270 474 37 33502 1502 3861 575 360 8553 0 0 0 3 0 49,171 121 Kiruhura HC IV 1892 4540 27 17168 464 1493 136 87 1837 10 17 0 2 4 0 49,093 122 Kassanda HC IV 1604 3208 8 15744 1256 3518 225 272 4320 0 0 0 18 1 48,956 123 Patongo HC III 1515 3356 23 19802 489 2033 102 327 4030 0 0 0 1 0 47,009 124 Muko HC IV 1258 2033 22 24141 443 1325 492 941 1639 0 0 0 2 0 46,933 125 Kazo HC IV 890 1773 36 28469 568 2288 494 144 3859 0 0 0 1 0 46,894 126 124

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank St.Paul HC IV 2338 7218 80 4777 975 1091 249 1021 2835 380 733 231 26 91 4 46,470 127 Budondo HC IV 1450 2665 24 19355 628 1761 466 660 3582 0 0 0 3 5 0 46,405 128 Adumi HC IV 1446 5501 40 18446 634 1581 111 292 5011 1 1 0 11 47 2 45,300 129 Ntara HC IV 1802 2892 36 11473 900 1570 849 518 4031 150 159 99 12 7 0 45,278 130 Kyazanga HC IV 1433 2711 19 19474 419 2017 242 162 2009 0 7 0 2 2 0 44,676 131 Rubuguri HC IV 1274 4159 34 21715 464 920 286 113 2188 0 4 0 6 1 0 44,242 132 Bwijanga HC IV 1203 3101 27 20254 547 2120 132 224 3266 49 106 8 3 5 0 42,925 133 Nyimbwa HC IV 1363 2867 18 18225 500 1512 99 414 2503 1 10 0 4 6 0 42,683 134 Namatala HC IV 1069 1254 34 23825 124 2086 361 321 4049 1 24 8 1 1 0 42,674 135 Atiak HC IV 1378 4133 29 19648 160 1006 150 281 3111 0 0 0 7 0 42,459 136 Nyamuyanja HC IV 1089 2181 25 21965 523 1026 65 319 4159 56 69 0 8 0 42,452 137 Toroma HC IV 1196 3348 36 20766 429 845 555 432 2252 0 0 0 4 3 0 42,217 138 Kaproron HC IV 1593 2751 34 14719 463 1137 176 162 2228 0 9 0 5 5 0 42,112 139 Rwesande HC IV 2005 5700 38 7642 525 1238 123 178 2969 151 224 0 22 9 2 41,705 140 Wagagai HC IV 1036 1753 19 22669 335 678 488 64 1887 71 127 42 1 3 0 40,876 141 Rugaaga HC IV 1255 2930 20 17949 299 1697 266 631 2415 0 0 0 2 3 0 40,049 142 Lwengo HC IV 1073 2115 11 19943 366 1591 457 168 4903 0 0 0 3 0 39,957 143 Nsiika HC IV 1056 424 25 19883 526 1039 45 335 2254 30 39 1 2 8 0 39,513 144 125

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Ssekanyonyi HC IV 1025 2328 24 19680 513 1355 281 49 2606 0 4 0 5 7 0 38,984 145 Maddu HC IV 1114 1762 32 17852 475 1461 817 72 3036 0 0 0 4 5 0 38,719 146 Hamurwa HC IV 676 1636 29 23160 646 1566 555 791 2206 0 0 0 2 0 38,427 147 Ssembabule HC IV 913 776.3 17 19755 500 2457 112 625 4256 0 0 0 2 0 38,398 148 Kikyo HC IV 1696 2620 34 11012 168 612 15 105 2223 0 0 0 2 1 1 38,103 149 Rubaya HC IV 1124 2416 33 17945 438 1118 158 307 1557 0 0 0 4 1 0 38,098 150 Mparo HC IV 1241 2078 25 15529 401 791 426 1125 767 0 0 0 7 1 0 37,473 151 Kamwezi HC IV 980 2443 32 18878 394 753 394 210 1712 0 31 100 5 0 36,569 152 Buhunga HC IV 900 2851 18 18590 526 756 149 409 2062 0 0 0 2 0 35,789 153 Kyannamukaaka HC IV 993 2446 31 19057 154 832 18 51 2713 5 8 48 2 1 0 35,715 154 St. Joseph G.S. Kyamulibwa Ngo HC IV 1659 4711 73 8500 265 196 199 944 54 125 228 28 5 1 35,096 155 Kalagala HC IV 1182 1760 30 13016 453 1442 164 909 2329 10 38 0 5 2 0 34,734 156 Walukuba HC IV 0 30034 519 2049 516 272 3380 0 0 0 1 0 34,724 157 Kalangala HC IV 738 427 45 21025 284 827 38 265 1217 28 54 10 8 8 2 34,323 158 Bukwa HC IV 1589 4758 60 8646 166 570 340 82 2508 20 78 2 8 3 0 34,309 159 St. Ambrose Charity HC IV 1765 3830 61 3613 479 420 192 86 3091 282 367 261 61 75 4 33,450 160 Kojja HC IV 552.8 157.6 77 17806 677 2151 373 1054 7110 18 70 0 5 7 0 32,694 161 ASTU HC IV 0 31955 0 245 0 0 0 0 0 32,078 162 126

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Kikuube HC IV 0 24242 1011 2885 145 364 2499 0 0 0 10 0 31,494 163 Buwasa HC IV 316 366 13 22551 344 1050 16 152 2906 0 0 0 5 0 30,201 164 Buvuma HC IV 744 1385 20 16062 323 1200 176 46 3011 1 18 0 4 1 0 30,150 165 Bushenyi HC IV 427 762 29 20457 303 1063 336 330 2547 0 768 0 0 29,751 166 Buwambo HC IV 450 834 19 19625 365 1226 49 95 3285 2 2 0 1 2 0 29,542 167 Bishop Masereka CF HC IV 1403 3092 20 5569 340 980 4 266 2386 157 334 90 6 2 0 29,416 168 Butenga HC IV 821 1280 21 13785 378 1277 356 43 1589 13 49 17 5 4 0 29,146 169 Maziba Gvt HC IV 751 2090 34 15051 343 832 141 577 972 0 0 0 2 0 29,000 170 Kamukira HC IV 0 25938 139 733 179 776 1241 0 0 0 0 27,725 171 Masindi Military HC IV 694 2907 45 16834 38 194 23 41 472 0 0 0 4 0 27,657 172 Kiyumba HC IV 784 1647 15 12595 385 757 143 77 1535 24 29 0 1 4 0 27,076 173 Kyantungo HC IV 697 1889 22 14287 178 557 90 89 2455 0 0 0 6 0 26,491 174 SAS Clinic, Bombo Road 0 24951 165 644 121 138 833 0 0 0 1 0 26,394 175 Mwera HC IV 687 1591 18 13056 300 711 117 135 2209 6 9 0 1 0 25,784 176 Kampala Hospital 0 19570 933 1395 265 233 2619 0 0 0 7 1 25,705 177 Bugamba HC IV 579 1435 29 13461 331 1670 115 179 2493 0 0 0 0 25,282 178 Busanza HC IV 587 1677 16 14465 256 630 57 158 875 0 0 0 1 1 0 25,148 179 Ngoma HC IV 307 819 20 16863 159 1087 167 191 4802 0 0 0 3 14 0 23,946 180 127

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Butiru HC III 0 20937 139 1150 56 1692 3127 0 0 0 0 23,706 181 Mbarara Municipal Council HC IV 0 15389 205 3347 5425 405 4520 0 0 0 0 21,907 182 Ntungamo HC IV 0 15339 812 2522 173 408 4283 0 0 0 5 0 21,807 183 Luwunga Barracks HC IV 221 629 28 16424 103 633 94 136 1003 8 8 0 0 20,886 184 Bukasa HC IV 290 524 11 15235 95 284 84 68 1028 0 21 0 2 0 20,484 185 Makonge HC III 685 878 28 6237 249 1131 657 1042 3823 0 0 0 3 1 0 19,937 186 North Kigezi HC IV 939 2315 33 3711 268 337 316 320 751 13 22 7 6 2 0 19,773 187 Kataraka HC IV 121 155 5 16330 86 730 157 118 2206 0 1 0 11 1 0 19,519 188 St. Franciscan HC IV 612 1225 20 4793 71 105 20 155 0 18 0 4 2 0 14,422 189 Ntuusi HC IV 59 112.6 8 10735 199 1491 79 307 2814 0 0 9 1 1 14,116 190 Nyamirami HC IV 85 8 12 8914 153 587 6 190 1500 0 0 0 2 0 11,646 191 Women's Hospital, FC-Bukoto 0 7886 45 216 42 0 0 0 0 0 8,240 192 HiimaIaa (Uci) HC IV 0 4879 9 56 11 31 48 0 0 0 0 4,983 193 Pearl Medical Center HC IV 0 1298 162 164 10 4 2776 0 0 0 0 2,752 194 Kawempe HC IV 0 2280 30 0 0 0 0 2,295 195 Ayira Health Services 0 0 0 0 0 0 0 0-196 128

Facility Admiss ions Patient Days Beds Total OPD Deliveri es Total ANC Postnat al Attenda nces Family Plannin g Immuni zation Caesari an Section s Major operati ons Blood transfu sion units IPD Deaths Fresh Stillbirt hs Materna l deaths SUO Rank Mbarara Municipal HC IV 0 0 0 0 0 0 0 0-197 129

MINISTRY OF HEALTH P. O. Box 7272 Kampala Uganda Plot 6 Lourdel Rd, Nakasero General Telephone: +256-414-340874 / 231563/9 Permanent Secretary's Office: +256-414-340872 Fax: +256-414-231584 Email: info@health.go.ug