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UGANDA EPISCOPAL CONFERENCE UGANDA CATHOLIC MEDICAL BUREAU ANNUAL REPORT 2014 Uganda Catholic Medical Bureau 2014
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UGANDA EPISCOPAL CONFERENCE
UGANDA CATHOLIC MEDICAL BUREAU
ANNUAL REPORT
2014
Uganda Catholic Medical Bureau
2014
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HEALTH COMMISSION OF THE UGANDA EPISCOPAL CONFERENCE - 2014
Figure 1: Members of the Health Commission after their meeting on December 12th 2014 at Uganda
Catholic Secretariat.
Front row from your left: Rev. Fr. Emmanuel Katabazi, Rev. Fr. Anthony Rweza, His Grace Archbishop Paul
Bakyenga, Rt. Rev. Bishop (emeritus) Martine Luluga, Rt. Rev. Bishop Robert Muhiirwa (Chairman), Rt. Rev.
Bishop Egidio Nkaijanbwo (Vice Chairman), Dr. Ronald Kasyaba (Ex-officio Asst. Executive Secretary)
Hind row from your right: Mr. Peter Opata Ogandi (ex-officio – Executive Secretary for the HIV/AIDS
department), Ms Mary Katusiime (Ag. General Manager of JMS), Dr. Engoru, Msgr. John Baptist Kauta
(Secretary General), Msgr. Primus Asega, Dr. Sam Orochi Orach (Executive Secretary of UCMB
In the middle in blue shirt between Bishop Martine Luluga and Msgr J.B. Kauta is Rev. Fr. David Matovu
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TABLE OF CONTENT
LIST OF TABLES ................................................................................................................................................... 6
TABLE OF FIGURES .............................................................................................................................................. 6
LIST OF ACRONYMS AND ABREVIATION ............................................................................................................. 8
FROM THE EXECUTIVE SECRETARY ..................................................................................................................... 9
EXECUTIVE SUMMARY ................................................................................................................................... 10
INTRODUCTION ............................................................................................................................................. 11
MISSION STATEMENT OF UGANDA EPISCOPAL CONFERENCE .......................................................................................... 11
MISSION STATEMENT OF UGANDA CATHOLIC MEDICAL BUREAU .................................................................................... 11
THE CATHOLIC HEALTH SERVICES ..................................................................................................................... 13
UCMB IN 2014 ............................................................................................................................................... 15
STRENGTHENING CORPORATE GOVERNANCE .............................................................................................................. 16
STRENGTHENING HEALTH SYSTEMS THROUGH BETTER USE OF INFORMATION TECHNOLOGY ....................... 17
Major successes during 2014 ....................................................................................................................... 17
CONTRIBUTION TO THE HEALTH SECTOR STRATEGIC AND INVESTMENT PLAN (HSSIP) OUTPUTS ........................................... 20
Services Output trend (in Standard Unit of Outputs) ................................................................................... 20
Maternal Health ........................................................................................................................................... 20
Natural Family Planning Project .................................................................................................................. 22
UCMB contribution to the National HIV response ....................................................................................... 23
HIV ACT Project specific performance .......................................................................................................... 24
The TB REACH Project .................................................................................................................................. 25
Quality and Patients Safety .......................................................................................................................... 26
Hospitals Drug Prescription & Dispensing Practices Survey - summary Results, May 2014. ....................... 27
CUAMM project ........................................................................................................................................... 28
Contribution to availability of quality and affordable medicines and medical supplies in Uganda ............. 28
BUILDING AND STRENGTHENING PARTNERSHIPS ............................................................................................ 29
HUMAN RESOURCE FOR HEALTH IN UCMB FACILITIES .................................................................................... 30
Total workforce in the network .................................................................................................................... 30
Distribution of health workers in UCMB network ........................................................................................ 31
Quality of staff in facilities under UCMB ...................................................................................................... 32
Stability and Attrition of health workforce in the UCMB Health facilities. .................................................. 32
Human Resource for Health Projects ........................................................................................................... 36
CONTRIBUTION TO PRODUCTION OF HUMAN RESOURCES FOR HEALTH ....................................................... 38
Central Coordination .................................................................................................................................... 38
Support supervision and mentoring ............................................................................................................. 38
Joint HTI PNFP technical workshop .............................................................................................................. 39
Data management training for HTIs ............................................................................................................ 39
Collaboration with Ministry of Health in training ........................................................................................ 40
Joint HTI PNFP technical workshop .............................................................................................................. 40
The UCMB Scholarship Fund – Its performance and its benefits .................................................................. 41
Other scholarships ....................................................................................................................................... 43
Clinical Pastoral Care/Education .................................................................................................................. 45
HEALTH FINANCING IN UCMB NETWORK: 2013/2014. .................................................................................... 45
Financing of recurrent costs ......................................................................................................................... 45
Recurrent cost recovery in hospitals ............................................................................................................ 47
Expenditure areas ........................................................................................................................................ 48
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Performance-based-financing (PBF) – The experience in Jinja diocese. ...................................................... 50
UCMB FINANCIAL REPORT ................................................................................................................................ 53
UCMB SUMMARY OF FINANCIAL SITUATION, JANUARY – DECEMBER 2015 ............................................... 53
Statement of balances of restricted (donor) funds as at December 31st
2014. ............................................ 60
CHALLENGES .................................................................................................................................................. 61
ACKNOWLEDGEMENT ...................................................................................................................................... 62
ANNEXES .......................................................................................................................................................... 63
Figures on out-patient attendances in hospitals .......................................................................................... 63
Figures on in-patient admissions in hospitals .............................................................................................. 63
Figures on deliveries ..................................................................................................................................... 64
Figures on immunization .............................................................................................................................. 64
UCMB STAFFING IN 2014 ............................................................................................................................. 65
PROFILE OF JOINT MEDICAL STORE (JMS) .................................................................................................... 66
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LIST OF TABLES
Table 1in 2014: Distribution of health facilities under UCMB by levels and dioceses ......................... 13
Table 2: Lower level beds by dioceses .................................................................................................. 14
Table 3: Hospital beds by dioceses ....................................................................................................... 14
Table 4: Staffing level and years served in UCMB by end of 2014 ....................................................... 15
Table 5 and Figure 3: Level of performance of the ICT project activities ............................................. 17
Table 6: Trend in total Standard Units of Output - general trend of utilisation of services ................. 20
Table 7: Trend in out-patients servies attendance ............................................................................... 20
Table 8: Trend in immunisation ............................................................................................................ 20
Table 9: Trend in antenatal clinic attendance ...................................................................................... 20
Table 10:UCMB facilities performance in Key HIV indicators during the year. .................................... 23
Table 11: Trend in workforce in Catholic health facilities under UCMB ............................................... 30
Table 12: Distribution of health workers between hospitals and lower level facilities in UCMB
network as of June 30th 2014 ................................................................................................................ 31
Table 13: Distribution of staff by all levels of care ................................................................................ 31
Table 14: Proportion of clinical staff in hospitals and lower level facilities who are qualified ............ 32
Table 15: Total staff turnover in the UCMB network (all cadres and all levels combined). ................. 33
Table 16: Recruitment onto the MoH-HDP Bursary program............................................................... 43
Table 17: Performance of government facilities in Kamuli district with PBF support in 2013/13 ....... 51
Table 18:Trend of quality scores by health facilities in 2013/24 - the year in which government
facilities became involved ..................................................................................................................... 52
Table 19: PEPFAR funding to UCMB in 2014 ......................................................................................... 53
Table 20: UCMB staff list – 2014 ........................................................................................................... 65
TABLE OF FIGURES
Figure 1: Members of the Health Commission after their meeting on December 12th 2014 at Uganda
Catholic Secretariat. ................................................................................................................................ 3
Figure 2: Map of Uganda showing the distribution of Catholic health facilities accredited to UCMB as
of December 31st 2014 ......................................................................................................................... 13
Table 5 and Figure 3: Level of performance of the ICT project activities ............................................. 17
Figure 4: EPRMS illustration to Hospital Managers in Aber.................................................................. 18
Figure 5: The DHC Sr. Liberata Amito receiving the Laptop from His Grace John Baptist Odama the
Archbishop of Gulu ............................................................................................................................... 18
Figure 6: Distribution of deliveries by level of health facilities in the UCMB network in 2014 ............ 21
Figure 7: Trend of deliveries in hospitals and lower level facilities ...................................................... 21
Figure 8: Trend in number of deliveries in the different categories of the lower level health facilities
.............................................................................................................................................................. 22
Figure 9: The entrance to JMS' head offices and the main sales and dispatch store ........................... 28
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Figure 10: General trend of turnover of clinical cadres in UCMB health Centers and hospitals .......... 33
Figure 11: Trend of attrition of key clinical cadres in UCMB hospitals 2010/2011 to 2013/2014. ...... 34
Figure 12: Turnover of key clinical cadres in lower level UCMB health facilities in 2010/11 to 2013/14
.............................................................................................................................................................. 34
Figure 13: Reason for the attrition of key clinical cadres in UCMB hospitals and Health Centre
(Source: 2013-2014 staffing movement Report) .................................................................................. 35
Figure 14 Support Supervision visit to St Kizito Hospital –Matany, Moroto Diocese. Second (right) is
the Bishop of the diocese, Rt. Rev. Damiano Guzzetti. The others are Dr. Ronald Kasyaba (AES)
(right), Mr. Peter Assimwe (left) and Rev. Sr. Catherine Nakiboneka (second left) ............................. 39
Figure 15:Participants of a Joint PNFP HTI Technical workshop held on 25th-27th February 2014. ... 41
Figure 16:Participants at an EMoNC training at Pope John Hospital –Aber ......................................... 44
Figure 17: Figure 15:Participants at an EMoNC training at St. Joseph Hospital Maracha .................... 44
Figure 18: Trends in income for recurrent cost in UCMB network (Hospitals + Lower Level Facilities)
.............................................................................................................................................................. 46
Figure 19: Distribution of total (including capital costs) expenditure - combined for hospitals and
lower level facilities in UCMB network ................................................................................................. 48
Figure 20: Distribution of recurrent expenditures in health facilities under UCMB............................. 49
Figure 21: Trend of total SUO in 5 lower level facilities of Jinja diocese .............................................. 50
Figure 22:Trend of UCMB local income as a proportion of total revenues .......................................... 54
Figure 23: Total OPD attendance (new and re-attendance) in UCMB Hospitals : Cumulative values. 63
Figure 24: Total Admission (cumulative number) UCMB Hospitals ...................................................... 63
Figure 25: Cumulative number of deliveries in UCMB Hospitals. ......................................................... 64
Figure 26: Cumulative number of Immunization doses for UCMB Hospitals. ...................................... 64
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LIST OF ACRONYMS AND ABREVIATION
ACT AIDS Care and Treatment ACHAP African Church Health Associations Platform AES Assistant Executive Secretary AIDS Acquired Immunideficiency Syndorm C4C Connect- For-Change. It is a partnership of organisations in the Netherland. CDC Center for Disease Control and Prevention CUAMM Italian Catholic NGO – Doctors with Africa DHC Diocesan Health Coordinator DFID The British government’s “Department For International Development” DkA Dreikoningsaktion der Katholischen Jungschar HC Health Center HIV Human Immunodeficiency Virus HMIS Health Management Information System HRM Human Resource Management HTI Health Training Instition JMS Joint Medical Store ICT Information and Communication Technology IICD International Institute for Communication and Development MDR Multi Drug Resistant NFP Natural Family Planning NPP Natural Plan Project (for Natural Family Planning) NU-Health Northern Uganda Health project NU-HITE Northern Uganda Health Integration for Enhanced Services project MAUL Medical Access Uganda Limited MoH Ministry of Health PEPFAR Presidents Emergency Fund For AIDS Relief PHC CG Primary Health Care Conditional Grant PNFP Private Not For Profit RCC-HSN Roman Catholic Church Health Services Network SDS Strengthening Decentralisation for Sustainability ( A project of Cardno Emerging
Markets to strengthen Human Resources for Health) TB Tuberculosis TB REACH UCMB Uganda Catholic Medical Bureau UCS Uganda Catholic Secretariat UEC Uganda Episcopal Conference UNFPA United Nation’s Fund for Population Activities UNICEF United Nations Children’s Fund USAID United States Agency for International Development WISN Workload Indicator of Staffing Needs
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FROM THE EXECUTIVE SECRETARY Dr. Sam Orochi Orach
In 1933/34 the Catholic Bishops of Uganda thought about formation of what is now Uganda
Catholic Medical Bureau (UCMB), which was finally formed in 1934/35. December 31st 2014
(midway 2014/15) therefore marks 81 years since UCMB was conceived and 80 years of
actual life. In 1955 UCMB was formally recognised by the then colonial government and
gazetted as a channel for transferring grants-in-aid to Catholic-founded health facilities.
This process streamlined the support already being given to the facilities by the
government.
From the first catholic health facility (Lubaga hospital) formally founded in 1899, we are
ending the year 2014 with 283 health facilities formally registered or accredited with UCMB.
Three more will formally get onto the list in early 2015, bringing the total number to 286. In
this report we reflect on work UCMB and its network of the 283 already accredited or
registered with UCMB and the diocesan health departments did in the year 2014.
On behalf of the management of UCMB I sincerely thank those who enabled the Catholic
health players to deliver services to those who needed. Please see our full appreciation
later at the end of this report. I wish you a good reading and hope that this report will gives
a good insight into what UCMB is, what it does for and together with the network it heads
and coordinates. I also hope that it will give you reason to want to partner or collaborate
with UCMB and the whole Catholic health services in Uganda.
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EXECUTIVE SUMMARY In 2015 Uganda Catholic Medical Bureau coordinated and served 32 hospitals (these being about
25% of all hospitals in Uganda and 57% of all PNFP hospitals) and 251 health centres (lower level
units – LLU) accredited to it. As we close the year already five more facilities are getting accredited
and so we are opening with 288 health facilities in the network. The UCMB network currently also
has 12 institutions for training nurses and midwives and one, Kitovu hospital continued with an
institution for training only Laboratory Assistants. Those make 13 health training institutions. The
year ends with plans underway to open two more training institutions – for nurses in St. Joseph
Kitgum hospital and for laboratory technicians in Maracha hospital. Nsambya, Lacor and Rubaga
training institutions also train Laboratory Assistants besides training nurses and midwives. The
Catholic Church has one medical school, the Mother Kevin Post Graduate School of Medicine of
Uganda Martyrs University, meanwhile St Mary’s Lacor hospital is a training site for Gulu University
Medical School.
Over the years there has been increased volume of work carried by UCMB, largely due to the
increased coordination of vertical projects, notable the AIDS Care, Treatment and Prevention (ACT)
project. We also have the projects supporting human resources in the network financed from
PEPFAR through MIldmay and Cardno (SDS project). Reporting on percentage of planned work
actually completed hides the fact that these are percentage of increased volume of planned
activities. As usual, the work of UCMB manifests itself in the systems strength or foundation on
which the member facilities carry out their services. Accordingly, performance of the network forms
part of the performance report on UCMB although there are also external confounding factors
beyond the control of UCMB that influence the network performance as well.
The report also brings forward some of the challenges being met by UCMB as well as its network in
together providing the much needed services to the people of Uganda especially the poor.
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INTRODUCTION
The Uganda Catholic Medical Bureau (UCMB) which is the health department of the Catholic
Church in Uganda was started by the Bishops around 1934. Although the Uganda Catholic
Secretariat (Secretariat of the Uganda Episcopal Conference) was started much later, UCMB
now exists as one of its departments.
Mission Statement of Uganda Episcopal Conference
To promote Integral Human Development in the Whole World
Inspired by Gospel Values (Lk 4:18 ff)
Mission Statement of Uganda Catholic Medical Bureau
In Faithfulness to the Mission of Christ, we provide professional and
sustainable holistic health services, through partnership, to enable
the population to live their life to the full.
UCMB’s mandate includes coordination of the health facilities of the Catholic Church,
representing them before government and other partners, advocating for them, supporting
health systems strengthening in the network. It therefore works to ensure quality, build the
capacity of, and strengthen health systems within health facilities under its control and at the
level of diocesan health coordination. UCMB also coordinates selected vertical programs.
While health systems strengthening is a core function that cuts across everything UCMB
does, its other key functions include representing the Catholic healthcare network in dealing
with government and other health sector players, managing linkages with other public and
private organizations and advocacy. In total, UCMB manages 23% of Uganda’s total
hospitals, 13% of total health centers, 28% of total hospital beds, and 37.5% of the total
medical training centers (for nurses and midwives) in Uganda, while serving 15-17% of the
total population in the country.
Because the work of UCMB is to support the network and has impact on its overall
performance and vice versa, the report also reflects on the overall situation experienced by
the network in the year and its performance and therefore not only on activities performed
by UCMB.
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The year 2014 has been part of the current strategic plan period 2012-2016 which is
operating under six strategic objectives or goals:
1. Goal 1: UCMB made more competent and sustainable.
2. Goal 2: Effective Corporate Governance and Management.
3. Goal 3: Health services within the RCC- HSN meet the National and UCMB service delivery quality standards
4. Goal 4: Greater recognition and visibility of the RCC-HSN within the national health delivery system and within the Roman Catholic Church.
5. Goal 5: Effective Strategic Partnerships developed and maintained 6. Goal 6: Strengthened human resource capacity for health service delivery
The theme under which UCMB and its network of catholic health facilities operated in 2014
was “Moving towards Total Quality Management: Remaining relevant and competitive”.
This was in line with objective 3 in the strategic focus of the current Health Sector Strategic
and Investment Plan (HSSIP) of Uganda and is about “Accelerating quality and safety
improvements”. It was also in line with the Mission Statement and Policy of Catholic Health
Services in Uganda which demand provision of quality care and training and maintaining
quality of care at the heart of all services.
In addition, while the theme for the current strategic plan is ““Strategic positioning to
enhance services delivery”, in the third goal specifically the network also commits to
provision of quality services.
In working through the goals of the strategic plan and the theme specific to the year, UCMB
and the network sort to strengthen and improve on the six building blocks of the WHO
health systems building blocks.
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THE CATHOLIC HEALTH SERVICES
From the first health facility officially started in 1899 (Lubaga hospital), UCMB now
coordinates, represents, and supports 283 health facilities accredited to it as well as 13
heath training institutions. The health facilities comprise of 32 hospitals, 6 health centres
level IV, 170 health centres at level III, and 75 health centres level II. Each of the 19 dioceses
has a Diocesan Health Department managed by a Diocesan Health Coordinator. It is the
contribution made to the performance of Uganda’s health sector by of this network that is
presented here.
Table 1in 2014: Distribution of health facilities under UCMB by levels and dioceses
Harmonised Level Gulu Province
Kampala Province
Mbarara Province
Tororo Province
Grand Total
HC II 12 23 26 14 75
HC III 29 62 47 32 170
HC IV 3 3 6
Hospital 7 11 7 7 32
Grand Total 48 99 80 56 283
Figure 2: Map of Uganda
showing the distribution
of Catholic health
facilities accredited to
UCMB as of December
31st 2014
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The health facilities under UCMB together have a total of 10,551 beds as distributed below
among the hospitals and the lower level facilities and by dioceses. Not all the dioceses have
hospitals but all have lower level health facilities (health centers).
Table 2: Lower level beds by dioceses
DIOCESE Total
Arua 384
Fortportal 392
Gulu 134
Hoima 274
Jinja 132
Kabale 455
Kampala 309
Kasana 182
Kasese 42
Kiyina Mityana 28
Kiyinda 304
Kotido 160
Lira 261
Lugazi 81
Masaka 712
Mbarara 357
Moroto 43
Nebbi 81
Soroti 343
Tororo 327
Grand Total 5001
Table 3: Hospital beds by dioceses
Diocese Total
Arua 200
Fortportal 333
Gulu 1187
Jinja 280
Kabale 379
Kampala 782
Kasana Luweero 60
Kasese 222
Lira 181
Lugazi 260
Lugazi 62
Masaka 200
Mbarara 331
Moroto 284
Nebbi 399
Soroti 100
Tororo 290
Grand Total 5550
The chapters and sections that follow from here describe not only the work of UCMB but the cumulative effects or outcome of this work. It is to be noted that all that UCMB does translates influences the performance of catholic founded health facilities accredited to it. The status and performance of the facilities therefore form an integral part of this report.
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UCMB IN 2014
UCMB worked to remain competent to carry its mandate for the network. This included, but not limited to the following:
It ensured the adequacy and condition of its assets needed for its operations
Its governance structure, the Health Commission and its committees were functional and provided good guidance
It carried out its duty of representing the network at national level with government and other partners
The human resource capacity was maintained although one staff was lost in the fourth quarter of the year.
But two other staff also joined the department. These were the coordinator for the Natural Family Planning project
And a program officer for the Human Resource Project supported by Cardno Emerging Market’s SDS project
Some of the department’s staff continued to study and obtained higher academic qualification. Internal continuing education sessions were also organised to increased common understanding and competencies across sections for the purpose of better integration.
The efforts towards increasing internally generated revenue were not successful.
Improving the core HR competence levels within UCMB
All office operations went well although operational costs kept rising.
With the opening of the new office building at the Uganda Catholic Secretariat, the Hanlon building, UCMB now has more office space.
The full list of staff of the department in 2014 is given at the end of this report. Forty eight percent (48%) of the staff had worked for only 3 years or less and these were related to vertical programs. Only twenty four (24%) had served for 10 or more years. One staff, the Accountant who also doubles as the departmental Administrator had served for 24 years (in the same department). This data shows the demand and inevitable change in human resource that comes with involvement in coordination and management of vertical programs, especially those related to Global Health Initiatives. Table 4: Staffing level and years served in UCMB by end of 2014
Years served at UCS Total Per cent
1 1 4%
2 10 40%
3 2 8%
6 1 4%
7 2 8%
9 3 12%
10 1 4%
11 1 4%
12 2 8%
14 1 4%
24 1 4%
Grand Total 25 100%
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Meanwhile, a new expatriate staff, Ms. Cecil Blaga, from DKA Austria was received in December 2014. Her work is to strengthen financial management in the network as well as strengthening the capacity for resource mobilization both at UCMB and in health facilities.
STRENGTHENING CORPORATE GOVERNANCE
Among the many things done to strengthen corporate governance is training of managers and governors, support supervision and mentorship of the managers of the hospitals and diocesan health offices, improving their capacity to use management and governance tools and information, and ensuring that governance structures are working. As in previous years training and mentorship to increase data reliability, demand and use was one of the top priorities because data form the center of a facilities planning and implementation. The outcome of all the work done to strengthen and support Corporate Governance in the health facilities and at the diocesan health departments is cumulative. As at December 2014 the following were some of cumulative outcomes:
There has been great improvement in management capacity in the hospitals. This has been achieved through training of hospital managers in the health services management courses at Uganda Martyrs University and through focused training workshops. The hospital that will need closer attention in 2015 is Dabani. It has a combination of 4-NEWs i.e. a new Board of Governors that has appointed a new Medical Superintendent, a new Hospital Administrator and a new Accountant. The combination of a new board and all top management members being new is causing some instability.
Diocesan health coordination has also greatly improved. In every diocese major aspects of DHC work such as information management, reporting and technical supervision to health units are being done.
Strategic planning in hospitals has been embraced. In 2008, only two hospitals had strategic plans. At the moment, almost all hospitals have 5 year strategic plans.
Governance boards in hospitals and dioceses have improved tremendously. In 2008, about 5 dioceses still did not have diocesan health boards. Today, all hospitals and diocesan health departments have functioning boards. The board inductions and trainings in corporate governance have created a strong awareness of the roles of governance in institutional development. Two hospitals that will need closer attention in 2015 to strengthen their governance are Kamuli (Jinja diocese) and Virika (Fort Portal diocese)
We supported all hospitals, Diocesan Health Departments and health centres in developing or improving governance and management documents (constitutions, human resources management manuals, financial management manuals, internal communication guidelines, procurement and contracts guidelines etc). All institutions have these critical documents. What remains is ensuring they are actually being used, and used well too.
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STRENGTHENING HEALTH SYSTEMS THROUGH BETTER USE OF INFORMATION TECHNOLOGY
During the year 2014, the C4C project targeting Health Systems Strengthening in the Health Facilities
using ICTs registered good progress in terms of embedding ICTs in the core of health facility activities
and awareness creation. By design, 2014 activities build on what was already setup in the previous
years.
While the main objective of the project is to promote access to equitable, quality and efficient
health services by enabling continuous capacity development, information/knowledge sharing
within UCMB network, effective patients’ records management and accurate, complete and timely
reporting to support decision making, the 48 activities were to be executed. However, 21% were not
executed due to unforeseen challenges. See table below.
Table 5 and Figure 3: Level of performance of the ICT project activities
Major successes during 2014
Equipment and Infrastructure development in Health facilities:
In all, 14 hospitals out of 32 (43.7%) have established local area networks and equipped with
computers for continuous training and have Electronic Patient Record Management System
(EPRMS). Of the 14 Hospitals, 4 Hospitals started on EPRMS during 2014 i.e. Mutolere, Maracha,
Lwala, St. Anthony Tororo.
Target number was 5 facilities instead of 4 because reduction in financing during the year 2014. The
strategy is to keep helping facilities take-up Electronic Patient Records Management as strategy to
improve on quality of care by easing access to patient history and support decision making for health
workers. So far UCMB has received several requests from Health Facilities to support
implementation of EPRMS but UCMB is still looking for resources to support them.
Done, 71%
Partially
Done, 8%
Not Done, 21%
Activity Status Status Percentage executed
Done 71% Partially Done 8% Not Done 21%
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Figure 4: EPRMS illustration to Hospital Managers in Aber
Currently 213 Lower Level Units out of 251 (84.9%) have computers connected to internet in the
UCMB network and they are able to use word, excel and internet based communication –emails,
skype.
Of the 213 mentioned above, 185 (74%) were supported by C4C project and during 2014 alone, 60
Lower level Units received modems, computers and training in computer basics and HMIS.
Figure 5: The DHC Sr. Liberata Amito receiving the Laptop from His Grace John Baptist Odama
the Archbishop of Gulu
ICT skills development:
From the year 2011, about 1,413 health workers (about 17% of all health workers in facilities
accredited to UCMB) have been trained in ICTs especially basics of computer –Operations, word,
Excel, Power point, internet and emails; Of these 579 were trained in 2014 alone.
These trainings were targeting strengthening capacity of health workers and systems at the facilities:
HMIS & tools, Computer basics, EPRMS-Care2x, Systems Administration, Learning/change
management workshop for Hospital Managers, Teleconferencing, Patient Satisfaction Survey
(Akvoflow, tablet use, data collectors for Patient satisfaction survey, Project Management for
managers.
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Financial benefits:
Aber Hospital reported improved user fee collections of 3% towards end of 2014 while others are
using the system to cut down on stationary costs. Instead of phone calls by coordinators to Health
Units, they write emails and receive data by emails this helped cut down on transport costs.
Teleconferencing tool is used for remote desktop during support to hospitals using EPRMS-Care2x
which is a huge saving compared to traveling to solve simple problems.
System Change:
During 2014, there was positive change in the attitude by health workers. Continous training and
equipping of Health Units with ICTs contributed greatly to this change. UCMB received positive
remarks from Health workers about access to information, knowing what is happening in rest of the
world, access to medical information. It is hoped that this will translate into staying longer in rural
Health Units – higher retention rate.
However small, all hospitals now have a component of ICTs included in their plans. This is important
for sustainability of the ICTs.
Challenges specific to this project
Due to lack of resources, not all departments in hospitals have been computerized. OPD,
pharmacy and laboratory have been computerized in many health facilities with EPRMS while In-
Patient, Maternal and Child health Unit as well as HIV have not yet been computerized in most
health facilities.
There is also need to have sustainability plans so as to replace any equipment that needs
replacement.
Sometimes success creates additional challenges for instance Lower Level Units that never
received computers and modems are complaining because of the success by others “How can
you compare us with those who have been trained and have computers?-comment by one staff
from health unit in Kabale”. Hospitals using EPRMS are requesting for more computers for
expansion to inpatient and to cover remaining areas.
There is a need to further mobilise financial resources to enable them to get the required
computers and training to computerize the whole health facilities. This will also enable facilities
acquire sustainable and green source of energy as opposed to buying hundreds of litres of diesel
to run generators.
Misuse of data by staff from facilities for instance loading data for one month on tablets being
used for collection of data on patient satisfaction survey and then it’s used for just one week. In
this case, the coordinators had to request units to top-up since they had used data for other un-
intended things. On one side it shows that use of computers has increased/improved but it’s
important to have plan for such misuse.
Adequate security for ICT equipment is important however, the protection offered by user and
management is more critical than “padlocks”-physical security. Some equipment has been
reported stolen by facilities thus affecting activities
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CONTRIBUTION TO THE HEALTH SECTOR STRATEGIC AND INVESTMENT PLAN (HSSIP) OUTPUTS
Services Output trend (in Standard Unit of Outputs)
A number of services are provided in the health facilities. Utilisation of all the services is
summarised in terms of the Standard Unit of Output (SUO), in the equivalents of out-
patients attendance, hence SUOop
Table 6: Trend in total Standard Units of Output - general trend of utilisation of services
SUOop 08 09 09 10 10 11 11 12 12 13
Hospital ( SUOop) 5,920,317
6,664,836
5,912,531
5,708,374
5,481,327
Lower Level Units ( SOUop) 3,607,680
3,997,081
3,524,457
3,478,879
3,387,431
Total SUOop 9,527,997
10,661,917
9,436,988
9,187,253
8,868,758
Change (rise or drop) 11.9% -11.5% -2.6% -3.5%
The overall drop in utilisation is partly attributable to the increasing number of health
facilities belonging to government other faith-based health networks and the pure private
sector. It is also partly attributable to the general drop in malaria cases in most parts of the
country.
Table 7: Trend in out-patients servies attendance
OPD 08 09 09 10 10 11 11 12 12 13
Hospital 1,227,618 1,240,042 1,214,350 1,235,403 1,183,209
Lower Level Units 1961673 2160843 1994222 1912142 1916417
Total OPD attendances 3,189,291
3,400,885
3,208,572
3,147,545
3,099,626
Change (rise or drop) 6.6% -5.7% -1.9% -1.5%
Table 8: Trend in immunisation
Immunisation 08 09 09 10 10 11 11 12 12 13
Hospital 599,763 572,998 526,141 600,186 541,600
Lowe Level Units 1596227 1341818 1317068 1519196 1315767
Total Immunisation 2,195,990
1,914,816
1,843,209
2,119,382
1,857,367
Change (rise or drop) -12.8% -3.7% 15.0% -12.4%
Maternal Health
Table 9: Trend in antenatal clinic attendance
ANC 08 09 09 10 10 11 11 12 12 13
Hospital 166,812 130,368 141,036 159,992 155,850
Lower Level Units 188479 191488 182311 192116 203970
Total ANC 355,291
321,856
323,347
352,108
359,820
Change (rise or drop) -9.4% 0.5% 8.9% 2.2%
21
As seen in the previous years, deliveries occur not only in health centers of level III and
above but also in health centers of level II, the latter accounting for 10% of total deliveries in
the network.
Figure 6: Distribution of deliveries by level of health facilities in the UCMB network in 2014
While deliveries in hospitals have slightly dropped in the last two years, they have still
slightly risen in the lower level facilities.
Figure 7: Trend of deliveries in hospitals and lower level facilities
HC II 10%
HC III 27%
HC IV 3%
Hospitals 60%
DELIVERIES IN UCMB FACILITIES IN 2014
29,420 32,774 34,653
43,265 45,809 47,991
55,623 56,379 56,828 60,507 61,006
55,800
Hospital Deliveries, 53,491
16,588 15,549 14,770 18,847
23,727 22,614 24,329 25,978 29,143
34,451 34,926 34,624
LLU Deliveries, 35,744
46,008 48,323 49,423
62,112
69,536 70,605
79,952 82,357 85,971
94,958 95,932 90,424
Total Deliveries, 89,235
0
20,000
40,000
60,000
80,000
100,000
120,000
01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10' 10-11' 11-12' 12-13' 13-14'
NUMBER OF DELIVERIES IN UCMB FACILITIES
Hospital Deliveries LLU Deliveries Total Deliveries
22
The growth in number of deliveries is much more obvious in the health centers of level II.
The reasons include:
These health centers being the closest to many mothers who may not easily travel to
higher level health facilities during labour.
A good number of health center IIs in the UCMB network are actually both
structurally and functionally already at level III. The only need formal recognition as
level III by the Ministry of Health.
Figure 8: Trend in number of deliveries in the different categories of the lower level health facilities
Natural Family Planning Project
This project is funded by the Catholic Relief Service (CRS) with a grant from the Institute for Reproductive Health of the Georgetown University in Washington DC. It is implemented in and around three hospitals – Lubaga (Kampala Archdiocese), Virika (Fort Portal) and Ambrozoli Memorial, Kalongo (Gulu Archdiocese). In 2004 the following activities were planned and carried out.
Staff of the three hospitals and of UCMB were trained in financial management.
Selection and training of activity managers done for the three hospitals.
Forms for referring clients from the community to health facility were developed and are in use by the community family planning providers.
Staff were recruited for the project in each of the hospitals.
Support supervision was conducted in each of the three hospitals.
Protocol for managing volunteers was designed and is in use. It indicates that the volunteers shall receive some little stipend per client recruited into use of natural
23
planning (NFP) by the volunteer. Note: the users of natural family planning are not the ones paid.
Continuing Medical Education in NFP was conducted by CRS while UCMB planned to do so in early 2015.
Information, Education and Communication (IEC) materials were developed in form of T-shirts, car stickers, and tyre covers. They were distributed. More have been developed and will soon be printed.
Provision of NFP to clients is on-going at the three facilities and their respective community catchment areas.
UCMB contribution to the National HIV response
UCMB provides comprehensive HIV services throughout its network of facilities either by
using their own resources and government support, or supported by other partners, mainly
PEPFAR funded implementing partners. Overall, during the year the following were some of
the key things achieved.
HCT: UCMB facilities counselled, tested and gave HIV results (HCT services) to a total of
524,817 individuals, 126,291 pregnant women attending antenatal, postnatal and maternity
services and 3,756 couples were also counselled, tested and received results for HIV.
HIV/ART: A total of 158,372 individuals (8% of whom were children below 15 years) were
provided with comprehensive HIV services through our network of hospitals and Lower
Level Units across the country. Of these HIV patients, 86,016 (60% of total in HIV care) were
given antiretroviral therapy (ART). UCMB facilities contribute 21- 24% of the total number of
individuals on ART in the country.
Table 10:UCMB facilities performance in Key HIV indicators during the year.
Category Children <15
Years
15 Years and
above
Total
HCT
Number of individuals counselled and tested for HIV
and given their results at UCMB facilities during the
year.
38,653 486,164 524,817
HIV/ART
Number of new patients enrolled in HIV care at 1,442 11,270 12,712
24
UCMB facilities during the year.
Cumulative Number of individuals on ART ever
enrolled in HIV care at UCMB facilities this year.
34,039 149,118 183,157
Number of HIV positive patients active on pre-ART
Care at UCMB facilities.
4,771 59,313 64,084
Number of HIV positive cases who received CPT at
last visit in the year at UCMB facilities.
8,631 107,710 116,341
Number of new patients started on ART at UCMB
facilities during the year.
1,001 9,046 10,047
Total Number of individuals CURRENT on ART in
UCMB facilities.
8,272 86,016 94,288
TOTAL NUMBER OF HIV INDIVIDUALS CURRENT IN
HIV CHRONIC CARE.
13,043 145,329 158,372
HIV ACT Project specific performance
UCMB on behalf of the Registered Trustees of the Uganda Episcopal Conference (UEC), with
support from PEPFAR through CDC, implements a comprehensive HIV program in 17 of its
hospitals and 2 Health centers– the AIDS Care and Treatment (ACT) Program. This program,
in its 2nd year of the 5 year grant period, aims at providing comprehensive HIV/AIDS Care,
Treatment and Prevention Services in the 19 Faith-Based Health Facilities located in the
central, northern and western parts of the Republic of Uganda. The facilities include;
Nsambya hospital, Lubaga hospital, & Kamwokya Christian Caring community in Kampala
district; Nyenga hospital in Buikwe district ; Nkozi hospital in Mpigi district ; Villa-Maria
hospital in Kalungu district ; Virika hospital in Kabarole district, Comboni Kyamuhunga
hospital in Bushenyi district, Kasanga Primary health centre in Kasese district, St Mary’s
Lacor hospital in Gulu district, St Joseph’s hospital in Kitgum district, Aber hospital in Oyam
district, and Kalongo hospital in Agago district. Others are: Kisubi hospital Wakiso district,
Bishop Asili in Luweero district, Angal hospital in Nebbi district, Kitovu hospital in Masaka
district, Naggalama hospital in Mukono district, and St. Anthony Tororo hospital in Tororo
district.
Additionally, the project serves another 15 lower level health care facilities that serve as
outreaches of main hospitals. Three community-based organizations (CBOs) in the northern
region of the country work closely with two of the hospitals; Comboni Good Samaritans
works with Lacor hospital; Meeting Point Kitgum and Christian HIV/AIDS Prevention Services
25
(CHAPS) working with Kitgum hospital. The target facilities serve a catchment area spanning
more than 30 districts, with rural, hard to reach, poor and disadvantaged clients.
The performance review of the project in the last financial year shows that the program has
provided 64,595 clients with HIV services (50% of the overall UCMB achievement) ;
counseled, tested, and provided results to 153,948 individuals (65% of UCMB annual
achievement. 87% of those found positive have been linked to HIV care either directly in
program run facilities or other facilities of their choice through a referral system. The project
also looks after 64,595 patients in HIV care (42% of the entire UCMB output and 42,471
currently on ART in the program supported hospitals alone. Through this program a total of
20,128 men and children in reproductive age group have been circumcised as part of the
combination prevention approach. The project has also registered tremendous performance
in health systems strengthening mainly through equipping all labs in the participating
facilities with latest CD4, blood chemistry and microbiology diagnostic equipment. As a
result of this growth, two laboratories of Aber Hospital, Kalongo Ambrosoli Hospital (both in
northern Uganda) have been co-opted as part of the national EID hub system despite not
being Regional referral hospitals.
The program also provided OVC services to 9,800 children and their carers through its
robust OVC program, gave 45,000 individuals in HIV care PHDP services and did CD4
monitoring tests to 64% of all its patients (64,595) in care. Continuous skills development
and enhancement among health workers in the areas of HIV, TB, and community services
were also provided to over 600 health workers working in the project facilities.
The TB REACH Project
In its efforts to enhance TB/HIV co-management, UCMB got an award through a WHO
funding mechanism to support the national TB program to scale up case finding and
treatment for TB using the GeneXpert diagnostic technology. Currently 2- 2 modular
GeneXpert machines are running these services in the districts of Tororo, Busia and Mpigi,
not only serving the host hospitals of Nkozi and St Anthony’s, but the entire districts. Over
the year, more than 250 patients were identified and put on treatment in addition to
identifying and referring 5 MDR cases to MoH managed MDR treatment center.
26
Quality and Patients Safety
Onsight support and Induction Onsite support and induction in quality improvement was done in the following facilities: Bishop Asili , Kisubi , Lubaga, Maracha hospitals, Kamwokya Christian Caring Center and ,the health facilities of Lugazi and Kabale dioceses. The focus was mainly on: 1. Assessing quality ( assessing 15 health service components using the UCMB – MOH-
CORDAID tailored tool 2. Orienting the facility staff on principles and concepts Quality Improvement (QI) and
how to utilise data to improve quality of care. 3. Conducting Continuing Medical Education (CME)on QI models and sustainability
measure for QI. 4. Strengthening the structure for QI and planning. 5. Documenting about small-test-of-change (SMOC) project.
Comprehensive Quality assessment tools and guideline
The document was developed in partnership with MOH. There are seven core areas of focus for the assessment and improvement and in total there are 68 standards to assess. The seven areas are:
• Leadership and Governance • Human Resources for Health • Health Financing • Health Information • Medicines, Health Supplies and Vaccines • Service Delivery (Health Infrastructure, Essential Clinical Care, Preventive care &
Diagnostics) • Client Centred Care / Patient Safety.
The challenge is that because the process is led by MoH, UCMB currently has limited control over it – and yet UCMB cannot replicate the activity.
Patients Safety Efforts By end of 2014:
Eight hospitals were implementing the UCMB surgical safety checklist. These include Buluba (Jinja diocese), Kalongo (Gulu Archdiocese), Kisubi, Nkozi, Nsambya and Rubaga (Kampala Archdiocese), Virika (Fort Portal diocese), and Ibanda in Mbarara Archdiocese. It is hoped that the number using the checklist will increase because it is one of the undertakings of the hospitals for 2014 / 2015
It was realised in 2014 that incident / error reporting was still on-going but done informally because the managed had not provided the books for reporting for the fear of litigation.
Ninety one per cent of the Hospitals reported to have ad hoc quality and safety improvement committees. Kalongo (Gulu Archdiocse), Dabani and St Antony (Tororo Archdiocese) had
27
none. To include, the sub teems namely clinical audit teams, neonatal death monitoring team, infection control, drug therapeutically, maternal death audit are needed.
Ninety four per cent of the hospitals monitor and report (including indicators) on quality and safety activities ( except St Anthony, Dabani in Tororo Archdiocese)
Formation of structures for quality improvement
The supported health facilities either formed or revived QI committees or teams and developed the terms of reference (TOR) and QI plans Hospitals Drug Prescription & Dispensing Practices Survey - summary Results, May 2014.
The UCMB hospitals network has been conducting annual drug prescription and dispensing practices
surveys since 2004, with the objective of monitoring and improving the quality of drug prescription
and dispensing practices. The indicators monitored include: Average number of drug prescribed to
prevent possible poly-pharmacy, proportion of antibiotics, proportion of injectable medicines,
dispensing rate , objective examination rate as well as the presence of patient history and diagnosis
on the medical form. On average 2,560 patients forms are extracted for the survey annually. Over
the previous three years, the analysis of the survey returns from the 32 hospitals separated the
results for chronic and none chronic diagnoses to enable a better interpretation of the results as
shown in the table below.
Drug Prescription & Dispensing Practices Survey Summary Results for 32 UCMB Hospitals: May 2013 & May
2014.
Source: UCMB
The results in the above table shows that the average number of drugs per prescription for chronic
cases was above the WHO standard of 2.6 drugs per prescription; although a slight reduction from
3.51 to 3.20 drugs per prescription was observed on May 2014. The average antibiotic rate and
injectable rate were with the WHO recommendation except 7 hospitals that exceeded the 20% rate
as of May 2014 . The dispensing rate was below 100% in the 3 years implying none availability of
Assessment Indicators
WHO
Standard
2001
May
2012
Results
May
2013
Results
May
2014
Results
Range May 2014 Survey
Chronic Diagnoses Min Max
Average number of drugs
prescribed < 2.60 3.35 3.51 3.20 2.25 5.5
Antibiotic Rate < 20% 10% 9% 11% 0% 38%
Injectable Rate < 15% 5% 2% 2% 0% 14%
Dispensing rate 100% 95% 98% 94% 76% 100%
None Chronical Diagnoses
Average number of drugs
prescribed < 2.6 2.93 2.89 2.98 2.28 3.72
Antibiotic Rate < 20% 32% 28% 33% 27% 44%
Injectable Rate < 15% 6% 4% 5% 0% 34%
Dispensing rate 100% 95% 96% 97% 86% 100%
28
some medicines at the time of the survey. On May 2014, 15 hospitals had less than 100% stock of
medicines mainly due to inadequate funds.
The results for none chronic cases shows that the average number of drugs per prescription over
the 3 years is close to the WHO recommendation of 2.6 though 13 hospitals had an average of 3
drugs as reflected by the range of 2.28 to 3.72 drugs. The attainment of the recommended antibiotic
rate is still a challenge as all hospitals are above the 20% rate implying the need to do more
mentoring of the prescribers. The injectable rate was largely archived except in 3 hospitals that
exceeded 15%. The dispensing rate slightly improved over the 3 years and on May 2014, 26 hospitals
were above 96%.
CUAMM project
CUAMM supported 4 hospitals (Aber, Angal, Naggalama and Nyapea) under a project called
“Facilitating access to obstetric and neonatal quality care in the frame work of public private
partnership in hospitals of catholic network in Uganda” the project ran from 2011 up to
August 2014. UCMB had 2 specific activities in the project. Training dedicated hospital staff
to become information officer and conducting induction courses for the Board of Governors
members of the 4 hospitals. All the activities were done and the project recently closed
successfully.
Contribution to availability of quality and affordable medicines and medical supplies in Uganda
UCMB and its sister organisation, the Uganda Protestant Medical Bureau cofounded the
Joint Medical Store in 1979. It is currently the largest non-government owned supply chain
and store in Uganda. Although some health facilities under UCMB implementing the CDC
supported Aid Care and Treatment (ACT) project received HIV/AIDS commodity through
another implementing partner, Medical Access Uganda Limited (MAUL), JMS fulfilled its
mandate in serving the health facilities accredited to UCMB and UPMB and beyond
including other private-not-for-profit (PNFP) facilities and the private sector.
Figure 9: The entrance to JMS' head offices and the main sales and dispatch store
A full profile of the Joint Medical Store is provided in the annex of this report.
29
BUILDING AND STRENGTHENING PARTNERSHIPS
UCMB has continued to try to nurture and further strengthen the partnerships it has established
over years with the Ministry of Health, local governments, other medical bureaus, and local as well
as international actors in health. At the national level UCMB played an active role as a member of
the Health Policy Advisory Committee (HPAC), which is the top policy-making organ of the Ministry
of Health (MOH). It is also represented in various technical working groups of MOH. At district level,
UCMB continued to encourage its network to be active members of the District Health Management
Teams through the Diocesan Health Coordinators and Executive heads of the hospitals.
As part of this partnership, guided by the Public-Private-Partnership for Health (PPPH) policy, the
government of Uganda, through Ministry of Health continued to support health facilities under the
UCMB with Primary Health Care (PHC) Conditional grants for recurrent expenditures. More of this is
explained under the section on health financing of the network.
The partnership with Cordaid a Catholic NGO in The Netherlands has existed for about one and a half
decades. However it is not clear how this support will continue to translate into financial support
amidst the global financing changes. While funds from PEPFAR formed the largest fraction of UCMB
budget financing, the core and cross-cutting work of UCMB in health systems strengthening was still
largely supported by Cordaid in 2014.
UCMB has also partnered at global level and with some development partners. It is currently
implementing a PEPFAR-funded project to increase access to comprehensive HIV treatment services.
Other indirect partnerships with PEPFAR are those with organisations that are funded by PEPFAR.
These are Cardno Emerging Markets through the SDS project and Mildmay (U). As described
already, both have supported strengthening of human resources for health in the UCMB network.
UCMB has also continued to collaborate with Intrahealth (Uganda) in the area of strengthening
human resources management. Partnership also continued with SURE which has transitioned
through a new project into Uganda Health Supply Chain to support medicines and health supplies
management in the network.
It has also collaborated with DFID and Cordaid to have performance-based financing projects
implemented in Northern Uganda (Acholi subregion) and Eastern Uganda (Jinja diocese). UCMB has
also partnered with WHO and UNITAID in implementing a TB detection and treatment project.
Other partners who supported UCMB included the Toyai Association in Italy, Baylor College of
Medicine Children Foundation – Uganda, Catholic Relief Services, and the US Conference of Catholic
Bishops (USCCB).
There have also been collaborators like the other religious Medical Bureaus (UPMB, UMMB and
UOMB), Health Development Partners, other NGOs like CUAMM and AVSI.
UCMB explored possibility of collaboration and partnership with a number of other organisations
although some of them did not translate into concrete forms within the year. As the year ended
(December) Horizont 3000 sent a Technical Assistant to work with UCMB to strengthen finance
management and resource mobilisation in the network. Real work of this Technical Assistant was to
30
start in January 2015. There were also preparatory works done with the Belgian Technical
Corporation (BTC) for the starting of the Performance-Based Financing (PBF) to support the Private-
not-for-profit (PNFP) facilities in the West Nile and Rwenzori regions.
UCMB is a member of the African Christian Health Associations Platform (ACHAP) that is
headquartered in Nairobi, Kenya. For the last two years the Executive Secretary of UCMB
has represented the East African Region on the Board of Directors of ACHAP.
HUMAN RESOURCE FOR HEALTH IN UCMB FACILITIES
Total workforce in the network
The total workforce in the UCMB networks has gradually grown as health facilities grow in
numbers, levels and scope and vertical expansion of services they offer. To some extent it is
also due to attempts by facilities to recruit slightly above the establishment as a safety net against
attrition. Table 11 shows this trend. Over the last five years (2009-2014) there has been a
total workforce growth of 21% with annual growth ranging from 2% to 5%. For the last 10
years workforce in health centers (lower level facilities) has on average been 33% of the
total workforce in the Catholic health facilities and has stagnated at 34% in the last three
years.
Table 11: Trend in workforce in Catholic health facilities under UCMB
Total Workforce 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Lower level facility
Workforce 2180 2299 2501 2296 2297 2133 2451 2522 2688 2790 2920
Hospital Workforce 4429 4342 4523 4648 4774 4850 4902 5068 5169 5435 5502
Total 6609 6641 7024 6944 7071 6983 7353 7590 7857 8225 8422
As at June 30th 2014 the total workforce in health facilities under UCMB was 8,422 as
compared to 8,225 as at June 30th 2013. This was a rise of about 4% over one year. Table12
shows the distribution of the clinical and non-clinical staff by level of care.
31
Table 12: Distribution of health workers between hospitals and lower level facilities in UCMB
network as of June 30th
2014
Level of care Clinical staff Non-clinical staff Total %
Hospitals 3668 1834 5502 65%
Lower level units
1953 967 2920 35%
Total 5621 2801 8422 100%
% 67% 33% 100%
Table 13: Distribution of staff by all levels of care
Level of health care Total Clinical % clinical to total
Health Center level II 921 580 63%
Health Center level III 1903 1142 60%
Health Center level IV 96 53 55%
Hospitals 5502 3668 67%
Besides the Health Centre level IV, the proportion of the total staff who do clinical work is
about the same.
Distribution of health workers in UCMB network
Sixty five per cent of the health workers are in the hospitals and 35% are in lower level
facilities. Of the total workforce 67% are employed for clinically related work and the
remainder (33%) provide non-clinical support services e.g. administration, security, sanitary
work etc. Of those engaged for clinical services in hospital 86% are qualified; in the lower
level health facilities 89% of the clinical staff are qualified.
It is, however worth noting that the major problem with health workers in the UCMB
network and other PNFPs has largely not been with numbers but with high rate of turnover.
As recruitment and employment is done by individual health facilities or religious bodies,
those in the rural areas are less attractive in terms of working conditions, hence lower
retention rates.
Because many of these facilities are in rural areas, thus working with government to extend
services to those who could have been more disadvantaged, Ministry of Health has
seconded some doctors while different districts have also deployed some staff to improve
services. This is not only in the spirit of public-private-partnership for health (PPPH) but also
seeing extending of services as a priority. Accordingly 10% of the staff in the UCMB network
were either seconded by Ministry of Health or deployed by respective local governments.
Another 10% were qualified health workers posted by missionary congregations or
expatriates or volunteers seconded by international organisations. The remaining 80% were
privately employed by the health facilities. Part of the 80% were employed due to the
32
support to the respective facilities through partnership projects between UCMB and Cardno
Emerging Markets (the Strengthening of Decentralisation for Sustainability (SDS)) and with
Mildmay. A total of 78 health facilities located in 37 districts are benefittinng from from
these two projects. Mildmay is supporting 93 health workers in 13 districts in the Central
region while Cardno Emerging Markets is supporting another 93 health workers in 24
districts in Eastern and South Western regions. The key cadres supported include, Clinical
Officers, Midwives, Nurses, Laboratory Technicians and Medical Officers. In total they are
186 cadres remunerated under these partnerships. UCMB recognizes and appreciates this
support as it has boosted the hospital and health centre human resource in these facilities.
Quality of staff in facilities under UCMB
This is being measured by a proxy in terms of the proportion of the clinical staff being
qualified in their area of work (e.g. doctors, nurses, midwives, laboratory etc. etc.)
Table 14: Proportion of clinical staff in hospitals and lower level facilities who are qualified
2010 2011 2012 2013 2014
% Clinical Qualified staff in hospitals 65% 65% 67% 64% 67%
% Qualified staff in LLUs 56% 55% 56% 57% 46%
Stability and Attrition of health workforce in the UCMB Health facilities.
As stated earlier human resource for health has for several years remained a major
challenge to the UCMB not because of shortage in numbers per se but because of their
turnover. Data indicate that the overall workforce number is stable, but that number is
sustained by rapid and frequent replacement of departures. Access to training through
scholarships (including the UCMB scholarship – see later) also motivates staff and
contributes to some retention.
Table 15 Shows the trend of total (all cadres – qualified and non-qualified) staff turnover in
hospitals and in lower level facilities (health centers). The trend suggests some stability in
the hospitals and a slight reduction in turnover in lower level facilities over the last two
years.
33
Table 15: Total staff turnover in the UCMB network (all cadres and all levels combined).
2010 2011 2012 2013 2014
Total staff turnover in hospitals 17% 20% 16% 23% 16%
Total staff turnover in LLUs 22% 34% 30% 23% 21%
Figure 9 below shows that the turnover rate specifically for the clinically qualified health
worker has for long been higher in health centres than that of the counterparts in hospitals.
Figure 10: General trend of turnover of clinical cadres in UCMB health Centers and hospitals
Turnover of key key / selected cadres in hospitals
Doctors, clinical officers (COs) enrolled nursing (EN) and midwifery (EMW) are considered
here to give a general picture among key clinical cadres. Midwives had the highest rate
(54%) of turnover followed doctors at 49% and clinical officers at 43% (figure 10). Midwives
and clinical officers have for the second year running maintained stable but high turnover
rates. Recruitment by local governments generally caused a bit shift of health workers away
from PNFP facilities.
34
Figure 11: Trend of attrition of key clinical cadres in UCMB hospitals 2010/2011 to
2013/2014.
Turnover of key key / selected cadres in hospitals
A similar picture of rise in turnover among enrolled midwives has been observed in the
health centers over the last one year as depicted in the figure … .below.
Figure 12: Turnover of key clinical cadres in lower level UCMB health facilities in
2010/11 to 2013/14
35
Reasons for the attrition of key clinical cadres in the hospitals
As staff continue to leave the health facilities many reason are given on departure to other
jobs. Figure12 below shows the reasons departing staff gave during exit interviews.
Figure 13: Reason for the attrition of key clinical cadres in UCMB hospitals and Health
Centre (Source: 2013-2014 staffing movement Report)
Figure 12 above shows that many of the health workers moved to Government for
employment. This is in search for better pay.
Other reasons given for the departure of health workers include going for further studies,
End of contract and bonding agreement, termination of their contracts due to reasons
ranging from financial constraints to restructuring of the hospital / units, poor performance,
absconding from work, indiscipline and other misconduct while on duty et al.
While a number of hospitals have tried to reduce the remuneration gap between them
hospitals and government, this is less possible for lower level facilities.
Other non-financial strategies to motivate staff are also being tried like training, better
accommodation, staff saving schemes, free medical treatment, offering lunch and transport
allowances for non-residential staff and others.
36
Replacement / recruitment
By the end of 2013/2104, many of the recruits were fresh graduates, a proportion of 52%
were from training schools and 26% were from the fellow Private Health Facilities (PNFP-
PFFP). Meanwhile, 13% of the new recruits were from government health facilities as
compared to 9% in 2012/ 2013. Most of the staff who leave government before retirement
age to join the private sector do not join UCMB facilities. Instead, a good number of those
few joining UCMB facilities from government have formally retired from civil service.
Therefore, the UCMB health facilities have remained centres for “mentoring” or transit
routes to civil service and other employers, and for a few it is a retirement destination. This
is perhaps a picture seen in other PNFP networks as well.
Human Resource for Health Projects
The Uganda Catholic Medical Bureau through support from the US Government-PEPFAR and
USAID, is supporting 190 health workers in 78 districts of Uganda. Through this support
from the Mildmay project and Strengthening Decentralization for sustainability (SDS) the
focus has been mainly on in line with the mission of the Uganda Catholic Medical Bureau: In
faithfulness to the mission of Christ we provide professional and sustainable health services,
through partnership to enable the population live their life to the full.
Human resource is one of the critical six building blocks of health and therefore
strengthening health workers is thus critical for meeting health needs. The Mildmay and SDS
projects engaged UCMB to address the Human Resource for Health crisis for the delivery of
health services so as to meet the Health Sector Strategic and investment plan targets. The
projects have managed recruitment, induction, training, supervision, payroll and
management of 190 private not for profit health care workers in over 78 districts. The role
of UCMB is to ensure that the quality of care is maintained at the health facilities.
SDS Coverage
The program covers the central, Eastern and western regions of Uganda. Districts according
to region and coverage are shown below. The program covers the dioceses of Jinja,
Mbarara, Kabale and Tororo.There are 39 facilities that are being supported with health
workers in the dioceses mentioned.
Region Districts
Central Buyende ,Kaliro, Mayuge,Namayingo
Eastern Budaka, Bukwo, Bulambuli, Butaleja, Kapchorwa, Kween, Mbale, Paliisa, Sironko,
Western Buhweju, Bushenyi, Ibanda, Isingiro, Kabale, Kanungu, Kiruhura, Kisoro, Mitooma, Ntungamo, Rukungiri, Rubirizi
37
Cadres that are working and supported by the SDS program within these health facilities
include; Medical Officers, clinical officers, Enrolled midwives, Enrolled nurses, Enrolled
comprehensive Nurse and Lab technician and these take on different roles with in the
districts.
Cadre Number
Medical Officers 5
Clinical Officers 18
Enrolled Midwives 32
Enrolled Nurses 25
Lab technician 1
Enrolled Comprehensive Nurse 3
Registered Nurse 1
Total 85
Mildmay Coverage
The Mildmay project supports over 95 staff in the the dioceses of Kamplala,Kiyinda -
Mitiyana,Luweero,Masaka,Lugazi and Masaka.These staff cover 39 facilities in the districts
of Mityana, Mubende, Mpigi, Gomba, Luweero, wakiso, Buikwe, Masaka ,Lyantonde Lwengo
,Sembabule, Bukomansimbi, and Kalungu Districts.
Cadre Number
Medical Officers 2
Clinical Officers 26
Enrolled Midwives 27
Enrolled Nurses 12
Lab technician 15
Registered Nurse 5
Nursing Officers 8
Total 95
Achievements
There is an increment in the qualified staff working in the lower level units. This has
been registered in 2013 and 2014.Mildmay project has registered an increment of
21% qualified staff with in the supported lower level units.
The recruited staff are available and working at the health facilities. The Mildmay
project has 95 staff while the SDs project has 85 staff. Staffing numbers have
improved as there were gaps which were not filled before and these were filled with
the support from the HRH projects. This has therefore, reduced worked at the
facilities. Facility In-Charges and DHCs report improvements in patient numbers,
38
improved waiting time and that some facilities are now coming up since staff are
available to offer services.
HCT and EMTCT services have improved in 2014 compared to 2013. Facilities like
Konge, Njeru and Kyamaganda have greatly improved, since they could hardly see
mothers for HIV/AIDS services before HRH support.
Good human resource practices have been enhanced in facilities now that staff have
personnel files, contracts, performance appraisals and this has improved staff
performance and improved human resource management of facility activities.
Training in leadership & management for facility in-charges and DHCs has been held
for Mildmay project to ensure that performance indicators are met and improve
performance management in facilities. The SDS project will hold a similar training for
facility in-charges Health unit management committee and DHC next year to ensure
performance management at the facilities.
Support Supervision visits are done every Quarter .UCMB is required to visit all heath
facilities on a quarterly basis to complete a check list with observation on each
visit. This presents opportunity to do general support supervision beyond HRH
Support.
CONTRIBUTION TO PRODUCTION OF HUMAN RESOURCES FOR HEALTH
Central Coordination
UCMB does the coordination and supervision of the health training schools which are part of the hospitals attached to it. We also work to strengthen management systems in the training institutions. The Health Training Institution and Training (HTI/T) desk marks 7.5 years since it was established in 2006. This desk was established to ensure that all HTIs affiliated to UCMB access a full range of technical assistance UCMB provides.
Support supervision and mentoring
Visits were made to hospitals with HTIs for Health Systems Strengthening: 12 of the 13 (92%) HTI (s) were visited namely: Mutolere, Nyakibale (in Kabale diocese), Virika (Fort Portal diocese) Kitovu and Villa Maria (Masaka diocese), Matany (Moroto diocese), Kalongo (Gulu Archdiocese), Nsambya and Rubaga (Kampala Archdiocse), Kamuli (Jinja diocese), Ibanda (Mbarara Archdiocese), and Nyenga (Lugazi diocese). It was only Lacor HTI that not visited in 2014.
39
Figure 14 Support Supervision visit to St Kizito Hospital –Matany, Moroto Diocese. Second (right) is
the Bishop of the diocese, Rt. Rev. Damiano Guzzetti. The others are Dr. Ronald Kasyaba (AES)
(right), Mr. Peter Assimwe (left) and Rev. Sr. Catherine Nakiboneka (second left)
Collaboration with Ministries of Health and that for Education continued through various meetings. These provided opportunities for lobby and advocacy for the training schools under UCMB. Joint HTI PNFP technical workshop
UCMB and Uganda Protestant medical Bureau (UPMB) jointly organized a PNFP HTI technical workshop with funding Baylor-Uganda. There were 55 participants out of the expected 70. Among them were the hospital Managers, Principals of HTI and members of Boards of Governors or Chairpersons of the committees for the 21 PNFP health training institutions. Among other things the workshop covered the Audit report by Baylor-Uganda on Bursary Scheme, HTI accreditation, and introduction of Student Satisfaction Survey.
Data management training for HTIs
Data management training was done for health training institutions to contribute to the
improvement of HTI monitoring and evaluation of performance through improved data
collection, analysis and use for decision making. The participants capacities were
strengthened through the practical exercises in generation of quantitative/qualitative
reports using Microsoft excel, developed HTI registers, student performance per program
(i.e. Promotional/ State final exams). They were also introduced to generation of reports on
selection of candidates/students and the use of pivot tables.
Some of the existing challenges include; lack of job descriptions that mandate them to perform as expected and failure to monitor curriculum coverage despite their efforts to fill the classroom/ attendance registers (both for the tutors and students). Hence the HTI are unable to correlate class registers with prescribed curriculum theory/practical hours.
40
To promote services of special interest to the Catholic health services, and to support improvement of Maternal and Child health, there following were achieved:
A Natural Family Planning User Handbook was developed and approved by Health Commission on 12th Dec 2014.
Seventy nine midwives and ECN were trained at St Joseph Hospital Maracha (for Arua and Nebbi dioceses), Pope John –Aber Hospital (for Gulu Archdiocese and Lira diocese) and St Joseph Kamuli Mission hospital (for Jinja and Lugazi dioceses). Training focused on the six pillars of safe motherhood. Participants came from lower level units (health centers)
A few HTI have incorporated NFP module in their training program (e.g. Rubaga and Kalongo)
Regular assessment of quality of services (audits) was done. Student's satisfaction survey tool was developed and disseminated for initial testing.
Collaboration with Ministry of Health in training
i. In 2014 MOH provided laboratory equipment to schools doing Midwifery training
like Lubaga, Kalongo, Ibanda and others.
Joint HTI PNFP technical workshop
UCMB jointly organize the first join PNFP HTI TW with UPMB and this activity was financed by Baylor-Uganda. The participants were 55 out of the 70 that were and these included hospital Managers, Principals of HTI and BoG or HTI Chairperson of the statutory HTI committees of the 21 PNFP HTI. During this TWS the following are some of the key issues that were done; provided feedback on PNFP HTI performance, Internal Audit report by Baylor-Uganda on Bursary Scheme, HTI accreditation, introduction of Student Satisfaction Survey among others.
41
Figure 15:Participants of a Joint PNFP HTI Technical workshop held on 25th-27th February 2014.
The UCMB Scholarship Fund – Its performance and its benefits
The goal of the scholarship fund is promotion of high standards of quality of care and
management in RCC Health Institutions/Organisations. It aims at increasing/building
institutional capacity in RCC Health Institutions/Organisations and Religious Congregations
involved in health care through facilitation of professional training of their personnel by
means of co-funded scholarships.
The scholarships are not in full. Beneficiary health facilities meet non-tuition costs like
transport and other personal out-of-expenditures. Over the last ten years 860 health
workers in Catholic health services have got training from this scholarship fund. Eighty five
per cent of these have been in clinical fields and the other 15% being trained in
management related fields.
2010 2011 2012 2013 2014
Total No. of eligible Applications 108 97 90 74 88
Total No. of Awardees 56 51 66 49 51
Award rate 52% 53% 73% 66% 58%
Total Amount awarded 191,982,200 231,540,000 429,665,258 258,191,500 266,200,000
Average Amount Awarded per
person
3,428,254
4,540,000
6,510,080
5,269,214
5,219,608
42
The objective of the scholarship fund over the last three years was to support training of at
least 130 health workers. Instead, over the last three years scholarships have been
granted to 166 health workers, i.e. a 128% performance on target.
UCMB has also for some time now trained Clinical Pastoral Care givers (Clinical Pastoral
Education) to produce a team that spiritually support clinical care in health facilities. So far
separate funding has been used for this. While there is still a process of soliciting separate
funds for Clinical Pastoral Education, this is now also to be part of the common scholarship
fund.
Despite the high attrition, the per cent of qualified clinical has been maintained at average
of 66% in hospitals and 54% in the health centers. This is partly due to the training.
A study by Uganda Martyrs University in 2008 demonstrated that the Scholarship fund had
indeed increased the willingness to stay, hence reduced staff turnover among the
beneficiaries. Although this study has not been repeated, other studies on willingness to
stay have mentioned opportunity fort training among the retention factors. Besides,
despite staff turnover still remaining high in Private-not-for-profit (PNFP) networks including
those of the Catholic Church, UCMB has observed a gradual reduction in staff turnover in
hospitals over the years. In general there is some form of stabilisation both in total
workforce and in staff turnover. It is believed that, albeit small, the continued granting of
scholarships is still contributing to this positive trend of slowed or reducing turnover.
Funding the Scholarships
The steady rise in total workforce in the network of UCMB and increasing scope of services
imply increasing population from which training needs and applications are received. The
almost inevitable turnover is also additional reason for training for replacement in some
situations. The average annual award has been around Ug. Sh. 220,000,000.00 only out of
an estimated need of sh. 611,000,000. Of the sh.220 million, the Joint Medical Store (JMS),
a supply chain owned jointly by Uganda Catholic Medical Bureau and the Protestant Medical
Bureau has over the last four years increasingly contributed up to sh.140,000,000 a year.
This is the amount it will also contribute in 2015. DkA Austria has annually contributed Euro
20,000.00. Depending on the exchange rate this has been translating into Ug. Sh.
60,000,000.00 – 70,000,000.00. Attempts to raise funds for the scholarship from other local
sources have so far not been successful. The contributions from DkA and JMS have
therefore been very important even though the total could not meet the need from the
applicants.
The annual average award rate for the last 11 years has been 71.6%. However, the last five
years was 60.6% only due to the less availability of the fund (see table below).
43
Other scholarships
Besides the UCMB scholarship there are a few other opportunities for scholarship that exist
in the Ministry of Education and Sports or directly provided by some development partners.
UCMB does not have control on these scholarships and they are meant for the whole
country. A few staff in the UCMB may also access them.
The MoH and Development Partner (MoH-DP) Bursary scheme to PNFP-HTI that has been running from 2012 to 2014 targets certificate midwives, diploma for medical Laboratory Technicians and certificate medical laboratory technicians. While the UCMB scholarship targets staff of health facilities under UCMB and are given to the schools with the aim of strengthening human resource capacity for the facilities, the MoH-DP scholarship targets out of school students who are not yet trained and not employed, mainly from hard-to-reach districts or districts the Development Partners are operating in and are given to the individuals. The table below shows the number of students who have been enrolled into the bursary scheme since 2012 in twenty –one PNFP health training Institutions in Uganda. These bursaries have been offered by BAYLOR COLLEGE OF MEDICINE CHILDREN’S FOUNDATION – UGANDA as mean to support and improve National training system for health workers in collaboration with Ministry of Health to contribute to the availability and equitable distribution of well-trained health workers in Uganda.
Table 16: Recruitment onto the MoH-HDP Bursary program
Description Trend of the MOH-Development Partner-Bursary Scheme to PNFP-HTIs : SAINTS Project by Baylor-Uganda 2012-2014
Year
Medical Bureaus UCMB UMMB UPMB Total UCMB UMMB UPMB Total UCMB UMMB UPMB Total Overall
Certificate Midwives 219 0 100 319 355 25 183 563 284 20 123 433 1315
Cert Med Lab. 85 23 70 178 90 34 99 223 401
Diploma Med Lab 20 20 46 86 20 27 44 91 28 13 30 71 248
Total 324 43 216 583 465 86 326 877 312 33 153 504 1964
201320132012 2014
44
Figure 16:Participants at an EMoNC training at Pope John Hospital –Aber
Figure 17: Figure 15:Participants at an EMoNC training at St. Joseph Hospital Maracha
45
Clinical Pastoral Care/Education
Since 2007, UCMB has trained 67 people to provide pastoral care to the sick. Out of the 67,
22 have done their first unit; 25 have completed the second unit. 12 have have completed 3
units and 8 have completed the 4 units and out of the 8, who have completed CPE units, 2
have Diplomas in pastoral care & counseling.
The CPC givers are followed up by the PCS coordinator with support supervisions into the
health facilities on regular basis. Last year support supervisions were made to the following
health facilities: Benedictine eye hospital, Daban and St. Anthony’s hospitals in Tororo
Archdiocese. Virika , Angal and Maracha hospitals.
The PCG of the sick who are in the health facilities have regular refresher courses. Last
year’s refresher course took place from the 17th to 21st August and twenty two (22) turned
up for the refresher course.
Last year we too had a CPE which is usually for ten solid weeks. The participants were eight
in number and they are now back to their health facilities. During their graduation, we too
had our 1st two graduates with Diplomas in pastoral care and counseling in the history of the
program here in Uganda.
HEALTH FINANCING IN UCMB NETWORK: 2013/2014.
Financing of recurrent costs
Total expenditure by the UCMB facilities amounted to 147.9 billion shillings in FY 2013/2014 compared to 131.6 billion in FY 2012/2013. This was financed partly by user fee collection, donations and Government subsidies which included the primary health care conditional grant to the facilities and the MOH-DP Bursary funds for trainee beneficiaries in UCMB Health Training Institutions. Overall, government subsidies to UCMB facilities contributed 10.49% of the budget financing in the year, user fees financed 48.71% and donations contributed 40.80% (Figure 17).
46
Figure 18: Trends in income for recurrent cost in UCMB network (Hospitals + Lower Level Facilities)
Source: UCMB Government contribution decreased slightly in absolute terms from 13.1b (2012/2013) to 12.9bn (2013/2014). This support includes subsidy through the PHC CG for NGO - Non Wage Recurrent and the Bursary Scheme funded by Development Partners through MoH going to some beneficiaries from hard-to-reach districts. Although donor funds contributed 40% of the total budget financing (capital and recurrent costs combined), analysis of the hospital funding shows that 31% (of this 40%) went towards capital costs, another 31% was for projects related to HIV/AIDS, TB and Malaria and 38% in goods and services for other recurrent activities. It means that costs related to HIV/AIDS/TB and Malaria projects accounted for 45% of the donor-funded recurrent costs. If costs of services e.g. salaries of expatriates, goods in kind are deducted from the “Goods and Services” line of donation little of the 38% contribution is left for fungible financing of from donations. This means donor funds are currently not supporting much of the non-vertical services provided in health facilities. With reducing budget support is observed an inevitable rise in user fee collection as an attempt to raise more funds locally. The drop in budget support at facility level is partly due to the reduced total (absolute) allocation to the PHC CG Non-wage for NGO and to the individual facilities and increasing number of facilities, some being in very needy geographic locations. It is also due to reducing purchasing value of the shilling as unit cost of service keeps rising, besides inflation. It is however also important to note to note that the higher absolute figures of user fees today are comparable or even lower than the figures in real terms about 10 years ago when government stagnated its support to PNFPs and yet costs are rising by the day in both absolute and real terms. Overall, user fees financed 54% of the recurrent budget in 2013/14 (52% for hospitals and 61% in lower level units).
47
Available data shows that 10-15 years or more ago when government budget support was rising, user fees in the UCMB network and other PNFP accounted for less and less financing as the facilities were able to reduce specific charges and flatten fees. As population size increases and in the quest for universal coverage, facilities will need to increase scope, volume and quality of services. These, as well as rising costs of inputs like human resources, medicines and medical supplies and costs of various technologies have inevitably led and will continue to lead to increased unit and total cost of service and will demand more investment and recurrent expenditure. In absence or even stagnancy of or reduced fungible funding towards recurrent costs these factors will inevitably force further increase in user fees in absolute terms. It is therefore important that facilities like those under UCMB and other PNFP that work closely under the same objectives with government are proactively supported to reduce the burden of these costs to help them make services more available to the population. Advantage should be taken of the allocative flexibility in the UCMB facilities and that of other PNFP to leverage the resources they attract into the country and what they help pull out of the community (in terms of user fees) into the health sector and increase availability and accessibility of services. Recurrent cost recovery in hospitals
Twenty of the 32 hospitals (62.5%) could not even recover 50% of their expenditures from user fees. Matany hospital in the northeast district of Napak (Karamoja region) had the lowest contribution of user fee to its recurrent expenditure financing at 8%. Meanwhile operation of a private wing by Kisubi hospital along Kampala-Entebbe road in Wakiso district has been the main contributor to its recurrent cost recovery from user fee standing at 108% in 2013/14.
48
Expenditure areas
Quite often services provided in UCMB facilities and other PNFP facilities have been greatly appreciated despite the budgetary strain they experience. One of the key performance factors is flexibility in managing and using the available resources. This is a known factor in non-state service providers world-wide.
Figure 19: Distribution of total (including capital costs) expenditure - combined for hospitals and lower level facilities in UCMB network
Figure 19 shows that the major drivers of costs in facilities (hospitals and lower level facilities combined) are employment costs of medical goods and services. While medical goods and services, for example, took 25% of the overall expenditures (including capital costs), it was 31% of recurrent costs.
49
Figure 20: Distribution of recurrent expenditures in health facilities under UCMB
Although all health facilities continued to be financially constrained, especially the rural ones, the advocacy work of UCMB together with other Medical Bureaus, at least ensured continued support from government. Although grants for essential drugs were not obtained the support of the Ministry of Health towards budget support was retained. Linked to the above, the implementation of direct financial transfers to the health facilities was started with UCMB facilitating the obtaining and transmission to MoH of all needed information from the health facilities. UCMB continues to monitor and intervene where transfers to facilities hit a snag. Health facilities have greatly appreciated the direct transfers despite some hiccups that occasionally occur. Start-up activities for the Belgian support to the PNFPs in the Rwenzori and West Nile regions were begun. With financial support from Cordaid, UCMB has had Performance-Based Financing (PBF) piloted in health facilities of Jinja Diocese and later extended to government health facilities in the same diocese within Kamuli district. The figure below shows that during the implementation of the PBF utilization of services in the facilities increased. The downward trend in the last three years corresponds to the trend generally seen in the country explainable by among other things reduced cases of malaria reported to health facilities. The picture in government facilities that have just come on board are similar to what was seen in diocesan facilities in the first year of the project, 2009/2010..
50
Performance-based-financing (PBF) – The experience in Jinja diocese.
With financial support from Cordaid, UCMB has had Performance-Based Financing (PBF)
piloted in health facilities of Jinja Diocese and later extended to government health facilities
in the same diocese within Kamuli district. This report gives the findings of the evaluation of
the program. The PBF program started in the FY 2009/2010-2011/2012, with only 5 PNFP
health facilities within Busoga region (Jinja diocese). In 2012 it was externally evaluated and
the results were quite impressive. The improvements at facility level translated into
increased number of patients with access moving up from 123,334 contacts (in Standard
Units of Output – SUO) in 2008/09 to 182,812 SUO in 2010/2011 and a slight decline was
registered in the subsequent years. Percentage of qualified staff employed also improved
from 62% in 2008/09 to 74% in 2010/11. Other indices of quality of performance like
rational use of medicines and patient satisfaction scores improved significantly. The
Standard Units of Output (SUO) performances analysis is shown in figure 20.
Figure 21: Trend of total SUO in 5 lower level facilities of Jinja diocese
The downward trend in the last three years corresponds to the trend generally seen in the
country explainable by among other things reduced cases of malaria reported to health
facilities. The picture in government facilities that have just come on board are similar to
what was seen in diocesan facilities the first year of the project, 2009/2010.
It is the successful implementations of this pilot that necessitated an extension of a one year
pilot (FY 2013/2014) targeting 18 health facilities , more importantly also targeting 10
Government facilities in Kamuli district, the first one of its kind in Uganda.
51
Overall, Performance based financing program was a success not only in the five facilities in
first phase, but also in the current 18 target health facilities. True to its philosophy of PBF,
the support given to the health facilities under the program translated into more benefits
including the target communities. Health units received support in terms of bonus grants
which they used to improve their infrastructure, purchase medical equipment and
medicines, install solar lighting in wards and engage in community integrated health
programs among other investments.
The first pilot phase was designed on the basis of four key indicators; accessibility of services
measured by the number of patients seeking care in the health facility, equity that is
measured by reduction or flattening of user fees paid by patients to access care, efficiency
measured by cost per unit of service and lastly quality that was measured by the percentage
of qualified staff employed in the health facility. These four indicators have traditionally
been used by the Uganda Catholic Medical Bureau, the health office of the Catholic Church
in Uganda to monitor how of Catholic health facilities are remaining compliant to their set e
mission. The evaluation noted that when extension is done in both public and private
facilities, the concept of SUO should be unpacked to have harmonised understanding.
In the FY 2013/2014 PBF extension was done to include 18 facilities of which 10 are
government/public and indeed the SUO was unpacked and instead health service indicators
were used and this created a fertile ground for sound implementation of the program. The
one year project results in public facilities are shown below;
Table 17: Performance of government facilities in Kamuli district with PBF support in 2013/13
NO INDICATORS TARGET ACHIEVED %
1 OPD visits 260,984 325,555 125
2 AN 1st visit 19,507 14,865 76
3 AN 4 visits 6,149 5,157 84
4 AN: IPT2 7,027 8,570 122
5 Delivery 6,997 6,507 93
6 Referral EMONC for pregnant mothers 416 481 116
7 PN care 4,596 4,254 93
8 FP New users 7,583 6,997 92
9 child immunized 11,330 10,103 89
10 TB treatment 192 121 63
11 Caesarean Section 792 600 76
% AVERAGE SCORE 93
In the government facilities participating in this project PBF has been seen as the only
current “magic bullet” to revamp change in the health service delivery. Besides other direct
investments, it has helped improve on timely, accuracy and reliability of the HMIS data,
infrastructure investment, purchase of medical equipment and medicines, installation of
52
solar lighting in wards and engagement in community integrated health programs, and has
checked on late coming and absenteeism of staff, and above all strengthened HC IVs e.g.
Namwendwa and Nankandulo, to become operational to begin carrying out caesarean
section operations and blood transfusion which they had never done before.
In addition, PBF strengthened the quality of service delivery which was conducted on
quarterly basis by an impendent body. The performances are as shown below.
Table 18:Trend of quality scores by health facilities in 2013/24 - the year in which government
facilities became involved
UCMB FACILITIES
HEALTH FACILITY 1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER
1 BULUBA HOSPITAL 90 92 85 89
2 NAWANYAGO 78 89 90 93
3 ST.BENEDICT 85 83 92 90
4 KAMULI M.HOSPITAL 87 80 88 91
5 BUDINI 80 83 87 83
6 BUSWALE 76 86 84 86
7 WESUNIRE 76 76 88 89
8 IRUNDU 74 71 80 85
AVERAGE 81 83 87 88
PUBLIC FACILITIES
HEALTH FACILITY 1ST QUARTER 2ND QUARTER 3RD QUARTER 4TH QUARTER
1 NABIRUMBA 82 82 88 80
2 NAMASAGALI 74 87 84 87
3 BUTANSI 69 86 84 91
4 NANKANDULO 68 80 86 86
5 BALAWOLI 68 79 79 88
6 LULYAMBUZI 69 70 77 78
7 MBULAMUTI 67 82 68 70
8 NAMWENDWA 0 93 94 95
9 BULOPA 0 80 89 76
10 KITAYUNJWA 0 0 73 69
AVERAGE 50 74 82 82
53
UCMB FINANCIAL REPORT
UCMB SUMMARY OF FINANCIAL SITUATION, JANUARY – DECEMBER 2015
INCOME
Summary of Income and Expenditure
Category Sum of Total Budget 2014
Sum of Actual Jan to Dec 2014
Performance against budget
A Income
21,975,063,773
17,630,278,881 80%
Expenditure
21,975,063,773
15,648,959,689 71%
Utilisation 89%
Cost Centre Budget item group Total % of total
External Income Carried Forward 16,071,700 0%
External Allocations 16,983,165,672 96%
External Income Total 16,999,237,372 96%
Local Income Carried Forward 100,000,000 1%
Local Donors 184,195,727 1%
Local Revenues 346,845,782 2%
Local Income Total 631,041,509 4%
17,630,278,881 100%
The largest funding to the department was from external sources accounting for 96% of all
funds available to implementation of the plan. However, as much as 81% was for PEPFAR
funded vertical projects as seen in the table below. This amount of money could not
therefore support the system-wide, network-wide work of UCMB. The supported specific
thematic areas and covered few of the health facilities.
Table 19: PEPFAR funding to UCMB in 2014
Grant Shillings Percent of PRPFAR Grants
CDC for ACT project 12,447,365,093.00 87%
Mildmay for HR project 862,356,701.00 6%
Cardno (SDS) HR project 1,001,730,900.00 7%
Baylor Collage of Medicine (Uganda) - HTI workshop 56,578,728.00 0%
Total 14,368,031,422.00 100%
54
The major work done across the network of Catholic health services under UCMB and
focusing on strengthening health systems along the WHO building blocks was funded mainly
from Cordaid using a smaller grant.
Figure 22:Trend of UCMB local income as a proportion of total revenues
55
Comprehensive Statement of Income
Cost Centre Budget item group Budget item line Sum of Total Budget Yr 3
Sum of Actual Jan to Dec 2014
External Income Carried Forward Toyai Friends - 16,071,700.00
External Allocations Baylor College of Medicine Children's Foundation - Uganda 56,578,728.00 56,578,728.00
CDC-PEPFAR 16,027,087,500.00 12,447,365,093.00
Cordaid 1,019,534,200.00 1,028,043,208.00
Cordaid - IICD - C4C 818,368,929.55 876,877,192.00
CRS 100,508,175.00
CUAMM 23,800,000.00 19,608,099.00
DKA Austria 70,000,000.00 65,785,500.00
Horizont 3000 54,000,000.00
Mildmay 1,016,779,560.00 862,356,701.00
Personal Friends (Toyai) 13,200,000.00 6,600,000.00
Project proposal for fundraising 410,500,000.00 -
SDS 1,437,700,500.00 1,001,730,900.00
TB REACH 414,628,198.00
UNICEF 417,360,000.00 36,684,998.00
USCCB (Pastoral Solidarity Fund) 62,400,000.00 66,398,880.00
External Allocations Total
21,427,309,417.55 16,983,165,672.00
External Funds / Revenue Total 21,427,309,417.55 16,999,237,372.00 Local Income Carried Forward Local revenue carried forward 80,000,000.00 100,000,000.00
Carried Forward Total 80,000,000.00 100,000,000.00
Local Donors Exchange gains 20,000,000.00 26,164,431.00
IRCU 33,530,340.00
Recoveries from Reserves - 158,031,296.00
Local Donors Total 53,530,340.00 184,195,727.00
Local Revenues Administrative fee from Staff advance scheme 350,000.00 855,000.00
AGM Income 6,300,000.00 7,200,000.00
Annual Contribution of HTIs 2,200,000.00 2,600,000.00
Annual Contribution of units 63,000,000.00 56,475,000.00
Bank interest 20,824,015.00 9,270,432.00
ICT Recoveries 5,000,000.00 3,125,000.00
Incidentals 2,000,000.00 1,415,000.00
56
JMS contribution to Scholarship 125,000,000.00 140,000,000.00
Logistic Services 2,200,000.00 1,523,500.00
Recoveries from Printing and Publications 50,000,000.00 19,640,000.00
Recoveries from sales of assets 7,350,000.00 2,370,000.00
Treasury Management Yield 120,000,000.00 102,371,850.00
UCMB staff honoraria and Sitting Allowances 10,000,000.00
Local Revenues Total 414,224,015.00 346,845,782.00
Local Income Total
547,754,355.00 631,041,509.00
TOTAL FUNDS AVAILABLE (INCOME)
21,975,063,772.55
17,630,278,881.00
EXPENDITURES
Summary of expenditure by goal areas
Goal Cost Centre Sum of Total Budget Yr 3
Sum of Actual Jan to Dec 2014
Performance Proportion of total
1 A competent and sustainable UCMB 2,242,099,933 1,982,079,424 88% 13%
2 Effective Corporate Governance and Management 3,694,584,277 3,153,206,819 85% 20%
3 Effective Strategic Partnerships developed and maintained 0
4 Greater recognition and visibility of the RCC-HSN within the national health delivery system and within the Roman Catholic Church
54,999,775 38,155,000 69% 0%
5 Health services within the RCC- HSN meet the National and UCMB service delivery quality standards
13,267,335,000 8,145,931,446 61% 52%
6 Strengthen human resource capacity for health service delivery 2,716,044,788 2,329,587,000 86% 15%
TOTAL 21,975,063,773 15,648,959,689 71% 100%
Total utilisation of available funds was at 89% of the funds available.
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Comprehensive Statement of Expenditure
Goal Cost Centre Budget item group Sum of Total Budget Yr 3
Sum of Actual Jan to Dec 2014
Comments
Goal 1 A competent and sustainable UCMB Assets Replacement 40000000 183669142
Contingency 87561528
D 1 Health Commission functions (incl. Committees) 61000000 40941200
D 2 National Coordination and Representation 1100000
Done under office expenses
Emergency Fund 13200000 6600000 Supporting dioceses
General Reserve 60000000 57869142
Human Resource Employment - UCMB 749943769 635365296
Increasing internally generated revenue 250000000
Was meant to be a fund-raising for construction
Integrating management of special projects in the main UCMB functions 0
Office running 160000000 440409244
Strengthen Operational Research 50000000 0 Was meant to be from research project proposals
Strengthen the ICT and M&E 769294636 617225400
Strengthen UCMB capacity for support supervision 0
Goal 1 Total
A competent and sustainable UCMB Total 2242099933 1982079424
Goal 2 Effective Corporate Governance and Management
Human Resource Employment - UCMB 3340284277 2851036035
Spent less because of attrition and some positions not filled
Strengthen data reliability, demand and use in health facilities 60000000 50406280
Strengthen functionality of RCC-HSN corporate governance 153800000 135104700
58
structures
Strengthen health financing and finance management 0
Strengthen human resources management (entry, deployment, stay and exit) 40500000 18785500
Strengthen management systems and processes at all levels 100000000 97874304
Goal 2 Total
Effective Corporate Governance and Management Total 3694584277 3153206819
Goal 3
Health services within the RCC- HSN meet the National and UCMB service delivery quality standards 0
Collaborative management of the ACT Program 12737595000 7952630819
Promotion of services that are of special interest to RCC-HSN 132400000 175825917
Regular assessment of quality of services (audits) 20000000 17474710
UEC-UNICEF Partnership to keep child alive 377340000
Goal 3 Total
Health services within the RCC- HSN meet the National and UCMB service delivery quality standards Total 13267335000 8145931446
Goal 4
Greater recognition and visibility of the RCC-HSN within the national health delivery system and within the Roman Catholic Church
Advocacy to internal and external key stakeholders 0
Done as part of routine work of staff without special budgetary provision
59
Participating in national and local health events 0
Done but without special budget
Promoting RCC-HSN accountability and advocacy to the public 20000000 20655000
Supporting health assemblies, regional meetings of diocesan health coordinators et
Timely disseminating of literature related RCC-HSN to all stakeholders 34999775 17500000
Publications, adverts
Goal 4 Total
Greater recognition and visibility of the RCC-HSN within the national health delivery system and within the Roman Catholic Church Total 54999775 38155000
Goal 5 Effective Strategic Partnerships developed and maintained
Dissemination of the PPPH Policy once approved 0
Done through distribution of copies of the policy to the network
Monitor implementation of PPPH policy at district and national level 0
Done but not through a formal process
Partnership guidelines implementation 0
Goal 5 Total
Effective Strategic Partnerships developed and maintained 0
Goal 6 Strengthen human resource capacity for health service delivery
Improving the quality and relevance of health training 0
Done as part of support supervision
Inter-bureau capacity building for HTIs 56578728 56578728
Mildmay support to HRH in UCMB network 1016779560 865641163
Publications 65000000 3316040
SDS to HRH in UCMB network 1302686500 1198265569
Sustain and Operate the UCMB Scholarship Fund 275000000 205785500
Goal 6 Total
Strengthen human resource capacity for health service delivery Total 2716044788 2329587000
GRAND TOTAL OF EXPENDITURES 21975063773 15648959689
60
Statement of balances of restricted (donor) funds as at December 31st 2014.
Balance at Balance at
31-Jan-14 Income Expenditure appropriations/harmonising
PMS Fund account 31-Dec-14
Ushs. Ushs. Ushs. Ushs.
2014 2014
CORDAID
C158/9506
General
8,509,008 1,019,534,200 964,455,798 0 63,587,410
Toyai 16,071,700 6,600,000 135,000 22,536,700
CORDAID C4C 132,202,292 744674900 669,076,411 207,800,781
DKA / Austria 0 65,785,500 65,785,500 0
CDC ACT 176,904,496 12,270,038,596 11,136,779,866 1069290688 240,872,538
CUAMM Support 2,608,099 17,000,000 11,189,000 8,419,099
MRC 420,000 0 0 420,000
TB REACH 143,654,423 270,973,775 257,618,748 157,009,450
Mildmay 22,651,701 839,705,000 865,641,163 -3,284,462
SDS 0 1,001,730,900 944,031,333 57,699,567
CRS 0 100,508,175 97,763,357 2,744,818
Baylor Uganda 0 56,578,728 56,578,728 0
PASTROL
Solidarity Fund 0 66,398,880 33,014,560
33,384,320
UNICEF
SUPPORT 0 36,684,998 36,684,998
0
0
reconciled figure 0 0
503,021,719 16,496,213,652 15,138,754,462 1,069,290,688 791,190,221
The balance carried forward for CDC-ACT project above amounting to sh. 240,872,538
excludes an amount of sh.164,829,834 only obtained from exchange rate gains as balance
carried forward (thus total balance carried forward may be treated as
sh.240,872,538+164,829,834 = 405,702,371).
61
CHALLENGES
The main challenge was financial.
1. Local funding is still a far dream in financing work of UCMB. Besides being low, its percentage remains even lower against total funding due to the large dependence on external funding.
2. In the process of realignment of the project period for CDC funded projects with period for appropriation of funds by the US Congress there was a 6 months no-cost extension that resulted into significant under-funding of the project. That meant that the ACT project had to use funds meant for 12 months to cover 18 months. This was aimed at harmonizing the project period with the Federal process of appropriating funds so that no project period would stand the risk of starting with delayed disbursement. The no-cost nature was due to a miscalculation of the UCMB’s project’s
pipeline funding. Fortunately, while this greatly affected the technical support to
facilities and caused halting of a number of activities at facilities, in as far as targets for the project period were concerned these were already largely met. However it greatly constrained operations in the last five months of 2014. With the ACT project accounting for a large part of the budget, this no-cost extension accounted for the most part of the variation in the income budget performance.
3. While there is increasing funding opportunity for vertical programs that address fewer facilities and with single focus, the very important work of UCMB in supporting or strengthening health systems across the whole of its network is greatly constrained by reduced funding.
4. The other challenge is the reduction in funding commitment from other donors for 2015.
62
ACKNOWLEDGEMENT
Once again UCMB gives appreciation to the Bishops (UEC) for their continued and tireless
support both collectively and through the Health Commission. UCMB is very grateful
because more Bishops have demonstrated keen interest in the functioning of their health
departments and supported them in one way or another. The Chairman, the Vice
chairman and members of the Health Commission have been available to guide and support
the department. We thank the Standing Committees of the Health Commission (Finance &
Planning, Pastoral Care of the Sick, Health Training Institutions and training, Scholarship
Fund Management Committee) for their effective transaction of business on behalf of the
Commission.
UCMB equally feels indebted to the management, executives and other staff of Uganda
Catholic Secretariat and all its departments and units for for the opportunities we have been
able to collaborate.
The department is very grateful to all donors especially Cordaid, CDC (PEPFAR), DkA Austria,
Mildmay, Cardno Emerging Markets (SDS project) and the doctors in the Toyai Association in
Italy for having provided the resources needed for the implementation of the strategic plan.
At the national level we are indebted to the Government of Uganda especially Ministry of
Health and Ministry of Finance, Planning and Economic Development (MoFPED) for the
budget support to the network despite the stagnation. In the last five years the Joint
Medical Store (JMS) has been making the biggest contribution to the UCMB Scholarship
Fund. UCMB on behalf of the beneficiaries of the scholarship and on its own behalf says
“Thank you”. We thank all the other partners or donors who, as part of our collaboration
with them gave direct support to the health facilities accredited to UCMB. Among them is
the Ministry of Health, DFID, NU Health, Baylor (U), etc.
Not least, management of UCMB thanks the staff of the department for holding together
and making effort to blend and work as a team.
63
ANNEXES
Figures on out-patient attendances in hospitals
Figure 23: Total OPD attendance (new and re-attendance) in UCMB Hospitals :
Cumulative values.
Source : UCMB
Figures on in-patient admissions in hospitals
Figure 24: Total Admission (cumulative number) UCMB Hospitals
Source : UCMB
577,
744
597,
707
685,
891
729,
519 82
4,82
3
872,
562
939,
896
1,14
4,62
0
1,09
3,66
1
1,07
5,24
1
1,14
3,59
3
1,22
7,61
8
1,24
0,04
2
1,21
4,35
0
1,23
5,40
3
1,18
3,20
9
1,13
6,01
0
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10 10 11 11 12 12 13 13 14
Total OPD attendance (new and re-attendants) cumulative in UCMB Hospitals
154,
705
159,
706
149,
872
172,
318
199,
464 23
8,62
1
255,
635 28
7,11
8
297,
594
266,
579
273,
777
280,
963
331,
327
286,
175
266,
613
257,
459
247,
203
0
50,000
100,000
150,000
200,000
250,000
300,000
350,000
97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10 10 11 11 12 12 13 13 14
Total Admissions (cumulative) in UCMB Hospitals
Decreased by 4%
Decreased by 4 %
64
Figures on deliveries
Figure 25: Cumulative number of deliveries in UCMB Hospitals.
Source: UCMB
Figures on immunization
Figure 26: Cumulative number of Immunization doses for UCMB Hospitals.
Source: UCMB
23,7
09
22,6
18 26,9
18
28,4
03
28,9
49
32,3
77
34,0
64
42,7
38
44,9
02
47,0
00
54,5
08
54,9
79
55,0
21
58,7
44
60,5
51
55,8
00
56,4
73
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10 10 11 11 12 12 13 13 14
Cumulative number of deliveries in a sample of 65% of PNFP Hospitals
39
2,9
55
42
7,8
41
48
1,8
29
48
9,0
92
41
8,8
64
41
2,4
30
42
9,0
62 4
95
,30
4
46
8,6
63
47
8,1
51
50
1,3
89
59
9,7
63
57
2,9
98
52
6,1
41 6
00
,18
6
54
1,6
00
52
4,6
77
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10 10 11 11 12 12 13 13 14
Total Immunisation doses given (cumulative) in UCMB Hospitals
Increased by 1.21%
Decreased by 3.12%
65
UCMB STAFFING IN 2014:
This list also includes one staff who left in October 2014. It excludes staff working in the
ACT project who are placed in other departments
Table 20: UCMB staff list – 2014
Uganda Catholic Medical Bureau (UCMB)
Name Designation Joined UCS
1. Dr. Sam Orach Orochi Executive Secretary 2004
2. Dr. Ronald Kasyaba Assistant Executive Secretary 2013
3. Mr. Ronald Kamara COP - ACT Project 2000
4. Mrs. Florence Bamenya Accountant/Administrator 1990
5. Ms. Monicah Luwedde Patients Safety, Quality and Data Manager 2002
6. Mr. Joseph Martin Owori Driver 2002
7. Mr. Robert Kizito Driver 2003
8. Mr. Godfrey Begumisa ICT System Administrator 2005
9. Mr. Jenard Ntacyo ICT Systems Dev. Officer 2005
10. Mr. Charles Kirumira Kizza ICDM Advisor 2005
11. Fr. Festo Adrabo Clinical Pastoral Care of the Sick Co-ord. 2007
12. Sr. Catherine Nakiboneka HTI& Training Coordinator 2007
13. Mr. Peter Asiimwe Organisation Advisor 2008
14. Mr. Justus Muhangi M&E Coordinator 2011
15. Dr. Henry Mwesezi Deputy COP – ACT project 2011
16. Mr. Joel Arnold Emuto Laboratory Technical Advisor 2012
17. Mr. Kayemba Robert Mutebi Psychosocial Support Coordinator 2012
18. Mr. Katende Timothy IT Officer - General support 2012
19. Mrs. Christine Oba Edemaga Nursing Advisor 2012
20. Dr. Mbusa Kabagambe Patrick Assoc. Clinical HIV/AIDS Adv. 2012
21. Mr. Katuramu Paul Monitoring & Evaluation Officer 2012
22. Dr. Migisha Daniela Busharizi Mat. & Child HIV/AIDS Co-ord. 2012
23. Mrs. Kajoina Anne Nursing Advisor 2012
24. Mrs. Gloria Naluswa Kakuru Laboratory Specialist 2012
25. Mr. Lawrence Ssekimpi Strategic Inform and CQI Adv. 2012
66
PROFILE OF JOINT MEDICAL STORE (JMS)
Plot 1828, Gogonya Road, Nsambya P.O. Box 4501, Kampala. Tel: +256-414-510-096/7 +256-312-264-044/5 Toll Free: 0-800-123-124
Email:[email protected],
Website: www.jms.co.ug
OVERVIEW
Joint Medical Store (JMS) is a Private-not-for-Profit (PNFP) Non-Governmental
Organization (NGO) established in 1979 as a joint venture between the Uganda Catholic
Medical Bureau (UCMB) and the Uganda Protestant Medical Bureau (UPMB).
LEGAL STATUS
JMS is duly registered as a corporate body under the Trustee Incorporation Act Cap 165
and under the NGO Registration Statute, 1989. JMS is licensed by the National Drug
Authority to engage in the import, export, whole sale and distribution of Medicines and
related health supplies.
GOVERNANCE
The ownership of JMS lies with the Board of Trustees and the organization is governed
by the Board of Directors. The Board consists of members with impeccable character
drawn from various disciplines that ensure the proper running of the organization based
on good corporate governance principles. The Board, through the various Board
Committees, also ensures close supervision and timely decision making.
VISION
To be the Leading and Closest provider of Quality Health Supplies for the Glory of God
MISSION
To supply Medicines, Medical Equipment and Related Health Care Supplies and Training
of Assured Quality to the people of Uganda at affordable Price assuring a preferential
position for health Units registered with UPMB and UCMB.
PRODUCT RANGE
JMS provides a wide range of quality but affordable products in a one stop shopping
center that meet customers’ diverse needs. The products consist of Medicines, Medical
67
Sundries, Medical Equipment, Equipment Spares and Accessories and Laboratory
Supplies. All the products meet international standards and are approved by National
Drug Authority
SERVICES
In addition to the products on sale, JMS provides other services such as Medical
Equipment Maintenance, Medicines Management, Special Order Services and Drug
Information. JMS also publishes a Quarterly Info- bulletin and monthly Newsletter for
customers and provides free drop off services within Kampala on request and elsewhere
at a fee.
QUALITY
JMS is committed to the provision of Medicines, Medical Equipment and related Health
Care Supplies and Training of assured quality at affordable prices through efficient and
effective operations managed by continuous improvement and customer satisfaction. To
this end, JMS commits financial, human, physical and technological resources to ensure
the provision of quality products and services that meet acceptable national and
international standards and customer needs.
PREMISES
JMS’ stores, with a combined floor space of over 3,100 square meters located at Plot
1828 Gogonya Road and Plot 956 Old Ggaba Road, Nsambya, are well equipped with all
amenities that guarantee the safe, secure and efficient handling of supplies.
CUSTOMERS
JMS currently serves over 3,000 customers that include, Health Units accredited to
UCMB and UPMB, Government Hospitals and other health Centers, NGOs both Local
and International, Foreign customers in the DR-Congo, Rwanda, Southern Sudan,
Private Pharmacies and Clinics.
Some of the international customers or projects serviced by JMS include: CDC, MSH,
Goal, WHO, and Northwest Medical Teams, USAID, Marie Stopes, CRS, Norwegian
Peoples Aid, Malteser International, UNICEF, International Rescue Committee, Plan
international, American Refugee Committee, World Vision, UNHCR and many more.
PARTNERS & COLLABORATIONS
JMS enjoys good working relationships with various partners such as the Ministry of
Health, World Health Organization, National Drug Authority, National Medical Stores,
Catholic Relief Services and CORDAID. We have had Successful Collaborations in the
Supply of Essential Medicines, Antiretroviral drugs, ACT, Medical Equipment and
Laboratory supplies, as well as training.
68
HUMAN RESOURCE
Our Human Resource Consist of a team of skilled, dedicated and responsive personnel
who value integrity and ensure the provision of high quality service.
