CCIH 2015 Tonny Tumwesigye Plenary 2

Uganda Protestant Medical Bureau

Contribution of UPMB in Ending Extreme poverty

Dr. Tonny Tumwesigye

Executive Director

CCIH Annual Conference 26th – 29th June 2015

www.upmb.co.ug Health in Totality

Background

• Founded in 1957 by government notice no. 672

• National umbrella organization for Protestant,Adventist and Pentecostal Founded member healthfacilities.

• Health technical arm of the COU and the SDA Church

• 80% are in Rural & Hard to reach Areas

• It is one of the four religious medical bureau networksin Uganda (UCMB, UMMB, UOMB)


UPMB Motto, Vision & Mission

• Motto:

– “Health in Totality”

• Vision:

– “Transformed lives through Christian quality health care”

• Mission:

– "Supporting members to witness for Christ through the provision of quality health care“


Coverage of UPMB

18 Hospitals

10 Health Centre IV

255 Lower Level Health Facilities

10 Health Training Institutions

80% Very Hard to Reach

Areas

Private Not for Profit

Established following the

Need


Facilities across Uganda-(DHIS2 – GIS


UPMB Strategic Areas of focus (2014-2018)1) Institutional Capacity Development

• Interventions like training and resource mobilization to improve

– HRH for member health facilities and Governance structures

2) Support to Health Service Delivery

• Concentrates on logistical and technical facilitation for MHF

– Infectious diseases e.g. HIV/AIDS and Reproductive health initiatives and NCD

– Health Systems Strengthening-CHI

3) Patient Safety and Quality Health Services

• Looks at setting standards and monitoring compliance to them for

– Accreditation

– Patient safety promotion, ICT improvement and Support supervision

4) Research Advocacy and Networking


Historical feature of Uganda’s health system


Contribute to all health system building blocks and levels of care


1. Policy, Leadership & Management

1. Policy development, monitoring and evaluation of the national plan

1. SWAp structures (PPPH) e.g. HPAC and District Fora

2. Medical Bureaus (Self-coordinating bodies)

3. NFB PNFPs

2. Leadership, Planning, coordination & Management of Health Services

– Through established coordination structures – Medical Bureaus

– 29 PNFP facilities are Health sub district headquarters

– Participation in DHMTs where the districts have actively involved them


2. Contribution to Health Infrastructure

1. 42% of the Country Hospitals

2. 42% of the Country Hospital Beds

3. About 65% of the institutions training nurses/midwives in Uganda are PNFP

• 92% of these are under three Medical Bureaus


Hospitals HC IV HC III HC II Total

UCMB 32 6 172 75 285

UPMB 18 10 57 198 283

UMMB 5 2 22 21 50

UOMB 1 1 3 9 14

56 19 254 303 632

Other PNFPs 11 ? ? ?


3. Contribution to Hospital Capacity

No. of Hospitals Per cent

Government 65 41%

PNFP 67 42%

Private 27 17%

Total 159 100%

Other PNFP ?Data

Help to extend access to services to the people


4. Contributing to Human Resource Production

UCMB UPMB UMMB Total

Sites training Traditional Nurses and Midwifery 12 10 1 23

Sites training ECN 0 10 1 11

Sites training traditional EMW (cert) 12 10 0 22

Sites training traditional EMW (diploma) 3 3 0 1

Sites for cert. Laboratory Training 3 2 1 4

Sites for diploma Laboratory Training 3 1 0 6

Universities training Cos, Mos (UMU - Post grad) 1 1 0 2

Training in PH, Health Service Management (UMU & UCU)

1 1 0 2

Training site for Government (University, Interns) 10 4 1 15


Recruitment & Posting of staff to MHFs

Personnel

Total No. of Staff 2013-

2014

Doctor 34

Clinical Officer/Medical Assistant 115

Lab Assistant 147

Enrolled Nurse 132

Enrolled Midwife/ECN 118

Registered Nurse 58

Total 607


5. Contribution to supply Chain

• Joint Medical Store-2nd Largest in the Country

– Started in 1979 (Peak of Uganda Health Crisis)

– Jointly by UPMB and UCMB

– PNFP facilities have not stopped procuring essential medicines from JMS


6. Provision of the NMHC package by the PNFPs E.g. OPD, In-patients and Deliveries

Health Facilities under UPMB also manage 10% of patients on Antiretroviral therapy


7. Contribution To Health Resource Mobilisation

• Resources mobilised by the PNFP for work in health should be considered as mobilised for Ugandans

– Mobilising from donors

– Mobilising local resources through user fees or Health Insurance schemes (e.g. Community Health Insurance)-UPMB has the largest CHI in Uganda

• Increasing support from government or donors helps reduce reliance on user fees

• Reduction in support amidst increasing cost of service forces PNFPs to increase user fees


45.8% 47.9% 49.9%59.2%

7.6%8.3%

11.5%

7.0%22.1%21.5%

21.3%22.0%

24.5% 22.3%17.3%

11.8%

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

120.0%

FY 2010-2011 FY 2011-2012 FY 2012-2013 FY 2013-2014

UPMB Hospitals: Trends in income for recurrent operations

User Fees Gov't subsidy (Money & drugs) Donations Other incomes

60 – 80% of donor funds are for HIV/AIDS, TB and Malaria



60%

50%

46%

43%

35%37%

32%34% 33%

31%

35%33%

39% 38%41% 41%

0%

10%

20%

30%

40%

50%

60%

70%

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

Hospital Recurrent Cost Recovery Rate (Median in UPMB Hospitals as example)

When government subsidy was highest

Reducing government

subsidy


8. Contribution to Innovation

• PBF

• In in Jinja diocese where it has been extended to government facilities in Kamuli district with very good results

• In Acholi sub-region supported by DfID

• Voucher system (UPMB) supported by Big Lottery UK

• Building maternal homes in hospitals to improve on maternal health – a long time feature of some PNFP facilities


9. Contributing to Quality Improvement Initiatives

• Having accreditation systems that could be adopted nationally

• About 15 years experience now

• Production of Patient Safety Manual

• Annual Patients Satisfaction surveys

• Tools now also used by other organizations


10. Contributing to Health Technology

• Digitalising patient-level data collection in hospitals

• Capacity to feed data into DHIS2 built in some PNFPs to below district level – HC II in some cases

• Digitalising patients satisfaction survey

www.upmb.co.ug Health in Totality25

11. Other areas of Contribution

• Provision of community based services

–Outreaches, home based care, (Community Outreach Programs)

• More by the NFB – PNFPs

• E.g. 70% of HIV community-based prevention work

• HFs also work with the NFB PNFPs


Major challenges• High staff turnover rate

– Most departures are destined to government (60 –70%)

– Some to Vertical Projects, mainly in HIV/AIDS




• Non Recognition by the State/being seen as enemies and or Competitors

• Rising unit costs and total cost of service provision

–Most people look at what patients pay but not facilities spend beyond what patients pay

–Amidst reducing government allocation to facilities and severely reduced donor funding


• Reduced support – end of credit line – affecting capacity to procure

• Many facilities were shifted by MoH and some grant conditionalities to procure HIV/AIDS commodity from another supply chain mechanism other than JMS



Recommendations

• We are not enemies of & Or competitors with the State but are Complementing their role

• Study practices in other African counties like Zambia, Malawi, Ghana etc to inform Government-PNFP partnership on HRH

• Performance-based financing (PBF) to be adopted both for the PNFP and government facilities

• The capacity at JMS to be supported as the Supply-chain system for the PNFPs

• Scale up Community Health financing


THANK YOU

Date post:	14-Aug-2015
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CCIH 2015 Tonny Tumwesigye Plenary 2

Healthcare