UGANDANS ENJOYING BETTER HEALTH SERVICES

UGANDANS ENJOYING BETTER HEALTH SERVICES By Moses Sserwanga The state of a country’s health sector is manifested in the available infrastructure and human resource to cater for the health needs of the people because a healthy and productive population is vital for socio-economic growth and nationaldevelopment. That’s why in its2011-2016 manifesto,the National Resistance Movement (NRM) government led by President YoweriMuseveni promised a number of interventions to turn around Uganda’s health sector. Among the issues the government set out to address was the lack of adequate qualified health workers at both nationalreferral hospitals and local health centers, II, III and IV. The Ministry of Health has since re-allocated an estimated Shs5.7 billion to recruit staff at Health Center IVs. At least 400 graduate health workers have been directly posted to local Government health Units. According to the current Uganda Health Sector Review Report, staffing in public health facilities improved from 58% in 2011/12 to 63% in 2012/13 though still below the recommended target of 70%. The increase in staffing level was a result of thetargeted recruitment for Health Center IVs and IIIs in 2012/13. District level staffing increased from 55% to 60.5%. However, the report indicates that 7,619 of new health workers recruited into the system from Government of Uganda and donor fundsis relatively low due to internal movements i.e. health workersmoving from hospitals to Health Center IVs and IIIs and from one rural district to a more urban district. Hence, the net increase in staffing is not significant. The results of the last health panel survey findings of 2010/11 received in 2013 indicated absenteeismat Health Center II and III level had increased by 2% from 46% in 2009/10 to 48% in 2010/11 instead of adecrease by 20% as per set target. There is need to establish an institutional mechanism foractive monitoring and reporting of health workers absenteeism. Medicines and Medical Supplies available to all government facilities The Health Sector Review Report notes that the National Medical Stores (NMS) continues to supply medicines and health supplies to public health facilities andachieved several of the planned outputs. Notably there was increased access to MaamaKits to82% of mothers delivering in public health facilities. During the financial year 2012-2013, NMS commenced supply ofmedicines and health supplies to all health facilities in the UPDF, Police Force and Prisonservices. The availability of the six tracer medicines (first line antimalarials (ACTs), Depoprovera, Sulphadoxine / Pyrimethamine, measles vaccine, ORS and Cotrimoxazole) in both public andprivate health facilities has continued to improve over the last four years with the percentageof facilities without stock out of any of the 6 tracer medicines increasing from 21% in 2009/10to 48% in 2011/12 and is now 65% in 2012/13. This is a positive trend compared to the recommended target of 60% for 2012/13. Performance of semi-autonomous institutions According to the Review, all the semi-autonomous institutions including; Mulago National Referral Hospital, ButabikaNational Referral Mental Hospital, Regional Referral Hospitals, Uganda Cancer Institute, UgandaHeart Institute and Uganda Blood Transfusion Services showed improvement in provision ofsecondary and tertiary referral services and specialized services and infrastructuredevelopment. The major challenge was inadequate resources (financial and human). Uganda Cancer Institute The Uganda Cancer Institute was able to provide a range of services which included; Outpatients: 12,096 patients; Inpatients: 2,652 patients; Physiotherapy: 2,652 patients andmedical social support: 14,748 patients. The Institute carried out Laboratory: 69,156investigations and Imaging: 9,870 investigations. The Institute achieved almost all of the planned outputs aimed developing the Institute. The 5year strategic plan is being finalized and over 70% of the planned works were completed. Thecancer research coordination structures have been established and the research agenda beingfinalized. Hospital Performance Hospital outputs were assessed using the Standard Unit of Output (SUO). The 14public referral hospitals and fourlarge Private hospitals (Lacor, Nsambya, Mengo and Lubaga) attended to a total of; 2,537,666 Outpatients; 89,626 deliveries and 339,670 admissions among other outputs. On average eachhospital attends to; 140,981 outpatients, conducted 4,979 deliveries and 19,981 admissions. The SUO for these hospitals increased from 5,361,005 in 2011/12 to 8,189,908 in 2012/13. Average staff productivity increased to 2,724 from 1,534 SUO/Staff in 2011/12. Mbale RRH and Masaka hospital had the highest SUOs of 858,116 and 792,551 respectively. The report shows that a total of 110 hospitals offering general hospital services and reporting through the District Health system wereassessed. They collectively attended to a total of; 3,754,144 outpatients; conducted 150,276deliveries and 690,621 admissions among other outputs. On average each hospital attends to;35,080 outpatients, 1,392 deliveries and 6,412 admissions. The total SUO for GHs has increasedfrom 10,506,636 in 2011/12 to 15,129,354 in 2012/13 with notable increase in performance foradmissions, outpatient attendances and deliveries. However, there was a decline in the immunization contacts at the government hosiptals. The 5 top performing hospitals were Iganga, Busolwe, Bwera, Mityana and Pallisa. The Top 5 performing maternal health care facilities In addition to performing Caesarean Sections, 193 Health Center IVs were also assessed using the SUO. In total Health Center IVs attended to 4,473,744 outpatients; conducted 123,610 deliveries; and admitted 395,898 patients. The 5 top performing Health Center IVs in 2012/13 were Bugobero ,Kawempe , Mukono Town Council, Serere and Luwero. Management of HIV/Aids The health sector maintained a positive trend in performance for the HIV/AIDS prevention, care and treatment services. The percentage of children exposed to HIV from their mothers accessing HIV testing within 12 months increased from 32% in 2011/12 to 46% (47,444 children) in 2012/13 . The performance is still below the set target of 55% for the year. There was also remarkableimprovement in the percentage of eligible persons receiving ARV therapy to 76% (total of566,444 of whom 524,603 adults and 41,520 children) from 59% in 2011/12. This achievement was also above the set target (65%) for the year. In FY 2012/13 193,000 new patients were enrolled on the life saving ART against the planned target of 110,000 new patients. This enrolment for the first time exceeded the number of estimated new infections (140,000) over the same period marking a tipping point in the ART programme. This was a result ofstrengthened programs of; accelerated accreditation of health facilities, scale up of Option B+,Web Based ARV Ordering Systems, supply chain rationalization which strengthened the PSMand improved overall support to health facilities by the MoH and Implementing Partners. Impact of government interventions in the health sector The Ministry of Health recommends implementation of the child survival strategy at all levels of care inorder to achieve the Millennium Development Goal four. The review shows that thesector continues providing key interventions like vitamin A supplementation, mass dewormingand health education to sustain improvement of the under-five nutritional status andreductionofanemia. There is need tocontinue community mobilization and involvement in the new community based interventions.Data from the 2011 AIDS Indicator Survey (AIS) revealed an increase in the HIV prevalenceamong adults from 6.4% in 2004/05 to 7.3% in 2011. This trend is attributable to both newinfections and improved survival. Access to a comprehensive rangeof HIV/AIDS care services has been improved through accelerated accreditation of ART siteswhich increased number of health facilities providing ARVs to 1,160 excluding specializedclinics, research programmes and private clinics. A total of 400,000 out of 1,000,000 (40%) Theproportion of pregnant women living with HIV receiving ARVs increased from 50% in 2009 to96% in 2012. There was an increase in the number of malaria patients reported in the outpatients from13,263,620 in 2011/12 to 15,997,210 in 2012/13. Malaria remained the leading cause of morbidity and mortality among all age groups and accounted for 20.6% (5,079/24,651) of allinpatient deaths in 2012/13. The sector improved malaria case management through increasedaccess to medicinesand use of Rapid Diagnostic Tests at HC IIs and IIIs without microscopes. IndoorResidual Spraying was conducted in the 10 target districts for the last 2 years with up to 92%coverage, protecting more than 2.6 million people. There was remarkable reduction of indoorresting vector population reduction as well as remarkable reduction of malaria prevalence intarget districts. Coverage for immunization services showed an increase in the percentage of under oneyear immunized with third dose of pentavalent vaccine (DPT3) from 85% in 2011/12 to 87% (1,319,860 children out of 1,520,347 target, of which 88% were males and 85% females)which is above the HSSIP target (83%) for the year. The DPT3 coverage of 85% in 2012/13 isabove the HSSIP target (83%) for 2012/13. Regarding measles immunization, 85% (1,285,020 children out of 1,520,347 target, of which 86% were males and 83% females) of one year old children were immunized against measles in 2012/13 . Recommendations for better health services The Review recommends that the health sector should focus on interventions geared at improving service delivery at the primarycare level specifically through improving the existing health infrastructure, provision of basicequipment, dissemination of guidelines for standard precautions and infection prevention andcontrol, providing appropriate diagnostic facilities and essential medicines by level of care. Allthis should be augmented with provider training to enhance their knowledge and skills. The Ministry of health needs to carry out further analysis to identify additional factors affecting functionality of HC IVs. KEY FACTS: • National government health budget declined from 8.3% in 2011/12 to 7.4% in 2012/13. • Still below the9.8% target for the year which is also below the Abuja target of 15%. Demographic Information • Demographic Variables Proportion Population • Total Population 100% 35,356,90 • Children below 18 years 56% 19,799,864 • Adolescents and youth (young people) (10 – 24 years) 34.7% 12,268,844 • Orphans (for children below 18 years) 10.9% 3,853,902 • Infants below one year 4.3% 1,520,347 • Children below 5 years 19.5% 6,894,596 • Women of reproductive age (15 – 49 years) 23% 8,132,087 • Expected number of pregnancies 5% 1,767,845 UBOS 2012 Midyear Projection New health facilities to be constructed Staff houses to be built at district hospitals of Moroto,MubendeMiyana, Masindi, Kawolo, Iganga, Anaka,Moyo,Kitgum, Itojo, Kiryandongo, Entebbe, Nebbi, Apac, Nakaseke, Buwenge and, Bukwo. Under World Bank loan hospitals to be upgraded and rehabilitated; Mubende, Moroto Regional referral hospitals and the 17 general hospitals. Installation of solar systems in 156 health centres is under way. The facilities that are benefiting from this programme include; Kibale, Mityana, Mubende, Kabale, Kanungu, Luweero and Rukungiri. Installation is also ongoing in Nakaseke, Kitgum, Apac, Amuru, Kaberamaido, Adjumani and Dokolo. And procurement of ambulances for 27 Health Center IVs, 17 general hospitals and two hospitals is in progress. An ambulatory transport scheme for Kampala is also being worked on. Construction of three general hospitals in Kampala i.eKawempe, Makindye and Rubaga in addition to the newly constructed in Naguru. This will help in the decongestion of Mulago National Referral hospital. A loan of (USD88 million) from the African Development Bank has been approved for the construction of hospitals in Kawempe and Makindye. The writer is a communications, media and legal consultant Based in South Sudan msserwanga@gmail.com