HEALTH SECTOR

The sector is comprised of 2 sub-sectors; that is District Health Officer and Primary Health care.

Sector mandates

In order to contribute to the achievement of the overall health sector objectives, local governments are charged with operational planning, management and delivery of health services by carrying out:

  • Health service delivery
  • Supervision
  • Monitoring
  • Resource mobilisation and allocation and
  • Enforcement of the health related laws and regulations

The Local Government Act (Schedule 2) specifies that Local Governments have the responsibility of delivering on the national health policy.

The responsibility centers for implementation of these activities are at four levels: the District Local Government level, the Health Sub-District (HSD) level (Health Centre IVs), Lower Level

Health Facilities level[1] and the Community level.


Table 2.6 Health sub/sectors

Vote Function Associated LG Mandate
General (District) Hospital Provision of curative and preventive health services, health education and promotion and rehabilitation.
Primary Health Care To provide preventive and curative health services, health education and promotion; rehabilitative health services, hygiene and Sanitation and Health Sub District (HSD) management.
District Health Office/Management To carry out the oversight function to health facilities and general health service delivery including: Coordination, Planning, monitoring and supervision, health promotion, epidemic and disaster preparedness and response, capacity building and regulation.

The Lower Level Health Facilities are Health Centres IIs and IIIs

Major health Service delivery Indicators

  • Total number of Health Facilities are 17 (7 govt and 10 PNFPs)

Gov’t               Private

  • Hospital 0                      0
  • Health centre IV 1                      0
  • Health centre IIIs 3                     10
  • Health centre IIs 3                      0
  • Trained VHTs        1016                     –
  • ICCM Trained VHTs 508
  • Practicing Doctors: population ratio – 1:151,075 (Only one medical Doctor)
  • Nurse: population ratio –1:12,700.
  • Clinical Officer Population -1:15,240 (One clinical officer)
  • Deliveries in health facilities and under medical personnel supervisor is 20%
  • Theatre to population ratio: 1:151,075

Top 5 causes of morbidity in the district

  • No Pneumonia – Cough or Cold – OPD 30%
  • Malaria – OPD           25%
  • Pneumonia – OPD 5%
  • Skin Diseases – OPD 3%
  • Intestinal Worms – OPD 3%
  • Gastro-Intestinal Disorders (non-Infective) 3%
  • Diarrhea – Acute – OPD 3%

The biggest causes of morbidity in the district are Pheumonia and malaria and the different trends for malaria were studied in different sub/counties during different quarters.

Table 2.7 Comparison of Malaria Incidence amongst sub counties with the District

Source: Office of the DHO 2015

The table shows malaria incidence in sub/counties and it is indicated that in 2012 Kibinge had the biggest percentage of malaria at 42%, Bigasa and Town Council were at 0%. The disease burden increased in 2013 and Bigasa had the highest percentage of 50%. The burden reduced in 2014 to 21% in the district with Bukomansimbi T/C with the highest percentage of 33%. The reduction was brought by intervention of other implementing partners like Malaria Consortium, recruitement of new health workers, strengthening the VHT interventions and increased drug stocks. According to the census results (2014) 91.4% own mosquitoe nets and 97.6% received mosquito nets for free. This will help in the reduction of malaria.

HIV care and Tuberculosis treatment and control services

  • 8 accredited sites or health facilities to offer HIV care services.
  • HIV prevalence:10.6% regional
  • Estimated HIV prevalence now 5.4% in the district (DHIS2).
  • Estimated HIV prevalence in ANC mothers 5.0%.
  • %age positivity rate of HIV–exposed babies turning HIV positive 8.6% (target <5%) by 2015
  • TB case detection rate (CDR) 24.8 %.( target 70%)
  • TB case treatment success rate.

 

Table 2.8:  Current Staffing levels in the District

Status Number Percentage
Total approved posts 135 100%
Total posts filled 90 66.7%
Total vacant posts 45 33.3%
Gender ratio of filled posts Males: Females 34:56

Source: Office of the DHO Bukomansimbi 2015

Table 2.9: Building infrastructure in health facilities

Health facility Description of the facility
Poor, inadequate or missing Fair, good, fairly adequate space
Butenga HC IV Wards, maternity wing, staff quarters, mortuary, cold chain room Laboratory, doctors house
Bigasa HC III OPD block, ward non-existent, martenity block, laboratory, staff residence
Kitanda HC III Martenity block, wards absent, pit latrines, staff quarters, patient latrines OPD block, laboratory room
Kisojjo HC II No staff quarters, no laboratory, OPD block, grossly inadequate, latrine incomplete
Kagoggo HC II Staff quarters lacking OPD and general building block
Kigangazi HC II OPD block too small, lacks staff quarters Sanitary facilities in fair general condition.
Mirambi H/C III Staff quarters, wards, OPD block too small. Laboratory room

 

Table 2.10 Physical Health infrastructure

Health facilities* by level Facility Ownership Number accredited Total Health Facilities
Govt. Private Not for Profit Private for Profit ART Number of facilities providing ART for children PMTCT Number of SLMTA enrolled laboratories
HC II 3 0 0 0 3 3 0 3
HC III 3 8 2 6 7 7 0 13
HC IV 1 0 0 1 1 1 0 1
General hospital 0 0 0 0 0 0 0 0
Regional Referral hospital 0 0 0 0 0 0 0 0
*List specialized clinics 0 0 0 0 0 0 0 0

Source: Office of the DHO Bukomansimbi 2015

2014 Census results revealed that 39.2% of the households are located 5kms or more from the public health facility. This indicates that more health units should be built atleast per parish inorder to improve health service delivery.

 

2.1.5.1 REPRODUCTIVE HEALTH

Uganda’s vision 2040 aims at improving the quality of the population which will focus on creating a more sustainable age structure by reducing the high fertility rate through increased access to quality reproductive health services and focus on building an efficient health services delivery system through emphasizes prevention over curative services.

The goals for NDP/DDP are similar to MDGs as well SDGs especially for women and children. The NDP states that although high mortality is a health outcome, it is not solely the responsibility of the health sector and the activities geared towards reduced mortality are muilti-sectoral. In addition, the NDP indicates that high mortality is not due to lack of appropriate policies in Uganda but rather due to inadequate policy implementation.

The decentralization policy stipulates efficiency and effectiveness of service delivery, guided by the constitution of Uganda and Local Government Act. The second National Health Policy (2010/11-2019/20) and the health sector strategic and investment plan (HSSIP) 2010/11-2014/15 defines maternal, child and Newborn mortality reduction as the 3 outcomes of the health sector.

The roadmap for the reduction of marternal and newborn mortality, National child survival strategy and other strategies and related frameworks have prioritized high impact interventions, which are appropriate for vulnerable population including less advantaged.

In Uganda the maternal mortality ratio decreased from 524 deaths per 100,000 live births in 2000-01 to 418 deaths in 2006, and it increased to 438 deaths per 100,000 live births in 2011.  This is analysed as about 3% of women dying during pregnancy, during childbirth, or within two months of childbirth.  Though maternal mortality ratio has declined significantly in recent years, it is still above the Millennium Development Goals (MDGs) 2015 target of 131 and will need accelerated effort to deep the trend.

In order to address issues of reproductive health, the DDP2 will implement the sharpened plan as elaborated below.

What is the Sharpened RMNCH Plan?

  • Examines why slow progress to MDGs 4&5
  • Prioritises and Optimises
  • Sets an agenda for how to accelerate
  • A starting point for dialogue and to renew commitments
  • Sets mechanisms for information and mutual accountability for MNC survival

Vision

  • To end preventable deaths through
    • A strategic shift from doing business as usual
    • Ensuring universal coverage of high impact health interventions
    • Using all 3 service delivery platforms.

Objectives

  • To accelerate greater coverage in high-burden populations
  • To expand coverage of high impact interventions that directly reduce maternal, newborn and child mortality
  • To harness non health sector interventions that impact on maternal, newborn and child vulnerability and deaths.
  • To develop and sustain collective action and mutual accountability for ending preventable maternal, newborn and child deaths
  • These Strategic Shifts are about using ways to gain big changes with small shifts.  Rather than changing the existing strategies, the shifts aim at the highest impact with the least effort and are “the little hinges that swing big doors”.  The strategic shift moves from focusing on intervention and activities to impact focus.
  • The five shifts form the focus for action to overcome obstacles to prevent avoidable death. They reflect a national commitment and also recognize the importance of district leadership at a local level and encourage districts, partners, CSOs and other players to implement them. The five strategic shifts in doing business differently or greater impact are

Table 2.11: The five Strategic shifts which will be implemented in the district

S/N Strategic shift Strategies
S/N Focus Geographically

 

·         Increase efforts in districts where most MNC deaths occur, prioritizing budgets and committing to action plans to end these preventable deaths.
  High burden populations

 

•          Refocus district to scaling up access for the underserved population groups

•          Delivery of integrated service packages at the 3 service

•          delivery platforms

  High impact Interventions

 

•          Target biggest opportunities for impact eg Kangaroo mother care ,

•          Scale, sustain highest impact, evidence-based interventions

•          Be innovate to accelerate results

  Multi-sectoral

 

•          Educate girls and women

•          Empower women to make decisions

•          Environmental factors  should be addressed e.g. sanitation and hygiene

  Mutual accountability

 

•          Transparency and mutual accountability for results -all levels

•          Shared voice, goal and M&E

•          Share knowledge and rectify if necessary

 

 GUIDING PRINCIPLES

  • Time bound by setting district targets
  • Leveraging by building on and catalysing actions by a broad range of partners
  • Use tools and processes developed by previous initiatives
  • Separate Functions of stakeholders. Unbundle functions, activities, processes, roles and responsibilities for RMNCH within the district service delivery system to improve efficiency.
  • Inclusiveness especially of private sector and other sectors
  • District leadership and ownership

The thirteen lifesaving commodities have been first tracked by the UN commission to ensure that they are available to all women and children in need. These cover a range items for reproductive, maternal, child and newborn health.

  • Reproductive Health Commodities comprising Female Condoms, Contraceptive Implants and Emergency Contraceptive Pills
  • Maternal Health Commodities comprising Misoprostol for prevention and treatment of PPH, Magnesium Sulphate for prevention, treatment of severe pre-eclampsia and eclampsia, Oxytocin injection for prevention and treatment of PPH
  • Newborn Health Commodities comprising Antenatal Corticosteroids for management of preterm labour, Injectable Antibiotics for Neonatal Sepsis, Newborn Resuscitation Devices and Chlorohexidine for Cord Care
  • Child Health Commodities comprising Oral Rehydration Salts and Zinc treatment for Diarrhoea, Amoxicillin tablets for treatment of pneumonia in children.

 District Management Efforts to reduce mortality and improve marternal health

  1. Strengthen RMNCH leadership at all levels:
    • At district levels appointing Assistant DHO (RMNCH)
    • At HSD level, appoint focal point for RMNCH and support their functions especially in High Priority areas/districts
  2. Reducing out of pocket expenditure for poor
    • At facility level HUMC, embrace the scale up RH Voucher systems and within the private sector:
  3. Increasing access and use of lifesaving commodities for RMNCH
    • Within the annual district procurement plan, include:
      1. RMNCH lifesaving commodities forecasting, quantification and requisition within routine facility and district activities
      2. Formularies and syringes for sick newborn treatment at all levels
  1. Addressing Human Resource constraints
    • Deployment of Midwives for difficult to reach districts
    • Linking with training schools to lower level facilities as practicum sites
    • Competence based in-service training, mentoring and support supervision in use emergency lifesaving commodities and interpersonal communication
    • Revise the job descriptions of nurses and midwives in line with RNMCH requirements
    • Revise staffing for midwives based on actual facility coverage rather than level
  2. Strengthening monitoring and Supervision
    • Generate quality HMIS reports on key RMNCH indicators
    • Carry out RMNCH service Availability mapping
    • Use of RMNCH scorecard to monitor performance
    • Train and facilitate MPDR committees in HSDs to act on review findings and to undertake independent audits/verifications
    • Produce and effectively disseminate annual RMNCH district report

 Table 2.12: Indicators to truck progress (For district level score card)

Category Indicator Source
Pre-Pregnancy & adolescence Couples accepting a contraceptive method postpartum HMIS
Pregnancy Pregnant women receiving IFA HMIS
Pregnant women taking 2 or more doses of IPT HMIS
Sera-positive Pregnant women treated with ARVs HMIS
Delivery Women provided with a uterotonic immediately after delivery HMIS
Women identified for pre-eclampsia and provided MgSO4 HMIS
EmOC/Newborn care Women in P/Term labour receive atleast 1 dose of dexamethasone HMIS
Newborns treated for puerperal sepsis HMIS
Newborn provided KMC among LBW HMIS
Sero-posistive infants treated with ARVs HMIS
Postnatal period Newborn infection cases treated with parental antibiotics HMIS
DPT 3 coverage and dropout rate HMIS
U5 diarrhoea cases provided ORS and Zinc HMIS
U5 pneumonia cases provided with antibiotics HMIS
Outcomes Stillbirths, Neonatal, Child and Maternal Deaths HMIS
Health systems Health facilities with stockouts of lifesaving commodities HMIS
VHTs stockouts of LSCos (subset as allowed per policy) HMIS
Health facilities with trained midwives HMIS
HC IV and above provide CEmONC HMIS
Lower facilities with delivery services provide BEmONC SARA
Proportion of resources allocated and spend based on commitments. SARA
Equity Malnourished children provided treatment (boys and girls) HMIS
Female to Male ratio of OPD HMIS
Concentration indices for priority indicators (Two-year interval) LQAs
Cross-cutting Household with latrine coverage HMIS
Overall summary (Geographical equity) Health facilities below lower benchmark Summary

Table 2.13: Current development partners in the Health department.

Partner Intervention
TASO, Villa Maria Home Care Programme, AHF (UG CARES) in Comprehensive HIV/AIDS management.

 

PREFA PMTCT
Malaria Consortium/Stop Malaria Project and Training of VHTs
WHO Disease Surveillance
Marie Stopes Reproductive health
UNICEF Training of VHTs, birth registration and OVC management
MILDMAY Health system strengthening, HIV/AIDS, HRH sanitation, capacity building and reduction of new HIV cases in adolescent girls and young women.
CARITAS MADDO Training and equipping VHTs and nutrition
GLOBAL FUND Malaria and TB
PACE Positive living project (HIV/AIDS)
Rakai Health Sciences Program Safe male circumsion (SMC)