Health

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.

 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.    Reducingout 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

4.   

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

5.   

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)