PARUAMENT OF THE REPUBLIC OF UGANDA REPUBLIC OF UGANDA

REPORT OF THE SECTORAL COMMITTEE ON HEALTH ON THE SECTOR MINISTERIAL POLICY STATEMENT AND BUDGET ESTIMATES FOR THt FY 2OL8l L9

MAY, 2018

OFFICE OF THE CLERK TO PARLIAMENT PARLIAMENT BUILDING KAMPALA-UGANDA $"

ffi &yo's \ \ s 1.O INTRODUCTION

In accordance with Articles 90 and 155 (a) of the Constitution of the Republic of Uganda, Section 13(5) of the Public Finance Management Act, 2015 and Rule 18S of the Rules of Procedure of the Parliament of Uganda, the Sectoral Committee on Health is mandated among other things to: 1) Examine and comment on policy matters affecting Ministries and Departments under their jurisdiction and; 2) Examine critically Government recurrent and capital budget estimates and make recommendations on them for general debate in the House. 3) Ensure Government compliance with approved plans and programmes

In accordance with the above mandate, the Minister for Health laid at Table the Ministerial Policy Statement (MPS) for Health Sector on 15fr March, 2018, and consequently, the Speaker referred the MPS to the Committee on Health for scrutiny. The Committee considered the Health Sector Ministerial Policy statement together with statements from the auxiliary agencies and now reports.

2.O BACKGROUND

Ministerial Policy Statements set out the performance and plans of spending Agencies, linking them with their policy objectives. Ministers present these statements to parliament following the presentation of the budget framework paper by the Minister of Finance, Planning and Economic Development. These statements are used by Parliament to assess the performance of sectors 13(5) /spending agencies. This role of Parliament is provided for under Section of the Public Finance Management Act, 2015.) v The MpS summarizes the past performance of the sector and the plans for future expenditure and activities. They outline anticipated sectoral challenges and strategie s to overcome them. They also present: tputs and the w w 2 #/)n-" & costing; final work plans; cash plans; and staffing structure and procurement plans of the sector among others.

3.O SCOPE

This report unpacks the Health Sector Ministerial Policy Statement for FY 2Ot8 I Le.

4.O METHODOLOY In scrutinizingthe sector Ministerial Policy Statements, the Committee adopted the following methodolory

4.1 Interactions with stakeholders

a) Held meetings with the following; i) The Ministers of Health and Public Service iif Offrcials from the self accounting entities listed below; 1) Vote 014 Ministry of Health 2) Vote 114 Uganda Cancer Institute 3) Vote 115 Uganda Heart Institute 4) Vote 116 National Medical Stores 5) Vote 134 Health Service Commission 6) Vote 151Uganda Blood Transfusion Services 7) Vote 161 Mulago National Referral Hospital 8) Vote 162 Butabika National Referral Hospital 9) Vote 304 Uganda Virus Research Institute P 10) Votes 163 - L76 for 14 Regional Referral Hospitals in Arua, Fort Portal, Gulu, Hoima, Jinja, Kabale, Masaka, Mbale, Soroti, Lita, Mbarara, Mubende, Moroto & Naguru. t 11) Vote 501-850 Local Governments - Primary Health care ffi ( tiilThe Civil Society Budget Advocacy Group (CSBAG)

3 (, @,t*"* n b) Met and interacted with the Shadow Minister for Health, Hon Ochen Julius, Kapelebyong County, (Indepf representing the Leader of Opposition (LOP)

4.2 Litetature Revlew

The Committee reviewed the following documents: 1) The Policy Statement and budget estimates for the health sector 2Or8l t9; 2l The Alternative Policy Statement from the Shadow Minister of Health; 3) The Auditor General's report on the accounts of the Agencies in the health sector; 4) Previous sector Parliamentar5r recommendations on the Ministerial Policy Statements and budget framework papers. 5) The National Development Plan (NDP) II

5.O SECTOR PERFORMANCE DURTNG FV 2Ol7lL8

The Committee noted that; o The Ministry of Health is a government body set up with the mandate of stewardship and leadership of the health sector. The Ministry of Health is responsible for policy review and development, supervision of health sector activities, formulation and dialogue with health development partners, strategic planning, setting standards and quality assurance, resource mobilization, advising other Ministries, departments and agencies on health-related matters, and ensuring quality, health equity, and fairness in contribution towards the cost of health care. o In pursuit of the health system objectives, the Government of Uganda v through the Ministry of Health ensures mechanisms that offer equity for all citizens in accessing health services for life threatening health problems, ,{ particularly to avert pregnancy and birth-related mortality and childhood killer diseases, strengthen the capacity of health facilities to improve service provision, build and expand the national health infrastructure through a L 4 Qq-.r.-.-..-.r.lrr''.-Lg-

\ medium term health facility development plan, as well as establishing an appropriate and efficiently functioning referral system.

5.1 CROSS CUTTING ISSUF,S

S.1.1 Compllance of the Ministerial Policy Statement to National Development Plan (NDP II)

The overall purpose of compliance to NDP II is to institutionalize alignment of the annual budgets to the national planning frameworks. To the contrary, the Committee observed that; . The Compliance Certificate produced by National Planning Authority (NpA) in line with Section 13(6) and 13(7) the Public Finance and Accountability Act 2015, reveals that the health Sector's Annual budget compliance level for FY 2ol7ll8 remained static at 51.7o/o almost similar to the level of 51% recorded for FY 2016lL7 out of the expected

LOOo/o. . Several aspects that are critical to the attainment of the NDP II targets still need greater attention. The stagnation is attributed to the low budget absorption by majority of the heatth sector institutions especially under Projects.

sector MDAs have a It was noted that, 21 out of the 24 (87 .5o/o) of the health approved strategic plans. Those without strategic plans include: Mulago National referral hospital, Fort Portal RRH and Kabale RRH. Lack of an approved strategic plan renders planning allocation of resources to NDP health sector strategic interventions hence negatively affecting attainment of key set targets ffi $&

5 q I t- \ Observation

The Committee observed that; o Health sector financing and performance are hinged on the strategic directives set out in the Health Sector Development Plan (HSDP) 2015l16 - 2OL9 l20. o FY 2ol8l19 marks the midterm period for the HSDP which is a critical point of reflection o It takes cognizarrce of the fact that FY 2ol8l19 will be the second lastyear of the NDP IL

Recommendation

The Commlttee recommends tho;t; a) The sector's strateglc obJecttues for FY2O78/19 should place emphasls on dlsease preaentlon measures at household qnd communltg leuel, recr1tltment and tralnlng of crltlcql health staff, reductlon ln congestlon ln heo,lth facllltles, and lmgtrouefitertt ln doctnr-patlent ratlo, qmang others. b) Goaernmcnt should prtortttze the delaged lmplementatlon of proJects under the sector, delaged operatlonallzatlon of natlonal health lnsurance, and attractlon of senlor qnd consultant leuel posltlons ln aanlous faclltttes ccross the country

5,L.2 Compliance of the Minlsterial Policy Statement to Gender and Equity W-

Section 13(15)(9) of the PFMA, 2015 provides that the Minister of Finance Planning and Economic Development shall, in consultation with the Equal Opportunities Commission issue a certificate of compliance to gender and equit5r, specifying measures taken to eq opportunities

L

6 a Y $ \iiY for women, men, persons with disabilities and other marginalized groups.

Obsenration

The Committee noted that;

O The Minister of Finance Planning and Economic Development simply issued a generalized Certificate for all MDAs instead of a separate Certilicate for each Policy Statement as required by Law. Consequently, it was difficult for the Committee to ascertain the basis upon which the Certificate was isstled in respect to the Health Sector. The Certificate did not provide details as to which specific measr-rres the MDAs have taken to equalize opportunities for Men, Women, Persons with disabilities and other marginalized groups for FY 2017 -t8.

Some entities like; Masaka Regional Referral Hospital and Uganda Cancer Institute (UCI) in the Health sector did not meet the required standards for attainment of Certificate of Gender and Equity Compliance as required by law.

o There is apparent lack of capacity in the MDAs to ensure compliance to gender and equity issues Recommendatlon ry The Mtntstry of Health together wtth the Equal Opportunltles Commlsslon should mdke dellberate eJforts to enhance the

7 ffi u capacltg of the sector agencles to lmproae on the sector posltlon regardlng gender and equltg compllattce,

6.0 SECTOR BUDGET PERFORMANCE

The table below shows the Health Sector Half Year Budget Performance FY 2Ot7 lt8

1: Health Sector H Year FY 2017/ 18 o/o % o/o Absorptio o Category Approved Released Spent Share Released n Wase 400.86 204.55 ]87.L24 21.3o/o 5l.Oo/o 9l.sVo Non-wage 408.43 294.7t 272.60-1 21.7o/o 72.2o/o 92.5o/o Dom Dev't to2.t4 77.24 44.1511 5.4Yo 75.60/o 57.2o/o External Dev't 9t2.66 264.39 38.11I1 48.6%0 29.Oo/o 14.4o/o Arrears 28.06 28.7 L 26.37I/l l.5o/o lO2.3o/o 91.9o/o AiA 26.82 8.73 7.3811 l.4Vo 32.5o/o 84.6%;0 Total 1,978.95 878.32 575.rcI/ too.oozo 46.7o/o 65.5o/o o/w GoU 966.30 613.93 s37.63I1 sr.4o/o 63.5% 87.6Vo o/w External 9L2.66 264.39 38.11I1 48.6% 29.O% L4.4o/o Source: Ministry of Finance, Planning Economic Development, Yea r Bu d g et Pe rformo nce

The Committee noted that;

a The overall Health sector budget approved for FY 2Ol7 118, amounted to ucx 1,878.96bn. Out of this ucx 400.86bn was wage, UGX 408.43bn was non-wage, UGX lO2.l4bn was Government of Uganda development, UGX 912.66bn was external financing, UGX 28.06bn was arrears and UGX 26.82bn was for appropriation in Aid (AiA). By the end of December 2017, the overall sector budget release amounted to UGX 878.32bn (46.7%). This performance is attributed to the lower than expected release performance under the external development budget category and AiA

a External financing amounted to UGX 264.39bn (29o/o) while AiA collections amounted to UGX 8.73bn (32.5o/ol.

v a Out of the total released budget, UGX 575.73bn was actually spent (65.5%) leaving a total of UGX 302.59bn of the released budget unspent.

The table provides a summary of unspent Balances by Progralnme

Table 2: Programmes with unspent Balances (UGX, Vote Programme Amount Share Ministry of Ol4 Health 04 Clinical and Public Health 5.26 l.2o/o ffid &otherSupplies 2L4.39 49.3o/o ffinine&Sup. Services 4.28 l.Oo/o Na 161 Mulaso 54 Services 12.29 2.8o/o 116 NMS 59 Pharmaceu & M Su S 9.2 2.lYo 122 KCCA OZ Community Health Management 6.1 1 l.4o/o 115 Heart Institute Heart 4.t2 O.9o/o re Hos 167 Jinia Hospital 56 Services 3.O7 o.7% 174 UCI 7 Cancer S 2.72 O.60/o 1 Healthcare 173.10 39.8o/o o w (Wage) t47.53 34.Oo/o o w Con t t9.96 4.60/o Total 434.54 100.o% Source: Ministry of Finance, Planning ond Economic Development, Holf Year Budget Performonce

The Committee was informed that the poor budget release absorption is attributed to; o Delayed execution of projects, for instance external financing actual expenditure outturn amounted to UGX 38.11bn out of the released UGX 264.39 representing a performance of 14.4o/o.

a Inability of Government to provide counterpart funding for such projects contribute to low absorption and delayed absorption as donors usually require Government to meet its obligations before their funding is committed in any contract.

o The prolonged procurement processes coupled with multiple administrative reviews because of different interested stakeholders.

9 Qqt''-vr9

(. Obsenzation

The Committee observed that the Low budget compliance levels are mainly as a result of; o The low budgetary absorption for the development category at 14.4o/o for the donor category is attributed to delays in release of counterpart funding by Government. o Development projects funded through loans or donations subjected to both PPDA as well as funders' conditionality. Meeting the funders' conditionality usually takes time and lots of negotiations resulting into low absorption of the budget.

Recommendatlon The Commlttee recommends tlut; c The Mtntstry of Health should consult the Mlntstry of Flnance, Plonnlng qnd Economlc Deuelopment to explore uqgs of proutdtng counter7oart funding in 4 mo;nner that does not affect proJect lmplementqtlon. o In oleut o! the PPDA requlrements, the Mtntstry of Heolth should alutolgs be proacttae bg pldnnlng aheqd to oddress the prolonged procurement process.

7.O HEALTH SECTOR BUDGET OUTLOOK FOR FY 2018/ 19 Table 3: Ouerall Etudget Allocation $- Table 3: Health Sector Outlook G billions Cateeorv 20t7 I t8 20t8lL9 Chanses o/o chanses 7o share Waee 385.20 57+.27 189.08 49.1o/o 25.2vo Non-wage 401.33 454.95 53.62 L3.4o/o 19.9o/o Rccurrcnt 786.s3 1.029.23 242.70 3o.9"/o 45.1o/o Domestic 101.07 t70.42 69.35 68.6Yo 7.5o/o External 908.66 1.026.86 118.20 13.Oo/o 45.Oo/o Devclopmont 1.OO9.73 1,197.24 187.55 18.60/o 52.5o/" Arrears 28.05 4.t9 -23.855 -85.Lo/o O.2o/o Appropriation in Aid (AiA) 27.53 51.37 23.83 86.6Yo 2.3o/o Total 1,851.83 2,242.06 430.23 23.2o/o 100.o% Source: MFPED, Annual Efudget Estimates FY 2018/ 19 Y 10 q The Committee observed that

The overall budget for the health Sector for FY 2OL8l19 is projected to amount to UGX 2,282.O6bn compared to UGX 1,851.83bn approved for FY

2Ol7 118 representing an increase of UGX 43O.23bn (23.2o/ol. Out of this UGX 1,O29.23bn (45.1%) is recurrent (wage & Non-wage), UGX 1,197.28bn (52.5%) is for development, UGX 51.37bn (2.3o/ol, appropriation in Aid (AiA) while UGX 4.19bn is for arrears (O.2o/ol.

a The increment in the overall sector allocation is attributed to the projected growth in all budget categories other than arrears which will register a reduction of UGX 23.855bn.

o The wage bill is projected to grow by UGX 189.08bn from UGX 385.2bn approved in FY 2Ol7l18 to UGX 574.27bn in FY 2ol8l19 while non-wage will grow by UGX 53.62bn.

o Domestic and external development budget categories are projected to grow by UGX 69.35bn and UGX 118.2bn respectively.

7.1 Vote Specific Budgetary Nlocation

Table 4: Health Allocation Vote Vote 2OLTlLa 2OtAlL9 Changes o/o Change 7o Shate 014 I\Iinistry of Health 969.05 1,050.49 8L.44 8A0% 46.03% 114 Uganda Cancer Institute 52.25 93.O7 40.82 78.L2% 4.O8% 115 Uganda Heart Institute 18.1 19.57 L.47 8,L20/o o,960/o 42.O2 16.28% L3.Llo/o T 116 National Medical Stores 258.O7 300.09 134 Health Service Commission 5.42 5.2 -o.22 -4.060/o O.23o/o 151 UBTS 9.72 20.18 10.46 LA7.6toA 0.88% 161 Mulago Hospital Complex 75.47 94.55 19.08 25.28o/o 4.L4Yo 162 Butabika Hospital t2.76 t4.75 1.99 \5.600/o O.650/o 163 Arua Referral Hospital 6.68 9.49 2-81 42.O7o/o O.42o/o 164 Fort Portal Referral Hospital 7.28 9.83 2.55 35.03% O.43Vo 165 Gulu Referral Hospital 6.97 9.25 2.28 32.7Lo/o O.4lo/o 166 Hoima Referral Hospital 7.i9 9.24 2.05 28.5t% O.4$o/o 3.28 s9.tlVo O.52o/o L 167 Jinja Referral Hospital 8.61 11.89 r\

77

c. f. 168 Kabale Referral Hospital 6.49 8.1 1.61 24.8L% 0.35% 169 Masaka Referral Hospital 6.83 8.87 2.O4 29.87o/o O.39o/" 170 Mbale Referral Hospital to.77 t3.42 2.65 24.670/o O.59o/" 171 Soroti Referral Hospital 5.9 8.16 2.26 38.31olo O.36Yo 172 Lira Referral Hospital 6.52 8.86 2.34 35.89o/o O.39Vo 173 Mbarara Referral Hospital 8.O2 10.65 2.63 32,79% O.47o/o 174 Mubende Referral Hospital 5.64 7.92 2.28 40.430/o 0.35% 175 Moroto Referral Hospital 6 6.8 0.80 13.33% o.300/o 176 Naguru Referral Hospital 6.703 8.66 1.96 29.2Oo1o 0.38% 304 WRI 1.864 7.377 5.51 295.760/o o.e2% 50 1-850 Local Governments 343.23 545.64 202^41 58.97o/o 23.97% Total 1,851.83 2,282.06 430.23 23.23o/o 100.00% Source: Health Ministerial Policg Statement FY 2018/ 19

Table 4 shows the breakdown of the health sector budget by vote. The Ministry of health headquarters is earmarked to receive the highest budgetary share of 46%o followed by Local Government transfers at 23.9o/o and NMS at 13.2o/o. The highest increment will be registered under Votes 501 - 850 LG amounting to UGX 2o2.41bn, followed by Vote 014 Ministry of Health UGX 81.44bn, NMS UGX 42.O2bn, Uganda Cancer Institute UGX 4O.82bn, Mulago national referral hospital UGX 19.08bn and UBTS UGX 10.46bn.

8.O GENERAL OBSERVATIONS AND RECOMMENDATIONS

8.1 VOTE O14: MINISTRY OF'HEALTH 8.1.1 Over Dependence on External Financing +r The Committee observed that; o Overall, external financing of the health sector budget for FY 2OL8l19 will account for 45o/o while GoU share is projected at 55%. It should be noted that 73.2o/o of the external financing is earmarked for HIV, TB and Malaria which would otherwise be a priority for GoU financing. This over- dependence exposes lives of Ugandan to high health risk in the event that donors withdrew@ry their support. a Whereas a number of donor-financed projects require counter-part funding to the tune of UGX 64bn only UGX 26bn has been earmarked in FY 2OlSl19. This financing gap will result into delayed disbursements of donor funds leading to delays in project implementation and budget absorption challenges similar to what is being experienced in FY 2ol7ll8 and previously.

Recommendation The Commlttee re-iterates its previous recommendation that; a) Government must gradually increase lts budgetary allocation towards the Health Sector as a means of mitigatlng potential risk of donor dependency otherwise Parllament shouldntt approve the Health sector budget where the share of GoU development financing in the total sector budget is not growing.

b) Government should renew its commitment towards counter-part funding to match donor llnancing requirements as a means of mitigating budgetary absorptlon challenges currently faced by the sector as well as the potentlal burden of penalties, litigations and their likely consequences.

a.L.z Budgetary Allocation for Interns-doctors and Senlor House Oflicers The committee noted that; o The intern-doctors and senior house off,rcers play a key role in the delivery of health care across the country. o The wage bill for the health sector has increased by UGX 189.08bn majorly on account of enhanced salaries for health workers across the board. The committee commends government for this positive development. o No provision has been made to address the issue of Intern-doctors and Senior House Officers' allowances, contrary to tJle promise by

L M 13 r- )K C tr Government to the effect that the Intern-doctors'and senior house officers' allowances would be considered in the budget for FY 2018/ 19.

a Whereas the Ministry of Health had committed to finalize the policies on Intern-doctors and 'senior House Officers' by the end of June in 2017, this has not yet been achieved.

a There is lack of clarity on which of the three of ministries; Health, Public Service and Education and Sports is responsible for the appointment of Intern-doctors.

Recommendation The Committee recommends that;

af Government should double the payment to intern-doctors and Senior House Officers at the rate of UGX 1'88O,OOO and UGX 2,OOOTOOO/= respectlvely beginning FY z0tgll.g to avoid re-occurrence of the industrial action and the attendant effect on health senrice delivery. (The Total allocation for intern doctors ts UGX L9,21=6n while the allocation for the Senior House Officers is UGX S.albnl

b) In addition, the committee re-iterates its earlier recommendatlon that the Minlster for Health should finalTze the policies on management of both Intern-doctors and Senlor House Officers within two (2) months after adoption of this report.

8.1.3 Human Resource for Health

The Committee noted that;

The sector continues to suffer from inadequacy of health personnel at various levels of health service delivery with the national average at 73o/o by the end of June 2017. The probiem is most ath centre two v L4 (2) level with a staffing level of 53% and at general hospital level with an average of 680/o.

Similarly, Uganda Cancer and Heart Institutes are faced with related challenges at 54oh and 620/o respectively. The Committee notes that whereas the current staffing norms require a total of 392 personnel (senior consults and Senior Medical Officers Special Grade); only abott 23o/o are currently recruited.

a Analysis of the recruitment plans for FY 2}l8l19 revealed that most of the positions aligned for filling relate to non-medical cadres and lower level cadres yet there is a huge staffing gap at medical specialists and consultant levels especially in Regional referral hospitals across the countr5r. In addition, it was noted that the budgetary provisions for the planned recruitments do not take into account the enhancements made in salaries of health workers w.e.f from next FY 2ol8l19.

Recommendations

The Committee re-iterates its earller recommendatlons that; a| Government should prioritize recruitment of crltical staff as a means of improving health senzice delivery across all health levels of heath senrice delivery to facilitate attainment of the health sector planned outcome targets. bf Government should address atl challenges related to motivation of health personnel in a comprehensive manner including provision of decent accommodation and medical supplies $-

@ 15 e.

f 8.1.4 Operatlonalization of the Natlonal Health Insurance Scheme

The Committee; o Expressed concern over the delay in actualizing tJ:e implementation of the Public Health Insurance Scheme (NHIS) which was conceived in 2012 (about five years ago). o Observed that whereas NHIS has the potential to improve health service delivery in the country Government has not taken more concerted efforts to OperationaJize the National Health Insurance Scheme o Adoption and implementation of the MflS would gradually lead to improvement in Result Based Financing and thus address issues of quality and efficiency. Recommendation

The Commlttee recommends that @vernment fast-tracks the NHIS blll so thqt lmplementatlon star-ts FY 2O79/2O.

8.1.5 Preventive Health Care The Committee was informed that; o Seventy Five percent (75o/ol of the disease burden in Uganda is preventable and if Uganda is to achieve her target of Universal Health Coverage by 2O2O, there is need to address public health focusing on prevention, health education and promotion. o To avert the above situation the Ministry of Health is planning introduce Community Health Extension Workers (CHEWS) which requires Shs UGX 3bn. s*

ffi 0" L6 S-t- Recommendation

The Commlttee recommends tholt @aerttment should; a) Increase fundtng to Preaentlue heqlth cqre. b) Work out q poltcg on the lmplementqtlon of the Communttg Health Extenslon Workers (CHEWS) strategg

8.1.6 Uniforms for Health Personnel The Committee noted that; o Whereas Parliament had recommended for an additional UGX 6bn in FY 2OlT118 to facilitate procurement of Uniforms for health workers to ease identification and protection of health workers, the problem still persists. o Consequently, there has been growing cases of individuals masquerading as health practitioners with health facilities extorting money from Patients with promises of treatment. o The item for Health worker's uniforms require UGX 10 billion in FY 2OLS119, however, only Shs. 3bn has been provided for this expenditure o The beneficiaries were not satisfied with the quality and standard of the uniforms procured.

The Commlttee recommends that a) An qddltlonal Shs. 7/=bn should be proulded to facllttate the procurement of unlfortns for heo,lth utorkers to edsre ldenttflcq.tlon qnd protectlon of heo;lth uorkers and for the beneflt of pattents. b) The comm1ttee recommend.s that the qualttg and standard.s of unlfonns should be obsented. (e.g Small, Medlum, Large and ertra- large)

t7 W W \- 8.1.7 Sewage Management at Kiruddu and Kawempe Hospitals

The Committee expressed concerns for the delayed construction of waste management facilities (lagoons) and the resultant mosquitoes which are becoming public nuisances to the patients and the neighborhoods in Kiruddu and Kawempe Hospitals respectively.

The Committee was informed that; o The Ministry of Health, in consultation with National Water and Sewerage Corporation has extensively discussed the issue of waste management for Kawempe and Kiruddu Hospitals. o NWSC has advised that Kawempe will be connected to the main sewer line in the next Financial Year. o Whereas the plan for Kiruddu Hospital in the original design had a provision for a sewer line, this was not provided for, creating a need to construct a lagoon for the hospital. o The cost for the above interventions is Shs. 3 billion while the cost for connecting Kawempe hospital to the main sewer line will be determined by NWSC.

Recommendation The Commlttee recomfltends that Shs. 9bn be avalled bg @aernment to address the qhoae challenges

8.1.8 The alleged fake Drugs on the Market W The Committee observed that; o The prevailing presence of fake drugs on the market is a serious public health issue in the country. The rising and emergence of fake drugs on the market including the cancer drugs and the recent of fake

1B

L n Hepatitis B vaccines is attributed to the numerous unlicensed suppliers that are allowed to operate in the countr5r. Recommendation

The Committee recommeads that; a) The NDA Act should be amended to proulde for seaere punlshment for the culprlts. b) NDA and Uganda Natlonal Bureau of Standards (UNBS) are urged to be more utgllant ln thelr monltorlng role. c) Mtntstry of Heqlth should deuelop a pollcg for tnccines and dtttgs that are not ltsted on the Nqtlonal Immunlzqtlon Schedule e,g Hepatltls B, d) Massttrc publtc sensltlza;tlon campalgns sltould be conducted bg NDA on hout to spot fake dntgs partlcularlg those thqt mag be easllg dupllcated.

8.1.9 Reproductive maternal and child Health senrice

The Committee noted that; o Reproductive health encompasses a range of services including family planning, the prevention and treatment of HIV and IDS, the diagnosis of sexually transmitted diseases/infections, use of contraceptives, unmet needs for family planning and post-abortion care among others. o Some achievements have been made in the following; ffi,W,LW, (a) Maternal Mortality Ratio (MMRI: The MMR has reduced to 326 per 100,000 live births (UDHS 2016l from 438 per 100,000 (UDHS 2O11). The reduction is attributed to Governments efforts in recruiting critical skilled staff especially Medical Officers and midwives to functionalize HC IVs and IIIs, renovation and equipping of hospitals and HC IVs improvements

79

<_ in the roads network, all which have improved access to maternal health services. (bl Neonatal Mortality Rate (NMRI: The NMR has reduced from 27 per 1000 live births(UDHS 2011) to 22 per 1000 live births (WHS 2015). The reduction is attributed to training skilled birth attendants and health workers and availability of life saving commodities.

(cl Total fertility rate (TF'R|: The TFR for Uganda stands at 5.8 (NPHC, 2Ol4), which is a decline from 6.2 (NPHC 2000). The general declining trend in TFR is associated with more understanding of the concept of family planning as having families that we are able to take good care of. This is due to underlying socio-economic determinants like improved education for women, improved economic status combined with improved child survival among other factors.

(d) Infant Mortallty Rate (IMR): Has improved from 54 per 1000 live births (UDHS, 2011) to 44 per 100O live births (WHS, 2015). This is due to the high impact child survival interventions.

(el Under Five Mortality Rate: The UFMR has improved from 90 per 10OO live births (UDHS, 2OIl) to 66 per 1000 live birth (HS,2015) This is due to the high impact child sunrival interventions. (0 HfV+ pregnant wotnen not on HAART receiving ARVs for eMTCT during h pregnancy, labour, delivery and postpartum was 907o (38,243142,4671 in 2016117 which was above the 68.30/o (34,357/50,323) in 2OLSll6 and above the HSDP target of 87%o. w (gf Adolescence: The term "adolescent" refers to people aged between 10 - 15 years, and "Youth'to those aged between 15 - 24years."Young people" is a Jerm that covers both age groups i.e. those aged between 10 years. 20 Adolescence is defined as a period of physical, psychological and social transition from childhood to adulthood and may fall within either age group. Uganda has a predominately young population with 47.3o/o being under 15 years. One in every four Ugandans (23.3o/ol is an adolescent; and one in every three (33.5%) is a young person.

Obsenration

Whereas it is the policy of the Government of Uganda to enhance the reproductive health status of all Ugandans by increasing equitable access to reproductive health services and by improving the quality, efficiency and effectiveness of the services at all levels, there are still some challenges that must be addressed.

Recommendation The Commlttee theretore recommends that, goverflment should; l) tlrgentlg come utlth a pollcg and guldellnes on qdolescent and sexual reproductlae heo,lth 2) Ensure unlaersq.l free crccess to comtrtrehenslae emergencg obstetrlc q.nd neonatal colre serolces from 43o/o to 90% through ensurlng that a"ll HC4s offer comprehenslve obstetrlc care 3) Goaernntent should fia,lflll lts commltment of USD 5 hI eaery Jlndnclo,l gear for reproducthrc heo,lth cqre. 4) Deoetop neut pollctes and lnnoaatlue partnershtps to foctts on adolescentv heo,lth and tmplement neut leglslqtlon on gender equalltg.

2t 'r ,)Q,ffi 8.1.10 Inadequate allocation to Health Promotion, Communication and Environment Health The Committee noted that; . Despite the fact that components such as sanitation under the health sector need a lot of health education, local governments have not prioritised Health Promotion, Communication and Environment Health. o The Community Health Worker Extension Strategr is currently an unfunded priority. This stratery is a critical avenue in enabling effective health education, as well as promoting community rehabilitation services.

Recommendation

The Commlttee recomfitends that; a) @aernment should conslder allocatlng more resources to the dlstrlct^s heo,lth departments and, health sub-dlstrtcts spectfl,callg for heo,lth educqtlon qnd reproducttae heqlth. b) Gotwnment should conslder enactlng q poltcg to gutde the lmplementqtlon of the cHDws progrdm before allocatlng funds for thls actluttg.

8.1.11 Coustructlon and Upgrading of Health Centers

The Committee was informed that; o Following t]le Presidential directive that arising out of the disparities in geographical distribution and accessibility health facilities, each district should have a general hospital. o Coupled with the fact that, out of the 59 Districts that do not have General Hospitals only 18 of them have NGO Hospitals which receive government PHC non-wage grants while 41 districts do not have any public or private hospital. @ 22

\$' The Ministry is planning to revamp all HCIVs in the country to make them fully functional and upgrade HCIII in 29 cou.nties without HCIVS.

o The estimated cost per hospital for construction, human resources, Medicines and Medical Equipment is estimated at a startup average UGX 31.3/= billion. o In addition to the above the Committee noted that; a) Twenty nine (29) counties do not have HC IVs while the existing HC IIIs in these counties need to be upgraded. The total cost for this upgrade is Ushs 164.6 billion. b) Priority will be given to the 132 sub counties without any government health facility c) Two Hundred Twenty Five (225) Sub Counties that have HCIIs will be upgraded to HC IIIs in a phased manner.

Recommendation

The Commlttee recommends tho:t; o Government should find tlstts 764.6 blllton to upgrade the exlstlng HC IIIs to HCWs o Goaernment should Jlnd Stus 26O/=bn to ensure eaery sub-countg has a functlonql HC III

8.1.12 Coordination between Ministry of Health and Local Governments ffi The Committee observed that, while local governments are the biggest implementer of most the health sector programs and projects there is no clear Iinkage between the ministry and the local governments t5qus!- 23 ) Anr- rE Recommendatlon

The Commlttee recommends that, @rwnment should put ln place a poltcg to strengthen the monltorlng qnd eoaluatlon unlt. For examptle, an lnter-mlntsterlal commlttee to cluster the lnter-llnkages betuteen the Central @uentment qnd Local @aernments

8.1.13 Hiring of Forelgn Health Workers The Committee expressed resenration on the plan by the Government to hire Cuban doctors to be posted at Regional Referral Hospitals; a move that may attract more expenditure in the general facilitation and remunerations.

Observation

The Committee observed that this was an unfavorable and de-motivating policy direction that should be dropped in favor of Ugandan trained doctors.

Recommendation

The Commlttee recomfitends that; o Instead ol htrlng &tbqn doctors, Gorrcrrtment should use that maneg to enlrance the wages of Health uorkers

8.1.14 Medical supplies: Lack of clinical and diagnostic lmaging equipments

In addition to the above, the Committee noted that; W a Butabika Referral Hospital and other Regional Referral Hospitals (RRH) plus District Referral Hospitals do not have diagnostic ts.

24 o Clinical imaging is an essential component of health care which supports and improves the effectiveness of clinical decision-making. o The diagnostic imaging equipment recommended by MOH for regional level hospitals in uganda includes; x-ray generating apparatus; duo-diagnostic; fluoroscopy; three-phase radiography system; mobile / portable x-ray, ultrasound machines, CT Scan machines and MRI machines among others

Observation

The Committee observed that, non-use of or poor imaging services lead to wrong diagnosis and treatment, unnecessary health expenditures, and poor health outcomes. Regional Referral Hospitals should have good diagnostic imaging services to provide expert care and bridge the continuum of care by stemming the flow of uncomplicated cases from general hospitals to National Referral Hospitals.

The Commlttee therefore recommends that; q) A sum of UGX Tobn for the purcha,se of cr sccrn mqchlnes dnd uGx 7OO/=6n for the MRI machlnes should be provlded, for thts expendlture

8.1.15 Key Programmes/Projects under the Health Sector

The Committee was informed that Donors provid.e development assistance to the Ministry for programmes like immunization, HIV/AIDS, Malaria, and TB. These include constrtrction of centralized Vaccine stores and district vaccine stores just like the support being given to other developing countries. Observation ffi The Committee observed that whereas availability of external financing offers fiscal space to government to allocate its meager resources to other equally competitive priorities, it is rislry and unsustainable

{:- 25 1\ <_- t^ Recommendation

The Commlttee recommends for the operatlonallzatlon of the folloulng .funds uthlch utere approued bg parllament c{r q. utag of reduclng dependencg. Theg lnclude; 7) The Immunlzatlon Tntst trt.tnd, 2) Prouldlng 7o/=bn to operatlonallze the ArDS Tvttst Fttnd.

9.O VOTE SPECIFIC OBSERVATIONS AND RECOMMENDATIONS

9.1 VOTE114: UGANDA CANCER INSTTTUTE (UCII The Committee observed that the visibility of the Uganda Cancer Institute beyond Kampala is lacking and the levels of awareness of the services offered by the Institute are very low amongst the population

Recommendations

The Commlttee recomfitends that; o @aerttment should proulde for Shs. 778/m for cancer out-reach program.s llke Cancer autareness, heo,lth and educatlon rlsk reducaon o haerttmcnt should provlde Shs 144/=bn for the establlshment and operatlonq.llsqtlon of reglonal co;ncer centers, namelg; Mbarara, IWbale, Gulu and Antq.

9.2 VOTE115: UGANDA HEART INSTITUTE ( The committee was concerned over; w The increasing prevalence of heart conditions in the country with l:4 experiencing cardiac related SSCS

1N- F,[ o The persistent lack of space leading to heart surgeries to be carried out only twice a week . in-spite of the land mark surgeries such as coronary by-pass. o The inadequate space where the institute has only 20 beds out of 36, prior to modification and no space for Out Patients despite the refurbishment and expansion of Mulago Hospital Complex to a new Super Specialized facility which hosts the Uganda Heart Institute (UHI). o The limited space in the intensive care unit o Delayed approval to secu.re a loan to fund the construction of a home for UHI.

Recommendations The Commlttee recomntends that; o Ugq.nda Heqrt Instlfifie moves to estqbltsh Reglonal Referrq.ls Hospltals to counter the rlslng cardlo;c related slcknesses whose preaalence ls put at q. rqtlo of 7 out of eaery 4 P:fl tlgandans haalng heart relqted lssues. o Goaernment should proulde more funds for the expanslon of IIHI o (IHI should focus should focus on progrqmmes of care and preaentlon o Gouerrtment should secure 234/-bn to estq.bllsh a home for LIHI.

W

r{v +trrl-'.!

27 $e, k 9.3 VOTE 116: NATIONAL MEDICAL STORES Table 5; /VMS Medicines and Medicat Supplies (UGX, billions) Faclllty Level 2Ot7lL8 20r8lL9 Changes o/o Change Supply of EMHS to HCII (Basic Kit) 1 1.163 21.O76 9.91 88.8% Supply of EMHS to HCIII (Basic Kit) 18.360 20.360 2.OO 70.9% Supply of EMHS to HC IV 7.992 12.782 4.79 59.9% of EMHS to General L4.456 79.457 5.00 34.60/o Supply of EMHS to Regional Referral Hospitals 13.o24 18.233 5.21 40.o% of TB medicines to accredited facilities Su of EMHS to National Referral 12.366 16.366 4.00 32.3o/" Su of EMHS to Units 18.104 77.704 (1.00) -5.5% Su of and Donated Medicines 2.500 25.630 23.73 925.2% Supply of Reproductive Health Items 8.000 16.000 8.00 ro0.o% Immunisation Supplies r7.000 19.000 2.OO ll.$Yo Supply of Lab commodities to accredited facilities 5.000 1o.296 5.30 tos.9% of ARVs to accredited facilities 94.891 86.931 ff.961 -8.40/o Supply of Anti-malarial Medicines to accredited 8.109 to.220 2.tt 26.Oo/o facilities 7.000 6.640 (0.36) -5.r% Total 237.964 *300.094 62.13 26.Lo/o Source: MFPED, Annual Budget Estimates FY 2018/ 19 * NB: This includes AiA amounting to UGX 2g.l2gzbn and wage (EMHS to HC II) of UGx 9.9131bn.

Budgetary Allocation for Mediclnes

The Committee noted that; ' The budget for medicines and medical supplies under NMS is projected to increase by ucx 62.13bn from ucx 2sr.g64bn approved in Fy 2ol7 /18 to ucx 300.094bn (incl. AiA and wage component of ucx 9.913bn) representing an increase of 26.10/o. m , . Despite the above increase, the allocation to supply of affiI to accredited facilities, Supply of TB medicines to accredited facilities and supply of EMHS to specialized units is projected to reduce by UGX 7.96bn, UGX O.36bn and UGX 1bn respectively fi** ,) 28 a The highest increment is projected under the Supply of Emergency and Donated Medicines category whose allocation is earmarked to grow by UGX 23.13bn from UGX 2.5bn in FY 2Ol7l18 to UGX 25.63bn in FY 2er8lte.

Recommeudation The Commlttee recommends tlut; a) Goaernment prouldes qn addltlonal 6Oblllton to cater for the expected lncreqse ln number of neut patlents on ART under the neut Test qnd Treqt Poltcg for HIV tnfected people b) fuaernment prouldes 35 blllton for the ACTs qnd c) fi\trther tho;t tuuetttment prouldes 5 blllton for Mamq Klts d) @uernment should proalde 44 blllton for procttrlng La,boratory commodltles e) NMS should contlnue operatlng q.s a publtc entetprlse c{r Parllamr,nt eaaluqtes the effect on sewlce deliaery lf lt operates cs an MDA,

9.4 Vote: 151 UGANDA BLOOD TRANSFUSION SERVICES (UBTSI The Committee noted that o The Uganda Blood Transfusion Service (UBTS) is a semi-autonomous, centrally coordinated organization in the Ministry of Health sufficiently decentralized to render services to all regions of the country. o The Nakasero Blood bank acts as a reference centre for the Regional Blood Banks and other public and private hospitals o The budget for UBTS for FY 2OLB|19, had been increased by 10.46 bn i.e from 9.72bn to 2O.18bn, representing 1O7.6%o increase. o In line with the strategic objectives of the Sector Development PIan UBTS achieved the following among others; providing timely acc€ss to safe blood and blood products for the t of; children with severe due

<_

29 .r->:, q. \.t\ to malaria; women with complications due to pregnancies; child birth; road traffic accident victims; cancer; AIDS/HIV; and Heart surgery among others. o The Committee was informed that; UBTS is planning to do the following, among others, in FY 2OlB/Lg a) Expanding the blood Transfusion infrastructure to operate adequately within a decentralized health care delivery system b) Continuing to transform blood collection centers into blood distribution centers to bring services nearer to the health care facilities. c) Increasing Ernnual blood collection necessary to meet the transfusion needs for all patients in the country by putting in place additional blood collection teams. Obsenration The Committee observed whereas UBTS indicated its intentions to increase annual blood collection in the country, by putting in place additional blood collection teams, it fell short of indicating mechanisms for collaborating with Uganda Red Cross Society and other stakeholders like; Schools, Churches, Mosques, etc as well as building its own capacity in terms of personnel and equipment to collect and store blood.

Recommendation

The Commlttee recommends; c/ Shs. 7/=bn should be proulded, to cater for estobushtng forma.l mechanlsms to enable t BTS to collq.borqte wtth tlganda Red Cross socletg and other stq,keholders llke; schoots, churches, Mosques, etc to promote lncreased cccess to sqfe blood and, blood. products for emergeflcg transfus{on ln tlganda. b) Accordtnglu, the commrttee recommend,s that the stm of shs. 2001=6 for professlonat fees be reallocqted, to thts lnltlatlae as start-up fund

30 Nr 9.5 Vote 134: HEALTH SERVICE COMMISSION (HSCI

The Committee was informed that; o The Health Service Commission (HSC) derives its mandate and functions from Articles 169 and 170 of the 1995 Constitution of the Republic of Uganda; section 56(3) of the Local Government Act, CAp 24g and, the HSC Act, 2OO1 section 25(2ll.

o The Committee was further informed that following the approval of new staffing structures for Ministry of Health, Mulago National Referral Hospital, Uganda Cancer Institute, the Commission has to carry out staff validation and consequently recruit for the vacant positions.

a Entebbe grade B, Kawempe, and Kiruddu Hospitals have been upgraded into Regional Referral Hospitals thus a need for staff to operationalise them into Regional Referral Hospitals

o In line with the above mandate a total sum of UGX l.4l=6o is required by the HSC to; a) Recruit 850 Health workers of all categories for MoH He, National Referral Hospitals, Regional Referral Hospitals, UBTS, prisons Health Services and NCTL. b) Support supervision to 56 Districts/Districts Service Commissions, t4 RRHs and KCCA Health Units. c) Provide Technical support to the District Service Commissions. This is provided for under Section 55 (3) of the Local Government Act, CAp 243 and Section 25 of the Health Service commission Act 2ool. d) Implement the E-recrrritment

31 s( e) Monitor and tracking implementation of the HSC decisions, deployment, reporting and retention of Health Workers; carried out.

Observatiou The Committee noted that; o Although the wage bill for the staff to be recmited has been provided for in FY 20L8/19, the operational costs for the recruitment exercise were not provided.

o Recruitment, provision of Technical support to the District Service Commissions together with Implementation of the E-recruitment System are very critical in improving health service delivery o Whereas the Health Service Commission has no permanent home, its land in Butabika is not developed and thus, it can easily be encroached on. Recommendation The Commlttee recommends thqt

a) A total o/ shs 4.41=6n be proulded ln the budget for Fy 2org/r9, out of uthtch Shs UGX 1.4/=bn is to enable the Commlssdon qchleae lts outllned outputs. a/ r consttttctron of HSC head,quarters rn Butoblkq. to reduce on the costs for rent. c) @uentment expedltes salary and gratuttg enhqncement for the members of the Commlsslon of Shs. l.O6Obn

9.6 vote 3o4: UGANDA vIRUs RESEARCH INSTITUTE (wRrl The Committee noted that; a Uganda Virus Research Institute, (UVRI) is a medical research institute owned by the Uganda government that carries out research on communicable diseases in man and animals, with e on viral transmitted infections. ) W 3 a WRI was established to conduct scientific investigations on viral and other communicable diseases so as to contribute to knowledge, policy, practices and engage in capacity development for improved public health.

9.6.1 Encroachment on Zika forest The Committee learned that; o Zika forest in Wakiso District is being encroached on by the surrounding community. This continuous encroachment will affect scientific investigations carried out by the institute. o This is the forest that the Wzu uses to carry out routine surveillance of arboviruses.

Recommendation

The Commlttee relterates its recomrtendqtlons that; a) The Mlnlstrles of Loco,l fuuernment, Health qnd the Nqtlonal Forestry Authorltg utork together to esto.hltsh legal boundarles of the Zlka forest dnd declqre lt a protected areq gazetted tor research. b) Ushs 7.5/= bn should be provtded ln the budget for 2018/19 for the preseruatton of ZII{A forest

9.7 VOTE 161 MULAGO NATIONAL REFERRAL HOSPITAL

The Committee noted that Mulago National Referral Hospital is currently operating in 3 campuses of Old (Upper) Mulago, Kawempe and Kiruddu General Hospitals while renovations are ongoing at Lower (New) Mulago setting up the requisite infrastructure to upgrade it into a Super Specialized Hospital. When completed the Super-specialized Hospital (New Mulago) will provide super specialized healthcare, training and also carryout research while Old Mulago will be upgraded into a National Referral Ho to e specialized servlces.

33 a C\, r ry 9.7.L Enactment of a law on Organ Transplants

The Committee was informed by Mulago National Referral Hospitals that one of its challenges as it gears up to start performing kidney and other organ transplants is that there is no legal framework governing organ transplants

The Commlttee recommends tltat o Goaerrtment should .fdst trolck the commltment to finance the operatlonq.llsqtlon of the Super Speclaltzed Hospltal Gut utell .ut Mulago Natlonq.l refertal Hospltal ulthout dng delag o The three (3) lnstlttttlons, namelg; tlpper Mulago, Maternal ond Neonatal hospltals dnd the Super Speclaltzed Hospltal slauld be run qutonomouslg effectfue Julg 2078 to ensure effTclencg. c Goaerrtment should proalde Shs. 7,5bn requlred, .for the ProPer mq.ng.gement of Kawemgte qnd Kttttddu hospftal,s. Thts utlll enoble the tuto faclllttes to contlnue prouldtng settfices to the publilc. o Goaerttment should lntroduce a laut on o"gan transplant ln Uganda,

9.8 VOTE T62 BUTABII(A NATIONAL REFERRAL HOSPITAL The Committee was informed that; o Majority of the regional referral hospitals have mental health units that are not fully operational due to the lack of Psychiatrist specialists in the country. There are only 34 Psychiatrists registered T with the Uganda Medical and Dental Practitioners Council. This presents a major challenge in the provision of specialized artd general mental health services to the people of Uganda. o The ongoing infrastructural projects at Butabika Hospital stalled

34 b" ,W" v ,t ) Obsenration The Committee noted that; o In Uganda there are 34 psychiatrists o The hospital is overcrowded and operating beyond its capacity e.g the 550 bed capacity -hospital is serving over 850 patients. Recommendations

The Commlttee recomtttends that; o The Mlnlstry of Health should ensure that the requlred staffing leoels qre qttalned ln the hospltal bg provtdtng lncenthres and scholarshtps for tralnlng psgchtqtrlc doctors and nurses for both the Nattono,l qnd Reg lonal refetral H o spltals, o Goaernment should conslder Infrastntcturq.l deuelopmcnt. o There should be qn atffnnatlve actlon to support Mental Health practltloners

9.9 Vote L63-1762 REGIONAL REFERRAL HOSPITALST

The Committee noted that; o There are 14 Regional Referral Hospitals located in different regions of Uganda namely: Arua, Fort Portal, Gulu, Hoima, Jinja, Kabale, Masaka, Mbale, Soroti, Lira, Mbarara, Mubende, Moroto and Naguru. Observation

The Committee was concerned over;

a The un-ending life span of the on-going development projects at both q National and Regional Referral Hospitals \ 35 ^ ry p[wu 6 a Whereas a total of Shs. 20 billion was being allocated for infrastructural development for all regional referral hospitals, the irrational budgetary allocations makes it thinly distributed and therefore ineffective a Lack of standardization, structural designs and costs of projects.

Recommendations The Committee recommends that; a) The all contracts should be temporarllg halted., reuleuted qnd reallgned. b) @aernment should prlortttze and conslder pha,stng the program bg taklng on feuter numbers of Hospttals eaery Flno;ncldl Year. c) Efforts should be geared toutqrds stqndqrdl"zatlon of all sttttcturq,l deslgns qnd costs of proJects.

1O.O GENERAL OBSERVATIONS AND RECOMMENDATIONS The Committee observed that lack of counterpart funding has hampered a lot of Government projects. Consequently, the following key sector unfunded priorities should be considered by Government for inclusion in the budget for 2Ol8 I 19. These include;

10.1 Counterpart Fundlng required in FY 20tgl 19 The Committee noted that out of UGX 57,900,000,000 required for counterpart funding only UGX 16,030,000,000 has been provided leaving a total sum of UGX S6r4TOrOOO,OOO as unfunded (See details here attach.ed as Annex)

The Commlttee recommends tho;t the total sum of UGX S6,4T0.000.000 lndlcated. as unfunded should qaalled for the smooth lmplenentatlon of the concented @aernment proJects

\-% $k c 36

I LO.2 Constituency Health Assembly Fund

The Committee observed that the above-mentioned funds used to be availed every quarter to fund activities of the Constituency Health Assembly and to address health issues within the constituency especially monitoring of all health care prograrns at all levels.

The Committee is further aware that the majority of Members of Parliament and other leaders especially at the districts and sub counties lack information about the allocations for their respective constituencies and their role as Chairpersons of Health Assemblies.

The Commlttee recommends thqt UGX 6/=bn be proulde for the relntroductlon of the Constltrtencg Assemblg Fund and the roles of Members of Parltqment under thts asslgnment utlll be monltorlng, eaaluqtlng and supenislon

1O.3 National Ambulance Service System

The Committee noted that;

o Injury and medical emergencies are arnong the leading causes of morbidity and mortality in Uganda. The burden has cost the country enormously both in terms of human life and resources. Currently, pre-hospital care is given on an ad hoc basis, by fragmented providers namely the Police and community by-standers near crash scenes in case of road traffic crashes. In spite of the high emergency toll, the emergency services are clearly insufficient and there is low capacity to the injured. s 37 & o To avert the above situation Government, in 2014, through the Ministry of Health tried to establish the Uganda National Ambulance Service (UNAS) to address the need for emergency pre-hospital care in Uganda. o The National Ambulance Serwice System will be a universally accessible Pre- hospital Care Services in Uganda and its main goal shall be to provide prompt quality Pre-hospital care for the acutely ilI and injured and support the population's emergency healthcare by utilizing effective principles and practices of patient care while maintaining the dignity of those we serve. . The following strategic objectives shall include; a) To set up an efficient national ambulance service that promptly responds to and manages all health emergencies. b) To educate the public about health emergencies including but limited to maternal and child health emergencies. c) To enhance the strengthening of capacity of A&E units at health facilities to handle and effectively manage emergencies including but not limited to maternal and child health and medical response to disasters. d) To strengthen capacity for research on health emergencies. e) To develop a fully-fledged emergency medicine health profession. The Committee observed that; o Many injured and ill arrive at health facilities by any means of transport possible such as Boda-bodas, police trucks, and private cars and so on. Despite the presence of ambulances across the country, tJ:e majority of which are attached to health facilities and a few run by private institutions, less than 7oh of patients arrive at health facilities by ambulance. o Emergencies, whether due to road traffic crashes, violence, illness or other causes, affect not only the immediate victim, but also his or her family and members of the community. Emergencies in Uganda have exacted a large societal and economic toll both in terms of the direct costs of medical care and the indirect economic costs of premature death and disability. This is

38 q b s attributed to the absence of a formal Emergency Medical Service system (EMS). o An EMS system comprises of a continuum of care comprising of lay first responder response at the communit5r level; pre-hospital care and transportation through an ambulance service; and definitive care at health facility emergency units. This system requires several key building blocks that include; a dedicated human resource of trained ambulance crews, a Call and Dispatch system with a toll free number; ambulance vehicles that meet the standards to offer quality care; an efficient referral system and governance.

a However, whereas this type of service very critical in health service delivery, no funding for this activity was provided in the budget for FY 2OtBl19.

Recommendation

The commlttee recommrends tholt q total sum of uGX67, O73r45Or4OO/= (USD $ tB.64M) be aaalled lor the establlshment of the Natlonql Ambuldnce Setttlce Sgstem mondqted. to offer Pre-hospltal cdre and Emergencg setdce ln Uganda

11.O CONCLUSION

Health is critical to the development and productivity of labor as a factor of production and therefore should be a priority of Government not only in policy statements but also in actual allocation and utilization of resources. The need to closely monitor the health outcomes is critical lest we fall victim to superfluous reporting in policy documents but with no bearing to the realities in the communities. MoH should always consider planning embarking on any ner*'

39 A

\ Annex 3: Counterpartfunding requbed in FY 2018/19

ril' rr."l "it'j

700m to cover gap for transfer to GF, 300 million for national Global fund for Global fund asset AIDS, TB and verification 0220 Malaria 8,500,000,000 2.100.000,000 1,000,000,000 exercise. Renovation and 9olo of contract Equipping of sum as required Kayunga and in the Financing Yumbe General agreement for 1344 Hospitals 5.000,000,000 1,530,000,000 3.470,000,000 advance GAVI vaccines For ROTA and Health vaccine which is Sector to be introduced Development 3,000,000,00 on GAVI vaccine 1436 Plan Support 13,200,000,000 10.200,000,000 0 list in FY 2018/19 Support to To clear Mulago Hospital certificates of Rehabilitation Roko (Super construction as specialised the project is 1 187 Hospital) 13,200,000,000 1,300,000,000 11,900,000,000 Required GoU contribution for project. Got suplementary of Shs. 8.6 bn in 17l18. The Regional project is due for Hospital for completion at Paediatric close of FY t394 Surgery 10,000,000,000 900,000,000 9.100,000,000 20r8lt9 I Busolwe Hospital 8. 000,000,000

TOTAL 49,900,000,000 16,030,000,000 36.470.000,000

47 c

n\\-.]1 ffi r (\ - ,l- Rt. Hon. Speaker and Hon. Members,

I beg to report.

Annexes:

1) HeattLt Sector Erternal Financing bg Programme/Project FY 2018/19 (UGX, billions)

2) Changes in Health Sector Budget Artlook bg Vote (UGX, billions) @b6"sr40 q s N, q bo + (I ts s + + A + + (,l + (,l (I (Jt A o E 6) (1, tr (I H (rl C/) N (} o) H o o o 5 o + A o 5 s + N h) o p 0r_ N 5 + o + s o o o) o o o ul l\) t\) 6 (} o l) ! gr o + 5 g)s (,r I otl o d Ed o 01 o) a s a C'I a H o C o Fl q) g o rt o 5 c ) d D d !, x t Fl. = FI t o o It' )! F q) N tr o a (, o o ,a o d o o- + ,rl d o !t p. p o o It fr I u .: o) E o g) I 0 (} o p o !i o p. ts I D I E 5 It th t =CL p p ai I' B ! b g T o,= p E p o t, !t D ll o Jr a ]J q 0) EL + Fl d d B 41 f, c5 o U tl z 1A E !) t t o tl o p o oFt It o o A) t rrt p o El o ot D F o U EFt T o 3 0) 0) o q) d o o o g fr + s J o g= o 0) F 5 o A) o p) p !, p t -t o o f = o o !t d o E e. .I o o .l o 0, U U Url o T U U o € E d B o d o o o o o o E o o o o i o U) o o o o o ,0 E tr (, F E c o t o o B a o o r o 1 o il o o al ..t t !r + !, t, B t, o a 5 o t o H r! t Ff d tr d o p T o o o I o t, !, D o a o d E d r B "? Fl (}o B \l o r ts o o -l E a CL 5 o o ts o * tt o u .o t tr t ! o o o o t a o s"d td o a. 5 E 5 o I !, H o t! \ (o CL d t E o A" X A H'U o o E H Fl 6 o t p o E '0 tr, o i, u, E' f o o) 0) ET € D u, o F 6 o = ET a x rl fi E. t ,tl 6' a o o H F d € t rit 0) B tq U o 3 |l E t tl, E E b d o E a p o o t !) E !) z = o o I 5 o o o c ,rl E H r J t ll o t o I E a !) t A) o o rq p o o 0 p o H E' rrt F E rd p o !, ,c F U B d I 3 o F o i o ai p o o o I ID o o x oi.| ! It o, o o U o D r* n) b o It o q o t G o !l 5 ! U ) o U 1 p o o a e r Fl o o o ,q o 5 t\) .! z t o t, rt 0q o o o { o D t, l-{ o 'U D B |lo d I o ! c F 6 t E ET '0 o l\r =o E rq ( e Ft"0 \o o Q E H c E o o o o E o It o m x p o d !t H o o o o o o li o t E o 5 t G U !, F ts ts 0 o o o o H tll !, o I (D o E o o U I t, \) o No @ H t\)o \o (o o glOl ll, ro (x lr, s + @ @ (]) o) F Ot H @ .{ -t 5 or l- i 5 l.) N N P tr P : J P I lrt A t J L N (o (o + 5 N is \ \ N to (, g) H \o b o\ 01 s + Or o o C'] N 01 gr o\ or @ e Or o G) o) o o { -l @ o N N 6 o ts @ F N P { o o (l) g) { gI O'l lJ co @ H s + (I N !.,, o) P g) to gl H l4 @ (,r oi F 5 P o i 5 P 9 9 P o) !., I N L, 0) b 5 N 5 5 o @ o q){ q)-l + b (I& grb o o t) C') C') C'T Or o o { 01 or t\) N I @ 6 o $4' o t ur o) lra t, rO (, or s & $ Ut *l $ E c0 a p F ln t\l s * N tl (, P I*' o. o @ 6 g) m p o p $ f tl) tA t ro cl rI I o,, F | T A A 0c & hi e,l o u o { { { h b FJ b o \: h o dt E {} el Ol 6 !S to d\ o\ b h) lll o) g at { t\) gr (, E ts s ot aI { o I I I , I ld o F (r H H * & (} I $ l,*1 o € & S' o o (} H ($ dl I (} o |rr F rD h) H lJ 1.. (} (} It 6 s !a !,1 I !o F* o f,i t+ !r & c} o \) p s io l.r .aI il C} 6! c0 gr Io (} gt t tt xe b b { { a u b s [] b ul ,rl s Bt a 6\ s s s * s s s s * s F t( s s s s s s s s ID €(! o o { ET s H H LrJ P P ot P I P 90 o F :x !r l- o l' o i I H !' P P o o !x t, s u, u, c, (, gr H P P Ch Ol N i,u (Jl C) ll o w b o o o N w \o ul o ie N o s a >R s x a x x s >R s s x x s >s x >R x }R s o\ ;s s s >s x @- \2':L q a -ts a)P (1 P a F o *ii o\ o\ o 'oO oo\ oo o o o { { @{ { { 6€ co o\ 5P 9ir + g 6 N { urz 3+ o @ z r o o6- c m o i E= o o L otr s u =tr D I UB s9 x6' =.6 6 o m cr -D o o D E o o pI F 'U m o!t o r I 6 o F s F o o D D 6) E D o 6 I 9. il 6' 6_ 6' @ a) F o F I o o s o o F F l 6 x 3 o 6' 6 o o G. o g = X I 6' I @; E. o s o tF d' o o t E- o t I o ts il !i -t E E o E. D I' (!f, p U N N o = co \o o a o a N N !! !, N :r { 0c tr l.r t t h o 0l !n io b b i! { o to \ u N q io o\ o 0a o .I N b u + o @ u a N 6 co q o (n E o N I q N o o u 1z o o o N r r ts F lx I !ro a(! io L! ir b q q h to { o\ @ ,QE /r F ;5 b ir \ \ \o u Q iD 6 Ol at (, o @ N N N o U \o @ u o\ + o (, N { 0) lr .o t+ B t, P R N 9 I I N o o p o ts N r tJ N o E o\ A o + o h + b + b o o o io eo (D U) N 6 \o o o € o\ € o\ 6 N { 6 o a o {b o o or+ \) Fl @ E: o € o o o o o o ! x tr N o o I o I P I 9 9 I I 'o b 'o f G { P N o b o b b o o o o o o o o o t o\ @ o o o o o o o o o o o o o o o N a o\ !t 9. @ oco FI N o I N o o o o I P o P o I I o P I I 'o oI P I N q o a LD io N o o o b b h o N i! b 6 @ @ q !) o o o o + @ o\ u o @ N \o o (/l t-t o N (, o o o o I I I I o ){ o I o :.r P I N 6 ! 'u o o to (n b o b o Ld i/u i, o o\ )i (, o o aPls + u u u o u N o o\ o o o d

o N u o q h o\ 6 q{ u u 4k- h + I I I P )J : I p P N P b o h o q io (D b or io N o + { b N o N 6 N N o U o \o 6 o N N o o u a+ eo o { { { (.) o o C (n o o \o d { N !r !r gt I t I I !r u t a t !) I t t o o o h co b LD io { O l. t ir o N o + { h to o\ b 0q N u + a q N { co o { co \o N N o s N o { J>( N cr N or { z 5 a N N l'r N !x !d t I D o p !r o\ + !, :, u : co N ,e t o io b b \ o\ @ o o st \o o @ N co o\ $ o \o w s o N N o ! 6 o o 6 N o t o o N N E { o !, N 'co !'r N 9 o 90 o o ;5 b o b CD N o '\o ! o q ,s b b o b b b \o o\ 6 o o\ o q L o\ o o\ o\ 6 o \o o\ or o o\ N { o N ot. N ln o o o o o o\ x N N I I I 9 P I o P s) P I I 'o I 6 o o o o o o o b o o o o o b o b o o i$ o I q o o o o o o o o o o o o (> o 6 @ o o o o o\ D' =)\

o N o o 9 o I I P I P P I P I I I I t> N o o o o o o b { o qo b o t, 6 co u o\ o co o o N \o o o u d =lt (,r N o o o @ a o I P I s) 9 I P I Io to (, b N b o b 6 u N 6 \ b i- o\ { o o\ o q q o o o u co Ot o o o

N N o p p o \o \o N o o co + s P 6 : o P P P !r p P bo @ N N b A f N q N !, o 6 to € o\ o bo q o o u o b o o 6 6 o\ o N o or { o o CO \o ! ! C^ o ,ts N !t (., N N s 6 ljl N !'J N N N !, N \o o o Fr ) F N q N o\ o a\ b b, N b N ut o b N o to E N b @ o s ur $ @ u co u o o\ N N N s GI t LJ o (as t (! o N N N o N qr (.)N ul \o *1. o o o { E rO ul slalp p F P !.J u !, J I P ) N o @ s b o b o ts * b { o\ 0r s s s $lE slsF s s s s a s s * s s o o 6 I p I I F I $! P :tr It ,F I N N \D t s s s s s s s s s s 6

.W>MN I SIGNATURE SHEET FOR MEMBERSH OF THE COMMITTEE ON HEALTH ON THE MINISTERIAL POLICY STATEMENT AND BUDGET ESTIMATES FOR FY 2018/ 19

NO Name ConstituencY Party Signature

1 Hon. Dr. BukenYa Bukuya CountY NRM Micheal (Chair Person) 2 Hon. Kahunde Hellen- DWR Kiryaudongo NRM (Vice Chairperson) W 3 Hon. Adoa Hellen DWR Serere NRM 4 Hon. Ayebazibwe Justine DWR Isingiro NRM 5 Hon. Babirye KitYo Sarah Youth Rep. NRM 6 Hon. Bebona Babungi. J DWR Bundiburyo NRM &L-u^q 7 Hon. Kemirembe Pauline DWR Lyantode NRM q M 8 Hon. Mbwatekamwa Gaffa Kasambya CountY NRM NRM 9 Hon. Kajungu Mutambi DWR Mbarara NRM 10 Hon. Kamusiime Innocent Butembe countY P NRM 11 Hon. Muheirwe M Danie 1 Buhaguzi countY t2 Hon. Ndamira Catherine DWR Kabale NRM NRM 13 Hon. Ayaka Rose Atim DWR Karacha .1) t4 Hon. Nayebale SYlvia DWR Gomba NRM NRM 15 Hon. Alyek Judith DWR Kole NRM 16 Hon. Lyomoki Sam Workers ReP t7 Hon. Ssebikaali Yoweri Ntwetwe CountY NRM -!ffi"{ Joel l8 Hon. SsembatYa Edward N Katikamu South NRM I 9 Hon. Rwakimari Beatrice DWR Ntungamo NRM County $k--- Kagadi NRM 20 Hon. Mbabazi DWR --ru ffi,

^ Kyomuhendo Janepher 2t Hon. Baguma Spellanza DWR Kyenjojo NRM U 22 Hon. Atyanga Stella DWR Moroto NRM 23 Hon. Mirembe Lydia DWR Butambala INDEP Daphine 24 Hon. Baseke Fred Ntenjeru south INDEP , 25 Hon. Kinobere Herbert Kibuku county INDEP Tom 26 Hon. Aol Ocan BettY DWR Gulu FDC ru 27 Hon. Sizomu Gershomu Bungokho North FDC 28 Hon. Atim Joy Ongom DWR Lira UPC 29 Hon. Asimwe EverlYne UPDF Army Buregreya (Cpt.)