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Value for Money Audit Report on Implementation of The THE REPUBLIC OF UGANDA OFFICE OF THE AUDITOR GENERAL RY OF HEALTH www.oag.go.ug | E-mail: [email protected] OFFICE OF THE AUDITOR GENERAL P.O.Box 7083, Kampala, Tel: +256 414 344 340 Fax: +256 414 345 674 E-mail: [email protected] RENOVATION AND CONSTRUCTION OF SELECTED HEALTH VALUE FOR MONEY AUDIT REPORT ON FACILITIES UNDER THE UGANDA HEALTH SYSTEMS IMPLEMENTATIONSTRENGTHENING PROJECT OF THE MARKET(UHSSP), INFRASTRUCTUREMINISTRY OF HEALTH RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA SYSTEMS STRENGTHENING PROJECT (UHSSP), MINIST COMPONENT OF THE MARKETS AND AGRICULTURAL TRADE IMPROVEMENT PROGRAMME A REPORT BY THE AUDITOR GENERAL A REPORT BY THE AUDITOR GENERAL VALUE FOR MONEY AUDIT REPORT ON THE IMPLEMENTATION OF THE EXPRESS PENALTY SCHEME (EPS) VALUE FOR MONEY AUDIT REPORT ON THE IMPLEMENTATION OF THE EXPRESS PENALTY SCHEME (EPS) 1 MARCH 2015 1 BY UGANDA POLICE FORCE | A REPORT BY THE AUDITOR GENERAL DECEMBER,BY UGANDA POLICE2015 FORCE | A REPORT BY THE AUDITOR GENERAL THE REPUBLIC OF UGANDA RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH A REPORT BY THE AUDITOR GENERAL DECEMBER, 2015 AUDITORAUDITOR GENERAL’S MESSAGE GENERAL 31st December 2015 The Rt. Hon. Speaker of Parliament Parliament of Uganda Kampala VALUE FOR MONEY AUDIT REPORT ON THE RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH In accordance with Article 163 (3) of the Constitution of the Republic of Uganda 1995 (as amended), I hereby submit my report on the value for money audit undertaken on the Renovation and Construction of Selected Health Facilities under the Uganda Health Systems Strengthening Project, Ministry of Health. My office intends to carry out a follow – up at an appropriate time regarding actions taken in relation to the recommendations in this report. I would like to thank my staff and the Consultants who undertook this audit and the staff of Ministry of Health for the assistance offered to my staff during the period of the audit. John F. S. Muwanga AUDITOR GENERAL TABLE OF CONTENTS TABLE OF CONTENTS 6 RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH | A REPORT BY THE AUDITOR GENERAL TABLE OF CONTENTS LIST OF TABLES ....................................................................................................................... ii LIST OF ACRONYMS AND ABBREVIATIONS ........................................................................... iii EXECUTIVE SUMMARY ............................................................................................................. iv CHAPTER ONE INTRODUCTION ........................................................................................................................ 2 1.1 Background .................................................................................................................... 2 1.2 Motivation ........................................................................................................................ 2 1.3 Description of the audit area.......................................................................................... 4 1.4 Audit objective ................................................................................................................. 6 1.5 Audit scope ..................................................................................................................... 6 CHAPTER TWO AUDIT METHODOLOGY............................................................................................................. 8 2.1 Sampling ........................................................................................................................... 8 2.2 Data collection .................................................................................................................. 8 CHAPTER THREE 3.1 Roles and responsibilities of key players ...................................................................... 11 3.2 Process description ........................................................................................................ 13 CHAPTER FOUR FINDINGS, CONCLUSIONS AND RECOMMENDATIONS ........................................................ 18 4.1 Planning .......................................................................................................................... 18 4.2. Procurement ................................................................................................................... 24 4.3 Implementation and progress of works ........................................................................ 25 4.4 Post construction preparedness for facilities renovated/ Constructed under UHSSP. .... 33 APPENDICES APPENDIX I:UHSSP technical secretariat organogram ......................................................... 35 APPENDIX II: Documents reviewed ......................................................................................... 36 APPENDIX III: Interviews conducted ....................................................................................... 37 APPENDIX IV: Procurement process ...................................................................................... 38 APPENDIX V: Summary of findings per individual hospitals .................................................. 39 RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS i STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH | A REPORT BY THE AUDITOR GENERAL LIST OF TABLES Table 1: Contract amounts for the 9 health facilities under review ....................................... 6 Table 2: Variation orders per health facility ............................................................................ 20 Table 3: Variations due to inadequate topographical surveys per hospital ........................... 21 Table 4: Variations .................................................................................................................... 22 Table 5: Contract execution period and status of Implementation of works ......................... 25 Table 6: Criteria for UPV tests (BS 1881, 1983) ....................................................................... 30 Table 7: Showing results of Non-destructive tests using Rebound Hammer ....................... 30 Table 8: Selected Results of Non-destructive Tests using UPV ............................................ 31 Table 9: Operational capacity of health facilities under review .............................................. 33 ii RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH | A REPORT BY THE AUDITOR GENERAL LIST OF ACRONYMS AND ABBREVIATIONS AWPs Annual Work Plans BoQs Bills of Quantities CC Component Coordinators DPC Deputy Project Coordinator EmONC Emergency Obstetric and Neonatal Care ESIA Environment and Social Impact Assessment FP Focal Person GH General Hospital HCIV Health Centre IV HIV/AIDS Human Immuno Virus/Acquired Immune Deficiency Syndrome ICT Information Communication Technology IDA International Development Association INTOSAI International Organization of Supreme Audit Institutions MoH Ministry of Health MTEF Medium Term Expenditure Framework NACME National Advisory Committee on Medical Equipment NDA National Drug Authority OAG Office of the Auditor General PAD Project Appraisal Document PC Project Coordinator PDE Procurement Disposal Entity PIP Project Implementation Plan PPDA Public Procurement and Disposal of Public Assets Authority PS Permanent Secretary RRH Regional Referral Hospital ToR Terms of Reference TWG Technical Working Group UGX Uganda Shillings UHSSP Uganda Health Systems Strengthening Project UNMHCP Uganda National Minimum Health Care Package UPV Ultra-Pulse Velocity USD United States Dollars VFM Value for Money RENOVATION AND CONSTRUCTION OF SELECTED HEALTH FACILITIES UNDER THE UGANDA HEALTH SYSTEMS iii STRENGTHENING PROJECT (UHSSP), MINISTRY OF HEALTH | A REPORT BY THE AUDITOR GENERAL EXECUTIVE SUMMARY UHSSP was a five year project, which was established in 2010, commenced operations in February 2011, and was due to end on 31stJuly 2015 prior to receiving a 2 year extension. The project is jointly funded by the Government of Uganda (GoU) and the World Bank to a tune of USD 14.31 million and USD 130 million, respectively. The funding from the World Bank is through a loan obtained from the International Development Association (IDA)1. The project has four components, namely: a) Improved Health Workforce Development and Management, b) Improved Infrastructure of Existing Health Facilities, c) Improved Leadership, Management and Accountability, and d) Improvement for Maternal, Neonatal and Family Planning Services2. The objective of the component for Improved Infrastructure of Existing Health Facilities was to improve physical infrastructure in terms of functionality and usage by providing minimum standards of quality health care services through the sub-components of; -(i) renovation of selected health facilities; (ii) provision of medical equipment; (iii) improved capacity for operations and maintenance; and (iv) strengthening the referral system3. Owing to concerns over the progress of the implementation of the infrastructure facilities under the project, the Office of the Auditor General undertook a value for money audit
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