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08 Health.Pdf THE REPUBLIC OF UGANDA HEALTH SECTOR BUDGET FRAMEWORK PAPER FY 2018/19 – FY 2022/23 MINISTRY OF FINANCE, PLANNING AND ECONOMIC DEVELOPMENT Health Budget Framework Paper FY 2018/19 Sector: Health Foreword The Health Sector Budget Frame Paper (BFP) was developed within the context of the Sector Wide Approach (SWAP) premised on the Programme Based Budgeting (PBB) principles. The Sector Budget Working Group in consultation with respective programmes and sub-programmes identified the sector outcomes, outputs and planned activities for )LQDQFLDO<HDU )< DQGWKHPHGLXPWHUP The structure of the BFP for FY 2018/19 is therefore, in accordance with the Sector Programmes that link financial resources and other inputs to sector outputs and outcomes in a precise and coherent manner. The PBB provides a useful tool to improve how the sector makes decisions on allocating its resources, and helps to identify opportunities to improve the efficiency of public spending on health. PBB links outcome, output and activity performance indicators and targets with budget allocations over the medium term. This creates opportunities for efficiency-enhancing measures and redeployment of cost savings to meet priority needs. The priority actions within Programmes and the intra Programme allocations are in pursuance of an input mix that leads to the attainment of the Sector goals. Priority actions and resource allocations for the sector are guided by jointly agreed undertakings in the Health Joint Review Mission and the Sector Budget Working Group within the realm of the National Development Plan (NDP) and the Health Sector Development Plan (HSDP). Despite, the limited resource envelope to the sector notwithstanding, particular attention will be paid to areas that harness efficiency gains that will lead to improved service delivery and these include: 1. Prioritizing health promotion, prevention and early intervention with focus on improving hygiene and sanitation, integrated community case management of common conditions through the Community Health Extension Workers (CHEWS) and the introduction of the community health extension workers¶strategy. 2. Human resources for health training, attraction, job scheduling, motivation, retention, and development will be prioritized. Additional resources for recruitment and incentives will be mobilized with focus on improving staffing for critical Human Resource for Health (Anesthetic officers, psychiatrists, DHOs & ADHOs). Revision of staffing norms for Regional Referral Hospitals and LGs to address the current need. Improve health worker performance by scaling up attendance tracking with automated biometric attendance analysis, routinely and introducing performance contracts for all health managers with clear outputs and targets. The Ministry will continue providing uniforms to health workers in a phased manner. 3. Strengthening inter sectoral collaboration to address the social determinants of health e.g. safe water, education, housing, nutrition, etc. 4. Reducing referrals abroad. The sector developed a proposal to reduce referrals abroad. In the short term the major focus is to improve Uganda Cancer Institute, Uganda Heart Institute and Mulago Hospital. 5. Improving health workers¶performance through performance contracts for managers. 6. Improving supply of blood through community mobilization to donate blood and increased resource allocation to Uganda Blood Transfusion Services. 7. Strengthening enforcement of the Public Health Act for increased standard latrine coverage. 8. Reducing stocks of expired drugs from facilities by developing a strategy for minimizing expiry of medicines and mobilizing resources for disposal of expired medicines. Advocating for increased allocations for medicines and laboratory supplies and reagents. 9. The Ministry will progressively in a phased manner upgrade HC IIs to IIIs and construct HC IIIs in sub-counties without, considering the population and provide PHC Development Funds for completion of unfinished projects in the LGs. Special attention will be towards functionalization of HC IVs and hospitals in districts with special needs like islands, difficult terrain and large populations. Infrastructure developments in the referral hospitals will aim at improving critical service delivery areas like emergency care and specialized services. 10. 7KH0LQLVWU\ZLOOWDNHLQYHQWRU\RIHTXLSPHQWLQKHDOWKIDFLOLWLHVUHGLVWULEXWHWKRVHZKLFKDUHQRWLQXVHDQG disposal of all old equipment before procurement of any new equipment. 11. Improving planning, including procurement planning and resource management in the sector through capacity building and support to improve efficiency in procurement and projects execution, to reduce resource wastage. Enforcing resource and financial management guidelines including value-for-money and mandatory timely Health Budget Framework Paper FY 2018/19 Sector: Health accountability for all deployed sector resources at all levels. 12. Improving the Health Management Information System by availing the HMIS tools to facilities (printing and distribution of the HMIS tools on quarterly basis); revision of the HMIS for inclusion of National ID Number in the patient registration; improving data quality through mentorship and data quality audits; and stabilizing the eHMIS connectivity to enable timely reporting. The Ministry of Health will work with NITA-U for IT platform integration, disseminate and implement the five-year e-Health strategy. 13. Implement the Health Financing reforms, including the National Health Insurance Scheme (NHIS) and Results Based Financing (RBF). The Ministry will fast track the legislation process for establishment of a NHIS and scale up the RBF program in the public and PNFP sectors. The Ministry of Health would like to register its appreciation to the Health Sector Development Partners who have not only supported the Health Sector financially but also through technical guidance. Their input in shaping policy and sector monitoring is highly valued. The Sector highly values the support and guidance that has been given by Ministry of Finance, Planning and Economic Development. Many thanks also go to the Civil Society and Private Sector partners ZKRKDYHFRPSOHPHQWHGWKHGHOLYHU\RIVHUYLFHVE\WKH6HFWRU Health Vote Budget Framework Paper FY 2018/19 Vote:014 Ministry of Health V1: Vote Overview (i) Snapshot of Medium Term Budget Allocations Table V1.1: Overview of Vote Expenditures Billion Uganda Shillings FY2016/17 FY2017/18 FY2018/19 MTEF Budget Projections Approved Spent by Proposed 2019/20 2020/21 2021/22 2022/23 Outturn Budget End Sep Budget Recurrent Wage 6.045 7.650 1.156 7.650 8.415 8.836 9.278 9.742 Non Wage 41.236 56.835 5.837 56.026 68.352 78.604 94.325 113.190 Devt. GoU 47.216 28.840 0.754 28.840 35.184 42.221 42.221 42.221 Ext. Fin. 531.986 878.415 1.122 666.131 449.962 139.663 92.177 0.000 GoU Total 94.496 93.325 7.747 92.516 111.951 129.662 145.824 165.153 Total GoU+Ext Fin 626.482 971.740 8.869 758.646 561.914 269.324 238.002 165.153 (MTEF) A.I.A Total 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Grand Total 626.482 971.740 8.869 758.646 561.914 269.324 238.002 165.153 (ii) Vote Strategic Objective a. To provide inclusive and quality health care services through policy formulation and providing strategic direction, planning and coordination of health care provision in Uganda. b. To address the key determinants of health through strengthening of inter-sectoral collaborations and partnerships. c. To enhance the health sector competitiveness in the region and globally. V2: Past Vote Performance and Medium Term Plans 1 Health Vote Budget Framework Paper FY 2018/19 Vote:014 Ministry of Health Performance for Previous Year FY 2016/17 Health Infrastructure Rehabilitation work was done at Mulago National Referral Hospital at Mulago and all Regional Referral Hospitals including installation of oxygen plants, Renovation of 19 medicine stores & Civil works ongoing for construction of 26 staff houses under GAVI Ground breaking for the construction of a specialized hospital at Lubowa and a Paediatric Surgery Hospital at Entebbe under the Public Private Partnerships Commenced renovation of Kawolo hospital Construction of 34 staff housing units at HC IIIs in Karamoja 24 LGs were supported with funds to expand and renovate the following hospitals and HC IVs; Adjumani GH, Kitgum GH, Kabarole GH, Kiboga GH. Kapchorwa GH, Pallisa GH, Itojo GH, Kitagata GH, Bugiri GH, Atutur GH, Apac GH, Abim GH, Bundibugyo GH, Kaberamaido GH, Masindi GH, Kagadi GH, Kambuga GH, Tororo GH, Gombe GH & Bududa GH Public Health Increased community awareness and demand for services; advocacy by leaders at various level by RDC, LC-5 chairmen, religious leaders; community participation in containment of outbreaks for example Cholera, Rift Valley Fever, Yellow Fever. A total of 24,019,282 Lost Life Insecticide ±treated Nets were secured and distributed in 109 districts IRS was conducted in the twenty districts Rapid diagnostic kits (RDT) for testing malaria and anti-malarial medicines were procured and distributed. Submitted a funding application to the Global Fund to Fight AIDS, TB and Malaria and has secured a grant of US$ 188,322,878 to fund malaria control efforts in the period of three years (2018±2020). 59 million male condoms were procured and distributed HIV testing services were provided to a total of 11,742,311 individuals including 10,292,539 adults and 1,449,772 children. A total of 405,054 young men were circumcised NTLP updated its Strategic Plan for 2015/16-2019/20, finalized
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