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Annual Health Sector Performance Report THE REPUBLIC OF UGANDA Annual Health Sector Performance Report Financial Year 2006/2007 October 2007 Blank Page Foreword The health sector in FY 2006/07 implemented the 2nd Year of the Health Sector Strategic Plan II (HSSP II). The focus has been on scaling up interventions and consolidating reforms initiated during the HSSP I and in the 1st Year of the HSSP II in order to achieve the Poverty Eradication Action Plan (PEAP) objectives and Millennium Development Goals (MDGs). The Uganda Demographic and Health Survey 2006 shows that there have been improvements in Infant Mortality Rate, Under5 Mortality Rate and Total Fertility Rate. The data is not conclusive on Maternal Mortality Ratio. These improvements in health outcomes indicate that it is indeed possible to make a difference in the life of Ugandans. The improvements in health outcomes were contributed to by different sectors; however the contribution of the health sector in terms of stewardship and advocacy, and improved coverage with good quality services for preventive, promotive and curative has been key. The AHSPR 2006/07 documents sector performance against agreed HSSP II indicators and Year II targets. The AHSPR 2006/07 indicates fairly good performance as shown by the performance against the 8 PEAP and HSSP II indicators. The sector performance for FY 2006/07 was on or above target for 3 indicators namely: Couple Years of Protection (CYP) a measure of family planning uptake; Proportion of children below 1 year that have received pentavalent vaccine 3rd dose; and New OPD attendance per capita. Sector performance was below target for 3 indicators namely: Proportion of deliveries taking place in government and PNFP health facilities; Proportion of health facilities with tracer medicines all the time (i.e. without stock outs of tracer medicines); and Sanitation measured by household latrine coverage. It was not possible to determine sector performance against 2 indicators namely: Proportion of approved posts filled by trained health workers; and HIV Sero-prevalence. The sector’s performance over FY 2006/07 had many challenges including: low and stagnant levels of funding from the government budget; and increasing but rather unpredictable and earmarked funds from Donor Projects and Global Health Initiatives. Given this scenario it is important that we continue improving our coordination mechanisms within the sector to ensure increased efficiency and maximum benefit from all resources available to the sector. All stakeholders in the sector including central and local government leaders (politicians, administrators and technical staff), development partners, civil society representatives, and private providers of health services, need to contribute to improved sector performance. The National Health Assembly and Joint Review Mission present an opportunity for sharing of ideas among stakeholders. At the end of December 2007 we will have been through two and a half (2 1/2) years of the HSSP II. As stakeholders in the sector it is important that we review our Mid- Term performance and see whether we are in line with the HSSP II and MDGs. If the current strategies are unlikely to take us where we would like to go, we should be frank and say so, and come up with more relevant and appropriate strategies. Dr. Stephen Malinga, MP MINISTER OF HEALTH iii Blank Page iv 5 Pictures from NHA, JRM 2007 and TRM 2007 6 7 Table of Contents Foreword Acronyms Illustrations Executive Summary Chapter 1 Introduction Chapter 2 Overview of Health Sector Performance FY 2005/06 Chapter 3 Delivery of the Uganda National Minimum Health Care Package Chapter 4 Integrated Health Sector Support Systems Chapter 5 Implementation of Health Sector Strategic Plan II Annexes Annex 2.1: Annex 3.1: Annex 4.1: Annex 5.1: 8 Acronyms ABC Abstinence, Be faithful, Condom use AFP Acute Flaccid Paralysis AHSPR Annual Health Sector Performance Report AIM AIDS Integrated Management ANC Ante Natal Care ARV Antiretroviral BCC Behaviour Change Communication BEmOC Basic Emergency Obstetric Care CB-DOTS Community based Directly Observed Treatment CDC Centre for Disease Control CDD Community based Drug Distributors CEmOC Comprehensive Emergency Obstetric Care CME Continuing Medical Education CYP Couple Years of Protection DDHS District Director of Health Services DOTS Directly Observed Treatment DPs Development Partners ENT Ear, Nose and Throat EPI Expanded Programme for Immunisation ESD Epidemiology and Surveillance Division FP Family Planning GFATM Global Fund for AIDS, TB and Malaria GoU Government of Uganda GTZ German Technical Cooperation HC Health Centre HDP Health Development Partners HMIS Health Management Information System HPAC Health Policy Advisory Committee HRD Human Resource Division HSSP Health Sector Strategic Plan HUMC Health Unit Management Committee IDSR Integrated Disease Surveillance and Response IEC Information, Education and Communication IMCI Integrated Management of Childhood Illnesses IPT Intermittent Presumptive Treatment IRS Indoor Residual Spraying IST In-service Training Strategy ITN Insecticide Treated Nets JRM Joint Review Mission KABP Knowledge, Attitude, Behaviour change, Practice KDS Kampala Declaration on Sanitation KPI Kampala Pharmaceutical Industries LLIN Long Lasting Insecticide Nets LSS Life Saving Skills LTPM Long Term Permanent Methods MAAIF Ministry of Agriculture, Animal Industries and Fisheries MCP Malaria Control Programme 9 MDGs Millennium Development Goals MIP Malaria in Pregnancy MNT Maternal and Neonatal Tetanus MoES Ministry of Education and Sports MoH Ministry of Health MoU Memorandum of Understanding MRC Medical Research Council MTR Mid-Term Review NCD Non Communicable Diseases NCRL Natural Chemotherapeutics Research Laboratory NGO Non Government Organisation NHA National Health Assembly NHP National Health Policy NIDs National Immunisation Days NMS National Medical Stores NVS National Voucher Scheme OPD Outpatient Department OPV Oral Polio Virus PC Palliative Care PEAP Poverty Eradication Action Plan PEPFAR President’s (Bush) Emergency Plan for AIDS Relief PET Post Exposure Treatment PHC Primary Health Care PHC-CG Primary Health Care Conditional Grant PHP Private Health Practitioners PMTCT Prevention of Mother to Child Transmission PNFP Private Not-For Profit PPPH Public Private Partnership for Health PSI Population Services I QA Quality Assurance RIDs Rabies Immunisation Days SHI Social Health Insurance SHSSP Support to the Health Sector Strategic Plan SOP Standard Operating Procedures SRH Sexual and Reproductive Health and Rights SWAp Sector Wide Approach TASO The AIDS Support Organisation TBL TB and Leprosy TCMP Traditional and Complementary Medicine Practitioners TOT Training of Trainers TT Tetanus Toxoid UBTS Uganda Blood Transfusion Services UDHS Uganda Demographic and Health Survey UNBS Uganda National Bureau of Standards UNHCO Uganda National Health Consumers Organisation UNHRO Uganda National Health Research Organisation UNMHCP Uganda National Minimum Health Care Package UPHOLD Uganda Programme for Human and Holistic Development UVRI Uganda Virus Research Institute VACS Vitamin A Capsule Supplementation 10 VCT Voluntary Counselling and Testing VPH Veterinary Public Health WHO World Health Organization WP Wettable Powder Formulation 11 Illustrations Figures 12 Tables 13 Boxes 14 Executive Summary: 15 Chapter 1 Introduction ....................................................................................................... 17 1.1 Background.................................................................................................................... 17 1.2 The framework for achieving sector goals & objectives................................... 17 1.3 The Annual Health Sector Performance Report FY 2006/07........................ 17 1.4 Sources of Information............................................................................................... 20 1.5 Outline of the Report .................................................................................................. 21 Figure 1.1: Framework for the Sector Programme in the HSSP II ..................... 19 16 Chapter 1 Introduction 1.1 Background The FY 2006/07 was the second year of implementation of the Health Sector Strategic Plan II (HSSP II 2005/06 to 2009/10). As per the Memorandum of Understanding (MoU) for the implementation of the HSSP II through the Sector Wide Approach (SWAp), the preparation and discussion of an Annual Health Sector Performance Report (AHSPR) is a key milestone. 1.2 The framework for achieving sector goals & objectives In the HSSP II the framework for the sector programme has been adjusted to reflect the central nature of the delivery of the Uganda National Minimum Health Care Package (UNMHCP) and the important and supportive role the programme objectives have. Similarly the organisation of sector plans and reports like the AHSPR reflect this restructuring, with the focus in the document on the performance against the UNMHCP and the supporting Health System (Figure 1.1). 1.3 The Annual Health Sector Performance Report FY 2006/07 The AHSPR 2006/07 objectives are: o To review the performance of the sector for the FY 2006/07 identifying achievements and constraints; o To assess progress towards HSSP II targets – in particular review against HSSP II Year II targets. The HSSP II includes a set of indicators and targets against which sector performance is reviewed. The indicators were chosen through a thorough consultative process to reflect: o Sector policy priorities,
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