THE REPUBLIC OF UGANDA
Health Sector ANNUAL MONITORING REPORT Financial Year 2014/15
October 2015
Ministry of Finance, Planning and Economic Development P.O.Box 8147, Kampala www.finance.go.ug
THE REPUBLIC OF UGANDA
HEALTH SECTOR ANNUAL MONITORING REPORT FINANCIAL YEAR 2014/15
October 2015
Ministry of Finance, Planning and Economic Development P. O. Box 8147 Kampala www.finance.go.ug
TABLE OF CONTENTS
ABBREVIATIONS AND ACRONYMS ...... 1
FOREWORD ...... 3
EXECUTIVE SUMMARY...... 4
CHAPTER 1: INTRODUCTION ...... 6
1.1 Background ...... 6
1.2 Rationale for the report ...... 6
1.3 Report outline ...... 7
CHAPTER 2: METHODOLOGY ...... 8
2.1 Scope of the report ...... 8
2.2 Process ...... 8
2.3 Data Collection ...... 9
2.4 Sampling ...... 9
2.5 Assessment guide ...... 9
2.6 Limitations of the report ...... 9
Chapter 3: SECTOR PERFORMANCE ...... 10
3.1 Introduction ...... 10
3.2 Financial Performance of the Health Sector ...... 10
3.3 Physical Performance of the Health Sector ...... 11 3.4 Ministry of Health (Vote 014) ...... 11
3.4.1 Uganda Health Systems Strengthening (Project 1123) ...... 11
3.4.2 Support to Mulago Hospital Rehabilitation (Project 1187) ...... 31
3.4.3 Rehabilitation and equipping of health facilities in the West (1314)...... 43
3.4.4 Construction of Specialized Neonatal and Maternal Unit in Mulago Hospital (Project 1315) ...... 45
3. 5 UGANDA CANCER INSTITUTE (VOTE 114) ...... 48
3.6 UGANDA HEART INSTITUTE (VOTE 115) ...... 52
3.6.1 Uganda Heart Institute Project (Project 1121) ...... 52
3.7 Mulago Hospital Complex (Vote 161) ...... 56
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3.8 Rehabilitation of Regional Referral Hospitals (Project 1004) ...... 59
3.8.1 Arua Regional Referral Hospital (Vote 163) ...... 60
3.8.2 Kabale Regional Referral Hospital (Vote 168) ...... 62
3.8.3 Gulu Regional Referral Hospital ...... 65
3.8.4 Moroto Regional Referral Hospital (Vote 175) ...... 66
3.8.5 Fort Portal Regional Referral Hospital (Vote: 164) ...... 68
3.8.6 Masaka Regional Referral Hospital (Vote: 169) ...... 70
3.8.7 Mbarara Regional Referral Hospital (Vote 173) ...... 72
3.9 PRIMARY HEALTH CARE (PHC) DEVELPMENT GRANT ...... 74
3.9.1 Arua District ...... 75
3.9.2 Gomba District ...... 78
3.9.3 Ibanda District ...... 78
3.9.4 Kabale District ...... 81
3.9.5 Kabarole District ...... 85
3.9.6 Katakwi District ...... 87
3.9.7 Masaka District ...... 90
3.9.8 Mbarara District ...... 93
3.9.9 Nakapiripiriti District ...... 96
3.9.10 Napak District ...... 100
3.9.11 Nebbi District ...... 104
3.9.12 Nwoya District ...... 106
3.9.13 Nakaseke district ...... 109
Analysis ...... 110
CHAPTER 4: CONCLUSIONS AND RECOMMENDATIONS ...... 112
4.1Conclusion ...... 112
4.2 Recommendations ...... 112
References ...... 113
ANNEX 1: LIST OF PERSONS INTERVIEWED ...... 114
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ABBREVIATIONS AND ACRONYMS
ADB African Development Bank AIDS Acquired Immune Deficiency Syndrome ARVS Anti-Retroviral BP Blood Pressure CATIC China National Aerial-Technology International Engineering Corporation COMPLAT China National Complete Plant DHO District Health Officer DHT'S District Health Teams ECG Electrocardiogram EmNOC Emergency Obstetric and Neonatal Care FY Financial Year GoU Government of Uganda
HC Health Centre
HIV Human Immune Virus HMIS Health Management Information System HSD Health Sub District HSS Health Strengthening Support ICT Information Communication Technology ICU Intensive Care Unit ID Infrastructure Design IFC International Fund Corporation IFMS Integrated Financial Management Services ISDB Islamic Development Bank JMS Joint Medical Stores KCCA Kampala Capital City Authority KM Kilometers MFPED Ministry of Finance Planning and Economic Development MoH Ministry of Health MoPS Ministry of Public Service MRI Magnetic Resonance Imaging NMS National Medical Stores NWSC National Water and Sewerage Corporation OPD Out Patent Department ORS Oral Rehydration Solutions PPDA Public Procurement and Disposal for Public Assets Authority Q1 Quarter One
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Q2 Quarter Two Q3 Quarter Three Q4 Quarter Four RHI Reproductive Health Items RRH Regional Referral Hospital TBAS Traditional Birth Attendants TOT Training Of Trainers US$ United States Dollar UBTS Uganda Blood Transfusion Services UCI Uganda Cancer Institute UHI Uganda Health Institute UHSSP Uganda Health Sector Strategic Plan UNBS Uganda National Bureau of Statistics UNICEF United Nations International Children Emergency Fund UNMHCP Uganda National Minimum Health Care Package VAT Value Added Tax VHTS Village Health Teams
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FOREWORD
The Health Sector is one of the National Development Plan (NDP) investment priorities that will help propel the country to upper middle income status. Government investment in this sector during FY2014/15 was aimed at reducing morbidity and mortality in order to contribute to poverty reduction, economic and social development of the people of Uganda.
During FY2014/15, 8.5% of the National Budget was allocated to this sector. This monitoring report assesses the performance of selected programmes/projects within the sector, detailing their financial and physical progress, implementation challenges and proposed actions for improvement.
I urge all institutions to follow up on the implementation issues that have been identified. Particular attention should be given to the challenges that constrain performance of the sector as a whole in order to enhance effectiveness of programme implementation.
Keith Muhakanizi Permanent Secretary and Secretary to the Treasury
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EXECUTIVE SUMMARY
The annual monitoring focused on four Ministry of Health (Vote 014) projects namely; Uganda Health Systems and Strengthening (UHSSP-Project 1123), Support to Rehabilitation of Mulago Hospital (Project 1243), Rehabilitation and equipping of health facilities in the West (1314) and construction of the Neonatal Maternal Unit (Project 1315). Other votes monitored were Mulago National Referral Hospital (Project 0392), Uganda Heart Institute (vote115), Uganda Cancer Institute (Vote 114). Seven Regional Referral Hospitals (Arua, Fort Portal, Gulu, Kabale, Masaka, Mbarara and Moroto) and Primary Health Care Development grants in 14 local governments1.
Selection of the projects and programmes was based on the significance of the budget allocation with focus on large expenditure programmes. Regional referral hospitals and districts were selected with the aim of having a regional representation. Data was collected using a number of methods including interviews with project/programme implementers and beneficiaries, reviews of secondary data sources like policy documents and observation or physical verification of outputs. Physical performance was rated using average percentage achievement of set targets during FY2013/14. The overall financial performance of the sector was derived from the average percentage payments made per vote during the financial year.
Findings The overall physical performance for projects monitored was 79% against 93.3% financial performance. Good performing projects included: Rehabilitation of Regional Referral Hospitals (Project 1004) at 92.2%, PHC development projects at 91.4%, Mulago Hospital Complex (Project 0392) 87.5%. Uganda Heart Institute Project (Project 1121) at 75%. Overall, the MoH projects monitored achieved 68.9%. (Construction of the Neonatal Maternal Unit (Project 1315) 77.5%, Uganda Health Systems Strengthening Project (UHSSP) at 70.3%. Rehabilitation and equipping of health facilities in the West (1314) at 67.5% and Support to Rehabilitation of Mulago Hospital (Project 1243) at 60.3%. ) Projects that performed averagely were Uganda Cancer Institute Project (Project 1120) with 58%, construction works at Nebbi General Hospital under the Uganda Health Systems Strengthening Project (UHSSP) achieved 65% against 83% time progress.
Challenges • There is no clear management, operational and sustainability plan on consolidation of the newly established infrastructure under the Uganda Health Systems Strengthening Project (UHSSP). Issues of staffing, medical supplies, management of utilities were still unclear to user hospitals. Deterioration in terms of cleaning and maintenance of already handed over structures in some hospitals like Nakaseke general hospital was noted. • Some of the poor quality equipment under UHSSP remained un-replaced and many were not yet withdrawn from affected health facilities. • Losses under the UHSSP and Support to Rehabilitation of Mulago project. The supplier M/s Simed International BV was declared bankrupt before delivering some equipment and withdrawing poor quality supplies made in the previous FYs. • Continued certification and payment for poor quality works in various districts visited.
1 Arua, Gomba, Ibanda, Kabale, Kabarole, Katakwi, Masaka, Mbarara, Moroto, Nakapiripirit, Nakaseke, Napak, Nebbi, Nwooya districts
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• Procurement delays still constrained achievement of set targets under a number of projects including the Uganda Cancer and Heart Institute development projects.
Recommendations • The MoH should prioritise optimal operationalization of the newly constructed infrastructure through planning for adequate provision of medical supplies, staff and the nonwage budget for operations of beneficiary hospitals. • The MoH should ensure that all poor quality equipment is withdrawn and replaced in a timely manner to facilitate provision of improved quality care in beneficiary hospitals. • The Chief Administrative Officers (CAOs) should reprimand District Engineers that certify poor quality works. • District administrations should also forward contractors that continue to do shoddy work should also be forwarded to PPDA for blacklisting. • Accounting officers that fail to commence procurement in a timely manner should be reprimanded by MFPED. • Implementing agencies should fast track procurement processes to facilitate achievement set targets in stipulated timelines.
Conclusion Overall annual sector performance was very good 79%. Over 93% of released funds was spent by entities monitored. Procurement delays affected most of the projects monitored. The sector still faced a number of challenges in terms of service delivery. These were mainly caused by lack of adequate staff, medical supplies, infrastructure and equipment among others. The sector established a number of infrastructures and procured equipment during the financial year, however, there was no clear plan regarding consolidation and effective operationalization. The MoH and all stake holders need to come up with a clear plan on consolidation of this infrastructure, effective operationalization of equipment for sustainable development and maximum gain on investments made during the financial year
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CHAPTER 1: INTRODUCTION
1.1 BACKGROUND The health sector is one of the National Development Plan (NDP) investment priorities in the medium term2. Its main goal is to reduce morbidity and mortality as a contribution to poverty reduction, economic and social development of the people of Uganda3. The health sector comprises a number of spending agencies (votes); The Ministry of Health (Vote 014) as the central agency in charge of policy analysis and formulation, strategic planning, provision of nationally coordinated services that include emergency preparedness, health research, monitoring and evaluation of the overall health sector performance. National Medical Stores (Vote 116) responsible for drug stock management. There are specialized services provided by a number of semi-autonomous institutions namely; Uganda Cancer Institute (Vote 114); Uganda Heart Institute (Vote 115); Uganda Blood Transfusion Service (Vote 151); Uganda Aids Commission (Vote 107) and Health Service Commission (Vote 134). Mulago and Butabika National Referral Hospitals (Votes 161 and 162 respectively) provide comprehensive specialist services, health research and all services of general and regional referral hospitals. A total of 14 Regional Referral Hospitals (Votes 163 – 176) offer specialized clinical services and higher level medical and surgical services4. Districts take primary responsibility for delivery of frontline healthcare services through provision of Primary Health Care (PHC). Districts are responsible, for management of human resources for district health services, general hospitals and health center’s (II, III and IV)5. There were 43 general hospitals, 182 HC IVs, 977 HCIIIs and 1,734 HCIIs by December 2013. During FY 2014/15, the sector’s key areas of focus were: • Human resource, attraction, motivation and retention of staff. • Improvement of maternal and child health services including reproductive health. • Control of HIV/AIDS, Malaria, and Tuberculosis (TB). • Improving Primary Health Care focusing on disease prevention, health promotion, and functionalizing lower level health facilities. • Reduction of referrals abroad through equipping, recruitment, staff motivation and acquisition of specialized medicines. • Enhancing blood collection under the Uganda Blood Transfusion Services. • Control/preparedness for disease outbreaks including surveillance.
1.2 RATIONALE FOR THE REPORT
The Budget Monitoring and Accountability Unit (BMAU) of Ministry of Finance, Planning and Economic Development (MFPED) was established in FY 2008/09 to track implementation of selected government projects and programmes in a number of sectors. These include; Agriculture, Infrastructure (Energy and Roads), Industrialization, Information and Communication Technologies (ICT), Social services (Education, Health and Water and Sanitation), Microfinance and Public Sector Management.
This is achieved through regular field monitoring exercises to verify receipt and application of funds by the user entities. Where applicable, beneficiaries were sampled to establish their level of satisfaction with the public service. The monitoring was confined to levels of inputs, outputs and intermediate outcomes in the health sector.
2 NDP FY 2010/11 - 2014/15 3 MoH Ministerial Policy Statement FY 2014/15 4Arua Regional Referral Hospital (RRH) Fort Portal RRH, Hoima RRH, Gulu RRH, Jinja RRH, Kabale RRH, Masaka RRH, Mbale RRH, Soroti RRH, Lira RRH, Mbarara RRH, Mubende RRH, Moroto RRH, and Naguru RRH 5 Ibid
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This report seeks to highlight performance of the health sector in achievement of annual planned outputs of selected programmes and projects during FY 2014/15. The report highlights; • Overall sector performance • Linkage between physical and financial performance through assessment of whether funds released were commensurate with outputs. • Project/programme efficiency, effectiveness and beneficiary satisfaction. • Implementation challenges • Recommendations.
1.3 REPORT OUTLINE This report is organized into four chapters. Chapter one presents the introduction, Chapter two the methodology, chapter three the sector performance, while chapter four presents the conclusions and recommendations.
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CHAPTER 2: METHODOLOGY
2.1 SCOPE OF THE REPORT The chapter presents findings of; four MoH projects, one National Referral Hospital, two specialized institutions, seven Regional Referral Hospitals and Primary Health Care grants in 14 local governments. Details are presented in Table 2.1.
Table 2.1: Projects and programmes monitored in Q4 FY 2014/15
Vote Program/Project Institution visited/location 014 MoH Uganda Health Systems MoH, Moroto RRH, Nakaseke, Mityana, Strengthening (Project 1123) Kiryandongo, Nebbi and Iganga General Hospitals Rehabilitation of Mulago Mulago Hospital/Kampala hospital (Project 1243) Rehabilitation and equipping of Kabale, Hoima and Fort Portal RRHs health facilities in the West (1314) Construction of the Neonatal Mulago Hospital/Kampala Maternal Unit (Project 1315) 114 Uganda Cancer Uganda Cancer Institute Project Mulago /Kampala Institute (UCI) (Project 1120) 115 Uganda Heart Uganda Heart Institute Project Mulago Hospital/Kampala Institute (UHI) (Project 1121) 161 Mulago Hospital Support to Mulago Hospital Mulago Hospital/Kampala Rehabilitation (Project 1187) and the development grant (Project 0392) Regional Referral Arua RRH Arua district Hospitals Fort portal RRH Kabarole district Gulu RRH Gulu district Kabale RRH Kabale district Masaka RRH Masaka district Mbarara RRH Mbarara district Moroto RRH Moroto district Vote 501-850 PHC Development Grant Arua, Gomba, Ibanda, Kabale, Kabarole, Katakwi, Masaka, Mbarara, Moroto, Nakapiripirt, Nakaseke, Napak, Nebbi, Nwooya districts Source: Author’s compilation
2.2 PROCESS Selection of the programmes/projects reviewed was based on two criteria: • Significance of the budget allocations to votes within the sector budget, with emphasis placed on programmes/projects with expenditures of over Ug shs 1billion by the end of FY 2014/15. • Programmes that submitted progress reports by the end of Quarter three in FY 2014/2015.
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2.3 DATA COLLECTION Data was collected through a combination of approaches: • Reviewed secondary data sources including: Health Sector Ministerial Policy Statement for FY 2014/2015; National and Sector Budget Framework Papers; Sector project documents and performance reports in the Output Budgeting Tool (OBT). MFPED budget documents including the Budget Speech, Public Investment Plans, Approved Estimates and data from the Budget Website was used. • Reviewed and analyzed financial data from the Integrated Financial Management System (IFMS), Legacy System and bank statements from some implementing agencies. • Conducted consultations and key informant interviews with project managers in implementing agencies both at the Central and Local Government level; • Conducted field visits to project areas and held discussions with local government officials (Chief Finance Officers, District Health Officers (DHOs) and beneficiaries. • Observation and photography were also used during the monitoring exercise.
2.4 SAMPLING The sampled outputs were purposively selected from the information provided in the Ministerial Policy Statement FY 2014/15 and progress reports under the health sector. Referral hospitals and districts were selected with the aim of representing all regions in Uganda. Physical performance of project/ program targets was assessed through monitoring a range of indicators and linking the progress to reported expenditure. The variables monitored depended on whether an output/target was complete or ongoing. For completed projects, monitoring focused on achievement of intermediate outcomes and beneficiary satisfaction.
2.5 ASSESSMENT GUIDE Performance of programs and projects monitored was rated using the guide in Table 8.2
Table 8.2: Assessment guide used to measure performance of project monitored in FY 2014/15
SCORE COMMENT 80% and above Excellent (All set targets achieved and funds well utilized) 70%-79% Very good (Most of the set targets achieved and funds absorption is 70%- 79%) 60%-69% Good (Some core set targets achieved and funds absorbed to 60%-69%) 50-59% Fair (Few targets achieved and funds absorption is 50%-59%) Less than 50% Below average (No targets achieved and funds absorption is less than 50%) Source: BMAU
2.6 LIMITATIONS OF THE REPORT • Limited financial information especially donor perfomance on some projects under MoH. • Poor road network in Karamoja sub-region constrained monitoring of some selected projects, for example Natrurum HC II in Napak district. • Incomplete information especially in cases where responsible officers were out of office hence relevant documents were not readily available.
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CHAPTER 3: SECTOR PERFORMANCE
3.1 INTRODUCTION This section presents the overall physical and financial performance of the health sector. Physical performance was measured using average achievement of set targets except the Uganda Heart Institute where weights were assigned to targets during FY2014/15. The sector financial performance was based on absorption of released funds by entities monitored during the FY.
3.2 FINANCIAL PERFORMANCE OF THE HEALTH SECTOR The approved budget for the FY 2014/15 was Ug shs 1.25 trillion inclusive of donor funding (41%) and exclusive of arrears, energy savings and non-tax adjustments. This allocation was 8.5% of the national budget. The MoH was allocated 45% of the health budget, 26% to local authorities and district hospitals, 17% for National Medical Stores; 5% for Regional Referral Hospitals, 4% for National Referral Hospitals, and 3% to other spending agencies in the sector.
The GoU revised budget for the health sector was 732 billion of which 717 billion (98%) was released and 713 billion (99%) spent by 30th June 2015. This was excellent release and expenditure performance. Details of budget performance by vote are indicated in Table 3.1 below: Table 3.1: Health Sector financial performance FY 2014/156
Vote number Vote Budget Release Expenditure
014 Ministry of Health 55,267,135,368 50,184,200,413 49,516,096,223
107 Uganda Aids Commission 7,047,968,117 6,956,759,295 6,789,304,047
114 Uganda Cancer Institute 12,155,505,913 11,648,804,796 11,124,229,950
115 Uganda Heart Institute 9,092,930,500 8,533,150,961 8,249,896,512
116 National Medical Stores 218,614,466,778 218,002,390,818 217,982,009,931
134 Health Service Commission 4,780,823,971 4,319,470,155 4,268,450,962 Uganda Blood Transfusion 151 Service 6,977,967,406 6,977,962,312 6,959,793,618
131-162 National Referral Hospitals 58,962,117,196 56,183,363,078 55,761,469,542
163-176 Regional Referral Hospitals 74,799,298,824 69,816,708,324 68,193,397,598 501-850 PHC Development 284,761,327,000 284,761,327,000 284,761,327,000
Total 732,459,541,073 717,384,137,152 713,605,975,383 Source: IFMS and Legacy System
The financial performance of entities monitored was 93% with Mulago Hospital Complex achieving 100%, Uganda Heart Institute 100%, Regional referral hospitals 97.6%, Uganda Cancer Institute 95%, Local governments-(PHC development) 85% and MoH projects 79.1%
6 Exclusive of donor component
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3.3 PHYSICAL PERFORMANCE OF THE HEALTH SECTOR The overall physical performance for projects monitored was 79% with Regional referral hospitals 92.2%, Local governments-(PHC development) 91.4%, Mulago Hospital Complex 87.5%, Uganda Heart Institute 75%, Uganda Cancer Institute 58% and MoH projects 68.1% Detailed performance of all entities visited is highlighted below:
3.4 MINISTRY OF HEALTH (VOTE 014) Four projects under vote 014 were monitored these were; Uganda Health Systems Strengthening (Project 1123), Rehabilitation of Mulago hospital (Project 1243), Rehabilitation and equipping of health facilities in the West (1314) and Construction of the Neonatal Maternal Unit (1315). The following was established:
3.4.1 Uganda Health Systems Strengthening (Project 1123) Background The Uganda Health Systems Strengthening (UHSSP) project commenced on 25th May 2010 and was expected to end on 31st July 2015. However, the project was extended by two years (up to 2017) to facilitate completion of ongoing works. It is aimed at reducing maternal mortality through renovation and infrastructure development of health facilities in Uganda. It is set to achieve the following objectives;
i) Strengthen human resource management and development. ii) Enhance physical functionality of health facilities by renovating health infrastructure and provision of medical equipment. iii) Strengthen provision of reproductive health services to reduce maternal and pre-natal death through provision of Emergency Obstetric and New-born Care (EmNOC) equipment. iv) Strengthen the leadership and management of the health sector through training, performance, contracting, and client charters among others.
The project is financed by a World Bank loan worth US$130 million. It was expected to benefit two Regional Referral Hospitals (Mubende and Moroto RRHs), 17 General Hospitals and 27 Health Centre IVs. However, funds for civil works were insufficient thus the number of beneficiary general hospitals was scaled down to only eight while RRHs were reduced to one. These are; Anaka, Iganga, Entebbe, Nakaseke, Mityana, Nebbi, Moyo, Kiryandongo general hospitals and Moroto RRHs,
The HC IVs are Kasanda, Kiganda, Ngoma, Mwera, Kyantungo, Kikamulo, Kabuyanda, Mwizi, Kitwe, Rubare, Aboke, Aduku, Bwijanga, Bullisa, Padibe, Atyak, Obongi, Pakwach, Buvuma, Budondo, Ntenjeru- Kojja, Buyinja, Nankoma, Bugono, Kiyunga, Kibuku and Budaka.
The project has four components namely; (a) Improved infrastructure of existing health facilities: allocated US$85 million (US$ 61million for civil works and US$ 24 million for medical equipment and furniture). Improved maternal health, new-born care, and family planning services allocated US$30 million. (b) Improved management, leadership, and accountability for health service delivery allocated US$10 million. (c) Improved health workforce development and management allocated US$5 million.
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Expected outputs by June 2015 • Physical functionality of health facilities enhanced by renovation of health facilities. • Leadership and management strengthened in areas of logistics, procurement, contracting, health communication and feedback management, accreditation of health facilities and training managers of health facilities. • Systems for human resource development and management strengthened through offering scholarships to health workers and support to professional councils.
Planned outputs for FY 2014/15 • A total of 19 ambulances procured and distributed to 19 hospitals. • Construction works at the nine beneficiary health facilities monitored. • Scholarships to health workers from hard to reach areas pursuing specialised courses awarded. • Family planning supplies including mama kits procured. • Village Health Teams (VHTs) supported to register mothers. • Leadership and Management (a hospital accreditation developed and piloted, communication strategy developed, prescription habits study conducted, health sub district concept, business plans for professional councils developed and supply chain management for medicines improved). • Construction works for nine hospitals undertaken. • Another 13 hospitals7 and 27 HC IVs scheduled for rehabilitation.
Financial Performance Cumulatively, the World Bank disbursed US$ 96,034,604.46 (74%) of the signed loan amount of US$130 million. By 30th June 2015, a total of US$ 71,374,768.18 (74.3%) was spent. Expenditures were mainly on health infrastructure components (68%), reproductive health (18%), project management (7%), human resource development and management (4.3%), Leadership and Management (2%). During FY 2014/15, a total of US$ 25,578,458.64 (27%) was disbursed. The project had a balance of US$ 27,855,354 carried forward from FY 2013/14 hence US$ 53,433,812.64 was available for expenditure. A total of US$ 28,441,938.72 (53% of the available fund) was spent.
Expenditure were made on; health infrastructure (79%), reproductive health (10.5%), project management (5.1%), human resource development and management (4%), Leadership and Management (0.83%).
The GoU approved budget for recurrent expenditures FY 2014/15 was Ug shs 550 million; of which Ug shs 382 million (70%) was released and spent. Expenditures were mainly on fuel and lubricants, allowances 16%, Travel in land 16%, staff training 15%, maintenance of vehicles 13%, travel abroad 8%, books, periodicals and newspapers at 2%.8
Physical performance The project achieved 70.3% of its annual targets. Construction works were on going while other activities including procurement of ambulances were achieved. Table 3.2 shows detailed project physical performance as at 30th June 2015.
7Pallisa, Kitgum, Apac, Bugiri, Abim, Atutur, Kitagata, Masindi, Buwenge, Bukwo, Itojo, Mubende and Moroto Hospitals. 8 IFMS
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Table 3.2: Overall physical performance of UHSSP June 2015 Target Performance Remarks
19 Ambulances procured Achieved These were procured and distributed to 19 beneficiary hospitals on 4th and distributed to 19 May 2015. Beneficiary hospitals were Mubende RRH, Moroto RRH, hospitals. Kiryandongo, Entebbe, Masindi, Lyantonde, Nakaseke, Mityana, Buwenge, Apac, Kitgum, Anaka, Moyo, Itojo, Nebbi, Bukwo, Pallisa, Bugiri and Iganga general hospitals.
These were given to improve referral processes, handle accident and emergencies in a timely and efficient manner at beneficiary hospitals. They were procured at a total of US$ 1.045 million out of US$ 1.528 million budgeted. MoH sought guidance from the World Bank on the utilization of the balances.
Construction works at 9 Achieved The civil works were closely monitored on a daily basis by the Clerk of beneficiary health facilities Works appointed by MoH and those appointed by the consultant monitored (Arch Design or ID Forum).
Monthly site visits were conducted by MoH staff and engineers. Other stake holders involved in the monitoring were; district technical and political officials as well as the administration of beneficiary hospitals.
Scholarships awarded to Achieved 65 scholarships were awarded during FY 2014/15. Over 750 health workers from hard scholarships were awarded during the two previous FYs. to reach areas pursuing specialized courses.
Procuring family planning Partially NMS was mandated to procure family planning supplies including supplies and mama kits Achieved gloves, contraceptives, implants and delivery kits for health facilities. (50%) However, this was limited to only government health facilities leaving out the private sector which was also in dire need of these products.
As a result, NMS could not absorb all the funds allocated to this activity. It absorbed only US$ 6.7million instead of the allocated US$ 13.8 million.
Efforts to involve the Uganda Health Marketing Group (UHMG) to reach out to the private sector under the guidance of MoH were finalized while supply of other products like Jadel were expected to be completed by February 2016.
Supporting Village Health Achieved Procured and distributed 17,925 registers to villages in sub counties Teams (VHTs) to register with registered VHTs. However, there more than 55,000 villages in mothers Uganda. This means that the intervention covered a third of the villages in Uganda9.
The registers were not translated in the different local languages making it difficult for VHTs to fully comprehend. However; they had pictorial guidance for further emphasis on specified issues.
In terms of maternal and child health services, beneficiary VHTs were expected to register and follow up pregnant mothers, emphasize deliveries in health facilities, educate them about danger signs and immunization of children.
Plans were underway to procure more registers.
9 Villages with registered VHTs were considered.
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Target Performance Remarks
Leadership and Achieved Hospital accreditation; strategies and tools to accredit hospitals and Management (a hospital health centers were finalized. Business plans for professional councils accreditation and completed and finalized. communication strategy developed. Health sub Communication Strategy was developed and expected to be district concept, business implemented by MoH. plans for professional councils and improved Improved supply chain management for medicines was enhanced supply chain management through procuring two trucks for NMS in order to enhance delivery of for medicines developed). medical supplies to beneficiary health facilities.
Construction works for Partially Six out of nine hospitals were visited and works were ongoing. nine hospitals undertaken. achieved Progress ranged from 65% in Nebbi to 95% in Nakaseke. Average (83%) physical performance was 83%. The quality of works in hospitals visited was observed to be good.
Another 13 hospitals Not achieved The World Bank did not approve additional funding of US$ 90million scheduled for expected facilitate construction of these hospitals. The MoH was in rehabilitation. the process of seeking alternative sources of funding. Negotiations with the Islamic Development Bank (IsDB) for possible funding were underway.
27 HC IVs scheduled for Not achieved Contracts for 26 HCs were awarded in three lots and sites handed rehabilitation over to the contractors in June 2015. Civil works were expected to be completed by June 2016.
All the works in the three lots will cost a total of US$ 13,022,517.66. Lot one and two were awarded to M/s Excel Construction Limited at a contract sum of US$ 9,597,779.89. Nineteen health centers will be rehabilitated; Kitwe, Rubare, Kabuyanda, Mwizi, Kasanda, Kiganda, Mwera, Kyatunga, Kikamulo, Ngoma, Buvuma, Budondo, Ntenjeru Kojja, Buyinja, Nankoma, Bugono, Kiyunga, Budaka and Kibuku.
Lot 3 was awarded to M/s Amugoli General Enterprises Limited at US$ 3,424,737.77 to rehabilitate seven HCs. These are; Bwijanga, Aduku, Aboke, Pakwach, Atiak, Padibe and Obongi.
The number dropped from 27 to 26 HCIVs because Tullow Uganda agreed to rehabilitate Bulliisa HC IV.
Source: MoH and Field findings
Replacement of substandard equipment: In July 2015, substandard equipment including beds was withdrawn from some health facilities. All withdrawn equipment had not been replaced and the contractor was not clear on replacement dates. For example in Mityana hospital, nine items delivered by Sino Africa were rejected and withdrawn on 29th July 2015. These were filing cabinets, steel cupboards, patient trolleys, instrument cupboards, examination couches, beds, instrument trolleys, patient screens and bowel stands were rejected.
Quality of health service delivery had heavily deteriorated, inpatients were sleeping on the floor hence clinicians complained of the difficulty to provide treatment using Intravenous (IV) fluids. Patients also complained of body and back pain due to sleeping on the floor.
It was also noted that one of the suppliers (Simed International BV) was declared bankrupt yet he outstanding deliveries and had not also withdrawn some of the substandard equipment from various health facilities. Substandard equipment was worth US$ 400,000 while outstanding
14 | HEALTH SECTOR ANNUAL MONITORING REPORT FINANCIAL YEAR 2014/15 deliveries were up to US$ 950,000. The Solicitor General advised MoH to recover the funds lost through cashing the security bond and initiate a new procurement for the outstanding equipment.
Field Findings
Six out of nine beneficiary hospitals were visited to assess level of implementation progress. The following was established:
1) IGANGA GENERAL HOSPITAL
It is located along Kampala-Tororo highway and was constructed in 1968. It is a 100-bed district hospital serving a population of 1.5 million people in the surrounding districts of Iganga, Bugiri, Namutumba, Kaliro, Jinja and Mayuge among others. It offers in and outpatient services as well as specialist clinics.
The project was introduced to the hospital in 2013. Hospital Administration was extremely happy with the project. They noted that a face lift to the hospital had led to increased number of patients in expectation of better services. The contract details and a summary of progress are presented in Table 3.3;
Table 3.3: Contract details and progress of civil works of the UHSSP at Iganga Hospital by 29th July 2015 Contractor China National Aero-Technology International Engineering Corporation (CATIC) Contract Sum 4,933,884.78 (US$) Contract period 18 months Commencement date 31st January 2014 Original completion date 31st July 2015 Revised completion date 20th December 2015 Physical progress 91% Financial progress 2,860,032.64(57.97%) Time progress 99% Scope of Works • Remodelling and refurbishment of the OPD • Construction of OPD extension • Remodelling of Maternity ward to enlarge labour suites • Construction of new theatre with two operating rooms • Construction of four unit-two bedroom staff houses • Construction of attendants kitchen and laundry • Construction of new mortuary with nine body fridge • Construction of placenta pit and medical pit • Upgrading water supply including 144,000 reservoir and boreholes with solar water pumps • Construction of new sewage lagoons and upgrading network. Consultant Arch Design Source: MoH, contractor, consultants and field findings
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Physical progress was estimated at 91% against the planned target of 99%. The contractor was behind schedule by 8%. Delays were attributed to lack of space to shift the patients to allow refurbishment and remodelling works. The majority of new works were at substantial completion. Table 3.4 indicates detailed physical progress by scoped items.
Table 3.4: Implementation status of the UHSSP at Iganga Hospital as at 29thJuly 2015 Item Physical Progress Remarks/ Outstanding works New Infrastructure Theatre 99% Handed over and not yet in use on 28th July 2015 Causality ward 99% Labelling of offices, consultation rooms was ongoing. It was ready for use. OPD 98% Minor plumbing finishes were pending
Staff houses 100 Handed over to the hospital, not yet in use. Placenta pit 100% Handed over to the hospital and in use Medical pit 100% Handed over to the hospital, not in use due to pending installation works of the incinerator
Kitchen and attendant 100% Handed over to the hospital and in use. laundry
Generator house 100% Handed over to the hospital and in use.
Mortuary 97% The mortuary fridge was not yet installed. It had however been shipped to Uganda by the supplier. Mechanical works 75% Drilling and piping complete however, installation of the tank was outstanding
Renovation Works and scope involved scrapping off old plaster, roofing, plastering, painting, splash apron and floor works (Terrazzo), new toilet system Existing OPD 10% Delays in handing over facility to the contractor due to lack of space to relocate patients. Antenatal and Maternity 75% Awaiting completion of painting, fitting, glassing, Block terrazzo grinding, and floor hacking. Rehabilitation of the lagoon - No major works were done because the proposed lagoon belonged to National Water Sewerage Corporation (NWSC) instead of the hospital as earlier envisaged. However, man holes connecting the hospital to the lagoon were rehabilitated. External works 80% Original works complete, pending works were new, these were; construction walkways, rehabilitating the existing trenches and fencing of the hospital. Source: Field findings and CATIC report
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New Theatre (left) and Casualty unit (right) substantially complete at Iganga Hospital
Left: Ongoing extension works on the maternity ward. Right: Floor works in the maternity ward at Iganga Hospital
2) KIRYANDONGO GENERAL HOSPITAL Kiryandongo Hospital is located 225km along the Kampala - Gulu Highway. The hospital is in Kikube parish, Kiryandongo sub-county, Kibanda County in Kiryandongo district. It is a 109 bed hospital serving a population of over 400,000 people from areas of Kiryandongo, Masindi, Nakasongola, Oyam, Apac, Amuru, and Nwoya districts. The hospital offers a number of services including OPD, in patient, ophthalmology, X-ray, ultra sound, orthopedics’, health promotion and education, occupational therapy, HIV, immunization, environmental health special clinics among others. Implementation of the UHSSP project at the hospital started in 2013. The contract details and a summary of progress are shown in Table 3.5
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Table 3.5: Contract details and progress of civil works of the UHSSP at Kiryandongo Hospital by 30th June 2015
Contractor China National Complete Plant (COMPANT) Contract Sum US$5,654,229.90 (Exclusive of VAT) Contract period 18 months Commencement date 2nd February 2014 Original completion date 31st July 2015 Revised completion date 20th December 2015 Physical progress 77% Financial progress US$3,765,717 (66.6%) Time progress 94% Scope of works • Construction of the OPD, causality, laundry houses, attendant’s kitchen, incinerator house, placenta and medical pit and extension of the T-block. • Renovation of the old OPD, old T-block and staff houses (12 units).This included replacement of the old roof, re –enforcement with steel structure and suspended ceiling, Internal and external painting, electrical and plumbing works, replacement of glasses in the windows and doors, old 50 KVA transformer with a capacity 500 KVA transformer. • Upgrading water supply including 144,000 reservoir and boreholes with solar water pumps. Consultant Infrastructure Design (ID) Forum Source: Field findings, Kiryandongo hospital The hospital achieved 77% against 94% time progress. Some infrastructure had been handed over to the hospital while the rest was at substantial completion. Table 3.6 indicates detailed physical progress by scope.
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Table 3.6: Implementation status of the UHSSP at Kiryandongo General Hospital as at the end of July 2015 Physical Item progress Outstanding works and remarks Fixing of the cement sand barium sulphate, wall plastering and the lead lined door for the X-ray room, internal wall painting, fixing the electrical and mechanical fitting, and polishing of the terrazzo were outstanding. Although, The facility was not yet complete, it New Outpatient had been handed over to the hospital for use to pave way for the department 95% renovation works at the old OPD. Terrazo polishing completed and ongoing in the theatre. Some New causality 99% internal finishes were outstanding. Facility completed and handed over to the hospital on 29th may Attendants Kitchen 100% 2015. Facility completed and handed over to the hospital on 10th New Incinerator 100% February 2015. Facility completed and handed over to the hospital on 10th Medical waste pit 100% February 2015. Facility completed and handed over to the hospital on 10th Placenta pit 100% February 2015. Attendants laundry Facility completed and handed over to the hospital on 29th May block 100% 2015. Drilling the last of the three boreholes, fixing the water pump to Electrical-mechanical the boreholes, site lights and sewage line to the lagoon were works 95% outstanding. Fixing of the paving blocks in the parking areas ongoing, External works 45% construction of access roads and landscaping were outstanding. Refurbishments Completion of demolitions, concrete block walling, fixing the galvanized roofing sheets, window glass glazing, fixing window and door frame, internal and external plastering, electrical, mechanical works, ceiling, wall and floor finishing, painting, timber Existing OPD 20% and joinery fittings were outstanding. Walling of the concrete block and internal plastering were completed. Ongoing works included; Window and door glassing, fixing of steel window and door frames, timber doors. Pending T-block extension and works included; wall tile fixing, completion of terrazzo floor refurbishments 80% finishes, electrical, mechanical fixing, fittings and joinery paintings Existing two six unit Fixing of electrical fittings was ongoing, timber and joinery, and staff house 95% paintingongoing. Generator house 98% Fixing of electrical fittings and painting were outstanding. Source: Field findings Kiryandongo Hospital
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New OPD at substantial completion and ongoing refurbishment works at the old OPD at Kiryandongo Hospital
Left: New Casualty substantially completed and right: the renovated staff quarters Kiryandongo Hospital
3) MITYANA GENERAL HOSPITAL The hospital is located 77km away from Kampala City in Mityana district. It is the main health care facility in the district serving over 600,000 people in Mityana, Mpigi, Kiboga, and Gomba districts. It is a 100 bed capacity hospital. The monitoring team visited the project on 30th July, 2015, and established the following; The UHSSP project commenced on 24th February 2014 and expected to be completed by 2th July 2015, contract details and a summary of progress are indicated in table 3.7; Table 3.7: A summary of contract details and progress of works of UHSSP civil works at Mityana General Hospital by 30thJuly 2015 Contractor Sino Hydro Corporation Ltd Contract Sum 6,090,929.55 (US$) Contract period 18 months Commencement date 24th February 2014 Original completion date 24th August 2015 Revised completion date 20th December 2015 Physical progress 85% Financial progress US$ 3965219.87 (65%) Time progress 95% Scope of Works Construction of new Out Patient Department (OPD), Causality unit, female and maternity wards, theatre, mortuary, six unit staff accommodation, placenta and medical pit, attendants kitchen and laundry. Electricity, water and sewerage improvement works, external works including construction of walk ways and compound works among others. Consultant Arch Design Source: Field findings, Mityana Hospital
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Physical progress was estimated at 85% against 95% time progress. Some works were completed including the placenta and medical pit, kitchen, laundry and staff house. Other activities were still on-going as indicated in Table 3.8.
Table 3.8: Implementation status of the UHSSP at Mityana General Hospital by 30th July 2015 Item Physical Progress Remarks/ Outstanding works T-block accommodating 80% Painting, fixing sinks, plumbing works, terrazzo wards, theatre and mortuary gridding in the theatre, electrical and mechanical works, glassing, inside doors, plastering, fittings and other internal finishes were ongoing. OPD/Causality ward 95% Major structure works complete. Outstanding works include; fixing of lights, completion of painting, and grinding of terrazzo. Staff houses 100%. Completed but not yet in use due to accessibility issues. It is located in a place where other works were still ongoing. Placenta pit 100% Handed over to hospital and in use. Medical pit 100% Handed over to hospital. Generator house 100% Handed over to hospital. Kitchen and attendant 100% Handed over to the hospital but not yet in use due laundry to accessibility issues. Elevated water tank 100% Completed but not yet in use. It was awaiting installation of a pump to facilitate pumping water from the underground water tank to the elevated tank. 400m3underground water 100% Construction and pipe work done. Pending works tank, included; installation of a pump. This activity was noted to be part of additional works since the geological survey indicated that boreholes earlier planned were not suitable for the geological area. External works 30% Outstanding works include; fencing, road works, landscaping, and construction of driveways and walk ways. Source: Field findings
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Completed staff house and underground water tank at Mityana Hospital
Left: Aerial view of the OPD and T-Block and right: Front view of the OPD Mityana Hospital
Implementation challenge • Delays by the contractor were attributed to design changes led to increased volume of works. 4) MOROTO REGIONAL REFERRAL HOSPITAL The hospital was constructed in 1940s; it is located in Moroto Municipality. It serves the seven districts of Karamoja sub region. These are Moroto, Napak, Nakapipirit, Kaboong, Kotido, Abim and Amudat. The 320 bed capacity hospital was elevated to a regional referral hospital status on 1st July 2009. The UHSSP project was introduced to the hospital in 2013 and works commenced in December 2013. They were supervised by M/s Arch Design Limited. Table 3.9 indicates a summary of contract details and progress of works at Moroto hospital.
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Table 3.9: Summary of contract details and progress of works of the UHSSP at Moroto RRH by 25th June 2015 Contractor M/s Excel construction Company limited Contract Sum US$8,842,878.01 Contract period 18 months Commencement date 19th December 2013 Expected Completion date July 19th 2015
Revised completion date Not yet granted. The contractor requested for three months time extension Physical Progress 89.02% Financial Progress US$5,095,209 (58%) paid to the contractor Time Progress 94% Scope of Works Construction of the OPD/Casualty, Generator house, Placenta pit, Construction of twelve two bed room staff house and three-bedroom staff houses, Power supply, medical waste pit, attendants' kitchen and attendants' laundry , two septic tanks, water tank 144,000 liters and three bore holes. Source: Field findings, Arch Design
Some works including the staff houses, placenta pit and medical pit were completed and handed over to the hospital. Detailed physical progress of project is summarized in table 3.10 Table 3.10: Implementation status of the UHSSP at Moroto RRH by July 2015 Physical Item progress Outstanding works and remarks
Completion of; plastering, shuttering, roofing, flooring, mechanical fittings, all finishes, and external works, Outpatient department 83% painting; second and third terrazzo grinding. Three two bed room staff houses 100% Completed and handed over in March 2015
Four three bedroom staff houses 100% Completed and handed over in March 2015 Power House 100% Completed and handed over in May 2015. One bore hole was completed in March. Pipe work was completed for the electrical and solar bore holes. Drilling of three bore holes 100% Installation of pumps was not yet done.
Construction of two septic tanks 100% Completed in March and June 2015 respectively. Placenta pit and medical waste pit 100% Complete and handed over in December 2014.
Elevated water tank 100% Completed
Gate House 50% Form work for the column and walling were outstanding. External reticulations and clearance of the site were External works and walk ways 85.5% outstanding. Source: field findings and Arch Design, Moroto Hospital
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The overall physical progress was 89.02% against the 94.80% time progress as at 25th June 2015. Delays resulted from weak soils at the OPD required mass excavation of the foundation, compaction of up to four meters instead of the one and half meters initially planned. Delays were also attributed to the poor road infrastructure which affected timely delivery of construction materials.
Left: OPD under construction. Right: Internal finishes in the OPD Moroto Hospital
Left: One of the completed septic tanks Right: Ongoing external works at Moroto Hospital
Implementation challenges • Delays in project commencement (by two months) because the consultant had not reported to site. • Poor soil texture delayed progress of works at the OPD. • Poor roads hence delays in delivery of construction materials. • Lack of land on which to construct the lagoon. This led to design changes from a lagoon to construction of two septic tanks. • Unavailability of the construction materials within the project area delayed implementation of the planned activities.
5) NAKASEKE GENERAL HOSPITAL
The hospital is located 65Km away from Kampala city in Nakaseke District. It is the main health care facility in Nakaseke district serving over 200,000 people in Nakaseke, parts of neighbouring Luweero, Nakasongola and Wakiso districts among others. The 100 bed capacity hospital was built in the 1970s. Civil works commenced on 31st January 2014 and were expected to be completed by 31st July 2015. A summary of contract details and progress of the project are indicated in table 3.11;
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Table 3.11: Contract details of civil works for the UHSSP at Nakaseke General Hospital by 23rd July 2014 Contractor Yanjian Uganda Company Ltd Contract Sum US$ 5,090,612.33 Contract period 18 months Original Commencement date 21st December 2013 Revised commencement date 31st January 2014 Original completion date 30thJune 2015 Revised Completion date 31st July 2015 Physical progress 95% Financial progress US$ 4,659,671.99 (91%) Time progress 98% Scope of Works • Construction of new OPD • Construction of causality block • Construction of attendants kitchen and laundry • Construction of placenta pit and medical pit • Remodelling and refurbishment of the T-block (Theatre, labour suit, private wards and mortuary) • Refurbishment of the two staff houses • Upgrading water supply including 144,000 reservoir and boreholes with solar water pumps • External works involving construction of walk ways, compound access roads, fencing, clearing and landscaping, earth works and embankments, drainage works among others. Consultant Arch Design Source: Yanjian Uganda and field findings
Physical progress was estimated at 95% against 99% time progress. Delays were due to design changes, unavailability of construction materials on the local market and absence of the as built drawings for the existing structures. The contractor requested for a 90 days extension to complete outstanding works. Detailed implementation status is indicated in Table 3.12.
Table 3.12: Implementation status of the UHSSP at Nakaseke General Hospital by 23rd July 2015 Item Overall physical Remarks/ Outstanding works Progress Construction of new OPD 100% Handed over to the hospital and in use. Construction of Causality 100% Handed over to the hospital but not yet in use due ward to other on-going works surrounding the infrastructure. Attendants Kitchen 100% Handed over to the hospital and in use. Attendants Laundry 100% Handed over to the hospital and in use Placenta pit 100% Handed over to the hospital and is in use Medical pit 100% Handed over to the hospital and in use Refurbishment and expansion works T-block 85% Block work, plastering, painting, shuttering, electrical mechanical works and other internal finishes were ongoing. Existing OPD 90% Completion of painting, plumbing and some internal
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finishes was ongoing Staff houses 100% The two six unit staff houses were refurbished. 144m3litre tank 0% This was not constructed because the existing water tank was sufficient for the hospital as agreed by stakeholders. Generator house 100% Handed over to the hospital External works 80% All external works around the T-block had not started. Source: Yanjian Uganda Company Ltd and field findings
New OPD and Casualty unit completed at Nakaseke General Hospital
Left: Ongoing refurbishment works at the T-block. Right: Completed female ward in use at Nakaseke Hospital
6) NEBBI GENERAL HOSPITAL
The hospital is located in Nebbi Town Council, 423 Km from Kampala Capital City. It is a 108 bed capacity hospital serving a population of over 200,000 people from the West Nile sub region. The district hospital was built in the 1973s. The project was introduced in 2013 and civil works commenced in the same year. Table 3.13 indicates a summary of contract details and progress of works at Nebbi General Hospital. Table 3.13: Contract details of civil works for the UHSSP at Nebbi General Hospital by 2ndJuly 2014 Contractor China Railway No.5 Engineering Group Ltd Contract sum US$ 3,876,045.19 Contract period 18 months Commencement date 24th February 2014 Completion date 31st August 2015
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Revised Completion date 20th December 2015.
Overall physical progress 65% Financial progress US$1,386,970 (35.78%) Time progress 89% Scope of works: Construction of new OPD, causality unit, attendants’ kitchen, attendants’ laundry, Placenta pit and medical waste pits. Refurbishment of the T-Block, OPD, two staff houses type B3, generator house and the lagoon. Source: MoH, Nebbi Hospital
Physical progress was estimated at 65% against 89% time progress. Completed works included the placenta and medical pit, kitchen and laundry. Other activities were at substantial completion as indicated in Table 3.14.
Table 3.14: Implementation status of the UHSSP at Nebbi General Hospital as at 2nd July 2015 Item Physical Scope of works Outstanding works / remarks progress New OPD 87% New OPD Fixing gutters, door shutters and window constructed with the glasses, terrazzo laying and grinding, worktop necessary clinical construction, internal and external painting, rooms. waste drainage works, fabrication and installation of metallic shelves in stores and record rooms, carpentry and joinery works were pending.
Casualty block 90% Casualty unit with Pending works included; fixing gutters, ceiling theatres and door shutters, internal and external painting, relaying the terrazzo in the theatre floor and new terrazzo on walls. Fabrication and installation of eaves structures, carpentry and joinery works, retaining wall construction, storm water channel construction, rain harvest and elevated tank construction, additional floor traps, fabrication and modification of windows in structures. Waste water drainage works, worktop construction, fabrication and installation of metallic shelves in stores and record rooms were pending T-Block 62% Extension and Completed works included; roofing, ceiling extension refurbishment of the works on new block, walling, plastering works, wards there in. window and door frame fixing, and ramp construction. Pending works included; completion of roofing, ceiling on the old structure and refurbishment works in the male ward and existing theatre. Door frame fabrication and fixing, electrical and mechanical installation. Block walling demolition of the theatre and mortuary were also outstanding.
Attendants 98% New attendant Electrical installations and external works were kitchen kitchen outstanding. Attendants 98% New attendant Connection of the laundry to sewerage line, laundry Laundry external works were outstanding. Placenta pit 100% New placenta pit Completed
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Item Physical Scope of works Outstanding works / remarks progress Medical waste 100% New medical waste Completed pit pit Refurbishment 92% Refurbishment Outstanding works included fixing of door of Staff houses including; plumbing, shutter, internal and external painting, electrical, painting, carpentry and joinery works, mechanical replacement of installations, rain water harvest tank doors and windows. construction. Improvement of the Elevated tank fabrication and installation, gutter roof structure, repair fixing, splash apron, walkways and storm water of walls, new ceiling, construction, electrical and sanitary fitting new roof; new war installation. drops, shelves, cabinet and sink
Old OPD 0% Refurbishment Not started, works were awaiting completion of works the new OPD to allow shifting and accommodation of patients. Generator 90% Replacement of the Internal and external painting, storm water house doors, re-roofing, channel construction, gutter fixing, roof enhancement of the structure painting, and installation of a new roof structure, major generator were outstanding. repairs on the walls, and splash apron. External works 2% All external works in Major works to begin after completion of the the hospital and drainage works. around the refurbished staff houses Electrical works 48% Installation of 52% of the works were pending. electrical works Mechanical 63% All mechanical 37% of the works were outstanding. works works for the new structures and refurbished structures Lagoon Refurbishment Laying clay in ponds, storm water channel construction, outfall line construction and filings to make levels as instructed, and construction of manhole outstanding. Source: Nebbi Hospital
Left: New OPD and New Casualty under construction on the right at Nebbi Hospital
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Refurbishment of staff houses and ongoing works at the T-block, Nebbi Hospital
Implementation challenges
• Delays in approval of variations as a result of designs changes; it took an average four months for variations to be approved by the consultant and MoH. • Weak soils that required deeper excavation from the original one meter depth to two meters with back filling and compaction. This delayed project implementation at the OPD and casualty. • Presence of rocks required geological technical tests and surveys to be done. This had not been anticipated hence affected progress of civil works at the T-block.
Gender and Equity issues
The project is aimed at reduction of maternal mortality through renovation and infrastructure development of health facilities, support to reproductive health services through provision of EmNOC equipment, human resource management and development through training of health workers.
In terms of civil works, the project hired more male than female workers on all construction sites visited; this was attributed to the labour intensive nature of the work involved during construction. Most of the female except for Mityana Hospital10 site were involved in casual labour.
In terms of equity, the project generally benefited the eastern, central and northern regions of Uganda. The western region did not benefit much from this project because there was a Japan International Cooperation Agency (JICA) project that was implemented in the same region. Beneficiary hospitals included Kabale, Fort portal and Hoima RRHs.
10 A female clerk of works was employed by MoH in Mityana.
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Intermediate project outcomes (May 2010- June 2015) The project was expected to end on 30th June 2015 and the following intermediate outcomes were noted:
• Improved response to maternal and child issues especially in hospitals that received specialised equipment, family planning supplies including contraceptives, implants and delivery kits by NMS. • Improved service delivery at beneficiary hospitals due to training and provision of equipment. In Mityana hospital, the ambulance received had greatly contributed to saving lives. A minimum of three patients were picked up daily by the ambulance for emergency medical attention.
• Facelift to the nine hospitals benefiting from civil works. The intervention had led to influx of patients hoping for better health care compared to none beneficiary health facilities. Hospitals like Mityana introduced new clinics.
• Motivation of health workers due to refurbished staff houses as well as availability of necessary equipment.
• Capacity development of beneficiary health workers led to improved patient care in beneficiary health facilities. Health workers in Kiryandongo hospital noted that they had been trained on use of some equipment like incubators for premature babies.
Source: MoH
Analysis Link between financial and physical progress There was a good link between physical and financial progress with 79% of the donor disbursement spent on components like Health Infrastructure, Support to Reproductive Health through supply of family planning supplies by National Medical Stores and capacity building activities through training of health workers in hard to reach areas of Uganda.
Achievement of set targets Average physical progress of the project was 70.4% of the set targets. Although, the project was expected to end in June 2015, a number of construction works had not been completed, others had just been awarded while procurement of some equipment and family planning supplies was ongoing.
Comparative analysis Works at all health facilities visited were of good quality and beneficiaries were optimistic that the investment would greatly improve service delivery. All works were behind schedule. Works at Nebbi hospital performed poorly at only 65% against 89% time progress. Nakaseke performed best at 95% against 99% time progress. The World Bank and MoH extended the completion dates for civil works to 20th December 2015 to enable all contractors’ complete outstanding works.
Sustainability issues
There was no clear sustainability plan and consolidation of the new developments. Some of the new infrastructure handed over to hospitals was already deteriorating due to limited capacity to maintain, clean and operate it. The staff (both support staff and health workers) were overwhelmed with work and while others threatened to resign at some health facilities like Iganga Hospital. Issues of increased utility bills, lack of staff to attend to increased patients, limited medical supplies were noted in all of the beneficiary health facilities visited.
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Implementation challenges • Lengthy procurement processes delayed achievement of set targets especially civil works, procurement, distribution of equipment and family planning supplies. • Failure to withdraw some of the poor quality equipment from beneficiary health facilities. • Lack of funds to undertake construction works in the 13 hospitals.
Emerging Issues
• Financial losses on both poor and unsupplied equipment by Simed International BV.
Conclusion The project did not achieve its set targets by the end of project phase. Expected outputs for civil, works, procurement of family planning supplies and equipment had not been achieved. However there is evidence on ground that the intervention is improving service delivery. The project was extended for more two years (2017) to facilitate completion of outstanding works.
Recommendations • The MoH should fast track all ongoing procurements to avoid further delays and project extensions. • The MoH should undertake a thorough due diligence on suppliers of all equipment to avoid future losses resulting from financial incapacities of selected suppliers. • The MoH should develop sustainability and management plans for the completed infrastructure and equipment supplied. • The MoH should ensure that suppliers withdraw and replace all poor quality equipment. • The MFPED should fast track negotiations with development partners (IsDB) regarding additional funds for construction of the 13 hospitals.
3.4.2 Support to Mulago Hospital Rehabilitation (Project 1187)
Background The project also referred to Improvement of Health Service Delivery in Mulago Hospital and City of Kampala Project (MKCCAP) is aimed at improving health services at Mulago Hospital, the referral and counter referral system. The excess demand for services and overcrowding of facilities at Mulago hospital necessitated creation of new facilities serving Kampala area, remodeling and rehabilitation of Mulago existing facilities. This was also done to precipitate the functioning of the hospital to provide super specialized services for a national referral hospital. The project total loan is US$ 86 million of which US$ 71.3 million (82%) is from African Development Bank (ADB) and US$ 15.5 million (17%) by Nigerian Trust Fund (NTF)11. The project commenced in January 2012 and was expected to be completed in June 2015. The project is premised on three components. These include: • Component one: Capacity development and systems strengthening. • Component two: Revitalizing referral and counter-referral systems. • Component three: Expanding and improving specialized health services in Kampala City.
11 Changes in foreign exchange rates reduced the loan amount from US$ 86 million to 79 million by July 29th 2015.
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Expected out puts by June 2015 • Master plan for Mulago Hospital. • Health workers trained. • Ambulance management system. • Kawempe and Kiruddu hospitals and lower Mulago constructed.
Planned outputs for FY 2014/15 • Health workers trained. • Services for the management for the ambulance system procured. • Construction of Kawempe, Kiruddu and rehabilitation of Lower Mulago Hospital under taken. • Supervision for lower Mulago, Kawempe and Kiruddu hospitalsunder taken. • Purchase of one project vehicleundertaken.
Financial Performance The total project approved budget for FY 2014/15 was Ug shs 56,680,000,000 of which Ug shs 850,000,000 (1%) was GoU funded and Ug shs 55,830,000,000 (99%) was financed by development partners; African Development Bank (ADB) and Nigerian Trust Fund (NTF). The GoU released 100% of its budget and 99% was spent. Expenditures were mainly on operational costs of the project. The ADB and NFT released a total of US$ 16,306,364.60 of which US$ 15,884,280.60 (97.4%) was spent. Expenditures were mainly made on payment of Kawempe, Kiruddu, and lower Mulago contractors (77%), medical equipment for Mulago Hospital (10%), project supervision and Mulago master plan at 5.2%, refund for project preparation cost at 3.8% and operational costs at 3.7%. Cumulatively, a total of US$ 26,333,150.14 (32% of the entire loan) was released by the end of FY 2014/15. The ADB released 87.4% of the disbursement while 12.5% was by the NTF. A total of US$ 22,217,566.42 (84%) was spent. Civil works, consultancy services and medical equipment took up 97.3% of the total expenditure as detailed in table 3.15 Table 3.15: Detailed financial performance of Support to Rehabilitation of Mulago Hospital by end of June 2015 Item Hospital Contractor Contract sum Cumulative Payment FY Payment (US$) 2014/15 (US$) Civil Kiruddu General M/s China New Era–China 10,369,012.18 5,456,560.06 2,482,765 Works Referral Hospital No.4 Metallurgical Joint (52.6%) Venture Kawempe General M/S China National Aero- 11,341,651.23 5,591,000.14 2,295,235 Referral Hospital Technology International (49%) Engineering Corporation Lower Mulago M/s Roko Construction 29,617,820.64 8,370,543.05 7,459,263 Hospital Company Limited (28.2%)
Supervisio Kiruddu and M/s Perse Architecture 693,059 199,253.74 315,814 n and Kawempe General (28.7%) consultanc Hospitals y services Lower Mulago M/s AMPC in a joint 935,945 374,378.00 327,581 Hospital venture with Sharp Shop (40%) Architects, South Africa and Joadah Consult, Uganda Medical Lower Mulago Various supplier (Refer to 8,194,373.47 1,613,360.78 1,613,360.78 equipment Hospital table 8.18) (19.6%) Total 21,605,095.77 14,494,019
Source: MoH
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Physical performance by component The project involves implementation of a number of activities under three components. These include; capacity development and systems strengthening, revitalizing referral and counter- referral systems as well as expanding and improving specialized health services in Kampala City. Detailed physical performance by component is indicated below:
Component one: Capacity Development and Systems Strengthening; this involved a number of activities like training of health workers and research. The following was achieved; Health workers trained: This activity was aimed at improved knowledge and skills in two main areas - leadership and management, and clinical excellence. A total of 1,739 health workers were supposed to be trained by the end of the project.
• A training plan was completed in 2013 and revised in November 2014 taking into consideration needs of hospital user departments. Training commenced in April 2013 and by end of June 2015, a total of 923 (53%) health workers had been trained, 83% of which were trained in clinical related activities.
• Training activities included; infection and control measures, trauma and injury management, Echo Cardiography, Electrocardiogram (ECG), nuclear medicine, Administrative Officer’s Law, Pulmonology, Kidney Transplant, Intensive Care Unit (ICU) Management, Geriatrics and Stroke Management among others.
• A total of 14 scholarships in a Masters of Medicine (MMED) in seven specialties were awarded. These were; Medicine, Pediatrics, Surgery, Obstetrics/Gynecology, Anesthesia, ENT and Ophthalmology. Beneficiaries were expected to get into their third year of study in September 2015. Upon completion of their studies, beneficiaries were expected to work in Mulago, Kawempe and Kiruddu hospitals for at least two years.
Research undertaken: this output involved undertaking of a hospital and HC IV performance assessment in Uganda. It was done and completed in July 2014. The hospitals and HCIVs were assessed on availability, efficient and effective use of; management services, equipment, infrastructure, drugs, laboratory and blood bank.
This study was supported by the World Health Organization (WHO), MoH and Makerere University (MUK), School of Public Health. The study was completed in one year and dissemination of the findings in the draft report to various stakeholders was done in June 2015. The final report was expected by July 30th 2015.
A baseline survey to assess the current quality of health care services in Mulago Hospital and KCCA health facilities in order to evaluate the effect of project interventions at the end of the project was undertaken. This was an in house study done by Mulago in collaboration with Makerere University School of Public Health.
Preparation works for the study were done in October 2014. Data collection was completed in June 2015, analysis and report writing were still ongoing. A final product was expected in the second quarter of FY 2015/16.
Component two: Revitalizing Referral and Counter-referral systems; this component involves a number of outputs. These are; • A National Referral Policy and System developed. • 10 ambulances procured. • A call center for the ambulance operations established. • Paramedics for the ambulance services trained. • Communities sensitized about the referral and counter referral system. • A revised referral and ambulance system implemented.
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The following was achieved by end of FY 2014/15; A National Referral Policy and system developed: this was not developed following the decision by both the World Bank and MoH that it was a lengthy process which could not be completed within the project life span. During the project midterm review, it was agreed that the project limits its self to the development of the referral system for Kampala and Metropolitan Area.
10 ambulances procured: M/s Achilles and Sohne GMBH was contracted to supply 10 ambulances at a sum of US$ 587,000 on 20th March 2015. Ambulances were expected to be delivered by October 2015. It is expected that every division in Kampala will get two ambulances.
A revised referral and ambulance system and call center implemented: The consultant to design a sustainable referral and ambulance management system had not been procured by 30th June 2015. During FY 2013/14, the International Finance Corporation (IFC) was identified to offer the services however it was later realized that it did not have enough capacity to offer all the services as indicated in the scope of works by MoH.
The entire procurement process was restarted in November 2014 and M/s Sanigest was identified to have all the required skills and experience to undertake the works. They were therefore asked to submit their technical and financial proposal which was submitted on June 12th 2015.
Other outputs like training of paramedics, community sensitization and implementation of the referral and ambulance system were dependent on achievement of two key out puts. These are: Procurement of 10 ambulances and designing of a sustainable referral management system. Overall performance of this component was rated at 20%.
Component three: Expanding and improving specialized health services in Kampala City; this component involves a number of outputs. These are;
1) A 30 year Master Plan for Mulago National Referral Hospital developed. 2) Two 200-Bed General Referral Hospitals constructed (Kawempe and Kiruddu). 3) Lower Mulago Hospital rehabilitated and modernized to provide super specialized services. 4) Medical equipment and furniture procured for Kawempe, Kiruddu and Lower Mulago Hospitals
5) Supervision and consultancy services for construction works at the three hospitals.
The following was achieved under this component;
1) A 30 year Master Plan for Mulago National Referral Hospital developed: This was developed and submitted by 31st December 2014. It was done by M/s Joadah Consult at a sum of US$ 369,900. The plan was presented to Mulago Hospital Board on 15th January 2015. The consultant had been paid 100% of the contract sum by 29th July 2015.
2) Two 200-Bed General Referral Hospitals constructed and equipped (Kawempe and Kiruddu): Construction was on going and 10 levels were constructed for both hospitals. They will house the following services; Level 1: Accident and emergency/casualty, laundry and mortuary; Level 2: OPD housing consultation rooms, treatment rooms, ample waiting spaces; Level 3: Laboratory, imaging diagnostic services including Ultra Sound, X-Ray, Fluoroscopy, Mammography, CT-Scan, Magnetic Resonance (Imaging MRI), Pharmacy with Dispensing and Store;
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Level 4: Central Sterile Supply Department (CSSD), main operation theatre with two operation rooms and recovery beds. Level 5: Maternity ward complete with obstetrics theatre with 26 patient beds, 10 delivery beds. Level 6: Pediatric ward with 66 beds. Level 7: Male and female wards with 66 beds. Level 8: Private clinic and ward with five single bed rooms, seven twin bed rooms and one- four- bed room. The Clinic will house the pediatric, dental, antenatal and laboratory wards. Level 9: Main board room (100 Sitter). Level 10: Helipad and water tank.
KIRUDDU GENERAL REFERRAL HOSPITAL The hospital is located along Salaama Road in Makindye division, Kampala City Council. It is expected to serve people from surrounding areas of Salaama, Busabala, Makindye, Munyonyo, Muyenga, Kabalagala and Kansanga among others. M/s China New Era–China No.4 Metallurgical Joint Venture was awarded the contract to construct the hospital at a sum of US$ 10,369,012.18.
The scope of works involves construction of a 10 storey main hospital building, two storey services or administration block, four storey staff housing block for 16 staff houses and external works involving opening and construction of access roads, parking, fences and gate.Civil works commenced on 1st January 2014 and were expected to be completed on 31stDecember 2015.
By 30th June 2015, the overall physical progress was 64% against the expected 79%. By 28th July 2015, progress was at 68%. Works done included;
Main block: the infrastructure had been roofed and plastered save for level one. Painting with undercoat done for levels 3, 4,6,7,8,9,10. Structural works were ongoing with the contractor finalizing block work for service ducts. Floor works including casting terrazzo was done for level 3, 6,7,8,9. Terrazzo grinding was done for level 3, 6, 7 and 9. Preparatory terrazzo works including laying of floor stripes were ongoing at level 5. Terrazzo works on Level 8 had not started. Installation of external aluminum windows was ongoing for level 6, 7, 8 and 9. Electrical and mechanical installations were ongoing with the first fix completed. About 68% of the works were completed by 30th June 2015.
Ongoing works on the main block at Kiruddu Hospital
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Services block: this is a three level infrastructure expected to accommodate the administration of the hospital, cafeteria and conference rooms. Superstructure was completed, most of the roof works including the ring beam, hand rails along the stair case, casting terrazzo among others were completed. About 34% of the works were done by end of the FY.
Services Block under construction at Kiruddu Hospital
Outs standing works included; internal block work, partitioning, fixing iron sheets, final plumbing and electrical works, fixing doors and windows, complete plastering, painting and grinding terrazzo. Staff houses: this infrastructure is expected to house 16 health workers. Completed works included superstructure, plastering, and roofing, most of the electrical and plumbing works. Over 80% of the works were completed. Outstanding works were; final coat of paint, fixing internal door frames and doors, power connections, final plumbing works including fixing fittings, final grinding and polishing of terrazzo. External works: these include construction of access roads, parking, fences, gate, retainer walls, walk ways, driveways, leveling, grassing, tank fixing and installation among others. Progress was at 40%. Overall good quality works were observed and were attributed to strict supervision by both MoH and the consultant (M/s Perse Architecture). The contract was however behind schedule, this was due to; design changes and concentration of one crane on the main block delaying commencement of works on the services block.
KAWEMPE GENERAL REFERRAL HOSPITAL:
This hospital is located in Kawempe division, Kampala City Council. It is expected to serve surrounding areas of Kampala and Wakiso district among others. This project was awarded to M/S China National Aero-Technology International Engineering Corporation at a contract sum of US$ 11,341,651.23. Scope of works involved construction of a 10 storey main hospital building, two storey services/administration block, four storey staff housing block of 16 staff houses and external works involving opening and construction of access roads, parking, fences and gate.
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Works commenced on 1st January 2013 and expected to be completed by 31st December 2015 (within 2 years). Overall physical progress by 30th June was 52% against the expected 79%. By 28th July 2015, progress was at 57.3%. Works done include:
Main block: overall physical performance of the infrastructure was at 60%. Block work was complete, most of the plastering, undercoating on some floors, electrical and plumbing works (first fix), floor screeding, most of the terrazzo casting and grinding on some floors was completed. Outstanding works included; final works on the terrazzo, fixing internal and external widows, painting, roofing (fixing iron sheets), second fix of external and mechanical works. Services block: progress was estimated at 54% with both internal and external block work completed, plastering and under coating, first fix of electrical and mechanical installations were also completed. Staff houses: progress was at 9% and the contractor was behind schedule, this was attributed to delays in site hand over. It was handed over to the contractor in February 2015. The site was also located on very steep land hence difficulty and delays in implementation of civil works. By 28th July 2015, ongoing works included sub structural works and construction of retainer walls. External works: these include construction of access roads, parking, fences, gate, retainer walls, walk ways, driveways, leveling, grassing, tank fixing and installation among others. Progress was at 41%.
Ongoing works on the services block at Kawempe Ongoing works on the main building at Kawempe Hospital Hospital
3) LOWER MULAGO HOSPITAL REHABILITATED AND MODERNIZED TO PROVIDE SUPER SPECIALIZED SERVICES
The contract to rehabilitate and upgrade Mulago hospital was awarded to M/s Roko Construction Company Limited at a contract sum of US$ 29,617,820.64 inclusive of Value Added Tax (VAT). The contract sum without VAT is US$ 25,099,848 of which US$ 16,263,118.13 (68.5%) is financed by ADB and US$ 7,478,660.67 (31.5%) by NTF. The balance US$ 4,517,972.28 is the VAT component to be financed by GoU.
The scope of works involves general renovations and remodeling civil works including extensions and decoration works, overhauling electrical systems, mechanical systems. These included; plumbing, sewerage and external drainage systems. Up grading ICT systems and external works including road networks, pedestrian walkways, parking yards, gates and entrances.
The project will involve supply and installation of an assortment of high tech-medical equipment estimated to cost US$18.3m. Procurement of the equipment was ongoing with the main batch expected to be delivered in June 2016 just before completion of construction works. The site was handed over to the contractor on 24th October 2014 and actual works commenced on
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17thNovember 2014. They were expected to be completed within two years (17th November 2016) exclusive of the 12 months of the Defects Liability Period. The contract was phased into three:
Phase one represents 60% of the total contracted works. It involves rehabilitation and up grading works on wards and renal unit (Block A), ICU extension (Block D), Radiology (Block F), Mortuary (Block J and H), operating theater (Block B and K) and extension, ENT, Causality, OPD and Administration (Block G). Works were expected to be completed within 10 months.
Phase two involves works on Block B-level one/existing theaters, Block D-ICU, private OPD, Private Obstetrics and Gynecology, Block C wards, private wards, Uganda Heart Institute (UHI), Lifts and phase two of ICT. It is expected to commence on 14th September 2015.
Phase three will be done in six months and involves external works and establishment of a water fountain. Works were slated to commence on 16th May 2016.
Overall physical progress was 29% against 33% time progress by 30th June 2015. By the time of monitoring done in 28th July 2015, physical progress was at 37.5%.
Under Phase one: overall physical progress was 65% against 80% time elapsed. Preliminary works were completed, block work on levels 1,2,3,4 and 5 and renal unit (Block A) were completed. Plastering done and undercoating on the walls was ongoing. Electrical and mechanical works (first fix) were on going. All broken glass were replaced, prefabrication of new window frames and re-fixing completed.
Works on the operating theater and extension (Block B and K) were ongoing with the substructure completed. Columns and slab complete on level two, column works on level three were at 80%. Demolitions on Block D (ICU extension) were at 50%, 100% on Block F (Radiology) and block work was at 90%. Diversion of water and steam pipes was ongoing.
Progress on Block G (ENT, A and E Administration) was at 20%. Demolitions were complete, excavations and foundation for A and E were complete. Block work on all levels was complete, Plastering, electrical and mechanical (first fix) works were ongoing. Block H and J (Mortuary); demolitions were complete and sub structure works were ongoing at 65%. There were design changes on this infrastructure to accommodate requirements of the hospital. External works were at 60% with foundation concrete for the gate structure complete and its fabrications delivered on site. Electrical works (first fix) was at 23% and mechanical installations at 14%. It involved plumbing (first fix works) and defining pathways for medical gases. ICT installations were at 18% including pathways and inserts.
Ongoing construction and refurbishment works at lower Mulago Hospital
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4) MEDICAL EQUIPMENT AND FURNITURE PROCURED FOR KAWEMPE, KIRUDDU AND MULAGO HOSPITAL Kiruddu and Kawempe General Hospitals: contracts to supply equipment were advertised on 18th June 2015 and the closing date for bids is 14th August 2015. They were expected to be signed by September 2015 and deliveries made in December 2015. Each hospital will receive equipment worth US$ 4 million including a CT-Scan, medical gas installation for each bed and a centralized oxygen plant among others. Mulago Hospital: the hospital equipment was procured into two batches divided into 11 lots. Front loaded equipment included easily movable machinery in view of the ongoing rehabilitation works at the hospital. It was valued at a sum of US$ 8.1million. The second batch equipment were valued at US$ 9.8 million and includes heavy duty medical equipment and machinery that cannot easily be moved once installed. The hospital received 32% of the equipment that was front loaded in the first batch. Table 3.16 indicates details of equipment received at Mulago hospital by end of June 2015.
Table 3.16: Medical equipment received by Mulago Hospital as at end of FY 2014/15 (US$) Lot No. Item Supplier Contract Advance Balance Due Amount Payment 1 Laboratory Microheam Scientific Equipment and Medical Supplies 368,317.13 73,663.43 294,653.70 Ltd 2 Sub-lot 1 Radiotherapy China Sinopharm Equipment International 2,083,000.00 416,600.00 1,666,400.00 Corporation 2 Sub-lot 2 Imaging Equipment China Sinopharm International 1,481,820.00 296,364.00 1,185,456.00 Corporation 3 Sub-lot 2 Neurology Simed International B.V Equipment 186,133.54 34,544.22 151,589.32 3 Sub-lot 3 Eye and ENT Achelis Uganda Ltd Equipment 470,811.83 87,377.21 383,434.62 3 Sub-lot 4 Endoscopy and Simed International B.V Urology Equipment 1,073,277.41 205,599.21 867,678.20 3 Sub-lot 5 General Medical & Global Scientific Physiotherapy Supplies Ltd 387,837.45 77,567.49 310,269.96 Equipment 5 Medical Furniture Kaglon Medical Supplies Ltd 189,300.00 37,860.00 151,440.00 8 Laundry and CSSD Wynstock Uganda Ltd - Equipment 34,950.00 34,950.00 9 Workshop Tools Rima (E.A) Ltd 587,062.00 117,412.40 469,649.60 3 Sub-lot 1 Intensive Care Unit Philips Pharmaceuticals Equipment ltd/Critical care 1,331,864.11 266,372.82 1,065,491.29 Solution Ltd
Total 1,613,360.78 8,194,373.47 6,581,012.69 Source: MoH The administration of Mulago hospital confirmed that it received a number of equipment in different departments. For example the radiotherapy department received imaging equipment including a 3D treatment plan system, 4D ultra sound heavy duty machines, X-ray machines, defibrillator, and cardiac ultra sound among others. Eye and ENT equipment including angle pause lamps, diagnostic sets, tanopens, and visual field machines among others.
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Laboratory equipment including centrifuge, coulometers, blood gas analyzer, water distiller, refrigerator for the blood bank, automated media dispenser among others. Equipment for departments/units received included: Neurology, Endoscopy, Urology, Physiotherapy, CSSD and Intensive Care Unit. Other equipment received included medical furniture and laundry machinery. Medical furniture worth US$ 380,000 supplied by M/s Kaglon in Lot 9 did not meet the required specifications. It was therefore rejected and supplier tasked to have it withdrawn from the hospital.
Left: Angle poise lumps. Right: Chemistry Analyzer at Mulago national referral Hospital.
Apart from Lot 9 equipment, the hospital administration was happy and satisfied with the rest of equipment received from the project. The latest model of equipment on the international market was received. It was both time and energy efficient hence greatly reduced the waiting time in different departments visited. The staff received adequate training on use of the equipment. It also came along with one year guarantee and service contract of two years.
5) SUPERVISION AND CONSULTANCY SERVICES FOR CONSTRUCTION WORKS Designs for both Kawempe and Kiruddu Hospitals were completed by M/s Perse Architecture (the project consultants). Supervision works were ongoing at both hospitals. M/s AMPC in a joint venture with Sharp Shop Architects, South Africa and Joadah Consult, Uganda were contracted to design and supervise works at lower Mulago. Works commenced on 9th September 2013. Designs were completed and the consultant was already supervising rehabilitation and upgrading works at Mulago hospital. The project also planned to purchase one project vehicle during FY 2014/15: M/s Victoria Motors supplied a Pajero to the Project Management Unit (PMU) a sum of US$ 66,669 inclusive of VAT. The vehicle was received in July 2015 and had contributed towards smooth project operations.
OPERATIONALIZATION, CONSOLIDATION AND PROJECT SUSTAINABILITY
Some efforts were geared towards operationalization and consolidation of the newly established infrastructure. These include: Planning and budgeting for human resource: The KCCA incorporated the human resource and operational cost requirements for Kawempe and Kiruddu Hospitals in their budget of FY 2015/16. The overall KCCA GoU budget for FY 2015/16 moved from Ug shs 254,718,286,000 in FY 2014/15 to Ug shs 339,833,770,000 (Tax inclusive). Capacity building efforts: The project trained more than 750 health workers from Mulago, Kiruddu and Kawempe hospitals in clinical excellence, leadership and management modules. Over 10 long term scholarships were awarded and undertaken by medical officers. These will be bonded
40 | HEALTH SECTOR ANNUAL MONITORING REPORT FINANCIAL YEAR 2014/15 for two years. It is therefore expected that the medical officers will transfer the knowledge to other staff through sharing of experience in the three aforementioned hospitals for improved service delivery. Training on use and operation of medical equipment already received was undertaken. More training was scheduled for equipment to be received in the three hospitals for efficient operations, management and use. In Mulago Hospital, a bio medical engineer was sponsored to undertake a course on maintenance of medical equipment, this member of staff was however not on the Mulago hospital salary structure. Retention of such staff was therefore envisaged to be challenging amidst the limited wage bill. Service contracts and warrants on equipment procured: Major equipment like the CT scan had service contracts of two years and one year warranty period. It was noted that after the two years, the plan on maintenance and servicing of this machinery was not yet clear to the hospital. The cost of servicing and maintenance of a CT scan was estimated to be US$ 90,000 a year while the MRI was US$ 90,000-100,000. It is also estimated that Mulago hospital alone will require not less than Ug shs 5billion annually for maintenance and servicing of all equipment received. The plan for equipment maintenance in the three hospitals needs to be prioritized by MoH, Mulago and KCCA to avoid losses at the servicing and maintenance contracts.
Analysis Link between financial and physical performance There was a good link between the two variables with payments commensurate physical works on ground. The cumulative disbursements were 32% of the entire loan and over 20% of the overall project targets were achieved12. Expenditures made during FY 2014/15 (97.4%) achieved 60% of the projects annual targets.
Achievement of set targets The project achieved 60% of its annual targets; only two out of the planned five outputs for FY 2014/15 were achieved. Although construction works under Kawempe and Kiruddu hospitals were expected to end in December 2015, site visits indicated that this was far from being achieved. Both contractors requested for extension of time to finalize works. Table 3.17 presents a summary of overall project performance by 30th June 2015.
Table 3.17: Summary of the overall performance for project 1187 by 30th June 201513 Target Achievement/Remarks Health workers trained Partially achieved (53% of health workers were trained). Services for the management for the Not achieved. The contract to design the management of ambulance system procured, the ambulance system was not signed by end of FY 2014/15. (0%) Construction of Kawempe, Kiruddu and Partially achieved. Although works were ongoing, all rehabilitation of Lower Mulago Hospital contractors on Kawempe and Kiruddu and lower Mulago under taken. were behind schedule. (48% achieved) Supervision for lower Mulago, Kawempe and Achieved. Consultants were on site, supervising works on Kiruddu hospitals under taken. a daily basis. (100%) Purchase of one project vehicle undertaken The vehicle was procured and in use. (100%) Average physical performance for FY 2014/15 was (60.2%) Source: Authors compilation
12 Payments made for operational costs were not quantified in terms of targets. 13 Performance targets clearly indicated in the MoH work plan (FY 2014/15) were assessed.
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Comparative analysis: Works and payments to the contractor of Kiruddu hospital were ahead of schedule. Works were at 64% and payments at 52%. In Kawempe Hospital, physical progress was 54% against 49% financial progress. Time progress for both contracts was 79% and behind schedule. Delays in Kawempe were caused by contractor inadequacies as well as delays in site handover for the staff houses.
Much of the equipment delivered at Mulago hospital was better than that supplied to a number of health facilities visited under UHSSP. This was mainly due to rigorous involvement of all stakeholders. A thorough needs assessment was done for all user departments to establish the status of all available, missing and necessary equipment was done.
Technical people from beneficiary user departments including bio medical engineers were involved in drawing of specifications. Users were part of the evaluation committee composed of 53 members. Medical engineers from department of Physics of MUK were involved in verification of equipment.
As a result, equipment in the entire Lot 9 (medical furniture) was rejected for failure to meet specifications. The supplier was therefore tasked to withdraw and replace poor quality equipment before it was put to use. Technical guidance was also sought from experts from the Uganda National Bureau of Standards (UNBS) and International Atomic Energy Agency (IAEA) The UHSSP, however did not thoroughly involve users in procurement of equipment. Views, experience and expertise of users including beneficiary health facilities were not sought.
Implementation challenges • Foreign and exchange losses as a result, the loan amount has gradually reduced from US$ 86 million to 79 million • Works on the three contracts were behind schedule and will therefore not be completed in stipulated timelines. • Design changes resulting from frequent requests from Mulago hospital administration affecting progress of works as scheduled. It also led to variations in both scope of works and contractual obligations.
Conclusion According to the policy documents14, the project end date was June 2015 however by that date, most of the key outputs including training of health workers, procurement of the 10 ambulances, designing of the ambulance management systems among others had not been achieved. All the contractors undertaking civil works were behind schedule. The project did not achieve its set targets by end of the project period.
Recommendations • The MFPED should explore alternative sources of funding to bridge the financial gap resulting from foreign exchange losses.
• The MoH should ensure timely completion of projects to minimize effects of global external shocks on budgets that come along with delayed project implementation.
• MoH should also ensure that projects are well designed; risks and costs should clearly be defined to minimize losses during project implementation.
14Public Investment Plan FY 2014/15-2016/17) and the MoH Ministerial Policy Statement 2014/15
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• The PMU under MoH together with project consultants should task the contractors to expedite civil works in stipulated timelines to avoid any further delays.
3.4.3 Rehabilitation and equipping of health facilities in the West (1314) Background The project commenced on 1st July 2014 and expected to be completed by 20th June 2019. It is financed by Japanese International Corporation Agency (JICA) and its main objective is to improve functionality of the regional referral system through improved quality of primary health care services in Uganda. Specific objectives include; • Improve functionality of OPDs at regional referral hospitals. • Improve per capita patient attendance at regional referral hospitals. • Enhance management of medical logistics at regional referral hospitals.
M/s Iwata Chizaki Inc. was awarded the contract to undertake rehabilitation works at a sum of JPY 1,370,000,000. Works commenced in September 2014 and expected to be completed by 15th March 2016 (within 15 months). Scope of works involved; construction of OPD block, main operating theatre and maternity ward at Hoima RRH; construction of OPD, causality block and operation theatre, maternity ward at Kabale RRH.
The project was supervised by a Consortium of Yokogawa Architects and Engineers, Inc and INTEM, consulting, Inc. M/s Sirus Corporation was also awarded the contract to procure, install and train users about the equipment at a sum of JPY 199,990,000 within 8 months (8th August 2014-15th March 2016).
Expected outputs by June 2019 • New OPD at Kabale and Hoima RRHs • New operating theatre at Kabale and Hoima RRHs • New maternity ward constructed at Kabale and Hoima RRHs • Medical equipment supplied at Kabale, Hoima and Fort Portal RRHs
Planned outputs FY 2014/15 • Operating theatre, maternity ward, OPD with causality unit constructed at both Kabale and Hoima (RRHs). • Fort portal, Hoima and Kabale RRH equipped.
Financial performance During FY 2014/15, the project was allocated a total of Ug shs 43.58 billion15. The donor release and expenditure information could not be established by 11th September 2015. However, the contractor had been paid a total of 12.6 billion16 (JPY 548,000,000) as advance payment (40%) by December 2014. This represents 28% of the annual budget.
Physical Performance The project overall performance was estimated at 61.7 % against a target of 60%, the project was slightly ahead of schedule. The equipment was expected to be delivered to beneficiary hospitals by end of October 2015.
15 The project is 100% funded by JICA 16 Exchange rate at 1 Ug shs = 23 Japanese Yen (December 2014).
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Field findings
KABALE HOSPITAL The project was introduced in 2011 and actual works commenced on 1st October 2014. It is expected to be completed within 14 months (by 15th November 2015). The scope of works involves construction of a new OPD with a causality unit housing the reception, pharmacy, laboratory services, minor operating theatre, and consultation rooms among others.
Physical progress was estimated at 61.54% against the target of 60%, the contractor was therefore ahead of schedule by 1.54%. Physical progress at the OPD was estimated at 58.08%, 65% for the operating theatre and maternity respectively. The consultant was optimistic that the contractor will complete the works within set timelines. Good quality works were observed. Table 3.18 indicates progress of works at Kabale RRH.
Table 3.18: Overall physical progress of rehabilitation works at Kabale RRH Item Percentage Progress Remarks
Foundation work 90% Framing of the OPD and operating theatre Earthwork 80% structures was complete with roof trusses erected. Walling for the operating theatre was at 95% and Building structures work 60% 60% for the OPD. Outstanding works included completion of brick Finishing work 60% work, plumbing, electrical installation, fixing Electrical work 50% shutters which were already on site, plastering; HVAC system work 30% flooring, suspended ceiling works, painting, Special installation works 20% external works.
Infrastructure works 10% Other works 0% Estimated overall progress 61.54% Source: Field findings
L-R: OPD under construction and ongoing internal block work at the first floor of the OPD, Kabale RRH
L-R: Operating theatre/maternity and ongoing ceiling works at Kabale RRRH
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Fort Portal, Hoima and Kabale RRH equipped: The three hospitals had not received the equipment by 30th June 2015. It was expected in October 2015 upon completion of civil works.
M/s Sirus Corporation had already completed procurement of equipment from Japan and shipment process was expected to commence in August 2015. Equipment to be delivered includes; causality, orthopedic, ultra sound, operating theater, ENT, CSSD and OBSY/GYN machinery among others. Biomedical engineers from three beneficiary hospitals were expected to travel to Japan for training on proper handling and maintenance of equipment.
Implementation Challenges
• Tax arguments delayed delivery of imported material: in the project planning phase, all imported materials were VAT exempt, however during FY 2013/14 there was a policy shift requiring contractors to pay. Disagreements between JICA and customs officials regarding who was responsible for VAT payments between GoU and JICA continued to affect timely delivery of construction materials for both Kabale and Hoima sites. • Absence of good construction materials within the project area: materials like sand were ferried from Kalungu district (over 300 kilometres away from the project site). This was not only expensive but also time consuming.
Achievement of set targets The project achieved 67.5% of the annual targets. The civil works targets were achieved while those of equipment targets partially achieved (35%). Table 3.19 indicates a summary of project performance by 30th June 2015. Table 3.19: Summary of the overall performance for project 1314 by 30th June 2015 Target Achievement/Remarks Operating theatre, maternity ward, OPD with causality unit Achieved (100%). constructed at both Kabale and Hoima (RRHs). Fort portal, Hoima and Kabale RRH equipped. Partially achieved. Procurement was completed, equipment awaiting shipment and delivery (35%)17 Average physical performance for FY 2014/15 was (67.5%) Source: Authors compilation Conclusion The project satisfactorily achieved one out two targets by 100%. Civil works were on schedule and of good quality. Shipment of already procured equipment had commenced. The project is expected to contribute towards increased safe deliveries, reduce morbidity and mortality from major causes of ill health and premature death through ensuring universal access to the Uganda National Minimum Health Care Package.
3.4.4 Construction of Specialized Neonatal and Maternal Unit in Mulago Hospital (Project 1315) Background It is estimated that around 16 women die from birth related complications in Uganda daily. Maternal health is therefore not only a critical health issue but also a development challenge for Uganda18. It is against this back ground that construction and equipping of a specialized Maternal and Neonatal Unit was envisaged to be important in improving maternal and neonatal health in Uganda.
17 Procurement of equipment was estimated to take 35%, shipment and delivery at 45% while installation and training of users at 20% rating of the output. 18 PIP FY 2014/15-2016/17
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This project is funded by GoU and a loan from the Islamic Development Bank (IsDB) at estimated to cost US$ 34.14 million (IsDB US$ 30.72 and GoU US$3.42). The project commenced operations in February 2014 and expected to end within five years (by February 2019).
It is expected to improve infrastructure, supply equipment/materials and training of health workers. It will facilitate decongestion of Mulago hospital by focusing on provision of tertiary and specialized maternal and neonatal health services in Obstetrics/Gynecology (OBGYN) Department.
It has three components namely; • Improvement of access to specialized maternal and neonatal health care services through construction and equipping a 320 bed six storey hospital complex. The complex will offer services including risk antenatal, delivery, postnatal, gynecological oncology, urogynaecology especially obstetric fistula, assisted reproductive health technologies and a private wing. • Improve quality of care through specialized training, preparation of guidelines and medicals protocols. • Support to project management, consultancy services for preparation of detailed engineering, medical equipment installation and financing auditing.
Expected out comes by February 2019 • Improved infrastructure for maternal health care (Buildings and equipment). • Additional skills through personnel training. • Improved quality of specialized RH care services. • Introduction of new and advanced services. • Decongested MNRH particularly the OBGYN Department. • Reduction in Maternal and Neonatal morbidity and mortality in Uganda.
Planned outputs FY 2014/15 • Maternal and neonatal hospital construction undertaken. • Supervision of civil works undertaken. • Specialist staff training undertaken. • Contract staff salaries for the project staff paid.
Financial performance Cumulatively, the IsDB disbursed US$ 5,230,474.06 (17%) of the loan amount and 100% was spent by June 2015. During FY 2014/15, a total of US$ 682,520.50 was released and spent. Expenditures were mainly direct payments to Arch Design (64%) and operational costs (36%). The GoU approved budget was Ug shs 800,000,000, 100% was released and 82% was spent.The balance was returned to consolidated fund, non-absorption of released funds was attributed to late commencement of civil works during the financial year. Details of performance are indicated in Table 3.20.
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Table 3.20: Project 1315 GoU financial performance by 30th June 2015 (Ug shs) Item Budget Encumbrance Actual Balance Payments Contract staff salaries 350,000,000 0 348,335,713 1,664,287
Social Security contribution 90,000,000 0 89,767,561 232,439 Travel Abroad 16,000,000 0 15,617,632 382,368 Fuel, Lubricants and oils 24,000,000 0 24,000,000 0 Maintenance- Vehicles 20,000,000 578,200,000 17,501,450 1,920,350 Non residential buildings 300,000,000 0 165,741,864 134,258,136 Total 800,000,000 578,200,000 660,964,220 138,457,580 Source: IFMS
Physical performance Maternal and neonatal hospital construction: M/s Arab Contractors (Osman Ahmed Osman and Company) was awarded the contract to construct a 320 bed hospital at a contract sum of US$ 24,460,004.009. The contract was signed on 19th May 2015, site handed over on 28th May 2015 and actual works commenced on 9thJune 2015.
Civil works were expected to be executed within 24 months (by 8th June 2017). By 29th July 2015, the contractor had completed only 2% of the works with the demolitions done, site cleared, setting of buildings and stripping of top soil done. Excavations works were on going. No payments had been made. The facility will be equipped and the medical equipment and furniture estimated at US$ 7.55 million. Lists of all required equipment with details of specifications were compiled by Arch Design. They were submitted and approved by the IsDB.
Support to the health information system was not been undertaken, however, a total of US$ 700,000 was allocated for this activity.
Supervision of civil works undertaken: M/s Joadoh Ongoing excavation works for the Maternal and Neonatal Unit at Consult Limited was awarded Mulago Hospital the contract to supervise construction works of the specialised Maternal and Neonatal Unit at a sum of US$ 440,000. The contract was signed on 19th May 2015, works started on 26th May 2015 and expected to end in May 2017 (within 24 months). Consultant had commenced work.
Specialist staff training: A total of US$ 1 million was allocated for this activity. The bank was expected to fund US$ 400,000 and US$ 600,000 by GoU. A training plan was developed, training institutions and trainees to undertake specialised trainings were identified. Training was expected to begin in September 2015. A total of 194 health workers including doctors and nurses in the Obstetric department of Mulago Hospital will be trained in a period of two years. The training plan also takes into consideration of training of administrative personnel in administrative governance.
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Contract staff salaries for the project staff paid; the project employs 12 staff (six technical and six support staff) and were paid a total of Ug shs 348 million during the FY 2014/15.
Analysis
Link between financial and physical performance Over 100% of the disbursements were used to achieve 77.5% of the set targets. It is important to note that although the 22.5% of the set targets were not achieved, funds had been expended on preparatory works and operations. This represents a good link between financial and physical performance. Achievement of set targets The project achieved 77.5% of the set targets, three out of four set targets were satisfactorily (75%) by 100%. The core targets for the FY 2014/15 were therefore achieved. Efforts to undertake the remaining 15% (actual specialist training) were in their final stages. Table 3.21 presents a summary of the project performance by 30th June 2015.
Table 3.21: Summary of Project 1315 performance by 30th June 2015 Output Targets Achievement/Remarks Maternal and neonatal Commence construction of the Achieved. Construction hospital construction maternal neonatal hospital commenced during the FY as undertaken planned. (100% of annual set targets) Supervision of civil works Supervision consultant procured Achieved. Consultant was procured undertaken and already supervising works. (100% of annual set targets) Specialist staff training in 194 health trained in a period of two Partially achieved. No staff had obstetric and neonatal years been trained by end of the FY, undertaken however preparatory works had commenced. (10% achieved) Contract staff salaries for All contract staff salaries paid Achieved. Project contract staff was the project staff paid paid. (100% of annual set targets) Average achievement of set targets for the FY 2014/15 was 77.5%. Source: Author’s compilation and analysis
Conclusion The project was on track with the contractor and consultant on site. Preparatory works to commence specialist training were underway. The project did not face any major challenges and therefore expected to progress as planned. Completion of this project will greatly contribute towards improved maternal and child health in Uganda.
3. 5 UGANDA CANCER INSTITUTE (VOTE 114) Background The Uganda Cancer Institute (UCI) offers super specialized services in areas of cancer treatment, research and prevention. It has a three-fold mission; • Research into all aspects of common cancers in Uganda. • Provision of optimal evidence based clinical care. • Provision of training for health care professionals using endemic cancers as model disease for training.
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Efforts to transform the UCI into a regional centre of excellence in line with its mandate as a lead agency in implementation of comprehensive National Cancer Control Program (NCCP) are underway. Annual monitoring focused on the implementation of the development grant (Project 1120). The project commenced on 1st July 2010 and was expected to be completed on 30th June 2015. It is aimed at setting up new infrastructure and developing the existing UCI into a modern Cancer Treatment Center.
Expected outputs by June 2015 • Medical equipment, infrastructure development, furniture and fixtures in place.
Planned outputs FY 2014/15 • Radiotherapy bunker constructed. • Specialized machinery and equipment procured. • Payment of retention, interest on extra works and idle charges relating to the cancer ward.
Findings
Financial performance The approved project budget for FY 2014/15 was Ug shs 8,707,941,732 of which 100% was released and Ug shs 8,261,501,198 (95%) spent by 30th June 2015. Expenditures were made on nonresidential building (52%). These included; payments to the Arch Tech Consult, the bunker consultant, retention and extra works for the newly constructed six storey ward.
Some funds amounting to Ug shs 2.3 billion were diverted to payment of VAT for the UCI Cancer Center (Huston complex). Other payments were made for procurement of equipment and furniture 36%, Engineering and design studies and plans (7%) among others. Table 3.22 indicates detailed expenditure as at 30th June 2015.
Table 3.22: Detailed expenditure of Project 1120 by 30th June 2015
Percentage Item Amount Allocated Amount Spent Expenditure Non Residential Buildings 4,400,000,000 4,273,706,566 52 (Depreciation)
Machinery and Equipment 2,957,941,732 2,950,686,271 36 Engineering and design studies and 800,000,000 556,489,000 7 plans Transport Equipment 450,000,000 382,452,461 5
Monitoring and Supervision and 100,000,000 98,166,900 1 Appraisal
Total 8,261,501,198 100 Source: IFMS
Physical performance Half of the equipment had been procured and delivered at the UCI. Supply of the rest of the equipment was underway. Overall project physical progress was at 58% with only one out of three targets satisfactorily achieved by 100%. Table 3.33 indicates detailed project performance against set targets.
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Table 3.23: Physical performance of development grant under UCI (Project 1120) by 30thJune 2015 Annual Targets Performance Remarks Radiotherapy Bunker Partially Design works were on going with Arch Tech Consult constructed. achieved working together with M/s Stup, an Indian firm in line (25%) with the guidance from International Atomic Energy
Agency (IAEA). Initially, the contractor for the bunker was expected on ground by June 2015, this was however extended to September 2015. A total of Ug shs 2,342,302,320 for this project was re- allocated to payment of VAT for the UCI Cancer Center (Huston complex).
Purchase of specialized Partially Half of the equipment expected from different suppliers machinery and equipment achieved was delivered end of the FY2014/15. (50%)
The UCI received equipment including the intercom, video teleconferencing machinery, office equipment, two vehicles, endoscope machine, hospital linen, motorcycles, TVs, CCTV cameras, Endoscopy machine, and laboratory refrigerator among others were. Imaging, pathology, general hospital equipment and instruments, hospital furniture including beds, infusion chairs, and bedside cabinets were expected by end of August 2015.
Retention, interest on Achieved Retention, interest and extra charges of Ug shs 413 million extra works and idle (100%) was paid by December 2014. Extra works of Ug shs 462 charges relating to the million were also approved and paid. cancer ward paid The building was occupied and it houses the children’s clinic, consultation rooms, medical wards for children, male and female patients, a pathology unit as well as a private wing among others. Average achievement of set targets for the FY 2014/15 was 58.3%.
Source: UCI
L_R: Newly acquired equipment including wheel chairs, drip stands and a Chemistry Analyzer at UCI
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Project intermediate outcomes (2010-2015) The project phase reviewed ended on 30th June 2015. As a result of project implementation, a number of intermediate outcomes were highlighted. These included the following:
• Improved comprehensive cancer management services offered as a result of amalgamation radiotherapy unit at Mulago Hospital with the UCI. Equipment procured including the laboratory fridge, chemistry analyzer had improved timely provision of services. • Improved communication; the newly installed intercom had eased communication and administrative work done in a timely manner.
• Increased work space as result of the construction of the Huston Complex and the six level cancer ward. The two structures were already housing some administration offices.
• Strategic direction as a result of the plan developed; the grant enabled establishment of a strategic plan detailing opening and operationalization of the five cancer regional centers. Three out of five centers were operational and offer treatment of simple cancer related illnesses at a regional level; these are; Mayuge, Mbarara and Arua.
• Recognition of the UCI as a cancer center of excellence at the East African Community (EAC) level. Plans to establish the EAC Cancer Regional Center were underway. The IAEA was also planning on opening up the Virtual University Center for Cancer Control at the UCI.
• Improved mixing chamber for chemotherapy; hence done in a timely in well protected environment. Despite, the above achievements, the monitoring team noted that the quality of service at the UCI was still unsatisfactory. A number of challenges including staffing gaps and inadequate supply of medical supplies among others need to be addressed for better service delivery.
Analysis Link between financial and physical analysis The link between physical and financial progress was fair with 95% of the released funds spent on achievement of 58% targets for of FY 2014/15. This was attributed to delays in designing the radiotherapy bunker and procurement of equipment as well as reallocation of Ug shs 2.3 billion meant for the bunker project to payment and clearance of tax obligations for the UCI Huston complex.
Achievement of set targets The UCI achieved 58% of its annual targets. Core targets including a radiotherapy bunker designed and procurement of specialized equipment were not achieved by end of the FY.
Implementation challenge • Delays in procurement of new equipment, the existing equipment was outdated and characterized by frequent breakdowns leading to high maintenance costs, inaccurate results and long exposure of patients to radiation.
Other challenges constraining effective utilization of newly acquired infrastructure and quality service at the UCI. • Staffing gaps with the doctor patient ratio at 1:100 and nurse-patient ratio at 1:50. The UCI also has only one physiotherapist and one counselor. The situation was worsened by the outdated staffing structure of the UCI. • High level of floor cases due to lack of medical furniture including beds. A number of patients were staying at the verandahs of UCI.
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• Lack of adequate drug combinations to effectively manage cancer. This in most cases contributes to loss of lives. • Increased number of patients in relation to the UCI annual allocations. • Lack of awareness about non-communicable diseases like cancer hence many individuals seek medical attention at a later stage when the disease is unmanageable and expensive.
Conclusion The UCI achieved one out of the three annual development targets by 100%. This was attributed to reallocation of funds, delays in procurement of equipment and design of the radio therapy bunker. The UCI registered a number of achievements including improved cancer care and treatment over the years. Consolidation of project achievements highlighted is very important, therefore efforts to maintain the newly created infrastructure and equipment procured should be prioritized by the UCI.
Recommendations • The UCI should task selected suppliers to ensure delivery of equipment in stipulated timelines. • The UCI should ensure that all equipment purchased and infrastructure constructed have a clear maintenance, operationalization, and servicing plans over time for maximum gains on investment. • The MPS and MFPED should increase the UCI wage allocation to facilitate recruitment of adequate staff. • The MoPs should also revise the existing staffing structure to suite contemporary requirements of modern cancer treatment. • The MoH should further prioritize non-communicable diseases including cancer by providing substantial budgets to both preventive and curative strategies at all levels. Awareness strategies should also be enhanced at community level (HC II). • The MoH should support regional referral hospitals to effectively streamline cancer services in their daily activities including community outreach programs. This will not only create more awareness but also decongest the UCI.
• The MFPED should test the viability of allowing the UCI manage and procure specialized medicines for at least one year. During this period, the relationship between managing their own medical supplies, loss of lives and quality of health care should be tested by an independent body.
3.6 UGANDA HEART INSTITUTE (VOTE 115) Background The institute was set up to serve as a center of excellence for the provision of comprehensive medical services to patients with cardiovascular and thoracic diseases at an affordable cost. This was envisaged to facilitate improved service delivery and enable continuous development of the institute. It is also aimed at offering an enabling environment for research and training for sustainable development of cardiac super specialty. Annual monitoring focused on Uganda Heart Institute development grant (Project 1121). 3.6.1 Uganda Heart Institute Project (Project 1121) The project commenced on 1st July 2010 and expected to be completed by 30th June 2015. Its main objective was to improve the infrastructure and services of the institute to provide convenient and affordable heart treatment to the local population and the East African region.
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Project expected outputs by 30th June 2015 • Specialized medical equipment procured including cardiac beds, patient monitors, ventilators, ECG/ECHO machines, blood gas analyzer; Anesthesia machines, Intriotic balloon pumps. • Proposed UHI Complex constructed and commissioned. • Office furniture for surgeon’s office and laboratory procured.
Planned outputs FY 2014/15 • Five desktop computers and three laptops procured. • Software for medical records management procured. • Assorted equipment and machinery procured.
Findings
Financial performance The approved budget for FY 2014/15 was Ug shs 5,500,000,000 of which 100% was released and Ug shs 5,642,009,427 (103%) spent by 30th June 2015. Expenditures were mainly on; procurement of computers, assorted equipment and machinery including Echo machine, anesthesia delivery systems, ultrasonic nebulizer among others.
Physical performance Project physical progress was at 75%, one out of three targets was achieved by 80%19. Table 3.24 indicates detailed project performance on set targets.
Table 3.24: Physical performance of development grant under UHI (Project 1121) by 30th June 2015 Annual Targets Performance Remarks Five desktop computers and three 0% Not Achieved laptops procured Software for medical records 0% Not Achieved. Procurement was put on hold. management procured Selected bidders quoted a higher price than that anticipated by the UHI. Assorted specialized equipment and Substantially Most of equipment had been delivered by end of machinery procured. These included Achieved the FY 2014/15. the following; (80%) Details of equipment procured 100% Awarded to M/s Meditec Systems Limited at a Immuno Assay machine sum of US$ 48,320. It was delivered by 31st December 2014. Autoclave (75 cubic liters) 100% It was delivered by 31st December 2014. Oiless compressor 100% Awarded to M/s Biomed Systems at a sum of US$ 11,564,000. It was delivered by 31st December 2014. Sound Nebulizer 100% Awarded to M/s Meditec Systems Limited at a sum of US$ 14,301. It was delivered by 31st December 2014. Anesthesia Delivery System 100% Awarded to M/s Philips Pharmaceuticals Ltdat a sum of US$ 97,680. It was delivered by 31st December 2014.
19 Over 94% of the project’s annual budget was allocated to procurement of specialised equipment. 80% of the equipment was procured and delivered at the UHI by June 2015. The rest of the outputs performed at 0% hence 75% weighting.
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Hematology analyzer 100% Awarded to Crown Health Care Uganda Ltdat a sum of US$ 68,000. It was delivered by 31st December 2014. Automated coagulation machine 100% It was delivered by 31st December 2014. Two suction machines 100% Awarded to M/s Meditec Systems Limited at a sum of US$ 4,000. It was delivered by 31st December 2014. Handheld Echo machine 100% Awarded to M/s Meditec Systems Limited at a sum of US$ 34,823. It was delivered by 31st December 2014. Portable Echo–machine 100% Awarded to M/s Meditec Systems Limited at a sum of US$ 6,050. It was delivered by 31st December 2014. Heavy duty washing machine 100% It was delivered by 31st December 2014.
Defibrillator machines 0% In the final stage of procurement by end of July 2015. Holter cooler machines and surgical 0% Contracts for the supply of equipment were equipment terminated because suppliers could not deliver in a timely manner. Echo radiography machines 100% The contract was awarded to M/s Philips Pharmaceuticals (Uganda) Limited at a sum of US$ 583,950. These were delivered. Delivery supply and installation of 30 100% Awarded to M/s Crown Health Care (Uganda) medical syringe pumps lot 1 Limited at a sum of Ug shs 270,000,000. These were delivered by 30th June 2015. Delivery installation and commission 100% Awarded to M/s Meditec Systems Limited at a of Intra-Aortic Baloon Pump, sum of US$ 130,000. It was delivered, installed and in use. Delivery and installation of cardiac 0% Contract had not yet been signed by 30th June monitors (trolleys). 2015. Supply, delivery and installation of 30 100% Awarded to M/s Crown Health Care Uganda medical infusion pumps Limited at Ug shs 300,000,000. Delivered by end of the FY. Supply, delivery and installation of a 100% This was awarded a sum of US$ 17,900 to M/s Holter monitoring machine with Meditec Uganda Ltd. It was delivered by end of ambulating BP the FY. Supply and delivery of cardiac beds 0% Procurement was concluded during first quarter of FY 2015/16. Average physical performance of the UHI on the three targets for FY 2014/15 was 75%. Source: UHI
L-R : A Hematology machine and washing machines at the UHI
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Benefits of the investment A number of benefits were registered as a result of equipment procured by the UHI; these were: • Morale of health workers boasted; most of the consultants, doctors and nurses had the necessary equipment to attend to patients. The Echo equipment was noted to be clearer and gave more detail on the condition of the patient than the older version the institute had. • Reduced long lines due to timely attendance to patients. This means that examinations, reports and medical decisions were made in a timely manner. • Improvement in quality of care; this translated into increased numbers of patients attended to in the diagnostics and outpatient department. • Reduced stress on medical personnel due to exhaustion as a result of using old equipment that was time consuming and characterized by frequent breakdowns. • Increased referrals from other health facilities to the UHI Intensive Care Unit.
Project intermediate outcomes (2010-2015)
The project phase reviewed ended on 30th June 2015. A number of intermediate outcomes were highlighted as a result of project implementation. These included: • Catheterization laboratory constructed led to the ability to undertake more advanced laboratory investigations in a timely manner.
• Reduction in abroad referrals since introduction of a number heart surgeries. These include; pace marker implantations, all surgeries that do not involve stopping of the heart (Patient Ductus Arterious), Ventricular Septial Defects (VSD); these operations involve stopping the heart for several hours to enable surgery and correction. Ability to undertake Titrallogy of Fallot (TOF); valve and coronary surgeries among other surgeries. Most of the surgeries in stage one to three of heart surgeries indicated above can be undertaken by the UHI, it is however constrained to carry out stage four operations which involve complicated surgeries like heart transplants.
• Recognition from international bodies due to collaboration efforts world over. The UHI was already collaborating with Case Western Reserve University in the USA. This enabled receipt of high end training of staff.
• The pilot Mobile ICU and equipment in the ICU and the entire UHI greatly improved service delivery hence saving of lives.
• Although the construction and commissioning of the UHI Complex was not achieved during the period under review, the development grant enabled drawing of the designs and necessary preparatory arrangements which will form basis for construction of the complex upon availability of funds.
Source: UHI
Analysis
Link between financial and physical performance Overall, the link between financial and physical was fair, with 103% of the budget spent on achievement of 75% of the annual targets. The bulk of the funds were spent on procurement of 80% of the equipment.
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Achievement of set targets The UHI achieved one out of three targets by over 80% (procurement of specialized equipment and machinery)20. Others including procurement of desktops and the medical software were not achieved.
Challenges • Procurement delays hence 20% of the equipment was not supplied by end of FY 2014/15. • Limited space at the UHI since it is still housed by the Mulago Hospital complex. Patients, equipment and staff were visibly squeezed in their areas of operations. • Inadequate budget operations to undertake all heart surgeries both open and closed as demanded by the public. The UHI therefore operates at less than 30% of its capacity. • Lack of a proper private wing to suit the needs of certain classes of patients like the rich hence continued abroad referrals. The UHI losses over US$ 5,000 per patient referral abroad. • Inadequate staffing levels and outdated structure for proper management of heart diseases at the UHI. • Limited capacity to undertake more heart operations including those under stage four.
Conclusion The UHI procured a number of equipment (80%), these had greatly eased operations and improved the quality of service. Much of the equipment procured was already in use. The institute faces a number of challenges including procurement delays, limited budgets, space, and staffing. The UHI should commence the procurement process in a timely manner to avoid future delays. Recommendations • The MFPED should prioritize funding specifically for open and closed heart surgeries to enable the UHI function to its full capacity. • The UHI should continuously encourage the public and the private sector to sponsor both open and heart surgeries as part of their corporate social responsibility. • The MFPED and the UHI should prioritize construction of the UHI complex, adequate staffing and equipment. This will reduce the number of abroad referrals. • The UHI should partner with other hospitals worldwide for technical capacity building to facilitate undertaking of complicated heart surgeries under stage four.
• The MoPs should also revise the existing staffing structure to suite contemporary requirements of heart surgeries, care and disease management.
3.7 MULAGO HOSPITAL COMPLEX (VOTE 161)
Background The hospital is Uganda’s largest health facility and it is located at Mulago hill in Kampala Capital City. It is one of the two National Referral Hospitals in Uganda21. It was founded in 1913 and expanded in 1962 by constructing lower Mulago. The hospital’s bed capacity is 1,790 and receives an average of 40,000 people daily. It is mandated to provide super-specialized health care, training and conduct research in line with the requirements of MoH. The monitoring team assessed performance of the development grant (Project 0392). The project phase reviewed commenced on 1st July 2013 and ended on 30th June 2015.
20 This was the main target because it was allocated 94% of the annual budget 21 The other National Referral Hospital is Butabika Hospital.
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Project expected outputs by June 2015 • 100 housing units constructed (first phase), • 1000 beds and 1000 mattresses supplied, • 1000 cellular blankets and 1000 bed sheets supplied.
Planned out puts for FY 2014/15
• Construction of 100 staff houses started in FY 2012/13 continued.
Findings
Financial performance The approved budget for FY 2014/15 was Ug shs 5,020,000,000 of which 100% was released and spent by 30th June 2015. All expenditures were made on construction of the 100 unit staff house at Mulago Hospital. Cumulatively, M/s Block Technical Services Limited, the contractor for the 100 unit staff house was paid a total of Ug shs 8,088,897,861 (42% of the contract sum).
Physical Performance Construction of a 100 unit staff houses: M/s Block Technical Services Limited was awarded the contract to construct two-five floor block houses at a sum Ug shs 19,370,174,700. The infrastructure is expected to accommodate 100 health workers of Mulago Hospital. Civil works on the first block commenced on 24th October 2013 and were expected to be completed within two years (by 24th October 2015). Works on the second block began in November 2013 and expected to be completed by November 2015.
The MoH infrastructural division was supervising the project. The works were progressing well and by end of FY 2014/15, the contractor had achieved 50% progress on both blocks by 30th June 2015. By 31st July 2015, physical progress had moved to 70% against 80% time progress.
Delays were attributed to failure by Kampala City Council Authority (KCCA) to approve the structural plan on the lift shaft in a timely manner. The contractor requested for a four months time extension that had not yet been granted by July 31st 2015. He was optimistic that all works would be completed by February 2016.
Wardrobe frames, door and window frames, internal plastering were done. Roofing works were on going. Outstanding works included painting, glassing, and completion of electrical and plumbing works. External works were at 20% completion with outstanding works on grassing, retainer walls, paving walk ways and the parking. Good quality works were observed, the client was happy and satisfied with the quality of works done by the contractor.
Two fifty unit staff houses under construction at Mulago Hospital
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The hospital was already receiving housing applications for staff houses under construction from members of staff. Allocation of the units was expected to be based upon individual level of responsibility prioritising middle level health workers with emergency related work at the hospital. Family size and performance in designated departments, tenancy agreements of one year will be signed with selected health workers.
Project outcomes (2013-2015)
th The project phase reviewed started in July 2013 ended on 30 June 2015. The expected outputs for the period under review were achieved and some of the intermediate outcomes registered include:
• Reduction in hospital floor cases (number of patients without beds) by 60%. This was a result of the 1000 beds, blankets and bed sheets procured. Although the hospital invested in this venture, all beds could not be accommodated in a number of wards due to limited space hence the continued 40% floor cases. Some of the beds were kept until completion of infrastructural renovations at the hospital. Patients were notably squeezed in the wards and at risk of catching more infections.
• Improved morale of health workers especially those with hope of being accommodated in the 100unit staff houses.
Source: Mulago Hospital
Analysis
Link between physical and financial performance There was a strong link between physical and financial performance. The hospital spent 100% of its development grant for FY 2014/15 on construction of the 100 unit staff houses. Achievement of set targets The hospital achieved 87.5% of the annual development target. The contractor did not achieve the construction targets for the period under review. Works were behind schedule 10%. Implementation challenges • Price changes affecting contractor’s cash flows and implementation of planned works. Depreciation of the Uganda shillings against the dollar affected the price of construction materials on the market. • Delays in payments to the contractor by the client. This was mainly due to the phased (quarterly) release of funds to Mulago hospital against the pace at which the contractor worked. • Limited budget to complete scheduled works. Although the mode of financing was phased, the contractor was likely to complete the works with some unpaid certificates. • Changes in project design led to variations and delays in implementation of planned works as scheduled. These included creation of space for a lift shaft as required by KCCA.
Other challenges affecting the quality of service at Mulago hospital
• Inadequate staffing levels; the hospital had 1,832 out of 2,166 health workers as per the 1995 structure. The old structure lacks some important cadres like neurologists. • Low payments of medical consultants in the public compared to private sector led to demotivation and brain drain. • Limited budgets to effectively run the hospital. The hospital had accumulated utility arrears to tune of Ug shs 2.4 billion for electricity and 2.2 for water as of June 30th 2015. • Lack of adequate medical supplies
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• Lack of clinical space due to on going renovations. • Lack of staff accommodation amidst limited development funds allocated to the hospital.
Conclusion The hospital had one development target which was achieved by 87.5%. The 100 unit staff house was at 70% against a target of 80% during the period under review. The gap for staff accommodation was still big problem at Mulago hospital. The need to fast track completion of the 100 unit staff house is therefore paramount. This will not only motivate health workers but will also translate into increased efficiency and effectiveness of health workers as well as improved service delivery at the hospital. Recommendations • Mulago hospital should prioritise staff accommodation by earmarking adequate funds for either renovation or establishment of new structures. The hospital estimated about Ug shs 48 billion to put up other 200 staff houses in next three years. • The Mulago hospital and MFPED should embrace Public-Private Partnerships in establishment of staff housing at Mulago hospital. • The MoPS should expeditiously revise the staffing structure of Mulago to include a mixture of cadres like neurosurgeons, eulogists, and specialists in plastic surgery construction, ICT experts to facilitate telemedicine, counsellors, senior consultants and customer care specialists among others. • The MFPED and MoPS should prioritise motivation of health workers including consultants at all levels for improved service delivery.
3.8 REHABILITATION OF REGIONAL REFERRAL HOSPITALS (PROJECT 1004) Background The mission of the Regional Referral Hospitals is to provide specialized and high quality health services, conduct tertiary medical health training, research and contribute to National Health Policy. Regional Referral Hospitals (RRHs) offer specialist clinical services such as Psychiatry, Ear, Nose and Throat (ENT), Ophthalmology, higher level Surgical, Medical services, and Clinical support services (Laboratory, Medical Imaging, and Pathology). They are also involved in teaching and research. Annual monitoring focused on the development grant of RRHs (Rehabilitation of Regional Referral Hospitals), Project 1004 in seven of the fourteen RRHs in Uganda. These were; Arua, Fort portal, Kabale, Gulu, Masaka, Mbarara, and Moroto. The project phase reviewed commenced in July 2013 and ended on 30th June 2015. It had the following objectives: • Rehabilitation of old and broken infrastructure. • Construction of vital infrastructure including staff accommodation. • Adequately equip the hospitals with medical and office equipment and furniture. • Improve on infrastructural security of the hospitals. • Provide appropriate transport for the performance of hospital activities • Improve on internal and external communication. • Provide alternative/backup power and water sources.
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Financial performance The revised project budget for FY 2014/15 was Ug shs 13.5 billion of which Ug shs 13.4 billion (99.2%) was released and Ug shs 12.0 billion spent22. Expenditures were made on construction, rehabilitation and procurement of equipment under different RRHs. Detailed financial performance per hospital is indicated in table 3.25.
Table 3.25: Detailed financial performance of the Rehabilitation of Referral Hospitals grant (Project 1004) in Ug shs by 30th June 2015
Hospital Revised Budget Releases Expenditure
Mbale Hospital 799,879,880 799,879,880 399,268,863
Lira Hospital 999,849,850 999,849,849 999,825,438
Naguru Referral Hospital 1,019,846,847 1,019,846,847 1,019,846,847
Arua Hospital 999,849,850 999,849,390 999,849,390
Fort Portal Hospital 699,894,895 699,894,394 699,894,394
Gulu Hospital 999,849,850 999,849,390 999,849,390
Hoima Hospital 1,199,819,820 1,199,684,409 1,199,684,409
Jinja Hospital 999,849,850 999,849,399 999,849,399
Kabale Hospital 699,894,895 699,894,895 699,894,895
Masaka Hospital 1,099,834,835 1,099,830,656 1,099,830,656
Soroti Hospital 949,879,880 814,879,879 814,879,879
Mbarara Regional Hospital 1,099,849,850 1,093,133,283 1,093,133,283
Mubende Hospital 999,849,850 999,849,849 999,849,849
Moroto Hospital 999,849,850 999,685,140 999,685,140
Total 13,568,000,002 13,425,977,260 12,025,656,692 Source: IFMS
Field findings
3.8.1 Arua Regional Referral Hospital (Vote 163) Arua hospital is a 372 bed hospital located in Arua Municipality that was elevated to regional referral status in 1994. It serves a total of 3.5 million people including 500,000 from the neighbouring countries of Democratic Republic of Congo and South Sudan. It is mandated to provide quality general and specialised health services to the people of the West Nile region of Uganda in the districts of Adjumani, Arua, Koboko, Maracha, Moyo, Nebbi, Yumbe and Zombo.
22 IFMS and Legacy System, June 2015.
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Planned outputs FY 2014/15 These were: • Lagoon constructed. • Six unit staff houses constructed. • Retention and outstanding balances for the projects of FY 2013/14 paid.
Financial Performance The total revised budget for FY 2014/15 for project 1004 was Ug shs 999 million, of which 100% was released and Ug shs 945.7 million (94.6%) spent by 30th June 2015. Detailed expenditures are shown in the table 3.26.
Table 3.26: Capital development payments for Arua Regional Referral Hospital, by 30th June 2015 Payments in FY Project Contractor Contract sum 2014/15 Construction of the six unit staff house M/s ROHI Services Limited 1,001,744,280 330,059,780 M/s Ambitious Construction Construction of the Lagoon Limited 512,034,863 494,087,958 Consultancy services for the construction of the sewage Lagoon M/s KK Partners Architects 46,020,000 46,020,000 Consultancy services for supervision and remodeling of the maternity ward (Outstanding balance) M/s Joadah Consult 52,493,500 20,997,400 M/s KG Adubango Payment of retention for the Construction and construction of a perimeter wall Engineering works 853,171,190 37,734,072 Payment of balance and retention for improvement of waste water drainage M/s Changeling Engineering system Limited 68,577,705 13,852,635 Payment of retention for supervision services for Improvement of water M/s Blessed Investment drainage system Limited 30,318,750 3,031,875 Source: Arua RRH
Physical performance A hospital lagoon constructed: the project was awarded to M/s Ambitious Construction Company Limited at a contract sum of Ug shs 512,034,863. Construction works commenced on 13th September 2014 and were completed in January 2015. The project was designed and supervised by M/s KK Partnership Architect at a cost of Ug shs 46,020,000. The project was handed over to the hospital and was functional at the time of the monitoring visit in July 2015. As a result of completion of the lagoon, the 320 bed storey medical ward was operationalized. Previously, this ward had not been commissioned since its completion in FY 2012/13 due to lack of a lagoon at the hospital. Good quality works were done.
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Completed Lagoon at Arua Regional Referral Hospital
Six unit houses constructed; this contract was awarded to M/s Rohi Services Limited at a contract sum of Ug shs 1,001,744,280. Works commenced in May 2013 and were expected to be completed by May 2014, however due to budget cuts of over Ug shs 400million during FY 2013/14, the project was rolled over to FY 2014/15. Physical progress was estimated at 85% against financial progress of 59%. Budget cuts continued to affect the project progress Construction of the super structured was complete, it had been roofed, and plastered, outstanding works included completion of painting, glassing of the second floor doors and windows, electrical installation, completion of plumbing and external works (landscaping).
Six unit staff house at Arua Regional Referral Hospital
Implementation challenge • Under funding of the project led to continuous rollover of construction works across three FYs. 3.8.2 Kabale Regional Referral Hospital (Vote 168) The 280 bed hospital located in Kabale Municipality in Southwestern Uganda, approximately 426 kilometers from Kampala. It serves a population of about 2 million people in the districts of Kabale, Kisoro, Rukungiri, Kanungu, and some parts of Ntungamo as well as people from neighboring countries of Rwanda and the Democratic Republic of Congo.
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Planned outputs FY 2014/15 • Site cleared for JICA project. • Medical equipment for the private wing procured. • Solar power installed. • Furniture for the private wing procured. • Specialised medical equipment procured. • Dental equipment procured. • External works for the private wing completed. • Walkway from maternity to ENT clinic constructed.
Findings Financial performance The project annual approved budget was Ug shs 700 million of which 100% was released and spent. Detailed financial performance is as indicated in table 3.27. Table 3.27: Detailed capital development expenditure of the project by 30th June 2015 (Ug shs) Payments in Project Contractor Contract sum FY 2014/15
Site clearance for the JICA project M/s Gesis (U) Limited 69,920,900 69,920,900 M/s Crown Health Care Procurement of medical equipment (U) Limited 111,764,000 111,764,000 M/s E-Power Solutions Installation of solar System Limited 78,922,660 78,922,660 M/s Jacaranda Office Procurement of furniture for the Furniture and Equipment private ward Limited 68,840,000 68,840,000 M/s Kamutongo Contractors and Construction of walkway from Suppliers Company maternity to ENT clinic Limited 128,021,740 128,021,740 Procurement of specialized medical equipment M/s Mednet Healthcare 108,536,720 108,536,720 M/s Crown Health Care Procurement of dental equipment (u) Limited 4,996,100 4,996,100
Completion of external works of private wing building M/s Gesis (U) Limited 128,080,479 128,080,479
Bank charges Stanbic bank 812,296 812,296 Source: Kabale RRH
Physical progress Site cleared for JICA project; the contract to demolish and clear the site for the JICA project was awarded to M/s Gesis Uganda Limited at a sum of Ug shs 69million. The demolition of the site commenced on 11th September 2014 and was completed on 22nd October 2014 by. The contractor was paid 100% of the contract sum. The site was cleared and construction works for the JICA project was progressing well.
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Medical equipment for the private wing procured; M/s Crown Health Care (U) Limited supplied the equipment at a sum of Ug shs 115 million. It was delivered on 19th June 2015. It included an assortment of equipment for the labor ward, dental and theater. The equipment was in good condition and in use.
Solar system procured and installed. The scope of work included, supply and installation of solar system at the medical, surgical, gynecology, TB, and maternity wards. The system was supplied by M/s E-power solutions at a contract sum of Ug shs 78.9 million. The system was installed and functioning well. It had reduced the expenditure on fuel for the generator in the hospital amidst intermittent power supply in the region.
Installed Solar system at the surgical ward at Kabale RRH
Furniture for private wing procured; the hospital procured furniture for the private wing from M/s Jacaranda Office Furniture and Equipment Limited at a cost of Ug shs 68,840,000. The furniture was supplied on 16th June 2015. The items supplied included drug shelves, office chairs and tables, ward ropes, reception benches/chairs, and desks. These were in use and were observed to be of good quality as none had broken down by time of monitoring.
Left: Drug shelves in the private wing pharmacy and Right: a reception table Kabale RRH
Specialized machinery and equipment procured; the equipment was supplied by M/s Crown Health Care (U) Limited at a sum of Ug shs 111,764,000. The machinery and specialized equipment were delivered on 19th June 2015. By July 2015, some of the procured equipment had been installed at the private ward while most of the theater equipment was under verification.
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The delivered equipment included: Operating table and lights, patient trolleys, Anesthetic trolley, examination lights, X-ray film viewer, oxygen concentrators, neonatal beds, Blood Pressure (BP) machines, incubators, bedside lockers, delivery beds, glucometer, a telescope and ophthalmology- scopes, obstetrics equipment and dental equipment. The equipment had improved timely diagnosis of patients and number of patients to in the private wing.
Left: Equipment in the theatre due for installation and Right: an Incubator in the neonatal Unit at the private wing Kabale RRH
External works for the private wing completed; the contact was awarded to M/s Gesis (U) Limited at a sum of Ug shs 128 million. The scope of work involved; landscaping, stone pitching, planting of grass and drainage works. These works began in January 2015 and were completed by 30th June 2015. Walkway from maternity to ENT clinic constructed; the contract was awarded to M/s Kamutongo Contractors and Suppliers Company Limited at a sum of Ug shs 128 million. The construction of the walk way began 13th October 2014 and completed at the end of January 2015. It was completed and payments made to 100%. The walk way connects the ENT/Eye Clinic to the pediatrics and maternity wards.
3.8.3 Gulu Regional Referral Hospital Gulu hospital is a 250 bed hospital established in 1934. It is mandated to provide quality general and specialised health services to the people of Acholi Sub- region in the districts of Amuru, Nwoya, Agago, Amuru, Kitgum, Lamwo and Pader. Planned outputs FY 2014/15 • Contribution to phase one construction of 54 units of staff houses made. • Retention for staff house and administration block paid
Financial Performance In FY 2014/15, the hospital was allocated a development budget of Ug shs one billon all of which was released and 100% spent by 30th June 2015.
Construction of foundation of 54 units-three storey staff housing complex: Construction works were awarded to M/s Block Technical Services at a sum of Ug shs 6.2billion. Construction works began December 2014 and were still on going. The contract period is three years and is expected to be completed by December 2017. Scope of works included construction of a three storey building with 54units. Form work for the first floor slab was on going with 80% of the June 2015 target achieved. The contractor was fully mobilised with both workers and materials on site. The contractor was paid a total of Ug shs 909.849 million including advance.
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The project is supervised by ACE consultant a sum of Ug shs 210 million. M/s ACE consultant was paid Ug shs 50Million in FY 2014/15.
Different views of the construction works of the 54 units staff house at Gulu RRH
Retention for staff house and administration block; a total of Ug shs 16.3 million was paid to M/s Mable Enterprises Limited as retention for the construction of the staff house. M/s Block Technical Services was paid Ug shs 23.7 million as retention for the construction administration block. Both the staff house and administration block were completed in FY 2013/14 at a revised contract sum of Ug shs 1,384,105,008 and Ug shs 720,343,718 respectively.
General challenges affecting performance of the hospital • Staff accommodation; 95% of the staff were not accommodated at the hospital, this greatly frustrated and demotivated health workers. • Shortage of staff including nurses, midwives and medical officers: The hospital had only six out of twelve midwives, four out of forty medical officers required. This greatly constrained service delivery. • Demotivated intern doctors, these had not received their salaries for several months yet they were the majority of personnel in a number of wards. • Lack of adequate equipment hence some specialists like those in the ENT department could not effectively offer a good service as well as properly train intern students.
Recommendations
• The MoPS and MoH in consultation with the MFPED should review the wage bill for the hospital upwards to enable the hospital recruit the critical staff so as to improve service delivery in the hospital and the region at large. • The MoH should ensure that all intern’s salaries and allowances are prioritized and paid to ensure proper training and improved service delivery at the hospital. • The hospital should prioritize procurement of specialist equipment including ENT to improve service delivery and training of medical professionals at the hospital.
3.8.4 Moroto Regional Referral Hospital (Vote 175) The 350 bed hospital is located in Moroto Municipality, in Northeastern Uganda. It serves a total population of 1.3million from the districts of Abim, Amudat, Kabong, Kotido, Moroto, Napak and Nakapiripirit.
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Planned outputs for FY 2014/15 • Ten units staff house completed. • Six unit staff house completed.
Findings Financial performance The hospital annual approved development budget for FY 2014/15 was Ug shs 999.8 million of which 100% was released and Ug shs 892 million (89.2%) spent by the end of the financial year. Details of expenditure are indicated in Table 3.38. Table 3.38: Detailed financial performance of Project 1004 by 30th June 2015 (Ug shs million) Output Contractor Contract Sum Cumulative Payment done payments FY 2014/15 Ten unit staff houses M/s Musuuza Building 2,296 1,838 797 constructed Contractors Limited M/s Joadah Consultant Services 179 95 Completion of the six M/s Apel Engineering Limited 119 35 No payments units staff house during the FY
Source: Moroto RRH
Physical performance Ten unit staff houses constructed; the contract was awarded to M/s Musuuza Building Contractors Limited at an initial contract price of Ug Shs 2.036 billion. It was revised to Ug shs 2.296 billion upon approval of Ug shs 260 million variation. This was as a result of additional requirements to excavate deeper into the foundation due to weak soils which were not anticipated and indicated in the initial BoQs.
The scope of works involved; construction of a 10 unit’s staff house, tiled and fully furnished with wardrobes, a five stance VIP latrine, landscaping and compound works, installation of water tanks, and compacting 300 meters of Murram road. Works commenced in February 2014 and were expected to be completed in 12months.Works were not completed by the contract end date and were extended to July 2015. Delays were attributed to late approval of design changes in view of weak soils.
The contractor had been paid 80% of his contract sum. Although the contractor is expected to complete the works in time, the hospital will not be in position to pay for work done due to financial constraints. By the end of June 2015, 90% of the works were done. Completed works included, the super structure, roofing, shuttering, floor tiling, and electrical installation. Ongoing works included; plumbing, painting, external works and some internal finishes.
The contractor was likely to complete construction works by end of July 2015 as stipulated in the contract extension. The quality of civil works was noted to be Ten units staff house near completion at Moroto RRH good.
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Completion of the six units staff house; construction works started in FY 2012/13 and were expected to be completed within one financial year, however, it was not possible because the first contractor M/s Kamcon Technical Services abandoned works upon roofing and fixing shutters the facility. The contract sum for Kamcon was Ug shs 478,994710, 90% of which had been paid.
The abandoned staff house was characterized by poor quality works that needed urgent attention. A new contract was awarded to M/s Apel Engineering Limited to complete and replace poor quality fittings at a contract amount of Ug Shs 119 million. An advance payment of Ug Shs 35million was paid to the new contractor.
Left: Six unit staff quarters and Right: Ongoing plumbing works in the kitchen of one of the six unit staff quarters at Moroto RRH
The scope of works for the new contract included replacement of internal doors (six doors per unit), painting of the walls, plumbing works in the toilets, bathrooms and the kitchen, installation of wardrobes for the bedrooms, completion of refill works, completion of wiring and acquisition of a wiring certificate; installation of kitchen cabinets and general rectification works; compound works including grading and leveling.
Works commenced in December 2014 and expected to be completed within six weeks. Physical progress was estimated at 90%. Pending works included completion of painting, plumbing works, installation of kitchen cabinets and all external works. The new contractor was very slow and was unlikely to complete the works within the FY 2014/15.
3.8.5 Fort Portal Regional Referral Hospital (Vote: 164) Background Fort Portal RRH, also referred to as Buhinga Hospital started in 1920 as a dispensary hospital for Tuberculosis (TB). It was upgraded into a regional referral hospital in 1996, designed as a 351 bed capacity hospital, but has since expanded to 500. It serves a population of 2.5million residing in the Rwenzori sub region comprising of seven districts; Kabarole, Kyenjojo, Kasese, Kyegegwa. Kamwenge, Bundibugyo and Ntoroko.
Planned outputs for FY 2014/15 • 12 one bed roomed staff houses constructed. • Government buildings and administrative infrastructure renovated and maintained. • Assorted specialized equipment including Televisions, Theatre, ward and OPD equipment procured.
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Findings Financial performance The approved budget for FY 2014/15 was Ug shs 700 million of which 100% was released 115% and spent by 30th June 2015. Over expenditure was due to utilization of balances carried forward from FY 2013/14 amounting to 149 million. Expenditures were made on construction of the 12 unit staff house, procurement of office equipment, renovation of the neonatal unit, part fencing, supply and installation of mobile toilets at the surgical ward. Table 3.29 indicates detailed financial performance of Project 1004 at Fort Portal RRH.
Table 3.29: Detailed financial performance of Project 1004 by 30th June 2015 Output Contractor Contract Cumulative Payment Sum payments done FY 2014/15 12 one bed roomed staff M/s Frematex Limited 1,389,998,225 1,028,293,651 712,139,951 houses constructed Renovation of the neo- M/s Better Technologies, 8,032,024 8,032,024 8,032,024 natal unit Engineering and Consultancy Limited Supply and installation of M/s Crest Tanks Limited 21,672,000 21,672,000 21,672,000 mobile toilets Partial fencing of the M/s Bagu General 38,780,700 38,780,700 38,780,700 hospital Enterprises Limited Replacement of shutters M/s Better Technologies, 4,700,000 4,700,000 4,700,000 on Anti-Retroviral Therapy Engineering and clinic Consultancy Limited Monitoring and appraisal Sundry persons NA 7,558,150 7,558,150 of the development projects Assorted equipment M/S Tech Planet 18,110,000 18,110,000 18,110,000 supplied Development. Total 810,992,825 Source: Fort Portal RRH
Physical Performance
12 one bed roomed staff houses constructed: The contract was awarded to M/s Frematex Limited was at a sum of Ug shs 1,208,694,135 which was revised to Ug shs 1,389,998,225. The revision was to take into account the design changes involving adjustment of the scope of works from; construction of six to twelve staff houses, changing from a cement floor to tiling, and use of face bricks instead of front painting.
Scope of works involved site clearance, construction of 12 unit staff houses to completion, electrical and plumbing works, external works including landscaping, paving, leveling, construction of retainer walls, stone pitching and grassing. Works commenced on 21st January 2014 and expected to be completed on 31st July 2015.
The contractor had done 89% of the works and was behind schedule by six weeks. A request for extension of time was forwarded to the client requesting for six more weeks. This had not been granted by 6th July 2015. The contractor expected to complete the works by 15th September 2015.
The 12 units had been roofed, plastered, painted with the first coat, electrical and plumbing works (first fix) done. Outstanding works included floor tiling, painting of the final coat, electrical and plumbing works (final fix), general finishes, and external works.
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The works were supervised by the MoH Infrastructural Division. Quality of work was good and hospital administration were satisfied with it. The units were expected to house nurses, anesthesia personnel, laboratory staff and midwives undertaking emergency medical care at the hospital. Housing the medical personnel at the hospital was expected to attract and contribute towards retaining of staff at the hospital.
Government buildings and administrative infrastructure renovated and maintained: The scope of work included; renovations on the neonatal unit of the private wing, partial fencing of the hospital, supply and installation of mobile toilets, and replacement of shutters on ART clinic. The following was achieved;
Renovation of the neo-natal unit: the contract was awarded to M/s Better Technologies, Engineering and Consultancy Limited at a sum of Ug shs 8,032,024. Works involved; demolitions, remodeling of the unit into a wider room, aluminum door and window installations, as well as relocation of electric wire points.
Works started on 24th April and completed on 22nd May 2015. The neonatal unit was in use and accommodates more than 10 babies a day. The initiative was appreciated by the community as it was free of charge and greatly contributed to reduced infant mortality rates in the region.
Supply and installation of mobile toilets: The contract was awarded to M/s Crest Tanks Limited at a sum of Ug shs 21,672,000. The mobile toilets were installed at the surgical ward by 15th March 2015. The facility was in use and contributed towards proper sanitation and human waste disposal at the hospital.
Partial fencing of the hospital: Part of the fence for the hospital was destroyed by heavy rains. Materials worth Ug shs 36,808,800 were procured from M/s Bagu General Enterprises Limited and were supplied on 14th October 2014. The hospital sought casual laborers to fix the fence at Ug shs 4,142,600. Works were done and completed in October 2014. The newly constructed fence had greatly contributed to security of the hospital.
Replacement of shutters on ART clinic: The contract was awarded to M/s Better Technologies, Engineering and Consultancy Limited at a sum of Ug shs 4,700,000. These were replaced by 14th October 2014.
Assorted specialized equipment procured to benefit the theatre, wards and OPD: These were not procured, however office equipment including three desktop computers, two printers, five Uninterruptable Power Supply (UPS), one printer, external hard discs, one laptop charger and a battery were procured at a sum of Ug shs 18,110,000 from M/S Tech Planet Development. Supplies were made on 15th April 2015. These were seen and in good working condition.
3.8.6 Masaka Regional Referral Hospital (Vote: 169) Background The hospital is located in Masaka Municipality in South-central Uganda. It was constructed in 1927 with a bed capacity of 330 and has since been expanded to 540 beds. It serves total population of 2 million people in districts of Masaka, Bukomansibi, Kalungu, Sembabule, Kalangala, Lwengo, Rakai, and Lyantonde.
Planned outputs for FY 2014/15 • Foundation and superstructure for the maternity complex 100% completed. • Supervising consultant and contractor for the 30 unit staff hostel procured. • Solar installation of the private wing. • Three water tanks, office equipment procured and installed.
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Findings
Financial performance
The approved budget for FY 2014/15 was Ug shs 1 billion of which 100% was released and spent by 30th June 2015. Expenditures were made on construction of the maternity complex, procurement of equipment and tanks and construction of staff house among others. Details indicated in table 3.30
Table 3.30: Detailed financial performance of Project 1004 by 30th June 2015 (Ug shs)
Output Contractor Contract Sum Cumulative Payment done payments FY 2014/15 Foundation and superstructure M/s Tirupati (U) 10,612,395,786 1,065,826,494 705,867,000 for the maternity complex 100% Limited completed Consultancy services for the M/s Joadah 328,000,000 229,600,000 32,800,000 supervision of the maternity and Consult Children’s ward Complex. Consultancy for supervision of M/s Fencon 291,265,300 145,632,650 145,632,650 senior staff hostel Consulting Engineers Procurement of ultra sound M/s Achelis (U) 122,988,085 122,988,08 122,988,008 machines Limited Supply of three new ultrasound M/s Achelis (U) 54,645,435 54,645,435 54,645,435 machine probes Limited Supply of one new digital M/s Kazinga 15,599,999 15,599,999 15,599,999 photocopying machine Channel Office World Limited Supply and installation of three M/s Sauda .M. 17,455,740 17,455,740 17,455,740 water harvesting tanks Nampera Contractors Solar installation on the private M/s Shine 14,930,000 14,930,000 14,930,000 wing Long(U) Limited Total 1,109,918,829 Source: Masaka RRH
Physical Performance
Foundation and superstructure for the maternity complex 100% completed: The contract was awarded to M/s Tirupati (U) Limited at a contract sum of Ug shs 10,612,395,786 on 28th May 2014. Scope of works involved construction of a five storey building. The site was handed over to the contractor on 17th June 2014 and expected to be completed by June 2017.
By 22nd July 2015, foundation was at 100% complete and works of the first floor slab were ongoing. Overall physical progress was at 25%. M/s Joadah Consult was contracted to design and supervise construction at a sum of Ug shs 328 million. By the 30th June 2015, the consultant was paid 70% of the contract sum while the contractor was paid Ug shs 1,065,826,494 (10.4%).
Supervising consultant and contractor for the 30 unit staff hostel procured: M/s Fencon Consulting Engineers were contracted to design and supervise the staff house at a contract sum of Ug shs 291,265,300. The contract was signed on 27th May 2015 and works commenced in June 2015, expected to run for 20 months. Delays were attributed to administrative reviews.
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The BoQs were done, the process for advertising for a contractor had commenced. Funds for this activity were reallocated to construction of the maternity ward (Ug shs 200million) upon clearance from MFPED to avoid return of money to consolidated Fund amidst the hospital needs.
Three water tanks, office equipment procured and installed: The contractor was awarded to M/s M Nampera Contractors Limited at a sum of Ug shs 17,455,740 to supply and install three tanks of 10,000 liter capacity. These were supplied and installed on the OPD, TB Ward and the hospital Laundry.
Solar installation of the private wing: this was completed by M/s Shine long Uganda Limited at a sum of Ug shs 14,930,000. It was installed in May 2015 and in use. It had reduced the expenditures on use of the generator, security lighting, and connection of entertainment gadgets like Television sets. The investment was funded by the hospital Net Tax Revenue (NTR). Equipment procured: this was supplied by M/s Achilles Limited at a sum of Ug shs 122,988,085.
3.8.7 Mbarara Regional Referral Hospital (Vote 173) The 350 bed hospital is located in Western Uganda and serves over 4million people in the districts of Mbarara, Ibanda, Kiruhura, Isingiro, Ntungamo, Sheema, Bushenyi, Buhweju, Rubirizi and Mitooma. The hospital also received patients from Kabale, Masaka, Fort Portal and neighbouring countries like Rwanda and Tanzania.
Planned outputs for FY 2014/15 • Office furniture for the refurbished administration block procured. • Administration block refurbished. • Start construction of a 16 units flat for staff quarters commenced. Findings Financial performance The approved project budget for FY 2014/15 was Ug shs 1.009 billion of which 100% was released and spent by the end of the financial year. Table 3.31 showing detailed project performance by end of FY 2014/15. Table 3.31: Detailed financial performance of Project 1004 by 30th June 2015 (Ug shs million) Output Contractor Contract Cumulative Payment done FY Sum payments 2014/15 Office furniture for the refurbished Prime Impex 49,870,000 49,870,000 49,870,000 administration block procured Limited Administration block refurbished M/s HAAS 151,236,521 148,087,112 148,087,112 Constructio n Limited M/s Tania 45,271,500 45,271,500 45,271,500 Limited Start construction of a 16 units flat M/s Block 2,254,450,52 756,771,388 756,771,388 for staff quarters commenced Technical 0 Services Total 1,000,000,000 Source: Mbarara RRH
Office furniture for the refurbished administration block procured: furniture including filling cabinets, office chairs and desks, reception counter, secretarial chairs, office chairs, board room tables and chairs, sofa set, centre table work stations and waiting chairs was supplied by M/s Prime Impex Limited. Furniture was delivered on 22nd May 2015. Most of the furniture was still in the store expect that of the board room which was in use.
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Administration block refurbished: M/s HAAS Construction Limited was awarded the contract at a sum of Ug shs 151,236,521. Works commenced on 9th December 2014 and expected to be completed on 9th April 2015 (within four months). The scope of works involved mobilization, foundation works, super structure, internal plastering, floor works, fixing aluminum doors, plumbing works, electrical installations and ICT connectivity.
Civil works were supervised by the Mbarara University Engineer. By end of June 2015, physical progress was 75%. M/s HAAS was slow and unlikely to complete works in stipulated timelines, hence M/s Tania Limited was contracted to finalize works at the administration block. The contractor had plastered and in the process of fixing door frames by end of the FY.
Start construction of a 16 units flat for staff quarters commenced: M/s Block Technical Services was awarded the contract to undertake the works at a sum of Ug shs 2,254,450,520. Works commenced in December 2014 and expected to be completed within twelve months (December 2015). The scope of works included construction of 16units (two blocks) from foundation to completion with plumbing and external works.
Civil works were supervised by the Mbarara University Engineer. By end of June 2015, physical progress was at 32% against 28.5% financial and 50% time progress. The contractor was behind schedule and this was attributed to unfavourable weather which affected timely implementation of works.
CHALLENGES AFFECTING DELIVERY OF QUALITY SERVICES IN RRHS
• Lack of staff accommodation at various hospitals. • Inadequate staff exacerbated by the old and outdated staffing structure. • Low doctor-patient ratio with most of them having 1:32000 in their catchment areas compared to 1:26,000 recommended by MoH. This compromises the quality of service as medical workers are prone to making mistakes due to exhaustion.
• Inadequate budget affecting operations, attraction and retention of health workers. • Inadequate equipment such as; thermometers and Blood Pressure machines (BP) have not been supplied by National Medical Stores (NMS) making delivery of good quality services difficult. Analysis Link between financial and physical performance There was a strong link between the financial and physical performances, with 97.6% of the disbursements were absorbed by RRHs visited. The funds were mainly spent on construction of staff houses, procurement of specialised equipment and furniture, construction of maternity wards as well as renovation works in the various hospitals. Achievement of set targets The project achieved 92.2% of the set targets for FY 2014/15 in the RRHs visited. Activities in line with construction, rehabilitation and procurement of specialised equipment were undertaken as planned. Over the years, the project improved quality of health care at a number of regional referral hospitals as indicated below;
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Intermediate Project out comes (2010-2015) at Fort Portal RRH
• Improved Non-Tax Revenue (NTR) due to construction and functionalization of the private wing. Revenue increased from Ug shs 40 million to 400 million annually translating into improved health service delivery at the hospital. • Reduced infant mortality rates due to expansion and equipment of the neonatal unit at the hospitals. Referral of neonates increased from zero to over 20 a month from health facilities within the catchment area. • Improved patient care due to availability of health workers at all times. This was a result of construction of the interns mess. The facility also attracted intern doctors at the hospital, the number increased from three to over 16 doctors over the years. • Reduced operational costs including rent, fuel costs incurred to pick and drop nurses and intern doctors to and from the hospital. • Improved treatment as a result of better diagnostic equipment that was procured during the project period. • Improved performance of the hospital as a result of retooling the government/administrative offices. Office equipment facilitated data capture and processing in a timely manner.
Source: Fort Portal RRH
Conclusion
The RRH achieved 92% of the set targets, a number of infrastructure was constructed during the financial year. This included staff houses, maternity wards, renovations of government buildings and procurement of specialized equipment and furniture. The project improved service delivery at various ways including reduction of infant mortality rates at Fort portal Hospital. However, service delivery challenges still existed at all hospitals visited.
3.9 PRIMARY HEALTH CARE (PHC) DEVELPMENT GRANT The majority of the frontline health service delivery is managed by local governments through the primary health care grant system. Local governments have responsibility for the management of human resources for District health services, management of general hospitals and management of health centres (Level II, III, and IV). The mission of votes 501-850 is to facilitate the attainment of a good standard of health by all people of Uganda in order to promote a healthy and productive life. Services provided under the Primary Health Care Grant system include: • Provision of health services through the Primary Health Care system. • Recruitment and management of personnel for district health services, • Health infrastructure development such as construction of Outpatient departments( OPD), construction of medical wards(Children, Maternity, General, Male and Female), staff houses, and sanitary facilities, • Training and capacity building of human resources, • Coordination and supervision of health service delivery by the private and not for profit, facilities, • Staff mentoring, monitoring and support supervision.
During FY 2014/15, the PHC development grant focused on consolidation and renovation of existing infrastructure of health facilities. This involved undertaking activities such as painting, repairs of medical buildings, staff houses, broken floors, ceilings and leaking roofs; replacement of broken doors, glasses and windows. Annual budget monitoring focused on 13 districts. These were: Arua, Gomba, Ibanda, Kabale, Kabarole, Katakwi, Masaka, Mbarara, Nakapiripiti, Nakaseke, Napak Nebbi, and Nwoya.
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Findings
Financial performance The total development budget for PHC development was Ug shs 30 billion and 100% was released. Field findings confirmed that all local governments visited received 100% of their budgets. Average financial performance for districts visited was excellent at 86%. Absorption was excellent (98%) for most districts like Arua, Masaka, Napak, Katakwi, Nakaseke and Kabarole. However, Gomba (39%), Nebbi (64%) and Nwoya (65%) did not absorb all released funds by end of 30th June 2015. Detailed financial performance is indicated in table 3.32. Table 3.32: Expenditure performance for PHC development by 30th June 2015 in the districts monitored
% Expenditure District Approved Budget Releases Expenditure performance Arua 472,737,033 472,737,032 472,231,546 100 Kabale 197,761,811 197,761,350 179,393,807 91 Kabarole 179,920,702 179,920,702 179,920,702 100 Katakwi 238,600,141 238,599,680 281,399,692 98 Masaka 140,364,307 140,364,307 140,364,307 100 Mbarara 164,124,239 164,124,238 142,208,985 87 Nakapiripiti 415,262,076 415,262,076 382,727,922 92 Nebbi 260,719,675 260,719,674 167,264,845 64 Ibanda 164,336,762 164,336,761 132,862,585 81 Nakaseke 156,209,516 156,209,060 156,209,060 100 Gomba 64,307,124 64,307,123 25,079,778 39 Napak 665,397,869 665,397,430 799,917,631 100 Nwoya 308,234,928 308,234,927 202,291,184 66 Source: Field findings
Field findings 3.9.1 Arua District Planned outputs for FY 2014/15 • A semidetached staff house at Logiri HC III constructed. • A semidetached staff house at Pawor HCIII constructed. • A semidetached staff house at Burua HCIII constructed. • A semidetached staff house at Rhino camp HCIV constructed. • Retention of maternity ward at Ayuvuni HC III paid. • A semidetached staff house at Lezebo HCIII completed retention paid. • Medical equipment procured.
Financial Performance
In FY2014/15 the approved budget including PRDP was Ug Shs 475.7 million of which 100% was released and Ug shs 472.2 (99.9%) spent. Expenditures were made on the planned outputs as indicated Table 3.33.
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Table 3.33: PHC development payments by Arua district by 30th June 2015
Contract Sum Payments in Output Description Contractor (Ug shs) FY 2014/15
Construction of staff house at M/s Palorinya Riverland 107,632,921 98,592,364 Logiri HCIII Enterprises Construction of staff house at M/s Gerago Consult (U) 118,041,455 111,030,619 Pawor HCII Limited Construction of staff house at M/s Abiriga Hassan 124,967,568 118,718,910 Rhino Camp HCIV Enterprises Construction of staff house at M/s Tawakal technical 106,792,741 101,442,006 Burua HCIII services Completion of a semidetached M/s Abiku Engineering 84,629,000 14,290,174 staff house at Lazebo HCII Services Limited Payment of retention for the M/s M.G Hidaya construction of maternity ward 122,163,666 6,908,073 Enterprises at Ayivuni HCIII Procurement of medical Joint Medical stores 7,179,400 7,179,400 equipment Technical verification and Assistance on the development District Engineer 14,070,000 projects Total expenditure 472,231,546 Source: Arua District
Physical Performance
The annual monitoring focused on four out of seven planned outputs and physical progress was rated at 98%. These were; Construction of a staff house at Rhino Camp HCIV, Logiri HCIII, Burua HCII and Pawor HCIII. The following was established:
Construction of staff house at Rhino Camp HCIV: M/s Abiriga Hassan Enterprises was awarded the contract to undertake works at a sum of Ug shs 124,967,568. The scope of works included; construction of semidetached staff house, kitchen and two stance pit latrine with a bathroom. Works began in November 2014 and were completed in May 2015. Good quality civil works were noted for both the staff house and pit latrine. Although the facilities had been completed in May 2015, they had not been handed over to the HC by 2nd of July 2015. The contractor was paid 95% of the contract sum by 30th June 2015.
Construction of a staff house at Pawor HCIII: Works were awarded to M/s Geraqo Consult (U) Limited at a contract sum of Ug shs 118 million. The scope of works included construction of semidetached staff house, kitchen and two stance pit latrine with a bathroom. Works began in November 2014 and expected to be complete by end of June 2015. By 3rd July 2015, the facilities were walled; roofed, plastered, first coat painting done, doors, windows and water tank fixed. Physical performance was estimated at 85% against 94% financial progress. Outstanding works included: glassing, completion of painting, connecting gutters to the water tank, some internal finishes. Quality of works was noted to be good on facilities constructed.
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Completed staff house at Rhino Camp HCIV Arua Substantially completed staff house at Pawor District HCIII Arua District
Staff house completed at Burua HCII: M/s Tawakal Technical Services was awarded the contract to undertake works at a sum of Ug shs 106,792,741. The scope of works included construction of semidetached staff house, kitchen and two stance pit latrine with a bathroom. Works began in November 2014 and were completed in May 2015. Physical progress was at 100% against 94% financial progress. Good quality civil works were also noted on the infrastructure. The staff house had not been occupied since the HC had not commenced operations. The district authorities expected to Completed staff house and Kitchen Burua HCII Arua district operationalize the HC during the FY 2015/16.
Construction of a staff house at Logiri: M/s Palorinya River Land Enterprises was awarded the contract to undertake civil works at a contract sum of Ug shs 107 million. The scope of works included; construction of semidetached staff house, kitchen and two stance pit latrine with a bathroom. Works began in November 2014 and are expected to be complete in June 2015. By 2nd July 2015, the physical progress was estimated at 98% against 92% financial progress. The staff house, kitchen and VIP latrine had been roofed; doors and windows fixed as well as undercoating done.
Outstanding works included; completion of floor works for the toilet, internal finishes for the staff house and kitchen, and completion of painting. The contractor was optimistic that by the end of July 2015, the civil works would be complete.
Staff house and kitchen substantially completed at Logirin HCIII Arua District
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3.9.2 Gomba District Planned outputs for FY 2014/15 • A four double room staff house constructed at Maddu HC III. Financial Performance
In FY 2014/15 the approved budget for PHC development grant was Ug Shs 64 million of which 100% was released and Ug shs 25.2 million (39%) spent. All expenditures were made on construction of Maddu HC III. The district had unspent balances amounting to Ug shs 38.8 million by the end of the FY. These were returned to consolidated fund.
Physical performance
Construction of a staff house at Maddu HC III: The project was awarded to M/s Semain Construction Company Limited at a contract sum of Ug shs 50 million. Works commenced in January 2014 and expected to be completed in April 2014 (within four months). However, this was not achieved due re-allocation of funds to cater construction of an emergency toilet in Buyanja HC II. The contractor could therefore not be paid in a timely manner yet he had cash flow issues. He abandoned works at super structure and ring beam level.
Works were re-advertised for completion during FY 2014/15. M/s Ndondo Construction Company Limited was awarded the contract to complete the infrastructure at a contract sum of Ug shs 49.7 million. Works commenced in April 2015 and expected to be completed in August 2015 (Within five months). By 22nd July 2015, the contractor had done 50% of completion, however overall physical progress of the project was 70%. The contractor had roofed, casted the ceiling and internal plastering was ongoing.
A total of Ug shs of 13.8million (28%) was paid for work done. Although the contractor was on site, he was also cash constrained; the district was unable to clear his certificates since project funds had been returned to consolidated fund. The project therefore rolled over to FY 2015/16. The project is unlikely to be completed within 2015/16 since the PHC development grant was further reduced to Ug shs 13million.
Challenges
• Limited technical and financial capacities of local contractors hence fail to complete projects in time. • Pressure from politicians to support local contractors by awarding them contracts. • Limited accommodation for the district heath workers. More than 50% of the health workers were not accommodated at their respective health centers. This greatly affected service delivery at the district. • Failure to implement the district’s five- year development plan due to continued budget cuts. 3.9.3 Ibanda District Planned out puts FY 2014/15 • Doctor’s house renovated at Ishongoro HCIV. • OPD at Rushango HCII completed. • Modified junior staff house completed at Kashambura HCII. • Modified junior staff house and two stance pit latrine completed at Kabare HCII. • Two stance lined pit latrine completed at Bwaha HCII, Rubaya HCII, and Rwensambya HCII.
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Financial Performance In FY 2014/15 the approved PHC development budget was Ug shs 164million of which 100% was released and Ug shs 132 million (81%) was spent. Table 3.34 indicates payments made per output during FY 2014/15.
Table 3.34: PHC Development payments by output at Ibanda District FY 2014/15
Contract Sum (Ug Payments in Output Description Contractor shs) FY 2013/14
M/s Galizooka Construction of a modified Junior Mutigyeki Tom and 40,626,550 staff house at Kashambura HCII 37,889,434 Company Limited
Construction of 2stance lined Pit M/s Amnic Contractors latrine at Bwaha, Rubaya, and and Builders Company 24,494,469 21,098,957 Rwensamya HCIIs Limited
Construction of modified Junior staff M/s Mukiza and house and two stance pit latrine at 42,928,730 Company Limited 40,646,428 Kabare HCII
Completion of OPD block at CKAT Trust Contractors 42,214,342 25,972,166 Rushango HCII Limited
M/s Amnic Contractors Renovation of doctors house at and Builders Company 8,145,186 7,255,600 Ishongoro HCIV Limited Total expenditure 132,862,585
Source: Ibanda District
Physical performance: The monitoring team visited all the five planned projects and the following was established; Renovation of the doctor’s house at Ishsongoro HCIV: M/s Amnic Contractors and Builders Company Limited was contracted to undertake works at a sum of Ug shs 8,145,186. The scope of works included; renovation of the ceiling, painting, replacement of two wooden with metallic doors, door locks and reconstruction the splash apron.
Works commenced in February 2015 and completed in June 2015. The contractor was paid 90% of the contract sum. The facility had not yet been handed over to the HC by July 2015. The monitoring team noted good workmanship however the heavily dilapidated floor was not included in the contract and rehabilitation works.
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Newly renovated Doctor’s House at Ishsongoro HCIV in Ibanda District
Completion of OPD at Rushango HCII: M/s CKAT was awarded the contract to complete construction works at the Rushango OPD. Works commenced on 17th February 2015 and were expected to end by 30th June 2015. The scope of works included; completion of the substructure, construction of the superstructure and splash apron, fixing shutters with bugler proof, roofing, internal and external finishes. By 6th July 2015, the progress of works was estimated to be at 75% and the contractor was behind schedule. Completed works included; supper structure, plastering and roofing while ongoing works were construction of the splash apron, fixing windows and flooring.
Outstanding works included fixing doors, painting, and external works. By the end of the FY the contractor had been paid 61%. Good quality works were noted.
Ongoing works at Rushango HCII, Ibanda District
Modified junior staff house completed at Kashambura HCII; civil works were awarded to M/s Galizooka Muttgyeki Tom and Company Limited at a sum of Ug shs, 40,626,550. Works commenced on 17th February 2015 and were completed by 30th June 2015. The scope of works involved construction of a staff house and a two stance VIP pit latrine at the HC. By July 2015, the works had been handed over to the HC. The team noted good quality works and the facility was already in use. It was accommodating two health workers and were happy with the development.
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Completed staff house and 2-Stance pit latrine at Kashambura HCII Ibanda District
Modified junior staff house completed at Kabare HCII; Construction works were awarded to M/s Mukiza and Company Limited at a sum of Ug shs 42,928,730. Works commenced on 17th February 2015, completed and handed over to users by end of 30thJune 2015. The scope of works involved; construction of the junior staff house and a two stance VIP pit latrine.
The contractor was 95% of the contract sum. The team noted good quality works and the facility was already occupied. It was accommodating two health workers; it had greatly reduced absenteeism and boosted morale of health workers.
Three two-stance lined pit latrines at Bwaha, Rubaya, and Rwensamya HCIIs constructed: M/s Amnic Contractors and Builders Company Limited was awarded the contract to construct the three pit latrines at a contract sum of Ug shs 24,494,465. Works commenced on 17th February 2015 and were expected to end on 30th June 2015. The scope of works involved construction of three two- stance lined pit latrines.
By 6th July 2015, works were completed by 100% and contractor paid 86%. Good quality works were noted. The two pit latrines had been handed over to the HCs expect the one of Rubaya HCII.
Two stance lined pit latrine at Rubaya HCII Ibanda district
3.9.4 Kabale District Planned outputs FY 2014/15 • Power installed at Kamwezi HCIV. • OPD at Kibanda HCII renovated. • OPD at Nyarurambi HCII renovated. • OPD at Mukyogo HCII constructed. • DHO’s Office renovated.
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• 30 gas cylinders procured. • Staff house at Kara HCII roofed. • Retention for the DHO’s gate paid • Microorganism for the toilets procured • Renovation of OPD and maternity ward at Kyogo HCIII OPD.
Financial performance In FY 2014/15 the approved budget for the development grant was Ug shs 197,768,000 of which 100% was released and Ug shs 179, 393,807 (98.2%) spent. Expenditures focused on activities highlighted in Table 3.35:
Table 3.35: PHC Development payments at Kabale District FY 2014/15 Contract Payments in FY Output Description Contractor Sum(Ug shs) 2014/15 (Ug shs) M/s Concrite Projects Power installation Kamwezi HCII Limited 6,749,600 5,578,948 Renovation of the OPD at Kibanda M/s Concrite Projects HCII Limited 17,552,500 14,508,194 M/s Vivo Energy (U) Procurement of 30 gas cylinders Limited 7,860,000 7,860,000 7,200,000 Renovation of the DHO’s office Force on account (Budget) 1,570,000 Procurement of microorganisms for M/s EM Technologies (U) the toilets at health facilities Limited 15,004,000 15,004,000
Renovation of Kyogo HCIII OPD M/s Gesses (U) Limited 26,113,400 22,307,040 Renovation of Kyogo HCIII maternity ward M/s Gesses (U) Limited 27,060,000 17,277,584 Construction of OPD at Mukyogo HCII M/s Henhopex (U) Limited 48,360,300 35,361,648 M/s TUR Holdings Roofing of Kara HCII staff house International Limited 8,118,400 6,935,040 M/s Henhopes Enterprises Renovation of Nyarurambi HCII Limited 19,293,000 6,935,040 Retention for renovation of DHO’s M/s Concrite Projects gate. Limited 10,991,200 1,099,120 Source: Kabale District
Physical Performance Seven out of ten projects were physically verified. These were; Rehabilitation of Kibanda HCII, power installation at Kamwenzi HCIV, renovation of OPD at Kyogo HCIII, renovation of maternity ward at Kyogo HCIII, construction of OPD at Mukyogo HCII, and rehabilitation of Nyarurambi HCII. The following was established:
Rehabilitation of Kibanda HCII; M/S Concrite Projects Limited was contracted to undertake the civil works at a sum of Ug shs 17,552,500. Works commenced on 15th June 2015 and expected to be completed by 30th June 2015. The scope of works included; floor screeding, ceiling, and painting, replacement of wooded with metallic doors, plumbing works in the maternity room, and splash apron works.
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Left: Newly rehabilitated Kibanda HC II. Right: Newly rehabilitated floor at Kibanda HC II in Kabale District
Physical progress was estimated at 80% against 83% financial progress. Completed works included; floor screeding, splash apron, painting, removal of all wooden doors, fixing of three metallic doors. Outstanding works included replacement of six internal doors. The monitoring team noted poor workmanship; the screeded floor had already cracked while the replaced doors were not closing properly.
Power installation Kamwezi HCIV; M/s Concrite Projects Limited was awarded the contract to install grid power at Kamwezi HCIV at a contract sum of Ug shs 6,749,600. Works commenced on 7th April 2015 and were expected to be completed by 15th June 2015.
At the time of the monitoring visit 7th July 2015, the company had finished with pre- installation works including installation of the meter, and earthling. Physical progress was estimated at 60%. Pending works including converting solar to grid power wiring as well as power connection to the building.
Renovation of a Maternity ward at Kyogo HCIII: M/s Gesses (U) Limited was awarded works to renovate the maternity ward, at a contract sum of Ug shs 27,060,000. The scope of works included; painting the roof, tiling the labor suit, rough casting of the ward, installation of the gutters, and stone Preliminary works for power installation at Kamwezi HCIV in pitching of the courtyard. Kabale District
The project rolled over from FY 2013/14 into FY 2014/15 due budget shortfalls. Actual renovation works started in August 2014 and were completed in June 2015. The works had been completed and contractor paid Ug shs 24,354,000 (90% of the contract sum). During FY 2014/15, 63% of the contract sum was paid.
Renovation of Kyogo HCIII OPD: M/s Geses (U) Limited was awarded the contract to renovate the OPD at a sum of Ug shs 26,113,400. The scope of works included; painting the OPD and roof, replacement of broken plywood, splash apron works, rough casting, and partitioning part of the maternity ward to create circumcision room, replacement of louvers in the maternity ward, replacement of broken glasses and replacement of solar batteries.
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By July 2015, the contractor had finished with all works on the OPD and started partitioning of the maternity ward. Civil works were estimated to be 80% complete. Outstanding works included replacement of louvers, broken glasses and replacement of the solar batteries.
Left: Renovated OPD and Right: Renovated maternity ward at Kyogo HCIII Kabale district
Partial construction of OPD at Mukyogo HCIV: M/s Henhopex Enterprises Limited was contracted to carry out the partial construction works at a contract sum of Ug shs 48,360,300. Works commenced on 27th March 2015 and were expected to be completed by 15th June 2015. The scope of works included, construction of the sub structure, frame, external and internal walls.
By 7th July 2015, physical progress was estimated to be 70% against 73% financial progress. The contractor had casted the ring beam. Outstanding works included completion of walling, and construction of the roof trusses.
OPD at Mukyogo HCII under construction
Renovation of the Nyarurambi HCII OPD: Civil works were awarded to M/s Henhopex Limited at a contract sum of Ug shs 19,293,000. Works commenced on 13th February 2015 and were completed on 15th May 2015. The scope of works included; floor screeding, repair of cracked walls, painting, construction of the ramp and verandah. By July 7th 2015, the works had been completed and contractor paid 85% (cumulative) of the contract sum. During FY 2014/15, 35% of the contract sum was paid. The monitoring team noted poor quality works especially on the screeded floor and other internal finishes.
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Renovation of the DHO’s office: this was carried using force account. The scope of works included removing, cleaning, repairing and installation of gutters, minor repairs of the external skirting, and clearing the site after works. Works started in April 2015 and were still on going by 7th July 2014. Progress was at 80%. A total of Ug shs 1.5million had been spent on works done.
Implementation challenge • Continuous floor and wall renovations. This was attributed to absence of good quality sand in the district hence most of the newly constructed floors had cracked. Affected health centers during FY 2014/15 included Nyarurambi HCII and Kibanda HCII.
3.9.5 Kabarole District Planned outputs for FY 2014/15 • Payment of retention for construction of OPD at Kasesenge HC II • A placenta pit and waste pit at Kidubuli HCIII constructed. • A placenta pit and waste pit at Nyabuswa H/C II constructed. • Pit latrines constructed at Nyamiseke, Nyakitokoli and Kiboota. • Two Health Centres equipped with furniture. • Nyarugongo H/CII constructed. • OPD at Kirere Health centre II constructed. • OPD Block at Bwanika H/C II constructed. • Kisomoro H/C III general ward completed.
Financial performance In FY 2014/15 the approved budget for PHC development grant was Ug Shs 179 million of which 100% was released and spent. All expenditures were made on construction and rehabilitation works on various health facilities, payment of retention and procurement furniture. Physical performance According to the Acting DHO, the following was reportedly achieved during the FY. Payments were verified by the monitoring team.
Payment of retention for construction of OPD at Kasesenge HC II in Habibaale Sub County: A total of Ug shs 11 million was paid as outstanding payment on works done and Ug shs 4.7 as retention for a contract executed by Abakatunguka Company Limited. Works had been completed in June 2014.
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A placenta pit and waste pit at Kidubuli HCIII in Busoro Sub County constructed: This was done by M/s Nkmat Contractors Limited at a sum of Ug shs 6,465,650. Works started on 15th October 2014 and completed on 30th November 2014. The facility was reportedly complete and 100% of the payments made.
A placenta pit and waste pit at Nyabuswa H/C II constructed: this was done by M/s Acram Uganda Limited at a sum of Ug shs 6,465,650. Works started on 15th October 2014 and completed on 30th November 2014. The facility was reportedly complete, in use and 100% of the payments made.
Construction of latrine at Nyamiseke HC II: M/s DayStar (12) Company Limited was awarded the contract at a sum of Ug shs 10,197,957. Works started on 17th September 2014 and completed on 15th January 2015. The facility was reportedly completed, in use and payments made.
Construction of latrine at Kiboota HC II in Buheesi Sub County: M/s Wabuba Enterprises Limited was awarded the contract at a sum of Ug shs 10,505,918. Works started on 15th September 2014 and completed on 15th March 2015. The facility was reportedly completed and in use.
Two Health Centres equipped with furniture: 24 benches, 36 office chairs and five standard chairs were supplied by M/s Mulum Enterprises Limited at Ug shs 7,570,000 for Kiboota, Nyamiseke and Nyakitoli HCs.
Nyarugongo H/CII constructed: this was not undertaken and nothing paid by end of the FY. The monitoring team physically verified five out puts and the following was established;
Kibiito H/C IV maternity ward completed: this was done in collaboration with Baylor Uganda Limited at a contract sum of Ug shs 1,238,000,000 by M/s Mabeco Uganda Limited. The GoU was expected to contribute Ug shs 106 million (9%), Ug shs 66 million by UNICEF (5.3%) and the rest was contributed by Baylor Uganda Limited contributed. Works commenced in FY 2012/13 and completed in 2014. The infrastructure was commissioned on 22nd August 2014.
It had greatly improved maternal health and deliveries by skilled health workers in the area. This was evidenced by improved deliveries at the health facility from 512 in FY 2011/12 to 1,332 in FY 2014/15. Caesarean births increased from 10 (2%) to110 (8%) in FY 2014/15.
Kisomoro H/C III general ward completed: M/s Kamu Works Limited was awarded the contract to complete the H/C at a sum of Ug shs 37,970,000. Works commenced on 10th May 2015 and expected to be completed by 25th June 2015. Scope of works involved; fixing widow and doors, curtain boxes, internal finishes, external finishes and electrical installations. By the time monitoring done on 6th August 2015, the contractor was finalising works, physical progress was estimated at 95%. The monitoring team noted that the floor and ceiling floor were characterised by large cracks. Drainage challenges around the infrastructure were also noted.
OPD Block at Bwanika H/C II constructed: M/s Delimaz Company Limited was awarded the contract at a sum of Ug shs 32,224,000. Works commenced on 26th September 2014 and expected to be completed 15th April 2015. Scope of works involved preliminary works, substructure, building frames, widow and doors, roofing, site cleaning and handover. Works were completed and 100% of the payments made. The infrastructure was not operational by time of monitoring done on 6th August 2015. Poor floor finishes were noted.
OPD at Kirere Health centre II constructed: M/s Delimaz Company Limited was awarded the contract at a sum of Ug shs 29,257,000. It was later revised to Ug shs 33,257,700 resulting from additional works that had not been foreseen. Works commenced on 12th May 2014 and expected to be completed 12th August 2014, however, actual completion was on 11th March 2015. This was because the contractor had both technical and financial capacity issues.
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Scope of works involved site clearance, foundation works, concrete floor slab, internal and external walling, roofing, door and widows. Although the infrastructure was completed in March 2015, it was not operational by August 2015. It was characterised by large cracks in the patient benches, veranda and the floor.
Construction of latrine at Nyakitokoli HC II in Karagura Sub County: M/s SMJ and K Holding Limited was awarded the contract at a sum of Ug shs 10,854,728. Works started on 28th September 2015 and completed on 15th January 2015. The facility was in use and quality of works was visibly good.
Implementation challenge • Limited PHC development budgets hence most health facilities lacked essential infrastructure like laboratories, OPD, maternity, counselling rooms, offices among others. Most health facilities also lacked medical equipment including beds, laboratory equipment among others.
3.9.6 Katakwi District Planned out puts for FY 2014/15 • Vehicle for DHO’s office procured. • Maternity ward in Ongongoja HCIII constructed. • Solar in Okocho HC II installed. • Staff house in Okocho HCII completed. • Maternity ward in Omodoi HCII constructed. • Outpatient Department in Palam HCII completed. • Maternity ward in Okocho HCII constructed. • Fencing of Kapujan HCIII completed. • Five stance drainable pit latrine in Kapujan HCIII completed.
Financial Performance
The approved budget for PHC development grant including PRDP was Ug shs 238,600,141, of which 100% was released. The district carried forward Ug shs 47,941,739 from FY 2013/14 hence a total of Ug shs 281,399,692 was spent by end of June 2015. This was excellent financial performance. Details of expenditure are indicated in the table (3.36) below.
Table 3.36: PHC development payments by Katakwi district by 30th June 2015
Output Description Contractor Contract Payments in FY sum(Ug shs) 2014/15 (Ug shs)
Procurement of Vehicle for DHO’s office M/s Cooper Motors (U) 106,912,490 106,912,490 Limited. Construction of Maternity ward in M/s Dio Builders and 81,278,400 77,214,480 Ongongoja HCIII. Engineers. Installation of solar in Okocho HCII M/s Gino Enterprises. 5,000,000 5,000,000 Completion of staff house in Okocho HCII M/s Broad base 36,100,000 27,153,080 Engineering Limited. Construction of a maternity ward in M/s Babone Bigere 79,639,100 57,903,580 Omodoi HCII Company Limited.
Payment of retention for completion of M/s Ober and Sons 33,965,339 1,698,267 OPD in Palam HCII Enterprise.
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Payment of retention for construction of M/s Dio Builders. 2,925,350 2,925,350 maternity ward in Okocho HCII
Payment Fencing of Kapujan HCIII. M/s Holly Hands 1,893,000 1,892,720 Company Payment of retention for construction of a M/s Generation Life Span 13,994,500 699,725 five stance drainable pit latrine in Kapujan 2000 Limited. HCIII Source: Katakwi district
Physical Performance:
All planned projects during the FY 2014/15 were monitored. The following was established;
Vehicle for DHO’s office procured: M/s Cooper Motors supplied the motor vehicle at a contract price of Ug shs 106,912,490. By 22nd June 2015, the vehicle was delivered to the district and fully paid.
It was in good mechanical condition and expected to enhance monitoring and supervision activities at various health facilities in the district.
Maternity ward at Ongongoja HC11 constructed: M/s Dio Builders and Engineers was awarded the contract to undertake the works at a sum of Ug shs 81, 278,400. Civil works started in February 2015 and Suzuki Vitara procured for DHO’s Office Katakwi expected to be completed by end of June 2015.
Financial and physical progress were at 95%. The super structure was roofed, plastered, external painting done, windows and doors fixed. Major pending works included completion of internal painting, and glassing. Good quality civil works were noted.
Substantially completed maternity ward Ongongoja HCII Katakwi district
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Maternity ward at Omodoi HC11 constructed: M/s Babone Bigere Company Limited was contracted to undertake the works at a sum of 79,639,100. Works commenced in January 2015 and were expected to be completed by 30th June 2015.
By 22nd June 2015, physical progress was estimated at 60% against 72% financial progress. Walling was completed and roof trusses fitted. Pending works included; plastering, completion of roofing, painting, flooring and shuttering.
Maternity ward at Omodoi HCII Katakwi district
Staff house at Okocho HCII completed: M/s Broad Base Engineering Limited was contracted to undertake completion works at a sum of Ug shs 36,100,000. The scope of works included; roofing, fitting of doors and windows, flooring, splash apron works, plastering and painting. Physical progress was estimated to be at 90% against 72% payments. Outstanding works included painting and glassing. The quality of civil works was observed to be good, however, the staff quarters lacked sanitary facilities. These were not planned in the contract.
Power installed at maternity ward in Okocho HCII: The installation works were contracted to M/s GINO Enterprises at a sum of Ug shs 5,000,000. By 22nd June 2015, solar power was already installed at the maternity ward.
Retention for maternity ward Okocho HCII paid: Retention worth Ug shs 2,925,350 for the construction of the maternity ward was paid to M/s Dio Builders. Although the retention was paid, some defects were not rectified. For example, some door locks had broken and were not replaced while other doors failed to lock properly.
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Left to right: Staff house, solar power and defective door in the maternity ward Okocho HCIII Katakwi District
Retention for fencing of Kapujani HCIII: M/s Holly Hand was paid Ug shs 1,893,000 as retention for construction of a fence at the health center completed in FY 2013/14. It was observed that the fence constructed had no dwarf wall and animals were crossing into the health facility. The gate was already falling apart with one part stuck onto the ground and failed to close.
An animal crossing through the fence and a broken gate at Kapujani HCIII Katakwi District
Retention for completion of a five stance drainable pit latrine: M/s Life Span2000 Limited was paid the retention for construction of a five stance drainable pit latrine at Kapujani HCIII. It was observed that although the retention was paid, the contractor had not corrected defects and therefore the facility could not be used the beneficiary HC.
3.9.7 Masaka District Planned outputs for the FY 2014/15
• Staff house at Makonzi HCII partially constructed. • Staff house at Kitunga HCII completed. • Renovation of maternity ward at Kyanamukaka completed. • Mpugwe staff house renovated. • Retention for projects of FY 2013/14 paid.
Financial Performance
In FY 2014/15, the approved PHC development budget was Ug shs 147.881 million of which 100% was released and Ug shs 142.88(97%) spent. Table 3.37 indicates detailed financial performance per output during FY 2014/15.
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Table 3.37: PHC development payments by Masaka district by 30th June 2015 (Ug shs)
Payment to the Contract Project Name Contractor contractor during sum FY 2014/15 Staff house at Makonzi HCII partially M/s P&D Traders and 50,358,940 constructed Contractors 53,000,411 M/s Bekabye General Kitunga Staff House completed 27,846,761 Enterprises 29,303,589 Maternity ward at Kyanamukaka M/s Kaleta Construction 29,549,602 HCIV renovated Company Limited 32,982,700
Staff house at Mpugwe HCIII M/s P&D Traders and 23,734,800 renovated Contractors 24,984,000
Payment of retention for construction M/s Bekabye General 3,393,127 of Kitunga staff house phase I Enterprises 33,610,500 Payment of retention for construction M/s Tick Services (U) 4,997,309 of Mpugwe OPD Limited 99,950,000 Monitoring and supervision of N.A N.A 3,000,000 construction activities. Total 142,880,539 Source: Masaka District
Physical Performance
The annual monitoring focused on all planned outputs and the following was established:
Partial construction of staff house at Makonzi HC II in Kyanamuka Sub County: M/s P&D Trader’s and Contractors was awarded the contract at a sum of Ug shs 53,009,411. Works commenced in January 2015 and expected to end in April 2015. The scope of works involved construction of the staff house up to roofing stage.
By 22nd July 2015, works were completed with the structure roofed. Other works were expected to be completed in the next construction phase. These included fixing of internal doors, painting, floor works, glassing and verandah works. The health workers were happy about the intervention since they were sleeping in the OPD section of the facility. The midwife that was posted to the facility had left for another HC due to lack of accommodation, this intervention was therefore expected to also improve service delivery within the community.
Staff house at Makonzi HCII, Masaka District
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Staff house at Kitunga HCII completed: Works were awarded to M/s Bekabye General Enterprises at a sum of Ug shs 29,303,589. The scope works involved plastering, painting, fixing shutters and flooring. Civil works commenced in January 2015 and completed in May 2015. The quality of civil works was observed to be good. The staff house however, had not been occupied by 22nd July 2015.
This was reportedly due to lack of electricity in the facility. The contractor was paid 95% of the contract sum by 30th June 2015. The staff house was expect to accommodate four health workers. Staff house at Kitunga HCII, Masaka District
Maternity ward at Kyanamukaka HCIV renovated: Works were awarded to M/s Kaleta construction Company Limited at a contract sum of Ug shs 32,982,700. Renovation works commenced in December 2014 and completed in March 2015. The scope of works involved replacing of the roof, installation of gutters, face boards and louvers. Painting, replacing windows, doors and ceiling. Frosting windows in the delivery rooms for improved privacy, water connection and splash apron works.
By 21st July 2015, works were completed and the maternity ward was in use. The contractor had been paid 89.59% of the contract sum.
A number of benefits were registered including increased number of deliveries at the health facility due to the comfort, privacy, and cleanness of the ward. Health workers noted that the Renovated maternity ward Kyanamukaka HCIII, Masaka District intervention had led to easy management labor and better service delivery.
Staff house at Mpugwe renovated: Civil works were awarded to Kaleeta Construction Company Limited at a sum of Ug shs 24,984,000. The scope of works involved rough casting, painting of the iron sheets, replacement of internal doors and broken glass in some windows, reconstruction of the splash apron and general painting. Civil works commenced in January 2015 and completed in May 2015. The beneficiaries were happy with the project and works done.
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Renovated staff house at Mpugwe HCIII, Masaka District
Benefits:
Retention for projects completed in FY 2013/14 paid: Retention worth Ug shs 4.9million was paid to M/s Tick Services Uganda Limited for the OPD construction at Mpugwe HCIII. A total of Ug shs 3.3million was paid to M/s Bekabye for the partial construction of Kitunga HCII staff house.
3.9.8 Mbarara District
Planned out puts for FY 2014/15 • Junior staff house constructed at Kagongi HCIII • Junior staff house constructed at Kaliro HCII • Junior staff house partially constructed at Nyabikungu HCII • Junior staff house constructed at Ryamiyonga HCII
Financial performance In FY 2014/15 the approved budget for PHC development grant was Ug shs 164,125,040 of which 100% was released and Ug shs 142,208,985 (87%) spent on activities highlighted in Table 3.38. Table 3.38: PHC Development payments by the Health Department of Mbarara District FY 2014/15
Contract Sum(Ug Payments in FY Output Contractor shs) 2014/15 (Ug shs) Junior staff house M/s AKJO (U)limited 43,263,284 31,622,308 constructed at Kagongi HCIII Junior staff house M/s Cream General 44,742,650 41,653,448 constructed at Kaliro HCII services
Junior staff house partially constructed at Nyabikungu M/s JB Kabuyanda 31,043,440 28,877,545 HCII Junior staff house M/s Katamba Tech constructed at Ryamiyonga 43,343,878 40,055,684 Services HCII Source: Mbarara District
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Physical performance: The monitoring team visited all the four projects and established the following; Junior staff house constructed at Kagongi HCIII: M/s AKJO (U) Limited was contracted to undertake the works at a sum of Ug shs 43,263,284. The scope of works involved construction of; a two unit staff house and a two stance pit latrine at the HC. Civil works commenced on 10th February 2015 and were completed on 9th June 2015. The contractor was paid 73% of the contract sum. The staff house had not been handed over to the HC by time of monitoring done on 22nd June 2015
The monitoring team noted good quality works at both the staff house and VIP latrine. The facility was expected to improve accommodation, morale, privacy and service delivery at the HC. Previously, four health workers were sharing a two unit staff house at the HC, this compromised privacy and affected the morale of health workers.
Improved junior staff house and VIP latrine at Kagongi HCIII, Mbarara district
Junior staff house constructed at Kariro HCII: M/s Cream General Services was awarded the contract at a sum of Ug shs 44,742,650. The scope of works involved construction of a two unit junior staff house and a two stance VIP latrine. Civil works commenced on 5th February 2015 and completed on 14th June 2015. The contractor was paid 93% of the contract sum by 30th June 2015. The monitoring team noted good quality works at both the staff house and VIP latrine. The community was optimistic that facility would improve health service delivery at community level with availability of health workers most of the time.
Improved junior staff house and VIP latrine at Kariro HCII, Mbarara district
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Improved junior staff house partially constructed at Nyabikungu HCII: M/s JB Kabuyanda was awarded the contract at a sum of Ug shs 31,043,440. The scope of works involved; partial construction of a two unit staff house and a two stance pit latrine. The partial construction works included; substructure, walling and framing, roofing, plain vibrated concrete fixing doors and windows. Civil works commenced on 20th April 2015 and expected to be completed by 20th July 2015.
By 22nd June 2015, the VIP latrine and partial construction works for the staff house were completed and the contractor paid 93% of the contract sum. The monitoring team noted good quality works at both the staff house and VIP latrine. Outstanding works on the staff houses planned were planned under phase two. These included plastering, glassing, painting, floor finishes, drainage works, electrical works and other finishes
Partially constructed junior staff house and completed VIP latrine at Kariro HCII, Mbarara district
Improved junior staff house constructed at Ryamiyonga HCII: M/s Katamba Tech Services was awarded the contract at a sum of Ug shs 43,343878. The scope of works involved construction of a two unit staff house and a two stance VIP latrine. Civil works commenced on 5th February and completed on 4th May 2015. The contractor had been paid 93% of the contract sum. Good quality civil works on both the staff house and VIP latrine were noted. The staff house had not been handed over to the health facility and was expected to improve service delivery through reduced absenteeism of health workers.
Completed junior staff house and completed VIP latrine at Ryamiyonga HCII, Mbarara district
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3.9.9 Nakapiripiriti District Planned out puts FY2014/15
• Two stance drainable pit latrine in at Tokora HC1V constructed. • Two staff houses in Tokora HC1V rehabilitated. • Four stance Drainable pit latrine in Acegertolim HCII constructed. • Staff house in Nayonaingikalio HCII constructed. • Two sets of two stance drainable pit latrine in Lomorunyagae HCII constructed. • Refresher training of Health Unit, Management committees carried out. • Maternity ward in Namalu HCIII completed. • Nabilatuk HC1V General Ward rehabilitated. • Rehabilitation of Nabilatuk HCIV General ward • Retention for a twin staff house in Lorengdwat HCIII paid. • Completion of fencing for Lorengdwat HCIII • Repair of motor vehicles • Completion of fencing Natirae HCII • Two staff houses in Tokora HC1V renovated. • Retention for first phase fencing Lorengdwat HCIII paid. • Staff house in Lemusui HCIII renovated. • OPD at Lemusui HC III renovated.
The following projects were implemented towards end of FY 2014/15. These had not been included in the sector’s annual work plan. • Completion of staff house at Nayonaiangikalio HCII. • Renovation of a fourth the staff house at Nabilatuk HCIV.
Financial Performance
The approved budget for FY2014/15 was Ug shs 415,262,076 of which 100% was released and Ug shs 382,727,922 (92%) spent by 30th June 2015. This was excellent release and expenditure performance. Details of expenditure are indicated in the table below (3.39).
Table 3.39: PHC development payments by Nakapiripiriti district by 30th June 2015
Planned Activity Contractor Contract Sum Payments in FY 2014/15 Construction of two stance Drainable pit M/s EJok Edeke 6,764,310 6,297,877 Latrine in Tokora HC IV International (U) LTD
Construction of Four stance Drainable pit M/s Slogana 2010 12,544,035 11,674,631 Latrine in Acegertolim HC II Construction of staff house in Nayonai M/s Lila Enterprises LTD 46,218,820 46,218,820 Angikalio HC II Construction of two Sets of two stance M/s Kolir Youth 13,719,300 12,767,370 drainable pit Latrine in Lomorunyagae HC Development LTD II Renovation of OPD at Lemusui HC III M/s Lord in One 13,152,150 12,006,676 Enterprises LTD Renovation of staff two houses in M/s Makal Construction 50,740,800 47,241,720 Nabilatuk HC IV PRDP Co. Ltd
Construction of staff house in M/s Kadam Contractors 10,709,540 13,215,240 Lomorunyagai HC II
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Refresher Training of Health Unit Planning Office and 25,000,000 25,000,000 Management Committees on their roles DHO’s Office (PRDP) Completion of Maternity Ward in Namalu M/s Nakwiir 26,436,000 25,919,200 HC III (PRDP) Development Company. Ltd Rehabilitation of staff house in Tokora HC M/s Longoli I Agencies 25,000,000 24,555,000 IV (PRDP) Completion of payment for a twin staff M/s Karamoja 5,185,195 5,227,195 house in Lorengedwat HC III Amalgamated Agencies
Renovation of two staff houses in Tokora M/s Kodike United 54,741,000 7,264,500 HC IV Company Ltd Completion of payments for Fencing M/s Karamoja 700,000 700,000 Lorengedwat HC III Amalgamated Agencies
Renovation of Health staff house in M/s Komoret Suppliers 23,891,500 22,678,433 Lemusui HC III and Contractors Ltd
Completion of payment for the M/s Kawar General 2,500,000 2,500,000 construction of staff house in Natirae HC Traders II Repair of Motor Vehicles M/s Bugema Garage 25,000,000 25,000,000 Completion of Fencing of Lorengedwat HC M/s Kilipa CO. LTD 13,937,721 2,555,450 III Completion of staff house in Nabilatuk HC M/s Agenoni (U) LTD 2,395,208 2,395,208 IV Renovation of staff house in Nayonai M/s Obur Enterprise 17,747,200 10,744,500 Angikalio HC II Completion of Fencing Natirae HC II M/s Lokosowa and Sons 17,304,263 15,292,426 Enterprise
Construction of staff house in Acegertolim M/s Galaxy Gen. 45,967,657 9,403,676 HC II Suppliers & Co. Ltd
Completion of staff house in M/s Lila Enterprise 41,191,060 38,565,400 Nayonaiangikalio HC II Renovation of staff houses in Nabilatuk M/s High Tech. Works 24,692,850 15,504,600 HC IV (U) Ltd Source: Nakapiripiti District
Physical Performance
The annual monitoring focused on eight outputs. These were; construction of a pit latrine at Todora HCIV, construction of a staff house at Nayonaiangikalio HCII, renovation of two staff houses at Tokora HCIV, completion of fencing at Lorengedwat HCIII, payment of retention for the staff house and first phase fencing at Lorengedwat HCIII, renovation of four staff houses at Nabilatuk HCIV, and completion of maternity ward at Namalu HCIII.
Two stance pit latrine constructed at Tokora HCII: M/s Ejok Edeke International (U) Limited was contracted at a sum of Ug shs 6,764,310 to undertake the works. Civil works commenced in March 2015 and completed in May 2015. The pit latrine was handed over and in use.
Two staff houses renovated in Tokora HC1V: M/s Kodike United Company Limited was awarded the contract to undertake renovation works at a sum of Ug shs 54,741,000. The scope of works
97 | HEALTH SECTOR ANNUAL MONITORING REPORT FINANCIAL YEAR 2014/15 involved; replacement of ceiling, ridges, broken glasses, windows, wooden doors with metallic doors, filling minor cracks, painting, splash apron construction, plumbing and septic tanks. Civil works started in April 2015 and were expected to be completed by 30th June 2015.
By 23rd June 2015, physical progress of civil works was estimated to be 60% against 13% financial progress. Major works on the first house and septic tank were near completion while those of the second house had just started. The renovation works were slow due to lack of adequate materials on site.
Staff houses under renovation Tokora HCIV, Nakapiripirit District
Maternity ward at Namulu HCIII completed: Civil works for the completion of the maternity ward were awarded to M/s Nakwiir Development Company Limited at a contract sum of Ug shs 26,436,000. The scope of works involved; roofing, plastering, painting, construction of ramp, splash apron, fitting of shutters, and other external works.
Civil works began in March 2015 and were expected to be complete by 10th June 2015. By 23rd June 2015, the maternity ward was completed and contractor paid 98% of the contract sum. The facility was already in
Completed maternal ward Namalu HCIII, Nakapiripiriti use. The civil works were generally of good District quality.
Staff house in Nayonaiangikalio HC11 constructed: M/s Lila Enterprises Limited was contracted to construct the first phase of staff house at a contract sum of Ug shs 46, 218, 820. The scope of works involved construction of the staff house up to ring beam level. Civil works began in March 2015 and completed by 23rd June 2015.
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Towards the end of FY 2014/15, the same contractor was awarded the contract to complete the works at a sum of Ug shs 41,191,060. The scope of works included roofing, plastering, fixing doors and windows, painting, flooring and eternal works. By 23rd June 2015, completion works had not commenced.
Completed phase of staff house Nayonaiangikalio HCII, Nakapiripiriti District Nabilatuk HC1V staff houses renovated: the renovation of three staff quarters was awarded to M/s Makal Construction Company Limited at a contract sum of Ug shs 50,740,800. The scope of works involved floor screeding, painting, replacement of iron sheets and ceiling. Renovation works commenced in May 2015 and were expected to be completed at the end of June 2015.
Staff houses under renovation Nabilatukl HCIV, Nakapiripiriti district
Civil works were however estimated at 50% against 93% financial progress as of 24th June 2015. Renovation works on the two staff houses had commenced while those on the third house had not started. The district also paid retention worth Ug shs 2,395,208 to M/s Agenoni (U) Limited for construction of staff house at Nabilatuk HCIV.
Fencing at Lorengedwat HCIII completed: M/s Kilipa Construction Company was awarded the contract to complete fencing of the health facility at a contract sum of Ug shs 13,937,721. Fencing was completed by 22nd June 2014. The fencing was observed to be good and created security to HC. The district also paid retention worth Ug shs 700,000 to the first contractor M/s Karamoja Amalgamated Agencies for the first phase of fencing the health center. Although retention for the first phase was paid the contractor did not rectify defects at the gate.
Completed Fence at Lorengadwat HCIII, Nakapiripiriti
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Retention worth Ug shs 5,185,195 for the completion of a twin staff house in Lorengedwat HCIII was paid to M/s Karamoja Amalgamated Agencies. The staff house which was completed in FY 2010/11 was in good condition and in use by the staff at the facility.
Implementation challenges
The district faced a number of challenges. These include;
• Delayed payment of contractors affected completion of planned activities. Some contractors noted that payment of certificates took a period of over one month. • Inadequate financial capacity of contractors led to heavy reliance on advances from the district to implement civil works. • Procurement delays led to failure to complete planned activities within the FY hence rolling over projects to FY 2015/16. • Poor road network made transportation of construction materials difficult and costly. • Absence of good quality construction materials within Karamoja region. Most of construction materials were procured from Mbale. This increased construction costs which in most cases were not planned and budgeted for in the BoQs.
Recommendations • The district Engineering Department should factor the cost of transporting materials to the district while developing BoQs to avoid both procurement and construction delays. • The district should ensure timely clearance of certificates to avoid delays in the implementation of the projects. • The Uganda Road Fund (URF) should allocate adequate funds to the district to upgrade the district road network.
3.9.10 Napak District Planned outputs for the FY 2014/15
• Two Staff houses at District Medical Officers (DMO’s) clinic constructed. • OPD and VIP pit latrine at the DMO’s clinic constructed • Staff house at Namendera HCII constructed. • Staff house at Apetolim HCII constructed. • OPD at Amedek HC II constructed. • Staff house at Natrumrum HC II constructed. • OPD at Natrumrum completed. • Retention for Amedek staff house paid.
Financial Performance
In FY 2014/15 the approved PHC development budget was Ug shs 672.27 million of which 100% was released. The district carried forward Ug shs 131.4 million from FY 2013/14 hence spent Ug shs 691.836 million (86%). Table 3.40 indicates payments made per output during FY 2014/15.
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Table 3.40: PHC development payments by Napak district by 30th June 2015 (Ug shs)
Payment to the Contract contractor Project Name Contractor sum during FY 2014/15 Construction of staff house at M/s Napak Technical 103,150,000 98,238,095 Naturumrum Health Centre III Services Construction of staff house at District M/s Samaro Investment 120,661,750 85,887,472 Headquarter (U) Ltd
Construction of staff house at Apeitolim M/s Namorotot General 112,276,450 106,929,952 HC II Enterprise (U) Limited
Construction of staffs’ house at M/s Kadila Traders 98,408,640 89,462,400 Namendera Health Centre II Limited Construction of OPD at Amedek Health M/s Makal Construction 135,000,030 122,727,300 Centre II (U) Limited Construction of staff house at the DMO's M/s BMK(U) Limited 138,345,000 131,421,779 clinic M/s Gumare General Completion of OPD at Natrumrum HCII 45,340,630 45,340,630 Stores Payment of retention for staff house at 9,760,465 Amedek HCII Payment of retention for Construction of 2,068,601 generator house at District Headquarters Total 691,836,694 Source: Napak District
Physical Performance
The annual monitoring focused on seven outputs and the following was established;
Staff house at the DMO’s Clinic constructed: M/s Oryemcan Company Limited was awarded the contract at a sum of Ug shs 120,661,750. The scope of works involved construction of a twin staff house, installation of a solar system and a water harvesting system. Civil works commenced in February 2015 and were expected to be completed by end of May 2015. By 24th June 2015, physical progress was estimated at 60% against 70% financial performance. Roofing was completed and shutters fixed. Ongoing works included internal plastering and plumbing works.
Second staff house at the DMO’s clinic constructed: Funds amounting to Ug shs 131million, rolled over from FY 2013/14 for a project that did not take off due to land wrangle with the Uganda Wild Life Authority were used for finance this project. Works were awarded to M/s BMK (U) Limited at a contract sum of Ug shs 138,345,000. The extra Ug shs 7million was financed from FY 2014/15 budget. The scope of works included construction of the staff house, plumbing with water harvesting system, and installation of a solar system.
Civil works began in February 2015 and completed by June 2015. The quality of civil works was good and 95% of the contract sum had been paid by end of the FY 2014/15.
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Staff houses constructed at the DMO’s clinic, Napak district
OPD at the DMO’s Clinic constructed: The project was mainly funded by the Local Government Management Service Delivery (LGMSD) grant (87%). M/s HRN Business Services was awarded the contract to undertake the works at a sum of Ug shs. 135,000,000. Civil works began in January 2015 and was expected to be completed in April 2015. The scope of works involved construction of a clinic with; a treatment room, examination room, emergency delivery room, rest room, mini laboratory and store. Plumbing works, water harvesting system, solar system and a two stance VIP latrine. Works were completed and not yet commissioned. Quality of works was good. The district had not yet paid its obligation to the contractor by end of June 2015.
Completed OPD and two stance VIP latrine at the DMO’s Clinic in Napak District
Staff House Namendera HCII constructed: M/s Kadila Traders was awarded the contract to undertake the works at a sum of Ug shs 98,408,640. Civil works commenced in January 2015 and were expected to be completed in April 2015. The scope of works involved construction of a twin staff house, plumbing with water harvesting system, installation of a solar system and two stance VIP latrines. By 24th of June 2015, the works had been completed, however, the facility had not yet been handed over to beneficiary HC. Civil works were observed to be of good quality.
Completed staff house and pit latrine Namandera HCII in Napak District
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Staff House at Apetolim HC11 constructed: Works were awarded to M/s Namurotot Enterprises at a contract sum of Ug shs 112,276,450. The scope of works involved construction of a twin staff house, plumbing with water harvesting system, installation of a solar system and two stance VIP latrines. Civil works began January 2015 and were expected to be completed in April 2015. By 25th June 2015, the staff house was completed and in use. The quality of civil works was observed to be good.
Completed staff house Apetolim HCIII in Napak District
OPD at Amedek HC11 constructed: M/s Kadila Traders Limited was awarded the contract to undertake the works at a sum of Ug shs 135,000,000. The scope of works involved construction of the OPD, plumbing works with water harvesting system and a two stance VIP latrine.
Works began in January 2015 and were expected to be completed by end of April 2015. Civil works were estimated to be 80% complete as of 25th June 2015 with walling, plastering, first coat painting, flooring, roofing and installation of solar power completed. Ongoing works involved painting, some internal finishes and external works. The contractor was behind schedule and this was attributed to the poor road infrastructure which affected timely transportation of constriction materials to site.
OPD under construction and constructed staff house Amedek HCII in Napak District
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3.9.11 Nebbi District
Planned outputs FY 2014/15 • Staff house at Goli HCIII completed. • Semidetached staff house at Panyigoro HCIII completed. • OPD at Akworo HCIII rehabilitated. • Kitchen at Padwotmidyere HC III completed. • Isolation ward renovated. • Two stance pit latrine constructed at Panyimur HCIII.
Financial performance
In FY 2014/15 the approved budget was Ug shs 260,719,675 of which 100% was released. A total of Ug shs 167,264,845 (64%) was spent by 30th June 2015. Table 3.41 indicates the detailed payments made per output during FY 2014/15.
Table 3.41: PHC Development payments by output at Nebbi District FY 2014/15
Contract Sum (Ug Payments in FY Output Description Contractor shs) 2014/15 Completion of staff house at Panyigoro M/s Zaki Construction 29,057,517 29,057,517 HCIII Limited Renovation of Isolation ward at M/s Mola and Sons trade 55,000,000 52,250,000 Panyimur HCIII Construction of a two stance pit latrine M/s River Shore Trade 7,999,970 7,199,973 at Panyimur HCIII links Rehabilitation of general ward at M/s Jepthar and Sons 51,524,818 28,186,542 Akworo HCIII Trade Construction of kitchen and pit latrine M/s Mola and Sons Trade 20,000,000 18,033,879 at Padwo-midyere HCIII M/s River Shore Trade Completion of staff house at Goli HCIII 49,853,702 32,536,916 Links Total expenditure 167,264,827 Source: Nebbi District
Physical performance
The annual monitoring focused on all the planned outputs. The following was established;
Staff house at Panyigoro completed; M/s Zaki Construction Limited was awarded the contract to complete the construction works at a contract sum of Ug shs 29,057,517. Works began in December 2014 and completed by 30th June 2015. The facility was handed over and occupied. The civil works were noted to be of good quality. The staff house however lacked a kitchen and other sanitary facilities, these were not planned for in the contract.
Staff house at Goli HCIII completed: M/s River Shore Trade Links was awarded the contract at a sum of Ug shs 49,853,702. Civil works began in December 2014 and were substantially completed (95%) by 30th June 2015. The contractor had been paid 65% of the contract sum. The scope of works involved construction of a semidetached staff house and installation of a ten thousand liter tank. Outstanding works included completion of painting and some internal finishes. The civil works were observed to be of good quality.
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Completed staff house at Goli HCIII, Nebbi district Completed staff house Panyigoro HCIII, Nebbi District
Renovation of Isolation Ward completed; M/s Mola and Sons Traders was contracted to undertake the civil works at a contract sum of Ug shs 55million. The scope of works involved re- roofing, painting, ramp construction, and replacement of the ceiling board. Civil works began in December 2014 and were expected to be completed by 30th April 2015.
Major works on the isolation ward had been completed by 2nd of July 2015. Physical progress was at 95% against 95% financial progress. The contractor was behind scheduled and outstanding works included completion of painting, replacement of curtain boxes and sink. Poor finishes were observed at the isolation ward. Delays in completion of works led to congestion in the general ward.
Construction of pit latrine at Panyimur HCIII completed: M/s River Shore was awarded the contract at a sum of Ug shs 7,999,970. The scope of works involved construction of a two stance VIP latrine. Civil works began in December 2014 and were completed in April 2015. The contractor was paid 90% of the contract sum. The latrine had improved sanitation at the health facility.
Left: Renovated Isolation ward. Right: Newly constructed pit latrine at Panyimur HCIII, Nebbi District
Construction of kitchen and pit latrine at Padwot-Midyere completed: M/s Mola and Son Trade was awarded the contract to construct a kitchen and pit latrine at Padwot-Midyere at a contract
105 | HEALTH SECTOR ANNUAL MONITORING REPORT FINANCIAL YEAR 2014/15 sum of Ug shs 20million. The scope of works involved construction of a two stance VIP latrine and a kitchen block of two units. Civil works began in February 2015 and were completed in April 2015. The contractor was paid 90% of the contract sum. The latrine had improved sanitation at the staff quarters. The kitchen had also improved the morale and welfare of health workers since they were previously cooking at their verandahs.
General ward at Akworo rehabilitated: M/s Jepthar and Sons Limited was contracted to undertake civil works at a contract sum of Ug shs 51,524,818. The scope of the works included; Re- roof, painting, ceiling, construction of the ramp, replacement of wooden doors and windows with metallic ones. The contractor had completed the works and paid 55% of the contract sum.
The facility was handed to the HC and occupied. It was however, noted that the intervention disorganized the solar system hence stopped working. The staff were however happy with the intervention since it provided a better and clean working environment than before.
Renovated general ward Akworo HCIII at Nebbi Constructed staff houses and latrine Padwotmidyere district HCIII, Nebbi district
3.9.12 Nwoya District Planned outputs FY 2014/15 • Fencing at Kochgoma HCIII completed. • OPD at Longole HCII renovated. • OPD at Panokrach HCII renovated • Four stance drainable pit latrine at Panokrach HCII constructed. • One block of four units of staff house with a two stance VIP latrine at Aparaa HC II constructed. • OPD and maternity ward at Todoro HC II rehabilitated.
Financial performance
In FY 2014/15 the approved budget was Ug shs 308,234,927 of which 100% was released and Ug shs 202,291,184 (65.6%) spent by 30th June 2015. Table 3.42 indicates the detailed payments made per output during FY 2014/15.
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Table 3.42: PHC Development payments by output at Nwoya District FY 2014/15
Contract Sum Payments in FY Output Description Contractor (Ug shs) 2014/15
Rehabilitation of OPD and Maternity M/s RAL Investment 55,401,389 46,373,528 ward at Todora HCIII
Completion of Fencing Koch Goma M/s Pathway Technical 48,513,340 46,087,673 HCIII Services Construction of a four unit staff M/s Lacan-Bil (U) house and drainable latrine at Paraa 115,610,508 109,829,983 Limited HCII Total expenditure 202,291,184 Source: Nwoya District
Physical performance
The annual monitoring focused on three out of the planned six outputs. The following was established;
Fencing of Kochgoma HCIII Completed; M/s RAL Investment was contracted to complete the fence of the HC at a contract sum of Ug shs 48,513,340. Works began April 2015 and completed by 30th June 2015. The monitoring team noted good quality works. The contractor had constructed a dwarf wall as fencing foundation unlike the previous contractor. This made the fence stronger in the section under review than the other part constructed in FY 2013/14.
The fencing improved security at the health facility since trespassers were closed out. It also prevented the community from encroaching on the facility land.
Staff house and a two stance drainable VIP latrine at Para HCII constructed; M/s Lacan-Bil (U) Limited was awarded the contract to undertake the civil works at a sum of Ug shs 115, 610,508. Civil works began in April 2015 and completed by 30th June 2015. The works had been completed.
The team noted good quality civil works. The staff house was accommodating four health workers and had contributed to improving service delivery at community level since health workers were available at the HCs all the time. It was also expected to contribute towards attraction and retention of staff at the facility.
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OPD and maternity ward at Todoro HC II rehabilitated; M/s RAL Investment was contracted to undertake these civil works at a contract sum of Ug shs 55,401,389. The scope of the works included; ceiling works, construction of a ramp and splash apron, plastering, replacement of five doors, reroofing, and painting
The scope of works for the maternity ward included; ramp construction, repairing the splash apron, installation of two transparent iron sheets, ceiling, plumbing works and installation of the lightening arrestor. Civil works began in February 2015 and expected to be completed by 30th June 2015.
Overall the physical progress by 1st July 2015 was estimated to be at 95% against 84% financial progress. Outstanding works included completion of plumbing works in the maternity ward and internal finishes. The OPD had been handed over to the facility while the maternity ward had not been completed.
Works for renovation of Lulyango HCII, Fencing of Para HCII, and rehabilitation of Panokrach HCII had been awarded and sites handed over but no civil works had started by 1st July 2015.
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3.9.13 Nakaseke district Planned outputs for FY 2014/15 • Retention for completion of a Maternity ward at Kinyogoga HC III paid. • Wakyato HC III rehabilitated. • Power installed in DHO’s office at the district headquarters. • Kapeka HCIII rehabilitated.
Financial Performance
In FY2014/15 the approved budget for PHC development grant was Ug Shs 156 million of which 100% was released and spent by 30th June 2015. Expenditures were made on the above four planned outputs.
Physical Performance
All the four outputs were verified.
Kapeka HCIII rehabilitated: works were undertaken by M/s Nakamuwa Construction Company Limited at a sum of Ug shs 47,387,714. Civil works commenced on 25th April 2015 and completed on 25th June 2015 (within three months). The scope of works involved rehabilitation works on three structures namely;
a) Main building; floor repairs, painting, skirting, construction of a splash apron, rough casting, rain water drainage, ceiling repair with plywood, window and door repairs with new locks and replacement of glass. b) Maternity ward; painting, floor repairs, skirting, replacement of door frames and ceiling works. c) Staff quarters; painting, rough casting, window and door repairs.
Works were done and completed on all the three structures indicated in the scope.
Wakyato HC III rehabilitated: works were undertaken by M/s Nakamuwa Construction Company Limited at a sum of Ug shs 47,750,812. Civil works commenced on 25th April 2015 and completed on 25th June 2015 (within three months). The scope of works involved rehabilitation works on three structures namely; a) Main block; painting, floor repairs, re-roofing, ceiling repairs, door and window repairs. b) In charge’s house; painting, masonry repairs, block work with burnt clay bricks, reroofing, ceiling repairs, window and door repairs. c) Two staff quarters; painting, ceiling repairs, door and window repairs.
All the above works were done to completion (100%) at Wakyato HC III. It was noted that the new ceiling in the main block was already cracking with visible water leakages sipping through. Minor floor and verandah cracks were noted as well. The staffs were happy with the renovation noting that health services were given with much ease since works had eliminated bats and their foul smell at both the staff houses and main block.
Power installed in DHO’s office at the district headquarters: M/s Allied Energy and Water Technical Services were contracted to undertake the works at a sum of Ug shs 48,757,748. Works commenced on 2nd June 2015 and completed on 26 June 2015 (within three weeks). The scope of works included; a one pole electrical supply, installation and connection. These works involved power cabling, socket outlets and lighting protection.
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The works were completed and the DHO’s office was connected to power by time of monitoring done on 23rd July 2015. A number of office equipment including computers and printers were visibly connected and in use.
Retention for completion of a Maternity ward at Kinyogoga HC III paid: a total of Ug shs 13 million was paid as retention and balances on outstanding payments for works completed by M/s Kast Engineering Works Limited.
Implementation challenges
• Pressure to spend funds before close of the financial year often times led to certification and payment of substandard work. • Limited budgets to undertake required construction and rehabilitation works at heavily dilapidated health infrastructure within the district.
Analysis Link between financial and physical performance There was a good link between the financial and physical performance with over 85% of the disbursements absorbed by districts visited. The funds were mainly spent on construction of staff houses, maternity ward, power installations and sanitary facilities among others.
Achievement of set targets The project achieved 91.4% of the set targets for FY 2014/15 in the districts visited. Activities in line with repairs, renovations and consolidation of health infrastructure were implemented in various districts. The grant had contributed to improved service delivery in some districts like Nakaseke district as indicated in the Box below:
Intermediate program outcomes of the PHC Development Grant at Nakaseke and Masaka district The program has been implemented in Uganda for over 30 years. This box highlights some of the intermediate outcomes as noted in two local governments. These include:
• Improved service delivery at with a number of theaters, doctors houses, staff houses, OPDs, admission wards among others were constructed in various districts including Masaka and Nakaseke districts. • Increased deliveries at health centers. In Kinyogoga Health Center III (Nakaseke District), deliveries increased from one to over 30 babies a month due to construction of the maternity ward. Before the intervention, mothers were delivered in a ward where there was no privacy and most of them preferred delivering from either their homes or Traditional Birth Attendants (TBAs). • Savings on office operational costs; the DHO of Nakaseke district was renting office space at Butalangu Town Council to run all health related services. This became no more upon construction of the DHO’s office at the district headquarters. Source: Nakaseke and Masaka Districts
Overall Implementation challenges
• Certification and payment of poor quality by district authorities. • Heavily dilapidated health infrastructure at all local governments visited • Lack of medical equipment, staff and transport in a number of health facilities visited
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• Inequitable allocation of the PHC development grants with some districts getting much more than others against the same needs. • Constrained monitoring and supervision of health facilities due to communication gaps between MFPED and DHOs regarding direct releases to lower health facilities.
Conclusion
The PHC development grant focused on consolidation and renovation of existing infrastructure of health facilities in most of the districts visited. Infrastructure at health facilities was renovated with leaking roofs and floors repaired window glasses and doors replaced among others. Most of the districts visited achieved over 80% physical progress on planned works during 2014/15 except Gomba (50%). A number of challenges including staffing gaps, inadequate transport, medical equipment and staff accommodation continued to constrain service delivery at local government level. Poor quality civil works continued to be certified and paid by officials in a number of districts visited.
Recommendations • The Chief Administrative Officers (CAOs) should reprimand District Engineers that certify poor quality works. • District administration should also forward contractors that continue to do shoddy work should also be forwarded to PPDA for blacklisting • The MoH should undertake a comprehensive analysis of the infrastructural gaps in all local governments. Plan and budget for it in a phased manner in clearly stipulated timelines for improved service delivery and clear outcomes. • The MFPED and MoH should communicate details of direct releases to DHOs to enhance proper supervision and monitoring of activities across health facilities.
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CHAPTER 4: CONCLUSIONS AND RECOMMENDATIONS
4.1 CONCLUSION Overall annual sector performance was very good. Good performance was registered under the following projects; Support to Mulago Hospital Rehabilitation, Construction of Specialised Neonatal and Maternal Unit, Rehabilitation and Equipping of Health Facilities in west as well as capital development works on Mulago Referral hospital. On the other hand, there were incidences of shoddy work in some local governments.
There was no clear plan regarding consolidation and effective operationalization of the infrastructure and procured equipment. In addition, the sector still faced a number of challenges in terms of service delivery. These were mainly caused by lack of adequate staff, inadequate transport, medical supplies, infrastructure and equipment among others. Poor quality civil works continued to be certified and paid by officials in a number of districts visited.
4.2 RECOMMENDATIONS • The Chief Administrative Officers (CAOs) should reprimand District Engineers that certify poor quality works. • District administration should also forward contractors that continue to do shoddy work should also be forwarded to PPDA for blacklisting • The MoH should undertake a comprehensive analysis of the infrastructural gaps in all local governments. Plan and budget for it in a phased manner in clearly stipulated timelines for improved service delivery and clear outcomes. • The MFPED and MoH should communicate details of direct releases to DHOs to enhance proper supervision and monitoring of activities across health facilities. • The MoPS, MoH, health service commission and Local governments should fast track the recruitment of b health workers at all levels for timely and effective delivery of health services. • The MoH should develop sustainability and management plans for the completed infrastructure and equipment supplied under the Uganda health systems strengthening project, rehabilitation of facilities in west region and support to Mulago hospital rehabilitation project.
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REFERENCES
MFPED (2015): Extracted from June-September 2015; http://www.budget.go.ug/ Ministry of Finance, Planning and Economic Development, Kampala. Ministry of Finance, Planning and Economic Development, Approved Estimates of Revenue and Expenditure FY 2014/2015, Kampala, Uganda MFPED, 2015. Budget Monitoring Report Second Quarter FY 2014/15. March 2015. Ministry of Finance, Planning and Economic Development, Kampala. Ministry of Finance, Planning and Economic Development Public Investment Plan [PIP] FY 2014/15- 2016/17 (Kampala) Ministry of Health (2014); Ministerial Policy Statement, FY 2014/2015 (Kampala 2014) Ministry of Health (2015), “Quarter four Performance report” 2014/2015. Regional Referral Hospitals “Annual Work Plans” FY 2014/2015 The Independent “Reforming Uganda’s Health Sector”2014. Kampala. Uganda Health Systems Strengthening Project “Aide Memoire” (2010). Kampala. Uganda Health Systems Strengthening Project“Aide Memoire” (2014). Kampala
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ANNEX 1: LIST OF PERSONS INTERVIEWED
Institution Name Designation Project E-mail Support Mulago Rehabilitation of
Dr.Henry G.Bwebesa Project Coordinator Mulago Hospital [email protected] Support Mulago Rehabilitation of [email protected] OR
Mr.Steven Anywar Financial Management Specialist Mulago Hospital [email protected] Mr. Omiat John Kokas Procurement specialist UHSSP-MoH
Mr. Peter Kajubi Project Accountant UHSSP-MoH [email protected]
Eng. Fraincis Wakabi Engineer HID UHSSP-MoH [email protected]
John Ssengendo M&E Specialist UHSSP-MoH [email protected] Support to Maternal and Neonantal MoH Patrick Kazoora Project Accountant Unit Mulago NRH [email protected]
Dr Baterana Byaruhanga Executive director Mulago Hospital Rehabilitation of Mulago Hospital [email protected]
Mr.David Nuwamya PHA Mulago Hospital Rehabilitation of Mulago Hospital [email protected] [email protected],
Dr. Jackson Orem Director UCI UCI project [email protected]
Dr. Omagino Director UHI UHI project [email protected]
Mulago Mr. Bogere Robert Procurement Officer UHI UHI project [email protected] Rehabilitation of region referral Mr. Okise Antonio Senior Accountant- Arua Hospital hospital [email protected] Rehabilitation of region referral Dr. Charles Olaro
Director Fortportal RRH hospital [email protected] Mr. Blessed Kulwekisa Rehabilitation of region referral [email protected] Naloda Patrick Head PDU Fort portal RRH hospital Rehabilitation of region referral
RRHs Dr Nathan Onyachi Director Gulu RRH hospital [email protected]
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Rehabilitation of region referral
Mr.Mwembe Sam Senior Accountant Gulu RRH hospital [email protected] Rehabilitation of region referral
Mr.Edward Kavuye PHA Kabale RR Hospital hospital [email protected] Rehabilitation of region referral
[email protected] Mr. Julius Byaruhanga Procurement Officer Kabale RRH hospital Rehabilitation of region referral
[email protected] Mr. Felix Ogwanga Accountant Kabale RRH hospital Rehabilitation of region referral Mr. David Tibemanya SHA Kabale RRH hospital
Mr.Tusubira Samuel Assistant Consultant Kabale JICA project [email protected] Rehabilitation of region referral [email protected] OR
Dr Florence Tugumisirize Director Masaka RRH hospital [email protected] Rehabilitation of region referral
Hajji Mugisha Ereazer PHA Masaka RRH hospital [email protected] Rehabilitation of region referral
Mr. Kamara Basil Senior Accountant Masaka RRH hospital [email protected] Rehabilitation of region referral
Dr Nyeko Philbert Director Moroto RRH hospital [email protected] Rehabilitation of region referral Otim Samuel SHA Moroto RRH hospital Rehabilitation of region referral Masette Samuel Assistant Accountant Moroto RRH hospital
Kironde Bumali Project manager UHSSP Moroto [email protected]
Mayanja Richard Quantity Surveyor UHSSP Moroto [email protected] Bukenya Hassan Store Manager UHSSP Moroto [email protected] Ms.Rehema Musa Accountant Health-Arua PHC Development Mr.Anziku Manaseh Senior health Educator Arua PHC Development
Dr George Kiwanuka DHO Gomba PHC Development [email protected]
Bamwine Julius DHO Ibanda PHC Development [email protected] Medical Superintendent Iganga Dr James Wako Hospital UHSSP Iganga [email protected] Senior Hospital Administrator
Bateganya Iddi Iganga Hospital UHSSP Iganga [email protected]
Wilson Wangesen Project Manager (Contractor) UHSSP Iganga [email protected]
Districts Alex Wu Site Engineer UHSSP Iganga [email protected]
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Emmanuel Ssebusungu Quantity Surveyor UHSSP Iganga [email protected]
Abong Lamec Anthony Clerk of Works -Arch Designs UHSSP Iganga [email protected] Margaret Mugisha Accountant Health Kabale District PHC Development
Elitir Francis Senior Account Assistant Katakwi PHC Development [email protected]
Lung Wanxi Project manager Kryandongo HSSP [email protected]
Rutu Sam Clerk of Works MoH [email protected]
Tumwesige Mutiti Sam Hospital Administrator [email protected] Dr. Fred Mutabazi Ag medical supritendant UHSSP Kiryandongo
Dr Musisi Stuart DHO Masaka PHC Development [email protected]
Judith Kyomugisha health Accountant Mbarara PHC Development [email protected] Dr Lubega Muhamed Assistant DHO Mbarara PHC Development Hospital Administrator Mityana UHSSP Mityana
Dr Anguzu John DHO Nakapiripiti PHC Development [email protected]
Dr Lokwang Peter In charge Tokora HCIV PHC Development [email protected]
Lopeyok Raphael Accountant Health PHC Development [email protected]
Sr. Nassuna Rebecca Ag DHO Nakaseke PHC Development [email protected]
Sr Narus Regina Assistant DHO Napak PHC Development [email protected] Jonathan Lokutae Accountant Health Napak PHC Development
Mr. Alinga District Engineer Napak PHC Development [email protected]
Dr. Oryema Jakor DHO Nebbi PHC Development [email protected]
Oaikane Mary Ann Accountant Health Nebbi PHC Development [email protected] Onen Chan Gilbert Senior Hospital Administrator UHSSP Nebbi Adhikuseka Timothy Site Engineer UHSSP Nebbi Clerk of works Infrastructure Rwarumwe Medard Design Forum UHSSP Nebbi
Engineer Vita Charles Clerk of works MoH UHSSP Nebbi [email protected]
Bishop Loum Ag DHO Nwoya District PHC Development [email protected]
Akena Fralogba Accountant Health Nwoya District PHC Development [email protected]
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THE REPUBLIC OF UGANDA
Health Sector ANNUAL MONITORING REPORT Financial Year 2014/15
October 2015
Ministry of Finance, Planning and Economic Development P.O.Box 8147, Kampala www.finance.go.ug