Ministry of Health Report

REPUBLIC OF UGANDA

MINISTRY OF HEALTH

REPORT

REVIEW OF IMPLEMENTATION OF THE MINISTRY OF HEALTH WORKPLAN FOR THE 3rd and 4th QUARTERS 2019/20 FY

(JANUARY TO JUNE 2020)

OCTOBER 2020

MINISTRY OF HEALTH

REPORT:

REVIEW OF

IMPLEMENTATION OF THE

MINISTRY OF HEALTH

WORKPLAN Semi-annual

(3rd and 4th QUARTERS)

January to June FY 2019/20

Ministry of Health Plot 6 Lourdel Road P.O.Box 7272 Kampala, Uganda. Tel: 256-414-340872 / 340873 Email: [email protected] Web: www.health.go.ug

TABLE OF CONTENTS Acronyms and Abbreviations ...... vii Executive Summary ...... viii 1.0 Progress on Issues from the Health sector review of Q3+Q4 Performance FY 2019/20 ...... 1 Chapter One: Finance and Administration Department ...... 10 1.1 Mandate ...... 10 1.2 Overall objective ...... 10 1.3 Strategic objectives ...... 10 1.4 Challenges ...... 14 1.5 Recommendations ...... 14 Chapter Two: Standards, Compliance, Accreditation and Patient Protection Department (SCAPP) ...... 15 2.0 Mandate ...... 15 2.1 Mission Statement ...... 15 2.2 Objectives ...... 15 Chapter Three: Health Sector Partners and Multi-Sectoral Coordination Department (HSP&MSC) ...... 20 3.0 Challenges ...... 27 Chapter Four: Health Sector Strategy and Policy Department ...... 28 4.0 Divisions ...... 28 4.1 Mandate ...... 28 4.2 Vision ...... 28 4.3 Mission ...... 28 Chapter Five: Human Resource Management Department ...... 46 5.2 Mandate ...... 46 5.3 Mission ...... 46 5.4 Objectives ...... 46 Chapter Six: Health Promotion, Education and Communication Department .. 60 6.0 Mandate ...... 60 6.1 Objectives ...... 60 6.2 Challenges ...... 64 Chapter Seven: Reproductive and Child Health Department ...... 65 7.0 Mandate and Specific Tasks ...... 65 7.1 Challenges ...... 69 7.2 Recommendations ...... 69 Chapter Eight: Environmental Health Department ...... 70 8.0 Introduction ...... 70 8.1 Performance of department in-line with key Performance indicators ...... 70 Chapter Nine: Community Health Department ...... 76 9.0 Mandate ...... 76 9.1 Goal ...... 76 9.2 Objective ...... 76 Chapter Ten: National Disease Prevention and Control Department (NDC) .... 81 10.0 Overview of the NDC Department ...... 81 10.1 Objectives...... 81 Chapter Eleven: National Communicable Diseases Department (NCDs) ...... 95 11.0 Mandate of NCD Department...... 95 11.1 Strategic Objectives of the Department ...... 95

Chapter Twelve: Integrated Epidemiology Surveillance and Public Health Emergencies Department (IES&PHE) ...... 99 12.1 Mandate...... 99 12.2 Strategic Objectives: ...... 99 11.3 Challenges ...... 105 11.4 Way forward / Recommendations ...... 105 Chapter Thirteen: Clinical Services Department ...... 106 13.0 Brief overview ...... 106 13.1 Mandate...... 106 Chapter Fourteen: Department of Pharmaceuticals and Natural Medicines .... 110 14.0 Mandate...... 110 14.1 Mission ...... 110 14.2 Areas of Priority ...... 110 Chapter Fifteen: Nursing Services Department ...... 130 15.0 Vision ...... 130 15.1 Mandate...... 130 15.2 Objectives...... 130 15.3 Core Functions ...... 130 15.4 Cross cutting issues from the previous review ...... 130 Chapter Sixteen: Emergence Medical Services Department (EMS)...... 143 16.0 Mandate...... 143 16.1 Vision ...... 143 16.2 Mission ...... 143 16.3 Goal...... 143 16.4 Objectives...... 143 16.5 Strategic objectives ...... 143 16.6 Key Performance indicators of the unit ...... 143 16.7 Challenges ...... 150 16.8 Recommendations ...... 150 Chapter Seventeen: Health Infrastructure ...... 152 17.0 Mission ...... 152 17.1 Overall Objective ...... 152 17.2 Specific Objectives ...... 152 17.3 Planned Activities ...... 152 Chapter Eighteen: Health Service Commission ...... 160 18.0 Vision ...... 160 18.1 Mission ...... 160 18.2 Mandate...... 160 18.3 Strategic Objectives ...... 160 Chapter Nineteen: Uganda Virus and Research Institute (UVRI)...... 147 19.0 Mandate...... 147 19.1 Vision ...... 147 19.2 Mission ...... 147 19. 3 Objectives ...... 147 19.4 Institute Challenges ...... 163 19.5 Actionable solutions ...... 163 Chapter Twenty: Uganda National Health Research Organization (UNHRO) . 164 20.0 Mandate...... 164 20.1 Vision ...... 164 20.2 Mission Statement ...... 164

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Chapter Twenty-One: National Chemotherapeutics Research Institute (NCRI) ...... 155 21.0 Introduction ...... 155 21.1 Mandate (UNHRO act 2011) ...... 155 21.2 Outputs for NCRI ...... 155 Chapter Twenty-Two: National Drug Authority (NDA) ...... 156 22.0 Introduction ...... 156 22.1 Mandate...... 156 22.2 Vision ...... 156 22.3 Mission ...... 156 22.4 Strategic objectives ...... 156 22.5 Challenges that affected performance for Quarter one ...... 157 22.6 Recommendations for performance improvement ...... 157 Chapter Twenty-Three: National Medical Stores (NMS) ...... 168 23.0 Mandate...... 168 23.1 Vision ...... 168 23.2 Mission ...... 168 23.3 Objectives...... 168 23.4 Performance (Q3 and Q4 FY 2019/20) ...... 168 23.5 Challenges ...... 172 Chapter Twenty-Four: Uganda Blood Transfusion Services (UBTS) ...... 173 24.0 Background: ...... 173 24.2 Mission ...... 173 24.3 Mandate...... 173 25.4 Objectives...... 173 Chapter Twenty-Five: Allied Health Professionals Council (AHPC) ...... 184 25.0 Mandate...... 184 25.1 Vision ...... 184 25.2 Mission ...... 184 25.3 Functions of Council ...... 184 Chapter Twenty-Six: Uganda Nurses and Midwives Council (UNMC) ...... 188 26.0 Introduction ...... 188 26.0 Vision ...... 188 26.1 Mission ...... 188 26.2 Mandate...... 188 26.3 Objectives...... 188 Chapter Twenty-Seven: Pharmacy Board ...... 201 27.0 Mandate...... 201 27.1 Functions ...... 201 27.2 Strategic Objective ...... 201 27.3 Challenges ...... 203 27.4 Way forward ...... 203 Chapter Twenty-Eight: Uganda Medical and Dental Practioners Council (UMDPC) ...... 204 28.0 Strategic Objectives ...... 204 28.1 Challenges ...... 211 28.2 Way forward ...... 211 Chapter Twenty-Nine: Mulago National Referral Hospital (MNRH)...... 213 29.0 Mandate...... 213 29.1 Mission ...... 213 29.2 Objectives...... 213

Table 27: Mulago NRH Q3+Q4 Performance FY 2019/20 ...... 214 29.3 Challenges ...... 215 Chapter Thirty: Mulago Specialized Women and Neonatal Hospital (MSWNH) ...... 216 30.0 Mission ...... 216 30.1 Objectives...... 216 30.2 Challenges ...... 217 Chapter Thirty-One: Kiruddu National Referral Hospital ...... 218 31.0 Introduction ...... 218 31.1 Vision ...... 218 31.2 Mission ...... 218 31.2 Core values ...... 218 31.3 Goal...... 218 31.4 Strategic Objectives ...... 218 Table 29: Kiruddu NRH Performance Q3+Q4 FY 2019/20 ...... 219 Challenges and proposed solutions ...... 221 Chapter Thirty-Two: Kawempe National Referral Hospital ...... 223 32.0 Introduction ...... 223 32.1 Mandate...... 223 32.2 Mission ...... 223 32.3 Objectives...... 223 Table summary on performance for the Quarter: 3 & 4 ...... 224 Chapter Thirty-Three: Uganda Heart Institute ...... 227 33.0 Mandate (UHI Act 2016) ...... 227 33.1 Mission Statement ...... 227 33.2 Objectives...... 227 33.3 Key Performance Indicators ...... 227 Table 30: Uganda Heart Institute Performance Q3+Q4 FY 2019/20 ...... 228 Chapter Thirty-Four: Uganda Cancer Institute (UCI) ...... 232 34.0 Background ...... 232 34.1 Mandate...... 232 34.2 Functions of UCI ...... 232 34.3 Overview of Vote Expenditures ...... 233 34.4 Summary on Performance based on the Key Performance Indicators of the UCI ...... 234 Chapter Thirty-Five: Naguru Regional Referral Hospital ...... 244 35.0 Introduction ...... 244 35.1 Vision ...... 244 35.2 Mission ...... 244 35.3 Strategic Objectives ...... 244 Chapter Thirty-Six: Entebbe Regional Referral Hospital ...... 250 36.0 Mission ...... 250 36.1 Mandate...... 250 36.2 Strategic Objective ...... 250 36.3 Challenges ...... 252 Chapter Thirty-Seven: Butabika National Referral Hospital ...... 253 37.0 Mission Statement ...... 253 37.1 Key Objectives ...... 253 37.2 Planned Activities for FY 2019/2020 ...... 253 Annexes ...... 259

Annex I: Programme ...... 259 Annex II: Reporting Format: Reporting Format: Quarter 3 and 4 FY 2019/20 ...... 262 Annex III: Attendance for the MoH performance review for the first and second quarters 2019/20 FY (July to December 2019) ...... 263

LIST OF TABLES Table 1: Finance & Administration Q3+Q4 Performance FY 2019/20 ...... 11 Table 2: SCAPP Q3+Q4 Performance FY 2019/20 ...... 16 Table 3: HSP&MSC Q3+Q4 Performance FY 2019/20 ...... 21 Table 4: Health Sector Strategy and Policy Q3+Q4 Performance FY 2019/20 ...... 29 Table 5: Human Resource Department Q3+Q4 Performance FY 2019/20 ...... 47 Table 6: Health Promotion, Education and Communication Department Q3+Q4Performance FY 2019/20 ...... 61 Table 7: Reproductive and Child Health Departmant Q3+Q4 Performance FY 2019/20 ...... 66 Table 8: Environmental Health Department Q3+Q4 Performance FY 2019/20 ...... 71 Table 9: Community Health Department Q3+Q4 Performance FY 2019/20 ...... 77 Table 10: National Disease Prevention and Control Department Q3 +Q4 Performance FY 2019/20 ...... 82 Table 11: NCD Q3+Q4 performance for FY 2019/2020 ...... 95 Table 12: IES&PHE Q3+Q4 Performance FY 2019/20 ...... 100 Table 13: Clinical Services Q3+Q4 Performance FY 2019/20 ...... 107 Table 14: Department of Pharmaceutical and Natural Medicines Q3 & Q4 Performance FY 2019/20 ...... 111 Table 15: Nursing Services Department Q3+Q4 Performance FY 2019/20 ...... 131 Table 16: EMS Department Q3+ Q4 Performance FY 2019/20 ...... 145 Table 17: The performance Q3&Q4 ...... 153 Table 18: Health Service Commission Q3+Q4 Performance FY 2019/20 ...... 161 Table 19: UVRI Q3+Q4 Performance FY 2019/20 ...... 149 Table 20: NDA Q3+Q4 Performance FY 2019/20 ...... 158 Table 21: NDA Q3+Q4 Performance FY 2019/20 ...... 158 Table 22: NMS Q3+Q4 Performance FY 2019/20 ...... 169 Table 23: AHPC Q3+Q4 Performance FY 2019/20 ...... 185 Table 24: UNMC Perfomance Q3+Q4FY 2019/20 ...... 189 Table 25: Pharmacy Board Q3+Q4 Performance FY 2019/2020 ...... 202 Table 26: UMDPC Q3+Q4 Performance FY 2019/20 ...... 205 Table 27: Mulago NRH Q3+Q4 Performance FY 2019/20 ...... 214 Table 28: MSWNH Q3+Q4 Performance FY 2019/20 ...... 217 Table 29: Kiruddu NRH Performance Q3+Q4 FY 2019/20 ...... 219 Table 30: Uganda Heart Institute Performance Q3+Q4 FY 2019/20 ...... 228 Table 31: UCI Q3+Q4 Performance FY 2019/20 ...... 235 Table 32: Summary of performance for Q3 &Q4 ...... 251 Table 33: The performance – Q 3 &Q 4 FY 2019/2020 ...... 255

Acronyms and Abbreviations

AHPC Allied Health Professionals Council CQI Continuous Quality Improvement EAC East African Community EMS Emergency Medical Services EmOC Emergency Obstetric Care FY Financial Year HFQAP Health Facility Quality of Care Assessment Program HSC Health Services Commission ICT Information Communication Technology JICA Japan International Cooperation Agency LG Local Government Ministry of Finance Planning and Economic Development Ministry of Finance MOFPED Planning and Economic Development MoH Ministry of Health MoPS Ministry of Public Service MOU Memorandum of Understanding MUWRP Makerere University Walter Reed Project NCD Noncommunicable Diseases NCRI National Chemotheurapeutic Reseach Institute NDA National drug Authority NDC National Disease Control NMS National Medical Stores RH Reproductive Health RHSP Rakai Health Sciences Project RRHs Regional Referral Hospitals SMC Senior Management Committee STDs Sexually Transmitted Infections PHC Primary Health Care TQM Total Quality Management TWG Technical Working Group UMDPC Uganda Medical and Dental Practioners Council UNFPA United Nations Fund for Population Activities UNHRO Uganda National Health Research Organization UNICEF United Nations Children’s’ Education Fund UNMC Uganda Nurses and Midwives Council URMCHIP Uganda Reproductive Maternal and Child Health Services Improvement Project UVRI Uganda Virus Research Institute VMMC Voluntary Medical Male Circumcision

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Executive Summary

The workshop to review the implementation of the Ministry of Health (MoH) work plan for the third and fourth quarters for 2019/20 financial year (FY) will take place between October 6-8, 2020 in Kampala. The main objective of the workshop is to review implementation of the MoH work- plan for Departments, Programmes and National level institutions against planned outputs and budget for the period January to June 2020. The meeting will also receive progress on the crosscutting actions from the previous performance meeting (i.e. the review of the first and the second quarters for 2019/20 PY. The key highlights of the performance by each unit is as follows: Finance and Administration coordinated and conducted 20 field supervision visits by technical officers and three Honourable Ministers for Health. Payment of entitlements of top management and provision of cleaning and gardening services was done during quarter (Q3) Q3 & Q4. MoH headquarters utility bills for water and electricity were paid and installation of Information Communication Technology (ICT) services. Standards Compliance Accreditation and Patient Protection: The department organised the review of the 3rd and 4th quarter performance scheduled to take place between October 6-8, 2020. Printed 4000 copies of revised patients’ rights and responsibility charter and printed 6000 copies of client charter. Organized the review of Health Facility Quality of Care Assessment Program (HFQAP) tool copies were printed and the department reviewed the Health Sector Quality Improvement Frameworks and Strategic Plan. Conducted Support supervision to all Regional Referral Hospitals (RRHs), General Hospitals (GHs) and Health Center (HC) IVs for the 129 districts and built capacity of health workers in QI. During Q3&Q4 the department supported the implementation of Quality of care in Maternal and new-born. Health Partner and Mult-sectoral Coordination Department (HSP&MSC): Organized and conducted support supervision of PNFPS, RRHs, HCIVs and HCIIIs to provide standard guidelines and the Primary Health Care (PHC) grant utilization guidelines. The department reviewed the Health sector refuge plan in view of the COVID-19 response that was held in five refuge and nutrition Technical Working Group (TWG) meetings and held regional Joint Review Mission (JRM) for half year performance. The department documented best practices and trained partners to private sector and protective equipment for staff on COVID-19 and enhanced multi-partnership coordination in promoting Public-Private-Partnership programs (PPP) programs. Carried out support supervision to review the private hospitals for purposes of categorizing them as GHs and RRHs. Health Sector Planning and Policy developed the national health policy for FY 2020/21-2029/30(NHP III) and conducted Local Governments (LGs) consultative meetings and developed the concept note for Technical Assistance (TA) to support the process. The department supported LGs in the development of annual Health sector performance reports and prepared submissions of district health annual work plans and budgets. 15 LGs who had performed poorly were supported in Planning during national annual assessment and benchmarked the best practices that can be replicated in the poor performing LGs. Regulatory impact assessment was also conducted by the department during the period under review and two reports were compiled. The Health Sector Budget Framework paper (HSBFW) paper and Ministerial policy statement for 2020/21 was prepared and workshops, budget conference were supported to develop the budget guidelines for LGs FY 2020/21. The department printed and distributed health management information system (HMIS) tools. The planning department pre-qualified 332 health facilities during the assessment in 28 LGs to prepare for funding under Results based financing (RBF) and verified quarterly Extended District Health Management Teams (EDHMTs) outputs in 79 LGs. Human Resources for Health implemented minutes from the Health Services Commission (HSC) for the third and fourth quarters of the FY. Paid administration salary to 100% including arrears and cleared payment for contract staff as well as bonded health workers. Printed staff identity cards. The human resource department participated in support supervision of staff in all the regional referral hospitals to build their capacity to understand the human resources process right from the point of entry and exit and restrain from absenteeism.

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Health Promotion, Education and Communication organized and conducted stakeholders’ engagements on Health Promotion and Disease Prevention with participants from different disciplines. Prepared and conducted Top Management regional sensitization meetings focusing on COVID-19 standard operating procedures (SOPS). The health promotion department prepared and conducted support supervision tallied to building capacity of LGs and disseminating information on health promotion and COVID-19 and reproductive health (RH). Village health teams (VHTs) performance assessment was conducted in eight LGs. Environmental Health supported technical backstopping to LGs that implemented sanitation and hygiene activities during Q3 & Q4 and ensured prevention and control of diseases associated with LGs with poor hygiene and sanitation. Controlled occurring of vector borne diseases in Busoga region and supervised 15 HAT treatment centres. The department rolled out management information system by FO across 10 USF LGs to strengthen their monitoring and evaluation system. Reproductive and Child Health prepared and organized the training of training of trainers (TOTs) in 40 LGs to disseminate messages regarding high burden of teenage pregnancy and developed adolescent targeted messages that explain the early health risks associated. Monthly Adolescent Health working (ADH) working meetings were conducted and quarterly extended Maternal Child Health-Global Financing Facility (MCH-GFF) stakeholders’ meetings conducted. Community Health organized and supported support supervision for integrated nutrition services in three LGs (Bugiri, Tororo and Manafwa) and disseminated COVID-19 SOPs. The department conducted operational research studies on functionality of demonstration gardens and participated in mentorships.

National Disease Control (NDC) procured 657 motorcycles and trained 30 TOTs to orient health workers in 54 LGs on Missed Opportunities for Vaccination (MOV) strategies. Built capacity of 900 health workers through mentorship in 15 LGs and held monthly vaccine meetings. The department conducted the registration of VHTs, children and strengthened mobilization for Routine Immunization (RI). COVID-19 SOPs for HIV/TB were developed and disseminated in line with the National HIV consolidated 2018 guidelines. The HIV epidemiological status reports were developed and District level targets for HIV epidemiological control developed and disseminated. Non-Communicable Diseases (NCDs): The department organized and supported National NCD stakeholder meeting during Q3 & Q4 and conducted support supervision in the mental health facilities including at RRHs. Visited 30 LGs to support Mental Health and Psychosocial Support (MHPSS) activities and link them to communities as well as GHs. Support supervision was conducted in Kampala region. Integrated Epidemiological Surveillance and Public Health supported and supervised the yellow fever response in the districts of Buliisa and Moyo. The department assessed the preparedness and readiness for COVID-19 SOPs in Busia, Kibale, Kisoro and Tororo. Support supervision was conducted to prevent cholera outbreak in hotspots Lower Local Governments (LLGs) and supervised Points of Entry (POE) in 6 LGs. Assessed the weekly epidemiological surveillance reports to track the capacity of seven LGs in the management of COVID-19 surge. Nursing services conducted technical support and 10 integrated supervision field visits, mentored, and coached 908 Nurses and Midwives in waste management, report writing, proper documentation and 5s professionalism as well as emphasised on attendance to duty in selected districts in Uganda. The Nursing department organized and supported support supervision in selected two National Referral Hospitals (NRHs) and two RRHs to enhance their capacity to provide quality services. Emergence Medical Services Department (EMS) concluded the finalized the development of Ambulance norms and standards with five clinical protocols. The department developed the National EMS pre- hospital care guidelines in response to COVID-19 and submitted for printing. Organized and conducted stakeholder meetings to functionalize the 911 short code allocations by Uganda

Communications Commission (UCC). Support supervision was conducted to ascertain the functionality of emergency medical services in LGs and RRHs in preparation for COVID-19. Provided a standby EMS in response to upsurges and a total of 1067 cases were handled at an average of 356 cases per month. The EMS department procured assorted personnel protective equipment and supplies. Clinical Services organized and supported support supervision in three RHHs and 12 schools and GHs, HCIVs and disseminated Hep B guidelines Pharmaceuticals and National Medicines supported support supervision to track the utilization of COVID-19 supplies in the isolation centres and to investigate on adherence to the treatment guidelines and find out the functionality of management systems in RRHs as a determinant for essential medicines. Health Service Commission: 900 health workers were recruited including emergency recruitment for COVID-19 outbreak and 946 health workers were validated in Entebbe, Kawempe, Kiruddu, and Mulago specialized and neonatal hospital. The HSC supported technical backstopping of District Service Commissions (DSC) in 16 LGs and conducted support supervision in 28 Districts and four RRHs. Uganda National Health Research Organisation (UNHRO): Supported the coordination of the secretariat for research and reviewed the national guidelines for COVID-19 research. The National health research participated in joint zoom national consultative workshop to harmonise the framework for East African Community (EAC) research and attended the Hague based annual and general assembly as well as the EDCTP meetings to discuss proposals for EU-African and global health Partnership. Uganda Virus and Research Institute (UVRI) organized and conducted a training for 50 staff in Biosecurity and Biosafety. Influenza Surveillance activities were carried out in sites of Kiswa, Kitebi and Nsambya. Six monitoring field visits were conducted in Arua, Masaka, and Mengo and two technical support supervision visits were carried out.15 contracts committee meetings were organized and conducted during Q3 &Q4. Natural Chemotherapeutics Research Institute (NCRI): 57 herbal samples and formulae analysis for the phytochemical constituents was done during the Q3 & Q4. Utilities were and staff allowances paid. Facilitated five research scientists to undertake laboratory training in South Korea. Conducted research in development of sugarcane juice to optimize the sugarcane extracts for commercial production. National Drug Authority (NDA): Inspections for compliance field visits were conducted involving 11,731 drug shop and 1,307 pharmacies. 31 sensitization meetings were held and a total of 1,254 participants in attendance on licensing of drug outlets, regulations, and guidelines. Nine enforcement operations were conducted, and 225 non-compliant pharmacies were identified. 907 products were evaluated including 817 products for human and 90 for veterinary products. The National drug Authority (NDA) organized and conducted four trainings and sensitization meetings to build capacity of domestic herbal manufacturer and 15 local inspections and 13 foreign were conducted during the Q3 &Q4. Attended 10 joint meetings and activities that was held with, Uganda National Bureau of Statistics (UNBS), The College of Veterinary Medicine, Animal Resources and Biosecurity (COVAB), Ministry of Agriculture, Animal Industry and Fisheries (MAAIF) and UVF. National Medicines Services: Procured Essential Medicines and Health Supplies (EMHS) stored and delivered to HCIIs, HCIIIs, HCIVs, GHs and NRHs. Supplied EMHS to specialized units and delivered emergency items that were donated and distributed equitably to health facilities in the regions affected with COVID-19 pandemic. Reproductive health medicines were stored and distributed to facilities. Immunization supplies stored and distributed to health facilities including laboratory commodities, Artemisinin-based Combination Therapy (ACTs) and antiretrovirals (ARVs).

Allied Health Professionals Council (AHPC): 1,205 professionals were registered and licensed; 3,046 health facilities were inspected for licensing; Nine regions were supervised, and 97 districts were supported with inspection funds. The Allied health organized and conducted sensitization meetings of Chief Administrative Officers (CAOs) and District Health Officers (DHOs) in 36 districts. Uganda Nurses and Midwives Council (UNMC): 2,442 health workers were registered and enrolled newly qualified nurses and midwives. Participated in the inspection of health institutions and universities. Nine management meetings were held, and quarterly council and committee meetings were organized and conducted as well as two regional meetings. Uganda Dental and Medical Practioners Council (UDMPC): Conducted seven inspections of medical and dental schools and two inspections and accreditation of new internships sites visited. Pharmacy Board: Organized and conducted mentorship and support supervision of 11 internship sites and carried out joint supervision with NDA. Two pharmacy management board meetings were conducted during Q3 &Q4. Entebbe referral hospital: 2,300 inpatients were admitted and discharged, 85% bed occupancy rate, 5,2044 specialised outpatient services provided and medicines, supplies were procured and dispensed to about 75%. Butabika referral hospital: organized and conducted two senior management and two management meetings. Utilities were paid, 3,188 inpatients admitted and discharged, 11,879 laboratory tests were done, research on workplace ethics regarding violence, knowledge, attitudes, and practices were organized and conducted. Mulago National Referral Hospital: admitted and discharged 109,917 inpatients and 350,126 0ut-patient services were provided, 3,801,791 children were immunized and renovated the upper Mulago structures. Uganda Cancer Institute: (UCI): 19 collaborative research studies conducted during Q3 & Q4. Uganda Heart Institute (UHI): 24 patients open heart surgery was conducted and 23 closed heart surgery. 7,146 outpatient cases seen and 49 ICU. Two support supervision was conducted. Mulago specialized women and neonatal: 2,375 inpatients admitted and discharged, 851 operations were carried out, 644 deliveries conducted, 7859 outpatient department (OPD) cases clerked and treated. 4,312 images 3,595 laboratory tests conducted. 2,762 immunization services were provided during Q3 &Q4. Kiruddu National Referral Hospital: Provided inpatients and outpatient services. Medicines and health supplies were procured and dispensed. Challenges: The COVID-19 pandemic has deterred the implementation of planned activities thus poor budget alignment e.g. delayed implementation of some of the planned activities to facilitate finalization of the HSDP II, development of the National Health Policy III and MoH Annual Activity Plan FY 2020/21. MoH Headquarters expanded human resource requirement following the restructuring without corresponding increase in budget funding for operations and inadequate working office space. Continued increase in non-communicable diseases and shortage of medicines and supplies required for this critical service area. Increasing trends for perinatal and maternal deaths especially following COVID-19. Inadequate dissemination and utilization of its research findings, which constrains contribution to evidence-based policy formulation and practice.

1.0 Progress on Issues from the Health sector review of Q3+Q4 Performance FY 2019/20 ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 1. OPENING REMARKS BY HON. MOH

1.1 Circular from OPM indicates likely outbreak of Conduct WASH and Cholera vaccination activities for Cholera vaccination conducted in the water borne diseases as a result of anticipated the hot spot districts (CHS- Integrated Epidemiology & districts 5 out of the targeted 11 districts flooding Public Health Emergencies, CHS Env. Health) Activity to be completed in the 2nd Quarter of 2020/21 FY. Progress delayed by COVID-19 outbreak. 1.2 Corona Virus (COVID 19) is an increasing threat 1. To step-up prevention and control measures: Prevention and control measures that to Uganda. 10 African countries have confirmed  There should be restricted travelling abroad were undertaken included: closure the cases including DRC our neighbor and into the country boarder entry points plus the airports;  screening at ports of entry stepped-up public awareness campaign;  Ensure that all public places have hand washing lock-down; development of SOPs for equipment and temperature monitoring public facilities and institutions, and equipment guidelines for case management and  Minimize body to body contact (1 meter) disposal of infected dead people. (CHS- Integrated Epidemiology & Public Health Additional measures put in place included Emergencies, All staff at MoH staff and the public) restricted gathering; wearing of face masks and night to dawn curfew. 1.3 Quantifications of key supplies: medicines and lab Quantifications of key supplies should not be done by Process initiated to address the gap with reagents by Divisions Malaria, HIV, TB is not these Divisions and be handled by Pharmaceutical and the respective programmes to achieve proper. Natural Medicines department (CHS P&NM) this requirement.

2. MOTIVATIONAL SPEAKER 2.1 Customers are not interested in what we are able All departmental review reports should capture, Work is in progress to try but what we can deliver outputs, outcomes, and deliverables (All HoDs)

3. FINANCE AND ADMINISTRATION 3.1 Expenditure was above the budget allocated for  Allocate additional funding for the department No additional funding provided yet. Still Programme 2 (CHS HFP) lobbying for additional funding.

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 3.2 Lack of office space especially for the new staff at Plan for additional office space to cater for the PS has appointed a committee on office MoH headquarters expanding staff office requirements (US/F&A) space chaired by the US/F&A which will review the problem and advise the PS 3.3 UNHRO has outstanding audit queries which have Audit queries should be addressed, and payments Audit query was addressed, and problem hindered annual contribution to be paid cleared (Ext. Dir UNRHO & Ag. US-F/A) solved

4. HUMAN RESOURCES FOR HEALTH 4.1 Irregular appraisal of staff by HODs. Most staff who Staff appraisal to be done quarterly by HODs Most staff have submitted the staff are at U2 and above have not submitted All staff from U2 and above to sign and submit appraisal forms performance contracts to HRM performance contract before the end March 2020 79% staff at U2 and above required to fill (Ag. Commissioner HRM/HODs) the performance contract have complied. The non-complaint staff shall submit to the PS for disciplinary action 4.2 Delays to submit recruitment and retirement plan  Submit recruitment and retirement plans by the end Recruitment plan 2020/21 FY was to MoPS of each FY endorsed by the PS and submitted to  Replace staff due for retirement 6 months in advance MoPS (C-HRM) Retirement plan for FY 2021 was submitted with the work-plan for FY 2020/21 5. STANDARDS COMPLIANCE ACCREDITATION AND PATIENT PROTECTION 5.1 Inadequate reporting on issues addressed and the  Support supervision teams should share key issues Composition of the Support Supervision gaps identified for improvement and follow-up addressed and actions undertaken for follow-up from Teams were reconstituted to involve from support supervision field visits. the supervision (DHS G&R) RRHs and Districts with revised TOR. Capacity building is continuous to improve the quality of reporting. 5.2 Presentations were not following the agreed upon Departments should follow the shared format by the Focal Persons reminded to follow the format Secretariat (All HODs) format. Engagement to improve the quality of reporting is ongoing 6.HEALTH MONITORING UNIT (HMU) 6.1 Reports from support supervision are not shared Shared reports with the PS (ED HMU) Submission of reports to PS taking with PS-MOH for follow-up implemented

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 7. HEALTH SECTOR PARTNERS AND MULTI-SECTORAL COORDINATION 7.1 Mapping was done but the roadmap for the next Expedite development of the roadmap for the partner Work in progress steps to improve sector coordination has not been support and coordination (CHS-HP-MSC) shared

7.2 Memorandum of Understanding (MoU) are  HP-MSC D should share guidelines/ process for Work in progress managed by different units without involving HP- managing MoUs in MOH MSC D which is the chief custodian in MOH  HP-MSC D to develop and share inventory for MoUs (CHS-HP-MSC) 8. HEALTH FINANCING & POLICY

8.1 MoH structure expanded without corresponding Plan to increase funding according to the new MoH Still lobbying for additional funding increase in funding structure (CHS HFP) 8.2 NHIS was presented to Parliament and forwarded Follow up with the Committee (CHS HFP) Health Committee of Parliament to the Parliamentary Committee for Health. completed public hearing. Final report to H.E the President has expressed concern about the be tabled to Parliament for 2nd reading affordability of the proposed policy change to and debate. operationalize the NHIS 8.3 There are new big projects which are about to be Cost and include in the MTEF the additional funding Partial funding given to the health facilities completed: Kayunga and Yumbe, Kawolo. These (CHS HFP) to start operations shall require additional funding to be operational 8.4 The newly up-graded HC IIIs in LGs shall need Cost and include in the MTEF the additional funding Required funding given for the upgraded additional budget to be operationalised (CHS HFP) HC IIIs in LGs 8.5 Many maternity units are poorly equipped and need Cost and include in the MTEF the required additional Funding channeled through the World to be re-tooled funding to retool maternity units in the health sector Bank funded Uganda Reproductive (CHS HFP) Maternal and Child Health Services Improvement Project (URMCHIP) 9. COMMUNITY HEALTH 9.1 Nutrition commodities are not among the NMS To provide budget to include the nutrition commodities Position paper has been developed and supply list in the EDL on the NMS supply list (CHS Pharm) shared with SMC by Nutrition Division. From May 2020 partners shall not be responsible Funding not yet provided for procurement of nutrition commodities

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 10. HEALTH EDUCATION PROMOTION AND COMMUNICATION 10.1 Funding of 20% PHC to LG for Health Promotion To develop guidelines on how to use the funds (Ag. C- Consultations concluded. To get the & Disease prevention activities shall be increased HEP&C) guidelines ready before the end of the to 30% (2020/21 FY). 2nd quarter

There are no clear guidelines on how use of the funding 11. COMMUNICABLE DISEASE CONTROL 11.2 Upsurge of measles cases among the refugee Work with the affected districts and partners to have UNEPI joined effort with UNHCR for the communities children in the refugee camps immunized (ACHS new arrival vaccination package which Vaccines & Immunization) reduced the upsurge of new measles cases.

11.3 High prevalence of Hepatitis B in Karamoja region Evaluate the programme for management of Hepatitis B Programme for Hepatitis B vaccination is has hindered setting up a blood collection centre in program in Karamoja region (ACHS Vaccines & being reviewed to encourage screening to Karamoja region leading to reduced access to Immunization) care and support for the high-risk areas. blood transfusion services in the region This approach will be operationalized in the next PY.

12. NURSING SERVICES 12.1 Some staff do not wear uniform while on duty Send letter signed by the PS to CAOs to enforce Letter was written and shared districts. wearing of uniform by staff while on duty (CHS N) Department is making follow-up on implementation. 12.2 Inadequate uniform provided to staff in LG Mobilize for additional funding for uniform for all staff MoH has procured uniform for all Nurses (CHS N) and Mid-wife 12.3 There are many schools which are not adequately Develop and share plan for improved support Concept developed and shared with supervised for health care services supervision to schools (PMO School Health/N) MoES. Work is progress 12.4 Some schools don’t have health-care services Districts (DSC) should be allowed to recruit nurses for Process affected by the COVID-19 Recruitment of nurses for schools is conducted by schools pandemic. Stakeholders’ meeting the MoES which is not addressing the need To engage the inter-ministerial committee for the way scheduled before the end of the calendar forward (PMO School Health/Nursing Department) year 2020.

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS

13. HEALTH INFRA-STRUCTURE 13.1 Inadequate funding for servicing radiology medical  Should centralizing the procurement and servicing of Policy being revised to centralize the equipment. The new radiology equipment is very biomedical equipment. procurement, management, maintenance costly to maintain  Build capacity of the service providers (Ag.CHS HID) and disposal of biomedical equipment. This will require adjustment of the staff structure centre and regional referral hospitals , training, development of a modern central and regional workshop. 13.2 Lack of technical staff for radiology and imaging at Make a provision for this technical staff to be available at Deliberate effort required for the training MoH MoH (Ag.CHS HID) and retention of the staff. Scholarships required for the training. 13.3 Inadequate staff accommodation in health facilities Provision of improved staff accommodation should be This was well captured in the strategic prioritized for the next 5 year (Ag.CHS HID) plan and will require an extensive funding as most of the health workers reside far from the health facilities. New projects have all taken care of staff accommodation e.g. Kayunga, Yumbe, Kawolo nd Gombe including UgIFT. Need to look for other methods of funding. e.g. grants. 13.4 Lack of report on progress made on the current Report on progress made on the current MoH Infra- Report available. HID has monthly status MoH Infra-structure projects structure projects to be shared in the next review report and will avail in the next meeting (Ag.CHS HID) 13.5 New architectural drawing was not reviewed for New architectural plans should be shared for All Health facility plans go through all the environment suitability environment suitability (Ag.CHS HID) approvals and environmental approval has not been in the list of criteria. If now a requirement the drawings are available. 15. EMERGENCE MEDICAL SERVICES (EMS) 16.1 Standards and SOP for ambulances not available Expedite availability of standards (CHS EMS)  Development of the Uganda Standards for Pre- Hospital Care (USPHC) 2020 was finalised.  The Standards are ready for approval and subsequent endorsement.

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 16.2 Inequitable distribution of ambulances and the high Consider implementing call and dispatch at regional  KOFIH is supporting the maintenance costs for ambulance in districts level system to improve access and sustainability of establishment of a prototype regional ambulance services (CHS EMS) hub at Masaka RRH  Another regional hub is planned to be established within Kampala Metropolitan Area at Uganda China Friendship Hospital, Naguru 

17. PHARMACEUTICALS AND NATURAL MEDICINES (PHARM. &NM) 17.1 Un-coordinated collection and disposal of MoH should get access to the MoU between Green Engagement is in progress to share the medicines and supplies by Green Label Label and USAID and further guide on the management updated policy guidelines on waste of medical wastes (CHS Pharm) management 18. HEALTH SECTOR PARTNERS AND MULTI-SECTORAL COORDINATION 18.1 Mapping was done but the roadmap for the next Expedite development of the roadmap for the partner A MSC and partnership framework is steps to improve sector coordination has not been support and coordination (CHS-HP-MSC) being developed with support from shared WHO

19. NATIONAL MEDICAL STORES (NMS) 19.1 Delays to deliver health supplies which attributed Create a special fund (Equivalent to 8% of the budget) Not yet done as discussions are still to IFMS. There is system causes delay to process to be outside IFMS so that some vital operations to be ongoing. The challenge has not been payments for officers who deliver medicines and implemented (GM NMS) resolved. supplies to HFs 19.2 Discrepancy between supply and orders made To write letter to DHOs guiding HF In-charges not to If NMS delivers EMHS that have not been accept deliveries by NMS where the supply does not ordered for by the health facility, those correspond to the orders made unless a satisfactory items should not be received by the explanation is given (GM NMS) health facility, unless they are items where MoH has asked NMS to deliver as donations on its behalf. Communication to be shared.

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS 20. UGANDA BLOOD TRANSFUSSION SERVICES (UBTS 20.1 Inequitable distribution of blood in the country Quantify the HC IVs with shortage of fridges that Quantification was done and list is of HC particularly for HC IVs due to lack of blood fridges should be supported to provide BTS IVs that need fridges is available. Still (Dir UBTS) lobbying for additional funding.

21. PROFESSIONAL COUNCILS Increased cases of malpractice and professional Enhance the oversight function and penalize those  The Uganda Nurses and Midwives misconduct in the health sector violating the regulations without delay (All Registrars) Council has since tried and published those who were found guilty of professional misconduct.  Furthermore, the cases that are criminal in nature were forwarded to police for further investigation and prosecution in courts of law.

 Uganda Medical and Dental Practioners Council (UMDPC) had 2 inquiries done where one doctor was deregistered for incompetence, another suspended and 2 reprimanded for negligence. Decisions were placed in New Vision newspaper

22.NON COMMUNICABLE DISEASES (NCDS)

22.1 Increasing shortage of medicines for Hypertension Quantify and cost the gap for medicines/supplies for Costing not yet done and Diabetes Mellitus Hypertension and DM to be included in the budget There is urgent need to revise the (NCDs) Uganda Essential medicines list to include highly recommended medicines for NCDs as per current treatment practice. This has not been achieved. The costing will

ISSUE PLAN OF ACTION (RESPONSIBLE OFFICER) PROGRESS hence be based on some products which need to be phased out. 22.2 Low uptake of screening services for NCDs in The activity should be prioritized during support Circular to all health service centre health facilities supervision Heads was sent out by the DGHS, Individual screening is recommended ((C-NCD) Additional Guidance on prioritization of NCDs during Covid 19 also signed and sent out 22.3 Insufficient facilities for physical activity in schools. All schools should have access to a play ground Communication awaiting reopening of There is increasing obesity in Schools Write a communication to DEOs ( NCD) schools. Initials contact with Director MOE&S disrupted by Covid 19 Pandemic

DEPARTMENTS

Chapter One: Finance and Administration Department

1.1 Mandate To provide political direction, give policy guidance and render support services to enable the Ministry to fulfil its mandate 1.2 Overall objective To ensure administrative and support services to the Ministry to enable it to fulfil its mandate 1.3 Strategic objectives  To support and coordinate activities, meetings, and events of the Ministry  To provide logistics and utilities to the Ministry  To process and effect timely release of funds to departments and staff for implementation of activities  To facilitate the procurement of supplies and works for the Ministry  To ensure compliance with Government regulations, procedures, and policies  To ensure proper use of care for, security of and maintenance of Ministry assets and premises  Maintain effective linkages between the Ministry, the Executive, Parliament, and other Government agencies

Table 1: Finance & Administration Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget release Expenditure/ budget Explanation (Q3 &4) achievements/results (Q3 &4) performance for (Q3 &4) variation/ **results Monitoring and evaluation Field visits for three 20 field visits were 481,072,906= 481,072,906= N/A Ministers and technical undertaken officers Payment of entitlements to Timely computation, All entitlements of top 80,000,000= 220,000,000= Additional Top Management processing and payment managers processed and funds were of Q3 and Q4 paid sourced from entitlements other programmes Payment of Staff Welfare Timely computation, Transport and lung 33,750,161= 51,642,000= Other related processing and payment allowance for staff at U4 items were of staff welfare and below salary scale charged. processed and paid. Provision of security to MoH Ensuring proper All MoH installations were 32,000,000= 101,644,000= Other related installations deployment and prompt secured and allowance for items were payment of allowances the personnel paid. charged. to the security personnel. Provision of cleaning and Ensuring routine MoH premises were 764,175,657= 764,175,657= NIL gardening services to MoH cleaning and cleaned and service installations beautification of MoH providers duly paid. premises

Payment of utilities to MoH Ensuring that all the All payments for electricity 50,642,000= (water) 50,642,000= (water) Payments are headquarters prepaid utilities are duly and water were paid. 653,594,730= (electricity) 653,594,730= (electricity) up to date. paid in time. More funds were sourced from other departments.

Output description Quarterly targets Outputs Budget release Expenditure/ budget Explanation (Q3 &4) achievements/results (Q3 &4) performance for (Q3 &4) variation/ **results Maintenance of vehicles, Timely assessments and Most Ministry vehicles 468,972,107= 468,972,107= NIL machinery and equipment repair/service of were well maintained. vehicles. Lifts were fully serviced. Timely maintenance of Generator was fully Other funds lifts serviced. 37,820,211= 37,820,211= were used for minor repairs on the building. Stationery Ensure that all programs All the requisitioned 1,123,978,000= 1,123,978,000= NIL have adequate supplies supplies were provided. of stationery items throughout the quarters. Commemoration of National Participating in all Participated in 2 national 0 57,500,000= Funds were and International days national/ International events. (26th January 2019 sourced from events. Victory day and 8th March other budget 2019 Women’s Day) lines. ICT Services Installation, repairs and Procurement of 13 825,600,090= 825,600,090= Funds were maintenance of ICT computers, 4 laptops, 3 sourced from equipment photocopiers, 6 printers. other budget Servicing of ICT equipment lines.

Retooling the LAN for the pentagon and establishment of telephone services. Repairs and Merging HRIS and maintenance of ICT integration with equipment attendance. Expansion of CCTV to the stores and boardroom.

Transferring funds to other Ensuring that all funds Funds were remitted to 187,713,955= 187,713,955= N/A Government councils released for councils Allied Health Professionals, are remitted. UMDPC while UNMC and Pharmacy Council spent at source. Contribution to international Ensuring that all funds Funds were remitted to 230,000,000= 391,812,369= Additional organizations released for East Central and South funds were international bodies are Africa Health Community because of remitted. and WHO. unspent balances in Q1 and Q2. Ensuring effective and efficient Timely processing and All the telephone lines 63,029,744= 63,029,744= N/A communication within MoH loading of airtime on all were duly paid. MoH telephone lines.

1.4 Challenges Inadequate funds for postage and courier services and commemoration of national functions 1.5 Recommendations Increase the Finance and Administration budget ceiling to cater for the underfunded priorities 1.6 Cross Cutting Issues from Q1 And Q2 The accounting officer nominated an office accommodation committee to analyze the current sitting space visa vie the number of staff and come up with a better proposal that suits the current need.

Chapter Two: Standards, Compliance, Accreditation and Patient Protection Department (SCAPP)

2.0 Mandate To ensure that health services provided are within acceptable standards for the entire sector, both public and private health services 2.1 Mission Statement To promote a work culture which pursues excellence and rejects poor quality in health services 2.2 Objectives  Coordinate sector performance, monitoring and evaluation  Ensure Standards and Guidelines are developed, disseminated and used effectively  Build and strengthen regular supervision system at all levels of care in-order to promote provision of quality health services  Facilitate establishment of internal Quality Improvement (QI) capacity building for QI at all levels including operations research on quality health services

Table 2: SCAPP Q3+Q4 Performance FY 2019/20 Quarterly targets (Q3 Outputs Budget Expenditure/ Explanation for variation/result &4) achievements/results (Q3 &4) release budget (Q3 &4) UGX performance M Output description (Output 080101): Sector Performance: Review of  Funded by Uganda Health System Strengthening Activity Review for 2nd and 3rd quarters is implementation of the (USAID) scheduled to take place in August 25m No variation MoH W-plan for the 2nd  Combined performance review for Qtr. 3 and 4 2020 and 3rd quarters  Scheduling and method of review meeting affected by COVID  3 SMC meetings could not take place because of COVID-19 Conduct 6 Senior  Updated the membership for SMC in view of new recruitment at Management Committee 3 SMC meetings were conducted 3m No variation MoH Headquarters. To be used to improve attendance meetings (SMC)

Output description (Output code:080102): National standards and guidelines developed To print 4,000 copies of Planned dissemination to be combined with orientation of the the revised Patient 4,000 copies of the revised Patient Hospital BoG and HUMCs Rights and Rights and Responsibility Charter 36 m No variance Responsibility Charter printed

Print 6,000 copies of 4,000 copies of the MoH Client the revised MoH Client Planned dissemination to be combined with orientation of the Charter were printed and 40m No variance Charter Hospital BoG and HUMCs disseminated internally

Print 3,500 copies of the MoH 3,500 copies of the MoH Implementation plan finalised Comprehensive Comprehensive Support NA No variance Support supervision guidelines have been revised and aligned to the Support Supervision Supervision Strategy were printed strategy. Presented to TWG and SMC and were endorsed. Strategy Print 5,000 copies of Process awaiting approval of the the MoH Support MoH Support Supervision NA No variance Improved quality of support supervision is expected Supervision guidelines guidelines

Quarterly targets (Q3 Outputs Budget Expenditure/ Explanation for variation/result &4) achievements/results (Q3 &4) release budget (Q3 &4) UGX performance M Review the Health Health Facility Quality of Care  Reduced cost of implementing HFQAP by 5m per district Facility Quality of Care Assessment Programme (HFQAP)  Improved scoring by reviewing the categorisation of the 75m No variance Assessment Programme tool was revised and digitalised standards (HFQAP) tool  Analysis made more accurate as there in real time reporting Print 16,000 copies of 16,000 copies of HFQAP were  Capacity built for HFQAP self-assessment the revised HFQAP printed for district self-internal 120m No variation  IPs to be coordinated by DHT assessment Review the Health Procured lead consultant Sector Quality Stakeholder consultation in  Writing process to be undertaken in Q1 and review process shall Improvement progress 35m No variation be finalised in Q2 Framework & Strategic Plan (HS QIF SP) Line activity (Output code:080103 ): Supervision of Local Governments Conduct Integrated Support supervision to all RRHs,  Funded by URMCHIP supportive supervision GHs and HC IVs for the 135  Senior Top participated One visit to RRHs, GHs and HC districts took place in the 3rd  Focused on health DHT leadership, Reproductive Maternal & conducted due IVs for all the 129 quarter 2019/20 FY 280mill Neonatal Health Services, Diagnostics and radiology services districts: 2 visits to Covid-19 outbreak etc  RRHs and specialists were involved and consolidated report to be shared with SMC in Q1  Supported functionality of Regional QI Committees and To conduct capacity QI support supervision conducted supported RMNCH activities in Karamoja, Acholi, West Nile, building for QI in 80 72 m No variation in 25 districts Kigezi and South Buganda sub-regions districts  Increased participation of clinicians in QI activities 2nd monitoring and evaluation of  Supported by Japan International Cooperation Agency Monitoring and implementation of 5S conducted (JICA) evaluation of NA NA in Arua, Kigezi, Gulu and Lira RRH  implementation of 5S Increased focus on problem identification and solving (QI projects have been initiated Line activity (Output code:080103): Facilitate establishment of internal QA capacity at all levels

Quarterly targets (Q3 Outputs Budget Expenditure/ Explanation for variation/result &4) achievements/results (Q3 &4) release budget (Q3 &4) UGX performance M To conduct Health  Supported by United Nations Childrens’ Education Fund Facility Quality HFQAP conducted in 9 districts: (UNICEF) Assessment Programme Moroto, Kotido, Abim, Nabilatuk, Approx. 15 mill  Data entry, analysis and dissemination completed No variation (HFQAP) to 9 districts Karenga, Amudat, Napak, per district  Problem identification conducted by district. Regional QI being in Karamoja Sub- Nakapiripit, Kaabong activated to operationalise QI with coordination meetings; regions mentorship and monitoring Supporting implementation of QI  Training for 50 ToT QI trainers was conducted in MNCH in 6 Learning districts  WHO MNCH QI Couching and mentorship manual was conducted (Hoima, Kamuli, 115m No variation customised? Kasese, Kiryandongo, Nwoya, and  Follow-up of district QI couches was conducted and guided in Supporting Sheema) problem identification and solving implementation of QoC in Maternal and New-  Supported by CHAI Supported implementation of born care in 6  Improvement of ANC, PNC and delivery in the HFs. Learning districts Maternal and Neonatal care in Hoima RRH and 6 districts of NA No variation  60 % reduction morbidity among the new-born (new-born Mityana, Kasanda, Mubende, successfully resuscitated) Kitenga HC III Kakumiro, Kibaale, and Kikuube

Line activity (Output code:080104): National standards and guidelines disseminated To disseminated HF HF QIF SP disseminated to QIF SP to Western, disseminated to all the districts in Inadequate None  Activity was combined with Q3 support supervision Central and Teso sub- the country funding region To disseminated Health Health Service Standards Inadequate  Combined with the Area Team support supervision field visits Service Standards to all disseminated to all the districts in None funding of April to August 2020, districts in the country the country

Challenges and proposed solutions to mitigate them. Challenge Possible solution Responsible officer

Lack of office space. 11 officers Lobbying for additional office CHS SCAPP sharing one office space

Reduced funding for QI activities Re-prioritising using the available All from IPs resources Integrating as much as possible. Lack of transport for field work Lobbying for additional office CHS SCAPP space

Delayed processing funds for Early requisitioning and follow-up ALL activities

Chapter Three: Health Sector Partners and Multi-Sectoral Coordination Department (HSP&MSC)

3.1 Governance and Policy dialogue This encompasses the underlying engagements between government and partners in the health sector and the degree to which the partners are included in discussions regarding policy, standards, guidelines, regulation and practices. Create platforms for dialogue and alignment of partners support to national health priorities. Develop a multisectoral vision and framework for the health sector. 3.2 Service delivery Provide oversight /stewardship of all activities being conducted by implementing partners and the private sector in the health sector. Supervision and monitoring of clinical and non-clinical work in private health facilities and clinical services provided by non-governmental organizations 3.3 Regulation and governance: Policy coordination: agreement on principles, guidelines, and best practices. This comprises the coordination of partner support to the health sector. It entails among others how the partners align themselves and relate to national strategic directions, priorities and plans. It involves mapping, registration of partner providers and assessing quality of care and development of coordination frameworks. 3.4 Exchange of Health Information: To foster cooperation in health matters with Global and Regional Health Partners, through harmonization and alignment of policies, regulations, strategies, health delivery systems and processes, agreed support; and strengthen exchange of information for a strong health system. This involves review of MOUs, dissemination of Global health declarations and protocols and ensuring all are in harmony. 3.5 Operational coordination: Coordination of partner programs in the health sector- related to social determinants of health, MSC, appraisal of partner projects, alignment during the implementation of projects and programmes (e.g. co-financing, joint reviews and evaluations)

Table 3: HSP&MSC Q3+Q4 Performance FY 2019/20 Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results Support Supervision 2 Field visits I. Conducted support supervision of PNFP’s Maracha Hospital, Kuluva 30m 29m Hospital, Aber Hospital, Mutolere Hospital, Kisizi Hospital and Nyakibale hospital, Bwindi Hospital. The Hospitals need to be supported with improving their HMIS through Electronic medical records II. Supervised Arua RRH’s, Gulu, Lacor in preparedness and readiness to respond to Covid 19 and how to build partnership with the private sector. III. Rapid assessment of Kikube and Kiryandongo Districts on refugee health integration processes and capacities and resources required for full integration. IV. Carried out FACILITY supervision, mentoring and monitoring service delivery in Panyadoli HC3, Kyangwali HC4 and Nyapea Hospital and Nkozi Hospital V. Undertook assessment of health facilities along the oil pipeline in Gomba, Sembabule, Lwengo, Rakai, Kyotera and Masaka in collaboration with PAU and prepared a report on possible investments to revamp the health insfratructure in the pipeline areas. Coordination I. Reviewed the Health sector Refugee response Plan in view of COVID 50m 50m and extended the plan implementation period to 2021/ II. Partners Off budget funding report prepared, printed and disseminated III. Held one Refugee National steering committee meeting to review implementation of HSIRRP IV. Held five Refugee Health and nutrition TWG meetings to assess monthly performance V. Held a regional JRM for half year review in Koboko for West Nile region health partners

Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results VI. Development of the Draft Multi Sectoral Coordination Framework which has been circulated to all programs for their input and further enhancement.

Training I. Training of partners, private sector and POE staff on COVID 19 SOPs 20m 20m and implementation of the agreed EAC regional response and monitor implementation of designated stop points for interstate truck drivers

Private Sector I. Ongoing Revision of the PPPH Strategy. Coordination II. Parliamentary approval secured for the Karamoja infrastructure Development project 11. III. Draft concept notes for recasting the PPPH strategy developed IV. Three PPPH TWG meetings organized and attended by most private sector health players V. Participated in writing and developing Human Resource for health strategic plan for Health in Mbale.

Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results Global & Regional I. Developed the EAC Regional plan for EM bulk procurement Partner supported Health Coordination II. Developed Policy briefs for EAC Joint Meeting of Ministers of Health, Trade, Transport and EAC Affairs on COVID-19 (23-25TH March.). III. Coordinated implementation of the outcome of the recommendations and brief for Summit. IV. Finalized the “EAC COVID-19 Regional Response Plan”. V. Finalized the delivery mechanism of the EAC NPRL Mobile Labs, and collection from Mutukula Border (18 march). Key outputs: 4 four Wheel Land cruiser vehicles (2 cargo carrier and 2 passenger carrier, test kits and other consumables, PPEs). VI. Developed Policy brief and participation in Bilateral Ministerial Meeting between Kenya and Uganda (28-30 April) on COVID RESPONSE regarding Truck DRIVERS. Output VII. Participated in NTF, Strategic and Transport sub-committee meetings. VIII. Participated in the development of the repatriation plan of Ugandans stranded abroad in conjunction with MOFA, Immigration, CAA and Ministry of Finance Planning and Economic Development (MoFPED) (representative of MOH). IX. Coordinated the discharge of COVID19 foreign patients and those from quarantine with MOFA and respective Embassies/High Commissions, and treatment centres, to ensure seamless entry of the persons back to their countries of origin (official nominee). X. Developed a Policy brief and participated in the EAC Regional Joint Meeting of Ministers of Health, EAC Affairs, Transport and Trade (28- 29, May); & follow up implementation of the EAC Summit directives. XI. Coordinated implementation of the outcome of the above (RECDTS, DESIGNATION OF LABS, Engagement with TRUCK OWNERS AND DRIVERS to ensure compliance and registration, URA dialogue, Devices, IT of labs, IC, regular virtual meeting with EAC-S, TMEA and colleagues from PSs). XII. Gave weekly update to the Strategic Meeting chaired by Hon. Minister on the EAC regional response plan implementation, bilateral issues.

Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results XIII. Coordinated and prepared technical papers for the Joint meeting of EAC Ministers of Health and EAC Affairs on the Regional Response Plan for COVID-19. XIV. Engaged key stakeholders such as Immigration, URA in the implementation of the Regional response plan. XV. Finalized preparations for the delivery and receipt of the EAC Secretariat donated BSL3-4 Mobile Laboratory. XVI. Participated in a regional meeting to develop a framework for EAC pooled procurement of essential medicines. The outcome is a refined proposal for presentation to the EAC Sectoral Council of Ministers for policy guidance. XVII. Prepared technical briefs and participated in the 69th ECSA Health Ministers’ Conference in Lusaka Zambia together with the Minister of State (PHC). The resolutions of the meeting will guide the regional strengthening of all the Health systems blocks. XVIII. Participated in the WHS Preparatory meeting which has since been postponed because of COVID-19 Pandemic.

Enhance partnerships 20m 20m I. Developed a concept paper on Private facility engagement on Covid with support from master card II. Conducted a data analysis of some private health facilities and it was observed that 90% of private health facilities in Kampala, Wakiso and Mukono are not reporting into DHIS yet they provide over 90% of the services to the patients III. Reviewed private hospitals for purposes of categorising them as General Hospitals, Referral Hospitals and Community Hospitals IV. Participated in Pre-qualification of assessment of Health Facilities in Nebbi District to join URMCHIP Project

V. Organization of the Joint Global Fund, GAVI, Gates and Nordic MPs Mission held in February

Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results VI. Participated in developing one health integrated work plans for refugee hosting districts of: Ntungamo, Isingiro, Kyegegwa, Kamwenge, Hoima, Masindi, Iganga and Kamuli VII. Prepared documentations and Received 5 Japanese AMBULANCES as a donation VIII. Participated in development of an IGAD-EU project on COVID RESPONSE in the member states- 60M-EURO project where the country shall be receipt of testing kits, ambulances, PPEs, Mobile labs and some vehicles.

M&E I. Participated in monitoring World Bank Projects in Karamoja and 3m 3m Lango Districts (Schools and Health facilities being constructed under UGIFT). II. Prepared a report on progress of HSIRRP implementation and presented to CRRF meeting in Hoima. Refugees still need a lot of support and integration of the refugee population into the RAF

Enhance data base I. Revised the 4WD matrix for mapping health partners in view of for Partners COVID 19 pandemic

Key Output Quarterly Outputs achievement (Q3 and 4) Budget Expenditure/Budget Explanation for description targets (Q3) Release Q3 performance variation/ andQ4) **results Leaderships and II. Participated in 01 regional Joint review meeting in West Nile and 8m 8m Partner supported support services presented a paper on partnerships and multi-sectoral coordination. III. Participated in dissemination of mass non-medical masks distribution in ACHOLI sub region- IV. Participated in strategically aligning Covid Mitigation Policies to the Response level and available resources V. support to strategic planning for Covid 19-response. VI. Support to drafting a brief on the socio-economic effect of covid-19 VII. Engaged Ministry of Local Government and insurance Regulatory Authority to plan for community wellness at parish level as a mechanism to ensure community social security. VIII. Supported Covid 19 community engagement and social protection pillar to finalize plan. IX. Conducted weekly engagement with the media-TV, radio, social Networks and webinars on health, Global and population policies and programs. X. Coordinated a covid-19 local language communication strategy and implantation plan with Uganda medical Association Elders forum.

3.0 Challenges  The COVID-19 Pandemic interrupted implementation of some of the planned activities  Inadequate funding for refugees and POE  Need for vehicles for supervision and monitoring

Chapter Four: Health Sector Strategy and Policy Department

4.0 Divisions  Planning and Policy  Budget, Finance and Reporting  Health Information Management  Policy Analysis Unit  Results Based Financing Unit 4.1 Mandate  Governments to ensure that services provided by the Department meet their needs.  Coordinate development and analysis of sector policies, strategies  Coordinate development of sector plans and budgets  Development of guidelines for planning and budgeting  Coordination of resource mobilization and resource tracking in the sector  Identification, appraisal and monitoring of sector projects  Develop, review and maintain the Health Information Management System for the country.  Monitoring implementation of the sector plans and projects  Carry out research, studies and surveys to generate evidence for planning and policies.  Mentoring and capacity building of Local Governments in planning, policy implementation and budgeting 4.2 Vision Facilitate strategic resource mobilization, planning and allocation through prudent use of evidence 4.3 Mission To ensure development of quality, comprehensive evidence-based policies, strategic plans, sector performance reports, and equitable allocation of financial resources in the health sector Division Planning Department has three Divisions. These include: o Planning and Policy o Budget, Finance and Reporting o Health Information Management The Report reflects performance by the various Divisions and Units.

Table 4: Health Sector Strategy and Policy Q3+Q4 Performance FY 2019/20 No. Output Description Quarterly Outputs Budget Release Expenditure / Explanation for targets Achievement (Q3 & Q4) Budget Variation / ** (Q3 & Q4) / Results Performance Results (UGX)

1 Development of the Health Sector Drafting and Final Draft presented to - - Technical Development Plan 2020/21 – finalization of SMC and HPAC awaiting Assistance 2024/25 (HSDP II) the HSDP II costing before presentation (Consultants) to Top Management for supported by approval WHO and UNICEF 2 Development of the National Draft NHP III 38,680,000 38,680,000 Health Policy 2020/21 – 2029/30  LG consultative (NHP III) meetings undertaken  Concept note developed for TA to support the process 3 Development of the COVID-19 COVID-19 Plan and budget finalized and - - Supported Preparedness and Response Plan Preparedness & under print through the and budget Response Plan & COVID-19 budget supplementary developed budget 4 Development of the NRM Draft NRM Draft Manifesto in place - - Budget neutral Manifesto 2021 – 2026 Manifesto 2021 awaiting Top Management – 2026 approval developed 5 Undertake interim actuarial study NHIS interim NHIS interim actuarial study - - Activity carried for the NHIS actuarial study completed and draft report forward from in place previous quarter.

Planning and Policy Division No. Output Description Quarterly Outputs Budget Release Expenditure/ Explanation for targets Achievement (Q3 & Q4) Budget Variation / ** (Q3 & Q4) / Results Performance Results (UGX) 1 Support to LGs in 40 Local 16 Local Governments were 22,720,000  22,720,000Only 16 LGs we Development of Annual Health Governments supported Name LGs and Sector Performance Reports supported. summary of findings/Report and Preparation & Submission of District Health Annual Work plans & Budgets provided. 2 Technical back-up Support in 15 LGs Supported 15 LGs Actually Supported 21,500,000 21,500,000 N/A planning to Local Governments The LGs supported include: that performed poorly in the Kagadi, Butambala, Jinja, Annual LG Performance Kibuku, Buliisa, Lamwo, Assessment (Health Gulu, Apac, Kakumiro, Performance Measures) 2019 Adjumani, Kiryandongo, & benchmarking from best Kibaale, & Hoima Districts; performing LGs provided. and Njeru, and Kira Municipal Councils.

Summary of findings: Innovations  Signing of Annual Performance Agreements between DHOs and Health Facility In-charges  Recognition of Best performance both Political and Technical Officers (Awarding of medals, certificates,

Best Practices  Focus on Teamwork among staff  Joint supervision (both Political and Technical)  Timely processing of Funds  Timely dissemination of Key Documents to lower level facilities  Regular Performance Review and Internal mock assessments  Strong partnership with IPs led by the district leadership  Community participation in monitoring of leaders and timely feedback mechanism

On the other hand:

No. Output Description Quarterly Outputs Budget Release Expenditure/ Explanation for targets Achievement (Q3 & Q4) Budget Variation / ** (Q3 & Q4) / Results Performance Results (UGX)  Poor Record keeping for services delivered;  Lack of innovations such as those indicated above, were found to be responsible for poor performance, among others

3 Support to selected LGs in 4 LGs Supported 4 LGs supported and plans - - Supported by Developing One Health Plan (Isingiro, developed. UNICEF. for Refugee hosting Districts Ntungamo, provided. Kyenjojo & Bugweri)

4 Bills, Policies fast tracked, and 6 Bills & Policies: 6 cabinet memoranda and cabinet memos prepared information papers drafted and submitted for cabinet approval:  The Uganda Human Organ Donation and Tissue transplant Bill, 2020 was presented to Cabinet in April 2020 and approved. However, it was sent back to incorporate some changes and is for Budget neutral resubmission to Cabinet requires

No. Output Description Quarterly Outputs Budget Release Expenditure/ Explanation for targets Achievement (Q3 & Q4) Budget Variation / ** (Q3 & Q4) / Results Performance Results (UGX) stationery and  Cabinet Information personnel paper to update Cabinet on Covid-19 Response.  Cabinet memo on establishment of Border Post Health Units.  Proposal to borrow Euros ten million from the Government of the Republic of Italy to finance the Karamoja infrastructure development project- phase II. This was presented to cabinet by MoFPED and approved.  Cabinet Memo for proposal to borrow us dollars 15 million from the world bank for additional financing of the East African Public Health Laboratory Networking Project. Awaiting presentation to cabinet.  Public Health Act amendment awaiting submission to Cabinet

 Amendment of the Public Health Act.  Community Health Policy

 Migration of health worker’s Policy.  Nursing and Midwifery Policy 6 Memoranda of Understanding 4 MoUs prepared 4 MoUs were prepared and NA NA Budget Neutral between MoH and Partners and Concluded concluded: drafted and submitted to SGs Office for clearance  Health partners Uganda (HPU) and MoH to increase access to quality and affordable health care in Uganda through health cooperatives.  MoH and Food for the Hungry (FH) to support the provision of goods (Vitamin A and Albendazole) as a complementary intervention intended to strengthen routine immunization and implementation of

No. Output Description Quarterly Outputs Budget Release Expenditure/ Explanation for targets Achievement (Q3 & Q4) Budget Variation / ** (Q3 & Q4) / Results Performance Results (UGX) Integrated Child Health Days initiative  MoH and Infectious Diseases Institute for conducting training of health workers on use of rapid diagnostic tests for malaria  MOU between MOH and NMS to support supply and distribution of Covid- 19 response commodities to Referral hospital, MOH and boarder points of entry

Budget, Finance and Reporting Output description Quarterly Outputs Achievements / Budget release Expenditure/ budget Explanation for targets (Q3 &4) results (Q3 &4) (Q3 &4) performance variation/ **results Health sector Budget Framework BFP & MPS 17,000,000 17,000,000 NA

Paper& Ministerial Policy Statement prepared by April  Prepared a sector BFP 2020/21 that was for FY 2020/21 2020 discussed in Cabinet & Parliament  Prepared the sector MPS 2020/21 that was laid in Parliament,  Printed and distributed 100 copies of the MPS to Parliament and other stakeholders Health sector Budget preparatory Budget preparatory 23,000,000 23,000,000 Institutional workshops and budget conference workshops and  Participated in the Local Government priorities Budget conference budget consultative workshops identified to were held  Health sector budget inform resource conference/workshop was held between allocation for FY 2nd and 5th March 2019 2020/21  Prepared the Indicative Planning Figures (IPFs) for LGs. Wage increased by 3.46% from 2019/20 to 2020/21 whereas Non- Wage Recurrent increased by 52.93% from FY 2019/20 to FY 2020/21 Revised the PHC Non-Wage Recurrent Grant allocation Formulae for FY 2020/21. The Allocation formula for FY 2020/21 included the population in refugee hosting districts. It also included minimum fixed allocation for all levels of care

Compilation & submission of Q2 & Q3 budget NA NA NA

Quarterly Budget performance Performance  Q2 & Q3 quarterly budget performance reports reports prepared. reports for Vote 14 compiled and submitted to MoFPED

Output description Quarterly Outputs Achievements / Budget release Expenditure/ budget Explanation for targets (Q3 &4) results (Q3 &4) (Q3 &4) performance variation/ **results Preparation of the Budget and Grants Guidelines FY 72,000,000 72,000,000 Guidelines  guidelines for LGs for FY 2020/21 2020/21 developed Prepared the Sector Grant and Budget disseminated and Guidelines for LGs for FY 2020/21 supported by  Prepared Health Facility Budget UgIFT Program guidelines FY 2020/21  Printed and disseminated 525 copies of the Sector Grant and Budget Guidelines to all LGs  Printed and disseminated 2,500 copies of Health Facility Budget guidelines to all Health Facility In-charges Quarterly Budget monitoring visits Undertook budget 15,585,000 15,585,000 NA  undertaken monitoring visits to The capacity of the RRHs was enhanced all RRH to review in population of the quarterly the FY 2019/20 Q3 performance reports and errors and gaps performance discussed and filled with team to ensure reports. that they are corrected.  Also, the team recommended, that there should be timely submission of the quarterly budget reports. Hold Sector Budget Working Group 6 Budget Working 3,000,000 3,000,000 3 SBWG  meetings Groups held 3 Budget Working Groups held meetings for Q4 were not held due to Covid-19 Project appraisals 3 projects NA NA The 2 projects  appraised. 1 project (1566 Retooling of MoH) for digitalizing the recommended for inclusion in the budget RRHs were for FY2020/21. This is a succession deferred for next project for institutional support to MoH DC approval process.

Health Information Management Division Performance Report for Q3 & Q4 FY 2019/20 Output Description Quarterly targets Outputs Budget Release Expenditure / Budget Explanation for (Q3 & Q4) Achievement (Q3 & Q4) Performance Variation / ** / Results Results Information sharing and knowledge Upload 50 40 Publications uploaded on the Knowledge - - Budget neutral management Publications on the management Portal. Knowledge management Portal. Roll out from MTRAC to MTRAC Roll out Rolled out Nil Nil supported by PRO for weekly surveillance reporting Weekly epidemiological surveillance has UNICEF improved from 54% to 79.4% Quarterly data analysis for health 2 2 reports generated for Q2 and Q3 PBS - - Budget neutral sector performance reports reporting and 1 for Q1 and Q2 performance Printing and distribution of HMIS 9 essential HMIS OPD, Child Health, Maternity, Inpatient 1,000,000,000 1,000,000,000 Over 80% of the Tools tools printed and Registers, Medical form 5, Child health, tools not yet disseminated Antenatal Cards and Form 033B were printed printed due to inadequate funds. Roll out EMRS in all General and EMR in 16 RRH EMR system operating in 16 RRH - - CDC/GF Regional Referral Hospitals Develop a health information Linking DHIS2, Not Done Nil Nil Building Report in exchange platform to allow data EMR, Mtrac-Pro EMR to DHIS2 integration (interoperability) Data analysis for half year 1 1 - - Budget neutral performance report on Health indicators Monitoring accuracy, completeness 50% of the health 20% of the health facilities visited Nil Nil The resources and timeliness of the reports from facilities visited were supposed to health facilities, on monthly basis, come from GF feedback; as well as Data Quality but was not Assessment released. 20% was contribution from partners and COVID-19 Restriction affected

Output Description Quarterly targets Outputs Budget Release Expenditure / Budget Explanation for (Q3 & Q4) Achievement (Q3 & Q4) Performance Variation / ** / Results Results continuity of activities. Enhance the capacity to collect, Roll out of Revised Rolled out in all the districts - - Supported by analyze and the dissemination health HMIS tools Partners (UNICEF related data at all level. and Regional IPs)

Results Based Financing Unit Performance Report for Q3 & Q4 FY 2019/20 No. Output Description Quarterly Outputs Budget Release Expenditure/Budget Explanation for targets Achievement (Q3 & Q4) Performance Variation / ** Results (Q3 & Q4) / Results (UGX) 000’s 1 Pre-qualification assessment 332 health facilities A total of 332 health facilities were 287,961.851 287,961.851 9 HC IIIs did not qualify of health facilities in the 28 in 28 Districts prequalified and 323 qualified for RBF and will be assessed in remaining Phase III districts implementation Q1 of FY 2020/21  283 HC IIIs and 49 HC IV  270 Public and 62 PNFP 2 Training of Phase III Districts 49 districts trained 2,403Health workers from 520 Health 3,423,915.8 2,182,040.741 Outstanding payment and health facilities on RBF facilities in 49 districts trained and PIP’s due to hotels and are developed. currently being processed 3 Verification of Quarterly Q2 FY 2019/20 72,535,400 72,535.400 EDHMT outputs. 79 districts  79 EDHMTs were verified and payments Verifications for the two worth UGX 0.443Bn to be made Q1 quarters were conducted FY2020/21 in June and July due to  58% of the districts conducted COVID-19 lockdown. comprehensive supervision of facilities This has led to demotivation of DHMTs  41% of the 79 Districts held and Health facilities. comprehensive DHMT meetings  Only 29% of the 79 Districts achieved 100% score of the Medicines and Health supplies management assessment  35% of the 79 districts have a functional Quality Improvement Management System Q3 FY 2019/20 82 EDHMTs were verified and payments 61,958 61,958 82 districts worth UGX 0.488Bn to be made in Q1 FY 2020/21.

No. Output Description Quarterly Outputs Budget Release Expenditure/Budget Explanation for targets Achievement (Q3 & Q4) Performance Variation / ** Results (Q3 & Q4) / Results (UGX) 000’s

 42% of the districts conducted comprehensive supervision of facilities  37% of the 82 Districts held comprehensive DHMT meetings.  Only 27% of the 82 Districts achieved 100% score of the Medicines and Health supplies management assessment 4 Transfer of start-up grants 50 Phase III Start-up Grants transferred in Q4 4,019,013.76 3,721,542.61 Some health facilities and to Phase III health facilities DHMTS and 520 district had errors or and DHMT’s health facilities inconsistencies in their Account details and the funds bounced. This is being addressed. 5 Supervision of RBF Quarterly Top Management supervision conducted to 31,626.7 Implementation by the Central and South Western Regions. Districts and Health facilities  Some facilities have tangible investments from the RBF funds. E.g. Baale HC IV in Kayunga procured a blood bank (fridge), Mukono Hospital procured a 3D Ultra- sound machine, etc. However:  Many Facilities are not adequately supervised by the DHTs and District Auditors

No. Output Description Quarterly Outputs Budget Release Expenditure/Budget Explanation for targets Achievement (Q3 & Q4) Performance Variation / ** Results (Q3 & Q4) / Results (UGX) 000’s  There is no evidence of meaningful investment in improving RMNCAH service delivery in some facilities.  There is lack of transparency in distribution of staff incentives  In-charges are not actively involving the MCH staff in prioritization of investments to improve on MCH services. 6 RBF payments to health HF invoices from 77 districts validated 7,000,000 7,198,212.1 The facility performance

facilities  Q1 FY 2019/20 amounting UGX 7.2Bn was higher than expected 79 Districts especially for the long- term Family planning methods and this is due to the additional support from Marie Stopes Uganda in terms of outreaches to these

facilities.

There has been an increase in quality score from an average of 80.4% to 83% for HC IIIs and 82.8% to 85% for HC IVs between Q4 FY2018/19 and Q1 FY2019/20. Q2 there was delayed submission of invoices from 16 districts due to

No. Output Description Quarterly Outputs Budget Release Expenditure/Budget Explanation for targets Achievement (Q3 & Q4) Performance Variation / ** Results (Q3 & Q4) / Results (UGX) 000’s delayed payment of 7,000,000 5,858,534.01 DHMTs for verification. HF invoices from 63 districts validated Payments will be made in amounting to UGX 5.9Bn Q1 FY2020/21  Q2 FY 2019/20 – 79 districts Payment of the validated invoice of UGX 5.06

billion was deferred for

payment in Q1 FY 2020/21 as process was

concluded at end of FY  HF invoices from 55 districts validated amounting UGX 5.06Bn 7,200,000 0

 Q3 FY 2019/20

- 82 districts

NB: **Results refers to the outcome of the intervention in the short or long term depending on the available evidence. This may be explained separately outside the matrix table.

Challenges and proposed solutions to mitigate them.

 Covid-19 lockdown delayed implementation of some of the planned activities e.g. finalization of the HSDP II, development of the National Health Policy III and MoH Annual Activity Plan FY 2020/21  Departments are not allocating funds for Regulatory Impact Assessments for policy proposals and this results in delayed submissions to Cabinet.  Poor response by all departments in development of their annual work plans and itemized budget estimation and development of annual work plans

 Poor response in submission of quarterly PBS performance reports. Must run after departments to get the reports yet it is mandatory to submit performance reports Recommendations  All Departments/programs/projects to develop and submit work plans, budgets and progress reports timely  Departments to budget for RIAs as part of the policy formulation process and approval  Recruitment of staff for the M&E Unit in the Planning Department

Chapter Five: Human Resource Management Department 5.1 Introduction The Human Resource Department is established to provide strategic human resource function to the MoH and the Health Sector generally. In particular, the Department is required to support the Ministry in attaining one of its 2019/2020 priority of addressing human resource challenges in the sector. These challenges include attraction, motivation, retention, training and development of Human resources for health. 5.2 Mandate The mandate of the department is to provide strategic human resource function to the Ministry and the Health Sector generally. In particular, the Department is required to support the Ministry in attaining one of its 2018/2019 priority of addressing human resource challenges in the sector. These challenges include attraction, motivation, retention, training and development of human resources for health. 5.3 Mission To ensure adequate available competent, motivated and productive health workforce that deliver quality health services to the population. 5.4 Objectives  Coordinate HR policy formulation, implementation, interpretation and evaluation in the Ministry and the sector.  Coordinate HR planning in the Ministry  Coordinate all matters related to appointment, deployment, confirmation, training/development, motivation and reward, compensation and retirement of staff in the health sector,  Budget and manage the wage bill for the Ministry  Provide technical guidance on HR issues for projects and programs in the health sector  Provide technical guidance on human resource matters to Ministry, RRHs and the Local government

Table 5: Human Resource Department Q3+Q4 Performance FY 2019/20 Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) Implementation of 100% HRM planned activities 354,452,001 Q4= 354,452,001 354,452,001 98% performance HRM activities conducted Q3= 120,000,000 120,000,000

Administration of 100% General Staff salaries paid Centralized General Staff salaries paid Centralized 43 officers accessed on staff salaries the payroll. Q4- APRIL Q4- APRIL paid 614,723,032/= to paid 614,723,032/= to 1 was deactivated due 434 staff. 434 staff. to transfer.

Local Contract. Local Contract. 4 Officers were retired. 77,944,616/= paid to 60 77,944,616/= paid to 60 staff staff 1 Officer was promoted Q4 MAY Q4 MAY Paid 874,275,964/= to Paid 874,275,964/= to OUTSTANDING 459 staff. 459 staff. SALARY ARREARS

Contract. Paid Contract. Paid 1. General Staff salaries 16,210,674 /= to 21 staff 16,210,674 /= to 21 staff =13,099,664 2. Contract (COVID- 19) = 129,180,924 Q4 JUNE Q4 JUNE paid 750,816,299/= to paid 750,816,299/= to 469 3. Bonded HW Salary 469 staff staff = 786,245,279

Local Contract Local Contract Paid Paid 53,508,849/= to 26 Staff 53,508,849/= to 26 Staff

SALARY ARREARS PAID SALARY ARREARS PAID

138,274,860/= 138,274,860/=

Paid 641,897,805/= to Paid 641,897,805/= to 164 164 staff staff

BONDED HEALTH BONDED HEALTH WORKERS WORKERS

Paid 303,374,894/= to 90 Paid 303,374,894/= to 90 bonded staff bonded staff

Printed staff identity cards for the following categories of staff 1.Malaria control prog= 27 2.Global fund= 7 3.Established staff = 35 4.Contract (COVID -19) =169

Q3 January –March 2020

1. Appointed and Deployed 42 officers to Headquarters 2. Appointed and deployed 37 Medical Officer to PNFP`S 3. Handled 11 transfers and responded to 23 appeals 4. Made payment schedules for 39 Training Centres thus making

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) payment for 1145 Medical Interns 5.Developed a probationary Register for newly appointed Officers 6. Handled recruitment of CONVID -19: - (i) Medical Doctors 50 (ii) Nursing Officesrs 20 (iii)Asst. N.O 30 (iv)Lab technicians 10 (v)Aneasthetic Officer 4 (vi)Retired 1

General Staff salaries paid

Q3- January paid 501,583,235 to 398 staff.

Contract. 70,301,626/= paid to 62 staff

February–Paid 603,077,507 to 402 staff.

Contract. Paid 71,768,853 /= to 62 staff

March,paid 652,642,793/= to 426 staff

Contract. Paid 69,390,826/= to 61 Staff

Staff Identity Printed staff identity 70 staff identity cards As planed cards printed cards for the following printed categories of staff 1. Malaria control prog= 27 2. Global fund= 7 3. Established staff = 35 4. Contract (COVID -19) =169

HSC /PSC 100% Q4, April – June 2020 Q4, April – June 2020 minutes 1. Prepared and issued 1. Prepared and issued appointments letters in implemented appointments letters in respect to: respect to: a) probation – 56 a) probation– 56 b) Promotion- 26 b) Promotion- 26 c) Transfer of service – 24 c) Transfer of service – d) With the service - 8 24 e) re-designation - 114 d) With the service - 8 f) retention after validation of RRHs (KIRUDDU, e) re-designation - 114 Entebbe, Kawempe & Women Specialized f) retention after RRH = 850 validation of RRHs Sub Total= 1,078 (KIRUDDU, Entebbe, Kawempe & Women 1. Confirmation in appointment = 293 Specialized RRH = 850 2. Processed Appointment on contract in Sub Total= 1,078 response to COVID-19=386 3.Deployment letters for P&P staff = 215

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) 1. Confirmation in 4.Deployment for COVID-19 staff = 386 appointment = 5.Deployment to PNFP = 37 293 6.Processed study leave = 1 2. Processed Q3 January –March 2020 Appointment on contract in response 1. Appointed and Deployed 42 officers to Headquaters to COVID-19 = 2. Appointed and deployed 37 Medical Officer to 386 PNFP`S 3. Deployment letters 3. Handled 11 transfers and responded to 23 for P&P staff = appeals 215 4. Made payment schedules for 39 Training 4. Deployment for Centers thus making payment for 1145 Medical COVID-19 staff = Interns 386 5.Developed a probationary Register for newly 5. Deployment to appointed Officers PNFP = 37 6. Handled recruitment of CONVID -19: 6. Processed study (i) Medical Doctors 50 leave = 1 (ii) Nursing Officesrs 20 (iii) Asst. N.O 30 (iv) Lab technicians 10 (v) Aneasthetic Officer 4 (vi) Retired 1

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) Processing Initiation and 7 Pensioners accessed Centralized Variations on monthly Pension and processing of the Payroll and were paid pensions are as a result Gratuity for Gratuity and Sh.789,914,830/= of continuous physical payment Pensions validation of pensioners. benefits Monthly Pension paid to 623 pensioners for the New retirees accessing month of April worth the Pensions payroll Sh.410,219,857=

Administration of Monthly Pension paid to Pension Payment 630 pensioners for the month of April worth Sh.430,768,714/=

Monthly Pension paid to 631 pensioners for the month of April worth Sh.402,671,412/=

Physical Pensioners on 659 Pensioners verified Q4 Centralised As planned Verification of the MoH by 30th June 2020 659 Pensioners verified by 30th June 2020 Pensioners Payroll verified Q3 undertaken 610 Pensioners verified by 15th January 2020 Q2 610 Pensioners verified by 30th March 2020 Q1 601 Pensioners were validated

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) Support Support Support supervision to Q4 Most votes supervised Supervision RRHs Supervision Mbarara RRH, Kabale Support supervision to Mbarara RRH, Kabale highlighted challenges of and District Local RRHs and RRH, Kisoro DLG, RRH, Kisoro DLG, Rubanda DLG, Kabale DLG, budget shortfalls to Governments District Local Rubanda DLG, Kabale Rukiga DLG, Isingiro DLG and Mbarara DLG facilitate recruitment of Governments DLG, Rukiga DLG, health workers. conducted Isingiro DLG and Mbarara DLG -Staffing gaps observed and there is need for continuous technical support -Delayed pension processing -Lack of functioning R&S committee -Inadequate medical equipment as one of the reasons for absentism Human Resource Time taken Meeting to discuss Q3 Still ongoing for Health 10 Human Resource for Initiating development of Human Resource for year Strategic Health 10-year Strategic Health 10-year Strategic plan. Plans Developed plan held in Jinja

Coordination of 100% 386 Health workers Q4 90% of recruited staff HR recruitment compliance to recruited on six-month 386 Health workers recruited on six-month assumed duty and 20% for COVID-19 recruitment contract &deployed to contract &deployed to National and Regional of those who assumed procedures National and Regional Referral Hospitals in response to COVID-19. duty missed salary due Referral Hospitals in The breakdown is as follows to delayed access to the response to COVID-19. 1.MOSG = 23 system The breakdown is as 2. MO = 73 follows 3. Epidemiologist =39 1. MOSG 4. Nursing Off = 57 = 23 5. Asst. Nursing Off= 80 2. MO 6. Enrolled Nurse = 12 = 73 7. Ambulance Asst = 20 8. Psych Clinical Off= 5 9. Lab Technicians = 16

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) 3. Epidemiologist 10. Drivers = 14 =39 11. Call Centre Agents = 47 4. Nursing Off = 57 Q3 5. Asst. Nursing 210 positions advertised and 215 Medical Off= 80 Personnel recruited to support national efforts Recruitment of in the fight against COVID-19 additional Medical 6. Enrolled Nurse personnel on-going = 12 7. Ambulance Asst = 20 8. Psych Clinical Off= 5 9. Lab Technicians = 16 10. Drivers = 14 11. Call Centre Agents = 47

Strengthening Dissemination Directors of RRHs Q4 Low compliance of staff performance and training on guided on signing Directors of RRHs guided on signing to Performance management in Performance Performance Performance Management with PS/MOH Management initiatives RRHs Management Management with Q3 PS/MOH Tracking of completed appraisals for 2018/19. a) 34 Staff with performance plans. Low compliance of staff b) 225 completed filling appraisal forms to Performance Management initiatives

Records HSC Minutes Minutes pho copied, filed Q4 1,420 case processed 90% cases handled Implementation of HSC Minutes on serial No. 1 to relevant files and Q3 remaining cases is on implemented. to 4 of 2020 forward to technical 1,210 Documents scanned and uploaded on the going officers for system and forwarded to the permanent implementation of secretary decisions

Output Quarterly Outputs Budget release Cumulative budget Expenditure/ budget Explanation for description targets achievements/ (Q4) performance performance variation/results (Q4) results (Q4) (Q4, Q3,Q2,&Q1) Received and Receiving, Appointments processed Applications all processed One applicant declined Received and processed processed registering and issued Number of HRH Specialized and Special Grade the appointment offer applications for applications for submitting of Cadres selected appointments for health appointments for application to workers for COVID-19 health workers HRM and recruitment exercise for COVID-19 issuing of recruitment appointment exercise letters Appointment and Issuing of 284 appointments, Q4 100% cases of appointments, confirmation All cases handled Appointment and deployment appointments, confirmations and and deployments handled deployment letters letters issued out confirmation deployments handled Q3 issued out and 284 appointments, confirmations and deployment deployments handled letters for health workers Indexed and Indexing and 1,100 documents Q4 All mails and documents classified and filed All documents classification of classifying classified and routed to Q3 processed documents documents action officers 1,100 documents classified and routed to action from the officers permanent secretary Organise HRH (8) Number of HRH 10,000,000/=  Advertisement Selection has not taken Selection and Specialized and Specialized and Special place due to COVID-19 Training of (14) Special Grade Cadres selected candidates for Grade Cadres sponsorship

Implementation Report at HRHDI- Mbale Output 4th Quarter Outputs Budget release for Expenditure/ Explanation for Description Targets achievements/ 4th Quarter budget variation/ results performance **results Drafted 5-year Conduct planning Conducted 3 days planning 5.188.000 5.188.000 As planned Strategic plan meeting to review meeting that reviewed implementation of 2015/16-2019/20, identified 2015/16-2019/20 broader areas, a road map strategic plan and and activities to be carried draw a road map for out during 2020/21-2025- 2020/21-2025-2026 2026 strategic plan Strategic Plan This activity was conducted with Paid with funds As planned National TOTs Train 30 National 30 National TOTs were financial support from WHO- from WHO trained on TOTs on reducing trained to train health works Uganda Reducing MOV on reducing MOV Missed Develop the capacity Trained health workers in This activity was to be supported Paid with funds As planned Opportunities of health facility (34) districts: Amuria, Budaka, by WHO from WHO for vaccinations workers on reducing Bududa, Bugiri, Butaleja, (MOV) MOV Butebo, Buyende, Gomba, Jinja, Kaberemaido, Kagadi, Kaliro, Kamuli, Kamwenge, Kapchorwa, Kapelebyong, Kassanda, Kibale, Kibuku, Kween,Luuka,Lwero, Manafwa, Mayuge, Mbale, Mitooma, Mpigi, Nakaseke, Namisindwa, Pallisa, Serere, Sironko and Soroti on reducing missed opportunities for vaccination (MOV)  Trained (136) District Health Teams (DHTs) on MOV  Trained 928 health workers trained at the health facilities on MOV

Road Map for Developing HRHDI 5-year Strategic Plan Time Frame Responsible Person Expected Output No Items 1. Generate proposal to solicit for funds

Hire consultant to spearhead the process of By 30th July 2020 MoH/ Development Hired consultant strategic thinking and develop a strategic plan Partner/ HRHDI 2 Hold stakeholders’ meetings to brainstorm ideas 1st wk. of Aug. 2020 HRHDI/ Development Draft of Broader strategic areas to be and focus the strategic thinking to key issues that partner considered in the strategic plan can strengthen and promote in-service training in the country 3 Make draft Zero of the strategic plan 2nd wk. of Aug. 2020 Hired Consultant Draft Zero of the Strategic Plan

4 Hold stakeholders’ meeting to review draft Zero 3rd wk. of Aug. HRHDI/ Consultant A copy of reviewed Draft Zero

5 Make Draft 1 of the strategic plan 4th wk. Aug. Consultant A copy of draft strategic plan draft 1 2020 6 Present Strategic plan Draft 1 to TWG at MoH 1st Sept. wk. 2020 MoH- HRM+HRHDI Copy of reviewed strategic plan with amendments

7. Present the strategic plan to SMC at MOH 2nd wk. of Sept. 2020 MoH- HRM+HRHDI Approved copy of strategic plan by SMC

8. Approval of strategic plan 2020 4th wk. Sept. 2020 MoH- HRM Approve strategic plan 2020/2021- 20205/2026

Review of the HRHDI to the 2015/16-2019/2020 strategic plan and Program for Development of HRHDI strategic plan for 2020/21-2025/26 Achievements  All the groups presented in the plenary  Plenary presentations were discussed and items to be considered in the next strategic investment and development plan were identified, The proposed items to be considered in the next strategic plan were: 5.2 Group 1: Organisation structure, Institute’s mandate, core functions and legal status  The organisation structure to be enlarged to include the position of the principal as a head of the institute, Information Technical Officer and Assistant, Accountant and the Assistant, a second driver and two more Security Officer.  The institute have management board to provide oversight role  The linkage between the institute and CPD centres to be well stipulated and aligned with a clear structure for easy coordination 5.3 Group 2: Development and delivery of in-service training programs and innovations.  The institute to conduct training needs assessment using standard tools that can be shared with CPD centres  Emphasis on blended eLearning in-service training programs to reduce on absenteeism and promote access of health workers to the in-service courses  Establish e-library  Constant and stable internet connection at the institute for eLearning and other administrative functions such as ibanking  Emphasis on development and approval of in-service training program curricula as a measure for quality control  Reactivate regional CPD centres 5.4 Group 3: Funding and Infrastructure Development The new strategic Development Plan should clearly state strategies Institute should use to:  Lobby for more resource allocation to the institute  Creation of the institute vote to ensure sustainable funding to the institute in-service training programs  Support the institute on writing fundable projects especially in research  Develop Infrastructure development plan for the institute  Start income generating in-service courses for sustainability 5.5 Challenges  The team had to review several policy documents for background information before getting to discussions and agreeing on the way forward.  Plenary discussions were time consuming especially in agreeing on procedures of engaging the consultant, expected outputs and mechanisms for stakeholder’s engagement.  There were also some interruptions on some member’s concentration especially the PHTO heading the institute activity being in his workplace. He had to attend to some urgent call on office duty work while also being the key informant for some of the information required in the planning team.

5.6 Recommendations  The lead consultant be hired to spearhead the development of 5-year strategic plan  The hired consultant to: o Identify broader strategic areas to be considered in the 5-year strategic investment plan o Solicit ideas from stakeholders to guide on strategic road map for the country in- service human resource development o The management to set timelines for completion of the strategic plan to be observed by the lead consultant  HRHDI with support from MoH- Human Resources for Health Management Department to solicit for funds to support development of the strategic development plan. Write proposal seeking for funds to support development of the strategic plan.  The consultant be hired by the end of July and strategic plan be completed by August 2020.

Chapter Six: Health Promotion, Education and Communication Department

6.0 Mandate To strengthen health promotion systems for disease prevention and increase demand for quality Health Care Services 6.1 Objectives  To integrate health promotion into all health programmes  To increase health awareness, knowledge and change attitudes of individuals for adoption of health seeking behaviour  To improve systems for effective health communication to the public.  To advocate for health promotion and disease prevention at all fora  To engage different stakeholders for Health Promotion and Education action

Table 6: Health Promotion, Education and Communication Department Q3+Q4Performance FY 2019/20 Output description Quarterly targets (Q3 & Q4) Outputs Achievements/Results Budget release Expenditure/ Explanation (Q3& Q4) (Q3 &Q4) budget for variation/ performance **results Control of Develop messages on COVID 19 Developed messages on COVID 19 No cost implication Control of communicable & prevention for print, radio and for various scenarios: General communicable Non social media channels awareness on prevention, Stigma & Non communicable reduction, Truck drivers, Community communicable diseases transmission diseases

Print IEC materials for COVID-19 Printed IEC materials on COVID-19 UNICEF public awareness. in English and local languages and WHO distributed them. MOH Conduct public awareness Conducted 216 Radio talk shows and GOU/ICT campaign on mass media 20 TV talk shows on COVID-19 country wide Pretest and translate IEC Pretested and translated COVID 19 70,000,000/= materials on COVID 19. IEC materials in 23 local languages Hold stakeholder engagements on Reproductive Health advocacy 206,000,000 health promotion and disease meetings involving cultural leaders URMCHP prevention from the Buganda, Lango, Alur, Global Fund Busoga and Teso chiefdoms were held. Memorandums of Understanding between MoH and these Kingdoms and chiefdoms were endorsed. Translate IEC materials to Materials were translated in 20 Global Fund promote the Long Last Insecticide Languages and disseminated Net Campaign. countrywide. Conduct Top management Top Management officials featured 83,360,000 regional sensitization on the use on different radio stations GOU of face masks to prevent COVID- throughout the country and 19 sensitized the masses on the use of face masks. Laws, Policies, Actively Participate in the A National One Health USAID Laws, Policies, Guidelines & Development of a National One Communication strategy to be used Guidelines & strategies strategies

Output description Quarterly targets (Q3 & Q4) Outputs Achievements/Results Budget release Expenditure/ Explanation (Q3& Q4) (Q3 &Q4) budget for variation/ performance **results Health Communication strategy by the different line ministries and to address zoonoses. sectors Develop of a comprehensive Desk review and interviews of UNICEF Public mobilized communication strategy for the stakeholders were carried out by the to participate in health sector consultants (Real Group). the activities of the various MOH programmes Develop, produce and distribute Guidelines on COVID19 (Mass No cost implication Religious and guideline & SOPs on COVID19 gatherings, use of public transport, cultural leaders safe burial, self-quarantine, engaged to workplaces, use of face masks) support EVD preventive activities Buganda and Busoga kingdoms engaged to support Health Promotion and Disease Prevention initiatives Capacity Building Orient Call Center Agents on 150 Call Centre Agents from various No cost implication Capacity & Development COVID-19 to better respond to call centres at MOH, MTN, Airtel, Building & callers UTL, CDFU, Marie Stopes, Africel, Development Rackmount and Anti -Corruption Unit were oriented on COVID-19 risk communication Technical Support Conduct health promotion The districts of: Kazo, Kyegegwa, 42,950,800/= Technical and mentorship for focused technical supportive Hoima, Kikuube, Kagadi, Buliisa, GOU Support and Health Promotion supervision in selected districts Kabarole, Bundibugyo, Kisoro, mentorship Kabale, Rubanda, Kanungu, Kyotera, for Health Rakai, Isingiro, Ntungamo, Iganga, Promotion Bugiri, Busia, Tororo and Mayuge were technically supported in

Output description Quarterly targets (Q3 & Q4) Outputs Achievements/Results Budget release Expenditure/ Explanation (Q3& Q4) (Q3 &Q4) budget for variation/ performance **results managing risk communication interventions. Offer technical support on The DHEs of: Busia, Bugiri, Buikwe, 40,000,000 Control of COVID 19 prevention to DHEs Masaka, Kyotera, Lyantonde, UNICEF communicable & of border and highway districts. Kiruhura, Mukono, Kiryandongo, Non Luwero, Nakasongola, Tororo, communicable Soroti, Mbale and Namusindwa diseases districts were technically supported Conduct a VHT performance A VHT performance assessment in 50,000,000 assessment in 8 districts of the districts of: Moroto, Kotido, World Food Karamoja region Abim, Nabiltatuk Nakapiripirit, Programme Kaabong, Napak and Amudat was conducted. Conduct regular monitoring of Conducted monitoring of 9 Call 4,800,000/= Call Centers supporting the Centers supporting COVID 19 URMCHP COVID 19 response response (MOH, MTN, Airtel, UTL, CDFU, Marie Stopes, Africel, Rackmount and Anti -corruption Unit) Develop messages on COVID 19 Developed messages on COVID 19 No cost implication Control of prevention for print, radio and for various scenarios: General communicable social media channels awareness on prevention, Stigma & Non reduction, Truck drivers, Community communicable transmission diseases

6.2 Challenges  Inadequate manpower at the department to support the different Ministry Programs/ Divisions/ Departments in health Promotion interventions  Limited funding to support Radio and Tv programs on COVID 19 to match the ever-changing trends in the response  COVID-19 outbreak affected implementation of other routine planned Health Promotion activities  Outdated vehicles (Film Vans) which keep breaking down in the field hampering implementation supervision and endangering the lives of officers  Lack of new equipment to operate the film vans to required standards

Chapter Seven: Reproductive and Child Health Department

7.0 Mandate and Specific Tasks  Policy formulation, standards setting, and quality assurance for Reproductive, maternal, new-born, child and adolescent health services in Uganda.  Mobilization, Monitoring and coordination of partners and resources for delivery of Reproductive, maternal, new-born, child and adolescent health services  Capacity development, training and technical support for RMNCAH areas  Coordination of health research in RMNCAH areas  Monitoring and evaluation of the Reproductive, maternal, new-born, child and adolescent health sector performance

Table 7: Reproductive and Child Health Departmant Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/ release budget **results results (Q3 &4) (Q3 &4) performance Monthly ADH working group 6 5 Meeting held 6.5M United 100% Coordinated program delivery meetings. Nations Fund ** Covid-19 Pandemic caused for Population suspension of meetings Activities (UNFPA) Develop National Guidelines on Adolescent health Continuity of access UNFPA Continued access to Quality SRHR Provision of Guidelines of Policy and guidelines to care Guidelines for services by Adolescents and young Delivery of Adolescent health adolescent and youth people. services. in Covid-19 Context -Guidelines and SOP for reopening Schools - Protocol for Conducting Adolescent targeted outreaches in Covid- 19 Context Develop national ADH strategy Draft 0 ADH concept Note, (5.5M) UNFPA 100% **Inadequate funds availed. and costed implementation Plan Strategy situation analysis, Legal and policy environment, Theory of Change. Develop adolescent targeted 12 topics covered 14 areas developed UNFPA- 3.0m Finalisation and consolidation messages for health risk URMCHIP- 60% underway delayed by CoVID. prevention 25M SRHR/HIV/GBV integration. 2 2 Meetings held UNFPA Coordinated program delivery

TOTs conducted from 40 90 90 160m 100% Create a pool of Mater Trainers in districts ADH health facilities from 40 teenage 400 200 231m 50% Improved Capacity of Facilities to pregnancy high burdened URMCHIP offer Quality of Adolescent and districts supported in youth responsive SRHR services adolescent and youth health responsive service delivery

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/ release budget **results results (Q3 &4) (Q3 &4) performance Monthly MCH TWG meetings 5 meetings 5 meetings held UNICEF,  held MCHN, Developed continuity of care BAMA, guidelines for RMNCAH  Coordinated continued delivery of RMNCAH services amidst covid-19  Approved the adolescent health standards, standards for reopening of schools, and protocols for conducting adolescent health outreaches amidst covid  Approved proposal for inclusion of cabetocin and tranexamic acid into UCG guidelines and maternal health guidelines, standards, and protocols  Approved 2 studies/projects  Addressing maternal and newborn deaths using cloud- based platform in Rakai and Kyotera  Antenatal couple’s counselling study project quarterly extended MCH-GFF 2 meetings 1 meeting held UNICEF 10M 1 meeting scheduled for April was stakeholders meeting convened not held due to COVID-19

7.1 Challenges  In adequate funds to implement planned activities  Delayed release of Funds  Inadequate critical healthcare workers- midwives, Doctors, Anaesthetic officers to Support Functionality of HC-IVs  VHTs supporting iCCM Lack of registers  iCCM VHTs have not been trained in the use of Rectal Artesunate 7.2 Recommendations  Strengthen collaboration with other key stakeholder such as UN agencies and other government sectors to support EmONC  Mobilize additional resources from partners to increase Coverage of ICCM establishment  A vehicle be allocated to the school health program to enable implementation of the planned activities timely

Chapter Eight: Environmental Health Department

8.0 Introduction Environmental Health Department has two Divisions of; Inspection, Sanitation and Hygiene Section and that of Vector Borne and Neglected Tropical Diseases. The key role of the Department is to oversee and ensure quality Environmental Health and Vector Control Service delivery in the country, as part of the National Primary Health Care (PHC) package and therefore contribute to the significant reduction in morbidity and mortality rates related to Environmental Health and Neglected Tropical Diseases. Key activities undertaken during the reporting period include: Technical support supervision, cross boarder meeting between countries as well as stakeholders’ meetings, epidemiological surveillance as well post treatment surveillance for a number of diseases. Mass treatment for Bilharzia was also conducted in some districts. This report covers activities conducted by both Divisions during the period of both Quarter One and Two for the FY 2019-2020. 8.1 Performance of department in-line with key Performance indicators  14 of 20 (70%) of districts were supervised and supported in sanitation activities towards achieving ODF communities  3 of 5 meetings were held with stakeholders to review the Public Health Act 2000  3 meetings were held with Partners in sanitation and hygiene-NSWG  12 of 20 (60%) of districts supported with interventions towards control of vector borne and Neglected Tropical Disease  1 district (Mayuge) was supported in activities for mass drug administration for Bilharzia

Table 8: Environmental Health Department Q3+Q4 Performance FY 2019/20 Sn Output Description Quarterly Target Achieved in Budget Expenditure/ Explanation of Variation (Q3 &4) Quarter 3 release Budget (Results) (Q3 &4) Performance QUARTER THREE 1 Strengthening Partnerships NSWG1meeting 1 - 120,000/= - 2 Prevention and control of Technical support Activity 32.52m/= 100/= There was no variation diseases associated with to districts conducted in poor hygiene and sanitation implementing Pallisa, As well as support to sanitation and Isingiro, districts integrate WASH in hygiene activities Rwampara, COVID-19 Control Sheema, measures Bulambuli, Maracha and Moyo 3 Prevention and control of Technical support 10.75m/= 100/= The allocation to Division was low thus Vector borne diseases to districts interventions were conducted only in implementing MDA Busoga sub-region districts in district in Busoga Sub-region 4 Supervised 15 HAT Activity targeted 15 Lwala 21.1m/= 100% No noted variation treatment centres HAT treatment Hospital centres (Kaberamiad o, Dokolo HC IV, Alebtong HC IV, Namunagulw a (Iganga), Moyo Hosptial, Adjumani Hospital, Atiak HC IV, Laropi HCIII, Itula HCIII and Aliba HCIII in

1 NSWG-National Sanitation Working Group 71

Sn Output Description Quarterly Target Achieved in Budget Expenditure/ Explanation of Variation (Q3 &4) Quarter 3 release Budget (Results) (Q3 &4) Performance Obongi, Yumbe Hospital and Midigo HC IV in Yumbe, Omugo HCIV-Arua, Koboko HCIV and Maracha Hospital - QUARTER FOUR 1 Strengthening disease Rules were Over 10 - -

control and prevention developed with Rules  Rules are developed on demand legislations through progression of developed  They keep changing in regard to development of Public pandemic and under prevailing health situation in the Health Rules in line with force country control of COVID-19 outbreak 2 Emergency responses to - Damages in 14.5m/= 100%  floods in the district of KHM were Funding was from COVID-19 budget Kasese assessed,  There was no dedicated budget to this communities effort supported, and medical needs assessments done 2 Prevention and control of Technical support Supervision 63.3.m/= 100% diseases associated with supervision to visits (Qtr 4)

poor hygiene and sanitation support districts conducted in  District were followed up to assist develop plans the districts them streamline WASH activities with integrating WASH COVID-19 control measures in COVID-19 interventions in Rwampara, Isingiro,

Sn Output Description Quarterly Target Achieved in Budget Expenditure/ Explanation of Variation (Q3 &4) Quarter 3 release Budget (Results) (Q3 &4) Performance Sheema, Pallisa,  Also developed COVID-19 rules were Bulambuli, Moyo disseminated during these support and Maracha visits —

Activities Conducted under UNICEF Support Sn Output Description Quarterly Achieved in Budget Expenditure/ Explanation of Variation Target Quarter 3 & 4 release Budget (Q4) (Results) (Q4) Performance QUARTER FOUR ACTIVITIES 1 Technical support to 7 districts 8 districts 7 districts were 11.74m/= 100%  under UNICEF support for supported Districts sanitation progress towards sanitation improvement against planned District Wide ODF was greatly affected (Adjumani, Kamwenge, Iganga, 8 to assess by outbreak of COVID-19 disease. Isingiro, Kamuli, Karenga and progress However, there was a remarkable Kaabong) towards increase in hand washing coverage, as a achieving preventive measure against this disease district wide as well as other hygiene related ODF2 infections USF Quarter 3 Report Sn Output Description Q3 Target Achieved in Budget Expenditure/ Explanation of Variation Quarter 3 release Budget ** results (Q3 Performance 1 Refresher of the key district staff 12 districts 12 districts 14.2m/= 100%

in Teso regions on USF M&E and from Teso  Key M&E tools reviewed and Financial Management region covered. understood by district staff requirements based on the new A total of 60  Action plans developed on how to results framework staff trained on strengthen M&E in districts M&E  Plans developed by each district to train data collectors at sub county and village levels

2 ODF-Open Defecation Free 73

Sn Output Description Q3 Target Achieved in Budget Expenditure/ Explanation of Variation Quarter 3 release Budget ** results (Q3 Performance  Challenges with financial management identified and solved 2 Roll out of the MIS by FOs across 10 10 districts 43.1m/= 100%  10 USF districts to strengthen districts were oriented A pool of MIS data collectors was their M&E systems on the MIS in established in each district January, Feb  Training data was collected and sent and March 2020 into the system and shared with Moyo, Zombo, trainees Arua, Nebbi, Alebtong, Kole,  Action points for scaling up the Otuke, adoption of the MIS across districts Nabilatuk, was developed Katakwi & Kapelabyong 3 Hold 1 PCM meeting to review 1PCM 1 PCM meeting - -  the 2019 annual report prepared meeting was held in Minutes for the previous meeting were following the GSF Jan to Dec January to reviewed and updates on the previous calendar. review the USF action points were provided 2019 annual  The USF 2019 annual report was report. presented to the PCM members and it Attended by 15 was approved with some changes. participants  Comments on the 2019 annual report were received from the PCM members 4 Support the celebration of the 1 Sanitation 1 Sanitation 18.5m/= 100%  National sanitation week in Week Week The sanitation week celebration was Bulambuli district celebration celebration postponed due to the COVID 19 organized to be pandemic. Another date is yet to be celebrated in fixed Bulambuli was  6 planning meetings were held by the postponed due EA with various stakeholders on the to COVID 19 sanitation week celebrations pandemic  Various IEC materials, T-shirts and capes on the sanitation week were procured

Sn Output Description Q3 Target Achieved in Budget Expenditure/ Explanation of Variation Quarter 3 release Budget ** results (Q3 Performance 5 Conduct technical review 2 districts 2 meetings 18.3m/=  meetings in Hoima and Yumbe were held in Previous performances shared among districts Hoima and districts Yumbe districts  Best Operating Practices identified in Jan and Feb during field visits for replication 2020  Challenges to implementation of programme activities identified and discussed among participants 6 Conduct district visits to develop 8 districts 8 districts 24.4m/= 100%  a sustainability strategy in Lango targeted visited Lira, A massive movement towards attaining region Kole, Alebtong, ODF status among these districts was Apac, developed Amolator,  Capacity of the district staff to conduct Kaberamaido, Institutional Triggering was built

Chapter Nine: Community Health Department

9.0 Mandate To support integrated public health services for prevention and control of both endemic and epidemic diseases 9.1 Goal To achieve effective high impact health and nutrition interventions at scale, ending disability and deaths due to common preventable diseases and realizing other health goals 9.2 Objective Institutionalization of Community Health as service/practice at all level of Health Services delivery through effective and efficient linkages of community health projects

Table 9: Community Health Department Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results SOPs for continuation of Develop SOPs for COVID-19 guidelines translated into None Virtual Meetings; via essential services in Nutrition, PWD and sign language Zoom context of COVID-19 older persons in the SOPs for PWD and older persons None pandemic COVID-19 response developed in COVID-19 response guidelines guidelines SOPs for Nutrition developed in None Virtual Meetings; via COVID-19 response Zoom Booklet on nutrition guidance in None Virtual Meetings; via context of COVID-19 developed Zoom Policies, guidelines plan and Develop strategies and Concepts, draft strategy, and work strategies on Nutrition guidelines plans developed for National developed community engagement and social protection strategy 2020-2021. Develop strategies and Development of AT strategies still in guidelines for Assistive initial phase; Country capacity Technologies (AT) assessment completed and steps to hold a national AT stakeholder meeting initiated

Completion of MIYCAN guidelines and training NONE Via Zoom Meetings Maternal Infant Young packages completed Child and Adolescent Nutrition (MIYCAN) guidelines and corresponding training packages Develop and Surge model for monitoring spikes and None Via Zoom Meetings implement the surge trends in acute malnutrition developed model for malnutrition as a specific pillar in the training package to monitor spikes and for Integrated management of Acute trends in acute malnutrition (IMAM)in 6 virtual malnutrition in meetings Karamoja region

Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results Support supervision Conduct support Nutrition support supervision done in 4,000,200 4,000,200 mentorship and coaching in supervision for the 3 districts health service delivery integrated nutrition services delivery in 3 districts of Bugiri, Tororo and Manafwa Conduct support Support supervision on nutrition 7,432,000 7,432,000 supervision for services delivery in context of COVID- nutrition services 19 guidelines conducted in 9 selected delivery in context of RRH and Host district COVID-19 guidelines in Lira, Arua, Gulu, Masaka, Mbarara and Kabale, Mbale, Jinja and Moroto Supervision & Mentoring & supervision conducted in 2.614.000/ 2.614.000/= mentoring of health Moroto, Lira, & Mbale Referral = workers in hearing Hospitals Ear/Nose/ Throat depts. impairment in 3 Referral Hospitals Food security and Strengthen Conducted Operational research None None Funding from world bank Nutrition project in functionality of studies on functionality of UFSNP Uganda demonstration gardens demonstration gardens

Conduct Assessment Assessment of primary schools, health None None Funding from world bank of primary schools, facility and community performance in UFSNP health facility and UMFSNP supported areas community performance in UMFSNP supported areas A meeting on lessons Meetings on Lessons learnt experience None In kind Funding from world bank learnt, experience sharing and opportunities for scale up of UFSNP sharing and project workshops in the regions of opportunities for scale Eastern, Rwenzori, Western and West up of project Nile regions held. (These were high workshops in the level meetings that were presided over regions fort the 78

Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results Eastern, Rwenzori, by Ministers from each of the Western and West participating ministries). Nile regions. Show case on the Public exhibitions to the public during None In kind Funding from world bank undertakings of the the Harvest money (Nambole Stadium) UFSNP UFSNP and Rwenzori region expo (Kasese District) done. Coordination, Conduct monthly Conducted the 6 monthly Nutrition None In kind Funded by Jhpiego Consultative, Awareness Nutrition TWG TWG meetings conducted for the (Refreshments advocacy and TWG meetings for Q3 and months of Jan, Feb, March April May and/lunch) Meetings Q4 and June in 2020. Meetings for execution Conducted 3 coordination meetings on None In kind JHPIEGO funded of integrated child integrated child health days. (Refreshments health days in the and/lunch) month of April Meetings with district Conducted one day meetings in the Supported by political & technical districts of Kiboga, Kiryandongo, partners; Brien leaders in Mubende Mubende, Mityana & Kasanda for Holden Institute region to increase eye increasing profile for prevention of (BHVI) health profile blindness & visual impairment in January 2020 Conduct consultative 3 days meeting held at WHO in March In kind WHO supported meetings with WHO & 2020 Geriatric experts on steps to finalize older persons health care services strategic plan Capacity building for Generate a pool of Conducted one (01) national level None UNICEF funded Delivery of Integrated Trainers on IMAM Trainer of trainers (ToT) workshop for nutrition service delivery service delivery 70 participants on IMAM based on the available 2019 revised guidelines. Build capacity of health A total of 321 health workers trained None UNICEF funded workers to deliver on IMAM: (110 under Mbarara RRH, 98 integrated management under Arua RRH and -113 under Hoima of acute malnutrition RRH. services

Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results Build capacity of health 296 health workers trained on nutrition None UNICEF funded workers to provide service delivery during Ebola Virus nutrition services in Disease from 12 prone districts that Ebola virus disease included Insingiro, Kamwenge, outbreak prone Kyegegwa, Kampala, Wakiso, Kisoro, districts Adjumani, Rubirizi, Ntoroko, Kabarole, Kanungu and Hoima. Research to inform Conduct research to Data collection visits done in 10 health Funded by Brian Holden planning & policy establish actual cataract regions extracting actual cataract Vision Institute (BHVI). surgical rate in Uganda surgeries done for last 5 years in all Data collection centres doing cataract surgery in interrupted by COVID- February & March 2020 19 outbreak. Research to inform Analyze research data Data for the cataract surgeries research planning & policy on to establish actual from 129 health facilities visited cataract surgery cataract surgical rate in analysed and draft report ready. Uganda

Challenges and proposed solutions to mitigate them. Challenge Proposed solution Insufficient quality of nutrition Data capture, use and Orientation of records assistants and Biostatistician on reporting for performance improvement Nutrition in HMIS COVID-19 disrupted activity implementation Fast track activity implementation while using the COVID- 19 prevention guidelines Range and type of activities dictated by partner due to Increased GOU funding allocation over reliance on their funding Limited nutrition services delivery capacity especially Open scope of nutrition human resource at health facility level.

Chapter Ten: National Disease Prevention and Control Department (NDC)

10.0 Overview of the NDC Department Mandate on Policy Development, Coordination, Planning, Implementation oversight, Monitoring and Evaluation of Communicable Disease Control Programs in Uganda 10.1 Objectives  Provide policies and standards for control of communicable diseases  Prevent and control both Endemic and epidemic Diseases including other public health threats  Improve epidemic preparedness, surveillance and comply with international Health Regulations.  Strengthen programs targeting Diseases for elimination and eradication

Table 10: National Disease Prevention and Control Department Q3 +Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance UNEPI Procured 657 657motorcycles, 57 657 motorcycles procured motorcycles, vehicles, two and distributed 57 vehicles, refrigerated trucks and 71vehicles received and 63 4 medium –size distributed motorized boats Two refrigerated trucks procured and 4medium-size motorized boats Missed Opportunity for Train 30 Tots to orient Trained 30 TOTs in 34 out Vaccination (MOV) HWs in 54 districts on of 54 targeted districts: strategies in 54 districts MOV strategies implemented

Reactive Oral Cholera At least 95% of 94,954 With support from WHO, Vaccination (OCV) of persons aged 1 year 66,466 (70%) of 94,954 campaign targeting all and above reached with were reached with OCV in inhabitants of 5 sub the first dose (OCV1) in Southern Division, Northern counties (Southern Southern Division, Division, Rupa, Nadunget & Division, Northern Division, Northern Division, Rupa, Katikakile of Moroto district Rupa, Nadunget & Nadunget & Katikakile of conducted Katikakile) of Moroto Moroto district district conducted conducted

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Yellow Fever Reactive Develop Micro plans District microplans were Vaccination Campaign in and vaccinate 95% of completed but campaign 6 districts (Buliisa, Koboko, eligible population aged was not conducted Maracha, Yumbe, Moyo & between 9 months and Obongi) conducted 60 years with YF vaccine

District level capacity Capacity of 900 health 955 health workers building through workers built through mentored in 15 districts integrated supportive mentorship in 15 (Kagadi, Kasese, Kitagwenda, supervision/on the job districts (Kagadi, Kasese, Lyantonde, Lwengo, Masaka, training-selected regions Kitagwenda, Lyantonde, Butaleja, Budaka, Pallisa, conducted Lwengo, Masaka, Butaleja, Budaka, Pallisa, Pallisa

Produce and disseminate Produce and Two audio visual messages Routine Immunization disseminate Routine on continuity of audio-visual clips for key Immunization audio- immunization and MCH audiences to help visual clips for key services during COVID confront misinformation audiences to help period were produced and and vaccine hesitancy confront misinformation three talk shows were held and vaccine hesitancy

3 monthly vaccine 3 monthly vaccine 3 monthly vaccine management meetings management meetings management meetings held

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance VHT registration, VHT registration, VHT registration, Children Children Registration and Children Registration Registration and mobilisation for RI and mobilisation for RI mobilization for RI supported in 15[i] supported in 14[ii] supported in 14 districts

districts districts

Funding to 24[iii] urban Funding to 24 urban Funding to 24 urban districts to enhance C&E, districts to enhance districts to enhance C&E, EVM KPI monitoring, C&E, supportive supportive supervision and supportive supervision supervision and mentorship effected

and mentorship effected mentorship effected

Routine Immunization outine Immunization Routine Immunization and and HPV vaccination and HPV vaccination HPV vaccination media media messages and media messages and messages and radio talk radio talk show radio talk show show appearances in 21 FM appearances in 21[1] FM appearances in 21 FM radio stations across the radio stations across the radio stations across Country aired (Ongoing)

Country aired the Country aired

AIDS CONTROL PROGRAM PMTCT training content Program staff PMTCT Program developed and Vitual training No Cost No variation for the forthcoming training content for the disseminated to program no cost rollout of the 2020 forthcoming rollout of staff PMTCT training consolidated HIV the 2020 consolidated content for the forthcoming prevention, care and HIV prevention, care rollout of the 2020 treatment guidelines and treatment consolidated HIV developed guidelines develeped prevention, care and treatment guidelines.

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Mentorships and Mentorships and This was done in regions of IP supported. IP supported. Cost IP supported. Cost not closed coaching of health coaching of health high HIV burden in South Cost not not closed workers and Community workers and western Uganda and closed Service Providers in the Community Service Northern Uganda. linkage and referrals of Providers in the linkage Additionally, the program clients from community and referrals of clients conducted the orientation to facility and from from community to of Peers and community facility back to facility and from facility service providers in the in community for other back to community for the new care and support services other support services Treatment guidelines conducted conducted

Meeting to follow-up Meeting to follow-up Program performance with IP IP supported. with the over 50 Group- with the over 50 PEPFAR support for Oct- supported. Cost not closed Antenatal/Postnatal Peer Group- Dec. 2019 and Jan. 2020 Cost not Leaders/Facilitators Antenatal/Postnatal performance was presented closed trained previously held Peer and discussed Leaders/Facilitators Guidance on PEPFAR COP. trained previously held 20 priorities were shared with participants Implementing partners shared their program performance with PEPFAR funding at the regional level . COVID-19 Infection COVID-19 Infection These guidelines aimed at IP supported. IP supported. Cost Prevention and Control Prevention and Control reducing crowding of clients Cost not not closed guidance for continued guidance for continued at ART delivery points as closed HIV & TB Services HIV & TB Services well as ensuring continued Delivery disseminated Delivery disseminated access to ART during the COVID-19 pandemic

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance National HIV National HIV The guidelines have been 103,000,000 103,000,000 No variation consolidated 2018 consolidated 2018 rolled out guidelines developed guidelines developed

HIV Epidemiological HIV Epidemiological HIV Epidemiological status 42,095,000 42,095,000 No variation status report developed status report developed report (UNAIDS)

Distrct level targets for Distrct level targets for District targts 98,424,000 98,424,000 No variation HIV epidemiological HIV epidemiological (UNAIDS) control developed control developed

Standard operating Standard operating These guidelines will help 12,000,000 12,000,000 No variation it was IP procedures for the procedures for the health worker compile supported recently revised HMIS recently revised HMIS patient level data while at tools including the HTS tools including the HTS the same time improving client card, the ART client card, the ART the quality of data Care card, the health Care card, the health submitted in DHIS2 for use facility monthly report facility monthly report by stakeholders. (HMIS105) and the (HMIS105) and the Health unit quarterly Health unit quarterly report HMIS106a. During report HMIS106a. this process, validation During this process, rules for all data validation rules for all elements in HMIS 105 data elements in HMIS and HMS 106a were 105 and HMS 106a developed were developed

NATIONAL TB LEPROSY PROGRAM (NTLP) BudgetX'000

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Implementation of TB Conduct sub-national ACF facility-based trainings 254,815 254,815 COVID prevention restrictions active case finding (ACF) ACF training targeting were conducted in Jinja, toolkit at 200 health 1,000 health workers Bugisu, Teso, Busoga, Gulu, facilities in 50 districts from 160 health Ankole, Tooro, Lango facilities in 41 scale up region, where over 1,600 districts health workers were trained in active TB case finding toolkit

Conduct coaching and 325 Health care waorkers 53,748 53,748 Delay in implementation due to mentorship in active were mentored at the 40 COVID case finding at 40 health health facilities. The rest o facilities in 9 pilot the facilities mentorship on districts going

Support utilization of X- Conduct user’s training 12 health workers from the 18,561 18,561 All targeted hospitals attended ray services for TB for health workers from 5 beneficiary hospitals and 9 diagnosis 5 beneficiary hospitals Biomedical engineers from on application of mobile MOH Equipment digital X-ray maintenance unit and RIMA (EA) Ltd, a local agent for DELFT Systems Ltd

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Support utilization of X- Support installation and The digital X-ray machine 203,000 20,300,000 All targeted hospitals Xray ray services for TB operationalization of was commissioned by the machines were intstalled diagnosis the mobile digital X-ray Minister of State for Health for TB diagnosis at 5 and installed in Kamuli, beneficiary hospitals Bududa, Katakwi, Kaabong hospitals and Rwekubo HC IV

Conduct supervision to Conduct targeted 12 regions 44HF facilities 134,535 134,535 regions and districts supervision to new and were reached. 400HCWs poorly performing were mentored on TB districts

Commemorate WTD Carry out TB wellness Wellness clinic for MoH 53,000 53,000 CoVID prevention restrictions clinic for MOH staff staff conducted presided prevented implementation of using the mobile digital over by Hon. Minister of commemoration event in Lira X-ray for TB screening, Health, the Permanent Printing materials for Secretary. 231 health WTD workers were screened for TB 16 was presumptive for TB and 1 confirmed with TB and started on treatment

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Support implementation Conducted TB case Reviewed performance in Partner supported of initiatives for finding and TSR TB CN and TSR for last improving TB treatment improvement TWC quarter and actions to success rates meetings with improve performance. TSR implementing partners in the cohort evaluated April-June reached its highest at 81% Conducted Joint Five sites in Gulu region Coaching visit to 5 TSR (Gulu RRH, Koch Goma improvement HC III, Lacor Hospital, collaborative sites in Kitgum GH and St Joseph Acholi Region Hospital Kitgum) were coached and supported to implement action plans for improving TB patient retention, treatment outcome and TPT indicators Procure& Equip HDU for Procure and distribute Oxygen concentrators were 94,870 94,870 management of severely oxygen concentrators procured and distributed 11 sick TB patients to MDR-TB initiation to 11 MDR-TB initiation facilities hospitals. 6 will be distributed to the remaining facilities

Conduct MDR-TB Supervision MDR TB 17 Supervision conducted in all 69,138 69,138 Mentorship and treatment initiation 17 treatment initiation supervision facilities facilities

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Conduct DETECT child 10 districts Conducted DETECT child 72,028 72,028 TB mentorship in the 10 TB mentorship in the 10 scale up districts (Hoima, scale up districts Hoima, Iganga, Kakumiro, Iganga, Kakumiro, Kamuli, Kamuli, Kamwenge, Kamwenge, Kasese, Lira, Kasese, Lira, Luwero, Luwero, Mubende, Oyam. Mubende, Oyam) Selected health facilities were supported and over 200 HCWs oriented on Child TB management Strengthen Leprosy 4 High leprosy burden 2 SCG (Nandere and IKI-IKI 15,400 15,400 management districts supported SCGs) Supported and mentored DHT of Kibuku and Budaka districts; 27 People Affected by Leprosy (PALS) were reviewed (14 Kibuku and 13 Budaka) and counselling done, and Skills re-enforcement done. Foot maps taken for 5 PALs Conduct operations Conduct Latent TB Two OR studies on going. 14,216 14,214 Cost of training research in TB Infection (LTBI) study LTBI where training of health workers from Soroti, Arua, Mulago and Hoima were trained, and all Oral MDR-TB regimen

Conduct regional Conducted in 12 7/12 regions organised 0 0 Partner supported performance review regions performance reviews in meetings quarter 1,

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Conduct Partner 2 partner Coordination, 1 NCC conducted Q3, 3 0 0 Partner supported and virtual Coordination 2 NCC Partner coordination enagements engagements including meetings conducted NCC

Conduct SMEAR, Paed, 3 TWC per program 4 TWC conducted, finalised 0 0 BCC, Technical Working area HMIS tools SOPs, Data committee meetings validation rules, planning for TB/leprosy case-based surveillance system

Conduct TB emergency Conduct biannual Uganda TB emergency 0 0 response support supervision to response coordinated, 12 all regions of the incident management country meetings held together with the response regions of Lira, Acholi, Lango and Uganda Prison Services. Weekly meetings are attended by implementing partners, district health teams and Uganda prison services.

NATIONAL MALARIA CONTROL PROGRAM

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Case Management Integrated community Trained 1,200 VHTs on case management ICCM and basic VHT package in 9 Karamoja SURMA supported districts

Developed guidelines in relation to COVID 19

Quarterly integrated meetings for 3,868 VHTs from 9 SURMA supported Karamoja districts Some of our partners have supported COVID-19 works in 75 districts.

Supervised 11209 VHTs through home visits in Acholi and Lango areas, and 85% of them can diagnose and treat malaria correctly.

Held two ICCM national TWG coordination meetings.

Distributed 1640 iCCM medicine boxes.

154VHT supervisors supported to collect iCCM data

Conducted VHT coordination meetings on collecting community ICCM data in 33 GF [TASO] supported districts reaching 25,622 VHTs.

VECTOR BORNE AND NEGLECTED TROPICAL DISEASES Conducting support Conducting support support supervision supervision supervision in 8 districts conducted in 8 districts affected by nodding affected by nodding syndrome syndrome

Assesment of Stock out Assessment of Health All health facilities with of drugs for nodding facilities with stock out stock out of drugs for syndrome of drugs for nodding nodding syndrome syndrome replenished with drugs strengthening surveillance Conduct surveillance in Guinea worm survillance for guinea worm in high 10 districts of high risk strengthened in districts risk districts of Guinea worm hosting refugees and importation bordering South Sudan

Larviciding Launching larviciding in Larviciding launched in 3 districts Kabale, Rubanda and Kisoro

Training Workforce Training of workforce 100VHTs trained in for larviciding larvicide application

Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &4) achievements/results release (Q3 budget **results (Q3 & 4)) & 4) performance Conducting support Conducting baseline Baseline line surveys and supervision surveys and mapping of mapping of breeding sites breeding sites conducted in Butanda subcounty Kabale district First round first round first round implementation implementation of implementation of of larviciding in Butanda larviciding larviciding in all completed breeding sites post intervention conducting post post intervention monitoring and intervention monitoring monitoring and evaluation evaluation and evaluation conducted in Butanda sub county Post treatment surveys conducting post Conducted post treatment (PTS) for Onchocerciasis treatment surveillance surveillance for in formerly endemic onchorcerciasis in Zombo onchocerciasis districts districts

Mass drug treatment Conducting mass drug mass drug treatment for treatment in Bilhazia Bilhazia conducted in 14 endemic districts endemic districts

NTD sustainability plan Develop NTD NTD sustainability plan sustainability plan developed

Chapter Eleven: National Communicable Diseases Department (NCDs)

11.0 Mandate of NCD Department The overall mandate of the Non-communicable Diseases Department is to coordinate all efforts geared to prevent and control life style and mental health conditions in the country 11.1 Strategic Objectives of the Department  To coordinate and strengthen advocacy efforts to raise the priority accorded to the prevention and control of NCDs including Mental Health in the national development agenda.  To strengthen and coordinate the multi-sectoral capacity and guidance, to accelerate country response for NCD prevention and control.  To coordinate efforts to reduce modifiable risk factors for NCDs and underlying social determinants of health  To strengthen the health system to address NCDs through people-centred primary health care.  To strengthen the national capacity for quality research for the prevention and control of NCDs.  To strengthen the national M&E system for NCDs Table 11: NCD Q3+Q4 performance for FY 2019/2020

Targets for (Q3) Outputs (Q3) Budget Source of funding Variance

Commemorate Event held in Arua UCI World Cancer and town presided over Childhood cancer day by the Hon combined on the 15th Minister of State of January 2020 for Primary Health Care

Attend Capacity Participated in the building sessions East African diabetic conference and the East African NCD assembly hosted at Entebbe Resort Beach Hotel

Draft protocol for Held two (2) the next NCD survey meeting to discuss the NCD risk factor survey. Draft under development. Letter of request for funding sent to WHO

Task team created to develop the protocol for the next NCD survey.

Quarterly targets (Q3) Outputs Budget Source of funding Variance achievements/results (Q3)

Visit and support Visited 9 NCD service 4m MOH Nil districts in masaka delivery health facilities region in masaka, kalungu and bukomansimbi districts

Hold one National NCD stakeholder 10M UNCDA NA NCD stakeholder meeting held on March meeting 17th 2020.

Stakeholders updated on achievements and challenges of NCD care in the country.

Stakeholders updated on their various activities

Build a case for Aseries of workshops UNCDI NA NCDs and injuries and reviews conducted under the NCDI to identify the major poverty commission NCDs other than cancer, CVDs, DM, Chronic respiratory conditions and Mental Health and substance abuse. Others such as Injuries, Sickecell disease and Kidney Failure were found to account for another huge percentage. Financial needs for each condition were also estimated

Send out a message Circulate aimed at No Cost MOH NA urgeing service integrating NCD in provider to prioritize other essential care NCDs sent out to all DHOs and IPs.

Quarterly Targets Outputs Budget Source of Funding Variance (Q3)

Commemorate the Event held on 13,860,000 Epilepsy Support NA international 10th/02/2020 at Association of Epilepsy Day Fairway Hotel in the Uganda (ESAU) presence of different stakeholders

Support supervision Support visits done MoH NA in Mental Health in RRHs of Hoima units at RRHs and Fortportal

Coordinate MHPSS  Held weekly MoH NA activities in COVID- MHPSS sub 19 pillar CDC meetings  Developed WHO MHPSS SOPs and Guidelines

Quarterly Targets Outputs Budget Source of Funding Variance (Q4)

Support supervision Support visits donen 8,210,000 MoH NA in the Mental health in RRHs of Soroti units at RRHs and Kabale

Coordinate MHPSS  Trained COVID Fund NA activities in COVID- Health 19 workers on UNICEF MHPSS in COVID WHO  Provided CDC MHPSS services at different quarantine sites and isolation centres  Held weekly MHPSS sub pillar meetings

MHPSS support  Visited 30 28,300,000 GoU NA supervision in districts of districts with MoH Uganda and linked MHPSS activities in hospitals to those in communities

Target Q4 Output Q4 Budget Source of funding

Support visits to Kampala Support visits done in 6,000,000 MoH region Districts Kampala region Districts of Mukono, Buikwe, Kayunga, Buvuma, Mityana districts and MJAP – Links Project for NCD services

Guide service providers to Developed an NCD- NCD/UNCDA continue NCD services Covid-19 lockdown under lockdown providers and patients service access Guide and circulated through NCD stakeholders

Planning and resource Held two cervical cancer No cost NCD/ACP mobilization prevention screening and management planning meetings with PEPFAR team, CHAI, NHLS, UCI and ACP.

Created task teams to develop tools and materials for training, M&E, logistics, supervision Key Challenges for NCDs  Inadequate funding for NCD treatment and preventive services  Inadequate integration of NCDSs in other services  Limited population awareness of the dangers of NCDs  High prevalence of NCDs and their predisposing  Lack of enabling laws and policies on food, alcohol, marketing and food labelling.  Limited HW capacity  Inadequate supplies and resources for lifestyle diseases and Mental Health medicines, test kits, equipment, HR etc.  Difficulties in integrating mental health into primary health care  Weak NCD referral system for severe NCDs  Lack of functional Multi-sectoral collaboration and prioritization of NCDs

Chapter Twelve: Integrated Epidemiology Surveillance and Public Health Emergencies Department (IES&PHE) 12.0 Introduction The department has 3 divisions  Surveillance, Information and Knowledge Management  Preparedness and Public Health Emergency  Veterinary Public Health and Zoonosis 12.1 Mandate Prevention, timely detection and response to all public health emergencies/threats (disease epidemic/conditions and public health disasters) including zoonosis. The department is also mandated to coordinate national implementation and monitoring of International Health Regulations (IHR 2005) 12.2 Strategic Objectives:  Surveillance and response to all IDSR priority diseases/conditions including zoonotic diseases, cholera, typhoid, emerging Viral haemorrhagic fevers  Prevention and response to all public health emergencies/threats (disease epidemic/conditions and public health disasters).  To ensure the attainment of the International Health Regulations (2005) core competencies.  To ensure cross boarder collaboration and community empowerment to emergency preparedness and response including refugees and other migrant and vulnerable population

Table 12: IES&PHE Q3+Q4 Performance FY 2019/20 Output Quarterl Outputs Budget Expenditure/ Explanation for descriptio y targets achievements/ release budget variation/ n (Q3 &4) results (Q3 &4) (Q3 &4) performance **results DIVISION OF PUBLIC HEALTH EMERGENCIES (PHE) 30 districts 15 No performance 0 0 Funds for the activity for and districts quarter 4 were not communitie and accessed by the Division s communiti despite making a supported es requisition. to prevent, supported mitigate to and prevent, respond to mitigate PHEs and respond to PHEs

Provide Respond Continued to 0 0 COVID 19 funds were special to 5 coordinate and lead coordinated at the office support to outbreaks implementation of of CHS. IES&PHE weak and 2 the EVD districts at health preparedness and EVD preparedness and the highest disasters Response Plan that response activities were risk of in districts started in August funded directly by PHEs to affected to 2018 in response to Partners respond to provide EVD Risk in DRC- PHEs the until 25th June 2020 necessary when WHO The other PHE response interventi declared the end of activities were also ons DRC Ebola outbreak supported directly by by timely responding partners to numerous alerts across the country. The country has now integrated EVD surveillance into COVID 19 surveillance along DRC border particularly in Kasese district Responded and contained to Cholera outbreaks in Kampala 2(0), Kisoro 39(0), Kyegegwa 38(0), Isingiro 137(1), Busia 19(1) and Bududa 64(1) Responded and contained to Anthrax in Arua 11(0) and Kapchorwa 4(0) Responded and contained to Yellow fever in Koboko 3(0), Masaka 5(0)

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Output Quarterl Outputs Budget Expenditure/ Explanation for descriptio y targets achievements/ release budget variation/ n (Q3 &4) results (Q3 &4) (Q3 &4) performance **results and Buliisa 3(1), Moyo 9(5) Responded and contained to RVF in Kasese 1(1), Ntoroko 1(1) and Obongi 1(1). Responded and contained to Food poisoning in Lamwo 33(0) and Budaka 32(1) Supported surveillance and control of Measles and Rubella outbreak Nakapiripirit (Rubella), Obongo, Kaabong and Masaka Lamwo, Nakaseke and Isingiro districts (Measles). Supported and 9,981,000= 9,981,000= This activity was Supervised the (GoU) (GoU) supported by GoU in Q3 Yellow fever response activities in the districts of Buliisa and Moyo Assessed the 6,189,200=( 6,189,200=(Go This activity was preparedness and GoU) U) supported by GoU in Q3 readiness for covid- 19 in the districts of Tororo, Busia, Kabale and Kisoro Capacity of 1 priority No particular district 0 0 Capacity building activities DHTs, district was capacity built for COVID 19 surveillance RRTs and selected, using GOU funds have been majorly communitie and but Country wide supported by partners s built to capacity training/orientation prevent built /mentoring for and COVID 19 were mitigate the conducted across impact of the country using PHEs partner funds as indicated below: One day country wide district DHT orientation for COVID 19 for 135 districts (CHAI, IDI, Resolve funds), one day Hub and POE training (CHAI funds), two days district enhanced surveillance orientation for 135 districts and surge capacity 101

Currently working towards strengthening surveillance in both private and public health facilities Needs Conduct 0 0 No funds were available assessment one (1) for this activity, though s, hotspot micro planning for Oral Operationa mapping Cholera Campaign was l Research, done conducted for six hot spot hotspot districts as indicated mapping on below: PHEs conducted

Prevent Supported Supported six 21,900,000= 20,900,000= cholera six districts of Busia, outbreaks districts of Namayingo, in cholera Busia, Ntoroko, Kasese, hotspot Namaying Obongi/Moyo, districts o, Arua/Madi Okollo Ntoroko, develop the plans for Kasese, OCV. Campaign Obongi/M scheduled in oyo, September 2020 Arua/Madi Okollo develop the plans for OCV. Campaign scheduled in Septembe r 2020 Overall Results (Outputs-Outcomes) of the PHE division

 Coordinated and contributed to the preparedness and response surveillance strategy for COVID 19 pandemic Uganda through spear-heading surveillance activities and district capacity building for surveillance  Continued to coordinate and contribute to the preparedness and response surveillance strategy for EVD risk following a protracted outbreak in DRC until the declaration of its end on 25th June 2020 by WHO  Conducted microplanning in six hot spot districts of Busia, Namayingo, Madi Okollo/Arua, Moyo/Obongi, Kasese and Ntoroko; plans were used to order for vaccines from Geneva and are expected to arrive in the Country 24th- 29th August 2020. The campaign is scheduled to be conducted in September 2020. This integrated approach of oral cholera vaccination is part of the Country efforts to end cholera in line with the global strategy. However, the country is still challenged with access to safe water and adequate sanitation. The national cholera strategic plan is due for midterm evaluation

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Output Quarterl Outputs Budget Expenditure/ Explanation for descriptio y targets achievements/ release budget variation/ n (Q3 &4) results (Q3 &4) (Q3 &4) performance **results  Led and supported timely national response to various other outbreaks as indicated above (cholera, measles, rubella, yellow fever) thus contributing significantly to national health security against outbreaks DIVISION OF SURVEILLANCE VETERINARY PUBLIC HEALTH AND ZOONOSIS (VPH&Z) Establishme 10 District One Health 91,392,600= 83,742,600= No Partner funding was nt and Districts Teams Established (GoU) (GoU) received for this activity training of and trained in the 2 during qtr3&4. The fund District districts of Kitgum was used for Anthrax One Health and Agago response in Queen Teams Elizabeth. (In 5 Districts)

Technical One Supported 3 Limited Funding and The support Health Districts of three districts will be supervision Technical Lyantonde, Kisoro covered using the Qtr1 on Support and Kanungu for 2020/2021 release prevention Supervisio One Health activities and control n (5) of zoonotic 4 Anthrax 3 districts Supported diseases prone in Anthrax districts in Kasese, Bunyangabu Western and Rubirizi Uganda districts COVID 19 6 Districts Supported and 12,983,000= 12,983,000= Limited Funding Ports of with supervised PoE in 6 (GoU) (GoU) Entry (PoE) funding districts of Arua, Supervision from the Zombo, Nebbi, Commissi Amuru, Buliisa and oner’s Kagadi office Results-Outputs and outcomes for VPH&Z  Supported the districts of Luwero, Nakaseke, Nakasongola, and Kiryandongo in one Health team operation  Improved management of outbreaks of Anthrax in queen Elizabeth National park  Covid-19 screening and Reporting happening at PoEs Surveillance Information and Knowledge Management Division (SIKM) Integrated Integrated Conducted an 19, 863, 19, 863, 200= All Funding by GoU and Disease Disease Integrated Disease 200= (GoU) (GoU) Achieved as planned Surveillance Surveillanc Surveillance technical technical e technical support supervision support support in 17 under supervision supervisio reporting districts of in under n in 10 Lwengo, Kyenjojo, reporting under Lyantonde, districts in reporting Mubende, Mbarara, HMIS and districts in Kassanda, disease HMIS and Rwampara, specific disease Kyegegwa Kotido, surveillance specific Abim, Pader & surveillanc Kitgum and follow of e consistently poor conducted reporting districts of . Jinja, Bugiri, Mayuge, Kamuli, Iganga, Conduct Conducted COVID- 0 0 Limited funding and the COVID- 19 surveillance activity was Supported by 19 support for 10 IDI 103

Output Quarterl Outputs Budget Expenditure/ Explanation for descriptio y targets achievements/ release budget variation/ n (Q3 &4) results (Q3 &4) (Q3 &4) performance **results surveillanc districts: Kyenjojo, e support Kitagwenda, for 5 Kamwenge, Kasese Rwenzori and Kyegegwa, sub-region Mubende, Mityana, districts, Kassanda, Kiboga, and 5 Kyankwanzi Mubende regional referral districts: Assessment Assessme Assessed the weekly 26, 380, 26, 380, 000= All Funding by GoU and of the nt of the epidemiological 000= (GoU) (GoU) Achieved as planned weekly weekly surveillance epidemiolo epidemiol reporting and gical ogical mTRAC use in 11 surveillance surveillanc Districsts of reporting e Rubanda, Kabale, and reporting Rukiga, Rukungiri mTRAC and Mbale, Luwero, use in mTRAC Manafwa, Districsts use in 8 Nakasongola, Districsts Bududa, Masindi and Namisindwa. Weekly Conduct A total of 24 Weekly 0 0 In-housework, No funding surveillance 24 weekly bulletin articles involved and Lack of Funds data verificatio published and shared to publish in Newspapers, verification, n, analysis, to all surveillance only soft copies shared analysis and disseminat stakeholders disseminati ion of on to surveillanc enhance e data and early make detection publicatio and n through feedback the mechanism weekly EPI s bulletin Support Support A total of 26 ports 9,032,000= 9,032,000= Supported by, GoU, supervision supervisio of entry were (GoU Q4 for (GoU Q4 for TDDAP, IDI and still there to ports of n to 5 supervised they Kidepo Kidepo Airfield, was Limited Funding entry (land ports of include Alakas, Airfield, Opotpot and crossing entry (4 Suam, Lwakakha, Opotpot and Kamion) and land Adramachako, Logir, Kamion) Entebbe crossing Oraba, Bunagana, Airport) and Katuna, Mirama, Entebbe Mpondwe, Ishasha, Airport) Pakwach, Dei, conducted Panyamur Goli, Padea, Vurra odramachaku, Lia, Oraba, Saliamusala, Busia, Malaba,, Mayanja, Kidepo Airfield, Opotpot and Kamion Conducted Covid-19 56,152,271= 56,152,271 from 5 districts Supported by Surge capacity from IDI IDI IDI and 2 Districts of development on Kyotera and Rakai enhanced supported by WHO 104

Output Quarterl Outputs Budget Expenditure/ Explanation for descriptio y targets achievements/ release budget variation/ n (Q3 &4) results (Q3 &4) (Q3 &4) performance **results surveillance in 7 high Risks districts of Amuru Adjumani, Yumbe, Arua, Koboko, Kyotera & Rakai Supported Covid-19 0 0 Limited funding and the data management at activity was Supported by POEs of Busia IDI Malaba Mutukula and Elegu Activated and 0 0 Funded by EAPHL MoH Delivered medical supplies & equipments in preparedness and response to covid-19 at Busia, Elegu, Malaba and Cyanika PoEs Results-Outputs and outcomes for SIKM  All reported PHE alerts verified, and all outbreaks were contained  Supported the districts of Rubanda, Kabale, Rukiga, Rukungiri Mbale, Luwero, Manafwa, Nakasongola, Bududa, Masindi and Namisindwa. in terms of weekly epidemiological surveillance reporting and mTRAC use for surveillance data management  Improved weekly surveillance reporting in the districts of Jinja, Bugiri, Mayuge, Kamuli, Iganga, Lwengo, Kyenjojo, Lyantonde, Mubende, Mbarara, and Kassanda.  24 Weekly EPI Bulletins for Q3 & Q4 Published and Disseminated  Covid-19 Surge capacity development built in areas of System alerts, Contact tracing, quarantine, Laboratory & Port health (PoE)  Covid-19 screening and Reporting happening at PoEs

11.3 Challenges  Funding insufficient to cover all planned activities hence we had to prioritize  Inadequate Infrastructural / Office space with new recruited officers in the department  Lack of Computers, instruction aides like projectors and internet Access in the department  Increasing trends for animal bites and other Zoonotic diseases making response difficult.  Increasing trends for perinatal and maternal deaths  Consistence poorly weekly surveillance reporting for Kampala and Wakiso districts  Increased data quality issues reported by the health facilities 11.4 Way forward / Recommendations  There is need to lobby funds from IPs to support and implement the planned activities  There is need to provide sitting space to the department to accommodate all Technical officers in the 3 Divisions of PHE, VPH & SIKM  There is need for provision of computers, projectors and internet Access  MCH to follow with the perinatal and maternal deaths in the affected districts for control  Continuous follow up to the poorly weekly surveillance reporting districts  Continuous verification of all reported PHE and participation in weekly surveillance data cleaning exercise

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Chapter Thirteen: Clinical Services Department

13.0 Brief overview The department of clinical services is composed of three divisions  Division of Hospital and lower level facilities  Division of Oral health,  Division of Palliative care The department closely works with other departments, that of Pharmacy, infrastructure, and quality assurance to ensure delivery of quality services. The Commissioner oversee the work of all the three divisions 13.1 Mandate The department of clinical services has the mandate to supervise the provision of health care services in hospitals and health facilities, and ensure service provision follows the prescribed national policies, guidelines and standards within the health sector

13.2 Functions/ Outputs  To develop, review and disseminate policies, guidelines and standards for curative services, oral health and palliative care  To supervise evaluate and update the delivery of curative, oral health and palliative care services  To provide integrated and specialized technical support supervision to health workers in hospitals and health care providing camps.  Coordinate the activities and meetings of the following (committees/TWGs/ programs Medical Board: o Uganda Medical Internship Committee. o Welfare of Intern doctors, nurses and pharmacists and SHOs. o Technical working groups Hospitals and health facilities. o Specialist surgical/treatment camps (Fistula, Dental, Cancer camps) o Case definition during outbreaks and epidemics

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Table 13: Clinical Services Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget release Expenditure/ Explanation for (Q3 &4) achievements (Q3 &4) budget variation/ (Q3 &4) performance **results Division of Oral Health Technical support supervision 9 dental units supervised 3 RRHs (Mubende 2.2M Funds could only Hoima, Fort portal facilitate supervision of dental units supervised three hospitals 5 districts 12 schools in 5 districts 4.6M 100% Districts have ready of mityana, Kiboga, plans for raising Buikwe, Iganga, Bugiri awareness on oral screened diseases and conditions in 12 primary schools 3 Regional referral Mubende, Hoima, Fort 7.9M hospitals portal supported 18 HCIVs 9 Hc IVs in lango 13.600,000 Facilitation was Karamoja and Acholi inadequate regions supported with fistula- care training and accessed for Emergency Obstetric Care (EmOc) and theatre functionality

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DIVISION OF HOSPITALS AND LOWER LEVEL FACILITIES Output Quarterly Outputs achievements/ Budget Expenditure/ Explanation description targets (Q3 results (Q3 &4) release budget for &4) (Q3 &4) performance variation/ **results Technical 3 Regional referral Mubende, Hoima, Fort portal 7.9M support hospitals supported 18 HCIVs 9 Hc IVs in lango Karamoja and 13.600,000 Facilitation Acholi regions supported with fistula- was care training and accessed for EmOc inadequate and theatre functionality Technical Hepatitis B data Hepatitis B data validation in support validation in 4 Kabarole, Kamwenge, Bundibugyo, supervision districts and Kitagwenda.

Dissemination of Hep B guidelines in Hepatitis B dissemination of 3 DISTRICTS. guidelines in Kamuli, Buyende and Luuka.

Technical support supervision of 4 districts on Technical support supervision Hepatitis B provideded in Ntoroko, Bundibugyo, activities Bwera, and Kamwengye. districts

ADDITIONAL ACTIVITIES DONE COVID 19 activities:  Health worker training in the hospitals of Kabale, Mbarara RRHs.IPC training in Mubende, Kikuube, Kagadi, Hoima and Masindi districts  Assessment of COVID 19 Preparedness in the refugee settlement camps and their host communities in the districts of Adjumani, Yumbe, Moyo, Obongi, and Madi Okolo Fistula Activities:  Commemoration of the International Day to End Obstetric Fistula  Conducted1st Fistula Technical Working Group Meeting Challenges and proposed solutions to mitigate them:  Facilitation is not adequate to enable all the planned activities to be done.  There is shortage of staff in the division due to the vacancies that are yet to be filled Proposed solutions:  To ensure vacant positions are filled  To improve funds disbursement so that activities are done timely as planne

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Chapter Fourteen: Department of Pharmaceuticals and Natural Medicines

14.0 Mandate Provide stewardship of the pharmaceutical services and oversight for the National Medicines Policy implementation 14.1 Mission Contribute to the attainment of the highest standard of health by the population of Uganda, through ensuring the availability, accessibility, affordability, and appropriate use of essential pharmaceutical products of appropriate quality, safety, and efficacy always 14.2 Areas of Priority  Selection, procurement, Quantification, and Inventory Management.  Strengthen system for efficient procurement of EMHS  Ensure that end users receive maximum therapeutic benefit from medicine within available resources  Coordination, Monitoring, and evaluation of PSM

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Table 14: Department of Pharmaceutical and Natural Medicines Q3 & Q4 Performance FY 2019/20 Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Co-ordination of national ware houses Fuel, Lubricants, Departmental Vehicles Departmental 5,140,000 5,140,000 NA GoU Well-functioning and oils Vehicles serviced departmental vehicles and maintained Technical Support - Monitoring and - Functionality of 22,381,521 22,381,521 NA GoU Improved capacity of Supervision Technical Support management the health workers in Supervision for COVID systems for medicines 19 supplies and general essential management and Medicines Management medicines and availability of key Systems at Selected COVID 19 essential medicines Regional Referral supplies reviewed, and health supplies at Hospitals and Selected medicines HF level Districts of Arua, Lira, availability and Kiryandongo and Gulu management improved

Partner, Agency Health Partners, Allowances for 2,750,000 2,750,000 NA GoU Improved Coordination, and Institutions and Coordination coordination of routine office Agencies meetings Partners, Agencies operations and efficiency of office routine operations

Well Fair and Departmental staff Provide break tea, 1,100,000 1,100,000 NA GoU Improved motivation Entertainment lunch, and news of the departmental papers officers Allowances Allowances for support Allowances for 2,226,000 2,226,000 NA GoU Improved motivation staff support staff of the departmental support staff Supply chain management activities to improve drug availability Procurement of Commodities procured -All VMMC sites Makerere -Continue supply of Commodities i.e. and distributed to received STI drugs University VMMC and STI drugs. Medicine, LLINs, districts - Reviewed and Walter Reed specific supplies for submitted the 111

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Voluntary (STI drugs, emergency COP20 supply Project -Total of $4m availed Medical Male drugs and other VMMC plan for public (MUWRP), Rakai from UNFPA for CY Circumcision supplies) sector for ARVs Health Sciences 2021. (VMMC), Icon and and Lab. Order Project) RHSP, -Supported the love branded for ARV (RHITES E, EC, COVID-19 Global condoms. medicines worth SW, Acholi & Fund grant application $3.5M placed. Lango), and received approval Prepared and MOH-PD for $11m for submitted JMS procurement of COP 20 supply COVID19 Tests kits plan for and PPEs. Fluconazole -NMS is expected to formulations. adopt and supply -Reviewed and facilities according to submitted to proposed changes. GHSC-PSM, the Q3 JMS supply plans for ARVs, VMMC, OI, reproductive health and laboratory commodities. Additionally, prep ared condom and condoms lubricant supply plan for balance of $ 745,526.43 under COP-19. - Prepared National RH commodity requirements, gap and supply plan for CY 2021 and submitted to UNFPA. 112

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Participated in the GF grant making (CY 2021- CY2023) by reviewing and updating the HIV/TB and Lab quantification workbook and the HIV/TB Health Products Management Template (HPMT). - Reviewed of FP procurement plans for HCIIs and HCIIIs to ensure availability of FP method mix and processed and forwarded MOH request to NMS. - Prepared additional requirement of TLE 400mg for WRA for the TLD transition period and for those that are ineligible for TLD. Prepared and forwarded MOH request to PEPFAR for support for the procurement of additional TLE 113

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status 400. Supply plan prepared for TLE 400mg, 90 pack for balance of $850,000 from COP 19 for public sector. Support Regimen Regimen Transition Weekly reports Not all facilities IPS, Transition to TLD is Transition & report on status of the were submitted are on the surge MOH-PD ongoing while Optimization Regimen Transition & reporting facilities optimization of Optimization list Pediatric ART clients implementation has been disrupted by low stocks of Lop/rit 100/25mg Conduct trends Trend analysis Reports -Conducted an MOH-PD The savings yielded analysis and assessment of worth $13.6m which tracking of forecast Global Fund HIV was allocated for GF accuracy for product and PSM PNFP ARV gap fill HIV/AIDS, Malaria, savings. ($2.35m), public TB, RMNCAH - Prepared 6- sector ARVs commodities. month ARV stock ($6.25m), Viral Load status and ($2m), HIV test kits consumption data ($1.8m) & CD4+ trend analysis for commodities ($0.5m). the FY2020 Q2 PEPFAR Report. Compiled data for FP commodities procured and issued from 2015- 2019 and shared with DHI/Track 2020 for correlation to FP indicators.

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Support JMS and 100% Timely of - Prepared a -The GHSC-PSM GHSC-PSM, JMS continued to NMS to store and commodity delivery to distribution list for project MOH-PD distribute HIV/AIDS, distribute Service delivery points 14,933 packs of subcontracts JMS Malaria and Family commodities in a HIV Stat-Pak and and NMS to Planning commodities timely manner to 1.1m packs of TLE manage, to over 600 PNFP service delivery 600mg at JMS warehouse and SDP’s spread points which is at risk of distribute throughout the expiry. Prepared commodities country. NMS allocation lists for procured on continued to Amoxicillin behalf of USAID. distribute ARVs dispersible tablets, procured by GHSC- co-packaged PSM to over 1,200 ORS/Zinc and public sector cycle beads under accredited sites. GFF round 1 -The President’s procurement. Malaria Initiative Additionally, through GHSC-PSM prepared contributed towards allocation list for warehousing of the OI medicines at third long lasting JMS. insecticide treated -Compiled and nets (LLINs) for the submitted the RH Universal Coverage commodities Campaign (UCC) Procurement through storage of the Planning and nets at NMS and Monitoring transportation of nets Report (PPMR) from NMS to the sub- for February 2020. county level. -Conducted inter- -QPPU was able to warehouse mediate inter- transfers of ARVs, warehouse transfers RTKs and RH between NMS or commodities from MAUL and JMS to JMS to NMS to mitigate impending mitigate shortages. stock-outs and Additionally, expiries based on the 115

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status conducted recommendation of transfer of the commodity antimalarial security group. commodities and -GHSC-PSM combined oral continued to monitor contraceptives the implementation of from NMS to JMS the third-party logistics contract by holding review meetings. -Reviewed PNFP supply plans for ARVs, VMMC, OI, reproductive health and laboratory commodities. Prepared and reviewed supply plans for additional COP19 $13m for JMS and MAUL for procurement of ARVs, EID and pharmacovigilance commodities. Additionally, prepared public sector ARVs supply plan for PEPFAR $27.8m ARV gap fill for CY2020. Support JMS and GHSC-PSM to - Health Systems GHSC-PSM -The HSS trained JMS NMS to put in implement Phases 3 and Strengthening staff on how to place mechanism 4 which will link the (HSS) Technical develop the monthly to collect and labor report to payroll Assistance carried labor from daily plan analyse data to information and out phase III do check act tool and enable Activity determine true landed training of JMS the pay role Based Costing staff on how to information. The 116

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status cost of goods and develop the labor report is used validate costs by activity monthly labour. by the JMS -JMS developed management to executive monitor efficiency of dashboards from warehouse operations the labor report at receiving, put away, The operations picking and dispatch. analysis tool was The operations also shared analysis tool was also -GHSC-PSM shared which provides continued to operations managers discuss on with more insight on monthly basis the what drives the labor report efficiency changes generated by JMS shown on the including dashboard developed. throughput at -This quarter, the receiving, focus was centred on selection, put- impact of COVID-19 away and dispatch. on operations of JMS Discussions and how it impacted focused on impact efficiency. of COVID-19 on Next quarter the efficiency in focus will be to different develop a plan to operational areas. expand ABC to include other JMS warehouses and discuss the JMS fees structure with USAID. Support Implementation plan to  A two-day GHSC-PSM The costed activity Dissemination of improve the public dissemination plan was discussed in National Supply health supply chain in workshop the medicines’ Chain Assessment place was held management and report and engage  Developed a procurement technical stakeholders to costed working group (MPM- develop investment activity plan TWG) and forwarded 117

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status plan to move which was to MOH senior public health forwarded to management for supply chain to MOH senior approval. higher maturity management levels Assess Framework for An evaluation of GHSC-PSM -Radley to carry out compatibility of adoption of interested in-depth interviews JMS warehouse international standards vendors was done with JMS staff to management in place and Radley was understand the system readiness engaged. current architecture for compliance to of the Warehouse and develop Management System framework for -The HSS to develop adoption of RFQ to be shared international with vendors of Radio standards for Frequency (RF) barcoding backbone and award the successful vendor. -Plan is to review Radley scope of work and issue a purchase order Strengthen facility Number of timely Accurate and MUWRP, RHSP, -Submission of Forecasting, reports submitted. timely orders MOH-PD complete and quality Ordering, submitted to the orders. Reporting of warehouses -Availability of medicines to medicines and health National Level supplies hence warehouses (Rate, improved patient care. Timeliness, Quality) and storage at health facilities for essential medicines and HIV commodities

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Support No of distributions and Conducted -Some HC IIs that MUWRP, -Use of the distributions & redistributions distribution and make ARV distributions & redistributions of conducted Re-distribution of orders, do not redistributions medicines, supplies HIV TEST kits order for HIV guidelines is expected within districts in (Determine), CD4 test kits. to minimise stock line with MOH cartridges, TB -Some HC IIIs and outs and expiries of guidelines LAM determine, HC IIs have small commodities Serum crag, storage space. -Improved availability Atazanavir, TLD of medicines and 90 packs, Pead. health supplies ARV drugs for PNFPs (ABC/3TC, LPVr, Dolutegravir, INH and Pyridoxine Conduct bi- Number of meeting Meetings MUWRP, RHSP, Submission of quality monthly order successfully conducted conducted MOH-PD orders review meeting SPARS implementation (Support Supervision Activities) Conduct bimonthly Number of facilities Approximately Data bundle, -Low involvement MUWRP, RHSP, -There is some SPARS visit (EM, supported 60% of the airtime, Fuel, in SPARS (RHITES E, EC, improvement in Lab, TB, ART) facilities have been motorcycle activities by the SW, Acholi & ordering, stock supervised. maintenance, DHT-follow up. Lango) management, SDA and -Covid-19 Dispensing, Transport lockdown affected Prescription, refund for several MMS to traceability of MMS/LSS/DT reach out and commodities. LS support facilities. -Limited support supervision from MOH. -Competing priorities within the districts handled by MMS. -Few MMS trained in LAB SPARS. 119

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Most MMS still have challenges with PFM indicators. Transition the Districts supported to All the districts -Most RHITES EC, - The implementation implementation of implement SPARS have been implementing RHSP, IDI, of EM SPARS and SPARS intervention by transitioned to Partners have not MURWP, Uganda ART SPARS is being interventions Implementing Partners Implementing fully embraced Cares, carried out in most partners. SPARS MOH-PD districts while Lab interventions. SPARS and PFM support is in a few districts. -SPARS implementation has improved logistics systems at facility level. Quantification of EMHS commodities Quantification of Updated quantification -Prepared and MOH-PD - Prepared a priority reports/ submitted the distribution list for commodities (HIV, Documentation Procurement 14,933 packs of HIV RMNCH, TB, Lab, Planning and Stat-Pak and 1.1m Malaria, Hep B, Monitoring packs of TLE 600mg at vaccines, EMHS) Report (PPMR) JMS which is at risk of for RH expiry. Prepared commodities for allocation lists for May 2020. Amoxicillin dispersible Additionally, tablets, co-packaged compiled national ORS/Zinc and cycle stock status for beads under GFF ARVs, Lab and round 1 procurement. TPT for the Additionally, prepared PPMR-HIV report allocation list for OI for Uganda. medicines at JMS. -Supported the quantification and 120

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status review of COVID- -Compiled and 19 commodity disseminated the requirements national RMNCAH including PPE & quantification 2019- Lab testing needs. 2022. Prepared public Prepared and sector gap analysis for updated on a FP and nutritional weekly basis the commodities for input stock status and in the MOH budget pipeline tracker call for FY 2020/21. for COVID-19 Supported the commodities. UNFPA commodity Additionally, quarterly review and supported the gap analysis for CY utilization of the 2020. Additionally, eELMIS for reviewed and finalized processing orders allocation of $4.6M for COVID-19 for GFF round 2 commodities RMNCAH procurement for FY 2020/21. -Supported ARVs, Laboratory, VMMC, condom and OI commodities quantification for PEPFAR COP 20 planning. Reviewed ARV forecast in light of transition of 31,000 ART clients from MAUL to JMS. Additionally, conducted a quantification of new commodities for cervical cancer and 121

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status pharmacovigilance as new priorities for COP2020.

Updated Updated quantification Supported the MOH-PD - Prepared and shared quantification reports/documentation. preparatory with warehouses the documents for all process for the distribution lists for key commodities - rollout and ABC/3TC 600/300mg, HIV, TB, Malaria, dissemination of LPV/r 100/25mg, RMNACH, EMHS the HIV ABC/3TC 120/60mg and Lab consolidated and DTG 50mg treatment pediatric regimen guidelines, optimization for all providing guidance PNFP facilities and on which regions public health facilities need to be in Zone 4 and Zone 5. prioritized. Additionally, prepared Participated in the a distribution list for review and update PV commodities for of the condom PNFPs and ffinalized strategy 2021- allocation lists for 2025. RMNCAH commodities procured under GFF. Streamline the Harmonised distribution Participated in MOH-PD Prepared and Alternative RH by IPs to the PNFP Alternative supported the Distribution sector Distribution dissemination of MOH Strategy (ADS) for Strategy (ADS) circular guiding IPs RH commodities transition task and districts on how through Joint force meetings to prepare for full Medical Stores with the DHOs. transition to the one- warehouse-one facility policy for RH commodities. Participated in the review of the policy implementation with 122

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status IPs and the Uganda family planning consortium (UFPC).

Monitor stock Stock Status Report -Prepared and MOH-PD The stock status status and update disseminated the monitoring enabled supply plans on MOH bimonthly inter-warehouse bimonthly basis stock status transfers of ARVs and reports for 1st RH commodities February 1st April across the different and 1st June 2020 warehouses to and conducted mitigate shortages. two commodity -Additionally, updated security group the online stock status meeting to update dashboard for ARVs, stakeholders on TB medicines and the national stock RTKs. Conducted status. meeting with JMS and -Prepared and SITES on automation disseminated of data collection for monthly facility the online stock status stock status for dashboard. January, February, March, April, May and June 2020. - Maintained an updated online weekly stock status dashboard for ARVs, RTKs, RH, TB and Malaria commodities. Prepared and disseminated a weekly national 123

Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status stock status report for ARVs, Lab, TB and opportunistic infection commodities. Additionally, held joint weekly supply chain meetings with USAID, GHSC- PSM and Global Fund to discuss key ARV, Lab, TB and OI supply chain issues, identify any risk and mitigation measures considering the COVID-19 situation Coordination, Monitoring and Evaluation Conduct monthly Monthly meetings Monthly MOH-PD Updates on supply Medicines and Medicines and chain were shared. Procurement Procurement Management Management Technical Working Technical Group meetings Working Group meetings, commodity security group coordination meetings conducted.

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Stake holder -Participate in strategic quarterly IPs MOH-PD, IPs Updates on supply coordination and and operational meetings held chain were shared. planning meetings meetings for Pharmacy department. Data Utilisation for Decision Making -DHIS2 (WAOS, TWO, PIP) Support facilities to Support supervision Some facilities MUWRP, RHSP,   implement eLMIS report on eLMIS, No. of Prepared a have backlog of (RHITES E, EC, The RxSolution is (Rx solution, facilities and districts scope of work data not captured SW, Acholi & expected to TWOS, WAOS, reached for the into RX Solution Lango), improve on the PIP) System for proposed system. MOH-PD process of EMHS through Web Based dispensing drugs Ordering and technical support  There is increased supervision. Reporting system for use of WAOS & TWOS for Reproductive Health/Family ordering by facilities Planning Commodities  There is (RH WOS). improvement in  Participated in relation to the accuracy of the preparatory orders made meeting to  Better visualisation review data of stock status requirements across the region for the RH WOS with  The Health DHI and Information UNFPA. Systems Program Additionally, (HISP) is expected Supported the to commence with design of Lab development of web-based the RH web-based ordering ordering system system

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status

 Finalized the development of Lab web- based ordering system and submitted the budget to TASO-GF to support TOT and facility training. Additionally, revised the RH order form to add key maternal health commodities & align to existing systems. WAOS and TWOS -Support TB web-based There is ongoing MUWRP, RHSP, Facilities are slowing Data analysis and ordering system capacity building (RHITES E, EC, picking interest in data utilization (TWOS) on Data analysis SW, Acholi & analysis and using implementation, data being given to Lango), their data for analysis and utilization facilities. MOH-PD informed decision making. Promote Reporting -No. of Weekly Reports Most facilities Some facilities MUWRP, RHSP, -Availability of real (RASS, Weekly Submitted were support by have stopped (RHITES E, EC, time stock status data Reporting and -No. of facilities IPs on weekly reporting using SW, Acholi & for each facility. monthly reporting. RASS reporting RASS. Lango), -Redistributions can Reporting) -No of districts and are now MOH-PD easily be done from an reporting with RASS reporting using informed point. RASS

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Harmonise, Print LMIS tools and SOPs in Some of the new - Some HC iis are MUWRP, RHSP, Some of the new and disseminate place tools (Stock card, not yet (RHITES E, EC, tools were printed LMIS tools and stock books) were conversant with SW, Acholi & and Distributed to SOPs E.G (stock printed the use of the Lango) improve cards, Stock books, new tools documentation. redistribution -Not all the tools books, expired were printed medicines books, HMIS 105) Support Expiry No. of facilities This has been MUWRP, RHITES -Safe disposal of Tracking of supported to manage done in some E expired commodities. Pharmaceutical Pharmaceutical Waste districts which This has helped to Waste by districts include: Buikwe, avoid re-cycle of the and facilities Kayunga, Mukono expired items in the and Buvuma facilities. Conduct client Survey conducted in A survey was HEP A draft report is yet satisfaction survey 145 facilities. conducted in to be shared. on SRH services which 75 facilities were visited. Appropriate Medicine Use (AMU) Conduct ADR Facilities reached with  IPs are Meanwhile some MUWRP, RHSP, There is Improved mentorship to ADR reporting and supporting facilities have not (RHITES E, EC, detection and strengthen ADR sensitization conducted facilities yet training on SW, Acholi & reporting on ADR by reporting and on ADR ADR reporting, Lango) facilities. sensitization on reporting for example in use of ADR Buikwe and IPs are Buvuma Districts continuou sly carrying out sensitizati on on the use of ADR

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Line activity Target Outputs Budget Expenditure Explanation for Source of Results variation in funding/ performance Accountability status Carry out Train health workers in There is IPS Health workers are Pharmacovigilance all areas concerning continuous follow updated in all areas (PV) Spontaneous up and regarding medicines implementation Pharmacovigilance mentorships of management. health workers from all ART sites in Pharmacovigilance Improve Infrastructure for storage Rehabilitation and -No. of stores  Most of MUWRP  To separate expansion of rehabilitated the ART Facility store facility medical - No. of facilities with sites have from District stores to meet shelves installed been store GPP standards supporte  The storage

d with of some improvin facilities have g their been storage improved facilities  Renovati ons are also ongoing in some facilities.

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Next Steps  Continue to carry out routine stock status monitoring  Monitor GOU, PSM and Global Fund orders  Conduct quarterly PNFP supply plan review meetings.  Compile PPMR report for RH commodities for August 2020  Continue supporting national ARV/TB response considering the COVID-19 pandemic  Support the development and rollout of the web-based ordering systems for lab and RH commodities.  Continue providing the COVID-19 logistics support  Participate in weekly meetings with USAID, GF and GHSC-PSM  Support the rollout of ART guidelines  Support the transition of health facilities from IDI-Westnile, IDI-Hoima and DOD supported facilities.  Monitor transition of ART clients to DTG and LPV/r-based formulations

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Chapter Fifteen: Nursing Services Department

15.0 Vision Uganda where quality nursing and midwifery profession is realized to deliver high quality health and social care 15.1 Mandate  MoH nursing department is mandated to ensure standard and quality nursing and midwifery services are delivered in accordance with the government policies and priorities.  Nursing and Midwifery forms the backbone of health care service delivery with over 75% and spends 95% hours with the patients therefore, there is a critical need for mentorship to improve skills in order to deliver quality preventive and curative services to the population to achieve UHC  However, the Nursing and Midwifery profession faces a lot of challenges in the areas of service delivery. Some of these include:  Nursing and Midwifery care package for example documentations, report writing, basic procedures such as vital observations, infection control.  Professionalism for example code of conduct while on duty, attendance to duty (abscentism), use of uniform while at work and communication to the patients.  Leadership challenges at all levels Quality of care and skills have continued to improve but at a slow pace that cannot cope with the 21st century disease burden and dynamics. For this reason, it is vital to support the team on the ground for quality improvement in the delivery of quality care to the community and public at large. During quarter one the team supervised Hoima region and in quarter two, Mbale region was supervised and team worked in collaboration with other senior Nurses / Midwives and the leaders in the region. 15.2 Objectives  To promote professionalism in the District/Region (Documentation, 5s, waste management, Report writing, Attendance to duty)  To provide Nursing and Midwifery current updates and emphasize implementation of schemes of service  To strengthen Quality improvement activities/ projects  To identify ways of solving Nurses and Midwives challenges.  To sensitize Nurses and Midwives in the Region on NNC and Nightingale challenge  To re-enforce strategies put in place for attendance to duty with the Nurses and Midwives leaders 15.3 Core Functions  Develop Policies, guidelines, and Standards of practice for Nurses and Midwives  Provide technical leadership and support to Nursing and Midwifery services in the country.  Capacity building through training, mentorship, meetings and workshops  Co-ordination and collaboration of Nursing and Midwifery activities Nationally Regionally and Internationally 15.4 Cross cutting issues from the previous review The department drafted a letter, consulted health information and HR departments, and was advised to collect more data on abscentism from at least half of the districts to give a national wide picture.

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Table 15: Nursing Services Department Q3+Q4 Performance FY 2019/20 OUTPUT QUARTERLY OUTPUTS, ACHIEVEMENTS/ BUDGET BUDGET EXPLANATION DESCRIPTION TARGETS RESULTS (Q3, Q4) RELEASE PERFORMANCE FOR VARIATIONS (Q3, Q4) (Q3, Q4) Technical Support 4 TSS Conducted 10 Integrated technical Q3 36.5 Some items are Supervision and support supervision and 2 follow up in 94 Q4 31 99% centralized mentorship/ coaching to 400 Nurses and facilities, mentored and coached in total Total health facilities on Midwives to be 908 (100%) Nurses and Midwives and 160 67.5 importance of mentored other health workers in 54 districts. documentation quarterly practices, report 54 Nurses and Midwives and 15 other writing, waste health workers management, 5s, mentored and coached in Apapai HCIV, professionalism and Serere General hospital, Katakwi general attendance to duty hospital, Toroma HCIV, Kapelabyong among Nurses and HCIV, Amuria general hospital in 6 Midwives done facilities.

50 Nurses and Midwives and 13 other health workers mentored and coached in Soroti RRH, Princes Anne, Atiriri HCIV, Mukura HCIII, Ngora DMO, Freda Care Hospital, Kumi HCIV, Atutur hospital, Bukedia HCIV and Salem hospital in Soroti region in 10 facilities.

31 Nurses and Midwives and 6 other health workers mentored and coached in Mityana general hospital, Ssekanyonyi HCIV, Mwera HCIV, Kiganda HCIV and Mubende RRH in Central region in 5 facilities.

53 Nurses and Midwives and 11 other health workers mentored and coached in Tirinyi HCIII, Kibuku HCIV, Palisa TC HCIII, Butebo HCIV, Busiu HCIV, Nabiganda HCIV, Kasaba Memorial hospital, Butaleja HCIII and Busolwe hospital in Mbale region in 9 facilities 131

OUTPUT QUARTERLY OUTPUTS, ACHIEVEMENTS/ BUDGET BUDGET EXPLANATION DESCRIPTION TARGETS RESULTS (Q3, Q4) RELEASE PERFORMANCE FOR VARIATIONS (Q3, Q4) (Q3, Q4)

35 Nurses and Midwives and 13 other health workers mentored and coached in Bukwo HCIV, Bukwo hospital, Kaptum HCIII, Kapropon HCIV, CheptuyaHCIII, and Kapchorwa hospital in Sebei region in 6 facilities.

Anaka Hospital, Kochgoma HC III in Nwoya district Atiak HC IV in Amuru district, Lalogi HCIV and Lanenober in Omoro district, Awach HC IV, Gulu Independet hospital, Lacor hospital and Gulu RR in Gulu district. 35 N/M, and 16

others mentored in 9 facilities

Lwala hospital in Kalaki district, Kaberamaido hospital and Otuboi HCIII in Kaberamaido district 11 N/M, and 5

others mentored in 3 facilities

Matany Hospital, Iriri HC IV and Kangole in Napak district Tokora HC IV in Nakapiripirit district, Nabilatuk HCIV in

Nabilatuk district, Kalita HC IV and

Amudat hospital in Amudat district,

Moroto RRH, Loputuk HC IV and Nadunget HC IV in Moroto district. 42 N/M, and 22 others mentored in 10 facilities

Kotido HCIV, Karenga HCIV, Abim hospital, Kabong, Kopoth, Kanawat, Kapedo HCIII 63 N/M, and 22 others mentored in 7 facilities

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OUTPUT QUARTERLY OUTPUTS, ACHIEVEMENTS/ BUDGET BUDGET EXPLANATION DESCRIPTION TARGETS RESULTS (Q3, Q4) RELEASE PERFORMANCE FOR VARIATIONS (Q3, Q4) (Q3, Q4) Rubugiri HCIV, Kisoro hospital, St Francis hospital Mutolere, Mukumbiri HCIII and Bunagana border in Kisoro district, Kabale RR hospital, Rubaya HCIV, Kamuganguzi HCIII in Kabale district. 63 N/M and 19 others mentored and

coached in 8 facilities

Ntara HCIV, Mahyoro HCIV Kicwamba HCIII) in Kitagwenda district, Kyarusozi in Kyenjojo, Rukunyu hospital and Padre

Pio in Kamwenge district. 59 N/M and 20

others mentored and coached in 8

facilities Follow up supervision in Adjumani,

Mungula HCIV, Moyo, Yumbe, Koboko,

Laropi, Midigo 62 N/M and 8 others

mentored and coached in 7 facilities. Follow up Tech supervision on the agreed

actions to Nurses and Midwives in

Mbarara RRH, Ruharo Hospital, Ntungamo district Itojo Hospital, Bushenyi Hospital in Bushenyi and Ibanda district Ishongororo HC IV Uganda Matrys hospital. 30 N/M and 10 other health workers mentored and coached in 6 Facilities.

Discussed on improvement of service delivery, key nursing issues with Nurses and Midwives, importance of formation of Nurses and Midwives federation, NNC, the Challenge and the year of the Nurse and Midwives.

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OUTPUT QUARTERLY OUTPUTS, ACHIEVEMENTS/ BUDGET BUDGET EXPLANATION DESCRIPTION TARGETS RESULTS (Q3, Q4) RELEASE PERFORMANCE FOR VARIATIONS (Q3, Q4) (Q3, Q4)

Procured and distributed PPEs to Entebbe and Mulago in collaboration with NNC and the department.

Action plans for each facility developed and ADHOs to follow up the actions.

Capacity Building 2 2 National and 2 Each Quarter 36 Nurse, Midwives and 10 other health Regional meetings not workers mentored, and skills built in done due to the Covid 2 National Amuria general hospital during half day 19 pandemic. 2 Regional meeting. meetings The department in collaboration with NNC organized the 1st National health leaders meeting aimed at knowledge sharing, resource mobilization and support to raise the profile and status of front-line Nurses and Midwives during covid 19. A total of 25 Nurses and Midwives attended the meeting.

The department attended the International women’s day celebrated world -wide to eliminate discrimination against women and focused on helping women gain full participation in global development. IDM

MOH in partnership with UNFPA organized media conference at MOH, scientifically organized MD on UBC TV 134

OUTPUT QUARTERLY OUTPUTS, ACHIEVEMENTS/ BUDGET BUDGET EXPLANATION DESCRIPTION TARGETS RESULTS (Q3, Q4) RELEASE PERFORMANCE FOR VARIATIONS (Q3, Q4) (Q3, Q4) and event hosted by Mulago Women's hospital and graced by Hon Min PHC. Vital roles of Midwives amidst covid 19 was appreciated by all.

IDN

MOH in partnership with UNMU scientifically organized on UBC TV and event hosted by UNMU. Vital roles of Nurses and Midwives amidst covid 19 was appreciated by all.

Distributed PPEs to Entebbe and Mulago in collaboration with NNC and the department.

7 training meetings held in Arua, Adjumani, Gulu Hoima, Soroti, Mbale and Tororo for front line N/M on covid 19 14m

-Co vid 19 information to patients emphasized

-Psycho-social support to staff and 14m patients -Demonstrate proper use of PPEs.

Donning and Doffing

60 N/M -Continuity of services amidst covid 19 Per region A total of 245 N/M 100% mentored, and capacity built

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Nurses and 1 RIA report in place and other Support from Midwives Policy work on going Seed Global and UNFPA

NMAU strategic In collaboration with the Funding by plan National Midwives Association UNFPA of Uganda through UNFPA developed Midwives strategic plan draft in place School health 2 1 Supervision was done to Travel Technical support Supervision 6 schools Nagongera P.7 inland supervision to Per each Tororo girls, Tororo College, school Nurses quarter Tororo Parents and Manjas ss, Mama junior

Carrier guidance, done to the 7 Nurses and Midwives

7 Nurses and Midwives 2. Teachers and 3 Matrons mentored and coached.

School Nurses not supervised Schools closed in Q4 due to covid 19 pandemic. Laptops for the 2 Computers were not procured 6m Because of department delayed procurement process. Welfare and 7 Staff welfare and 5.8m 5.8m entertainment entertainment in 2Qs taken care of for smooth running of office done

Vehicle 2 Vehicle was still under 7.8m Centralized maintenance warranty maintenance of Toyota. Travel abroad No travel in the 2 Qs 12.3m Due to Covid 19 pandemic Allowances Office staff paid lunch and 7.3 7.3 transport

Fuel Officers received fuel in the 13m 13m two Qs

Small office Toner, 2 USB and 2 extension Centralized Cables procured

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LESSONS LEARNT Technical support supervision improves communication between the nursing department (MOH), supervisors and subordinate for better service delivery. Regular technical supervision motivates leaders, helps to resolve conflict, and builds trust and capacity of the leaders on the ground Builds trust in the nursing and midwifery leadership at national level. Positive Community/ Patients attitude on covid 19 preventive measures ACHIEVEMENTs 1- RIA report for Nurses and Midwives in place 2- IDM/ IDN were successfully commemorated scientifically celebrated 3- Follow up was done, 5s, uniform use, waste management, IPC (waste segregation, hand washing) had improved and knowledge gained. 4- Participated in the quantification of health workers uniform and distribution plan developed 5- 54 districts including hard to reach were supervised on nursing and midwifery services in the regions. 6- 908 Nurses and Midwives were supervised and mentored on nursing and midwifery services and 104 other cadres including doctors, clinical officers and nursing Assistants 7- 7 one day COVID-19 training - meeting for Nurses and Midwives conducted successfully in Arua, Adjumani, Gulu, Hoima, Soroti, Mbale and Tororo districts and a total of 245 (more than 100%) Nurses and Midwives were oriented on COVID-19 National guidelines for case management, IPC and psychosocial support provided for the Nurses and Midwives. 8- 54 districts and the 94 facilities supervised had COVID-19 Task Force and they conduct meetings at least once a week. 9- Most of the Nurses and Midwives were in uniform and the clinical coats were received. 10- Key findings was shared with the facility management and district leadership, 11- Clarifications and guidance was provided on Infection Prevention and Control (IPC) during covid 19 training- meeting. FINDINGS FROM THE SUPERVISED FACILITIES POSITIVE  Mubende RRH was one of the exemplary hospitals which was well organised with substantive Nursing and Midwifery leadership in place  94 facilities supervised exist with hand washing to prevent COVID 19 and are offering services to the community  Staff to offer services were available on duty  In 4 facilities, Nurses and Midwives were found working together with at-least a Doctor  Most of the facilities had duty rosters in place to guide hospital coverage  Patograph was used to monitor labour progress in 60 facilities  Staff performance appraisal is done in all the 94 facilities  25 of the facilities had signing in done on the ward to enforce punctuality and track for absenteeism.  All essential services are ongoing including immunization with minimal interruptions.  In patient services and maternity services run 24 hours and staff work 3 shift coverage.  One facility had a special women’s Clinic, handling gender-based violence, cancer screening and treatment at early stage, before referral to Mulago.  Most of the facilities supervised were clean

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 Facilities supervised in the morning hours had OPD services done (FP, ANC, Immunization)  22 facilities had evidence of monthly meetings organized with minutes.  All the 94 facilities received uniforms and are being utilized as protective and identification  The leadership of the districts, facility as well as the Nurses and Midwives welcomed and appreciated the team for orientation training and visits to the care points  Key IEC materials, commodities and supplies like gloves, detergents, masks, testing kits among others were available for effective management of COVID-19 though few  Risk communication is addressed using different platforms like radio-talk shows and community mobilization through the local councils and VHTs  Some districts had vehicles available to pick and drop health workers who reside away from the facilities  Ambulances and boda-boda vouchers system are available for pregnant mothers to access prompt care  CPDs conducted in most of the facilities but Nursing topics are not evident  Some facilities observe infection control practices very well  Health education done in few facilities  Sick bays were well organized, and the school Nurses had the right qualification.  2 schools had visiting clinicians  All the facilities received uniforms and the use is getting better  Death audits are done (Maternal/ Perinatal) NEGATIVE/ AREAS OF IMPROVEMENT  Inadequate internal support supervision of nursing services in Hospitals.  Most of the facilities do not have nursing and midwifery leadership in place (Acting)  Ward rounds not done in another facilities e.g Amuria  Abscentism is still being registered in other facilities  There is still poor use of Patograph for monitoring mothers in labour e.g Mityana  Documentation remains a challenge in most facilities; Patients information is either incomplete or not documented at all.  Some facility wards were congested with patient’s e.g Katakwi general hospital.  Some Nurses and Midwives are still in in-complete uniform and they use open shoes while in uniforms.  Panic and fear among the health workers including Nurses and Midwives on COVID-19 given the porous borders, high influx of refugees and inadequate PPEs for care.  Some of the isolation center are too small and can only accommodate about 4-5 clients.  Some isolation facilities do not have interior washrooms.  No accommodation for the critical cadre making work very difficult during the covid 19 pandemic  Transport challenges for staff during this pandemic. The staff move long distances for work making it difficult especially towards curfew times and they are beaten.  5s is still poorly practiced in most of the supervised facilities  Task shifting still practiced, affecting quality of services  Routine Nursing procedures have been surrendered to patient attendants and care takers  Infection control and waste segregation is still a challenge in some facilities.  Accommodation challenges for critical cadres.

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 Fridge temperatures for vaccines not monitored in some facilities  No visible QI projects in many of the facilities  The nursing scheme of service is not being implemented in most of the supervised districts.  Baby Matrix was not being scored in some health facilities  Inadequate staff in all the supervised facilities  Transfers of Nurses and Midwives without knowledge of administrator’s  Equipment: BP machines and Thermometers still lacking in some health facilities  JIK or chlorine mixing, the standard formula is not followed by most health facilities leading to distraction of the equipment’s. (Poor equipment care) ACTION TO ADRESS CHALLENGES / RECOMMENDATION Continuous internal/ external mentorship was encouraged to perfect skills: Weekly CPD was encouraged to retain knowledge Check in and out to address abscentism: Team had half day mentorship meeting to improve service delivery in facilities e.g Amuria general hospital. Action plans developed, PNO and ADHO-MCH of supervised facilities to make follow up on agreed areas  HR MOH consulted on Mubende unplanned transfers.  The ADHO, DHO, and district teams to mobilize transport for staff especially, during this time of lock down, as a short-term measure.  The ward in charges to work with the ADHO - MCH to ensure that patients on the wards have mosquito nets, to prevent malaria.  To improve in areas of documentation especially, observation chart, treatment book utilization.  Nurses must use complete uniforms; closed shoes as means of protecting themselves from hazards.  The PNO, should compile names of staff for uniforms and shoe sizes ready for submission to MoH.  Good practices found on the ground encouraged to continue

Photo1: Team during mentorship sessions

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Photo 2: Team with staff after mentorship session in Kween and Soroti

Photo 3:Team with staff after mentorship session in Apapai and Mubende

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Photo 4: Team during mentorship sessions in Amuria with Hospital Superintendant and District Health Officer (DHO)

Photo 5: Poor waste management Poor 5s implementation

Photo 6: Emphasizing importance of ward cleanness in Amuria

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Photo 7: Poor uniform use Good uniform use

Photo 8: Bad practices accommodation and storage of motorcycle on the ward

Photo 9: Poor equipment care Meeting at Rubugiri HCIV

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Chapter Sixteen: Emergence Medical Services Department (EMS)

16.0 Mandate To establish accessible, quality and coordinated emergency medical services in the country by focusing on the core mandate of the MoH 16.1 Vision Efficient and responsive emergency care services accessible to all 16.2 Mission To reduce the loss of lives and prevent disability through ensuring high quality, safe and patient centered pre- hospital and hospital emergency medical services that meets the needs of the population. 16.3 Goal To contribute to Universal Health Coverage through providing accessible and affordable emergency medical services 16.4 Objectives  To strengthen leadership and governance structures for EMS across all levels of health service delivery.  To develop dedicated human resources for emergency care through training, capacity building and review of the HRH structure at Health facilities.  To develop and maintain appropriate infrastructure for the delivery of EMS.  To plan for essential medical products and technologies for delivery of emergency care services  To mainstream emergency care data into existing health information systems.  To mainstream structures for monitoring and evaluation of emergency care services.  To strengthen research on Emergency Care Services 16.5 Strategic objectives  To increase access to on-scene emergency medical care to 50%  To increase the proportion of emergency patients receiving ambulance response within 1 hour to 50%  To increase availability of quality emergency care in 14 Regional Referral Hospitals, 147 District Hospitals and 193 HCIVs  To continuously improve and sustain the operations of the national EMS system 16.6 Key Performance indicators of the unit  Proportion of calls and inter-facility referrals received and responded to  Policy guidelines developed and disseminated  Number of emergency care providers trained (In-service and pre-service)  Proportion of Patients that receive care at the scene of emergency  Percentage of emergency cases that arrive at the facility using an Ambulance  Percentage of patients who had an assessment of level of consciousness (like GCS, AVPU)  Percentage of Patients accessing care within 1 hour from arrival to the emergency unit  Proportion of patients who developed complications within 24 hours after management /care  Proportion of patients with hypoxia administered with Oxygen  Proportion of patients with open wounds who received external haemorrhage control  Severity adjusted survival (validated score) to 24 hours among those severely injured in RTAs  Emergency Unit LOS

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 Proportion of emergency patients who receive TT vaccine within 24 hrs

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Table 16: EMS Department Q3+ Q4 Performance FY 2019/20 Output Quarterly targets Outputs achievements/ Budget release Expenditure/budge Explanation for description (Q3 and Q4) Results (Q3 and Q4) (Q3 and Q4) t performance variation/ **results

EMS Policy Support development Ambulance norms and standards 20,000,000 20,000,000 Supported by KOFIH Framework of emergency clinical finalised, 5 clinical protocols planned (to development protocols, norms, be spearheaded by MakCHS), Call & standards and dispatch guidelines developed. guidelines EMS manual for Masaka completed National EMS Pre-Hospital Care 27,500,000 27,500,000 Supported by KOFIH Guidelines for COVID-19 completed and submitted for printing 150 copies

Development of Emergency Care 20,000,000 20,000,000 Supported by KOFIH Protocols Process on going

Development of Emergency Care Charts 13,500,000 13,500,000 Supported by KOFIH for Greater Masaka Region Process on going

Human resource Build capacity of human 40 drivers and ambulance assistants 19,400,000 19,400,000 Supported by KOFIH capacity resource in response trained in pre-hospital emergency care development for to COVID-19 response to COVID-19 emergency care 10 Call and Dispatch officers trained inn 12,190,000 12,190,000 Supported by KOFIH Call and Dispatch

Building capacity of 9 Medical Officers trained in Basic - - Supported by the GoU and human resource in Emergency Care URCS collaboration Basic Emergency Care and First Aid

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7 Ambulance Drivers trained in First Aid - - Supported by URCS

Establishment of an Functionalization of the Conducted a meeting with stakeholders 11,050,000 11,500,000 Fully absorbed Emergency Care Short Code to functionalize the 911 short code Communication allocated by the UCC System Functionalized the 911 short code - - Discussions on-going allocated by the UCC

Support the Steering committee set up. - - Discussions ongoing establishment of Malteser international funding is for soft medical call and & Computer hardware dispatch system KOFIH and URMCHIP support will help in setting Masaka RRH Call centre Establishment of National Call and - - Supported by Korean Dispatch centre/ Ambulance at Naguru Foundation for International RRH Health, Malteser International, SEED Global Health, Ismaili Community in Uganda, Uganda Insurers Association TOTAL E&P, Signify Foundation, Philips /Dembe Total, Ismael Community, Naguru RRH Conducted meetings for development of - - Supported by Seed Global the Regional Call and Dispatch System Health, Clinton Health Access Initiative (CHAI)

24-hour EMS Support Supervision to Conducted support supervision to 12,450,000 12,450,000 Fully absorbed system and Districts and Health ascertain the functionality of emergency functional referral Facilities medical services in Karamoja Sub Region system established The activity covered the districts of;

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Moroto, Kaabong, Kotido, Napak, Nakapiripirit, Amudat, Nabilatuk and Kalenga districts.

Support Supervision for Conducted support supervision for 4,420,000 4,420,000 Supported by KOFIH Masaka RRH and Masaka RRH and Bukomansimbi Butenga Bukomansimbi DLG HCIV in preparation of COVID-19 preparedness and orientation of health managers on emergency response to Non COVID-19 Emergencies Provision of standby Provision of standby emergency medical 4,200,000 4,200,000 Item overspent because was emergency medical services during the COVID-19 outbreak under budgeted compared services for the month of February to the requests of standby emergency services Full deployment of emergency medical - - Supported by both MoH services for Kampala Metropolitan Area and KCCA (22 Ambulance Vehicles); 10 at the headquarters and 12 at KCCA. The total of 67 human resources comprising both drivers and Ambulance Officers. 27 at KCCA and 41 at the MoH The team handles both COVID-19 and Non COVID-19 Emergencies Provision of standby Standby emergency medical services 203,045,000 203,045,000 Paid under COVID-19 Fund emergency medical during the COVID-19 outbreak for the services in response month of March, April and June COVID-19 A total of 1067 cases were handled at an average of 356 cases per month provided Procurement of A donation of 9 BLS (Type B) - - Supported by the Ambulance Vehicles in Ambulance Vehicles towards response Government of Japan, China response to COVID-19 to COVID -19 recieved Aid, Riham Group of Companies, Pakistan Association in Uganda and Government of India

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Road Ambulance vehicles procured with Procurement in progress support fro: and supported by the  33 Type B – Basic Life Support Government of Uganda, Ambulances, Government of URMCHIP project - World Uganda Bank, URMCHIP project -  2 Type C – Advanced Life Support World Bank Contingency Negative Pressure Ambulances, Emergency Response Government of Uganda Component – CERC and  7 Type B – Basic Life Support GoU-Uganda Red cross Ambulances under URMCHIP Society partnership project - World Bank  10 Type B – Basic Life Support Vehicles under URMCHIP project - World Bank (Contingency Emergency Response Component – CERC) 10 Type B- Basic Life Support Ambulances and which will be stationed at designated spots on 10 pilot major highways - GoU-Uganda Red cross Society partnership.  3 Type C – Advanced Life Support - -  Procurement in both Government of Uganda progress and supported  11 Type B – Basic Life Support by Government of through GAVI project Uganda and GAVI project

Repair of Ambulance Assessment of repairment needs for 450,000,000 450,000,000 Supported by URMCHIP vehicles for ambulance vehicles in targeted districts functionality in progress (implementation of one of the findings from support supervision) Procurement of Assorted personal protective equipment 74,710,000 74,710,000 Supported by KOFIH Personal Protective and supplies procured Equipment for Emergency COVID-19 Response

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Fuel and Lubricants Fuel for office 66,480,000 66,480,000 Fully absorbed operations and support supervision activities Books, periodicals Books, periodicals 372,000 372,000 Fully absorbed &Newspapers &Newspapers for the Q3 and Q4 Staff welfare For staff tea and bites 2,058,000 2,058,000 Fully absorbed and Departmental Meetings Allowances Allowances for lunch 2,886,000 2,886,000 Fully absorbed and Transport

Printing, stationary Printing, stationary 7,200,000 7,200,000 Fully absorbed & Photocopying &Photocopying

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16.7 Challenges • Failure to provide for Human resources at regional and lower level facilities is major hinderance to achievement of set targets • Inadequate Ambulance Vehicles • Lack of a central call and dispatch center to coordinate and respond to time bound emergencies among the public • Inadequate OR lack of EMS financing both at the Central and District levels 16.8 Recommendations • Review of Human Resource for Health structure from National referral Hospital to HCIII to include ambulance and emergency care staff • Urgent need for Ambulance Vehicles • Need to establish a Medical Call & Dispatch Centre • Prioritize funding to fill gaps in ambulance and A&E units at HCIV-Hospital PHOTO GALLERY

The COVID-19 Preparedness training for Ambulance Drivers and EMTS supported by KOFIH

Photo 10: IPC Training and Ambulance Decontamination The simulation exercise

Photo 11: The lectures

The COVID-19 Preparedness training for Call and Dispatch Officers supported by KOFIH

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Photo 12: The lectures Practicum at Linear Call Center

Photo 13: The trainers and participants Practicum at Linear Call Center The Inaugural meeting for Regional Call and Dispatch System Development

Photo 14: The presenters Group sessions

Photo 15: Group sessions

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Chapter Seventeen: Health Infrastructure

17.0 Mission The Mission of HID is to Manage Health Infrastructure Efficiently, Cost Effectively and Sustainably. 17.1 Overall Objective To establish a Network of Functional, Efficient and Sustainable Health Infrastructure for Effective Health Services Delivery closer to the Population 17.2 Specific Objectives • To Consolidate Functionality of existing lower level Health Facilities • To strengthen the Referral System • To Rehabilitate/Consolidate/Remodel existing Secondary and Tertiary Health Facilities • To strengthen Management of Health Infrastructure and Establish a Sustainable Maintenance Programme 17.3 Planned Activities • Maintenance of Medical in health facilities in Central Region • Procurement of Medical Equipment Spare Parts and Accessories. • Revision of Regional Workshops’ Operational Manual and PPM SOPs. • Training of Engineers and Technicians in Medical Equipment Maintenance, Maintenance Planning and Management • Maintenance of Philips brand Ultrasound scanners and Standard radiography and Fluoroscopy x-ray machines in RRHs, GHs & Mulago NRH by M/s Dash-S Technologies Inc. • Carry out Quarterly Supervision and Monitoring of Health Infrastructure Projects and Equipment Maintenance Country Wide • Carry out Technical Support Supervision of Health Infrastructure Development Projects and Managem

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Table 17: The performance Q3&Q4 Annual planned Quarter’s Quarter 4 actual Cumulative outputs in FY 2019/20 for Q3 Provide outputs planned outputs (quantity & Q4 reasons for (quantity and outputs and location) any variance or location) (quantity and underperformance location) Quarterly  Carry out  Supervised staff  Assessed the readiness of Lira, Gulu & Arua  The planned Regional Medical Equipment Maintenance technical support quarterly house construction RRHs; Lacor, Moyo and Adjumani GHs to Workshops’ performance review meeting in Moroto was supervision and technical works in China- isolate and treat COVID19 patients. postponed in line with COVID-19 guidelines. monitoring of support Uganda Friendship  Monitored and assessed the operation status  The meeting to review the RWs operation manual and Health supervision of Hospital Naguru of 36 Solar systems installed with funding from preventive maintenance SOPs was funded by JICA-5S- infrastructure Regional and the Cold room the DFID/UN Foundation in the Districts of CQI - Total Quality Management TQM Project. projects and Medical construction at the Kyegegwa, Kyenjojo, Kamwenge, Sheema,  Funds for the activity for monitoring the 36 Solar systems equipment Equipment Uganda Blood Bushenyi, Kabarole, Ibanda and Mitooma. installed with DFID/UN Foundation support were maintenance Maintenance +Transfusion  Provided technical support for the released in Q3 but delayed by the COVID-19 outbreak. carried out Workshops. Services. development of technical specifications and  Carry out the  Assessed the BoQs for construction of a LAN network for quarterly readiness of Lira, sharing x-ray images between the new supervision of Gulu & Arua RRHs; buildings under construction by the JICA infrastructure Lacor, Moyo and Grant Aid Project and old buildings in Arua development Adjumani GHs to and Lira RRHs. projects. isolate and treat  Held meeting with selected members from the  Conduct HI COVID19 patients. regional workshops and NACME to review TWG,  Provided technical the Regional workshops’ operation manual and NACME and support for the preventive maintenance SOPs in Hoima and HID meetings development of Mubende respectively. to review technical  Organized and attended two quarterly Policy specifications and Regional Medical Equipment Maintenance guidelines on BoQs for Workshops’ performance review meetings in health construction of a Mbale and Soroti RRH. infrastructure LAN network for  Monitored construction works in Arua, Gulu development sharing x-ray and Lira RRHs under the JICA Grant Aid and images between the Project and attended six site meetings. management. new buildings  Supervised the commissioning and testing of under construction the x-ray machine with CR system in Butenga by the JICA Grant HCIV in Bukomansimbi District. Aid Project and old 153

Annual planned Quarter’s Quarter 4 actual Cumulative outputs in FY 2019/20 for Q3 Provide outputs planned outputs (quantity & Q4 reasons for (quantity and outputs and location) any variance or location) (quantity and underperformance location) buildings in Arua  Supervised and monitored medical equipment and Lira RRHs. maintenance, inventory collection and update  Held meeting with by Mbarara RRH, China-Uganda Friendship selected members Hospital Naguru and all Regional workshops. from the regional  Support supervision of laboratory equipment workshops and maintenance was carried out in in 4HCIVs NACME to review (Tokora, Tiriri, Walukuba & Bugembe) and the Regional 4RRHs (Jinja, Mbale, Soroti & Moroto). workshops’  Supervised and monitored laboratory operation manual equipment maintenance in 4HCIVs (Tokora, and preventive Tiriri, Walukuba & Bugembe) and 4RRHs maintenance SOPs (Jinja, Mbale, Soroti & Moroto). in Hoima and  Supervised the construction of the Interns Mubende hostel in Kabale RRH and construction of staff respectively. house and hospital rehabilitation works in  Monitored and Naguru RH. assessed the  Provided technical support and attended site operation status of meeting for the construction of a walk-in cold 36 Solar systems room at UBTS. installed with funding from the DFID/UN Foundation in the Districts of Kyegegwa, Kyenjojo, Kamwenge, Sheema, Bushenyi, Kabarole, Ibanda and Mitooma.

Maintenance of Maintenance of Outstanding arrears 491No. solar systems in 157 Heath facilities in Maintenance contracts expired but M/s Intercross Agencies 491 solar 491 solar paid to M/s Farmco Ntoroko, Bundibugyo, Kiryandongo, Masindi, Ltd. was not fully paid – Approx. UGX 23 Million still systems in 157 systems in 157 International Ltd. and Mbale, Sironko, Bulambuli, Bukwo, Mayuge, outstanding. Heath facilities in Heath facilities M/s CAA 154

Annual planned Quarter’s Quarter 4 actual Cumulative outputs in FY 2019/20 for Q3 Provide outputs planned outputs (quantity & Q4 reasons for (quantity and outputs and location) any variance or location) (quantity and underperformance location) 11 ERT II carried out in International GmbH. Amuria & Katakwi Districts were maintained; beneficiary Bundibugyo, for maintenance of and 80% were kept in good functional condition. Districts carried Ntoroko, solar systems in out and 85% of Masindi, Bundibugyo, the solar systems Kiryandongo, Ntoroko, Masindi, kept in good Mbale, Sironko, Kiryandongo, Mbale, functional Bulambuli, Sironko, Bulambuli, condition. Bukwo, Mayuge, Bukwo, Mayuge, Amuria & Amuria & Katakwi Katakwi Districts Districts, and Moyo, and 85% of the Gulu, Amolatar and solar systems Soroti Districts kept in good respectively. functional condition. Well maintained Maintenance of Paid M/s Dash-S Maintenance of Philips brand Ultrasound M/s Dash-S Technologies Inc Maintenance Service contract and functional Philips brand Technologies Inc. scanners (49) and x-ray machines (42) was expired at the end of July 2019. Decision was made not to Ultrasound Ultrasound outstanding contract carried out in 10RRH, 23GH, 28HCIV & Mulago renew service contract on the basis of the imaging equipment scanners and X- scanners (49) amount for NRH by M/s Dash-S Technologies Inc. – 66% of not being fully supported by Philips Medical Systems the ray machines and Standard maintenance services the x-ray machines and 78% of the Ultrasound manufacturer. maintained in radiography and offered under the scanners were kept in functional conditional by 10RRH, 23GH, Fluoroscopy x- contract for the end of the contract. 28HCIV & Mulago ray machines maintenance of NRH (42) carried out Ultrasound scanners in 10RRH, (49) and x-ray 23GH, 28HCIV machines (42) in & Mulago NRH 10RRH, 23GH, by M/s Dash-S 28HCIV & Mulago Technologies NRH. Inc. 65% of available 65% of available  89 pieces of  Thirty-six (36) Solar systems installed with  Funds for the activity for monitoring and servicing the 36 medical equipment medical medical equipment funding from the DFID/UN Foundation in the Solar systems were released in Q3 but implementation kept in good equipment kept were fully Districts of Kyegegwa, Kyenjojo, Kamwenge, was delayed by the COVID-19 outbreak. working condition in good working maintained in Sheema, Bushenyi, Kabarole, Ibanda and  Fund for equipment maintenance for Q4 were released in Naguru RH, condition in 2HCIVs and Mitooma were maintenance and software for late and the maintenance activities just started and are Nakaseke, Naguru RRH, 17HCIVs by the inverter and battery monitor updated. ongoing.

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Annual planned Quarter’s Quarter 4 actual Cumulative outputs in FY 2019/20 for Q3 Provide outputs planned outputs (quantity & Q4 reasons for (quantity and outputs and location) any variance or location) (quantity and underperformance location) Gombe, Kayunga, Nakaseke, Biomedical  564 Pieces of medical equipment were Entebbe & Kawolo Gombe, Entebbe Engineers and maintained by Biomedical Engineers and GHs, 28HCIVs & Kawolo GHs, Technicians from Technicians from Wabigalo workshop. and 30 HCIIIs in 28HCIVs in Wabigalo  Serviced equipment included suction machines, central region. central region. workshop; while oxygen therapy apparatus, patient trolleys in maintenance needs 9No. KCCA Ambulances. for two (2)  Equipment in good working condition was equipment were raised from 68.7% in Q1 to 70.2% in Q4. assessed and are pending.  Equipment in good working condition stood at 70.2% at the end of Q4.  Thirty six (36) Solar systems installed with funding from the DFID/UN Foundation in the Districts of Kyegegwa, Kyenjojo, Kamwenge, Sheema, Bushenyi, Kabarole, Ibanda and Mitooma were maintenance and software for the inverter and battery monitor updated.

Assorted Medical Procurement of  No spare parts  Two framework contracts were signed for Priority was given to payment of outstanding amounts for M/s Equipment spare Medical were procured supply of medical equipment spare parts, but Dash-S Technologies Inc. parts procured Equipment spare 156

Annual planned Quarter’s Quarter 4 actual Cumulative outputs in FY 2019/20 for Q3 Provide outputs planned outputs (quantity & Q4 reasons for (quantity and outputs and location) any variance or location) (quantity and underperformance location) parts for no spare parts were procured in the whole Maintenance of year. equipment in 2RRHs, 8GHs and 40 HCIVs in Central region carried out. Collect and Medical Equipment inventory  For Central region, equipment inventory data  Inventory in the HCIIIs was partially funded by IDI. update Medical equipment data collection entry in the NOMAD database stands 1RRH equipment and inventory update and entry in (Naguru), 100% GHs (Entebbe, Gombe, solar systems updated for all the NOMAD Kawolo, Nakaseke & Kayunga), 19 HCIVs and inventory database hospitals & database was carried 57 HCIIIs. HCIVs and 30 out for Naguru RH, HCIIIs in central 5GHs (Entebbe, region and solar Gombe, Kawolo, systems Nakaseke & Kayunga) inventory 19 out of 20 HCIVs updated for 157 and 57 HCIIIs. Heath facilities in Bundibugyo, Ntoroko, Masindi, Kiryandongo, Mbale, Sironko, Bulambuli, Bukwo, Mayuge, Amuria Districts.

REHABILITATION AND EXPANSION OF KAYUNGA & YUMBE HOSPITALS PROJECT BUDGET PERFORMANCE REPORT Q3 & Q4 FY 2019/20 Outputs: Monitoring and supervision, Purchase of specialized machinery and equipment; Hospital rehabilitation/expansion Output Quarterly Targets Outputs/Achievements Budget Expenditure/Budget Explanation for Variation/Results Description (Q3 & 4) Release Performance Q3 & 4 Shs ‘000’ Shs ‘000’

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Monitoring, 10 Support and 10 Support and monitoring visits 660,102 652,792 None supervision and monitoring visits each undertaken each to Kayunga and Yumbe evaluation of to Kayunga and Yumbe Hospitals health systems Hospitals

Purchase of Kayunga and Yumbe  Requests for advance payments 1,160,580 1,160,580 Delays in procurement of medical equipment & machinery and Hospitals fully equipped submitted to the Funding Agencies. furniture and the vehicles was attributed to the equipment and furnished  Lot 1A bids received and evaluated, lockdown of Government business due to the and the evaluation report submitted Corona virus pandemic. to MCC  Procurement for ambulances, Subsequently, the funds were surrendered to the minibuses and pickups was cleared MoH for deployment to other essential activities. by the MoPS, CME for MoWT approved the technical specifications for the vehicles Hospital 100% Construction and 99.5% Construction and rehabilitation 7,409,509 7,409,509 1. At Kayunga, work was substantially completed in construction and rehabilitation works for works completed for Kayunga Hospital. accordance with the revised work schedule. rehabilitation Kayunga and Yumbe 93% construction and rehabilitation Hospitals completed works completed for Yumbe Hospital 2. At Yumbe, work was not completed according and handed over Both hospitals not yet handed over to the revised schedule because of workers’ pending completion of works. strikes at the start of civil works, excessive heavy rains between June and December 2019 which affected progress of external works; difficulties with transportation of materials to the Yumbe Site due to damaged roads. Total 9,230,191 9,222,881

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NATIONAL LEVEL INSTITUTIONS

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Chapter Eighteen: Health Service Commission

18.0 Vision The Vision of the Health Service Commission is “a fully resourced health workforce that is responsive, efficient and effective in Uganda’s socio-economic transformation process”. 18.1 Mission “To build a fundamentally strong and competent human resource base for efficient and effective health service delivery”. 18.2 Mandate  Advise H.E. the President of the Republic of Uganda in performing, in relation to the Health Service, his or her functions under Article 172 of the Constitution  Appoint persons to hold or act in any office in the Health Service, including the power to confirm such appointments, exercise disciplinary control over those persons and remove them from office  Review terms and conditions of service, standing orders, training and qualifications of members of the health service and matters connected with their management and welfare and make recommendations to Government.  Regularly apprise Parliament on the performance of the Commission through Annual Reports  Issue Guidelines to District Service Commissions (DSCs) for recruitment of Health Professionals, discipline of health workers, and render advice to District Local Governments and District Service Commissions as may be required on matters regarding the management of human resource for health 18.3 Strategic Objectives  Provide timely advice H.E the President and Government on matters relating to the state of health services as mandated by law  Recruit in an efficient and effective manner health worker to meet Uganda citizens’ health needs in accordance with Health Sector Policy and Development Plan 2015/16 – 2019/20.  Carry out advocacy and make recommendations to improve the terms and conditions of service of the health workers  Enhance the institutional capacity of the HSC to deliver on its mandate

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Table 18: Health Service Commission Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget Expenditure/ Explanation for variation/ (Q3 &Q4) achievements/ release budget **results results (Q3 &4) (Q3 performance &Q24) 900 Health Workers 450 Health Workers 38 Health Specialists 0.404 0.404 Validation of health workers was prioritized to recruited recruited Recommended to H.E the operationalize the newly created Hospitals of President for appointment 258 Entebbe, Kiruddu, Kawempe and Mulago Health Workers appointed. Specialized Women and Neonatal Hospital. Emergency recruitment due to Covid-19 outbreak was prioritized to manage the Covid-19 outbreak. Emergency 576 Health Workers were 0.150 No budget allocation for emergency recruitment recruitment (Covid-19 recommended to MoH for of health workers in response to Covid-19 outbreak) contract appointment. outbreak. HSC had to prioritise within the budget allocation

500 Human Resource for 250 HRH decisions. 620 Human Resource for Health 0.013 This is dependent on submissions from Health Health Decisions made. decisions made. Institutions. 946 Health Workers of Entebbe, 0.112 Validation of health workers in the newly Kiruddu, Kawempe and Mulago established hospitals of Entebbe, Kiruddu, Specialised Women and Kawempe and Mulago Specialised Women and Neonatal Hospitals validated. Neonatal Hospitals was prioritised within the budget allocation due to urgency to operationalise the Hospitals Support Supervision carried 42 Districts and 7 Support Supervision carried out 0.065 0.048 Priority was placed on recruitment and validation out in 84 Districts and 14 RRHs in 28 Districts and 4 RRHs. of Health workers and recruitment for Covid-19. RRHs. Technical support to Dependant on the Technical Support provided to 0.017 Technical support is demand driven. Districts /DSCs provided. requests from sixteen (16) districts. Districts

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Performance and career Staff trained as per training plan 0.035 0.035 enhancement training for HR staff attended training at Civil staff carried out. Service College Jinja. Secretarial and Administrative staff attended the Association of Secretaries and Administrative Professionals annual training. Support HIV/AIDs affected Sensitisation Support to staff provided. 0.009 Planned Sensitisation workshop was affected by staff. Sensitization workshop undertaken and lockdown due Covid-19 outbreak. on HIV/AIDs and Gender & support to staff Equity issues conducted. provided

Administrative related costs Provided Administrative Services provided 0.954 0.954 Administrative related costs (Rent, Pension & (Rent, Pension & others) Administrative others) Services. Monitoring and Monitoring and tracking was 0.045 0.029 Terminal review and evaluation carried out to tracking carried out through hands on inform the next strategic plan. implementation of the support and periodic Lockdown due to Covid-19 outbreak affected HSC decisions performance reports. the process of development of the New Strategic Terminal review and evaluation plan of the 3rd five-year strategic plan carried out.

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17.5 Challenges and proposed solutions. Internal to the HSC i. Increase of the wage bill for Health Institutions without a corresponding increase in the recruitment budget of the Commission ii. Inadequate Budget for key output areas of the Commission such as Support supervision and Technical Support. iii. Inadequate Office space iv. Inadequate tools, equipment and vehicles External to HSC i. Covid-19 outbreak affected the normal operations and planned core activities ii. Attracting and retaining some categories of Health Workers for example Senior Consultants, Consultants and Medical officers Special Grade (MoSG) in RRHs, Pharmacists and Anesthetic Officers in RRHs. iii. High numbers of applicants for certain cadres like Nurses, Midwives, Laboratory and Clinical Officers. This increases the cost of handling the recruitment and the time taken. iv. Non alignment of the recruitment process to the budgeting process. v. Structures for Regional Referral Institutions and Health Units under Local Governments have not been reviewed NB: The submission made by Departments, Programmes/Institutions is for preparing a consolidated narrative MoH review report for the 3rd and 4th quarters which is supposed to be ready before the review meeting. The format for presentation (which is power point) during the actual review meeting shall be shared with you later.

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Chapter Nineteen: Uganda Virus and Research Institute (UVRI) Introduction The UVRI is currently the only specialized research institute in Uganda and the Great Lakes Region with a concentration of local and international researchers working in unique collaboration on viral and other diseases of Public Health importance. The Institute is organized under six (6) departments which are closely inter-related. Five of the science departments, are each headed by an Assistant Director who reports to the Director. The two support departments; Finance and Administration headed by the Principal Assistant Secretary. The Institute’s programmatic activities currently comprise the following areas:  Basic research  Applied research (intervention, diagnostics, clinical, operational/implementation science or IS)  Epidemiology and surveillance  Social/economic research  Capacity development and training  Advice for regulation, policy development and quality improvement Innovation  Operations 19.0 Mandate UVRI is mandated to conduct health research pertaining to human infections and disease processes associated with or linked to viral etiology and provides capacity building to target beneficiaries. 19.1 Vision To be a world class center of excellence in health research. 19.2 Mission To conduct scientific investigations on viral and other diseases to contribute to knowledge, policy and practice and engage in capacity development for improved public health. 19. 3 Objectives  To increase and expand UVRI’s involvement in research and surveillance of viral diseases of public health importance including their link to non-communicable diseases  To expand the knowledge and skills base for public health research  To widen the financial resource base and improve efficiency and effectiveness in the use of the available resources.  To develop a centralized, accessible, and reliable sample repository system.  To improve coordination of projects at UVRI and partner programs and their core functions  To improve the infrastructural and human resource capacity at UVRI

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Table 19: UVRI Q3+Q4 Performance FY 2019/20 Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Output: 04 Hold 24 contracts Committee 15 contracts committee meetings held. 2.3bn 2.72bn Delayed Administration and meetings. initiation of Support Services procurement by Output: 04 6 trips from the I.T , Human 2 supervision trips made to each UVRI field user department Administration and Resource and administration site Support Services sections made to UVRI up country stations

Finalize the UVRI I.C.T Policy UVRI ICT Policy finalized. service and maintain IFMS and IFMS and IPPS serviced and maintained IPPS scan and route to the action All in coming mails scanned and routed to officer all incoming mails. action officer.

Servicing & Maintainace of Routine Servicing & minor done and Institute Equipment carried Repair 5 Institute vehicles. Repairs done for 5 institute vehicles.

Complete and finalize repairs Repairs on the UVRI Rockefeller House, the UVRI Rockefeller House, Library, Goose House, and UVRI Clinic Library, Goose House, and UVRI completed. Clinic .

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Incineration of Biomedical waste Biomedical waste Incinerated were

Repair and Service the Institute Repairs on the Incinerator were Incinerator completed. Service and maintain all Institute All UVRI Generators serviced and generators maintained Maintained and clean UVRI office UVRI office premises maintained and premises plus roads and hedges cleaned plus Roads and hedges in the UVRI in the UVRI residential Quarters residential Quarters have been regularly . maintained.

Construction of a power A power substation constructed at UVRI substation equipment at UVRI Carry out Science Open days to Due to COVID 19 science open day was engage the school going children not carried out and interest them into science at an early age

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results facilitated 4 UVRI Staff to attend 1 UVRI Staff was facilitated to attend a International conferences conference in cape town , South Africa including one held in Cape Town South Africa.

Develop the UVRI strategic plan Task force Review of the first Draft of the for 5 year from FY 2020/21 to UVRI strategic plan for FY 2020/21 to 2024/2025. 2024/2025 is ongoing.

Prepare the UVRI Ministerial UVRI Ministerial Policy Statement prepared Policy Statement for FY and submitted to MoH, Ministry 2020/2021

FY2020/2021 produced and FY2020/2021 produced and submitted to submitted to Parliament, MOH Parliament, MOH and MOFPED. and MOFPED.

Output: 06 Surveillance for Arboviruses Influenza surveillance activities carried out 0.13bn 0.16bn Delayed Arbovirology, carried out in 7 sites Kiswa, Kitebi, Nsambya, initiation of Emerging and

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Remerging Disease Surveillance for VHFs Carried Surveillance for VHFs Carried Out in 4 procurement by Research Out in the country hospitals of Entebbe, Tororo, Fort Portal, user department and Mbarara hospitals

ILI and SARI influenza Responded to the Yellow fever activity in surveillance Moyo and Buliisa districts.

Response to emerging and re- The Institute started responding and emerging diseases continue to respond to the COVID-19 pandemic.

Identified yellow Fever cases In January and February 2020, 4 yellow among samples from Moyo and Fever cases among samples from Moyo, Buliisa, and Buliisa, were identified including a case from Maracha district

Output: 07 Ecology Clinic supported to deliver 841 patients were given medical care at 0.13bn 0.15bn Delayed / Zoology Research clinical services UVRI Clinic. initiation of

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results The facility received another 711 clients procurement by who reported to the clinic for HIV testing user department services of whom 46 clients tested positive and were linked to care

Support EPI unit to combat 95.9% Virus isolation results reported immunolabel diseases like measles, polio Train & maintain GCLP Training & maintainance of the GCLP accreditation of the laboratory caried out and accreditation of the and associated clinic and field laboratory and associated clinic and field functions functions carried out

score 100% scored in virus 95% scored in virus isolation and Virus isolation isolation results were timely.

Report Measles and Rubella IgM 97.8% of Measles and Rubella IgM results results were timely reported.

Rubella surveillance Eleven Congenital rubella syndrome(CRS) samples received at the laboratory

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Output: 08 Establish Immune profile of Immune profile of survivors (:Plague,Yellow 0.13bn 0.16bn Delayed Immunology survivors (:Plague,Yellow fever fever and other highly pathogenic viruses) initiation of Research and other highly pathogenic and immunized patients established procurement by viruses) and immunized patients user department Recruit, immunize & assess Immune responses to viral vaccines immunity in vaccine trials: HIV, monitored Immune response profile to Ebola, Rift Valley Fever, Yellow plague, Yellow Fever and other Viral Fever & other viral vaccine trials Hemorrhagic Fever (VHF) established.

GCLP audits; & supervise Six trips to transport both Yellow Fever corrective actions for Mengo, cases from their homes to the clinical Arua, Kyamulibwa & Masaka centers in Masaka and Entebbe, their blood sites conducted samples were collected at three time points, processed and stored in the labs of Masaka and Entebbe.

Procure Reagents and Reagents and consumables for evaluating consumables for evaluating antibody and cellular immune responses antibody and cellular immune availed responses

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Output: 09 General Follow up on patients who fail We received 429 samples for patients 0.13bn 0.16bn Delayed Virology Research on second line antiretroviral failing on second-line antiretroviral therapy initiation of therapy for HIV drug resistance for HIV drug resistance testing and testing procurement by testing and testing of samples is ongoing. user department

Recruit and follow up Super- Super-infected HIV infected individuals infected HIV infected individuals recruited , followed up and evaluated

Enrollment of RRH in EQA We await results from the service provider scheme regarding performance of the labs in the External Quality Assessment (EQA) scheme.

Procure reagents for the Additional reagents for the General General Virology lab Virology HIV Reference lab procured

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Prevalence of Hepatitis B_HIV Results of central level testing for the Coinfection among teenage 18/19 Antenatal clinic (ANC) sentinel pregnant mothers surveillance round were submitted to MoH and testing for the 19/20 round started; about 8,000 out of 13,000 samples were tested by end of the quarter.

Support for staff to attend Some Staff attendances to International international Conferences Conferences affected by COVID 19

Carry out Capacity building in Capacity building in HIV testing and HIV testing and Prevalence of Prevalence of HIV and Syphilis in ANC HIV and Syphilis in ANC carried out among staff

Output: 10 Surveillance Malaria vector Carried out field sampling for Zika virus 0.13bn 0.13bn N/A Entomology population sizes and dispersal, at vector distribution within Entebbe and Research project study site Kampala

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Distribution & Insecticide Arboviral vectors trapped and caught at resistance profiles: Malaria & target study sites. from 2 sites in Eastern Arbo-vectors studied Uganda and 2 sites in Northern Uganda.

Research into Wolbachia as a Research into Wolbachia as a novel novel technology for potential technology for potential vector-based Vector-based malaria Control malaria carried out in Western districts of conducted Uganda including Kasese and Kibale.

Output: 11 Conduct Longitudinal HIV Longitudinal HIV surveillance in 0.16bn 0.17bn Delayed Epidemiology and surveillance in Rakai,Masaka and Rakai,Masaka and surrounding Districts initiation of Data Management surrounding Districts conducted procurement by Research user department

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Develop a code for statistical A total of 6 manuscripts are being analysis and generation of prepared for submission in peer reviewed statistical reports. journals covering topics that include;- Partner Violence and HIV, Best interventions for HIV incidence, Combinational HIV prevention, Non communicable diseases and occupation.

Strengthen Good Good Epidemiological Practice at UVRI Epidemiological Practice at UVRI strengthened

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Explore the influence of social 6 Monitoring visits were conducted (2 in determinants and social Masaka, 1 in Kayunga, 2 in Mengo and 2 in transitions on HIV acquisition in Arua) to explore the influence of social hot-spot communities with high determinants and social transitions on HIV HIV incidence and trading acquisition in hot-spot communities with centers among adolescents and high HIV incidence and trading centers young adults among adolescents and young adults

Strengthen the Research Ethics Two trainings involving a total of 24 people committee - REC were conducted in Entebbe covering Emerging Ethical aspects with emphasis on Human Infection Models and Pandemics

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Carry out Capacity building in Two sets of classes each of 10 people statistical techniques and data (total 20 people) were conducted in management Masaka and introduced to REDCap and MySQL A consultant Geo-statistician and one Epidemiologist were involved in training and piloting GIS data collection in Masaka District and in Kasensero (Kyotera District).

Train staff in Data Management Predictive modelling involving GIS was trained in Masaka and Rakai and Datasets ready for analysis were used to generate predictive seasonal models of HIV incidence and Non-Communicable Diseases

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Output Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for description release budget variation/ results (Q3 &4) (Q3 &4) performance **results Output: 19 Human Train staff in Retirement and 30 staff from UVRI were trained in 0.16bn 0.16bn N/A Resource Exit management preparing for retirement and exit Management Management with support from the MoPS- Services Human Resource Management Public Service Pension Scheme and the exit policy of the Public Service & management of terminal benefits under the decentralized system among others

Train staff in Biosecurity and 50 staff trained in Biosecurity and Biosafety Biosafety, Treat of staff with medical health Medical bills for 3 UVRI Staff (Monica issues Katushabe-PHRO, Dr. Bwogi Josephine-

Staff welfare maintained The Institute continued to cater for staff welfare including provision of sugar, tea Bites, coffee, Milk.

Output: 20 Records letters and communications Letters and communications couriered, and 0.02bn 0.02bn N/A Management couriered Records and archives staff records up dated. Services maintained in the registry.

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Information and mail routed for action by responsible officers.

Output: 77 Procure 2 lap tops for staff, a 2 lap tops for staff, a colored printer for 0.01bn 0.03bn Purchase of colored printer for PAS and PAS and Personal Protective Equipment s Specialized Personal Protective Equipment s for staff procured in the wake of COVID Machinery and for staff procured in the wake of 19. Equipment COVID 19.

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19.4 Institute Challenges  Inadequate office and laboratory space  There is inadequate funding for UVRI especially for research reagents which constrains the delivery of its mandate and mission.  There is currently no centralized and accessible sample repository system, which has constrained proper sample management and utilization.  There is inadequate dissemination and utilization of its research findings, which constrains its contribution to evidence-based policy formulation and practice  There is inadequate transport especially sample collection vehicle.  Lack of funds to pay off squatters from the institute land. 19.5 Actionable solutions  To increase and expand UVRI’s involvement in research and surveillance of viral diseases of public health importance including their link to non-communicable diseases  To develop a centralized, accessible, and reliable sample repository system.  To improve the infrastructural and human resource capacity at UVRI  Enhance collaborative partnerships between UVRI and other training Institutions  Increase awareness of science among the students  Encourage exchange and sabbatical programs  Diversify donor funding  Establish a national sample repository for biotechnology innovation  Construct a science block to house laboratories, offices, stores, and a conference facility.  Enhance the human resource capacity at UVRI

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Chapter Twenty: Uganda National Health Research Organization (UNHRO)

20.0 Mandate  Coordination and regulation and stewardship of health research  Research agenda priority setting (ENHR)  Ethics and good practice enhancement  Information sharing and management  Knowledge translation and evaluation  Organizing and capacity building for research  Harness innovations and new tools 20.1 Vision Create a culture in which health policy and practice is driven by research evidence to improve the health and socio-economic development of the people of Uganda. 20.2 Mission Statement To create scientific knowledge for the application of evidence-based health policies and interventions for the improvement of health care delivery and socioeconomic development for the people of Uganda.

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Chapter Twenty-One: National Chemotherapeutics Research Institute (NCRI)

21.0 Introduction Natural Chemotherapeutics Research Institute (NCRI) is a government research and development centre under the MoH. The centre undertakes the development of quality natural products and services for improved health care delivery by applying both indigenous and modern technologies. 21.1 Mandate (UNHRO act 2011) To conduct research on natural products and traditional medicine systems in treatment and management of Human diseases and justify their therapeutic claims. 21.2 Outputs for NCRI  Pre-clinical and clinical evaluation of medicinal plants  Improvement and maintenance of institutional infrastructure and capacity building.  Conservation of medicinal and Aromatic plants

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Q3_4 Actual Output Planned Annual Budget Source Comments Outputs (Qty and Location) Output description 1: To strengthen governance and Secretariat for health research…cont Emoluments/taxes 41.2m Support Coordination Wage subvention MOH *Figures for each quarter and Secretariat 13.6m/month @3months 14.1m and

Taxes- URA, NSSF 2.7m e) Office running Q (IT, 2.0m utilities, web, internet, MOH *Figures for each quarter stationary-

- utilities and web paid (July-Sept), fuel, misc. Total=Sh 60m/ per Q

Output description 1: To strengthen governance and Secretariat for health research contd a) Review COVID a)Held 8 ZOOM UNCST/UNHRO UNCST/UNHRO Guidelines on Research during the National Guidelines for consultative workshops to pandemic and on the pandemic Health Research Involving review the national finalized and disseminated Aug 2020 Human Participants in Guidelines for COVID COVID pandemic Research during the Available on UNHRO and UNCST Websites. pandemic from March 2020 Focus: priorities, ,and procedures SOPs Participants: key stakeholders - UHNRO,NDA, UNCST academia, and MoH

Output Description 2: To Review the EAC regional Health research agenda a) Review the regional Draft to form a harmonized Health Research Agenda a) Participated in a zoom EAHRC EAHRC framework for EAC research joint national consultative priorities workshop (EAC) Health

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Q3_4 Actual Output Planned Annual Budget Source Comments Outputs (Qty and Location) Research Agenda updates by EAHRC

Output Description 3: To strengthen sharing scientific partnerships and collaboration _ International Conference on AIDS and Sexually Transmitted Infections (STDs) in Africa (ICASA 23) a) Preparations for the -a) COVID pandemic complicating International Scientific i) Review and manage ICASA/IAS ICASA/IAS processes. 10000potential Conference Ion AIDs and abstracts participants. STDs in Africa (ICASA) ii) Participated in the initial due in Kampala in Last such conference was 1996 2021/2022. UAC hosting visits/arrangements by a the conference. team from IAS and ICASA Secretariats, Ghana Visit UAC and ICASA websites for details Member/Chair the Prevention Committee at

UAC

Output Description 4: To Develop an HIV research Strategy in the light of the COVID pandemic -a) Develop an HIV USAID FHI 360 a) Strategy formulated and will be Research strategy to a) Participated in a Zoom USAID FHI 360 distributed from and via meeting with African ACPs support HIV prevention [email protected] during COVID pandemic and Researchers on COVID

Output Description 5: To strengthen partnerships and collaboration with European Union (EDCTP) a) participate and attend a) 8 Uganda proposals granted, and the EDCTP General a) Participated at The EDCTP/UNHRO EDCTP/UNHRO others are under serious Assembly by Member Hague based Annual consideration and grants approved Countries . General Assembly (UVRI, Ethics, Clinical, clinical trials, conference – held on malaria, Ebola) 8 June 2020 156

Q3_4 Actual Output Planned Annual Budget Source Comments Outputs (Qty and Location) NB EDCTP=European b) Represented Uganda Union Developing delegation Countries Technical Program) c) Participated in EDCTP meeting to discuss b) Discuss and decide on proposals for EU-Africa funding priorities by Global Health Partnership EDCTP for 2020-2023 in EDCTP July 7 2020

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Table 20: NDA Q3+Q4 Performance FY 2019/20 Output Quarterly Outputs Budget Expenditure/ Explanation description targets achievements/ release budget for variation/ (Q3 &4) performance results (Q3 &4) (Q3 &4) **results Pre-clinical Conduct 57 herbal samples and formulae 10,810,000 10,810,000 and clinical laboratory analyzed for their phytochemical

evaluation analyses on constituents. of 60 Herbal 27 Herbal samples and medicinal samples and formulations selected for their 1,980,000 1,980,000 plants formulations. antiviral components to be developed into natural products for management of Covid -19 related symptoms. Purchased Laboratory chemicals, reagents, animal feeds, laboratory sundries and 8,000,000 8,000,000 laboratory animals. Improvem Institutional Paid Utilities for UMEME and 11,000,000 11,000,000 ent and infrastructur fuel

maintenan e, Purchased tyres and carried ce of maintenance 12,800,000 12,800,000 out vehicle service and institutiona and capacity maintenance of M/V UG5341M. 11,592,000 l building infrastruct maintained. ure and Lunch and transport allowances capacity for staff for January, February, building March, April, May and June 2020. 11,592,000 14,749,600 Facilitated 5 research scientists 11,993,400 out of pocket allowances for travel to South Korea to undertake laboratory training on 4,155,000 herbal medicine techniques from 158

Output Quarterly Outputs Budget Expenditure/ Explanation description targets achievements/ release budget for variation/ (Q3 &4) performance results (Q3 &4) (Q3 &4) **results 4th to 11th January 2020, 14,749,600 1,345,000 Memorandum of Understanding 11,993,400 on research collaboration between NCRI and Korea 3,700,000 Institute of Oriental Medicine, 4,155,000 16,500,000 KIOM was signed. 1,345,000 14,700,000 Stationery, Newspapers, and small office equipment. 6,000,000 Staff welfare paid. 3,700,000 Purchased masks and PPEs for NCRI staff. 6,500,000 Conducted research and 2,000,000 development of Sugar cane juice to optimize sugarcane extracts 3,000,000 for commercial production. 16,500,000 Purchased a briquette extruder 14,700,000 1,500,000 machine used for value addition 6,000,000 of sugar cane by products, a collaborative project with the RT. Honorable speaker of

parliament of Uganda. 6,500,000

2,000,000

3,000,000

Developed a sanitizer (Excel Sanitizer) that was distributed 1,500,000 for use in the fight against the Covid-19 pandemic.

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Output Quarterly Outputs Budget Expenditure/ Explanation description targets achievements/ release budget for variation/ (Q3 &4) performance results (Q3 &4) (Q3 &4) **results Purchased raw materials used for manufacturing of briquettes. Dissemination and publishing of research information for THP communities Facilitation for officers to attend retreat on MPS preparation in Seeta, Mukono from 2nd to 5th March 2020. Repairs of laboratory equipment. Transport facilitation for staff during Covid-19 lockdown (May 2020) Conservati Maintain medicinal Collected selected plants with 6,955,000 6,955,000 on of plants garden, antiviral activity to be analysed 4,720,000 4,720,000 medicinal establish and developed into natural and demonstration products to manage Covid -19 Aromatic gardens, and related symptoms from plants provide raw Nakasongola district. materials for new Ethno-botanical survey and herbal drugs documentation of medicinal development. plants used in the management of common ailments in Luwero district.

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Chapter Twenty-Two: National Drug Authority (NDA)

22.0 Introduction NDA was established by an Act of Parliament in 1993, currently the National Drug Policy and Authority (NDP/A) Act, Cap. 206 of the Laws of Uganda (2002 Revised edition). 22.1 Mandate “To ensure the availability, at all times, of essential, efficacious and cost-effective drugs to the entire population of Uganda, as a means of providing satisfactory healthcare and safeguarding the appropriate use of drugs”. 22.2 Vision “A Uganda with safe, effective and quality medicines and healthcare products”. 22.3 Mission “Promoting and protecting public health through the effective regulation of human and animal medicines and healthcare products” 22.4 Strategic objectives The strategic plan is composed of 14 strategic objectives but for the purpose of this report the following objectives have been highlighted  Increase compliance to the NDP/A Act and Regulations  Promote domestic production of human and veterinary medicines and health care products  Strengthen the systems, processes, and procedures for pre-market regulatory activities on medicines and health care products  Strengthen the systems, processes, and procedures for post-market regulatory activities for medicines and health care products  Provide relevant and appropriate drug and health care product information to the public  Participate actively in EAC and other harmonization initiatives  Harness the synergies available through national, regional, and international partnerships and collaboration and regulatory framework for food safety, medicines, and other health care products.  Engage all external stakeholders effectively

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Performance Targets for half year in FY 2019/20 # Indicator Reporting Planned Semi-Annual Rating Interval Half year performance Target 1. Proportion of pharmaceutical product samples from post marketing surveillance failing quality tests. Quarterly 8% 31% (114 out of 369) a Proportion of human samples from post marketing surveillance failing Quality Control tests for compliance with Quarterly 3% 17% (21 out of recognized pharmacopeia. 121) b Proportion of vet samples from post marketing surveillance failing Quality Control tests for compliance with recognized Quarterly 4% 40% (4 out of pharmacopeia. 10) c Proportion of herbal samples from post marketing surveillance failing Quality Control tests for compliance with Quarterly 20% 24% (10 out of recognized pharmacopeia. 42) d Proportion of medical device samples from post marketing surveillance failing Quality Control tests for compliance with Quarterly 2% 25% (17 out of recognized pharmacopeia. 68) e Proportion of public health product- hand sanitizer samples Quarterly from post marketing surveillance failing Quality Control 48% (62 out of tests for compliance with recognized pharmacopeia. 128)

2. No. of ADR reports submitted per 100,000 people. Annually 2.4 4.4 (1824 out of 410) 3. Number of domestic produced TCM (herbal) products on 140 the medicines register. Annually 225 4. Proportion of locally manufactured and registered essential >10% medicines in Uganda. Annually 5% (200/4204) 22.5 Challenges that affected performance for Quarter one  Some manufacturing facilities turned down the inspection dates due to Covid-19 crisis and this affected the performance for facility inspections especially the foreign and local facilities.  Frequent breakdown of vehicles in the regions that affected performance.  Covid-19 crisis that affected most of field activities including sensitizations meetings, foreign inspections for GMP 22.6 Recommendations for performance improvement  To reschedule the inspection dates for all the local and foreign manufacturing facilities that turned down their dates and have them inspected in FY 2020-2021 when COVID-19 health conditions improve.  To add five vehicles to the affected regional offices of Central, Hoima and Lira, pharmacovigilance and enforcement team to allow them reach out to their target population and be in position to meet their targets.  Management to put measures in place on how to handle counterfeits in the community

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Table 21: NDA Q3+Q4 Performance FY 2019/20 S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 1.1.1 All licensed 9,152 drug shops A total of 11,731 drug shops and 1,307 pharmacy 3145 326,380,00 0 Target pharmacies receive and 1,103 compliance visits were conducted. 0 achieved a support visit pharmacies quarterly. All licensed drug shops supported once a year. 1.1.2 Implement a rapid 100% of identified A total of 9 enforcement operations were conducted. A 3120 269,618,00 287,425,721 All the non- response with;1 illegal outlets total of 225 non-compliant pharmacies were identified 0 compliant enforcement handled to a logical operating illegally and 100% of identified non-compliant pharmacies operation per conclusion. pharmacies were handled to a logical conclusion. were closed. district (130) against illegal drug outlets, hawkers and illegal 1.1.3 Conduct 130 46 sensitization A total of 31 sensitization meetings were held with a total 3110 154,400,00 239,491,660 COVID-19 sensitization meetings held of 1,254 participants in attendance. The table below 0 effect. meetings. summarizes sensitization meetings held per region per quarter and number of participants.

Conduct 84 radio Six (6) radio talk A total of 51 radio talk shows were conducted. Target talk shows shows held per surpassed region. Conduct 7 Conduct 7 A total of 8 collaborative meetings were held with law Target collaborative collaborative enforcement agencies and professional bodies that included achieved. meetings and award meetings. URA, UNBS, blood transfusion and OPM. stakeholders. 1.3.2 a) 1800 900 Human & A total of 907 products were evaluated including; 817 5120/5 50,150,000 144,395,116 Target Evaluation Veterinary Human and 90 Veterinary products. This is illustrated in 140 achieved Human and Medicines Evaluated. the table below. Veterinary Medicines.

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line b) 970 484 variation A total of 371(149 major and 222 minor) new variation Target not Variations. applications for Human & Veterinary Medicines were achieved. evaluated

1.3.3 8 engagement Six (6) Engagement A total of four (4) trainings and sensitization meetings to 5185/5 124,500,00 11,386,820 The two was meetings with meetings held with build capacity of domestic herbal manufactures were held. 190/51 0 not done national/regional/int local herbal 80 because of ernational bodies stakeholders. Covid 19 involved in herbal Lockdown. regulation. 6 meetings with Four (4) reports for A total of four (4) trainings and sensitization meetings to Target domestic training and build capacity of domestic herbal manufactures achieved manufacturers to sensitization meet capacity for meeting. regulation requirements. Stakeholder map 2019/2020 1.3.3. 80 foreign & 100 40 Foreign and 50 A total of 84 products were evaluated including 35 foreign Emphasis was local (herbal) local herbal and 49 local herbal products. The quarterly performance is put on local products evaluated products Evaluated. illustrated in the below. herbal products. 1.4.2 License 2216 Issue licensing  As of 31st January 2020, 99.01% (400 of 404) Target pharmacies & guidelines and complete applications for pharmacy renewals 3140 82,718,000 86,598,950 achieved 12,000 drug shops. Inspect premises for were inspected for licensing and regulatory licensing. decision made.  A total of 9457 out of 11192 (84.50%) Drug Shops have been licensed during the PY.

500 publics and 250 facilities A total of 452 (180% of 250 planned facilities) facilities Target PNFP health units inspected for GPP were inspected for GPP. achieved inspected compliance

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 200 domestics 200 domestics, 15 local inspections were conducted during the PY. 3190/3 1,333,224, 290,369,031 COVID-19 180 foreign (150 100 foreign facilities A total of 13 foreign inspections were conducted during 200 000 effect curtailed announced and 30 inspected for GMP the PY. the activities. unannounced) compliance. 22 GMP Desk assessments were conducted. 120 desk reviews 90 desk applications No API Facilities inspected. 20 API facilities evaluated for GMP compliance and 10 API facilities inspected 1.4.3 95% of 95.1% (3,915 out of 4,115) consignments were inspected 95% of pro-forms consignments within 2 days. 3230 29,426,000 20,279,000 Target verified within 3 inspected within 2 From the table above, 53% of the imports were released achieved days working days. human and the least being veterinary materials represented 95% consignments Volume of imports 4%. inspected within 2 and exports Release Released days released at PoE. Month/Indic Released Released d Raw Medical ator Human Veterinary Material Devices s Totals 2197 151 1409 352

1.4.4 Conduct testing of Test 570 Human Table showing all the medicine samples that were received 412041 214,760,80 170,210,331 Performance 1000 Human medicines and tested in reporting period. 50, 0 was affected by

medicines samples 4170 COVID-19

lockdown Samples 250 Veterinary 100 Veterinary where

medicines tested medicines samples Received Tested Passed Failed Failure rate (%) Testing %age performance is Herbal tested 96 51 41 10 20% 53% not adequate. 100 LLINS tested 100 LLINS tested medicines Human 250 244 217 27 11% 98% medicines Veterinary 200 Gloves tested 100 glove samples 85 123 119 4 3% 145% tested medicine 450 condoms 200 condom LLINS 8 7 7 0 0% 88% tested samples tested Gloves 93 114 105 9 8% 123% Condoms 206 283 282 1 0% 137%

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 150 surgical 50 samples (10 Sutures and 69 68 51 17 25% 99% instruments sutures, 20 syringes syringes (Sutures, Syringes and 20 needles) of Public and needles) surgical instruments Health tested Products( 195 182 115 67 37% 93% Hand Sanitizers) Total 1002 1072 937 135 13% 107% The overall number of batches tested were 1072 out of 1002 contributing to 107%. The overall failure rate is 13% (135 out of 1072 including backlogs) of which 37% were for Public Health Products, 20% for Herbal, 25% for surgical instrument, 8% for gloves, 3% for veterinary and 11% for human medicines. 1.4.7 250 ADR reports 500 ADR Collected A total of 676 ADR reports were received against the 6130,6 135,604,00 186,526,475 The increase in analyzed, and semi-annual target of 500. Out of the ADRs reported, 170 0 ADR reporting feedback given per more than half of the reports (57%) reported to be is attributed to quarter serious. Majority of reports were submitted through increased scanned paper forms via mail (48%), while 31.5% was sensitization. through physical hard copies, 14.4 % through an e- reporting platform, 1.7% via the Med safety mobile app and 3.9% via WhatsApp.

1.4.8 a) 1 sensitization 1 sensitization One (1) sensitization meeting held on ethical drug 6192 72,800,000 39,975,000 Target workshop held on workshop held on promotion and roll out of the DPROM system to external achieved drug promotion drug promotion users. In addition, one Sensitization meetings held with Bus Owners /Operators (Western, South western, eastern and Northern regions) on stopping illegal drug hawking in their buses. b) 2 surveys 2 surveys Two (2) surveys conducted in the south-western regions Target undertaken every 6 undertaken and South- Eastern regions. The surveys were to ascertain achieved months on the proportion of advertisements / promotion activities compliance with related to drugs in the market that are authorized. advertising requirements

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line Engagement c) Regulatory action One (1) Meeting Engagement meeting held in collaboration with UCC with with UCC and taken on 10 illegal with the illegal media station owners/operators that are running illegal media herbal drug advertisers drug related advertisements. operators and advertisers. Additionally, one (1) Show cause notice written to Rashid owners were in Lukwago for illegally advertising on CBS radio and one (1) collaboration caution letter was sent out to Dei Natural Products with UCC. International limited on an illegal advertisement run on television. 1.4.9 200 Certificates of 100 Certificates of A total of 387,514.3 kgs of obsolete materials were 3290 20,616,000 23,779,180 COVID-19 destruction issued. destruction issued destroyed and a total of 59 destruction certificates were effect. and 10,000kgs issued. destroyed. 1.4.1 ISO/IEC 17025 ISO/IEC 17025 Passed ISO 17025: 2017 audit. The Medicine Laboratory is 4160- 1,345,200 110,571,314 Target 0 Accreditation for Accreditation for ISO 17025: 2017 accredited. 4260/4 achieved medical devices and medical devices and Passed audit for WHO Prequalification. The medicine 270 medicine WHO medicine WHO laboratory remains prequalified. pre-qualification. pre-qualification 95% of lab 95% of lab 97.4% of the equipment is functional. The five (5) non- 4180,4 25,779,200 148,992,139 Target equipment fully equipment fully functional equipment’s includes two (2) Dissolution testers 190 achieved functional. functional Pharma test and Eureka, one (1) Auto Titrator, one (1) Analytical balance and one (1) Air Burst machine.

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 5 proficiency tests 5 proficiency tests a) 3 Inter proficiency tests done for medicines 4200,4 74,814,400 66,518,092 successful successful including a) Cotrimoxazole tablets - assay- passed 210 Target participation with participation with and b) Paracetamol tablets - assay- passed; Diss achieved more than 80% pass more than 80% pass doubtful results - tablets had broken edges, rate rate Investigation report made. Unidentified powder - FTIR, Rel substances -Results not yet obtained b) 01 Inter proficiency test done for condoms including organized by FHI360 - Freedom from Holes test - passed (one Alert) and Lubricant quantity - passed (one above 3 sigma) c) 01 Inter Proficiency test done for gloves including Organized by Enersol - All passed.

Intra Proficiency tests done: a) Medicines laboratory - Ox tetracycline HCL inj - Assay - All passed b) Medical devices - Condoms - All passed except 02 persons - CAPA to be made. c) Medical devices - gloves - All passed except one person - CAPA to be made. 1.4.1 Under PMS, 575 80 Vet, 120 Human, Developed the PMS Annual sampling plan for 2019-2020 6193 104,000,00 123,565,700 Due to the 1 samples purchased and 60 Medical Participated in sampling FMD Vaccines Submitted the 0 COVID and tested in the Devices. WHO quality survey report on selected antimalarial and pandemic, lab, 30 regulatory antibiotics in Uganda. sampling of officers trained, Sno. Category Sampled % of Annual products develop in place an 1 Human 249 62% intended for application for 2 Herbal 94 94% Q3 was reporting 3 Veterinary 26 26% suspended and complaints. 4 Medical Devices 93 62% were pushed to A total of 423 samples were submitted for laboratory next FY. analysis. PMS was involved in sampling hand sanitizers as part of the COVID-19 response. 44 samples were submitted and 32 (72 %) of them failed quality testing.

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line Five (5) recalled Target 10 Recalls followed up PMS initiated 14 recalls and the details are achieved illustrated in the table below.

SNo Name of Product Batches (s) . 1. Wormita 80504 2. Agovir T66016 3. All products from Grand All Pharmaceuticals 4. Hydrogen peroxide 172 mouth wash 5. Ashialben 2.5% All 354 6. Dabendazole 0230618 7. Olfen 100 Decap 1850457 8. Ciproleb 500 T4108, T3088 & T4528 9. Cycloren 00118 10. Tricip RQ707 11. Alamycin 10 9231-600A 12. Unosure 72 DLBK05 13. Betalinctus All 14. Benoxide All PMS also conducted 6 audits of recalled products including;

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line PMS investigated 10 product related complaints Target 20 complaints 10 complaints including; achieved investigated per investigated per 1. Mannitol complaint from Mbale RRH. Feedback given to quarter quarter warm the preparation before use. 2. Diapam (Diazepam inj, 298 & 302) reported from Lwengo district and UMC. Findings not conclusive. 3. HIV/Syphilis duo kit due to suspected lack of efficacy from Kinoni HC and Kabale RRH. Samples sent to UVRI for analysis. 4. Netvaicaine (Bupivacaine inj) from Kabale RRH and Kitagata Hospital. Samples sent to the laboratory for quality analysis. The product was recalled on basis of the serious ADRs. 5. Seczol (Secnidazole) from Mbarara 6. Phenytoin injection (283) in Mulago Hospital and South East - Sampled for analysis. 7. Ophthalmic products imported by Swastik- Importer requested for justification. 8. Gentamicin Injection (299 & 300) - samples sent to the lab and products recalled from the market due to impurities. 9. Valcontin (292). Samples were sent to the Lab for analysis. The product batches implicated were recommended for destruction. 10. Penstrep Injection – on going investigation. 1.5.1 12 talk shows (TV), 10 talk shows, 12 Seven (7) talk shows achieved of which 4 on radio and 6110, 109,600,00 167,216,622 12 infomercials, 1 infomercials, 1 3on TV, 2 informercials developed, 2 newspaper articles 6150 0 Target not collaborative article and published. achieved due to activity on drug and 1 campaign. the COVID 19 substance abuse per Six (6) Regional campaigns on veterinary drug regulation Lockdown. quarter done in five (5) regions (Central, Western, South Western, Northern and Eastern on Veterinary drug regulation. Participated in one expo: Harvest Money Expo (14th to 16th February 2020.

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 6 campaigns 6 radio talk shows, 1 a. Sixteen (16) support visits were carried out in all 8610 20,124,000 47,750,000 Target conducted (12 radio article and 2 TV talk the 7 regions as sensitization and follow up on the achieved talk shows, 2 TV shows. vaccine cold chain. shows, 2 articles b. Participated in holding three (3) TV talk shows in published) to collaboration with DPS and Western region improve visibility of teams. Veterinary activities. c. Participated in three (3) Radio talk shows: Ibanda, Kasese and Ibanda in collaboration with DPS. d. Four (4) articles published of which one (1) newspaper article was developed and published focusing on the processes and the challenges faced by NDA in executing its mandate 10 Joint activities 10 Joint activities Attended ten (10) joint activities and the meetings were 8630 48,000,000 24,850,000 Target held, meeting held, meeting held with UNBS, COVAB, MAAIF, and UVF. achieved reports shared, and reports shared, and recommendations recommendations implemented implemented 2.4.2 3 GCP inspections Six (6) GCP Three (3) GCP inspections were conducted for the OPTIM 6182/ 46,640,000 16,895,000 No inspections conducted per Inspections study, the ZIPS study and the PREGART study. 6185 done in Q4 due quarter (12 GCP conducted to Covid. conducted). 40 CT applications 80 CT applications A total of 75 (8 new, 39 renewals and 28 amendments) Less processed per processed clinical trial applications were evaluated. applications quarter were received.

3.3.1 5 Guidelines and 2 Guidelines and 5 Four (4) Guidelines & corresponding forms revised, four 8715 31,600,000 12,506,200 Some reviews 7 SOPs SOP and 1 TOR (4) SOPs & corresponding forms revised and Two (2) were done by Terms of Reference were developed the externally parties. 31 operational As per schedule / Procurement process of 8 vehicles was completed and the 9055,9 415,800,00 612,806,619 Target vehicles Contract review vehicles delivered. Preliminary processes are underway. 066,90 0 achieved 67 77 operational motorcycles

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S.I Planned Annual Semi-Annual Actual Semi-Annual Output Budge Budget Expenditure Justification Output Planned Output t Line 3.4.1 Annual work plan Annual work plan Consolidated budget and work plan submitted to MoH for 7185 38,220,000 38,245,969 Target budget prepared by budget prepared by review and approval. achieved 31st Jan 2020 31st Jan 2020 3.6.1 6 Meetings of the 6 Meetings of the A total of thirteen (13) Meetings of the Authority and 4 1110- Target Authority and 4 Authority and 4 meetings each of the committees were conducted in the 1195, 56,724,280 37,844,080 surpassed meetings each of meetings each of the FY and the details are reported in the detailed annual 1220, the committees committees held. reports. 1240 held. 3 Public events 3 Public events A total of six (6) of public events were participated in to The target was participated in to participated in to show case NDA operations surpassed showcase NDA showcase NDA operations operations

3.3.3 LAN infrastructure LAN infrastructure LAN upgrade - NDQCL segment, Mbarara, Hoima and Jinja 8510,8 16,978,400 16,989,200 Target Upgrade to support Upgrade to support were done 520 achieved online submission online submission.

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Chapter Twenty-Three: National Medical Stores (NMS)

23.0 Mandate National Medical Stores is set up by an Act of Parliament, NMS Act Cap 207 as a statutory body responsible for procurement, storage and distribution of medicines and medical supplies primarily to Government health facilities. 23.1 Vision A population with adequate and accessible Quality Medicines and Medical Supplies 23.2 Mission To supply essential medicines and medical supplies effectively and efficiently to health facilities in Uganda. 23.3 Objectives To provide supplies of medicines and other pharmaceutical supplies to the Ugandan Population. 23.4 Performance (Q3 and Q4 FY 2019/20)  The Corporation received funds for procurement, storage and distribution of essential medicines and health supplies in accordance with the levels of care.  By the end of the fourth quarter of FY 2019/20, the Corporation had received 97.9% of the approved annual budget i.e. Ugx 388,120,277,901 of Ugx 396,172,214,900 and the expenditure by the end of the PY was 99.8% i.e. UGX 387,541,441,854 of the released funds.

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Table 22: NMS Q3+Q4 Performance FY 2019/20 Output Description Quarterly targets (Q3 & Q4) Outputs achievements/ Budget Expenditure/ Explanation for results (Q3 & Q4) release budget variation/ (Q3 & Q4) performance results 085906 Procure, store and distribute EMHS basic kits Essential medicines and health supplies 2,030,812,885 2,030,812,885 N/A Supply of EMHS to HC worth Ugx 2.03 billion to health Centre IIs spread worth UGX 2.03 billion procured 11 throughout the country. The basic kit contains stored and distributed to Health (Basic Kit) painkillers, antibiotics, anti-acids, antidotes, de- Centre 11s during the period. wormers, anti-hypertensives, gloves, cottonwool, medicals stationery, etc. for general treatment of ailments affecting children, women, men, disabled and the elderly. 085907 Procure, store and distribute EMHS basic kits Essential medicines and health supplies 4,023,082,565 4,023,082,565 N/A Supply of EMHS to HC worth Ugx 4.02 billion to health Centre 11s spread worth UGX 4.02 billion procured 111 (Basic Kit) throughout the Country. stored and distributed to Health Centre 111s 085908 Procure, store and distribute EMHS Orders worth Essential medicines and health supplies 2,326,797,805 2,326,797,805 N/A Supply of EMHS to HC Ugx 2.33 billion to HC IVs. These orders contain worth UGX 2.33 billion procured 1V supplies for the general treatment of conditions stored and distributed to Health affecting children, women, men the elderly and Centre 1Vs disabled 085909 Procure, store and distribute EMHS orders worth Essential medicines and health supplies 3,539,611,906 3,639,521,906 Part of the funds spent Supply of EMHS to UGX 3.54 billion to General hospitals. These Worth UGX 3.64 billion procured were unspent by Q2 General Hospitals supplies are based on the district specific prevailing stored and distributed to General hence available. ailments and clinical guidelines aligned to levels of Hospitals care in the Health referral system of Uganda. 085910 Procure, store and distribute EMHS Orders worth Essential medicines and health supplies 3,316,942,174 3,316,942,174 N/A Supply of EMHS to UGX 3.32 billion to regional Referral Hospitals. worth UGX 3.32 billion procured Regional Referral These cater for both specialised conditions peculiar stored and distributed to Regional Hospitals to the regions as well as general treatment. The Referral supplies selection takes into consideration clinical Hospitals. guidelines in accordance with levels of care in the health referral system. 085911 Procure, store and distribute EMHS orders worth Essential medicines and health supplies 2,977,225,297 2,977,225,297 N/A UGX 2.98 billion to National Referral Hospitals meant to cater for referred patients in accordance

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Output Description Quarterly targets (Q3 & Q4) Outputs achievements/ Budget Expenditure/ Explanation for results (Q3 & Q4) release budget variation/ (Q3 & Q4) performance results Supply of EMHS to with the health referral system. The supplies cover Worth UGX 2.97 billion procured National Referral specialised medicines and health supplies to cater stored and distributed to National Hospitals for complicated ailments and for the mentally Referral Hospitals. challenged patients that require the high levels of consultancy. 085913 Specialised items worth UGX 9.41 billion Essential medicines and health supplies 9,412,601,920 9,412,751,253 N/A Supply of EMHS to procured, stored and distributed to UHI and UBTS worth UGX 9.41 billion procured Specialised Units to cater for heart patients and national blood stored and distributed to Uganda supply requirements respectively. Jigger treatment Heart Institute (UHI) and Uganda supplies continue to be rolled out to the affected Blood Transfusion Services (UBTS). parts of the Country. 085914 Emergency supplies and donated items worth UGX Essential medicines and health supplies 690,000,000 690,000,000 N/A Supply of Emergency 0.69 billion equitably distributed to health facilities worth UGX 0.69 billion cleared, and Donated Medicines in regions affected with outbreaks of epidemics. stored and distributed to Health facilities. 085915 Reproductive health supplies especially the Mama Reproductive health items especially 4,416,000,000 4,416,000,000 N/A Supply of Reproductive Kits worth UGX 4.42 billion procured, stored and Mama kits worth UGX 4.42 billion Health Items distributed to health facilities spread throughout procured stored and distributed to the country. Mama kits are for safe delivery of Health facilities. mothers and family planning supplies are for better planned families and improved quality of life. 085916 Immunisation Immunisation supplies including Hepatitis B Vaccine Immunisation supplies including 13,290,886,212 13,306,035,846 Part of the funds spent Supplies worth UGX 13.29 billion procured, stored and Hepatitis B vaccines worth UGX 13.31 were unspent by Q2 distributed. The vaccines are for the routine billion procured stored and distributed hence available vaccination of children in the course of their to Health facilities. growth as well as specific ones for children below 5years, girls above 10 years, and women of childbearing age. Hepatitis B Vaccine to be distributed to the affected regions. 085917 Laboratory commodities worth UGX 0.47 billion Laboratory commodities worth UGX 472,000,000 474,081,317 Part of the funds spent Supply of Lab procured, stored and distributed to health facilities 0.47 billion procured stored and were unspent by Q2 Commodities to to aid proper disease diagnosis prior to distributed to health facilities from hence available accredited Facilities appropriate prescription of medicines. These are Health Centre IIIs onwards. supplied beginning with the HC IIIs on wards.

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Output Description Quarterly targets (Q3 & Q4) Outputs achievements/ Budget Expenditure/ Explanation for results (Q3 & Q4) release budget variation/ (Q3 & Q4) performance results 085918 Procure, store and distribute ARVs worth UGX ARVs worth UGX 53.0 billion 53,002,425,682 53,002,425,682 N/A Supply of ARVs to 53.0 billion to treatment centres with the aim of procured stored and distributed to accredited Facilities improving the quality of life of the affected people the accredited health facilities. in accordance with the test and treat policy. 085919 Anti-Malarias worth UGX 1.43 billion procured, Anti-Malarials worth UGX 1.43 billion 1,425,306,375 1,434,238,192 Part of the funds spent Supply of Anti-Malarial stored, and distributed to health facilities for procured stored and distributed to were unspent by Q2 Medicines (ACTs) to treatment of malaria. These supplies contain adults the accredited facilities. hence available accredited facilities and pediatrician dosages. 085920 Store and distribute anti TB drugs to accredited During this period, storage and - - These supplies were Supply of TB medicines centres. The supplies include the various lines of distribution of the procured anti-TB procured and paid for to accredited facilities treatment for multi disease resistant strains. drugs continued and was eventually by Q2 hence no completed by the end of Q4 expenditure in Q3 and Q4 085921 Administrative Support worth UGX 21.83 billion provided to the Provided support worth UGX 23.81 21,830,515,653 27,352,893,555 Part of the funds spent Services procurement, storage and distribution of essential billion to the procurement, storage were unspent by Q2 085922 Corporate medicines and health supplies to health facilities. and distribution of essential medicines hence available Services and health supplies.

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23.5 Challenges  Implementation of the Integrated Financial Management System (IFMS) o Processing of facilitation for delivery of EMHS to facilities. o With effect from 1st July 2020, the Corporation implemented the approved annual budget for FY 2019/20 in IFMS, including the portion for other corporate services which was excluded in the previous PYs. This meant that even the facilitation to staff for delivery of supplies to the different facilities spread across the country had to be paid out of the IFMS. As a result, dispatching of EMHS to the facilities commenced late, following the release of cash limits, approval of warrants and receipt of payments. This affected the delivery of supplies as originally planned hence leading to complaints of late deliveries from the health facilities.  Proposed mitigation: NMS reverts to the previous position where the budget for operational activities is implemented outside the IFMS. o Appropriations Act.The Appropriations Act restricts the expenditure of a vote to the total funds appropriated for the FY. However, there are votes that have budgets or have secured funding for procurement of medicines and supplies. These entities are willing to transfer these funds to NMS for the procurement of those specific medicines and medical supplies however, these funds cannot be received and expended by the Corporation. o Proposed Mitigation: Votes to follow the provisions of the PFMA, 2015 and have funds formally reallocated to the National Medical Stores for procurement, storage and distribution of the required medicines. o Additionally, all funds earmarked for procurement, storage and distribution of EMHS should be pooled to the NMS vote during the budgeting and budget approval phases.  Covid-19 Pandemic The outbreak of the Covid-19 pandemic and its related effects affected implementation of activities as planned and hence impacting on the eventual budget absorption. o Proposed Mitigation: Prioritise activities and fit operations within the agreed standard operating procedures (SoPs).

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Chapter Twenty-Four: Uganda Blood Transfusion Services (UBTS)

24.0 Background: The Uganda Blood Transfusion Service (UBTS) is the National Blood Service responsible for all blood transfusion and safety activities for the entire country.

24.1 Vision: An effective, efficient and sustainable Blood transfusion service in Uganda.

24.2 Mission To provide sufficient and efficacious Blood and Blood components through voluntary donations for appropriate use in Health care service delivery.

24.3 Mandate To make available safe and adequate quantities of blood and blood products to all hospitals in the country for proper management of patients.

25.4 Objectives  To expand the Blood transfusion infrastructure to operate adequately within a decentralised health care delivery system.  To increase the annual blood collection necessary to meet the blood requirements for all patients in the hospitals throughout the whole country.  To operate an active nationwide Quality Assurance Program that ensures Blood Safety- improves quality systems.  To promote appropriate clinical use of blood.  To strengthen the organisational capacity of UBTS to enable efficient and effective service delivery

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Summary table on performance for the Quarter

Output description Quarterly targets (Q3 Outputs Budget Budget Explanation for variation/ &4) achievements/ release performance **results results (Q3 &4) (Q3 &4) Billions Billions Collection of blood  Mobilize 250,000 potential  Mobilized 240,000 potential 3.63 3.920  Shortages in medical blood donors in 6,000 blood donors in 6,000 supplies arising from delay mobilization campaigns mobilization campaigns in release of U.sh10bn  Undertake 6,000 sessions  5,503 sessions undertaken supplementary funding to  Collect 150,000 units of in preparation for blood NMS by Ministry of Finance, blood collection Planning and Economic  Counsel 150,000 donors on  135,268 units of blood Development donation activities collected  Hualted collection due to inadequate storage facilities Laboratory services  Test 150,000 units of blood  Tested 135,268 units of 1.140 1.37  Shortage of medical  Issue 142,500 units of safe blood supplies and reagents blood to health facilities  Issued 116,585 units of safe  Collections halted due to  Disposal of 7,500 units of blood to health facilities inadequate storage facilities discards in a safe manner  Disposed of 18,683 units of  High discards unsafe blood Quality Assurance  Review any obsolete  Printed all documents and 0.185 0.285 No variations Services documents distributed to 2 regions  Distribute and train 150 staff except regional to 5 regional blood banks organogram, training and and 5 collection centers awareness of QMS has  Check 1% of all blood improved components prepared in  Step 2 accreditation was each blood bank achieved for Nakasero,  Train regional staff in blood document standardization reception, cold chain and and utilization has blood transportation improved greatly  Only 1% of units from Nakasero were tested and

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Administrative Support • Pay for utilities • Paid for utilities 2.2990 2.509 No variations Services • Operate and maintenance • Operated and maintained 61 vehicles &3 of 61 vehicles &3 motorcycles motorcycles • Managed cleaning services contract • Manage cleaning services • Carried out support supervision in 7 contract Regional Blood Banks • Carry out support supervision in 7 Regional Blood Banks

Capital Purchases • Commence construction of • Construction of stores and cold rooms at 1.3 2.57 No variations stores and cold rooms at NBB started NBB • One vehicle delivered and 3 are on • Procure 4 vehicles transit • Procure assorted medical • Procured assorted medical equipment for equipment blood collection • Procure ICT equipment • Procured and installed 30 computers

Planning, Monitoring,  Finalize preparation of UBTS  Finalized preparation of UBTS BFP and 0.352 0.382 No variations and Information Services BFP and Budget for FY Budget for FY 2019/20. 2019/2:  Finalized UBTS M&E Framework and  Finalize UBTS M&E tools Framework and tools:  Prepared UBTS Q3 &4 Performance  Prepare UBTS Q3 &4 Reports: Performance Reports:  Prepared UBTS Annual Performance  Prepare UBTS Annual Report for 2018/19 FY Performance Report for  Unit cost study for blood supply is being 2018/19 FY undertaken.  Undertake unit cost study for blood supply

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Challenges Poor reporting on patients’ safe blood and blood products uptake by the health facilities However, the data on safe blood and blood products orders received and issued to selected health facilities are shown below.

WHOLE BLOOD PACKED CELLS (PC) PLASMA (PL) PLATELETS (PT) (WB) SATISFACTION LEVEL 71% 54% 83% 45% BLOOD ISSUED 26,567 3,982 424 1,559 BLOOD ORDERED 37,590 7,310 508 3,479

UBTS has provided the Transfusing Health Facilities with a Reporting Format for uptake of safe blood and blood products. Reporting will be monthly

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Inadequate storage Facilities

Progress on Remodeling and Construction of a Store at Nakasero Blood Bank

PROGRESS PHOTOGRAPHS FOR THE MONTH OF MARCH 2019

Photo 16: Excavation of the soil to reduce Photo 17: 4Excavation of the soil to reduce levels levels

Photo 18: Excavation of the foundation Photo 19: 6Excavation of the foundation trenches of the store trenches of the store

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Photo 20: Casting the reinforced concrete Photo 21: Casting the reinforced concrete retaining wall base retaining wall

Photo 22: Casting the reinforced concrete Photo 23: Hardcore filling in the foundation ground beam and soil backfilling in foundation

Photo 24: Casting the reinforced concrete Photo 25: Construction of concrete block ground floor slab walling for the ground floor

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PROGRESS PHOTOGRAPHS FOR THE MONTH OF JUNE 2019

Photo 26: Construction of the concrete block Photo 27: Fixing the formwork for the first-floor wall for the ground floor slab

Photo 28: Construction of the concrete block Photo 29: Casting the reinforced concrete wall for the ground floor retaining wall

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PROGRESS PHOTOGRAPHS FOR THE MONTH OF JULY 2019

Photo 30: Laying the steel reinforcement bars and Photo 31: Casting the reinforced concrete slab for the hollow clay blocks for the first-floor slab and fixing first floorand fixing the steel portal rafters the steel portal rafters

Photo 32: Reinforced concrete slab for the first floor Photo 33: Fixing the mild steel Z-section purlins

Photo 34: Construction of the concrete block walling Photo 35: Fixing the mild steel Z-section purlins for the first floor

High Maintenance Cost of Vehicles UBTS has procured 4 vehicles for blood collection. However, this PY, Government provided no budget for procurement of vehicles. Low blood collection during student holidays UBTS is strengthening its partnerships with government agencies, corporate bodies, cultural and religious institutions to boost blood collection during holidays

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PROFESSIONAL COUNCILS

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Chapter Twenty-Five: Allied Health Professionals Council (AHPC)

25.0 Mandate The Allied Health Professionals Council is a statutory body established by the Allied Health Professionals Act Cap. 268 to regulate, supervise and control the training and practice of Allied Health Professionals in Uganda. 25.1 Vision A Council that protects society from harmful and un-ethical professional practices. 25.2 Mission To regulate, supervise, control, and enforce standards of education, training and practice for Allied Health Professionals in order to effectively contribute to health productive life of Ugandans. 25.3 Functions of Council  To regulate the standards of allied health professionals in the country.  To regulate the conduct of allied health professionals and to exercise disciplinary control over them.  To supervise the registration and licensing of Allied Health Professionals and publication of the names of registered Allied Health Professionals in the gazette.  To advise and make recommendations to the Government on matters relating to the allied health professions.  To exercise general supervision and control over the allied health professions and to perform any other function relating to those professions or incidental to their practice.  To perform any other functions conferred upon it under this Act or referred to it from time to time.

Photo 35: Manager quality assurance and inspection, inspecting facility with poor equipment handling starndards in Jinja

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Table 23: AHPC Q3+Q4 Performance FY 2019/20 Explanation for Quarterly targets Outputs achievements/ Budget release Expenditure/ budget Output description variation/ (Q3 &4) results (Q3 &4) (Q3 &4) performance **results REGISTRATION AND LICENSING Verification and Registration of 2,263 Applicants 1,205 Professionals were verified 30.2 M 22.7 M Reduced performance Allied Health professionals and registered arising from the Covid-19 Licensing of professionals and 15,042 professionals 8,523 Professionals licensed lockdown restrictions issuance of Certificates Licensing of private health 2,043 health facilities 1,364 health facilities were facilities licensed Reg. and Licensing Private 471 laboratories 514 laboratories were licensed Laboratories done Inspection and support supervision Sensitisation of CAO’s and 40 Districts Conducted sensitization of CAOs 9.4M 7.9 M Enhancement of Regulatory DHO’s on council’s mandate & DHOs in 36 districts (Central aspects, Compliance and Region, West Nile and quality improvement management of military hospital at discussions with Bombo stakeholders Conduct support supervision of 7 regions supported 9 regions supervised (Jinja, Mbale, 19.1M 20.6 M Improved performance by Regions Soroti, Arua, Masaka, Hoima, regional offices Fortportal, Gulu and Moroto Support to District Allied Health 50 District supervisors 97 districts supported with 40M 91.4 M Timely registration and Supervisors inspection funds renewals by Allied Professionals Inspection of health facilities Inspect of at least 2000 3,046 Health facilities inspected 79.2M 28.8 M Enhanced AHPC service implemented health facilities delivery at Regional levels

Inspection of health training 40 Institutions None 45.4 M None All health training institutions implemented institutions were closed due to COVID-19 Pandemic Support Professional Association 5 Associations 2 Associations supported 7.5 M 2 M Limited CPD activities due CPD Meetings to Covid-19 restrictions Conduct committee, Advisory 19 meetings Organised 12 meetings 135.6 M 106.8 M Contract appointments of Boards and council meetings staff and budget for 20/21 approved

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Explanation for Quarterly targets Outputs achievements/ Budget release Expenditure/ budget Output description variation/ (Q3 &4) results (Q3 &4) (Q3 &4) performance **results Payment of staff Salaries and Pay staff salaries, wages Promptly effected staff salaries, 633M 651.1 M Nil Wages and allowances for 54 wages and allowances to 51 employees employees Fulfilment of staff Gratuity 9 employees 8 employees paid service gratuity 30M 28.6 M Nil obligation for expired contracts. Fully functional council vehicles 7 vehicles and 4 7 vehicles & 4 Motorcycles 65 M 60.7 M Nil and Motorcycles Motorcycles regularly maintained & functional NTR collected by A H P C 2,635,300,500 1,953,966,233 Reduced revenue due to COVID-19 lockdown measures Subvention received from MoH UGX 37.5M UGX 33.75M Budget cut by MoH Vehicles procured Two brand new vehicles Procured two double cabins 390M 395M None

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24.5 Challenges • Unsettled court case involving Environmental Health Worker's Association and AHPC. • Some of the health facilities continue to be operated by nonqualified staff and most drug outlets practising beyond scope of the licenses • Dwindling NTR revenues arising from low registration and licensing during COVID-19 crisis which is bound to affect Council operations. • Arising from the revenue shortfalls, the council was unable to gazette allied health professionals and health units as required by the law. • Lack of adequate means of transport for west Nile & mid-western regional offices 24.6 Measures to mitigate the above challenges Following the Solicitor General’s advice on challenges of licensing for persons in public service, AHPC shall with approval of the Minister publish gazette fees. • Increased media awareness on mandate of AHPC to reduce quack medical practitioners • Allocated a brand-new vehicle to eastern region to support inspectorate activities • Expedite e-licensing to easy and enhance compliance • Increase community and professional awareness on mandate of AHPC via the media • Engage NDA on outlets practising beyond scope • Review MakCHS proposals regarding the recognition of Cytotechnologists and graduates with Bachelor of Biomedical Sciences • Seek Multi-lateral Development partner and possible Donor support to augment NTR budget through proposal writing. • Solicit for extra funding support from mother Ministry to support inspection and Quality Assurance activities

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Chapter Twenty-Six: Uganda Nurses and Midwives Council (UNMC)

26.0 Introduction The Uganda Nurses and Midwives Council (UNMC) is a statutory body established by the Uganda Nurses and Midwives Act, 1996 to regulate the training and practice of nursing and midwifery profession so as to ensure public safety. The Council has the mandate to protect the public from unsafe nursing and midwifery practices; ensure quality of nursing and midwifery services; foster the development of the nursing and midwifery profession; and confer responsibility, accountability, identity, and status of the Nurses/Midwives in Uganda. 26.0 Vision The vision of UNMC is to be a statutory body that effectively regulates nursing and midwifery professions for public safety. 26.1 Mission The mission of UNMC is to set and regulate nursing and midwifery training and practice standards; register and licence nurses and midwives and to provide professional guidance for public safety in Uganda. 26.2 Mandate The functions of the council are to:  Regulate the standards of nursing and midwifery the country  Regulate the conduct of nurses and midwives, and exercise disciplinary control over them  Supervise the registration and enrolment of nurses and midwives, and publication of the names of the registered and enrolled nurses and midwives in the Gazette  Advise and make recommendations to government on matters relating to the nursing and midwifery professions  UNMC is a professional regulatory and supervisory body committed to the provision of quality nursing and midwifery services to the public 26.3 Objectives Using the UNMC strategic plan 2017/18 – 2021/22, the council strives to achieve the following objectives:  Promote standards and ensure compliance by nurses and midwives.  Strengthen regulation of education, training of the nurses and midwives’ professionals  Strengthen policy and regulatory framework  Strengthen and develop capacity of UNMC Secretariat for effectiveness.

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Table 24: UNMC Perfomance Q3+Q4FY 2019/20 Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce Registration and 4000 targeted for 2442 new qualified nurses and 119.16M 33.326M The activity was carried out partly, up to enrollment of newly registration and midwives were registered and 20th March 2020 due to the Covid-19 qualified nurses and enrollment, 2000 per enrolled as follows: Lockdown midwives quarter Category Number Locally trained 2432

Foreign trained 10

 186 were at registered level while (1 at masters, 35 at bachelor’s in nursing, 1 at bachelors in midwifery, & 149 at Diploma)  2256 were at enrollment level.

Renewal of Practicing 4000 targeted for 3972 nurses and midwives were - - Renewals were slightly less than the target license for nurses and renewal, 2000 per renewed due to difficulty in transportation for the midwives in practice quarter Q3 – 3853 nurses and midwives resulting from covid- Q4 – 119 19 lockdown.

Results Please find below a detailed table 1 with the cadres of nurses and midwives Registration and renewal 28 clinics were targeted A total of 46 clinics were - - Renewals were less than the target due to of license for Nursing & for registration, 14 per registered, 25 nursing clinics and 21 difficulty in transportation for the nurses Midwifery private clinics quarter (14 nursing maternity clinics and midwives resulting from covid-19 clinics and 14 maternity Q3 – 34 lockdown. clinics) Q4 – 12

340 clinics were targeted A total of 197 clinics were for renewal, 170 per renewed, 45 nursing clinics and 152 quarter (130 nursing maternity clinics

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce clinics and 210 maternity clinics Participation in the 3 Health training 10 health training institutions 21.68M - Inspection could not be carried out due to inspection of Health institutions and applied for inspection for various the Covid-19 Lockdown. The number of training institutions and Universities were reasons HTIs/ Programs depends on public demand Universities with Nursing targeted for inspection; 5 and Midwifery programs nursing and midwifery No health training institution was Results in collaboration with the programs; and 8 HTIs inspected Please see details below of HTIs that MoES and NCHE for for full registration applied for inspection as table 2 accreditation inspection Review and approval of 5 programs curricular 2.5M - Role of accreditation of programs is for A total of 9 curricula/ programs Nursing and Midwifery were targeted MoES thus the Council may not control were submitted, of which 7 were Training the number of curricular received for handled as below: Curricular/Training review & approval. o 5 reviewed and reports programs made Results o 2 programs - awaiting Please see below as table 3 for details assessor’s feedback

Supervision of 2 Supervisory visits of 11 No supervision was held 1.425M - The activity was not carried out as planned attached/placed student students were planned in due to the covid-19 lockdown. Nurses without requisite the 2 quarters, visits However, out of the 11 students, requirements into the were every 2 months only 5 students reported for the The affected Universities were expected to BNS program attachment in Hoima Regional co-fund this activity. referral hospital. Results Details of the students expected for

attachment

Students who reported Universit y 1. Kaggo Allan CIU 2. Muruli Aaron CIU 3. Agnes Lawrence UCU Gorobe Alfred

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce 4. Daniel Aguet Nhial UCU Aguet 5. Anna Modong Alex UCU Alimo

Students who never reported 6. Nankinga Gertrude CIU 7. Najma Abdullah Hersi CIU 8. Samuel Habtemariam VU Kidane 9. Achi Zanak VU 10. Ibrahim Hasiya VU Plangnang 11. Semrah Araya Tsegay VU

Verification of nursing 15 health training Students not verified 14.03M - The activity was not carried out as planned and midwifery students institutions to be verified due to the closure of schools resulting in health training in 3 regions, Central, far from covid-19 lockdown. institutions East & Northern Supervision of attached 2 Supervisory visits were A total of 27 student 13.06M - The activity was not carried out as planned student Nurses and planned, 1 per quarter nurses/midwives were attached. due to the closure of schools resulting Midwives who were not These students were however not from covid-19 lockdown. successful on pre- supervised registration interviews or Results were on orientation of Please see attached details of students 8weeks as foreign attached as table 4 trained

Maintenance of an Weekly update of Weekly updates were done. - - Maintained as planned updated database for all database eligible nurses and Nurses and midwives published Results midwives; and its Publish nurses and online By end of June 2020, there were 72,702 publication midwives online nurses and midwives, 53,155 had valid practicing licenses thus were available online. Compliance with renewal was 73%.

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce Digitalization of licenses Issue digitalized licenses Not achieved 16M - Processing is awaiting management and for registered nurses and for newly registered board approval of the sample produced. midwives nurses and midwives Development of an Develop online CPD Online CPD monitoring - - Developed with support from World Online registration monitoring system for demonstration system developed Continuing Education Alliance (WCEA). system for nurses and nurses and midwives midwives, and for System is being piloted and tested Results nursing and maternity both on android powered phones 2471 nurses and midwives are using the clinics and on desktop computers. CPD app

Below is the visualization of the app in figure 1. Functionalization of the Present the system to The system was not presented to 37M - Activity is done with support from UNFPA GIS system MoH Senior MoH senior management management for committee (SMC) for approval We still await placing of item on the SMC approval agenda

Roll out mapping of Mapping of nurses and midwives in The activity was not carried out as planned nurses and midwives in the selected districts not done due to the covid-19 pandemic that Amudat, Kween, Bukwo, discouraged gatherings as a way to stop its Kibuku, Amuria, spread Kiryandongo, Wakiso, & Bundibugyo Results So far 47,832 nurses and midwives appear on the GIS dashboard. Disciplinary hearings for 2 disciplinary hearing No disciplinary hearing was held 10M - The hearing had been scheduled for 25th & professional misconduct planned to handle 61 26th March and 20th and 21st May 2020 but cases cases was not implemented due to Government measures and regulations to stop the spread of the Covid-19 pandemic

Disciplinary 24 cases were targeted No case was investigated nor 34.06M - No investigation or follow up was done investigations for for investigations, with followed up due to Government measures and professional misconduct varying numbers in each regulations to stop the spread of the cases and follow up of quarter Covid-19 pandemic concluded disciplinary cases

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce 13 cases were targeted for follow up Publication of quacks and 94 concluded cases and 63 concluded cases and quacks 7.5M 9.950M Increased rates per unit of publication concluded disciplinary quacks were planned for were published cases recommended for publication Results such in media See below details of the published cases as figure 2 Review of the Legal Consult the solicit A specific person under the First 25M 11.79M Accomplishment of this task is under the framework that governs general’s office Parliamentary Counsel (Mr. John control of first parliamentary Counsel nurses and Midwives in Paul Edoku, a senior state attorney Uganda (NM Act, 1996) Prepare Regulatory & Legislative Drafting and Policy Impact Assessment and Formulation Expert) was assigned Cabinet Memo for to work with the Council. submission to MoH and Cabinet for approval Preparation of the RIA and Cabinet Memo is still in progress

Representation of the Council planned to be 5 representations of council were 4M 1.37M Activities were not implemented as Council in courts of law represented in court 8 made planned because of: on various cases times, 4 per quarter  One of the cases was concluded early  Appearance date for the other case in Arua was within the Covid-19 pandemic period when movement and convening was restricted.

Results Please see attached details of the Court appearances as table 5 Development of Seek advice from the A specific person under the First - - Funds for this task is incorporated within Standards for nursing and Solicitor general’s office Parliamentary Counsel (Mr. John the funds for review of the Nurses and midwifery practice Paul Edoku, a senior state attorney Midwives Act., 1996 Redraft the Scope of & Legislative Drafting and Policy Practice for Nurses and Formulation Expert) was assigned to work with the Council.

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce Midwives into a Accomplishment of the redrafting of the regulation Redrafting of the Scope of practice scope of practice into a regulation is under is still in progress the control of first parliamentary Counsel Present the following standards/guidelines to The standards/guidelines were the UNMC governing presented before the council and council for approval they were approved.  Mentorship standards for Student Nurses and Midwives  Nursing and Midwifery Private practice guidelines Monitoring and Monitor & Evaluate the A Report for 200 pre-registration - - Implemented as planned evaluation of Council pre-registration interviewees who filled the activities interview process questionnaires was drafted  Write a report on the process Support supervision of 2 supervisory visits of: No supervision of health facilities - Activities were not performed as planned Health facilities  16 districts, 8 per was performed due to the Government measures and quarter in the regulations to stop the spread of the islands and districts Covid-19 pandemic with landing sites  48 health facilities, 24 Health Facilities per quarter, 3 per district.  10 Nursing and Maternity clinics, 5 per quarter Sensitization of nurses  32 facility-based 1 national webinar (online) was held - - Webinar was organized with support from and midwives, and the sensitizations, 16 per with nurses and midwives the Nurses and Midwives Think Tank and public on professional quarter (2 Seed Global sensitizations per district)

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce code of conduct and Activities were not performed as planned ethics  4 regional radio talk due to the Government measures and shows, 2 per quarter regulations to stop the spread of the Covid-19 pandemic Accreditation of CPD 2 CPD accreditation No CPD accreditation meeting was 8M - Activities were not performed as planned providers and Programs meetings, 1 per quarter held due to the Government measures and for Nurses and Midwives of: regulations to stop the spread of the  10 CPD providers, 5 Covid-19 pandemic per quarter  20 CPD programs, 10 per quarter

Review of the UNMC Review the UNMC mid- UNMC mid-term performance - - Implemented as planned Mid-term performance term performance under reviewed, and report drafted under the strategic plan the Strategic plan 2017/18 – 2021/22 2017/18-2021/22

UNMC Management 6 management meetings 9 meetings were held on 23rd& 28th 8M 7.66M More Meetings were held to enable committee meetings were planned January; 3rd, 18th, 23rd, 24th & 25th articulation of the FY 2020/21 work plan March; and 15th, 18th & 26th June, and budget 2020 Quarterly Council and 10 meetings were 13 meetings were held, 4 full 88.5M 36.685M More meetings were held by the full Committee meetings planned, 2 full council council meetings and 9 committee council and Finance, Planning and meetings and 8 meetings respectively Administration committee to allow committee meetings for thorough discussion of annual work plan Finance, Planning & and budget for FY 2020/21 Administration; Disciplinary; Education, Results Training & Registration; 4 Council meetings held on 25th Feb 24th, and Inspectorate and 25th & 26th June 2020 Quality Assurance 5 FPAC meetings held on 24th March 4th, 5th, 17th & 18th June 2020

1 Disciplinary Committee meeting held 20th March 2020

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce 2 ETR committee meetings held on 18th March & 15th June 2020

1 IQAC Meeting held on 17th March, 2020 Collaboration with 4 national, regional & 2 regional 87.742M 50.724M Some planned conferences were not held national, regional and international meetings meetings/conferences/visits were due to the covid-19 pandemic international nurses and were planned held in Kenya midwives’ bodies on Results quality standardization A regional conference on GIBB app regarding online registration and licensure was attended

A benchmarking visit was made to Kenya Nursing and Midwifery Council on online registration and licensure Establishment of UNMC Establishment of: Internal Audit function and Audit - - Implemented as planned internal controls,  Internal Audit committee were established transparency and function & Audit accountability committee PDU and Contracts Committee  Procurement and were established Disposal Unit & a Contracts Committee UNMC capacity to Planned to pay salaries of 31 staff were paid salary & 644.975M 435.661M It was not spent as planned because: attract, maintain, 35 staff allowances for 6 months  Some positions are not yet filled like 1 develop, and retain highly Regional supervisor, 1 driver, Finance productive human Planned to pay & Planning manager, Assistant resource allowances to 35 staff inventory and management officer, & cleaner

 Some of the new staff reported in February and March 2020 Development of UNMC A procurement and A procurement and Disposal work - - Implemented as planned Procurement and Disposal work plan FY plan FY 2020/2021 for UNMC in Disposal work plan FY 2020/2021 for UNMC to place. 2020/2021 be developed

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce Orientation and training Train Council staff on In-house training and capacity 5M 2.6M Orientation of new UNMC staff not of Council staff basic procurement building of Senior management and conducted due to the Government practices contracts committee members by measures and regulations to stop the  In--house training PPDA conducted spread of the Covid-19 pandemic  Capacity building of Senior management and contracts committee members by PPDA Orientation of new UNMC staff not Orientation of new conducted UNMC staff Acquisition of a Suitable Advertise the bid Invitation to bid advert still running - 2.2M The process was interrupted by the PPDA office premises for the up to 24th July, 2020 guidelines that required halting of all Council Evaluate the bid sourcing processes resulting from the Covid-19 pandemic Run the best evaluated bidder notice

Procurement of UNMC Procure services and All the planned services and 76.868M 74.394M The actual cost of procurement was lower services and supplies supplies as below: supplies were procured than planned  Stationery  7100 Blank certificates  Servicing of vehicles  Hotel services  Printer Cartridge  Upgrade of internet  4 Laptops  2 adverts for disciplinary and house purchase

Identification of and The unit planned to: The internal key stakeholders - - Implemented as planned equipping of identified included: 1) the

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce Stakeholders with audit  Identify key internal Governing council, 2) senior knowledge and external management and employees and 3) stakeholders the external key stakeholders  Obtain a clear (external auditors, the government, understanding of and the clients - Nurses and their expectations midwives)  Explain the role of Internal Audit to Key expectations were obtained manage expectation. and considered in the development of the Audit strategy

The role of internal audit was clearly explained to the stakeholders (what the function can do and what it cannot do) Development of UNMC Draft the UNMC UNMC internal audit charter - - Implemented as planned internal audit charter internal audit charter developed and presented to the Council for approval on 26th June Present the internal audit 2020. The charter was approved. charter to the Council for approval Development of UNMC Draft the UNMC UNMC internal audit strategy - - Implemented as planned internal audit strategy internal audit strategy developed and presented to the for the next 3 PYs Council for approval on 26th June 2020. The strategy was approved. Present the internal audit strategy to the Council for approval Development of UNMC Draft the UNMC annual UNMC annual internal audit plan - - Implemented as planned annual internal audit plan internal audit plan developed and presented to the Council for approval on 26th June Present the annual 2020. The plan was approved. internal audit plan to the Council for approval Response to the External To respond to the The queries arising from the audit - - Implemented as planned audit queries external audit queries of the PYs ending 30th June 2018

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Output description Quarterly targets Outputs achievements/ Budget Budget Explanation for variation/ (Q3 &4) results (Q3 &4) release performa **results (Q3 &4) nce for FY 2017/18 and and 30th June 2019 were responded 2018/19 to and submitted to PSST.

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25.6 Challenges and Recommendations In the 3rd and 4th quarter, the council was mainly faced with two major challenges that included:  Slow recovery from the leadership crisis and litigation that the council faced, which resulted into: o Backlog of activities, thus prioritization needed to be made o Backlog of issues to be handled and approved by the new governing council (board) o Delay in purchase of spacious council premises, compromising availability of office space for council expanded staff  The Covid-19 pandemic that deterred the implementation of activities which required movement from one place to another or gathering of persons as a way of stopping its spread. Council staff/members and clients were affected equally. Basing on the challenges above, the council believes that the following recommendations will improve its performance in the next PY:  Re-strategize implementation of council activities, most especially the need to move from manual to electronic implementations  Expedite the development of the online registration system  Strengthen the health supervisory authorities (regional and district) to enhance execution of council activities at the grassroots, without necessarily requiring movement of staff at the head office.

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Chapter Twenty-Seven: Pharmacy Board

The Pharmacy Board is established by the pharmacy and drug act chapter 280, of 1971 27.0 Mandate  Protect the public from substandard and unethical Pharmaceutical practices by ensuring that Pharmacists are duly registered, competent, and fit to practice pharmacy  Regulate Pharmacy Professionals and practice in both the private and public sector 27.1 Functions  Enforce standards of Pharmacy practice in private and public institutions  Regulate the conduct and discipline of Pharmacists  Maintain a register of pharmacists  Publish in the gazette lists of registered Pharmacists 27.2 Strategic Objective Pharmaceutical Services delivered by appropriately trained and registered Pharmacists in accordance with approved standards

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Table 25: Pharmacy Board Q3+Q4 Performance FY 2019/2020 Output description Quarterly targets Outputs Budget Expenditure/ Explanation for (Q3 &4) achievements/ release budget variation/ results (Q3 &4) (Q3 &4) performance **results Pharmacy Practice Legislation& Review financial Draft Financial 2,000,000 2,000,000 Lock down slowed the pace implementation framework implication for the implication in Place strengthened PPPP bill. Prepare a Cabinet Cabinet memo being Memo for PPPP bill prepared in collaboration with The policy analyst unit Pharmacy Board Activities Two Pharmacy Two Pharmacy Board 5,000,000 7,500,000 Arrears from qtr 2 were paid Board meetings Meetings One meeting of the One vetting committee vetting Committee meeting 700,000 700,000 Register new Pharmacists 22 new Pharmacist Finalise Displinary registered guideline. Final draft approved by the Board Mentorship and supervision of 20 internship sites 11 internship sites were 5,930,000 5,930,000 Internship sites supervised supervised Joint support supervision with Two Joint support One Joint supervision 8,920,000 8,920,000 councils and NDA supervisions with NDA Operational support to the Fuel, welfare 4,500,000 4,500,000 Registrar’s office maintenance of small equipment’s

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27.3 Challenges  Delays in the passing of the PPPP bills limits the mandate of the Pharmacy Board and to some extent this is responsible for the challenges we are seeing the regulation of the sector  The office of the registrar has only one person this has affected service delivery 27.4 Way forward  The is needed to expedite the process of enacting the bill  We should explore the possibility of employing some people on contract to support the registrar as we work on the bill. at least a driver and administrative assistant

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Chapter Twenty-Eight: Uganda Medical and Dental Practioners Council (UMDPC)

28.0 Strategic Objectives  Promoting & monitoring standards of professional education, training and practice in Uganda.  Enhancing quality assurance and compliance with professional practice standards  Developing and reviewing key policy and regulatory frameworks  Strengthening and developing capacities of the Council for effectiveness and efficiency.

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Table 26: UMDPC Q3+Q4 Performance FY 2019/20 Objective 1: Professional Education and training in various training institutions strengthened Output Quarterly Output Budget Expenditure/Budget Explanation for variation/ Description target Achievement/Results Q3&Q4 Performance (U shs Results (Q3&Q4) (Q3&Q4) (U shs Millions) Millions)

Inspection of Inspect 7 7 Ugx 8.32 Ugx 5.89 Kabale ,IUIU,King Ceasor, Makerere dental, Medical & Dental University UCU medical and dental, Busitema and Gulu Schools in Uganda medical and 1 universities inspected together with the Joint dental school EAC medical and dental councils. All inspected Universities apart from IUIU were stopped from admitting new students until they fulfilled the requirements spelt out to them

5 medical schools were stopped from admitting Inspection of 11 medical and 11 visited until s Medical & Dental dentals Schools in EAC Inspection and 2 2 5.37 4.27 Mengo and Nsambya ECSACOP training sites accreditation of inspected and accredited by Council to train ECSACOP training Specialists Physicians sites

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Output Quarterly Output Budget Expenditure/Budget Explanation for variation/ Description target Achievement/Results Q3&Q4 Performance (U shs Results (Q3&Q4) (Q3&Q4) (U shs Millions) Millions)

Inspection of new Inspect 5 Inspected 2 Inspection of Ibanda and Holy innocent hospitals internship sites/ internship sites 4..39 3.98 were inspected and found fit for internship centers training

Maintaining 10 Universities 0 Desk work Desk work Poor compliance. Asked NCHE to submit the register for 1st year returns from the Universities students

Reviewing Medical Review Reviewed 4 curricula's 0 0 Curricula of equator submitted to NCHE. & Dental training 5curriculum for Payment done by NCHE programs medical and dentistry programme

Training of 20 16 6 4.6 Training done in collaboration with HEPI and curricula reviewers aimed at improving the quality of curricula reviews

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Objective 2: Compliance with professional practice standards promoted Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/R Q3&Q4 Performance (U shs Results (Q3&Q4) esults (Q3&Q4) (U shs Millions) Millions)

Facilitating CPD Facilitate 4 Facilitated 0 providers associations professional 3.02 2.49 association to conduct CPD activities

Conducting MLEB Conduct 1 Conducted 1 Exam conducted for foreign trained students. 3 Exams exam exam 3.02 2.924 out 11 passed

Training of MLEB 20 16 5.33 5.2 Training done with HEPI aiming at improving the examiners quality of examination conducted to foreign trained students. Conducting Peer Conduct 3 peer 4 assessments 16 candidates Peer reviewed. 2 failed review meetings for review sessions held 3.99 3.8 foreign trained assessments doctors

Hosting Medical 2 2 Conducted in Jinja. Dr Kivumbi Martin suspended inquiries 4.960 4.396 and Dr Namala Angella reprimanded. Dr Kamutera Gerald was de-registered for incompetence. Regional ethical 2 3 AOGU and URA sensitization 8.4 7.9 Mbale UMA branch sensitised workshops

Inspection of health Inspect 50 Inspected 17 7.7 5.8 Conducted with partners facilities in Kampala health units

Inspection of health Inspect 100 Inspected 5 Inspection done in Rugyeyo Community hospital, facilities up country facilities 11.04 3.876 Aber Hospital, Kajjansi Air Ambulance

Providing Provisional 43 0 0 Desk work Licenses to the

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Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/R Q3&Q4 Performance (U shs Results (Q3&Q4) esults (Q3&Q4) (U shs Millions) Millions)

Medical & Dental Practitioners

Providing Full 87 0 0 Desk work Registration Licenses to the Medical & Dental Practitioners

Providing Annual 4015 0 0 Desk work Practicing Licenses to the Medical & Dental Practitioners

Providing Specialist 107 0 0 Desk work Certificates to the Medical & Dental Practitioners

Providing temporary 327 0 0 Desk work Licenses to foreign trained Medical & Dental Practitioners

Providing certificate of 76 0 0 Desk work good standing to the Medical & Dental Practitioners

Providing Operating - 146 0 0 Desk work Licenses to new health facilities

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Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/R Q3&Q4 Performance (U shs Results (Q3&Q4) esults (Q3&Q4) (U shs Millions) Millions)

Providing Operating 531 0 0 Desk work Licenses to existing health facilities

Objective 3: Policy and regulatory framework promoted Output Description Quarterly Output Achievement/Results Budget Expenditure/Budget Explanation for variation/ target (Q3&Q4) Q1&Q2 Performance (U shs Results (Q3&Q4) (U shs Millions) Millions)

Production and 3 1 0 - Finalizing the UMDPC amendment Bill dissemination of and General Regulations with the regulations Solicitor General

Objective 4: UMDPC governance and management structure for efficiency and effectiveness strengthened Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/Results Q1&Q2 Performance (U shs Results (Q3&Q4) (Q3&Q4) (U shs Millions) Millions)

Procurement of Council vehicle 2 1 498.649 196.943 First vehicle was delivered. Second vehicle to be procured in this quarter. Facilitating Council Meetings 2 3 6.74 6.98 Council meeting held

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Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/Results Q1&Q2 Performance (U shs Results (Q3&Q4) (Q3&Q4) (U shs Millions) Millions)

Facilitating Finance & Administration 2 2 Committee Meetings 3.880 2.5

Facilitating Ethics & Disciplinary 5 3 5.1 3.987 Committee Meetings

Facilitating Education & Training 2 1 3 .88 Committee Meetings

Facilitating Inspection & Registration 2 0 2 .0 Committee Meetings

Facilitating Research & Quality 1 0 .8 .0 Assurance Committee Meetings

Facilitating extra ordinary meetings 5 2 0 0

Facilitating Registrars Forum Meetings 12 1 3.5 2.4 One meeting supported by UMDPC

Promote collaboration and establish 1 Discussed joint protocols on partnerships with national, regional and COVID 19 international medical and dental related bodies 4 zoom meetings - - EAST AFRICAN COMMUNITY

AFRICA REGION 7 zoom meetings -

Promote collaboration and establish 2 2 zoom meetings - - Updates on regulation within partnerships with national, regional and COVID 19 era international medical and dental related bodies INTERNATIONAL

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Output Description Quarterly Output Budget Expenditure/Budget Explanation for variation/ target Achievement/Results Q1&Q2 Performance (U shs Results (Q3&Q4) (Q3&Q4) (U shs Millions) Millions)

Enhance research policy and practices - - - - Fellowship trainings and within the council advertising meetings held

Digitize the registration and licensure 1 1 - - Launched online CPD to processes of professionals and health practitioners facilities and ensure easy accessibility

28.1 Challenges  Inadequate transport for inspection  Inadequate funding to conduct inspections 28.2 Way forward  Procurement of more vehicles is in process

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NATIONAL REFERRAL HEALTH INSTITUTIONS

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Chapter Twenty-Nine: Mulago National Referral Hospital (MNRH)

29.0 Mandate To provide super-specialized healthcare, training and conduct research in line with the requirements of the MoH. 29.1 Mission To offer state-of-the-art health services 29.2 Objectives  To increase the range and quality of super-specialized health care services thereby reducing referrals abroad.  To provide super-specialized training to health workers.  To conduct operational research in order to promote evidence-based practice.

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Table 27: Mulago NRH Q3+Q4 Performance FY 2019/20 Output Quarterly targets Achievements/Result Budget Budget Explanation for Variation description (Q3&Q4) s(Q3&Q4) Release Spent Ugx Ugx

Inpatient 125,000 inpatients 109,917 inpatients 13.01bn 15.75bn Limited space of operation due to ongoing services 625,000 patient days 698,199 patient days works in Lower Mulago. 22,500 operations 17,107 operations 5 days lengths of stay 6 days –lengths of stay Due early precautionary measures put in place by the Government to curb the spread of corona virus; a ban on public transport, public Outpatient 380,000 outpatients 350,126 outpatients 0.23bn 0.23bn gatherings etc which made it difficult for services 21,394 emergencies 15,629 emergencies patients to seek care in the last two quarters 9,000 dialysis sessions 0 dialysis sessions of the PY

Diagnostic 1,000,000 lab tests 949,149 lab tests 0.068bn 0.068bn services 32,500 Images 24,639 images

Immunization 2,500 immunizations 1,791 immunizations 0.015bn 0.015bn

Staff houses Additional (Phase 2) 100 Procured a service 0.78bn 0.78bn Financial deficits mainly due to the Covid 19 construction staff units to offer provider for a detailed pandemic accommodation of health design and architectural workers in emergency works for additional staff areas houses to be constructed.

Rehabilitation of interns and nurses hostel Opd and Completion of external General renovations of 0.02bn 0.46bn other ward works including the hospital upper rehabilitation demolition, remodeling, Mulago structures renovating and expanding of infrastructure works. Renovation and upgrading of Assessment Center Parking

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Output Quarterly targets Achievements/Result Budget Budget Explanation for Variation description (Q3&Q4) s(Q3&Q4) Release Spent Ugx Ugx

Security lighting around the hospital premises improved

29.3 Challenges  Reduction in annual private patients’ services collections mainly due to ongoing renovation works and Covid 19 pandemic that necessitated suspension of some services  Financial deficits due to Covid 19 pandemic and the hospital being one of the treatments centers

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Chapter Thirty: Mulago Specialized Women and Neonatal Hospital (MSWNH)

30.0 Mission To provide quality specialised Reproductive and Neonatal Health care to referred patients as well as enhance training and research 30.1 Objectives  To increase the range and quality of super-specialized maternal and neonatal health care services thereby reducing referrals abroad.  To conduct super-specialized training to health workers.  To conduct and promote evidence-based research to guide practice in all areas of reproductive and neonatal.

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Table 28: MSWNH Q3+Q4 Performance FY 2019/20 Output description Quarterly targets Outputs Budget release Expenditure/ Explanation for (Q3 &4) achievements/ (Q3 &4) budget variation/ results (Q3 &4) performance **results Inpatient services 2,500 in patients 2,375 inpatients 3,294,962,713 3,256,646,692 Reduction in number of Performing at 98.8%. patients in Q4 as a result 600 operations 851 operations of COVID 19. 750 deliveries 644 deliveries 300 Referrals 258 Referred patients

Outpatient services 6000 Specialised 7,859 Specialized 1,616,030,285 1,592,011,578 Increased public outpatient attendances, Outpatient Performing at 98.5%. awareness of the hospital cleaned and attendances, family services offered by the fumigated, utilities paid, planning, utilities paid, hospital. equipment maintained, hospital cleaned and generators and fumigated, equipment ambulances fueled maintained, generators and ambulances fueled Diagnostic services 1450 Images 4,312 images, 442,000,000 442,000,000 Reduction in numbers as 5,000 lab tests 3,595 lab tests Performing at 100% a result of covid 19 which saw numbers reduce. Immunization 2500 2,762 immunizations 38,000,000. 38,000,000. Increased awareness of Immunization Performing at 100% hospital services.

30.2 Challenges  Lack of budget for pension and gratuity  Insufficient funds for allowances, salary for contract staff and casual laborers.  Insufficient staff in key areas like ICU, anesthesia among others  Drop in patient numbers because of the Covid 19.

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Chapter Thirty-One: Kiruddu National Referral Hospital

31.0 Introduction Kiruddu National Referral Hospital previously a health center IV is located at Salama road on Buziga hill approximately 10km from the city center. It was constructed under the Mulago Kampala Capital City Project and it was upgraded to a referral Hospital to decongest the Count\ry’s National Referral Hospital, revitalize the referral system, and improve health services in the city. Kiruddu hospital is a 200-bed capacity hospital that opened its doors for operation in May 2016 as temporary extension that accommodated the Department of Medicine and the Burns/plastic surgery unit of Mulago National Referral Hospital. In the PY 2018/19, it started on a transition to an independent hospital with an independent interim management and staff to offer medical and surgical services. In the PY 2019/20, we successfully attained a vote with vote number 177 as an independent hospital with an independent management and staff to offer medical and surgical services 31.1 Vision A Centre of excellence in specialized healthcare, training and research in Uganda and beyond. 31.2 Mission To provide high quality patient focused health care, research and training that is readily accessible, cost effective and meets the expectations of the communities we serve. 31.2 Core values The members of staff cherish the following core values abbreviated as SERVE:  Service through teamwork- as departments, units, and individuals, we collaborate to serve our patients effectively and compassionately, each other and community.  Excellence – we are committed to achieving the highest level of excellence in patient care, discovery, and education  Respect- we foster an environment of mutual respect and trust amongst ourselves and with all whom we serve.  Value: We value what we do and our patients, and we economically utilize the resources and accountable to the population and leadership we serve.  Enthusiasm and Innovation – we seek ideas and approaches that can change the way the world discovers, teacher and heals. 31.3 Goal To reduce morbidity and mortality due to specialized health care conditions through provision of quality health care, research and training. 31.4 Strategic Objectives  To provide a higher- level specialized preventive, curative, rehabilitative and palliative health care services.  To improve institutional efficiency and effectiveness in allocation and accountability of Resources.  To strengthen the referral system and partnerships for effective health services delivery.  To conduct research for improved health services delivery.

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Table 29: Kiruddu NRH Performance Q3+Q4 FY 2019/20 Output description Annual Outputs Budget Expenditure/ Explanation for variation/ targets achievements/ release budget **results results (Q3 (Q3 & Q4) performance &Q4) Inpatients Major operations 2000 830 3,684,055,200 4,617,015,328 Major operations are above the target services because theatres for ENT/ Ophthalmology/ Maxillofacial/ Burns and Plastic surgery operations units are fully operational Specialist admissions 20,000 10,646 The admissions are above the target because currently Kiruddu is the only Internal Medicine tertiary referral site operating. Specialists outpatients’ 89,000 20,343 However, because of the Covid-19 consultations lockdown, patients attendances both for General outpatients to be 42,300 16,203 specialist clinics and general outpatients seen were affected Medicines and Quantity of medicines and 4.5Bn 333,833,821 Due to insufficient funds, a negative of Health supplies Health supplies received UGX 326,956,856 was carried forward to procured and and dispensed against plan the FY 2020/21 dispensed including Dialysis Services Diagnostic Laboratory investigations 86,600 25,233 Diagnostic services are above target Services X-ray 4,000 837 except X-ray, CT scan machines broke CT scans 3,000 482 down for the better part of Q3. Ultrasound 5,000 1349 ECG/ECHO 0 638 HIV testing 0 6036 Blood transfusion 0 3391 Hospital Assets inventory updated Assets inventory No Variation Management regularly updated and support Performance and financial HMIS data reports services reports compiled and submitted. submitted timely Management committees held monthly meetings Health talks 12 12 No Variation

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Output description Annual Outputs Budget Expenditure/ Explanation for variation/ targets achievements/ release budget **results results (Q3 (Q3 & Q4) performance &Q4) Preventive and Community engagement 4 4 rehabilitation meetings services Specialist Support 4 3 supervision Immunisation carried out 6,720 16,617 Performed well above the set targets due to good mobilization by political and Community leaders Human Pay change reports, data 261 staff on 2,392,367,382 2,444,419,375 New staff Resource captured, payslips and payroll were paid management payroll managed salaries Services Records A functional registry 1 A registry is No variation Management established established services

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Challenges and proposed solutions Challenges Recommendations 1. High utility bills especially power due to operations of the oxygen plant, dialysis Request Ministry of Finance to increase budget on utilities. machines, washing machines and diagnostic equipment

2. Shortage of assorted medical equipment for Ophthalmology, Surgical Departments, Procurement medical equipment under Retooling on annual Medical Departments. Examples include autoclaves, Refrigerators, ECG, endoscopy, basis slit lamps, operating microscope, , cardiac monitors, suction machines, nebulizers, defibrillators, ICU Beds. .

3 Limited Budget for Medicines and payment of salaries. The Budget for Medicines Increase Hospital Budget to provide for Medicines and should be increased to 10 Bn and salaries to 10 Bn to recruit specialists Recruitment of staff

Records / Biostatistics 1. A completely manual records management system Introduction of an Integrated Computerized System

Infrastructure 1. Less funding especially for utilities and maintenance of buildings, equipment, furniture, Increase budget for the Hospital and motor vehicles 2. Power fluctuation and surges that have a massively spoilt Hospital equipment namely Provide an independent power line. Installation of power Ct Scan, X-ray, Lab equipment etc stabilizers to protect machines from being affected by power surges

3. Better sanitation in the hospital Request NWSC to expedite construction of Wastewater Plant.

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Challenges Recommendations 4. Limited space for offices, wards, stores, staff quarters and isolation areas for epidemics Procurement of more land to cater for Hospital expansion like Covid-19 5. Massive storm water especially after rains running passing through the hospital Kampala Capital City Council needs to divert water so that it compound from Buziga hills that has damaged the hospital compound does not pass through the hospital

6. Lack of staff transport Procurement of a staff van Diagnostics 1 CT scan machine broke down for six (6) months Stabilise Power Supply by UMEME.

2 Shortage of reagents for laboratory equipment NMS to be consistent with Supply of Reagents and Consumables 3 Shortage of consumables for the X-ray machine, CT scan, fluoroscopy, ultrasound Budget for procurement emergency supplies machine Human Resources for Health 1. Limited number of specialist’s nurses and other critical staff available Provide budget for wage and salaries to pay specialists and another critical cadre of staff 2. 65% of the approved staff posts are not filled Recruit critical staff to fill in the gaps Pharmacy 1. Insufficient supply of essential and specialized medicines (The available budget for Increase Budget to purchase Medicines and Health supplies. medicines only procures 50% of the required medicines)

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Chapter Thirty-Two: Kawempe National Referral Hospital

32.0 Introduction The report summarizes the key output performance of the hospital for quarter one and two FY 2019/20 based on the planned work plan. 32.1 Mandate To provide quality and efficient maternal and Paediatric health care services. 32.2 Mission To provide quality specialized healthcare in Obstetrics & Gynaecology, Paediatrics and adolescent health, HIV/AIDS care and enhance research and medical training in line with the MoH Policy. 32.3 Objectives  To offer specialized Health care services in Obs/Gyn, Paediatrics & Adolescent health.  To operationalize and strengthen management systems through administrative service.  To contribute to human resource development through training, coaching & mentoring of health workers  To contribute to National Health Policy development through operational research.

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Table summary on performance for the Quarter: 3 & 4 Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results Inpatient services 6,392 Patients  27,401 Patients Increased Number of Admissions Admissions patients both referred 2.990.000.000 2.260.000.000 and self-referred  11,688 Deliveries For Caesarean sections, there was increase in cases of birth  4515 C/section complications Outpatient services 20,182 Outpatients  38,129 Outpatients seen Good service delivery seen 1.170.000.000 870.000.000 and improved client care  9,860 Antenatal visits led to an increase in the number of patients that sought for services from KNRH Diagnostic services 7,455 laboratory tests  25,679 laboratory tests More lab equipment done, and 3,514 Units done 230.000.000 130.000.000 have been placed of blood transfused  4,187 units of blood through MOH leading to transfused more investigations

 5,170 Images done Immunization services 2966 Immunizations  14,997 Immunizations Increased number of done done 660.000.000 500.000.000 clients and availability of vaccines. Prevention and 6 Outreaches on FPS  No Outreaches done Because of the lock rehabilitation services & Immunization  754 Physiotherapy patients 590.000.000 470.000.000 down due to covid19 no 720 Occupational outreaches were treated therapy patients seen conducted. 600 Physiotherapy  589 Occupational therapy For physiotherapy and patients seen patients seen occupational therapy there was an increase in the Number of patients both referred and self- referred.

And Other outputs General

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Output description Quarterly targets Outputs achievements/ Budget Expenditure/ Explanation for (Q3 &4) results (Q3 &4) release budget variation/ (Q3 &4) performance **results Hospital Management and 100% Hospital 67% Hospital support services Inadequate manpower Support Services support services provided; utilities paid, and medical 1.130.000.000 760.000.000 to handle repairs and provided; utilities paid, and non-medical equipment maintenance like and medical and non- maintained plumbers, carpenters medical equipment and also due to lock maintained down because of covid19 delayed services. Medicines and health 100% Medicines & 48% Medicines & Health supplies 390.000.000 190.000.000 Delayed submission of supplies procured and Health supplies procured invoices and payment dispensed procured process ongoing. Human Resource 340 staff paid salaries 338 staff paid salaries 10.213.000.000 10.199.000.000 Two staff not yet set up Management Services in the system Records Management 100% medical record 67% medical records supplies 30.000.000 20.000.0000 The lockdown because Services supplies provided provided of covid19 delayed the procurement process

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Challenges and proposed solutions to mitigate them.  The execution of some of the planned activities for quarter four was interrupted due to the lock down that started end March 2020 because of the Outbreak of COVID19 pandemic.  Insufficient budget for wage. The hospital has presented the request to MOFPED, public service, MOH and parliament.  No allocation for capital Development budget. The hospital has presented the request to MOFPED  Overwhelming number of patients resulting into high utility costs thereby creating Arrears in Electricity. Requesting for Arrears from MOFPED to offset the outstanding arrears.  adequate manpower with staffing level of 297 staff as opposed to Approved structure of 930 staff. The hospital has engaged MOH, public service and health service commission. The current staffing level is at 30% which is far way below the WHO required standard of 65%. This leaves a very big gap in provision of efficient and quality health care service.  Inadequate budget for Medicines and other health supplies (Required budget is 4.5 billion and allocated is 1.5 billion). The hospital has presented the request to MOFPED, MOH and parliament.  Limited space for service delivery. Plans to procure land for expansion under capital development.  High Maintenance costs due to high number of patients. Allocate more funds for maintenance

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Chapter Thirty-Three: Uganda Heart Institute

33.0 Mandate (UHI Act 2016) To undertake and coordinate the management of cardiovascular disease in Uganda. 33.1 Mission Statement To provide preventive, promotive and clinical cardiovascular services and conduct research and training in cardiovascular science 33.2 Objectives  To enhance health promotion and prevention of cardiovascular disease  To increase institutional effectiveness and efficiency in delivery of cardiovascular services  To provide quality, equitable and accessible cardiovascular services to both local and international clients.  To carry out clinical and operational research in cardiovascular disease and its management  To regulate quality of cardiovascular care in Uganda. 33.3 Key Performance Indicators Key Output Indicators Indicator Measure Planned Actuals by END 2019/20 Q2 Key Output: 01 Heart Research No. of Proposals on Heart Disease Number 10 3 No. of Publications on Heart Disease Number 10 7 Key Output: 02 Heart Care Services No. of heart operations Number 150 44 No. of Outpatients Number 25,000 10,434 No. of Thoracic and Closed Heart Operations Number 650 211 % Reduction in Referrals abroad Percentage 35% 38% Key Output: 03 Heart Outreach Services No. of outreach visits Number 13 6 No. of Public Awareness activities Number 10 3

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Table 30: Uganda Heart Institute Performance Q3+Q4 FY 2019/20 Output Quarterly targets (Q3 & Outputs achievements/ Budget Expenditure/ Explanation for description Q4) results (Q3 & Q4) release (Q3 & budget variation in Q4 UGX BN) performance performance (Q3 & Q4 UGX BN) 085801 Heart  5 research papers  1 research paper on RHD published 0.078 bn 0.090 bn No significant Research published. in peer reviewed journal. variation

 6 disease registries  6 ongoing registries ongoing.  UHI Research Ethics Committee  1 staff training session approval process ongoing. on research conducted.

085802 Heart  75 open heart and 50  24 open heart surgeries, 23 closed 3.073 bn 3.729 bn Performance was Care closed heart surgeries heart surgeries and 129 mainly affected by and 275 catheterization procedures inadequate space and the covid-19 catheterization performed. outbreak. procedures.  7,149 outpatient attendances  12,500 outpatient  4,154 ECHOs, 3,082 ECGs, 37,607 attendances. lab tests performed.  8,000 ECHOs, 7,000  49 ICU and 191 CCU admissions. ECGs, 75,000  654 general ward admissions. laboratory tests, other diagnostic services conducted.  350 ICU/CCU, 900 general ward admissions. 085803 Heart  6 support supervision  2 support supervision visits to Mbale 0.064 bn 0.107 bn Performance was Outreach visits to regional and Soroti RRHs. mainly affected by the covid-19 referral hospitals.  1 health awareness camp held at the outbreak which made Annual Judicial conference. it difficult for staff to

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Output Quarterly targets (Q3 & Outputs achievements/ Budget Expenditure/ Explanation for description Q4) results (Q3 & Q4) release (Q3 & budget variation in Q4 UGX BN) performance performance (Q3 & Q4 UGX BN)  5 health camps  TV and radio talk shows on heart travel both inland conducted. disease. and abroad.  Awareness campaigns on heart disease conducted through health talks, media, etc. 085804 Heart  UHI Board facilitated.  UHI Board facilitated. 1.586 bn 1.598 bn No significant Institute Support  UHI management and  UHI management and staff meetings variation in Services performance. staff meetings facilitated. facilitated.  Service providers contracted for  Service providers cleaning, sanitation, maintenance contracted for cleaning, services. sanitation, maintenance  UHI utilities paid. services.  UHI staff facilitated on official duty.  UHI utilities paid.  UHI staff facilitated on official duty. 085819 Human  UHI staff salaries and  UHI staff salaries and pension paid. 4.315 bn 4.890 bn No significant Resource pension paid.  Staff facilitated to attend capacity variation Management  UHI staff facilitated to building workshops, seminars, and Services attend training in conferences. specialty areas.  Interviews conducted.  UHI staff facilitated to  UHI staff facilitated to attend attend capacity building capacity building workshops and workshops and seminars. seminars.  Staff Professional Fee paid.  Staff Professional fees paid.

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Output Quarterly targets (Q3 & Outputs achievements/ Budget Expenditure/ Explanation for description Q4) results (Q3 & Q4) release (Q3 & budget variation in Q4 UGX BN) performance performance (Q3 & Q4 UGX BN) 1121 Uganda Government Buildings and Heart Institute Administrative Infrastructure Infrastructure:  Renovation works of ICU at Block 0 bn 2.450 bn Awaiting completion Project  ICU at Ward 1C, 1C, Mulago Complex ongoing. certificates to make Mulago complex payments. 0.470 0.285 bn completed.  1 anaesthesia back up machine

Purchase of Specialised procured. Machinery & Equipment: 0 bn 0.046  1 anaesthesia back up machine procured.  12 computers procured. Purchase of Office and ICT Equipment, including Software  15 computers procured.

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Challenges:  Inadequate space for UHI services  Inadequate funding to procure certain super specialized sundries/supplies  Covid-19 outbreak also affected performance of UHI Solutions:  Parliament to allocate the additional UGX 5.0 Billion (parliamentary resolution, 14th February 2018).  ROKO to speed up renovating the 12-bed ICU.  Expedite process of identifying a potential funder for constructing and equipping the UHI Home.

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Chapter Thirty-Four: Uganda Cancer Institute (UCI)

34.0 Background Uganda Cancer Institute (UCI) is a Government Agency established by an Act of Parliament, The Uganda Cancer Institute Act, 2016. UCI was formally opened in 1967 to treat children with Burkitt’s lymphoma and to-date over forty (40) types of cancers are handled annually. The Institute offers a range of specialized services which include but are not limited to: medical oncology, palliative care, cancer screening services, specialized oncology pharmaceuticals, hematology, laboratory services, imaging services, rehabilitation, social worker services, and training services among others. 34.1 Mandate The institute is mandated to undertake and coordinate the management of cancer and cancer-related diseases in Uganda. The UCI is critical to the evolution of a National Centre of Excellence, providing specialized treatment and care for all types of cancer using all the available subspecialty expertise possible, as well as engineering oncology-centered research and training. 34.2 Functions of UCI As a body corporate, The UCI Act, 2016 provides for the functions of the institute as:  To develop policy on the prevention, diagnosis and treatment for cancers and on the care for patients with cancer and cancer-related diseases, and to coordinate the implementation of the policy  To undertake and coordinate the prevention and treatment of cancers in Uganda  To provide comprehensive medical care services to patients affected with cancer and cancer related diseases  To provide palliative care and rehabilitation services to patients with cancer  To oversee the management of cancer and cancer related services in public and private health centers

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 To establish and manage regional cancer units  To conduct or coordinate cancer related research activities in Uganda and outside Uganda  To conduct or cause to be conducted training in oncology and related fields  To promote and provide public education on cancer and cancer related matters  To procure highly specialized medicines, medical supplies, and equipment for the institute  To provide consultancy services 34.3 Overview of Vote Expenditures

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34.4 Summary on Performance based on the Key Performance Indicators of the UCI Programme Outcome Indicators Indicator Measure Planned 2019/20 Actuals By END Q4 % reduction in cancer incidence Percentage 0.02% 0.02% % change in disease presentation (from stage III & IV to II & I) Percentage 3% 3%

% of patients under effective treatment Percentage 60% 71.7% Key Output Indicators Indicator Measure Planned 2019/20 Actuals By END Q4 Number of cancer research studies initiated Number 20 22 Number of peer reviewed publications and presentations Number 25 21 Number of training workshops conducted by UCI Number 4 3 Number of inpatient stays Number 40000 54,387 No. of investigations undertaken Number 650,000 657,847 Number of outpatient visits Number 50,000 68658 Number of new cancer patients registered Number 5,000 5,352 Number of outreach visits conducted Number 32 30 Number of clients examined Number 61,600 140,363

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Table 31: UCI Q3+Q4 Performance FY 2019/20 Annual planned outputs Annual cumulative outputs Reason for Deviation 4 REC monitoring reviews, CAB meetings and 3 REC monitoring review were carried out. No CAB training meetings carried out meetings and training meetings were carried out. 20 Collaborative research studies initiated 19 Collaborative research studies (2MUJHU, 12 Fred Hutch and 2Cambridge) were initiated at the UCI. 30 UCI staff supported UCI staff to present at 21 UCI staff were supported to present at International No staff were supported to present in International Conferences and Research fora Conferences and Research for a. Q4 due to travel suspensions arising out of of Covid-19 restrictions 12 REC meetings held 16 REC meetings were held UCI UCI International Conference on Cancer International Conference on Cancer was held in Serena hotel Conduct 12 community outreaches and support 8 community outreaches and support trainings at the Outreaches were suspended in Q4 due trainings at the Mayuge Community Cancer Mayuge Community Cancer Research Center were to Covid-19 restrictions Research Centre conducted.

Support 15 student-initiated research proposals at 23 student-initiated research proposals were supported. the UCI 48 research proposals reviewed by UCI REC 42 research proposals were reviewed UCI Research Ethic No research proposals were rviewed in Committee throughout the year. Q4 because UNCST had suspended all researches in March Eight (8) UCI initiated research projects supported Seven (7) UCI initiated studies were supported Four (4) Support visits to Mayuge Community Five (5) Support visits to Mayuge Community cancer cancer research center conducted research center was conducted 5 clinical trials initiated at the UCI Three (3) clinical trials (Mirasol trial, Rituximab trial and Clinical trials were suspended in Q4 by Aspire Clinical Trial) were initiated at the UCI UNCST due to Covid-19

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33.2 Cancer Care Annual planned outputs Q2 actual outputs Reason for Deviation 500 new patient cases received and attended to at UCI 582 new patient cases were received and attended to at satellite clinics UCI satellite clinics Dispense 60,000 prescriptions to patients at UCI 297,537 prescriptions were dispensed to patients Participate in the world records and information Staff in the records dept. participated in the world records conference and information conference 1,000 histo-pathology examinations carried out 2,554 histo-pathology examinations were conducted. 1,500 cytology examinations carried out 1,429 cytology examinations were conducted 1,500 minor surgical procedures carried at UCI 1,331 minor surgical procedures were carried out at UCI 200 major surgical procedures carried out at UCI 212 major surgical procedures were carried out at UCI 500 Lumbar Punctures carried out at UCI 526 lumbar punctures were carried out 3,000 CT scans conducted at UCI 1,626 CT scans were conducted. Equipment failure from Oct - Nov-2019 and the lengthy festive season which limited number of patients to the dep't

350,000 assorted clinical laboratory investigations (CBCs, 657,857 assorted clinical laboratory investigations (CBCs, chemistries, Blood transfusion, platelets transfusions, HIV chemistries, Blood transfusion, platelets transfusions, HIV tests, Urine analysis, Bone marrow processing, Peripheral tests, Urine analysis, Bone marrow processing, Peripheral films, B/S for malaria, cytology, Microbiology) conducted films, B/S for malaria, cytology, Microbiology) were at UCI conducted at UCI

480 health education sessions conducted with groups of 452 health education sessions were conducted with groups cancer patients and caregivers of cancer patients and caregivers 4 audio visual clips to be disseminated to patients for The audio-visual clips were produced. They are yet to be patient education designed approved by the communication committee before dissemination to patients 60,000 prescriptions dispensed to patients 297,537 prescriptions were dispensed to patients 10,000 X-rays performed at UCI 7,158 X-Rays were performed 144 diagnostic mammography procedures performed 0 diagnostic mammography procedures were performed. The expected equipment were not received 150 Gynae Operations performed at UCI 70 gynae operations were performed at UCI 200 bone marrow procedures performed at UCI 340 bone marrow procedures were performed

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Annual planned outputs Q2 actual outputs Reason for Deviation 200 CT interventions performed 0 CT interventions were performed The were no CT interventions performed due to equipment failure 3,600 mammography screening investigations performed 130 mammography screening investigations were performed 300 ultrasound interventions performed at UCI 156 ultrasound interventions were performed Lack of adequate supplies like biopsy needles and sundries like linen 400 Bone marrow Procedures performed at UCI 340 bone marrow procedures were performed 7,000 ultrasound scans performed at UCI 5,867 ultrasound scans were performed 105,000 meals prepared and served for general inpatients 105,983 meals were prepared and served for general inpatients 1,000 patient days of psychosocial assessment and 2,051 patient days of psycho-social assessment and support support provided were provided 10,000 inpatient days of comprehensive oncology clinical 9,793 inpatient days of comprehensive oncology clinical care provided at UCI satellite clinics care were provided at UCI satellite clinics 15,000 outpatient days of comprehensive oncology clinical 15,982 outpatient days of comprehensive oncology clinical care provided at UCI satellite clinics care were provided at UCI satellite clinics 3,500 days of physiotherapy sessions provided to patients 3,643 days of physiotherapy sessions were provided to patients 40,000 inpatient days of comprehensive oncology clinical 44,594 inpatient days of comprehensive oncology clinical care provided at UCI care provided at UCI 48,000 outpatient days of comprehensive oncology clinical 52,766 outpatient days of comprehensive oncology clinical care at UCI care were provided at UCI 5,000 new patient cases received and attended to at UCI 4,770 (Females: 2,699. Males:2,071) new patient cases received and attended to at UCI 60,000 for infusion reconstituted at UCI pharmacy 69,557 chemo for infusion was reconstituted at the UCI pharmacy 5,000 new patient files retrieved and availed to the clinical 4,770 new patient files were retrieved and availed to the team for patient documentation. clinical team for patient documentation.

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33.3 Cancer Outreach Semi-Annual planned outputs Q2 actual outputs Reason for Deviation 24 Short distance cancer awareness & screening in 22 short distance outreaches were conducted throughout the year. Communities conducted Total screened: 26,306Males: 14,632 Females: 11,674. There were no short distance outreaches conducted in Q4 due to covid- 19Restrictions. 260 cancer awareness and screening clinics at UCI 277 cancer awareness and screening clinics were conducted. Total conducted people screened: 45,419(M: 15,419 F: 27,021 Children: 3,346) Eight (8) Long distance outreaches conducted Eight (8) long distance outreaches were conducted in Luwero, arua, Bugiri, Kabale, Buikwe, Kazo and Mityana districts. Total people educated: 11,005 (Males: 4,262 Females: 6,743). Total people screened: 3,085 (Males: 582. Females: 2,503) There were no long- distance outreaches conducted in Q4 due to covid-19 Restrictions Six (6) cancer survivor-ship sessions to groups of cancer Conducted six (6) cancer survivor-ship sessions as follows; Kabila survivors conducted Country Club on 30/8/2019, Kampala golf club Kitante Road on 4/10/2019Uganda Cancer Society Uganda Cancer Institute board room on 10/10/2019, CCCP screening clinic on 9/12/2019, Golf Course hotel on 10/2/ 2020, Golden Tulip Hotel on 3/3/2020 Six (6) TV and twelve (12) Radio talk shows conducted Conducted four (4) TV shows (UBC TV) and eleven (11) radio talk- shows. (UBC West, Q-FM Lira, radio North Alebtong, 3 on Top Radio, Pacis FM Arua, 4 on Namirembe FM)

Four (4) research projects in cancer prevention, early Five (5) research projects were initiated detection, community cancer care initiated 1. Breast Cancer Early Detection and Diagnostic Capacity in Uganda 2. Breast cancer care in Uganda: A multi-center study on the frequency of breast cancer surgery in relation to the incidence of breast cancer 3. Socio-culturally mediated factors and lower level of education are the main influencers of functional cervical cancer literacy among women in Mayuge, Eastern Uganda 4. Mobile cancer preventive and early detection clinic in Uganda: Working with local communities as partners towards bridging the cancer health disparity 5. Cancer Risk Studies and Priority Areas for Cancer Risk Appraisal in Uganda. Sensitization sessions for stakeholders in cancer control Conducted 8 sensitization sessions in 7 Districts (Kabarole 17/7/2019, made in 6 districts Kyejonjo -18/7/2019 and Kyegegwa -19/7/2019, Kamuli 9/9/2019,

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Semi-Annual planned outputs Q2 actual outputs Reason for Deviation Kiruhura - 10/9/2019, Kaliro 10/9/2019, Luuka 11/9/2029 and Mukono 25/9/2019 10,000 Fliers/Leaflets/Brochures, 12,000 Brochures, 750 posters and 750CDs and 20 flash discs audio- visual on cancer produced and distributed to the public Twenty-four (24) district health teams trained/oriented 24 district health teams of 126 members in total on cancer health on the national cancer health education and risk education, risk reduction, cancer screening/early detection and proper reduction, cancer screening and early detection and referral. The trainings were held on;31st Aug. and 1st of Sep. in Mbale cancer referral for 5 district teams.11th and 12th September in Mbarara for 6 district teams.14th and 15th Aug. 2019 in Arua for 4 district teams.28th and 29th September in Gulu for 6district teams. Iganga, Mayuge and Luwero districts for one (1) team each

33.4 Radiotherapy Semi-Annual planned outputs Q2 actual outputs Reason for Deviation 2,000 patients planned for radiation therapy using CT- 1,806 patients were planned for radiation therapy using CT- Simulator, Conventional simulator and computer planning simulator, convention simulator and computer planning 2,000 new patients attended to 1,723 new patients were attended to 2,400 brachytherapy insertions conducted per yr 274 brachytherapy insertions were conducted 35,000 treatment sessions conducted on cobalt 60 machine 34,449 treatment sessions were conducted on cobalt 60 machine 1,000 compensators and immobilization devices constructed 214 compensators and immobilization devices were constructed 4,160 patients who completed treatment followed up 4,742 patients who completed treatment were followed up Radiotherapy equipment maintenance and service done twice Radiotherapy equipment was maintained and serviced during the quarter. Terabalt 80 was serviced four times (2 times internal and external) BII serviced once and the simulator serviced once.

Radiation leakage monitoring around the bunker conducted Radiation leakage monitoring around the bunker was conducted once 260 radiation therapy education sessions provided to patients 254 radiation therapy education sessions were provided to patients Staff thermo-luminescent dosimeters (TLDs) read 12 times a Staff thermos-luminescent dosimeters (TLDs) were read four year times in the year 2,000 on treatment patients reviewed 2,487 on-treatment patients were reviewed

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Uganda Cancer Institute Project Semi-Annual planned outputs Q2 actual outputs Reason for Deviation Complete 100% civil works construction of the Funds were front-loaded in Q2 and interim certificates were paid. Radiotherapy Bunkers and installation of the LINAC Cobalt-60machine was installed and commissioned, Internal finishes machine 90% done; Placement of drainage pipes done. Finalization of mechanical third fix (installation of fire detection and fighting system, installation of patient units and accessories), all external works finalized. Finalization of electrical third fix (installation of fittings and switches, finalization of procurement for capital equipment, transformers, panels & generators). Bunker No. 1 was handed over and installation of the LINAC commenced (installation and commissioning will take 4 months)

Complete 85% civil works construction of the Funds were front-loaded in Q2 and interim certificates were paid. Civil service support building for the radiotherapy works: 100% done Internal finishes 95% done; Finalization of mechanical bunkers and nuclear medicine. third fix (installation of fire detection and fighting system, installation of patient wc units and accessories), all external works finalized. Finalization of electrical third fix (installation of fittings and switches, finalization of procurement for capital equipment transformers, panels & generators). Protective fence for CCCP building erected Contract for erecting the protective fence was awarded. CCP building was furnished. UCI UMEME meters separated from Mulago NRH Payment for separating UMEME meters was made under LPO 1227 meters Complete payment for fencing the land for the Payment for fencing the land for the Regional Cancer Center in Regional Cancer Center in Mbarara Mbarara was made Regional Centers refurbished OPD toilets and 6- The center in Jinja was refurbished. Works executed on the theatre level building trenches renovated and staff house in JRRH. Funds were however insufficient to undertake works in Arua, thus pushed to FY 2020/21OPD toilets could not be renovated in isolation due to their linkage to the STC line. All the toilets had to be comprehensively repaired together with those of STC. However, the quotation was above the budget due to the incorporation of the toilets at STC. This activity was thus comprehensively planned for FY 2020/21.

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ADB Support to UCI Semi-Annual planned outputs Q2 actual outputs Reason for Deviation Project coordination. Selected students trained As of 15th May 2020, the project had a total number of 187 long-term trainees (Masters, PhD, Fellowships). As of 15th May 2020, 103 trainees have completed long-term training programs. These include eighteen (18) fellows in different programs including Pediatric Hematology and Oncology, Adult medical Oncology and Hematology, surgical oncology, gynecologic ± Oncology and 1 in interventional radiology, 25 MMEDs (Radiology, surgery, internal medicine, pathology, anesthesia and pediatrics), 1Radio pharmaceutics, 17 other masters, and 42 other programsThe advert for the fellowship program intake for the year 2020/21 was made in February 2020. Applications are currently being received. Dates have been revised because of the ongoing COVID-19 lock-down and social disruption. Weekly PCU meetings were held, later suspended due to Covid-19 towards the end of the PY.The project enrolled 10 fellows in the three established fellowship programs. A total of six fellows were offered admission including 1 in pediatric Oncology, three in Gynecologic-Oncology and two in the Adult Medical Oncology program Complete construction of the Multipurpose Cast levels 1-5 of block A of the building. First fix for electrical The major cause of delay has been the building for the East Africa Center of and mechanical works up to level 05 for block A. Block work disruptions in mobilisation of labour Excellence in Oncology. Handover of the and plastering for block A up to level 04. All earthworks and materials for construction Building by June 2020 finalized Advance procurement of all capital electrical and especially in the months of April and mechanical equipment done to 65%. External works are at May due to Covid-19 restrictions, The 30%progressCast level 6 of Block ACast grade slab of level 2 contractor has intermittently exhibited Block B signs of cash flow stress, which has resulted into the reduced mobilisation of all inputs. Covid-19 restrictions in manufacturing countries for major capital equipment hindered the realization of the procurement targets for capital equipment. Unfortunately, this is still ongoing.

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Specialized machinery and equipment The Contract for the supply of the Magnetic Resonance Imaging (Automated blood culture analyzer, automated (MRI) scanner was signed on the 1st November 2019. The discrete, chemistry immunoassay analyzer, request for 20% advance payment to the supplier was affected automated heamatology analyzer, by the Bank in March 2020. However, the supplier is still electrophoresis machine, flowcytometer, awaiting site readiness to deliver and install the equipmentThe coagulation analyzer, tissue processor, rotary Bank gave a No Objection for the ICT Equipment and microtone, Routine histochemistry, centrifuge, telemedicine Evaluation Report on the 10th of January 2020 and water bath, digital weighing scale, freezer, two a Best Evaluated Bidder Notice was published on 13th of microscopes integrated with advanced January 2020 to 24th of January 2020. The contract was cleared cameras, cryostat-double compressor, slide by the Solicitor General and signed on 19th February 2020 and storage and block storage, microscope multi a request for 20% advance payment was sent to the Bank. An head and regular, UV interpreter, Anaesthesia inception meeting with the supplier and all key stakeholders was held on 7th May 2020The Contract for the supply of the Magnetic Resonance Imaging (MRI) scanner was signed on the 1st November 2019. The request for 20% advance payment to the supplier was affected by the Bank in March 2020. However, the supplier is still awaiting site readiness to deliver and install the equipmentThe Bank gave a No Objection for the ICT Equipment and telemedicine Evaluation Report on the 10th of January 2020 and a Best Evaluated Bidder Notice was published on 13th of January 2020 to 24th of January 2020. The contract was cleared by the Solicitor General and signed on 19th February 2020 and a request for 20% advance payment was sent to the Bank. An inception meeting with the supplier and all key stakeholders was held on 7th May 2020

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Institutional Support to Uganda Cancer Institute Semi-Annual planned outputs Q3 actual outputs Reason for Deviation Network connection for both data and voice for the Network connection for both data and voice for the fabricated fabricated CCCP building CCCP building was completed

Network and infrastructure on 6-level building repaired Network and infrastructure on 6-level building were repaired and and installed. installed 16 Desktop computers, 5 laptops, 1 heavy duty printer 16 Desktop computers, 5 laptops, 1 heavy duty printer and 1 and 1 colored printer procured. coloured printer were procured and delivered.

25 Oxygen regulators, 5 oxygen regulators for anesthetic The contract for the assorted medical equipment was amended to machine. 30 bedside screens, 20 deliver in FY 2020/21 because of the impact of Covid-19. glucometers, adjustable examination beds, 50 digital Manufacturers closed due to Covid-19 hence the equipment clinical thermometers procured. 4 ordinary microscopes, couldn't be delivered. platelet agitator, microtone, Ecri medical equipment procured. Mammography machine and its printer, diathermy for theatre, 20 Ambu bags, nebulizer, 10 portable pulse oximeters, 5 wall mounted diagnostic sets, oxygen keys, 10 Suction machines procured

Challenges The construction of the multipurpose building was behind schedule, attributed to NEMA's revised directives to have transportation of mass excavated material done only at night thereby slowing down works at the beginning of the financial and also Covid-19 pandemic towards the end of the PY. There were disruptions in mobilization of labor and materials for construction especially in the months of April and May due to Covid-19 restrictions. The contractor also intermittently exhibited signs of cash flow stress, which resulted into the reduced mobilization of all inputs. Covid-19 restrictions in manufacturing countries for major capital equipment hindered the realization of the procurement targets for capital equipment both for the procurement under ADB Support to UCI and the Institutional support to UCI.

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Chapter Thirty-Five: Naguru Regional Referral Hospital

35.0 Introduction Naguru Referral Hospital is a referral hospital located within Nakawa Division, Kampala District. The hospital was constructed by the Peoples’ Republic of China and donated to the Government of the Republic of Uganda on 6th January 2012 The Hospital has an official bed capacity of 100 beds upgraded from what was initially referred to as the Naguru Health Centre IV. With this upgrade, the hospital’s infrastructure, equipment and human resource was aligned to that of the Regional Referral Hospital status in Uganda as mandated in the National Hospital policy of 2006. On 12th June 2018, Cabinet approved the hospital as a National Hospital for Tertiary Trauma, Emergency and Orthopaedic services. Naguru referral hospital is evolving to take on new roles in consonance with the MoH strategy to form specialised metropolitan public hospitals of Kampala 35.1 Vision To be a center of excellence at providing Trauma specialized, specialised and general health services in the central region and beyond. 35.2 Mission To contribute to the reduction of morbidity and mortality in the catchment area, through provision of quality Emergency and Trauma Health Care services, research, training and collaboration. 35.3 Strategic Objectives  To provide quality health care services  To strengthen health services research  To conduct training of health workers and students  To strengthen the supportive role to other health facilities in the region  To strengthen hospital partnerships  To build a healthy, productive and motivated workforce

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Summary Hospital Operations / Nonwage expenditure Output description Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for variation/ results (Q3 &4) release budget **results (Q3 &4) performance 16048 Admissions 16048 Admissions 0.32 0.29 There was an overall 26% reduction in admissions in Inpatient services 102% Bed Occupancy Rate (BOR) 102% Bed Occupancy Rate (BOR) 0.43 0.43 the 4th quarter. i.e. Inpatients admissions in Maternity 4 Average Length of Stay (ALOS) 4 Average Length of Stay (ALOS) reduced by 15%, Paediatrics reduced by 55%, Surgery 5763 Major Operations (including 5763 Major Operations (including reduced by 18% and Medical reduced 43%. The Caesarean section) Caesarean section) reason could have been attributed to difficulty of patients accessing the hospital and fear of COVID 19. Outpatient services 123443 Specialized Clinic 123443 Specialized Clinic Attendances 0.07 0.07 Quarter 4 had increased referral to the hospital for Attendances 659 Referrals cases in 0.098 0.098 Maternal and child services because patients were 659 Referrals cases in 78440 Total general outpatients’ sure of being attended to. 78440 Total general outpatients’ attendance There was a 24% slight increase of attendance in attendance General OPD and 50% reduction of attendance mainly from specialized clinics of Medical, Paediatrics and Gynaecology. The reason could have been difficulty of patients accessing the hospital and fear of COVID 19. Diagnostic services 3487 X-rays Examinations 3487 X-rays Examinations 0.06 0.05 The quarter had a 50% reduction in performance for 9933 Ultrasound scans 9933 Ultrasound scans 0.076 0.076 X-Ray with a major reason of limited supply of x-ray 249 CT Scans 249 CT Scans films by NMS. This hindered service delivery of plain 113588 Laboratory tests including 113588 Laboratory tests including x-ray imaging for general patients. In addition, Dental blood transfusions of 181 were blood transfusions of 181 were X-ray unit was not utilised because it lacked Pathology diagnostics services Pathology diagnostics services protective shields. There was a 53% reduction in number of ultrasound because of continued lack of Computerised Radiology imaging systems. The CT scan was not operational because very old and the spare parts and Technicians could not be accessed from China. Hospital Management Assets register updates was 80% Assets register updates was 80% 0.25 0.24 Most of the planned activities were achieved but and support services complete. The process was still complete. The process was still 0.317574 0.317574 there was disruption to attend to the urgencies ongoing by end of the Quarter. ongoing by end of the Quarter. related to COVID-19. User training on some equipment User training on some equipment with with support from the Chinese support from the Chinese technical technical team was done. team was done.

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Output description Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for variation/ results (Q3 &4) release budget **results (Q3 &4) performance Quarterly reports were submitted as Quarterly reports were submitted as planned through (PBS, IFMIS, HMIS, planned through (PBS, IFMIS, HMIS, DHIS2 among others). DHIS2 among others).

Prevention and 31812 Antenatal cases (all attendees) 31812 Antenatal cases (all attendees) 0.04 0.03 The Quarter had reduction in attendances from rehabilitation services 35936 Children immunized (all 35936 Children immunized (all 0.047044 0.47044 previous quarter attendances of 50% in ANC all immunizations) immunizations) attendees, 50% in immunisation services attendances, 3673 Family Planning users attended 3673 Family Planning users attended to 22% in Family Planning and 46% in ANC all visits. to (new & old) (new & old) The reason could have been attributed difficulty of 10707 ANC Visits (all visits) 10707 ANC Visits (all visits) patients accessing the hospital and fear of COVID 25% HIV positive pregnant women on 25% HIV positive pregnant women on 19. HAART receiving ARVs for EMCT HAART receiving ARVs for EMCT during pregnancy during pregnancy

Immunisation Services 65731 Childhood Vaccinations given 65731 Childhood Vaccinations given 0.00101 0.00101 The Increased number of vaccinations by 45% in the 0.0044 0.0044 quarter could have been attributed to other facilities closing during the COVID 19 lockdown. However 49% Vaccination dropout rate could have been attributed to difficulty in accessibility to health facility and closing of other health facilities to complete the doses.

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Output description Quarterly targets (Q3 &4) Outputs achievements/ Budget Expenditure/ Explanation for variation/ results (Q3 &4) release budget **results (Q3 &4) performance Human Resource Human Resource supported Held department performance review 5.38 4.62 Due to COVID 19 the hospital could not hold the Management Services departments on performance meetings for 1st, 2nd and 3rd & 4th 6.13 6.13 performance review meetings for third quarter due review meetings for the quarter as quarter was submitted online. to observance of SOP for COVID-19, but was well as Ongoing staff appraisal subsequently held together with Qtr 4 process and performance Began the process of staff appraisal and agreements. performance agreement review for the Staff were guided on reorganising year 2019/2020. duty Rotas for COVID 19 management. Took the lead in reorganising the staff duty Rotas for management of COVID Gratuity to 6 retired and staff 19 Patients. salaries by 28th of every month were paid. Gratuity to 6 retired and staff salaries by 28th of every month were paid. Organised staff training and learning through Peng cloud, Webinar and Organised training and learning Zoom on COVID 19 with hospitals through Peng cloud, Webinar and and those in China. Staff were Zoom on COVID 19 management trained on management of with hospitals in the country and in emergency medical services and China. Staff were trained on ambulance services by MOH. management of emergency medical services and ambulance services by MOH. Hospital conducted training on Continuous Quality Improvement (CQI) Kaizen Records Management Daily update of reports were done Daily update of reports were done in 0.0005 0.0005 Due to COVID 19 there was delay from the Services in HMIS registers. Medical report HMIS registers. Medical report 0.002 0.002 departments to submit QTR3 reports on time. submission was done through the submission was done through the DHIS2 system. IICS system was not DHIS2 system. functional in the quarter. This IICS system was not functional in the resulted into higher recording of quarter. This resulted into higher clients using paper because the recording of clients using paper process was quicker. because the process was quicker.

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Summary Hospital capital development Output Quarterly targets utpts achievements/ Budget Expenditure/ Explanation for variation/ description (Q3 &4) results (Q3 &4) release budget **results (Q3 &4) performance staff house Planned activity to be Planned activity was accomplished There was an achievement to most of the construction accomplished for the for the staff house construction 0.6 0.6 planned activities by end of the quarter. staff house

Perimeter wall at construction Planned activity for the quarter, construction of Staff residence Planned activity for the quarter for wall fence was accomplished

construction of wall fence 0.1 0.1 Master plan and completed. pre-feasibility The delay in time for delivery of master plan Master plan and pre- study report was because of the various inquiries and feasibility study for the Master plan and pre-feasibility was 0.2 0.2 consultations done during the pre-feasibility hospital Trauma centre awaiting final report by the end of study. at completion stage by the quarter. the end of the quarter. ICT equipment & ICT items delivered ICT items were all delivered and 0.055562 0.055562 There was delay in delivery of ICT items services and verified. verified. These were mainly however there was achievement to most of the computers, laptops, small ICT parts planned activities by end of the quarter. Strategic Plan for repair. development Strategic Plan process The delay in time for delivery of strategic plan Strategic Plan process began and to be ongoing by the 0.049973 0.049973 report was because of the various inquiries and was at semi-final report by the end end of the quarter consultations done during the preparation. of the quarter Key spare parts Medical Equipment's Planned activities for medical 0.050000 0.050000 Most of the planned activities were achieved. for major and some of the spares equipment purchase and purchase of However, difficult in acquiring the spares for diagnostic for repair to be spares for some equipment were repair of diagnostic equipment from China in the equipment delivered. achieved by the end of the year. quarter.

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Challenges, Variances and proposed solutions Quarter 4 ended with unspent total balance of Ug shs 6,430,646/= (Allowances 118,826/=; Vehicle maintenance 411,820/= and Medical Waste collection 5,900,000/=). The reason being a repeat payment process was ongoing by the end of the PY when the IFMIS stopped. Q4 Wage was not released. However the balances from the previous quarters together with partial release were able to pay April and May and eventually June salaries. The major challenge in Obs & Gyn was lack of Magnesium sulphate. It was not delivered by NMS. Theatre lights and operation beds were faulty, for the spares were not readily available locally. Q4 ANC attendance number reduced compared to the previous three quarters due to patients finding difficulty in accessing the health facility during the lock down and the morbid fear of COVID 19. As a result, Caesarean section rate was high in the quarter due to late referrals from the lower facilities and maternal death rate increased. The department could not hold meetings in April which are always very important for patient’s management. Ophthalmology department still lack an operating microscope to enable offer of specialized ophthalmology services. Patients were referred to Mulago for specialized services due to lack of eye scan, lack of ward space and lack of operating microscope. The Community Health eMTCT services for testing was almost suspended and Babies’ eMTCT tests PCR could not be done in April and May because there was no regular transport to work for some of the staff, and the patients were few. The number women in ANC increased in June month. Outreach activities were affected by regulations and directives on lock down for gathering communities. The hospital Infection control practice was hindered during the quarter because of inadequate supplies. However, later support came in from MOH. The hospital received an increased number of referrals. However, in June the number reduced because the surrounding private facilities were opening from the easing of the lockdown. The Nutrition services lacks a ward for managing the severe nutrition cases, the severe forms were therefore referred to Mulago Mwanamujimu unit. The Paediatrics unit meetings as well as Hospital ward rounds were reduced due to the absence of SOPs on COVID 19 and absence of staff on duty due to lock down. The department had reduced patient attendance in OPD by 50% and admissions by 55%. Under Support services, documentations from lower facilities referrals were incomplete as a result it was time consuming at point of receiving patients. The catchment area for hospital services was still not determined since there are other health facilities in the region such as Kawempe and Kiruddu Hospitals. The hospital continued not to have an equipment maintenance Workshop budget. The water pipes in the hospital are rusting and require major overhaul. The Oxygen plant had mechanical faults that required the contractor from Turkey to maintain it. In future there will be urgent need to pipe oxygen to the ICU wards for both COVID 19 patients and other critical patients. The Human Resource related services experienced high expenses for staff transport to and fro home and hospital. In accordance with the MoH guidelines, Hardship allowance was limited to a few working on COVID 19 cases. This demotivated other hospital staff. The Staff managing the COVID 19 lacked accommodation. The Chinese Medical drugs and sundries as budgeted in the Off-budget support were not delivered because of the NDA regulations that bar importation of medicines not on the national list. In turn, Chinese Medical Team and hospital ordered from China, small medical equipment’s and medical supplies in exchange of the value of medicines and supplies that would have been donated.

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Chapter Thirty-Six: Entebbe Regional Referral Hospital

36.0 Mission To provide the highest possible level of specialized health services to all people of Central Southern Region including Entebbe International Airport, VIP Areas and Lake Victoria Islands. 36.1 Mandate To have a reconstructed referral hospital with a multi skilled, motivated staff, facilities and equipment that suit National and International standards. 36.2 Strategic Objective  To provide comprehensive specialized curative, promotive, preventive and rehabilitative health care services  To provide specialized outreach support supervision services for District lower Health Facilities  To provide tertiary and continuing Professional Development to health care workers  To contribute to the designing of policies and guidelines of the MoH  To participate in the monitoring and evaluation of health services in the country  To undertake and conduct operational, technical and professional research  To provide quality assurance and support services to health care delivery system

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Table 32: Summary of performance for Q3 &Q4 Output description Quarterly targets (Q3) Outputs Budget Expenditure/ budget Explanation for achievements/ release performance variation/ results (Q3) (Q3) **results Inpatient Services 1800specialist admissions made, 85% 2300 admissions made, 85% 0.08/= billion 0.08/= billion Improved specialized & bed occupancy rate 7days average bed occupancy rate, 4days diagnostic services length of stay average length of stay. Outpatient services 4400 Specialized and General 52,044 Specialized Outpatient 0.04/= Billion 0.04/= Billion Improved specialized & outpatient consultations made Consultations made; 93,487 Diagnostic services. General outpatient consultations made Medicines and health 100% of the specialized health supplies 75% of the specialized health 0.11/= Billion 0.10/= Billion Some medicines and supplies procured and procured and dispensed supplies procured and other specialized dispensed dispensed supplies are not available at NMS. There is limited credit medicine allocation Output description Quarterly targets Outputs Budget Expenditure/ budget Explanation for (Q4) achievements/ release performance variation/ results (Q4) (Q4) **results Inpatient Services 1800specialist 1500 admissions made, 80% 0.11/= Billion 0.11/= Billion Reduced specialized & admissions made, 85% bed occupancy rate, 4days diagnostic services bed occupancy rate average length of 7days average length of stay Outpatient services 4400 Specialized and 22,000 Specialized outpatient 0.06/= Billion 0.06/= Billion Improved specialized & General outpatient Consultations made; 25,000 Diagnostic services as consultations made General outpatient health workers are Consultations made. constantly trained and equipped with skills. Medicines and health supplies procured 100% of the specialized 85% of the specialized health 0.15/= Billion 0.14/= Billion There is limited credit and dispensed health supplies supplies procured and medicine allocation. procured and dispensed dispensed. Some medicines and other specialized supplies are not available at NMS

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36.3 Challenges  Entebbe hospital has inadequate resources both financial and manpower, space and staff accommodation, overwhelming work load, continuous stock out of medicines and sundries due volume of patients served against limited budgetary allocation.  There is need for general structural up lift of the hospital main stores and inpatient wards  The hospital staff established structure is limited and requires urgent review.  The hospital has no Medical Equipment Maintenance Workshop and experiences frequent equipment break down due to poor maintenance, lack of routine servicing and user training associated with high repair costs  The hospital has limited staff accommodation with only about 2% of the staff accommodated. Rentals are awfully expensive and therefore staffs stay far away from the hospital. This affects retention, duty coverage and attendance to emergency and other cases.  Inadequate funding despite the big mandate. Outputs are much higher compared to the set targets.  Cost of services provided is not well explained to the consumers. Guidance has not been provided.  Lack of additional funding to expand and meet the increasing demand for specialized service delivery.  Some positions are not filled despite having the budget provision for the wage bill.  There are unfilled vacant positions that are pending clearance from the HSC. 36.4 Proposed solutions.  Expedite filling the vacant positions.  Expedite the recruitment process by HSC before the funding is lost at the end of the FY.  Additional funding requirement should be included in the budget for 2020/21 FY as unfunded priority.  Funding gap should be included in the work-plan as unfunded priority and lobby for additional funding.  Organise stakeholder engagement regarding the new fees structure

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Chapter Thirty-Seven: Butabika National Referral Hospital

37.0 Mission Statement . To offer super specialized and general mental health services, conduct mental health training, carry out mental health related research and provide support to mental health care services in the country for economic development 37.1 Key Objectives  To provide super specialized, curative and rehabilitative mental health services in the country.  To undertake and support mental health related research.  To carry out and support training in mental health.  To provide outreach services in mental health and support supervision to Kampala district and Regional Referral Hospitals.  To provide general health Outpatient services to the neighbouring population.  To provide advice to Government on mental health related policies.  To advocate for mental health in the country 37.2 Planned Activities for FY 2019/2020  Provision of inpatient Mental Health care (review and diagnosis, investigations, provision of food, medicines, dressing and beddings etc.)  Provision of Mental Health and General Outpatients care.  Community Outreach Clinics  Technical support supervision to Regional Referral Hospitals.  Resettlement of Patients  Conduct Mental Health related research  Training of Health Workers and Students in Mental Health Care.  Maintenance of infrastructure and grounds  Equipping of ADU  Construction of Staff houses  Procurement of MRI machine  Extension of Radiology unit  Expansion of Female Admission ward  Construction of phase one perimeter wall  Procurement of assorted furniture.

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BUDGET PERFORMANCE FY 2019/2020: (JULY 2019 TO JUNE 2020)

DESCRIPTION APPROVED RELEASES PERF EXPENDITURE PERF. % UNSPENT VARIATION BUDGET % RELEASE

WAGE 5,699,926,000 100% 5,322,910,696 93.3% 347,015,304 Attributed to unpaid 5,699,926,000 salaries of staff that were not recruited incomplete procurements. NON-WAGE 6,752,313,000 6,752,313,000 100% 6,732,208,018 99.7% 20,104,982 No variation PENSION 372,695,000 372,695,000 100% 372,553,498 100% 141,502 No significant variation GRATUITY 450,974,400 450,974,400 100% 135,128,840 30% 315,845,560 Some files had not been validated by MoPS. DEVELOPMENT 8,308,141,000 8,308,141,000 100% 8,178,989,104 98.4% 129,151,896 Some construction work affected by the Covid-19 pandemic. TOTAL 21,580,380,000 21,580,380,000 100% 20,741,790,156 96.1% 838,589,844

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Table 33: The performance – Q 3 &Q 4 FY 2019/2020 Quarterly Target Outputs Budget Expenditures Variances (Q 3 & Q4) Achievements Releases (Q 3 & Q4) (Q 3 & Q4) ADMINISTRATION AND MANAGEMENT Staff paid salaries and allowances All staff paid salaries and allowances. 2,836,899,421 2,724,812,453 Attributed to unpaid salaries of staff that were not recruited incomplete procurements. 2 Hospital Management board meetings 2 Management board meetings held 2,079,834,841 2,300,246,249 Fewer meeting held due to the 6 Senior Management meetings 4 Senior Management meetings held. Covid-19 pandemic. Staff medical expenses paid Staff medical expenses Utilities paid paid Hospital infrastructure and grounds Utilities were paid maintained. Hospital infrastructure and grounds Vehicles, machinery, and equipment maintained. maintained Vehicles, machinery, and equipment were maintained.

MENTAL HEALTH INPATIENT SERVICES 4,675 patients admitted 3,188 patients admitted 1,540,574,080 1,564,758,835 Fewer admissions because of 15,400 Laboratory investigations done. 11,879 laboratory tests conducted Covid-19 pandemic in an effort 1,375 X-ray investigations conducted. 329 X-ray investigations conducted to reduce crowding. 1,100 Ultrasound conducted. 499 ultrasound investigations conducted 157,000 inpatients days 78,500 inpatient days 149% bed occupancy rate 138 bed occupancy rates 780 patients rehabilitated 936 patients rehabilitated 4,250 patients provided with 3 meals, All 3,188 inpatients provided with uniforms uniforms and beddings. and beddings. LONG TERM PLANNING FOR MENTAL HEALTH Mental Health Research conducted. . Research on Pattern of workplace 18,502,000 18,500,678 No variation (2 Short term research undertakings) violence experienced by health workers and intervention used at mental health units in Uganda was completed . Research on Knowledge, attitude, practices and coping strategies of medical

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Quarterly Target Outputs Budget Expenditures Variances (Q 3 & Q4) Achievements Releases (Q 3 & Q4) (Q 3 & Q4) staff of Butabika Hospital towards Vocid- 19 is ongoing. SPECIALISED OUTPATIENT AND PHC SERVICES 14,696 patients attended to in the Mental 15,386 patients attended 51,836,080 57,536,910 A spike in numbers in mental Health clinic health OPD clinics.

2,465 patients attended to in the Child 2,929 patients attended to in the Child Mental Health Clinic Mental Health Clinic

441 patients attended to in the Alcohol and Drug Clinic 135 patients attended to in the Alcohol and Unit was closed in the 4th Drug Clinic Quarter due to Covid-19 22,000 Medical (general, Dental, Orthopedic, Family planning, HIV/AIDS, General outpatients’ clinics were TB, STD, Eye clinic, Trauma unit 14,494 Medical (general, Dental, closed and some patients could Theatre/minor) outpatients attended to Orthopedic, Family planning, HIV/AIDS, TB, not travel to the Hospital STD, Eye clinic, Trauma unit because of the lockdown due to Theatre/minor) outpatients attended to Covid-19

COMMUNITY MENTAL HEALTH SERVICES 30 outreach clinics conducted in the areas 24 outreach clinics conducted in the areas 68,303,000 74,858,308 Variance is due to funds released of Nkokonjeru, Nansana, Kitetika, of Nkokonjeru, Nansana, Kitetika, in 1st & 2nd quarters. Kawempe Katalemwa and Kitebi Kawempe Katalemwa and Kitebi

1,760 patients seen in the clinics 2,872 patients seen in the clinics

12 visits to regional referral hospitals 8 visits to regional referral hospitals mental mental health units health units. Visited Mubende, Moroto, Lira, Mbarara, Arua, Soroti, Hoima and Fewer long training visits done to Masaka. improve support supervision quality. 374 patients resettled within 450 patients resettled Kampala/Wakiso.

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Quarterly Target Outputs Budget Expenditures Variances (Q 3 & Q4) Achievements Releases (Q 3 & Q4) (Q 3 & Q4)

Limited travel due to Covid-19.

IMMUNISATION SERVICES 500 Children immunized 481immunized 5,000,000 5,000,000 No significant variation.

HUMAN RESOURCE 1. Management of payroll 1. Managed the payroll 10,000,000 10,000,000 No Variation 2. Developing a wage bill and retirement 2. Developed a wage bill and retirement plan plan 3. Management of pension and gratuity 3. Managed pension and gratuity 4. Management of reward and sanction 4. Managed of reward and sanction 5. Supporting performance and 5. Supported performance management management of staff of staff RECORDS MANAGEMENT 1. Conducting internal medical records 1. Conducted research and assisted 2,500,000 2,500,000 No Variation systems audit researchers 2. Sensitization and training 2. Conserved and preserved medical 3. Manage records and assist users records 4. Compile statistical reports 3. Managed records and assisted users 5. Updating data on PBS 4. Updated data on PBS 6. Managing leave 5. Managed leave

CAPITAL DEVELOPMENT Construction of the Boundary wall Construction of the Boundary wall ongoing. 754,256,232 2,694,744,643 The variance of Shs. 1,940,488,411 were funds released in quarter one and two. Expansion of the Female Admission ward. Construction of Female Admission ward Nil 698,339,331 Funds were released in Quarter ongoing. one. Completion of 6 Units staff houses Houses completed and handed over Nil 200,000,000 Funds were released in Quarter one. Expansion of the Radiology Unit Construction of the Radiology Unit Nil 248,536,669 Spent funds were released in ongoing. quarter one.

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Quarterly Target Outputs Budget Expenditures Variances (Q 3 & Q4) Achievements Releases (Q 3 & Q4) (Q 3 & Q4) Procurement of MRI Machine Opened a letter of credit with Bank of 3,500,000,000 3,502,848,522 No significant variation Uganda. Supply of Office Office furniture delivered Nil 108,119,800 Spent funds were released in furniture Quarter one Supply and delivery of medical furniture Medical furniture delivered Nil 261,000,000 Funds were released in quarter two. Procurement of Assorted Medical Assorted medical equipment supplied. Nil 99,514,000 Funds were released in quarter equipment two.

36.2 CHALLENGES:  Performance was generally affected by the Covid 19 pandemic.  Inadequate funds on most items.  Excessive number of patients upto 142% bed occupancy leading to overcrowding.  High rate of destruction due to the nature of the patients.  Limited space for admission and need for expansion.  Land encroachment.

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Annexes

Annex I: Programme Programme for Performance Review of Implementation of MoH Work-Plan for the Third & Fourth Quarters, 2019/20 Fy (January to June 2020): 6th to 8th October 2020

TIME DEPARTMENT/INSTITUTION PRESENTER CHAIRPERSON DAY 1: TUESDAY 6TH OCTOBER 2020 8.00 - 9.00 am REGISTRATION SECRETARIES: SCAPP- D 9.00 - 9.10 am WORKSHOP OBJECTIVES DGHS 9.10 - 9:25 am FINANCE & ADMINISTRATION - Administration US (F&A) - Internal Audit DGHS - Accounts - Procurement 9:25 – 9:40 am HUMAN RESOURCES MANAGEMENT C-HRM

9.40 – 9:55 am STANDARDS COMPLIANCE CHS (SCAPP) ACCREDITATION AND PATIENT PROTECTION (SCAPP) 9.55 -10.45 am DISCUSSION ALL 10.45 -11.20 am Opening Remarks Hon. MOH 11.20-11.50 am TEA BREAK 11.50 – 12:05 pm HEALTH MONITORING UNIT (HMU) Dir. HMU Hon MOSH GD

12:05 -12.20 pm HEALTH SECTOR PARTNERS & MULTI- C-HPMC SECTORAL COORDINATION 12.20 -12:40 pm HEALTH SECTOR PLANNING FINANCING & POLICY CHS (HPFP) - Planning Division - Budget and Finance - Health Information & Technology - PAU 12:40- 12:55 pm COMMUNITY HEALTH CHS CHD - VECTOR CONTROL - VPH - DISABILITY & REHABILITATION 12.55– 1.30 pm DISCUSSION All 01.30- 2.30pm LUNCH BREAK 2.30 – 2.45 pm REPRODUCTIVE AND CHILD HEALTH CHS RCH 2. 45 – 3.00pm HEALTH EDUCATION PROMOTION & Ag.C-PE&C COMMUNICATION DHS CS 3.00 - 3.15pm ENVIRONMENTAL HEALTH CHS (E) 3.15 - 3.30 pm INTEGRATED EPIDEMIOLOGY & CHS IES SURVEILLANCE 3.30 - 3.45 pm COMMUNICABLE DISEASES CHS Comm. Diseases 3.45 - 4.15 pm DISCUSSION All 4.15 - 4.30pm NON-COMMUNICABLE DISEASE Ag. CHS (NCP&C) PREVENTION AND CONTROL (NCDP) 4.30 - 4.45 pm CLINICAL SERVICES CHS CS 4.45- 5.00 pm NATIONAL LABORATORY AND Ag. CHS NLDS DIAGNOSTIC SERVICES 5.00– 5.30 pm DISCUSSION All 5:30 PM EVENING TEA & DEPARTURE

DAY 2: WEDNESDAY, 7TH OCTOBER 2020 259

TIME DEPARTMENT/INSTITUTION PRESENTER CHAIRPERSON 9.00 - 9.15 am NURSING CHS N 9.15 - 9.30 am EMERGENCE MEDICAL SERVICES CHS EMS Hon MOSH PHC 9. 30 – 9.45am UGANDA BLOOD TRANSFUSION Ext. Dir UBTS SERVICES (UBTS) 9:45– 10:00 am HEALTH INFRASTRUCTURE Ag. CHS HID 10:10– 10:40am DISCUSSION All 10:40 -11:10am TEA BREAK 11.10 – 11.25am PHARMACY AND NATURAL MEDICINES CHS-HIS Chair HSC 11.25 – 11.40 am National Medical Stores (NMS) Manager NMS 11.40 – 11.55 am NATIONAL DRUG AUTHORITY (NDA) Director UBTS RESEARCH INSTITUTIONS 11:55 am– 12: 10 pm UNHRO E/Director 12:10– 12:25pm UVRI E/Director 12:25– 1:00 pm DISCUSSION All 1:00 – 2.00 pm LUNCH BREAK 2:00 – 2:15pm NCRL E/Director NATIONAL REFERRAL HOSPITALS 2: 15 – 2:30pm UGANDA HEART INSTITUTE (UHI) E/Director 2.30 – 2.45 pm UGANDA CANCER INSTITUTE (UCI) E/Director 2.45 - 3.00 pm MULAGO HOSPITAL E/Director 3.00 -3-15pm BUTABIKA HOSPITAL E/Director 4:15 – 4:30pm MULAGO WOMEN’S HOSPITAL Ag. ED 4.30 - 5.00pm DISCUSSION All 5:00 pm DEPARTURE DAY 3: THURSDAY, 8TH OCTOBER 2020 9.00 - 9:15 am KAWEMPE HD 9.15 - 9:30 am NAGURU HD DHS HG/R 9.30 - 9:45 am KIRUDDU HD 9.45 - 10:00 am ENTEBBE HD 10.00 - 10:15 am HEALTH SERVICE COMMISSION Chair HSC HEALTH PROFESSIONAL COUNCILS 10:15 - 10:30 am UGANDA MEDICAL & DENTAL REGISTRAR PRACTITIONERS COUNCIL 10.30 - 11.15 am DISCUSSION All 11.15 - 11.45 am BREAK TEA 11:45- 12:00 MD UGANDA NURSES & MIDWIVES REGISTRAR COUNCIL 12:00- 12:15 pm ALLIED HEALTH PROFESSIONALS REGISTRAR COUNCIL 12:15- 1:00 pm PHARMACY BOARD REGISTRAR 1.00 -1.30 pm DISCUSSION All 1.30 - 2. 30 pm LUNCH 2.30am- 4.00pm Wrap up: PS  Summary of cross cutting issues & way forward for Third and Fourth Quarters  Closure by the PS 4. 00 pm DEPARTURE

Rapporteurs 1. Dr. Joseph Okware DHS GR Chair-person 2. Dr. Martin Ssendyona Ag. CHS /SCAPP-D Secretary

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TIME DEPARTMENT/INSTITUTION PRESENTER CHAIRPERSON 3. Dr. Aggrey Batesaaki ACHS Compliance and Member Inspection/SCAPP-D 4. Dr. Miriam Nakayima SMO. SCAPP-D Member 5. Dr. Turyasiima Munanura SMO. SCAPP-D Member 6. Charles Okurut Senior Economist SCAPP- Member D 7. Dr. Alex Kakala QI Advisor SCAPP-D Member 8. Dr. Julius Amumpe QI Advisor SCAPP-D Member 9. Dr. Benson Tumwesigye QI Advisor SCAPP-D Member 10. Dr. Betty Atai QI Advisor SCAPP-D Member 11. Dr. Juliet Tumwikirize QI Advisor SCAPP-D Member 12. Dr. Elizabeth Namagala QI Advisor SCAPP-D Member 13. Mr. Eriya Kategaya IT Member 14. Susan Nakawungu Secretariat Member

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Annex II: Reporting Format: Reporting Format: Quarter 3 and 4 FY 2019/20 1. Introduction: The MoH is required to conduct quarterly performance review meeting to report on progress made in implementing MoH work-plan during the FY. The performance review meeting for the 3rd and 4th quarters 2019/20 FY (January to June 2020) is scheduled to take place from 6th to 8th October 2020.

2. Reporting format: The report should highlight the following:  Brief overview of the Department, Programme, Institution, (i.e. Mission, mandate and objectives, etc.)  Progress on cross-cutting issues from the last MoH review (Quarter 1+ Quarter 2)  Summary on performance based on the key performance indicators of the unit (as extracted from DHIS2)  Table summary on performance for the Quarter:

Output Quarterly Outputs Budget Expenditure/ Explanation description targets achievements/ release budget for variation/ (Q3 &4) results (Q3 &4) (Q3 &4) performance **results

NB: **Results refers to the outcome of the intervention in the short or long term depending on the available evidence. This may be explained separately outside the matrix table.  Challenges and proposed solutions to mitigate them.

NB: The submission made by Departments, Programmes/Institutions is for preparing a consolidated narrative MoH review report for the 3rd and 4th quarters which is supposed to be ready before the review meeting. The format for presentation (which is power point) during the actual review meeting shall be shared with you later on.

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Annex III: Attendance for the MoH performance review for the first and second quarters 2019/20 FY (July to December 2019) No. Name Org. Title Telephone Email

1 Hon. Aceng Jane Ruth MoH Minister of 772664690 [email protected] Health

2 Hon. Joyce Moriku Kaducu MoH MOSH-PHC 772623407 [email protected]

3 Hon. Nabbanja Robinah MoH MOSH-GD 772664662 [email protected]

4 Dr. Diana Atwine MoH PS 775324462 [email protected]

5 Dr. Henry G. Mwebesa MoH Ag. DG 772221291 [email protected]

6 Dr. Olaro. Charles MoH DHS CS 772516363 [email protected] 7 Dr. Okware Joseph MoH CHS. SCA&PP 772405094 8 Felicitas Ojwang UNACON 772627491

9 Emmanuel Aiyebyoona MoH SPRO 779220588 [email protected]

10 Dr. Pius Okong HSC Chairperson 772982903 [email protected]

11 Abirahmi Kananathan MoH Commis 753751202 [email protected] Officer

12 Tugaineyo Amanda MoH Commu Intern 703428466 [email protected]

13 Dr. Ajambo Miriam MoH SMO 774939491 [email protected]

14 Agnes Chandia Baku MoH SPNO 772886201 [email protected]

15 Matwale Kayiwa Gabriel MoH Sen. 772487431 [email protected] Entomologist

16 Munganga Maria Gorret MoH Nursing 704773835 [email protected] Officer

17 Prudence Beinamaryo MoH SHE 789548930 [email protected]

18 Dr. Ssenyonjo Godfrey MoH SMO 772497728 [email protected]

19 Nagayi Agnes MoH Sen. Stat, 783414113 [email protected] SCA&PP

20 Dr. Byakika Sarah MoH MoH 772423358 [email protected]

21 Dr. Jackson Amone MoH CHS-CS 782828848 [email protected]

22 Dr. Waniaye Nambohe MoH CHS-EMS 772503598 [email protected]

23 Dr. Julian Nabatanzi NMU Dep. Director 773161781 [email protected]

24 Dr. Bahatungire R. Rony MoH SMO(CS) 782192488 [email protected]

25 Okuna Neville. O MoH CHS PNM 772619895 [email protected]

26 Dr. Upenytho George MoH CHS-CH 772564798 [email protected] 27 Mpiima Patrick AHPC Registrar 772503126

28 Nyamutale Peter Allied Dep. Registrar 772406631 [email protected] Health

29 Chandiru Fiona Nursing Nursing 772606074 [email protected] Dep Officer

30 Timothy Musila HSP&MSC ACHS (psc) 701410323 [email protected]

31 Aciro Joyce Nursing Nursing 7745587500 [email protected] Dep Officer

32 Bako Emilly Atriia Nursing SNO 772692777 [email protected] Dep

33 Olum Samson MoH ACHRM 779344569 [email protected]

34 Jimmy Ogwal MoH Biostat 772352905 [email protected]

35 Dr. Alfred Mubangizi MoH Ag. ACHI- 772686842 [email protected] NTD

36 Maria Nkalubo MoH POO 755378085 [email protected]

37 Patrick Tusiime MoH CHS/ CDC 772406672 [email protected]

38 Dr. Bwire Godfrey MoH PMO 758805784 [email protected]

39 Paul Mbaka MoH Ag. ACHS- 755850171 [email protected] DHI

40 Walimbwa Aliyi MoH SHP 72947241 [email protected]

41 Jacqueline Bagaaya MoH SPO 705000242 [email protected] Rwabajungu

42 Majwals Robert NT&P Epidemologist 783317499 [email protected] 43 Federika Maroin MoH ODI FELLON 700662303 federica.mang un @gmail.com 263

No. Name Org. Title Telephone Email

44 Dr. Martin Ssendyona MoH PMO 772413686 [email protected]

45 Dr. Joshua Musinguzi MoH ACHS AIDS 414340874 [email protected]

46 Doka Moses MoH SIS 772182905 [email protected]

47 Akena Stephen Abwoye MoH Biostat 773321985 [email protected]

48 Samuel Sejjaaka MAT Facilitator 757745765 [email protected] ABACUS

49 Dr. Juliet Nabbanja MoH PDS 757485681 [email protected]

50 Dr. Katumba Ssentongo UMDPC Registrar 772412710 [email protected]

51 Mubangizi Andrew MoH POT 772683961 [email protected]

52 Dr. Isaac Kadowa MoH Ass. Com 772468777 [email protected]

53 Dr. Kakala Alex MoH SQIA 772643655 [email protected]

54 Dr. Sebisubi Fred MoH Pr. Ph. ACHS- 750740967 [email protected] Pharm

55 Tom Aliti MoH ACHS/ P 772574789 [email protected]

56 Mugarura Crhis ACHS/ P 772428404 [email protected]

57 Driwale Alfred MoH PM-UNEPI 772515222 [email protected]

58 Dr. Jesca Nsungwa Sabiiti MoH CHS 772509063 [email protected]

59 Dr. Namagala Elizabeth MoH QIA 772490150 [email protected]

60 Dr. Kusiima Odeth MoH SMO 775282184 [email protected]

61 Dr. Richard Mwesigwa UNFPA National 772670282 [email protected] Coordinator

62 Okurut Charles MoH Sen. Health 782640413 [email protected] Econ

63 Mugenyi Arthur 700900434 [email protected]

64 Richard Kabanda MoH Ag. 773961965 [email protected] Commissioner HPE 65 Abiola Abubakah MoH SBCC 781659974 moh-sbccofficer@@gmail.com

66 Dr. Jesca Nsungwa Sabiiti MoH CHS 772509063 [email protected]

67 DR. Juliet Nakku MoH DED 772469678 [email protected]

68 Dick Muhwezi MoH Grants Coordi 772770488 [email protected]

69 Chimwemu Msuyacurs UNICEF Health 753741327 [email protected] Specialist

70 Rita Atugonza MoH SMO 776180360 [email protected]

71 Julian Kyomuhangi MoH CHS 772429336 [email protected]

72 Areke James Stephen HSC S/Econ 782093119 [email protected]

73 Okia Bosco MoH PHI 772863963 [email protected]

74 Dr. Ssali Charles MoH SAS 757115850 [email protected]

75 Dr. Mutumba Robert MoH PMO 782456411 [email protected] 76 Dr. Dorothy Kyeyune UBTB Director 772425293 directorubtb.go.ug Byabakama

77 Irene Mwenyango MoH PMO 772487327 [email protected]

78 Dr. Dinah Nakyanda B MoH ACHS-ADSH 702677192 [email protected]

79 Dr. Hafsa Lukwata S MoH Ag. ACHS- 781033393 [email protected] MCH

80 Dr. Mugabe Frank MoH PMO 772431418 [email protected]

81 Dr. Gerald Mutungi MoH Ag. CHS- 772401429 [email protected] NCDS

82 Dr. Peter Wambi MoH SHP PFP 777086021 [email protected]

83 Expeditus Ahimbisibwe MoH PHE 772700094 [email protected]

84 Airshi Tasei JICA Leader 789936298 [email protected]

85 Naoki Take JICA Expert 5S-CQI [email protected]

86 Dr. Juliet Tumwikirize MoH QIA 772853878 [email protected]

87 Dr. Tumwesigye Benson MoH SQIA 702269676 [email protected]

88 Racheal Beyagira MoH MOSG 786479344 [email protected]

89 Dr. Susan Nabidd MoH CHS/ NHIDS 772435995 [email protected] CGP

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No. Name Org. Title Telephone Email

90 Mugalu Kamya UHSS HRH Team 772980696 [email protected] leader

91 Bakisese B. John MoH SHP 702527918 [email protected] 92 Dr. Nakinsige Anne MoH PE 772558926 nakinige2yahoo.co.uk

93 Ilakut Angelah MoH Ag. Reg 782836159 [email protected]

94 Sarah Ngalambi MoH 77242922 [email protected]

95 Namusoke Samalie MoH P. Nutritionist 772491557 [email protected] 96 Dr. Doreen Ruth Akuno MoH JRRH 774760663 [email protected]

97 Dr. Nkurunziza Edward MoH HD JRRH 772412498 [email protected]

98 Betty Atai - Ngabirano MoH, SIA -SCAPP 772420987 [email protected] SPARK

99 Evarist Ahimbisibwe MoH Ag. US 781871190 [email protected]

100 Dr. Julius Amumpe MoH QIA 773717636 [email protected]

101 Dr. Ronald Miria Ocaatre MoH PCO 772515112 [email protected]

102 Dr. Damian Rumzanna MoH Epidemologist 784762166 [email protected]

103 Samson Kironde UHSS COP 772705719 [email protected]

104 Dr. Nekemiah Katusiime Kawempe Ag. ED 772557057 [email protected] NRH

105 Thomas Maria USAID - DCOP 772866833 [email protected] UHSS

106 Seru Morris MoH Ag. 772570869 [email protected] 107 Dr. Ebony Ouinto MoH Met Spe 772625898 108 Kigudde Ivan MoH PA-PS 783333943

109 Dr. Makanga Livingstone MoH ACHS (P&I) 754692999 [email protected]

110 Turyahabwe Stavia MoH ACHS 773783932 [email protected]

111 Kalyebi Peter MoH PEHO 772459098 [email protected]

112 Dr. Solome Nampewo MoH SMO/TA 772524060 [email protected]

113 Dr. Fred Nsubuga MoH SMO 786376737 [email protected]

114 Joshua Musasizi MoH STA/ PSP 781029898 [email protected] 115 Tabley Bakyayita MoH Ag. ACHS 772521288 [email protected] (HP&E)

116 Kategaya Eriya MoH VISO 704223183 [email protected]

117 Eng. George Otim MoH Ag. CHS/ HI 772459779 [email protected]

118 Dr. Batiibwe Ep INFH HD 772435040 [email protected]

119 Dr. Kenneth Kalai MoH SMO 7740444773 [email protected]

120 Chris Mugarura MoH ACP 772428404 [email protected] 121 Omega Jotham MNRH Hosp Admin 7772834247 [email protected]

122 Dr. Jacson Orem UCI ED 782320543 [email protected]

123 Birikire Elisha AHPC 772855898 [email protected]

265