HEALTHseptember 2o17/ issue no. 3 NEWSLETTER

Health Issues With this quartely health the Private-not-for-profit project In this issue: newsletter the Belgian and Support to development of Development Agency (BTC) and Human Resources. > Result based financing the Ministry of Health of The Ministry of Health will use want to reach out to health this platform to communicate on > News from Ministry workers all over Uganda and health issues. The newsletter of Health of Uganda health policy makers on both the will also give a voice to health national and district level. workers and will keep you > ICB II and PNFP updates updated on the implementation You will be updated on the of the new result-based > Interviews with nurses development of our Institutional financing system. Capacity Building project, on

THE BELGIAN BTC UGANDA DEVELOPMENT COOPERATION THE REPUBLIC OF UGANDA Ministry of Health Result based financing: Belgium govt allocates Shs 3.5 billion for rural health centers in West Nile

By Felix Okello not want to attend both ante-natal and West Nile press deliveries in health units. A patient from Atido village in Erussi Sub-county, Oliver Kintho, said: “When I . The Belgium government has came here, I was made to pay Shs 2,000 THE FUNDS allocated Shillings 3.5 billion to 23 health although the total bill could be Shs 5,000 centers, under the PNFP project. For the Adjumani 133 million because I was told that there is reduced ICB II project, there is an extra 2.6B UGX Moyo 92 million cost now of health. The high costs of allocated in West Nile and hospitals to health care had scared away many rural ensure increased patient attendance and Yumbe 131 million poor to resort to herbs or come when offering of quality health care to patients Koboko 46 million their condition is at the verge of death.” in the period of 2017/18 Financial Year. Maracha 511 million The Belgian government is funding the During the Health Sector Review Meeting Nebbi 1 billion health centers in West Nile and Rwenzori for West Nile that ended recently, the Arua 852 million regions after thorough assessment BTC National Technical Assistant, Mwaka Zombo 684 million and verification of the beneficiary Agoba, said: “Through this funding, we health centers. The Assistant Chief want to ensure that the quality health Administrative Officer for Arua, Martin care for the rural community who are Andua, said: “Many of the health centers poor improve. The money will also enable “When I came here, I was made to pay especially in rural areas are limping. the poor patients to pay half or less than Shs 2,000 although the total bill could be They have virtually become hard to reach what they used to because we subsidize Shs 5,000 because I was told that there is areas. We need to have robust programs the health centers to offer the services.” reduced cost now of health. The high costs to revive the centers and curb the theft He said through the Result Based of health care had scared away many of drugs because it affects the quality of Financing, the focus is to ensure that rural poor to resort to herbs or come health care.” there is improvement in maternal and when their condition is now worse at the child health where some mothers still do verge of death.”

2 HEALTH newsletter Update from Ministry of Health of Uganda Uganda renews commitment to better breastfeeding practices as the world marks breastfeeding week 2017 As part of the week-long activities to By Vivian Serwanjja commemorate World Breastfeeding & Abirahmi Kananathan Week, over fifty cultural leaders from 17 cultural institutions in Uganda pledged ganda joined the rest of the 98% their commitment and support to World to commemorate World encourage mothers to breastfeed their UBreastfeeding Week under the The percentage number of infants are initiated children. theme “Sustaining Breastfeeding Week to breastfeeding within the first one hour of life. Together for a Healthy Nation”, an annual However, only 66% of infants are exclusively According to the Uganda Demographic event that takes place between August 1 breastfed for the first six months of life and 32% Health Survey 2016, 98% of infants are and August 7. are mixed fed while 2% are not breastfed at all. initiated to breastfeeding within the first one hour of life. However, only 66% of During the commemoration event, this year’s theme, workplace feeding infants are exclusively breastfed for the State Minister for Primary Health Care, first six months of life and 32% are mixed Dr. Joyce Moriku Kaducu underscored policies should be put in place and breastfeeding facilities introduced at fed while 2% are not breastfed at all. Government efforts in surpassing the Currently, there are numerous myths Global targets of at least 50% of infants workplaces. A senior pediatrician at Mulago Hospital, surrounding breastfeeding among several exclusively breastfeeding. She, however cultures. This prompted cultural leaders noted that mothers need adequate Dr. Jolly Nankunda advised mothers against initiating babies on infant formula. to join in the campaign to sensitize support to allow them breast feed their their subjects on the importance of babies up to two years. “Infant formula unlike breast milk does not have protective factors that help the breastfeeding. “Men, I challenge you to support women child’s body to fight the diseases” she said. This meeting provided a platform for to enable them successfully breastfeed. the leaders to present myths from their Provide mothers with more space and “The only situation where a mother respective traditions and regions on time to feed their babies, by taking up breastfeeding. Clarence Bwambale, household activities during feeding time” can avoid breastfeeding is when she is suffering from a disease such as cancer spokesperson for the Obusinga bwa Hon. Kaducu urged. She added that men Rwenzururu said that women going need to support women in attending at and is on chemotherapy” Dr. Nankunda stated. She said that HIV-positive through their monthly menstruation period least four antenatal care (ANC) visits are considered unhealthy and therefore during pregnancy and provide nutrient mothers are advised to exclusively breastfeed their babies as both mother not supposed to breastfeed their babies rich foods for the breastfeeding mother. as the milk is considered to be bad. Cecilia De Bustos, Nutrition Specialist at and baby are on treatment, hence reducing the risk of infection. Samalie Namukose, Principal Nutritionist UNICEF noted that in order to achieve at Ministry of Health expressed shock upon learning some of the myths. She also took the opportunity to caution mothers against initiating their babies on formula earlier than recommended. “Manufacturers of baby foods are taking advantage of mothers by claiming that formula foods are better than breastmilk and this is highly misleading” she said. “I urge all cultural leaders to sensitize and encourage your subjects to breastfeed their babies exclusively for six months” Namukose said.

Breastfeeding contributes to healthy growth and development, protecting children during their critical first two years and later in life. It benefits the economies, lowers health care costs and ultimately boosts productivity for the nation. 3 HEALTH newsletter PNFP Update II (ICB II). This will enable every By Dora Anek focus from its start on sustainability, with supported PNFP and public health facility & Hannes De Meyer a broader strategic approach (health (79), districts (16) and other planning financing mechanisms) and maintained stakeholders to develop, update and mong key achieved, on-going and in the 2 pilot regions in 16 districts. implement their own specific long term planned activities of the PNFP Strategic Plan (2018-2023) and Annual Aproject are: Capacity building process in strategic Work Plan. planning •Training of hospital board management A majority of health facilities have •Supporting the finalization of the draft The Ministry of Health (MoH) in problems with planning, financial for implementation plan for the PPPH collaboration with BTC and the districts budgeting and long-term vision. Almost Strategy. (15) in the Rwenzori and West Nile none of them (especially HCIII) have •Conduct review meetings with DHT and region embarked on a capacity building a long term strategic plan, lack a facilities on verification and reporting. process in strategic planning of health comprehensive one or this plan is not •Training of Newly qualified (accredited) facilities and districts in July 2017. implemented. A strategic plan with PNFP facilities in RBF and Business This one-year programme is part of financial budgeting can be a key tool Plan development. the Private-non-for profit (PNFP) and to guide an organisation in its long- Institutional Capacity Building Project term growth, autonomy and quality As a pilot for the RBF financing, it improvement. becomes important to note that an effective RBF requires effective data This strategic planning process management (data mining), which is comprises 6 step-by-step sessions. Each maybe the most difficult part of the session is organised every 8 weeks, system. It is foreseen that from the during a period of 1 year. Each session wealth of data that RBF will provide, will focus on a specific topic of the long- key performance indicators will be term strategic plan. identified. This will provide evidence of successes and weaknesses that will The first two sessions of the strategic enable to constantly improve the system planning process were organised in the health sector.The achievement of together with the MoH. 79 health both PNFP and ICB II projects will be facilities, 16 districts and 15 other complemented after closure by the new organisations attended these first two project “Support to Strategic Purchasing sessions comprising of more than 400 of Health Services in Uganda” which will participants.

4 HEALTH newsletter ICB II Update

By Dora Anek The need for an adapted procedure file system, Integrated Information for medicine management under RBF System for Health or IIS4H, which CB II project is glad to was identified and its development and has been agreed upon with the MOH, announce the commencement approval by the MoH is complete. Resource Centre should boost quality Iof the Results Based Financing care. (RBF) this July 2017. Key ICB II project activities •Medicine management training was planned and on-going: done in May 2017 so that the staff could Ministry of Health (MoH) and BTC signed •The finalisation of the MoH own e-patient be oriented in medicine management to grants with BLG which was immediately avoid stock outs during implementation. followed by performance agreements Participants were drawn from all the 29 signed between 15 district Local facilities and mainly those involved in Governments and 29 Health Facilities in The need for an adapted medicine management. The participants the Rwenzori and West Nile region. procedure for medicine included Medical superintendents, in- management under RBF was charges of HC IVs and HC IIIs. Others Maternal and Child Health remains the were nursing officers, midwives and main focus of the MoH and receive a identified and its development and health information assistants. preferential treatment in the set-up of approval by the MoH is complete. •Mentorship programme for continuous RBF. training from regional hospital specialist which started in July 2017 and on-going. •Installation of telemedicine facilities between the Regional Referral Hospitals and the districts. •The project successfully held a regional Joint Review Mission which took place in the two regions of West Nile (30th – 31st August) and Rwenzori region (5th – 6th September). The mission brings together the district leadership and implementing partners to discuss best health practices in the regions. • Financial trainings were held in Rwenzori and West Nile reagion in July 2017. • It is planned that staff from districts can go to the RRH for specific inservice training. • Out reaches of specialists to HC IV and general hospitals have started. 5 HEALTH newsletter in an Interview with nurse Lodonga

separating the waste. The total patient them to a HC IV. management has improved thanks to RBF. A lot of our patients suffer from malaria, pneumonia and diarrhea. Another What are the challenges common problem is injuries due to a related to RBF? traffic accident. The challenge we have is staff turn- over. Not all our patients are able to pay It happens regularly that people seek their fees, even though they are low. I better paid employment. We cannot feel people don’t think that health is a compete with public health facility wages. priority. They don’t put money aside for So when staff get the chance to earn possible health problems. People need more money at a public facility they take sensitization regarding this. it. The job security is also higher in a Even though people have to pay for government job. treatment in this facilility and they don’t have to do this in public facilties I still What can we do to change this? feel we have a role to play. We can offer We should offer the same wage as public higher quality. facilities do. The beautiful thing about my job is Since when have you been working in helping a woman becoming a mother. this facility? From the first time she visits the health I’ve been here for 10 years now. 4 years facility until she gives birth. It is also a ago we moved to this bigger site because very joyful moment when you see a very LODONGA HC III we want to transform our health centre sick patient pull true. When you help them Sr. Theresa ANGUPARU 3 into a healthcentre 4. We believe this to recover and they can go home taking will be better for patients, because now up their everyday activities. This to me is m a staff member of this facility. I we have to refer them for some cases to the most rewarding aspect of my job. was trained as a nurse and midwife. a HC 4, but getting there is not always What I don’t like are logistical issues. I’I also received training to understand easy. By the time people get there their When a mother is giving birth but there the PNFP Result-Based financing project. conditions have often worsened. are complications, we refer to mother. I now know enough to explain it to the Sometimes that facility also refers the other staff member so that they are also I’m originally from Arua and was placed mother to another centre. This can aware of the opportunities. here by my congegration. I have a have serious health consequenses and bachelor in nursing services because sometimes leads to deaths that could all RBF specifically focuses on quality I wanted to help people with my have been prevented. improvement. They pointed out some knowledge. I wanted to provide a service I like that through RBF we can make our important gaps in our service delivery. for them. own decisions. We are on the ground and Things we were already thought in school know best how to address our needs. So but that hadn’t really been implemented 10 years ago we had more patients it is good that this system allows us to yet in our health facility. For example: because there were fewer facilities in the take up this responsibilities. space between the beds, curtains area. Now that there are more people between beds (privacy of patients), go to the closest one. We operate as hand washing, following all the steps in a referral facility, some cases we can’t treatment protocol (take temperature, handle ourselves because we do not take bloodpressure, take weight,…), have the staff or equipment we than refer

6 HEALTH newsletter Update from SDHR = Support to development of Human Resources Living Your Dream

By SDHR team to skills gaps of Human Resources in strategically selected beneficiary You can be anything that you set your s a young girl growing up in Arua, organizations. mind to be, you can study to become Banduni Alice watched her uncle, a doctor as long as you always Aan anesthetist share stories of In the process she has become the remember to work hard and to trust how he saved patients in Arua hospital first woman to study Anesthesia in that God has gotten a plan for you. I and knew that that was her destiny. No her village with the hope to work and have so far spoken to two young ladies matter that the entire anesthetists were practice in Arua referral hospital where and managed to convince them to join male and that she was female she is already employed as a the course and study. and African. She simply senior nurse, knew she would be is bordered by Yumbe one. District to the north, “ Studying a diploma in Anesthesia at Mulogo school of Now a 28-year- to the northeast, Anesthesia means a salary increment, old nurse, Alice to the which is very exciting for I can take has realized east, care of my family” says Alice, her face her dream and to the southeast, beaming with a smile. is living into it Zombo District to after she was the southwest, the She is seated on a leather sofa offered a long Democratic Republic in the office of the Senior hospital term trainng of the Congo(DRC) administrator, a squared room painted opportunity to the west, and in bright green neon colors, a small by the Belgium to sticker is attached to the light switch, Development Agency the northwest. The reads in bold “Do not switch on the in Uganda under district referral hospital lights during the day, it is good to save it its project SDHR is located about 425 power” which addresses the kilometers (264 mi), by main problems related road, northwest of “It is mostly ladies that can talk . to patients to convince them with certain treatment this is why studying anesthesia is important for me as a woman” “ The whole of Arua referral hospital has five theaters with only three anesthetists and they are all men, however the demand is higher and there is always going to be an emergency in the labor ward, the accidents ward, given the three anesthetists are stretched, this is why I decided to study anesthesia so I can help out with the workload”

Her Massage to Young women in Arua You can be anything that you set your mind to be, you can study to become a doctor as long as you always remember to work hard and to trust that God has gotten a plan for you. I have so far spoken to two young ladies and managed to convince them to join the course and study.

7 HEALTH newsletter Update from Ministry of Health of Uganda This year, In May, World Health Organization (WHO) unanimously adopted a resolution on cancer Uganda holds 7th Biennial treatment globally. The resolution made to help boost cancer treatment efforts, International Conference on provides guidance on health promotion and risk factor reduction, as well as the Cancer and Palliative Care need to address inequity in access to early detection Uganda Cancer Institute celebrates Speaking at the opening of and appropriate treatment, 50 years of existence in providing the seventh joint International The two-day conference held under including pain relief and treatment to cancer patients. Conference on Cancer and the theme “United against Cancer: palliative care. The resolution Palliative Care, Rt.Hon. Prevention to end of Life care” emphasizes prevention and By Vivian Serwanjja Ruhakana Rugunda noted was organized with focus on the timely access to treatment & Abirahmi Kananathan the magnitude of Cancer in spectrum of continuum of cancer and care. Uganda. “Cancer is a big care from prevention to end of life problem affecting people he Prime Minister care. In his key note address, Prof. regardless of their social of Uganda, Rt. Hon. Charles Olweny, the board Ruhakana Rugunda status” He said. T Duties, Hon. Sarah Opendi chair of UCI noted that cancer and State Minister of Health management at all levels is “As you are aware, we have underscored the efforts of for General Duties, Hon. expensive, and called for limited resources, which are Uganda Cancer Institute Sarah Opendi opened the focus on prevention through shared among competing (UCI) in providing treatment 7th Biennial International vaccination, screening and priority areas. We need to to cancer patients. The Conference on Cancer and early detection. He urged for tackle Cancer together by Institute, which is a regional Palliative Care at Speke the enforcement of the ban pooling our financial, technical centre of excellence has Resort, Munyonyo. on cigarette smoking saying and infrastructural resources provided care to patients tobacco is the only consumer and using them efficiently and from within Uganda, Kenya, The two-day conference held product that kills 50% of its effectively” Hon. Rugunda the Democratic Republic of under the theme “United users. against Cancer: Prevention said. Congo, Rwanda and Burundi, among other countries. It has to end of Life care” was Dr. John Weru, a consultant Hon. Rugunda called upon also conducted some of the organized with focus on the palliative medicine specialist development partners to help ground-breaking research on spectrum of continuum of from Aga Khan University in the fight against cancer cancer in Africa. cancer care from prevention Hospital, Nairobi, said there by providing the required to end of life care. was need to address pain that financial and technical “As a Ministry, we have The conference kick started is associated with Cancer. with a health camp targeting support. diligently worked with Palliative Care Association This conference provided patients with breast cancer a forum for stakeholders to This conference was also a of Uganda (PCAU), Hospice and providing treatment. contribute to policy debates platform to celebrate 50 years Africa Uganda and partners to Breast Cancer is among the and issues leading to better of existence of the Uganda provide Palliative Care in 90 common cases of cancer management and treatment Cancer Institute (UCI). In out of 116 districts in Uganda” affecting 28 per 100,000 of Cancer in Uganda and her opening remarks, State Hon. Opendi Noted. women in Uganda. beyond. Minister of Health for General 8 HEALTH newsletter Interview

treatment, or you don’t have money to In an interview with senior even get there.

We simply don’t have enough health nurse Sr. Sally Obiru workers in this country, this has created a negative outlook towards in particular nurses. We should be angry at the SR. SALLY OBIRU system, not at the people who are trying Senior Nursing Officer to work within it and deliver the best possible care they can. his hospital started out as a healthcenter in 1948 and was People get ennoyed when they go to a set up by missionaries. Over the T ‘free’ public facility but still end up paying years it developed into a hospital. I only a lot of the service because the facility started working here in November 2016. simply does not have drugs, or an X-ray Before I worked in Arua referral hospital machine or something else. the biggest public district health facility. I retired from there in 2014 but felt I still The population has increased a lot, but had some good years in me. My brain healthcare has not followed this trend. still allows me to work. Therefore I started The government needs to act urgently. teaching nurses, but soon enough I was Our resource basket needs to be topped- missing the real bed-side care I loved up. Staff is going through a lot of stress giving so much and that is why I took up and burn outs are happening as a result this job in Kuluva hospital. I’m now the of that. It is just not labeled as it, people senior nursing officer of this hospital and will say: ‘this nurse in unfriendly, she it feels good to work here, and to nurse doesn’t want to do her job.” But why again. would people go through the trouble of earning their degree only to not do their Unfortunately it is hard for us to keep job? People work hard for those things, staff. We train people and they stay here they want to hand out good care but the in the beginning of their career to get circumstances are really demanding on experience but once they have gathered We simply don’t have enough health workers in health staff. I think the national health this they will leave us when a better this country, this has created a negative outlook policy is well designed but up to now it offer comes along. Even though we are towards in particular nurses. We should be angry has not been implemented. We should a protestant hospital we do not look at at the system, not at the people who are trying to work on that. religious background when hiring staff, work within it and deliver the best possible care we hire staff because of their skills and they can. Kuluva positive points not because of their religion. I’m proud of Here at kuluva we really have a strong that. team spirit. We are open and don’t suffer but when I became a nurse I took it upon silently. When someone has an issue Thanks to RBF we have seen an increase myself to do better than that hospital did we discuss it. Every week we have at in both Out-Patients and an increase in for me. I’m grateful for the people I have least 2 meetings it is the only way to stay admitted patients. Our wards have been been able to help. When you are going informed and share experiences. When full, but this comes with new challenges. home after your shift and think about this, staff feel that they are being listened to or about how a patient has thanked you; they become more motivated. Nursing was not my priority when I was you really feel blessed. As a faith based hospital we try to stay in younger I wanted to be a teacher. In contact with the closest other FB hospital my home the only people who were I received my first training in Mulago Maracha. We also communicate through employed were teachers so this is what hospital in 1973 and started working as a the Inter-religious cooperation. I wanted to be. But my class teacher in nurse in 1976. It has been 40 years now. In this hospital we also put up flyers P7 told me I would never make it as a No, I did not celebrate, I don’t feel like concerning the use of condoms. In the teacher. So I tried my second choice, doing that. When I officially stop working beginning it was difficult to introduce this to become a secretary, when this also as a nurse I might consider it, but until method. People thought that condoms didn’t turn out I got admitted in nursing then I just want to focus on my job. would encourage unsafe, reckless school, my third option. So I’m thinking behavior. But the government invited that maybe it was Gods first option for I believe that in all those years I have us for different trainings and we still me. I haven’t regretted it ever since. It seen the general Health in this country saw people coming in with HIV, STDs, also makes me think of a bad experience improved. People have been sensitized teenage pregnancies. So we concluded I had in a hospital in secondary school. more about health but unfortunately that people still behave reckless, even I felt very sick but they made me wait all health is still not accessible to all without the condoms. Therefore we said: day long and told me at the end there Ugandans. It remains hard for many why not encourage people to protect was nothing wrong with me. I never people to gain access to quality themselves? I think it has been a good wanted to return to a hospital after that, healthcare. Either facilities are too decision. far away or you don’t have money for 9 HEALTH newsletter Hungry for more news?

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