Health Issues with This Fifth Edition of Quarterly and Support to Development of in This Issue: Health Newsletter, Enabel and the Human Resources

HEALTHMARCH 2O18/ ISSUE NO.5 NEWSLETTER

Health Issues With this fifth edition of quarterly and Support to development of In this issue: health newsletter, Enabel and the Human Resources. Ministry of Health of Uganda want > BTC becomes Enabel to reach out to health workers all The Ministry of Health will use over Uganda and health policy this platform to communicate on > News from Ministry makers on both the national and health issues. of Health of Uganda district level. The newsletter will also give > ICB II and PNFP updates You will be updated on the a voice to health workers and development of our Institutional will keep you updated on the > Interview with Paul Asaba, Capacity Building project, on implementation of the new result- RBF focal person the Private-not-for-profit project based financing system.

THE BELGIAN DEVELOPMENT COOPERATION

THE REPUBLIC OF UGANDA Ministry of Health Enabel, a new name for the Belgian Development Agency

On 1st January 2018, the Belgian The Belgian development policy brings partners and organisations together Technical Cooperation (BTC) changed focuses on inclusive economic growth, to put things in motion and foster change. name. The Belgian development agency is human rights and in particular women’s now called Enabel. The renewed agency’s and children’s rights, digitisation What is Enabel’s assignment? mission is to implement and coordinate and the least developed countries. the Belgian development policy. The Enabel implements Belgium’s name change and the broadened mission Why Enabel? governmental development policy. The of the Belgian development agency are agency actively explores assignments part of a major reform of the Belgian Enabel is a Belgian variant of the English and funding opportunities offered by Development Cooperation, which strongly verb enable, but with ‘-bel’ at the end. third party donors in view of assisting aligns the Belgian development policy Enabel means making things possible, and strengthening Belgium’s foreign with the Sustainable Development Goals. policy as a social undertaking. Why this reform? Enabel’s legal status With this reform the Belgian gov- The ‘Enabel’ Law was published in the ernment aims to better align Enabel, like BTC, is a public-law Official Belgian Gazette on 23 November its development policy with the company with social purposes. All 2017 following its approval by the Belgian 2030 Agenda for Sustainable contracts, agreements and commitments Parliament. This Law transforms the Development and the Sustain- signed or made by BTC remain valid. implementing agency of the Belgian able Development Goals (SDGs). governmental cooperation BTC into a Enabel is entrusted with more coordinating and implementing agency for autonomy, more competences and the Belgian development policy: Enabel. a broader mandate than before. This way, the agency is better equipped With this reform the Belgian government facilitating and empowering, which is to achieve its vision, to contribute to a aims to better align its development exactly what the Belgian development sustainable world where women and policy with the 2030 Agenda for agency does: enable partners to do men live under the rule of law and Sustainable Development and the what is required to achieve sustainable are free to pursue their aspirations. Sustainable Development Goals (SDGs). development in their country. Enabel helps create circumstances that enable development; Enabel supports, motivates, encourages and promotes change; Enabel

2 HEALTH newsletter Donation Of 41 Motorcycles To PNFP Health Facilities Implementing RBF

By Peter Asiimwe Health facilities located in municipali- tie and towns were eliminated since he PNFP project procured 41 means of transport are fairly available. motorcycles (Honda) and donated them to 41 health facilities where Rwenzori region was allocated 20 T motorcycles while 21 went to West Nile. Likewise, hospitals were found to have ad- Result Based Financing is implemented. equate means of transport and were not Rwenzori region was allocated 20 The priority was given to remote health considered for this donation with the ex- motorcycles while 21 went to West Nile. centres with a poor road network ception of a few located in far remote areas.

During the prequalification assess- Management of motorcycles ment for RBF, we found that most health facilities (especially HCIIIs) The motorcycles are registered in the did not have any means of trans- Some equipment including ultra names of Enabel and will remain the prop- port to enable even basic movements. sound scans and ECG machines erty of Enabel until the end of the project. will still be provided to Hospitals and Health facilities will ensure that Facilities were finding it difficult to HCIVs in a few months to come. the motorcycles are well main- conduct outreaches in far places. tained, insured and serviced. The health facility as an institution should These motorcycles therefore, are part of the have an official means of transport not only process by Enabel and Ministry of Health for outreach services but also for ease of to equip health facilities to make them have interaction with external stakeholders. capacity to provide better quality services.

The RBF model we are implementing Selection of beneficiary health facilities requires that a facility has minimum ca- 41health facilities re- pacity to deliver quality services before payment for outputs can be considered. ceived a motorcycle each. The priority was given to remote To achieve this, the project provided some health centres with a poor road net- input financing in kind – medical equipment work. Facilities covering a wide catch- and medicines – at the start of the project. ment population were also prioritized.

3 HEALTH newsletter PNFP Update

• Session 4 of the Strategic planning By Dora Anek Given that resources for health are finite, process was organised from 31st Janu- & Hannes De Meyer the payment structure used in this proj- ary until 16th February for all PNFP RBF ect keeps changing based on approved facilities and 16 districts in West Nile and clear technical/financial reporting and Rwenzori. The focus of this ses- The PNFP Project continues to register by the districts and the health facilities. sion was on formulating targets and in- success in supporting Institutional ar- dicators for strategic and operational rangements to shape incentives, which Snapshot of organised activities during objectives, staff planning and budget- affect health actors’ behaviours, and thus this last Quarter (January – March 2018) ing of the strategic plan (2018 – 2023). determine their overall performance. • Preparation of the Annual Results • Handover of 41 Motorcycles dur- The RBF payment structure in the Report 2017 during a Stakeholder meeting the first week of February to 41 PNFP project creates the potential for ing on 19th January 2018 focusing on Health facilities (21 in West Nile re- increased payments made to the Dis- progress and achievements of the year 2017 gion and 20 in Rwenzori region) tricts based on performance. While on the other hand, it emphasises the sig- • Supporting verification of the health facili- nificance of the design of the incentives. ties accredited for RBF in both Rwenzori and Results so far show that the project has West Nile in January and February 2018. successfully demonstrated the effect of The funds transferred after submission of Results Based Financing on the quality the district performance report and for ser- • Close follow-up and providing feedback and the quantity of services in the pri- vices delivered during the previous quarter to facilities and District Health Teams vate non-for-profit health sub sector in the can be used to pre-finance implementation contained in the previous validation com- two regions of West Nile and Rwenzori. of the activities of the following Quarter. mittees report and review together with the DHTs (RBF Focal Points) the verification and support supervision plans.

4 HEALTH newsletter ICB II Update

By Dora Anek Despite the complexity of the process of Snapshot of organized activities during RBF implementation no major obstacles this last Quarter (January – March 2018) Just coming out of a Mid Term Review have been encountered.During the first in November 2017, the team agrees quarter (January – March 2018), the In- • Preparation of the Annual Results re- that the most important expected impact stitutional Capacity Building II Project port 2017 during a stakeholders meeting of the project will be on policy making. continued to support activities with the on 19 January 2018 focusing on prog- aim of strengthening the health systems ress and achievements of the year 2017. Together with the PNFP project, the in the sector in the Rwenzori and West ICB II project is leading the way to insti- Nile regions where it implements in col- • Regional Health Forum successfully tutionalizing Results Based Financing laboration with the Ministry of Health. held for Rwenzori region on 30 to 31 as an alternative financing mechanism. January which brought together vari- ous stakeholders in the region to share ”In 2017, the project progressed success- The need for an adapted procedure for experiences and identify best practices. fully towards its objective to implement Re- medicine management under RBF was sults Based Financing in 29 qualified public identified and its development and approval • RBF Orientation Training from 7th health facilities in 8 districts of the West by the MoH is complete. to 8th February 2018 for the 5 newly Nile and 8 districts of the Rwenzori region. accredited facilities in West Nile.

• Medicine Management Training from 13th – 15th February 2018 for the 4 newly accredited public facilities in West Nile.

• Session 4 of the Strategic planning process was organized from 31st January until 16 February for all 29 public RBF facilities and 16 districts in West Nile and Rwenzori.

• Supporting verification of the health facilities accredited for RBF in both Rwenzori and West Nile in January and February.

• Handover of assortment of ICT equipment (31 desktops, 27 laptops, 29 projec- tors and 14 printers) in February 2018 to 31 public health facilities in the West Nile region (16) and Rwenzori region (15).

5 HEALTH newsletter IN AN INTERVIEW WITH NURSE LODONGA Update from Ministry of Health of Uganda Uganda to roll out Rota-Virus Vaccine

I would like to see zero cholera cases targeted interventions that includes reported from all districts because we know use of oral cholera vaccines to what causes cholera and how to prevent complement WaSH in cholera hotspots. ganda to roll out Rota-virus it using old and new tools” Aceng said. UVaccine early 2018. Ministry of “We are also introducing oral cholera Health has unveiled plans to roll out She cautioned district and local leaders vaccine to complement provision of water, the rota-virus Vaccine this year. The who ignore their communities’ practice sanitation and hygiene in the Cholera vaccine is used to protect children of out open defecation and being shy of hotspots specifically for the fishing under one year from diarrheal diseases the standard 100% latrine coverage. “I community who according to research which is among the leading direct urge you all to take note and act before contribute 58% of reported cholera causes of infant mortality in Uganda. we arrive at your doorsteps” she said. cases annually” Hon. Aceng noted.

Speaking during a stakeholders’ meeting According to researchers from Makerere The Ministry of Health and Makerere on prevention, control and elimination of University School of Public Health and University in collaboration with John Cholera in Uganda at Makerere University, the Ministry of Health, Uganda is heavily Hopkins Bloomberg School of Public Kampala, Minister of Health, Hon. Dr. affected by Cholera and ‘hotspots’ – also Health have organized a meeting on Jane Ruth Aceng noted that the Ministry known as the four Cholera prone districts the above dates to share experiences, is now focusing on health promotion and were identified in Uganda and these are; research and new strategies in cholera disease prevention hence the decision Nebbi, Pakwach, Hoima and Buliisa. In prevention and control so as to scale up to introduce the rotavirus vaccine on 2017, 265 Cholera cases were confirmed in interventions. You have been identified the routine immunization schedule. the country. The risk factors of the diarrheal as a key stakeholder for this meeting. “No young child should die of diarrhea. disease were attributed to; Poor sanitation Diarrheal diseases can be prevented. The among locals especially the fishing Acting Director General Health Services, introduction of the rotavirus vaccine will communities, inadequate safe water, Dr. Henry Mwebesa noted that 75% go a long way in curbing infant mortality Flooding/rain and cross-border movement. of disease burden in Uganda due to diarrheal diseases” she added. arises from preventable diseases. In June 2017 Uganda launched a Hon. Aceng underscored Government’s multisector plan for cholera prevention, The Stakeholders meeting brought efforts and interventions that have led control and ultimately elimination. together academia and researchers to a steady decline of Cholera, one This plan is in line with World Health from Makerere University School of of the diarrheal diseases in Uganda. Organization (WHO) strategy for Public Health, Johns Hopkins School of She, however, warned that diarrheal cholera elimination by the year 2030. Public Health, World Health Organization diseases should not be part of Ugandan The national plan emphasizes scaling (WHO), and UNICEF who shared lessons population. “The decline is not enough. up of access to safe Water, Sanitation and best practices that Uganda could and Hygiene (WaSH), health education, learn from in order to eliminate Cholera. health care services in addition to

6 HEALTH newsletter Update from Support to development of Human Resources Project (SDHR) Success Story Bundibugyo Hospital

By SDHR team was resulting in wastage of medicines.

undibugyo Hospital is a Trainings so far accomplished include: We currently have a functional government Health facility run Culture and sensitivity techniques in emergency care department by Bundibugyo District Local Mulago hospital Medicines B running on a 24 hour basis Government on behalf of the Ministry of management in Mbarara regional Health. It is located in Bundiugyo district, referal hospital; Surgical trauma and with staff skilled in managing 84km from Fort portal town with a other emergency management in emergency surgical cases catchment Population of 44,009 persons. Mbale Regional Referral hospital. Long term trainings include: The staffing levels amount to 4 Medi- Diploma in sonography/imaging cal Officers, 1 Anaesthetic Officers, techniques; PGD in monitoring and 5 Clinical officers, 13 midwives, 22 evaluation; Bachelors degree in We currently serve many people with Nurses, 0 Lab Technologists, 4 lab medical laboratory science is on going. ease than before, it now takes less than technicians, 1 lab Assistants, 2 Re- Total number of staff trained so far is 29. 3 staff to run a dispensary seeing over cords Assistants and 3 RCT volunteers. 400 patients and clients in 8 hours, this Points of celebration so far was not possible before the training. Support from the SDHR Project We currently have a functional emer- In the year 2015 the hospital gency care department running on Lessons Learnt received support from Enabel-SDHR to a 24 hour basis with staff skilled in Skills development can be achieved help bridge gaps in human resource. managing emergency surgical cases. through attachments, observations and Among issues identified were poor hands on training with limited resources. medicines management, lack of a Over 150 cases of surgical and non sonographer, limited skill in sur- surgical emergencies have been handled Skills development can be gical trauma care manage- at our emergency dept since March 2016. achieved with a motivated staff, this ment with many referrals resulting motivation may only come through from limited skill, and inability to encouraging, working with them to perform culture and sensitivity testing that develop and implement the action plans.

7 HEALTH newsletter Update from Ministry of Health of Uganda Emergency Medical Services in Kampala Metropolitan Area Improved

He added that in collaboration with By Vivian Serwanjja partners, the Ministry is in the process of & Abirahmi Kananathan developing an Emergency Medical Services Policy, Standards and Strategy which will spell out the coordination of ambulances n a bid to improve Emergency The Ministry of health handed over in different regions in the country. IMedical Services across Kampala a fleet of 7 ambulances funded Metropolitan Area, the Ministry of Health Acting Deputy Executive Director, handed over a fleet of 7 ambulances by African development bank to KCCA, Ms. Juliet Namuddu commended funded by African Development Bank to Kampala Capital City Authority the Ministry’s efforts and entrusting Kampala Capital City Authority (KCCA). (KCCA) the authority with the responsibility of running the ambulances across the city. During the handover ceremony, the Under-Secretary, Ministry of Health, Mr. “Without ambulances, it is difficult to respond Ssegawa Ronald Gyagenda highlighted the to emergencies in a timely manner” she said. multisectoral approach among Government “The key resources for operation are bodies aimed to improve service delivery human resources such as ambulance Ms. Namuddu informed the public that KCCA across the city and country at large. crews, fuel and maintenance of the has put in place a call center (Toll Free: ambulances is crucial to effectively run 912) to enable dispatch and coordination He noted that among many existing services the ambulances” Mr. Ssegawa said. of ambulances across Kampala City. to expand service delivery, procurement and effective use of ambulances were important to improve the quality of care for emergency cases by ensuring quick response during emergencies.

8 HEALTH newsletter Interview In an interview with Paul Asaba, RBF-focal person- Bunyangabu District

Strengths of our district health team

• Existence of a good working health district management team • Functional committee • Sufficient district staff with a level of 76%

Challenges for our district health team

As a new established district we also face some challenges: We lack offices. We are currently hosted by our HC IV in the district.We don’t have vehicles to do technical support supervisions. There is a percentage of partners that have not yet bonded with us. We are currently starting some new partnerships and we

The quality of services of our health facilities has been improved. We see a very significant difference in terms of service delivery, quality Paul ASABA – Focal person Result Based from the greater Kabarole district. and customer care. Financing (RBF) ICB II and PNFP for Bunyangabu Kabarole agreed with the involvement District of political leaders and cultural leaders. hope many will follow soon. As a district we support supervision. We y name is Paul Asaba and I am the We also lack some critical cadres in the do mentorship, data quality assessment RBF-focal person for Bunyangabu district like an Antithetic Assistant, Assistant and we even do some random sampling District and currently working DHO maternal health and Assistant M like surveys to assess the level of patient as a health district information assistant. DHO Environmental among others. Before I was assigned as the RBF focal satisfaction and the use of the VHT system. person for the greater Kabarole district. We have 24 health facilities in our district, Opinion about Result Based Financing Responsibilities as RBF-Focal person including public (governmental) and private-not-for-profit health facilities. Result Based Financing supports the We have 1 health center IV, 11 health As RBF-Focal person I have routine activities like immunisation and center III and 12 health centers II. three important responsibilities: maternity health services (deliveries) 1. To coordinate the RBF-activities Among those, we have 2 health facilities, Yerya and Mitandi health 2. To participate in the verification The quality of services of our health center III which are supported through exercises of RBF-related activities facilities has been improved. We see Results Based Financing (RBF). 3. To work closely with the a very significant difference in terms of RBF-implementing health facilities in service delivery, quality and customer care. With regard to ICB II, there is one health activities like mentorship and supervision Besides this, the communities facility that is going to be on board. have benefited from RBF thanks We have three other health Buyangabu District to the reduction in user fees. facilities that hopefully can start Bunyangabu District is a new district that as well with the implementation. was established in July 2017. Before it belonged to the greater Kabarole district. It was a community request to separate