PARLIAMENT OF UGANDA
ffiM f H
REPORT OF THE SECTORAL COMMITTEE ON HEALTH ON THE MTNTSTERTAL POLTCY STATEMENT FOR FY 2O2Ol2O2t
APRIL, 2O2O
OFFICE OF THE CLERK TO PARLIAMENT PARLIAMENT BUILDING KAMPALA-UGANDA
Health Committee Report on MPS FY 2020-21 Page 1 1. INTRODUCTION Hon. Chairperson and Hon. Members; In accordance with Articles 90 and 155(4) of the constitution of the Republic of Uganda and Rule I77 of the Rules of Procedure of the Parliament of Uganda, the Sectoral Committee on Health Considered the Ministerial Policy Statement and the budget estimates for vote under its mandate and hereby presents its report.
2. METHODOLOGY The Committee reviewed the Ministerial Policy Statement for the Ministry of Health for FY 2O2O l2l, the Report of Parliament on the National Budget Framework Paper (NBFP) for FY 2O2O 121 and the medium term, the summary of Parliamentary Sectoral Committee recommendations for FY 2OL9I2O, the certificate of Gender and Equity issued by the Minister for Finance, Planning and Economic Development on Policy Statement for the Ministry of Health and those of Self Accounting Institutions under the sector, the National and Regional Referral Hospitals.
3. SCOPE OF THE HEALTH SECTOR The health sector covers the budget proposals for the Votes/Ministries, Departments and Agencies under listed. The Health Sector consists of 28 votes (incl LG Health) and these include:- Vote 014 Ministry of Health; Vote 114 Uganda Cancer Institute (UCI); Vote 115 Uganda Heart Institute (UHI); Vote 116 National Medical Stores (NMS); Vote 134 Health Service Commission (HSC); Vote 151 Uganda Blood Transfusion Services; Vote 161 Mulago National Referral Hospital; Vote 162 Butabika National Referral Hospital; Vote 163 Arua Regional Referral Hospital; Vote 165 Fort Portal Regional Referral Hospital; Vote 165 Gulu Regional Referral Hospital; Vote 166 Hoima Regional Referral Hospital, Vote 167 Jinja Regional Referral Hospital; Vote 168 Kabale Regional Referral Hospital; Vote 169 Masaka Regional Referral Hospital; Vote 170 Mbale Regional Referral Hospital;
Health Committee Report on MPS FY 202O-2t Page 2 Vote t7l Soroti Regional Referral Hospital; Vote L72 Lira Regional Refessrral Hospital; Vote L73 Mbarara Regional Referral Hospital; Vote 174 Mubende Regional Referral Hospital; Vote L75 Moroto Regional Referral Hospital; Vote t76 Naguru Regional Referral Hospital; Vote L77 Kiruddu National Referral Hospital; Vote t78 Kawempe National Referral Hospital; Vote 179 Entebbe Regional Referral Hospital; Vote 180 Mulago Specialized Women and Neonatal Hospital; Vote 304 Uganda Virus Research Institute'
4. THE MANDATE OF THE HEALTH SECTOR The Committee noted that the health sector is central in the attainment of Uganda's Vision 2O4O as it is expected to contribute to the production of a healthy and productive population required for effective socio-economic transformation. The specific objectives of the Sector include: 1. To provide inclusive and quality health care services through policy formulation and providing strategic direction, planning and coordination of health care provision in Uganda; 2. To address the key determinants of health through strengthening of inter- sectoral collaborations and partnerships; 3. To enhance the health sector competitiveness in the region and globally; and; 4. To increase financial risk protection of households against impoverishment due to health expenditures.
S.OVERALL HEALTH SECTOR BUDGET PERFORMANCE (EXCL. UAC & KCCAI Table 1: Half Year Budget Performance by Category (UGX, billions) Category Approved Spent % Spent Wage 611.4 295.3 48% Non-wage 651.6 423.4 650h GoU 186.7 81.4 44Vo Ext 1, 1 19.3 133.8 l2o/o Arrears 5.9 4.9 83o/o Total 2,574.9 938.9 360/o Source: Ministry of Health Ministerial Statement FY 2O2O l2l
Health Committee Report on MPS FY 2020-21 ,/ Page 3 The total budget approved for the health sector (excl. UAC and KCCA) amounted to UGX 2,574.9bn. Out of this, UGX L,268.9bn (49%) was for recurrent of which UGX 611.4bn was wage and UGX 651.6bn was for non- wage. On the other hand, UGX 1,306bn (sL%l was for development of which UGX 186.7bn (14%l was domestic financing while UGX 1.119.3bn was from external financing (85%). By the end of the first half of FY 2029 l20, a total of UGX 938.9bn was reported as spent representing 36oh of the total approved budget. This performance is attributed to the lower than expected performance under the development category at 160/o as compared to the recurrent budget at 57o/o. The observed non-wage budget performance above the expected pro-rata budget is attributed to the frontloading under National Medical Stores (NMS) resulting into a non-wage budget performance of 66% Figure 1 shows details of the budget performance by category.
Figure 1: Half Year Budget Performance (UGX, billions)
1.9 ,Arrears 5.9
irxr 1 ,1 19.3
ffi&ee 8l .4 Cloi,i ffi 186.7
Non-u'agt' 651.6
Wirs(' 61i.4
200 0 400 o o0O O 800.(:) 1,000 0 1.200 0
&i spent ffi,\pll.ctverl
Source: Health Ministerial Policy Statement FY 20 L9 l20 $
Health Committee Report on MPS tY 2020-21. Page 4 5.1 Vote Specific Performance Vote O14: Ministry of Health Table 2: Ministry of Health Budget Performance by Programme (UGX, billion)
Programme Approved Spent by Dec Spent (%) 01 Health Governance and Rezulation o.69 o.32 47o/o 02 Health Infrastructure and Equipment 273.73 49.98 78o/o 03 Health Research o.79 0.39 50% O5 Pharmaceutical and Other supplies 830.38 84.57 lOo/o O6 Public Health Services 33.66 TL.32 34% O8 Clinical Health Services 47.79 23.15 48o/o 49 Policv. Plannine and Support Services 22.66 6.88 3Oo/o Total 7,209.69 176.6t l5o/o Source: Ministerial Policy Statement FY 2O2O I 2l It should be noted that the total budget approved under vote 014 Ministry of Health amounted to UGX 1,2o9.69bn representing 47o/o of the total sector budget (excl. UAC & KCCA). However, by the end of the first half of the FY 2Ol9l2O, only UGX 176.61bn had been spent equivalent to 17oh of the total sector budget spent and 15% of the total vote budget approved. The observed under performance is attributed to the lower than expected budget performance under the following programme: Health infrastructure and equipment (l8o/ol, pharmaceutical and other supplies (lOo/ol, public health services (34o/ol and policy, planning and support services (30%).
Vote 116 National Medical Stores (NMSI Table 3: Budget Performance FY 20 19 l20 (UGX, billions)
Category Approved Spent %o Spent Wage 11.99 5.61 47o/o Non-wage 384.19 253.41 660/0 GoU Ext Arrears Total 396.t7 259.O2 65o/o Source: Ministerial Policy Statement and PBO Computations. The total budget approved under NMS amounted to UGX 396.17bn of which UGX 384.19bn was for non-wage and UGX 11.99bn was forwage. By the end of the first half of the FY 201912O, a total of UGX 259.O2bn had been spent (65%1. Whilst the non-wage budget performed at 660/o as a result of
Health Committee Report on MPS FY 2020- Page 5 frontloading to enable timely procurement and distribution of essential medicine sand medical supplies, the wage under performed by 3%. The reported expenditure for the first half was as follows: Table 4: Budget Performance First Half FY 2Ol9l2O
# Health Facility Level Purpose Amount (UGX, billions) 1 Health Centre II EMMS 8.24 2 Health Centre III EMMS 23.9r 3 Health Centre IV EMMS 9.43 4 General Hospital EMMS t4.2 5 Regional Referral Hospitals EMMS 13.43 6 National Referral Hospitals EMMS L2.06 7 Specialised Units (UHI & Medicines & 2t.96 UBTS) Medical Supplies 8 ACTS, ARVS & Anti-TB Drugs 97.O9 Drugs 9 Emergency & Donated items Medicines & t.6t Medical Supplies 10 Reproductive Health items Reproductive 10.30 commodities. 11 Immunization Supplies (incl. Vaccines L3.37 Hepatitis B Vaccine) t2 Laboratory Items Reagents. 9.65 13 NMS support Services Operations 18.10 L4 NMS waqe Wage 5.61 Source: Ministerial Policy Statement FY 2019 l20
5.2 Performance of Projects under the Health Sector FY 2Ol9l20 A: Ministry of Health
Table 5: Performance of MoH Projects FY 2029l20 (UGX, billions)
Project Approved Spent Perf. o/o
Institutional support to MOH t4.228 1.158 80
Italian support to HSSP and PRDP 10.663 o.010 Oo/o Support to Mulago hospital rehabilitation. 2t.360 7.946 37% Rehabilitation and construction of general hospital. 23.026 8.011 35.h
Construction of specialized Neonatal and Maternal Unit at 5.100 0.050 lo/o Mulago.
Health Committee Report on MPS FY 2020- 1. Page 6 Renovation and equipping of Kayunga and Yumbe Hospitals 75.t57 8.680 l2o/o
Construction and equipping of the international Specialized 0.050 0.020 4Oo/" Hospital of Uganda.
Regional hospital for Paediatric Surgery 1.085 o.240 22o/"
Uganda Reproductive Maternal and Child Health services 119.961 23.845 2Oo/o Improvement projects.
Strengthening Capacity of Regional Referrals (DRIVE) 3.OOO OYo
East Africa Public Health Lab. Network Project Phase II. 19.453 7.162 37o/o
Global Funds for AIDS, TB and Malaria. 760.303 70.490 9o/"
Gavi Vaccines and health sector development plan support. 69.7t2 13.989 2Oy:o Uganda Sanitation Fund Project II 4.375 1.t32 26Vo
Total t,t27.473 t42.733 L3o/o Source: Ministry of Health MPS FY 2O2O l2l A review of the Budget performance of the health sector projects reveal that out of a total of UGX l,727.473bn approved under various projects (Table), only UGX I42.733bn had been spent by the end of December 2OI9. This translates to a financial performance of l3oh. This lower than expected performance has been attributed to delays in completion of planned activities leading to lower than expected disbursements of external funds. With the current measures adopted to mitigate the spread of COU-19 pandemic, it is unlikely that the appropriated funds shall be absorbed by the close of the FY 2019 l2O. B: Uganda Cancer Institute (UCII
Table 6: Performance of UCI Projects FY 2029l20 (UGX, billions)
Proiect Approved Spent Comment 1 120 Uganda Cancer 10.3090 7.7455 Financial performance was at 75o/. by Institute Project December 2019 this was on account of frontloading of funds to clear completed certificates.
Internal wall are at 85"/o completion, mechanical works at LOOo/" completion. Awarded contract for erecting the protective fence.
Health Committee Report on MPS FY 2020-21, Page 7 1345 ADB Support to 40.6906 3.1048 Financial performance was at 8o/o by end of Uganda Cancer Institute first half. Construction of the multipurpose building for the East Africa Centre of Excellence in Oncologr. Expected to handover the building by end of June 2O2O.
By end of December 2Ol9: 9O'A of excavations had been done, procurement of capital electrical and mechanical equipment was at 607o. External works at 25o/o and construction works at 2Ooh compared to the target of 4lo/o. Total 50.9996 10.8503 Source: Ministry of Health Policy Statement FY 2O2O 121 A review of the performance of Uganda Cancer Institute's Budget performance for Projects revealed that the Uganda Cancer Institute Project, performed at 75% by close of December on account of frontloaded funds to clear completed certificates. Consequently, in terms of physical performance, it was reported that 85% of the works on internal walls had been completed and all mechanical works (10O%).
On the other hand, out of the total approved budget amounting to UGX 4o.691bn under the ADB support to UCI, only UGX 3.405bn (8%) had been spent by the end of December 2019. This lower than expected financial performance was on account of slower that planned progress on physical works which performed at 25o/o (external works) and 2Ooh (construction works) as compare to the target of 4loh. With the effects of measures adopted to mitigate the spread of COVID-19, it is expected that the overall progress of this project will be further affected and much of these funds will remain unspent by close of the FY 20 19 l20. 5.3 Vote Challenges and Plans to Improve Performance
1. Huge disease burden owing to mainly malaria, new-born conditions and growing number of NCDs. 2. Inadequate staffing at all levels a significant number of posts are not filled and current staffing norms not commensurate withthe services provided and workload. 3. Inadequate funds for the maintenance of medical equipment nationwide. 4. Management of various disease and public health emergencies is not equitably funded.
Health Committee Report on MPS FY 2020-21, Page 8 5. The current influx of refugees into the country and internally displaced persons puts pressure on existing resources and is a risk of importation of vaccine preventable diseases. 6. Poor governance and management practices at health facilities. 7. Stocks outs of key commodities at facility level owing to inadequate budget allocation for EMHS. 8. Domestic arrears totalling up to Shillings. 42 billion not provided for in the budget.
5.3.1 Plans to improve Vote Performance a Investment in health promotion and disease prevention interventions since 75o/o of the diseases are preventable. o The staffing norms will be revised to take into consideration the growing population and range of services provided. a Prioritize equipping and accreditation of HC IVs to provide blood transfusion for improving Emergency Obstetric and Newborn Care. a Increased focus on retooling and maintenance of medical equipment including training and recruitment of Biomedical Engineers. a Advocacy for financing of the Refugee Health and Nutrition Plan from contingency funds at district and national level for epidemic response. a Strengthen supervision and mentorship of the Local Governments and health facilities. O Continue to improve infrastructure including staff accommodation. o Emphasize data use at sub-national level and point of collection through training and mentorship and in with collaboration with the Division of Health Information. Improve coordination of donors and ensuring alignment to country strategies to the Paris Declaration principles for more aid effectiveness.
Health Committee Report on tr/PS FY 2020-21. Page 9 6. HEALTH SECTOR PROPOSED BUDGET ALLOCATTON FY 2O2Ol21 & MT 6.1 Overall Proposed Budget Allocation
Table 7: Health Sector Budget by Category FY 2O2O 121 (UGX, billions) Category 2Or8l19 2Or9l20 2O2O l2L 2O2t 122 Change o/o Share Change (%l Wage 556.67 6tL.42 629.7L 628.79 18.29 3.Oo/o 23.1o/o Non-wage 482.62 649.49 697.r7 823.43 47.68 7.3% 25.60/o GoU 198.43 186.73 t91.22 19L.22 4.50 2.4o/o 7.Oo/o External 453.49 1,L19.34 1,195.35 813.78 76.O1 6.8o/o 43.9% Arrears 4.O7 5.90 7.70 1.80 30.5% o.3% Total 1,695.28 2,572.87 2,72L.t5 2,457.23 L48.28 5.8Yo 100.0% O/w Recurrent 1,043.36 1,266.80 1,334.58 L,452.23 67.77 5.4o/o 49.O% O/w Development 651.92 r,306.o7 1,386.57 1,005.00 80.51 6.2o/o 51.0% Source: Ministerial Policy Statement FY 2O2O I 2l The total budget proposed for the Health Sector (excl. UAC & KCCA) amounts to UGX 2,721.15bn. This translates into an increment of UGX 148.28 (5.8%) over and above the approved budget of UGX 2,574.94bn for FY 201912O. O:ut of this UGX 1,334.58bn (49o/ol is recurrent (wage, non-wage & Arrears) while UGX 1,386.57bn (51%). is development (GoU & External). It should be noted that all budget categories are projected to record budget increments. The highest increase is projected under the external financing category at UGX 76.Olbn, followed by non-wage at UGX 47.68bn. The wage category is projected to increase by UGX L8.29bn. Domestic development will increase by 4.5bn while additional UGX 1.8bn is earmarked towards arrears category.
Figure 2: Budget Share by Category FY 2O2Ol2O
: Extefnal .#h,F'(5 ..44aA:
Source: Ministerial Policy Statement & PBO Computations
Health Committee Report on MPS tY 2020-2L Page 10 6.2 Budget Allocation Comparison between NBFP and MPS FY 2O2Ol2l Table 8: Comparison since NBFP (UGX, billions)
Category NBFP MPS change o/o change Wage 62L.18 629.7r 8.53 lo/o Non-wage 661.30 704.86 43.56 7o/o Recurrent 7,282.48 1,334.58 52.10 4o/o GoUDevt 167.42 191.22 23.80 r4% Donor Dev't 100.52 1,195.35 1,094.83 1O89o/o Development 267.94 1,386.57 1,1 18.63 417Yo Total Budget L,550.42 2,721.L5 r,L70.73 76% Source: NBFP & Ministerial Policy StatementFY 2O2Ol2l A comparison between the sector NBFP budget proposals and the MPS allocations reveals an overall increment of UGX l,l7o.73bn in the MPS budget proposals. Of this, UGX 1,094.83bn is under external development financing, UGX 43.56bn is under non-wage, UGX 23.80bn is domestic development and UGX 8.53bn is for additional wage allocation. The observed changes are a reflection is inadequate planning and lack of adherence to the PFMA which requires that Parliament to approve the Budget Framework Paper and the national resource envelope. Table 4 shows the proposed changes in vote specific allocations for FY 2O2O121 as provided for in the MPS in comparison with proposals in the NBFP.
Table 9: Health Budget Proposals by Vote FY 2O2O l2l &, MT (UGX, billions)
Vote / Institution NBFP MPS Chanee 014 Ministry of Health 230.1,1 L,254.68 L,024.57 50 1-850 Local Governments s49.32 632.87 83.55 116 National Medical Stores 396.t7 396.t7 0.00 163 - 176 Regional Referrals 1,4t.70 748.43 6.73 161 Mulago Hospital Complex 69.16 64.72 -4.43 114 Ueanda Cancer Institute 33.97 105.85 71.88 151 Uganda Blood Transfusion Service (UBTS) 77.94 t7.82 -0.L2 115 Ueanda Heart Institute 24.7L 2s.05 0.34 162 Butabika Hospital 21.s8 2t.55 -0.03 180 Mulago Specialised W&N Hospital 9.40 14.58 5.19 304 Uganda Virus Research Institute (UVRI) 9.O7 9.03 -0.04 134 Health Service Commission 6.87 7.t5 0.28 177 Kiruddu 72.02 t3.o2 1.00 178 Kawempe 8.90 10.22 1.33 Total 1,530.90 2,72t.L5 1,190.25 Source: Ministerial Policy Statement & PBO Computations
Health Committee Report on MPS FY 2020-21. Page 11 6.3 Budget Allocation by Vote/Institution Vote 014 Ministry of Health is projected to receive the highest budget at UGX 1,254.68bn (460/ol, followed by transfers to lower level health facilities (PHC) at UGX 632.87bn (23o/o), National Medical Stores (NMS) will receive UGX 396.17bn (14' ), Regional referral hospitals together will receive UGX 154.69bn (6%), National referral Hospitals are projected to receive 5% and other Self- Accounting Institutions (SAEs) are destined to share 6% (Figure 3 & 4). Figure 3: Budget Share by Institutional Category
National Referral Other SAEs (Mulago, Butabika, 60/0 Resional Referratsa wempe 6..&
Source: Ministerial Policy Statement & PBO Computations Figure 4: Budget proposals by Vote/Institution (UGX, billions)
to.223 177 Kiruddu 13.015 7.rt 9.03 14.58 162 Butabika Hospital 2r.54 25.05 151 Uganda Blood Transfusion.. t7.82 iwffi 105.85 161Mulago Hospitai Complex 64.72 w L54.69 116 National Medical Stores lwffiwt 396.77 632.87 014 Ministry of Health t,254.68
Source: Ministerial Policy Statement FY 2O2O-2
Health Committee Report on MPS FY 2020-21 Page 12 7. HEALTH SECTOR PRTORTTTES FOR FY 2O2O|2L The key sector priorities for FY 2O2O 121 include the following: a) Prevention and control of Communicable Diseases with focus on high burden diseases (HIV/AIDS, TB, Malaria, Neglected Tropical Diseases) and epidemic prone diseases through community-based surveillance approaches. b) Prevention and control of Non-Communicable Diseases and injuries through promotion of physical exercise, healthy eating (e.g. address trans-fats) and regular health checks and advocacy for reduction the consumption of alcohol and tobacco products to reduce the increasing burden of NCDs, develop and implement hospital protocols to scale up triage and response to emergencies arising from high cases of Road traffic accidents and screening and management of NCDs. c) Improvement of Reproductive, Maternal, Neonatal, Child and Adolescent Health services. Specifically, by functionalizing theatres at HC IVs and equipping (fridges, power back up & laboratory reagents) HC IVs to provide blood transfusion services to reduce maternal and neonatal deaths and other medical emergencies; implementation of the revised Male Involvement Strategr to increase male participation in family planning and utilization of other RMNCAH services and improve maternal and perinatal death reviews. d) Improving the emergency medical services and referral system by improving the functionality of high dependency units / ICUs in referral hospitals and hospitals along the highway, training in pre-hospital and Hospital Emergency care and improving communication on referral and ambulance systems. e) Expand community-level health promotion, education and prevention services in all programs to reduce exposure to communicable and non- communicable conditions risks with targeted interventions in districts with low coverages. This will include fast-tracking amendment and implementation of the Public Health Act, evidence generation for the CHEW Policy and building capacity of governance structures at community level (CDOs, Parish Chiefs) to adopt the multi-sectoral approach to health. 0 Support health systems improvement in health information management and rrse, research and technologr (Digitalising of the hospital and medical records).
Health Committee Report on MPS FY 2020-21 Page 13 g) Strengthen Public-Private Partnerships in areas of reporting and financial access. h) Establishment of the National Health Insurance Scheme and improve the allocative and technical efficiency in the provision of financial resources in the health sector with focus on prevention vs curative.
8. BUDGETARY ALLOCATION FOR CROSS-CUTTING ISSUES A total of UGX 186.36bn has been earmarked towards activities related to HIV/AIDS (152.01bn), Gender (22.75bn) and environment (11.88bn). It should be noted that out of the UGX 152.0lbn for HIV/AIDS, UGX 140.3bn is under NMS and it is meant to procure ARVS and other supplies for HIV/AIDS patients. In addition, out of UGX 22.73bn under Gender related activities in allocation under NMS for Mama Kits and other reproductive health commodities (Table 7l shows the vote specific allocations by specific intervention.
Table 10 for Cross-cu Issues G billion Vote/MDA HIV/AIDs Gender Environment Total 014 MoH 7.OO 3.00 2.50 t2.50 114 UCI o.o2 o.o2 0.05 0.09 115 UHI o.04 o.26 0.13 o.43 116 NMS 140.30 14.72 0.35 155.37 134 HSC 0.0i 0.01 0.01 o.o2 151 UBTS o.r2 0.10 0.10 o.32 161 Mulaeo o.l2 0.10 0.10 o.32 162 Butabika 0.50 o.20 0.10 0.80 163 Arua 0.04 0.05 o.20 o.29 164 Fort Portal 0.03 0.03 0.05 0.11 165 Gulu 0.90 0.50 0.80 2.20 166 Hoima o.70 o.30 o.30 1.30 167 Jinia 0.00 o.o2 0.00 o.o2 168 Kabale 0.00 0.01 o.oo 0.01 169 Masaka 0.35 0.16 0.40 0.91 170 Mbale o.06 o.o5 0.05 0.16 171 Soroti 0.01 0.01 0.o1 o.o2 172 Lira 0.15 o.20 0.16 0.51 173 Mbarara 0.18 o.t2 0.01 0.3 i 174 Mubende o.20 0.06 o.L4 0.14 175 Moroto 0.54 o.26 0.18 o.97 176 Nasuru o.20 0.40 o.23 0.83 177 Kiruddu 0.05 2.OO 5.00 7.O5 178 Kawempe 0.05 0.01 o.o1 o.o7 179 Entebbe 0.05 0.04 0.05 o.t4 180 Mulaeo SW&NH o.25 0.10 o.70 1.05 304 UVRI 0.05 o.o2 o.25 o.32 501-850 LGs 0.10 0.10 Total 152.O1 22.76 11.88 186.36 Source: Ministerial Policy Statement FY 2O2O I 21
Health Committee Report on PS FY 2O2O- 1 Page 14 e",[" 9. OBSERVATIONS AND RECOMMENDATIONS 9.1VOTE O14 MINISTRY OF HEALTH 9.1.1 Effects of COVID-19 on Health Service Delivery
The Committee commends Government for the vigilance and support towards the management and control of COVID-l9 pandemic. In addition, the Committee applauds the private sector (groups and individuals) for the material and financial support rendered towards the management of this global pandemic. The COVID-19 pandemic despite the fact that it is being managed, it has stretched the health sector and exposed all the gaps that exist. This ranges from lack of adequate resources (financial, human and infrastructural), weak and non-functional Ambulance services system, and absence a safe-working environment for health personnel and patients among others. Despite the risks involved in the management of COVI-19, there is dire need of medical supplies including the basic protective wear (PPEs and masks) that the health personnel require in the course their duty - to save lives of patients and those at risk. Arising from this pandemic, many of the planned activities for the FY 2019 l20 will not be achieved. Consequently, much of the external financing funds will remain unspent by close of the FY. This will necessitate revision of work plans for FY 2O2O 121 to take into account activities that may have to be carried forward from the FY 2Ol9l20. This pandemic despite its negative effects, it has been a wake-up call in as far as checking the functionality of our health systems. [t is therefore critical that we re-evaluate and reprioritize the Health sector if it is to withstand similar shocks when they happen. It is important to focus our efforts in critical areas that guarantee safety of the lives of Ugandans: ensuring adequate and effective healthy infrastructure, well-trained and motivated health personnel, an effective and efficient referral system, as well as instituting a comprehensive monitoring and supervision system that guarantee functionality of the health systems at all times. The Committee noted that whereas Government through donations and additional budgetary allocation towards the health sector will be underrating procurement for critical essential medicines and health supplies, including but not limited to intensive Care facilities (ICUs), procurement of Ambulances as well as other essential commodities needed at this material time, there are no
Health Committee Report on MPS FY 2020- Page 15 clear strategies to have these sustained in the FV 2O2O l2l and the medium term. It should be noted that functionality of ICUs requires constant supplies of essential medicines and supplies as well as the attendant human resources to have them operational. In addition, an efficient Ambulance Systems will require adequate allocation of the operational budget (non-wage) at all levels of deployment. The non-wage will have to be enhanced to ensure availabiliff of fuel, remuneration to Drivers and to cater for wear and tear which will necessitate repairs and occasional replacement of some parts.
Whereas the Government has responded to the current shortage of medical personnel by recruiting on contract (six months) about 25O medical staff, this is a temporary measure yet there is shortage of health staff at all levels of health service delivery across the country.
Consequently, Government will have to consolidate the gains from the COVID- 19 pandemic by providing adequate resources that will guarantee improved health service delivery to save on foreign exchange usually lost when Ugandans seek medical care abroad. The COVID-19 pandemic has signaled to all nations that self-sufficiency in terms of health is critical. When all travel abroad was barred, there was no alternative for home-based medical care. Recommendation
The Committee therefore recommends that Gooernment should re-prioritize its FY 2O2O/21 budget uith a uieut of allocating adequate budgetary resources to consolidqte the gains from procurements and installations arising out of efforts to manage COVID- 79 pandemic. The Health Sector Wage and non-utdge budgets should be enhanced to guarantee an eflicient and effectiae health seruice delioery sgstem. The alreadg recnrited contract staff should be absorbed. into the mainstream seruice to reduce on the statfing gaps in the sector. 9.L.2 Lack of Critical Human Resource for Health The Committee observed that despite the pledge by the NRM Government to achieve loooh staffing in the health sector by 2018, the sector continues to struggle with attraction of critical health personnel at various levels of health service delivery. A review of the Ministry of Health Specialists Status Report
Health Committee Report on MPS FY 2020-2t Page 16 (April 2OI9) indicates that the staffing levels for specialists was at 313 (29o/ol out of lO92 positions required at both National and Regional Referral Hospitals. This leaves about 779 (7lo/ol not filled.
By the end of July 2018, the staffing levels for medical specialist for Mulago hospital complex and at regional referral hospitals stood at 38o/o, senior consultants, consultants and Medical Officers Special Grade at 39o/o,38% and 37o/o respectively.
In addition, whereas in September 2017, a total of 1,392 specialist had been registered by the Uganda Dental and Medical Practitioners'Council (UMDPC), only 113 (28.8o/ol of the required 392 positions were employed in regional referral hospitals. There challenge has been and remains to have these specialists (available on the market) to be attracted and retained at all levels of health service delivery. This has resulted into delivery of low quality healthcare as well as inadequate supervision and mentorship to guarantee career growth for younger professionals including medical interns.
The Committee appreciates the allocation of an additional wage allocation UGX 18.29bn in FY 2O2Ol21 over and above FY 2Ol9l2O health sector budget. However, notes that previously, there has been delayed recruitment of health workers even when resources have been availed resulting in non absorption of the wage budget (average of UGX 15bn over the previous three financial years).
This has been attributed to delays by the Ministry of Public Service to clear the process of recruitment. The Committee was informed that the Ministry of Public service only clears recruitment after confirmation of availability of funds. There is a huge shortage of critical staff for most of the health cadres as indicated in Table 9 below.
Table 1 1: Staffing norms for specific fields in Public Health Institutions Cadre Positions Total Norms Total Filled o/oFilled Lab Staff 2,993 2,740 2,756 IOlo/o Nursing Staff 3,O32 18,843 17,258 87o/o Midwifery 2,994 6,729 5,353 SOYI Theatre Staff 233 5t2 368 72Yo Health Inspectors 3,150 3,778 2,185 58o/. Doctors 1,342 2,256 1,298 58o/" Pharmacy Staff 351 116 64 55o/" Health Educators 2,061 420 200 48Yo Anaesthetic Officers 232 855 247 29o/"
Health Committee Report on MPS FY 2020-21, Page 17 &"16-6 General Surgery 42 22 20 52o/o Internal Medicine 42 t6 24 38% Paediatrics 42 19 2t 45o/o Obstetrics/ Gynaecolos/ 42 22 20 52o/o Orthopedics 28 3 25 Llo/o Anaesthesia 28 2 26 7Vo Psychiatry 28 2 26 I "/o Ophthalmologr 28 9 1B 32o/o ENT 28 3 25 lLo/o Radiologr 28 8 20 28.5o/o Public Health 28 4 24 l4Yo Pathologr 28 3 25 llo/. MoH Human Resource for Health Audit Report, 2017
Recommendation The Committee recommends that Government should ensure that; i) Parliam;ento;ry approaq.l of the health sector recruitment plans should suffice as clearo,nce for the Health Service Commission to proceed with recruitment of health workers to aaoid. delags; ii) Health Seruice Cornmisston should address the current rigidities that impede the recntitment process. iii)Ministry of Health should fast trq.ck the 2076 Presidential directiae to efthance salaries of consultants and senior consultants to a leael of their counter p@rts in educqtion institutions. ia) Allocate UGX TObn in the sector budget for training of the Critical Cadre staff. a) Include UGX Sbn ors a hard-to-reach alloutqnce specificq.llg for specialists, consultants qnd other critical health care staJf for the hard-to-reach areds.
9.1.3 Intern Doctors and Senior House OIficers Over the years, the number of medical interns has been growing from about 200 Interns in the year 2OOO to the current level of llTO Interns. This increase has been attributed to increased University Student enrollment to medicine, Dental, Pharmacy and Nursing courses. It should be noted that Medical Interns unlike other categories of Interns serve as frontline health workers world over and perform critical functions just like public servants for the duration of their internship. However, despite Parliament's previous recommendations that Government should develop an Internship Policy that should help streamline Medical Internship to avoid recurring industrial action usually with far reaching
Health Committee Report on MPS FY 2020-21. Page 18 implication to health service delivery in many facilities across the country, this has not been achieved. In addition, Parliament had recommended that adequate resources should be provided to facilitate Medical Interns as well as Senior House Officers at the bare minimum. Recommendation The Committee recommends tha|
(i) Effectiae FY 2O2O/21, allocation for Medical Intertts' alloutances should be raised from UGX 73.52bn to UGX 35bn. (ii) An additional allocation of UGX 8.4bn should be prouided to facilitqte the enhancement of alloutances for Senior House Officers.
9.l.4Implementation of the National Health Insurance Scheme (NHIS) The Committee observed that Government tabled the National Health Insurance Scheme (NHIS) Bill 2019 before Parliament for consideration and enactment. Whereas the enactment of the NHIS law will greatly contribute to the attainment of Universal Health Coverage (UHC) by 2O3O in line with the Sustainable Development Goal (SDG) No.3.81, the Budget for FY 2O2O121 does not provide for the much needed resources to have it implemented in FY 2O2O121. The Committee noted that the Ministry has allocated a pantry UGX 0.5bn to cater for preparatory activities during the FY 2O2Ol2l. It should further be noted that the NHIS preparations have now taken over seven years but with little progress to-date. The NRM manifesto requires that the NHIS should be in place by 2021 to facilitate affordable healthcare and reduction in out of pocket household expenditure.
Recommendation The Committee recommends that; Goaernment should adhere to its commitment cs euidenced bg the certificate of finqncio'l implications tssued to the AIIflS bill and prouide for resources required to implement the scheme utith effect from Julg 2O2O utithout ang further delag.
' achieuing uniuersal health couerage, including financial nsk protection, access to qualitg essential healtlt care seruices and access to safe, effectiue, qualitg and affordable essential medicines and uaccines for all and reducing the out-of- pocket expenditure on health.
Health Committee Report on MPS FY 2020-21. Page 19 9. 1.5 Inadequate Counter-part F'unding Lack of counterpart funding for externally funded projects under the sector continues to constrain timely execution and completion of key projects in the sector. Further, the Italian Project for Karamoja Sub-Region stalled and would require an additional UGX 8.4bn to have them completed in FY 2O2Ol2l.
Government of Uganda committed to contributing UGX 6.3bn annually in counterpart funding for the Regional Hospital for Paediatric Surgery-Entebbe under the Italian funded Emergency Life Support for Civilians War Victims. However, this has accumulated to UGX 13.7bn arising from its failure to clear tax obligations and the inability to meet 2Oo/o of the constructions costs in FY 2Ol9l2O. For FY 2O2Ol2l, UGX 6.3bn is the expected contribution of by Government's towards the project contribution for financing of the project in fulfilment Government commitment.
The Committee recommends that; i) Goaernment should prioritize prouiston of counterpart funding to all keg projects with readg external financing in ?Y 2O2O/21 to aaoid the likelg costs arising from breach of contractual obligations with Funders. ii) Goaernment should prouide the additional UGX 8.4bn for completion of the lto,lian project in Karamoja sub-region uithin the sector's budget for FY 2O2O/21. iii)Goaernment should desist from ooer commitments to projects that require counterpart funding utithout certaintg and aaailabilitg of budgetary funds are auailable. ia) The UGX 6.3bn be aaailed in the budget for 2O2O2/21 as Gooernment's c;nnual contribution to the project crs stated in the Jinoncing agreement a) Goaernment should continue to mobilize these resources to expedite settlement of the arrears relating to the project
9.1.6 Funding for the Operationalization of Rehabilitated General Hospitals The Committee noted that whereas Kawolo, Kayunga and Yumbe General Hospitals previously under rehabilitation are now complete, there are no funds to have them operationalized. Kawolo General Hospital (funded through the Spanish Debt-Swap) requires UGX 600m while for Kayunga and Yumbe hospitals each require an estimated UGX 40Om for operationalization.
Health Committee Report on MPS tY 2020-21, Page 20 Relatedly, during the FY 2Ol9l20, Parliament allocated UGX 3bn towards the rehabilitation of Gombe General Hospital. Whereas the rehabilitation requires an additional allocation of UGX 3bn in phased II to have it completed, this funding is not available in the FY 2O2Ol21 budget.
Recommendation The Committee therefore recommends that;
Goaernment should prouide the required o,llocation of UGX 7.4bn to operationalize Kawolo, Kagunga qnd Yumhe General Hospitals in the next FY 2O2O/21.
9.1.7 Domestic Arrears (Litigations| The Committee observed that the Ministry of Health had accumulated a huge bill arising from payment of domestic arrears to the tune of UGX 42bn. In addition, another UGX 40bn will soon accrue arising from contingency liabilities from pending court cases. Once the contingency liabilities materialize, the total amount of domestic arrears will rise to UGX 82bn. The Committee noted that the continued accumulation of domestic arrears is contrary to the existing commitment control system and the provisions of the PFMA, 2Ol5 (amended).
Recommendation The Committee recommends that: The Ministry of Health should desist from accumulation of arrears going forutard and prioritize settlement of all ueritied arrears to free resources due to the priaate sector a.s a meo;ns of promoting pritnte sector growth.
9.1.8 Dependency on External Funding The Committee noted that the health sector budget was heavily dependent on external financing especially the development budget category with 86% of the total health development budget funded from external sources. With this distribution, any negative shock to the external environment, like the case of COVID-19 can easily distort health service delivery in Uganda. Parliament has previously recommended that Government should adopt a paradigm shift where the health sector budget is domestically funded in a phased approach but with little success.
Health Committee Report on MPS FY 2020-21, Page 21 Recommendation The Committee therefore reiterates its recommends that; (i) Goaernment should follow up on its promise to prioritize the health sector starting FY 2O2O/21 utith more inaestment in the health sector infrastntctural deaelopments to aaoid last minute panic ushere external resources mag not be forth-coming.
9.1.9 Inadequate allocation to Regional Equipment Maintenance Workshops The Committee noted that continually, regional Equipment maintenance Workshops for the diagnostic equipment are resource constrained despite their importance in ensuring that medical diagnostic equipment are maintained in usable and serviceable status across all facility levels.
In many facilities, the Committee has found X-ray machines and Ultra-sound Scans out of use dues to simple repairable defects resulting into un-told suffering to patients. The Committee was informed that an estimated UGX Sbn is required to undertake maintenance contracts and equip the Regional Equipment Maintenance Workshops up and running. However, these funds are have not been earmarked in the FY 2O2O121 budget.
Recommendation The Committee recommends that; Pqrliament allocates UGX Sbn toutards funding the regional medical equipment maintenar,ce utorkshops in FY 2O2O/21.
9.1.10 Support Supenrision and Monitoring The Committee observed that inadequate supervision of health services at all levels remains a major cause of poor health sector outcomes. The Committee noted that due to the meager budgetary allocations, the sector's ability to carry out support supervision visits at all levels is greatly challenged. As a result, there is a weak link between the various levels within the health sector delivery system. Further, Regional Referral Hospitals offer very minimal supervision to lower level health facilities which constraints the referral system and overall health service delivery outcomes.
The Committee further noted that due to the weak supervision in the sector many health facilities have initiated huge infrastructural projects against a
Health Committee Report on MPS FY 2020-21. Page 22 small resource envelope. The available budget is overstretched leading to stalling of projects with risks of ligations arising from breach of contracts.
Recommendation The Committee therefore reiterates it earlier recommendation that; The Ministry of Health and that of Finance Planning and Economic Deoelopment should allocate UGX TObn annuallg for Monitoring ond supetttision of health facilities as a meo;ns of improuing the perfortnclnce of the Sector utith effect from FY 2O2O/21.
9.1.11 Oxygen Plants at Kawempe and Kiruddu National Referral Hospital Kiruddu and Kawempe National Referral Hospitals entered into an arrangement to procure oxygen while they were still under Mulago National Referral Hospital and the arrangement is on-going. Kiruddu and Kawempe will be required to pay UGX 2.5bn and UGX 870m respectively by the end of the 5- year contractual term. When the Committee scrutinized the cost-benefit of contracting-out this service against setting up Oxygen Plants at each of the two facilities, it was found that the current arrangement is very costly to Government.
Recommendation The Committee recommends that The management of Kirttddu and Kautempe Referral Hospitals should consider terminqting the current contracts with a uieut of setting up Oxggen Plants which is more economical just like the case for other regional referral hospitals country wide.
Parliament should priorities the setting-up of tuto Oxggen Plants at Kautemgte and Kintddu as cost sauing meo,sure bg allocating UGX 2bn in ?Y 2O2O/21.
9.L.IzInternational Super Specialized Hospital of Uganda (at Lubowaf Redemption of Promissory Notes under the International Hospital of Uganda at Lubowa was expected to commence in FY 2O2O121. Based on the projections in the Health MTEF and the cashflow projections from patient revenues (US$ 43 million) indicated at the time authoring Government to issue promissory notes towards the construction of this facility, if no additional resources are earmarked to the Health Ministry to finance this project (US$ 191 million) during the operational period, the project will erode the fiscal space for Ministry's non-wage budget. Health Committee Reportw on MPS FY 2020-21, Page 23 This will have negative implications to heath service delivery due resulting from the constrained operation budget (non-wage). To avert this, the Government should provide for additional resource under the Ministry of Health starting with FY 2O2O 121 to finance the operations of the hospital and the redemption of the promissory notes. Moreover, additional resources may be at the expense of other projects or borrowing to finance the deficit.
Recommendations The Committee recommends that; Parliament allocates a total of UGX 265bn in the budget of the heqlth sector for FY 2O2O/21 to facilitate the redemption of the first set of Promissory Notes as enuisaged in the contractual terms.
9.1.13 Regional Hospital for Paediatric Surgery-Entebbe The Government signed an agreement to set up a Regional Paediatric Hospital based in Entebbe with the project total cost is estimated at UGX 98bn. However, there are already outstanding commitments by Government totaling to UGX 21.8bn. Out of this, UGX 1.8bn is for civil works while UGX 20bn for taxes. Although the facility was expected to be complete in 2Ol9l2O, no allocation has been made in FY 2O2O l2l.
Recommendation The Committee recommends that; Gooernment reneps its commitment and prioritizes cln allocqtion UGX 27.8 towards the financing of this facilitg.
9.L.L4Inadequate Diagnostic Equipment at National & RR Hospitals The Committee noted that there is widespread and general lack of diagnostic equipment such as X-Ray machines, MRI and CT-scans at the National and Regional Referral Hospitals. This undermines the diagnostic capacity of the RRHs hence adding pressure to the National Referral Hospitals.
The Committee was further informed that Government was considering a memorandum of understanding (MoU) with the development partners (the Netherland Government) to provide medical equipment through the DRIVE project, these efforts have never materialized since FY 20181 19. The Committee observed that this project require a counterpart allocation of UGX 20bn towards as a quarterly contribution. Consequently, it will require Governments total commitment if this project is to be actualized in the near future.
Health Committee Report on MPS FY 2020-21 Page 24 Recommendation The Committee therefore recommends that; Goaernment should prioritize and allocate UGX TOSbn toutard.s the purchase of the assorted diagnostic equipment for all Regional Referral Hospitals ccross the country.
9.1.15 Emergency Medical Senrice National Ambulance Senrice System The Committee observed that among the major planned interventions for the health sector budget strategic priorities has been in the area of devising mechanisms to reduce accidents and injury (currently 600/o are due to vehicles & Boda-bodas) through working with Ministry of Works & Transport to strengthen driver testing & strict guidelines to Boda-bodas.
The Committee noted that although some of the accidents and injuries are fatal and would require Emergency Medical Services to save the lives of victims, there is weak emergence medical service and Ambulance system to-date. Indeed the current COVID-l9 pandemic has provided a mock exercise from which we must learn important lessons for immediate improvement. The Committee has not seen any allocation towards this very critical undertaking.
Recommendation The Committee reiterates it earlier position and recommends that; Goaernment should allocate UGX 22.5bn toutards a phased establishment of the Notional Ambulance Seruice System. This utill greatlg improue the much needed pre-hospital cdre and emergencg service in Uganda.
9.L.6 Health Promotion and Prevention The Committee noted that the departments of NCDs and Health Promotion are allocated meagre resources yet the sector prioritizes preventive health care and yet the NCDs constitute a significant portion of the disease burden in the country.
Health Committee Report on MPS FY 2020-21 Page 25 &^^* Recommendation The Committee recommends that; i) Parliament allocates UGX TObn to Non-Communicable Dtseases Departments of Ministry of Health for preaention and health education; ii) Another UGX 42bn be allocated for Village Health Teams and Communitg Health Workers for heo,lth prevention qnd promotion
9.2 VOTE 114 UGANDA CANCER TNSTTTUTE (UCrl The Committee noted the shift in the Uganda Cancer Institute programs on cancer prevention. The Institute has moved to establish regional cancer centres in Arua, Mbarara, Gulu and Mbale to take cancer related services nearer to the populations in line with the preventive and promotive health care approaches.
The Institute plans to focus more on mass screening and treatment of cervical cancer amongst women and girls. This move should be applauded in light of the efforts to comply with the gender and equity responsiveness by entities under the health sectors. However, the required resources of UGX 3.75bn for the purchase of the 2HDR machines for treating cervical cancer is not included among the critical activities funded for UCI.
Recommendation The Committee therefore recommends that; Pqrliament should approue UGX 3.75bn to enable UCI acquire the 2HDR machines needed for treating ceruical cancer patients.
9.3 VOTE 115 UGANDA HEART INSTITUTE The national heart institute (Uganda Heart Institute) continues to lack space and a permanent home. The institute is now housed in one of the buildings of the Uganda Cancer Institute awaiting to be relocated back to Mulago Hospital upon completion of the renovation works.
The challenge of space and lack of a permanent home will not be resolved even with the relocation to renovated Mulago. The institute is grossly limited in the scope of operations and functionality to an extent that it cannot attain the desired targets.
Health Committee Report on MPS FY 2020-21, Page 26 The institute requires an additional UGX 2.8bn during FY 2O2O l2l to complete the rehabilitation of the Intensive Care Units. Further, the proposed new home of the UHI is estimated at USD 7Om and a funding proposal has been submitted to Ministry of Finance, Planning and Economic Development (MoFPED).
Recommendation The Committee reiterates its recommendation that; i) USD 7Om should be prouided for expansion, constntction, equipping and stafJing of the Uganda Heart Institute (Neut UHI home), ii) Parliament allocates UGX 2.8bn for rehabllitation of the UHI ICUs iii) The UGX TObn should be prouided for increased output in cardiac intententions and human resource training, welfare and deaelopment as per the Parliament resolution of 72th Febrttary, 2018.
9.4 VOTE 116 NATTONAL MEDTCAL STORES (NMSI Stock-Outs of Medicines and Medical Supplies Drugs The Committee noted a slight decline in availability of drug stocks from 85o/o to 84o/o measured by a basket of 4l commodities. Many health centres reported having medicine about 85oh of the time. This is attributed to the additional UGX60bn that was allocated to the entity as increment in the National Medical Stores budget for medicines.
However, the current allocation of UGX 16bn for Reproductive Health Commodities has a funding gap of UGX 13bn for Mama Kits. Of the required UGX 22bn for TB drugs and laboratory supplies, only UGX 7bn was allocated to NMS leaving a funding gap of UGX 15bn. It should be noted that an additional allocation to the Agency would result in a further diminish on the frequency of stock outs of medicine.
Recommendation The Committee therefore recommends that; il Parliament allocates additional UGX SObn to .l\lMS to improue on the aaailabilitg of dntgs in the heo,lth facilities ccross the country. iil An additionql UGX 28bn be allocated to .I\IMS to address funding gaps in reproductiae health commodities, TB dntgs and laboratory supplies.
Health Committee Report on MPS FY 2020-21, Page 27 TiilGoaernment should urgentlg allocate UGX 73bn for the procurement of Mama Kits in FY 2O2O/21
9.s voTE 134 HEALTH SERVTCE COMMISSION (HSC) 9.5.1 Refund of UGX 62Orn allocation meant for transport HSC The Committee observed that Health Service Commission continues to among other face challenges of delivering on its mandate. The Commission lost UGX 62Om arising from the Cabinet decision to reallocate funds for transport equipment thereby affecting the capacity of the Commission to undertake support supervision. The Commission needs to develop standing orders for the health sector and that could require UGX 1bn.
Recommendation The Committee therefore recommends that; Parliament allocates UGX 62Om and UGX Tbnfor transpora equipment and deoeloping Standing Orders for the health sector respectiaelg.
9.5.2 Low Wage Performance for the Sector The Committee noted a persistent low wage performance under the sector over successive financial years. This was attributed to the staffing bottlenecks caused by an old staffing structure available for the Health Service Commission. This stifles the recruitment process.
Thus, the wage allocation remains high while the performance remains low thereby rendering redundant the resources that would have otherwise been committed to other critical areas in the sector. The Committee further noted that a rigid and protracted-time consuming recruitment process strictly adhered by the Health Service Commission, as well as the delay by the Ministry of Public Service to clear for recruitment the agencies for which Health Service Commissions recruits, is one of the leading causes of the persistent low wage performance for the sector. This results in late search for candidates.
It was noted that poor attraction of the requisite staff renders the wage allocation unutilized and hence poor u
Health Committee Report on MPS FY 2020-21. Page 28 Recommendation The Committee thus recommends that; i) UGX 7.27bn should be provided to enhance the recntitment capacitg of the Health Service Commissionl ii) Health Seraice Commission should address the rigidities in its rectttitment process that hinder attraction of critical cadre staff.
9.6 VOTE 151 UGANDA BLOOD TRANSFUSTON SERVTCES (UBTSI UBTS has shortage of critical staff required to constitute additional five (5) blood collection teams each comprising of 5 Blood Donor Recruiters, 5 Senior Nursing Officers, 5 Nurses, 10 Enrolled Nurses, Donor Clerks and 10 Drivers.
If recruited, the additional critical staff would increase blood collection with by 60,000 units and narrow the existing gap of 120,000 units if the WHO standards are to be met (WHO recommends a blood collection target of lo/o of the population). This translated to a total of 420,000 units for Uganda. To attain this, a total budget of an additional UGX 3.3bn is required in FY 2O2O l2l. Uganda Blood Transfusion Services (UBTS) further requires transport equipment for blood collection at a cost of UGX 400m.
Recommendation The Committee recommends that; Parliament approaes UGX 3.7bn toutqrds the rectttitment of critical staff and trqnsport equipment for Uganda Blood transfusion Sentices for FY 2O2O/21.
9.7 VOTE 161 MULAGO HOSPITAL COMPLEX Mulago Hospital Complex rehabilitation is near completion and stands at 99o/o level of completion to-date. The Committee was informed that re-opening of the facility as awaiting completion of installation of equipment. Currently, Mulago Hospital complex is being used as a treatment and isolation center for COVID- al9 patients and will commence immediately the country is out of this problem.
However, the Committee noted that funds to fully operationalize the hospital upon completion are not allocated. This is most likely to render the hospital redundant or operate under difficult budget constraints. The Committee was informed that Mulago retires about 50 staff annually across all categories of cadres, who need to be replaced annually. In addition, a number of Staff originally working at the facili for Kawempe, Kiruddu and
Health Committee Report on MPS FY 2020-21. Page 29 8**)"6 Mulago Specialized Women and Neonatal Hospital. Consequently, to replace these critical staff, the hospital requires a wage bill of UGX 55.018bn.This money is not provided for under the budget.
The Committee noted with concern that UGX2bn that had been part of the long term contract to complete a 150 unit staff complex had been re-allocated to another priority.
Recommendation The Committee recommends that; i) Parliament approues UGX SObn in the budget for FY 2O2O/27 for full the operationalization of the Mulago Super Specialized H o sp ital up o n co mp letio n; ii) Parliament approaes re-allocation of UGX 4bn for distribution to Kawempe qnd Kirttddu Nqtional Referral Hospitals to enhance their medicines budg ets. iii) UGX TObn be q.llocated to Mulago for FY 2O2O/27 for a phased recrttitment of hospital staff to ensure the right statfing norms. iu) The Committee recommends that this moneg be retained at part of the Mulago Hospital Capital deoelopment.
9.8 VOTE 178 I(ATVEMPE NATIONAL REFERRAL HOSPITALS The Committee noted that Kawempe hospital was upgraded to National Referral Hospital status. Consequently, it is expected to provide services commensurate with its current status. However, the hospital faces a challenge of inadequacy of critical staff with only 35% staffing level across all cadres. This constrains its capacity to deliver quality health services are greatly undermined.
Cureently, the Hospital's total wage bill is UGX 6bn and their total requirement is UGX 19.5bn. The shortfall is UGX. 13.5bn
Further, the medicines stocks for Kawempe lasts about 5-6 weeks for a quarter allocation due to big numbers of patients. The total budget for medicines and other EMS required for FY 2O2Ol21 is UGX 4bn. However, only 1.5bn has been allocated for FY 2O2O121. The budget shortfall amounts to UGX 2.5bn
The hospital lacks most of the paediatric and equipment especially the Paediatric beds and ambulance which cost UGX 1.5bn and UGX 2bn respectively and yet they have zero allocations in the budget.
Health Committee Report on MPS FY 2020-21. Page 30 Kawempe's utilities have been allocated UGX 338m out of the required UGX 78Om with a budget deficit of UGX 442m. Additionally, the hospital continues to pay for oxygen consumption at about UGX 14.lm monthly.
Recommendation The Committee recommends that; i) Parliament allocates dn additional UG 73.5bn to cqter for recrttitment of staff. ii) An additional UGX 7bn be approaed for setting up the oxggen plant at Kautempe National Referral Hospital.
9.1O VOTE 177 KIRUDDU NATIONAL REFERRAL HOSPITAL Together with Kawempe, Kiruddu was elevated to the status of National Referral Hospital with a niche in internal medicine. However, current budgetary allocations to the facility do not include capital development.
With a very limited and inadequate budget for medicines, lab and other EMS, understaffing especially consultants and nurses, high utility bills (especially electricity) and general maintenance of expensive medical equipment. Normally, about 25o/o of the patients in Kiruddu are always on oxygen taking the monthly expenditure on oxygen to UGX 30m.
Kiruddu's Sewage plant is incomplete. A total of UGX 950m, ia required to complete the project. However, this amount has not been provided for in the Budget.
Recommendations The Committee recommends that; i) Kitttd.du's budget should be enhqnced. bg allocating additional UGX 5.2bn for recntitment of critical staff. ii) Parliament qpproaes UGX 2.2bn for retooling of the hospital; and Prouide UGX 5.2bn to cater for increased utilitg bills (UGX 4OOm,), lab and other EMS (UGX 2.7bn for dialgsis and UGX 2bn for reagents and supplies).
9 .11 MULAGO SPECIALIZED WOMEN AND NEONATAL HOSPITAL The Committee expressed concern over delays to fully operationalize th,e facility despite its completion over two years. This leaves the hospital meant to operate at a super specialized level at a level like any o er hospital
Health Committee Report on MPS FY 2020-21 Page 31 The specialized hospital is faced with a staffing gap of 57o/o of the critical staff in the super specialized areas of Intensive Care Unit (ICU), Invitro Fertilization (IVF) and Anaesthesia. Moreover, no wage allocation was made for recruitment of the same - this requires UGX. 7.435bn, inadequate budget for specialized medicines with a funding gap of UGX 1.5bn and the inadequate non-wage recurrent to cater for operational activities - this requires UGX 7.2bn. There were no resources whatsoever allocated for capital development (assorted medical equipment at UGX 13.O6bn and Transport at UGX 2.96bn and payment of pension and gratuity for FY 2O2Ol2l.
Recommendation The Committee recommends that; i) Parliament should allocate UGX 7.435bn for recntitment of more stulf to bridge the required gap in offertng super specialized seruices and enable the hospital to operate at optimal leael. ii) UGX 7.7bn should be allocated to the hospital for pagment of pension and gratuitg. iii)UGX 7.5bn be provided in FY 2O2O/21 for purchase of super sp ecialized medicines I iu) An additional UGX 73.O6bn) be prouided for medical equipment for Mulago Specialized Women and Neonatal Hospital; and o) UGX 7.2o2bn be prouided to the hospital to cater for non-urage recttrrent costs.
9.L2 REGTONAL REFERRAL HOSPTTALS (RRHSI 9.L2.1 Capital Development Projects at Regional Referral Hospitals During the review of the NBFP FY 2O2O l2l, the Committee noted that there are a number of on-going multi-billion capital development projects ongoing at majority of the RRHs. However, most of these projects' completion dates have been are affected by insufficient annual budgetary allocations. As a result, most of the ongoing projects have stagnated with little hope for their completion in the near future if no additional resources are to be provided in the sectors budget. The Committee noted that there is no additional allocation to guarantee a phased construction process.
In addition, whereas regional referral hospitals have been structures to perform similar functions with the various regions of the Country, it has been noted the ongoing capital development are not standardized. This has led to variances in both cost and space utilization among others unlike the uniformity in
Health Committee Report on MPS FY 2020-21. Page 32 structure/features and costing exhibited in the ongoing upgrading of lower level health facilities across the country. The committee commends the Hon. Minister for Health for heeding to Parliament's recommendation to have development funds for Regional referral Hospitals pooled and have all infrastructural projects phased and allocated sufficient funds to complete the already ongoing projects in a phased manner.
Recommendations The Committee therefore reiterates its earlier recommendations that; i) Ministry of Health should halt initiation of new projects in the sector until the on-going ones dre completed. ii) Parliament should allocate an extra TObn to enable the completion of projects in all the hospitals. iii)Ang future capital deaelopment should be standardized across the aarious leaels of health setttice deliaery.
9.L2.2 Power Connections to Regional Referral Hospitals The Committee noted that a number of RRHs are connected to single-phase power lines which frequently cause damage especially medical equipment due to power surges. It was further noted that most RRHs do not have power back- up systems resulting into shortage of alternative power sources in event of load shading.
Thus, the double cost of settling bills and repairing of damaged equipment is burdensome to in a situation of a constrained budget leading to accumulated utility arrears. It should be noted that a stable power source for the RRHs does not only shield medical equipment from damage but is also a vital element in the running of equipment, preserving cold chain, theatres and in mortuaries,
Recommendation The Committee recommends that; i) An additional UGX 3bn should allocated for setting up power back up across the RRHs. ii) Pqrliqment should allocate UGX Sbn to facilitate the connection of the respectiae RRIIs to three- phase power lines.
9.12.3 Inadequacy of StaffAccommodation at RRHs The Committee noted that a big section of staff across health facility levels are not accommodated due to serious shortage of on-campus staff accommodation facilities. However, the RRHs are grossly . This challenge affects timely
Health Committee Report on MPS FY 2020-21. Page 33 attendance to duty and in cases of emergency where critical cadre staffs live far away from the health facilities.
The problem is worsened by the time that capital development specifically on staff accommodation takes to reach completion. Most projects on staff accommodation at entering the fifth lStt; year of construction without clear dates of completion.
Recommendation The Committee therefore recommends that; Staff dccommodation should be prioritized to ensure that critical staff liue in close proximitg to the healthfacilities.
9.13 VOTE: 3O4 UGANDA VIRUS RESEARCH INSTITUTE (IIvRIl
The Uganda Virus Research Institute (UVRI) carries out scientific research on communicable diseases especially viral diseases of public health importance. The Institute's broad mission is to conduct scientific investigations on viral and other communicable diseases so as to contribute to knowledge, policy, practice prevention and build capacity while promoting institutional sustainability. The Auditor General in his report of FY 2018119, noted that out of the budget revenue o UGX 26On as NTR only UGX 1.07bn was collected representing 4L.2o/o of the target, this was due to the breakdown of the institute's Nitrogen plant.
The Auditor General also noted that the Institute's Nitrogen plant broke down in 2Ol7 and had been replaced by the time of the audit. According, the Accounting Officer was advised to liaise with the Ministry of Finance for funding the replacement of the broken down Liquid Nitrogen Plant. The liquid nitrogen is the cheapest for storing samples for a long time than storing them in electric deep freezers. Deep freezers use a lot of power which is costly. Their storage tanks do not need expensive regular repairs like electric freezers. Liquid nitrogen can easily be transported in containers to collect samples from the field in any part of the country. The plant can be a source of income because the institute can sell nitrogen to other research institutes to boost the NTR.
The current budget provisions are so small to cater for general running of the institute leaving a critical gap for funding research, surveillance and emergency preparedness activities and general operations of the institute.
Health Committee Report on MPS FY 2020-21. Page 34 The budget shortfall for FY 2O2Ol21 is UGX 3.31bn for surveillance, emergency preparedness research, procuring an institute Nitrogen Plant and compensating squatters. Recommendation
The recommends that during FY 2O2O 121 a total of UGX 3.31bn be allocated to Uganda Virus Research Institute (UVRI) to urgently address critical areas as follows; i) UGX 67Om should be allocated for the procurement and installationof the Nitrogen plant; ii) Goaernment should allocate resources utorth UGX 25Om .for procurement a LOOO KVA generator qnd its maintenancel iii)Goaernment should commit UGX 89Om toutards rapid responses towards outbreaks of Ebola and other emerging and re-emerging infections in the country; ia) A total of UGX SOOw should allocated to support the Institute in Understanding Protectioe Immune responses among surviuors of uiral he amo rhag ic infe ctions a) Allocate UGX 35Om toutards control of emerging HIV dntg Resistance; and ui) A tune of UGX 47Om should be secured for the procurement of specialized research machinery and equipment to handle rapid. responses to outbreaks (cold cho;in machinery and equipment, autoclaae double door- hi-tec sterilizers, deep freezer etc)
10. OTHER KEY ISSUES 1O.1 Operationalization of the Upgraded Health Centres HCIIIs and HCIVs The Committee appreciates the efforts of Government in ensuring that the process of upgrading of HC IIs to HC IIIs and HC IIIs to HC IVs is actualised. However, the Committee was concerned about the slow pace of operationalization of the health facilities.
The medicines and other supplies for the upgraded health facilities are not included in the sector budget under National Medical Stores (NMS) Health Committee Report on MPSw6 FY 2020-21 Page 35 The continued delay to operationalize the upgraded HCIIIs denies communities equitable service delivery due to inadequate resource allocation as resources are earmarked in accordance with health facility status.
Recommendation The Committee recommends that; i) Parliament should ensure that Goaernment through the Ministry of Heo.lth expedites the operationalization of the upgraded facilities in before ?Y 2O2O/21.
Health Committee Report on MPS FY 2020-21 Page 36 11. CRTTTCAL UNFUNDED PRTORITTES IN THE SECTOR FOR FY 2O2O121. Table 12: List of Unfunded Activities UG billion # Activity Amount Comment (ucx, billion) Required allocation for There is need for Government to support surveillance, emergency UVRI in areas to further enhance their. preparedness research, 3.31 procuring an institute Nitrogen Plant and compensating squatters. Uganda Virus Research Institute (UVRI).
Install Blood Fridges in 89 2.2 Equip HCIVs to provide Obstetric Care HCIVS. to approx. 8,400 currently referred to hieher level facilities. Wage requirement for B9 3.8 Ministry of Public Service is revising the Anaesthetic and t24 Staffing structures to accommodate Anaesthetic Assistants2 at these critical cadres required to facilitate HCIVS. surgical procedure operations at HCIVs.
Recruitment expenses for 0.1 Facilitate HSC to regularize recruitment Medical Specialists at Regional of 11 medical specialists currently on Referral Hospitals. Contract. The Wage bill is available.
Wage requirement for 55 staff 0.86 To enable 55 staff be absorbed in LG formerly under PEPFAR support Health facilities. to LGs. Digitalisation of Regional 3.0 Required in FY 2O2O 121 to link Regional Referral Hospitalss. Referral Hospitals to the Server at Mulago (a total of UGX 8bn will be required in a phased manner). Set up the power backups for 3.0 Need to reinforce and maintenance of a consistent and stable power constant power supply across the RRHs supply Connection to support Medical 5.0 facilitate the connection of the respective Equipment RRHs to three- phase power lines Funding for mTrack system of 0.9 Support investment in mTrack to ensure Surveillance. continuity of the weekly reports and timely surveillance. Support supervision, Training & 1.0 MOH will provide orientation and orientation of Health Unit training of Health Unit Management management Committees. Committees (HUMCs) through their sub- counties. Funding for TB commodities. 15.0 Funding for TB commodities to improve treatment success, retention rates and
'MOH has alreadg trained these professional staff under URMCHIP/ WB project and bonded them to recruitment in the public seruice. 'Mulago National Referral Hospital, Kawempe, Uganda Cancer Institute and Uganda Heart Institute haue been couered
Health Committee Report on MPS FY 2020-21 Page 37 reduce drug resistance Procurement of Mama Kits 13.0 To reduce maternal and peri-natal mortality. Funds to support full 50.0 There are no funds available for operationalization of the Mulago operationalization and yet the hospital is Super Specialized Hospital upon 99%o complete completion; Funds to support acquisition of 3.75 Machines needed for treating cervical 2 HDR machines cancer patients
Funds required for a phased 22.5 This Ministry of Health needs to improve establishment of the National pre-hospital care and emergency Ambulance Service System. services in Uganda.
Allocation for the purchase of 105.0 RRHs are short on critical assorted the assorted diagnostic diagnostic equipment equipment. The sector needs resources for 10.0 The Ministry of Health is short on training of the Critical Cadre critical cadre staff staff.
Allowance specifically for 5.0 Critical cadre staff working in hard-to- specialists, consultants and reach areas require additional other critical health care staff for motivation the hard-to-reach areas
Funds required for Personal 6.0 There is need to protect health care Protective Equipment (PPE) workers from infection while on duty throughout the country and after.
Additional funds for the 8.4 Government should provide the required completion of the Italian project counterpart funding in Karamoja sub-region.
Government's Annual 6.3 Government's needs to allocate these contribution towards the funds in honour of its commitment as Regional Paediatric Surgery stated in the financing agreement of the Hospital in Entebbe project.
These are the outstanding tax t3.7 There is need for Government to arrears arising from the failure priorit2e clearance of arrears for the by Government to meet the tax project obligations Allocation required to support 10.0 Departments of Non-Communicable Health Promotion UGX 1Obn Diseases need to be adequately facilitated to implement programs on prevention and health education;
Health Committee Report on MPS FY 2020-21. Page 38 Funds needed to facilitate VHTS 42.0 Government needs to prioritize health in the 70,000 villages in the prevention and promotion. country to do health promotion and prevention Funds required for staff 13.5 Government should prioritize staff recruitment to move Kawempe recruitment to fill the existing structure from 35% staffing to 100%
Required allocation for 0.95 Proper waste management at the completion of the sewage plant hospital to safeguard the surrounding communities is a priority that should be supported by Government Total 347.415 Source: Ministerial Policg Statement FY 202O/21
Health Committee Report on MPS FY 2020-21 Page 39 Budgetary Allocations for the Ministry of Health Votes FV 2O2O-21
Table 13
Vote Institution Recurrent Development Total (incl. (ucx, ooo) (ucx, oool Pension) (ucx, ooo) oL4 Ministry of Health 84,899,553 1,273,903,738 1,358,803,29O tL4 Uganda Cancer Institute 21,r11,730 84,741,287 105,853,O17 115 Uganda Heart Institute 20,400,o17 4,650,000 25,O5O,O17 LL6 National Medical Stores 396,172,215 396,L72,215 L34 Health Service Commission 7,O7O,g9l 80,000 7,150,891 151 UBTS 15,954,2O9 1,870,000 L7,824,20,9 161 Mulago Hospital Complex 58,702,O49 6,020,000 64,722,O49 L62 Butabika Hospital 13,238,644 8,308,141 21,546,785 304 UVRI 6,748,559 2,280,OOO g,o2g,559 163 Arua RRH 10,1 10,541 800,000 1Or91Or541 164 Fort Portal RRH 8,792,316 780,000 9,572,316 165 Gulu RRH 9,953,378 1,900,000 LL,753,378 166 Hoima RRH 8,460,904 200,000 9,660,9O4 L67 Jinia RRH 10,301,680 1,600,000 11,9O1,680 168 Kabale RRH 6,807,892 1,goo,ooo g,7o7 rgg2 L69 Masaka RRH 7,964,r25 3,496,562 LL,460,687 L70 Mbale RRH 11,239,734 750,000 LL,989,734 17L Soroti RRH 7,141,535 200,000 7,341,535 L72 Lira RRH 1o,619 ,526 2,515,000 L3,L3'41526 773 Mbarara RRH ro,5l4,o12 800,000 LL,3L4,Ol2 174 Mubende RRH 8,512,150 2,7 50,OOO LL,262,LSO 175 Moroto RRH 5,7 46,853 1,200,000 6,946,85,3 176 Naguru RRH 8,570,725 1,176,000 9,746,725 177 Kiruddu RRH 13,o14,735 13,O14,735 778 Kawempe RRH 1o,223,289 LO,223,289 L79 Entebbe RRH 3,7 59 ,92O 3,7Sg,g2O 180 MulagoSW&NHospital 14,581,456 14,581,456 Source: Ministerial Policy Statement & Annual Budget Estimates FY 2O2O-21
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O. a cd Cd o '5 +J Cd tr u Sr +) p. -(+J 6 tr Htr o G (d a o o +-J Cd +J o Cd o Frto a t< Fl. -c +-) o O qi c Cd ti H Cd d 'rd $i B o o li f-l 6 {-J CJ cd L o C) & Cd o d H d cd +) h O z l-J O O ti O O bx UT M d OT d H ti ! {-J O a4H O. +r O d o d -o Cd f-J r NO NAME CONSTITUENCY SIGNATURE 1 Hon. Bukenya Iga Michael- Chairperson Bukuya County ) 2 Hon. Baguma Spellanza- Vice Chairperson DWR Kyenjojo I r 3 Hon. Ssebikaali Yoweri Joel Ntwetwe County 4 Hon. Atyang Stella DWR Moroto 5 Hon. Kemirembe Pauline DWR Lyantonde 6 Hon. Ssembatya Edward Ndawula Katikamu South W 7 Hon. Nayebale Sylvia DWR Gomba Y 8 Hon. Ayeb azlbwe Jastine DWR Isingiro 9 Hon. Bebona Babungi Josephine DWR Bundibugro 10 Hon. Lyomoki Sam Workers Rep 11 Hon. Rwakimari Beatrice DWR Ntungamo t2 Hon. Sizomu Gershom Wambedde (Rabbi) Bungokho North 13 Hon. Ssentongo Robina Nakasirye DWR Kyotera ,&-ezT t4 Hon. Baseke Fred Ntenjeru South ( 15 Hon. Kinobere Herbert Kibuku County t6 Hon. Dulu Mark Angel Adjumani East County 17 Hon. Wakabi Pius Rujumba Bugahya County 18 Hon. Turyahikayo Mary Paula Rubabo County 19 Hon. Soyekwo Kenneth Tingey, County 20 Arinda Gordon Kakuuma Bushenyi-Ishaka