i

MINISTRY OF HEALTH

HRH 5-YEAR ROLL OUT PLAN 2010/11-2014/15

Implementing HRH Policy and aligning HSSIP with HRH plans

Ministry of Health Uganda August 2011

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Foreword

The purpose of this roll out plan document is to roll out the 15 year HRH Strategic Plan and

align Human Resources for Health documents to ensure easy and implementation within

manageable activities in a given period. It addresses a number of salient Human Resources for

Health issues, identified through studies and broad consultation that require urgent attention

to promote good performance, productivity and cost-effective practices.

The Roll out plan was developed to respond to the HRH crisis in Uganda characterized by

inadequate number and skill mix of the health workforce to effectively respond to the health

needs in Uganda, low retention and motivation, poor performance and high rate of

absenteeism. Underpinning the HR shortage are weak HR leadership and management, low and

delayed pay, under funding, weak HR information and other personnel systems, and

unsatisfactory work environment characterized by shortage of supplies and basic equipment,

lack of staff accommodation and other social amenities.

I therefore implore all the actors in health sector development to support this roll out plan as

we work together towards health systems strengthening for the purpose of attainment of

national and international health goals.

Dr. Isaac Ezati

DIRECTOR OF HEALTH SERVICES (P & D)

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Acronymns

CPD Continuing Professional Development

GoU Government of Uganda

HC Health Centre

HDP Health Development Partners

HMDC Health Manpower Development Centre

HMIS Health Management Information System

HPAC Health Policy Advisory Committee

HRH Human Resource for Health

HSD Health Sub District

HSSIP Health Sector Strategic Plan

IEC Information, Education and Communication

iHRMIS Integrated Human Resource Management Information System

IMAI Integrated Management of Adult Illnesses

IMCI Integrated Management of Childhood Illnesses

IMR Infant Mortality Rate

IST In-service Training Strategy

KDS Kampala Declaration on Sanitation

LLU Lower Level Unit

LTEF Long Term Expenditure Framework

MAAIF Ministry of Agriculture, Animal Industries and Fisheries

MAP Multi-country AIDS Project

MDA Mass Drug Administration

MDGs Millennium Development Goals

MMR Maternal Mortality Rate

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MoES Ministry of Education and Sports

MoH Ministry of Health

MTEF Medium Term Expenditure Framework

MTR Mid-Term Review

NGO Non Government Organization

NHA National Health Assembly

NHP National Health Policy

NHS National Health System

OPD Outpatient Department

PEAP Poverty Eradication Action Plan

PHC Primary Health Care

PHC-CG Primary Health Care Conditional Grant

PHP Private Health Practitioners

PNFP Private Not-For Profit

PPPH Public Private Partnership for Health

PWD People with Disabilities

QA Quality Assurance

SEHO Senior Environmental Health Officer

SHE Senior Health Educator

SHI Social Health Insurance

SOS Sustainable Outreach Services

SRH Sexual and Reproductive Health and Rights

ST. ASST Stores Asstant

STENO S Steno-Secretary (Stenographer)

SWAp Sector Wide Approach

TCMP Traditional and Complementary Medicine Practitioners

TFR Total Fertility Rate

TT Tetanus Toxoid

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U5MR Under 5 Mortality Rate

UCMB Uganda Catholic Medical Bureau

UDHS Uganda Demographic and Health Survey

UNHCO Uganda National Health Consumers Organization

UNHRO Uganda National Health Research Organization

UNMHCP Uganda National Minimum Health Care Package

UPMB Uganda Protestant Medical Bureau

UVRI Uganda Virus Research Institute

VCT Voluntary Counseling and Testing

VHT Village Health Team

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Contents

1.1 Background ......................................................................................................................................... 1

1.2 Situation Analysis ............................................................................................................................... 2

1.3 Critical Issues ...................................................................................................................................... 3

2.1 The Goal of the Roll out plan........................................................................................................ 4

2.2 The Key Outputs ........................................................................................................................... 4

2.3 Specific Outputs of the roll out plan ............................................................................................. 4

2.4 Implementation Arrangements ...................................................................................................... 4

4.1 Health Worker Rationalization ............................................................................................................ 9

Table 5.1: Human Resource Investment 2010/2011-2014/15. .............................................................. 30

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1. INTRODUCTION

1.1 Background

The HRH Policy (April 2006) and Strategic Plan (June 2007) already developed are being

implemented. HRIS databases have been established at all the professional councils and at the

Humana Resource Management Division of MOH to improve availability of reliable data for

HRH policy, planning and management. In addition a nationwide health staff audit was done to

provide benchmark for recruitment planning. Initiatives have been made to strengthen HRH

support for improved performance including workplace policy and guidelines, introduction of

results oriented management, and Performance Improvement initiatives, among others. Retention

and turnover studies were done and a comprehensive motivation and retention strategy has been

drafted.

However the human resources for health crisis still persists. The total number and in skill mix of

the health workforce are inadequate to effectively respond to the health needs in Uganda. The

total estimated health workforce is about 45, 000, serving a total projected population of Uganda

of about 29 million. This means that there is one health worker for over 600 people, taking the

entire health workforce together. According to WHO a country with less than 2.28 health

workers (doctors, nurses and midwives only) per 1000 population is regarded to be in severe

shortage of health workers to meet its health needs. For Uganda this ratio is about 1.8. The

nationwide health staff audit in November 2008 found that only about 53% of the established

positions are currently filled. The available health workforce is inequitably distributed. About

71% of the doctors and 41% of the nurses and midwives are located in urban areas where only

13% of the population lives, while 87% of the population is rural. The productivity of the health

workforce is low, characterized by high rate of absenteeism estimated at an average of 40%. This

is partly attributable to weak leadership and management, and unsatisfactory work environment

characterized by shortage of supplies and basic equipment, lack of staff accommodation and

other social amenities.

The institutional capacity for HRH policy and planning is weak. There is no capacity to develop,

regularly monitor and review HRH policy and plans either at national or district level. Although

significant steps have been taken in the development of HR Policy and Strategic Plan HRH,

deployment and utilization the health workforce are still not rigorously directed in a sustainable

manner. This results into mismatch between service requirements and training, both in numbers

and skills, and inequity in the distribution of the available human resources.

The first Health Sector Strategic Plan (HSSP I) for Uganda covered the period 2001/2002-

2005/2006 and it guided health sector investments by Ministry of Health (MoH), health

development partners (HDPs) and other stakeholders over this period. At the end of this period

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an evaluation was done to assess key achievements and challenges during the implementation of

the HSSIP I and this formed the basis for the development of the second HSSP (HSSP II) for the

period 2005/6-2009/10. The HSSP II was completed in June 2010 when the first health policy

ended. It was therefore necessary that a Health Sector Strategic and Investment Plan (HSSIP) be

developed that will guide the health sector for five years starting from July 2010 to June 2015.

The HSSIP provides an overall framework for providing support to the health sector over the

next five years and its major aim is to contribute towards the overall development goal of the

Government of Uganda (GoU) of accelerating economic growth to reduce poverty as stated in

the National Development Plan (NDP) 2009/2010-2013-2014.

1.2 Situation Analysis

The health status indices in Uganda are still unacceptably poor. The population growth rate of

3.4 is one of the highest in the world. The total fertility rate is 6.9, while contraceptive

prevalence rate is 23.7% and unmet needs for family planning are up to 40.6%. Life expectancy

at birth is 43 years and about 50% of population is 15 years and below. About 38% of the

population lives below the poverty line.

Accessibility to facility based health services is low, at about 72% of the population. The doctor

to population ratio is at 1: 36,045; while the nurse to population ratio is 1:5,190 and midwife to

population ratio stands at 1:10,107. The utilization of maternity services remains quite low.

Although over 90% of pregnant women attend antenatal clinic at least once during pregnancy,

less than 40% deliver at health facilities. Most deliveries are therefore not supervised by skilled

service providers thereby putting the life of the mother at high risk in the event of complications.

Maternal mortality ratio (MMR) is 435 per 100,000 live births. Infant mortality rate (IMR) is 76

per 1,000 live births, while under-five mortality rate is 152 per 1,000 live births. .

Over 75% of burden of disease is due to 10 preventable diseases. The prevalence of HIV/AIDS

is 6.1% and it remains one of the leading causes of morbidity and mortality despite the

remarkable achievement Uganda has made reducing its transmission.

The magnitude of HIV infection among the reproductive age group 15 – 49 years in Uganda is

high. Out of the estimated population of 29 million people approximately one million women get

pregnant in a year, an estimated 6.5% of them living with HIV. The pregnancy makes their

vulnerability to infections and other diseases worse thereby increasing the risk of premature

death. With an average mother to child HIV transmission rate of 30%, it is estimated that about

20,000 children would be infected with HIV every year through mother to child transmission of

HIV (MTCT) if there is no intervention.

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The HIV/AIDS epidemic presents additional demand on the human resources because of the

special skills required for HIV/AIDS prevention and treatment, and health workers themselves

being affected by the disease.

The Five year roll out plan is intended to consolidate the HRH systems strengthening initiated by

the MOH with assistance of development partners, and to support full operationalization and

sustainability of the HRH Policy and Strategic plan, and the various HRH test interventions that

need to be rolled out and scaled up to realize the goals and objectives of the Health Sector

Strategic and Investment Plans (HSSIP).

1.3 Critical Issues

Uganda experiences a shortage of HRH and a skills imbalance with the existing workforce.

Nearly half of the established positions are vacant and the situation is worse in rural than urban

areas. Health workers are also unevenly distributed between the public and private sectors. The

health sector recognises the critical role of human resource in health in terms of numbers and

skills mix in order to deliver a quality basic package. Over the course of the HSSIP focus will be

on strengthening human resources through attraction, competence building, improved motivation

and remuneration of human resources relevant to the needs of Uganda and promotion of

professionalism among health workers.

Uganda has recognized Human Resources for Health (HRH) as one of the major reasons for slow

progress towards achievement of the Millennium Development Goals (MDGs) as well as the

targets the country set for itself in Health Sector Strategic Plan II, 2005/06 – 2009/2010 and

HSSIP 2010/11-2014/15. The National Development Plan gives priority to promotion of health

and prevention of disease, strengthening health systems, with a focus on programs of national

interest that are also the major contributors to the disease burden in Uganda. These include

reproductive health and child survival problems, HIV, AIDS and tuberculosis, malaria and

nutrition. These are priority areas where the country is currently experiencing high unmet need

for service provision. In 2008, 48% of people living with HIV, who needed ARVs, were not on

treatment. Less than 40% of mothers in labour are attended to by skilled health worker. Total

fertility rate is estimated at 6.9 while unmet need for family planning in 2010 was at 41% and

among the highest in Africa. Intermittent preventive treatment of malaria in pregnancy with

doses 1 and 2 (IPTp1 and IPTp2 respectively) is low (40% and 16% respectively) relative to

Antenatal Care (ANC) utilisation which is estimated at over 90% for first visits and 85% for

second visits. This is in part due to shortage of staff in health centres

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2. GOALS AND OUTPUTS OF THE HRH ROLL OUT PLAN 2010/11 – 14/15

2.1 The Goal of the Roll out plan

The goal of the roll out plan is to develop and maintain an adequate and competent health care

workforce to avail the people in Uganda equal access to quality health services.

2.2 The Key Outputs

The outputs of the roll out plan are derived from the HRH strategic plan 2005-2020 and HSSIP

2010/11-2014/15 whose goal is to attain and maintain an adequately sized, equitably distributed,

appropriately skilled, motivated and productive workforce matched to the changing population

needs and demands, health care technology and financing.

2.3 Specific Outputs of the roll out plan

i. Right HRH numbers and skills mix in the health sector attained.

ii. A comprehensive, well-coordinated and integrated HRH information System developed.

iii. Capacities for HRH policy, planning, Leadership and Management strengthened.

iv. HRH training and development to ensure adequate, relevant, well mixed and competent

community focused health workforce improved.

v. HRH Systems and Practices strengthened.

vi. Utilization and accountability for HRH resources in respect of HRH management

improved.

2.4 Implementation Arrangements

The MoH has led the health sector HRH development and management programs in the country

during HSSP II through the development and implementation of the HRH Policy (2006) and the

HRH Strategic Plan 2005-2010 (2007). In 2008, the sector also developed an HRH Strategic Plan

Supplement providing a “Health for the People scenario” in line with World Health Organization

health care delivery standards and the Global Health Workforce Alliance (GHWA) HRH Action

Framework (HAF) declarations. These two processes have provided accepted HRH policies,

strategies, systems, processes and action frameworks to address the HRH crisis in Uganda. The

new HSSIP will build on these previous processes and achievements.

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The MoH, in collaboration with Ministries of Public Service and Local Government have

established staffing norms for each level of health care. It will be important at the beginning of

the HSSIP for the sector, in conjunction with the Health Development Partners, other sectors

such as the Public Service institutions, MoFPED, MoLG and the private sector to identify the

gaps further in the existing health workforce including their training and competences. Once

these gaps have been identified, the MoH will work collaboratively with the MoES and other key

HRH education and training stakeholders to effectively plan for and develop the needed numbers

and competences. In addition, the Human Resource Development and Management agencies in

the MoH will work with the HSC, the DSCs and other relevant stakeholders to fill the existing

vacancies in the health sector. The MoH shall lobby and promote further the recentralization of

the recruitment and deployment of staff at district level to facilitate inter-district and intra-sector

transfers and redeployments.

During the period of the HSSIP, the sector priority in Human Resource investments will be to

attain a minimum of of 75% the expected norms. While attainment of 100% is ideal,

improvement in the numbers of Health Workers to 75%, from the current 56% of expected

norms is a target more within reach.

Table 2.1: Key indicators of change and assumptions

SUMMARY OF KEY DATA IN 2010 – 2014 SCENARIO

YEAR 2010 YEAR 2014

DEMOGRAPHIC INDICES

31,800,000 36,070,000 Total Population

3.2% Assumed average annual % change in population

13% Assumed % of population in urban areas

4.7% Calculated average annual % change in urban population (2005)

3.0% Calculated average annual % change in rural population (2005)

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3. ANNUALIZED WORKPLANS

Each year this roll out plan will be reviewed to pull out key activities for the year and cost them.

Table 3.1 Projected requirements for new recruits

Staff Type HRH estimated HRH 2014

Total

in

2009 Leavers figures staffing

staff

in 5 years in 5 years requirements required

(a) (b) ( c ) ( d) (e)=(b+d)

Spec Med Doctor&Dentist 811 41 770 1,006

1,046

Gen Med Doctor&Dentist 3,925 196 3,729 4,867

5,063

Pharmacy Professional 449 22 427 557

579

Nurse/midwife Professional 623 31 592 773

804

RegN.&PsyN Ass. Prof. 2,450 123 2,328 3,038

3,161 Mdwife Ass.Prof.(Registered) 2,928 146 2,782 3,631

3,777

Comp.Nurse (Registered) 1,614 81 1,533 2,001

2,082

EnrN.&EnrPsyN.Ass.Prof. 2,252 113 2,139 2,792

2,905

Comp.Nurse(Enrolled) 285 14 271 353

368 Mdwife Ass. Prof. (Enrolled) 1,432 72 1,360 1,776

1,847

Allied Health (professionals) 106 5 101 131

137

Allied Health Ass.Prof.(P.Hlth) 3,226 161 3,065 4,000

4,162

Allied Health Ass. Prof.(Clin) 2,785 139 2,646 3,453

3,593

Allied Health Ass. Prof. (Diagn) 950 48 903 1,178

1,226

Senior admin/managers 1,437 72 1,365 1,782

1,854

Skilled Prof. (Non-Medical) 3,178 159 3,019 -2,151

-1,992

Health Related Professional 481 24 457 596

620

Support Staff (Clin Services) 15,228 761 14,467 -3,611

-2,850 Other non-health semi-skilled 1,542 77 1,465 -79

-2

Support Staff (Other) 3,473 174 3,299 14,182

14,356

Total 49,175 2,459 46,716 40,276 42,735

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Table 3.2: Projected Annual Training requirements 2010 to 2014

Minimum Projected Intake requirements per year from 2010-2015 of the HRH Roll out Plan

2010 2011 2012 2013 2014 2015 Total

Spec. Med. Doctors & Dentists 65 65 65 65 65 65 390

Bach. of Medicine & Surgery 200 200 200 200 250 250 1300

Dental Surgery 20 40 40 70 70 80 320

Pharmacists 45 45 75 75 75 90 405

BSC Nurse professionals 100 100 100 100 100 100 600

Sub-Total 430 450 480 510 560 585 3015

Reg. Nurses 300 300 300 300 250 250 1700

Reg. Psy. Nurses 60 60 60 60 50 50 340

Reg.Midwife Assoc. Prof 250 250 200 150 150 150 1150

Reg. Comprehessive Nurse 100 100 150 150 150 150 800

Sub-Total 710 710 710 660 600 600 3990

Enrolled Nurses 150 150 120 120 120 120 780

Enrolled Psy. Nurses 100 100 100 100 100 100 600

Sub-Total 250 250 220 220 220 220 1380

Enrolled Midwife 350 300 300 300 350 350 1950

Enrolled Comprehensive Nurse 600 600 600 650 700 700 3850

Sub-Total 950 900 900 950 1050 1050 5800

Radiography (degree) 15 15 15 15 15 15 90

Radiography 25 25 30 30 30 30 170

Med. Lab Assistant 220 220 220 220 220 220 1320

Med. Lab Technician 100 100 100 100 100 100 600

Med. Lab Technologist 30 30 30 30 30 30 180

Med. Lab Scientist 20 20 20 20 20 20 120

Sub-Total 410 410 415 415 415 415 2480

Clinical Officers 250 250 250 300 300 300 1650

Physiotherapist 30 30 30 30 30 30 180

Orthopaedic Officer 20 20 20 25 25 25 135

Orthopaedic Techinician 20 20 20 20 20 20 120

Occupational Therapist 20 20 20 20 20 20 120

Pharmacy Technician 55 55 60 60 60 60 350

Sub-Total 395 395 400 455 455 455 2555

Environmental Health Scientist 20 20 20 20 20 20 120

Environmental Health Assoc 50 50 50 50 50 50 300

Assist Env. Health Assoc 150 150 150 150 150 150 900

Sub-Total 220 220 220 220 220 220 1320

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Grad Total

3,365

3,335

3,345

3,430

3,520

3,545

20,540

Table 3.3 Projected Annual Postgraduate Training requirements 2010 to 2014 for Medical

Officers

Discipline 2010 2011 2012 2013 2014 2015 Total

Internal medicine 5 5 5 5 5 5 30

Respiratory medicine 3 4 4 5 5 5 26

Dermatology 2 2 2 2 2 2 12

Sugery General 5 5 5 5 5 5 30

Sugery ENT 3 3 3 3 3 3 18

Sugery Opthalmology 5 5 5 5 5 5 30

Sugery Orthopaedics 4 4 4 4 4 4 24

Sugery - Neural 3 3 3 3 3 3 18

Sugery - plastic 2 2 2 2 2 2 12

Sugery – Padeiatrics 2 2 2 2 2 2 12

Sugery -cardio-thoracic 2 2 2 2 2 2 12

Sugery -Gastro-entology 2 2 2 2 2 2 12

Sugery –Urology 2 2 2 2 2 2 12

Anaesthesiology 3 3 3 3 3 3 18

Gynaecology&Obstetricts 3 3 3 3 3 3 18

Paediatrics 3 3 3 3 3 3 18

Family Medicine 5 5 5 5 5 5 30

Community Dentistry 2 2 2 2 2 2 12

Facial Oral Maxillar surgery 3 3 3 3 3 3 18

Psychiatry 3 3 3 3 3 3 18

Pathology 4 4 4 4 4 4 24

Microbiology 2 2 2 3 3 3 15

Public Health 4 4 4 5 5 5 27

Community Practice 3 3 4 4 4 4 22

Proposed Total 66 67 67 68 68 68 468

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4. IMPLICATIONS FOR IMPLEMENTING THE ROLL OUT PLAN

4.1 Health Worker Rationalization

If Uganda is to meet its priority health needs it requires a skilled health workforce that is

deployed and retained in areas where they are needed most. At the current level of population

growth rate (3.2%) per annum, the population is set to increase on average by about 1 million

people per year. With the creation of new districts in the country and expansion in number of

health facilities, the demand will increase for health services and additional health workers to

meet the national health priorities will be required.

This paradigm shift will affect and/or influence the following areas:

Policies, scopes of practice and competencies.

Definition of standards of care.

Pre-service education

Registration and Licensing.

In service training, Certification and credentialing.

Working conditions, productivity and performance

Recruitment, deployment, retention,

Program implementation, monitoring and evaluation.

Supervision and continuing education

Detailed short term strategies shall be developed to show what must be tackled urgently so that

health worker practice is safe as soon as feasible, but certainly by the end of 2012. A longer term

strategy will be developed concurrently, to show the potential for cost-effectiveness of different

skills mixes in teams, the value of advanced nursing roles, the needs for team work and

supervision to maximize quality care delivery and the possibilities for demonstration sites where

new and creative thinking can be tested in the arena of task shifting.

4.2 Investing in Human Resources

This plan advocates for investment in human resources for health so that all HRH institutions

are made functional. Health Manpower Development Centre needs re-engineering to come

back on the road.

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1.0 The right numbers of priority cadres and skills mix attained

Key outcome indicators: 1.1.1 Number and type of priority cadres attained.

Key outcome indicator: 1.1.2 Proportion of districts that have achieved the targeted staffing norms (75%)

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

1.1 Introduce mechanisms/incentives for attraction, recruitment and retention of health workers especially in hard to reach and stay areas.

Implement the Hard to Reach Strategy (See also Sect.1.5)

Develop and get approved a specific salary structure and remuneration package for health workers outside the Single Spine structure (See also 1.3)

Institutionalize and regularly budget for hardship, lunch allowances, and performance related pay

% increase in the no. of

staff in hard to reach

areas.

No. of districts

implementing hard to

reach and stay

framework

No. of medical

professionals receiving

lunch allowance

No. of health workers

on Performance related

pay

24 Districts

30,000 medical professionals

All health workers in civil service

x x

x x X

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Support Service Commissions in the Recruitment Process.

Review staffing norms in the sector.

1.2 Develop and implement a safe working environment to minimize health risk for the human resources and patients.

Develop / form health and safety committees.

Display health and safety guidelines at work places.

Train Health workers on Health and Safety

Provide appropriate medical equipment.

Provide health workers with appropriate uniforms and protective gear.

Safety Committees

reactivated

Guidelines for every

user displayed

Reduced number of

accidents at work

All committees constituted and

functional

60% 70 80 90 100%

1.3 Provide appropriate remuneration to health workers.

Implement benchmarks in the pay policy

Mobilise resources for HRH

Conduct surveys (e.g. job satisfaction, pay levels etc )

Progress towards

attaining the

recommended pay

levels

% increases in the

resources available

in the health sector

for HRH

Survey reports

prepared

85% by the end of 2015

2 surveys

65%

70%

X

75% 80%

X

85%

1.4 To construct, renovate and repossess staff accommodation for health workers at health facilities especially in hard to reach areas.

Develop minimum standard guidelines % of houses 100 % of health workers 65% 75% 85% 95% 100%

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for living conditions for health staff by facility level.

Re-possess former staff houses, renovate existing houses and construct new staff houses

Acquire land with land titles, and fence it for health facilities

Rent houses as a short term measure

repossessed by the

Health sector

Availability of land

titles

No. of houses rented

for health workers

accommodated

1.5 Develop and promote other incentive schemes for deployment and retention of health workers, especially in hard-to-reach areas.

Implement Hard to Reach and Stay Framework

Implement Reward and Recognition Scheme

Implement the motivation and retention strategy.

% Reduction of vacant

positions

% Reduction of attrition rates

75%

2% attrition rate

55%

5%

60%

4.5%

65%

4%

70%

3%

75%

2%

2.0 A comprehensive and integrated HRH information system developed and well-coordinated.

Key outcome indicators: 2.1 Number of HRH units with functional HRIS

Key outcome indicator: 2.2 Number of reports produced for decision making

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

2.1 Establish a complete and reliable HRH development and management information system

Plan, design and install HRIS infrastructures and software for HRH

Number of HRH units with

Installed and functional HRIS

MoH, 4 HPC and 112 distrits x x

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management and development at MoH, 4 HPC and 112 districts

Recruit train and deploy human resource for effective data management and dissemination at central level.

Recruit and deploy required HR for data management at the district level

Number of HR recruited for

data management

224 personnel to manage HRIS x x

2.2

3.0 Capacities for HRH policy formulation, planning and implementation strengthened.

Key outcome indicators: 3.1 Number of people trained in policy, planning and management

Key outcome indicator: 3.2

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

3.1 Institutionalize capacities for HRH projection and strategic planning

Identify and develop a core group of human resources with specialized skills to orchestrate HRH planning at all levels

Develop mechanisms that will create and maintain working instructional linkages with academic institutions to provide sustainable HRH planning and capacity.

Establish IST/CPD for core HRH staff through attachment and secondment to academic institutions

Number of people trained on

the core team

Number of academic

institutions

Number of IST/CPD for the

core HRH staff established

30

Makerere University, Nkozi,

Gulu, UMI,

30

3.2 Develop and implement a practical course in HRH policy and planning in partnership with Makerere School of Public Health.

Complete and implement the HRH policy, planning and management course

One curriculum completed

50 60 60 60 60

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curriculum

Mobilize resources for training.

Conduct training

Monitor and evaluate the training programme.

Amount of resources mobilized

3.3 Develop and implement a practical course in health systems management

Complete and implement the health systems management course curriculum

Mobilize resources for training.

Conduct training

Monitor and evaluate the training programme.

Number of people trained X x

3.4 Develop and disseminate HRH training guidelines for district planning.

Establish training and health professionals

development committees

Support and conduct/organise Training and

PDC meetings at various levels of service

delivery.

Build the capacities in IST/CPD training

skills

Number of committees

formed

Number of people trained

x x x x x

3.5 Develop and implement HRH policy monitoring and evaluation plan.

Develop guidelines for monitoring and evaluation

Train personnel

Conduct supportive supervision

Monitor and evaluate progress.

Number of guidelines and

standards developed

Number of districts supported

112 districts x x x x x

3.6 Scale-up evidence based HRH strategic planning to align it with equity requirement and

Number of districts with

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changing health sector priorities.

costed HRH action plans 112 districts

3.7 Develop a Task shifting strategy

Identify and quantify the task shifting

practices going on in the health sector.

Organize a stakeholders consultation

workshop

Finalize the development of the task shifting

strategy.

Disseminate the approved task shifting

strategy

A task shifting strategy

developed and formally

accepted by MoH

Number of districts

implementing a task shifting

strategy

112 districts implementing a

task shifting strategy

x x x x x

3.8 Draft a Policy and Bill to recognize and regulate Task shifting

x x

3.9. Rollout WISN in 80% of the districts.

Monitor districts to ensure allocation of health workers according to work pressures

x x x

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Pre-Service

4.1: Capacity Built for HRH training and development to supply the right number and quality of health workers

Key outcome indicators: 4.1.1 Leadership roles and coordination mechanism among all key stakeholders of health training institutions redefined

Key outcome indicator: 4.1.2 Training of health staff from within the hard to reach areas such as Karamoja and Kalangala Supported.

Key outcome indicator: 4.1.3 The five CPD Centres strengthened and better functional

Key outcome indicator: 4.1.4 Number of Districts with functional District Health Supervisory Authorities (DSA)

Act. No Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

4.1.1

Strengthen the Inter-ministerial HRH Development and Management Coordination Committee meetings

Number of meetings with

minutes

20 4 4 4 4 4

Develop and operationalize

mechanisms for coordination and

linkages of pre service training HTI

Number and type of

operational structures that

address joint planning based

on evidence

A well functioning MoH and

MoES coordination committee

for pre-service training

X x x x x

Hold HRH Stakeholders Coordination Meetings (MOH, HPC, MOES, MOPS, MOFPED, MOLG) to redefine its composition, TORs and functionality.

Number of times meetings

are held with minutes reports

and attendance lists

2 2

Hold Stakeholders Meetings to review existing policies and guidelines on training of health workers

Number of meeting with

minutes, attendance lists and

reports

2 2

4.1.2

Work with MoPS and local governments to address HR needs of hard to reach districts

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Work with hard to reach and stay districts to introduce bonding system of health workers

Number of districts with

operational bonding system

55 Districts 5 10 10 15 15

Conduct advocacy meetings for introduction of bursary schemes to students from hard to reach areas

No. advocacy meetings held 11 meetings 6 5

4.1.3 Draft a proposal for infrastructure development Availability of a draft report X

4.1.4 Develop training programs and guidelines Available training programs

and guidelines

X

4.1.5 Implementation of the programs Number of training programs

developed

X x x x x

4.1.6 Roll out leadership and management training in the 5 CPD centres

Number of functional CPD

centres

Mbale, Jinja, Lira, Arua and

Mbarara.

X x x x x

4.1.8 Establish the offices of District Supervisory Authority

Number of districts with

functional DSA

112 districts with DSA X

4.1.9 Conduct training program for the District Supervisory Authority

Number of health

professionals trained

X

4.1.10 Carry out support supervision to the districts Number of districts following

standard guidelines in their

operations

X x x x x

18

Post basic

4.2 : Build capacity for HRH training and Development to ensure constant supply of adequate, relevant, well mixed and competent community

focused health workforce.

Key outcome indicators: 4.2.1 Number of post basic students graduating from recognized institutions

Key outcome indicator: 4.2.2 Number of post basic students qualifying from recognized institutions

Act. No Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

4.2.1 Initiate review of the policy on training of ECN

Reviewed Policy on

Registered and Enrolled

Comprehensive nurse

program

A policy on training of ECN

reviewed and is in use

X x

Evaluate the ECN training program

Results of evaluation Streamlined training and well

written schemes of service for

Nursing cadres

X

Use the evaluation report to develop a training strategy

Training strategy IST strategy in operation x X

4.2.2 Strengthen CPD centres to promote distance and E- learning

5 CPD centres functional 5 CPD centres (HMDC Mbale,

Ji nja, Lira, Arua, Mbarara)

X X

4.2.3 Train HRH workforce in specialized areas (Tutors e.g. e-health, Palliative care, anesthesia, pathology, neurology, paediatric nursing, Biomedical engineering, plastic surgery, cardiology, Infectious diseases, urology, leadership & mgt, health economics

Trained health workers in the

specific specialized areas.

325 Spec Med doctors &

Dentist

150 Nurse Specialist

325 AHP Specialist

X x x x

4.2.4 Review/ develop course curricular in view of the changing needs of the community and technologies in health care,

Curricula for

Orthopaedics/

x x

19

rationalizing and harmonization of health cadres (CO, nurses, orthopaedic

Conduct a tracer study of the MB Ch B course graduates from MUK in view of reviewing the curricula

technology reviewed and

harmonized to be Post

Basic Course Curricula

curricular for EN, EM,

ECN, ENPsy reviewed to

accommodate bridge

gaps for service delivery

MB Ch B course curricula

at MUK reviewed

Harmonized training with the

changing needs

4.4 Develop Guidelines to clarify and harmonize roles and mandates of various stakeholders in HRH development.

Number of stakeholders

with clear mandates

Roles clarified for all HRH

actors

X x

4.5 Establish resource centre with hub and

satellites in support of in-service training

a) conduct needs assessment

b) procure materials, supplies and

equipment

c) training of health workers

Needs assessment report

Materials, supplies and

equipment procured

No. of health workers

trained using hub and

satellites.

Fully established resource

centre with hub and satellites

x

x

4.6 Develop DE Health service mgt and

leadership nine (9) months course at

HMDC Mbale

a) Develop curricula

b) Develop and repackage materials,

procure supplies and equipment

c) Conduct Health service mgt and

Nine (9) months course in

Health service mgt and

leadership developed

Materials and repackaged

printed

% of districts with health

workers trained undertaken

Health service mgt and

Develop distance education by

2011/12FY

x x

20

leadership course.

d) Monitoring and evaluation

leadership course

Availability of monitoring

report

Monitoring report available by

the end of 2014

4.7 Establish governance structures, rules and

systems to propel HMDC into a viable

semi- autonomous institution

a) Conduct a retreat to review the

mandate and location of HMDC in

MoH’s structure

b) Appoint and support Governing

board of HMDC

c) Support establishment of rules &

regulations of governing board

d) Conduct study visits to centres of

excellence (Arusha, Nairobi,

MTAC, UMI)

e) Secure technical assistance to

propel HMDC as a viable and

respectable centre for IST/CPD

Bill giving HMDC Auto/Semi

autonomy drafted

Board of governing body

appointed

Rules and regulations of the

governing body established.

Availability of study visit

report.

Technical Assistant deployed

at HMDC

A number of courses running at

HMDC by the end of 2012

4 centres of excellence visited

One Technical Assistant

deployed at HMDC

X x x x

4.8 Improve staffing levels and their capacities to design, deliver and coordinate quality training and research.

a) Recruit a core training staff b) Identify associate trainers form

MoH and Districts by subject area and make their data-base

c) Identify training needs of the core and associate trainers of HMDC

d) Sponsor the core and associate trainers in relevant skills

No. of core training staff

recruited

District trainers database

established

Training needs of core

trainers at HMDC identified

No. of training of core and

4 core trainers recruited

District trainers database for

80% of the districts established

4 core trainers sponsored for

x X

21

e) Attach the core and associate trainers to centres of excellence in IST/CPD

associate trainers sponsored

No. of core trainers

specialized training

4 core trainers attached to

centres of excellence annually.

4.9 Establish a system for coordinating research, monitoring and evaluation and Human resource development of health workers.

Establish basic standards and guidelines for supervising and monitoring of impact IST/CPD in the health sector.

Conduct evidence based M&E of the impact of CPD/IST in the in health service delivery (including attainment of MDG targets)

Establish data base of trainers (TOTs) at district levels.

Conduct a training needs assessment on IST/CPDs trainings at the district

Conduct IST and distance education courses based on new curriculum

Revertilise radio education programmes on Distance Education Programmes

Standard guidelines for

coordinating research,

monitoring and evaluation

developed.

Monitoring plan with

indicators developed and

used

Database of district TOT

established

Availability of training needs

assessment report.

% of districts with H/Ws

under taking distance

education programme.

No. of distance education

messages programmes

aired.

No. of Health workers

listening / participating in

distance education radio

programmes.

Database established in 80% of

the districts

H/Ws in 80 % of the districts

undertaking distance education.

x X

4.10 Revitalize Clinical instructors course

Conduct a TNA on clinical instructors

Review and print curriculum

Availability of reports on TNA.

Clinical Instructors course

X x

22

Conduct training of clinical instructors

reviewed.

No. of health workers trained

on Clinical Instructors

150 H/Ws trained on Clinical

Instructors Course

4.11 Market HMDC and promote its products and image among the HWs and the general public

Design and disseminate brochures and course announcements on distance education courses.

Design and disseminate annually programmes of training by learning objectives, target audience, location and cost.

No. of brochures designed

and disseminated annually.

5,000 brochures X X X

4.12 Establish e-learning at CPD centres E-learning established at

CPD centres

E-learning established at 4

CPD centres

x

Develop basic research curricular for IST/CPD

X

4.13 Integrate and decentralize IST/CPD

Conduct TNA periodically at the MoH and health service management and health facility levels for sustainable IST/ CPD plan to meet identified needs

Develop infrastructure and equip four established CPD centres

Availability of TNA report.

Infrastructure at HMDC

developed as per HMDC

infrastructure business plan

and other CPD centres

Quarterly x

4.14 Equity and gender balance in health workforce training and CPD

Conduct a gender audit to establish the current status in health

Develop guidelines for gender balance and equal opportunities in IST/CPD

Report on advocacy

meetings carried out.

Guidelines for gender

balance on CPD/IST.

A situation analysis report

showing the gender status in

the health sector

x X

x

23

Conduct mapping of the health work force distribution partner to further guide the selection of trainees to promote equity in health

Reports on distribution of

health workers

4.15 Accreditation, scheme of service and career progression.

Establish a national accreditation system for IST/CPD programmes for recognition and quality.

Review / develop schemes of service and career progression for health workers (Allied health)

National accreditation system

for IST/CPD established.

Schemes of service and

career progression for Allied

health workers reviewed.

Clinical Officers, Medical Labs,

Radiographers, Public Health

Dentists. Environmental Health

X X

4.16 Partner with Higher Institutions of Learning to review/develop and benchmark curricula.

Carry out a TNA in view of developing one year course out of the DEP courses.

Develop curriculum for the 9 DEP courses into one course

Print the Curriculum

Modularize the 9 DEP courses to for one year course.

Orientation of trainers/facilitators.

Continue conducting TNA to update the course modules and or develop new courses for priority areas for IST/CPD.

Print the course modules

Curricula on distance

education developed.

Report on TNA and identified

priority areas on IST/CPD

No. of associate trainers

identified in priority areas

No. of trainers oriented on

principles, procedures and

practices for curriculum

development

Curricula developed in

priority areas, finalized and

lunched.

No. of H/Ws trained on new

curricula

Partnerships allowing

harmonized IST programs for

health workers

Course modules and curricula

benchmarked by 2013

x X x

24

Identify core central trainers in the identified priorities for IST/CPD

Orient and train core central trainers development process of curriculum for IST/CPD.

Develop training materials in the new DEP IST/CPD courses.

Conduct training IST/CPD based on new curricula

5. HRH Systems and Practices strengthened.

Key outcome indicators: 5.1 Efficient recruitment and deployment system

Key outcome indicator: 5.2 Improved Health worker /population ratio

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

5.1 Review and streamline the recruitment system for health workers.

Review recruitment plan for the health sector and use it as a basis to lobby for funds (to include new districts)

Align recruitment programs with the graduation period

Recruitment plans

reviewed and

implemented

Reduced period

between graduation

and absorption

75% staffing positions filled

3 months

55%

X

60%

X

65%

X

70%

X

75%

X

5.2 Streamline the deployment and placement of health workers.

Develop a clear criteria for Criteria developed 3 months (MOH-HRM) X

25

deployment and implement it and implemented

5.3 Develop and promote HRH succession and exit planning.

Conduct pre-retirement training

Develop a succession plan

Mentoring and coaching health workers

Number of people

who have received

the pre-retirement

training

Number of

Succession plans

developed and

implemented

Number of coaching

guidelines

customized

70% of officers above 50 years

trained

50%

X

X

55%

X

X

60%

X

X

65%

X

X

70%

X

X

5.4 Review and establish appropriate management structures at different levels.

Review Hospital Boards and Health Unit Management Committee composition

Conduct a functional review of existing structures

No. of Charters and

Statutes reviewed at

every level

% of

recommendations

implemented

All Charters and Statutes

reviewed by end of year I

85%

X

65%

70%

75%

80%

85%

26

5.6 Work with MoPS to review job descriptions for health workers at RRH, NRH and central level Institutions.

Disseminate the revised job descriptions to all key stakeholders

Sensitize health workers

Declare vacant posts in accordance with the recruitment plan

Regional workshops

conducted

% of posts declared

5 Regional workshops

75%

X

X

55%

X

X

60%

X

65%

X

70%

X

75%

6.0 Professional standards, Codes of conduct and Ethics promoted and enforced

Key outcome indicators: 6.1 Number of Districts with functional District Supervisory Authorities (DSA)

Key outcome indicator: 6.2 Number of guidelines reviewed in response to emerging trends and technology

Key outcome indicator: 6.3 Number of HUMC/ HMB trained on effective ways of increasing health workers’ accountability towards communities developed

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

6.1 Establish the offices of District Supervisory Authorities

Number of districts with DSA

established

112 districts??? x

27

6.2 Conduct training program for the District Supervisory Authorities

Number of district

supervisory authorities

trained

x

6.3 Carry out support supervision to the districts Number of districts

supervised

112 districts x X x x x

6.4 Carry out evaluation of the program Midterm evaluation of the

program

x X x x x

6.5 Evaluate current guideline for operating a private health facility and training institutions

Number of guidelines

evaluated

x

6.6 Review and develop human resource manuals for HPCs

Number of human resource

manual developed

x

6.7 Assess responsiveness to community and political accountability

Number of communities

assessed

x X x x x

6.8 Train all HUMC/HMB on their roles and responsibilities

Training of HUMC/HMB

conducted

112 District x X x x x

6.9 Carry out Supervision to support the HUMC/HMB

Support supervision carried

out

112 Districts x X x x x

6.10 Carry out program evaluation in concert with civil society organizations and other Development Partners

Program evaluation done 112 Districts x X X x x

7.0 Promote the utilization and accountability for resources in respect of HRH management.

Key outcome indicators: 7.1 Number of HRH units with a good and functional accountability system

Key outcome indicator: 7.2

28

Act.

No

Activity Activity Indicator 5-Year Targets Yr 1 Yr 2 Yr 3 Yr 4 Yr 5

7.1 Strengthen management and leadership skills at central and local government levels in public and private health sectors to ensure clear roles and responsibility for HRH resources.

Number of local governments

with trained managers in

leadership and management

112districts, 13 Municipalities,

50 Town councils

x x x x x

7.2 Allocate HRH to critical areas of staff shortage. x x x x x

7.3 Conduct supportive supervision and performance management for health workers.

7.4 Develop mechanisms to ensure that all financial

resources to the HRH are administered

according to the GOU financial regulations.

Number of mechanisms

developed according to

established standard

x x x

7.4 Develop effective ways of increasing health

workers’ accountability towards client

communities.

x x

7.5 Identify and position proper institutional homes for HRH functions in the MOH, MOES and other institutions

Institute joint-sector working groups

Strengthen inter-sectoral (Inter-ministerial standing coordination committee) coordination mechanism

Number of times the

committee meets

with minutes and

attendance lists

A well functioning inter-

ministerial coordination

mechanism

X

X

X

X

X

X

X

X

X

X

7.6 Mainstream gender in the health sector

Mainstream gender concerns in the sector plans and policies

Adequate representation of key cadres

Strengthen participation of PNFPs in policy implementation

Mainstreaming concerns of the aged group

Number of plans

reflecting gender

mainstreaming and

discrimination

All the health sector plans

address gender concerns

X

29

7.7 Develop capacity for leadership and management for HRH managers and leaders at central and decentralized levels

Conduct a training needs assessment

(TNA)

Design a training plan to address the

Leadership and management gaps

Implement the Training plan by training

60 participants per year

Monitor and evaluate the training

Program

Number of participants

enrolled on the course

annually,

Number of HRH leaders

trained in leadership and

management

X

60

X

X

X

60

X

60

X

60

X

60

X

7.8 Advocate for increased funding for HRH to implementation HRH policy and strategic plan

Build capacity for negotiations skills

Develop a resource mobilization strategy

Enhance Public Relations and Customer

Care

Produce monthly HRH news paper

Hold monthly T.V and radio talk shows

Produce a documentary and other promotional materials on HRH issues

No. of Officials trained

Functional PR division

Increased budget for HRH

activities

X

X

X

X

X

X

30

5.0 COSTING OF THE ROLL OUT PLAN

Table 5.1: Human Resource Investment 2010/2011-2014/15.

Focus Areas 2010/11 2011/12 2012/13 2013/14 2014/15

Specialist Training 8,290,000,000 0 10,370,000,000 0 12,960,000,000

Systems and Partnerships 24,070,000,000 26,960,000,000 31,620,000,000 37,750,000,000 45,280,000,000

In-service Training 12,540,000,000 13,420,000,000 5,440,000,000 15,370,000,000 16,440,000,000

Implementation of HMDC Business Plan 550,000,000 1,220,000,000 1,940,000,000 1,770,000,000 1,640,000,000

Current Salaries with some additional recruitment 243,400,000,000 264,360,000,000 275,440,000,000 282,700,000,000 285,120,000,000

Retention/Motivation interventions 85,270,000,000 91,600,000,000 97,450,000,000 104,170,000,000 111,360,000,000

Uganda Cancer Institute training of specialists 2,500,000,000 2,680,000,000 2,860,000,000 3,060,000,000 3,280,000,000

Uganda Heart Institute training of specialists 4,730,000,000 5,210,000,000 5,730,000,000 630,000,000 6,930,000,000

Radiotherapy training of specialists 3,750,000,000 1,870,000,000 640,000,000 790,000,000 20,000,000

Mulago Hospital Training of Specialists 48,000,000,000 52,800,000,000 58,080,000,000 63,890,000,000 70,280,000

Total Ug Shillings 433,100,000,000 460,110,000,000 498,480,000,000 515,810,000,000 553,331,000,000