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Transcript of WELCOME TO THE FIRST BTC HEALTH NEWSLETTER HealthNewsletter.March... · WELCOME TO THE FIRST BTC...
1
WELCOME TO THE FIRST BTC HEALTH NEWSLETTER
With this quartely health newsletter the Belgian
Development Agency (BTC) and the Ministry of
Health of Uganda want to reach out to health
workers all over Uganda, health policy makers on
both the national and district level and BTC health
project staff.
You will be updated on the development of our
Institutional Capacity Building project and on the
Private-not-for-profit project. The Ministry of
Health will use this platform to communicate on
health issues. Besides this, the newsletter will also
give a voice to health workers and will keep you
updated on the implementation of the new result-
based financing system. ENJOY READING!
Issue 1, 30/03/2017
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BTC is the Belgian development agency. We support deve-
lopment projects across the globe to eradicate poverty.
The Sustainable Development Goals are the global
framework for BTC's support to different countries around
the globe. Our activities focus on fragile states and the
least developed countries, primarily in Africa.
We are a public agency and manage development
projects for the account of the Belgian Government
and other donors. This way, we actively contribute to the
global efforts for sustainable development.
Our primary mission is to implement the Belgian
governmental cooperation in the 14 partner countries of
Belgium. Through the intermediary of BTC's Global
Partnerships department, BTC also implements projects for
other donors, in particular for the European Commission.
The Directorate General for Development Cooperation and
Humanitarian Aid (DGD), which falls under the Federal
Public Service Foreign Affairs, Foreign Trade and
Development Cooperation, defines the cooperation
programmes but it does not implement them itself. This
task is entrusted to BTC.
Uganda and Belgium have been partners for 21 years.
Together we strive to improve the quality of health care and
education to ensure all Ugandans lead healthy and
productive lives.
Together with the Ministry of Health of Uganda, we
strengthen health services and primary health care on
a local level in both public and private facilities
through capacity building of medical staff and
result-based financing.
In cooperation with the Ministry of Education and Sports,
BTC supports the renovation, construction and equipment
of National Teacher Colleges and BTVET institutions. We
train lecturers on students based teaching and learning
methods and support the Implementation of the ‘Skilling
Uganda Strategy’. This strategy aims to increase the
employability of youth through better quality of instruction
and learning in apractical skills development environment
responsive to the labour market.
We support human resource development in 48 selected
organisations in the health, education and environment
sectors. And through the Study and Consultancy Fund, we
assist the government in formulating policy and strategic
documents.
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Access to affordable and appropriate quality health care is a universal right, but for many people in
the world it remains a distant dream. The government of Uganda is investing in setting up a universal
healthcare coverage plan. BTC supports this policy and assists public (ICB II) and faith-based (PNFP)
health facilities in delivering the best possible health care. To bring Uganda one step closer to
universal healthcare coverage a new system of performance-based financing is being introduced.
This system looks at results instead of inputs. Hospitals and health centers that perform well will
receive financial support to be spent with more autonomy.
Traditionally funding for health has been directed towards inputs like salaries, construction, training and equipment.
People thought that improved health care would follow but this hasn’t always been the case. The new system of
result-based financing turns the old logic upside down and focuses on improved performance.
Health facilities receive quarterly incentives for initiatives that are taken to implement the quality standards defined by the
Ministry of Health. They are also rewarded for quantitative performance targets like ‘number of child malnutrition
correctly treated’, ‘number of fully immunized children’ or ‘number of deliveries well managed’. The quantity and quality
of delivered health services will be verified on a quarterly basis. The better they preform, the more incentives they get.
In the performance contracts signed between health facilities and Local Government, the subsidies granted for
achieving these quantitative performance targets are linked to reducing the patient’s bill. Currently user fees
contribute to 50 to 60% of the total income of the health facilities, this is too high.
According to World Health Organization recommendations, not more than 20% of the cost of the health services should
be covered by user fees. By turning away from focusing attention on inputs, performance-based financing aims to
improve health system efficiency and effectiveness
Managers, doctors and nurses of local PNFP and public health facilities can set their own priorities according to
the needs on the ground and will receive the spending autonomy to back their choices up. They will gain more
decision making power, and become responsible for their own performance. This shift from a centralized budget to
more local decision making power is an important reform that BTC, together with the Ugandan government, is helping
beco a reality.
This is just the beginning of a challenging but exciting process. Two other east-African countries, Rwanda and Burundi
already introduced a system of performance-based financing with promising results to show for. To give two examples:
according to the Africa health forum of 2013 post-natal care visits in Burundi have gone up and the overall quality of care
in health facilities using PBF has increased in Rwanda. With the Ugandan government, the ministry of health and the
local PNFP partners on board, BTC believes that performance-based financing could be a real game changer for the
health sector in Uganda.
“Health workers
can set their
own priorities
according to
facility needs.”
4
98% COVERAGE FOR MASS MENINGITIS IMMUNISATION CAMPAIGN
People waiting patiently inline at Saint-Francis Health Centre III in West Nile region to get the menigitis vaccination.
In an effort to protect the population from the risk of Meningitis, government rolled out a routine preventive immunisation campaign to cover those districts that lie
in the Meningitis belt.
Earlier this year, the Ministry of Health in collaboration with World Health Organization and UNICEF launched the mass Meningitis immunization campaign in Omoro district in an event officiated by the Minister of Health Hon. Dr. Jane Ruth Aceng.
The immunisation exercise that took place between the 19th
and 23rd
January 2017, registered a roaring 98% cover-
age on average, across all the 39 high-risk districts.
The campaign purposed to immunize the population in the age group 1 -29 years, strengthen surveillance and routine immunization service delivery in the districts, and achieve a 80% coverage for vaccination in the 39 high risk districts.
The selected high risk districts included; Abim Adjumani, Agago, Alebtong, Amolator, Amudat, Amuria, Amuru, Apac, Arua, buliisa, Dokolo, Gulu, Hoima Kaabong, Kaberamaido, Katakwi, Kiryandongo, Kitgum, Koboko, Kole, Kotido, Lamwo, Lira, Maracha, Masindi, Moroto, Moyo, Nakapiri-pirit, Napak, Nebbi, Nwoya, Omoro, Otuke, Oyam, Pader, Soroti, Yumbe and Zombo.
The preventive immunization campaign focused on Northern Uganda and parts of Western Uganda, be-cause they lie in the Meningitis belt of Sub Saharan Africa, which has experienced frequent outbreaks of Me-ningococcal Meningitis epidemics leading to mortality and morbidity.
The dust winds and cold nights, which characterize the period between December and June in the meningitis belt, increase the risk of meningitis. Transmission of Meningitis is further facilitated by overcrowded housing and large population displacements.
Meningococcal Meningitis is a bacterial form of Meningitis that covers the thin brain membrane and spinal cord and can cause brain damage and death in 50% of cases if not treated. Anyone is prone to meningitis, however; in-fants and children are at more risk of contracting the disease. The risk factors for meningococcal meningitis are people who have had close or prolonged contact with a person infected with meningitis
Immunisation is one of the key strategies that the Government of Uganda is implementing in its roadmap to the attainment of the Sustainable Development Goal 3, which underlines the need for good health and well – being.
The health sector has made good progress in child immunization increasing from DPT3 coverage of 52% in 2012 to current coverage of 97%, and is expected to in-crease even further after this preventive campaign.
The health teams being trained on how to efficiently manage
the immunization campaign.
5
The BTC health projects made an entry into the first quarter
for 2017 with their main focus remaining to accomplish
planned targets for the current Financial Year as we draw
nearer to closure.
The project secretariat sits in Kampala at the MOH H/Qtrs, Annex
Building, Room D004 with a complete Finance and Administration team
whose scope covers the two projects while the technical teams remain
aligned to their respective projects both in Kampala and in the regions.
The head office team is joined by a Junior Technical Assistant who will
support the finance department in RBF Grants Management and capacity
building of the health facilities for the two projects.
The PNFP and ICB II projects which make up the BTC Health
projects are sister projects, working in parallel under the auspices of
the Ministry of Health in Uganda in the two regions of West Nile and
Rwenzori. The PNFP-project is also anchored at the Directorate of
Planning and Policy in the MoH. The project is also harmonizing with
other development partners with regards to supporting the MoH in imple-
menting the PPPH policy. Both BTC through the PNFP Project and
USAID support the setting up and functioning of a PPPH Node in the
MoH. In order to avoid duplication and maximize efficient use of re-
sources, BTC and USAID have coordinated their support to the PPPH for
the elaboration of a five years PPPH strategic plan.
1. The Results Based Financing which was kick started in July 2016
after prequalification assessment of health facilities in early 2016.
2. 32 PNFP health facilities (19 in Rwenzori; 13 in West Nile) received
quantity and quality RBF-payments in Quarter 1 and Quarter 2 of the
financial year 2016-2017.
3. The first RBF-payment (first quarter) was submitted in December
2016 (574 million UGX).
4. The second RBF-subsidies were paid in March (1,078 billion UGX)
5. 8 new PNFP health facilities are qualified to enroll in Quarter 3
6. 6 out of 15 districts received grants for supervision and verification
after quarter 2 (19 million UGX) in March 2017.
7. Drugs and medical equipment supply carried out with the support of
JMS to improve the management at health facilities level (2,065 billion
UGX). 23.3 million UGX is pending.
8. The project started the computerisation of all hospitals. Initial training,
installation of software to manage patient files was carried out in all
hospitals in 2016. Computers and LAN (local area network) were
installed in selected Health facilities with support from MOH and
Medical Bureau IT experts.
“8 new PNFP
health facilities
are qualified to
enroll in quarter
3 for RBF”
6
Institutionally the ICB II project is anchored in the Ministry of Health in the Planning and Development Directorate
(co-management). During 2016 critical progress is being made with the kick start of the Results-Based Financing
(RBF) of public facilities through prequalification and orientation activities as planned.
The second phase of ICB II which commenced early 2017 is progressing as it works in parallel with its sister project
PNFP to implement Results Based Financing (RBF) in selected public facilities in both regions (Rwenzori and West
Nile). All efforts will be made to implement the start of RBF in these facilities in the second Quarter of the calendar year.
It is highly probable that the correct implementation of RBF in the public health facilities will have the desired
impact; to further improve effective delivery of an integrated Uganda Minimum Health Care Package.
1. Preparation of the qualified public health facilities (29) for introduction of RBF. Two training weeks in
Rwenzori (15 Health facilities) and West Nile (14 health facilities) were organized for all qualified health
facilities in February.
2. Preparation of the districts (15) for introduction of RBF. A 3-days training was organised in Rwenzori and
West Nile in March.
3. Development of coverage maps for the districts.
4. Improve drugs and medical supplies management.
5. implement RBF financing through grant agreements.
6. Assure Quality of care through support supervision and continuous training of personnel.
7. Improve ambulance services and referral system at district level.
7
Government of Uganda launched a campaign to distribute 24 million Long Lasting Insecticide treated
mosquito Nets (LLINs) across the country in the second universal coverage campaign for LLINs. The
event was presided over by the Prime Minister, Rt. Hon. Dr. Ruhakana Rugunda who represented His
Excellency the President of the Republic of Uganda, Yoweri Museveni.
Uganda ranks sixth among African countries with high malaria-related mortality rates, and has one of the highest
reported malaria transmission rates in the world. The World Health Organisation (WHO) reports that globally malaria is a
major cause of ill health and deaths, with approximately 16 million cases and over 10,500 deaths reported in 2015.
The Rt. Hon. Dr. Ruhakana Rugunda emphasized the need for Uganda to triple her efforts in the fight against Malaria.
“Once Malaria is eliminated, the country’s GDP will increase by over 30 times in the next few years making us
attain our middle income economic status and also attaining the Sustainable Development Goal on Malaria ear-
lier than expected” Hon. Rugunda noted.
Minister of Health, Hon. Dr. Jane Ruth Aceng says, Government has adopted a multifaceted approach to Malaria
Control and Prevention that is embodied in the Uganda Malaria Reduction Strategic Plan to reduce annual
deaths from the 2013 levels of 47% to near zero, reduce Malaria morbidity to 30 cases per 1000 population and
reduce the malaria parasite prevalence to less than 7% by 2020.
The campaign will distribute nets to all 116 districts in Uganda in six waves over the next six months. Under this
campaign, one net will be given per two registered people in a household and will include a sensitization programme to
educate the communities about the importance of sleeping under a net and effective use.
The campaign is funded by the Government of Uganda, the Global Fund to Fight Malaria, TB and HIV, Against Malaria
Foundation, Department for International Development (DFID) and the USAID/President’s Malaria Initiative. Other
implementing partners include the World Health Organization, UNICEF, PACE, Communication for Health Communities,
UNBS, NDA and the Church of Uganda.
UGANDA LAUNCHES 2nd LONG LASTING INSECTICIDE TREATED NETS CAMPAIGN
Hon. Rugunda reiterated the right use of nets
adding that the mosquito nets should not be used
to catch fish, harvest nswa (blind ants), tethering
goats or sieving malwa (local brew).
Large scale LLIN distributions are a key
component to malaria prevention in Uganda. The
campaign follows a successful universal cov-
erage campaign in 2013 and 2014, which saw
21.5 million nets distributed across the
country. The last campaign contributed to a major
reduction in malaria prevalence in Uganda from 42
percent in 2013 to 19 percent now, according to
the Malaria Indicator Survey 2016. LLINs are a
highly effective, user-friendly and low-cost
intervention to protect communities from malaria.
8
‘We need to invest in good community health workers’
Sister Martina has been working in Saint-Francis
Health Facility III (PNFP), Arua district, for almost 10
years now. A midwife by training she is very
motivated to bring quality heatlh care to her
community. We spoke to her about the challenges
the facility faces, her love for the job, and the
changes she has seen over the years. « Even though
work is not always easy I still love my job. »
“We need to keep working to
eliminate the stigma around
HIV. Recently one of our
patients stopped taking his
drugs due to the stigma he
faced in the community.”
I’ve been here since 2007. So almost 10 years now. I should
really celebrate! Before coming here I used to work in Lira,
Saint-John hospital. The difference between the two facilities
is very big. In Lira we were supported by many ngo’s and we
had a very big HIV centre. Here we are situated in a place
where we really needed to convince the population of the
importance of health. People are just trying to cope in this
peasant community Before this healthcentre came in 2001
people died of preventable diseases. Especially in the
beginning it was hard to convince people to come in when
they were sick.
Even today it can create problems because of the stigma
connected to some diseases. We recently had a
gentleman who tested positively for HIV. In the beginning
he was taking his drugs, but after a while he stopped. He
got sicker and sicker and only returned to our health
centre when it was too late. He died last week.
Fortunately some improvement has been made.
The sisters who founded this health centre also trained
people in the community to become health assistants
and nurses. This helped establish a relationship with the
community.
Thanks to PNFP project and result-based financing we
have been able to reduce our fees. This has made
health care more accessible for the community. Still not
all people can afford it. People here depend heavily on
farming for their income but recently we have had a
shortage of rain. This means people have no income
and no money for health.
Even though work is not always easy I still love my job.
There is no better feeling than being able to help
someone. When you can help someone come out of
despair, that is just wonderful. God can do his work
through us and through me. As a human being I’m able
to help another human being return to his everyday life.
I hope this facility can be converted into a health centre
4. If we offer more services people might believe more
in the work we are doing. Now they get discouraged
when they are referred to another hospital because we
cannot handle the case. A lot of people cannot afford
this, some don’t even have the money for transport.
People are also afraid to die in an unknown place.
They even say: ‘why do you want us to die in some
strange place?”.
I realize it will take more than just better equipped
facility to convince people. We really need good
community health workers. They should coordinate with
community leaders, religious leaders and local political
leaders. Everyone needs to come together.
Sr. Martina in her office at St-Francis HC III in Arua.
9
General Statistics
BTC Health Project Statistics
Sources: World Health Organization, UNAIDS, President’s Malaria Initiative, Ugandan Ministry of Health, Health Projects BTC
0
10
20
30
40
PNFP Public
4029
Number of health facilities supported by BTC
0
10
20
30
40
50
HCIII HCIV GH
50
8 11
Type of health facilities supported by BTC
10
!
Send me your picture,
cartoon or article about what
is happening in your health
facility or district at:
Go to the website
of the MoH:
http://health.go.ug/ OR
We hope you enjoyed reading the newsletter! The BTC Team