UGANDA Data for Results and Accountability NOVEMBER 2013 Education and Health Services in

SOUTH AFRICA 2 SDI: An Africa-wide initiative

Acknowledgements  Government of Uganda  EPRC  SDI Partnership: World Bank, AERC, AfDB

Process: Consultation, design and adaptation of survey materials Instrument design: –Methodology underpinned by state-of-the-art research –Methodology piloted in Tanzania and Senegal –Adaptation of survey instruments to Uganda context through technical consultations Consultations held prior to survey in Kampala with GoU, non-government stakeholders, and sector experts Survey coverage: representative of health facilities and schools across the country and for each region SDI did not include higher level health facilities such as HC4s and hospitals

5 Health: UGX 850 Bil ( , 8% of budget) Education: UGX 1.6 Tr. ( , 15% of budget) Expenditure Behavior Inputs Value for Money, Quality, and Equity Maternal mortality ratio 438/100,000 (UDHS 2011) 6/10 P4 pupils cannot read sentence at P2 level (Uwezo 2011) Maternal mortality ratio 438/100,000 (UDHS 2011) 6/10 P4 pupils cannot read sentence at P2 level (Uwezo 2011) SDI aims to shed light on behavior at service delivery units Outcomes

6 What does SDI measure?

Education Findings

Input availability 8 Schools do well on infrastructure and equipment… UgandaPublicPrivate Teaching equipment94% 95% School infrastructure55%60%40% Pupil-teacher ratio …except for textbooks

What teachers do UgandaPublicPrivate School absence rate 24%27%14% Classroom absence rate 53%57%40% Classroom teaching time 3h19m2h58m4h18m 9  Teachers’ Effort  Out of 100 Ugandan primary teachers … Private school: 50% more instruction

What teachers know Teachers’ test scoresMinimum Knowledge …. according to the Uganda SDI data, students performance is strongly enhanced by teacher’s knowledge Teachers score much lower on teaching skills assessment

Regional disparities Students per class Time spent teaching per day (minutes) Northern classes 3 times larger than Kampala’s Northern students receive 2.5 times less teaching time

SDI: Uganda vs Kenya What teachers do: absenteeism What teachers know: minimum knowledge

Education summary Ugandan primary schools do well in terms of infrastructure and equipment … but textbook use is a challenge Teacher’s absenteeism both from school and classroom is a concern and is more serious in public schools and rural areas Only a small share of teachers in public and private schools alike master the curriculum they are supposed to teach There are large regional disparities 13

Health Findings

Infrastructure Availability ElectricityClean waterImproved toiletMinimum infrastructure Uganda73%93%89%64%

Drugs and equipment availability Tracer drugsMothers drugsChildren drugsHC2 drugsEquipment Uganda79%35%49%58%83%

What health providers do UgandaPrivatePublic Absence from facility 46%39%52% Absence by location and facility type Reason for absence

What health providers know A large gap between diagnostic and treatment

Regional disparities Diagnostic accuracy: competence Infrastructure availability

What providers do and know UGANDAKENYA AllPublicPrivateAllPublicPrivate Absence from facility 46%52%39%27%29%21% VS

Health summary Ugandan health facilities do well in terms of infrastructure and equipment but … availability of drugs, especially for mothers, is a challenge Absenteeism of health providers is a cause for concern, and is more serious in public facilities 1 out of 10 health providers did not manage to diagnose any of 5 conditions. A correct diagnosis is no guarantee for full treatment, the knowledge gap is large There are large regional disparities in equipment, infrastructure, and providers’ competence 21

Conclusion Uganda has made tremendous progress in access to basic education and health services but there are serious quality issues to be addressed Addressing quality of education and health services is crucial if Uganda is to build the healthy and educated workforce necessary to achieve Vision 2040 Improving quality will also ensure value for money by increasing efficiency and effectiveness of services Improving quality will require better management, a focus on providers’ incentives, and enhanced accountability 22

UGANDA Data for Results and Accountability NOVEMBER 2013 Education and Health Services in