1. Highlights of the Annual Health Sector Performance Report FY 2011/12
Dr. Jane Ruth Aceng
Director General Health Services
18th JRM - 24th September 2012
Speke Resort, Munyoyo

2. Outline Background Overview of the sector performance for FY 2011/12
Progress in implementation of priority activities under the;
Uganda National Minimum Health Care Package
Integrated Health Sector Support Systems.

3. Background to the report
AHSPR 2011/12 mainly focuses on:
the progress of the annual work-plans
overall health sector performance against the National Development Plan
Joint Assessment Framework 4
HSSIP targets set for the FY 2011/12

4. Back ground cont…
Takes into consideration the annual performance in terms of;
Effectiveness
responsiveness and equity
integrated support systems strengthening
the status of programme implementation
and overall development mechanisms.

5. Data used
Focuses on the 26 HSSIP core indicators which are linked with the monitoring of the National Development Plan through the Office of the Prime Minister and international initiatives such as the Millennium Development Goals.
Based on the health facility and district reports gathered as part of the Health Management Information System, administrative sources and programme data
Population based surveys, e.g. Demographic Health Survey and the Aids Indicator Survey
Service Availability and Readiness Assessment Study 2012
Other relevant sources of data

6. Progress 2011/12 FY

7. Financial Resources (inputs)
Total public health expenditure per capita increased from UGX 20,765 billion (US$ 9.4) in 2010/11 to UGX 25,142 billion (US$10.29) in 2011/12
External (donor) contributions constituted 34.8% of total public health expenditure in 2011/12, compared with 14% in 2010/11.
The GOU expenditure on health % of total Gov’t expenditure declined from 8.9% in 2011/12 to 8.3%, far short of the Abuja target of 15%.

8. Policies and Guidelines (inputs)
A number of policies and guidelines were developed and some disseminated during the year
Quality Improvement Framework and Strategic Plan
Ministry of Health Client Charter
The Public Private Partnership for Health Policy
Medicines Management Manual
Human Resource Operations Manual
National Laboratory Quality Manual
Data Demand and Use Manual

9. Workforce (1)
Overall, 58% (31,951 out of 55,443) of public sector positions were filled, short of the 65% target for 2011/12 FY. (These include all staff (professional and support) in public health facilities).
Staffing levels are as low as 19% in Namayingo district while some (37.7%) of the districts have staffing levels between 40 and 59%.

10. Workforce (2) Village Health Teams
Additional 15 districts have fully established VHTs (Total 84 districts)
Overall 78% of villages have trained VHTs
110,000 VHT members received bicycles

11. System Outputs (availability, access)
Medicines availability improved significantly. 70% of facilities reported no stock out of six tracer medicines up from 43% in 2010/11.
The % of HC IVs providing comprehensive emergency obstetric care (Caesarian section) remained low at 25% compared to 24% in 2010/11.
Access to HIV counseling and testing services stagnated at 38% (1,905 out of 5,033 facilities)
The % of facilities offering PMTCT services increased from 32% in FY 2011/10 to 36% in FY 2011/12.
Per capita Outpatient department utilization increased from 1.0 dollar in 2010/11 to 1.2 dollars in 2011/12.

12. System Outputs (quality, safety)
TB treatment success rates increased slightly from 70% to 71.1%, but fell short of the 85% target of FY 2011/12.
Client satisfaction not assessed

13. Service coverage and determinants (1)
Delivery in health facilities – was 40% up from 39% in 2010/11 though below the HSSIP target of 50%.
(UDHS 2011 – 58% supervised deliveries with 44% in public facilities and 12% in private facilities)
The % of pregnant women attending four ANC visits increased from 32% to 35%.
(UDHS % among women 15 – 49 years with a live birth in the 5 years preceding the survey)
The % of pregnant women who have completed IPT2 for malaria risk reduction was 44% up from 43% in 2010/11.
(UDHS % among women 15 – 49 years who had a live birth in the 2 years preceding the survey. )

14. Service coverage and determinants (2)
Immunization coverage with DPT3 was 85% down from 90% in 2010/11 however, above HSSIP target (82%) for the year
(UDHS % for children with vaccination cards at time of survey)
Measles coverage among children under one year increased to 89% from 85% 2010/11.
(UDHS % for children with vaccination cards at time of survey)

15. Service coverage and determinants (3)
% of children exposed to HIV from their mothers accessing HIV testing within 12 months was 28.3% down from 30% in 2010/11
% eligible persons receiving ARV therapy was 59.3% up from 53% in 2009/10
% of households with pit latrines was 72% from 71% in 2010/11.

16. Service coverage and determinants (4)
% U5 children with height /age below the lower line (stunting) was down to 33% but on track with HSSIP target (UDHS 2006 was 38%)
% U5 children with weight /age below the lower line (wasting) was down to 14% but on track with HSSIP target (UDHS 2006 was 16%)
Contraceptive use measured by;
Contraceptive Prevalence Rate was 30% up from 24% in 2006 (UDHS 2011)
Couple Years of Protection increased to 1,841,958 from 803,139 in 2010/11 (HMIS)

17. Trends in the Health Indices
Indicator
1990
1995
2001
2006
2011
% Reduction from Baseline
HSSIP Target
MMR (per 100,000 live births) NA
506
505
435
438
16%
131
Neonatal MR (per 1,000 live births) 27 33 29 7% 23
IMR (per 1,000 live births)
101 81 88 76 54
49% 41
Under 5 MR
(per 1,000 live births)
180
147
152
137 90
50% 56

18. Local government performance District league table

19. District League Tables 2011/12
12 indicators were selected
8 - coverage and quality of care (75%)
Pentavalent Vaccine 3rd dose coverage (15)
Deliveries in gov’t and PNFP facilities (15)
Outpatient visits per capita (10)
HIV testing in infants at-risk (10)
Latrine coverage (10)
Sulphadoxine / Pyrimethamine 2nd dose for IPT (5)
4th antenatal care visits (5)
TB Treatment Success Rate (5)

20. District league table cont…
4 - management indicators (25%)
Approved posts that are filled (10)
HMIS completeness and timeliness of reporting (5)
DHMT meetings held as planned (5)
Timely submission of medicine orders (5)

21. Top10 and bottom ranking districts
TOTAL SCORE
RANK
KABAROLE
83.3 1
GULU
83.1 2
LYANTONDE
79.0 3
KIBOGA
72.0 4
MPIGI
71.8 5
MBALE
71.7 6
LIRA
71.1 7
MASAKA
70.8 8
BUSHENYI
70.7 9
KABALE
69.6 10
DISTRICT
TOTAL SCORE
RANK
NTOROKO
41.5
103
HOIMA
41.4
104
KWEEN
40.8
105
GOMBA
40.2
106
AMOLATAR
39.1
107
ALEBTONG
35.3
108
KAABONG
33.9
109
AMUDAT
28.3
110
LAMWO
23.4
111
NAPAK
14.3
112

22. Trends in selected DLT Indicators
 FY
DPT3 Coverage
Deliveries in Pub. & PNFP facilities
OPD Per Capita
HIV testing in HIV exposed babies
IPT2
ANC4
Approved posts filled
% Completeness facility reporting
Medicine orders submitted timely
National Average
10/11 90 39 1 30 43 32 52 85 47
58.4
11/12
79.9
37.6
1.2
28.3
45.7 34
54.4
86.5
28.1
56.8
Increase
Decline

23. Key observations Hard-to-reach districts New districts
improved performance with 6 new districts in 2011/12 compared to only one scoring above the national average in 2010/11.
Butambala scored the highest among the new districts (14th overall)
9 of bottom 10 ranking districts are new
Hard-to-reach districts
There was improvement in performance of the 25 hard- to-reach districts with one third (9/25) scoring above the national average

24. Summary (1) There was decrease in GOU allocation for health
Donor financial contributions increased during the year
Human resources for health increased slightly but much below target of 65%
VHT establishment increased
Availability of medicines and OPD utilization increased
Access to HCT, PMTCT and EmOC services still low

25. Summary (2)
Client satisfaction not assessed to determine quality of services
There was improvement in almost all service coverage indicators with the exception of DPT3 and HIV testing for exposed babies which showed a downward trend from the previous year. However, most improvements were below the HSSIP indicator targets.
There is very slow progress in reduction of maternal and neonatal mortality whereas there is significant reduction in infant mortality and under five mortality.

26. Summary (3)
The gains in the health sector performance during the year under review can be attributed to a number of deliberate efforts and interventions e.g.
increased funding for EMHS
improved logistics management and supervision;
training in leadership and management at all levels;
Scaling up of VHTs.

27. Challenges Decrease in the already inadequate funding
Efforts in attaining and maintaining an adequately sized, equitably distributed and appropriately skilled health workforce were hampered by the limited wage bill.

28. Recommendations
Reducing off budget funding by ensuring that all projects and donor inflows are aligned to HSSIP and reflected in the budget.
Reducing out–of-pocket funding for health care by introducing prepayment systems like health insurance.
Increased wage bill to fill vacancies and improve remuneration of health workers.

29. Recommendations
Increase coordination and partnership with private providers in implementation of the sector priorities.
Strengthen supervision, monitoring and evaluation of implementation of the HSSIP 2010/11 – 2014/15 at all levels.
Funding of priority interventions at all levels of care.

30. Acknowledgement
Development Partners, Civil Society Organizations, Private Sector, all stakeholders and Clients of the health system for the support and contribution to health sector performance.
All health workers who have contributed to the sector progress.
Special thanks to:
The World Health Organisation, Kampala Office, who financed the printing of the Annual Health Sector Performance Report.