Fundamentals of Health Services Management: Session 4

Organization of Health Services in Uganda (Refer to HSSIP)

National level organization of health services in Uganda- i

The national health system is made up of public and private sectors. The public health system includes all facilities of the MoH, MoE, MoD and Ministry of internal affairs. The private health system is made up of PNFPs, PFP, TCMP (Traditional and Complementary Medicine Practitioners) The private health system provides about 50% of standard Units of output

 The health services are decentralized following the political system. At the national level, the system has the MoH and the National Referral Hospitals (Mulago and Butabika)

National level organization of health services in Uganda- ii

National level organisation of the health services in Uganda -iii

According to the HSSIP, the core functions of the MoH are: Policy analysis, formulation and dialogue; Strategic planning; Setting standards and quality assurance; Resource mobilization; Advising other ministries, departments and agencies on health-related matters;

Core functions of MoH

Capacity development and technical support supervision; Provision of nationally coordinated services including health emergency preparedness and response and epidemic prevention and control; Coordination of health research; and Monitoring and evaluation of the overall health sector performance.

Uganda national health services organisation National referral hospitals

provide comprehensive specialist services and are involved in health research and teaching in addition to providing services offered by general hospitals and Regional Referral Hospitals. There are so far only two national referral hospitals- Mulago and Butabika- (Mbarara is being prepared to become the 3rd The conversion is said to be about complete)

National Health Facilities are generally not sufficient!! (Source:MoH HSSIP)

Uganda National health services organisation- Regional referral hospitals

Offer specialist clinical services such as psychiatry, Ear, Nose and Throat (ENT), ophthalmology, higher level surgical and medical services, and clinical support services (laboratory, medical imaging and pathology). These hospitals serve a region They are also involved in teaching and research. This is in addition to services provided by general hospitals. Regional referral hospitals report to the centre

List of 12 RRHs
1.Arua Regional Referral Hospital 2.Fort Portal Regional Referral Hospital 3.Gulu Regional Referral Hospital 4.Hoima Regional Referral Hospital 5.Jinja Regional Referral Hospital 6.Kabale Regional Referral Hospital 7.Lira Regional Referral Hospital 8.Masaka Regional Referral Hospital 9.Mbale Regional Referral Hospital 10.Soroti Regional Referral Hospital 11.Moroto Regional Referral Hospital 12.Mubende Regional Referral Hospital

Private Not For Profit (PNFPs)

These are health facilities founded by faith based organisations. PNFPs provided the first organized health services to Africans in Uganda- beginning at Mengo in 1897 by A R

Cook.
The PNFPs belong to three main net works namely the UMMB, UCMB and UPMB. There are other bureaux including the Orthodox Medical Bureau.

PNFPs contribution to health services (NHP, 2009) The FBPNFPs account for 41% of the hospitals

and 22% of the lower level facilities and are

more present in rural areas, thereby

complimenting government facilities.

The PNFPs operate 70% of health training institutions with financial support from GoU

PNFPs
This ratio of PNFPs to government facilities is changing because government is converting many HC-IV to district hospitals. However, PNFPs are said to be more efficient than public health facilities- and are said to be more productive.

Ownership and organisation of PNFPs -i

PNFP health facilities belong either to the Anglican,

Pentecostal, SDA, Catholic or Muslim faiths.

Majority of PNFP health facilities belong to the Anglican or Catholic faith and are organized under the UPMB or UCMB. UCMB and UPMB as well other bureau, are umbrella organizations and just coordinate and empower the activities

of the facilities
Facilities belong to local congregations or dioceses

Ownership and organisation of PNFPs-ii

PNFPs are better structured and more organized than other private health services. They also have better collaboration among them selves and with government. As noted earlier , private health services provide up to 50% of standard units of out BUT have not as much integration with national health system as there should be for maximum outputs/benefit In this regard, a public private partnership for health(PPPH) is being worked on

 The PNFPs are guided by government policies At district level, PNFPs report to DHOs but they also report to diocesan health coordinators and health boards. PNFPs do not compete with public health facilities but rather suppliment government effort and about 20% of their budget, is met by government grants

Ownership and organisation of PNFPs -ii

PNFP Hospitals
PNFP Hospitals are classified as general hospitals although many may qualify to be regional referral hospitals. Some of these, like Nsambya, are now teaching hospitals and they offer specialized services

PFP Health facilities

There are approximately 14 private individuals owned by individuals or institutions. These provide services with the objective of making a profit. They are mainly in towns where users can pay. They are also treated as general hospitals although some of them like Kampala International receive referrals from other hospitals and are also teaching facilities According to NHP (2009), these PFP are largely unregulated and have little collaboration with government

 Mostly not regulated BUT up to 60% of Ugandan are said to use their services before visiting formal sector (NHP, 2009) They have little or even no functional relationship with private or public health services providers A legal framework for their functionality is awaiting implementation but has been developed

Traditional & Complementary Medicine Practitioners(TCMP)

District Health Services

During decentralisation, districts were charged with the responsibility of service delivery at district and health subdistrict (HSD) level District health services are managed by ministry of local government The district health team (DHT) chaired by the District Health Officer provides technical leadership for the health care services at the district level At the health sub district, a medical officer assists the DHO in managing the health care services. District Health Teams and HSDs supervise service delivery at government and PNFP facilities at different levels, except the national and regional referral hospitals.

Structure of health services at district level-i

The lowest level of the health care system in Uganda is the household/community or village. In the community/village, there is a Village Health Team (VHT) whose role is to link health facilities with the community (HSSP III).

Structure of health services at district level-ii

The first level of interaction between the formal health sector and communities is HCII where only out-patients services are available. HCIII provide maternity services and the first referral cover for the sub-counties (HSSPIII).

Structure of health services at district level-iii

Next to HCIII, are health sub-districts and according to the HSSPIII, P.4: The health subdistrict is mandated with planning, organization, budgeting and management of the health services at this and lower health center levels. At the districts, it is the responsibility of local government to plan for and provide health services as stated by the HSSPIII, p.4.

Comparing Core Functions of Central Government and District Local Governments

Central Government Core Functions Policy formulation Setting standards Quality assurance Resource mobilisation Capacity development Technical support Provision of nationally coordinated services e.g. epidemic control Coordination of health research Monitoring and evaluation of overall sector performance
District Local Government Core Functions Implementation of the national health policy Planning and management of district health services Provision of disease prevention, health promotion, curative and rehabilitative services with emphasis on the minimum health care package and other national priorities within the district Control of other communicable diseases of public health importance Vector control Health education Ensuring provision of safe water and sanitation Health data collection, management, interpretation, dissemination and utilisation