REPUBLIC OF UGANDA MINISTRY OF HEALTH GUIDELINES FOR GOVERNANCE AND MANAGEMENT STRUCTURES

Transcription

1 REPUBLIC OF UGANDA MINISTRY OF HEALTH GUIDELINES FOR GOVERNANCE AND MANAGEMENT STRUCTURES JANUARY 2013

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3 REPUBLIC OF UGANDA MINISTRY OF HEALTH GUIDELINES FOR GOVERNANCE AND MANAGEMENT STRUCTURES January 2013

4 Table of Contents Foreword... Acronyms... iii iv 1 Introduction Senior Top Management Committee (STMC) Top Management Committee (TMC) Health Policy Advisory Committee (HPAC) Senior Management Committee Technical Working Groups (TWGS) Heads of Departments Monitoring Performance / Compliance Annex ii

5 Foreword Governance is one of the six building blocks of the health system as defined by World Health Organisation. Governance involves ensuring strategic policy frameworks exist and are combined with effective oversight, coalition building, regulation, attention to system-design and accountability. Governance in health systems is about developing and putting in place effective rules for policies, programs, and how activities related to achieving health sector objectives are carried out. Management comprises planning, organizing, staffing, leading or directing, and controlling an organization or effort for the purpose of accomplishing desired goals and objectives available resources efficiently and effectively. The health sector has many actors involved in the governance and management of the health sector; including the public and private sector, Health Development Partners, health consumers and multiple government agencies beyond the MoH. A recently signed country Compact is a new mechanism for coordination in the health sector. In order to ensure proper coordination there is need for ongoing dialogue between the different stakeholders to ensure effective ownership, policy coherence, and sustainable programs. The Ministry of Health Guidelines for Governance and Management Structures for HSSIP 2010/ /15 have been developed to guide these structures in ensuring resources are managed effectively and activities are undertaken in the interests of the MoH mission. These guidelines will be widely disseminated to all stakeholders and performance of the governance and management structures will be monitored regularly. The Ministry acknowledges all who participated in the development of these guidelines with special mention of the Quality Assurance Department and the Supervision, Monitoring, Evaluation and Research Technical Working Group. Dr. Jane Ruth Aceng Director General Health Services iii

6 Acronyms AHSPR CDC CSO DGHS DHO EHHP HDPs HI HPAC HRH HSD HSSIP JRM LLHF MCH MoES MoFPED MoGLSD MoH MoLG MoPS MM&P NCDC NHA NMS PA PPPH RRH SCC SMC SME&R TMC ToR TWG Annual Health Sector Performance Report Communicable Disease Control Civil Society Organisation Director General Health Services District Health Officer Environmental Health and Health Promotion Health Development Partners Health Infrastructure Health Policy Advisory Committee Human Resources for Health Health Sub District Health Sector Strategic and Investment Plan Joint Review Mission Lower Level Health Facility Maternal and Child Health Ministry of Education and Sports Ministry of Finance, Planning and Economic Development Ministry of Gender, Labour and Social Development Ministry of Health Ministry of Local Government Ministry of Public Service Medicines Management and Procurement Non Communicable Disease Control National Health Assembly National Medical Stores Policy Analysis Public Private Partnership for Health Regional Referral Hospital Social Services Committee Senior Management Committee Supervision, Monitoring, Evaluation and Research Top Management Committee Terms of Reference Technical Working Group iv

7 1 Introduction Good governance and management of health services delivery is a key element in ensuring efficiency and effectiveness in the health sector. The governance and management structures described in the Health Sector Strategic and Investment Plan (HSSIP) 2010/ /15 intend to establish a substantive sector wide governance mechanism, to foster agreement on common procedures for consultation and decision making. The existing partnership instrument the compact serves as the formal instrument to guide coordination and partnership in health. It is guided by interpretation of the principles of the 2005 Paris Declaration on Aid Effectiveness. Governance in health is about the role of government in health and its relation to other actors whose activities impact on health. This involves overseeing and guiding the whole health system, private as well as public in order to protect the public interest. Improvement in coordination and management of the delivery of health and health related services is therefore a key strategic deliverable of the Ministry of Health (MoH). The following are the principles of governance in health; Strategic vision Participation and consensus orientation Rule of law Transparency Responsiveness Equity and inclusiveness Effectiveness and efficiency Accountability Intelligence and information Ethics Management comprises planning, organizing, staffing, leading or directing, and controlling an organization or effort for the purpose of accomplishing desired goals and objectives available resources efficiently and effectively. 1

8 The management principles include; Division of Work When employees are specialized, output can increase because they become increasingly skilled and efficient. Authority Managers must have the authority to give orders, but they must also keep in mind that with authority comes responsibility. Discipline Discipline must be upheld in organizations, but methods for doing so can vary. Unity of Command Employees should have only one direct supervisor. Unity of Direction Teams with the same objective should be working under the direction of one manager, using one plan. This will ensure that action is properly coordinated. Subordination of Individual Interests to the General Interest The interests of one employee should not be allowed to become more important than those of the group. This includes managers. Remuneration Employee satisfaction depends on fair remuneration for everyone. This includes financial and non-financial compensation. Centralization This principle refers to how close employees are to the decision-making process. It is important to aim for an appropriate balance. Straight Chain of Command Employees should be aware of where they stand in the organization s hierarchy, or chain of command. Order The workplace facilities must be clean, tidy and safe for employees. Everything should have its place. Equity Managers should be fair to staff at all times, both maintaining discipline as necessary and acting with kindness where appropriate. Stability of Tenure of Personnel Managers should strive to minimize employee turnover. Personnel planning should be a priority. Initiative Employees should be given the necessary level of freedom to create and carry out plans. Team work Organizations should strive to promote team spirit and unity 2

9 1.1 Governance and Management Structures There are different levels of governance and management based on the organizational levels in the health sector and these include national level, district level, health facility/institutional level. 1. The governance structures: These look at defining the guiding strategic direction and following up on the operation of interventions. They are largely defined through formal legislation, with members and functions formally gazetted by the Government. 2. The management structures: These guide internal organizational management functions which include, forecasting, planning, organizing, commanding, coordinating and controlling resources Governance Structures in Health a) National Level: Cabinet, Parliamentary Committee on Health, Ministry of Health Senior Top Management Committee b) Autonomous Institutions (Public and Private): Boards c) District: District Executive Committee, District Social Services Committee. These provide oversight for policy implementation, planning and resource allocation and use for the health system at this level, in adherence to national laws. d) Sub-county: Local Council III Executive, Sub-County Social Services Committee e) Referral Hospitals: Boards. These provide the oversight role for the effective functioning of the hospital in order to deliver quality services. f) Health Facility (General Hospital, HC IV, III & II): Management Committees which draw representation from the community members and provide the oversight function for primary care facilities. g) Community Level: Local Council I ensure effective community participation in management of health services Management Structures in Health a) Sector Level: Top Management Committee, Senior Management 3

10 Committee, Technical Working Groups and Heads of Departments b) National Institutional Level: Top Management, Heads of Departments c) District: District Technical Planning Committee, District Health Management Team, District Health Team, Health-Sub-District Team d) Sub-county: Sub-County Technical Committee e) Health Facility: Health Facility Management Team, Health Facility In- Charge f) Community: Village Health Team, Head of Household There are complementary / support structures to the governance and management structures in the health sector and these include; Health Service Commission Regulatory Bodies Professional Councils Health Policy Advisory Committee 1.2 Governance and Management Structures at the MoH Headquarters The MoH guidelines for the governance and management structures exclude the functions of the Cabinet and Parliament of Uganda, semiautonomous institutions, Local Governments and private sector. The governance and management structures for the District Health Services shall follow the Local Government structures under the decentralization policy and semi-autonomous institutions and private sector shall be according to the respective organizational arrangements. The specific structures for the health sector governance and management under the Long Term Institutional Arrangements include: Senior Top Management Committee (STMC), Top Management Committee (TMC), the Health Policy Advisory Committee (HPAC), the Senior Management Committee (SMC), Technical Working Groups (TWGs) and Heads of Departments as illustrated in figure 1 below. The sector shall work in close collaboration with the relevant committees

11 of Parliament and Cabinet for overall political, and policy oversight. The key role of Cabinet / Parliament is political and policy coordination, ensuring the sector is working towards its policy objectives as set out in the National Health Policy, and the country s National Development Plan by influencing the broader environment in which the health system operates. The stewardship function of Cabinet and Parliament encompasses; 1) Activities that go beyond the health system to influence the main determinants of health (e.g. education, poverty, environment). 2) Other issues external to the health system, but which foster or constrain its effectiveness. The health sector shall interface with Parliament and Cabinet whenever necessary but in any case, following the Joint Review Mission of the Health Sector. The focus of the meetings shall be to review sector progress in the past year (based on the AHSPR), against the policy imperatives set out in the NHP, and contribution towards the NDP. Figure 1: Governance and Management Structure Coordination ad Linkages ROLES STRUCTURE MEMBERS Strategic policy directions SENIOR TOP MANAGEMENT TOP MANAGEMENT COMMITTEE Minister of Health (Chair) Minister of State, PS, DGHS and Directors Minister of Health (Chair) Ministers of State, PS, DGHS, DHS P&D, DHS C&C, Commissioners and EDs of semi-autonomous institutions Operational policy direction HEALTH POLICY ADVISORY COMMITTEE SENIOR MANAGEMENT COMMITTEE PS (Chair) HDP (Co-Chair) DGHS, DHS P&D, DHS C&C, Commissioners, Representation from HDPs, private sector, CSOs, Line Ministries, Referral Hospitals, DHOs & semi-autonomous institutions DGHS (Chair) Heads of Departments, Divisions, Units and Sections, Program Managers, and Technical Advisors, Registrars Technical direction TECHNICAL WORKING GROUPS (14) HEADS OF DEPARTMENTS Representatives from MoH, HDP, CSO, PHPs, Professional Associations, Semi-autonomous Institutions, Health Consumers Clinical and Curative Services, Finance and Administration, Community Health, Quality Assurance, Planning and Development, Nursing, National Disease Control

12 1.3 Key Coordination Principles The following principles should guide operationalisation of the governance and management structures; 1. Each of these structures should have clear terms of reference (ToR) and scope of work for smooth running of business. 2. Linkage of functions of coordination structures with organizational (implementation) structures (Departments, Divisions and Units) to minimize duplication. 3. Liaison between committees and TWGs on cross cutting issues is a function of the Secretaries. 4. TWG membership should not exceed 30 members to ensure cohesion and analytical discussions. 5. Criteria for membership on these structures should be clearly defined. 6. Leadership of these structures should be known to all members. 7. Memberships of these structures should be published and well known to all members. 8. Dates for meetings should be scheduled and published. 9. Budget to support functioning of the management structures shall be part of the Budget Framework Paper. 10. Wide stakeholder involvement including consumer representation. 11. All members should be oriented on the coordination structures and TWG functions / ToR.

13 2 Senior Top Management Committee (STMC) The STMC forms the top most decision making organ for governance in the MoH. 2.1 Composition of STMC Chairperson: Minister of Health Secretary: Permanent Secretary Members: a) Minister of Health (General Duties) b) Minister of Health (Primary Health care) c) Director General Health Services (DGHS) d) Director Health Services - Planning and Development (DHS P&D) e) Director Health Services - Clinical and Community (DHS C&C) 2.2 Functions of STMC 1. Articulating the policy direction for the sector, taking broader Government objectives into consideration. 2. Endorse policies and regulations for the sector on issues generated from the relevant structures. 3. Review the mission and vision of the health sector 4. Spearhead inter-ministerial collaboration with line ministries other key stakeholders. 5. Mobilizing resources for achievement of the sector policy direction. 6. Monitoring adherence to the policy direction of the sector. 7. Accountability to stakeholders. 2.3 STMC Meetings 1. STMC meetings shall take place on a weekly basis. 2. The STMC meeting schedule shall be published annually.

14 3 Top Management Committee (TMC) The TMC forms the second top most decision making organ for governance in the MoH. 3.1 Composition of TMC Chairperson: Minister of Health Secretary: Permanent Secretary Members: a) Minister of Health (General Duties) b) Minister of Health (Primary Health care) c) Director General Health Services d) Director Health Services Planning & Development e) Director Health Services Clinical & Community Health Services f) Commissioners of Health Services (Clinical, National Disease Control, Quality Assurance, Planning, Community Health and Nursing) g) Executive Director Uganda Virus Research Institute h) Executive Director Uganda Blood Transfusion Services i) Executive Director Uganda National Health Research Organisation j) Executive Director National Drug Authority k) Executive Director National Chemotherapeutics Research Institute l) Executive Director Mulago National Referral Hospital m) General Manager National Medical Stores 3.2 Functions of TMC 1. Provide oversight function for all programmes, projects and other activities in the ministry. 2. Receive and discuss policies for the sector on issues generated from HPAC. 3. Ensure proper accountability for resources in the ministry.

15 4. Receive and discuss regulations formulated. 5. Ensure adequate and effective communication within the ministry and to the outside community / public. 3.3 TMC Meetings 1. TMC meetings shall take place on a monthly basis. 2. The TMC meeting schedule shall be published annually.

16 4 Health Policy Advisory Committee (HPAC) The Health Policy Advisory Committee was established as a forum for the Government, Health Development Partners (HDPs) and other stakeholders to discuss health policy and to advise on the implementation of the HSSIP and policies. HPAC is a donor / stakeholder coordination mechanism which supports the functions of the Top Management in policy related issues. 4.1 Composition of HPAC Chairperson: Permanent Secretary Co-Chairperson: Head of Development Partners Secretary: Commissioner Health Services Planning Members: a. Director General Health Services b. Director Health Services Planning & Development c. Director Health Services Clinical & Community Health Services d. Under Secretary - MoH e. Executive Director Mulago National Referral Hospital f. Executive Director Butabika National Referral Hospital g. Secretary of the Health Services Commission h. Commissioners of Health Services: Clinical, National Disease Control, Quality Assurance, Planning, Community Health and Nursing i. Assistant Commissioner Accounts j. Representatives of the HDPs k. Representatives of Bilateral Agencies l. Board Chairperson National Medical Stores (NMS) m. Representative of: - Medical Bureaus - Hospital Directors for the Regional Referral Hospitals - District Health Officers - Civil Society Organizations (CSOs) 10

17 - Health Consumers - Private Health Providers n. Representatives of related ministries: Ministry of Finance, Planning and Economic Development (MoFPED), Ministry of Local Government (MoLG), Ministry of Public Service (MoPS), Ministry of Education and Sports (MoES), Ministry of Gender, Labour and Social Development (MoGLSD). Other members shall be co-opted as need arises to address specific issues during HPAC proceedings 4.2 Functions of HPAC 1. Advise the MoH on policy related issues. 2. Review and discuss policy related issues from SMC. 3. Receive and advise on the following monitoring reports: o o o o Implementation of the Compact International Health Partnerships reports Quarterly Area Team monitoring reports Annual Health Sector Performance Report. o Progress report on implementation of JRM Aide-memoires - quarterly. o o o Technical Review meeting reports. Quarterly sector performance review reports. Other mandatory reports e.g. project or program reports 4. Participate in strategic planning for the sector. 5. Harmonize resource mobilization. 6. Participate in joint monitoring and evaluation of health programmes. 7. Strengthen collaboration and partnership with the ministry and other stakeholders. 4.3 HPAC Meetings 1. HPAC meetings shall take place on a monthly basis. 11

18 2. The schedule will be published annually. 3. Pre-HPAC meeting (Chair, Co-Chair and Secretary) shall be conducted to decide the agenda. 4. The Secretary to HPAC shall invite and communicate the agenda prior to the meeting. 5. All relevant information will be provided to members prior to the meeting. 4.4 Duration of Membership to HPAC HPAC remains in operation for the duration of each Health Sector Strategic Plan. The ToR of HPAC and membership will be reviewed during the Mid Term Review and End Term evaluation of the HSSIP to reflect appropriate response to changing health needs. 4.5 Funding for HPAC Activities All HPAC activities including special assignments will be funded from the health sector budget and other agreed sources. 12

19 5 Senior Management Committee This is a decision making organ and constitutes senior members of the MoH. SMC reports to HPAC. 5.1 Composition of SMC Chairperson: Director General Health Services Secretary: Commissioner Health Services Quality Assurance Department Members: a) Director Health Services Planning & Development b) Director Health Services Clinical & Community Health Services c) Under Secretary d) All Commissioners e) All Assistant Commissioners f) All Program Managers g) All heads of Units (Principal or Senior Level) h) All Principal Level Officers i) Technical Advisors j) Registrars of the Professional Councils SMC can co-opt members as need arises to address specific issues that may occur. 5.2 Functions of SMC 1. Review and discuss MoH workplan, budget, reports and other project activities for the Health Sector and forward to HPAC for approval. 2. Review and endorse technical standards and guidelines. 3. Review and discuss policy related issues from TWGs and propose viable policy options for HPAC consideration. 4. Receive, internalize and implement TMC decisions as may be directed/communicated from time to time. 5. Give guidance on technical and administrative issues within the sector. 13

20 6. Identify and discuss issues regarding general day to day functioning of the MoH including staff welfare. 5.3 Duration of Membership to SMC SMC is an institutionalized technical structure. Membership to SMC is by virtue of position at time of deliberations of the committee. 5.4 Funding for SMC Activities Activities for the SMC will be funded through the sector budget. 5.5 SMC Meetings 1. SMC meetings will be held monthly and will be published as scheduled. 2. The agenda for SMC will be arranged by the Secretary in consultation with the DGHS. 3. A report on monthly TWGs deliberations has to be a regular item on the agenda for SMC. 4. All technical presentations to be made to SMC shall first be discussed and forwarded by the respective TWG. 14

21 6 Technical Working Groups (TWGS) Technical coordination of health issues shall be through the TWGs, each focused on specific technical areas. These will be the forum through which technical issues are debated and agreed and specific recommendations and actions are implemented. The TWGs shall exist all the time, while ad hoc committees will be formed to address a particular task, and then disbanded when the task is completed. Ad hoc committees shall focus on specific health system challenges that need urgent action. At the beginning of HSSIP 2010/ /15, the health sector had 8 TWGs. The Basic Care Package TWG had four subcommittees which have been established as TWGs. Nutrition which was previously a component under the MCH subcommittee has also been established as a TWG to address the diverse nutrition interventions. The e-health, and Policy, Legal and Regulatory TWG have also been established to address the new innovations in Information Communication and Technology and strengthen policy development and analysis in the health sector. The TWGs are: 1. Health Sector Budget 2. Human Resources for Health 3. Health Infrastructure 4. Medicines Procurement and Management 5. Supervision Monitoring Evaluation and Research 6. Private Public Partnership for Health 7. Hospitals and Lower Level Health Facilities 8. Maternal and Child Health 9. Nutrition 10. Communicable Disease Control 11. Non-Communicable Disease Control 12. Environmental Health and Health Promotion and Education 13. e-health 14. Policy, Legal and Regulatory 15

22 All the technical working groups and committees will be managed through the SMC and reports from these shall be a standing HPAC agenda. Furthermore, HPAC and MoH Top Management may task TWGs with specific issues to resolve. 6.1 Cross Cutting Functions for TWGs a) Participation in preparation of health sector strategic and investment plans b) Participation in Midterm -review and end-term evaluation of the HSSIP c) Preparation of the AHSPR, JRM / National Health Assembly (NHA) d) Development and review of policies, strategic plans and guidelines e) Follow up and act on JRM Undertakings & Actions f) Identify and advocate for resource mobilization for the health sector. g) Establish and agree on TWG policy of conducting meetings and ensuring regular and active participation 6.2 Cross Cutting Issues for TWGs a) Each TWG shall decide on who should be the minute secretary of the TWG. b) Each TWG shall identify the specific members in line with the guidelines and communicate members of the TWG to the DGHS by 30th July each year. c) Activities for TWGs will be funded through the sector budget under the respective departments holding the secretariat to the TWGs. d) Two or more technical stakeholder committees can cooperate to address particular issues that cut across them. 6.3 TWG Meetings 1. TWG meetings will be held monthly and will be published as scheduled. 16

23 2. The agenda for TWGs will be arranged by the TWG Secretaries in consultation with the respective Chairpersons. 3. A summary report on monthly TWGs deliberations has to be forwarded to the SMC Secretariat for presentation in the subsequent SMC meeting. 4. All presentations to be made to SMC shall first be discussed and forwarded by the respective TWG Secretaries to the Secretariat of SMC. 5. Chairpersons of TWGs should ensure that policy issues are presented timely to SMC and subsequently to HPAC. 6.4 Health Sector Budget Working Group 6.4.1Composition of Health Sector Budget Working Group Chairperson: Director Health Services Planning & Development Secretary: Assistant Commissioner Budget and Finance Members: a) All heads of departments b) Representatives of HDPs c) Representative for the Medical Bureaus d) Representative of Health Service Commission e) Representative of Uganda AIDS Commission f) Directors of the Semi-autonomous Institutions National Referral Hospitals Uganda National Health Research Organisation Uganda Natural Chemotherapeutic Research Institute Uganda Virus Research Institute National Medical Stores Uganda Blood Transfusion Services National Drug Authority Uganda Heart institute Uganda Cancer Institute 17

24 g) Representatives of related ministries (MoFPED, MoLG, MoWE, MoES, MoPS) Specific ToR for Sector Budget Working Group 1. Assess existing health sector financing sources and mechanisms to determine application to the HSSIP. 2. Analyse efficiency and equity in the channeling and utilization of these resources 3. Assess the potential of alternative financing sources and mechanisms for capturing significant additional resources for the sector given HSSIP priorities, and efficiency and equity considerations. 4. Review project proposals prior submission to SMC to align them to the financing framework and Resource Envelope. 5. Review on-going and new projects and present its recommendations to HPAC for its endorsement 6. Prepare Annual Budget Framework Papers in line with the HSSIP and annual sector priorities as agreed by the NHA and JRM. 7. Regularly review the resource projections for the sector versus the actual budget outturns, and relationship with sector outputs. 8. Review existing procurement systems and advise on how best to harmonize them. 9. Review the MoH procurement plan. 10. Conduct yearly evaluation of the performance of the TWG members. 6.5 Human Resources for Health (HRH) TWG Composition of HRH TWG Chairperson: Director General Health Services Secretary: Assistant Commissioner Health Services, Human Resource Management Members: a) MoH representatives: - Human Resource Management 18

25 - Human Resource Development - Health Planning Department - Nursing Department - Clinical Services Department b) Representatives of HDPs supporting HRH Management and Development c) Representatives of Health Professional Councils d) Representative of Health Service Commission e) Representatives of related ministries (MoPS, MoES, MoLG, MoGLSD) f) Representatives of Professional Councils g) Representatives of Health Training Institutions h) Representative of the Medical Bureaus i) Representative of the CSOs Specific ToR for HRH TWG 1. Review health workers production, deployment/recruitment and exit from workforce with the view to improving proportion of approved staff position that are filled with appropriately trained and motivated health workers. 2. Identify ways to strengthen inter-sectoral collaboration, especially with MoPS, MoES, MoFPED, and MoLG. 3. Review the funding for HRH and recommend ways of improving its adequacy and effectiveness. 4. Review the role of the private sector including Private Not-For-Profits in HRH development and propose ways to improve the collaboration with the MoH. 5. Consider and propose new HRH interventions for the sector 6. Guide MoH and address issues that require disciplinary measures to be implemented. 7. Conduct yearly evaluation of the performance of the TWG members. 19

26 6.6 Health Infrastructure (HI) TWG Composition of HI TWG Chairperson: Commissioner Health Services, Clinical Services Secretary: Assistant Commissioner Health Services, Health Infrastructure Members: a) MoH representatives: Department for Clinical Services - HI Health Planning Department Finance and Administration Reproductive Health Division Nursing Department b) Representatives of HDPs supporting HI development c) Representatives of related ministries (MoFPED, MoWT) d) Representative of National Drug Authority e) Representative of National Medical Stores f) Representative of Joint Medical Stores g) Representative of Medical Bureaus h) Representatives of Professional Councils Specific ToR for HI TWG 1. Review the Health Infrastructure Policy and Development Plan. 2. Review standards for physical facilities, equipment, transport and logistics and propose ways and means to ensure equity in access. 3. Review and update the data base for the health facilities country wide 4. Propose effective methods and systems for ensuring quality and value for money, in contract management for infrastructure development at national & district levels. 5. Propose ways to engage development partners in efficient and equitable health infrastructure development. 6. Receive and review proposals for HI development in the health sector. 20

27 7. Conduct yearly evaluation of the performance of the TWG members. 6.7 Medicines Management and Procurement (MM&P) TWG Composition of MM&P TWG Chairperson: Director General Heath Services Secretary: Assistant Commissioner Health Services, Pharmacy Members: a) MoH representatives: Pharmacy Division Health Planning Department Finance & Administration Central Pubic Health Laboratory b) Representatives of HDPs involved in MM&P c) Representative of National Drug Authority d) Representative of National Medical Stores e) Representative of Joint Medical Stores f) Representative of Pharmacy Council g) Representative of Medical Bureaus h) Representative of CSOs i) Representative of MoFPED Specific ToR for MM&P TWG 1. Regular review of sector performance with the view to achieving zero-tolerance for essential medicines and health supplies stockouts. 2. Coordination of stakeholder interventions in Medicines Procurement, and Management 3. Advise on medicines and health supplies Supply Chain (SC) harmonization in the sector and advise on best practices in Supply Chain Management (SCM) 21

28 4. Make inputs into other TWG proposals and discussions to ensure that the various programmatic objectives are met 5. Mainstream the promotion of Rational Use of Medicines (RUM) in all medicines related interventions in the sector. 6. Coordinate and give advice on research related to medicines and health supplies 7. Provide advice on alternative policy options in the area of EMHS as may be needed, based on research evidence and best practices. 8. Establish a mechanism for and advise on M&E for Essential Medicines and Health Supplies (EMHS) SCM. 9. Conduct yearly evaluation of the performance of the TWG members. 6.8 Supervision, Monitoring, Evaluation and Research (SME&R) TWG Composition of SME&R TWG Chairperson: Commissioner of Health Services - Quality Assurance Secretary: Assistant Commissioner of Health Services - Quality Assurance Members: a) Ministry of Health representatives: Quality Assurance Department Health Planning Department: Resource Centre and Policy Analysis Unit Clinical Services Programme M&E officers (ACP, NMCP, TBLP, EPI) Project M&E Officers (depending on operational projects) b) Representatives of HDPs involved in SME&R c) Representative of Uganda National Health Research Organisation (UNHRO) d) Representative of Academic and Research Institutions (Makerere University School of Public Health and the Regional Center for Quality of Health Care - RCQHC) e) Representatives of CSOs / NGOs 22

29 f) Representatives of Medical Bureaus g) Representative of Health Consumers Organizations Specific ToR SME&R TWG 1. Periodically review and propose the Sector Monitoring Framework and performance indicators. 2. Review and document sector performance (different levels and entities, and entire sector) by level using the HSSIP monitoring framework quarterly, annually, midterm and end-term as appropriate. 3. Coordinate and provide guidance in development of service standards and service delivery standards in the health sector. 4. Support the process of streamlining / harmonization of various Information systems in the health sector for improved efficiency and easy availability of information. 5. Regularly review the various support supervision mechanisms in the sector (Area Teams, Consultant s Outreach Programmes and Technical supervision) with the view to ensure adherence to standards and recommend improvements. 6. Regularly review the quality improvement methods and interventions in the sector with the view to determine the quality of care and recommend improvements. 7. Coordinate development of the operational research agenda for the health sector strategic plan and recommend mechanisms to fund and implement research for the health sector strategic plan. 8. Propose mechanisms for integrating and coordinating research activities at levels of health service delivery. 9. Receive and present submissions of all TWGs to the monthly Senior Management Committee meetings 10. Conduct yearly evaluation of the performance of the TWG members. 6.9 Public Private Partnership for Health (PPPH) TWG Composition of PPPH TWG 23

30 Chairperson: Director Health Services, Planning and Development Secretary: Public Private Partnership for Health Desk Officer Members: a) Ministry of Health units: Health Planning Department Human Resource Department Pharmaceutical Division Finance and Administration b) Representatives of HDPs supporting PPPH c) Representatives of Medical Bureaus d) Representative for the CSOs e) Representatives of Contemplary Medical Practitioners f) Representatives of Private Health Providers g) Representatives of Professional Councils Specific ToR for PPPH TWG 1. Support the process of operationalising the National policy on PPPH and guide on its implementation. 2. Develop guidelines for the implementation of the PPH policy 3. Coordinate and harmonize public and private health providers and align strategies and interventions with the HSSIP. 4. Develop the data base on the private sector partners 5. Monitor the partnership and its contribution to the Health sector 6. Propose financing mechanisms for the partnership 7. Ensure sustainability of partnership and collaboration, forging the bond and enrolling new partners. 8. Consideration of new interventions and projects for the PPPH. 9. Conduct yearly evaluation of the performance of the TWG members. 24

31 6.10 Hospitals and Lower Level Health Facilities (LLHFs) TWG Composition of Hospitals and LLHFs TWGs Chairperson: Director Health Services Clinical & Community Health Services Secretary: Assistant Commissioner Health Services, Integrated Curative Members: a) MoH representatives: Clinical Services Department Planning Department Quality Assurance Department Pharmaceutical Division Nursing Department b) Representatives of HDPs supporting Hospitals and LLHFs c) Representative for the CSOs involved in facility based care and treatment d) Representative of Uganda Blood Transfusion Services e) Representative of Central Public Health Laboratories f) Representative of Health Consumers Organizations g) Representative for Medical Bureaus h) Representative of the Private Health Providers i) Representatives of the Professional Councils j) Representative of National Referral Hospitals k) Representative of Regional Referral Hospitals l) Representative of General Hospitals m) Representatives of District Health Officers Specific ToR for Hospital & LLHFs TWG 1. Develop and review relevant policies, training packages and strategies on hospitals and LLHFs with various stakeholders. 2. Give advice to the health sector regarding issues related to hospitals and LLHFs. 25

32 3. Provide overall policy and programme co-ordination with other program areas and sectors in regard to hospitals and LLHFs. 4. Provide guidance on strategic direction for capacity building on hospitals and LLHFs related programmes. 5. Provide guidance on cost-effective and high-impact interventions in regard to hospitals and LLHFs. 6. Coordinate and advice on operational research related to hospitals and LLHFs. 7. Review the catchment area of the hospitals and the LLHFs. 8. Conduct yearly evaluation of the performance of the TWG members Maternal and Child Health (MCH) TWG The MCH TWG includes, Sexual & Reproductive Health and Rights; New born Health and Survival; Integrated Management of Childhood Infections; Expanded Programme on Immunization Composition of MCH TWG Chairperson: Commissioner Health Services, Community Health Secretary: Assistant Commissioner Health Services, Reproductive Health Members: a) MoH representatives: Community Health Department UNEPI National Disease Control Pharmaceutical Division Nursing Department b) Representatives of HDPs involved in MCH c) Representative for the CSOs involved in MCH d) Representative of Uganda Peadiatricians Association e) Representative of the Association of Obstetricians and Gynaecologists in Uganda 26

33 f) Representative of Department of Obstetrics and Gynecology - MUCHS g) Representative of Department of Peadiatrics MUCHS h) Representative of the Private Health Providers Specific ToR for MCH TWG 1. Clear policy issues related to MCH and new programmes. 2. Monitor performance for MCH interventions 3. Give advice on implementation of technical programmes for MCH 4. Coordination of MCH activities for both Government and HDPs. 5. Coordinate and review new interventions for MCH and the related financing 6. Coordinate and advice on operational research related to MCH. 7. Coordinate and provide guidance in development of guidelines for MCH. 8. Conduct yearly evaluation of the performance of the TWG members Nutrition TWG Composition of Nutrition TWG Chairperson: Commissioner Health Services, Community Health Secretary: Principal Nutritionist Members: a) MoH representatives: Nutrition Child Health Reproductive Health Health Promotion and Education Environmental Health Aids Control Programme Malaria Control Programme Non-Communicable Disease 27

34 School Health Resource Centre Neglected Tropical Diseases b) Representatives of HDPs involved in nutrition c) Representatives from line ministries: (OPM, MoLG, MAAIF, MoES, MoGLSD) d) Representative of Uganda Peadiatricians Association e) Representative of Department of Peadiatrics - MAK f) Representative of Mwanamugimu Nutrition Unit Specific ToR for Nutrition TWG 1. Develop and review relevant policies, training packages and strategies on Nutrition with various stakeholders. 2. Give advice to the Health sector regarding issues related to Nutrition. 3. Monitor programme implementation with other program areas and sectors in regard to Nutrition. 4. Provide overall policy and programme co-ordination with other program areas and sectors in regard to Nutrition. 5. Provide guidance on strategic direction for capacity building on nutrition related of national programmes. 6. Provide guidance on cost-effective and high-impact interventions in regard to Nutrition. 7. Coordinate and give advice on operational research related to Nutrition. 8. Conduct yearly evaluation of the performance of the TWG members Communicable Disease Control (CDC) TWG The CDC TWG includes, Tuberculosis, malaria, HIV/AIDS and Diseases for eradication Composition of CDC TWG Chairperson: Commissioner Health Services, National Disease Control 28

35 Secretary: Assistant Commissioner Health Services, Epidemiology and Disease Surveillance Members: a) Ministry of Health units: Programme Managers (AIDS Control Programme, National Malaria Control Programme, TBLP, UNEPI, Guinea worm Programme, Onchocerciasis Programme) Pharmaceutical Division Clinical Services Department Epidemiology Surveillance and Response b) Representatives of HDPs involved in CDC c) Representative of Central Public Health Laboratories d) Representative of Uganda AIDS Commission e) Representative for the CSOs f) Representative of Physicians Association g) Representative of Peadiatricians Association h) Representatives of other Professional Association to be co-opted as need arises i) Health Consumer (Patient representatives) Specific ToR for CDC TWG 1. Give policy direction on communicable disease control interventions. 2. Advise and monitor implementation of communicable disease programmes in the sector. 3. Consideration of new interventions and projects in communicable disease prevention and control 4. Coordinate and give advice on research related to communicable disease control in the health sector. 5. Coordinate and provide guidance in development of guidelines for management of communicable diseases. 6. Conduct yearly evaluation of the performance of the TWG members. 29

36 6.14 Non Communicable Disease Control (NCDC) TWG This includes non-communicable diseases, disabilities and rehabilitative health; gender-based violence, mental health and control of substance abuse; integrated essential clinical care; oral health and palliative care Composition of NCD TWG Chairperson: Director Health Services Clinical & Community Health Services Secretary: Principal Medical Officer, Non Communicable Diseases Members: a) Ministry of Health representatives: Clinical Services Department National Disease Control Department Pharmaceutical Division Nursing Department b) Representatives of HDPs involved in NCDs c) Representatives of Academic Institutions (School of Public Health Tobacco Control Centre, MAK CHS Departments of Medicine, Peadiatrics and Surgery trauma centre) d) Representative for the CSOs e) Representative of Uganda Cancer Institute f) Representative of Uganda Heart Institute g) Representative of Uganda Peadiatricians Association h) Representative of Uganda Physicians Association i) Representatives of other Professional Association to be co-opted as need arises j) Health Consumer (Patient representatives) Specific ToR for NCD TWG 1. Provide guidance on Policy, strategic plan, standards and guidelines development for managing NCDs 2. Monitor interventions for NCDs in the sector 30

37 3. Coordinate and give advice on operational research related to NCDs. 4. Consideration of new interventions and projects for NCDs. 5. Coordinate and provide guidance in development of guidelines for management of non communicable diseases. 6. Conduct yearly evaluation of the performance of the TWG members Environmental Health and Health Promotion (EH & HPE) TWG This includes; Control of Diarrhoeal Diseases, School Health; and Epidemic and Disaster Prevention, Preparedness and Response Composition of EH & HPE TWG Chairperson: Director Health Services Clinical and Community Health Services Secretary: Assistant Commissioner Health Services, Environmental Health Members: a) MoH representatives: Health Promotion & Education Environmental Health Control of Diarrhoeal Diseases School Health Epidemic & Disaster Prevention, Preparedness & Response b) Representative of HDPs involved in EH & HPE c) Representatives of CSOs g) Representatives from related ministries: (MoLG, MoES, MoGLSD, MoWE) Specific ToR for EH & HPE TWG 1. Review relevant laws and policies for health education, promotion and environment. 2. Consideration of new interventions and projects in health promotion, education and environmental health. 31

38 3. Monitor performance and advise the health sector on interventions in environmental related activities. 4. Coordinate and give advice on operational research related to environmental health. 5. Coordinate and Provide guidance in the development of guidelines for management of epidemics, disaster prevention, preparedness and response. 6. Conduct yearly evaluation of the performance of the TWG members e-health TWG Composition of e-health TWG Chairperson: Director General Health Services Secretary: Assistant Commissioner Health Services, Resource Centre Members: a) MoH representatives: Resource Centre Finance and Administration Health Infrastructure Clinical Services Department Community Health Department b) Representative of Mulago Hospital c) Representative of Butabika Hospital d) Representatives HDPs involved in e-health e) Representative from Ministry of Information Communication and Technology f) Representative from National Information Technology Agency (NITA) Specific ToR e-health TWG 1. Coordinate & develop a strategic framework for e-health including updating strategic framework for HIS 32

39 2. Sensitize and mobilize stakeholders and donor community to support the process. 3. Develop Standards, Codes and definitions to support the e-health Framework. 4. To develop Standard Operating Procedures for e-health applications and services. 5. Propose required policy and legislative framework to support the attainment of the goals of e-health. 6. Receive, review and guide the health sector on new e-health innovations. 7. Coordinate and monitor implementation of e-health innovations in the health sector. 8. Conduct yearly evaluation of the performance of the TWG members Policy, Legal and Regulatory (PL&R) TWG Composition of PL&R TWG Chairperson: Director Health Services, Planning and Development Secretary: Principal Policy Analyst (Head Policy Analysis Unit) Members: a) MoH representatives: Planning Policy Analysis Unit Finance and Administration Quality Assurance b) Representatives of Professional Councils c) Representatives of Regulatory bodies e.g. NDA, d) Representative of HDPs e) Representative of office of the Solicitor General f) Representatives of CSOs g) Representatives of Health Consumer Organizations 33

40 Member from any of the Departments with pending policy legislation shall be co-opted as necessary Specific ToR for PL&R TWG 1. Review and discuss relevant policies/legislation and follow them up. 2. Guide development of policies and regulations in the health sector. 3. Follow up on the policies/legislation to final destination through all levels of management (enhance/ advance the approval process). 4. Monitor the implementation of the legislations pertaining to the health sector 5. Review the financial implications of the regulatory framework 6. Evaluate health policies. 7. Conduct yearly evaluation of the performance of the TWG members. 34

41 7 Heads of Department Meetings There are seven departments in the MoH each headed by a Commissioner Health Services. The Heads of Departments (HoDs) are the formal health managers at MoH level. The HoDs shall hold meetings to ensure smooth running of the various departments. 7.1 Composition Chairperson: Under Secretary Secretary: Principal Assistant Secretary Members: a) Commissioner Health Services - Clinical and Curative Services b) Commissioner Health Services - Community Health c) Commissioner Health Services - Quality Assurance d) Commissioner Health Services - Planning and Development e) Commissioner Health Services - Nursing f) Commissioner Health Services - National Disease Control 7.2 Functions of Heads of Departments 1. Ensure planning, implementation and monitoring of activities in the respective Departments. 2. Identify policy gaps and initiate discussions for review or development. 3. Ensure proper accountability for resources. 4. Sharing technical and administrative information to update employees on organizational changes and developments. 5. Ensure adequate and effective communication between the departments and stakeholders. 7.3 Terms of Reference for Heads of Department Meetings 1. HODs meetings shall take place on a monthly basis. 2. The HODs meeting schedule shall be published annually. 3. Document proceedings of the meeting capturing action points and responsible persons. 35

42 8 Monitoring Performance / Compliance Performance of the governance and management structures shall be monitored using an agreed matrix. Progress will be presented during the quarterly review meetings and performance reported on in the AHSPRs. Table 1: Monitoring Indicator Matrix for Governance and Management Structures Structure Indicator Target Measurement Means of Compliance Noncompliance verification Senior Top Management Committee Top Management Committee Proportion of planned meetings held Proportion of planned meetings held 100% Regular scheduling of meetings 100% Regular scheduling of meetings Cancellation of meetings Cancellation of meetings Minutes Minutes 3. Health Policy Advisory Committee Presence of the Chair to the meetings Attendance of meetings by all members 100% Regular attendance of members or alternates Absence without apology Meetings not held / no record of meetings Minutes 4. Senior Management Committee Proportion of planned meetings held 100% Regular scheduling and attendance of meetings Meetings not held / no record of meetings Minutes 5. Technical Working Group meetings Proportion of planned meetings held 100% Regular scheduling and attendance of meetings Meetings not held / no record of meetings Minutes 6. Heads of Department meetings Proportion of planned meetings held 100% Regular scheduling and attendance of meetings Meetings not held / no record of meetings Minutes 36