In this issue. News from Ministry of Health of Uganda ICB II and PNFP updates SDHR update Strategic planning process. Issue 6.

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1 Issue 6. June, 2018 In this issue. News from Ministry of Health of Uganda ICB II and PNFP updates SDHR update Strategic planning process The 6th edition of the quarterly health newsletter from Enabel together with the Ministry of Health of Uganda aspires to reach out to all health policy makers and health workers all over Uganda. You will be updated on the development of our Institutional Capacity Building project, on the Private-not-for-profit project, the Support to the Development of Human Resources project as well the activities of the Ministry of Health. 1

2 Uganda Heart Institute starts diagnosis and treatment of life threatening irregular heartbeats For the first time in Uganda, the diagnosis of irregular heartbeats also known as Electro-physiology Study (EPS) and its treatment known as Radio frequency Ablation (RFA) was carried out on 11 patients at the Uganda Heart Institute (UHI). Update from Ministry of Health Uganda Radio-frequency Ablation (RFA) is a treatment for life threatening irregular heartbeats and is a non-surgical, minimal-invasive treatmen using high frequency waves. Addressing the media at the Ministry of Health headquarters, Minister of Health, Hon. Dr. Jane Ruth Aceng noted that it s possible to treat such abnormal heart beats without opening the chest. During the Electrophysiology studies (EPS), various specialized wires are inserted into the blood vessels in the groin and advanced up to the heart with the visual aid of special X-Ray cameras. These wires pick signals and patterns of electric flow from different parts of the heart she further explained. Aceng added that In this way, we are able to identify the causes of the abnormal heartbeats within the heart. A special form of Electrical energy (Radiofrequency Ablation) is then delivered to stop the abnormal electric paths. This procedure has registered a cure rate of not less than 90% and eliminates the need to take drugs on a daily basis to suppress the abnormal rhythm. Abnormal Heartbeats also known as arrhythmias constitute 19% of the heart disease burden worldwide. At Uganda Heart Institute(UHI), they comprise of 25% of the patients seen on a daily basis. Hon. Aceng commends the expertise at UHI in conducting these procedures. These interventions will go a long way in reducing medical referrals abroad and increase the competitiveness of Uganda s health sector in the region she said. The Ugandan team that performs these procedures is led by Dr. Joselyn Rwebembera, the only one of her kind in Uganda. Patients who benefited from these procedures are full of praises about Dr. Rwebembera for saving their lives from a condition that could be potentially life-threatening. Notable among the achievements registered by Uganda Heart Institute this year is the successful Triple By-Pass Heart Surgery known as Coronary Artery By-Pass Grafting conducted exclusively by Ugandan doctors. Patients who have benefited from these procedures profusely thank the Government of Uganda for giving them renewed hope in continuing life without discomfort. In the last six years, UHI has carried out several procedures in the Catheterization Laboratory that include examining blood vessels of the heart for blockages, opening up blocked blood vessels of the heart and inserting wire loops to keep the vessels open, examining and treating blood vessels in the legs, Closure of holes in the hearts of babies and adults, opening up blocked heart valves without opening the chest, Triple By-Pass Heart Surgery known as Coronary Artery, Permanent implantation of a device that stimulates the heart to beat and many others. 2

3 Private Not For Profit (PNFP) update As implementation spills into its final year , the project continues to make critical achievements in the regions as planned. With a Steering Committee decision granted for extension till December 2018, preparations are underway to wind up official engagements of PNFP as a project to pave way for the new project Strategic Purchasing for Health Services in Uganda (SPHU). The technical/financial reporting by the districts and the health facilities has improved over the last quarters with adherence to the timeframes put in place. A snapshot of organised activities during this last Quarter (April June 2018): Session 5 of the Strategic planning process was organised in April for all PNFP RBF facilities and 16 districts in West Nile and Rwenzori and was a success with more than 350 participants. The focus of this session was on the finalisation of the long-term Strategic plan ( , annual work plans and Monitoring & Evaluation. The final session 6 will be organised in June Support to training of Public Private Partnership for Health (PPPH) desk officers for districts which took place in Hoima on 12th and 13th of April 2018 in Hoima district. Focus being to orient the PPPH focal persons on policy and equip them with knowledge Support to the Technical Working Group meetings for PPPH unit linking the private sector and the Ministry of Health Support to Annual General meeting 18th 19th April 2018 for Uganda Catholic Medical Bureau (UCMB) and support supervision monitoring to Uganda Orthodox Medical Bureau (UOMB) 30th May 7th June On board we have new facilities that recently signed performance agreements to kickstart Results-Based Financing. Luckily, they will continue implementation with the new project. These are Anyiribu HC III and Ediofe HC III (to partner with St. Asumpta in RBF) all PNFP project s main focus has remained to work in continued cooperation with its stakeholders to realize outputs during its final year of implementation while putting in place sustainability mechanisms to be established by the new project. in Arua district and Kei HC III in Yumbe District The project supported the Quality Assurance Department to carry out Quality improvement support supervision in Rwenzori region which is foreseen to foster improved functionality of the District Quality Improvement Team. Supply and delivery of medical equipment is ongoing i.e. Multichannel ECG Machine, Ultrasound Colour Doppler and foetal monitor for selected PNFP Hospitals and Health Centres. 3

4 Institutional Capacity Building (ICB) II update It s all good news for the project having been extended to December 2018 giving it time to finalize the remaining task in Results Based Financing (RBF) especially with the newly signed public facilities that just signed Performance Agreements this FY17/18. The project supports the elaboration of a locally developed e-patient file system called Nganisha. Once the system is tested and ready, it will be installed in the second line health facilities (HC IVs and General Hospitals) that are currently under RBF contract. Significant progress has been seen with the improved speed in verification and validation processes conducted by Ministry of Health, District Health Teams and MoH Planning Department. A snapshot of organized activities during this last Quarter (April June 2018): Session 5 of the Strategic planning process was organized from 5 until 20 April for all public RBF facilities and 16 districts in West Nile and Rwenzori and was a success with more than 350 participants. The focus of this session was on the finalization of the long-term Strategic plan ( , annual work plans and Monitoring & Evaluation. The final session 6 will be organized in June Additional public health facilities signed for the Implementation of Result Based Financing (RBF) this FY 17/18 after successful self-assessment exercise and accreditation. The 11 new facilities are Bubukwanga, Kisomoro, Bigodi, Karambi, Nyamabuga HC IIIs and An ambitious training of district and sub-district staff in support supervision by the QAID is supported by the project. The training in Rwenzori is complete and West Nile will follow soon. Kyenjojo Hospital all in Rwenzori and Aliba, Itula, Eremi, Laropi and Dufile HC IIIs all in West Nile region. They have been oriented and trained in RBF implementation modalities. Supply and delivery of medical equipment is complete i.e. Oxygen Concentrator, Multichannel ECG Machine & Ultra Sound, Colour Doppler for selected public Hospitals and Health Centres. Delivery of procured ICT equipment (Laptops, Computers, Printers and Projectors) for qualified HC IIIs to support operations is finally complete in the two regions of Rwenzori and West Nile. All district RBF Focal Persons have received a laptop to facilitate the verification and reporting processes. Supported the quarterly Regional Health Forum which brings together all stakeholders in the health sector in the regions to share best practices and lessons learnt as a way of strengthening health systems in the regions. In West Nile this took place on 16th and 17th of May To follow is the Rwenzori Regional Health Forum in June

5 UGANDA COMMEMORATES WORLD MALARIA DAY 2018 By Abirahmi Kananathan and Vivian Serwanjja Update from Ministry of Health Uganda Uganda joined the Global Malaria community in commemorating World Malaria Day 2018 on 25th of April at Mpigi Police Grounds in Mpigi District under the global theme Ready to Beat Malaria and local slogan, My mosquito Net, my night time weapon The theme highlights the collective energy and commitment of the Global Malaria Community involved in the fight against the deadly disease while the slogan was selected against the background that Government of Uganda just concluded a Universal Coverage Campaign where a total of 27 million mosquito nets were distributed countrywide. Over 38 million Ugandans benefited from this campaign and hence protected against Malaria. Under this campaign, one net was given per two people in a household. The choice of the district to host the commemoration event was based on its good practice in attesting to the Test and Treat Policy and rational use of Artemisinin-based Combination Therapy (ACT)- the recommended treatment for Malaria. Uganda has continued to make good progress towards a Malaria-Free nation by reducing Malaria prevalence markedly from 42% in 2009 to the current level of 19%. Malaria testing in the public sector has also improved from 60% to over 90%. cause therefore misusing the mosquito nets could result in individuals facing the law. Hon. Opendi further added eliminating Malaria should be a task for not only Uganda but the entire region. We are currently developing a strategy to eliminate Malaria as a region she said. World Malaria Day 2018 was graced with several skits by school children and community groups with emphasis on the benefits of sleeping under a mosquito net as well as testing and treating Malaria; medical camps for free HIV and Malaria testing services, screening for Cervical Cancer, general body check-up, Blood Donation drive, community mobilization events, school-based activities and exhibitions. Fighting Malaria is priority for the Government of Uganda. For example, in 2017 alone, over 400bn was spent on Malaria prevention initiatives.the Government has recently launched an initiative known as Mass Action Against Malaria (MAAM) to complement the ongoing interventions in the fight against Malaria under which the fight against the disease is taken to household level in order to highlight everyone s individual responsibility in eliminating Malaria from Uganda by Hon. Opendi implored local leaders to arrest individuals who would be found misusing mosquito nets. She said this is Government property and it has been given to you for a 5

6 STRATEGIC PLANNING A long-term strategic plan ( ) for every health facility and district in Uganda (as part of the PNFP and ICB-II project) Introduction Based on an analysis of a sample of health facilities, research and interviews with stakeholders, it can be concluded that a majority of health facilities have challenges with planning, financial budgeting and long-term vision. Almost none of them (especially HCIIIs) have a long-term strategic plan including a financial plan or lack a comprehensive one. A long-term strategic plan ( ) with financial budgeting can be a key tool to guide an organisation in its long-term growth, autonomy and quality improvement. This pilot project focuses on the long-term strategic planning of health facilities and districts and fits within the ICB II and PNFP projects and Result Based Financing (RBF)- scheme of Enabel and can be considered as fuel to better RBF-results and sustainable strengthening of the health facilities. Content Who? All public and PNFP-Health facilities in the West Nile and Rwenzori region, supported by the PNFP and ICB-II projects (79) with the involvement and support of the Ministry of Health of Uganda, 16 districts and other possible stakeholders (sub-counties, SDHR, medical bureaus, Baylor (Rwenzori) When? This strategic planning process started in June Each health facility and district will present their long-term strategic plan in June How? Comprehensive approach 1.Step-by-step process 6 sessions 2.Fieldwork between the sessions 3.Supervision and on-site support between the sessions 4.Extra? Additional courses 1. Step-by-step process 6 sessions The strategic planning process comprises 6 step-by-step sessions. A session is organised every 8 weeks, during a period of 1 year and followed by 4 staff per health facility, district staff and other planning stakeholders ( participants / session). Each session focusses on specific topics of the long-term strategic plan: 1.Vision, mission and values 2.Stakeholder-analysis, data collection and SWOTanalysis 3.Formulating strategic and operational objectives and actions 4.Measurement plans, budgeting and staff planning 5.Template long-term strategic plan ( ), to an annual work plan and monitoring and evaluation 6.All health facilities presents their long- term strategic plan Fieldwork health facility After every session, fieldwork will be given to every health facility based on the topics of previous sessions, to ensure: Quality of specific developed plan 6

7 4. Additional courses Feedback and involvement of all HF-staff and board. Broad supported plan Achieving common goals and motivation Presentation fieldwork during next session 5. Supervision and on-site support Supervision of fieldwork and on-site tailor-made support between two consecutive sessions will be organised. This supervision and support are necessary and complementary with the periodically organised step-by-step sessions and given fieldwork. 6. Additional courses Additional courses based on general health sector needs and specific health facility needs can be organised in two regions (West Nile and Rwenzori) which could lead to an extra item of the strategic plan. Conclusion 1.Rationale step-by-step approach Step-by-step: Time and focus on quality Approach: presentation, discussion, groupwork, fieldwork,... Capacity building in planning of health staff (coaches in their own health facility and district) Comprehensive plan (but still basic and practical) Commitment and involvement of all staff board Supported plan with common goals Improved ownership and autonomy On-site support and supervision Enhance involvement district and Ministry of Health The development of a long-term strategic plan ( ) and annual work plans for every health facility fits perfectly within the PNFP and ICB II projects and RBF-scheme of Enabel and the Ministry of Health and can be an important facilitator of further quality strengthening of every health facility. This pilot project, set up in two regions of Uganda, can be rolled out to other regions, districts and health facilities after final evaluation and capitalisation in August

8 SDHR-Project success story Staff training improving health service delivery - Kasese District Ithungu Mary Baluku a nurse and midwife; and Happy Cabrine also a nurse, both staff at Bwera hospital are some of the beneficiaries of the Support to the Development of Human resources projects long term sponsorship program to beneficiary organizations to which Bwera Hospital is one of them. They attended ECUREI institute where they studied Obstetric sonography, a course that has changed their mode of operation at Bwera hospital. Before the training, the xray machine and the ultra sound scan were broken down and patients were sent to Kasese hospital and beyond, several kilometers away to carry out scans. The training, brought with it various opportunities for patients in Bwera hospital and the vicinity. It was very hectic for expectant mothers and most would not go for the scans Mary asserts. Most mothers would not afford to take scans as it would be costly for them to travel in their state to go for ultra sound scans she adds. After we received this training opportunity, almost all mothers are coming for ultra sound scans on their antenatal visits as the scans are now done here. If there are problems, we can now identify them so early and thus save their lives and the unborn babies, they add. Even us, we now have this skill and we feel empowered especially after we identify a problem and know that this mother is going to be helped in time. Mary adds with Cabrine nodding in agreement. At Bwera Hospital, scanning is only done 3 times a week as the personnel are few and have to work in other departments. This implies that the queues will be extremely long on the 3 days with referred patients from other clinics in the vicinity that some are even postponed to the next day. As Mary and Cabrine confirm, they scan over 50 mothers and patients on a given day at Bwera hospital, which can be exhausting especially with the manual writing of reports. Their recommendation Despite the small challenges they still face in their work, such as lack of a computer to write reports, patients gowns and few staff that mean they work in several departments other than specializing in the area that they have trained in, they are contented and are grateful for the opportunity they received. Asked if they feel the training they received was really helpful, Cabrine chipped in excitedly, yes, yes of course. Before the training I didn t know anything about ultrasound scanning, I would simply read the conclusion on the report, but now I can assess the situation myself and know how best to handle it, Mary adds. We are very grateful to Enabel and the Belgium government for this opportunity that they gave to us, and we promise to use it to serve the public fairly and save mothers and babies in this region and beyond. Thank you Enabel, thank you SDHR project, they concluded. 8

9 Support to the development of Human Resources (SDHR) Project in pictures In pictures is the Midigo health center IV Yumbe district during a training from the SDHR project in Emergency care. 9

10 Go to the website of the MoH: 10