WELCOME TO THE FIRST BTC HEALTH NEWSLETTER

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1 With this quartely health newsletter the Belgian Development Agency (BTC) and the Ministry of Health of Uganda want to reach out to health workers all over Uganda, health policy makers on both the national and district level and BTC health project staff. You will be updated on the development of our Institutional Capacity Building project and on the Private-not-for-profit project. The Ministry of Health will use this platform to communicate on health issues. Besides this, the newsletter will also give a voice to health workers and will keep you updated on the implementation of the new resultbased financing system. ENJOY READING! Issue 1, 30/03/2017 WELCOME TO THE FIRST BTC HEALTH NEWSLETTER 1

2 BTC is the Belgian development agency. We support development projects across the globe to eradicate poverty. The Sustainable Development Goals are the global framework for BTC's support to different countries around the globe. Our activities focus on fragile states and the least developed countries, primarily in Africa. We are a public agency and manage development projects for the account of the Belgian Government and other donors. This way, we actively contribute to the global efforts for sustainable development. Our primary mission is to implement the Belgian governmental cooperation in the 14 partner countries of Belgium. Through the intermediary of BTC's Global Partnerships department, BTC also implements projects for other donors, in particular for the European Commission. The Directorate General for Development Cooperation and Humanitarian Aid (DGD), which falls under the Federal Public Service Foreign Affairs, Foreign Trade and Development Cooperation, defines the cooperation programmes but it does not implement them itself. This task is entrusted to BTC. Uganda and Belgium have been partners for 21 years. Together we strive to improve the quality of health care and education to ensure all Ugandans lead healthy and productive lives. Together with the Ministry of Health of Uganda, we strengthen health services and primary health care on a local level in both public and private facilities through capacity building of medical staff and result-based financing. In cooperation with the Ministry of Education and Sports, BTC supports the renovation, construction and equipment of National Teacher Colleges and BTVET institutions. We train lecturers on students based teaching and learning methods and support the Implementation of the Skilling Uganda Strategy. This strategy aims to increase the employability of youth through better quality of instruction and learning in apractical skills development environment responsive to the labour market. We support human resource development in 48 selected organisations in the health, education and environment sectors. And through the Study and Consultancy Fund, we assist the government in formulating policy and strategic documents. 2

3 Access to affordable and appropriate quality health care is a universal right, but for many people in the world it remains a distant dream. The government of Uganda is investing in setting up a universal healthcare coverage plan. BTC supports this policy and assists public (ICB II) and faith-based (PNFP) health facilities in delivering the best possible health care. To bring Uganda one step closer to universal healthcare coverage a new system of performance-based financing is being introduced. This system looks at results instead of inputs. Hospitals and health centers that perform well will receive financial support to be spent with more autonomy. Traditionally funding for health has been directed towards inputs like salaries, construction, training and equipment. People thought that improved health care would follow but this hasn t always been the case. The new system of result-based financing turns the old logic upside down and focuses on improved performance. Health facilities receive quarterly incentives for initiatives that are taken to implement the quality standards defined by the Ministry of Health. They are also rewarded for quantitative performance targets like number of child malnutrition correctly treated, number of fully immunized children or number of deliveries well managed. The quantity and quality of delivered health services will be verified on a quarterly basis. The better they preform, the more incentives they get. In the performance contracts signed between health facilities and Local Government, the subsidies granted for achieving these quantitative performance targets are linked to reducing the patient s bill. Currently user fees contribute to 50 to 60% of the total income of the health facilities, this is too high. According to World Health Organization recommendations, not more than 20% of the cost of the health services should be covered by user fees. By turning away from focusing attention on inputs, performance-based financing aims to improve health system efficiency and effectiveness Health workers can set their own priorities according to facility needs. Managers, doctors and nurses of local PNFP and public health facilities can set their own priorities according to the needs on the ground and will receive the spending autonomy to back their choices up. They will gain more decision making power, and become responsible for their own performance. This shift from a centralized budget to more local decision making power is an important reform that BTC, together with the Ugandan government, is helping beco a reality. This is just the beginning of a challenging but exciting process. Two other east-african countries, Rwanda and Burundi already introduced a system of performance-based financing with promising results to show for. To give two examples: according to the Africa health forum of 2013 post-natal care visits in Burundi have gone up and the overall quality of care in health facilities using PBF has increased in Rwanda. With the Ugandan government, the ministry of health and the local PNFP partners on board, BTC believes that performance-based financing could be a real game changer for the health sector in Uganda. 3

4 98% COVERAGE FOR MASS MENINGITIS IMMUNISATION CAMPAIGN In an effort to protect the population from the risk of Meningitis, government rolled out a routine preventive immunisation campaign to cover those districts that lie in the Meningitis belt. Earlier this year, the Ministry of Health in collaboration with World Health Organization and UNICEF launched the mass Meningitis immunization campaign in Omoro district in an event officiated by the Minister of Health Hon. Dr. Jane Ruth Aceng. The immunisation exercise that took place between the 19 th and 23 rd January 2017, registered a roaring 98% coverage on average, across all the 39 high-risk districts. The campaign purposed to immunize the population in the age group 1-29 years, strengthen surveillance and routine immunization service delivery in the districts, and achieve a 80% coverage for vaccination in the 39 high risk districts. The selected high risk districts included; Abim Adjumani, Agago, Alebtong, Amolator, Amudat, Amuria, Amuru, Apac, Arua, buliisa, Dokolo, Gulu, Hoima Kaabong, Kaberamaido, Katakwi, Kiryandongo, Kitgum, Koboko, Kole, Kotido, Lamwo, Lira, Maracha, Masindi, Moroto, Moyo, Nakapiripirit, Napak, Nebbi, Nwoya, Omoro, Otuke, Oyam, Pader, Soroti, Yumbe and Zombo. The preventive immunization campaign focused on Northern Uganda and parts of Western Uganda, because they lie in the Meningitis belt of Sub Saharan Africa, which has experienced frequent outbreaks of Meningococcal Meningitis epidemics leading to mortality and morbidity. The dust winds and cold nights, which characterize the period between December and June in the meningitis belt, increase the risk of meningitis. Transmission of Meningitis is further facilitated by overcrowded housing and large population displacements. People waiting patiently inline at Saint-Francis Health Centre III in West Nile region to get the menigitis vaccination. Meningococcal Meningitis is a bacterial form of Meningitis that covers the thin brain membrane and spinal cord and can cause brain damage and death in 50% of cases if not treated. Anyone is prone to meningitis, however; infants and children are at more risk of contracting the disease. The risk factors for meningococcal meningitis are people who have had close or prolonged contact with a person infected with meningitis Immunisation is one of the key strategies that the Government of Uganda is implementing in its roadmap to the attainment of the Sustainable Development Goal 3, which underlines the need for good health and well being. The health sector has made good progress in child immunization increasing from DPT3 coverage of 52% in 2012 to current coverage of 97%, and is expected to increase even further after this preventive campaign. The health teams being trained on how to efficiently manage the immunization campaign. 4

5 The BTC health projects made an entry into the first quarter for 2017 with their main focus remaining to accomplish planned targets for the current Financial Year as we draw nearer to closure. The project secretariat sits in Kampala at the MOH H/Qtrs, Annex Building, Room D004 with a complete Finance and Administration team whose scope covers the two projects while the technical teams remain aligned to their respective projects both in Kampala and in the regions. The head office team is joined by a Junior Technical Assistant who will support the finance department in RBF Grants Management and capacity building of the health facilities for the two projects. 8 new PNFP health facilities are qualified to enroll in quarter 3 for RBF The PNFP and ICB II projects which make up the BTC Health projects are sister projects, working in parallel under the auspices of the Ministry of Health in Uganda in the two regions of West Nile and Rwenzori. The PNFP-project is also anchored at the Directorate of Planning and Policy in the MoH. The project is also harmonizing with other development partners with regards to supporting the MoH in implementing the PPPH policy. Both BTC through the PNFP Project and USAID support the setting up and functioning of a PPPH Node in the MoH. In order to avoid duplication and maximize efficient use of resources, BTC and USAID have coordinated their support to the PPPH for the elaboration of a five years PPPH strategic plan. 1. The Results Based Financing which was kick started in July 2016 after prequalification assessment of health facilities in early PNFP health facilities (19 in Rwenzori; 13 in West Nile) received quantity and quality RBF-payments in Quarter 1 and Quarter 2 of the financial year The first RBF-payment (first quarter) was submitted in December 2016 (574 million UGX). 4. The second RBF-subsidies were paid in March (1,078 billion UGX) 5. 8 new PNFP health facilities are qualified to enroll in Quarter out of 15 districts received grants for supervision and verification after quarter 2 (19 million UGX) in March Drugs and medical equipment supply carried out with the support of JMS to improve the management at health facilities level (2,065 billion UGX) million UGX is pending. 8. The project started the computerisation of all hospitals. Initial training, installation of software to manage patient files was carried out in all hospitals in Computers and LAN (local area network) were installed in selected Health facilities with support from MOH and Medical Bureau IT experts. 5

6 Institutionally the ICB II project is anchored in the Ministry of Health in the Planning and Development Directorate (co-management). During 2016 critical progress is being made with the kick start of the Results-Based Financing (RBF) of public facilities through prequalification and orientation activities as planned. The second phase of ICB II which commenced early 2017 is progressing as it works in parallel with its sister project PNFP to implement Results Based Financing (RBF) in selected public facilities in both regions (Rwenzori and West Nile). All efforts will be made to implement the start of RBF in these facilities in the second Quarter of the calendar year. It is highly probable that the correct implementation of RBF in the public health facilities will have the desired impact; to further improve effective delivery of an integrated Uganda Minimum Health Care Package. 1. Preparation of the qualified public health facilities (29) for introduction of RBF. Two training weeks in Rwenzori (15 Health facilities) and West Nile (14 health facilities) were organized for all qualified health facilities in February. 2. Preparation of the districts (15) for introduction of RBF. A 3-days training was organised in Rwenzori and West Nile in March. 3. Development of coverage maps for the districts. 4. Improve drugs and medical supplies management. 5. implement RBF financing through grant agreements. 6. Assure Quality of care through support supervision and continuous training of personnel. 7. Improve ambulance services and referral system at district level. 6

7 UGANDA LAUNCHES 2 nd LONG LASTING INSECTICIDE TREATED NETS CAMPAIGN Government of Uganda launched a campaign to distribute 24 million Long Lasting Insecticide treated mosquito Nets (LLINs) across the country in the second universal coverage campaign for LLINs. The event was presided over by the Prime Minister, Rt. Hon. Dr. Ruhakana Rugunda who represented His Excellency the President of the Republic of Uganda, Yoweri Museveni. Uganda ranks sixth among African countries with high malaria-related mortality rates, and has one of the highest reported malaria transmission rates in the world. The World Health Organisation (WHO) reports that globally malaria is a major cause of ill health and deaths, with approximately 16 million cases and over 10,500 deaths reported in The Rt. Hon. Dr. Ruhakana Rugunda emphasized the need for Uganda to triple her efforts in the fight against Malaria. Once Malaria is eliminated, the country s GDP will increase by over 30 times in the next few years making us attain our middle income economic status and also attaining the Sustainable Development Goal on Malaria earlier than expected Hon. Rugunda noted. Hon. Rugunda reiterated the right use of nets adding that the mosquito nets should not be used to catch fish, harvest nswa (blind ants), tethering goats or sieving malwa (local brew). Large scale LLIN distributions are a key component to malaria prevention in Uganda. The campaign follows a successful universal coverage campaign in 2013 and 2014, which saw 21.5 million nets distributed across the country. The last campaign contributed to a major reduction in malaria prevalence in Uganda from 42 percent in 2013 to 19 percent now, according to the Malaria Indicator Survey LLINs are a highly effective, user-friendly and low-cost intervention to protect communities from malaria. Minister of Health, Hon. Dr. Jane Ruth Aceng says, Government has adopted a multifaceted approach to Malaria Control and Prevention that is embodied in the Uganda Malaria Reduction Strategic Plan to reduce annual deaths from the 2013 levels of 47% to near zero, reduce Malaria morbidity to 30 cases per 1000 population and reduce the malaria parasite prevalence to less than 7% by The campaign will distribute nets to all 116 districts in Uganda in six waves over the next six months. Under this campaign, one net will be given per two registered people in a household and will include a sensitization programme to educate the communities about the importance of sleeping under a net and effective use. The campaign is funded by the Government of Uganda, the Global Fund to Fight Malaria, TB and HIV, Against Malaria Foundation, Department for International Development (DFID) and the USAID/President s Malaria Initiative. Other implementing partners include the World Health Organization, UNICEF, PACE, Communication for Health Communities, UNBS, NDA and the Church of Uganda. 7

8 We need to invest in good community health workers Sister Martina has been working in Saint-Francis Health Facility III (PNFP), Arua district, for almost 10 years now. A midwife by training she is very motivated to bring quality heatlh care to her community. We spoke to her about the challenges the facility faces, her love for the job, and the changes she has seen over the years. «Even though work is not always easy I still love my job.» I ve been here since So almost 10 years now. I should really celebrate! Before coming here I used to work in Lira, Saint-John hospital. The difference between the two facilities is very big. In Lira we were supported by many ngo s and we had a very big HIV centre. Here we are situated in a place where we really needed to convince the population of the importance of health. People are just trying to cope in this peasant community Before this healthcentre came in 2001 people died of preventable diseases. Especially in the beginning it was hard to convince people to come in when they were sick. We need to keep working to eliminate the stigma around HIV. Recently one of our patients stopped taking his drugs due to the stigma he faced in the community. Even today it can create problems because of the stigma connected to some diseases. We recently had a gentleman who tested positively for HIV. In the beginning he was taking his drugs, but after a while he stopped. He got sicker and sicker and only returned to our health centre when it was too late. He died last week. Fortunately some improvement has been made. The sisters who founded this health centre also trained people in the community to become health assistants and nurses. This helped establish a relationship with the community. Sr. Martina in her office at St-Francis HC III in Arua. Thanks to PNFP project and result-based financing we have been able to reduce our fees. This has made health care more accessible for the community. Still not all people can afford it. People here depend heavily on farming for their income but recently we have had a shortage of rain. This means people have no income and no money for health. Even though work is not always easy I still love my job. There is no better feeling than being able to help someone. When you can help someone come out of despair, that is just wonderful. God can do his work through us and through me. As a human being I m able to help another human being return to his everyday life. I hope this facility can be converted into a health centre 4. If we offer more services people might believe more in the work we are doing. Now they get discouraged when they are referred to another hospital because we cannot handle the case. A lot of people cannot afford this, some don t even have the money for transport. People are also afraid to die in an unknown place. They even say: why do you want us to die in some strange place?. I realize it will take more than just better equipped facility to convince people. We really need good community health workers. They should coordinate with community leaders, religious leaders and local political leaders. Everyone needs to come together. 8

9 General Statistics BTC Health Project Statistics Number of health facilities supported by BTC Type of health facilities supported by BTC PNFP 29 Public HCIII HCIV GH Sources: World Health Organization, UNAIDS, President s Malaria Initiative, Ugandan Ministry of Health, Health Projects BTC 9

10 Send me your picture, cartoon or article about what is happening in your health facility or district at:! OR Go to the website of the MoH: We hope you enjoyed reading the newsletter! The BTC Team 10