Health newsletter 5

1. HEALTHNEWSLETTERMARCH2O18/ ISSUE NO.5
Ministry of Health
THE REPUBLIC OF UGANDA
> Interview with Paul Asaba,
RBF focal person
> News from Ministry
of Health of Uganda
> BTC becomes Enabel
Health Issues
In this issue:
With this fifth edition of quarterly
health newsletter, Enabel and the
Ministry of Health of Uganda want
to reach out to health workers all
over Uganda and health policy
makers on both the national and
district level.
You will be updated on the
development of our Institutional
Capacity Building project, on
the Private-not-for-profit project
and Support to development of
Human Resources.
The Ministry of Health will use
this platform to communicate on
health issues.
The newsletter will also give
a voice to health workers and
will keep you updated on the
implementation of the new result-
based financing system.
> ICB II and PNFP updates
THE BELGIAN
DEVELOPMENT COOPERATION

2. 2
HEALTH newsletter
On 1st January 2018, the Belgian
Technical Cooperation (BTC) changed
name. The Belgian development agency is
now called Enabel. The renewed agency’s
mission is to implement and coordinate
the Belgian development policy. The
name change and the broadened mission
of the Belgian development agency are
part of a major reform of the Belgian
Development Cooperation, which strongly
aligns the Belgian development policy
with the Sustainable Development Goals.
Whythisreform?
The ‘Enabel’ Law was published in the
Official Belgian Gazette on 23 November
2017 following its approval by the Belgian
Parliament. This Law transforms the
implementing agency of the Belgian
governmental cooperation BTC into a
coordinating and implementing agency for
the Belgian development policy: Enabel.
With this reform the Belgian government
aims to better align its development
policy with the 2030 Agenda for
Sustainable Development and the
Sustainable Development Goals (SDGs).
The Belgian development policy
focuses on inclusive economic growth,
human rights and in particular women’s
and children’s rights, digitisation
and the least developed countries.
WhyEnabel?
Enabel is a Belgian variant of the English
verb enable, but with ‘-bel’ at the end.
Enabel means making things possible,
facilitating and empowering, which is
exactly what the Belgian development
agency does: enable partners to do
what is required to achieve sustainable
development in their country. Enabel
helps create circumstances that enable
development; Enabel supports, motivates,
encourages and promotes change; Enabel
brings partners and organisations together
to put things in motion and foster change.
WhatisEnabel’sassignment?
Enabel implements Belgium’s
governmental development policy. The
agency actively explores assignments
and funding opportunities offered by
third party donors in view of assisting
and strengthening Belgium’s foreign
policy as a social undertaking.
Enabel’slegalstatus
Enabel, like BTC, is a public-law
company with social purposes. All
contracts, agreements and commitments
signed or made by BTC remain valid.
Enabel is entrusted with more
autonomy, more competences and
a broader mandate than before.
This way, the agency is better equipped
to achieve its vision, to contribute to a
sustainable world where women and
men live under the rule of law and
are free to pursue their aspirations.
Enabel, a new name
for the Belgian Development Agency
With this reform the Belgian gov-
ernment aims to better align
its development policy with the
2030 Agenda for Sustainable
Development and the Sustain-
able Development Goals (SDGs).

3. 3
HEALTH newsletter
By Peter Asiimwe
T
he PNFP project procured 41
motorcycles (Honda) and donated
them to 41 health facilities where
Result Based Financing is implemented.
Rwenzori region was allocated 20
motorcycles while 21 went to West Nile.
During the prequalification assess-
ment for RBF, we found that most
health facilities (especially HCIIIs)
did not have any means of trans-
port to enable even basic movements.
Facilities were finding it difficult to
conduct outreaches in far places.
The health facility as an institution should
have an official means of transport not only
for outreach services but also for ease of
interaction with external stakeholders.
The RBF model we are implementing
requires that a facility has minimum ca-
pacity to deliver quality services before
payment for outputs can be considered.
To achieve this, the project provided some
input financing in kind – medical equipment
and medicines – at the start of the project.
Some equipment including ultra
sound scans and ECG machines
will still be provided to Hospitals and
HCIVs in a few months to come.
These motorcycles therefore, are part of the
process by Enabel and Ministry of Health
to equip health facilities to make them have
capacity to provide better quality services.
Selectionofbeneficiaryhealthfacilities
4 1 h e a l t h f a c i l i t i e s r e -
ceived a motorcycle each.
The priority was given to remote
health centres with a poor road net-
work. Facilities covering a wide catch-
ment population were also prioritized.
Donation Of 41 Motorcycles To PNFP
Health Facilities Implementing RBF
Rwenzori region was allocated 20
motorcycles while 21 went to West Nile.
The priority was given to remote health
centres with a poor road network
Health facilities located in municipali-
tie and towns were eliminated since
means of transport are fairly available.
Likewise, hospitals were found to have ad-
equate means of transport and were not
considered for this donation with the ex-
ception of a few located in far remote areas.
Management of motorcycles
The motorcycles are registered in the
names of Enabel and will remain the prop-
erty of Enabel until the end of the project.
Health facilities will ensure that
the motorcycles are well main-
tained, insured and serviced.

4. 4
HEALTH newsletter
By Dora Anek
& Hannes De Meyer
The PNFP Project continues to register
success in supporting Institutional ar-
rangements to shape incentives, which
affect health actors’ behaviours, and thus
determine their overall performance.
The RBF payment structure in the
PNFP project creates the potential for
increased payments made to the Dis-
tricts based on performance. While on
the other hand, it emphasises the sig-
nificance of the design of the incentives.
The funds transferred after submission of
the district performance report and for ser-
vices delivered during the previous quarter
can be used to pre-finance implementation
of the activities of the following Quarter.
Given that resources for health are finite,
the payment structure used in this proj-
ect keeps changing based on approved
and clear technical/financial reporting
by the districts and the health facilities.
Snapshot of organised activities during
this last Quarter (January – March 2018)
• Preparation of the Annual Results
Report 2017 during a Stakeholder meet-
ing on 19th January 2018 focusing on
progress and achievements of the year 2017
• Supporting verification of the health facili-
ties accredited for RBF in both Rwenzori and
West Nile in January and February 2018.
• Close follow-up and providing feedback
to facilities and District Health Teams
contained in the previous validation com-
mittees report and review together with
the DHTs (RBF Focal Points) the veri-
fication and support supervision plans.
PNFP Update
• Session 4 of the Strategic planning
process was organised from 31st Janu-
ary until 16th February for all PNFP RBF
facilities and 16 districts in West Nile
and Rwenzori. The focus of this ses-
sion was on formulating targets and in-
dicators for strategic and operational
objectives, staff planning and budget-
ing of the strategic plan (2018 – 2023).
• Handover of 41 Motorcycles dur-
ing the first week of February to 41
Health facilities (21 in West Nile re-
gion and 20 in Rwenzori region)
Results so far show that the project has
successfully demonstrated the effect of
Results Based Financing on the quality
and the quantity of services in the pri-
vate non-for-profit health sub sector in the
two regions of West Nile and Rwenzori.

5. 5
HEALTH newsletter
ICB II Update
By Dora Anek
Just coming out of a Mid Term Review
in November 2017, the team agrees
that the most important expected impact
of the project will be on policy making.
Together with the PNFP project, the
ICB II project is leading the way to insti-
tutionalizing Results Based Financing
as an alternative financing mechanism.
”In 2017, the project progressed success-
fully towards its objective to implement Re-
sults Based Financing in 29 qualified public
health facilities in 8 districts of the West
Nile and 8 districts of the Rwenzori region.
Despite the complexity of the process of
RBF implementation no major obstacles
have been encountered.During the first
quarter (January – March 2018), the In-
stitutional Capacity Building II Project
continued to support activities with the
aim of strengthening the health systems
in the sector in the Rwenzori and West
Nile regions where it implements in col-
laboration with the Ministry of Health.
Snapshot of organized activities during
this last Quarter (January – March 2018)
• Preparation of the Annual Results re-
port 2017 during a stakeholders meeting
on 19 January 2018 focusing on prog-
ress and achievements of the year 2017.
• Regional Health Forum successfully
held for Rwenzori region on 30 to 31
January which brought together vari-
ous stakeholders in the region to share
experiences and identify best practices.
• RBF Orientation Training from 7th
to 8th February 2018 for the 5 newly
accredited facilities in West Nile.
• Medicine Management Training from
13th – 15th February 2018 for the 4 newly
accredited public facilities in West Nile.
• Session 4 of the Strategic planning pro-
cess was organized from 31st January until
16 February for all 29 public RBF facilities
and 16 districts in West Nile and Rwenzori.
• Supporting verification of the health facil-
ities accredited for RBF in both Rwenzori
and West Nile in January and February.
• Handover of assortment of ICT equip-
ment (31 desktops, 27 laptops, 29 projec-
tors and 14 printers) in February 2018 to
31 public health facilities in the West Nile
region (16) and Rwenzori region (15).
The need for an adapted procedure for
medicine management under RBF was
identified and its development and approval
by the MoH is complete.

6. 6
HEALTH newsletter
IN AN INTERVIEW WITH NURSE LODONGA
Uganda to roll out Rota-virus
Vaccine early 2018. Ministry of
Health has unveiled plans to roll out
the rota-virus Vaccine this year. The
vaccine is used to protect children
under one year from diarrheal diseases
which is among the leading direct
causes of infant mortality in Uganda.
Speaking during a stakeholders’ meeting
on prevention, control and elimination of
Cholera in Uganda at Makerere University,
Kampala, Minister of Health, Hon. Dr.
Jane Ruth Aceng noted that the Ministry
is now focusing on health promotion and
disease prevention hence the decision
to introduce the rotavirus vaccine on
the routine immunization schedule.
“No young child should die of diarrhea.
Diarrheal diseases can be prevented. The
introduction of the rotavirus vaccine will
go a long way in curbing infant mortality
due to diarrheal diseases” she added.
Hon. Aceng underscored Government’s
efforts and interventions that have led
to a steady decline of Cholera, one
of the diarrheal diseases in Uganda.
She, however, warned that diarrheal
diseases should not be part of Ugandan
population. “The decline is not enough.
I would like to see zero cholera cases
reported from all districts because we know
what causes cholera and how to prevent
it using old and new tools” Aceng said.
She cautioned district and local leaders
who ignore their communities’ practice
of out open defecation and being shy of
the standard 100% latrine coverage. “I
urge you all to take note and act before
we arrive at your doorsteps” she said.
According to researchers from Makerere
University School of Public Health and
the Ministry of Health, Uganda is heavily
affected by Cholera and ‘hotspots’ – also
known as the four Cholera prone districts
were identified in Uganda and these are;
Nebbi, Pakwach, Hoima and Buliisa. In
2017, 265 Cholera cases were confirmed in
the country. The risk factors of the diarrheal
disease were attributed to; Poor sanitation
among locals especially the fishing
communities, inadequate safe water,
Flooding/rain and cross-border movement.
In June 2017 Uganda launched a
multisector plan for cholera prevention,
control and ultimately elimination.
This plan is in line with World Health
Organization (WHO) strategy for
cholera elimination by the year 2030.
The national plan emphasizes scaling
up of access to safe Water, Sanitation
and Hygiene (WaSH), health education,
health care services in addition to
targeted interventions that includes
use of oral cholera vaccines to
complement WaSH in cholera hotspots.
“We are also introducing oral cholera
vaccine to complement provision of water,
sanitation and hygiene in the Cholera
hotspots specifically for the fishing
community who according to research
contribute 58% of reported cholera
cases annually” Hon. Aceng noted.
The Ministry of Health and Makerere
University in collaboration with John
Hopkins Bloomberg School of Public
Health have organized a meeting on
the above dates to share experiences,
research and new strategies in cholera
prevention and control so as to scale up
interventions. You have been identified
as a key stakeholder for this meeting.
Acting Director General Health Services,
Dr. Henry Mwebesa noted that 75%
of disease burden in Uganda
arises from preventable diseases.
The Stakeholders meeting brought
together academia and researchers
from Makerere University School of
Public Health, Johns Hopkins School of
Public Health, World Health Organization
(WHO), and UNICEF who shared lessons
and best practices that Uganda could
learn from in order to eliminate Cholera.
Update from Ministry of Health of Uganda
Uganda to roll out Rota-Virus Vaccine

7. HEALTH newsletter
By SDHR team
B
undibugyo Hospital is a
government Health facility run
by Bundibugyo District Local
Government on behalf of the Ministry of
Health. It is located in Bundiugyo district,
84km from Fort portal town with a
catchment Population of 44,009 persons.
The staffing levels amount to 4 Medi-
cal Officers, 1 Anaesthetic Officers,
5 Clinical officers, 13 midwives, 22
Nurses, 0 Lab Technologists, 4 lab
technicians, 1 lab Assistants, 2 Re-
cords Assistants and 3 RCT volunteers.
SupportfromtheSDHRProject
In the year 2015 the hospital
received support from Enabel-SDHR to
help bridge gaps in human resource.
Among issues identified were poor
medicines management, lack of a
sonographer, limited skill in sur-
gical trauma care manage-
ment with many referrals resulting
from limited skill, and inability to
perform culture and sensitivity testing that
was resulting in wastage of medicines.
Trainings so far accomplished include:
Culture and sensitivity techniques in
Mulago hospital Medicines
management in Mbarara regional
referal hospital; Surgical trauma and
other emergency management in
Mbale Regional Referral hospital.
Long term trainings include:
Diploma in sonography/imaging
techniques; PGD in monitoring and
evaluation; Bachelors degree in
medical laboratory science is on going.
Total number of staff trained so far is 29.
Pointsofcelebrationsofar
We currently have a functional emer-
gency care department running on
a 24 hour basis with staff skilled in
managing emergency surgical cases.
Over 150 cases of surgical and non
surgical emergencies have been handled
at our emergency dept since March 2016.
We currently serve many people with
ease than before, it now takes less than
3 staff to run a dispensary seeing over
400 patients and clients in 8 hours, this
was not possible before the training.
Lessons Learnt
Skills development can be achieved
through attachments, observations and
hands on training with limited resources.
Skills development can be
achieved with a motivated staff, this
motivation may only come through
encouraging, working with them to
develop and implement the action plans.
Success Story Bundibugyo Hospital
Update from Support to development of Human
Resources Project (SDHR)
7
We currently have a functional
emergency care department
running on a 24 hour basis
with staff skilled in managing
emergency surgical cases

8. 8
HEALTH newsletter
By Vivian Serwanjja
& Abirahmi Kananathan
In a bid to improve Emergency
Medical Services across Kampala
Metropolitan Area, the Ministry of Health
handed over a fleet of 7 ambulances
funded by African Development Bank to
Kampala Capital City Authority (KCCA).
During the handover ceremony, the
Under-Secretary, Ministry of Health, Mr.
Ssegawa Ronald Gyagenda highlighted the
multisectoral approach among Government
bodies aimed to improve service delivery
across the city and country at large.
He noted that among many existing services
to expand service delivery, procurement
and effective use of ambulances were
important to improve the quality of
care for emergency cases by ensuring
quick response during emergencies.
“The key resources for operation are
human resources such as ambulance
crews, fuel and maintenance of the
ambulances is crucial to effectively run
the ambulances” Mr. Ssegawa said.
He added that in collaboration with
partners, the Ministry is in the process of
developing an Emergency Medical Services
Policy, Standards and Strategy which will
spell out the coordination of ambulances
in different regions in the country.
Acting Deputy Executive Director,
KCCA, Ms. Juliet Namuddu commended
the Ministry’s efforts and entrusting
the authority with the responsibility of
running the ambulances across the city.
“Without ambulances, it is difficult to respond
to emergencies in a timely manner” she said.
Ms. Namuddu informed the public that KCCA
has put in place a call center (Toll Free:
912) to enable dispatch and coordination
of ambulances across Kampala City.
Emergency Medical Services in Kampala
Metropolitan Area Improved
The Ministry of health handed over
a fleet of 7 ambulances funded
by African development bank to
Kampala Capital City Authority
(KCCA)
Update from Ministry of Health of Uganda

9. 9
HEALTH newsletter
Paul ASABA – Focal person Result Based
Financing (RBF) ICB II and PNFP for Bunyangabu
District
M
y name is Paul Asaba and I am the
RBF-focal person for Bunyangabu
District and currently working
as a health district information assistant.
Before I was assigned as the RBF focal
person for the greater Kabarole district.
Responsibilities as RBF-Focal person
As RBF-Focal person I have
three important responsibilities:
1. To coordinate the RBF-activities
2. To participate in the verification
exercises of RBF-related activities
3. To work closely with the
RBF-implementing health facilities in
activities like mentorship and supervision
Buyangabu District
Bunyangabu District is a new district that
was established in July 2017. Before it
belonged to the greater Kabarole district.
It was a community request to separate
from the greater Kabarole district.
Kabarole agreed with the involvement
of political leaders and cultural leaders.
As a district we support supervision. We
do mentorship, data quality assessment
and we even do some random sampling
like surveys to assess the level of patient
satisfaction and the use of the VHT system.
We have 24 health facilities in our district,
including public (governmental) and
private-not-for-profit health facilities.
We have 1 health center IV, 11 health
center III and 12 health centers II.
Among those, we have 2 health
facilities, Yerya and Mitandi health
center III which are supported through
Results Based Financing (RBF).
With regard to ICB II, there is one health
facility that is going to be on board.
We have three other health
facilities that hopefully can start
as well with the implementation.
Strengths of our district health team
• Existence of a good working health
district management team
• Functional committee
• Sufficient district staff with a level of
76%
Challenges for our district health
team
As a new established district
we also face some challenges:
We lack offices. We are currently hosted
by our HC IV in the district.We don’t
have vehicles to do technical support
supervisions. There is a percentage of
partners that have not yet bonded with us.
We are currently starting some
new partnerships and we
hope many will follow soon.
We also lack some critical cadres in the
districtlikeanAntitheticAssistant,Assistant
DHO maternal health and Assistant
DHO Environmental among others.
Opinion about Result Based
Financing
Result Based Financing supports the
routine activities like immunisation and
maternity health services (deliveries)
The quality of services of our health
facilities has been improved. We see
a very significant difference in terms of
service delivery, quality and customer care.
Besides this, the communities
have benefited from RBF thanks
to the reduction in user fees.
In an interview with Paul Asaba,
RBF-focal person- Bunyangabu District
The quality of services of our health
facilities has been improved. We
see a very significant difference in
terms of service delivery, quality
and customer care.
Interview

10. 10
HEALTH newsletter
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Ministry of Health
THE REPUBLIC OF UGANDA