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D E C E M B E R , 2 0 1 8
OFFICE OF THE AUDITOR GENERAL
T H E R E P U B L I C O F U G A N D A
www.oag.go.ug | E-mail: [email protected]
A VALUE FOR MONEY AUDIT REPORT ON BUDGETPERFORMANCE BY SELECTED HEALTH
SECTOR INSTITUTIONS
A REPORT BY THE AUDITOR GENERAL
A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions
A Report by the Auditor General
December, 2018
T H E R E P U B L I C O F U G A N D A
AUDITOR GENERAL’S MESSAGE
24th December 2018
The Rt. Hon. Speaker of Parliament
Parliament of Uganda
Kampala.
VALUE FOR MONEY AUDIT REPORT ON BUDGET PERFORMANCE BY SELECTED HEALTH SECTOR
INSTITUTIONS
In accordance with Article 163(3) of the Constitution, I hereby submit my report on Budget Performance by
Selected Health Sector Institutions.
My office intends to carry out a follow-up at an appropriate time regarding actions taken in relation to the
recommendations in this report.
I would like to thank my staff who undertook this audit and the staff of the selected Health Sector Institutions
for the assistance offered to my staff during the period of the audit.
John F.S. Muwanga
AUDITOR GENERAL
IA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
TABLE OF CONTENTS
LIST OF TABLES................................................................................................................................................II ABBREVIATIONS...............................................................................................................................................III
EXECUTIVE SUMMARY.....................................................................................................................................IV
CHAPTER ONE...................................................................................................................................................1INTRODUCTION.................................................................................................................................................21.1 BACKGROUND TO THE STUDY...............................................................................................................21.2 MOTIVATION..........................................................................................................................................21.3 DESCRIPTION OF THE AUDIT AREA.....................................................................................................31.4 AUDIT OBJECTIVE.................................................................................................................................51.5 AUDIT SCOPE.........................................................................................................................................5
CHAPTER TWO..................................................................................................................................................6AUDIT METHODOLOGY.....................................................................................................................................72.1 SAMPLING............................................................................................................................................72.2 DATA COLLECTION................................................................................................................................72.3 DATA ANALYSIS.....................................................................................................................................8
CHAPTER THREE...............................................................................................................................................9SYSTEMS AND PROCESS DESCRIPTION.........................................................................................................103.1 ROLES AND RESPONSIBILITIES OF KEY PLAYERS............................................................................103.2 PROCESS DESCRIPTION......................................................................................................................11
CHAPTER FOUR...............................................................................................................................................12FINDINGS, CONCLUSIONS AND RECOMMENDATIONS...................................................................................134.1 EXTENT OF DELIVERY OF PLANNED OUTPUTS..................................................................................144.2 PLANNING AND BUDGETING.............................................................................................................204.3 RELEASE/DISBURSEMENT PERFORMANCE.....................................................................................234.4 UTILIZATION / ABSORPTION OF FUNDS............................................................................................264.5 MONITORING AND EVALUATION........................................................................................................29
GLOSSARY OF KEY TERMS...............................................................................................................................32APPENDICES...................................................................................................................................................33APPENDIX I: Macro structure of the Health Sector.........................................................................................33APPENDIX II: Selected Entities, Programmes and Sub Programmes.............................................................34APPENDIX III: Documents Reviewed..............................................................................................................37APPENDIX IV: Interviews Conducted................................................................................................................38APPENDIX V: Showing extent of delivery of Planned Outputs.........................................................................39APPENDIX VI: Showing details of funds diverted by Selected Health Sector Institutions..............................52APPENDIX VII: Showing duration of the Procurement Process.......................................................................64APPENDIX VIII: Showing inconsistencies in reporting among Selected Health Sector Institutions...............65
II A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
LIST OF TABLES
Table 1: Showing the Total budget vs Actual Expenditure for the 8 selected health sector entities
FY 2017/18..........................................................................................................................................................5
Table 2: Showing extent of delivery of sampled planned outputs by selected entities...................................14
Table 3: Showing reasons for partially achieved outputs by selected health sector institutions...................15
Table 4: Showing reasons for non-implementation of the planned outputs...................................................18
Table 5: Showing outputs without targets and performance indicators.........................................................20
Table 6: Summary of Selected Health Sector and MDA Compliance Assessment (%)...................................21
Table 7: Showing inconsistencies between the MPS FY 17/18 and the approved budget estimates...............22
Table 8: Showing Release performance for Selected Health Sector Entities FY 2017/18...............................23
Table 9: Showing percentage release of external financing Vs GoU counterpart funding.............................24
Table 10: Showing Unreleased funds on sampled outputs under MoH..........................................................24
Table 11: Showing Health Sector approved budget absorption rates FY 2017/18...........................................26
Table 12: Showing Funds Re-Allocation for a selection of outputs.................................................................27
Table 13: Showing funds diverted from the planned sampled outputs...........................................................28
Table 14: Detailing the time required for different activities of the procurement process.............................29
IIIA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
ABBREVIATIONS
MOH Ministry of Health
HSSIP Health Sector Strategic and Investment Plan
RRH Regional Referral Hospital
UBTS Uganda Blood Transfusion services
GoU Government of Uganda
MDAs Ministries Departments and Agencies
MFPED Ministry of Finance Planning and Economic Development
BMAU Budget Monitoring and Accountability Unit
NPA National planning Authority
UGX Uganda Shillings
NRH National Referral Hospital
BFP Budget Framework Paper
Bn Billion
FY Financial Year
MPS Ministerial Policy Statement
DGHS Director General of Health Services
IFMIS Integrated Financial Management Informantion System
NRH National Referral Hospital
IV A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
The health sector is one of the priority sectors of government that is critical in the attainment of Uganda Vision 2040 by producing a healthy and productive population that effectively contributes to socio-economic growth. The sector comprises a number of spending agencies (votes) namely; The Ministry of Health (Vote 014), National Medical Stores (Vote 116), Uganda Cancer Institute (Vote 114); Uganda Heart Institute (Vote 115); Uganda Blood Transfusion Service (Vote 151); Uganda Aids Commission (Vote 107), Health Service Commission (Vote 134), Mulago National Referral Hospital (Votes 161), Butabika National Mental Referral Hospital (Vote 162), 14 Regional Referral Hospitals (Votes 163 – 176), National Drug Authority, Joint Clinical Research Centre, Uganda Virus Research Institute, Uganda National Research Health Organization and Regulatory Councils, i.e. Uganda Medical and Dental Practitioners Council, Uganda Nurses and Midwives Council and Allied Health Practitioners Council.
Ministry of Health is the central agency in charge of policy analysis and formulation, strategic planning, provision of nationally coordinated services that include emergency preparedness, health research, and monitoring and evaluation of the overall health sector performance. The Health Sector Development Plan points out that, in terms of planning, there is a major shortcoming where health sector targets and activities are set without the requisite costing of activities and allocation of required resources to meet them. Also, priorities are not adequately set, which makes it difficult to implement plans in resource constrained situations. The Government of Uganda has steadily increased its budget allocation of funds to the health sector; however, it continues to allocate less than 10% of its budget to health care, which is less than the 15% agreed in the Abuja Declaration by heads of African states. The current funding of US$ 27 per capita per annum expenditure on health care is far below the US$ 44 per capita recommended1. Due to the resource constraints it is imperative that the available resources are utilized effectively to deliver on the health sector objectives.
The Office of the Auditor General undertook a value for money audit to assess the extent of delivery of planned outputs of eight (8) selected entities in the health sector in the financial year 2017/2018. The eight entities comprised of Ministry of Health, Mulago National Referral Hospital Complex, Uganda Blood Transfusion Services, Mbarara Regional Referral Hospital, Gulu Regional Referral Hospital, Mbale Regional Referral Hospital, Masaka Regional Referral Hospital and Fort Portal Regional Referral Hospital.
KEY AUDIT FINDINGSa) Extent of delivery of planned outputsIt was observed that out of the 52 sampled planned outputs in the 8 selected health sector entities, 14 outputs (27%) were fully achieved, 18 were partially achieved (34.6%) and 11 outputs were not implemented at all (21.2%). The extent of delivery for 9 (constituting 17.3%) of the planned outputs could not be assessed, because there were no performance targets and indicators set for the outputs. MoH which is the largest player in the sector was able to achieve 26% of its planned outputs; for the rest of the entities, the level of achievement ranged from 16.6% to 50%.
For the 18 outputs that were patially achieved under various entities, the major contributing factors for partial achievement were procurement delays, budget shortfalls, delayed release of funds and diversion of funds.
1 World Health Organization Profiles, http://www.aho.afro.who.int/profiles_information/index.php/uganda:health_ financing_system
EXECUTIVE SUMMARY
VA Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
b) Planning and BudgetingReview of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority (NPA) indicated that the Health sector is 51.7 percent compliant. Specifically, the sector performed at 88%, 38.1%, 67.6% and 37.3% at planning, project implementation, budget process instruments (BFP and AB) and annual budget performance, respectively. The performance was on account of low budget absorption by the majority of health sector institutions especially under projects.
In terms of strategic planning, the sector is doing well as six (6) out of the eight (8) selected entities had approved strategic plans. Also available is the approved health sector development plan which is aligned to the NDPII. However, Mulago Hospital Complex and Fort Portal RRH scored 0% at planning on account of not having approved strategic plans. It was also observed that under MoH there were a number of projects under implementation which were not among the interventions proposed in the NDPII.
c) Release/ Funds disbursement performanceDuring the FY 2017/2018, out of the total UGX 1.95 trillion allocated to the Health Sector, UGX 1.28 trillion which represents 66% was released. All votes received about 100% of the budget except MoH which received only 36%. For the eight (8) selected entities it was observed that overall, 55.6% of the approved budget was realized by the entities. Most of the entities received their entire budgetary allocations except MoH. For MoH, the shortfall was caused by low disbursement performance from external financing.
In terms of counterpart funding, it was observed that government released all the expected counterpart funding contributions on all the externally funded projects. Due to the poor release performance especially by MoH, a number of outputs and targets were either not implemented or partially implemented.
d) Utilization/ Absorption of funds Out of the total release of UGX 1.28 trillion, the health sector spent a total of UGX 1.191 trillion representing 93.04% of the released amount. For the 8 selected entities, the analysis showed that the entities spent 79% of the amount released. The unutilized funds (UGX 99.4 billion) were mainly funds earmarked for pension, gratuity and social contribution and construction projects among others. Failure to absorb funds was attributed to procurement delays and delayed verification of decentralised pensioners in Regional Referral Hospitals.
Further analysis of the performance of the selected outputs revealed that in addition to poor release performance, the delivery of the expected outputs was affected by budget variations such as reallocations, diversion/ mischarge of funds and delays in procurement. The analysis showed that for the eight (8) selected entities, on average over 50% (UGX 28 billion) of the funds released for the selected sub programs (outputs) were not spent on the planned outputs. This impacted on the achievement of the planned outputs. The Accounting Officers attributed this to resource constraints imposed by the MTEF limits issued by Ministry of Finance and the priority demands entities have to meet even where resources are not forthcoming.
e) Utilization/ Absorption of funds From the interviews held with project coordinators, heads of departments and Accounting Officers in the selected entities, the audit team established that there were no specific monitoring and evaluation work plans with clear set targets and indicators to facilitate monitoring of planned activities for the programs and projects selected for review.
VI A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
It was further noted through review of the expenditure files that although funds amounting to UGX. 1,287,353,819 were spent on monitoring and evaluation of projects and programs, there were no specific monitoring and evaluation reports on file to confirm that the expected monitoring and evaluation activities were carried out and recommendations made for corrective action.
f) Utilization/ Absorption of funds Review of the annual work plans, approved budget estimates and the 4th quarter cumulative performance reports indicated that in all the selected health sector institutions, there were some errors and inconsistencies in reporting on the delivery of outputs and in some instances there was no relationship between the planned outputs and the actual reported achievements. Also the revised approved budget figures in the Ministerial Policy Statements and cumulative vote performance reports were at variance with the actual revised budgeted figures captured in the IFMS.
KEY RECOMMENDATIONSa) The sector should strive to always give priority to the proposed NDPII health sector interventions and targets during planning and budgeting. The tendency to take on new projects outside NDPII projects should be restrained or undertaken in accordance with the national planning framework.
b) The Ministry should work closely with stakeholders to ensure that program activities are properly planned to facilitate timely disbursement of funds.
c) Accounting Officers should adhere to the approved budgetary allocations and work plans. Where inevitable, budget variations should be undertaken in accordance with the established procedures.
d) The sector should set realistic targets with clear performance indicators during planning and endeavour to revise the targets in case of low budget outturn caused by poor commitment from donors/Government to release all the funds as planned and in a timely manner.
e) The sector should constitute M&E units to properly monitor implementation of activities, consolidate all the reports generated from the individual Programme/project monitoring teams/ committees and follow up recommended corrective actions. In addition, the established units should ensure that specific M&E plans are developed with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance.
f) The sector should ensure that the performance is accurately reported to inform appropriate government policy actions.
OVERALL AUDIT CONCLUSIONOverall, the selected eight (8) entities in the sector partially achieved their expected planned outputs for the year. The delivery of the expected outputs and targets was affected by challenges in planning, budget shortfalls, funds absorption, procurement delays and budget variations among others.
To improve on the output delivery, it is important that the existing challenges in monitoring and evaluation are also addressed to ensure corrective action and accurate information for decision making.
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2 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
2 Health Sector Budget Framework paper 2018/2019, page 6
CHAPTER ONE
INTRODUCTION
1.1 BACKGROUND TO THE STUDYThe health sector is one of the priority sectors of government that is critical in the attainment of Uganda Vision 2040 by producing a healthy and productive population that effectively contributes to socio-economic growth. The sector comprises a number of spending agencies (votes); The Ministry of Health (Vote 014), National Medical Stores (Vote 116), Uganda Cancer Institute (Vote 114); Uganda Heart Institute (Vote 115); Uganda Blood Transfusion Service (Vote 151); Uganda Aids Commission (Vote 107), Health Service Commission (Vote 134), Mulago National Referral Hospital (Votes 161), Butabika National Mental Referral Hospital (162), 14 Regional Referral Hospitals (Votes 163 – 176) National Drug Authority, Joint Clinical Research Centre, Uganda Virus Research Institute, Uganda National Research Health Organization and regulatory councils, i.e. Uganda Medical and Dental Practitioners Council, Uganda Nurses and Midwives Council and Allied Health Practitioners Council.
Ministry of Health is the central agency in charge of policy analysis and formulation, strategic planning, provision of nationally coordinated services that include emergency preparedness, health research, and monitoring and evaluation of the overall health sector performance.
The Health Sector Priorities for the financial year 2017/2018 were as follows:a) Scale up Public Health Interventions to address the high burden of preventable diseases in our country. i) Scaling up of Health promotion, education and effective communication to the population. ii) Scaling up interventions to address the high burden of HIV/TB, Malaria, Nutritional challenges, Environmental
Sanitation and Hygiene, Immunization, Hepatitis B and Non-Communicable Diseases.
b) Introduce Community Health Extension Workers (CHEW’s) to educate the communities on the prevention of diseases and link the communities to the Health services.
c) Improvement of Reproductive, Maternal, Neonatal, Child and Adolescent health services to reduce mortality and morbidity and improve their health status.
d) Human resources (attraction, motivation, retention, training and development). Mobilize additional resources for recruitment and incentives.
e) Infrastructural developments; constructions, rehabilitation and remodelling focusing mainly on HCIIIs, HCIVs and Districts with special needs like islands, difficult to reach areas, large populations and socio-demographic peculiarities.
f) Mobilization of additional resources for medicines and health supplies especially laboratory supplies, reagents and Blood collection supplies.
e) Effective and well-structured Support Supervision to the Local Governments and strengthened regulatory authorities and professional councils in the Health sector.
1.2 MOTIVATIONOverall objective no. 3 of the NDP II emphasises the role of the health sector in contributing towards the production of a healthy human capital for wealth creation through the provision of equitable, safe and sustainable health services.2
3A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
3 Health Sector Strategic and investment Plan (2010/11–2014/15) Page 504 World Health Organization Profiles, http://www.aho.afro.who.int/profiles_information/index.php/uganda:health_ financing_system5 HSSIP 2010/11 – 2014/15 page 25
The Health sector development plan points out that, in terms of planning, there is a major shortcoming where health sector targets and activities are set without the requisite costing of activities and allocation of required resources to meet them. Also, priorities are not adequately set, which makes it difficult to implement plans in resource-constrained situations.
The Health Sector Strategic and Investment Plan (2010/11 – 2014/15) identified budgeting challenges which include but not limited to the following; inadequate resources for curative and preventive medicines, remuneration of health workers is very low and has not created sufficient motivation to attract qualified health workers to work in hard to reach areas, investments for basic infrastructures have not met the need for quality service provision in the health facilities and growth of essential medicines budget is not in line with the increasing needs for medicines of the population3.
The Government of Uganda has steadily increased its budget allocation of funds to the health sector. However, it continues to allocate less than 10% of its budget to health care, which is less than the 15% agreed in the Abuja Declaration by heads of African states. The current funding of US$ 27 per capita per annum expenditure on health care is far below the US$ 44 per capita recommended4. In the year 2017/18, Government allocated UGX1.95 trillion to the health sector. Due to the resource constraints, resources earmarked for health sector should be utilized effectively to ensure achievement of the sector objectives.
It is against this background that the Office of the Auditor General decided to undertake a value for money audit to assess the extent to which the health sector is achieving planned objectives in the employment of available resources.
1.3 DESCRIPTION OF THE AUDIT AREA1.3.1 General DescriptionThe provision of health services in Uganda is decentralised with districts and health sub-districts (HSDs) playing a vital role in the delivery and management of health services at those levels. The health services are structured into National Referral Hospitals (NRHs) and Regional Referral Hospitals (RRHs), General Hospitals, Health Centre (HC) IVs, HC IIIs, HC IIs and Village Health Teams (HC Is).
The health care delivery system in Uganda is organised in tiers, from the Village Health Teams (VHTs) to general hospitals. The national and regional referral hospitals are semi-autonomous institutions, while the district health services, general hospitals and lower level health centres are managed by LGs.
Several functions have been delegated to national autonomous institutions including Uganda Cancer Institute, Uganda Heart Institute, Uganda Blood Transfusion Services, Uganda Virus Research Institute, National Medical Stores, Central Public Health Laboratories, Professional Councils, National Drug Authority (NDA) and research institutions, Uganda National Health Research Organization (UNHRO), Uganda Natural Chemotherapeutic Research Laboratory. The Health Service Commission (HSC), and the Uganda AIDS Commission (UAC)5.
4 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
6 Ministry of Health Strategic Plan 2015/2016-2019/20207 Health sector development plan 2015/16 - 2019/20 Page 488 Health sector development plan 2015/16 - 2019/20 Page 489 Health sector development plan 2015/16 - 2019/20 Page 4810 NDP II page 190, Health sector Strategic Plan 2015/16-2019/20 page 37 and Health Sector Development plan 2015/16-2019/20 page 48.
1.3.2 Legal Framework for the Health sector6 The Health sector provides services in line with the Constitution of the Republic of Uganda (1995 as amended) and the LG Act (1997) which decentralised governance and service delivery.
The Sector Affiliated autonomous institutions were established by Acts of Parliament; UNHRO was established through the UNHRO Act, 2011, UAC was established by the Parliamentary statute no. 2 of 1992, NMS was established by the NMS Act 1993, the NDA was established in 1993 by the National Drug Policy and Authority Statute which in 2000 became the National Drug Policy and Authority (NDP/A) Act, Cap.206 of the Laws of Uganda (2000 Edition).
1.3.3 Health sector Mandate7
‘‘To accelerate movement towards Universal Health Coverage with essential health and related services needed for promotion of a healthy and productive life.’’
Health sector Vision8
‘‘To have a healthy and productive population that contributes to economic growth and national development.’’
Health sector Mission9
‘‘To facilitate the attainment of a good standard of health by all people of Uganda in order to promote a healthy and productive life.’’
1.3.4 Objectives of the Health SectorThe major objectives of the sector over the NDPII period are10: i)Contribute to the production of healthy human capital through provision of equitable, safe and sustainable health services.ii)Increase financial risk protection of households against impoverishment due to health expenditures Address the key determinants of health through Strengthening inter-sectoral collaboration and partnerships.
iii)Enhance health sector competitiveness in the region, including establishing centres of excellence in heart, cancer, renal care domains; and diagnostic services.
1.3.5 Activities of the Health SectorRegarding the development and maintenance of the National Health System over the Sector Development Plan period, the MoH is responsible for: a) Governance and Leadership. i) Policy formulation and dialogue. ii) Collaboration with all stakeholders. iii) Coordination of health programs. iv) Ensuring transparency and accountability. b) Strategic planning, resource mobilisation and budgeting.c) Setting regulations, standards and guidelines development and dissemination.d) Supervision, Monitoring and evaluation of the overall sector performance. e) Human resource capacity development and technical support. f) Infrastructure development.
1.3.6 Organizational Structure for the Health SectorThe key oversight functions of the health sector are managed through the Minister and the Ministers of State. The sector head is the Minister for Health who is assisted by two ministers of state (Minister of State for Health General Duties-MoSH GD and Minister of State for Health Primary Health Care-MoSH PHC); The Permanent Secretary who coordinates resources for effective management of Health Funds; The Director General of Health Services (DGHS) who coordinates technical functions for delivery of Health services; The work of the DGHS is coordinated through four (4) directorates: Directorate for Strategy, Policy & Development and Directorate of Curative Services, Directorate of Public Health and Directorate of Health Governance and Regulation and 20 departments.
5A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
The sector also has 16 medical directors in the national and regional referral hospitals as well as 14 Executive Directors of semi-autonomous agencies who complement the work of the Ministry in discharging its core functions through service delivery, research, training, procurement and distribution of drugs. The detailed organogram for the sector is shown in Appendix I.
1.3.7 FundingIn the FY 2017/2018, the allocation to the health sector was 6.4% of the total National Budget. The Budget for the Health sector increased from UGX 1.87 trillion in FY 2016/2017 to UGX 1.95 trillion in the FY 2017/2018. During the year under review the Health sector benefited from supplementary budgets in favour of National Medical Store, Uganda Cancer Institute, Mulago Hospital Complex and Ministry of Health. Below are the budgetary allocations and releases in Billions to the eight (8) selected health sector entities during the FY 2017/201811.
Table 1: Showing the Total budget vs Actual Expenditure for the 8 selected health sector entities FY 2017/18
ENTITY/ MDA’s Budgeted Actual Spent Variance (A-B)
Recurrent Development Total Budget
(A)
Rec’t Development Total Actual
(B)GoU Dev’t
Donor Dev’t
GoU Dev’t Donor Dev’t
MOH 64.48 28.84 878.41 971.73 57.32 31.77 209.52 298.62 673.11
UBTS 12.70 0.36 0.00 13.06 12.37 0.35 0 12.72 0.34
Mulago NRH 45.00 22.02 0 67.02 41.59 22.02 0 63.61 3.41
Gulu RRH 5.46 1.49 0 6.95 4.65 1.49 0 6.14 0.81
Mbarara RRH 4.79 1.98 0 6.77 4.36 1.87 0 6.24 0.53
Mbale RRH 6.94 3.06 0 9.99 6.69 3.06 0 9.74 0.25
Fort Portal RRH 5.28 1.06 0 6.35 4.43 1.06 0 5.49 0.86
Masaka RRH 4.33 2.06 0 6.38 4.01 2.06 0 6.07 0.31
TOTAL 148.98 60.87 878.41 1088.25 135.42 63.68 209.52 408.63 679.62
Source: OAG analysis of the approved budget estimates 17/18 and cumulative 4th quarter vote performance report 2018
Note: The total funding excludes appropriation in aid (AIA) and arrears.
1.4 AUDIT OBJECTIVEThe objective of the audit was to assess the extent of delivery of planned outputs in the eight (8) selected Health Sector entities during the year 2017/18. This was done through an evaluation of the processes of planning and budgeting, release of funds, Utilization of funds, monitoring and evaluation, and performance reporting.
1.4.1 Audit Questionsi. Is the sector plan linked to the National Development Plan II?ii. Are the set targets realistic and consistent?iii. Were the budgeted funds realized as planned and in a timely manner?iv. Where the released funds utilized for the intended purpose? v. Are the priority projects properly monitored and evaluated?vi. Are achieved results accurately reported?
1.5 AUDIT SCOPEThe audit focused on budget performance by the selected Health sector institutions. The study covered financial 2017/2018. For purposes of this audit, a selected sample of outputs of both capital development and recurrent nature were assessed and details are in Appendix II.
11 Approved budget estimates FY 2017/2018 Pages 30, 32
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7A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
AUDIT METHODOLOGY
The audit was carried out in accordance with the International Organisation of Supreme Audit Institutions (INTOSAI) standards and guidelines. The standards require that the audit is planned in a manner which ensures that an audit of high quality is carried out in an economic, efficient and effective way and in a timely manner.
The study relied upon document review, interviews and inspection to obtain relevant information to answer the audit questions. Data was collected from several government agencies and other key players in the health sector based on their role in budget implementation and monitoring of activities.
2.1 SAMPLINGSampling materiality was considered in the context of quantitative and qualitative factors such as relative magnitude, the nature and extent of the effect of these factors on the evaluation or measurement of the subject matter, and the interest of the intended stakeholders.
The selection of the sample of MDAs in the health sector was guided by the following; entities within and above 90% of the cumulative total health sector budget were selected. The selection of some regional referral hospitals was premised on the fact that these referrals, serve a relatively large population. Within the selected entities, the selection of the programmes was based on order of importance and link to the strategic plan and the national development plan, all Programmes with a budget of at least 25% of the selected entity’s total budget were picked for the assessment and other programmes were selected based on each entity’s capital development budget.
All outputs of a capital development nature under the respective sub programmes or projects were selected; outputs of a recurrent nature were also selected on the basis of budget significance or size in terms of monetary value and their importance in terms of achievement of the strategic sector objectives. The audit team also applied professional judgement when selecting other outputs of a recurrent nature where it was deemed appropriate. Entities, programmes, sub programmes and outputs sampled are attached in Appendix II.
2.2 DATA COLLECTIONThe data collection tool was designed basing on the key process points (Planning and Budgeting, Release of Funds, Utilization of funds, Monitoring and Evaluation, and Performance reporting) with risk indicators, key out puts for assessment among other parameters. The tool was used together with other data collection methods which include the following;
Methodology to establish whether the Sector Plan is linked to the National Development Plan IIThe Audit team reviewed the current sector development plan 2015/16-2019/20, the NDP II 2015/16-2019/20, approved MOH strategic plan 2015/2016-2019/2020, Annual work plans 2017/18, , MPS for F/Y 2017/18, MFPED budget documents including the Budget Speech, and approved estimates 17/18, BFP 2017/18 to establish linkage between the planning and budgeting documents, accuracy and consistency of the set targets. The Second National Health policy was also reviewed in order to gain an in-depth understanding of the legal and regulatory framework for the sector.
CHAPTER TWO
8 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Methodology to establish whether the Budgeted Funds were realized as planned and in a timely mannerApproved budgets were reviewed against the actual receipts from GoU and development partners to establish whether funds were released and received as planned, Budget analysis reports (BIG Reports) were also reviewed to ascertain the timing of released of funds from GoU, Bank statements for donor funded projects were obtained to ascertain the timing of the donor disbursements.
Methodology to establish whether the Released Funds were utilized for the intended purpose Payment files were analysed against the approved budgets and Work plans to ascertain if the funds released were spent on the actual outputs planned, and if the expenditure on the planned out puts was correctly charged according to the GoU chart of accounts. The payment files were further analysed against the Budget analysis reports to ascertain if the excess expenditure on planned outputs had approved reallocations or supplementary provisions. Interviews were held with the Ministry of Health departmental heads of the different programmes/ Departments, Project coordinators, Hospital directors of national and regional referrals to establish their roles and responsibilities as well as challenges they face in budget execution.
Methodology to establish whether the Priority Projects were properly monitored and evaluatedMonitoring and Evaluation plans were reviewed to ascertain wether monitoring activities were planned and budgeted for, and also ascertain wether the monitoring and evaluation parameters were realistic and in line with the MoH monitoring and evaluation framework. The Lead Agency (MoH) was also interviewed to establish how they were involved in ensuring that recommendations from monitoring were implemented by other institutions in the health sector.
Methodology to establish whether the Achieved Results were accurately reportedThe audit team reviewed quarterly performance reports 2017/2018, Health Sector Annual Performance Report 2017/18, the Government Annual Performance Report (GAPR 2017/2018), and conducted physical inspections to draw a comparision between the actual reported out puts and what is actually on ground to be able to conclude on the accuracy of the reported out puts. The team interviewed the project coordinators, project managers and the MoH officers in the planning department to ascertain the causes for any discrepancies. Details of documents reviewed and interviews conducted are detailed in Appendix III and IV.
2.3 DATA ANALYSISTo support the findings and conclusions, both qualitative and quantitative data was analysed. This was done to establish relationships and in some cases to explain certain observations. Qualitative data collected was summarized such as objectives, planned activities and actual outputs both recurrent and capital development in nature. These were grouped and compared in order to establish their link to the overall strategic objectives of the sector, relate findings and their causes, while quantitative data such as, number of patients served by each regional referral, budget amounts, actual receipts, and total expenditure was used to establish the level of absorption and performance.
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10 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
SYSTEMS AND PROCESS DESCRIPTION
3.1 ROLES AND RESPONSIBILITIES OF KEY PLAYERSENTITY/PLAYER KEY ROLES AND RESPONSIBILITIES
Parliament of Uganda (Health Committee) • Passing policies and laws• Resource allocation • Advocacy for health • Performance monitoring
National Drug Authority • Oversight, regulation and management of health products • Participation in MoH planning, monitoring and review
National Medical Stores • Management of procurement, warehousing and distribution of all health products• Participation in MoH planning, monitoring and review
Uganda Blood Transfusion Services • Coordination of provision of blood and blood products • Participation in MoH planning, monitoring and review
National and RRHs • Implementation of the MoH policies and guidelines • Participation in policy and strategy formulation and review • Participation in support supervision to LGs • Participation in performance reviews
Ministry of Finance, Planning and Economic Development
• Provision of adequate financial resources for implementation of the Strategic Plan• Provide data that is required to inform health planning (e.g. UDHS, Household surveys, vital statistics) • Participation in development policies and strategies • Project appraisals• Joint planning, monitoring and review of sector performance
Development Partners • Provision of demand-driven technical assistance and inputs into the implementation of the MoH priorities• Complement financing of the MoH priorities with earmarked or unearmarked funds • Actively participate in joint sector planning, monitoring and review
National Monitoring and Evaluation Working Group
• Maintains a monitoring and evaluation function within the SWG secretariat to coordinate MDA and LG monitoring as it pertains to Sector results, and for upwards reporting to coordinating Ministries.
Private Sector (PHPs, PNFPs, CSOs) • Contributing towards policies development, planning, monitoring and evaluation. • Resource mobilisation for health care from households, organisations both local and international. • Providing or participating in research, community and social mobilisation, advocacy, capacity building including human resources development, logistical support, technical assistance and other services at all levels. • Ensuring proper utilisation of resources and accountability
CHAPTER THREE
11A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
3.2 PROCESS DESCRIPTION3.2.1 PlanningIndicator Setting and ValidationAt the start of the budget planning calendar, MDAs are required to review the existing performance indicators for each output/outcome for use in the forthcoming financial year. MDAs then submit the validated indicators to the sector secretariats at the lead ministry for compilation and submission to the relevant desk officers at OPM for quality assurance. At OPM, the desk officers specifically check for relevancy; completeness; obsolete and missing indicators and mismatch of indicators as part of the quality control procedures. OPM then summons the National Monitoring and Evaluation Working Group (OPM, UBOS, NPA, and MoFPED) to review and submit the approved performance indicators to Budget Directorate of MoFPED for incorporation within the National budget and the budget reporting tool (Programme Budgeting System (PBS) formerly the Output budgeting tool (OBT)). The sector desk officers are required to upload the approved performance indicators by 15th November of the current financial year. The approval of the indicators is based on ensuring that the indicators are specific, measurable, achievable, reliable and timely, i.e. SMART beginning with the OPM desk officers and completed by the National Monitoring and Evaluation Working Group.
Target Setting MDAs are required to set the targets in line with the available resource envelope and capacity to implement the development objectives of the institution. The MDAs set the output/outcome indicator targets during the budget framework paper preparation process. The targets are further reviewed during the preparation of the ministerial policy statement by MDA in line with the appropriated resources. The set targets are forwarded to OPM for review and approval, and re-forwarded to MFPED for input into the OBT/PBS.
3.2.2 BudgetingEach Accounting Officer in consultation with the relevant stakeholders prepares a Budget Framework Paper for the vote, taking into consideration balanced development, gender and equity responsiveness and submits it to the Minister by 15th November of the financial year preceding the financial year to which the Budget Framework Paper relates. The Budget Framework Paper is supposed to be consistent with the National Development Plan and with the Charter for Fiscal Responsibility. The Minister, with the approval of Cabinet, submits the Budget Framework Paper to Parliament by the 31st of December of the financial year proceeding the financial year to which the Budget Framework Paper relates. After consideration of the BFPs by parliament, entities also present to parliament their proposed budgets (ministerial policy statements) which are then discussed by the relevant committees as part of the budget approval process. Approval of the budget is evidenced through the enactment of the Appropriation Act by Parliament.
3.2.3 Budget Implementation Release of FundsAfter approval of the Budget Estimates by Parliament in May, the Ministry of Finance, Planning and Economic Development, issues a Budget Execution Calendar in June. The execution calendar communicates the Annual Quarterly Cash flow plan and the Operational and Administrative guidelines for budget implementation. The release of funds to Votes is undertaken in accordance with the cash flow plans and through a warranting process managed by the Accountant General and the Directorate of Budget. The MDAs are however advised to hold regular internal meetings to review the status of implementation of approved work plan from time to time. The meetings include Departmental meetings, Directorate meetings, Senior Management Meeting and Top Management Meetings.
12 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Utilization of FundsAfter approval of the annual budget by Parliament, the Secretary to Treasury issues the annual cash flow plan of Government, based on the procurement plans, work plans and recruitment plans approved by Parliament. The annual cash flow plan issued forms the basis for release of funds by the Accountant General to the Accounting Officers. The Accounting Officer, based on the annual cash flow plan issued by the Secretary to the Treasury, plans and manages the activities as indicated in the policy statement of the vote. An accounting officer is charged with the overall responsibility for the successful execution of the procurement, disposal and contract management processes in the procuring and disposing entity.
Parliament may, by resolution, authorise the Minister to reallocate funds from a vote to another vote where the functions of a vote are transferred to that other vote. A vote that does not expend money that was appropriated to the vote for the financial year at the close of the financial year is expected to repay the money to the Consolidated Fund.
3.2.4 Monitoring and EvaluationTo ensure effective monitoring of the national health strategy, the MoH developed the M&E plan for the HSDP with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance. All programs and projects are also expected to develop specific program/project M&E Plans which should include programme indicators to measure process, outputs and immediate outcomes. These should, however, be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate the effects of health system strengthening to health outcomes.
At the national level, Bi-annual internal reviews by Sector Working Groups are carried out and include collating input and output performance data for key results as defined in Sector Investment Plans and the sector reporting framework. The bi-annual review includes all relevant sector stakeholders. The review focuses on the timeliness and accuracy of the collated performance data, before its upwards reporting, and recommendations for any corrective measures in the coming half year are made.
The budget of collating performance data and conducting quarterly and bi-annual reviews is provided for under the sector monitoring budget. Annual reviews are conducted by all Sector Working Groups, jointly with other stakeholders (such as Development Partners) as appropriate.
In addition to public institutions and executing agencies, citizens, Civil Society Organizations (CSOs) and Development Partners (DPs) play a role in the monitoring and evaluation of Government’s performance. These institutions; Provide an external perspective on Government performance and results, assist Government through financial, technical and other forms of assistance to strengthen its performance.
3.2.5 Performance ReportingAll MDAs are required to prepare and submit quarterly performance reports to the Ministry of Finance, Planning and Economic Development by 30th of the first month of the preceding quarter. e.g. the Third Quarter Report for the FY 2017/18 is required by 30th of April 2018. At MFPED, the reports are reviewed by the Desk Officers, and the Budget Monitoring Unit and issues of concern are brought to the attention of the relevant Accounting Officers for action.
In addition to the submitting reports to MFPED, MDAs are required to submit six months (Semi-Annual Government Performance Report and 12 months reports (Annual Government Performance Report) to OPM. A Cabinet retreat is held to review Government performance at half-year and after the end of the year and the retreat is coordinated by Office of the Prime Minister.
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14 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
CHAPTER FOUR
FINDINGS, CONCLUSIONS AND RECOMMENDATIONS
This chapter presents the audit findings, conclusions drawn from the findings and recommendation made for the improvement in implementation of the planned outputs by selected health sector institutions.
4.1 EXTENT OF DELIVERY OF PLANNED OUTPUTSThe eight (8) selected health sector institutions in the sector planned to implement and achieve a number of both recurrent and capital development outputs under various Programs and projects with set targets during the financial year 2017/2018. Based on the work performed during the audit, it was established that the selected entities in the sector partially achieved their planned outputs for the year.
Out of the fifty two (52) selected sample of planned outputs in the selected health sector institutions, fourteen (14) outputs were fully achieved representing 27% of the planned outputs, eighteen (18) were partially achieved (34.6%) and eleven (11) outputs representing 21.2% of the planned outputs were not implemented at all.
It was also observed that for the 9 outputs representing 17.3% of the planned outputs, the extent of delivery could not be assessed because no performance targets and indicators were set to facilitate the assessment. Set out in the Table 2 below is an analysis of performance of the selected entities.
Table 2: Showing extent of delivery of sampled planned outputs by selected entities
Entity No. of planned outputs
Actual outputs
Fully achieved Partially achieved Not Implemented No set targets (Not assessed)
MoH 27 7 9 9 2
Mulago NRH 1 1
UBTS 6 1 3 2
Gulu RRH 3 1 2
Fort Portal RRH 3 1 2
Masaka RRH 3 2 1
Mbale RRH 5 2 1 2
Mbarara RRH 4 2 2
Total 52 14 18 11 9
Source: OAG review of approved work plans, MPS, Budget estimates and 4th quarter performance reports 2017/18
As shown in the table above, MoH which is the largest player in the sector was able to fully achieve only 26% of its planned outputs. Similarly, for the rest of the entities the level of achievement ranged from 16.6% to 50%.It was observed that for the enteighteen (18) outputs that were patially achieved under various entities , the major contributing factors were procurement delays, budget short falls, delayed release of funds,diversion of funds among others as explained in Table 3 below;
15A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Table 3: Showing reasons for partially achieved outputs by selected health sector institutions
Project Output Funding (UGX ‘000)
Causes for the variances
Ministry of Health
Project: 1185 Italian support to HSSP and PRDP
080282: 68 Construction of staff houses in Karamoja region
(Target :100% completion of civil works)
Budgeted: 5,619,000
Released: 5,619,000
Spent : 5,619,000
Achievement: 61.1% completed
Donor delayed to disburse funds and the contractor stopped working since December 2017
080201: Monitoring, Supervision and Evaluation
(Target 12 monthly monitor-ing visits)
Budgeted: 100,000
Released: 100,000
Spent : 100,000
Achievement: 4 monitoring visits done
The number of visits reduced because the cost of each field visit increased including involvement of Local lead-ers.
Project: 1243 Rehabilitation and construction of General hospitals
080280: Rehabilitation and equipping of Kawolo and Busolwe hos-pitals
(Target: 50% completion of civil works)
Budgeted: 19,282,000
Released: 4,020,000
Spent : 3,726,879
Achievement: 28.5% completed
Works on Busolwe have not yet commenced. No contract for works signed because the available funds are not enough to cover the scope of works needed. Some funds were re-allocated (UGX 30M)
Project: 1344 Renovation and Equipping of Kayun-ga and Yumbe Gen-eral Hospitals
080280: 30% civil works for rehabilitation and expansion of Kayunga and Yumbe Hos-pitals completed
Budgeted: 27,885,000
Released: 19,322,667
Spent : 21,665,067
Achievement: 11%
Procurement delays.
Excess funds spent over the release (2,342,399,000) were funds diverted from other projects.
Project: 1394 region-al hospital for paedi-atric surgery
080280: completion of 50% of civil works
Budgeted: 9,428,039
Released: 9,428,039
Spent : 7,227,112
Achievement: 40% completed.
-Delays in clearance of imported ma-terials.
-Delays in release of counterpart funding, and continuous request for minor changes in the designs by the donors.
Diversion of funds (2,200,887,000)
080201: Monitoring, Supervision and evaluation (Hospital construction supervised)
Budgeted: 170,000
Released: 170,000
Spent : 169,987
Achievement: monthly monitoring done for 5 months
The project manager was not ap-pointed until the last quarter of the financial year.
Some funds were re-allocated
16 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Project Output Funding (UGX ‘000)
Causes for the variances
Project: 0220 global Fund for Aids, TB and Malaria
080575: Procure 7 delivery trucks for NMS and JMS 4 film Vans, Station Wagon, 2 cars for M&E officers
Budgeted: 3,415,896
Released: 3,415,896
Spent : 3,415,896
Achievement:
delivery trucks procured
2 film vans procured
1 station wagon procured
2 M& E cars procured for officers.
The two film vans were not yet procured due to Procurement delays
080577: Procurement of 150 Autoclaves, 239 GeneXpert Machines, Microscopes, Forklift, medicines shelves and racks, medicines boxes, x-ray machines
Budgeted: 31,857,132
Released: 31,857,132
Spent : 31,857,132
Achievement:
150 autoclaves procured
Forklift procured
Medicines shelves and racks constructed
The x-rays, GeneXpert machines and microscopes are being procured through pooled procurement mechanisms of the Global Fund which have longer lead times. The procurement is on course and delivery is scheduled for March 2019.
1436: Gavi vaccines and Health sector Development plan support
080501:
Preventive and curative Medi-cal supplies
(Procure
1,437,600 HPV doses
3,362,000 PCV doses
1,591,500 Penta doses
2,917,500 Rota doses
No targets set for IPV doses)
Budgeted: 20,000
Released: 10,000
Spent : 10,000
Achievement:
881,580 of HPV doses
1,914,600 of PCV doses
1,911,000 of Penta doses
Inadequate funding since counter-part funds allocated annually (UGX 10 bn) for the vaccines have remained constant for about 15 years yet the number of children to be immunized is increasing.
MULAGO HOSPITAL COMPLEX
OPD and other ward con-struction and rehabilitation
Budgeted: 22,170,000
Released: 22,170,000
Spent : 22,170,000
Achievement:
Construction of an organ transplant unit and remodeling of wards in final stages,
Funds worth UGX 14,203,379,232 were diverted
17A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Project Output Funding (UGX ‘000)
Causes for the variances
UBTS
Safe Blood Provision Collection of blood
240,000 unit of blood collected
300,000 blood donors recruited
240,000 unit of blood collected tested
Budgeted: 7,040,000
Released: 7,040,000
Spent : 7,040,000
Achievement:
209,633 units of blood collected
Unit collections were low due to inadequate test Kits and blood bags in Q1 and Q2
085301 Administrative support service
(target: -Management of facilities
-Replacement of old vehicles
-Maintenance of laboratory equipment
-Recruitment)
Budgeted: 1,000,000
Released: 1,000,000
Spent : 1,000,000
Achievement:
-Management of facilities
- one old vehicle replaced
Management explained that the funds allocated weren’t sufficient to implement all the planned activities.
Sub Programme 01: Administrative Support services
(Target: Construction of regional blood banks. (completion of Concepts, proposals and feasibility studies)
Maintenance of existing fa-cilities.
-Supervision and clinical in-terface to hospital clinicians and administrators)
Budgeted: 4,001,168
Released: 3,993,168
Spent : 3,663,834
Achievement:
-Supervision and clinical interface to hospital clinicians and administrators.
-Maintenance of existing facilities. -Recruitment of staff.
Other activities were not implemented due to insufficient budget allocations
GULU RRH
1004: Gulu Reha-bilitation Referral Hospital
Construction of 54 Unit staff houses
(Target Completion of the second slab and Initiation of the 3rd slab)
Budgeted: 1,338,000
Released: 1,338,000
Spent : 1,191,500
Achievement:
The second slab was not completed, and the 3rd slab hadn’t been initiated. (Overall achievement approx. 55%)
The slow progress of works was due to the limited annual funds allocated to the project by ministry of finance.
Part of these funds were diverted (UGX 146,500,000)
Demolition of the old radiol-ogy building
(Target: Complete demolition of the old radiology building and removal of debris)
Budgeted: 50,000
Released: 50,000
Spent : 48,000
Achievement:
Demolition done but the debris was not removed
This was due to Poor contract management
18 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Project Output Funding (UGX ‘000)
Causes for the variances
MASAKA RRH
01: Masaka Referral Hospital Services
Diagnostic services
(553,900 laboratory tests carried out
13,915 ultra sound scans made
5,949 x-ray examinations made)
Budgeted: 116,000
Released: 116,000
Spent : 113,500
Achievement:
(304,805 Laboratory tests done. 13,953 Ultra sound examinations done and 3784 X-Ray examinations done. 5,374 Blood transfusions done)
Lab. tests declined because of lack of reagents.
X-rays targets were not met due to inadequate and inappropriate supplies of x-ray films by National Medical stores.
1004: Masaka Rehabilitation Referral Hospital
085681: Staff houses con-struction and rehabilitation
(Foundation for all the 40 units staff hostel Completed 1 block of the staff hostel completed)
Budgeted: 500,000
Released: 500,000
Spent : 474,860
Achievement: (Raft foundation completed with steel and concrete.
This was because funding for the project was not adequate and as a result, the contractor only worked depending on availability of funds.
MBALE RRH
1478: Institutional support to Mbale Regional referral hospital.
085683: Construction and installation of a new incinerator and Renovation of acute care unit
(Target:100% completion of incinerator and putting it to use.)
Budgeted: 500,000
Released: 500,000
Spent : 404,209
Achievement:
Installation of incinerator completed but it was not yet in use by FY end ( 2017/18)
This was because there was need to change the roof structure of the incinerator house from wood as was in the original design to metal.
Source: OAG review of the approved annual work plans, MPS budget estimates and 4th quarter performance reports 2017/18
Outputs Not Implemented
The eleven (11) ouputs were not implemented in two (2) out of the eight (8) selected health sector institutions. The major reasons for failure to implement the planned outputs were; setting of unrealis-tic targets, inadequate preparedness to implement some outputs especially under the externally funded projects, budget shortfalls and diversion of funds among others, as explained in table 4 below;
Table 4: Showing reasons for non-implementation of the planned outputs
Programme Output Funding (UGX ‘000’) Audit observation
Ministry of Health
Project: 1344 Renovation and Equipping of Kayunga and Yumbe General Hospitals
080277: medi-cal equipment for full equipping of Kayunga and Yumbe hospitals
Budgeted: 6,700,000Released: 0Spent : 0
The set target was unrealistic since the medi-cal equipment could only be procured after completion of renovation and expansion of the hospital. Therefore the donorCould not release funds for the equipment as planned.
19A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Project: 1440 Uganda Repro-ductive Mater-nity and Child Health Services Improvement Project
080280: Procure-ment of motor vehicles for support supervision
Budgeted: 2,847,330Released: 2,847,330Spent : 2,847,330
Funds were diverted to procure medical equip-ment
080276: Procure-ment of birth, death mobile services for NIRA
Budgeted: 2,695,472Released: 0Spent : 0
The allocated Funds not enough to execute the scope of works. The procurement had to be re-tendered.The budgets were overly ambitious coupled with unrealistic targets.
080277: Procure-ment of critical reproductive equip-ment
Budgeted: 4,000,000Released: 0Spent : 0
Management hadn’t done the needs assess-ment on the intended beneficiary health care institutions.
080281: Maternity units’ construction in the selected lo-cal government’s health centres
Budgeted: 11,522,195Released: 0Spent : 0
A needs assessment hadn’t been done.There were no approved designs for the project
1436: Gavi vac-cines and Health sector Devel-opment plan support
080503: Monitoring and evaluation ca-pacity improvement
Budgeted: 425,217Released: 207,173Spent : 207,173
External funds were not realized to implement all the planned activities. Funds were utilized towards monitoring other projects
080572: Govern-ment buildings and administrative Infrastructure
Budgeted: 6,188,906Released: 0Spent : 0
Funds were not released by the donor
080575: Purchase of Motor Vehicles and other transport Equipment
Budgeted: 4,596,775Released: 0Spent : 0
Funds were not released by the donor
080575: Machinery and Equipment
Budgeted: 15,353,562Released: 0Spent : 0
Funds were not released by the donor
MBARARA RRH
0856: Regional Referral Hospi-tal Services
08580: Hospital construction /Reha-bilitation
Budgeted: 350,000Released: 350,000Spent : 323,610
Funds meant to facilitate implementation of the activities were diverted to construct a staff canteen and orthopaedic workshop at a contract sum of UGX 198,345,610 and UGX 26,390,000* respectively.
08585: Purchase of Medical Equipment
Budgeted: 300,000Released: 300,000Spent : 300,000
Funds were diverted for emergency repair and maintenance of a CT-scan and an X-Ray ma-chine at a contract sum of UGX 323,099,860.331 and UGX 24,143,140 respectively.
Source: OAG review of the approved annual work plans, MPS, Budget estimates and 4th quarter vote performance reports 2017/2018
Outputs without targets and performance indicators
As observed above, the assessment of delivery of expected outputs could not be undertaken for the nine (9) planned outputs falling under five (5) entities.This was due to lack of clear targets and peformance indicators for those outputs. Details of these outputs are shown in Table 5 below;
20 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Table 5: Showing outputs without targets and performance indicators
Entity Project Output Approved budgetUGX (‘000’)
Amount releasedUGX (‘000’)
Amount SpentUGX (‘000’)
MINISTRY OF HEALTH
Project 1027: Institutional support to ministry of health
080280:Hospital construction/ rehabilitation
1,620,000 1,620,000 1,620,000
080201: Monitoring, Super-vision and Evaluation
122,000 122,000 121,800
UBTS Safe blood Provi-sion
Purchase of office and ICT equipment
100,000 100,000 100,00
Purchase of office and Resi-dential furniture and fittings
20,000 20,000 19,800
FORT PORTAL RRH
0856: Regional Referral Hospital Services
08572: Government Build-ings and Administrative Infrastructure
39,572,000 39,572,000 37,200,000
08581: Staff houses construction and rehabilitation
882,428,000 882,428,000 54,893,000
MASAKA RRH Output 085682: Maternity ward construction and rehabilitation
1,558,000 1,558,000 1,027,655
MBALE RRH 1004: Mbale Reha-bilitation Referral Hospital
085683: OPD and other ward construction and rehabilitation (Construc-tion of surgical and cancer ward)
2,000,000 2,000,000 1,999,666
85685: Medical Equipment 227,571 227,571 227,359
Discussed in the next section are the various factors that impact on the delivery of the expected outputs in the sector. The factors arise from the review of the key processes resulting to planning, budgeting, release and utilization of funds, monitoring and evaluation.
4.2 PLANNING AND BUDGETING
The NDPII stresses the importance of the alignment of planning and budgeting instruments to ensure ef-ficient and timely implementation of activities while keeping the focus on national priorities. Section 13 (6) PFMA, 2015 requires the annual budget to be consistent with, the National Development Plan, the Charter of Fiscal Responsibility and the Budget Framework Paper. This alignment also ensures accurate reporting of the outputs and outcomes planned in the NDPII, sector and MDA plans.
A review of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority (NPA) indicated that the Health sector is 51.7 percent compliant. Specifically, the sector performed at 88%, 38.1%, 67.6% and 37.3% at planning, project implementation, budget process instruments (BFP and AB) and annual budget performance, respectively. The performance was on account of low budget absorption by the majority of health sector institutions especially under projects. The perfor-mance of the selected individual public spending entities in the health sector is summarized in the Table 6 below;
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Table 6: Summary of Selected Health Sector and MDA Compliance Assessment (%)
S/N MDA Planning Alignment (BFP & AB)
Budget Performance
Projects Performance
Total Score
1. Budget Performance 100 56.5 0.0 0 21.3
2. Uganda Blood Transfusion Service
100 70 40.0 40.0 52.0
3. Mulago Hospital Complex 0 83.0 60.0 65.1 54.1
4. Fort Portal Referral Hospital
0 70.0 40.0 95.1 54.5
5. Gulu Referral Hospital 100 36.9 40.0 95.1 61.9
6. Masaka Referral Hospital 100 69.8 40.0 77.5 69.2
7. Mbale Referral Hospital 100 56 40 40 55.2
8. Mbarara Referral Hospital
100 89.2 40.0 57.5 67.1
Source: OAG review of the certificate of compliance of the annual budget 2017/18 assessment report by National Planning Authority
As shown in the table above, the sector is doing well in terms of strategic planning as six (6) out of the eight (8) selected entities have approved strategic plans. Also available is the approved health sector development plan which is aligned to the NDPII. However Mulago Hospital Complex and Fort Portal RRH scored 0% at planning on account of not having approved strategic plans. In terms of budget performance, the sector was 37.3 percent compliant on account of its performance on budget outturn and expenditure outturn.
Furthermore, from the review of the NDPII and the MPS for the financial year 2017/18, the audit team established that programs and projects worth UGX 66,074,296,000 that were prioritized and planned to be implemented by Ministry of Health and whose funding accordingly released in the financial year 2017/18 from both development partners and government of Uganda were not among the health sector priority projects proposed under the NDPII.
MoH indicated that these projects came along after the approval and commencement of the NDPII and after the Ministry had negotiated and secured funding from development partners.
Although they indicated that the interventions/projects were in line with the sector objectives, the certificates of compliance were not availed to justify their prioritization.
Adoption of projects not aligned to the NDPII poses a risk of government not achieving the expected national development objectives and outcomes for the health sector as set out in the national development plan.
A further comparison of the Ministerial Policy Statement (MPS) 2017/18 and the approved budget estimates revealed that some outputs were allocated funds in the approved budget but the allocations in the MPS were not in tandem with the amounts reflected in the approved budget for the same year. Details are in Table 7 below;
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Table 7: Showing inconsistencies between the MPS FY 17/18 and the approved budget estimates
Project Output MPS Amount (UGX) Approved budget estimates (UGX)
1027: Institutional support to MoH
080275: Purchase of motor vehicle and other transport equipment
0 20,000,000
080276: Purchase of office and ICT Equip-ment including software.
0 55,000,000
1243: Rehabilitation and Con-struction of General Hospi-tals
080280: Hospital construction/ rehabilitation
300,000,000 450,000,000
1315: Construction of special-ized neonatal and maternal Unit in Mulago Hospital
080280: Hospital construction/ rehabilitation
0 1,500,000,000
1436: Gavi vaccines and Health sector Development plan support
080572: Government buildings and ad-ministrative Infrastructure
0 6,18,906,000
080575: Purchase of Motor Vehicles and other transport Equipment
not Indicated 4,596,775,000
080577: Purchase of Specialized Machin-ery and Equipment
not Indicated 15,355,562,000
Source: OAG analysis of the MPS and approved budget estimates FY 17/18
Inconsistencies between the MPS and the approved estimates are partly caused by failure by MoH to properly document the adjustments agreed upon during the budget approval process. Such inconsistencies can pose a challenge in performance reporting.
Management explained that the adjustments are communicated to MoH through minutes by the secretary to the parliamentary committee on health, and these changes are updated on the system (PBS tool) and forwarded to the ministry of finance. Furthermore, according to the officials from the MoH planning department, the copies of the adjusted MPS are not printed because of cost implications.
Management ResponsesIt is now a requirement that all projects implemented by Government have to be approved by the Development Committee of Ministry of Finance Planning and Economic Development and a certificate of compliance has to be provided by Parliament as a pre-requisite for approval of loans. Therefore, the projects mentioned were aligned to the NDP II as required by Government.
Management wishes to note that the MPS is presented to Parliament in April while the budget is approved in June and it is during this period that most development partners confirm their allocations. This is the main reason for variations as well as re-allocations and recommendations made by Parliament. Our approved budget estimates are consistent with the annual work plan.
Audit CommentCertificate of compliant was not presented to justify prioritization of the interventions. RecommendationsManagement should;a) Strive to always give priority to the proposed NDPII health sector interventions and targets during planning and budgeting. The tendency to take on new projects outside NDPII projects should be restrained or undertaken in accordance with the national planning framework.
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b) Ensure that the MPS is adjusted to reflect any changes approved by parliament as indicated in the approved budget estimates.
4.3 RELEASE/DISBURSEMENT PERFORMANCEAfter approval of the annual budget by Parliament, the Secretary to Treasury issues, the annual cash flow plan of Government, based on the procurement plans, work plans and recruitment plans approved by Parliament and this forms the basis for release of funds by the Accountant General to the Accounting Officers.During the FY 2017/2018, out of the total UGX. 1.95 trillion allocated to the Health Sector, UGX. 1.28 trillion which represents 66% was released. All votes received about 100% of the budget except MoH with only 36%.
For the selected sample of eight (8) entities, the review of the Ministerial policy Statements, approved Budget estimates and the Health Sector performance report showed that Parliament appropriated a total of UGX. 1,088,.092 bn for the eight (8) entities to cater for recurrent expenditure (UGX. 148.805 bn) and capital development (UGX. 939.287 bn). Out of the recurrent budget, UGX. 143.367 bn (96.3%) was released while for capital development budget the disbursements amounted to UGX. 338.881 bn (36.1%) representing a shortfall of UGX. 5.438 bn (3.7%) and UGX. 600.407 bn (63.9%) respectively. Details of release performance are shown in Table 8 below;
Table 8: Showing Release performance for Selected Health Sector Entities FY 2017/18
Entity Budget Component
Approved Budget (UGX billions)
Amount Released/ disbursed (UGX billions)
Variance (UGX billions)
% Variance
Ministry of Health
Recurrent 64.485 59.636 4.849 7.52%
Capital Development
907.255 306.863 600.393 66.2%
Mulago hospital complex
Recurrent 44.997 44.997 0 0%
Capital Development 22.02 22.02 0 0%
UBTS Recurrent 12.701 12.701 0 0%
Capital Development 0.37 0.356 0.014 3.8
Mbale RRH Recurrent 6.935 6.935 0 0%
Capital Development 3.058 3.058 0 0%
Mbarara RRH Recurrent 4.79 4.79 0 0%
Capital Development 1.978 1.978 0 0%
Gulu RRH Recurrent 5.46 5.46 0 0%
Capital Development 1.488 1.488 0 0%
Masaka RRH Recurrent 4.159 4.159 0 0%
Capital Development 2.058 2.058 0 0%
Fort Portal RRH Recurrent 5.278 5.278 0 0
Capital Develop-ment 1.06 1.06 0 0%
Total 1,088.092 482.837 605.256 55.6%Source: OAG review of the MPSFY 2017/18, IFMIS Budget analysis report and Annual Health Sector performance report 2017/2018.
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The table above shows that overall 44.4% of the approved budget was realized by the entities. Most of the entities received their entire budgetary allocations except MoH which realized 37.7%. For MoH the shortfall was caused by low disbursement performance from external financing as only 33.8% of budgted funds were realised. Regarding counterpart funding, it was observed that government released 103% of its expected counterpart funding contributions on all the externally funded projects as shown in Table 9 below.
Table 9: Showing percentage release of external financing Vs GoU counterpart funding
Component Approved Budget (UGX billions)
Amount released (UGX billions)
Percentage of Budget released
External financing 878.415 269.532 30.7%
GoU counterpart funding 15.389 15.83 103%
Source: MPS FY 2017/18, IFMIS payment file, budget estimates, Project financial statements and MoH Cumulative Vote
performance report for the 4th quarter
Analysis by the audit team indicated that due to the poor release performance, a number of outputs and tar-gets were either not implemented or partially implemented. For example under MoH, the analysis showed that for a selected sample of five (5) capital development projects having an appropriation of UGX 131.08 bn and amount released of UGX 29.01 bn constituting (3.2%) of the capital development appropriation and (9.45%) of the amount released respectively, over 77% of the amounts allocated funds were not released/ disbursed for implementation of activities. Consequently, seven (7) of the nine planned (9) outputs did not receive funds and were not implemented as indicated in Table 10 below;
Table 10: Showing Unreleased funds on sampled outputs under MoH
Program/ Project Output Budgeted Amount
(UGX ‘000’)
Amount released (UGX
‘000’)
Variance (UGX ‘000’)
% variance
Reasons for Variance
1436: Gavi vac-cines and Health sector Develop-ment plan sup-port
080572: Govern-ment buildings and administra-tive Infrastruc-ture
6,188,906 0 6,188,906 100 The donor did not release funds. Due to some pending verifica-tions of the first phase of the Health Systems Support 1(Appendix V)
080575: Pur-chase of Motor Vehicles and other transport Equipment
4,596,775 0 4,596,775 100 The donor did not release funds. due to some pending verifica-tions of the first phase of the Health Systems Support 1(Appendix V)
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Program/ Project Output Budgeted Amount
(UGX ‘000’)
Amount released (UGX
‘000’)
Variance (UGX ‘000’)
% variance
Reasons for Variance
Project: 1440 Uganda Repro-ductive Mater-nity and Child Health Services Improvement Project
080276: Procure-ment of birth, death registra-tion mobile ser-vices procured for NIRA
2,695,472 0 2,695,472 100 The procurement was re-tendered because the allocation made was not enough to cover the scope of works (Appen-dix V)
Full procurement of critical medi-cal equipment
4,000,000 0 4,000,000 100 The needs assessment of the health centres countrywide for medical equipment hadn’t been done (Appendix V)
Construction of maternity units in selected health centres
11,522,195
0
11,522,195 100 Management hadn’t developed technical designs for the con-structions.(Appendix V)
Project: 1344 Renovation and Equipping of Kayunga and Yumbe General Hospitals
080277: medical equipment for full equipping of Kayunga and Yumbe hospitals
6,700,000 0 6,700,000 100 Procurement of Equip-ment had to await com-pletion of works on the hospitals. (Appendix V)
080280: 30% of civil works for rehabilitation and expansion of Kayunga and Yumbe Hospitals completed
27,885,000 19,322,667 8,562,333 30.7 The project started late due to procure-ment delays and so the anticipated completion of works couldn’t be achieved. (Appendix V)
Project: 0220 global Fund for Aids, TB and Malaria
080572: Con-struction of med-icines warehouse in Kajjansi
48,214,788 0 48,214,788 100 The project was implemented by NMS. (Appendix IV)
Project: 1243 Rehabilitation and construc-tion of General hospitals
080280: rehabili-tation of equip-ping of Kawolo and Busolwe hospitals
19,282,000 9,688,432 9,593,568 49.8 Works at Busolwe did not start as anticipated because of funding challenges (Appendix V)
Total 131,085,136 29,011,099 102,074,037 77.9% Source: OAG review of the MPS FY 17/18, and the IFMIS Budget analysis reports
It was observed that for the majority of outputs, MoH made unrealistic plans and targets for the outputs and lacked the necessary preparedness to execute them.
This not only distorts the overall planning and budgeting of government but also delays the implementation and accrual of benefits to the intended beneficiaries.
RecommendationManagement should ensure that all the necessary preparations in terms of feasibility, baseline studies, needs assessments and execution plans are done and strictly followed as laid out in the Project documents to enable timely disbursement of funds from donors.
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4.4 UTILIZATION / ABSORPTION OF FUNDSAccording to PFMA 2015, Sec. 21(1) an Accounting Officer shall, based on the annual cash flow plan issued by the Secretary to the Treasury under section 15, plan and manage the activities as indicated in the policy statement of the vote. Out of the total release of UGX 1.28 trillion, the health sector spent a total of UGX 1.191 trillion representing 93.04% of the released amount. For the 8 selected entities the analysis showed that the entities spent 79% of the amount released as shown in Table 11 below.
Table 11: Showing Health Sector approved budget absorption rates FY 2017/18
Entity Budget Component
Approved Budget
(UGX billions)
Amount Released
(UGX billions)
Amount Spent (UGX billions)
Balance Unspent
(UGX billions)
% of unspent balances
Ministry of Health
Recurrent 64.485 59.636 56.197 3.439 5.77
Capital Development 907.255 306.863 217.129 89.73429.24
Mulago hospital complex
Recurrent 44.997 44.997 41.587 3.41 7.58
Capital Development 22.02 22.02 22.02 0 0.00
UBTS Recurrent 12.701 12.701 12.37 0.331 2.61
Capital Development 0.37 0.356 0.353 0.003 0.84
Mbale RRH Recurrent 6.935 6.935 6.685 0.25 3.60
Capital Development 3.058 3.058 3.057 0.001 0.03
Mbarara RRH
Recurrent 4.79 4.79 4.363 0.427 8.91
Capital Development 1.978 1.978 1.951 0.027 1.37
Gulu RRH Recurrent 5.46 5.46 4.653 0.807 14.78
Capital Development 1.488 1.488 1.487 0.001 0.07
Masaka RRH
Recurrent 4.159 4.159 4.007 0.152 3.65
Capital Development 2.058 2.058 2.058 0 0.00
Fort Portal RRH
Recurrent 5.278 5.278 4.434 0.844 15.99
Capital Development 1.06 1.06 1.057 0.003 0.28
Total 1,088.092 482.837 383.408 99.429 20.59
Source: OAG review of the approved budget estimates, MPS, IFMIS payment files and vote performance reports 2017/2018
The eight (8) selected entities did not absorb a total of UGX 99.429 bn representing 20.59% of the released funds. The unutilized funds were mainly funds earmarked for construction projects, procurement of special-ized medical equipment, pension, gratuity and social contribution, among others. Six (6) entities absorbed approximately 99% of their capital development budgets whereas MoH was unable to absorb 29.2% of its capital development release.
Failure to absorb funds was attributed to Procurement delays, and delayed verification of decentralised pensioners in Regional Referral Hospitals. Management ResponseLong procurement processes and delays in obtaining necessary approvals from development partners including release of funds remain critical challenges to the absorption of externally financed projects.
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RecommendationManagement should:a) Initiate the procurement processes early enough and seek the necessary approvals from the key stakeholders to ensure that the released funds are absorbed as planned.b) Expedite the verification process of all pensioners to ensure timely payments of pension and gratuity.
Further analysis of the performance of the selected outputs revealed that in addition to poor release performance, the delivery of the expected outputs was affected by budget variations such as reallocations, diversion/ mischarge of funds and delays in procurement as further discussed in the paragraphs below;
4.4.1 Re-allocation of Funds on selected outputsOut of the eight (8) selected health sector entities, reallocations of funds were observed only in MoH. From the review of the ministry’s six (6) selected outputs falling under 5 projects, the audit team established that a total of UGX 483,583,000 representing 9.8% of the output budget allocation was reallocated from the selected outputs towards other activities as shown in Table 12 below:
Table 12: Showing Funds Re-Allocation for a selection of outputs
Programme/project Output Budget allocation
(UGX ‘000’)
Re-allocation (UGX ‘000’)
% Output/ Programme reallocations
1027: Institutional support to MoH
080272: Ministry of health Headquar-ters renovated following the fire and office accommodation modernized
1,542,000 (154,000) 10%
080280: Hospital construction/ reha-bilitation
1,800,000 (180,000) 10%
Project: 1187 Support to Mu-lago Hospital Rehabilitation
080280: Hospital construction/ reha-bilitation
950,000 (95,000) 10%
Project: 1243 Rehabilitation and construction of General hospitals
080280: Rehabilitation of equipping of Kawolo and Busolwe hospitals(GoU Development)
300,000 (30,000) 10%
Project: 1344 Renovation and Equipping of Kayunga and Yumbe General Hospitals
080201: Monitoring, Supervision and Evaluation
300,820 (18,490) 6%
Project: 0220 Global Fund for AIDS, TB and Malaria
080503: Monitoring, Supervision and Evaluation (GoU contribution- mainte-nance of vehicles)
60,930 (6,093) 10%
Total 4,953,750 (483,583) 9.8%
Source: OAG analysis of the approved budget estimates, payment file, and IFMIS Budget analysis report FY 2017/18
In spite of the reallocations, MoH did not adjust the corresponding planned output targets to reflect the corresponding changes in the budgetary allocations. For example, the target of 50% completion of works for FY 2017/18 Busolwe general hospital was not adjusted among others.
Management ResponseManagement wishes to note that changes arising out of re-allocations are automatically reflected in the IFMS.
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RecommendationManagement should always re-adjust work plans and re-set planned output targets after funds re-alloca-tions on the various outputs as this will facilitate accurate reporting on the achievement of planned outputs.
4.4.2 Diversion of FundsSection 10.4 of the treasury instructions 2017 states that, in reviewing payment requests, an Accounting Officer shall have a primary responsibility of ensuring that there is no mischarge and diversion of funds through wrong coding of transactions and an Accounting Officer shall be held personally liable for any wrong charge accounts used for expenditure incurred by his or her vote.
A review of the Annual approved estimates, Work plans and the payment file for the sampled outputs revealed that a total of UGX 28.73 billion was diverted from the planned outputs towards other activities without authority as shown in Table 13 below;
Table 13: Showing funds diverted from the planned sampled outputs
Entity Amount Released
(UGX)
Amount Diverted
(UGX)
% of diversions
Ministry of Health 22,528,959,000 13,060,409,000 58
Mulago hospital complex 22,020,000,000 14,203,379,232 64.5
UBTS 87,942,000 80,092,259 91.1
Fort Portal RRH 1,020,428,000 59,200,000 5.8
Gulu RRH 1,338,000,000 146,500,000 10.9
Masaka RRH 2,058,000,000 278,577,914 13.5
Mbale RRH 580,709,000 119,719,823 17.1
Mbarara RRH 1,050,000,000 522,818,030 49.8
Total 50,684,038,000 28,470,287,258 56.2
Source: OAG analysis of the payment files and IFMIS Budget analysis reports 2017/2018
The analysis showed that on average over 50% of the funds released for the above Sub-Programs were not spent on the planned outputs (details in Appendix V).This impacted on the achievement of the planned outputs. For example Motor vehicles for support supervisions and districts, under the Uganda Reproductive Maternal and Child Health services Improvement Project, construction of the Regional hospital for pediatrics surgery all under MoH, Monitoring, supervision & Appraisal of capital works at Fort Portal RRH, Renovation of maternity and Surgical wards to improve on the labour suite and all other service areas on the two wards, and Purchase of assorted medical equipment including monitors for high dependency units (Sterilizers and laundry machines) in Mbarara RRH among others were affected by the diversions above.
RecommendationManagement is advised to desist from diverting funds towards unplanned activities. Where budget variations are inevitable, approvals for reallocations should be sought and planned targets adjusted accordingly. 4.4.3 Timeliness of the procurement processIn order to achieve timely delivery of services, procurement processes must be undertaken in a manner that ensures that the best service providers are identified in time.
For this analysis the team assumed that an efficient health sector entity would require at most sixty (60) days to complete the procurement of a service provider /contractors (from approval of bid documents to contract signing) as broken down in table 14 below;
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Table 14: Detailing the time required for different activities of the procurement process
No Procurement activity Maximum no of days required
1 Approval of bid documents 5
2 Advertising for cases of open bidding 15
3 Evaluation of bids 5
4 Approval of evaluation reports 2
5 Notice of best-evaluated bidders 10
6 Approval/ clearance from Solicitor General 14
7 Contract signing 3
8 Any other activities that may be necessary 6
Total required days 60
The audit team analysed time taken between the date of approval of bid and the date of contract signing by the health sector entities.It was established that three (3) out of eight (8) selected health sector entities that is; MoH, Mbarara RRH and Mbale RRH lost significant amount of time between the date of approval of bid document and contract signing. From the analysis of the time between the date of bid approval and the date of contract signing, audit observed that the procurement process took more than 60 working days before contracts with contractors and service providers were signed. The delays ranged from 10 to 417 days as indicated in Appendix VII.
The procurement delays in the externally funded projects were attributed to long approval requirements by donors at various stages. For GoU capital development projects the procurement delays were attributed to changes in designs and administrative reviews that resulted into re-evaluation.Delays in the execution of the procurement processes translate into delays in project implementation which affects the timely realisation of the Programme outputs.
Management Response Advice is noted. Steps are being taken to improve procurement efficiency. Two specialists for MoH have been recruited to help improve capacity of the Procurement and Disposal Unit. This notwithstanding, delays still occur because of the lengthy consultative process requiring development partners to approve each stage of the procurement process.
RecommendationManagement should endeavour to expedite the procurement processes early enough most especially where approvals are required from stakeholders to facilitate timely implementation of planned activities.
4.5 MONITORING AND EVALUATION To ensure effective monitoring of the national health strategy, the MoH which is the lead sector agency de-veloped the M&E plan for the HSDP with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance. All programs and projects are also expected to develop specific program/project M&E Plans which should include Programme indicators to measure process, outputs and immediate outcomes. These should be aligned with the goal, objectives and strategic interventions of the HSDP to demonstrate the effects of health system strengthening to health outcomes12.
12 MoH Strategic Plan 2015/2016-2019/2020
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In addition, the MoH M&E Framework for implementation of the HSDP points out that annual program/ project reports are a requirement from all programs and projects based on their specific M&E plans. Progress review reports shall be submitted to the MoH M&E unit before the annual sector reviews.
From the Interviews held with project coordinators, heads of departments and accounting officers in the selected entities, the audit team established that there were no specific monitoring and evaluation work plans with clear set targets and indicators to facilitate monitoring of planned activities for the programs and projects selected for review. It was further noted through review of the expenditure files that although funds amounting to UGX 1,287,353,819 were spent on monitoring and evaluation of projects and programs, there were no specific monitoring and evaluation reports on file to confirm that the expected M&E activities were carried out and recommendations made for corrective action.
This was partly caused by lack of fully-fledged M&E units/committees to plan and monitor all the programs and projects as per the designed M&E frameworks/ strategic plans. There was no specific sector M&E team to consolidate all the reports generated from other health sector agencies and local governments to enable enforcing of recommended corrective actions. As a result, performance gaps could not be identified timely to facilitate r corrective action. In addition, data validation could not be done which led to inconsistencies in reporting on the sector performance.
Accounting officers explained that whereas there is no fully fledged M&E units/ committees the Programs and projects implemented under each entity have project managers appointed and responsible for ensuring proper implementation of the Programmes/projects. For MoH, the infrastructural projects always appoint supervising consultants to conduct monthly reviews and assessment of the progress of works and report to the Ministry accordingly. Further, various Government organs and units such as Budget Monitoring and Accountability Unit (BMAU) and Office of the Prime Minister (OPM) monitoring units provide adequate monitoring of programs and projects implemented under the selected entities.
Management Response Traditionally the MoH has been employing M&E Personnel but deployed under different programs for example GAVI, Global Fund and World Bank projects. As auditors observed, there is need to coordinate the M&E officers in the Ministry. The Ministry has requested the Ministry of Public Service to allow for establishment of an M&E unit in the Ministry of Health. Approval is now awaited.
Audit CommentThe monitoring of activities in the selected institutions are not properly coordinated since there are no reports produced with recommendations for corrective action to be enforced by management or designated M&E committees.
RecommendationAll health sector entities are advised to constitute M&E units to properly coordinate the monitorng and implementation of activities, consolidate all the reports generated from the individual Programme/project monitoring teams/committees and follow up recommended corrective actions. In addition, the established units should ensure that specific M&E plans are developed with clear indicators and targets for assessing performance and ensure availability of accurate and timely information on health sector performance.
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Performance Reporting According to the budget execution circular 2017/18 Accounting Officers are required to submit quarterly budget performance reports indicating the actual performance against the planned outputs and perfor-mance for each quarter showing the quality/quantity and physical location of the reported outputs against expenditure using the format in the PBS.13
Review of the annual work plans, approved budget estimates and the 4th quarter cumulative performance reports indicated that in all the selected health sector institutions, there were errors and inconsistencies in reporting on the delivery of outputs and in some instances there was no relationship between the planned outputs and the actual reported achievements. Also the revised approved budget figures in the Ministerial policy statements and cumulative vote performance reports were at variance with the Actual revised budg-eted figures captured in the IFMS. Details are indicated in Appendix VIII.
Accounting officers explained that FY 2017/2018 was the first year of implementation of the PBB system hence the user challenges. However, they indicated that in case of any revisions to the work plans or mis-charge/ diversions, the system does not put those into consideration during report generation hence the inconsistencies.
Inaccurate reporting by the sector distorts the government annual performance information and may result in inappropriate policy decisions.
RecommendationsManagement should ensure that the performance is accurately reported to inform appropriate government policy actions.
OVERALL CONCLUSION Overall the selected eight (8) entities in the sector partially achieved their expected planned outputs for the year. The delivery of the expected outputs and targets was affected by weaknesses in planning, budget shortfalls, and challenges in absorption, procurement delays and budget variations among others. To im-prove on the output delivery, it is important that the existing weaknesses in monitoring and evaluation are also addressed to ensure corrective action and accurate information for decision making.
13 MoH Strategic Plan 2015/2016-2019/2020
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GLOSSARY OF KEY TERMS
Absorption Funds spent by MDA’s as a proportion of the funds released from Central Government approved Budget. This is the appropriated budget by the Parliament of the Republic of Uganda, which is normally undertaken in May of the proceeding, Financial Year.
Expenditure Actual spending by MDA’s (recorded by EFT transfers) reported on the IFMS and Legacy systems.
Item This is the lowest operational level of the budget, and represents the resources necessary to carry out activities, e.g. staff salaries, and travel inland, printing and stationery.
Key Performance Indicators These measure the performance of Programme Key Outputs, e.g. No. of health centres constructed.
Percentage of Budget Released This is the percentage of the approved budget (excluding supplementary budgets appropriated in year) that is released by Central Government.
Percentage of Budget Spent This is the percentage of the approved budget (excluding supplementary budgets appropriated in year) that is spent by MDAs through EFT transfers.
Sub-Programmes (Departments) These represent the results or sets of activities implemented by the Vote which contribute to the achievement of the Programme objectives. These are recurrent in nature, e.g. inspection of primary schools.
Sub-Programmes (Projects) These represent the results or set of activities implemented by the Vote which contribute to the achievement of Programme objectives. They primarily involve capital purchases and may be financed by the Government of Uganda and/or Development Partners, e.g. Emergency construction of specialized hospitals.
Release Central Government transfer of funds to MDA’s (including supplementary funds) from the consolidated fund.
Sector These are groups of institutions (Votes) or parts of institutions which contribute towards a common function, e.g. Health.
Supplementary Budget This is an in year addition to an MDAs’ approved budget. This budget is also appropriated by Parliament during the course of the Financial Year.
Unspent balances Funds that were released by Central Government but not spent by MDA’s. This calcula-tion does not include commitments (encumbrance) on the IFMS system.
Programmes These are groups of related services and capital investments delivered by a Vote or deliv-ered on behalf of that Vote by another institution e.g. Regional Referral services.
Votes These are institutions (Ministries, Departments, Agencies and Local Governments) which are the basis of the annual budget and appropriations made by Parliament, and the basis for accountability, e.g. Ministry of Health.
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OFFICE OF THE MINISTER
PERMANENT SECRETARY
NDA
Mulago National RH
Butabika National Mental RH UBTS
RRHs
UNHRO
UVRI UNCRI
UCI UHI
NMS
DIRECTOR GENERAL HEALTH SERVICE
DIRECTOR OF CLINICAL AND COMMUNITY
DEPARTMENT OF NURSING
DEPARTMENT OF NATIONAL DISEASE
DEPARMENT OF COMMUNITY
HEALTH
DEPARTMENT OF CLINICAL SERVICES
DIRECTOR OF PLANNING AND DEVELOPMENT
DEPARTMENT OF PLANNING
DEPARTMENT OF QUALITY
ASSURANCE
- PC - UMDPC - UNMC - AHPC
UGANDA AIDS COMMISSION
HEALTH SERVICE COMMISSION
DEPARTMENT OF FINANCE AND ADMINISTRATION
APPENDICES
Appendix I: Macro structure of the Health Sector
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Appendix II: Selected entities, programmes and sub programmes
SELECTED PROGRAMMES AND OUTPUTS APPROVED BUDGET (2017/18)
MINISTRY OF HEALTH 971,730,000,000
PROGRAM
Health infrastructure and equipment 97,747,000,000
SUBPROGRAM
District Infrastructure Support Programme
OUTPUTS:
Health center construction and rehabilitation 1,300,000,000
Staff houses construction and rehabilitation 500,000,000
SUBPROGRAM
Institutional support to MOH
OUTPUTS:
Government buildings and Administrative infrastructure 1,542,000,000
SUBPROGRAM
Italian support to HSSP and PRDP
OUTPUTS:
Staff houses construction and rehabilitation 5,619,000,000
SUBPROGRAM
Support to Mulago Hospital Rehabilitation
OUTPUTS:
Hospital construction/rehabilitation 950,000,000
SUBPROGRAM
Rehabilitation and construction of General Hospitals
OUTPUTS:
Hospital construction/rehabilitation 18,982,000,000
SUBPROGRAM
Renovation and Equipping of Kayunga and Yumbe General Hospitals
OUTPUTS:
Hospital construction/rehabilitation 27,885,000,000
Purchase of specialized Machinery and Equipment 6,700,000,000
SUBPROGRAM
Regional Hospital for Pediatric Surgery
OUTPUTS:
Hospital construction/rehabilitation 800,000,000
Purchase of Motor Vehicles and Other Transport Equipment 2,847,330,000
Purchase of office and ICT Equipment, including software 2,695,472,000
Purchase of Specialised Machinery and Equipment 7,319,536,000
Health center construction and rehabilitation 11,522,195,000
PROGRAM
Pharmaceutical and other Supplies
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SUBPROGRAM
Global Fund for Aids, Tb and Malaria
OUTPUTS:
Government building and Administrative infrastructure 48,214,788,000
Purchase of motor vehicles and other transport equipment 3,415,496,000
Purchase of specialised machinery and equipment 31,857,132,000
SUBPROGRAM
GAVI Vaccines and Health centre development plan support
OUTPUTS:
Government building and Administrative infrastructure 92,431,000,000
MULAGO NATIONAL REFERRAL HOSPITAL 67,020,000,000
PROGRAM
National Referral Hospital Services
OUTPUTS:
Demolition and Rebuilding of OPD and ICU 22,170,000,000
OUTPUT
OPD and other ward construction and Rehabilitation 22,520,000,000
UGANDA BLOOD TRANSFUSSION SERVICES 13,060,000,000
PROGRAM
Safe Blood Provision
OUTPUTS:
Collection of blood 3,800,000,000
Purchase of motor Vehicle and other transport Equipment 250,000,000
Purchase of office and ICT equipment 100,000,000
Purchase of office and Residential furniture and fittings 20,000,000
: 085301 Administrative support services
-Management of facilities
-Replacement of old vehicles
-Maintenance of laboratory equipment
-Recruitment
1,000,000,000
: Administrative Support services
Construction of regional blood banks.
Maintenance of existing facilities.
-Supervision and clinical interface to hospital clinicians and administrators.
-Recruitment of staff.
4,001,168,000
MBALE REGIONAL REFERRAL HOSPITAL 10,000,000,000
PROGRAM
Regional Referral Hospital Services
SUBPROGRAM
Mbale Rehabilitation Referral Hospital
OUTPUTS:
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OPD and other ward construction and rehabilitation (Construction of surgical and cancer ward) 2,000,000,000
Other structures ( Construction and installation of a new incinerator and Renovation of acute care unit
500,000,000
Machinery and Equipment ( Purchase of hospital vehicle 200,000,000
Office Equipment 130,000,000
Medical Equipment 227,571,000
SUBPROGRAM
Institutional support to Mbale Regional Hospital
OUTPUT:
OPD and other ward construction and rehabilitation 830,429,000
MBARARA REGIONAL REFERRAL HOSPITAL 6,770,000,000
PROGRAM
Regional Referral Hospital Services
SUBPROGRAM
Mbarara rehabilitation Referral Hospital
OUTPUT:
Purchase of a transport equipment- To buy a 30 seater van for transporting staff members during different official functions
400,000,000
Renovation of Maternity ward and surgical ward to improve on the labor suit and all other ser-vice areas on the two wards
350,000,000
Purchase of assorted medical equipment including monitors for high dependence units 300,000,000
16 unit staff quarters completion 928,000,000
GULU REGIONAL REFERRAL HOSPITAL 6,950,000,000
PROGRAM
Regional Referral Hospital Services
SUBPROGRAM
Gulu Rehabilitation Referral Hospital
OUTPUT:
Construction of 54 Unit staff houses 1,338,000,000
Demolition of the old radiology building 50,000,000
Procurement of assorted medical equipment 100,000,000
FORT PORTAL REGIONAL REFERRAL HOSPITAL 6,345,000,000
ROGRAM
Regional Referral Hospital Services
SUBPROGRAM
Fort portal rehabilitation Referral Hospital
OUTPUTS:
Staff houses construction and rehabilitation 882,428,000
Purchase of Medical Equipment 138,000,000
Government Buildings and Administrative Infrastructure 39,572,000
37A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Appendix III: Documents Reviewed
Document Reviewed Implementing Agency Purpose
Second National Devel-opment Plan 2015/16-2019/20 (NDPII)
Ministry of Health & affiliated autonomous institutions
• To ascertain the key priority objectives sector objectives that are to be pursued by the implementing agencies under the health sector
Second National Health policy 2010
Ministry of Health & affiliated autonomous institutions
• To ascertain those policies adopted by the health sector and their alignment with the NDPII.
• To establish how those key priority objectives that the health sector is to pursue.
• To understand the legal background/ frame work and mandate of the Health sector.
Health Sector Strategic and Investment Plan (HSSIP) 2010/11-2014/15
Ministry of Health & affiliated autonomous institutions
• To ascertain the long and medium-term agenda of the health sector and the alignment with the NDP and the National Health Policy.
• To establish how those identified key priority areas of the health sector are planned for in the HSSIP
Current Sector Devel-opment Plan (SDP) 2015/16-2019/20
Ministry of Health • To ascertain if the Sector development plan feeds into the long and medium-term agenda of the health sector and To establish how those identified key priority areas of the health sector are planned for in the SDP.
Ministerial Policy Statement and Budget Framework paper for F/Y 2017/18
Ministry of Health • To establish and identify the planned activities to be undertaken by the sector for the period 2017/18 and funds allocated on the different key priority areas as identified in the NDPII, HSSIP, SDP and the National Health Policy
Annual Approved Budget Estimates 2017/18
Ministry of Health and other affiliated autono-mous institutions
• To ascertain the approved funds allocated to the key priority areas under the health sector.
Annual Sector Perfor-mance Report 2017/18
MoH and affiliated autonomous health sector institutions
• To establish the level of performance in achieving the set targets regarding the identified key priority areas under the health sector.
• To establish the levels of absorption in the health sector in regards to the key priority areas.
BMAU Reports and oth-er budget monitoring reports
Ministry of Health and MFPED
• To ascertain the frequency and scope of monitoring activities and the extent to which follow-up of recommendations for implementations of the projects are undertaken.
Contract Management records (certificates of work done, contracts, BOQs, minutes of Site meetings etc.)
Sampled health sector institutions
• To establish if the processes of contract management has been done with due regard to economy efficiency and effectiveness.
Procurement records (invitation for bids/ ad-verts, evaluation reports, contract award notices, etc.)
Sampled health sector institutions
• To establish if the processes of procurement of contractors has been done with due regard to economy efficiency and effective-ness.
Financial Management records (bank state-ments, payment vouch-ers, claims etc.)
Sampled health sector institutions
• To establish if the processes of financial management has been done with due regard to economy efficiency and effectiveness.
38 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Appendix IV: Interviews conducted
Person/s Entity Purpose
Accounting officer, Principle assistant Secretary (PAS)
Undersecretary MOH
MOH • To understand the strategic goals and objectives of the ministry.
• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority areas.
• To understand the roles and responsibilities played by the MoH and different entities in the implementation of the key priority activities.
• To understand the processes and key players in the implementation of the priority Programmes.
• To obtain the challenges faced and achievements made while implementing the key priority objectives and the way forward.
Accounting officer UBTS • To understand the strategic goals and objectives of UBTS.
• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority areas.
• To understand the roles and responsibilities played by UBTS in the implementation of the key priority sector activities.
• To understand the processes and key players in the implementation of the priority Programmes in the sector.
• To obtain the challenges faced and achievements made while implementing the key priority objectives and the way forward.
Hospital Medical directors and Admin-istrators
National and Regional Referral Hospitals
• To understand the strategic goals and objectives of the NRHs and RRHs.
• To obtain an understanding of the structures put in place to aid the implementation of the activities under the key priority Programmes.
• To understand the roles and responsibilities played by the NRHs and RRHs in the implementation of the key priority activities.
• To understand the processes and key players in the implementation of the key priority Programmes.
• To obtain the challenges faced and achievements made while implementing the key priority objectives and the way forward.
39A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
App
endi
x V:
Sho
win
g ex
tent
of d
eliv
ery
of p
lann
ed o
utpu
ts
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
MIN
ISTR
Y O
F H
EALT
H
Pro
ject
: 102
7 In
stitu
tiona
l su
ppor
t to
Min
istr
y of
H
ealt
h
0802
72: M
inis
try
of
heal
th H
eadq
uart
ers
reno
vate
d fo
llow
ing
the
fire
and
offic
e ac
-co
mm
odat
ion
mod
-er
nise
d
100%
full
reno
va-
tion
of th
e 3rd
-floo
r of
fices
1,54
2,00
01,
388,
000
1,38
8,00
01,
388,
000
100%
of t
he
thir
d 3rd
floo
r re
nova
ted
and
mod
erni
sed
Onl
y 40
% o
f the
bud
get-
ed/ r
elea
sed
fund
s w
ere
spen
t on
the
outp
ut (U
GX
553,
161,
416)
and
the
rest
, i.e
. 60%
was
div
erte
d to
unp
lann
ed a
ctiv
ities
. (U
GX.
830
,880
,584
)
Poo
r pl
anni
ng b
y M
an-
agem
ent
0802
75:
Pro
cure
men
t an
d di
stri
butio
n of
mot
or-
cycl
es
Two
mot
orcy
cles
pr
ocur
ed a
nd d
is-
trib
uted
20,0
0020
,000
20,0
0019
,764
Two
mot
orcy
cles
pr
ocur
ed a
nd
dist
ribu
ted
Nil
0802
75:
Pur
chas
e of
IT
Equi
pmen
t inc
ludi
ng
soft
war
e
Thre
e C
ompu
ters
fo
r th
e of
fice
of th
e P
S an
d Fi
nanc
e an
d A
dmin
pro
cure
dN
ew A
ir c
ondi
-tio
ner
proc
ured
and
in
stal
led
55,0
0055
,000
55,0
0055
,000
Thre
e C
ompu
t-er
s fo
r th
e of
fice
of th
e P
S an
d Fi
nanc
e an
d A
d-m
in p
rocu
red
New
Air
con
di-
tione
r pr
ocur
ed
and
inst
alle
d
Nil
0802
80:
Hos
pita
l con
stru
ctio
n/
reha
bilit
atio
n
No
Targ
ets
set f
or
the
outp
ut1,
800,
000
1,62
0,00
01,
620,
000
1,62
0,00
0N
/AN
/AFa
ilure
to s
et a
ppro
pria
te
targ
ets
and
indi
cato
rs
Mon
itori
ng, S
uper
vi-
sion
and
Eva
luat
ion
Hea
lth
syst
ems
mon
itore
d an
d ev
alua
ted
122,
000
122,
000
122,
000
121,
800
Hea
lth
syst
ems
mon
itore
d an
d ev
alua
ted
N/A
No
clea
r ta
rget
, ind
icat
ors
( fre
quen
cy o
f mon
itori
ng
and
repo
rtin
g)
40 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pro
ject
: 118
5 It
alia
n su
p-po
rt to
HSS
P
and
PR
DP
0802
82: 6
8 Co
nstr
uc-
tion
of s
taff
hou
ses
in
Kar
amoj
a re
gion
100%
com
plet
ion
of
the
68 s
taff
hou
ses
5,61
9,00
05,
619,
000
5,61
9,00
05,
619,
000
61.6
% c
ompl
eted
App
roxi
mat
ely
39.4
% n
ot
achi
eved
Don
or d
elay
ed to
dis
burs
e fu
nds
and
the
cont
rac-
tor
sto
p w
orki
ng s
ince
D
ecem
ber
2017
0802
01:
Mon
itori
ng, S
uper
vi-
sion
and
Eva
luat
ion
Mon
thly
mon
itori
ng
repo
rts
prod
uced
100,
000
100,
000
100,
000
100,
000
4 M
onito
ring
&
supe
rvis
ing
visi
ts
done
8 m
onth
ly m
onito
ring
vi
sits
not
don
e.Th
e nu
mbe
r of
vis
its r
e-du
ced
beca
use
the
cost
of
each
fiel
d vi
sit i
ncre
ased
in
clud
ing
invo
lvem
ent o
f Lo
cal l
eade
rs.
Pro
ject
: 118
7 Su
ppor
t to
Mul
ago
Hos
pita
l Re-
habi
litat
ion
0802
80: R
ehab
ilita
tion
and
equi
ppin
g of
low
er
Mul
ago
100%
com
plet
ion
of r
ehab
ilita
tion
of
low
er m
ulag
o
950,
000
855,
000
855,
000
855,
000
98%
of L
ower
m
ulag
o re
habi
li-ta
ted
2% n
ot a
chie
ved
Pro
ject
: 124
3 R
ehab
ilita
-tio
n an
d co
nstr
uctio
n of
Gen
eral
ho
spita
ls
0802
80: r
ehab
ilita
tion
of e
quip
ping
of K
awol
o an
d B
usol
we
hosp
itals
50%
of w
orks
com
-pl
etio
n on
Kaw
olo
and
Bus
olw
e
19,2
82,0
0019
,282
,000
4,02
0,00
03,
726,
879
57%
on
Kaw
olo
com
plet
ed.
0% o
n B
usol
we
com
plet
ed O
ver-
all c
ompl
etio
n (2
8.5%
)
21.5
% n
ot a
chie
ved
Wor
ks o
n B
usol
we
have
no
t yet
com
men
ced.
No
cont
ract
for
wor
ks. F
unds
no
t eno
ugh
to c
over
the
scop
e of
wor
ks n
eede
d,
0802
01:
Mon
itori
ng, S
uper
vi-
sion
and
Eva
luat
ion
Cons
truc
tion
wor
ks
supe
rvis
ed
80,0
0080
,000
80,0
0079
,930
Ann
ual p
roje
ct
supe
rvis
ion
re-
port
pro
duce
d
Ther
e is
no
outp
ut
indi
cato
r or
freq
uenc
y of
m
onito
ring
sho
wn
in th
e ta
rget
set
Ther
e is
no
outp
ut
indi
cato
r or
freq
uenc
y of
m
onito
ring
sho
wn
in th
e ta
rget
set
41A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pro
ject
: 134
4 R
enov
a-tio
n an
d Eq
uipp
ing
of K
ayun
ga
and
Yum
be
Gen
eral
H
ospi
tals
0802
77: m
edic
al
equi
pmen
t for
full
equi
ppin
g of
Kay
unga
an
d Yu
mbe
hos
pita
ls
fully
equ
ippi
ng o
f ho
spita
ls
6,70
0,00
06,
700,
000
00
Non
eN
o eq
uipm
ent p
rocu
red
for
the
hosp
itals
The
set t
arge
t was
unr
e-al
istic
sin
ce th
e m
edic
al
equi
pmen
t cou
ld o
nly
be
proc
ured
aft
er c
ompl
e-tio
n of
ren
ovat
ion
and
expa
nsio
n of
the
hosp
ital.
Ther
efor
e th
e do
nor
Coul
d no
t rel
ease
fund
s fo
r th
e eq
uipm
ent a
s pl
anne
d.
0802
80: 3
0% c
ivil
wor
ks fo
r re
habi
lita-
tion
and
expa
nsio
n of
K
ayun
ga a
nd Y
umbe
H
ospi
tals
com
plet
ed
30%
of c
ivil
wor
ks
com
plet
ion
27,8
85,0
0027
,885
,000
19,3
22,6
6721
,665
,067
15%
com
plet
ion
for
Kay
unga
and
7%
com
plet
ion
for
Yum
be (O
ver-
all c
ompl
etio
n 11
%)
19%
not
ach
ieve
d P
rocu
rem
ent d
elay
s.Ex
cess
fund
s sp
ent o
ver
the
rele
ase
(2,3
42,3
99)
wer
e di
vers
ions
from
ot
her
outp
uts
0802
01:
Mon
itori
ng, S
uper
vi-
sion
and
Eva
luat
ion
Twel
ve s
ite m
eet-
ings
hel
dCo
ntra
ct im
plem
en-
tatio
n m
onito
red
300,
820
282,
330
282,
330
282,
330
Twel
ve s
ite
mee
tings
hel
d fo
r ea
ch s
ite
and
cont
ract
im
plem
enta
tion
mon
itore
d
No
mon
itori
ng r
epor
ts
from
MoH
Sta
ff
Pro
ject
: 13
94 r
egio
nal
hosp
ital f
or
paed
iatr
ic
surg
ery
0802
80: c
ompl
etio
n of
50
% o
f civ
il w
orks
50
% c
ompl
etio
n of
w
orks
800,
000
9,42
8,03
99,
428,
039
7,22
7,11
240
% c
ompl
etio
n10
% n
ot a
chie
ved
Del
ays
in c
lear
ance
of
impo
rted
mat
eria
ls
Del
ays
in r
elea
se o
f co
unte
rpar
t fun
ding
, and
co
ntin
uous
req
uest
for
min
or c
hang
es in
the
desi
gns
by th
e do
nors
.D
iver
sion
of f
unds
(2
,200
,887
)
0802
01:
Mon
itori
ng, S
uper
vi-
sion
and
eva
luat
ion
Cons
truc
tion
of th
e ho
spita
l sup
ervi
sed
170,
000
170,
000
170,
000
169,
987
Mon
itori
ng w
as
only
don
e si
nce
Febr
uary
201
8
Wor
ks im
plem
ente
d in
th
e fir
st 3
qua
rter
s no
t m
onito
red
Ther
e is
no
outp
ut
indi
cato
r or
freq
uenc
y of
m
onito
ring
sho
wn
in th
e
42 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pro
ject
: 14
40 U
gand
a R
epro
duct
ive
Mat
erni
ty
and
Child
H
ealt
h Se
rvic
es Im
-pr
ovem
ent
Pro
ject
0802
80: P
rocu
rem
ent
of m
otor
veh
icle
s fo
r su
ppor
t sup
ervi
sion
21 m
otor
veh
icle
s pr
ocur
ed
2,84
7,33
02,
847,
330
2,84
7,33
02,
847,
330
Non
eN
o ve
hicl
es p
rocu
red
duri
ng th
e ye
arFu
nds
dive
rted
to p
rocu
re
med
ical
equ
ipm
ent
0802
76: P
rocu
rem
ent
of b
irth
, dea
th m
obile
se
rvic
es p
rocu
red
for
NIR
A
Firm
for
deve
lop-
men
t of b
irth
and
de
ath
regi
stra
tion
proc
ured
2,69
5,47
22,
695,
472
00
Non
e Te
nder
to b
e re
-ad
vert
ised
Fu
nds
allo
cate
d no
t en
ough
to e
xecu
te th
e sc
ope
of w
orks
. The
pr
ocur
emen
t had
to b
e re
-ten
dere
d.Th
e bu
dget
s w
ere
over
ly
ambi
tious
, tar
gets
unr
e-al
istic
.
0802
77: P
rocu
rem
ent
of c
ritic
al r
epro
duct
ive
equi
pmen
t
Full
proc
urem
ent
of c
ritic
al m
edic
al
equi
pmen
t
4,00
0,00
04,
000,
000
00
Non
eN
o eq
uipm
ent w
as
proc
ured
Man
agem
ent h
adn’
t don
e th
e ne
eds
asse
ssm
ent o
n th
e in
tend
ed b
enefi
ting
heal
th c
are
inst
itutio
ns.
0802
81: M
ater
nity
un
its c
onst
ruct
ion
in th
e se
lect
ed lo
cal
gove
rnm
ent’s
hea
lth
cent
res
Cons
truc
tion
of
mat
erni
ty u
nits
in
sele
cted
hea
lth
cent
res
11,5
22,1
9511
,522
,195
00
Non
eN
o co
nstr
uctio
ns d
one
A n
eeds
ass
essm
ent
hadn
’t be
en d
one.
Ther
e w
ere
no a
ppro
ved
desi
gns
for
the
proj
ect
43A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pro
ject
: 022
0 gl
obal
Fun
d fo
r A
ids,
TB
an
d M
alar
ia
0805
72: C
onst
ruct
ion
of m
edic
ines
war
e-ho
use
in K
ajja
nsi
% c
ompl
etio
n of
the
med
icin
e w
are-
hous
e
48,2
14,7
8848
,214
,788
NA
NA
NA
Ther
e w
as n
o ta
rget
se
t for
the
outp
ut in
the
wor
k pl
an
Out
put n
ot im
plem
ente
d by
MoH
0805
75: P
rocu
re 7
de-
liver
y tr
ucks
for
NM
S an
d JM
S 4
film
Van
s,
Stat
ion
Wag
on, 2
car
s fo
r M
&E
offic
ers
7 de
liver
y tr
ucks
pr
ocur
ed4
film
van
s pr
o-cu
red
2 ve
hicl
es p
rocu
red
3,41
5,89
63,
415,
896
3,41
5,89
63,
415,
896
2 fil
m v
ans
deliv
-er
ed83
mot
orcy
cles
pr
ocur
ed2
stat
ion
wag
ons
proc
ured
1 do
uble
cab
in
proc
ured
2 fil
m v
ans
not p
rocu
red
No
plan
for
mot
orcy
cles
1 do
uble
cab
in p
rocu
red
not i
n th
e w
ork
plan
.83
mot
orcy
cles
pro
cure
d no
t in
the
wor
k pl
an
Pro
cure
men
t del
ays
0805
77:
proc
ure-
men
t of A
utoc
lave
s,
Gen
eXpe
rt M
achi
nes,
M
icro
scop
es, F
orkl
ift,
med
icin
es s
helv
es
and
rack
s, m
edic
ines
bo
xes,
x-r
ay m
achi
nes
150
aut
ocla
ves
proc
ured
23
9 G
enex
pert
ma-
chin
es p
rocu
red
No.
of M
icro
scop
e pr
ocur
edN
o of
Xra
ys p
ro-
cure
dM
edic
ine
boxe
s m
ade
Shel
ves
cons
truc
ted
Fork
lift p
rocu
red
31,8
57,1
3231
,857
,132
31,8
57,1
3231
,857
,132
150
auto
clav
es
proc
ured
Med
icin
e bo
xes
mad
eM
edic
ine
shel
ves
cons
truc
ted
Fork
lift
veh
icle
pr
ocur
ed
The
x-ra
ys a
nd m
icro
-sc
opes
are
bei
ng p
rocu
red
thro
ugh
pool
ed p
rocu
re-
men
t mec
hani
sms
of th
e G
loba
l Fun
d w
hich
hav
e lo
nger
lead
tim
es. T
he
proc
urem
ent i
s on
cou
rse
and
deliv
ery
is s
ched
uled
fo
r M
arch
201
9.
44 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
1436
: Gav
i va
ccin
es a
nd
Hea
lth
sec-
tor
Dev
elop
-m
ent p
lan
supp
ort
0805
03:
Mon
itori
ng a
nd e
valu
-at
ion
capa
city
im-
prov
emen
t
No
targ
et s
et
425,
217
425,
217
207,
173
207,
173
No
outp
ut
achi
eved
Exte
rnal
fund
s w
ere
not
rele
ased
to im
plem
ent t
he
plan
ned
capi
tal o
utpu
ts.
Ther
efor
e, m
onito
ring
co
uldn
’t be
car
ried
. (th
e G
oU h
ad o
utst
andi
ng
issu
es to
hav
e th
e M
oU
final
ized
with
the
dono
r)
0805
01:
Pre
vent
ive
and
cura
-tiv
e M
edic
al s
uppl
ies
Pro
cure
1,43
7,60
0 H
PV
dose
s3,
362,
000
PCV
do
ses
1,59
1,50
0 P
enta
do
ses
2,91
7,50
0 R
ota
dose
sN
o ta
rget
s se
t for
IP
V do
ses
20,0
00,0
0020
,000
,000
10,0
00,0
004,
696,
110
881,
580
of H
PV
dose
s1,
914,
600
of P
CV
dose
s1,
911,
000
of
Pen
ta d
oses
556,
020
HP
V1,
447,
400
PCV
(319
,500
) Pen
ta1,
856,
700
Rot
a1,
713,
600
IPV
0805
72: G
over
nmen
t bu
ildin
gs a
nd a
dmin
is-
trat
ive
Infr
astr
uctu
re
6,18
8,90
66,
188,
906
00
Don
or d
id n
ot d
isbu
rse
fund
s du
e to
out
stan
ding
is
sue
in th
e M
oU
0805
75: P
urch
ase
of
Mot
or V
ehic
les
and
othe
r tr
ansp
ort E
quip
-m
ent
4,59
6,77
54,
596,
775
00
Don
or d
id n
ot d
isbu
rse
fund
s du
e to
out
stan
ding
is
sue
in th
e M
oU
Mac
hine
ry a
nd E
quip
-m
ent
15,3
55,5
6215
,355
,562
00
Don
or d
id n
ot d
isbu
rse
fund
s du
e to
out
stan
ding
is
sue
in th
e M
oU
MU
LAG
O H
OSP
ITA
L CO
MP
LEX
45A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Out
put:
84
OP
D a
nd
othe
r w
ard
cons
truc
-tio
n an
d re
habi
litat
ion
Dem
oliti
on a
nd R
ebui
ld-
ing
of O
utpa
tient
dep
art-
men
t and
I.C.
U In
trod
uc-
tion
of a
n ad
ditio
nal F
loor
on
the
thea
tre
exte
nsio
n B
lock
K D
emol
ition
of
Mor
tuar
y an
d Co
nstr
uc-
tion
of th
e ne
w p
atho
logy
de
part
men
t (bl
ock
H)
Org
an T
rans
plan
t Uni
t on
Blo
ck A
leve
l 6Co
nstr
uctio
n of
an
orga
n tr
ansp
lant
uni
t in
final
st
ages
, rem
odel
ling
of w
ards
, exp
ansi
on o
f th
eatr
es;(c
entr
alis
ed o
p-er
atin
g th
eatr
e, A
&E,
ICU
) m
achi
nery
and
Med
ical
eq
uipm
ent h
ave
been
ac
quir
ed, a
nd in
stal
latio
n is
ong
oing
22,0
20,0
0022
,170
,000
22,1
70,0
00
22,1
70,0
00Co
nstr
uctio
n of
an
orga
n tr
ansp
lant
uni
tin
fina
l sta
ges,
re-
mod
ellin
g of
war
ds,
expa
nsio
n of
th
eatr
es;(c
entr
alis
edop
erat
ing
thea
tre,
A
&E,
ICU
) mac
hine
ryan
d M
edic
al e
quip
-m
ent h
ave
been
acqu
ired
and
inst
alla
-tio
n is
ong
oing
UG
X 14
,203
,379
,232
wer
e us
ed to
fina
nce
othe
r ca
pita
l dev
elop
men
t ac
tiviti
es
Fund
s w
orth
UG
X 14
,203
,379
,232
wer
e di
vert
ed
UB
TS
Safe
Blo
od
Pro
visi
onCo
llect
ion
of b
lood
24
0,00
0 un
it of
bl
ood
colle
cted
300,
000
bloo
d do
-no
rs r
ecru
ited
240,
000
unit
of
bloo
d co
llect
ed
test
ed
3,80
0,00
07,
040,
000
7,04
0,00
07,
040,
000
209,
633
units
of
bloo
d co
llect
ed
No
achi
eved
ta
rget
s on
blo
od
dono
r re
crui
t-m
ent a
nd u
nit
of b
lood
test
ed
repo
rted
30,3
67 u
nits
of b
lood
not
co
llect
edIn
adeq
uate
test
Kits
and
bl
ood
bags
in Q
1 an
d Q
2
Pur
chas
e of
mot
or
Vehi
cle
and
othe
r tr
ansp
ort E
quip
men
t
1 bl
ood
colle
ctio
n va
n pr
ocur
ed25
0,00
025
0,00
025
0,00
023
6,45
5P
urch
ased
I bl
ood
colle
ctio
n va
n
46 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pur
chas
e of
offi
ce a
nd
ICT
equi
pmen
t P
urch
ase
of m
a-ch
iner
y an
d eq
uip-
men
t, an
d CC
TV
100,
000
100,
000
100,
000
100,
00P
rocu
red
CCTV
ca
mer
a sy
stem
fo
r N
akas
ero
bloo
d ba
nk, a
nd
cano
n ph
oto-
copi
er
The
offic
e eq
uipm
ent t
o be
pro
cure
d w
ere
not
item
ized
in th
e W
ork
plan
The
offic
e eq
uipm
ent t
o be
pr
ocur
ed w
ere
not i
tem
-iz
ed in
the
Wor
k pl
an
Pur
chas
e of
offi
ce a
nd
Res
iden
tial f
urni
ture
an
d fit
tings
Cate
gory
and
num
-be
r of
offi
ce fu
rni-
ture
not
spe
cifie
d
20,0
0020
,000
20,0
0019
,800
Cate
gory
and
nu
mbe
r of
offi
ce
furn
iture
not
sp
ecifi
ed
Cate
gory
and
num
ber
of o
ffice
furn
iture
not
sp
ecifi
ed
Cate
gory
and
num
ber
of o
ffice
furn
iture
not
sp
ecifi
ed
Sub
Pro
gram
me
02
outp
ut: 0
8530
1 A
d-m
inis
trat
ive
supp
ort
serv
ices
-Man
agem
ent o
f fac
ili-
ties
-Rep
lace
men
t of o
ld
vehi
cles
-Mai
nten
ance
of l
abo-
rato
ry e
quip
men
t -R
ecru
itmen
t
No
targ
ets
wer
e se
t fo
r ea
ch a
ctiv
ity1,
000,
000
1,00
0,00
01,
000,
000
1,00
0,00
0M
anag
emen
t of
faci
litie
s
som
e la
bora
tory
equ
ip-
men
t mai
ntai
ned
and
one
old
vehi
cle
repl
aced
Man
agem
ent e
xpla
ined
th
at th
e fu
nds
allo
cate
d w
eren
’t su
ffici
ent t
o im
-pl
emen
t all
the
plan
ned
activ
ities
.
Sub
Pro
gram
me
01:
Adm
inis
trat
ive
Sup-
port
ser
vice
sCo
nstr
uctio
n of
re-
gion
al b
lood
ban
ks. (
co
mpl
etio
n of
Con
-ce
pts,
pro
posa
ls a
nd
feas
ibili
ty s
tudi
es)
Mai
nten
ance
of e
xist
-in
g fa
cilit
ies.
-Sup
ervi
sion
and
cl
inic
al in
terf
ace
to
hosp
ital c
linic
ians
and
ad
min
istr
ator
s.-R
ecru
itmen
t of s
taff.
Cons
truc
tion
of r
e-gi
onal
blo
od b
anks
. ( c
ompl
etio
n of
Co
ncep
ts, p
ropo
s-al
s an
d fe
asib
ility
st
udie
s)M
aint
enan
ce o
f ex
istin
g fa
cilit
ies.
-Sup
ervi
sion
and
cl
inic
al in
terf
ace
to
hosp
ital c
linic
ians
an
d ad
min
istr
ator
s.-R
ecru
itmen
t of
staf
f.
4,00
1,16
84,
001,
168
3,99
3,16
83,
663,
834
Supe
rvis
ion
and
clin
ical
inte
r-fa
ce to
hos
pita
l cl
inic
ians
and
ad
min
istr
ator
s.M
aint
enan
ce o
f ex
istin
g fa
cili-
ties.
-Rec
ruitm
ent o
f st
aff.
Conc
epts
, pro
posa
ls a
nd
feas
ibili
ty s
tudi
es n
ot
com
plet
ed
Insu
ffici
ent b
udge
t al-
loca
tions
47A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
GU
LU R
RH
1004
: Gul
u R
ehab
ilita
-tio
n R
efer
ral
Hos
pita
l
Cons
truc
tion
of 5
4 U
nit
staf
f hou
ses
Com
plet
ion
of th
e se
cond
sla
b an
d In
itiat
ion
of th
e 3rd
sl
ab
1,33
8,00
01,
338,
000
1,33
8,00
01,
191,
500
The
seco
nd s
lab
was
not
com
-pl
eted
, and
the
3rd s
lab
hadn
’t be
en in
itiat
ed.
(Ove
rall
achi
eve-
men
t app
rox.
55
%)
The
2nd s
lab
not y
et
com
plet
ed 3
rd s
lab
had
not b
een
initi
ated
The
slow
pro
gres
s of
w
orks
was
due
to th
e lim
ited
annu
al fu
nds
allo
cate
d to
the
proj
ect b
y m
inis
try
of fi
nanc
e.
Par
t of t
hese
fund
s w
ere
dive
rted
(UG
X 14
6,50
0,00
0)
Dem
oliti
on o
f the
old
ra
diol
ogy
build
ing
Co
mpl
ete
dem
oli-
tion
of th
e ol
d ra
di-
olog
y bu
ildin
g an
d re
mov
al o
f deb
ris
50,0
0050
,000
50,0
0048
,000
Old
rad
iol-
ogy
build
ing
dem
olis
hed,
th
e de
bris
not
re
mov
ed (o
vera
ll ac
hiev
emen
t ap-
prox
.65%
)
The
debr
is w
as n
ot
rem
oved
Poo
r co
ntra
ct m
anag
e-m
ent
1468
: Ins
ti-tu
tiona
l sup
-po
rt to
Gul
u R
egio
nal
refe
rral
ho
spita
l.
Pro
cure
men
t of a
s-so
rted
med
ical
equ
ip-
men
t
Pro
cure
BP
mon
itor
mac
hine
s an
d A
CB
C m
achi
ne w
ith it
re
agen
ts
100,
000
100,
000
100,
000
98,7
00P
rocu
red
BP
m
onito
r m
a-ch
ines
and
A
CBC
mac
hine
w
ith it
rea
gent
s
Nil
The
outp
ut w
as fu
lly
achi
eved
FOR
T P
OR
TAL
RR
H
0856
: Re-
gion
al R
efer
-ra
l Hos
pita
l Se
rvic
es
0857
2: G
over
nmen
t B
uild
ings
and
Adm
in-
istr
ativ
e In
fras
truc
ture
Gov
ernm
ent B
uild
-in
gs a
nd a
dmin
is-
trat
ion
build
ings
mai
ntai
ned
incl
ud-
ing
sani
tatio
n
39,5
72,0
0039
,572
,000
39,5
72,0
0037
,200
,000
Adm
inis
trat
ion
build
ings
mai
n-ta
ined
,re
gula
r cl
eani
ng
and
sani
tatio
n se
rvic
esCo
ntra
cted
. In
fect
ion
prev
en-
tion
and
cont
rol
mee
tings
in a
nd
outs
ide
the
hos-
pita
l and
hel
d.
No
targ
ets
with
per
for-
man
ce in
dica
tors
wer
e se
t in
the
annu
al w
ork
plan
to g
uide
the
exte
nt
of a
chie
vem
ent o
f the
pl
anne
d ou
tput
s. o
ut o
f th
e bu
dget
ed a
mou
nt
UG
X, 3
7,20
0,00
0 w
as
spen
t on
the
outp
ut
henc
e a
bala
nce
of U
GX
2,37
2,00
0
It w
as a
n ov
ersi
ght d
urin
g pl
anni
ng th
at m
anag
e-m
ent d
id n
ot s
et th
e ta
rget
s an
d in
dica
tors
to
mea
sure
per
form
ance
of
the
outp
ut. T
he v
aria
nce
of U
GX
2,37
2,00
0 w
as
refle
cted
as
unsp
ent b
al-
ance
in th
e pe
rfor
man
ce
repo
rt.
48 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
0858
1:
Staf
f hou
ses
cons
truc
-tio
n an
d re
habi
litat
ion
Engi
neer
ing
and
desi
gn w
orks
st
arte
d. M
onito
ring
and
supe
rvis
ion
of
cons
truc
tion
wor
ks.
Staf
f hou
ses
con-
stru
cted
, reh
abili
-ta
ted,
mai
ntai
ned
incl
udin
gsa
nita
tion
882,
428,
000
882,
428,
000
882,
428,
000
54,8
93,0
00Co
ntin
uatio
n of
wor
ks o
f a
16-u
nit s
taff
ho
stel
. On-
goin
g m
onito
ring
and
su
perv
isio
n of
co
nstr
uctio
n of
w
orks
No
perf
orm
ance
targ
et
was
set
for
the
outp
ut
(per
cent
age
of c
ompl
e-tio
n fo
r th
e FY
) and
the
freq
uenc
y of
mon
itori
ng
to g
uide
the
asse
ssm
ent
of p
erfo
rman
ce. O
ut o
f th
e ap
prov
ed b
udge
t of
UG
X 88
2,42
8,00
0,
the
hosp
ital s
pent
UG
X 54
,893
,000
hen
ce a
ba
lanc
e of
UG
X 82
7,53
5,00
0
Failu
re to
set
per
form
ance
ta
rget
s an
d pe
rfor
man
ce
indi
cato
rs w
as d
elib
erat
e by
man
agem
ent.
The
vari
-an
ce b
etw
een
the
budg
et
and
spen
t fun
ds w
as a
s a
resu
lt o
f mis
s re
port
ing.
A
naly
sis
of th
e pa
ymen
t fil
e in
dica
ted
that
UG
X 86
0,42
8,34
3 w
as s
pent
.
0858
5: P
urch
ase
of
Med
ical
Equ
ipm
ent
Ass
orte
d m
edic
al
equi
pmen
t pro
-cu
red
138,
000,
000
138,
000,
000
138,
000,
000
137,
446,
000
Ass
orte
d eq
uip-
men
t pro
cure
d fo
r su
rger
y an
d pr
ivat
e w
ards
as
wel
l as
shel
ves
for
libra
ry a
nd
the
reso
urce
ce
ntre
.
The
annu
al w
ork
plan
do
es n
ot d
etai
l spe
cific
as
sort
ed m
edic
al e
quip
-m
ent t
o be
pro
cure
d an
d un
it co
sts
atta
ched
to
eac
h to
just
ify th
e bu
dget
am
ount
for
the
Out
put.
UG
X 55
4,00
0 w
as
the
vari
ance
bet
wee
n bu
dget
and
spe
nt.
Gap
s in
pla
nnin
g fo
r ho
spita
l ser
vice
s su
ch a
s co
stin
g an
d bu
dget
ing
for
activ
ities
e.g
. the
bal
ance
be
twee
n bu
dget
and
spe
nt
of U
GX
554,
000
coul
d ha
ve
been
as
a re
sult
of o
ver
budg
etin
g.
MA
SAK
A R
RH
01:
Mas
aka
Ref
erra
l H
ospi
tal
Serv
ices
04 D
iagn
ostic
ser
vice
s55
3,90
0 la
bora
tory
te
sts
carr
ied
out
13,9
15 u
ltra
sou
nd
scan
s m
ade
5,94
9 x-
ray
exam
i-na
tions
mad
e
116,
000
116,
000
116,
000
113,
500
Labo
rato
ry
test
s do
ne w
ere
304,
805.
Ult
ra
soun
d ex
ami-
natio
ns w
ere
13,9
53. X
-Ray
ex-
amin
atio
ns d
one
wer
e 37
84.
Blo
od tr
ansf
u-si
ons
wer
e 5,
374
249,
095
labo
rato
ry te
sts
not d
one
2,16
5 x-
rays
not
don
e
Lab.
test
s de
clin
ed b
e-ca
use
of la
ck o
f rea
gent
s.
X-ra
ys ta
rget
s w
ere
not
met
due
to in
adeq
uate
and
in
appr
opri
ate
supp
lies
of
x-ra
y fil
ms
by N
atio
nal
Med
ical
sto
res.
1004
: M
asak
a R
ehab
ilita
-tio
n R
efer
ral
Hos
pita
l
Out
put 0
8568
1: S
taff
ho
uses
con
stru
ctio
n an
d re
habi
litat
ion
(
Foun
datio
n fo
r al
l th
e 40
uni
ts s
taff
ho
stel
com
plet
ed1
bloc
k of
the
staf
f ho
stel
com
plet
ed
500,
000
500,
000
500,
000
474,
860
Raf
t fou
nda-
tion
com
plet
ed
with
ste
el a
nd
conc
rete
.
No
sing
le b
lock
on
staf
f ho
use
com
plet
edFu
ndin
g fo
r th
is p
roje
ct is
no
t goo
d an
d as
a r
esul
t, th
e co
ntra
ctor
onl
y w
orks
de
pend
ing
on a
vaila
bilit
y of
fund
s.
49A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Out
put 0
8568
2: M
ater
-ni
ty w
ard
cons
truc
tion
and
reha
bilit
atio
n
Com
plet
ing
the
cons
truc
tion
of th
e su
per
stru
ctur
e of
mat
er-
nity
and
Chi
ldre
n’s
com
plex
1,55
8,00
01,
558,
000
1,55
8,00
01,
027,
655
Blo
ck w
orks
, pil-
lars
for
the
roof
, el
ectr
ical
wor
ks,
Cast
ing
of th
e fo
urth
floo
r, fi
rst
plum
bing
fixes
insi
de,
mas
onry
wor
ks,
star
ted
on th
e ro
ofing
of t
he
stru
ctur
e.
MB
ALE
RR
H
1004
: Mba
le
Reh
abili
ta-
tion
Ref
erra
l H
ospi
tal
0856
83: O
PD
and
oth
er
war
d co
nstr
uctio
n an
d re
habi
litat
ion
(Con
-st
ruct
ion
of s
urgi
cal
and
canc
er w
ard)
No
targ
et s
et fo
r th
e ye
ar in
the
wor
k pl
an
2,00
0,00
02,
000,
000
2,00
0,00
01,
999,
666
Wor
ks fo
r fir
st
floor
wer
e do
ne,
cast
ing
of th
e w
ing
of
the
thea
tre
bloc
k w
as a
lso
done
, an
d al
lco
lum
ns o
f the
se
cond
floo
r of
th
e w
ard
bloc
k w
ere
done
.
Not
abl
e to
asc
erta
in
Man
agem
ent d
id n
ot s
et
targ
ets
to a
chie
ve fo
r th
e ye
ar.
1478
: In-
stitu
tiona
l su
ppor
t to
Mba
le R
e-gi
onal
ref
er-
ral h
ospi
tal.
0856
83: O
ther
str
uc-
ture
s ( C
onst
ruct
ion
an
d in
stal
latio
n of
a
new
inci
nera
tor
and
R
enov
atio
n of
acu
te
care
uni
t
100%
com
plet
ion
of
Inci
nera
tor
hous
e,
cons
truc
tion
and
inst
alla
tion
of th
e in
cine
rato
r an
d pu
t to
use
.R
enov
ated
acu
te
care
uni
t
500,
000
500,
000
500,
000
404,
209
Inci
nera
tor
hous
e c
ompl
et-
ed, I
ncin
erat
or
inst
alle
d
The
inci
nera
tor
not y
et in
us
e by
yea
r en
d (2
017/
18)
Ther
e w
as n
eed
to c
hang
e th
e ro
of s
truc
ture
of t
he
inci
nera
tor
hous
e fr
om
woo
d as
was
in th
e or
igi-
nal d
esig
n to
met
al
8568
3: M
achi
nery
and
Eq
uipm
ent (
Pur
chas
e of
hos
pita
l veh
icle
Pro
cure
one
dou
ble
cabi
n pi
ckup
20
0,00
020
0,42
820
0,42
817
6,50
0O
ne d
oubl
e ca
bin
pick
up p
rocu
red
Nil
No
vari
ance
50 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
8568
3: O
ffice
Equ
ip-
men
t P
rocu
re
(a
ssor
ted
offic
e eq
uipm
ent)
130,
000
130,
000
130,
000
126,
500
Pro
cure
d an
d re
ceiv
ed O
ffice
Eq
uipm
ent w
orth
U
GX
126,
500,
000
(Hea
vy d
uty
phot
ocop
ier
UG
X 21
,562
,000
, Offi
ce
chai
rs, c
abin
s an
d de
sks
UG
X 20
,314
,343
, 21
lapt
op c
om-
pute
rs U
GX
30,9
12,8
00, b
uck-
ets
for
offic
e us
e U
GX
16,8
87,5
00
and
offic
e eq
uip-
men
t cos
ting
UG
X 3,
505,
000
Nil
No
vari
ance
8568
5: M
edic
al E
quip
-m
ent
Ass
orte
d m
edic
al
227,
571
227,
571
227,
571
227,
359
Pro
cure
d (a
utoc
lave
s,
mat
tres
ses,
and
ot
her
asso
rted
m
edic
al e
quip
-m
ent)
Not
abl
e to
asc
erta
in
Man
agem
ent d
id n
ot
item
ize
all t
he r
elev
ant
equi
pmen
t tha
t was
to b
e pr
ocur
ed d
urin
g th
e ye
ar
in th
e w
ork
plan
.
MB
AR
AR
A R
RH
51A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Pro
ject
Out
put
Pla
nned
Tar
get f
or
the
Fin
anci
al y
ear
Bud
gete
d am
ount
UG
X (‘0
00’)
Rev
ised
bu
dget
UG
X (‘0
00’)
Am
ount
re
leas
edU
GX
(‘000
’)
Am
ount
Spe
ntU
GX
(‘000
’)A
chie
ved
Targ
et
by F
inan
cial
ye
ar e
nd
Vari
ance
Caus
es fo
r th
e va
rian
ces
Pro
gram
me:
08
56 R
e-gi
onal
Ref
er-
ral H
ospi
tal
Serv
ices
0857
5: P
urch
ase
of
mot
or v
ehic
le a
nd
othe
r tr
ansp
ort e
quip
-m
ent
Pur
chas
e of
a
tran
spor
t equ
ip-
men
t- T
o bu
y a
30 s
eate
r va
n fo
r tr
ansp
ortin
g st
aff
mem
bers
dur
ing
diff
eren
t offi
cial
fu
nctio
ns
400,
000
400,
000
400,
000
400,
000
A 3
0 se
ater
van
fo
r tr
ansp
ortin
g st
aff m
embe
rs
duri
ng d
iffer
ent
offic
ial f
unct
ions
pr
ocur
ed
Not
all
fund
s w
ere
spen
t on
the
plan
ned
outp
ut. U
GX
79,5
20,9
22
was
div
erte
d to
pay
for
outs
tand
ing
bala
nce
on th
e pu
rcha
se o
f th
e m
edic
al d
irec
tor’
s ve
hicl
e pr
ocur
ed in
th
e FY
201
6/20
17. U
GX
320,
479,
078
was
spe
nt
on th
e pl
anne
d ou
tput
le
avin
g an
uns
pent
ba
lanc
e of
UG
X 16
,521
,000
/=
Man
agem
ent e
xpla
ined
th
at d
urin
g th
e pl
anni
ng
and
budg
etin
g pr
oces
s fo
r th
e FY
201
7/20
18
forg
ot to
inco
rpor
ate
the
outs
tand
ing
bala
nce
from
the
prev
ious
yea
r’s
outp
ut (p
urch
ase
of a
m
otor
veh
icle
) hen
ce
mak
ing
the
dive
rsio
n in
evita
ble.
0858
0: H
ospi
tal c
on-
stru
ctio
n/R
ehab
ilita
tion
Ren
ovat
ion
of
Mat
erni
ty w
ard
and
surg
ical
war
d to
im-
prov
e on
the
labo
r su
it an
d al
l oth
er
serv
ice
area
s on
the
two
war
ds
350,
000
350,
000
350,
000
323,
610
Non
eFu
nds
wer
e in
stea
d us
ed to
war
ds s
taff
ca
ntee
n co
nstr
uc-
tion
and
orth
oped
ic
wor
ksho
p. B
y th
e tim
e of
aud
it no
ne o
f the
st
ruct
ures
had
bee
n co
mpl
eted
. Th
e co
ntra
ctor
was
pa
id 1
00%
(198
,345
,610
) in
clud
ing
rete
ntio
n of
th
e co
ntra
ct s
um fo
r co
nstr
uctio
n of
the
staf
f can
teen
bef
ore
doin
g an
y w
orks
co
ntra
ry to
the
spec
ial
cond
ition
s of
the
cont
ract
(GCC
35.
1).
For
the
cons
truc
tion
of th
e O
rtho
pedi
c st
ruct
ure,
wor
ks w
ere
ongo
ing
and
was
at
roofi
ng b
y th
e tim
e of
au
dit i
nspe
ctio
n.
Of t
he fu
nds
rele
ased
, U
GX
26,3
90,0
00
rem
aine
d un
spen
t and
w
as s
wep
t bac
k to
th
e co
nsol
idat
ed fu
nd
at th
e en
d of
the
FY
2017
/18.
The
vari
ance
was
be
caus
e th
e Ea
st A
fric
a P
ublic
Hea
lth
Labo
ra-
tory
Net
wor
king
Pro
ject
(E
AP
HLN
P) s
uppo
rted
th
e ho
spita
l with
con
-st
ruct
ing
a la
bora
tory
at
the
site
whi
ch w
as
hous
ing
the
orth
oped
ic
wor
ksho
p an
d fo
r th
at
reas
on th
e ho
spita
l had
to
put
up
a st
ruct
ure
to
hous
e th
e or
thop
edic
w
orks
hop
and
prov
ide
a se
rvic
e.
-The
can
teen
was
co
nstr
ucte
d to
add
ress
th
e em
ergi
ng h
ygie
ne
issu
es a
roun
d th
e ho
spita
l sin
ce fo
od
vend
ors
had
turn
ed th
e ho
spita
l mai
n ro
ad in
to
a m
arke
t. Th
e va
rian
ce
betw
een
rele
ase
and
amou
nt s
pent
of U
GX
26,3
90,0
00 w
as b
ecau
se
it w
as s
wep
t bac
k to
the
cons
olid
ated
fund
at t
he
end
of th
e FY
.
0858
5: P
urch
ase
of
med
ical
Equ
ipm
ent
Pur
chas
e of
as-
sort
ed m
edic
al
equi
pmen
t inc
lud-
ing
mon
itors
for
high
dep
ende
nce
units
300,
000
300,
000
300,
000
300,
000
The
CT-S
can
an
d th
e X-
Ray
m
achi
nes
wer
e re
pair
ed a
nd
mai
ntai
ned
by
vari
ous
serv
ice
prov
ider
s
Ass
orte
d m
edi-
cal e
quip
men
t in
clud
ing
mon
i-to
rs fo
r hi
gh
depe
nden
ce
units
(Ste
riliz
-er
s an
d la
undr
y m
achi
nes)
not
pu
rcha
sed.
Emer
genc
e re
-pa
ir a
nd m
ain-
tena
nce
of th
e CT
-Sca
n m
achi
ne
and
the
X-R
ay
mac
hine
s
0858
1: S
taff
hou
ses
Cons
truc
tion
and
Reh
abili
tatio
n
16 u
nit s
taff
qua
r-te
rs c
ompl
etio
n 92
8,00
092
8,00
092
8,00
092
8,00
016
uni
t sta
ff
hous
e co
mpl
eted
Nil
52 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Appendix VI: Showing details of funds diverted by Selected Health Sector Institutions
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
MINISTRY OF HEALTH
INSTITUTIONAL SUPPORT TO MOH (1027)
Monitoring and Evaluation
Facilitation for Project supervision for the construction of Regional hospital for Pediat-rics surgery in Entebbe.
18057792 13-Jun-18 4,800,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18368710 23-Jun-18 2,850,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369589 23-Jun-18 1,100,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369171 23-Jun-18 1,100,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369184 23-Jun-18 1,300,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18368770 23-Jun-18 550,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369052 23-Jun-18 1,100,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369444 23-Jun-18 1,000,000 1027 227001
Facilitation to carryout Stocktaking exercise of MOH Stores.
18369260 23-Jun-18 1,100,000 1027 227001
Capital development outputs
Technical support on the development of bills of quantities for staff canteen and records centre
15342947 19-Oct-17 10,052,000 1027 312101
Final payment for construction and equipping of Buyiga Health Centre III.
16316876 12-Jan-18 41,865,372 1027 312101
Construction of MOH motor vehicle service bay as per Interim certificate No. 1.
17326732 16-Apr-18 67,116,360 1027 312101
Payment for Construction of Staff houses in Kapchorwa, Certificate No. 1
17301452 03-Apr-18 31,449,384 1027 312101
Payment for Construction of Staff houses in Kapchorwa, Certificate No. 1
17301452 03-Apr-18 174,718,800 1027 312101
Construction of MOH motor vehicle service bay as per Interim certificate No. 1.
17326732 16-Apr-18 12,080,945 1027 312101
Certificate 13 Payment for construction of specialised hospital.
18385616 25-Jun-18 52,651,332 1027 312101
Construction of MOH service bay in respect of certificate No.2.
18368849 23-Jun-18 11,067,462 1027 312101
Certificate 13 Payment for construction of specialised hospital.
18385616 25-Jun-18 292,507,402 1027 312101
Interim Certificate No.1 for construction of MOH canteen.
18369434 23-Jun-18 8,601,197 1027 312101
Construction of MOH service bay in respect of certificate No.2.
18368849 23-Jun-18 61,485,900 1027 312101
Interim Certificate No.1 for construction of MOH canteen.
18369434 23-Jun-18 47,784,430 1027 312101
Repair works for MOH headquarters and cen-tral medical equipment
16305634 05-Jan-18 247,907,823 1027 312101
53A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Funds advanced for the relocation of main water pipes to allow construction of a can-teen.
17326718 16-Apr-18 3,540,000 1027 312101
Consultancy services for the construction of SMNHUP.
18369126 23-Jun-18 133,741,104 1027 312101
Certificate 13 Payment for construction of specialised hospital.
18385616 25-Jun-18 295,137,569 1027 312101
Consultancy services for the construction of SMNHUP.
18369126 23-Jun-18 24,073,399 1027 312101
Certificate 13 Payment for constructions of specialised hospital.
18385616 25-Jun-18 53,124,762 1027 312101
Renovation of KAYUP project offices at Wab-igalo.
18368779 23-Jun-18 33,413,600 1027 312101
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 119,925,188 1027 312101
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 21,586,534 1027 312101
SUPPORT TO MULAGO HOSPITAL REHABIL-ITATION
Capital development outputs
Certificate 13 Payment for construction of specialized hospital.
18385616 25-Jun-18 81,042,226 1187 312101
Certificate 13 Payment for construction of specialized hospital.
18385616 25-Jun-18 450,234,589 1187 312101
REHABILITATION AND CONSTRUCTION OF GENERAL HOSPITALS
Monitoring and Evaluation
Facilitation for collection of EAPHLN data from various districts.
16040196 14-Dec-17 1,210,000 1243 227001
Facilitation for collection of EAPHLN data from various districts.
16040123 14-Dec-17 605,000 1243 227001
Facilitation for collection of EAPHLN data from various districts.
16040077 14-Dec-17 1,810,000 1243 227001
Facilitation for NGO inspection in Eastern and Northern Uganda.
16039978 14-Dec-17 1,560,000 1243 227001
Facilitation for collection of EAPHLN data from various districts.
16040065 14-Dec-17 2,415,000 1243 227001
Facilitation for NGO inspection in Eastern and Northern Uganda.
16040060 14-Dec-17 3,168,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414368 23-Jan-18 1,210,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414597 23-Jan-18 605,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414663 23-Jan-18 605,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414312 23-Jan-18 1,920,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414700 23-Jan-18 2,030,000 1243 227001
Facilitation during collection of data for the EAPHLN.
16414634 23-Jan-18 1,210,000 1243 227001
54 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Capital development outputs
Advance payment for renovation of Yumbe Hospital (LPO No.2)
18392437 26-Jun-18 228,813,559 1243 312101
Advance payment for renovation of Yumbe Hospital (LPO No.2)
18392437 26-Jun-18 41,186,441 1243 312101
CONSTRUCTION OF SPECIALISED NEONATAL AND MATERNAL UNIT IN MULAGO HOSPITAL
Capital development outputs
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 55,291,152 1315 312101
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 9,952,407 1315 312101
RENOVATION AND EQUIPPING OF KAYUNGA YUMBE GENERAL HOSPITALS
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992433 30-May-18 960,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)
17992379 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992390 30-May-18 960,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospi-tals and HC IVs for Kasajja A(440,000) and Dr.Wamasebu G(1,040,000).
17992532 30-May-18 1,480,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992401 30-May-18 1,843,571 1344 227001
Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)
17992385 30-May-18 440,000 1344 227001
Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Dr Idi Frankline A
17992428 30-May-18 1,040,000 1344 227001
Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Amumpe J 1,878,657)
17992512 30-May-18 2,318,657 1344 227001
Facilitation for integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992449 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992444 30-May-18 1,800,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992405 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)
17992412 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992448 30-May-18 880,000 1344 227001
55A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Intergrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Barigye C. 1,200,000))
17992516 30-May-18 1,640,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Dr Ogwang Alfred Francis.
17992452 30-May-18 1,200,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992461 30-May-18 1,040,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Tummushabe Joshua.
17992387 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992392 30-May-18 960,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992466 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992413 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992518 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992385 30-May-18 1,891,429 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992378 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992380 30-May-18 2,275,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992398 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Bagwowabo Edward.
17992402 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992414 30-May-18 2,043,571 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992498 30-May-18 2,040,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)
17992401 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Luyige Coleb.
17992513 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992505 30-May-18 880,000 1344 227001
56 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Intergrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver 440,000 and Sebutinde. 1,040,000))
17992442 30-May-18 1,480,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992465 30-May-18 1,040,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992429 30-May-18 2,195,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Baku Agnes.
17992389 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992396 30-May-18 1,971,429 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992464 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992524 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992386 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.(Driver)
17992444 30-May-18 440,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992415 30-May-18 960,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs for Nkalubo Mary.
17992388 30-May-18 880,000 1344 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992521 30-May-18 440,000 1344 227001
REGIONAL HOSPITAL FOR PAEDIATRIC SUR-GERY
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992431 30-May-18 880,000 1394 227001
Advance for Stationery, Folders, writing pads, and photocopying reports during integrated support supervision
17992516 30-May-18 1,400,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992406 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992435 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992460 30-May-18 2,188,657 1394 227001
57A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992399 30-May-18 2,088,571 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992440 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992423 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992388 30-May-18 1,632,314 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992441 30-May-18 1,932,200 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992439 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992452 30-May-18 2,102,929 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992473 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992504 30-May-18 1,120,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992426 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992382 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992384 30-May-18 1,040,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992507 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992527 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992526 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992424 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992446 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992516 30-May-18 1,824,000 1394 227001
58 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992445 30-May-18 2,226,600 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992509 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992408 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992409 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992454 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992457 30-May-18 1,824,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992438 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992419 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992436 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992418 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992530 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992391 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992532 30-May-18 2,125,857 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992519 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992381 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992462 30-May-18 1,200,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992395 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992467 30-May-18 960,000 1394 227001
59A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992517 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992506 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992447 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992511 30-May-18 1,958,657 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992529 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992453 30-May-18 2,140,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992432 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992410 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992407 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992421 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992442 30-May-18 2,013,429 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992416 30-May-18 2,162,657 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992403 30-May-18 1,772,200 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992434 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992510 30-May-18 2,281,286 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992387 30-May-18 1,962,314 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992430 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992459 30-May-18 960,000 1394 227001
60 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992501 30-May-18 2,140,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992428 30-May-18 2,386,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992508 30-May-18 800,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992397 30-May-18 2,175,743 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992450 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992427 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992755 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992515 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992389 30-May-18 1,928,571 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992400 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992417 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992458 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992528 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992383 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992394 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992523 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992503 30-May-18 2,017,857 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992443 30-May-18 880,000 1394 227001
61A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992525 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992451 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992422 30-May-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992425 30-May-18 960,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992402 30-May-18 1,965,857 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992502 30-May-18 800,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992437 30-May-18 440,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992456 30-May-18 2,175,743 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
17992520 30-May-18 2,342,929 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
18057804 13-Jun-18 880,000 1394 227001
Facilitation for Integrated support supervi-sion across RRHs, districts, general hospitals and HC IVs.
18131722 18-Jun-18 700,000 1394 227001
Capital development outputs
Settlement of advance payment certificates for the rehabilitation and expansion of Kayun-ga Hospitals.
18369373 23-Jun-18 190,541,594 1394 312101
Settlement of advance payment certificates for the rehabilitation and expansion of Kayun-ga Hospitals.
18369373 23-Jun-18 1,249,106,003 1394 312101
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 145,187,050 1394 312101
Advance payment for renovation of Yumbe Hospital.
18392437 26-Jun-18 806,594,720 1394 312101
Procurement of medical furniture (Under URMCHIP)
8,135,630,000
MULAGO HOSPITAL COMPLEX
Final payment for Imaging and Nuclear med-icine equipment
23-May-18 3,306,937,218
Payment for supply and installation of equip-ment-China Sinopharm Int.Corp.
11-Jun-18 46,866,085
Procurement of aCT scan 11-Jun-18 191,220,000
Other structures-part payment on installa-tion of oxygen plant
26-Sep-17 350,000,000
62 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Other structures-Supply of imaging &nuclear medicine equipment
26-Oct-17 9,636,724,729
Other structures-Construction of 100 units of staff houses
30-Oct-17 671,631,200
UGANDA BLOOD TRANSFUSION SERVICES
SDA, perdiem & fuel in Masaka 14982945 13-Sep-17 651,000
Funds required to facilitate budgeting system training for 19th - 21st July 2017
14669113 17-Aug-17 692,000
Fuel, Lubricants and oils for UBTS HQtrs. 14669109 17-Aug-17 2,131,250
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601012 09-Aug-17 151,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601005 09-Aug-17 151,000
Accountable advance required to facilitate re-view UBTS’s testing Algorthim workshop
14788669 24-Aug-17 1,200,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601006 09-Aug-17 232,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601002 09-Aug-17 151,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14600999 09-Aug-17 151,000
Mini Camp perdiem at Mubende for Nassoro Erinah & Auma Eunice
14601011 09-Aug-17 362,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601004 09-Aug-17 151,000
Baggage allowance for Mr. Ntibatekereza Charles (Askari)
14600998 09-Aug-17 2,700,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601011 09-Aug-17 232,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601000 09-Aug-17 151,000
Accountable advance for Blood Publicity and donation for the first week of August 2017
14472571 01-Aug-17 9,250,000
Allowance for currying out board of survey exercise for FY2016/17
14964651 06-Sep-17 1,831,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14601013 09-Aug-17 121,000
Mini Camp perdiem at Mubende Hospital 5th - 8th June,2017
14600996 09-Aug-17 121,000
Funds for Qtr.ii activities 15379615 24-Oct-17 4,880,000
Advance for mobilisation work for 2nd quar-ter for FY 2017/18 for Karugaba Richard
15379471 24-Oct-17 200,000
Advance for mobilisation work for 2nd quar-ter for FY 2017/18
15379413 24-Oct-17 200,000
Allowance to be recovered from her monthly SDA
15468566 26-Oct-17 500,000
Accountable advance required to facilitate blood donation drive during the month of oc-tober 2017
15522977 30-Oct-17 9,868,500
Advance for mobilisation work for 2nd quar-ter for FY 2017/18
15379419 24-Oct-17 200,000
63A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Funds required to facilitate internal auditor’s activities in Rukungiri Blood Collection Centre
15252056 02-Oct-17 330,000
Fuel pre-payment for UBTS headquarters for qtr.II
15379472 24-Oct-17 2,131,250
Advance for SDA to settle emergency home problem
16340206 18-Jan-18 500,000
Additional Regional Blood Bank activities(1) 16993458 12-Mar-18 6,480,000
Accountable advance required to enable a team host Nakasongola blood donor club at UBTS H/QTRS and their Major activities will be to tour the bank, learn more about blood donation activities, Donate Blood, and will UBTS’s Ambassadors
16775931 21-Feb-18 6,000,000
GULU RRH
Supply of Generator 15642048 13-Nov-17 48,500,000 85681 312102
Supply of Generator 15638157 10-Nov-17 50,000,000 85681 312102
Demolition of Structures 15638160 10-Nov-17 48,000,000 85681 312102
MBALE RRH
Payment for Repairs& Servicing Hospital Vehicles.
18390265 26-Jun-18 23,928,543 85683 312202
Payment for Construction of Perimeter wall fence at the Hospital.
18361486 22-Jun-18 46,836,680 85683 312104
Payment for Minor works. 17611279 03-May-18 1,200,000 85683 312104
Payment for Construction of perimeter wall at the Hospital land.
18361486 22-Jun-18 47,754,600 85683 312104
FORT PORTAL
Supply of bookshelves 18069887 14-Jun-18 37,200,000 85672 312104
Construction of storeyed staff houses certifi-cate no. 3 part payment.
17992316 30-May-18 12,000,000 85681 281503
Construction of storeyed staff houses certifi-cate no. 3 part payment.
17992316 30-May-18 7,500,000 85681 281503
Part payment on certificate no. 2 on the con-struction of 16 units of storeyed staff houses
16541045 29-Jan-18 2,500,000 85681 281503
MBARARA RRH
Pay for repair of CT scan - Lot 2 17019938 16-Mar-18 35,112,670 85680 312101
Pay for supply of materials and repair of CCTV cameras
18287374 20-Jun-18 3,653,000 85680 312101
Pay for supply Counter Desk for Registry office
16239836 18-Dec-17 1,708,640 85680 312101
Pay for repair of Patient trolleys 18035514 08-Jun-18 3,728,800 85680 312101
Pay for supply of sundry equipment for Secu-rity Dept.
18003757 01-Jun-18 60,000 85680 312101
Pay for supply of sundry equipment for Secu-rity Dept.
18003757 01-Jun-18 336,000 85680 312101
Pay for supply of materials to repair CT scan 18287400 20-Jun-18 1,042,000 85680 312101
Pay for supply of office Desk and chairs 17602516 02-May-18 290,000 85680 312101
Pay for supply of office Desk and chairs 17602516 02-May-18 700,000 85680 312101
64 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Description EFT / Check Number
Payment Date
Distribution Amount
Project Account
Pay for supply of sundry equipment for Secu-rity Dept.
18003757 01-Jun-18 120,000 85680 312101
supply of metallic shelves 15288569 06-Oct-17 8,121,310 85680 312101
Pay for supply of sundry equipment for Secu-rity Dept.
18003757 01-Jun-18 300,000 85680 312101
Supply and installation of Control Panel for X-ray
16239651 18-Dec-17 24,143,140 85685 312212
Pay for Lot 1 for supply of CT scan tube and maintenance services
17327329 16-Apr-18 245,156,860 85685 312212
Payment of cert. No. 2 for construction of staff canteen
18287412 20-Jun-18 64,259,437 85680 312101
Pay for Interim Cert. No. 1 for construction of staff canteen
18287412 20-Jun-18 134,086,173 85680 312101
Pay for repair of CT scan - Lot 2 17019938 16-Mar-18 35,112,670 85680 312101
MASAKA RRH
2PART PAYMENT ON INTERIM CERTIFICATE NO.3 FOR CONSTRUCTION OF THE SENIOR STAFF HOSTEL.
16287347 21-Dec-17 34,500,000 85682 312101
CONSTRUCTION WORKS DONE ON THE SE-NIOR STAFF HOSTEL [FINAL PAYMENT IN RESPECT OF INTERIM CERTIFICATE NO.3 INV. NO.1033 OF 13/11/2017].
16991750 9-Mar-18 218,938,294 85682 312101
EXTENSION OF GENERATOR POWER TO ALL WARDS AND UNITS AS PER INV. Nos 391,390,386,387, & 388.
18323987 21-Jun-18 25,139,620 85681 281504
TOTAL 28,734,212,001
Appendix VII: Showing duration of the procurement process
Procurement Subject Reference Code Date of initiation
Contract signing date
Average working
Days taken
Days delayed
MINISTRY OF HEALTH
Procurement of Assorted ICT equipment
MOH-URMCHIP/ SUPLS/2016-17/00006
05/10/2017 Not signed
Procurement of supply of 3 station wagon Lot 1
MOH-UHSSP/SUPLS/2016-17/00100/1
16/06/2017 16/02/2018 245 185
construction of staff houses for se-lected health facilities in Karamoja region
MOH KRSHP/WKRS/15-16/00003
10/09/2015 08/02/2016 151 91
Refurbishment and Equipping of Kawolo GH
MOH-SPSW/WRKS/2015-16/00001
30/05/2016 30/03/2017 304 244
The contract for Repartitioning and renovation of office space
MOH/WRKS/2016-2017/00631
10/04/2017 19/06/2017 70 10
The contract for Purchase of films vans for APC BCC interventions
MOH/SPLS/17-18/00209 20/03/2018 29/05/2018 70 10
Procurement of Electric Forklift MOH/SPLS/15-16/00830 13/10/2016 14/03/2017 152 92
65A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
MBARARA RRH
Construction of staff canteen MBRRH/WRKS/2017-2018/00087
5/02/2018 30/05/2018 83 23
Repair and maintenance of CT Scan
MBRRH/NCONS/17-18/00071
19/09/2017 9/01/2018 250 190
Supply of pioneer system console for the X-ray machine
MBRRH/SPLS/2017-2018/00036
7/09/2017 13/12/2017 109 49
Supply of a 30 seater Van MBRRH/SUPLS/17-18/00077
11/01/2018 14/07/2018 144 84
Construction of a 16 unit staff house
MBRRH/WRKS/2014-2015/00001
8/04/2014 4/01/2016 477 417
Construction of the Orthopedic Workshop
MBRRH/WRKS/17-13/00104
20/03/2018 30/05/2018 50 -9
MBALE RRH
Construction of an incinerator house and installation.
MBLRH/WRKS /16-17/00022
05/10/2016 16/05/2017 163 103
Construction of surgical complex building at Mbale regional referral Hospital
MBLRH/WRKS/2014-2015/00014
12/11/2014 05/08/2016 464 404
Supply of assorted office furniture MBLRH/SUP-PLS/2017-2018/00033
03/05/2018 Not yet signed by time of audit
Supply of assorted medical equip-ment
MBLRH/SUPLS/17-18/00018
21/02/2018 27/04/2018 47 -13
Supply of office furniture MBLRH/SUPLS/17-18/00018
21/02/2018 12/03/2018 19 -41
Appendix VIII: Showing inconsistencies in reporting among selected Health Sector Institutions
Programme /Project
Planned output Budget amount UGX (000)
Reported actual output Audit comment
MINISTRY OF HEALTH
Institutional sup-port to MoH
Output: 080272 Renovation of MoH 3rd Floor that was burnt.
1,384,042 Renovation of 3rd floor was com-pleted and handed over.
Amount spent UGX 1,384,042 on the output.
Only UGX 553,161,416 was spent on the planned output and UGX. 830,880,584 was diverted
Monitoring, Super-vision and evalu-ation
122,000 Annual transfer of funds to NMS, for uniforms and HMIS tools un-dertaken Health systems moni-tored, supervised and evaluated.
Amount spent UGX 121,800
A total of UGX 14,900 was diverted and therefore not expenditure under the Pro-gramme.
Support to Mu-lago hospital Rehabilitation
Hospital construc-tion / Rehabilita-tion
950,000 Construction of kawempe and Kiruddu at 99% completion
Procurement of medical furniture ongoing
Amount spent 855,000
A total of UGX 531,276 was diverted to completion of the specialized hospital
66 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Italian support to HSSP and PRDP
Output: 080282 Construction of 68 staff houses in the Karamoja region
5,619,000 18 houses partially completed (75%)
Amount Spent 2,610,000
Overall percentage com-pletion according to the latest progress report was at 66.6% for all the 68 staff houses
All the UGX 5,619,000 was spent during the financial year 2017/18
Renovation and equipping of Kayunga and Yumbe general hospitals
Monitoring and Evaluation
204,330 Twelve site meetings held and contract implementation moni-tored
Amount spent UGX 204,330
Only UGX 157,791 was spent on the project, and UGX 46,538 was diverted
Output: 080280 Hospital construc-tion/ rehabilitation.
Renovation and Equipping of Kayunga and Yumbe
0 NO Gou funds Spent A total of UGX 2,470,887,773 from GoU was spent on the output, but it is not reported about.
Regional Hospi-tal for paediatric surgery
Monitoring and Evaluation
140,000 A few visits were made in the last quarter from Head office
Amount Spent UGX 139,988
Only UGX 40,000 was spent on the project, and UGX 99,988 was diverted.
Output: 080280 Hospital construc-tion/ rehabilitation
Regional hospital for paediatric sur-gery
800,000 95%
completion of Excavation and concrete works, Erection of Rammed earth wall and steel structure was at 60%, Completion of the detailed design for Me-chanical, Electrical and Plumbing systems 100%, Internal and Ex-ternal
finishes
Amount Spent 9,428,000,000
Only UGX 7,036,570,633 was spent on the output and UGX 2,391,429,367 was diverted to Kayunga Yumbe project.
GAVI Vaccines and Health Sec-tor Development Support
Preventive and curative Medical supplies
10,000,000 Procured:
881,580 of HPV doses;
1,914,600 of PCV doses
1,911,000 of Penta doses;
1,060,800 of Rota Virus doses and
1,713,600 of IPV doses
Amount spent UGX 4,696,110
A total of UGX 10,000,000 was spent on the procure-ment of vaccines.
67A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Expenditure on Recurrent activ-ities
64,485,000 The released recurrent budget was UGX 59,047,000
According to the 4th Quarter performance report, the actual recurrent release was UGX 59,047,000 and as per the Integrated Financial Management Information System (IFMIS) BIG (Budget analysis) Report, the actual release was UGX 56,917,308. Management should explain the reasons for the varianc-es in the recurrent releases since the BIG Report and the 4th Quarter report should be in harmony.
UBTS
Capital develop-ment outputs
370,000,000 Total amount released on the capital development outputs UGX 150,000,000 and UGX 353,000,000 was spent.
Review of the Payment file and the BIG report from the IFMS system revealed that a total of UGX 356,000,000 was released for implementation of the capital development outputs out of which UGX 353,000,000 was spent
GULU RRH
Output: 81 Staff house construc-tion and rehabil-itation 312101: Construction of 54 unit staff House
312102: Demolition of old radiology building
UGX 1,338,000,000
UGX 50,000,000
• A total of UGX 1,338,000,000 was spent on the output by the year-end.
• There are no details on the activity apart from an expen-diture of UGX 50,000,000
•Review of the payment file indicates that only UGX 1,191,500,000 was spent on the output. And the bal-ance of UGX 146,500,000 was diverted.
•There were no details on the output indicated in the annual performance report. However a review of the payment file indi-cated that a total of UGX 48,000,000 was spent in respect of the output.
Output 77: Pur-chase of spe-cialised medical equipment
Assorted medical equipment includ-ing BP, and CBC machines
100,000,000 • An expenditure of UGX 98,700,000 under the spe-cialized machinery and Equipment without details on the out upon which the funds were spent.
• Review of the annual performance report re-vealed that there were no details about the output in the report apart from the expenditure of UGX 98,700,000
68 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
FORT PORTAL
Output: 085672 Government Buildings and Ad-ministrative infra-structure
312104 Other Structures
Government Build-ings and adminis-tration buildings
maintained includ-ing sanitation
39,572,000 Administration buildings main-tained, regular cleaning and sanitation services contracted. Infection prevention and control meetings in and outside the hos-pital and held. Actual spent was UGX 37,200,000.
Out of the budgeted UGX 39,572,000 for other struc-tures, UGX 37,200,000 was diverted to supply Book-shelves and paid to crown health care (U) Ltd. The re-ported actual outputs were never achieved as reported.
Output: 81 Staff houses construc-tion and rehabili-tation
Engineering and design works started. Monitoring and supervision of construction works. Staff hous-es constructed, re-habilitated, main-tained including
sanitation
882,428,000 Continuation of works of a 16-unit staff hostel. On-going monitoring and supervision of construction of works and actual spent was UGX 54,893,000
It was reported that UGX 12,000,000 was spent on Engineering and Design Studies & Plans for capital works, and UGX 7,500,000 spent on Monitoring, Super-vision & Appraisal of capital works. Audit noted that activities never took place since the funds earmarked for them were diverted and paid to the contractor. There was no single monitoring and evaluation report pro-duced to confirm that the activity took place.
It was reported that the actual amount spent for the output was UGX 54,893,000. Analysis of the payment file indicated that the actual ex-penditure on the output was UGX 860,428,343.
MASAKA RRH
Output: 81 Staff houses construc-tion and rehabili-tation
Construction of a 40 unit senior staff hostel
UGX 500,000,000
Foundation for all the 40 units’ staff hostel Completed. UGX 500,000,000 spent. Where UGX 30,000,000 was spent on Moni-toring, Supervision & Apprais-al of capital works and UGX 470,000,000 spent on Residential Buildings.
Review of the payment file indicated that the hospital spent UGX 728,298,674 which was over and above the budgeted amount by UGX 253,438,294 con-trary to the actual re-ported expenditure in the 4th quarter report of UGX500M.
Output: 82 Ma-ternity ward construction and rehabilitation
Construction of a maternity ward and children’s complex
1,558,000,000 Completing the construction of the superstructure of materni-ty and Children’s complex. Total reported expenditure was UGX 1,558,000,000.
Review of the work plans and payment files indicat-ed that whereas the hospi-tal budgeted to spend UGX 1,558,000,000 for construc-tion of a maternity ward and children’s complex, the hos-pital spent UGX 1,304,561,706 of the output and the balance of UGX 253,438,294 was di-verted.
69A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
MBALE RRH
Project 1478 Out-put 83: 83 OPD and other ward construction and Rehabilitation.
1. Procurement of Double cabin pickup truck
2. Purchase office equipment
3. Purchase of assorted medical equipment
4. Construction of a bigger incinera-tor, Renovation of acute care unit
UGX 200,428,543
UGX 130,000,000
UGX 227571,000
UGX 500,000,000
1. This output is not reported on in the annual performance report (Q4)
2. This output is not reported on in the annual performance report (Q4)
3. This output is not reported on in the annual performance report (Q4)
4. Incinerator constructed at 100% Fencing of hospital land at 5% completion.
1. A total of UGX 176,500,000 was spent on the output and the balance of UGX 23,928,543 diverted on repair of motor vehi-cles
2. A total of UGX 130,000,000 was spent on procurement of as-sorted office furniture.
3. The details of the out-put were not properly included/specified in the annual work plan
4. The renovations worth UGX 25,333,619 on the Acute care Units are not reported upon.
MBARARA RRH
Output: 80 Hospi-tal Construction/ Rehabilitation Renovation of maternity ward and surgical ward to improve on the labour suite.
UGX 350,000,000
1. Staff canteen construction BOQs already reviewed, contrac-tor procured and contract man-agement team appointed.
2. Funds already received, works started expected to be finished by August. Payments already made totaling to UGX 64,259,437 Million already received and paid to the contractor.
3. Works have been started to construct the Orthopedic struc-ture that is already at
roofing level to create room for the upcoming lab construction by the EAPHLN. The total cost is UGX 26,390,000 but the payment bounced
1. The works that were expected to be complete by August were not com-pleted by audit inspection time in September 2018. The report indicated that funds totaling to 64,259,437 was paid to the contract however, before 30th June 2018 funds amounting to 198,345,610 had been paid to the contractor before any work had been done contrary to the conditions of contract. The reported output has no relationship with the planned output as it was a diversion charged on the planned out-put code.
2. The reported construc-tion of the orthopedic work-shop has no relationship with the planned output as it was a diversion charged on the planned output code. It was also reported that the structure will be ready for handover in August 2018 but at audit inspection time in September, work was not complete and the site was abandoned.
70 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Output 85: Pur-chase of medical equipment
Assorted medical equipment includ-ing monitors for high dependence units (Ventilators, laundry washing machine and ster-ilization equip-ment)
300,000,000 The process was initiated to pro-cure sterilization and laundry but the CT Scan machine and X-ray broke down and had to be re-paired.
2.The contractor to repair the CT Scan was sourced and the CT scan machine is functional
3.The contract for repairs and maintenance including the atten-dant parts for the CT scan ma-chine has already been
signed with M/S Pacific Diagnos-tics
Ltd.
4. The Service contract for ser-vicing the X-Ray machine was secured and the machine is func-tional.
The two equipment installments are functional and in use
1.In the 4th quarter report, the hospital indicated that it had spent a total of UGX 245,156,860 on repair and maintenance of the CT scan and the X-ray machine. However, payment records indicate that a total of UGX 323,099,860.33 was spent on repair and maintenance of the CT scan and the atten-dant parts including taxes, and a total of UGX 24,143,140 was spent on the servicing of the X-ray machine.
Overview of Vote expenditure
Gou Development
1.978 bn It was reported that by end of quarter four (4) UGX 1.978 bn had been released and UGX 1.872 bn spent representing 94.6% of the releases spent.
However, review of the pay-ment file indicated that the hospital had spent about 98% leaving 26,390,000 un-spent.
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72 A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
73A Value For Money Audit Report on Budget Performance by selected Health Sector Institutions | A Report by the Auditor General
Audit House, Plot 2c ApolloKaggwa Road,P.O. Box 7083 Kampala,Tel: 041-7-336000,Fax: +256-41-435674,Email: [email protected],Website: www.oag.go.ug
Audit House, Plot 2c ApolloKaggwa Road,P.O. Box 7083 Kampala,Tel: 041-7-336000,Fax: +256-41-435674,Email: [email protected],Website: www.oag.go.ug