BFP Paper Jan2011

8/7/2019 BFP Paper Jan2011

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PADER DISTRICT LOCALGOVERNMENT

HEALTH DEPARTMENT

A BUDGET FRAMEWORK PAPER CONCEPT FOR THE FINANCIAL YEAR2011/12 PRESENTED AT THE BUDGET CONFERENCE HELD AT PADER

DISTRICT COUNCIL HALL ON THE 18TH JANUARY 2011


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JANUARY 2011

1.1 MISSION STATEMENT

To provide quality, accessible, affordable and equitably distributed healthservices, focusing on National and Local priorities, in order to improve the healthstatus of the people of Pader District.

1.2 GOAL AND SPECIFIC OBJECTIVES1.2.1 GOAL

The district health sector goal is the same as the National goal, which states thatwe aim at :

Reduced morbidity, mortality and disability from the major causes of ill-healthand premature death, and reduced disparities therein.

1.2.2 SPECIFIC OBJECTIVES

1.1.2.2 To develop and strengthen the human resource pool forthe optimal provision of quality health services

1.1.2.3 To strengthen the integrated support systems at all levels1.1.2.4 To provide the minimum health care package of services

to all the people of Pader District with adequatelyplanned for inputs.

1.1.2.5 To provide a network of functional, efficient andsustainable health infrastructure for effective health care


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delivery closer to the people1.1.2.6 To ensure effectiveness, efficiency and equity in the

allocation and utilization of resources and mobilizingmore resources with emphasis on transparency andaccountability

1.1.2.7 To ensure that communities are empowered to takeresponsibility for their own health and well being, and toparticipate actively in the management of their healthservices

1.1.2.8 To promote a healthy partnership with private not forprofit sector so that they also contribute to uplifting of thehealth status of the population

1.1.2.9 To promote research in health for development

1.3 The health delivery systemThe district has a total of 27 health units. There is 1 hospital, 1 health Centre IV,11 Health Centre IIIs and 14 Health Centre IIs. There is 1 health sub districtcorresponding to the only parliamentary constituency in the district. The DistrictHealth Office provides overall direction and oversees the health services in the

district. The Health Sub-District also assists in conducting closer supportsupervision and implementation of the Minimum Health Care Package. Theimplementation of health services is ensured through a network of health centersIII, II and Village Health Teams situated in the subcounties, Parishes and villagesrespectively.

The table below gives details of the health units in the various subcounties, inaddition to the staffing levels in each unit.

Table 1 : Summary table detailing the health units,functionality and staffing levelsHSD S/counties Health units (Level &

ownership)

Staffing levels

Recommended

Actual Comments

1. Aruu Atanga Atanga HCIII-Govt.Lawiye-adul HCII-Govt

199

120 NO

Angagura Angagura HC II-GovtAswa Ranch HCII-Govt

99

60 NO


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Laguti Laguti HC III-Govt.Amilobo HC II-Govt.Wipolo HC II-Govt.Pakeyo HCII-GovtPaibwor HCII-Govt.

199999

95100

NONO

Acholibur .Okinga HC II-Govt. 9 5

Latanya Acholibur HC III-Govt.Latanya HC II-Govt.Porogali HC II-GovtDure HC II-Govt.

19999

10554

Lapul Lapul HCIII-GovtAlim HC II-Govt.Lawire HC II-Govt.Mary Immaculate Hc II-Govt.

19999

01072

NO

Pajule Pajule HC IV-Govt.Paiula HC II-Govt.Oguta HC II-Govt.

Ogago HCII-Govt.Oryang HCII-Govt

4899

99

2935

60 NO

Kilak Kilak-HC III-Govt.5th Division Hospital

19-

7-

Ogom Ogom HC III 19 0 NOPuranga Puranga HC III-Govt.

Ogonyo HC III-Govt.All Saints HC II-NGOOret HCII-Govt

191999

12740 NO

Awere Awere HC III-Govt.Rackoko HC III-NGOLagile HC II-Govt.

Bolo HC II-Govt.Angole HCII-Govt.

19199

99

12239

10 NO

Pader TC Pader HC III-Govt.Pader TC

195

242

DHOs office 9 trained3 supportstaff

TOTAL 11Subcounties1 TownCouncil

Govt units and 3 NGOunits

206-govt.employees29-NGOstaff

NB: NO=Not operational

Source: Staff audit summary report

1.4 Other health service partners include1. AVSI(International Volunteers Service Association):Supports Kalongo

Hospital by supporting qualified personnel and equipment. It currently issupporting the PMTCT programme in Aruu HSD and VCT services in AruuHSD. It has constructed/rehabilitated a number of units and provided furnitureand esential drugs.


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2. Gulu Catholic Diocese: Supports All Saints Dispensary and MaryImmaculate HC IIs.

3. Uganda Australian Foundation: Offers a cocktail of services at RackokoHealth Center-promotive, preventive and curative.

4. Malaria Consortium-is currently supporting Malaria control activities.

5. UNICEF supports a myriad of maternal and child health activities in the healthsector which include: Reproductive Health (Adult & Youth Friendly services),HIV/AIDS/PMTCT, EPI, Home Based Care for childhood illnesses, NutritionalRehabilitation, Water and sanitation.

6. WHO-supports surveillance activities, strengthening support supervision,promoting CB-DOTs, introducing the VHT concept, introducing communityCo-ARTEM distribution.

7. AMREF supports immunisation activities, Home Based Care and water andsanitation interventions.

8. Christian Counselling Fellowship: This is a CBO established primarily toassist the formerly abducted child mothers.

9. Medical Teams International Integrated Health services.10.PATHFINDER-supports safe motherhood interventions.11.Marie Stopes Uganda-also supports safe motherhood interventions-

specifically Family Planning.12.CONCERN-supports WATSAN activities.13.UNFPA-supports Gender Based Violence and safe motherhood responses.14.COOPI- supports Gender Based Violence activities.15.WHO-supports Mental Health, Integrated Disease Surveillance.16.TPO-supports Mental health activities.17.NUMAT-supports Malaria, TB and HIV/AIDS activities.18.Baylor Uganda-supports Paediatric HIV/AIDS programmes.

1.5 REVIEW OF PERFORMANCE

1.5.1 FINANCIAL RESOURCES


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A 1.6 Proportion ofPHC funds used fordrugs

- - NO LONGERSENT TO THEDISTRICT

A 1.7 Proportion ofthe budgetaryDistrict Local

Governmentcontributiondisbursed

100% 9.6%

A 1.9 Percentage ofdisbursements fromdevelopmentpartners

100% 90%

1.5.2 PROGRAMME INDICATORS

Indicator Planned Actual Comments

A 3:Informationmanagement

A 3.2 Proportion of healthfacilities submitting timelyHMIS reports

100% 95%

A 4.3 Proportion of healthunits without stock outs ofany of the following;

chloroquine, SP,cotrimoxazole, ORS,measles vaccine & depoprovera

100% 35% .there was aninterruptedsupply for over

6 months

B 1 :CommunicableDisease Control

B 1.1 Malaria Control

B 1.1.1 Proportion of


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B 1.2 Tuberculosis control

B 1.2.1 TB casenotification rate

70% 75%

Above target

B 1.2.2 TB cure rate 85% 88% Above target

B 1.2.3 Community DOTScoverage (S/county as unitof coverage)

100% 41% Low coverage

B 1.3 HIV/AIDS ControlB 1.3.1 Urban/rural HIV

seroprevalence11% 6.4%

From ANC data

B 1.3.2 Total number ofVCT centers (include AIC)

22 24

B 1.3.3 Total client load forall VCT centers

B 1.3.4 PMTCTNumber of mothers

counselledNumber of mothers

testedNumber of mothers

enrolled

18004

18004

156

12231

12231

117

68%

100% of thecounselled75.1%

B 1.3.5 Number of patients

started on ARV therapy(new clients)

4951

B 1.3.6 Early InfantDiagnosis of HIV/AIDS

5932 6901 116%

B 1.3.6 Number of peopletreated under NTDs1.IVM2. Albendazole3. Zithromax4. Praziquantel

357 750365 932365 932357 750

248 491325 230317 753138 912

69.5%88.9%86.8%38.8%

B 2:

IMCI(integratedManagement ofChildhoodllnesses)

B 2.1 Percentage of health

workers trained in IMCI

40 29 73%-funds sent

for one training

B 3: Sexual andreproductivehealth

B 3.1 Proportion of newpregnant mothers attendingANC

22505 18004 80%


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B 3.1 Proportion of pregnantmothers attending ANC atleast 4 times

30% 52% Above target

B 3.2 Percentage ofdeliveries taking place inGOU and PNFP facilities

50% 34% Below target

B 3.4 Couple Years ofProtection (CYP)

15000 13377 Below target

B 4:Immunisation

B 4.1 DPT3/ HepB + Hibcoverage

80% 87% Above target

B 4.2 TT 2 coverage-Pregnant

TT 2 coverage- Non-pregnant

55%

50%

50%

40%

Below target

B 4.3 BCG coverage 90% 86% Below target

B 4.4 Measles coverage 90% 87% Below target

B 4.5 Polio third dosecoverage

90% 83% Below target

B 5:EnvironmentalHealth

B 5.1 Pit Latrine coverage 40% 40% On target

B 5.2 Proportion of thepopulation with access tosafe water

60% 47.2% Added effortsby NGOs hasled to a slightincrease

B 6: Healtheducation and

promotion

B 6.1 Proportion of VHTsformed/established

100% 100%

B 6.2 Proportion of VHTstrained

100% 100% Only 79%currently active

B 7.2 Percentage of Primaryschools with adequate PitLatrine stances according tothe national standards (1:40)

100% %

B 7.3 percentage of Primaryschools with functional safewater sources within kmradius

50% %

B 8: Nutrition B 8.1 Vitamin ASupplementation coverage

95% 95% On target

B 8.2 Proportion ofHouseholds consumingIodised salt (use samplesbrought by school children)

100% 100% All salt isiodised


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B 9: IDSR B 9.1 Proportion of H/unitswith at least one persontrained in IDSR

100% 100%

B 10: MentalHealth

B 10.1 Proportion ofhospitals and HCIVs withhealth workers trained in

mental health

2 2-KALONGOHospital &

PajuleHCIV

B 10.2 Number of mentalhealth cases seen in OPDand outreaches

NA 1953 Most areepilepsy cases

B 11: ClinicalCare

B 11.1 Infection Control- Proportion of health

facilities with handwashing and antisepsisfacilities

- Proportion of health

facilities with spillsmanagement practices

- Proportion of healthfacilities practicing therecommendedmangement of healthcare waste

100%

100%

100%

100%

60.9%

78.2%

B 11.2 Disability

Prevention/Rehabilitation-Proportion of HSDs withtrained Focal Persons fordisability

-Proportion of healthfacilities with ramps for thePWDs

-Number of assistive devicesprocured

0

100%

0

0

0

No funding

B 11.3 Oral/Dental Health

- Proportion of HC Ivs withfunctional Dental healthUnits

1 1 Only KalongoHosp.

C: Health Sector SupportFunctionsC 2.2 Technical supportvisits (DHT to HSDs)

4 4


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C 2.3 Technical supportvisits (HSDs to LLUs)

24 4 Inadequatefunding

C 2.5 Proportion of HC 3swith functional laboratoryservices

100% 62% Laguti, Kilak,Puranga HCIIIslack labs

D: Quality of care

D1: Accessibilityto services

D 1.1 Percentage of thepopulation within 5 km of apublic or PNFP health facilityproviding the MHCP

50% 40%

D2: Servicesutilisation

D 2.1 Total government andNGO OPD utilisation perperson per year

1.0 1.2 Above target

D3: Consumersatisfaction

D 3.1 Percentage of thepopulation expressingsatisfaction with health

services

NA NA The populationranked thehealth

department asthe best in thedistrict over theradio

1.6 Strategies of the health department to achieve its mission and ensurehealth for all and overall socio-economic development

1.6.1 Intensifying health awareness and behaviour change1.6.2 Strengthening community capacity for health promotion and improvedhealth service delivery

1.6.3 Strengthening interface between service providers and consumers1.6.4 Formulation of appropriate by-laws, ordinances and regulations forimproved Environmental health1.6.5 Provision of safe water for the communities and water quality surveillance1.6.6 Strengthen disease surveillance, epidemic preparedness andResponse1.6.7 Prompt and appropriate case management and referrals1.6.8 1.6.9 Strengthen co-ordination efforts in health service delivery1.6.10 Operationalise emergency obstetrical care services1.6.11 Scale up Goal oriented Ante Natal care and post natal care1.6.12 Scale up Prevention of Mother to Child transmission of HIV/AIDS

1.6.13 Implement Integrated Management of Childhood Illnesses and IntegratedCommnity Case Management of childhood illnesses1.6.14 Strengthen community integrated management of Acute malnuteition.1.6.15 Strengthen Expanded Programme on Immunisation1.6.16 Strengthen control of communicable and non-communicable diseases.1.6.17 Scale up of HIV/AIDS prevention, care, treatment and support services1.6.18 Recruitment of staff1.6.19 Strengthening support supervision of health workers and providing


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feedback1.6.20 Developing and circulating a league table rating performance of the healthfacilities and funds disbursed and utilized per quarter1.6.21 Promoting male involvement in health1.6.22 Develop and tracking performance indicators and targets for all health

cadres for Results Oriented Management1.6.23 Consolidate the functionality of existing health centers.

1.7 SWOT ANALYSIS

STRENGTHS

1. Healthy inter-sectoral collaboration2. Available resources (staff, transport, office equipment, logistics)

3. Political will4. Improved communication network

WEAKNESSES

1. Inadequate number of trained health staff2. Inadequate space and infrastructure for health service delivery3. Ill-equipped units4. Fairly difficult to maintain transport for referrals5. Inadequate supervision of health workers by Health Sub-District.6. Poor data management

OPPORTUNITIES

1. Donor support2. Good collaboration with community resource persons3. Good collaboration with the NGOs4. Good collaboration with the private not for profit units5. Improved security6. Good political support7. Increased wage bill & funds for recruitment

THREATS

1. Low tax base in the district2. NGOs closing office and some phasing out3. Donor fatigue4. Low will for volunteerism by the community5. High expectations for facilitation by resource persons fuelling discontent6. Moderate food insecurity


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7. High illiteracy rate

1.8 PRIORITY ACTIVITIES FOR FY 2011/12

To achieve our overall mission statement and objective, the following prioritieshave been identified:

A. SUBCOUNTY PRIORITIES

These priorities have been captured from the subcounty priorities submittedto the District planning unit. (Not all subcounties have submitted theirpriorities.)

Subcounty Project

Project area LocationAtanga Construction of HCII Ngo-too Parish-

Construction of HCII Gojani Parish-Boroboro villageConstruction of staffhouses

Lawiye-Adul HCII

Completion of Lawiye-

Adul HCII

Lawiye-adul HCII

Construction of HCII Kal Parish-Labongo guru vilageAngagura Construction of HCII Pungole Parish-Laraba villageLaguti Construction of OPD-

Lajeng HCIILapyem parish-Lajeng village

Construction of staffhouse

Lajeng village

Construction oflabortory

Laguti HCIII-Namorembe village-lapyem parish

Fencing at Laguti HCIII Lapyem parishMotorcycle for HA Laguti HCIII-Lapyem parishBeds and otherequipment

Laguti HCIII-Lapyem parish

Laguti Completion of AmiloboHCIII OPD

Lobut village-Paibwor parish

Construction of staffhouses at Paibwor HCII

Lobut village-Paibwor parish

Construction of 8stances toilet

Amilobo HC II-Amilobo Central village

Construction of staff Paibwor HCII-Lobut village


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housesConstruction of 8stances toilet

Paibwor HCII

Construction of staffhouses

Bira village

Construction of

maternity ward

Wilobo HCII-Bira village

Provision of beds Wipolo HCII-Bira villageConstruction of PakeyoHCII OPD

Lokaloye A village

Construction of latrines Wipolo & Pakeyo HCIILapul Construction of OPD Okworo

Construction of staffquarters

Alim HCII

Construction of staffquarters

Lapul HCIII-Koyo parish

Construction of pitlatrines

Lapul HCIII-Koyo parish

Fencing HC Lapul HCIII2 Staffquarters/retoling/fencing

Lawire HCII-Ato parish

Puranga Construction of OPD Laminocwidaparish,Aroinga,parwech,laminaciko,apur

Staffing Ogonyo,OretConstruction of latrines Ogonyo,OretProvision of adequatedrugs

Ogonyo, Oret

Provision of staffquarters

Oret, Ogonyo

Construction of

maternity ward

Ogonyo, Oret

Kilak Construction of OPD 4 parishesConstruction of latrines All HCIIsProvision of staffquarters

All HCIIs

Pader TC Construction of OPD All wards-Olwor central, Olwor North, Te-kituba,Pagwari East, Pagwari West, Ogeng South,Acoro, Olwor South, Lupwa South, Kiteny East,Lupwa North, Obong bene, Lagwai East, Lutyek,Lagwai zone A, Oloki-lee, Dog nam East, Te-

jingi, Dog nam, Te-oryang,Extension of piped

water

B. DEPARTMENT PRIORITIES

1. Infrastructure

Construction of staff houses, wards and upgrade HC IIs.

Electrification of Health centers along the grid.

Equip Health Centers


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2. Revitalise immunisation services meet targets set by district/UNEPI by:

Improving mobilization (community) and advocacy at all levels.

Capacity building for community resource persons (vaccinators, CHWs,Parish mobilisers)

Increasing No. of static units and outreaches. Strengthening of cold chain management.

Timely payment of allowances for outreaches.

Strengthening of the surveillance system through improved monitoring ofindicators, assessment of performance and providing feedback to all levels.

Providing more logistical support and ensuring a smooth supply of logistics

Recognition of the best performers through prize giving.

3. Stepping up Reproductive Health interventions by:

Recruit more midwives.

Providing the necessary minimum required equipment for deliveryservices.

Strengthening referral system through providing bicycle ambulances,vehicle and communication gadgets.

Promotion of management of MIP (Malaria In Pregnancy).

Initial training of fresh TBAs and re-training of Traditional Birth Attendants(TBAs) in service

In service training for midwives and other health workers.

Establish adolescent friendly reproductive health services

4. Scaling up of Malaria control activities by:

Promotion of the use of insecticide treated bed nets.

Effective treatment of malaria in the H/units.

Effective treatment of malaria at home by promotion of Home BasedManagement of fevers using Community Based Resource Persons (CBRPs).

Orienting staff on the rapid diagnostic test for malaria

Indoor Residual Spraying in communities, schools, health units etc

5. Strengthening TB control efforts by:

Implementing Communty Based-Directly Observed TreatmentShortcourse(CB-DOTS)

Supporting HSD TB focal persons Strengthening existing diagnostic and treatment centres

Expansion of diagnostic and treatment centres to underserved areas

Stepping up support supervision

Ensuring a smooth supply of anti-TB drugs by accuratequantification/forecasting

Training of health workers on CB-DOTS

Training of private practitioners on CB-DOTS


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6. Scaling up of HIV/AIDS interventions by:

Strengthening the PMTCT centres, VCT centres and Supporting VCToutreaches

Provision of ARVs

Holding monthly co-ordination meetings

Strengthen Support Supervision by facilitating HSD Supervisors

Train health workers

Sensitisation of communities on HIV/AIDS

Supply of consumables

Strengthening the district Laboratory network

7. Health Promotion and Education

Promote community participation in health by strengthening the VHTconcept, and ensuring HUMCs are established and functional for all units

Intensify health education, community dialogue to increase awarenessand promote behavior change

8. Nutrition

Open up more Outpatient Therapetic sites and strengthen the TherapeuticFeeding Centers.

Train staff on management of acute malnutrition

Conduct outreaches

Ensure smooth flow of supplies

Implement surveillance using technology for development initiative.

9. NTD Ensure smooth flow of supplies

Support Community Medicine Distributors

Conduct Mass Drud Administration.

Surveillance for adverse reactions

Environmental Health interventions

Community Health education

10. Mental Health

IEC for promoting mental health

Capacity building Ensure a smooth drug and logistics supply system

Avail case management guidelines

11. IDSR- Strengthen Integrated Disease Surveillance and Response by:

Capacity building

Purchase of data storage and analysis facilities and establish databases


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Support weekly reporting of diseases of epidemic potential

Purchase of communication equipment

Strengthen and expand the laboratory network by purchasinglaboratory equipment and supplies

12. HMIS Installing ICT facilities at district and HSD levels.

Capacity building on HMIS.

Reward system for improving timeliness, completeness and data analysis.

Provide quarterly feedback to all units.

Provide adequate HMIS materials for all functional units

13. Sexual and Gender based Violence

Data collection to quantify the extent of the situation.

Capacity building and attitudinal change for care of the afflicted.

Equipping units for case management.

Community mobilization/IEC for the prevention and early referral of thevictims.

Integration into mainstream reproductive health activities.

14. Drug Supply Chain Management(SCM)

Supervision of SCM

Build capacity for SCM at all levels

Strengthen the MTCs

15. Capacity Building

Provide In service and local training based on a capacity building plan. Strengthen Support supervision and on-job training.

1.9 CHALLENGES IN THE HEALTH SECTOR

1. Inadequate trained staff.2. Inadequate staff housing.3. Inadequate medicines and health supplies4. Gaps in management positions at various levels of

service delivery.

5. Minimal community participation in health promotion.6. High disease burden.7. Ill equipped health facilities.8. No funds for uniforms for health cadres.9. Lack of financial and supervisory support from the

Health Sub-District to the health facilities.10.Delays in processing funds in facilities to facilitate

service delivery and motivate vaccinators and parish


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mobilizers11.A few mothers still visit ANC at 9 months so they are

unable to get 2 doses of Fansidar and all the servicesoffered at ANC.

12.Low male involvement in health programmes.

13.Inadequate sensitization on health programmes .14.Maintenance of the referral system difficult due toinadequate funding.

15.Essential drug stock outs especially anti-malarials.16.Inadequate space for service delivery in some units.17.Inadequate funding.

1.10 WAY FORWARD1. Emphasis on consolidation of existing infrastructure by equipping,expanding(more space and staff houses) and renovation.2. Recruitment of more trained staff.3. Strengthen supervision by conducting frequent spot checks and scheduledvisits4. Promote health education through community dialogue, the media and drama.5. Subcounty chiefs and subaccountants to facilitate access to funds by units.6. Equip units through the credit line by the Ministry of Health.7. Management training for in-charges.8. Allocation of funds in the health units will be based on performance, workload,

staffing and responsibilities.9. Funds be allocated for maintenance of the eferral system.

Documents

BFP Paper Jan2011