Ucmb Annual Report 2010 - Final

UCMB Annual Report
2010
Prof. Henry Mintzberge;Health is not a business, health is a Calling;Kampala, June 27th 2007
UCMB Annual Report
2010
UCMB Annual Report
2010
Msgr. John Baptist Kauta

Secretary General Uganda Catholic Secretariat
The office of the Secretary General is proud to be associated with the Annual Report (January 1st to December 2010) of the Uganda Catholic Medical Bureau. The Annual Report provides all stakeholders with ample opportunity to see the excellent work done by the Bureau as well as its achievements, challenges, plans and projections for the future. We know that the successes and accomplishments of the Bureau include and presuppose the valuable contribution of many individuals. It is, therefore, appropriate at this juncture to extend our appreciation to the Catholic Bishops of Uganda, partners, the Board, the various departments of the Catholic Secretariat, the staff at the Bureau and all who play part in the various Catholic Medical institutions throughout Uganda for their generosity and sacrifice in the service of the sick. We pray that this good work continues with the collaboration and cooperation of all. We wish the Bureau God s abundant blessings for a future filled with human and, above all, divine accolades.
Figure 1 Part of the Catholic Secretariat offices. In the background is the new storied office block under construction
UCMB Annual Report
2010
The Strategic Plan 2007-2011 has been supported by:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. Cordaid Project n. 158/9506C Operational Plan 2007-9 (Ended 2009) Cordaid Project n. 100790 Operational Plan UCMB 2010-2011 Pastoral Solidarity Fund for the Church in Africa DANIDA support from Program MoH HSPSIII for PNFP HTIs Regione Lombardia - Italy Joint Medical Stores (JMS) support to the Scholarship Fund DkA Austria Project no. 158.000-D09/00161 Strengthening human resources for health in RCC units through the UCMB Scholarship Fund AVSI support - Italy UCS-CRS Partnership Project (No. CRS 2282 695 0095) Ended Dec 2009 UCS UCMB AID Relief Project (No.5413 6955014 404) Ended Dec 2009 IICD Project 30.421 (Ended 2008) SVFOG Project 0307-U-CT (Ended 2008)
UCMB Annual Report Table of Content
2010
Foreword Support of the UCMB Strategic Plan 2007-2011 List of Tables Table of Figures List of Acronyms Members of the Health Commission Leadership of the Health Commission Message from the Chairman, Health Commission of UEC Message from the Executive Secretary of UCMB Acknowledgement UCMB staff as at December 15th 2010 Some insight and messages from the longest serving staff of UCMB Executive Summary Introduction UCMB facilities as part of the National Health System Financial Report Report on activities implementation Key achievements Goal 1: Enhanced Partnership with public health sector at national, district level and other actors Goal 2: Improved sustainability, range and quality of services Goal 3: Improved governance, management and accountability structures and systems Goal 4: Improved development of personnel and contribution towards professional training Goal 5: Improved advocacy for self and for the served population Goal 6: Cross-cutting and over-arching objectives Major challenges
3 4 6 7 9 10 11 12 13 14 15 16 19 20 22 26 35 38 38 40 46 52 60 62 63
List of Annexes
Annex 1 Annex 2 Annex 3 Annex 4 Annex 5 Annex 6 Utilisation of Credit-line grants for medicines by hospitals and lower level units Trend of government support in terms of PHC Conditional Grant and Credit lines to the PNFP facilities RCC Hospital data Utilisation (access), Equity factor (user fee/SUO), Efficiency (cost/SUO and staff productivity), and Quality Data from Health Centres (lower level units Data on the Scholarship Funs Miscellaneous
UCMB Annual Report List of tables
2010
Table 1: Number of health facilities in Uganda by level and authority or ownership type ........................ 22 Table 2: Number of hospitals categorized as "Private-not-for-profit" (PNFP) in Uganda .......................... 22 Table 3: External Income by source (both in cash and in kind) .................................................................. 28 Table 4: Local income by sources ............................................................................................................... 28 Table 5 Expenditures by cost center areas ................................................................................................. 29 Table 6 Absorption level of donor funds in 2010........................................................................................ 30 Table 7Number beds and admissions in Health Centers of level II in different dioceses in 2010 .............. 41 Table 8: Total deliveries in Health Center level II, III and IV in the UCMB network ................................... 42 Table 9: Scholarships awarded by UCMB in 2010 by category of institutions of origin of candidates ...... 52 Table 10: Number of scholarships awarded in 2010 by broad category of nature of training .................. 52 Table 11: Allocation of Medicines Credit lines grant from DANIDA to PNFP hospitals to cover 2011 ....... 60 Table 12: Allocation of medicines credit lines grant from DANIDA to PNFP health centers to cover 2011 .................................................................................................................................................................... 61 Table 13: Proportion of all UCMB facilities compared to proportions of beneficiary facilities of other Medical Bureaus ......................................................................................................................................... 61 Table 14: Comparative proportion of health centers of different beneficiary health centers by level of care ............................................................................................................................................................. 61
UCMB Annual Report List of Figures
2010
Figure 1 Part of the Catholic Secretariat offices. In the background is the new storied office block under construction .................................................................................................................................................. 3 Figure 2: Categorization of health facilities under the UCMB umbrella by level of care ........................... 23 Figure 3: Relative distribution of Roman Catholic founded health facilities by region in Uganda ............. 23 Figure 4: Proportion of external and local income in the overall funding of UCMB in 2010 ..................... 27 Figure 5: Trend of external and local Income over the last six years (2005-2010) .................................... 27 Figure 6: : Trend in the local income as a proportion of the overall funding available to UCMB .............. 29 Figure 7: Trend of the net worth of UCMB ................................................................................................. 31 Figure 8: Trend in growth of the different components of the net worth of UCMB .................................. 32 Figure 9 Changes in the values of the different components of the net worth of UCMB in 2010 ............. 33 Figure 10: Level of implementation of planned activities in 2010 ............................................................. 36 Figure 11:The number of activities assigned to the different sections in UCMB. ...................................... 36 Figure 12: The trend of the level to which implementation of the volume of activities of each section have been completed in UCMB .................................................................................................................. 37 Figure 13: Level of completion of activities by their grouping according to the Goals of the Strategic Plan .................................................................................................................................................................... 37 Figure 14 Median level of completeness of implementation of the Uganda Minimum Health Care Package (UMHCP) by Health Centers in the UCMB network...................................................................... 41 Figure 15: Trend of total deliveries in Health Centers level II, III and IV in the UCMB network ................ 42 Figure 16 Proportion of HC II and HC III (combined) that provide all components of Emergency Obstetric Care (Medical level) .................................................................................................................................... 43 Figure 17 Provision of Comprehensive Emergency Obstetric Care in Health Center level IV .................... 44 Figure 18: A book containing error reporting forms for internal use by hospitals that are willing to do it. .................................................................................................................................................................... 45 Figure 19 (Left): Dr. Sam Orach and Peter Asiimwe of UCMB with members of the Board of Governors of Matany hospitals, Moroto district (Karamoja region) after induction of the board .................................. 46 Figure 20 (Right): Dr. Sam Orach in Karamoja, returning from Matany hospital after induction of the Board of Governors and a visit to the diocesan health office. ................................................................... 46 Figure 21 Mr. Kizza Charles (front right corner) meets staff of a health facility in Jinja diocese and the diocesan health coordinator during a data audit visit ................................................................................ 49 Figure 22 Bishop Egidio Nkaijanabwo, chairman of the Health Commission, officially launches the Nursing and Midwifery Procedure Manual during the Annual General Assembly in March 2010 ............ 54 Figure 23: Rt. Rev Egidio Nkaijanabwo (Chairman of the Health Commission and Dr. Sam O. Orach (Executive Secretary of UCMB) having launched the Nurses and Midwifery Practical Manual ................. 54 Figure 24 Rt. Rev. Martine Luluga, Bishop of Nebbi diocese with participants at a CPE refresher course conducted in Angal hospital........................................................................................................................ 55 Figure 25 (Left) Participants at a CPE course in Kitovu hospital - January - March 2010 .......................... 55 Figure 26 Participants at the second CPE course unit at Kitovu - September - November 2010 ............... 55 Figure 27: General trend of attrition among clinical staff in the UCMB hospitals (making 65% of PNFP hospitals) ..................................................................................................................................................... 56
UCMB Annual Report
2010
Figure 28: General trend in attrition of clinical staff in UCMB level health facilities (representative of PNFP LLUs) .................................................................................................................................................. 56 Figure 29: Trend of attrition of key clinical cadres in PNFP hospitals 2003/04 to 2009/10 ....................... 57 Figure 30: Attrition of key clinical cadres in lower level PNFP health facilities in 2005/06 to 2009/10 ..... 58 Figure 31: Staff attrition trends for selected cadres in PNFP hospitals in hard-to-reach districts in 2007/08 2009/2010 ................................................................................................................................. 59 Figure 32: Staff attrition rates of selected cadres in PNFP lower level units in 12 hard-to-reach districts in 2007/08 2009/2010 ............................................................................................................................... 59
UCMB Annual Report List of Acronyms

AVSI CUAMM DHB DHO DHC DKA ECN HC HPAC HSM HSSIP II HTI IICD JMS JRM LLU UMHCP MoH PNFP PPPH RCC SVOFG SWAp UMMB UMU UPMB Ass.ne Volontari Servizio Internazionale - Italian NGO Italian NGO (Doctors with Africa) Diocesan Health Board Diocesan Health Office Diocesan Health Co-ordinator Dreikoning Aktion Austrian Fundation Enrolled Comprehensive Nurse Health Commission Health Policy Advisory Committee Health Services Management Health Sector Strategic and Investment Plan Health Training Institutions International Institute for Communication Development Joint Medical Stores Joint Review Mission Lower level health unit Uganda Minimum Health Care Package of Services Ministry of Health Private non profit Public Private Partnership for Health Roman Catholic Church Vronestein Foundation - NL Sector Wide Approach Uganda Muslim Medical Bureau Uganda Martyrs University Nkozi Uganda Protestant Medical Bureau
2010
UCMB Annual Report
2010
Members of the Health Commission
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Name Rt. Rev. Egidio Nkaijanabwo - Chairman Most Rev. Paul Bakyenga Vice Chairman Dr. Jacqueline Mabweijano Rev. Sr. Ernestine Akulu Rev. Fr. Emmanuel Katabazi Dr. Lawrence Ojom Mr. Raphael Magyezi Ms Jane Francis Namukasa Rev. Fr. Joseph Matovu Dr. Vincent Bwete Mrs. Marcella T. Ochwo Rev. Sr. Christine Kizza Mr. Jimmy Opio Msgr. John Baptist Kauta Fr. Zachary Anthony Rweza Mr. Ronald Kamara
Address Bishop of Kasese Diocese Archbishop of Mbarara Chairman Diocesan Health Board (Kabale) Kasana-Luweero Diocese Health Department Diocesan Health Coordinator - Masaka Kitgum St. Joseph Hospital Mbarara Vice Chairman of Kyamuhunga Comboni hospital Nsambya Health Training Institution Masaka Chairperson for CPC Committee Uganda Martyrs University Dean of Faculty of Sciences Kampala Chairperson of the HTI&T Committee Mother General General Manager Joint Medical Stores Secretary General Uganda Catholic Secretariat Director of Interservice Chairman, Finance& Planning Committee Executive Secretary HIV/AIDS Department - UCS
Dr. Sam Orochi Orach, the Executive Secretary of UCMB is the Secretary to the Health Commission.
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UCMB Annual Report
2010
The Uganda Episcopal Conference (UEC) is a legal entity formed for the purpose of Jointly exercising, in matters within their competence, their pastoral office to promote common good of the People of God in their care, particularly by deliberating on matters of common interest and by enacting forms and methods of apostolate adapted to circumstances of time and place (Statute of the UEC). Decisions of the UEC are Rt. Rev. Egidio Nkaijanabwo implemented through various Commissions. Each Commission chairman Chairman of the Health Commission and the vice chairman are Bishops appointed by the Plenary of the UEC. The Health Commission deals with policy and oversight matters regarding the health department, the Uganda Catholic Medical Bureau. Over the last three years up to June 2010 the Bishop of Kasese diocese, Rt. Rev. Egidio Nkaijanabwo has been the chairman with Rt. Rev. Henry Ssentongo, Bishop of Moroto diocese being the vice chairman of the Health Commission. At the Plenary of the Bishops in June 2010, Rt. Rev. Henry Ssentongo decided to take leave from responsibilities of the Commission. The Plenary then elected and replaced him with His Grace Paul K. Bakyenga, the Archbishop of Mbarara Ecclesiastical Province. Rt. Rev. Henry Ssentongo was also chairman of the Health Commission from 2001 to 2004 while Most Rev. Paul K. Bakyenga was the Chairman from 2004 to 2006 with Bishop Egidio Nkaijanabwo as the vice chairman. Members of the Health Commission greatly appreciate the work done for the health department over the past years. The appointment of Archbishop Paul K. Bakyenga, somebody who has worked in the Commission before, has promptly filled the large gap that would have been left by the absence of Bishop Henry Ssentongo. Once again, with very warm hearts UCMB and its network say thank you to Bishop Henry Ssentongo and welcome Archbishop Paul K. Bakyenga back to the health Commission.
His Grace Paul K. Bakyenga Current Vice Chairman of the Health Commission
Rt. Rev. Henry Ssentongo Former Vice Chairman Health Commission
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UCMB Annual Report
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To all people of God, As we end the year 2010 I bring you warm greetings from the Health Commission of Uganda Episcopal Conference. The Roman Catholic Church in Uganda is filled with joy by the works done by thousands and probably millions of people around the world and particularly in Uganda to further Christs Healing Ministry. Christ loved the sick: He touched them and healed them, as we read in the Gospel that all those who had friends suffering from diseases of one kind or another brought them to Him, and laying his hands on each he cured them (Lk 4:40). As his disciples we have carried on this Mission of caring for the sick f rom the beginning of the Church here in Uganda. From the humble beginning with one health facility now known as Rubaga hospital in Kampala in 1899, the Church now has a total of 279 health facilities (30 of these are hospitals) accredited or registered with its technical arm, the Uganda Catholic Medical Bureau. These facilities continue to make big contributions to the health sector in Uganda. As a Church we would like to see more done to increase access to quality health care in Uganda. The need remains enormous. The Catholic health services network continues to register increasing demands while the resources required keep reducing in both absolute and real terms. On behalf of the Uganda Episcopal Conference I would therefore like to thank all those who have supported the church in the struggle to meet this increasing demand for services. I thank all the donors and the government of Uganda for their support. My prayer is that these types of support may increase to match the rapidly rising pressure. I also want to thank the Executive Secretary and staff of Uganda Catholic Medical Bureau (UCMB) for all the work they continue to do on behalf of the Bishops to coordinate the health facilities, advocate for them, support the strengthening of their systems and provide representation. As the challenges of health care increase I also call upon all users and potential users of the services to also try to lead the sort of life that exposes them less to the risks of diseases and ill-health. The healing ministry requires team work, bringing together various professions, knowledge, skills, and various acts of generosity to the poor etc. I call upon everyone to use all these assets to support the Healing Ministry (Romans 12:6-8). Finally, I wish you a good reading of this report and hope that it inspires you to support the work that UCMB is doing. May God bless you all.
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UCMB Annual Report
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From the Executive Secretary

(Dr. Sam Orochi Orach)
Uganda Catholic Medical Bureau (UCMB)

In this noble work of health care we fulfill the Holy Scriptures by pursuing the health ministry of Christ. Through the gospel according to St. John (John 10:10) He says The thief comes only in order to steal, kill and destroy. I have come in order that you might have life life in all its fullness. But we also learn that in order to save or protect life of others one must give his or her life to the people he or she is saving without reservation for Jesus further tells us (John 10:11) that I am the good Sheppard, who is willing to die for the sheep. He therefore tells us that this job demands commitment beyond self. He further says (John 15:13) The greatest love a person can have for his friends is to give his life for them. I want to take this time therefore to heartily thank all who have continued to serve in the healing ministry of Christ selflessly. Many among us have continued to do this when they themselves are sick and need our support. Many among us acquired infections in the course of saving the lives of others. Many moved on to the next life as a result of such infections acquired in the line of duty. Many have continued to serve even when the compensation they get can hardly feed their families or take their children to school. May the Almighty reward all these people and all others in the ways He knows best befit them. We pray for the repose of the souls of colleagues who moved on in the course of the year. I thank all those who have continued to support the effort of the network of health facilities under the umbrella of Uganda Catholic Medical Bureau in 2010. May the Almighty grant you more to be able to share with the needy. The Lord is just and will indeed reward you accordingly (Luke 6:38). The year has seen us go through many challenges especially the absence of credit line for medicines for half a year. This has created a lot of stress on health facilities. There are many other challenges that call for our increased and collective advocacy. I want once more to call upon all of us in the network and people who support our course in providing health care and complementing government in reaching the poor to increase advocacy and where possible give direct support to one another. I wish you all the best in 2011. Mathew 10:1 Jesus called his twelve disciples together and gave them authority to drive out evil spirits and to heal every disease and every sickness
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UCMB Annual Report
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UCMB gives appreciation to the Bishops (UEC) for their support and to the chairperson and members of the Health Commission of UEC for being there to continually guide the bureau. The bureau is similarly grateful to the Standing Committees of the Health Commission (Finance & Planning, Pastoral Care of the Sick, Health Training Institutions and training, Scholarship Fund Management Committee). Special thanks go to all the partners / donors who have made it possible for UCMB to carry out its mandate, especially Cordaid, Regione Lombardia, DANIDA and partners like AVSI, DkA Austria, and The Pastoral Solidarity Fund for Africa. We are also heartened by the support of the personal friends of Br. Daniele Giusti (The Toyai group) for extending their support beyond the presence of Br. Daniele in UCMB. UCMB is also grateful to Duke University for support it gave for piloting a program of Health Systems Strengthening through a Public-Private-Partnership for Health approach that brought on board service providers, academics and national coordination bodies (medical bureaus). Once again we want to thank the Government of Uganda especially Ministry of Health and Ministry of Finance, Planning and Economic Development (MoFPED) for the budget support to the network despite the stagnation. We also want to give appreciation to the recognition demonstrated of the work of UCMB through the award given to the Executive Secretary, Dr. Sam Orach, during the Joint Review Mission of 2010 in recognition and appreciation of his contribution to the health sector. UCMB is hopeful that that recognition and appreciation will translate into more support to the network of health facilities accredited to the bureau. We at UCMB feel indebted to the former staff of the bureau who have continued to support us either by coming back to do some work with us or by giving technical advice and sharing opinion on line. In particular we thank Dr. Br. Daniele Guisti (former Executive Secretary), Ms. Marieke Verhallen (former advisor on Organisational Development and Governance), and Mr. Andrea Mandelli (former advisor on Information, Communication and Data Management). UCMB functions as a composite part of the Catholic Secretariat and therefore appreciates the support of the management, executives and all staff of Uganda Catholic Secretariat Not least, UCMB is very grateful to its staff who have continuously shown team spirit in their work. We also want to appreciate those who could not continue with us into 2011 because of the big contribution they have made to the bureau in the time they were part of the staff. Mr. Isaac Mpoza Kagimu joined Capacity Plus in the middle of the year, while Johan de Koning left in December 2010 and returned to The Netherlands before taking up another job. We wish them well in their careers.
Yes, together we have and can do more if we commit to Christs healing ministry
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UCMB Annual Report
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Above (R): The staff of UCMB pose for an end-of-year photograph on th December 17 2010. From left to right are: Joseph Martin Owori Rev. Fr. Festo Adrabo Mrs. Florence Bamenya Ms. Monicah Luwedde Dr. Sam Orochi Orach Jenard Ntacyotugira Mrs. Margret Kawooya Rev. Sr. Catherine Nakiboneka Peter Asiimwe Charles Kizza Above (L): Mrs. Florence Bamenya (r) and Mrs. Margret Kawooya (l) with Dr. Sam Orach (c) after he had given them Certificate of Appreciation awarded by Uganda Catholic Secretariat for their long service with great commitment in UCMB. They have both served for over 20 years each. Thank you and congratulations
Not in the picture are: Robert Kizito Godfrey Begumisa Johan dKoning an expatriate
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UCMB Annual Report
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Mrs. Kawooya Margret
I have worked in Uganda Catholic Medical Bureau for 21 years now as Front Desk Officer/Secretary. Throughout this time I have loved my job and embraced the fact that a customer or client or indeed anybody who needs help is the most important person in an office. He/she calls with news, needs, expectations and even wants, all of which demand satisfaction. At UCMB we believe that somebody who needs our service does us a favor to come or call. Such a person has never been an interruption to me and so, deserves the most of my attention. As a front Desk Officer, I also handle secretarial work which includes receiving and sending out all UCMB correspondence, preparing documents for meetings, filing and archiving documents, preparing for workshops/seminars and any other assignment required by the Bureau As a department in charge of health care, all customers / clients are handled with courtesy, helpfulness, care, prompt service and quick solution to their problems. For the good number of years at UCMB, I have also found internal customer care very necessary. I have done that by ensuring that all staff co-operate with one another so that the output of one section is the input of another. Therefore all staffs at the Bureau are customers of one another. I have learnt that you can enjoy your work if you love it and it is you to create that love for it. I pray that the strong team work and self motivation that the staffs of UCMB have is continued.
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UCMB Annual Report

Mrs. Florence Bamenya
2010
I joined Uganda Catholic Secretariat in December 1990. This means that for 20 years, gates at the Uganda Catholic Secretariat have opened for me in the morning and closed behind me in the evenings. I thank the Almighty for enabling me to fulfill this. During these twenty years of stay, a lot has happened. We have shared, gained, lost and sacrificed. Among these three remarkable events greatly touched my life. The first event was the Popes visit to Uganda in 1993.The Catholic Secretariat was among the few places chosen to host the pope. Being a staff of the Secretariat I was lucky to be physically addressed by the Pope and get his physical blessing. The second event came in 2005 when Uganda hosted over 100 bishops from the AMECEA countries. I was humbled and honored to be among the organizers of this conference. I served on the Finance Committee as Assistant Treasurer to ensure that enough resources were available and that there was value for money at the end of the conference. Among the so many activities, were dinners organized by selected families. During these dinners we mixed freely with the bishops and shared a lot. From then on my attitude towards the bishops changed. I used to think they were supernatural human beings and that I should always keep a distance. Surely, how had I managed to serve the conference for 15 years with such a wrong attitude? Thanks for my involvement in AMECEA Conference it was a big turning point in my life. The third event was in 2004 when Msgr Joseph Obunga passed away suddenly. He was our Secretary General by then and spearheading the preparations of the AMECEA conference. His death threw the whole organization into confusion it was indeed a great loss. The death of Msgr Obunga has been the saddest moment during my stay at the Secretariat. He was a true father, a friend and a mentor to me and to others. May his soul rest in eternal peace.
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UCMB Annual Report
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Dr. Johan de Koning (PhD) was an expatriate who worked with UCMB to raise the profile of Quality and Safety of Care in the UCMB network. A specific coordination desk was established among other things.
Dr. Johan de Koning returned to The Netherlands from where he will proceed to take up another job in Jordan
Mr. Isaac Mpoza Kagimu

worked as HRH Advisor. He has moved to the Capacity Plus here in Kampala
UCMB appreciates the contribution that both Mr. Isaac Mpoza Kagimu and Dr. Johan de Koning made to the network, to UCMB itself, to Uganda Catholic Secretariat and to the health system in Uganda at large. We wish them success in their next part of their careers.
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UCMB Annual Report
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The current report covers the work of UCMB over the period from January 1st 2010 through December 31st 2010. It marks the 4th year under the strategic plan period running 2007-2011. The year was marked by further reduction in human resource at the bureau against an increasing demand for its services to the network health facilities and the diocesan health departments. Conceptualizing and guiding the UEC in the transition of AIDS Relief project was a major challenge that took a lot of energy out of the staff of UCMB to ensure that the department did not crush as a result. While it was a challenge, it also posed an opportunity to think of how to take advantage of some of these programs while ensuring that the core services of the bureau are maintained or even enhanced. The partial absence of the CPC Coordinator and the departure of the Human Resource Advisor The absence of the Finance Management Advisor was a challenge but it forced UCMB management to think outside the box and have some important activities carried out through outsourcing. It was therefore not totally a negative challenge. UCMB staff managed to obtain 107% of its budget (102% of external fund and 122% of local income). However activities had to be cut to fit into the foreseen narrow budget, thus still leaving bureau far from bringing on board important activities identified in the operational plan that had been put aside due to funding problems. External funds made up 71% of available revenue while local income made up the remaining 29%. Of the 397 activities planned, 86% were accomplished either fully or partially (near complete). This took up 82% of available funds. Investment payments were made for shares in Pax Insurance and land procurement as approved by the Health Commission in 2009.
The major achievements of the year were from advocacy actions. They include the securing of grants from DANIDA to provide medicines credit lines for PNFP facilities for two years after these facilities had gone without credit lines medicines for half a year. UCMB also led the negotiation and establishment of a partnership between Uganda Episcopal Conference and UNICEF, thus signing of a 3 year project that will support four dioceses. The Certificate Course in Health Services Management was taken over as a course of Uganda Martyrs University. The curriculum for training Clinical Mentors was also completed, approved by Uganda Martyrs University and the National Council for Higher Education and the course is now owned by the University. The general performance of the network improved despite the huge constraints, a sign of remaining focused on the Mission Statement of the RCC health services network. th
Prof. Henry Mintzberge;Health is not a business, health is a Calling;Kampala, June 27 2007
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UCMB Annual Report
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The year 2010 marked the fourth year for the implementation of the current RCC Strategic Plan (20072011) and the first year of the Operational Plan period 2010-2011. It was a year of both increasing challenges as well as successes. More still it was a year of great lessons by the now only Ugandan staff at a time of preparing to draw a new strategic plan in 2011 for the period 2012-2016. The report covers both financial and activity performances. As usual, it attempts to relate the two to each other and to the level of achievement of the targets set for the indicators. While quantitative analysis is done for both activities and level of achievements of set goals, attempt is given to reflect the qualitative outcomes as well. The main parts of the report are: The Introduction which contains the Statements of Mission and Aims of the Operational plan within which the annual activities have been carried out. A summary of performance of planned activities Brief on Finances for the year, also giving some trend analysis Brief on levels of activity completion and how they relate to the financial absorption and the achievements of the targets set for the indicators of the operational plan. Highlights of the key achievements in the operational period are also given. Major challenges Key events Conclusion Recommendations for 2011 and the next strategic plan period UCMB Personnel list for 2009 Annexes
Mission Statement
The strategic and therefore the operational plan are meant to further the Mission of the Catholic Health Services network which, in summary, is:
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UCMB Annual Report Aim of the Operational Plan
2010
This is carried through the annual plan. In line with the Mission statement, the aim of the Operational Plan 2007-09 is:
The goals of the Operational Plan are: 1. Enhance the partnership with public health actors and others 2. Improve sustainability, range and quality of services 3. Improve governance, management and accountability practices and systems of health institutions 4. Improve the development of personnel and contribution to training nationally 5. Improve advocacy for self and for served populations 6. Secure key and other strategic functions of the Bureau (Northern coordination, help in better definition of congregations roles, establish options for future legal status of health services, strengthen collaboration with UMU, secure core activities and governance of UCMB) The objectives and activities of 2009 were, as for the previous year, hence planned to move the network towards achieving this aim and Mission. There are 70 specific operational objectives, which should finally feed into achievement of 6 Strategic Goals. The objectives are monitored using 109 indicators at operational level and 57 indicators at strategic level. But 31 of the strategic level indicators are also shared with the operational level objectives, leaving a combined total of 135 indicators to monitor. Activities are planned annually to achieve the above objectives and goals. These take into account activities envisaged at the drawing of the strategic plan and operational plan.
.
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UCMB HEALTH FACILITIES AS PART OF THE NATIONAL HEALTH SYSTEM

Uganda Catholic Medical Bureau is the technical arm of the Uganda Episcopal Conference (UEC) responsible for coordinating the network of health facilities of the Roman Catholic Church (RCC) in Uganda. The Roman Catholic Church opened the first health facility in Uganda in 1879, the current Rubaga hospital. To date the Catholic Church has a total of 279 health facilities under the umbrella of its technical department, the Uganda Catholic Medical Bureau, UCMB. These facilities operate as part of the National Health System and part of the Health System of the respective districts in which they are located. The preliminary inventory of health facilities produced by Ministry of Health in May 2010 showed the following number of facilities by levels and category of ownership.
Hospitals HC IV HC III HC II Total
Government 65 165 847 1572 2649
NGO/PNFP 57 12 241 486 796
Private 9 1 26 960 996
Total 131 178 1114 3018 4441
Table 1: Number of health facilities in Uganda by level and authority or ownership 1 type
However the Ministry noted that the 960 private facilities categorized as HC II, especially those in Kampala, had included drug shops and clinics that did not meet the criteria of Health Centers. It is still worth noting that the number of private hospitals has increased in the last few years although they are much smaller in terms of bed capacities. Hospitals Out of the 131 hospitals, Private-not-for-profit hospitals make up 43.5% (also 43% of available hospital bed capacity). UCMB network alone makes up 23% of the hospitals in the country and 28% of the hospital bed capacity (calculated from the MoH data of Dec. 2009). There are 57 hospitals categorized by Ministry of Health as Private-not-for-profit. Among these 53 are faith-based belonging to the four medical bureaus as shown in table 2 below. AUTHORITY NO. INCL. "COMMUNITY HOSPITALS 30 17 5 1 4 57 NO. EXCLUDING "COMMUNITY HOSPITALS" 30 17 5 1
UCMB UPMB UMMB UOMB COMMUNITY (See list) TOTAL
Table 2: Number of hospitals categorized as "Private-not-for-profit" (PNFP) in Uganda
53
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The 279 health facilities of the Catholic Church are distributed by level of care as in figure 3 below
UCMB Health Facilities In 2010
Figure 2: Categorization of health facilities under the UCMB umbrella by level of care
The distribution of the health facilities by region shows that the majority (all levels combined) are in the central region, followed by the western, northern and eastern region in reducing order as shown in figure 4 below.
Figure 3: Relative distribution of Roman Catholic founded health facilities by region in Uganda
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Pictures of some of the hospitals in the UCMB umbrella in the four Ecclesiastical Provinces
Rubaga hospital, situated on Rubaga hill in Kampala is specially remembered here because it was the first health facility started by the Catholic Church in Uganda.
Rubaga hospital administration sectionthe first health facility built by the Catholic Church in Uganda
Nsambya hospital is also remembered specially for having started the first nursing school in Uganda in 1919 (the same year the first midwifery school was started in Mengo hospital by the Anglican Church).
Nsambya hospital on Nsambya hill, Kampala (The new Out-patients department)
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Entrance into Virika hospital was the first Catholic facility in Western Uganda Fort Portal diocese (internet photo)
An aerial view of Lacor hospital in Gulu district, Gulu Archdiocese one of the Catholic hospitals that sustained
health care in this region during the long period of conflict and war
Mutolere hospital in the cool southwest region close to the DRC and Rwanda (internet photo) Kabale
Inside a busy pediatric ward in Lacor hospital
(R) St. Kizito hospital, Matany in Karamoja region Northeastern Uganda, Moroto diocese taken during a rainy season. Moroto is a semi-arid region. But Matany hospital management has also planted a number of trees in and around the hospital as can be seen.
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This section summarises both the income and expenditure for year. Income is given for both external and local sources and spelt by each source. Herein also the positive balance carried forward from the previous year has been combined with actual new money received and reported as income for the year. The report also summarises the trend of income over the last six years from both external and local sources. Other things reported are the balances per donor source and balances on account, the net worth of UCMB and some investment efforts. The net worth of UCMB does not only reflect what it has in cash but also value of its immovable assets e.g. buildings.
INCOME
Table 1: Summary of external and local income in 2010 Budget Shs. 1,453,057,543 491,350,317 1,944,407,860 Actual Shs. 1,475,590,079 601,136,207 2,076,726,286 Performance % 102% 122% 107% Variance Shs. 22,532,536 109,785,891 - 132,318,427
External income Local income Total
Although UCMB registered a further drop in its overall funding, this was little and could be considered as both a stabilization within the last part of the Strategic plan (after the sharp drop of 2009) and reverting to the general trend of reduction as shown by the trend line. This general trend would indicate a predicted reduction in high cost accelerated activities but does also reflect a reprioritization thus leaving away a number of desired activities. It therefore does not mean a reduction in the need for high level investment in the core services of UCMB. As seen in Figure 1 below, external sources made up 71% of the funds available to UCMB in 2010. This is very similar to the 72% in 2009. While most of this was in actual grants, there were also contributions made in kind but UCMB gave them monetary values (estimates).
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UCMB Annual Report
2010
Figure 4: Proportion of external and local income in the overall funding of UCMB in 2010
Figure 2 below shows the trend in funding over the last six years as explained in the introduction above. Although not significant enough to sustain operations of the department, there is generally some effort to increase on the local funding as shown by the trend below.
Figure 5: Trend of external and local Income over the last six years (20052010)
As seen in Table 3, actual new funds transfer from Cordaid made up 55% of donor funds and together with the balance carried forward from 2009 and the contribution in kind in the form of salaries for an expatriate staff it was 68%. The money from CRS was not a new grant but a balance from the project that ended December 31st 2009 and was meant to simply complete pending payments. Indeed for the specific areas they supported, the other contributions (AVSI, DkA Austria, Pastoral Solidarity Fund,
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UCMB Annual Report
2010
Regione Lombardy, and the Toyai Friends) were very significant and the donors are indicated as in table 2. Contribution from Duke University came in kind through the work in the area of piloting Health Systems Strengthening.
Donor AVSI (After deducting deficit b/f of Ushs. 2,831,190) CORDAID CORDAID carried forward CORDAID Quality and Safety CRS Partnership Project DKA ( Austria) MoH-HSPS III DANIDA carried forward Pastoral Solidarity Fund for the Church in Africa Personal Friends Region Lombardy Duke University - In kind MoH-HSPS III DANIDA Total Less: Opening balances Total Income Received during the year
Amount Ushs. 38,128,586 810,000,000 160,937,186 35,000,000 5,178,343 53,563,248 32,890,764 36,465,986 18,550,000 212,000,000 30,343,400 42,532,566 1,475,590,079 (196,175,103) 1,279,414,976
Percentage % 3% 55% 11% 2% 0% 4% 2% 3% 1% 14% 2% 3% 100%
Table 3: External Income by source (both in cash and in kind)
Local sources therefore made up the remaining 29%. There was a reduction in the actual new revenue (U. sh. 402,712,465), as compared to that of 2009 (U. sh. 553,482,548). But the actual expendable local fund available was higher, being sh. 601,136,207 only. This apparent increase was largely contributed to by the recall from Assets Replacement Reserves (sh. 134,872,500)-later used for procurement of office equipments, purchase of land and purchase of capital shares into Pax Insurance- and the balance brought forward from 2009 (sh. 63,551,242).
Source of Local Income Annual General Meeting income Annual contribution of HTIs Annual contribution of units Bank interest Exchange gain ICT recoveries Incidental JMS contribution to scholarship Logistic services Other (Recovery from printing of nurses and midwifery practical manual) Treasury Management Yield UCMB staff honoraria and sitting allowances Total Add: Recovery from asset replacement / general reserve UCMB funds brought forward TOTAL AVAILABLE FOR THE YEAR
Amount Ushs. 5,540,000 1,800,000 59,895,000 16,957,043 111,092,881 9,571,820 1,101,321 115,000,000 216,300 68,550,000 10,820,500 2,167,600 402,712,465 134,872,500 63,551,242 601,136,207
Table 4: Local income by sources
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UCMB Annual Report
2010
The gradual growth, albeit slow, in local income as a proportion of the total fund available is shown in figure 3 below.
Figure 6: : Trend in the local income as a proportion of the overall funding available to UCMB
EXPENDITURES
Table 5 below gives a summary of expenditures by cost centers.
Table 5 Expenditures by cost center areas
Cost Centre A Core functions B Organisation Governance and Development C ICT D Capacity Building - Training E Capacity building - Scholarships F Capacity Building - HTI&T G Research, studies and expertise H Special Programs I Assistance Access GHI Funding J Quality and Safety in Care X M&E - Accountability Y Overheads YA Investments ZA Appropriation ZB Contingency Grand Total
Sum of Revised Sum of Actual for % performance % of total Mid-Year Budget Jan-Dec 2010 Variance against budget expenditure 220,231,333 202,608,256 17,623,076 92% 11.6% 368,302,627 246,527,972 121,774,655 67% 14.1% 90,497,441 75,441,424 15,056,017 83% 4.3% 189,250,029 134,498,950 54,751,079 71% 7.7% 198,605,428 189,370,446 9,234,982 95% 10.8% 178,528,310 154,395,463 24,132,847 86% 8.8% 144,893,400 78,734,452 66,158,948 54% 4.5% 50,000,000 51,961,200 1,961,200 104% 3.0% 37,554,305 37,554,305 64,144,000 59,770,450 4,373,550 93% 3.4% 6,500,000 6,200,000 300,000 95% 0.4% 175,900,987 194,833,846 18,932,859 111% 11.1% 134,872,500 134,872,500 7.7% 160,000,000 180,802,244 20,802,244 113% 10.3% 60,000,000 42,872,667 17,127,333 71% 2% 1,944,407,860 1,752,889,870 191,517,989 90% 100%
If the cost of investment is considered, the overall expenditure was 90% of the budget projection figure and 84.6% of the actual money available in the period. By and large the expenditures remained within budgeted range and the expendable available money (including that made available through recovery from reserves). The expenditure on overheads being above budget was because this item was underbudgeted during the effort to manage the deficit that existed at the beginning of the year while the reality dictated differently. But the operational overheads made up only 11.1% of the total expenditure
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which was good. In fact this figure includes both actual operational cost and assets depreciation costs in the ratio of 1:2. The core functions of UCMB which includes the functions of the governing structures, a limited financial support to the dioceses, the Annual General Meeting, the UCMB bulletin and the salaries of basic staff (the minimum level of staff that would be necessary in the worst situation) also took up only 11.6% of total expenditure. The zero expenditure on Global Health Initiatives (GHI) was because no funding was received from IRCU in the whole period. Fund became available in the last month of the year and was not useful to requisition and obtain at that time. Overall donor funds were used to the overall level of 84% as seen below (table 5). The difference between total expenditures as presented by management (1,752,889,870) and that by auditors (1,622,477,566) is first of all because we have reflected all gains from interests into appropriation while the auditors have deferred an amount of sh 4,645,890 being part of the earning from fixed deposit to 2011. In addition they have not reflected the capital expenditures (after reflecting the recovery from assets replacement reserves worth (sh.134,872,500). They have only reflected it as an increase in asset value in the balance sheet. The additional difference of sh.185,694 is due to management reflection equivalent higher inventory (stationery) value. Table 6 gives the balances on donor funds as at December 31st 2010.
Table 6 Absorption level of donor funds in 2010
Donor Amount available AVSI (after deducting deficit b/f of - 2,831,190) 38,128,588 Cordaid (Disbursement + balance carried forward) 970,937,186 Cordaid Quality and Safety in Kind 35,000,000 CRS Partnership 5,178,343 DKA (Austria) 53,563,248 MOH-HSPS III (DANIDA) (Iincl. Balance b/f from 2009) 75,423,330 Pastoral Solidarity Fund for the Church in Africa 36,465,986 Personal Friends 18,550,000 Region Lombardy 212,000,000 Work in kind Duke University 30,343,400 TOTAL 1,475,590,081 Utilized 25,997,971 829,218,738 35,000,000 5,178,343 53,563,248 75,423,330 36,427,600 18,550,000 125,195,234 30,343,400 1,234,897,864 Balance Absorption 12,130,617 68% 141,718,448 85% 100% 100% 100% 100% 38,386 99.9% 100% 86,804,766 59% 100% 240,692,217 84%
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NETWORTH VALUE OF UCMB

This is the value by which the assets of UCMB exceed its liabilities. The net worth of UCMB has continued to rise as shown in figure 6 below.
Trend in growth of total networth of UCMB
1,400,000
1,157,589 1,095,956
1,200,000
1,000,000
800,000
789,198 674,015 647,165

555,131550,446 488,077
Figure 7: Trend of the net worth of UCMB
600,000
400,000
401,211 270,308
200,000
191,878 167,748 139,109 102,585106,225
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
The net worth value is here computed to comprise of the following (Fig 7): Net-book value of assets (Capital Reserve), Cash available in the general reserves, Cash available on the Assets Replacement Reserves Value of work in progress being the contribution UCMB has made to the construction of the office building at Uganda Catholic Secretariat. It reflects the value of space that will be occupied by UCMB in the new building once completed.
Figure 7 shows how the different components of the net-worth of UCMB have changed over the last 14 years, 1996 2010.
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UCMB Annual Report

Work in progress (investment in UCS building) General Reserves Assets Replacement Reserves Fixed Assets net book value (Capital Reserves)
2010
Trend in Networth value of UCMB

1,400,000 1,200,000 1,000,000
800,000
Figure 8: Trend in growth of the different components of the net worth of UCMB
600,000 400,000 200,000 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
General Reserve The general reserve is built from money UCMB generates locally and gives the department the possibility to make important expenditures considered urgent but for which there is not money. It can be used to finance deficits in the budget if found absolutely necessary. The general Reserves reduced (by -2%) because the expenditure from it exceeded the appropriations. The main expenditure here was to finance the investment in Pax Insurance as decided in 2009 (see UCMB Annual Report 2009) worth sixty million shillings only (Ug. Sh.60,000,000.00 only). While UCMB seeks to invest with the hope of improving future sustainability, it is also cautious that it does not fix too much of its cash into assets; it will instead make more efforts to increase liquidity at the same time as a safety factor. Note: There also is a small emergency reserve. However this is not considered part of the net worth of UCMB because this fund is basically reserved to allow UCMB respond to some limited extent to emergencies affecting the network that it serves. In 2010, for example, UCMB supported Moroto diocesan health department with three million shillings to procure medicines and medical supplies from Joint Medical Stores during the outbreak of cholera. The emergency reserve is sustained by money from well-wishers e.g. Toyai friends in Italy, although part of their offer is also used to support the dioceses in other ways. Assets Replacement Reserve Little was spent in 2010 to procure new assets. Apart from not having to buy many new assets, one important reason was the decision taken not to replace the desk-top computers used by a number of staff as back-up source of data. This decision was both to reduce cost and to reduce environmental pollution. Instead external back-up discs are being procured with larger storage capacities yet very small costs and very small sizes. This does not rule-out procurement of desk-top computers in future if for routine use in office (not for backing-up data for individual sections).
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UCMB Annual Report
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Little expenditure on assets replacement meant that appropriation to the reserve exceeded expenditures, hence a big rise of 29% compared to the 2009 value. Again this appropriation is from sales of old assets (not from donor grants). Capital Reserve (Fixed Assets Net Book Value) The decline in value of capital Reserve or Fixed Assets net book value (by -15%) indicates that the total depreciation of assets in the year was more than the value of new assets (as little was spent on procuring new assets). The various changes or movements in the values of the different components of the net work are graphically shown in figure 8 below.
Changes in the value of the components of the Networth of UCMB compared to 2009 values
35% 30% 25% 20% 15% 10% 5% 0% -5% -10% -15% -20%
Fixed Assets net book value (Capital Reserves) -15% Work in progress (investment in UCS General Reserves building) -2% 0% Total 6% Assets Replacement Reserves 29%
Figure 9 Changes in the values of the different components of the net worth of UCMB in 2010
INVESTMENT FOR SUSTAINABILITY

Investment in land In 2009 it was agreed that UCMB buys some land and negotiations were completed for the procurement of a three and half (3.5) acres piece of land at Kyadondo, Block 167, Plot 497 Kiwale village along Gayaza Kiwenda road. The dream is that in future money will be obtained to construct a housing estate for rent on this piece of land. The actual procurement of this piece of land was done in early 2010 at the value of Ug sh. Sixty five million (sh. 66,302,500) only. In the worst scenario, the land which will have appreciated may be resold. This is referred to more specifically as Investment Property as it is expected to bear higher income for UCMB in future. This land is in the name of the Registered
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UCMB Annual Report
2010
Trustees of Uganda Episcopal Conference (UEC) but meant for development of UCMB to make it able to better serve the population as an organ of the UEC in future. Investment in Pax Insurance A decision was also made to invest (as part of Uganda Episcopal Conference) another sum of sixty million shillings (60,000,000) only into Pax Insurance Company from which UCMB will obtain dividends in the future. This amount was also paid in February 2010 with a clear agreement signed with the Secretary General and Finance Administrator that once Pax Insurance gives dividends to Uganda Episcopal Conference, the share equivalent to what UCMB has paid will be given to UCMB. Of course the money still remains of UEC as UCMB belongs to the Conference and any investment it makes serves the people as an organ of the Conference. Consideration for future investment UCMB is considering constructing a facility that will provide a fairly modern conference rooms with video conference equipment in the future. The intention has been agreed to by the Health Commission. It is likely that the video conference equipment will become available in 2011 and will be used from the current board room but later transferred if the conference building is constructed. Funds are not yet available for the construction. The process of acquiring land not too far from the Uganda Catholic Secretariat is going on alongside the architectural preparations. The office of the Secretary General (of Uganda Catholic Secretariat) has expressed interest in joining hands with the UCMB to obtain funds and construct the conference building. More technical discussions are yet to be held to look into the feasibility of this with a critical assessment of any possible effects on the intended purpose of creating sustainability of this department. UCMB has also reached a decision to use the money obtained from the sales of the Nurses and Midwifery Practical Manuals to establish a Printing and Publications Fund. This fund is to help the department in making future publications as a source of raising more money from which other appropriations may be made towards other needs if the fund grows to significant level.
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UCMB Annual Report
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At the beginning of the year the UCMB identified over 400 activities but had to cut down to 397 for various reasons. Some were rendered not applicable due to external circumstances, others dropped because shortage of funds would not make them possible because they were either tied to particular projects (e.g. the CRS-UCMB partnership project that did not get renewed because of the work on the AIDS Relief transition). Some were postponed to 2011 either because some pre-requisite activities needed to have been completed in 2010 or externally or because the lead technical persons were not there e.g. the Finance Management Advisor. Although management decided to outsource some activities related to Finance Management Advisory services many of the activities were also postponed because management observed that with the absence of a Finance Management Advisor for close to two years, it was more proper and urgent to reassess the Finance Management Advisory needs in the hospitals and diocesan health departments. For this purpose an activity to make this assessment was introduced and carried out by a consultant. This will now provide guidance on what to do from 2011 either through outsourcing (in the meantime) or when the position is filled (preferably in the new strategic plan period). The need to train diocesan health coordinators, as a way of building their capacities for sustainability became quite important and it was possible to carry out this activity by outsourcing. Similarly, the need to train hospital managers, especially the human resource officers and administrators in human resource planning and management became urgent due to demands from the network. This training was also carried out through outsourcing. It therefore looks like UCMB can do a lot more in the future by identifying in-country capacities to work with the local team on a non-permanent basis to carry out one-off activities or capacity building instead of always wanting the presence of a full-time staff. The number of activities left to be carried out was 397, which was very similar to those for 2009, that being 400. Out of these 69% were completed fully, 17% were almost fully completed and 14% could not be carried out (Figure 9). Those fully carried out and those almost fully carried out make up 86% against a fund utilization of 82%.
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UCMB Annual Report
2010
Figure 10: Level of implementation of planned activities in 2010
Although often implanted as a team, activities were implemented under the lead of separate sections of the bureau as shown in figure 10.
Figure 11:The number of activities assigned to the different sections in UCMB.
Figure 11 below shows the trend of the extent to which each section in UCMB managed to gets the volume of activities assigned to it completed in the last four years and the overall level of completion by the bureau. It is important to note that the different sections in UCMB complement one another. Therefore some sections that appear to have few activities do actually participate in the implementation of activities of other sections. Similarly, the office of the Executive Secretary and Administrator support each of the other sections.
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UCMB Annual Report
2010
120% 100% 80% 60% 40% 20% 0%
Level of completion of activities by section
Human Resource Advisory
HTI & T Coordination
Financial Management Advisory
Organisational Development and Governance
Quality & Safety of care
Executive level
Information, Communication and Data Management
2007 2008 2009 2010
The activities are also grouped according to how they relate to the different goals of the strategic plan. Figure 10 below summarizes the level of achievement of the activities according to their grouping by the strategic goals.
Level of implementation of activities by strategic goal

Activities under Goal 6 89%
Activities under Goal 5
81%
Administration / Accounts
Pastoral Care of the Sick
OVERALL
Figure 12: The trend of the level to which implementation of the volume of activities of each section have been completed in UCMB
84%
Figure 13: Level of completion of activities by their grouping according to the Goals of the Strategic Plan
94%
79%
Activities under Goal 1 70% 75% 80% 85%
88% 90% 95% 100%
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UCMB Annual Report
2010
Although many things were done or achieved only a few key achievements are highlighted here. In any case, the ability to sustain a relatively high level of activities against a reducing number of staffs at UCMB was an important achievement in itself. The Human Resource Advisor disengaged from UCMB in the middle of the year. The Coordinator of Clinical Pastoral Care and Clinical Pastoral Education was hospitalized for a long time but was able to return and use the help of outsourced assistants to complete all the planned activities.
Goal 1: Enhanced Partnership with the Public Health actors, at national and district level, and with other actors in faithfulness to the Mission.
The partnership with government, development partners and the other stakeholders is within the Sector Wide Approach (SWAp). It covers areas such as policy setting, common planning, sharing of resources, joint monitoring and evaluation etc. However, the recognition of the very significant role the PNFPs play in complementing government effort to provide health services to the people, especially the poor the need to harness that role, hence budgetary support, and the increasing financial constraints faced by the PNFP has made the agenda for financial support much more prominent. 1. The key achievements in the area of partnership relate to the Public-Private-Partnership for Health (PPPH) policy. The roll out of the public private partnership in health policy during the year was a significant step forward after a very long waiting. An awareness creation seminar was held with members of Parliament. It was organized by Ministry of Health and supported by the Italian Cooperation. Public sensitization / consultation at regional level was started and carried out in Jinja (East), Moroto (Northeast), Mbarara (South) and Fort Portal (West) and UCMB participated in these dissemination / awareness workshops. Other regions will be covered in 2011. A Cabinet Memo was presented and a Cabinet Number obtained for presentation of the proposed policy to Cabinet. The Cabinet received the Policy document but could not discuss it due to the pressure of the election period. It is hoped that they will discuss and approve it before the next parliament in May 2011 and that with this policy in place, collaboration with government both at central and district level may be more cohesive and concrete. 2. The agreement by DANIDA to support the essential drugs program for the PNFP via the medicines credit lines at Joint Medical Stores in 2011 was again a major sign of strong appreciation of the need for partnership in the health sector. This will be elaborated on further under goal 5 on advocacy.
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UCMB Annual Report
2010
3. UCMB also played a lead role in initiating and fixing a partnership between UNICEF and Uganda Episcopal Conference through which a number of activities will be implemented in four dioceses but some funds will come to the bureau to compensate for the level of effort of some staff in coordinating and monitoring this project. In what started as a UCMB-UNICEF partnership, this is the first project bringing many departments at the Uganda Catholic Secretariat together. The project will initially support the dioceses of Fort Portal, Moroto, Kotido and Gulu Archdiocese. Uganda Catholic Secretariat will carry out the central coordination and will be supported to do that. 4. The 3 major areas covered are health (including HIV), education and child safety and rights. The other supported areas are cross-cutting i.e. communication. The total grant over five years is sh.18,002,790,098. Out of this sh. 15,230,168,316 will go to actual Program Costs (89%), sh. 1,834,087,701 will go to Direct Program Support (management and coordination) (11%). An amount of sh. 938,534,081 (5.5%) will come to UCS as an indirect cost fee and can be used by the Secretariat and its participating departments for their own investments. Besides UNICEF will directly procure and distribute equipments. 5. The US government decided that American NGOs working in the area of HIV/AIDS transition their work to local organizations. The AIDS Relief Consortium headed by Catholic Relief Services proposed to transition its role to Uganda Episcopal Conference. The Bishops accepted and decided that UCMB as the technical arm (also the natural destination seen by outside partners for such a project) should work out the modality. But the discussion on the best structure and modality for such a transition into UEC or UCMB remained a difficult one the whole year. While UCMB worked hard to ensure that the transition of the AIDS Relief work in the area of HIV/AIDS to UCS (UCMB), as accepted by the Conference, would be done in such a way that it did not disrupt the functioning of the department, it was not easy to reach an agreement with CRS. This took a lot of energy out of the staff of the bureau; yet this discussion will spill into 2011 when it is expected PEPFAR will issue a Call For Proposal that UEC / UCMB is expected to respond to secure the grant that will sustain the support currently provided through AIDS Relief to 12 facilities (out of the 18 supported by the consortium). 6. Two more partnerships were established, one with the Solidarity Fund for Africa that supported the Clinical Pastoral Education and the Duke University that carried out work in Health Systems Strengthening including creation of Public-PNFP-PNFP (pilot) in Kabarole district. UCMB played a big role in steering this. The funds did not come directly to UCMB account but implementation was led by Makerere University School of Public Health and involved Uganda Martyrs University, Uganda Christian University and UPMB. This is a unique partnership that UCMB was happy to steer and is expected to grow. 7. The work of UCMB was nationally recognized by the award given to the Executive Secretary, Dr. Sam Orach, in terms of a plaque in recognition and appreciation of his contribution to the health services in Uganda.
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UCMB Annual Report
2010
Goal 2: Improved sustainability, range and quality of services

SUSTAINABILITY OF SERVICES Sustainability of services requires strengthening all the six building blocks of health systems (Governance, Leadership and Management; Human Resources; Health Financing; Strategic Information System; Medical products, vaccines and technology; Service provision which is the end product bringing together all the other building blocks). Most of these will be discussed under other goal areas. However, it suffices to say that problems of human resources and health financing are threatening sustainability of the UCMB health network and other PNFP networks the most. As shown in annex 2, government allocation of PHC Conditional grants to PNFP facilities is not only reducing in the amount of unit allocation; the amount actually received as percent of the reduced allocation is also coming down. This may partly be a central problem but it is also largely due to districts increasingly retaining some money destined to PNFP hospitals. So far government has done little to avert this phenomenon. In 2010 the district of Kaberamaido retained PNFP grants for one quarter until Ministry of Health and Ministry of Finance and Economic Development intervened following a complaint by UCMB. So far the releases to lower level units (health centers) appear to be good though the unit allocation is also reducing. Release of funds to health training institutions has improved with the start of the bursary scheme. RANGE OF SERVICES A third survey was done in 2009 to assess the level to which the lower level facilities carried out the range of the Uganda Minimum Health Care Package (UMHCP). The results came out in 2010. This followed two previous surveys carried out in 2003 and 2006. The health sector in Uganda has established a package of services (UMHCP) for each level of care. This survey, which assesses the extent to which facilities are moving towards providing the complete range of services prescribed in the package. Looking at the median value of level of completeness of the range of services within the UMHCP, the survey results suggest some stagnation especially at Health Centers of levels III and IV while Health Centers level II continued to increase the range of services the provided more steadily (figure 13). Overall the median range increased 64% (2003) to 73% (2006) then to only 75% (2009). Of the five clusters the fall in median value of implementing public health related services at HC III and HC IV levels was the clearest from 79% in 2006 to 68% in 2009 (it was 71% in 2003). The Reproductive Health and Rights Services had the slightest rise.
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UCMB Annual Report
2010
Figure 14 Median level of completeness of implementation of the Uganda Minimum Health Care Package (UMHCP) by Health Centers in the UCMB network
This may relate to the overall stagnation in performance of the sector seen during HSSP II period (although in the end they talk of progress). Various factors may be blamed for this, among them the financial constraint faced increasingly by the facilities. But the fact that despite this we still did not register an out-right drop but stagnation and instead still registered some slight rise (only 2% which is insignificant) may be attributed to the deliberate campaign by UCMB for the facilities to stick to the Mission statement and specifically the strategic plan goal of increasing range and quality of services. This bell rings at every technical workshop and other meetings. But the problem is that there is no other document or study result to compare with. So the reasons remain speculative. This could be a good study question for example to University students like those studying management at Uganda Martyrs University The phenomenon of health centers at level 2 providing in-patients services is fairly common in the network. It might represent a process of transition to level 3. Sixty five (53%) of the 122 health facilities graded as level 2 health centers also reported having beds and admitted a total of 32,967 patients in the year (average 687). These represent 14 out of the 19 dioceses. Eleven of the facilities known to UCMB as health centre level 2 are designated by Ministry of Health as level 3 health centers. Six of the health center 2s with beds did not report any admission of patients, but all the rest admitted patients as shown in table 7 below.
DIOCESE Fortportal Hoima Jinja Kabale Kampala Kasese Kiyinda Lira Lugazi Masaka Mbarara Moroto Soroti Tororo Sum of Beds in HC IIs 65 53 13 42 32 15 17 35 22 57 59 3 63 36 Sum of Total Admissions in HC IIs 4911 5202 592 2204 716 1990 1420 2180 28 1792 6167 57 5056 650
Table 7Number beds and admissions in Health Centers of level II in different dioceses in 2010
Deliveries in health centers:

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UCMB Annual Report
2010
Deliveries are expected to take place at Health Center level III, IV and hospitals. Health center of level II (without in-patient facilities) may only conduct deliveries in emergency situation. However, the practice of carrying out deliveries in Health Center level II on routine basis seems persistent and increasing. As for admission, this could be a transition phase for these health centers growing to the higher level of HC III. In a few cases therefore it may be a response to a real need for safe motherhood services. Table 12 and figure 14 below show that total deliveries are steadily increasing in both HC II and HC III while not showing obvious trend of increase or decline in HC IVs.
Table 8: Total deliveries in Health Center level II, III and IV in the UCMB network
00-01 Health Center II Health Center III Health Center IV 1,116 13,827 2,098
02- 03 2,511 11,440 2,108
03 04 2,702 11,104 1,380
04-05 3,491 13,815 2,144
05-06 5,452 17,339 1,546
06-07 4,418 17,061 2,066
07-08 4,815 18,623 1,911
08- 09 5,132 20,191 1,450
09-10 5,995 22,380 2,168
Figure 15: Trend of total deliveries in Health Centers level II, III and IV in the UCMB network
25,000
Health Center III

20,000
15,000
10,000
Health Center II,

5,000
Health Centre IV
00-01 02- 03 03 04 04-05 05-06 06-07 07-08 08- 09 09-10
Emergency Obstetric Care (EmOC) A major cause of maternal death is related to hemorrhage and sepsis related to delivery or abortions/ miscarriage, situations that require emergency actions. EmOC therefore deserves a special mention although this report does not cover individual health conditions. To be counted as providing EmOC a lower level facility must be providing all six basic elements and a health center IV or hospital must be
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UCMB Annual Report
2010
providing all eight elements. Basic EmOC availability comprises of (i) IV/IM antibiotics, (ii) IV/IM oxytoxics, (iii) IV/IM anticonvulsants (iv) Manual removal of placenta, (v) Assisted vaginal delivery and (vi) Removal of retained products. Comprehensive EmOC service comprises of all the 6 elements of basic EmOC plus (i) Caesarean section and (ii) Blood transfusion. There are no data at national level on percentage of health facilities providing EmOC1. But the general concern is that the provision is grossly inadequate, hence a major move by MoH to improve it. The UCMB network carries out annual surveys to follow availability of EmOC services. survey on provision of emergency obstetric care (EmOC) indicated that after the steady rise, there was a slight drop in the completeness of provision of the 6 elements. Figure 15 shows that provision of all basic elements of EmOC by health centers level II and III (combined) dropped from 59% in 2009 to 57% in 2010. It should be noted that whereas in Uganda deliveries are expected to be routinely carried out in health centers of level III, health centers level II are only expected to carry out emergency deliveries when it is not possible to refer to the higher level. However, as seen above more and more health centers of level II (both government and PNFP) carry out deliveries that seem to be routine. It is therefore not clear if these are health centers that are simply wrongly classified as level II or they are in some unofficial transition phase to level II. In any case the UCMB survey covers all those health centers carrying out deliveries no matter the levels.
Figure 16 Proportion of HC II and HC III (combined) that provide all components of Emergency Obstetric Care (Medical level)
A similar pattern was seen in Health Centers level IV. It is not yet clear if this was the first sign of the effect of the problems with partial unavailability of the credit lines for medicines in 2010.
MoH; Annual Health Sector Performance Report for FY 2009/2010, November 2010.
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Figure 17 Provision of Comprehensive Emergency Obstetric Care in Health Center level IV
QUALITY AND SAFETY OF CARE The general trend of quality of care in the RCC hospitals as measured by UCMB is shown in annex 1. But effort to improve quality of care along with safety of care to the patients (and ultimately to the health workers) has continued to gain profile in the UCMB network. In 2008 Cordaid supported a consultant, Dr. Johan de Koning, to come and work with both UCMB and Uganda martyrs University on issues of Patients Safety and Quality of Service. UCMB had expressed the desire to focus on improvement of quality of care and improving the indicators for monitoring progress. The contract of Dr. Johan de Koning ended in December 2010. During his time in UCMB a desk was established to specifically coordinate the effort in the network. A staff within UCMB was dedicated to this desk and worked jointly with the consultant. However these are additional to other measures, for example the accreditation process, UCMB had already instituted that contribute to quality improvement. The following are only a summary of the key achievements made in this area in 2010.
The accreditation program resulted in having 27 out of /28 eligible hospitals and 201 out of 245 eligible health units getting fully accredited. However Nkokonjeru hospital was later granted conditional accreditation by the Health Commission thus making the total number of hospital accredited 100%. Two hospitals (Benedictine and Holy Innocent) were not considered as they are still fulfilling some preliminary processes after registration. The proportion of accredited health units increased from 78% to 83% after the proportion dropping from 89% in 2007. This drop was largely due to a more strict vigilance by UCMB to cross-check fulfillment of accreditation criteria. A visit by UCMB team to meet and discuss with diocesan leaders yielded better compliance in Tororo Archdiocese as the most failures had been from that Archdiocese. At the first round of formal accreditation of the health training schools 11 out of 12 got accredited. Lacor Health Training Institution was not accredited because it did not meet some of the mandatory requirements.
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The presence of the quality and safety desk / focal person at the UCMB secretariat is a significant achievement and more local partners like the Ministry of Health, the Capacity Project and others are expressing willingness to collaborate with us through this desk. A Quality and safety committee was formed composed of nine members from the member institutions to guide the frame work of quality improvement in the network. Clear terms of reference were set for the committee. The first Quality and Safety Committee meeting identified Surgical Safety management, Maternal and child care, Infection control and Occupation hazards management , Rational Drug Use and medication safety management as areas of clinical care to concentrate on to stimulate quality and safety health care in the hospitals. Two quality and safety improvement interventions were identified including Voluntary Error Reporting and Surgical Safety Checklist. A Voluntary Error Reporting book (containing forms) was produced (simple enough to be reproduced by the hospitals) and the Surgical Safety Checklist produced as well.
Figure 18: A book containing error reporting forms for internal use by hospitals that are willing to do it.
The use of voluntary error report is to encourage a blame-free environment and reported errors are used for learning purposes to help institute measures or processes that can either prevent or minimize future occurrence of such errors.
Off-site orientation training was conducted from 28th - 30th June 2010 for a group of five pilot hospitals (Kisubi. Nkozi, Virika, Nsambya, and Buluba). The training was attended by 24 participants representing managers, and hospital quality assurance committee members. Another off- site training was conducted between August and September 2010 for staff in charge and Quality Assurance Committee members in the same five hospitals, to build capacity and instigate quality and safety culture and introduce safety improvement interventions. The participants were ranging from 20 to 35 depending on the size of the hospitals. The quality and patient safety improvement intervention (Voluntary Error Reporting book and Surgical Safety Checklist) was rolled out in the five pilot hospitals.
The foreseen challenges include. The current safety improvement culture which is not a blame free culture, challenges the management of errors (personalisation and not system approach) affecting the first adoption and integration of the voluntary reporting system into the hospital. There is lack of proper legal protection, hence the voluntary error reporting is not legally known in the health system of Uganda and this threatens the willingness and instils fear in hospital and staff to fully adopt system.
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2010
At hospital level there is still to some extent some lack of commitment with the accreditation program, for example the undertakings are not made part of the hospital activity plans and are not know to Boards. At health facility level there was some reluctance on the importance of accreditation. For example often there is no response from Health Unit Management Committees and Diocesan Health Coordinators once the unit is notified of failed accreditation. This is a clear indication that accreditation is still to a small extent seen as irrelevant.
Goal 3: Improved Governance, Management Accountability Structures and Systems
and
The work of UCMB in this area takes the largest part of the annual budget. It covers the Health Systems building blocks on leadership, governance and management and that on financing. Like for other areas only the key achievements of the year will be reported. Leadership, Governance and Coordination The regional workshops on corporate governance finally ended with the central region. This ensured that the entire RCC health network has been reached with this kind of training. Induction of new boards of governors for hospitals or diocesan health boards was also carried out.
Figure 19 (Left): Dr. Sam Orach and Peter Asiimwe of UCMB with members of the Board of Governors of Matany hospitals, Moroto district (Karamoja region) after induction of the board Figure 20 (Right): Dr. Sam Orach in Karamoja, returning from Matany hospital after induction of the Board of Governors and a visit to the diocesan health office.
The concept of corporate governance has been internalized and appreciated by many boards and managers in the whole network. It is expected that in the coming years, the impact of this essential capacity building initiative in governance and management will be beneficial to all the health facilities.
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Strategic planning, a hither to unappreciated undertaking has been embraced by many hospitals. At the end of 2010, 10 hospitals had on their won developed strategic plans. 7 hospitals had requested for support from UCMB towards developing their strategic plans. It is anticipated that by the end of 2011, 80% of all hospitals will each have a long term plan to guide their future operations. The renewed interest in strategic planning at hospital level has been partly due to the impact of the interventions the bureau has put in place to strengthen management and governance in the health facilities. In particular, the governance trainings and the board inductions have resulted in the board members continuous demand for strategic thinking and streamlining of planning processes. Through a collaborative project between UCMB and 3 Ugandan universities and Duke university in USA, two studies were commissioned that highlighted the great work that UCMB has done in building capacity in management and leadership in the health sector. While the project was limited to the Kabarole district, the findings of the two studies indicate that UCMB facilities had more developed governance and management systems than the public and other PFNFP facilities. RCC health facilities in Kabarole district benefited a lot from this project by further improving their management and leadership capacities. Besides the studies, training in leadership and management was conducted and Virika hospital and the diocesan health office benefited. Special mentorship is ongoing to support health facilities to strengthen their leadership and management competencies. A training manual has been developed and this will feed into the various capacity building initiatives of the bureau. In all the project activities, UCMB participated significantly both at the leadership and technical levels of the project. Although a lot of challenges remain, performances of Diocesan Health Departments show gradual improvement. In 2006/07 a total of 79% of the 19 DHDs scored Good or Very Good. In 2009/09 the total of those who scored Good Very Good was 84% (Annex 4). Significant improvement was particularly noted in the dioceses of Tororo and to a lesser extent in Soroti. For close to three years, the diocesan health offices of Soroti and Tororo were not functioning as expected. In 2010, special efforts were made towards streamlining the operations of the coordination offices in these two dioceses. A stakeholders forum was organized in Tororo while increased advocacy at the level of the bishop led to personnel changes in the diocesan health office of Soroti. Financial and technical support was further given to the two dioceses. By close of the year, performance of the 2 diocesan health offices and respective health facilities had significantly improved. But fluctuations keep occurring, often associated factors affecting presence or performance of the Diocesan Coordinator. Key challenges The delay in the process that should lead to the Bishops Conferences decision on the separation of the legal entity of the hospitals from the juridical person of the dioceses kept many activities that were consequential on it pending. It remains a key issue within the operational plan of UCMB that is likely not to be implemented in the remaining period of up to end of 2011. The current legal setup of mainly hospitals will in the coming future pose serious legal. It is expected that the process will be pushed faster in 2011.
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The financing of diocesan health offices remains a key challenge. In 2010, UCMB was flooded with requests from dioceses for financial support. This came even when in the previous year, UCMB tried hard to encourage diocesan health coordinators to engage in resource mobilization on their own. Diocesan authorities were also asked to support DHCs with resources generated within the diocesan resource mobilization efforts. All this proved difficult. Consequently, at the end of 2010, a training of DHCs was organized to provide them skills in proposal writing and resource mobilization. The impact of this training will be assessed in the coming years. As explained under Goal 1, one of the benefits UCMB hopes to get by getting involved a little more in HIV/AIDS work when UEC takes over what was done by CRS is the possibility of harmonising the vertical programs with the rest of the systems in the respective hospitals.
Information, Communication and Data Management (ICDM) the important tool for accountability, planning and advocacy
The ICDM section is responsible for all the matters of health management information system (HMIS) as well the aspects of information and communication technology (ICT) in UCMB and for providing technical support to the network. Data is processed and used to generate information that is used for planning, feedback to the network, and feeding into the national health sector performance assessment and for advocacy as well as reporting purpose. Apart from HMIS data there are surveys that are carried out annually like the patients satisfaction survey, drug prescription survey and survey on provision of emergency obstetric care (EmOC) servies. As in previous years results of these surveys were fed back to the network during the technical workshops. Data audit This is a rather new process to strengthen the health management information system. In 2009 UCMB carried out data audit in lower health facilities of Fort Portal and Jinja dioceses. This coincided with the introduction of the performance-based financing program in those dioceses funded by Cordaid. It therefore served both the purpose of that program and UCMBs objective. But in 2010 first data audit exercise was carried out in hospitals, covering 5 hospitals - Kamuli, Tororo, Lwala, Nkokonjeru and Aber. Seven additional dioceses were also covered. These were Tororo, Soroti, Lira, Hoima, Kasana- Luweero , Kiyinda Mityana and Masaka dioceses. The main objective was to ascertain the quality of the data reported by establishing the accuracy based on the HMIS registers. Feedback mechanism at the departmental level was still low as evidenced by the variances between the HMIS 105 and HMIS 108 reports and the data audit findings. Only Nkokonjeru hospital had all the HMIS reports tallying with the data audit findings. In dioceses the findings revealed a need to train staff in HMIS skills to reduce the variances that are due to lack of training at the lower level. UCMB carries training for hospital data managers and for diocesan health coordinators with the hope that they will train the people managing the lower level facilities in their dioceses. Following this exercise some diocesan health coordinators have carried out data audit in more health units. These include the coordinators for example Jinja, Masaka, and Tororo. UCMB would like to make this become
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a common feature of diocesan health coordination.
Figure 21 Mr. Kizza Charles (front right corner) meets staff of a health facility in Jinja diocese and the diocesan health coordinator during a data audit visit
UCMB again carried out progressive and refresher training for diocesan health coordinators and records assistants in June. Twenty five participants attended. The training for records assistants from Health Center level IV and hospitals was done in September 2010. In 2009 a cost analysis study of treating the commonest causes of morbidity was done for three hospitals, Rubaga, Nyapea and Ibanda. Three cost centers were identified and used for the study, these being the Out-patients department, In-patients department and Laboratory / X-rays combined. Analysis was done and interim report was produced with the help of PROGEA (Consulenza per organizzazioni pubbliche) in Italy. Meanwhile in 2010 cost analysis was carried out for four more hospitals, Nkozi, Villa Maria, Kitovu and Virika with the plan to have a combined final report (including the first three hospitals) in collaboration with the same organization, PROGEA. However, because the analytical framework proposed by PROGEA for the second batch of hospitals is different from that used for the first three, production of the combined report has further delayed. The consultant from PROGEA will travel to Uganda in the second quarter of 2011 to discuss with UCMB staff and harmonize the approach so that a final report can be produced for use. The Health Sector is revising the Health Information System. UCMB participated in this process as well as participating in one-week training in developing an electronic tool for the revised HMIS, termed District Health Information System which is expected to make the NHMIS more functional than before. The ICDM team has also been preparing for the implications of the UEC taking on the PEPFAR-funded project currently run by AIDS Relief to support some facilities in the provision of antiretroviral therapy. They participated in trainings by the Futures Group and another one by the Inter-religious Council of Uganda that is also supporting another group of health facilities, also using PEPFAR funds. In 2009 UCMB decided to extend the web-based access to data and information from initially only hospitals to cover also the diocesan health departments (data for health centers / lower level units).
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This process was completed in 2010 and the diocesan coordinators were inducted into the use of the new technology during the first technical workshop. In the meantime, full technical functionality and effective use of the ICT system in the diocesan health department of Tororo was restored with a new coordinator in place. The only remaining health center IV, Bukwo, was also connected to the internet. At UCMB itself reliability of the service was solved with the installation of the Industry Standard ADSL Moderm. In addition an external back-up drive for UCMB data was acquired. UCMB was represented at the East Africa Community E-health held in Rwanda Nov. 2010. This provided an opportunity to link up with the Director of Rural Communication Development Fund and a concept paper to fund the ICT needs in PNFP hospitals and HCIV was written and discussions are in progress. Challenges. During 2010 the following challenges were experienced . They will need to be addressed in 2011 but also as we move into the new operational plan. 1. Instability and unreliability of the internet service which also affected users on the entire network and stakeholders 2. Integration of proprietary and non proprietary application is a cost-effective and sustainable practical solution to computing problems. But the integration is a challenge to some users who sometimes venture to use pirated copies of the proprietary operational systems which fail to update from the internet. This has led to low functional effectiveness of the system in some diocesan health offices and hospitals. 3. Most diocesan health departments and hospitals lack disaster recovery plans for data and other storage medium. 4. Non-renewal of subscription by some diocesan health departments and hospitals has also reduced the technical functionality of the system. UCMB cannot afford to resume subscription on behalf of the dioceses and hospitals. 5. Under staffing of the section. The introduction of the Quality and Safety section reduced the availability human resource in the ICDM section. As part of cost-containment measure, the recruitment of a new data clerk delayed but this is now set for execution in 2011. Considering the importance of information and how this has been an area UCMB has again taken the lead; and further looking ahead as we prepare to draw another strategic plan, the following begin to appear important for the future as we close the year 2010. 1. Capacity building for LLU staff in managing HMIS data through training the In-charges and records Assistants in HMIS. UCMB has previous done this indirectly by training the diocesan coordinators, expecting them to train the health center in-charges. Unfortunately transfer of this knowledge and skills to the lower level has occurred well in only a few dioceses. It was planned during the now ending operational plan to directly train those managing the health centers but the cost became prohibitive. This plan will need to be revisited.
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UCMB Annual Report

2.
2010
Equipping the health workforce trained in the UCMB 12 Health Training Institutions (HTIs) with knowledge in HMIS tools by introducing a module of HMIS tools . This will solve the challenge Records Assistants and Departmental In-charges face in inducting the recruits from schools. Data quality will be improved and the module can be assessed under the local hospital examinations. Widening the scope of analysis for the HIV Aids data especially in facilities with HIV clinics. This can start with those funded by AIDS Relief and IRCU and other donors. Scaling up the data audit activities in all UCMB facilities. Improving ICT communication by establishing a Video Conference for the UCMB network. Ensuring that technical support in ICT is provided by reputable ICT firms in the UCMB network. Provision of ICT access to the LLU that are hard to reach starting with HCIII. Build capacity of In-charges and records staff in dioceses (other than the coordinator) in the management of HMIS tools and data. This should create more sustainability by not only depending on the diocesan health coordinator. Strengthening the HMIS applications in RC Hospitals network in use of E- HMIS tools, E-health and Digital libraries.
3.
4. 5. 6. 7. 8.
9.
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Goal 4: Improve the development of personnel and contribution towards professional training
Human Resource Development
UCMB contributes to improvement of human resources in the network through provision of scholarship to help facilities acquire cadres of staff they are lacking. The other contribution is by improving systems in health training schools as well as improving access to the schools. The Scholarship Fund After the almost total quiet in 2009, UCMB was able to give some more scholarships in 2010. Against the sudden end of the PSO project in 2008 UCMB had decided in 2009 as a priority to ensure those who were in school did not fall out. Funding to the scholarship fund was limited to DkA Austria and the support from Joint Medical Stores. At the moment therefore the scholarship is directed towards those already working in the facilities. One of its objectives2 is to improve retention of staff. This has already been shown to be a success as reported in the study by Uganda Martyrs University in 2008. The scholarship committee met twice in the year and awarded scholarships to 56 beneficiaries as shown in table 13 below. One scholarship was given to a UCMB staff.
Table 9: Scholarships awarded by UCMB in 2010 by category of institutions of origin of candidates
Dioceses (lower level health facilities) Hospitals Religious Congregations UCMB Total scholarships awarded in 2010 Total funds allocated
March 2010 Awards 10 11 5 26 83,060,000
October 2010 awards 13 12 4 1 30 103,987,600
Total awards 23 23 9 1 56 187,047,600
Table 10: Number of scholarships awarded in 2010 by broad category of nature of training
Area of training 2010 Managerial/administrative Clinical/technical TOTAL
Hospitals 2 20 22
Religious Congregations 0 9 9
Dioceses 2 22 24
Other 1 1
TOTAL 5 51 56
UMU; Evaluation of the UCMB Scholarship Fund, 2008

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UCMB Annual Report
2010
NB: All beneficiaries must be health workers and already working in RCC health facilities. It means that scholarship to religious congregations simply means that the candidates are religious and proposed by their congregations.
Beneficiaries of the scholarships in 2010

The beneficiaries of the scholarships in 2010 have been mainly health workers at basic and post basic levels. The committee prioritized the training of midwives and tutors who are in acute shortage in the country. In 2010, 6 candidates from 4 training schools were given scholarships to pursue tutorship courses. Due to limited funds at the moment, the committee is finding it difficult to consider applications for postgraduate studies especially for medical officers wishing to pursue specialized disciplines that require a lot of funds. The demand for scholarships remained high. For the year 2010, 108 applications were received and only 56 were successfully considered. Finding support for the sustenance of the fund remains crucial. From the applications received, we note that there are still cases of unplanned training of staff by hospitals, dioceses and congregations. This is something that institutions must address as UCMB cannot determine the staffing and training needs of individual facilities or congregations.
Support to Health Training Institutions and Training
A number of achievements were also made in this area and the following were the key ones. 1. The Nurses and Midwifery Manual was finalized in January 2010 and printed. It was officially launched by Rt. Rev. Egidio Nkaijanabwo, Bishop of Kasese diocese who is also the Chairman of the Health Commission, during the Annual General Meeting in March 2010. The manual has attracted a high demand but priority has been given to PNFP Health Training Institutions and health facilities. Revenue obtained from its sale is being used to set up a Printing and Publications Fund. 2. After completion of the Training curriculum for Clinical Mentors, it was officially accepted and owned by the Senate of Uganda Martyrs University (UMU). It was approved by the National Council for Higher Education. The course is to start in February 2011for the award of an UMU diploma. 3. Constructions at two Health Training Institutions (Kamuli and Villa Maria) were completed and handed over to the dioceses by the Danish Embassy and Ministry of Health. Constructions at two other sites, Nyakibale and Mutolere, are in final stages of completion 4. Implementation of the MOH-Development Partner Bursary scheme progressed well. Student enrolment on the Bursary scheme in PNFP Health Training Schools reached 422 for UCMB, 40 for UMMB and 300 for UPMB schools in 2010. This allows predictable income for the schools and increased access for poor students from most-underserved districts 5. Support supervision: 11/12 HTI (s) to follow up the key priorities areas for improving management and quality of training in RC HTI. 6. Review of Midwifery extension curriculum by AMREF ( Pre-requisite to start e-learning) 7. Implementation of the planned two Technical and two training workshops for PNFP HTI in 2010 and achievement of the set objectives related to improving quality of training, HRM and financial management and correct implementation of Bursary scheme
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UCMB Annual Report

Challenges
2010
Uncertainty of ECN program and Comprehensive Nurses graduates Non compliance by RC HTI to report on faithful to Mission to respective BOG- 4 performance indicators; (Only 4/12 schools reported to BOG and copied to UCMB ( Villa Maria, Matany, Nyakibale and Virika) 3. Poor Tutor to student ratio 1: 51 in PNFP HTI Network as compared to 1:20 standard ratio 4. Expire of period of DANIDA project in MOH
1. 2.
Figure 22 Bishop Egidio Nkaijanabwo, chairman of the Health Commission, officially launches the Nursing and Midwifery Procedure Manual during the Annual General Assembly in March 2010
Above left (standing left to right): Rev. Sr. Catherine Nakiboneka (HTI&T Coordinator in UCMB), Rev. Sr. Stella (Principle Tutor Nsambya HTI and representative RCC HTI on the UNMC, and Mrs. Marcella Terimuka Ocwo the Chairperson for the HTI&T Committee of the Health Commission. They handed over the Nurses and Midwifery Council to Rt. Rev. Egidio Nkaijanabwo, Chairman of the Health Commission. Above right: The Nursing and Midwifery Practical Manual that was launched during the Annual General th Meeting of March 17 2010
Figure 23: Rt. Rev Egidio Nkaijanabwo (Chairman of the Health Commission and Dr. Sam O. Orach (Executive Secretary of UCMB) having launched the Nurses and Midwifery Practical Manual
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UCMB Annual Report

Training for Clinical Pastoral Care
2010
Another important area still needing a lot of human resource development is clinical pastoral care. In 2010 the following were done: One two-week orientation course for CPE was held at Angal hospital with 9 participants. Two Clinical Pastoral Education units were carried out in Kitovu hospital with 6 participants the first from January March and the second from October December 2010. The CPC Coordinator visited the following hospitals to carry out supervision and give technical support - Angal, Nyapea, Maracha, Mutolere, Nyakibaale and Ibanda. He was unable to visit the following hospitals due to unforeseen ill-health - Kyamunga, Viraka and Kilembe mines. For the same reason it was not possible to organize yearly refresher course for the pastoral care givers. It was also not possible to organize for the OPCEA AGM which takes place in Nairobi, Kenya.
Figure 25 (Left) Participants at a CPE course in Kitovu hospital - January - March 2010
Figure 24 Rt. Rev. Martine Luluga, Bishop of Nebbi diocese with participants at a CPE refresher course conducted in Angal hospital
Figure 26 Participants at the second CPE course unit at Kitovu - September November 2010
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UCMB Annual Report

Health workforce in UCMB facilities as representative of PNFP facilities
2010
By June 30th 2010 the UCMB network had total workforce of 7,354 distributed as 4,903 (67%) in hospitals and 2,451 (33%) in lower level facilities (health centers). Over many years the workforce in the PNFP has been perceived and appreciated for being highly productive, at least relative to their counterparts in government facilities. But this performance remains under threat by the persistently high levels of staff turnover especially of the clinical staff, a factor that remains most outstanding as affecting human resource for health in the subsector. However there seems to be some stabilization in the staff turnover over the last few years and attrition in both hospitals and lower level health facilities seems to show a downward trend (Figures 25 and 26 below). This must be due to a combination of factors.
Trend of Attrition - Clinical Staff in Hospitals

40% 35% 30% 25% 20% 15% 10% 5% 0% 2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 22% 23% 20% 20% 22% 36%
20%
Figure 27: General trend of attrition among clinical staff in the UCMB hospitals (making 65% of PNFP hospitals)
Trend of Attrition - Clinical Staff in Lower Level Units

40%
35%
30% 25% 20% 15% 10% 5% 0%
34% 27% 26%
32%
22%
Figure 28: General trend in attrition of clinical staff in UCMB level health facilities (representative of PNFP LLUs)
2005/06
2006/07
2007/08
2008/09
2009/10
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UCMB Annual Report
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There are possibly multiple reasons for this stabilization. As shown from the evaluation of the UCMB Scholarship Fund in 2008, offering scholarship to improve capacity of staff is among the factors contributing to improved retention. Available data (from exit interviews at facility level) indicate that over 46% of the leavers in 2009/2010 joined government services as compared to 60% in 2007/2008. This might be either because either government recruitment has been less aggressive than earlier envisaged or a combination with other non-monetary processes improving retention in the facilities. Low salaries remain the most common reason given for leaving. While retention has remained a challenge to the PNFP facilities due largely to financial constraints, the absolute numbers of staff is always maintained due to rapid recruitment and replacement with fresh graduates. In 2009/10, overall 17% of hospital staff and 24% of health centre staff were lost. As of June 30th 2010 16% of the hospital staff and 27% of health center staff were new. This means that hospitals recruited short of replacing the attrition while health centers recruited a slight excess of replacing attrition. In total (hospitals plus health centers) 19% of the overall of the workforce in the UCMB network by June 30th 2010 were new, most of these being fresh graduates. The biggest problem caused by staff turnover in the PNFPs is therefore not only of numbers but of loss of experience and capacity and the repeated rigor and distress of the attrition-replacement cycle. These turnover figures though are worse for the clinical staff especially the nurses. The PNFP networks therefore still remain some sort of center for internship or transit routes to civil service and may be for other employers. The Figures below indicates the trend of attrition of key clinical cadres in 65% of the PNFP hospitals and Lower Level Facilities. The situation in hospitals
Figure 29: Trend of attrition of key clinical cadres in PNFP hospitals 2003/04 to 2009/10
Attrition of key cadres of clinical staffs in Hospitals

40%
35%
38% 35% 30% 29% 26% 26% 22% 21% 22% 16% 26% 36% 34% 32% 28% 29% 25% 30% 26%
30% 25%
21%
20% 15%
10%
14%
5% 0%
MO
2003/04 2004/05 2005/06
CO
2006/07 2007/08 2008/09
Combined EN + EMW
2009/10
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UCMB Annual Report
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Turnover rates for medical officers and clinical officers in hospitals remain high and are even increasing while a pattern of reduction similar to that in lower level facilities is seen for the enrolled nurses and midwives. In the last three years the attrition among enrolled nurses and midwives in hospitals rose from 25% in 2006/07 to 32% in 2007/08 before reducing to 30% in 2008/09 and now to 26% in 2009/2010. The situation in Lower Level Units
Figure 30: Attrition of key clinical cadres in lower level PNFP health facilities in 2005/06 to 2009/10
50% 45% 40% 35%
Attrition of key cadres of clinical staffs in lower level units

42% 38% 34% 30% 33% 46% 40% 46% 39% 37%
30%
25%
20% 15% 10% 5% 0%
CO
Combined EN + EMW
2005/06
2006/07
2007/08
2008/09
2009/10
In lower level PNFP facilities the movement of enrolled nurses and enrolled midwives is beginning to stabilize Figure 30 above suggests that attrition rate for enrolled nurses and enrolled midwives has further reduced from 46% in 2007/08 to 39% in 2008/09 and now 37% in 2009/2010. This favors the lower level facilities that serve the poor, operate in much more rural localities and are often constrained to retain key cadres. Attrition in hard to reach districts3 For some years PNFP staff attrition in the hard-to-reach areas has been higher than the overall network situation. Considering 12 hard-to-reach districts, mainly in post-conflict situation, there is now a similar stabilization for nurses and midwives and a similar rise in attrition for clinical officers and doctors working in hospitals. In fact the attrition rate for enrolled nurses and midwives (23%) is slightly lower than the overall average for the PNFP network hospitals (26%).
The districts referred to here are the 12 top in level of hard -to-reach according to the classification used for the inclusion for payment of hard-to-reach allowances. They are Pader, Kitgum, Nakapiripirit, Kotido, Moroto, Kaberamaido, Katakwi, Bundibidyo, Apac, Gulu, Lira and Soroti.
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Figure 31: Staff attrition trends for selected cadres in PNFP hospitals in hard-to-reach districts in 2007/08 2009/2010
60%
50% 40%
Attrition rates in PNFP hospitals in 12 hard to reach districts 2007/08 - 2008/09

54% 44% 39% 43% 39% 35%
31%
30% 20% 27%
34% 28%
23% 23%
10% 0%
CO
EM
2007 - 08 2008 - 09
EN
2009 - 10
MO
Figure 32: Staff attrition rates of selected cadres in PNFP lower level units in 12 hard-to-reach districts in 2007/08 2009/2010
70%
61%
66%
60% 50%
40% 30%
58%
52% 40%
38%
30%
20%
10% 0%
25%
27%
CO
2007 - 08
EM
2008 - 09 2009 - 10
EN
There is a similar trend in stabilization in the lower level facilities. But disaggregation of attrition among enrolled nurses and midwives shows that the overall drop is more influenced by the drop among midwives while enrolled nurses attrition remains high and even increased again in the last year. The reason for this is not clear but it could indicate that nurses have more diverse opportunities for
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employment in various organizations and projects. But it is not clear why this particular trend is only observed only at the lower level and not in the hospitals.
Goal 5: Improved Advocacy for self and for the served population
It was hoped that with the failure to train dioceses and hospitals in advocacy in 2009, the Health Systems Strengthening partnership project would, among other things, culminate in training district and diocesan health managers and governors in advocacy; and that the curriculum used would be used by UCMB to scale-up to other dioceses. However implementation of this new project hit a lot of snag in its initial stage. It is still hoped that this can be done in the next phase. But the capacity building in this area remains something of importance, even as we go into another strategic plan period, to be done by UCMB. The following are reported as key advocacy actions and outcome in 2010. But these are definitely building on outcome of advocacy by UCMB and the network over the previous years. 1. With the end of the DANIDA support to essential drugs to the health sector, and the decision of government to maintain credit line grants only for its facilities through National Medical Stores, the PNFP health facilities were left without the credit line for medicines. This situation in practice continued for the last half of 2010. But joint advocacy with the other medical bureaus and the support of the Bishops within the year finally brought home a new funding (Credit lines) for medicines and medical supplies through Joint Medical Stores (JMS) for two more years but its utilization will start in early 2011. The fund is from DANIDA whose project for supporting medicines supply to the sector had ended. The funds for 2011 have already been released to the JMS account. The amounts allocated as follows (for 2011) for hospitals:
Table 11: Allocation of Medicines Credit lines grant from DANIDA to PNFP hospitals to cover 2011
Medical Bureau UCMB UPMB UMMB UOMB TOTAL
No. of hospitals 30 17 5 1
% of beneficiary hospitals 57% 32% 9% 2%
Total (Ug. Sh.) 1,037,694,846 560,003,828 87,556,669 23,919,333 1,709,174,676
Average (Ug. Sh.) 34,589,828 32,941,402 17,511,334 23,919,333
% of allocation hospitals 61% 33% 5% 1% 100%
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Although UMMB has 9% of beneficiary hospitals, they are smaller in capacity and three of them are around Kampala. The allocation formula took into account the poverty level of the areas served by these health facilities. The allocation obtained for Health Centers (for 2011) is:
Table 12: Allocation of medicines credit lines grant from DANIDA to PNFP health centers to cover 2011
Medical Bureaus UCMB UPMB UMMB

UOMB
TOTAL
Total (Ug. Sh) 741,926,108 748,958,762 220,466,670 29,473,783 1,740,825,323
Average (Ug. Sh) 2,979,623 2,925,620 3,936,905 2,456,149
% of allocation to health centers 42.6% 43.0% 12.7% 1.7% 100.0%
UPMB has more health centers than UCMB. But UCMB has more Health Center IIIs than HC II hence the higher average amount per UCMB health center while UPMB has more Health Center IIs than Health Center IIIs. (Tables 9 and 10 below). The allocations were therefore largely fairly done.
Table 13: Proportion of all UCMB facilities compared to proportions of beneficiary facilities of other Medical Bureaus
AUTHORITY UCMB UMMB UOMB UPMB Grand Total
HC II 122 25 9 202 358
HC III 123 28 3 49 203
HC IV 4 3 5 12
Grand Total 249 56 12 256 573
% of beneficiary health centers 43% 10% 2% 45% 100%
Table 14: Comparative proportion of health centers of different beneficiary health centers by level of care
AUTHORITY UCMB UMMB UOMB UPMB Grand Total
HC II 49% 45% 75% 79% 62%
HC III 49% 50% 25% 19% 35%
HC IV 2% 5% 0% 2% 2%
Grand Total 100% 100% 100% 100% 100%
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In a similar away at the closure of the DANIDA funded project, funds were released in advance to the bursary basket where other donors are expected to contribute. 2. UCMB initiatives to encourage facility and diocesan efforts to engage in advocacy have been appreciated. Advocacy efforts at facility and diocesan level have continued to increase. In the year under report, 5 dioceses (Fort portal, Masaka, Kampala, Arua, and Moroto) organized health assemblies as advocacy events. Several hospitals organized hospital open days mainly to interface with the communities they serve. Due to financial constraints, a number of dioceses were unable to organize these events. In Fort Portal and Masaka dioceses the Annual Health Assemblies covered both hospitals and lower level facilities of each of them. This is cost saving instead of having separate ones for each hospital then for the diocesan health department. Political and Civic leaders from all districts in the respective dioceses were invited although some did not attend. There were very good discussions at both for a. In Masaka the Minister of State for Health, Hon. James Kakooza, attended and promised to support the PNFP subsector more. In Masaka the Chairman of Kabarole district called follow-up meetings to work out better ways of partnership. In the coming years, it is anticipated that more diocesan health offices and hospitals will organize these events and use them to improve the relations with various stakeholders. They wrote a memo to the Ministry of Health on some specific issues regarding support to the PNFP facilities in the district. 3. More advocacy was carried out at various fora involving the PNFP, Ministry of Health, Development Partners and other stakeholders, for example at the Health Policy Advisory Committee (HPAC), the Joint Review Mission etc.
Goal 6: Cross-cutting and overarching objectives

Coordination of dioceses in conflict / post-conflict areas
Although after a long time of failed attempt to get the northern dioceses together to take part in the Peace, Recovery and Development Program (PRDP) the Archbishop of Gulu appointed a person to coordinate this in 2009, not much has been achieved. The major problem appears to be weakness in the health coordination office of Gulu archdiocese that is at the center for all the northern dioceses and at the best position for interacting with stakeholders in the PRDP. The office was established, a strategic plan was drawn that was a bit too ambitious. It also appeared as if this office was positioning itself as The health coordinator for the north despite its weakness, hence the loss of direction and purpose. UCMB will not continue this support in 2011. Instead short-term support will be given to specific diocesan health departments, especially Kotido. Arua and Nebbi will only get support for half year to bridge a gap.
Supporting Religious Congregation in new thinking of roles in health

Financial constraints did not allow a planned workshop to discuss this with the Religious Congregations. But informal discussions during other fora were held and a number of Sisters have expressed the
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2010
increasing desire to meet and have in-depth discussions with UCMB to guide them. UCMB has requested for renewal of the old strategy of addressing Religious Superiors during their Annual General Assembly.
Collaboration with Uganda Martyrs University

UCMB views this collaboration as a systemic requirement as both the bureau and Uganda Martyrs University (UMU) belong to Uganda Episcopal Conference. Although the collaboration still needs to be strengthened further, the acceptance and taking over of the curriculum and training in certificate for Health Services Management, the Clinical Mentors Diploma course (as reported earlier) are signs of that good collaboration and ground for better one in future. The Vice Chancellor, Prof. Charles Olweny was personally involved in moving both processes forward along with the staff of the Faculty of Health Sciences.
UCMB Central processes

All central processes of UCMB moved on well as planned. The Health Commission and its committees carried out business as planned. However, as UCMB takes on more and more work (especially the partnerships) and staffing level reduces, the need for Assistant Executive Secretary has become more urgent. At the closure of the year the Health Commission decided that an Assistant Executive Secretary will be recruited in 2011. The post of the Human Resources Advisor will also be enriched and filled to take care of the increasing importance of human resources issues in health.
MAJOR CHALLENGES
Some challenges have already been reported under the different goals / sections. Here are a few crosscutting ones. Although the funding in 2010 was close to that for 2009, this left the bureau far from bringing on board important activities identified in the operational plan that had been put aside due to funding problems. This means that as we approach the end of the operational plan, the expected transfer of capacity to dioceses will still not be as expected. This challenge is also compounded by the fact that demands on systems keep becoming more and more complex and UCMB may perhaps never completely build enough capacity at the local level to leave it free from its current roll. The taking on of programs such as those managed by AIDS relief, other partnerships like those with UNICEF, UNFPA and other to come pose new challenges to the systems that has hitherto worked in some sort of independence or isolation. UCMBs experience in systems strengthening is already getting called upon by even other departments as we begin to work together on these new programs. The same need will increase lower down. Conceptualizing and guiding the UEC in the transition of AIDS Relief project was a major challenge that took a lot of energy out of the staff of UCMB to ensure that the department did not crush as a result. While it was a challenge, it also posed an opportunity to think of how to take advantage of
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2010
some of these programs while ensuring that the core services of the bureau are maintained or even enhanced. The absence of the Finance Management Advisor was a challenge but it forced UCMB management to think outside the box and have some important activities carried out through outsourcing. It was therefore not totally a negative challenge.
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Annex 1:
Utilization of Credit-line grants for medicines by hospitals and lower level units
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UCMB Annual Report
2010
66
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2010
Annex 2
Trend of government support in terms of PHC Conditional Grant and Credit lines to PNFP health facilities
67
Trend of government support to PNFP health facilities

25.00
2010
20.85 20.00
19.73 19.00 18.92 19.13
20.07 20.06
19.93
16.03
Ug Shiilings - billions
11.86
10.41
10.40
10.77
10.91 10.87 10.88 10.88 11
10.91
10.00
7.04
6.07 5.00
4.04 4.75
3.00 5.08 4.9 5.08
5.40
5.23
5.05 2.57
5.05
5.04
3.03
3.13
2.434
3.24
3.25
3.29
3.53 1.75
1.25 0.63
1.00 1.00
0.00 0.07 0.00 0.00
0.00
0.37
1.07 1.00
0.00
0.58 0.67
0.63 0.63 0.63 0.63
2.02 1.01 0.00
2.03 0.30 02/03 03/04 04/05 05/06 06/07 07/08 08/09

0.63
0.00
0.00 0.00 0.00
97/98
98/99
99/00
00/01
01/02
09/10
10/11
Hospitals
Lower Level Units
Health Training Schools
Drugs
Total
Allocations of Gov.t of Uganda to Catholic Units

14
12.303 11.974
11.568 11.741
12
10.046
11.368
10.927
10.796
10.568
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UCMB Annual Report
Billion Ugx
7.959
87.156
7.389
7.562
7.188
7.315
7.169
7.228
7.038
7.038
65.505 4
2.073
2.26
1.234
2.18
1.215 0.6 0.417
2.232
1.211
2.235
1.185 0.438 0.412
0.52 0.417 0.59 0.416
21.406 0
0.245
1.902
1.213
1.961
0.856
1.943
0.932 0.385 0.199
0.668 0.416
1.94
0.519 0.70 0.371
0.466 0.416
0.467 0.416
01/02
02/03
03/04
04/05
05/06
06/07
07/08
08/09
09/10
10/11
Hospitals
Lower Level Units
Health Training Schools
Drugs LLUs
Drugs Hospitals
Total
15.00
68
2010
PNFP Contribution to Health National Output

100% 90%
80%
UCMB Annual Report
70%
68%
72%
60% 50%
40%
83%
95%
30% 20% 10%

0%
PNFP Facilities 17%
PNFP Facilities 32%
PNFP Facilities 28%
PNFP Facilities 5%
OPD new cases
Deliveries
PNFP Facilities
DPT3
MoH Budget Alloc
GoU Facilities
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UCMB Annual Report
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UCMB Annual Report
2010
Annex 3 RCC Hospital data Utilization (access), Equity factor (user fee/SUO), Efficiency (cost/SUO and Staff productivity) and Quality
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UCMB Annual Report
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Utilsation of services (Access) in RCC hospitals

600000
500000
400000
109,707
200000
100000
0 97 98
-100000
98 99
107,366
99 00
110,210
00 01
125,191
01 02
135,128
02 03
147,246
300000
03 04
04 05
05 06
06 07
07 08
08 09
09 10
Utilization is showing a generally growing trend. There was initially a drop after 2004/05. This was most likely due to increases in user fees as government support started to stagnate and drop. There is now a rise. This could partly be due to the comparatively better services offered by the PNFP, hence patients preferring to pay and use the services. It could also partly be due to population growth or both.
191,926
182,255
172,832
Total Staff Productivity - in terms of SUO / Staff

3000
2500
168,324
169,094
196,073
228,257
09 10
1,201
1,379
1,085
1,224
1,289
1500
949 943
1000 500 0
98 99 99 00
00 01
896
01 02
956
02 03
03 04
04 05
05 06
06 07
07 08
08 09
1,118
1,334
2000
Staff productivity in hospitals is also following the pattern of utilization thus gradually but steadily increasing as a general trend.
1,355
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UCMB Annual Report

User fee (Shillings) per Standard Unit of Output
6000
2010
Trend of Cost per Standard Unit of Output - Hospitals
13000
4000
Shillings / SUO
4,657
4,392
2,142
2,080
7000
1,371
1,502
1,439
1,307
1,324
1,303
1,128
1,243
2000
1,408
1000
3000
1000
-1000 97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10
-1000 97 98 98 99 99 00 00 01 01 02 02 03 03 04 04 05 05 06 06 07 07 08 08 09 09 10
9000 8000 7000
Comparing the trends of cost/SUO and fee/SUO

7927
2,751
5000
3,046
1,514
3,570
1,721
3,859
3000
Shillings / SUO
7165
6391
6000 5000
4000
3570 3859
4657
5640 4911 4392

4323
5719
3000 2000 1000 0
2751
3046 2080 2142
1371
1502
1439
1307
1408
1324
1303
1128
1243
1514
1721
Cost incurred by facilities to provide services are rising much faster than health facilities are raising fees. Facilities have to subsidize the fees from any other income at the cost of meeting other obligations like maintenance of buildings, equipments etc
97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10
User fee / SUO
Cost / SUO
Linear (User fee / SUO)
Linear (Cost / SUO)
Percent hospital cost recovery from fees

60%
50%
50% 40%
49%
40% 34% 30% 30% 30% 26% 23% 22% 27% 26% 30%
30%
20%
10% 0%
97/98 98/99 99/00 00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10
Hospital cost recovery from fees dropped so low in the past because of government support. But with reduced support there is attempt to increase the recovery
4,323
4,911
5,640
9000
5,719
7,165
11000
6,391
7,927
5000
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UCMB Annual Report
2010
TREND OF TOTAL QUALITY IN THE UCMB HOSPITALS

140 130
120
113 110 108 100 100 96 90 80

70
112
110 106
60 50
2003/04 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10
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UCMB Annual Report
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Annex 4 Data from Health Centers (Lower Level Units)
75
OPD TOTAL CONTACT (new and re-att. PLUS HIV, PMTCT Contacts.) in a sample of 177 LLUs
2,500,000
5,000
Cost per SUO Median Values in a sample of 162 LLUs
2010
2,100,000
1,792,767
4,000
3,500
4,500
1,700,000
1,405,394
3,0002,720 2,500
1,620,537
3,291 2,969 2,530 2,887
3,048
2,934
3,109
2,772
1,300,000 900,000
737,921
1,000 1,500
814,734
900,291
959,811 938,361
2,000
500,000 100,000 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10
500 -
01-02
02-03
03-04
04-05
05-06
06-07
07-08
08-09
Total SUO in a Sample of 162 LLUs

3,000
3,000,000
SUO per Staff Median Values in a sample of 163 LLUs
2,822,499
2,653
2,641,100
2,400
2,500,000
2,451
UCMB Annual Report
2,000,000
1,963,884
1,856,874
1,950,928
1,701,667
1,720,726
1,500,000
1,800
1,278,891
1,377,020
1,521 1,315 1,188

1,200
1,597
1,667 1,672
1,766
1,000,000
500,000
01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10
600 01-02
02-03
03-04
04-05
05-06
06-07
07-08
08-09
09-10
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UCMB Annual Report
2010
Median OPD New Attendances in UCMB LLU 2002 - 2010

2,000 1,800 1,600 1,400
1,477 1,368
1,495 1,107
1,805 1621.5 1513 1495 1593

1412
1,844
1807
Attendances
1,200 1,000 800 600

400
1,324
1,362
1,267
1176 1054 1025.5 1043
948
755
942
900
986
200 -
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
2008-09
Financial Years OPD New Median Values under 5 OPD New Median Values - Female OPD New Median Values - Male
2009-10
77
Comparing the trends of cost/SUO and Fee/SUO in Lower Level Units

3500 3291
2969
3048 2887 2772 3109

2934
Median Cost/SUO
20 18 16 15 73% 74% 14 11 10 10 8 6 4 2 11 79% 14 11 15 73%
Staff composition in UCMB LLUs (median values)
100%
3000
2770 2530
90% 15 73% 11 11 15 73%
2010
16
2500
15
15
80%
Medan Fee/SUO
2000 1936
14 12
73%
73%
70% 69%
11
11
11
60%
1500 1089 1000 500 0 01/02 Medan Fee/SUO Linear (Medan Fee/SUO) Median Cost/SUO Linear (Median Cost/SUO) 02/03 03/04 04/05 05/06 06/07 07/08 08/09 09/10 1144 1148 1210 1209
50%
40%
30%
20%
10% -
0%
2001-02 2002-03 2003-04 2004-05 2005-06 2006-07 2007-08 2008-09 2009-10

Qualified staff Total Staff
% of Qualified Staff
Fees/SUO Median Values in a sample of 162 LLUs

2,500
70% 60%
Cost recovery in Lower level facilities
62%
UCMB Annual Report
2,000
1,936
50%
45%
52%
54%
47%
1,500
1,420 1,144
1,534
1,210 1,209
1,488
40% 30% 20%
39% 35%
41%
42%
1,089
1,000
1,148
500
10% 0%
01-02 02-03 03-04 04-05 05-06 06-07 07-08 08-09 09-10
01/02
02/03
03/04
04/05
05/06
06/07
07/08
08/09
09/10
1420
1534
1488
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UCMB Annual Report
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Annex 5 Data on the Scholarship Fund
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80
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2010
81
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2010
Annex 6: Miscellaneous
UNFPA, Emergency Obstetric Care, checklist for Planners
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