4 fundamentals of health services management.ppt

7/27/2019 4 Fundamentals of Health Services Management.ppt

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Fundamentals of Health Services

Management: Session 4

Organization of Health Services in

Uganda (Refer to HSSIP)


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National level organization of health

services in Uganda- i

The national health system is made up ofpublic and private sectors.

The public health system includes all facilities

of the MoH, MoE, MoD and Ministry of

internal affairs.

The private health system is made up of

PNFPs, PFP, TCMP (Traditional and

Complementary Medicine Practitioners)

The private health system provides about 50%

of standard Units of output


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National level organization of health

services in Uganda- ii The health services are decentralized following

the political system.

At the national level, the system has the MoHand the National Referral Hospitals (Mulago and

Butabika)


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National level organisation of the health

services in Uganda -iii

According to the HSSIP, the core functions of the

MoH are:

Policy analysis, formulation and dialogue;

Strategic planning;

Setting standards and quality assurance;

Resource mobilization;

Advising other ministries, departments and

agencies on health-related matters;


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Core functions of MoH

Capacity development and technical supportsupervision;

Provision of nationally coordinated services

including health emergency preparedness andresponse

and epidemic prevention and control;

Coordination of health research; and

Monitoring and evaluation of the overallhealth sector performance.


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Uganda national health services

organisation National referral hospitals

provide comprehensive specialist services and

are involved in health research and teaching in

addition to providing services offered by

general hospitals and Regional Referral

Hospitals.

There are so far only two national referral

hospitals- Mulago and Butabika- (Mbarara isbeing prepared to become the 3rd The

conversion is said to be about complete)


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National Health Facilities are generally

not sufficient!! (Source:MoH HSSIP)


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Uganda National health services

organisation- Regional referral hospitals

Offer specialist clinical services such aspsychiatry, Ear, Nose and Throat (ENT),ophthalmology, higher level surgical and medical

services, and clinical support services (laboratory,medical imaging and pathology).

These hospitals serve a region

They are also involved in teaching and research.This is in addition to services provided by generalhospitals.

Regional referral hospitals report to the centre


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List of 12 RRHs

1.Arua Regional Referral

Hospital

2.Fort Portal Regional Referral

Hospital

3.Gulu Regional Referral

Hospital

4.Hoima Regional Referral

Hospital

5.Jinja Regional Referral

Hospital

6.Kabale Regional Referral

Hospital

7.Lira Regional Referral

Hospital

8.Masaka Regional Referral

Hospital

9.Mbale Regional Referral

Hospital

10.Soroti Regional Referral

Hospital

11.Moroto Regional Referral

Hospital

12.Mubende Regional Referral

Hospital


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Private Not For Profit (PNFPs)

These are health facilities founded by faith based

organisations.

PNFPs provided the first organized health services to

Africans in Uganda- beginning at Mengo in 1897 by A R

Cook.

The PNFPs belong to three main net worksnamely the

UMMB, UCMB and UPMB. There are other bureaux

including the Orthodox Medical Bureau.


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PNFPs contribution to health services (NHP, 2009)

The FBPNFPs account for 41% of the hospitals

and 22% of the lower level facilities and are

more present in rural areas, thereby

complimenting government facilities.

The PNFPs operate 70% of health traininginstitutions with financial support from GoU


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PNFPs

This ratio of PNFPs to government facilities is

changing because government is converting

many HC-IV to district hospitals.

However, PNFPs are said to be more efficient

than public health facilities- and are said to be

more productive.


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Ownership and organisation of PNFPs -i

PNFP health facilities belong either to the Anglican,

Pentecostal, SDA, Catholic or Muslim faiths.

Majority of PNFP health facilities belong to the Anglican or

Catholic faith and are organized under the UPMB or UCMB.

UCMB and UPMB as well other bureau, are umbrella

organizations and just coordinate and empower the activities

of the facilities

Facilities belong to local congregations or dioceses


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Ownership and organisation of PNFPs-ii

PNFPs are better structured and more organizedthan other private health services.

They also have better collaboration among themselves and with government.

As noted earlier , private health services provideup to 50% of standard units of out BUT have notas much integration with national health systemas there should be for maximum outputs/benefit

In this regard, a public private partnership forhealth(PPPH) is being worked on


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Ownership and organisation of

PNFPs -ii The PNFPs are guided by government policies

At district level, PNFPs report to DHOs but

they also report to diocesan health

coordinators and health boards.

PNFPs do not compete with public health

facilities but rather suppliment government

effort and about 20% of their budget, is metby government grants


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PNFP Hospitals

PNFP Hospitals are classified as general

hospitals although many may qualify to be

regional referral hospitals. Some of these, like

Nsambya, are now teaching hospitals and theyoffer specialized services


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PFP Health facilities There are approximately 14 private individuals

owned by individuals or institutions.

These provide services with the objective of making

a profit. They are mainly in towns where users can

pay.

They are also treated as general hospitals althoughsome of them like Kampala International receive

referrals from other hospitals and are also teaching

facilities

According to NHP (2009), these PFP are largely

unregulated and have little collaboration with

government


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Traditional & Complementary Medicine

Practitioners(TCMP)

Mostly not regulated BUT up to 60% ofUgandan are said to use their services before

visiting formal sector (NHP, 2009)

They have little or even no functionalrelationship with private or public health

services providers

A legal framework for their functionality is

awaiting implementation but has been

developed


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District Health Services

During decentralisation, districts were charged with the

responsibility of service delivery at district and health sub-

district (HSD) level

District health services are managed by ministry of local

government

The district health team (DHT) chaired by the DistrictHealth Officer provides technical leadership for the health

care services at the district level

At the health sub district, a medical officer assists the DHO

in managing the health care services. District Health Teams and HSDs supervise service delivery

at government and PNFP facilities at different levels,

except the national and regional referral hospitals.


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Structure of health services at district

level-i

The lowest level of the health care system in

Uganda is the household/community or village.

In the community/village, there is a Village

Health Team (VHT) whose role is to link health

facilities with the community (HSSP III).


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Structure of health services at

district level-ii

The first level of interaction between the

formal health sector and communities is HCII

where only out-patients services are

available.

HCIII provide maternity services and the first

referral cover for the sub-counties (HSSPIII).


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Structure of health services at

district level-iii

Next to HCIII, are health sub-districts and

according to the HSSPIII, P.4: The health sub-

district is mandated with planning,

organization, budgeting and management ofthe health services at this and lower health

center levels. At the districts, it is the

responsibility of local government to plan forand provide health services as stated by the

HSSPIII, p.4.


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Comparing Core Functions of Central

Government and District Local Governments

Central Government Core Functions Policy formulation

Setting standards

Quality assurance

Resource mobilisation

Capacity development

Technical support

Provision of nationally coordinated

services e.g. epidemic control

Coordination of health research

Monitoring and evaluation of overall

sector performance

District Local Government Core Functions

Implementation of the national health policy

Planning and management of district health

services

Provision of disease prevention, health

promotion, curative and rehabilitative services

with emphasis on the minimum health carepackage and other national priorities within

the district

Control of other communicable diseases of

public health importance

Vector control

Health education Ensuring provision of safe water and sanitation

Health data collection, management,

interpretation, dissemination and utilisation

4 fundamentals of health services management.ppt

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